Effects of Complex Physical Therapy and Multimodal Approaches on Lymphedema Secondary to Breast Cancer: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

OBJECTIVE: What are the immediate, short-term, and long-term effects of complex physical therapy and multimodal approaches on lymphedema secondary to breast cancer? DATA SOURCES: Four electronic databases (MEDLINE, Embase, Cochrane Library, Physiotherapy Evidence Database) were searched from inception up to August 2020. STUDY SELECTION: Randomized controlled trials comparing complex physical therapy and multimodal approaches to the conservative treatment of lymphedema secondary to breast cancer. DATA EXTRACTION: Two independent researchers performed data extraction and assessed the risk of bias, respectively, using the predefined form and Cochrane Collaboration of Risk of Bias. The determination of evidence quality was carried out using the Grading of Recommendations Assessment, Development, and Evaluation tools. DATA SYNTHESIS: Fourteen studies were identified for the systematic review and 11 studies for the meta-analysis with standardized mean difference (SMD), 95% CI, and random-effect model. The common outcomes involved total volume, pain, and physical function of the upper limb. Complex physical therapy has shown a favorable tendency to control outcomes in the short- and long-term. The meta-analysis indicated a small effect for volume reduction (SMD, -0.18; 95% confidence interval [CI], -0.35 to 0.00) and a moderate effect for short-term pain reduction (SMD, -0.61; 95% CI, -1.19 to -0.02). CONCLUSIONS: High-quality evidence suggests a more significant effect of complex physical therapy on multimodal approaches to the control of the upper limb total volume, substantiating the absence of changes in the current clinical practice in the management of lymphedema secondary to breast cancer. Future research should aim to identify concrete effect of therapeutic modalities in the immediate-, short-, and long-term.

Psychometric properties of the Brazilian short-version of the Northwick Park Neck Pain Questionnaire.

OBJECTIVE: To translate, cross-culturally adapt and assess measurement properties of the translated version of the Northwick Park Neck Pain Questionnaire into Brazilian Portuguese. DESIGN: Cross-sectional study. SETTINGS: University healthcare facility and online. PARTICIPANTS: People with chronic neck pain (n = 178). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants answered the translated version of Northwick Park Neck Pain Questionnaire, the Neck Disability Index, the Numerical Rating Scale for pain, the Tampa Scale for Kinesiophobia and the Pain Catastrophizing Scale. Seven to ten days after that, a subset of 84 participants answered the Northwick Park Neck Pain Questionnaire again. The structural (exploratory and confirmatory factor analyses) and construct validities, internal consistency, reliability and concordance were assessed. Level of significance was set at 5%. RESULTS: Participants' (35.6 ± 13.5 years old) with symptoms duration of 54.4 ± 60.4 months scored 25.5 ± 14.0 on the Brazilian Northwick Park Neck Pain Questionnaire and 11.9 ± 5.8 on the Neck Disability Index. The structural analysis showed that the short version of the Northwick Park Neck Pain Questionnaire has an adequate structure to measure disability due to neck pain. Correlations with other questionnaires were between 0.268 and 0.678, Cronbach's alfa was 0.76, intraclass correlation coefficient was 0.96, standard error of measurement was 2.74 and minimal detectable change was 7.60. CONCLUSION: The short version of the Northwick Park Neck Pain Questionnaire is valid and reliable to be used in patients with chronic neck pain, as it presented adequate measurement properties of structural and construct validity, reliability and concordance.

The effect of proprioceptive training on postural control in people with diabetes: A randomized clinical trial comparing delivery at home, under supervision, or no training.

OBJECTIVE: Analyze postural control in the bipedal position as well as during gait and functional tests in patients with type 2 diabetes mellitus after supervised and unsupervised proprioceptive training. DESIGN: A three-group randomized controlled trial. SETTING: Physiotherapeutic Resources Lab, Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo. SUBJECTS: Eighty patients with type 2 diabetes allocated to three groups: control, home training, and supervised training. INTERVENTIONS: The supervised and home training groups performed two weekly sessions of proprioceptive exercises for 12 weeks. The control group was not submitted to any of treatment. MAIN MEASURES: Bipedal balance, gait, and performance on functional tests were evaluated before and after 12 weeks using the Balance Evaluation Systems Test (BESTest) and the force plate. RESULTS: No significant improvements were found regarding postural control, gait, or performance on the functional tests, as evidenced by the inter-group comparisons of the total BESTest score [control: 90.7 (81.5-92.6); home training: 85.2 (77.8-90.3); supervised training: 88.4 (82.6-91.4), P > 0.05] as well as the tests performed on the force plate (P > 0.05). The clinical effect size of the proposed intervention was less than 0.2, demonstrating no effect for the main outcome variable evaluated by the "Sensory Orientation" item of the BESTest and by the mCTSIB (pressure plate). CONCLUSIONS: The proposed proprioceptive training did not lead to improvements in postural control in patients with type 2 diabetes with no clinical signs of diabetic distal polyneuropathy when analyzed using the BESTest clinical evaluation and a force plate. TRIAL REGISTRATION: NCT01861392 (clinicaltrials.gov).

Photobiomodulation laser and pulsed electrical field increase the viability of the musculocutaneous flap in diabetic rats.

The purpose of this study is to investigate the effect of pulsed electrical field (PEF) and photobiomodulation laser (PBM) on the viability of the TRAM flap in diabetic rats. Fifty Wistar rats were divided into five homogeneous groups: Group 1-control; Group 2-diabetics; Group 3-diabetics + PEF; Group 4-diabetic + laser 660 nm, 10 J/cm2, 0.27 J; Group 5-diabetic + laser 660 nm, 140 J/cm2, 3.9 J. The percentage of necrotic area was evaluated using software Image J®. The peripheral circulation of the flap was evaluated by infrared thermography FLIR T450sc (FLIR® Systems-Oregon USA). The thickness of the epidermis (haematoxylin-eosin), mast cell (toluidine blue), leukocytes, vascular endothelial growth factor, fibroblast and newly formed blood vessels were evaluated. For the statistical analysis, the Kruskal-Wallis test was applied followed by Dunn and ANOVA test followed by Tukey with critical level of 5% (p < 0.05). The PEF reduced the area of necrosis, decreased the leukocytes, increased the mast cells, increased the thickness of epidermis and increased newly formed blood vessels when it was compared to the untreated diabetic group of animals. Laser 660 nm, fluence 140 J/cm2 (3.9 J) showed better results than the 10 J/cm2 (0.27 J) related to reduction of the area of necrosis and the number of leukocytes, increased mast cells, increased thickness of the epidermis, increased vascular endothelial growth factor, increased fibroblast growth factor and increase of newly formed blood vessels in diabetic animals. The laser and pulsed electrical field increase the viability of the musculocutaneous flap in diabetic rats.

Manual Lymphatic Drainage in Blood Circulation of Upper Limb With Lymphedema After Breast Cancer Surgery.

OBJECTIVE: The purpose of this study was to assess blood flow after manual lymphatic drainage (MLD) in women who had received surgery for breast cancer and had post-axillary lymphadenectomy lymphedema. METHODS: Sixteen volunteers (mean age 64 ± 11.44 years) were divided into 2 groups. Those in group 1 received MLD without upper limb elevation, and those in group 2 received MLD with elevation of 30° of the upper limb. Blood flow velocity of the brachial vein and artery were measured using Doppler ultrasound before, immediately after, and 30 minutes after MLD, with and without 30° of upper limb elevation as defined by a random crossover design and an interval (washout) of 7 days. Comparison of data before and after MLD was evaluated by the Friedman test. RESULTS: There was a significant increase of blood flow velocity in the brachial vein after the therapeutic procedure with upper limb elevation. However, after 30 minutes the data returned to the pretreatment value. CONCLUSION: This preliminary study indicated that MLD promoted increased brachial vein velocity flow in the short term.

Intra- and Inter-rater Reliability of Peripheral Arterial Blood Flow Velocity by Means of Doppler Ultrasound.

OBJECTIVE: Although it is possible to find studies that analyze the velocity of blood flow in different arteries, the reliability of Doppler ultrasound on peripheral arteries has not yet been completely established. Our objective was to evaluate intra- and inter-rater reliability of the measurement of blood flow velocity by Doppler ultrasound of brachial, radial, popliteal, and posterior tibial arteries. METHODS: Fifty healthy individuals of both genders, aged between 18 and 45 years, were included in the study. For the evaluation of arterial blood flow velocity, a portable Doppler ultrasound device was used to measure the mean and maximum blood flow velocity of posterior tibial, popliteal, brachial, and radial arteries. Two examiners performed assessments of the same volunteers independently and twice, with an interval of 1 week between them. RESULTS: We found good to very good reliability for measuring the mean and maximum blood flow velocity of the arteries evaluated. The intraclass correlation coefficients ranged between 0.501 and 0.866, standard error of measurement ranged between 0.81 and 9.45 cm/s, and minimum detectable change ranged between 2.25 and 26.13 cm/s. CONCLUSION: The assessment of mean and maximum blood flow velocity of the brachial, radial, popliteal, and posterior tibial arteries by means of Doppler ultrasound presents acceptable reliability values, which supports the use of this evaluation method in research and clinical practice.

Cold-water immersion alters muscle recruitment and balance of basketball players during vertical jump landing.

The purpose of this study was to evaluate the effects of cold-water immersion on the electromyographic (EMG) response of the lower limb and balance during unipodal jump landing. The evaluation comprised 40 individuals (20 basketball players and 20 non-athletes). The EMG response in the lateral gastrocnemius, tibialis anterior, fibular longus, rectus femoris, hamstring and gluteus medius; amplitude and mean speed of the centre of pressure, flight time and ground reaction force (GRF) were analysed. All volunteers remained for 20 min with their ankle immersed in cold-water, and were re-evaluated immediately post and after 10, 20 and 30 min of reheating. The Shapiro-Wilk test, Friedman test and Dunn's post test (P < 0.05) were used. The EMG response values decreased for the lateral gastrocnemius, tibialis anterior, fibular longus and rectus femoris of both athletes and non-athletes (P < 0.05). The comparison between the groups showed that the EMG response was lower for the athletes. Lower jump flight time and GRF, greater amplitude and mean speed of centre of pressure were predominant in the athletes. Cold-water immersion decreased the EMG activity of the lower limb, flight time and GRF and increased the amplitude and mean speed of centre of pressure.

Polarized currents inhibit in vitro growth of bacteria colonizing cutaneous ulcers.

Infections caused by Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli are among the microorganisms that often lead to infection in pressure ulcers. Polarized current has emerged as a possible intervention to limit bacterial proliferation. We analyzed the effect of fixed diphasic - Bernard (FD-B) and high voltage monophasic pulsed (HVMP) currents on bacteria S. aureus ATCC 25923 (Gram +), P. aeruginosa ATCC 27853 (Gram -), and E. coli ATCC 25922 (Gram -). After the bacterial strains were activated the bacteria were suspended in physiological solution (0.9%) and the concentration adjusted to 1.5 × 10(3) CFU/mL. The cultures were stimulated with FD-B current at (3, 6, and 9 mA, 100 Hz, 15 and 30 minutes) and HVMP (32, 64, and 95 V, 100 Hz, 30 and 60 min) while monitoring the pH and temperature. After the stimulation, the suspensions were plated and incubated for 24 hours at 37°C. Then the counts were made of colony forming units (CFU). Data were submitted to normality Shapiro-Wilk test followed by nonparametric ANOVA test and post hoc Tukey test with p < 0.05. There was a decrease in the CFU for the two currents, but the most effective reduction was in FD-B. The temperature remained constant and the pH measured alkaline at the negative pole and acid at the positive pole during stimulation. The application of FD-B and HVMP currents promoted inhibition of bacterial proliferation when stimulated in vitro, acting as an adjuvant resource in the healing process.

Evaluation of myofascial trigger points using infrared thermography: a critical review of the literature.

OBJECTIVE: The aim of this study was to review recent studies published on the use of infrared thermography for the assessment of myofascial trigger points (MTrPs). METHODS: A search of the MEDLINE, CINAHL, PEDro, and SciELO databases was carried out between November 2012 and January 2013 for articles published in English, Portuguese, or Spanish from the year 2000 to 2012. Because of the nature of the included studies and the purpose of this review, the analysis of methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. RESULTS: The search retrieved 11 articles, 2 of which were excluded based on language (German and Chinese). Three were duplicated in different databases, 1 did not use infrared thermography for diagnostic purposes, and the other did not use infrared thermography to measure the skin temperature. Thus, the final sample was made up of 4 observational investigations: 3 comparative studies and 1 accuracy study. CONCLUSION: At present, there are few studies evaluating the accuracy and reliability of infrared thermography for the diagnosis and assessment of MTrPs. Of the few studies present, there is no agreement on skin temperature patterns in the presence of MTrPs.

Immediate effects of electrical stimulation, diathermy, and physical exercise on lower limb arterial blood flow in diabetic women with peripheral arterial disease: a randomized crossover trial.

OBJECTIVE: The purpose of this study was to assess the effects of high-voltage electrical stimulation (HVES), continuous short wave diathermy, and physical exercise on arterial blood flow in the lower limbs of diabetic women with peripheral arterial disease. METHODS: A crossover study was carried out involving 15 diabetic women (mean age of 77.87 ± 6.20 years) with a diagnosis of peripheral arterial disease. One session of each therapeutic resource was held, with a 7-day washout period between protocols. Blood flow velocity was evaluated before each session and 0, 20, 40 and 60 minutes after the administration of each protocol. Two-way repeated-measures analysis of variance with Bonferroni post hoc test was used for the intragroup and intergroup comparisons. RESULTS: In the intragroup analysis, a significant reduction (P < .05) was found in blood flow velocity in the femoral and popliteal arteries over time with HVES and physical exercise and in the posterior tibial artery with the physical exercise protocol. However, no significant differences were found in the intergroup analysis (P > .05). CONCLUSION: Proximal blood circulation in the lower limb of diabetic women with peripheral arterial disease was increased by a single session of HVES and physical exercise, whereas distal circulation was only increased with physical exercise.

Lack of maintenance of shortwave diathermy equipment has a negative impact on power output.

Although shortwave diathermy has been widely used by physiotherapists, there are a few studies assessing the performance of the equipment in use. The aim of the present study was to evaluate the procedures adopted by physiotherapists as users of shortwave diathermy continuous (CSWD), as well as to measure the power output and frequency of CSWD equipment. [Subjects and Methods] Twenty-three physical therapists were interviewed and 23 CSWD equipment were evaluated. Admeasurement was carried out by using a standard phantom to simulate the electrode-skin distance, which ranged from 0.5 to 3.0 cm. Data analysis was performed by using descriptive statistics, ANOVA, and a post-hoc Tukey's test or Pearson's correlation coefficient. [Results] The questionnaires showed that 48% of the interviewees use the correct electrode-skin distance, 70% use a single electrical outlet, and 35% use a grounded electrical outlet, and that 48% of the physiotherapy tables and 61% of the plinths were made of wood. However, only 13% of the interviewees perform yearly preventive maintenance. The highest power (95.56 W) was achieved at electrode-skin distances ranging from 1.0 to 1.5 cm, with distances of 2.5 cm and 3.0 cm being null in four and eight equipment, respectively. There was a negative correlation between power output and electrode-skin distance as well as between power output and purchase date. [Conclusion] The physiotherapists involved in this study had inadequate knowledge about the correct use of CSWD equipment, which may adversely affect its performance and patient safety.

Decrease in Talocrural Joint Mobility is Related to Alteration of the Arterial Blood Flow Velocity in the Lower Limb in Diabetic Women.

[Purpose] The purpose of this study was to correlate the talocrural range of motion (ROM) and blood flow velocity in the lower limb arteries of diabetic women. [Subjects and Methods] Thirty women were divided into a control group (G1), consisting of 15 sedentary right-handed subjects (41.27 ± 7.24 years old) who had no history of blood system disorder, and a diabetes group (G2), consisting of 15 sedentary right-handed subjects (57.87 ± 6.20 years old) who had type 2 diabetes mellitus. Talocrural ROM was measured by using goniometry for dorsiflexion and plantar flexion movements. In addition, blood flow velocity of the dorsalis pedis, posterior tibial, and popliteal arteries was also assessed. [Results] No significant differences were found between the groups by comparing talocrural ROM and arterial blood velocity. However, a significant association was found in G2 only between the following variables: plantar flexion and blood flow velocity of the dorsalis pedis artery (rs = 0.57), plantar flexion and blood flow velocity of the popliteal artery (rs = 0.50), and dorsiflexion and blood flow velocity of the posterior tibial artery (rs = 0.57). [Conclusion] The decrease in talocrural ROM is related to a decrease in the arterial blood flow velocity in diabetic women.

Laser light sources for photobiomodulation: The role of power and beam characterization in treatment accuracy and reliability.

PURPOSE: Daily clinical use of therapeutic light sources can lead to changes in light emission stability with potentially significant consequences for usage in photomedicine treatment. The aim of this study was to evaluate the average and maximum power and to describe the beam diameter of different low-power laser photobiomodulation devices in clinical use in Brazil. METHODS: The power and light-emitting beam diameter of twenty-four therapeutic devices with an average age of 11±5 years, with an average weekly use of fewer than thirty minutes, were measured. RESULTS: The analyzed power varied between 2% to 134% of the values declared by the manufacturers. Differences in beam diameter of between 38% and 543% of the nominal values were also observed. It is also noteworthy that even between the same brand and model, differences in diameter were obtained. Finally, differences were observed in the power output after one and three minutes of sequential emission for 830 nm and 904 nm (p < 0.05), but not when comparing the difference between wavelengths in factor time. CONCLUSION: There is a need for a shared effort on the part of laser manufacturers to improve standardization and consistency of laser output power and beam diameters. At the same time, medical laser operators should also consider development of standardized protocols for maintenance and monitoring equipment performance over time to correct for fluctuations that could ultimately impact on treatment outcomes.

Correlation between the range of motion of the tibiotarsal joint and blood circulation in the lower limbs in diabetic individuals.

OBJECTIVE: The aim of this study was to evaluate the relationship between the range of motion and lower-limb hemodynamic indices in the tibiotarsal joint of individuals with diabetic neuropathy. METHODS: Twenty volunteers of both sexes, with a mean age of 61.45±7.05 years, were diagnosed with type 2 diabetes mellitus and diabetic peripheral neuropathy. Arterial blood flow was assessed using Doppler ultrasound, and the variables such as average velocity, pulsatility index, and resistivity index were also evaluated. A range of dorsiflexion and plantar flexion joint movements were assessed using digital goniometry before and after exercise. Data distribution was assessed using the Shapiro-Wilk test, followed by Pearson's correlation for normal data and Spearman's correlation for non-normal data, in order to verify the association between variables. RESULTS: A moderate correlation was found between dorsiflexion and pulse rate on two occasions before (rs=0.497) and after initial evaluation (rs=0.511). A low correlation was found between plantar flexion and mean velocity (rs=-0.357), pulsatility index (rs=0.439), and resistivity index (rs=0.328); dorsiflexion and mean velocity (rs=0.374), pulse rate (rs=0.332), and resistance index (rs=0.327) before evaluation, and peak (rs=0.346) was observed after the evaluation of blood circulation. CONCLUSION: There is a correlation between the range of motion of the tibiotarsal joint and the blood circulation of diabetics, ranging from moderate to poor for the different variables evaluated.

Reliability of quantitative sensory testing on myofascial trigger points in the upper trapezius muscle of individuals with chronic neck pain.

OBJECTIVE: The objective of this study was to measure the intra- and inter-rater reliability of the quantitative sensory testing for measuring the thermal pain threshold on myofascial trigger points in the upper trapezius muscle of individuals with chronic neck pain. METHODS: Thirty female participants were included, aged between 18 and 45 years and with bilateral myofascial trigger points, active and centrally located in the upper trapezius muscle. Two measurements with quantitative sensory testing were performed by each examiner at an interval of 1 week between them. RESULTS: We observed substantial reliability for the intra-rater analysis (intraclass correlation coefficient ranging between 0.876 and 0.896) and excellent reliability for the inter-rater analysis (intraclass correlation coefficient ranging between 0.917 and 0.954). CONCLUSION: The measurement of the thermal pain threshold on myofascial trigger points in individuals with chronic neck pain has acceptable reliability values, supporting the use of the quantitative sensory testing in the research setting and the clinical environment.

Intra- and inter-examiner reliability of digital images of skin donor areas in burns.

OBJECTIVE: The main objective of this study was to evaluate intra- and inter-rater reliability in the analysis of digital images of donor areas for skin in burn patients using the CaPAS plugin in the ImageJ®. METHODS: Donor sites were reviewed by two independent reviewers in duplicate. The capture of images was standardized on the same device and distance (with a millimeter ruler), without a flash. The evaluators were trained to capture the images and use the plugin. RESULTS: We selected 70 images from donor areas, from men and women between 18 and 60 years old. In the analysis of intra-examiner reliability, eight of the nine variables exhibited excellent reliability (0.985-0.998) and one (entropy) exhibited good reliability (0.525). The same was true for the inter-examiner analysis: excellent reliability for eight variables (0.824-0.993) and good reliability for entropy (0.501). CONCLUSIONS: The CaPAS plugin has proven to be a reliable tool for use in research in skin donor areas in burns, as demonstrated by its excellent intra- and inter-examiner reliability values. This is a pioneering study in the quantitative assessment of skin donor areas in burn patients using the CaPAS plugin.

Relationship between lymphedema after breast cancer treatment and biophysical characteristics of the affected tissue.

The treatment of breast cancer is often complicated by lymphedema of the upper limbs. Standard lymphedema evaluation methodologies are not able to measure tissue fibrosis. The ultrasound aspects related to tissue microstructures of lymphedema are neglected in clinical evaluations. The objective of this study was to identify and measure the degree of impairment, topography, and biophysical alterations of subcutaneous lymphedema tissue secondary to the treatment of breast cancer by ultrasonography. Forty-two women at a mean age of 58 (±9.7) years, with unilateral lymphedema due to breast cancer treatment, were evaluated. The upper limbs were divided into affected (affected by lymphedema) and control (contralateral limb). Each limb was subdivided into seven areas, defined by perimetry, evaluated in pairs. The biophysical characteristics thickness, entropy, and echogenicity were evaluated by ultrasonography. The results showed a significant difference in the echogenicity and thickness variables between the affected and unaffected upper limb, in all the extent of the upper limb, while entropy showed no significant difference. The findings indicate that the data presented were consistent both in identifying and measuring the degree of impairment and biophysical changes in the subcutaneous tissue of lymphedema secondary to the treatment of breast cancer.

Effects of therapeutic ultrasound and paraffin with or without vacuum massage on biomechanical properties of grafted skin after burn: a randomized controlled trial.

OBJECTIVE: This study aimed to compare the effects of therapeutic ultrasound and paraffin with or without vacuum massage on the biomechanical properties of grafted skin after a burn. METHODS: A total of 44 patients with deep second- and third-degree burns, with a mean age of 35.89 (±11.53) years, who visited the Hospital Burn Unity, were included in the study. The therapeutic interventions were randomly defined by drawing lots, with a crossover design (crossover), and a minimum interval of 7 days (washout) between interventions. Skin biomechanical parameters such as distensibility (R0) and viscoelasticity (R6) were noninvasively evaluated by Cutometer before and after 0, 10, 20, and 30 min of intervention with therapeutic ultrasound and paraffin alone, as well as associated with negative pressure therapy of the skin (vacuum therapy). In this study, all groups showed increased distensibility (R0) in the period immediately after the application of the resources and a progressive reduction in the effects in the consecutive tests. Participants with skin grafts showed a decrease in viscoelasticity (R6) in all groups, except therapeutic paraffin and therapeutic ultrasound and vacuum massage. CONCLUSION: The biomechanical properties of grafted skin after a burn are altered after therapeutic intervention with ultrasound alone or associated with vacuum massage, such as intervention with paraffin associated with vacuum massage, for both parameters evaluated, skin distensibility (R0) and skin viscoelasticity (R6). However, the same did not occur for the intervention with isolated paraffin. There was no significant difference between the interventions therapeutic ultrasound and therapeutic paraffin.

Relationship between pressure and thermal pain threshold, pain intensity, catastrophizing, disability, and skin temperature over myofascial trigger point in individuals with neck pain.

OBJECTIVE: The objective of the study was to correlate the thermal pain threshold (heat and cold) on myofascial trigger points with measurements of pain and skin temperature in patients with chronic neck pain. METHODS: This is a cross-sectional study. We included participants of both genders, aged between 18-45 years, with chronic neck pain (>90 days), and with active bilateral myofascial trigger point centrally located in the upper trapezius muscle. Neck Disability Index, Numerical Rating Scale, Pain-Related Catastrophizing Thoughts Scale, algometry, infrared thermography, and quantitative sensory testing were used for the evaluation. RESULTS: A significant, weak, and negative association was observed between pain intensity and heat pain threshold on the myofascial trigger point to the right (rho -0.381, p=0.022) and to the left (rho -0.334, p=0.049), and a significant, weak, and positive association was observed between pain intensity and cold pain threshold on the myofascial trigger point to the right (rho 0.471, p=0.004) and to the left (rho 0.339, p=0.043). CONCLUSION: Thermal pain threshold (heat and cold) on myofascial trigger points is associated with pain intensity in individuals with chronic neck pain.

Reliability of pressure pain threshold on myofascial trigger points in the trapezius muscle of women with chronic neck pain.

OBJECTIVE: The aim of this study was to evaluate the intra- and inter-rater reliability of pressure pain threshold measurement on myofascial trigger points in the trapezius muscle in women with chronic neck pain. METHODS: This reliability study involved 30 volunteers with neck pain for more than 90 days. The assessment procedures were performed by blinded researchers. Two examiners, who were previously trained in the use of algometry, independently performed two assessments of the pressure pain threshold at two time intervals, one week apart. RESULTS: The study sample consisted of 30 young adult women. Excellent intra- and inter-rater reliability were found for the pressure pain threshold on myofascial trigger points, with intraclass correlation coefficient values ranging between 0.752 and 0.874, standard error of measurement ranging between 0.18 and 0.22 kg/cm2, and minimum detectable change ranging between 0.45 and 0.62 kg/cm2. CONCLUSION: The present study showed that the assessment of pressure pain threshold through algometry presents satisfactory intraclass correlation coefficient values, considering different time and examiners, contributing to the spread of the use of this tool as a quantitative method of pain evaluation in myofascial trigger points.