Treatment-based classification for low back pain: systematic review with meta-analysis.

OBJECTIVE: To systematically review the effects of treatment-based classification (TBC) in patients with specific and nonspecific acute, subacute and chronic low back pain. METHODS: The following databases were searched: MEDLINE, EMBASE, PsycINFO, Global Health, CENTRAL, Web of Science, CINAHL, SPORTDiscus, PEDro and WHO from inception up to December 2021. We used the PEDro scale, the TIDieR checklist and the GRADE approach to evaluate the risk of bias, quality on reporting and the certainty of the evidence, respectively. RESULTS: Twenty-three trials (pooled n = 2,649) met the inclusion criteria. We have identified a total of 22 comparisons and 134 estimates of treatment effects. There was a very large heterogeneity with regards to the comparison groups. Most of individual trials had low risk of bias with a mean score of 6.8 (SD = 1.3) on a 0-10 scale. The certainty of evidence for most comparisons was low, which indicates that more high quality and robust trials are needed. We were able to pool the data using a meta-analysis approach for only two comparisons (TBC versus mobility exercises in patients with acute low back pain and traction for patients with sciatica). In general, the TBC approach seems to be useful for patients with acute low back pain, sciatica and with spinal stenosis. We strongly suggest readers to carefully read our summary of findings table for further details on each comparison. CONCLUSION: The TBC approach seems to be useful for patients with acute low back pain, sciatica and with spinal stenosis.

Prevalence and reliability of treatment-based classification for subgrouping patients with low back pain.

OBJECTIVES: To observe the distribution of patients who presented with low back pain (LBP) and to determine the between therapists' interrater reliability of assessments in a private outpatient setting using treatment-based classification (TBC) subgroups. METHODS: An observational and methodological study was conducted. Four hundred and twenty-nine patients (231 male; 198 female) presenting LBP symptoms and referred to conservative treatment were assessed by 13 physical therapists who conducted a 60-min examination process utilizing TBC subgroups. Interrater reliability analyses from six raters were assessed using Fleiss' kappa and previously recorded data (n = 30). RESULTS: In this study, 65.74% of patients were classified in only one subgroup, the most prevalent being stabilization (21.91%), followed by extension (15.38%), traction (11.89%), flexion (10.96%), manipulation (5.13%), and lateral shift (0.47%). Approximately 20.98% of patients were classified in two subgroups, where the most frequent overlaps were flexion + stabilization (7.46%), extension + stabilization (6.06%), flexion + traction (4.20%), extension + manipulation (1.86%), and 13.29% of patients were not classified in any TBC subgroup. Analysis of interrater reliability showed a kappa value of 0.62 and an overall agreement of 66% between raters. DISCUSSION: LBP is a heterogeneous clinical condition and several classification methods are proposed in the attempt to observe better outcomes for patients. Eighty-five percent of patients assessed were able to be classified when using the TBC assessment and reliability analysis showed a substantial agreement between raters. LEVEL OF EVIDENCE: 2c.

Combined therapy (ultrasound and interferential current) in patients with fibromyalgia: once or twice in a week?

BACKGROUND AND PURPOSE: Combined Therapy (CT) composed of ultrasound and Interferential Therapy has been reported as a cost-effective, local analgesic intervention on tender points in Fibromyalgia (FM). This study aims to investigate the difference between CT applied once a week and twice a week in patients with FM. METHOD: Fifty patients with the diagnosis of FM were randomized into two groups (G1 = once a week treatment and G2 = twice a week treatment) with each group containing 25 patients. All eighteen tender points were assessed and treated with CT during each session, over a three-month time period. Interferential Therapy was modulated at 4,000 Hz of current carrier, 100 Hz of amplitude modulated frequency and at a bearable sensorial threshold of intensity. Pulsed ultrasound of 1 MHz at 20% of 2.5 W/cm² was used. For evaluation, the Visual Analogue Scale, Fibromyalgia Impact Questionnaire, Post Sleep Inventory and the tender point count were utilized, and the examiner was blinded to the group assignments. RESULTS: G1 and G2 showed a significant improvement in Visual Analogue Scale (p < 0.0001 and p < 0.0005, respectively), Tender Points (p < 0.005 and p < 0.001, respectively), Fibromyalgia Impact Questionnaire and Post Sleep Inventory (p < 0.005 and p < 0.05, respectively). However, there was no significant difference between the two groups in all performed analyses. CONCLUSION: There is no advantage in increasing the number of sessions of combined therapy in terms of reducing generalized pain, quality of life and sleep quality for patients with FM.

ISOKINETIC AND FUNCTIONAL EVALUATION OF DISTAL BICEPS RECONSTRUCTION USING THE MAYO MINI-DOUBLE ROUTE TECHNIQUE.

OBJECTIVE: To evaluate the functional outcome among patients with distal biceps injuries who were operated using the Mayo mini-double route technique, with a minimum follow-up of six months after surgery, through digital isokinetic dynamometry, goniometry and subjective scores in order to establish objective and subjective improvement patterns and discuss the effectiveness of the procedure. METHODS: Nine patients who underwent surgery to treat distal biceps injury were evaluated by means of Cybex digital dynamometry using an angular velocity of 30°/s with five repetitions and 120°/s with 15 repetitions, in comparison with the uninjured side. DASH (Disabilities of the arm, shoulder and hand), Mayo elbow score and conventional goniometry were also used. RESULTS: Digital dynamometer showed that using the angular velocity of 30°/s with five repetitions, there was an average flexion deficit of 9.6% and an average supination deficit of -28.97%. Using an angular velocity of 120°/s with fifteen repetitions, the average flexion deficit was 4.43% and the average supination deficit was -24.1%. CONCLUSIONS: The loss of flexion followed the pattern already shown in the literature. However, in our series, there were supination strength gains, possibly due to the strict rehabilitation protocol. The technique used in this study was safe and low-cost, with few complications and good functional results.

TRANSLATION TO PORTUGUESE LANGUAGE AND CROSS-CULTURAL ADAPTATION OF THE MODIFIED ROWE SCORE FOR OVERHEAD ATHLETES.

UNLABELLED: Objetctive: Study was to translate and culturally adapt the modified Rowe score for overhead athletes. METHODS: The translation and cultural adaptation process initially involved the stages of translation, synthesis, back-translation, and revision by the Translation Group. It was than created the pre-final version of the questionnaire, being the areas "function" and "pain" applied to 20 athletes that perform overhead movements and that suffered SLAP lesions in the dominant shoulder and the areas "active compression test and anterior apprehension test" and "motion" were applied to 15 health professionals. RESULTS: During the translation process there were made little modifications in the questionnaire in order to adapt it to Brazilian culture, without changing the semantics and the idiomatic concept originally described. CONCLUSION: The questionnaire was easily understood by the subjects of the study, being possible to obtain the Brazilian version of the modified Rowe score for overhead athletes that underwent surgical treatment of the SLAP lesion.

Translation and cross-cultural adaptation of the rowe score for portuguese.

OBJECTIVE: To translate and culturally adapt the Rowe score for use in Brazil. METHODS: The translation and cross-cultural adaptation process initially involved the steps of translation, synthesis, back-translation and revision by the Translation Group. The pre-final version of the questionnaire was then created. The Stability and Function fields were applied to 20 patients with anterior shoulder luxation, and the Mobility field was applied to 20 health professionals. RESULTS: It was found that some of the patients had difficulty understanding some of the expressions of the questionnaire, so these were replaced with terms that were easier to understand. All health professionals understood the translation of the Mobility field. The altered questionnaire was then reapplied to another 20 patients, and this time it was understood by all the assessed subjects. CONCLUSION: After a careful process of translation and cultural adaptation, a definitive version of the Rowe questionnaire was obtained in Brazilian Portuguese. Level of Evidence II, Development of diagnostic criteria on consecutive patients.

FUNCTIONAL PERFORMANCE AND KNEE LAXITY IN NORMAL INDIVIDUALS AND IN INDIVIDUALS SUBMITTED TO ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION.

UNLABELLED: The aim of this study was to analyze the correlation between deficits in the isokinetic peak torque of the knee extensors and flexors with hop tests, postoperative knee laxity and functional scores in normal and ACL- reconstructed subjects with patellar tendon and hamstring tendon autografts. METHODS: Sixty male subjects were enrolled and subdivided into three groups: Twenty subjects without knee injuries (GC group) and two groups of 20 subjects submitted to ACL reconstruction with patellar tendon (GTP group) and hamstrings autograft (GTF group). RESULTS: The results showed significant correlation between knee extensors peak torque and performance in the hop tests for GTF and GC groups. There are no significantly correlations between post op knee laxity and Lysholm score compared with the hop tests and peak torque deficits. Concerning the differences between groups, the GTP group showed greater peak torque deficits in knee extensors, worst Lysholm scores and higher percentage of individuals with lower limb symmetry index (ISM) < 90% in both hop tests when compared to the other two groups. CONCLUSION: It is not recommendable to use only one measurement instrument for the functional evaluation of ACL-reconstructed patients, because significant correlation between peak torque, subject's functional score, knee laxity and hop tests were not observed in all groups.

RELIABILITY AND VALIDITY OF A MODIFIED ISOMETRIC DYNAMOMETER IN THE ASSESSMENT OF MUSCULAR PERFORMANCE IN INDIVIDUALS WITH ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION.

OBJECTIVES: The aim of this study was to evaluate the reliability and validity of a modified isometric dynamometer (MID) in performance deficits of the knee extensor and flexor muscles in normal individuals and in those with ACL reconstructions. METHODS: Sixty male subjects were invited to participate of the study, being divided into three groups with 20 subjects each: control group (GC), group of individuals with ACL reconstruction with patellar tendon graft (GTP, and group of individuals with ACL reconstruction with hamstrings graft (GTF). All individuals performed isometric tests in the MID, muscular strength deficits collected were subsequently compared to the tests performed on the Biodex System 3 operating in the isometric and isokinetic mode at speeds of 60°/s and 180o/s. Intraclass ICC correlation calculations were done in order to assess MID reliability, specificity, sensitivity and Kappa's consistency coefficient calculations, respectively, for assessing the MID's validity in detecting muscular deficits and intra- and intergroup comparisons when performing the four strength tests using the ANOVA method. RESULTS: The modified isometric dynamometer (MID) showed excellent reliability and good validity in the assessment of the performance of the knee extensor and flexor muscles groups. In the comparison between groups, the GTP showed significantly greater deficits as compared to the GTF and GC groups. CONCLUSION: Isometric dynamometers connected to mechanotherapy equipments could be an alternative option to collect data concerning performance deficits of the extensor and flexor muscles groups of the knee in subjects with ACL reconstruction.

The effect of hip abduction on the EMG activity of vastus medialis obliquus, vastus lateralis longus and vastus lateralis obliquus in healthy subjects.

STUDY DESIGN: Controlled laboratory study. OBJECTIVES: The purposes of this paper were to investigate (d) whether vastus medialis obliquus (VMO), vastus lateralis longus (VLL) and vastus lateralis obliquus (VLO) EMG activity can be influenced by hip abduction performed by healthy subjects. BACKGROUND: Some clinicians contraindicate hip abduction for patellofemoral patients (with) based on the premise that hip abduction could facilitate the VLL muscle activation leading to a VLL and VMO imbalance METHODS AND MEASURES: Twenty-one clinically healthy subjects were involved in the study, 10 women and 11 men (aged X = 23.3 +/- 2.9). The EMG signals were collected using a computerized EMG VIKING II, with 8 channels and three pairs of surface electrodes. EMG activity was obtained from MVIC knee extension at 90 degrees of flexion in a seated position and MVIC hip abduction at 0 degrees and 30 degrees with patients in side-lying position with the knee in full extension. The data were normalized in the MVIC knee extension at 50 degrees of flexion in a seated position, and were submitted to ANOVA test with subsequent application of the Bonferroni multiple comparisons analysis test. The level of significance was defined as p < or = 0.05. RESULTS: The VLO muscle demonstrated a similar pattern to the VMO muscle showing higher EMG activity in MVIC knee extension at 90 degrees of flexion compared with MVIC hip abduction at 0 degrees and 30 degrees of abduction for male (p < 0.0007) and MVIC hip abduction at 0 degrees of abduction for female subjects (p < 0.02196). There were no statistically significant differences in the VLL EMG activity among the three sets of exercises tested. CONCLUSION: The results showed that no selective EMG activation was observed when comparison was made between the VMO, VLL and VLO muscles while performing MVIC hip abduction at 0 degrees and 30 degrees of abduction and MVIC knee extension at 90 degrees of flexion in both male and female subjects. Our findings demonstrate that hip abduction do not facilitated VLL and VLO activity in relation to the VMO, however, this study included only healthy subjects performing maximum voluntary isometric contraction contractions, therefore much remains to be discovered by future research.