Comparing the Pilates method with no exercise or lumbar stabilization for pain and functionality in patients with chronic low back pain: systematic review and meta-analysis.

OBJECTIVE: To perform a systematic review with meta-analyses that evaluates the effectiveness of the Pilates method on the pain and functionality outcome in adults with non-specific chronic low back pain. DATA SOURCES: The search was performed in the following databases: Medline, Embase, AMED, Cinahl, Lilacs, Scielo, SportDiscus, ProQuest, Web of Science, PEDro, Academic Search Premier and the Cochrane Central Register of Controlled Trials from 1950 to 2011; the following keywords were used: 'Pilates', 'Pilates-based', 'back exercises', 'exercise therapy', 'low back pain', 'back pain' and 'backache'. REVIEW METHODS: The inclusion criteria were studies that assessed the effects of the Pilates method on patients with chronic low back pain. RESULTS: Five studies met the inclusion criteria. The total number of patients was 71 in the Pilates group and 68 in the control group. Pilates exercise did not improve functionality (standardized mean difference (SMD = -1.34; 95% confidence interval (CI) -2.80, 0.11; P = 0.07) or pain between Pilates and control groups (SMD = -1.99; 95% CI -4.35, 0.37; P = 0.10). Pilates and lumbar stabilization exercises presented no significant difference in functionality (mean difference (MD) = -0.31; 95% CI -1.02, 0.40; P = 0.39) or pain (MD = -0.31; 95% CI -1.02, 0.40; P = 0.39). CONCLUSION: The Pilates method did not improve functionality and pain in patients who have low back pain when compared with control and lumbar stabilization exercise groups.

Arthroscopy for temporomandibular disorders.

BACKGROUND: Temporomandibular disorders (TMDs) are considered a collection of disorders involving many organic, psychological and psychosocial factors. They can involve the masticatory muscles or the temporomandibular joint (TMJ) and associated structures, or both. It is estimated that 40% to 75% of the population displays at least one sign of the disease and 33% of the population reports at least one symptom. Arthroscopy has been used to reduce signs and symptoms of patients with TMD but the effectiveness has still not been totally explained. OBJECTIVES: To assess the effectiveness of arthroscopy for the management of signs and symptoms in patients with TMDs. SEARCH STRATEGY: The Cochrane Oral Health Group Trials Register (to 23 December 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2010), MEDLINE via OVID (1950 to 23 December 2010), EMBASE via OVID (1980 to 23 December 2010), LILACS via BIREME Virtual Health Library (1982 to 23 December 2010), Allied and Complementary Medicine Database (AMED) via OVID (1985 to 23 December 2010), CINAHL via EBSCO (1980 to 23 December 2010). There were no restrictions regarding the language or date of publication. SELECTION CRITERIA: Randomized controlled clinical trials of arthroscopy for treating TMDs were included. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data, and three review authors independently assessed the risk of bias of included trials. The authors of the selected articles were contacted for additional information. MAIN RESULTS: Seven randomized controlled trials (n = 349) met the inclusion criteria. All studies were either at high or unclear risk of bias. The outcome pain was evaluated after 6 months in two studies. No statistically significant differences were found between the arthroscopy versus nonsurgical groups (standardized mean difference (SMD) = 0.004; 95% confidence interval (CI) -0.46 to 0.55, P = 0.81). Two studies, analyzed pain 12 months after surgery (arthroscopy and arthrocentesis) in 81 patients. No statistically significant differences were found (mean difference (MD) = 0.10; 95% CI -1.46 to 1.66, P = 0.90). Three studies analyzed the same outcome in patients who had been submitted to arthroscopic surgery or to open surgery and a statistically significant difference was found after 12 months (SMD = 0.45; 95% CI 0.01 to 0.89, P = 0.05) in favor of open surgery. The two studies compared the maximum interincisal opening in six different clinical outcomes (interincisal opening over 35 mm; maximum protrusion over 5 mm; click; crepitation; tenderness on palpation in the TMJ and the jaw muscles 12 months after arthroscopy and open surgery). The outcome measures did not present statistically significant differences (odds ratio (OR) = 1.00; 95% CI 0.45 to 2.21, P = 1.00). Two studies compared the maximum interincisal opening after 12 months of postsurgical follow-up. A statistically significant difference in favor of the arthroscopy group was observed (MD = 5.28; 95% CI 3.46 to 7.10, P < 0.0001). The two studies compared the mandibular function after 12 months of follow-up with 40 patients evaluated. The outcome measure was mandibular functionality (MFIQ). This difference was not statistically significant (MD = 1.58; 95% CI -0.78 to 3.94, P = 0.19).   AUTHORS' CONCLUSIONS: Both arthroscopy and nonsurgical treatments reduced pain after 6 months. When compared with arthroscopy, open surgery was more effective at reducing pain after 12 months. Nevertheless, there were no differences in mandibular functionality or in other outcomes in clinical evaluations. Arthroscopy led to greater improvement in maximum interincisal opening after 12 months than arthrocentesis; however, there was no difference in pain.

Effect of the Pilates method on physical conditioning of healthy subjects: a systematic review and meta-analysis.

INTRODUCTION: Physical conditioning consists of a variety of health-related attributes and Pilates exercises are described as a form of this conditioning. The objective of this systematic review was to determine the effect of the Pilates method on health and ability outcome of the physical conditioning of healthy individuals. EVIDENCE ACQUISITION: The search was performed in the following databases: Medline, Cinahl, Embase, Lilacs, Scielo, Web of Science, PEDro, Cochrane Controlled Trials Register Library, Scopus, Science Direct and Google Scholar. (1950-2014). Included studies were randomized controlled trials (RCTs) that assessed the effects of the Pilates method on healthy subjects. EVIDENCE SYNTHESIS: Nine RCTs met the inclusion criteria. Pilates improved abdominal muscular endurance when compared with no exercises (mean difference [MD]=9.53%; 95% CI: 2.41, 16.43; P=0.009), however, there was no difference in flexibility (MD=4.97; 95% CI: -0.53, 10.47; P=0.08). Some positive effects (up to 6 months) of the Pilates practice were found in some RCTs' results as follows: Improvement of dynamic balance, quality of life and back muscle flexibility. CONCLUSIONS: The results indicate the Pilates exercises performed on the mat or apparatus 2 to 3 times a week, for 5 to 12 weeks, improves abdominal muscular endurance (on average, 10 more abdominals curls in 1-minute sit-up test) for both genders, when compared to no exercises.

Translation, cross-cultural adaptation and analysis of the psychometric properties of the lower extremity functional scale (LEFS): LEFS- BRAZIL.

BACKGROUND: There is a lack of questionnaires in Brazilian Portuguese to evaluate patient-reported lower limb function. OBJECTIVE: To translate, cross-culturally adapt to the Brazilian population, and evaluate the psychometric properties of the Lower Extremity Functional Scale (LEFS). METHOD: The LEFS was translated by two independent assessors and back-translated to English. Then, the LEFS-Brazil was tested on 20 patients who answered the questionnaire in the cross-cultural adaptation phase. For the evaluation of the psychometric properties, 100 patients answered the questionnaire. The reliability was tested by two independent assessors. The Medical Outcomes Study 36-item from Health Survey (SF-36) was used as the criterion method for construct validity. The sensitivity to change was tested for four consecutive weeks. RESULTS: The internal consistency was α = 0.96. The intra-observer reliability was CCI (intraclass correlation coefficient) = 0.96 and CCI interobserver = 0.98; the Bland and Altman mean difference (d) intra-observer = -1.52 and d interobserver = 0.46. The correlation between the LEFS and SF-36 in the first week was the following: physical function r=0.82, physical role r=0.57, emotional role r=0.43 and mental health r=0.33. The LEFS was responsive when comparing the mean of the first week to the second, third and fourth weeks and comparing the second to the fourth week. The cut-off point was 11, and the area under the receiving operator curve was 0.96 95% CI [0.88;0.99], with sensitivity = 0.96, 1-specificity = 0 and standard error = 0.02. CONCLUSION: The LEFS-Brazil is reliable, valid and responsive.

Translation, cross-cultural adaptation and analysis of the psychometric properties of the lower extremity functional scale (LEFS): LEFS- BRAZIL

BACKGROUND: There is a lack of questionnaires in Brazilian Portuguese to evaluate patient-reported lower limb function. OBJECTIVE: To translate, cross-culturally adapt to the Brazilian population, and evaluate the psychometric properties of the Lower Extremity Functional Scale (LEFS). METHOD: The LEFS was translated by two independent assessors and back-translated to English. Then, the LEFS-Brazil was tested on 20 patients who answered the questionnaire in the cross-cultural adaptation phase. For the evaluation of the psychometric properties, 100 patients answered the questionnaire. The reliability was tested by two independent assessors. The Medical Outcomes Study 36-item from Health Survey (SF-36) was used as the criterion method for construct validity. The sensitivity to change was tested for four consecutive weeks. RESULTS: The internal consistency was α = 0.96. The intra-observer reliability was CCI (intraclass correlation coefficient) = 0.96 and CCI interobserver = 0.98; the Bland and Altman mean difference () intra-observer = -1.52 and interobserver = 0.46. The correlation between the LEFS and SF-36 in the first week was the following: physical function r=0.82, physical role r=0.57, emotional role r=0.43 and mental health r=0.33. The LEFS was responsive when comparing the mean of the first week to the second, third and fourth weeks and comparing the second to the fourth week. The cut-off point was 11, and the area under the receiving operator curve was 0.96 95% CI [0.88;0.99], with sensitivity = 0.96, 1-specificity = 0 and standard error = 0.02. CONCLUSION: The LEFS-Brazil is reliable, valid and responsive. .