Psychological factors show limited association with the severity of Achilles tendinopathy.

BACKGROUND: This study aimed to investigate the association between psychosocial factors and the severity of Achilles tendinopathy, along with exploring their potential link to the pain's duration. METHODS: A cross-sectional study involving 111 individuals with Achilles tendon pain was conducted. METHODS: A cross-sectional study involving 111 individuals with Achilles tendon pain was conducted. Various psychological factors were assessed using the Pain Catastrophizing Scale, Chronic Pain Self-Efficacy Scale (CPSS), Tampa Scale for Kinesiophobia, and Hospital Anxiety and Depression Scale (HAD). Additionally, the severity of Achilles tendon pain was evaluated using the Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A-Br). Regression analyses were employed to determine the association of these psychosocial factors with pain severity and duration. RESULTS: Self-efficacy for chronic pain showed a slight association with Achilles tendon pain severity (ß = 0.42 [95% CI: 0.06 to 0.16], p = 0.001), explaining only 19% of the dependent variable. The other variables, including anxiety, depression, pain catastrophizing, and fear of movement, did not exhibit significant associations. CONCLUSION: The study suggests that psychological factors demonstrate limited association with the severity of Achilles tendinopathy. While self-efficacy for chronic pain was weakly associated, its clinical relevance remains uncertain. Future research, particularly longitudinal studies, should explore the influence of psychosocial factors on treatment adherence and response to enhance management strategies for Achilles tendon pain.

General low alertness in people with obstructive sleep apnea.

STUDY OBJECTIVES: In patients with obstructive sleep apnea (OSA), a previous study using a Go/No-Go task reported an average attention deficit. However, the temporal dynamics of such a deficit are unknown. Here, we investigated whether attention deficits in different subdomains increased as the test progressed. We also investigated the effect of target frequency and speed of stimulus presentation on performance. METHODS: Twenty-seven untreated people with OSA and 27 age- and sex-matched controls underwent a 15-minute Go/No-Go task, divided into 6 blocks. Each block was subdivided into 3 different interstimulus intervals (1, 2, and 4 seconds). Three blocks had a low and three had a high target probability (20% and 80%, respectively). Reaction time (alertness), variability of reaction time (sustained attention), commission errors (response inhibition), and omission errors (focused attention) were measured. RESULTS: Alertness was lower in the group with OSA compared with controls, as evidenced by a significantly higher average reaction time. This effect was seen from the start of the task and continued until the end but did not increase in test progression. The temporal pattern of intrinsic alertness deficits in patients with OSA was found to be independent of target frequency or interstimulus interval. CONCLUSIONS: The primary attention problem in OSA is on the alertness subdomain irrespective of the number of required responses or speed of stimulus presentation. The present results support the notion that OSA is distinct from other neurological and psychiatric conditions, such as depression or chronic pain. The results also suggest significant concerns regarding daily life activities (eg, driving). CITATION: de Souza Bezerra ML, van Duinkerken E, Simões E, Schmidt SL. General low alertness in people with obstructive sleep apnea. J Clin Sleep Med. 2024;20(5):689-698.

Motor Unit Number Index of the Upper Trapezius: A Meta-Analysis and Cross-sectional Study of Its Reliability.

Motor unit number index of the upper trapezius (MUNIX-Trapezius) is a candidate biomarker for bulbar lower motor neuron function; however, reliability data is incomplete. To assess MUNIX-Trapezius reliability in controls, we conducted a systematic review, a cross-sectional study (n = 20), and a meta-analysis. We demonstrated a high inter- and intra-rater intraclass correlation (0.86 and 0.94, respectively), indicating that MUNIX-Trapezius is reliable with between-study variability moderated by age and MUNIX technique. With further validation, this measure can serve as a disease monitoring and response biomarker of bulbar function in the therapeutic development for amyotrophic lateral sclerosis.

Phosphorus in alkaline soils of the semiarid region, Brazil: inorganic fractions, capacity factor, and availability.

The study was designed to quantify the contents of Pi fractions and correlate them with the P capacity factor of soils in the Brazilian semiarid region. We also evaluated the effect of soil P doses contact time and P availability for maize plants in alkaline soils of the Brazilian semiarid region. Soil samples were collected between the Piranhas-Açu (RN) and Jaguaribe (CE) rivers valleys. The maximum phosphate sorption capacity was highly correlated with the values of remaining P, indicating that it can be used as a measure to estimate the P capacity factor of these soils. Maximum P sorption capacity correlated with Fe2O3 and Ca2+ contents and pH values. These results demonstrate that P sorption is explained by P adsorption on the surface of iron oxides and by its precipitation with Ca2+ in alkaline soils. The contact time increases promote plant P contents decreased substantially in the first 30 to 60 days after fertilization and decreased until 120 days of incubation but then tended to stabilize at the longest soil P contact times.

The clay content and P-remnant estimate the P capacity factor in alkaline soils.In alkaline soils, there is a predominance of P­Ca and P­Fe.The availability of P stabilizes after 120 days.The largest corn biomass occurs between the P doses of 256­288 mg dm⁻³.

Ischaemic lumbosacral plexopathy following aortic dissection.

A 57-year-old man was diagnosed with acute myocardial infarction and Stanford type A aortic dissection that had spread to the common iliac arteries. He underwent a Bentall procedure for vascular repair. Immediately after surgery, he developed numbness and severe weakness in his left leg. On examination, he had hypotonia, absent deep tendon reflexes, weakness in the left leg (Medical Research Council (MRC) scale for muscle strength - 0/5 distal, 3/5 proximal) and reduced sensation in the left leg. Electromyography confirmed subacute involvement of the left lumbar and lumbosacral plexus. MR scan of the lumbar plexus showed diffuse muscle oedema involving the left gluteus maximus. We diagnosed ischaemic lumbosacral plexopathy secondary to extensive aorta dissection and internal iliac artery occlusion. We discuss the clinical features of ischaemic plexopathy and the diagnostic approach and review the vascular anatomy of the lumbosacral plexus.

The hypothalamic-pituitary-adrenal axis and the central monoaminergic systems: a pathophysiological link to insomnia with clinical implications.

The authors present a theoretical overview of the hypothalamic-pituitary-adrenal axis and the central monoaminergic systems, focusing on a putative pathophysiological relationship to insomnia complaints. Insomnia is an independent and self-perpetuating disorder that requires diagnostic and therapeutic attention in the presence of concomitant disorders, likely with bidirectional influence. An adequate understanding of such mechanisms can help for a better understanding of the interplay between clinical features, neurotransmitters, and the adrenal hypothalamic-pituitary axis may help clinicians to better manage insomnia patients.

Clinimetric properties of the knee extension prone test (KEPT): A new method to assess knee hyperextension deficit.

INTRODUCTION: The knee extension prone test (KEPT) can be a low-cost and affordable alternative for this assess knee hyperextension deficit. OBJECTIVE: To analyze concurrent validity and reliability of a new method for assessing knee extension prone (knee extension prone test; KEPT). METHODS: Participants were divided into two groups: Group 1 comprised healthy participants (HG) and Group 2 comprised participants with a history of knee injury (IG). Two examiners performed the following evaluations: (1) lateral knee goniometry, (2) anterior tibial inclinometry, (3) lateral photogrammetry in supine, (4) lateral photogrammetry in prone, and (5) KEPT. Concurrent validity was analyzed by Pearson's linear correlation coefficient (r), and intra- and inter-examiner reliability were analyzed by intraclass correlation coefficient (ICC). RESULTS: KEPT demonstrated good intra-examiner (ICC = 0.85, 95% CI = 0.75-0.89) and excellent inter-examiner (ICC = 0.92, 95% CI = 0.88-0.94) reliability. The standard error of measurement was 0.47° and 1.30° and the minimum detectable change was 2.35° and 6.5° for intra- and inter-examiner agreement, respectively. Concurrent validity of KEPT ranged from moderate to good (r = 0.54-0.78, p < 0.01). CONCLUSION: KEPT is a valid and reliable method for assessing knee hyperextension deficit in both healthy individuals and patients with knee injuries.

The Intersection Between Cerebellar Ataxia and Neuropathy: a Proposed Classification and a Diagnostic Approach.

Neuropathy is a common associated feature of different types of genetic or sporadic cerebellar ataxias. The pattern of peripheral nerve involvement and its associated clinical features can be an invaluable aspect for narrowing the etiologic diagnosis in the investigation of cerebellar ataxias. In this review, we discuss the differential diagnosis of the intersection between peripheral nerve and cerebellar involvement, and classify them in accordance with the predominant features. Genetics, clinical features, neuroimaging, and neurophysiologic characteristics are discussed. Furthermore, a diagnostic approach for cerebellar ataxia with neuropathy is proposed according to the different clinical characteristics. This is an Educational and Descriptive review with the aim of medical education for the approach to the patients with cerebellar ataxia and neuropathy. The diagnostic approach to the patient with cerebellar ataxia with neuropathy requires a detailed medical history, phenotyping, characterization of disease progression and family history. Neuroimaging features and the neurophysiological findings play pivotal roles in defining the diagnosis. Establishing an organized classification method for the disorders based on the clinical features may be very helpful, and could be divided as those with predominant cerebellar features, predominant neuropathic feature, or conditions with both cerebellar ataxia and neuropathy. Second, determining the mode of inheritance is critical on cerebellar ataxias: autosomal dominant and recessive cerebellar ataxias, mitochondrial or sporadic types. Third, one must carefully assess neurophysiologic findings in order to better characterize the predominant pattern of involvement: damage location, mechanism of lesion (axonal or demyelinating), motor, sensory or sensory motor compromise, large or small fibers, and autonomic system abnormalities.

Liming and biochar on sorghum growth and Arenosol chemical properties in the Semiarid environment / Efeito da calagem e do biochar no crescimento do sorgo e nas propriedades químicas do Neossolo Quartzarênico no ambiente Semiárido

This research evaluated the effect of liming (with and without) and biochar (with and without) on sorghum cv. BRS Ponta Negra growth and Arenosol chemical properties in the Semiarid environment. The experimental design was in randomized blocks, with treatments in a 2x2 factorial scheme, corresponding to the application or not of lime (0 and 2.5 t ha-1) and biochar (0 and 12.5 t ha-1). Biochar was produced from cashew branches. The experiment was conducted in 16 m² plots where the forage sorghum cultivar BRS Ponta Negra was cultivated. The soil chemical characteristics, the production attributes, and the structural characteristics of the sorghum cultivar studied were evaluated. There was no interaction between factors. The use of biochar increased the pH and Ca and P contents in the soil and contributed to increasing the panicle mass (2.51 t ha-1 of DM). Lime application affected the soil Ca content as the dose of 2.5 t ha-1 resulted in higher values of culm diameter (15.25 mm), panicle mass, and culm mass (2.63 and 7.50 t ha-1 of DM, respectively). Therefore, these results allowed to outline strategies for the use of limestone and biochar for forage production in semiarid environments in sandy soils. Because, these materials improve some chemical attributes of the soil and the production of forage sorghum. It is noteworthy that edophoclimatic conditions can change the response patterns observed in this research. Therefore, research in other regions is essential.

Este trabalho teve como objetivo avaliar o efeito da calagem (com e sem) e do biocarvão (com e sem) sobre o crescimento e a produção de forragem do sorgo forrageiro cv. BRS Ponta Negra e nas propriedades químicas do Neossolo Quartzarênico no ambiente Semiárido. O delineamento experimental foi em blocos casualizados, com tratamentos em esquema fatorial 2x2, correspondendo a aplicação ou não do calcário (0 e 2,5 t ha-1) e do biocarvão (0 e 12,5 t ha-1). O biochar era produzido a partir de galhos de caju. O experimento foi conduzido em parcelas de 16 m² onde foi cultivada a cultivar de sorgo forrageiro BRS Ponta Negra. Foram avaliadas as características químicas do solo, os atributos de produção e as características estruturais da cultivar de sorgo estudada. Não houve interação entre os fatores. O uso do biochar aumentou o pH e os teores de Ca e P no solo e contribuiu para o aumento da massa da panícula (2,51 t ha-1 de MS). A aplicação de calcário afetou o teor de Ca no solo, assim a dose de 2,5 t ha-1 resultou em maiores valores de diâmetro do colmo (15,25 mm), massa da panícula e massa do colmo (2,63 e 7,50 t ha-1 de MS, respectivamente). Portanto, esses resultados permitem traçar estrategias de uso do calcário e biochar para produção forrageira em ambientes semiáridos com solos arenosos. Pois, esses materias melhoram alguns atributos quimicos do solo e a produção do sorgo forrageiro. Vale ressaltar que as condições edofoclimáticas podem alterar os padrões de resposta observados nesta pesquisa. Portanto, a pesquisa em outras regiões é essencial.

Immune-mediated inflammatory polyneuropathy overlapping Charcot-Marie-Tooth 1B.

Charcot Marie Tooth (CMT) due to myelin protein zero (MPZ) mutations, may cause a wide variation of phenotypes, depending on the localization of the mutation within the gene. Among the most common phenotypes are: an infantile onset disease with extremely slow nerve conduction velocities (CMT1B) and an adult onset phenotype with nerve velocities in the axonal range (CMT2I). We reported a patient with CMT1B (MPZ p.Ser63del mutation) which developed an overlapping immune mediated polyradiculoneuropathy with recurrent episodes of quadriparesis and cranial nerve involvement. We observed reversible conduction block on serial neurophysiologic studies, non-uniform demyelination and good clinical response to prednisone and cyclophosphamide, as evidenced by objective functional recovery. Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)-like characteristics have not yet been described associated with a MPZ p.Ser63del mutation. This description adds evidence indicating that a defective structural myelin protein may predispose peripheral nerves to immune attacks.

Respiratory deposition of ultrafine welding fume particles.

The inhalation and the deposition of welding-generated ultrafine particles in welders' respiratory tracts have been linked to severe pulmonary impairments. In the present study, a mobile aerosol lung deposition apparatus (MALDA) was developed and applied to study the respiratory deposition of ultrafine welding fume particles. The MALDA was constructed with a set of physiologically representative human tracheobronchial airway replicas made with high-resolution 3D printers. Ultrafine welding fume particles were generated in a welding fume chamber and delivered to the MALDA. A series of respiratory deposition experiments were carried out using the MALDA to investigate the deposition of ultrafine welding fume particles in different airway generations of the tracheobronchial airways. The results showed that the fractional deposition of ultrafine welding fume particle in the human tracheobronchial airways down to the 9th airway generation could be readily and systematically measured by the MALDA. The estimated cumulative respiratory deposition ranged from approximately 9-31% for ultrafine welding fume particles between 10 and 100 nm in diameter. The results acquired demonstrated that the MALDA developed has the potential to become a useful apparatus in the future to estimate the respiratory deposition of ultrafine particles in real workplaces.

Motor unit number index (MUNIX) in myopathic disorders: Clinical correlations and potential pitfalls.

Our aim was to study motor unit number index (MUNIX) in myopathic disorders. We studied 11 patients with myopathy, and healthy controls. We obtained MUNIX, compound muscle action potential (CMAP), motor unit size index (MUSIX) and alpha (α, power exponent from MUNIX equation) measurements from three different muscles. MUNIX and CMAP were significantly lower in one muscle. This MUNIX decrease may not be related to motor neuron loss, but rather to muscle fiber atrophy. MUSIX and α did not change and may be useful in determining whether the MUNIX decrease is indeed due to motor unit loss.

Tonic pupils: an unusual autonomic involvement in chronic inflammatory demyelinating polyneuropathy (CIDP).

BACKGROUND: Chronic inflammatory demyelinating polyneuropathy (CIDP) is a neuropathy which affects mainly large myelinated axons and has a typically mild autonomic dysfunction mainly from postganglionic nerve fiber involvement. CASE REPORT: We report here an acute onset CIDP initially diagnosed as Guillain-Barré syndrome (GBS), unresponsive to treatment with intravenous immunoglobulin (IVIg), which later responded to plasmapheresis and corticoids. The patient had a markedly distal demyelination, prominent cranial nerve involvement and, interestingly, bilateral fixed dilated pupils. Despite complete clinical recovery, this neurological sign remained. CONCLUSIONS: Tonic pupils have previously been described in different neurologic conditions, including GBS, but not yet in acute onset CIDP or in variants with predominantly distal demyelination. It differs from the classical Adie's pupil because it lacks the light-near dissociation. This case report expands the range of possible autonomic signs in acute onset CIDP, which could help physicians establish optimal treatment strategies earlier on.

Intraexaminer and Interexaminer Reproducibility of the Downing Test for Sacroiliac Joint Evaluation of Symptomatic and Asymptomatic Individuals.

OBJECTIVE: This study aimed to assess the intraexaminer and interexaminer reproducibility of the Downing test in sacroiliac joint evaluation in symptomatic and asymptomatic individuals. METHODS: A reliability study was conducted with a test-retest design in 54 college students of both sexes. To assess the intraexaminer reproducibility, each participant was evaluated twice by the same examiner with a 7-day interval, and to assess the interexaminer reproducibility, each participant was evaluated by 2 examiners. RESULTS: Of the 54 participants included in the study, 18 (33.3%) were asymptomatic and 36 (66.7%) were symptomatic; a total of 108 sacroiliac joints were evaluated. Sacroiliac joint diagnosis based on the Downing test presented low intraexaminer reproducibility in all participants (κ = 0.12, 95% confidence interval [CI] 0.03-0.22), in asymptomatic individuals (κ = 0.18, 95% CI 0.02-0.34), and in symptomatic individuals (κ = 0.28, 95% CI 0.17-0.39). The interexaminer reproducibility also was low in all participants (κ = 0.18, 95% CI 0.09-0.27), in asymptomatic individuals (κ = 0.22, 95% CI 0.15-0.37), and in symptomatic individuals (κ = 0.16, 95% CI 0.05-0.27). The standard error of the measurement values were not lower than smallest detectable change values considering a CI of 95% for all participants. CONCLUSION: For this group of asymptomatic and symptomatic participants, the reproducibility of the Downing test was poor. The clinical utility of this test used in isolation is not supported by the present study.

Optimal E2 (reference) electrode placement in fibular motor nerve conduction studies recording from the tibialis anterior muscle.

INTRODUCTION: In this study we aimed to determine the contribution of the E2 (reference electrode) to the compound muscle action potential (CMAP) amplitude during fibular motor recording to the tibialis anterior (TA) when E2 is placed over routine referential vs. alternative sites. METHODS: The CMAP was obtained from 10 healthy subjects, using the active electrode (E1) over sites routinely used as E2 for the TA, whereas the E2 was over the contralateral knee. The same procedure was performed with the E1 over alternative E2 sites. RESULTS: Significant electrical signal was captured over routine E2 placement sites. Among the tested alternative E2 sites, the ipsilateral patella (especially its medial aspect) was the most electrically silent. DISCUSSION: Using alternative E2 sites with near isoelectric recordings can optimize near-field potential measurement in the fibular motor recording to the TA and represents a more accurate way of measuring nerve and muscle function. Muscle Nerve 59:249-253, 2019.

Analysis of Attention Subdomains in Obstructive Sleep Apnea Patients.

Background: Obstructive sleep apnea (OSA) is characterized by apnea-hypopnea during sleep. Overnight polysomnography (PSG) is usually used to detect the frequency of apneic and hypopneic events. Attention and executive deficits are commonly reported in OSA patients. Previous investigations suggested that cognitive impairments were dependent on attention deficits. However, attention is not a unitary domain and consists of different subdomains such as alertness, sustained attention, focused attention, and executive attention (impulsivity/hyperactivity). Little is known about the attention subdomains affected in OSA. Attention is commonly assessed using continuous performance tests, such as the continuous visual attention test (CVAT). Distinct variables can be derived from the CVAT. Each CVAT variable is associated with a specific attention subdomain. Objective: This study aimed to examine the variables of the CVAT that are affected by OSA and to identify the most reliable CVAT variable that distinguishes OSA from controls via discriminant analysis. Method: Patients scheduled to perform a PSG were invited to participate in this study. Immediately before the PSG, they performed the CVAT. Based on the PSG results, 27 treatment-naïve OSA patients were sampled. The same number of healthy controls were selected to match the two groups by age and gender. Five CVAT variables were examined: commission errors, omission errors, reaction time (RT), variability of reaction time (VRT), and coefficient of variability (VRT/RT). Results: ANCOVAs indicated that RT and VRT were affected by OSA. No difference in accuracy (omission and commission errors) was observed between healthy controls and OSA patients. When the VRT measurements were corrected for their respective RT values (VRT/RT), the mean difference on this coefficient did not reach significance. The discriminant analysis indicated that the two groups could be best differentiated by the RT variable. Conclusions: Attention problems, commonly observed in OSA patients, may reflect a primary problem on the alertness subdomain. The CVAT was able to detect the primary (alertness-RT parameter) and the secondary deficits (sustained attention-VRT parameter) associated with OSA. As there is no learning effect in the condition of retests, the CVAT can be used to assess the cognitive recovery in OSA patients during treatment.

Physiotherapy Questionnaires App to Deliver Main Musculoskeletal Assessment Questionnaires: Development and Validation Study.

BACKGROUND: Patient-reported outcomes (PROs) translate subjective outcomes into objective data that can be quantified and analyzed. Nevertheless, the use of PROs in their traditional paper format is not practical for clinical practice due to limitations associated with the analysis and management of the data. To address the need for a viable way to group and utilize the main functioning assessment tools in the field of musculoskeletal disorders, the Physiotherapy Questionnaires app was developed. OBJECTIVE: This study aims to explain the development of the app, to validate it using two questionnaires, and to analyze whether participants prefer to use the app or the paper version of the questionnaires. METHODS: In the first stage, the app for an Android operational system was developed. In the second stage, the aim was to select questionnaires that were most often used in musculoskeletal clinical practice and research. The Foot and Ankle Outcome Score (FAOS) and American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire were selected to validate the app. In total, 50 participants completed the paper and app versions of the AOFAS and 50 completed the FAOS. The study's outcomes were the correlation of the data between the paper and app versions as well as the preference of the participants between the two versions. RESULTS: The app was approved by experts after the adaptations of the layout for mobile phones and a total of 18 questionnaires were included in the app. Moreover, the app allows the generation of PDF and Excel files with the patients' data. In regards to validity, the mean of the total scores of the FAOS were 91.54% (SD 8.86%) for the paper version and 91.74% (SD 9.20%) for the app. There was no statistically significant differences in the means of the total scores or the subscales (P=.11-.94). The mean total scores for the AOFAS were 93.94 (SD 8.47) for the paper version and 93.96 (SD 8.48) for the app. No statistically significant differences were found for the total scores for the AOFAS or the subscales (P>.99). The app showed excellent agreement with the paper version of the FAOS, with an ICC value of 0.98 for the total score (95% CI 0.98-0.99), which was also found for the AOFAS with the ICC for the total score of 0.99 (95% CI 0.98-0.99). For compliance, 72% (36/50) of the participants in the FAOS group and 94% (47/50) in the AOFAS group preferred the app version. CONCLUSIONS: The Physiotherapy Questionnaires app showed validity and high levels of compliance for the FAOS and AOFAS, which indicates it is not inferior to the paper version of these two questionnaires and confirms its viability and feasibility for use in clinical practice.

Motor unit number index and neurophysiological index as candidate biomarkers of presymptomatic motor neuron loss in amyotrophic lateral sclerosis.

INTRODUCTION: Our objective was to determine the utility of motor unit number index (MUNIX) and neurophysiological index (NI) as surrogate biomarkers of disease progression in limbs without clinical signs of lower motor neuron (LMN) involvement from patients with slowly progressive amyotrophic lateral sclerosis (ALS). METHODS: Patients with slowly progressive ALS and at least 1 clinically unaffected limb were prospectively enrolled. Clinical signs of LMN loss and results from hand-held dynamometer (HHD), revised ALS Functional Rating Scale (ALSFRS-R), mean-MUNIX (from 3 different muscles), and NI were longitudinally recorded. RESULTS: Eighteen patients with 43 presymptomatic muscles were evaluated. Twenty-seven muscles remained clinically unaffected during study, with stable ALSFRS-R subscores and HHD measures. However, a significant decline in mean-MUNIX and NI was detected. DISCUSSION: Mean-MUNIX and NI were more sensitive than clinical measures at detecting LMN loss in presymptomatic limbs from patients with slowly progressive ALS. Therefore, these electrophysiological biomarkers should be included in early study phases as meaningful outcome measures. Muscle Nerve 58: 204-212, 2018.

The association of ankle dorsiflexion and dynamic knee valgus: A systematic review and meta-analysis.

OBJECTIVE: The objective of this systematic review was to evaluate the association between ankle dorsiflexion (ADF) and dynamic knee valgus (DKV). METHODS: Electronic searches were conducted in MEDLINE, EMBASE, CINAHL and SPORTDiscus. A modified Downs and Black checklist was used for quality assessment and meta-analysis was performed to compare standardised mean differences (SMD) of ADF. RESULTS: Seventeen studies met the inclusion criteria. Meta-analysis showed that reduced ADF is associated with participants presenting with DKV compared to controls (SMD -0.65, 95% CI -0.88 to -0.41). Subgroup analysis showed consistent results regarding different forms of ADF measurement; restriction in ADF measured in weight-bearing position (SMD -1.25, 95% CI -2.24 to -0.25), non-weight-bearing with knee flexed (SMD -0.56, 95% CI -0.97 to -0.16) or non-weight-bearing with knee extended (SMD -0.54, 95% CI -0.80 to -0.28) was significantly associated with DKV. CONCLUSION: The meta-analysis results provide evidence that reduced ADF is correlated with DKV. The assessment of ADF in the clinical setting is important, as it may be related to harmful movement patterns of the lower limbs.