Is adding dry needling to a standard care protocol beneficial in patients with chronic neck pain? A randomized placebo-controlled trial.

PURPOSE: To evaluate the short-term effects of adding a dry needling therapy to a standard care protocol based on education, exercise and electrotherapy, compared to a sham procedure and to a standard care protocol in isolation in patients with chronic neck pain. MATERIAL AND METHODS: A randomized placebo-controlled trial was performed. The participants in the dry needling group received a standard care protocol based on patient education, therapeutic exercise and electrotherapy, as well as two sessions of dry needling in the upper trapezius, levator scapulae, and/or sternocleidomastoid muscles. The participants in the sham dry needling group received the same standard care protocol and two sessions of sham dry needling. The participants in the control group received the same standard care protocol. The outcomes measured were pain intensity, pressure pain threshold, neck disability, range of movement, activation of deep cervical flexor muscles, kinesiophobia, pain catastrophizing, anxiety, and depression. RESULTS: No significant group by time interactions were found for any of the outcome variables except for lower cervical spine range of movement (F = 3.79; p = 0.030). CONCLUSION: The addition of two sessions of dry needling in the superficial neck muscles to a standard protocol did not yield superior results compared to either the standard care alone or the standard care plus sham dry needling in patients with chronic neck pain in any outcome except for cervical range of movement.

Effectiveness of aquatic training based on aerobic and strengthening exercises in patients with fibromyalgia: systematic review with meta-analysis.

BACKGROUND AND PURPOSE: fibromyalgia is a chronic condition causing widespread pain, fatigue, limited physical function, and reduced quality of life. Aquatic training is recommended as a first-line non-pharmacological treatment. This study aims to evaluate the effectiveness of aquatic training based on aerobic and strengthening exercises in improving symptoms in women with fibromyalgia. MATERIAL AND METHODS: a systematic review with meta-analysis was conducted by searching the PubMed, Scopus, Cochrane Library and Web of Science databases. Randomized clinical trials that compared aquatic therapy with either a control group or a land-based exercise group were included. Study quality was assessed using the PEDro scale, the risk of bias was evaluated using the Cochrane Risk of Bias Tool, and the certainty of the evidence was assessed the GRADE guidelines. RESULTS: six randomized clinical trials comprising 9 publications showed that aquatic therapy had statistically significant benefits compared to no intervention, including pain, fatigue, fibromyalgia impact, depression, physical function, and mental health in the short term. In the medium term, improvements were observed in fibromyalgia impact, physical function, and mental health. However, aquatic therapy was not found to be superior to land-based exercise. CONCLUSION: low to very low certainty of evidence suggested that aquatic training may reduce pain, fibromyalgia impact, fatigue and depression and improve physical function and mental health in patients with fibromyalgia. Further studies should investigate the medium and long-term effects of aquatic training using larger sample sizes.

Multicentre cross-sectional study assessing content validity of the International Classification of Functioning, disability and health core set for post-acute musculoskeletal conditions in primary care physiotherapy services.

OBJECTIVE: To assess content validity of the comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for post-acute musculoskeletal conditions in primary care physiotherapy services. DESIGN: Multicentre cross-sectional study. SUBJECTS: Patients with musculoskeletal disorders referred to primary care physiotherapy services. METHODS: Structured interviews were conducted using categories from the ICF Core Set, and their relevance was assessed using a visual analogue scale. An ICF category had to represent a problem for at least 5% of the sample in order to be validated. RESULTS: The study sample comprised 274 patients. All categories in the ICF Core Set were confirmed. Body functions related to pain and movement were the most commonly impaired, with ICF categories "b280 Sensation of pain" and "b710 Mobility of joint functions" having the highest prevalence (87.2% and 84.7%, respectively). Activity limitations and participation restrictions were concentrated in chapters "d4 Mobility" (63.5% for "d430 Lifting and carrying objects") and "d2 General tasks and demands" (59.5% for "d240 Handling stress and other psychological demands"). The most relevant environmental factors were "e225 Climate" (55.8%) and "e580 Health services, systems and policies" (39.4%). CONCLUSION: The ICF Core Set for post-acute musculoskeletal conditions shows appropriate content validity for primary care physiotherapy services.

The effectiveness of non-surgical interventions in athletes with groin pain: a systematic review and meta-analysis.

BACKGROUND: Groin pain is a common pathology among athletes, presenting pain and a reduced range of motion (ROM) as clinical characteristics. Passive physical therapy (PPT) and exercise therapy (ET) interventions are chosen firstly before surgery. The aim of this systematic review and meta-analysis was: (i) to qualitative review the effects of each non-surgical intervention; (ii) to quantitative compare the effects of PPTs plus ET intervention to ET in isolation in pain intensity, and hip ROM in athletes with groin pain. METHODS: A systematic review and meta-analysis was conducted. Pubmed, PEDro, Web of science, Scopus and Cochrane library were searched. Randomized controlled trials comparing PPT plus ET to ET interventions were included. The methodological quality and risk of bias of the included studies, were assessed with the PEDro scale and the Cochrane risk-of-bias tool. To assess the certainty of evidence the GRADEpro GDT was used. Meta-analyses were conducted using RevMan 5.4 using mean difference analysis to assess the variables pain intensity and hip ROM. RESULTS: A total of 175 studies was identified from the consulted databases. Five studies were included for systematic- review, from which three studies were meta-analyzed. The methodological quality of the included studies ranged from poor to high. ET compared to PPT plus ET provided statistically significant improvements in pain intensity in the short-term (MD = 2.45; 95% CI 1.11, 3.79; I2 :65%). No statistically significant differences between interventions were obtained for hip ROM in the short-term. CONCLUSIONS: The qualitative review showed that PPTs plus ET and ET seem to have positive effects on pain intensity and hip ROM. The quantitative analysis found very low certainty of evidence proposing a positive effect in pain intensity for ET interventions based on hip muscles stretching, compared to PPT combined with ET, in the short-term.

Effects of exercise therapy on diabetic neuropathy: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the effects of exercise therapy on neuropathic symptoms, signs, psychosocial aspects, and physical function in people with diabetic neuropathy (DN). METHODS: A search in PubMed, Web of Science, Physiotherapy Evidence (PEDro), and Cochrane databases was performed from inception to Invalid Date NaN, . Randomized clinical trials (RCTs) were selected in patients with DN comparing exercise therapy with a control group. The studies' methodological quality was assessed with the PEDro scale. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the overall quality. RESULTS: Eleven RCTs (n = 517 participants) were included. Nine studies showed high methodological quality. Mean (MD) and standardized mean differences (SMD) were observed in favor of exercise therapy for symptoms (MD = -1.05; confidence interval 95% = -1.90 to -0.20), signs (SMD = -0.66; confidence interval 95%= -1 to -0.32), and physical function (SMD = -0.45; confidence interval 95% = -0.66 to -0.24). No changes were found in psychosocial aspects (SMD = -0.37; confidence interval 95% = -0.92 to 0.18). The overall quality of evidence was very low. CONCLUSION: The quality of evidence suggesting that exercise therapy provides short-term benefits in neuropathic symptoms, signs, and physical function in patients with DN is very low. Furthermore, there were no effects found on psychosocial aspects.

Researcher's Perspective on Musculoskeletal Conditions in Primary Care Physiotherapy Units through the International Classification of Functioning, Disability, and Health (ICF): A Scoping Review.

(1) Background: Musculoskeletal disorders are the second cause of disability in the world. The International Classification of Functioning Disability and Health (ICF) is a tool for systematically describing functioning. Outcome measures for musculoskeletal disorders and functioning concepts embedded in them have not been described under the ICF paradigm. The objective of this scoping review was to identify ICF categories representing the researcher's perspective and to compare them with the ICF core set for post-acute musculoskeletal conditions. (2) Methods: This review was conducted as follows: (a) literature search using MEDLINE/PubMed, CINAHL, Web of Science, and Scopus databases; (b) study selection applying inclusion criteria (PICOS): musculoskeletal conditions in primary care, application of physiotherapy as a treatment, outcome measures related to functioning, and experimental or observational studies conducted in Western countries during the last 10 years; (c) extraction of relevant concepts; (d) linkage to the ICF; (e) frequency analysis; and (f) comparison with the ICF core set. (3) Results: From 540 studies identified, a total of 51 were included, and 108 outcome measures were extracted. In the ICF linking process, 147 ICF categories were identified. Analysis of data showed that 84.2% of the categories in the ICF core set for post-acute musculoskeletal conditions can be covered by the outcome measures analyzed. Sixty-eight relevant additional ICF categories were identified. (4) Conclusion: Outcome measures analyzed partially represent the ICF core set taken as a reference. The identification of additional categories calls into question the applicability of this core set in primary care physiotherapy units.

The effectiveness of visceral osteopathy in pain, disability, and physical function in patients with low-back pain. A systematic review and meta-analysis.

BACKGROUND AND PURPOSE: Systematic review and meta-analysis to assess the effectiveness of visceral osteopathy in improving pain intensity, disability and physical function in patients with low-back pain (LBP). MATERIALS AND METHODS: MEDLINE (Pubmed), PEDro, SCOPUS, Cochrane Library and Web of Science databases were searched from inception to February 2022. PICO search strategy was used to identify randomized controlled trials applying visceral techniques in patients with LBP. Eligible studies and data extraction were conducted independently by two reviewers. Quality of the studies was assessed with the Physiotherapy Evidence Database scale, and the risk of bias with Cochrane Collaboration tool. Meta-analyses were conducted using random effects models according to heterogeneity assessed with I2 coefficient. Data on outcomes of interest were extracted by a researcher using RevMan 5.4 software. RESULTS: Five studies were included in the systematic review involving 268 patients with LBP. The methodological quality of the included ranged from high to low and the risk of bias was high. Visceral osteopathy techniques have shown no improvements in pain intensity (Standardized mean difference (SMD) = -0.53; 95% CI; -1.09, 0.03; I2: 78%), disability (SMD = -0.08; 95% CI; -0.44, 0.27; I2: 0%) and physical function (SMD = -0.26; 95% CI; -0.62, 0.10; I2: 0%) in patients with LBP. CONCLUSIONS: This systematic review and meta-analysis showed a lack of high-quality studies showing the effectiveness of visceral osteopathy in pain, disability, and physical function in patients with LBP.

Effects of a Telerehabilitation Program in Women with Fibromyalgia at 6-Month Follow-Up: Secondary Analysis of a Randomized Clinical Trial.

(1) Background: Telerehabilitation allows health professionals to monitor patients without face-to-face contact. The objective was to analyze the effects of a telerehabilitation program based on aerobic exercise in women with fibromyalgia at 6-month follow-up. (2) Methods: Participants were randomized into the telerehabilitation group (n = 17) or the control group (n = 17). The telerehabilitation group performed 30 sessions of exercise for 15 weeks. The exercises were guided by video and adjusted by videocalls. Pain intensity, fibromyalgia impact, physical function, isometric strength and quality of life were measured at baseline and at 6 months after the end of the intervention. (3) Results: There were no between-group differences in pain intensity, fibromyalgia impact, physical function, isometric strength or quality of life at 6-month follow-up (p > 0.05). (4) Conclusion: A telerehabilitation exercise program based on aerobic exercises may not be an effective treatment for women with fibromyalgia at 6 months of follow-up due to the lack of between-group differences in any variable.

Hip Range of Motion and Strength in Male Athletes with Stage 1 Osteitis Pubis: A Cross-Sectional and Correlational Study.

BACKGROUND: The objectives of this study were: (1) to determine whether athletes with stage 1 osteitis pubis (OP) present differences in hip range of motion (ROM) and muscle strength, between both sides and compared with healthy athletes; (2) to investigate the relationship between the internal rotation (IR) ROM and pain intensity and physical function. METHODS: a cross-sectional and correlational study was designed, in which 30 athletes (15 athletes with stage 1 OP and 15 healthy athletes) were included. Pain intensity, physical function, hip ROM and hip muscle strength were assessed. RESULTS: The ROM assessment reported significant differences between both groups in the IR, external rotation (ER) and adduction (ADD) ROM of the painful side (PS) (p < 0.05). The OP group showed differences between both sides in IR ER and ADD ROM (p < 0.05). No statistically significant differences were found between or within groups in the maximum isometric strength of the hip (p > 0.05). A strong negative correlation between pain intensity and IR ROM (r = -0.640) and a strong positive correlation between physical function and IR ROM (r = 0.563) were found in the OP group. CONCLUSIONS: Male athletes with stage 1 OP present a hip IR, ER and ADD ROM limitation in the PS compared to non-PS and to healthy athletes. IR ROM is correlated to pain intensity and physical function in athletes with stage 1 OP.

The Effectiveness of Dry Needling in Patients with Hip or Knee Osteoarthritis: A Systematic Review and Meta-Analysis.

BACKGROUND: Osteoarthritis is one of the most common degenerative joint diseases. The main symptoms of the osteoarthritis have been linked to the presence of myofascial trigger points in the soft tissues. Dry needing (DN) is the most investigated technique for the treatment of myofascial trigger points. Thus, the aim of this study was to evaluate the effectiveness of DN in pain and physical function in patients with osteoarthritis in the short-, medium- and long-term. METHODS: PubMed, Cochrane Library, PEDro, Web of Science, and SCOPUS databases were searched in September 2022. Randomized controlled trials involving DN compared to non-pharmacological interventions, sham techniques or no additional treatment were selected. Quality of the studies was assessed with PEDro scale and risk of bias with Cochrane Collaboration tool. Meta-analyses were conducted using fixed or random effects models according to the Cochrane handbook for systematic reviews of interventions. RESULTS: Seven studies were included in the meta-analysis involving 291 patients with osteoarthritis. The methodological quality of the included studies ranged from fair to high. DN showed significant improvements in pain intensity (SMD = -0.76; 95% CI: -1.24, -0.29; I2: 74%) and physical function (SMD = -0.98; 95% CI: -1.54, -0.42; I2: 75%) in the short-term. No differences were found in the medium- or long-term. The risk of bias, heterogeneity, and imprecision of the results downgraded the level of evidence to very low. CONCLUSIONS: Very low-quality evidence suggests a positive effect of DN for reducing pain intensity and improving physical function in the short term in patients with osteoarthritis. Further investigation is needed to determine a medium- and long-term effects.

Effects of dry needling on pain, disability, kinesiophobia, pain catastrophizing and psychological distress in patients with chronic neck pain: A randomized controlled pilot study.

BACKGROUND: Myofascial trigger points (MTrPs) in neck muscles seem to be related to the main symptoms of patients with chronic neck pain. OBJECTIVE: The objective was to investigate the effects of dry needling (DN) on pain, disability, kinesiophobia, pain catastrophizing and psychological distress in patients with chronic neck pain. METHODS: A double blind randomized controlled pilot trial was designed. Twenty-one patients with chronic neck pain were randomly allocated to the DN group (n= 7), Sham-DN group (n= 7) or Control group (n= 7). All groups received a Transcutaneous Electrical Nerve Stimulation and Therapeutic Ultrasound (TENS/US) protocol with patient education. The DN and Sham-DN groups received two sessions of DN and sham DN, respectively. The primary outcome was pain intensity. Secondary outcomes were disability, kinesiophobia, pain catastrophizing, psychological distress, self-reported improvement and success of blinding. RESULTS: The DN group showed a greater decrease in pain intensity, disability and pain catastrophizing compared to the Sham-DN group (p< 0.05) and the Control group (p< 0.05). The DN group showed the highest self-reported improvement. CONCLUSION: Adding two sessions of DN in active MTrPs in upper trapezius, levator scapulae and sternocleidomastoid muscles to a TENS/US protocol with patient education decreased pain intensity, disability and pain catastrophizing in patients with chronic neck pain.

Effectiveness of non-pharmacological conservative therapies in adults with fibromyalgia: A systematic review of high-quality clinical trials.

BACKGROUND: Fibromyalgia is a chronic condition characterized by generalized pain. Several studies have been conducted to assess the effects of non-pharmacological conservative therapies in fibromyalgia. OBJECTIVE: To systematically review the effects of non-pharmacological conservative therapies in fibromyalgia patients. METHODS: We searched MEDLINE, Cochrane library, Scopus and PEDro databases for randomized clinical trials related to non-pharmacological conservative therapies in adults with fibromyalgia. The PEDro scale was used for the methodological quality assessment. High-quality trials with a minimum score of 7 out of 10 were included. Outcome measures were pain intensity, pressure pain threshold, physical function, disability, sleep, fatigue and psychological distress. RESULTS: Forty-six studies met the inclusion criteria. There was strong evidence about the next aspects. Combined exercise, aquatic exercise and other active therapies improved pain intensity, disability and physical function in the short term. Multimodal therapies reduced pain intensity in the short term, as well as disability in the short, medium and long term. Manual therapy, needling therapies and patient education provided benefits in the short term. CONCLUSIONS: Strong evidence showed positive effects of non-pharmacological conservative therapies in the short term in fibromyalgia patients. Multimodal conservative therapies also could provide benefits in the medium and long term.

Range of motion and muscle function on shoulder joints of young handball athletes.

BACKGROUND: The detection of primary risk factors through the assessment of shoulder range of motion (ROM) and muscle function could prevent injuries in the initial stages of the handball (HB) practice. OBJECTIVE: To compare shoulder ROM, muscle strength and muscle extensibility between throwing and non-throwing shoulders in young HB athletes and between non-HB athletes. METHODS: A cross-sectional study was designed. Participants aged between 14-16 years that practice physical activity regularly were included and divided in two groups. The HB group included volunteers who practiced HB, the control group included volunteers who practiced other activities. The variables measured were internal rotation and external rotation ROM, maximum isometric strength, and extensibility of the tissues of the posterior part of the throwing and non-throwing shoulder. RESULTS: Thirty-seven subjects were included. The HB group (n= 19) showed greater ROM in both shoulders compared to the control group (n= 18) (p< 0.05). The throwing shoulder of the HB group showed less internal rotation ROM, greater external rotation ROM and greater internal rotation strength when compared to the non-throwing shoulder (p< 0.05). CONCLUSIONS: The results of the study suggest that young HB athletes present differences in shoulder ROM compared to non-HB athletes. Also, HB athletes showed differences in ROM and strength between the TS and non-TS. Hence, the assessment of the shoulder ROM and muscle function should be taken into consideration to avoid injuries in this population.

Effects of Dry Needling in Teres Major Muscle in Elite Handball Athletes. A Randomised Controlled Trial.

Objective: To determine the effects of dry needling (DN) in active myofascial trigger points in the teres major muscle compared to an untreated control group in pain during throwing actions, shoulder range of motion (ROM), strength, and extensibility of the tissues in professional handball (HB) athletes. Methods: A randomised, single-blinded, controlled clinical trial was designed. Thirty HB athletes with shoulder pain were randomly assigned to the DN group (n = 15) or control group (n = 15). The DN group received a single session of ultrasound-guided DN technique in the teres major muscle. The control group received no intervention. Pain intensity during throwing actions (Numeric Pain Rating Score), shoulder ROM (inclinometer), isometric strength (hand-held dynamometer), and extensibility (inclinometer) were measured before and after treatment. Results: DN group showed statistically significant improvements with large effect sizes for pain intensity (p < 0.001; E.S: 1.3), internal rotation ROM (p < 0.001; E.S: 3.0) and extensibility (p < 0.001; E.S: 2.9) compared to the control group. No statistically significant differences were found for isometric strength (p > 0.05). Conclusion: A single session of DN in the teres major muscle was effective for improving pain intensity during throwing actions, internal rotation ROM and extensibility in HB athletes with shoulder pain.

Immediate Effects of a Telerehabilitation Program Based on Aerobic Exercise in Women with Fibromyalgia.

BACKGROUND: We analyzed the immediate effects of a Telerehabilitation Program (TP) based on aerobic exercise in women with fibromyalgia (FM) syndrome during the lockdown declared in Spain due to the COVID-19 pandemic. METHODS: A single-blind randomized controlled trial was designed. Thirty-four women with FM were randomized into two groups: TP group and Control group. The intervention lasted 15 weeks, with 2 sessions per week. The TP based on aerobic exercise was guided by video and the intensity of each session was monitored using the Borg scale. Pain intensity (Visual Analogue Scale), mechanical pain sensitivity (algometer), number of tender points, FM impact (Revised Fibromyalgia Impact Questionnaire), pain catastrophizing (Pain Catastrophizing Scale), physiological distress (Hospital Anxiety and Depression Scale), upper (Arm Curl Test) and lower-limb physical function (6-min Walk Test) were measured at baseline and after the intervention. RESULTS: The TP group improved pain intensity (p = 0.022), mechanical pain sensitivity (p < 0.05), and psychological distress (p = 0.005), compared to the Control group. The Control group showed no statistically significant changes in any variable (p > 0.05). CONCLUSIONS: A TP based on aerobic exercise achieved improvements on pain intensity, mechanical pain sensitivity, and psychological distress compared to a Control group during the lockdown declared in Spain due to COVID-19 pandemic.