The effectiveness of social prescribing in the management of long-term conditions in community-based adults: A systematic review and meta-analysis.

OBJECTIVE: The objective of this systematic review and meta-analysis was to evaluate the effectiveness of social prescribing interventions in the management of long-term conditions in adults. DATA SOURCES: Eleven electronic databases were searched for randomised and quasi-randomised controlled trials. REVIEW METHODS: Outcomes of interest were quality of life, physical activity, psychological well-being and disease-specific measures. Bias was assessed with the Cochrane Risk of Bias 2 tool. A narrative synthesis and meta-analysis were performed. RESULTS: Twelve studies (n = 3566) were included in this review. Social prescribing interventions were heterogeneous and the most common risks of bias were poor blinding and high attrition. Social prescribing interventions designed to target specific long-term conditions i.e., cancer and diabetes demonstrated significant improvements in quality of life (n = 2 studies) and disease-specific psychological outcomes respectively (n = 3 studies). There was some evidence for improvement in physical activity (n = 2 studies) but most changes were within group only (n = 4 studies). Social prescribing interventions did not demonstrate any significant changes in general psychological well-being. CONCLUSION: Social prescribing interventions demonstrated some improvements across a range of outcomes although the quality of evidence remains poor.

Effects of Concurrent Training on 1RM and VO2 in Adults: Systematic Review with Meta-analysis.

The purpose of this systematic review was to analyze the effects of concurrent training on one repetition maximum (1RM), maximum oxygen consumption (VO2max), and peak oxygen consumption (VO2peak) in healthy adults. The review followed PRISMA recommendations using randomized controlled trials in nine databases. Twenty-one studies met the inclusion criteria, totaling a sample of 796 subjects to perform the meta-analysis. As result, concurrent training provides similar increases in 1RM as strength training for upper limbs (standardized mean difference [SMD]: 0.12; 95% IC: [-0.18; 0.41]; p=0.43) and for the lower limbs (SMD: -0.32; 95% IC: [-0.79; 0.15]; p=0.19). Similarly, no difference was found in the aerobic capacity between the concurrent training vs. aerobic training groups ([SMD - VO2max]: -0.19; 95% IC: [-0.71; 0.33]; p=0.48 and [SMD - VO2peak]: -0.24; 95% IC: [-0.57; 0.08]; p=0.14). Based on the results found, we can affirm that a) similar to strength training, concurrent training provides maximum strength development for upper and lower limbs; and b) cardiorespiratory capacity is not impaired by concurrent training in relation to aerobic training, demonstrating the compatibility of the two training sessions.

Non-radiographic validity and reliability measures for assessing foot types: A systematic review.

BACKGROUND: Foot type classification is well recognized in clinical practice and orthopedic literature, a universally accepted classification or standardized measures to determine foot types are lacking. The objective of this study was to identify which non-radiographic assessment methods are considered valid and/or reliable for the classification of foot types. METHOD: A systematic database search was performed. Only cross-sectional studies that performed reliability and/or validity analysis of non-radiographic methods were included. To evaluate the risk of bias, the Critical Appraisal Tool (CAT) was used to evaluate the measurement properties of objective clinical methods. RESULTS: Twenty-six studies were included. The results of reliability and validity, in general, demonstrated high scores, but, inconsistencies were related to the variability of the measurements, heterogeneity of the methods used to determine reliability and validity, and lack of parameters for classifying foot types, which resulted in few elements to determine which method of foot type evaluation is valid and reliable. CONCLUSION: Given the Intraclass Correlation Coefficient and CAT results and the presence of normative values, the static measurements of the "Arch Height Index", "Foot Posture Index", and "Staheli Arch Index" can be suggested to classify foot types.

Do virtual reality games improve mobility skills and balance measurements in community-dwelling older adults? Systematic review and meta-analysis.

OBJECTIVE: To summarize evidence on the effectiveness of virtual reality games and conventional therapy or no-intervention for fall prevention in the elderly. DATA SOURCES: An electronic data search (last searched December 2016) was performed on 10 databases (Web of Science, EMBASE, PUBMED, CINAHL, LILACS, SPORTDiscus, Cochrane Library, Scopus, SciELO, PEDro) and retained only randomized controlled trials. REVIEW METHOD: Sample characteristics and intervention parameters were compared, focusing on clinical homogeneity of demographic characteristics, type/duration of interventions, outcomes (balance, reaction time, mobility, lower limb strength and fear of falling) and low risk of bias. Based on homogeneity, a meta-analysis was considered. Two independent reviewers assessed the risk of bias. RESULTS: A total of 28 studies met the inclusion criteria and were appraised ( n: 1121 elderly participants). We found that virtual reality games presented positive effects on balance and fear of falling compared with no-intervention. Virtual reality games were also superior to conventional interventions for balance improvements and fear of falling. The six studies included in the meta-analysis demonstrated that virtual reality games significantly improved mobility and balance after 3-6 and 8-12 weeks of intervention when compared with no-intervention. The risk of bias revealed that less than one-third of the studies correctly described the random sequence generation and allocation concealment procedures. CONCLUSION: Our review suggests positive clinical effects of virtual reality games for balance and mobility improvements compared with no-treatment and conventional interventions. However, owing to the high risk of bias and large variability of intervention protocols, the evidence remains inconclusive and further research is warranted.

Balneotherapy (or spa therapy) for rheumatoid arthritis.

BACKGROUND: No cure for rheumatoid arthritis (RA) is known at present, so treatment often focuses on management of symptoms such as pain, stiffness and mobility. Treatment options include pharmacological interventions, physical therapy treatments and balneotherapy. Balneotherapy is defined as bathing in natural mineral or thermal waters (e.g. mineral baths, sulphur baths, Dead Sea baths), using mudpacks or doing both. Despite its popularity, reported scientific evidence for the effectiveness or efficacy of balneotherapy is sparse. This review, which evaluates the effects of balneotherapy in patients with RA, is an update of a Cochrane review first published in 2003 and updated in 2008. OBJECTIVES: To perform a systematic review on the benefits and harms of balneotherapy in patients with RA in terms of pain, improvement, disability, tender joints, swollen joints and adverse events. SEARCH METHODS: We searched the Cochrane 'Rehabilitation and Related Therapies' Field Register (to December 2014), the Cochrane Central Register of Controlled Trials (2014, Issue 1), MEDLIINE (1950 to December 2014), EMBASE (1988 to December 2014), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to December 2014), the Allied and Complementary Medicine Database (AMED) (1985 to December 2014), PsycINFO (1806 to December 2014) and the Physiotherapy Evidence Database (PEDro). We applied no language restrictions; however, studies not reported in English, Dutch, Danish, Swedish, Norwegian, German or French are awaiting assessment. We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing and recently completed trials. SELECTION CRITERIA: Studies were eligible if they were randomised controlled trials (RCTs) consisting of participants with definitive or classical RA as defined by the American Rheumatism Association (ARA) criteria of 1958, the ARA/American College of Rheumatology (ACR) criteria of 1988 or the ACR/European League Against Rheumatism (EULAR) criteria of 2010, or by studies using the criteria of Steinbrocker.Balneotherapy had to be the intervention under study, and had to be compared with another intervention or with no intervention.The World Health Organization (WHO) and the International League Against Rheumatism (ILAR) determined in 1992 a core set of eight endpoints in clinical trials concerning patients with RA. We considered pain, improvement, disability, tender joints, swollen joints and adverse events among the main outcome measures. We excluded studies when only laboratory variables were reported as outcome measures. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, performed data extraction and assessed risk of bias. We resolved disagreements by consensus and, if necessary, by third party adjudication. MAIN RESULTS: This review includes two new studies and a total of nine studies involving 579 participants. Unfortunately, most studies showed an unclear risk of bias in most domains. Four out of nine studies did not contribute to the analysis, as they presented no data.One study involving 45 participants with hand RA compared mudpacks versus placebo. We found no statistically significant differences in terms of pain on a 0 to 100-mm visual analogue scale (VAS) (mean difference (MD) 0.50, 95% confidence interval (CI) -0.84 to 1.84), improvement (risk ratio (RR) 0.96, 95% CI 0.54 to 1.70) or number of swollen joints on a scale from 0 to 28 (MD 0.60, 95% CI -0.90 to 2.10) (very low level of evidence). We found a very low level of evidence of reduction in the number of tender joints on a scale from 0 to 28 (MD -4.60, 95% CI -8.72 to -0.48; 16% absolute difference). We reported no physical disability and presented no data on withdrawals due to adverse events or on serious adverse events.Two studies involving 194 participants with RA evaluated the effectiveness of additional radon in carbon dioxide baths. We found no statistically significant differences between groups for all outcomes at three-month follow-up (low to moderate level of evidence). We noted some benefit of additional radon at six months in terms of pain frequency (RR 0.6, 95% CI 0.4 to 0.9; 31% reduction; improvement in one or more points (categories) on a 4-point scale; moderate level of evidence) and 9.6% reduction in pain intensity on a 0 to 100-mm VAS (MD 9.6 mm, 95% CI 1.6 to 17.6; moderate level of evidence). We also observed some benefit in one study including 60 participants in terms of improvement in one or more categories based on a 4-point scale (RR 2.3, 95% CI 1.1 to 4.7; 30% absolute difference; low level of evidence). Study authors did not report physical disability, tender joints, swollen joints, withdrawals due to adverse events or serious adverse events.One study involving 148 participants with RA compared balneotherapy (seated immersion) versus hydrotherapy (exercises in water), land exercises or relaxation therapy. We found no statistically significant differences in pain on the McGill Questionnaire or in physical disability (very low level of evidence) between balneotherapy and the other interventions. No data on improvement, tender joints, swollen joints, withdrawals due to adverse events or serious adverse events were presented.One study involving 57 participants with RA evaluated the effectiveness of mineral baths (balneotherapy) versus Cyclosporin A. We found no statistically significant differences in pain intensity on a 0 to 100-mm VAS (MD 9.64, 95% CI -1.66 to 20.94; low level of evidence) at 8 weeks (absolute difference 10%). We found some benefit of balneotherapy in overall improvement on a 5-point scale at eight weeks of 54% (RR 2.35, 95% CI 1.44 to 3.83). We found no statistically significant differences (low level of evidence) in the number of swollen joints, but some benefit of Cyclosporin A in the number of tender joints (MD 8.9, 95% CI 3.8 to 14; very low level of evidence). Physical disability, withdrawals due to adverse events and serious adverse events were not reported. AUTHORS' CONCLUSIONS: Overall evidence is insufficient to show that balneotherapy is more effective than no treatment, that one type of bath is more effective than another or that one type of bath is more effective than mudpacks, exercise or relaxation therapy.

Effects of aquatic exercises in patients after total hip arthroplasty: A systematic review.

BACKGROUND: Total hip arthroplasty (THA) is a surgical procedure that can alter physical function and quality of life. OBJECTIVES: The aim was to verify the effects of aquatic exercises compared with exercises on land, control or other modalities, in patients undergoing THA on the primary outcomes: self-reported physical function, quality of life and pain; and secondary outcomes: muscle strength, functional capacity and gait. DESIGN: Systematic review that followed the PRISMA Statement and PROSPERO registered. The search was performed in the following databases: Web of Science, Embase, Medline, Cinahl, Lilacs, SPORTDiscus, Cochrane Library, Scopus, SciELO, and PEDro, from 1945 to 2022. The risk of bias assessment was performed using the Risk of Bias 2 (RoB2) from the Cochrane Collaboration. RESULTS: Three randomized controlled trials (RCTs) were included, with a total of 364 participants. In the selection process, two publications from the same study were found. The RoB2 assessment classified one RCT as "high risk of bias" and the others as "low risk of bias". Therefore, the analysis of the results considered only studies with a low risk of bias. For the self-reported physical function outcome, evaluated by WOMAC, improvement was observed in favor of aquatic exercises, when started on the 14th postoperative day. Pain improved after 24th week postoperative, in favor of exercise (effect size between 0.2 and 0.4). Quality of life, verified only by one RCT, improved at each time point evaluated (effect size between 0.01 and 0.10). The functional capacity showed no difference between the groups. This was the first systematic review to assess the benefits of aquatic exercises specifically in THA and it was possible to infer that the exercises initiated after 14 days of postoperative are safer. The protocol should include proprioceptive, coordination, and resistance exercises. The session can last around 30 min and is held three times a week. CONCLUSION: Decision making for treatment in the postoperative of THA may include aquatic exercises as a safe and efficacious alternative to improve self-reported physical function, pain, quality of life, and muscle resistance.

Use of posturography in patients with ankylosing spondylitis: A systematic review.

Background: Ankylosing spondylitis (AS) is characterised as a chronic inflammatory disease of the axial skeleton. The force platform is an option for performing the postural assessment of these individuals. Objectives: To review and evaluate the behaviour of the centre of pressure (CoP) variables during the postural control examination in patients with AS compared to a control group. Method: A systematic review, registered in PROSPERO, that followed the PRISMA Statement. A search was carried out in the following databases: Medline, Web of Science, Embase, Scopus, and Scielo, from 1945 to 2023. Studies were selected that aimed to understand the use of the force platform for the assessment of postural control. The risk of bias assessment was performed using the AXIS tool. Results: Five studies were included, with a total of 247 participants. The assessment of risk of bias presented high scores in the AXIS tool. Patients with a diagnosis of AS presented increased thoracic kyphosis in most of the studies, as well as large displacements in the anteroposterior (AP) and mediolateral (ML) directions, and altered total mean velocity (TMV) and frequency, indicating worse postural stability. Regarding the functional status, the most used questionnaires were the Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI) and Bath Ankylosing Disease Activity Index (BASDAI). Conclusion: Patients with ankylosing spondylitis present postural instability, verified by means of higher values of centre of posture variables. Clinical implications: Individuals with ankylosing spondylitis presented postural instability and balance deficit. Therefore, exercises for balance training and postural control are essential in the clinical management of these patients.

Effectiveness of aerobic physical training for treatment of chronic asymptomatic bacteriuria in subjects with spinal cord injury: a randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness and safety of aerobic physical training for treatment of chronic asymptomatic bacteriuria in subjects with spinal cord injury. DESIGN: Randomized controlled trial. SETTING: University hospital. SUBJECTS: Forty-two participants with spinal cord injury between C8 and T12 segments were randomly assigned to intervention or control groups. INTERVENTION: In the intervention group, subjects received a risk evaluation, stress test and urinary culture before the start of the study and after 16 weeks. The study consisted of aerobic physical conditioning with moderate intensity for the intervention group while the control group was asked to maintain their daily life activities. MAIN MEASURES: Increase of estimated peak oxygen consumption and also if there was a decrease in the proportions of positive urinary culture. RESULTS: The intervention group showed an increase of estimated peak oxygen consumption of between 939 (714-1215) and 1154 (1005-1351) mL/min (P = 0.009) and a reduction of chronic asymptomatic bacteria of between 52.3% (29.8-74.3%) and 14.2% (3-36.3%) (P < 0.001). No adverse effects related to physical activity were recorded during the period of training. CONCLUSION: The regular practice of physical activity of moderate intensity applied to patients with spinal cord injury may be an effective and safe method for the treatment of chronic asymptomatic bacteriuria.

Quality of life in individuals with knee osteoarthritis versus asymptomatic individuals.

BACKGROUND: Osteoarthritis (OA) is characterised by joint degeneration and represents the leading cause of disability in old age. OA entails a personal burden, with suffering and reduced quality of life (QoL). OBJECTIVE: To compare the QoL of individuals with OA to that of asymptomatic individuals in order to determine the actual impact of OA on the affected population. METHOD: Cross-sectional study with a sample of 140 patients diagnosed with OA. Another 51 sex- and age-matched asymptomatic individuals with no clinical signs of knee OA or lower limb osteoarticular symptoms for at least the preceding six months were recruited. Knee OA was stratified radiologically according to the Ahlbäck classification (1968). QoL was measured using the SF-36 questionnaire (Medical Outcomes Study 36-Item Short-Form Health Survey). The participants were assigned to "osteoarthritis" (OG) or "asymptomatic" (AG) groups. RESULTS: The OG presented greater body mass and BMI than the AG. Perceived QoL was worse for the OG than the AG across SF-36 domains. In the comparison of the grades of OA degeneration, the group with Ahlbäck grades 4 and 5 (severe) perceived their QoL as poorer than those with grades 1, 2, and 3 (moderate). The grade of OA, older age, and BMI were shown to be strong independent predictors of poor perceived quality of life. CONCLUSION: Individuals with knee OA showed worse perceived QoL compared with asymptomatic individuals. The domains with the lowest scores were physical functioning and functional limitation. Quality of life was influenced by BMI, age, sex, and grade of osteoarthritis.

Incentive spirometry for preventing pulmonary complications after coronary artery bypass graft.

BACKGROUND: Incentive spirometry (IS) is a treatment technique that uses a mechanical device to reduce pulmonary complications during postoperative care. This is an update of a Cochrane review first published in 2007. OBJECTIVES: Update the previously published systematic review to compare the effects of IS for preventing postoperative pulmonary complications in adults undergoing coronary artery bypass graft (CABG). SEARCH METHODS: We searched CENTRAL and DARE on The Cochrane Library (Issue 2 of 4 2011), MEDLINE OVID (1948 to May 2011), EMBASE (1980 to Week 20 2011), LILACS (1982 to July 2011) , the Physiotherapy Evidence Database (PEDro) (1980 to July 2011), Allied & Complementary Medicine (AMED) (1985 to May 2011), CINAHL (1982 to May 2011). SELECTION CRITERIA: Randomised controlled trials comparing IS with any type of prophylactic physiotherapy for prevention of postoperative pulmonary complications in adults undergoing CABG. DATA COLLECTION AND ANALYSIS: Two reviewers independently evaluated trial quality using the guidelines of the Cochrane Handbook for Systematic Reviews and extracted data from included trials. For continuous outcomes, we used the generic inverse variance method for meta-analysis and for dichotomous data we used the Peto Odds Ratio. MAIN RESULTS: This update included 592 participants from seven studies (two new and one that had been excluded in the previous review in 2007. There was no evidence of a difference between groups in the incidence of any pulmonary complications and functional capacity between treatment with IS and treatment with physical therapy, positive pressure breathing techniques (including continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP) and intermittent positive pressure breathing (IPPB), active cycle of breathing techniques (ACBT) or preoperative patient education. Patients treated with IS had worse pulmonary function and arterial oxygenation compared with positive pressure breathing. Based on these studies there was no improvement in the muscle strength between groups who received IS demonstrated by maximal inspiratory pressure and maximal expiratory pressure . AUTHORS' CONCLUSIONS: Our update review suggests there is no evidence of benefit from IS in reducing pulmonary complications and in decreasing the negative effects on pulmonary function in patients undergoing CABG. In view of the modest number of patients studied, methodological shortcomings and poor reporting of the included trials, these results should still be interpreted cautiously. An appropriately powered trial of high methodological rigour is needed to determine if there are patients who may derive benefit from IS following CABG.

The effectiveness of group and home-based exercise on psychological status in people with ankylosing spondylitis: A systematic review and meta-analysis.

INTRODUCTION: Ankylosing spondylitis (AS) is an inflammatory rheumatic disease in which the physical impact has been evaluated; however, the psychological consequences are less well explored. The primary aim of this review was to determine the effectiveness of group versus home-based exercises on psychological status of patients with AS. METHODS: Six databases were searched until January 2020. Eligible studies were randomised controlled trials including group or home-based exercise interventions. Risk of bias (RoB) was evaluated using the Cochrane RoB 2.0 tool. Relative percentage difference (RPD) between groups and effect sizes were presented as standardised mean differences (SMDs) with 95% confidence intervals (CI). RESULTS: Five studies met the inclusion criteria (n = 240), outcomes of interest were depression, anxiety and mental health. Three studies were low-risk RoB, one study was high-risk RoB and one study there was 'some concerns' of bias. Group-based exercise was more effective than home-based exercise for improving depression at 6-week (RPD 18%) and 3-month (RPD 42%), anxiety (RPD 17%) and mental health (RPD 20%). Home-based exercise was more effective than control interventions for improving depression (RPD 33%). A meta-analysis demonstrated group-based exercises compared to home exercises, improved depression (SMD: -0.54; 95% CI: [-0.89; -0.18]; p = 0.003) and physical function (SMD: -0.49; 95% CI: [-0.84; -0.14]; p = 0.006). CONCLUSION: Supervised group-based demonstrated improvements in depression, anxiety and mental health compared to home-based exercise. Individualised home-based exercise is more effective than no intervention for improving depression in people with AS.

The help-seeking by women with urinary incontinence in Brazil.

INTRODUCTION AND HYPOTHESIS: Lower tract urinary symptoms are underestimated by women as well as health professionals. The objective of this study was to evaluate the behavior of adult women with urinary incontinence and overactive bladder symptoms in seeking medical treatment. METHODS: Two hundred ninety-two women between 20 and 82 years old were interviewed. Urinary symptoms, epidemiologic, and quality of life (ICQ-SF) were related to the procurement of medical assistance. The Shapiro-Wilk, Mann-Whitney, and chi-square tests were used. RESULTS: The impact of the symptoms on quality of life was greater in younger women. Twenty-two percent of the participants, mainly the younger ones, reported seeking medical services due to several associated symptoms and quality of life impact. CONCLUSION: Younger women, association of several urinary symptoms, symptoms of urinary loss, and longer time since symptom onset were determining factors for seeking medical treatment.

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.

Comparing the effects of aquatic exercises with or without high intensity on the functional status, muscular endurance, and performance of patients with chronic low back pain.

BACKGROUND: The prevalence of low back pain is lower when physical fitness (aerobic and muscular) is higher. Strength exercises are important for subjects with low back pain, but there are few studies on the inclusion of aerobic exercise in low back pain programs. The aim of this study was to compare the effects of aquatic exercises with or without high-intensity component on the functional status, lumbar and abdominal muscle endurance, and performance of subjects with chronic low back pain. METHODS: Forty-eight volunteers between 20 and 60 years old were randomly allocated to an experimental group AEDWR (aquatic exercises plus deep-water running group, N.=25) or to a control group AE (aquatic exercises only group, N.=23). The dependent variables included functional status (Repeated Sit-to-Stand test), lumbar (Sorensen test) and abdominal (One Minute Abdominal test) muscle endurance, and physical performance (Maximum Physical Fitness test), which were measured before and after the 9-week intervention and at 21 weeks of follow-up. RESULTS: Lumbar endurance was higher in the AEDWR group at the end of the treatment, with a mean difference (MD) of 43.2 seconds, 95% confidence intervals (CI) (9.6; 76.7), P=0.01, d̅=0.74, and better in the follow-up with MD=40.2 seconds, 95% CI (7.1; 73.3), P=0.02, d̅=0.71, than in the AE group. Participant performance also improved on the 9th week in the AEDWR group, with an MD=0.53 kgf, 95% CI (0.008; 0.98), P=0.02, d̅=0.60. CONCLUSIONS: The addition of deep-water running exercise to aquatic exercises improved lumbar muscle endurance and performance when compared with aquatic exercises only, and this effect was maintained during the follow-up to lumbar muscle endurance.

The accuracy of national body fat cutoff levels in the prediction of elevated blood pressure among Brazilian male adolescents.

OBJECTIVE: To assess viability of the development of percentage body fat cutoffs based on blood pressure values in Brazilian adolescents. METHODS: A cross-sectional study was conducted with a sample of 358 male subjects from 8 to 18 years old. Blood pressure was measured by the oscilometric method, and body composition was measured by dual-energy X-ray absorptiometry (DXA). RESULTS: For the identification of elevated blood pressure, these nationally developed body fat cutoffs presented relative accuracy. The cutoffs were significantly associated with elevated blood pressure [odds ratio = 5.91 (95% confidence interval: 3.54-9.86)]. CONCLUSIONS: Development of national body fat cutoffs is viable, because presence of high accuracy is an indication of elevated blood pressure.

Electromyographic effect of mat Pilates exercise on the back muscle activity of healthy adult females.

OBJECTIVE: The purpose of this study was to examine back muscle activity during 3 traditional mat Pilates exercises. METHODS: Eleven healthy female volunteers, aged between 18 and 30 years, participated in this cross-sectional study. Surface electromyography (sEMG) of lumbar extensor muscles was recorded simultaneously with kinematics data to identify the phases of movement. Three mat Pilates back exercises were compared: (1) swimming, (2) single leg kick with static prone back extension, and (3) double leg kick. Root mean square values of each muscle were recorded with 2 pairs of surface electrodes placed bilaterally on one lumbar extensor muscle (at L5). During phases of each exercise, sEMG signals were identified by video analysis. Electrical muscle activation was normalized by the maximal voluntary isometric contraction and used to compare back muscle activity among exercises. A 2-way repeated measures analysis of variance was performed to assess the differences in activation level during the exercises. RESULTS: The value of electrical muscle activity in the lumbar extensors ranged between 15% and 61% of MIVC for the 3 types of Pilates mat work exercise. The swimming exercise increased lumbar extensor activity (29% on average) in comparison to the other 2 Pilates conditions. Interestingly, the double leg kick exercise generated significantly more lumbar extensor activity (26% on average) than the single leg kick. CONCLUSIONS: For this group of participants, the swimming exercise increased muscle activation relative to the other 2 exercise modes.

Low back pain affects coordination between the trunk segments but not variability during running.

This study aimed to analyze the coordination and variability between the thorax, lumbar, and pelvis segments in runners with chronic low back pain group (LBPG) and matched control group (CG). Twenty-six recreational runners were evaluated on a treadmill at 3.3 m/s. The coordination of the pelvis-lumbar and lumbar-thorax in all three planes and between the transverse and frontal plane of the lumbar segment were evaluated using the vector coding technique. Coordination was analyzed via histograms with the percentage of each pattern and the coupling angle during the cycle. The variability coordination was calculated from the angular deviation between the cycles. Differences were observed in the coordination patterns and in the coupling angle during the cycle. Between the pelvis-lumbar in the frontal plane, the LBPG (x¯ = 50.6% (SD = 10.7)) presented more in-phase pattern than the CG (38.6% (8.7; P = 0.05). For the lumbar-thorax, differences occurred in all planes. Between the frontal-transverse plane of the lumbar segment, the LBPG (27.6% (7.9)) presented more in-phase pattern than the CG (38.6% (8.7); P = 0.02). The variability did not demonstrate the differences between the groups; these differences were observed in coordination between the lumbar and adjacent segments in all planes. The model of rigid segments and the coordination analyses were sensitive to detect these differences, and the presence of more in-phase patterns could be related to the protection mechanism in order to avoid painful movements.

Test-retest reliability of multiscale fractal dimension measurements of plantar pressure maps during dynamic tasks.

The tools used to evaluate foot types are divergent since they adopt classic linear analyzes, based on anthropometric or image measurements, which do not dynamically contemplate the variability of foot shape. The use of newer techniques such as multiscale fractal dimension (MFD) may be a key to this type of problem. However, for these measures to be used safely and consistently, it is essential to evaluate their reliability. The aim of this study was to evaluate the test-retest reliability of MFD measurements of adult plantar pressure maps during gait, as well as the standard error of measurement (SEM), and minimal detectable change (MDC90). Seventy-two subjects were included in the test-retest, with a one week interval. The plantar pressure maps were constructed using a pressure platform. The data were processed in a routine for extracting the MFD curve measurements (maximum and integral values). The Intraclass Correlation Coefficient results (ICC3,k) were excellent for both measurements (maximum value 0.96, 95% confidence interval [0.93-0.97], and integral 0.95 [0.92-0.97]) with low SEM and MDC90 values below 10% of the mean. The application of MFD to the plantar pressure data generated by the pressure platform is reliable and could allow exploration of the complexity of foot shapes, enabling their classification.

Effectiveness of additional deep-water running for disability, lumbar pain intensity, and functional capacity in patients with chronic low back pain: A randomised controlled trial with 3-month follow-up.

BACKGROUND: Aquatic exercise (AQE) programme is commonly used as an alternative to the chronic low back pain (CLBP) treatment. The addition of aquatic aerobic exercises to AQE may be beneficial to patients with CLBP. DESIGN: Randomised controlled trial. OBJECTIVES: To assess the effectiveness of AQE with the addition of aerobic exercise - deep-water running (DWR) - compared to exclusive AQE in improving disability, lumbar pain intensity, and functional capacity in patients with CLBP. METHODS: Fifty-four adult patients with CLBP were randomised either to the experimental group (AQE + DWR) or the control group (AQE). An assessor who was blinded to the group allocation performed both pre- and post-interventions assessments. Both treatments lasted 9 weeks, with a 3-month follow-up. The primary outcome was disability, as evaluated using the Roland Morris Disability Questionnaire. The secondary outcomes were pain and functional capacity; pain was assessed using a visual analogue scale (VAS), and functional capacity (travelled distance) was measured using the 6-min walk test (6WT). RESULTS: A significant difference in pain was observed between groups after intervention in favour of DWR (mean difference -1.3 cm [95% confidence interval (CI) -2.17 to -0.45], d‾ = 0.80 [95% CI 0.22 to 1.33]). CONCLUSION: Treatment with DWR was effective in the short term for achieving the desired outcome of pain reduction when compared with AQE only but not for disability and functional capacity.