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RATIONALE:: Exercise programs for the management of fibromyalgia are well recognized as being effective. However, the incomplete descriptions of exercise programs make replication and implementation difficult. Also, existing reporting tools have not been validated in relation to pain relief as well as with each other. OBJECTIVES:: This study aimed to evaluate the description of exercise programs in randomized control trials for the management of fibromyalgia using different assessment tools, and the correlations of each tool in relation to effectiveness of pain relief of fibromyalgia, and the correlations between each tool. METHOD/RESULTS:: Through a consensus made by two different pairs of reviewers and an arbitrator, the mean total scores for the exercise programs were reported: 10.61/19 for Consensus on Exercise Reporting Template; 4.17/12 for Template for Intervention Description and Replication; 7.05/12 for the Consensus on Therapeutic Exercise Training; and 2.50/4 (aerobic) and 2.36/5 (flexibility and resistance) for the 2016 American College of Sports Medicine guidelines. This demonstrates generally low reporting scores (less than 60% out of the total number of items were reported). Overall, low correlations (Cohen's kappa value, ranging from -0.47 (poor) to 0.313 (fair)) were found between all tools and pain relief. Good to excellent correlations (0.680-0.908) among the reporting tools were shown. CONCLUSION:: Incomplete descriptions of exercise programs were consistently shown among the randomized clinical trials assessed in this study. The overall weak correlations demonstrated that the reporting tools have the limited ability to determine whether exercise programs were or were not effective for pain relief among individuals with fibromyalgia.
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Terapia por Exercício , Fibromialgia/reabilitação , Medição da Dor , Projetos de Pesquisa , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos TestesRESUMO
Purpose/Rationale: Physical exercise interventions for the management of knee osteoarthritis are well known to be effective and accessible forms of rehabilitation and symptom management. However, without adequate reporting of these interventions, accurate replication and clinical use is negatively impacted. OBJECTIVES: The main objective of this article was to assess content reporting using The Consensus on Exercise Reporting Template list and 2016 American College of Sports Medicine guidelines among moderate- to high-quality exercise interventions randomized controlled trials (total score of ≥6/10 on the PEDro scale) involving individuals with knee osteoarthritis. RESULTS: The Consensus on Exercise Reporting Template mean total score for all 47 included randomized controlled trials was 4.42 out of 19, demonstrating generally low quality of reporting. The Consensus on Exercise Reporting Template list and the 2016 American College of Sports Medicine guidelines scores were moderately correlated (based on 95% confidence interval, intraclass correlation coefficient = 0.508) for aerobic interventions only. CONCLUSION: The content analysis of exercise interventions in knee osteoarthritis demonstrated low scores for moderate- to high-quality trials. Improved standardized reporting is recommended to ensure knowledge transfer and replication of effective exercise programs for individuals with knee osteoarthritis.
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Terapia por Exercício , Osteoartrite do Joelho/reabilitação , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , HumanosRESUMO
Background: The rates of anterior cruciate ligament (ACL) graft failure or contralateral ACL rupture range from 17% to 30% in pediatric patients after ACL reconstruction (ACLR). A contributing factor to the high reinjury rate in this population may be the limited evidence regarding appropriate criteria for allowing unrestricted return to activity (RTA) postoperatively. Purpose: To review the literature and identify the most commonly used criteria when determining unrestricted RTA after ACLR in pediatric patients. Study Design: Systematic review; Level of evidence, 4. Methods: A search was performed of the Medline/PubMed, Cochrane Central Register of Controlled Trials, Embase, CINAHL, and SPORTDiscus databases using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The authors identified studies that included pediatric patients (<19 years of age) and specified the criteria used to determine RTA after ACLR. Results: A total of 27 articles met all criteria for review, of which 13 studies only used 1 criterion when determining RTA. Objective criteria were the most common type of criteria for RTA (17 studies). Strength tests (15 studies) and hop tests (10 studies) were the most commonly used tasks when deriving RTA criteria. Only 2 studies used validated questionnaires to assess the patient's physiological readiness for RTA, and only 2 studies used an objective assessment of movement quality before RTA. Conclusion: Only 14 of the 27 reviewed studies reported using >1 criterion when determining RTA. Furthermore, few studies used patient-reported outcome measures or lower limb kinematics as RTA criteria, indicating that more research is needed to validate these metrics in the pediatric population.
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PURPOSE: To identify the determinants of antibody responses to adjuvanted influenza A/H1N1/09 vaccines in a cohort of cancer outpatients. PATIENTS AND METHODS: Patients with cancer and controls were enrolled in a prospective single-center field study. Two doses of AS03-adjuvanted pandemic influenza vaccine were administered to patients and one dose was administered to controls. Antibody responses were measured using hemagglutination inhibition and confirmed by microneutralization. Geometric mean titers (GMTs) and seroprotection rates (defined as GMTs ≥40) were compared. RESULTS: Immunizations were safe and well tolerated in 197 cancer patients (lymphoma, 57; glioma, 26; lung or head and neck, 37; gastrointestinal, 41; breast, 36) and 138 controls. Similar seroprotection rates (82.3% versus 87%) and GMTs (336.9 versus 329.9) were achieved after two doses of adjuvanted vaccine in cancer patients and one dose in controls. Univariate analyses identified older age, prior immunization against seasonal influenza, lymphoma, CD4 count, active chemotherapy, and rituximab and steroid treatments as being associated with weaker antibody responses. However, only age and chemotherapy plus rituximab remained independent determinants of vaccine responses in multivariate analyses. CONCLUSIONS: Two doses of AS03-adjuvanted influenza vaccine elicited potent antibody responses in most cancer patients despite ongoing chemotherapy, with the exception of rituximab-induced B-cell depletion. Oncology patients treated in an outpatient setting benefit from preventive vaccination against influenza with adjuvanted vaccines.
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Anticorpos/imunologia , Formação de Anticorpos/imunologia , Vacinas contra Influenza/administração & dosagem , Vacinas contra Influenza/imunologia , Influenza Humana/prevenção & controle , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anticorpos/sangue , Feminino , Humanos , Vírus da Influenza A Subtipo H1N1/imunologia , Influenza Humana/complicações , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Pacientes Ambulatoriais , Estudos Prospectivos , Fatores SexuaisRESUMO
OBJECTIVE: To identify the determinants of antibody responses to adjuvanted split influenza A (H1N1) vaccines in patients with inflammatory rheumatic diseases. METHODS: One hundred seventy-three patients (82 with rheumatoid arthritis, 45 with spondylarthritis, and 46 with other inflammatory rheumatic diseases) and 138 control subjects were enrolled in this prospective single-center study. Controls received 1 dose of adjuvanted influenza A/09/H1N1 vaccine, and patients received 2 doses of the vaccine. Antibody responses were measured by hemagglutination inhibition assay before and 3-4 weeks after each dose. Geometric mean titers (GMTs) and rates of seroprotection (GMT≥40) were calculated. A comprehensive medical questionnaire was used to identify the determinants of vaccine responses and adverse events. RESULTS: Baseline influenza A/09/H1N1 antibody levels were low in patients and controls (seroprotection rates 14.8% and 14.2%, respectively). A significant response to dose 1 was observed in both groups. However, the GMT and the seroprotection rate remained significantly lower in patients (GMT 146 versus 340, seroprotection rate 74.6% versus 87%; both P<0.001). The second dose markedly increased antibody titers in patients, with achievement of a similar GMT and seroprotection rate as elicited with a single dose in healthy controls. By multivariate regression analysis, increasing age, use of disease-modifying antirheumatic drugs (DMARDs) (except hydroxychloroquine and sulfasalazine), and recent (within 3 months) B cell depletion treatment were identified as the main determinants of vaccine responses; tumor necrosis factor α antagonist treatment was not identified as a major determinant. Immunization was well tolerated, without any adverse effect on disease activity. CONCLUSION: DMARDs exert distinct influences on influenza vaccine responses in patients with inflammatory rheumatic diseases. Two doses of adjuvanted vaccine were necessary and sufficient to elicit responses in patients similar to those achieved with 1 dose in healthy controls.
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Adjuvantes Imunológicos/uso terapêutico , Anticorpos Antivirais/imunologia , Formação de Anticorpos/imunologia , Antirreumáticos/imunologia , Vírus da Influenza A Subtipo H1N1/imunologia , Vacinas contra Influenza/imunologia , Adjuvantes Imunológicos/efeitos adversos , Adulto , Anticorpos Antivirais/sangue , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/imunologia , Linfócitos B/efeitos dos fármacos , Linfócitos B/imunologia , Feminino , Testes de Inibição da Hemaglutinação , Humanos , Vacinas contra Influenza/efeitos adversos , Vacinas contra Influenza/uso terapêutico , Masculino , Pessoa de Meia-Idade , Espondilartrite/tratamento farmacológico , Espondilartrite/imunologia , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
Patients with celiac disease have an increased risk for severe influenza infection and they show less of a response to certain vaccine types. During the influenza A/H1N1/09 pandemic, we prospectively investigated pandemic vaccine responses in 14 pediatric patients with celiac disease and age-/sex-matched controls. All of the children with celiac disease reached protective antibody titers (≥40) and showed a geometric mean titer comparable with the control group (530 vs 573).
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Formação de Anticorpos , Doença Celíaca/imunologia , Vírus da Influenza A Subtipo H1N1 , Vacinas contra Influenza/imunologia , Influenza Humana/prevenção & controle , Vacinação , Adolescente , Adulto , Estudos de Casos e Controles , Doença Celíaca/complicações , Criança , Pré-Escolar , Suscetibilidade a Doenças , Feminino , Humanos , Influenza Humana/epidemiologia , Influenza Humana/imunologia , Influenza Humana/virologia , Masculino , Pandemias , Estudos Prospectivos , Fatores de Risco , Adulto JovemRESUMO
Background: Barriers and facilitators to research in sports medicine (SM) by physicians and allied health (AH) professions such as physical therapists and athletic trainers are understudied. The purpose of this research was to examine and compare research barriers, facilitators, and other research related facets including interests, comfort, knowledge, and resources among SM physicians and AH practitioners. Study Design: Cross-sectional survey. Methods: The survey was sent to Pediatric Research in Sports Medicine (PRiSM) members. The survey was designed to ask respondents to identify their top barrier and facilitator to conducting research. Research interest (binary), self-rated comfort reading research articles (0-100 scale), self-rated knowledge conducting research independently (0-100 scale), and available research resources were evaluated. Descriptive statistics, chi-square, and t-tests were used to compare the responses between SM physicians and AH practitioners. The value of p<0.05 was set as a statistically significant criterion. Results: The response rate was 35.7% (N=100). For both SM physicians and AH practitioners, the greatest research barrier was a lack of time. However, the leading research facilitators differed in the two professions. The top research facilitator for SM physicians was availability of research personnel, while availability of research mentoring was selected as a prime facilitator by AH practitioners. There were no differences in research interest between SM physicians (87.0%) and AH practitioners (95.5%, p=0.267). However, self-rated comfort reading research articles was higher in SM physicians (75.6±20.6) than AH practitioners (60.6±28.3, p=0.018). There were no differences in self-rated knowledge conducting research independently between SM physicians (70.2±18.6) and AH practitioners (63.4±24.6, p=0.163). Conclusion: Lack of time was the top research barrier for both SM physicians and AH practitioners. Regarding research facilitators, having available time was the main facilitator for SM physicians while availability of mentoring was the leading facilitator in AH practitioners. Level of Evidence: 3.
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BACKGROUND: Anterior cruciate ligament (ACL) rupture is a debilitating knee injury associated with sequela such as joint instability and progressive degeneration. Unfortunately, following surgical ACL reconstruction in adolescents, the rates of ACL graft failure range from 17 to 19%. A contributing factor to the high reinjury rate in this population may be the limited evidence regarding appropriate criteria for allowing unrestricted return-to-activities (RTA) postoperatively. Several systematic reviews have already sought to develop a consensus on what criteria should be utilized for releasing patients to unrestricted sports activities; however, these reviews have focused on adult populations, a group at much lower risk for reinjury. Our objective is to systematically examine the literature and identify the criteria used when determining unrestricted RTA following an ACL reconstruction in an adolescent population. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search will be performed of the MEDLINE/PubMed, Cochrane, Embase, CINAHL, and SPORTDiscus electronic databases. Searches will be conducted from January 1, 2000, until submission of the final review. Studies will be identified that include adolescent patients (10-18 years old) undergoing a primary ACL reconstruction and which have specified the criteria used to determine RTA. Each article will be independently screened by two reviewers. To supplement the electronic database search, citations within all included studies will be manually reviewed. Reviewers will record the RTA assessment utilized and the rates of ACL reinjury through a standardized data extraction sheet. Reviewers will resolve full-text screening and data extraction disagreements through discussion. Synthesis of the collected data will focus on compiling and mapping the most commonly used types of RTA criteria. DISCUSSION: This systematic review will determine the most commonly used RTA criteria in adolescent patients post-ACL reconstruction. This will help future interventions build more effective adolescent-specific RTA assessments through the validation of current RTA criteria as well as the implementation of new criteria according to the identified literature gaps.
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Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Instabilidade Articular , Relesões , Esportes , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/diagnóstico , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Criança , Humanos , Revisões Sistemáticas como AssuntoRESUMO
BACKGROUND: Responses to influenza vaccines are poorly characterized in immunocompromised patients. The goal of this study was to assess the efficacy of the AS03-adjuvanted influenza H1N1/A/09 vaccine in allogeneic hematopoietic stem cell transplant recipients. DESIGN AND METHODS: We enrolled 65 patients and 138 controls in an open prospective study. Controls received one dose and patients 2 doses of the AS03-adjuvanted influenza H1N1/A/09 vaccine at a 3-week interval. Geometric mean titers and seroprotection/seroconversion rates were determined by hemagglutination inhibition before and four weeks after the last immunization. Clinical and biological markers, including immunoglobulins, CD3+, CD4+, CD8+ and naïve CD4+ T-cell counts were assessed in all patients. RESULTS: Baseline seroprotection rates were low in patients (6.6%) and controls (14.8%). After 2 doses, patients (n=57, 92.3%) achieved similar seroprotection rates (84% vs. 87%, P=0.65) and antibody titers (305 vs. 340, P=0.88) as controls (n=131, 93.9%) after one dose. In univariate analysis, transplant-to-vaccination interval less than 12 months, active graft-versus-host disease, immunosuppressive drugs, hemoglobin less than 12 g/L, lymphopenia less than 1 G/L, IgG less than 4 g/L, IgA less than 0.5 g/L, IgM less than 0.5 g/L and naive CD4+ T cells less than 150/µL were significantly associated with weaker responses. Multivariate analysis identified transplant-to-vaccination interval and active graft-versus-host disease as the most powerful negative predictors of antibody responses (P=0.04 and P=0.002, respectively). Vaccination was well tolerated in both cohorts. CONCLUSIONS: In allogeneic hematopoietic stem cell transplant recipients, 2 doses of an adjuvanted influenza vaccine elicited comparable responses to a single dose in healthy individuals. However, vaccine responses remained poor in patients with ongoing graft-versus-host disease, supporting the need for additional strategies in this high-risk patient population. (ClinicalTrials.gov Identifier: NCT01022905).
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Doença Enxerto-Hospedeiro/imunologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Imunidade Humoral/imunologia , Vacinas contra Influenza/imunologia , Adulto , Idoso , Anticorpos Antivirais/sangue , Anticorpos Antivirais/imunologia , Formação de Anticorpos/imunologia , Feminino , Humanos , Imunização , Hospedeiro Imunocomprometido , Vacinas contra Influenza/efeitos adversos , Masculino , Pessoa de Meia-Idade , Transplante Homólogo/imunologia , Adulto JovemRESUMO
Neuromuscular control is critical for maintaining dynamic joint stability and mitigating the risk of anterior cruciate ligament (ACL) injury. Given the increased risk of ACL injury in females, sex-based differential muscle activation strategies are often associated with this risk. For example, the quadriceps-dominant muscle activation strategy sometimes observed in females has been discussed as a cause of their increased risk of ACL injury. However, there has been no synthesised knowledge on sex differences in muscle activation patterns associated with ACL injuries. Therefore, the purpose of this review was to synthesise sex differences in muscle activation patterns in movements associated with ACL injuries in both adult and adolescent populations. A systematic electronic database search was conducted. Thirty studies were included in the review. Females demonstrated higher pre- and post-landing activation of the quadriceps and lower activation of the hamstrings in 15 studies. Females also had higher quadriceps-to-hamstring co-contraction ratios during pre- and post-landing phases compared to their male counterparts in 4 of 9 studies that considered co-contraction. While some studies supported the quadriceps-dominant activation strategies in females, no consensus can be drawn due to methodological inconsistencies and limitations. Also, despite the importance of ACL injury prevention in children and adolescents, the evidence on sex difference in muscle activation patterns in this population is insufficient to draw meaningful conclusions.
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Lesões do Ligamento Cruzado Anterior , Adolescente , Adulto , Fenômenos Biomecânicos , Criança , Eletromiografia , Feminino , Humanos , Articulação do Joelho , Masculino , Músculo Esquelético , Músculo Quadríceps , Caracteres SexuaisRESUMO
The new SARS-CoV-2 Omicron variant (B.1.1.529) has been recently declared a Variant of Concern due to a series of important mutations in the viral spike protein and especially in the receptor-binding domain. While investigations into the spread of this new variant are ongoing, the first cases have been detected in Switzerland. Important questions have been raised: (1) Will the PCR assays commonly used to detect SARS-CoV-2 still work for the Omicron variant? (2) Can specific PCR features, e.g. S-gene dropout, be used to identify potential Omicron samples? In this minireview we provide current knowledge on the Omicron variant and guidance on its PCR validation.
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COVID-19 , SARS-CoV-2 , Humanos , Mutação , Reação em Cadeia da PolimeraseRESUMO
The rapid spread of the SARS-CoV-2 lineages B.1.1.7 (N501Y.V1) throughout the UK, B.1.351 (N501Y.V2) in South Africa, and P.1 (B.1.1.28.1; N501Y.V3) in Brazil has led to the definition of variants of concern (VoCs) and recommendations for lineage specific surveillance. In Switzerland, during the last weeks of December 2020, we established a nationwide screening protocol across multiple laboratories, focusing first on epidemiological and microbiological definitions. In January 2021, we validated and implemented an N501Y-specific PCR to rapidly screen for VoCs, which are then confirmed using amplicon sequencing or whole genome sequencing (WGS). A total of 13,387 VoCs have been identified since the detection of the first Swiss case in October 2020, with 4194 being B.1.1.7, 172 B.1.351, and 7 P.1. The remaining 9014 cases of VoCs have been described without further lineage specification. Overall, all diagnostic centers reported a rapid increase of the percentage of detected VOCs, with a range of 6 to 46% between 25 to 31 of January 2021 increasing towards 41 to 82% between 22 to 28 of February. A total of 739 N501Y positive genomes were analysed and show a broad range of introduction events to Switzerland. In this paper, we describe the nationwide coordination and implementation process across laboratories, public health institutions, and researchers, the first results of our N501Y-specific variant screening, and the phylogenetic analysis of all available WGS data in Switzerland, that together identified the early introduction events and subsequent community spreading of the VoCs.
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Although current H5N1 highly pathogenic avian influenza viruses (HPAIV) are inefficiently transmitted to humans, infected individuals can suffer from severe disease, often progressing rapidly to acute respiratory distress syndrome and multiorgan failure. This is in contrast with the situation with human influenza viruses, which in immunocompetent individuals usually cause only a respiratory disease which is less aggressive than that observed with avian H5N1 viruses. While the biological basis of inefficient transmission is well documented, the mechanisms by which the H5N1 viruses cause fatal disease remain unclear. In the present study, we demonstrate that human pulmonary microvascular endothelial cells (hPMEC) had a clearly higher susceptibility to infection by H5N1 HPAIV than to infection by human influenza viruses. This was measurable by de novo intracellular nucleoprotein production and virus replication. It was also related to a relatively higher binding capacity to cellular receptors. After infection of hPMEC, cell activation markers E-selectin and P-selectin were upregulated, and the proinflammatory cytokines interleukin-6 and beta interferon were secreted. H5N1 virus infection was also associated with an elevated rate of cell death. Reverse genetics analyses demonstrated a major role for the viral hemagglutinin in this cell tropism. Overall, avian H5N1 viruses have a particular receptor specificity targeting endothelial cells that is different from human influenza viruses, and this H5N1 receptor specificity could contribute to disease pathogenesis.
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Células Endoteliais/virologia , Glicoproteínas de Hemaglutininação de Vírus da Influenza/fisiologia , Virus da Influenza A Subtipo H5N1/fisiologia , Tropismo Viral , Animais , Apoptose , Células Cultivadas , Cães , Selectina E/biossíntese , Humanos , Interferon Tipo I/metabolismo , Interleucina-6/metabolismo , Ácido N-Acetilneuramínico/fisiologia , Selectina-P/biossínteseRESUMO
Females aged between 13 and 17 years old possess the highest non-contact ACL injury incidence of any sex-age strata. Considering that energy absorption strategies have been associated with a reduced risk for sustaining an ACL injury, evaluating landing performance in youth athletes requires investigations beyond the kinematic level. The purpose of this study was to identify sex-specific energy absorption strategies in adolescent males and females, including the relationship between strength and the observed strategies. Thirty-one healthy adolescent athletes completed unanticipated single-leg drop-jump landings on their dominant limb. Sex-specific kinematics and lower-limb contributions to energy absorption were then compared over the landing phase for each jump. Pearson and Spearman correlation coefficients determined the relationship between isometric joint strength and the observed kinematics and energy absorption. Female participants absorbed a larger proportion of the landing energy at the ankle (p = 0.046, d = 0.75) and smaller proportion at the hip (p = 0.028, d = 0.85) compared to males. Females also reached larger peak negative joint power in their knee (p = 0.001, d = 1.1) and ankle (p = 0.04, d = 0.79). Hip extension strength was positively correlated with trunk flexion (r = 0.559, p = 0.001) and negatively correlated with forward pelvic tilt (r = -0.513, p = 0.003). Females adopted an energy absorption strategy which utilized the distal joints to absorb a larger portion of the landing forces and tended to absorb the forces later in the landing phase relative to males. The greater reliance on distal joints is correlated to reduced hip strength and may increase the risk for sustaining an ACL injury.
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Lesões do Ligamento Cruzado Anterior , Traumatismos do Joelho , Movimento , Adolescente , Fenômenos Biomecânicos , Feminino , Humanos , Articulação do Joelho , Perna (Membro) , MasculinoRESUMO
The purpose of this study was to describe neuromuscular and kinematic differences during failed and successful drop-vertical jumps in a pediatric population. Healthy young athletes (n = 32) completed single-leg drop vertical jump landings where the required landing leg was unanticipated. Trials were categorized as failed if the participant shifted their base of support during the landing. Joint kinematics and muscle activation amplitudes were time normalized over the flight and landing phases. Statistical parametric mapping (SPM) was used to compare landings and a moving average convergence divergence oscillator was then calculated to determine where failed and successful waveforms began to diverge prior to reaching statistical significance. SPM determined that participants performed the failed trials with reduced pelvic tilt towards the landing limb during 41-69% of the flight phase, greater trunk flexion angle during 31-100% of the landing phase and greater trunk tilt away from the landing limb during 3-13% and 21-90% of the landing phase. Greater rectus femoris activation during the failed trials was identified during 88-100% of the flight phase, as well as 1-4% and 71-97% of the landing phase. Greater gluteus medius and biceps femoris activation was also identified in the failed trials during 54-72% and 76-89% of the landing phase respectively. These findings indicate that the control of proximal joints has an important role in determining if a participant will fail a landing; and that how athletes prepare for a landing may be more relevant than the kinematics following ground contact.
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Lesões do Ligamento Cruzado Anterior , Perna (Membro) , Fenômenos Biomecânicos , Criança , Humanos , Articulação do Joelho , Postura , Amplitude de Movimento ArticularRESUMO
BACKGROUND: The reporting quality of physical activity (PA) programs in randomized controlled trials (RCTs) for the management of juvenile idiopathic arthritis (JIA) remains unknown. This study aimed to assess and compare the reporting quality of PA programs in RCTs for the management of JIA using three difference standardized assessment tools, and to describe the elements that were similar and different between these tools. METHODS: A systematic search was conducted for moderate-to high-quality RCTs of PA programs in JIA, published up until January 2019. Two reviewers independently included 10 RCTs and scored the reporting quality of PA programs using the following tools: Consensus on Exercise Reporting Template (CERT) checklist, Consensus on Therapeutic Exercise Training (CONTENT) scale, and Template for Intervention Description and Replication (TIDieR) checklist. RESULTS: Results showed that reporting of PA programs in 10 moderate- to high-quality RCTs for JIA management remains incomplete. The average reporting quality (± standard deviation) for all RCTs combined was moderate for the three standardized assessment tools with 70.8 (±14.3)% for the TIDieR checklist, 53.2 (±20.2)% for the CERT checklist, and 70.0 (±18.9)% for the CONTENT scale. Despite some overlap, the three standardized assessment tools (TIDieR, CERT, CONTENT) included different elements resulting in different scores. All tools assess elements linked to PA programs (provider, location, timing, personalization and adherence), but the CERT checklist includes other essential elements (e.g., additional resources, motivational strategies, adverse events). CONCLUSIONS: The lack of complete reporting of PA programs in RCTs for the management of JIA and the variation in scores and assessed elements among standardized assessment tools show the need to improve reporting. Using the most comprehensive standardized tool (i.e., the CERT) and providing accessible supplemental information on PA programs may improve the reporting quality of PA programs in RCTs and help reproduce PA programs in research and clinical practice.
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Artrite Juvenil/reabilitação , Terapia por Exercício , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Relatório de Pesquisa/normas , Exercício Físico , HumanosRESUMO
Purpose: Physical activity level is a prognostic variable for patients with injuries. Self-report questionnaires exist to obtain these measures; however, they are not accessible to all populations because of language barriers. Therefore, the purpose of this study was to translate and validate the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) for francophones. Method: We translated the HSS Pedi-FABS using the forward-reverse translation approach and validated it among bilingual adults and an expert panel before administering it to a paediatric population. A repeated-measures crossover design was used: forty-three middle school students, aged 13.1 (SD 0.75) years, were randomly administered either the English or the French questionnaire. Two days later, all participants completed the other version. The translated questionnaire was assessed for its convergent validity (Spearman's r correlation coefficients [rs ]), internal consistency (Cronbach's α), and reliability (standard error of measurement [SEM]). Results: All assessments had a significance level of p < 0.001 with an excellent Spearman's r correlation coefficient between the participants' total scores on the translated questionnaires (rs = 0.911). The overall scores for the questionnaire and the individual items of the questionnaire revealed excellent internal consistency (α = 0.868) and reliability (SEM = 0.334). Conclusions: The validated and reliable translated questionnaire can be used by researchers and clinicians to assess physical activity levels in French paediatric populations.
Objectif : le niveau d'activité physique est un pronostic variable pour les patients qui présentent des blessures. Il existe des questionnaires d'autoévaluation pour obtenir ces mesures, mais ils ne sont pas accessibles à toutes les populations à cause de la barrière de la langue. La présente étude visait à traduire et à valider le Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) pour les francophones. Méthodologie : les chercheurs ont traduit le HSS Pedi-FABS au moyen du processus de rétrotraduction et l'ont validé auprès d'adultes bilingues et d'un groupe d'experts avant de l'utiliser auprès d'une population pédiatrique. Ils ont utilisé une méthodologie transversale par mesures répétées : 43 élèves du début du secondaire de 13,1 ans (ÉT 0,75) ont répondu au hasard au questionnaire anglais ou français. Deux jours plus tard, tous les participants ont rempli l'autre version. Les questionnaires traduits ont été évalués pour leur validité convergente (coefficients de corrélation Rho de Spearman [rs ]), leur cohérence interne (coefficient alpha [α] de Cronbach) et leur fiabilité (erreur type de mesure). Résultats : toutes les évaluations présentaient un seuil de signification de p < 0,001 et un excellent coefficient de corrélation Rho de Spearman entre les scores totaux des participants dans les questionnaires traduits (rs = 0,911). Les scores totaux du questionnaire et de chacun de ses éléments ont révélé une excellente cohérence interne (α = 0,868) et une excellente fiabilité (erreur type de mesure = 0,334). Conclusion : le questionnaire validé et traduit avec fiabilité peut être utilisé par les chercheurs et les cliniciens pour évaluer les niveaux d'activité physique de populations pédiatriques francophones.
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Anterior cruciate ligament (ACL) injury rates in female adolescents are increasing. Irrespective of treatment options, approximately 1/3 will suffer secondary ACL injuries following their return to activity (RTA). Despite this, there are no evidence-informed RTA guidelines to aid clinicians in deciding when this should occur. The first step towards these guidelines is to identify relevant and feasible measures to assess the functional status of these patients. The purpose of this study was therefore to evaluate tests frequently used to assess functional capacity following surgery using a Reduced Error Pruning Tree (REPT). Thirty-six healthy and forty-two ACLinjured adolescent females performed a series of functional tasks. Motion analysis along with spatiotemporal measures were used to extract thirty clinically relevant variables. The REPT reduced these variables down to two limb symmetry measures (maximum anterior hop and maximum lateral hop), capable of classifying injury status between the healthy and ACL injured participants with a 69% sensitivity, 78% specificity and kappa statistic of 0.464. We, therefore, conclude that the REPT model was able to evaluate functional capacity as it relates to injury status in adolescent females. We also recommend considering these variables when developing RTA assessments and guidelines.Clinical Relevance- Our results indicate that spatiotemporal measures may differentiate ACL-injured and healthy female adolescents with moderate confidence using a REPT. The identified tests may reasonably be added to the clinical evaluation process when evaluating functional capacity and readiness to return to activity.
Assuntos
Reconstrução do Ligamento Cruzado Anterior , Traumatismos do Joelho , Adolescente , Algoritmos , Árvores de Decisões , Feminino , Humanos , Joelho , Traumatismos do Joelho/diagnósticoRESUMO
BACKGROUND: Sex-related neuromuscular differences have been linked to greater risk of anterior cruciate ligament injuries in females. Despite this, it remains unclear if sex-related differences are present after injury. This study sought to determine if sex differences are present in the functional roles of knee joint muscles in an anterior cruciate ligament deficient population. METHODS: An isometric, weight-bearing, force-generation protocol required injured and healthy males and females to modulate ground reaction forces. Electromyography was used to classify the functional role of 10 lower limb muscles in their contribution to knee joint stability during various loading directions. These roles were compared between the four groups at 12 loading directions using a directional analysis. FINDINGS: Functional muscle roles were different between groups, except for injured males and healthy females. Healthy males had either joint actuators or specific joint stabilisers, but no general stabilisers; the vastus medialis and lateralis of injured males and healthy females were classified as general stabilisers while injured females added the gluteus medialis and medial gastrocnemius as general stabilisers. INTERPRETATION: A population-based hierarchy in functional muscle roles was discovered. Healthy males demonstrated the most specific muscle roles, which can be viewed as more adaptive to variable loading conditions. The more generalised stabilisation strategies seen in injured males and females would alter joint loading which may be detrimental to the knee joint health over time. In summary, (1) these injuries alter muscle roles; (2) these alterations are sex-specific; (3) rehabilitation might be optimised if sex-differences are considered.