Posturography measures in specific ballet stance position discriminate ballet dancers with different occurrences of musculoskeletal injuries.

BACKGROUND: This study aimed to identify the postural sway variables that can distinguish between ballet dancers with high and low occurrences of musculoskeletal injuries. METHODS: Fourteen professional ballet dancers were assigned to a high-occurrence group (N = 5, reports >2 injuries in the previous 6-months) or a low-occurrence group (N = 9, reports ≤1 injury). Center-of-pressure (COP) data were acquired using a force platform during the following tasks: single-leg stance with eyes open, single-leg stance with eyes closed, and demi-pointe stance with eyes open. The COP standard deviation (SD) and range (RA) in both the medial-lateral (ML) and anterior-posterior (AP) directions were estimated. Between-group comparisons were made through Welch's t-tests for unequal sample size along the effect size measure (Cohen's d). Spearman's rho was used to estimate the association between the number of injuries and the COP variables. The statistical threshold was set at 1%. RESULTS: A between-group effect was found only for the demi-pointe stance, with large effects for SDML (P = 0.006, d = 1.7), RAAP (P = 0.006, d = 1.7), and RAML (P = 0.005, d = 1.7). An inverse relationship was found between the number of injuries and the demi-pointe's COP range in both directions (Spearman's rho from -0.681 to -0.726, P = 0.007). CONCLUSIONS: COP measures taken in ballet-specific positions can distinguish between dancers with a high and low occurrence of musculoskeletal injuries. Suggestions are made to include ballet-specific tasks in the functional assessments of professional dancers.

Short-Term Changes in Posture and Pain of the Neck and Lower Back of Women Undergoing Lipoabdominoplasty: A Case Series Report.

Objective: The purpose of this study was to analyze short-term variations in posture and intensity of neck and lower back pain in women undergoing lipoabdominoplasty. Methods: This prospective case series study involved 17 women (age 43 ± 12 years, presurgical body mass index 27.0 ± 3.7 kg/m2). Participants were assessed preoperatively (T0) and at 15 (T15) and 30 days (T30) after surgery for clinical data (number of pregnancies, number of deliveries, presurgical body mass), neck and lower back angles calculated by photogrammetry, and pain intensity by numeric pain rating scale. Postoperative complications were assessed at T15 and T30. Results: After adjusting for age and presurgical body mass index, there was an increase in forward head position in T15 and a return by T30 (marginal R2 = 0.411). The lower back showed an increase in flexion at T15 and return by T30 (marginal R2 = 0.266). No statistical evidence of significance was observed for changes in the intensity of neck (P > .355) or lower back (P > .293) pain. Complications were mild and common at T15; most of them resumed at T30. Conclusion: A transient, nonlinear compensatory change in neck and lower back lordosis was observed 15 days after lipoabdominoplasty, with almost full recovery in the short term (30 days). No systematic change in pain intensity was observed within this period. Postsurgical complications were mild and common, and most of them resumed shortly after surgery.

Prefrontal tDCS modulates autonomic responses in COVID-19 inpatients.

BACKGROUND: maladaptive changes in the autonomic nervous system (ANS) have been observed in short and long-term phases of COVID-19 infection. Identifying effective treatments to modulate autonomic imbalance could be a strategy for preventing and reducing disease severity and induced complications. OBJECTIVE: to investigate the efficacy, safety, and feasibility of a single session of bihemispheric prefrontal tDCS on indicators of cardiac autonomic regulation and mood of COVID-19 inpatients. METHODS: patients were randomized to receive a single 30-min session of bihemispheric active tDCS over the dorsolateral prefrontal cortex (2 mA; n = 20) or sham (n = 20). Changes in time [post-pre intervention] in heart rate variability (HRV), mood, heart rate, respiratory rate, and oxygen saturation were compared between groups. Additionally, clinical worsening indicators and the occurrence of falls and skin injuries were evaluated. The Brunoni Adverse Effects Questionary was employed after the intervention. RESULTS: there was a large effect size (Hedges' g = 0.7) of intervention on HRV frequency parameters, suggesting alterations in cardiac autonomic regulation. An increment in oxygen saturation was observed in the active group but not in the sham after the intervention (P = 0.045). There were no group differences regarding mood, incidence and intensity of adverse effects, no occurrence of skin lesions, falls, or clinical worsening. CONCLUSIONS: a single prefrontal tDCS session is safe and feasible to modulate indicators of cardiac autonomic regulation in acute COVID-19 inpatients. Further research comprising a thorough assessment of autonomic function and inflammatory biomarkers is required to verify its potential to manage autonomic dysfunctions, mitigate inflammatory responses and enhance clinical outcomes.

Is postexercise hypotension a method-dependent phenomenon in chronic stroke? A crossover randomized controlled trial.

BACKGROUND: This study assessed the reproducibility of postexercise hypotension (PEH) detection after two bouts of mixed circuit training (MCT) using three approaches that accounts the pre-exercise values and/or a control session (CTL) to calculate PEH [i.e., ( A 1 = post - exercise - pre - exercise ${A}_{1}=\text{post}{\rm{ \mbox{-} }}\text{exercise}-\text{pre}{\rm{ \mbox{-} }}\text{exercise}$ ); ( A 2 = post - exercise - post - CTL ) $({A}_{2}=\text{post}{\rm{ \mbox{-} }}\text{exercise}-\text{post}{\rm{ \mbox{-} }}\text{CTL})$ ; A 3 = ( post - exercise - pre - exercise ) - ( post - CTL - pre - CTL ) ] ${A}_{3}=(\text{post}{\rm{ \mbox{-} }}\text{exercise}-\text{pre}{\rm{ \mbox{-} }}\text{exercise})-(\text{post}{\rm{ \mbox{-} }}\text{CTL}-\text{pre}{\rm{ \mbox{-} }}\text{CTL})]$ in chronic stroke (i.e., ≥6 months poststroke). The proportion of PEH responders determined using different cut-off values for PEH was also compared (4 mmHg vs. minimal detectable difference). METHODS: Seven participants (age: 56 ± 12 years; time post-stroke: 91 ± 55 months) performed two bouts of MCT and a CTL. The MCT involved 10 exercises with 3 sets of 15-repetition maximum, with each set interspersed with 45 s of walking. The systolic (SBP) and diastolic (DBP) blood pressures were assessed 10-min before and every 10-min along 40-min after CTL and MCT. RESULTS: The two-way random intraclass correlation coefficient for single measurements (ICC2,1 ) ranges for SBP were: A1 : 0.580-0.829, A2 : 0.937-0.994, A3 : 0.278-0.774; for DBP: A1 : 0.497-0.916, A2 : 0.133-0.969, A3 : 0.175-0.930. The proportion of PEH responders detected using 4 mmHg or the minimal detectable difference as cut-off values was not different in 97% of analyses (p > 0.05), and higher when using 4 mmHg in 3% of analyses (p = 0.031). The standard error of measurement was ≥4 mmHg in 47% of analyses for SBP, and 40% for DBP. CONCLUSIONS: The most reliable approach for determining PEH in chronic stroke was to subtract the postexercise from the post-CTL values. The proportion of PEH responders was not affected by the cut-off values applied.

Poststroke consequences upon optimization properties of postural sway during upright stance: a cross-sectional study.

BACKGROUND: The understanding of human postural control has advanced with the introduction of optimization process modeling. These models, however, only provide control parameters, rather than analytical descriptors of optimization processes. Here, we use a newly developed direct (pattern) search algorithm to investigate changes in postural optimization process in poststroke individuals. OBJECTIVE: This cross-sectional study investigated the optimization properties of postural stability during upright standing in poststroke individuals. METHODS: Twenty-nine poststroke and 15 healthy age-matched individuals underwent posturography with a force platform while standing for 60 s for acquisition of center-of-pressure data. Poststroke individuals were grouped depending on their weight-bearing (WB) pattern and their balance capability assessed through Berg Balance Scale (BBS). The optimization properties of postural stability were computed assuming the minimization of postural sway as cost function. RESULTS: The asymmetric WB poststroke group showed larger convergence rate toward the local minimum of postural sway than the symmetric WB group. Additionally, the low-balance capability group exhibited smaller values for averaged local minima and global minimum of postural sway coordinates compared with high-balance capability group. Significant correlations were found for BBS and the local minima and global minimum (Pearson's r ranged 0.378-0.424, P < 0.05). CONCLUSIONS: In summary, the optimization properties describing postural dynamic stability, steadiness, and global reference are altered in poststroke individuals with asymmetric WB pattern and low-balance capability.

Mixed circuit training acutely reduces arterial stiffness in patients with chronic stroke: a crossover randomized controlled trial.

PURPOSE: Investigate whether a single bout of mixed circuit training (MCT) can elicit changes in arterial stiffness in patients with chronic stroke. Second, to assess the between-day reproducibility of post-MCT arterial stiffness measurements. METHODS: Seven participants (58 ± 12 years) performed a non-exercise control session (CTL) and two bouts of MCT on separate days in a randomized counterbalanced order. The MCT involved 3 sets of 15 repetition maximum for 10 exercises, with each set separated by 45-s of walking. Brachial-radial pulse wave velocity (br-PWV), radial artery compliance (AC) and reflection index (RI1,2) were assessed 10 min before and 60 min after CTL and MCT. Ambulatory arterial stiffness index (AASI) was calculated from 24-h recovery ambulatory blood pressure monitoring. RESULTS: Compared to CTL, after 60 min of recovery from the 1st and 2nd bouts of MCT, lower values were observed for br-PWV (mean diff = - 3.9 and - 3.7 m/s, respectively, P < 0.01; ICC2,1 = 0.75) and RI1,2 (mean diff = - 16.1 and - 16.0%, respectively, P < 0.05; ICC2,1 = 0.83) concomitant with higher AC (mean diff = 1.2 and 1.0 × 10-6 cm5/dyna, respectively, P < 0.01; ICC2,1 = 0.40). The 24-h AASI was reduced after bouts of MCT vs. CTL (1st and 2nd bouts of MCT vs. CTL: mean diff = - 0.32 and - 0.29 units, respectively, P < 0.001; ICC2,1 = 0.64). CONCLUSION: A single bout of MCT reduces arterial stiffness during laboratory (60 min) and ambulatory (24 h) recovery phases in patients with chronic stroke with moderate-to-high reproducibility. TRIAL REGISTRATION: Ensaiosclinicos.gov.br identifier RBR-5dn5zd.

Accuracy of Palpation Procedures for Locating the C1 Transverse Process and Masseter Muscle as Confirmed by Computed Tomography Images.

OBJECTIVE: The purpose of this study was to examine the accuracy of palpation methods for locating the transverse processes of the first cervical vertebra and masseter muscle using radiographic images as the gold-standard method and the association between personal characteristics with the observed accuracy. METHODS: This was a single-blinded, diagnostic accuracy study. Ninety-five participants (49 women, 58 ± 16 years of age) were enrolled in this study. A single examiner palpated the neck and face region of all participants to identify the transverse processes of the first cervical vertebra and masseter muscles bilaterally. In sequence, participants underwent a multislice computed tomography scan for assessment of the superimposed inner body structure. Two radiologists assessed the computed tomography images using the same criteria and were blinded regarding each other's assessment and the anatomic landmarks under investigation. The palpation accuracy was calculated as the proportion of the correctly identified landmarks in the studied sample. The correlation of the palpation outcome (correct = 1; incorrect = 0) with age, sex (male = 1; female = 0), and body mass index was investigated using the point-biserial correlation coefficient. RESULTS: The right and left transverse processes were correctly located in 76 (80%) and 81 (85%) participants, respectively, and bilaterally in 157 events (83%), as evaluated by the consensus of the 2 radiologists. The masseter muscles were correctly localized bilaterally in 95 of 95 (100%) participants. Body mass showed statistical evidence of a weak, positive correlation with the correct location of the transverse processes of the first cervical vertebra at the right body side (r = .219; 95% confidence interval, 0.018-0.403; P = .033). CONCLUSION: Palpation methods used in this study accurately identified the location of the first cervical vertebra spinous processes and the masseter muscles.

Transcranial direct current stimulation combined with trunk-targeted, proprioceptive neuromuscular facilitation in subacute stroke: a randomized controlled trial.

Background: Stroke is the foremost cause of death and disability worldwide. Improving upper extremity function and quality of life are two paramount therapeutic targets during rehabilitation. Aim of the study: To investigate the effects of transcranial direct current stimulation (tDCS) combined with trunk-targeted proprioceptive neuromuscular facilitation (PNF) on impairments, activity limitations, and participation restrictions of subjects with subacute stroke. Methodology: Fifty-four subjects with subacute stroke were divided into three groups using block randomization. All three groups received rehabilitation sessions lasting 90 min in duration, four times per week, for 6 weeks. Group 1 (n = 18) received conventional physical therapy (CPT); group 2 (n = 18) received CPT, trunk-targeted PNF, and sham tDCS; and group 3 (n = 18) received CPT, trunk-targeted PNF, and bihemispheric motor cortex stimulation with tDCS. Changes in motor impairment, motor activity, and health-related quality of life assessments were outcome measures. Results: A two-way linear mixed model analysis revealed interaction effects (group × time) for all outcome measurements (Trunk Impairment Scale, Fugl-Meyer Assessment of Motor Recovery after stroke upper extremity subsection, Wolf Motor Function Test, 10-Meter Walk Test, and the Stroke-Specific Quality of Life scale; all p < 0.01 or lower). Overall, post-pre mean differences demonstrate more substantial improvement in the active tDCS group, followed by sham stimulation associated with the PNF group and the group that received CPT alone. Conclusion: Trunk-targeted PNF combined with bihemispheric tDCS along with CPT engender larger improvements in upper extremity and trunk impairment, upper limb function, gait speed, and quality of life in the subacute stroke population.

Does group-based high-intensity aerobic interval training improve the inflammatory status in patients with chronic heart failure?

BACKGROUND: Chronic heart failure (CHF) is a multifaceted syndrome associated with endothelial dysfunction and increased inflammation. Despite the existing controversies regarding the appropriate training modality, it is widely accepted that supervised cardiac rehabilitation (CR) interventions lead to proinflammatory biomarkers reduction and cellular adhesion molecules in patients with CHF. AIM: The aim of the study was to quantify the effects of 12-week group-based high-intensity aerobic interval training (HIAIT)/modified group-based HIAIT intervention (m-Ullevaal) vs. moderate continuous training (MICT) on serum levels of proinflammatory biomarkers. DESIGN: Single-blind, two-arm, prospective randomized controlled trial conducted on CHF outpatients performing group-based CR interventions throughout a 12-week period. SETTING: The setting of the study was the Medical Center of Outpatient Rehabilitation and Sports Medicine, Plovdiv, Bulgaria. POPULATION: The population included a total of 120 outpatients of both genders, mean age of 63.73±6.68 years, with stable CHF (NYHA classes II to IIIB, were randomly assigned to HIAIT/ m-Ullevaal (N.=60) or to MICT (N.=60) group. METHODS: Functional exercise capacity (FEC) of the eligible subjects was evaluated through 6-minute walk test (6MWT) and peak oxygen uptake. Blood samples were drawn at baseline, after 12 weeks follow-up for analyses of C-reactive protein (CRP), tumor necrosis factor-α (TNFα) and cellular adhesion molecules (CAM). RESULTS: Significant decreases in the serum levels of CRP (P=0.029), TNF-α (P=0.036), and vascular cell adhesion molecule-1 (VCAM-1) (P=0.040), were observed after 48 training sessions in the group-based HIAIT/m-Ullevaal intervention, except for intercellular adhesion molecule-1 (ICAM-1), which was higher in the MICT (P=0.034). FEC was significantly inversely related to CRP (r=-0.72, P<0.05), and the levels of VCAM-1 (r=-0.68, P<0.05). CONCLUSIONS: Both group-based CR interventions (HIAIT/m-Ullevaal and MICT) significantly reduced the serum levels of CRP, TNF- α, ICAM-1 and VCAM in patients with CHF. However, selected proinflammatory biomarkers changes and CAMs favorably decreased in the group-based HIAIT/m-Ullevaal intervention. The responses on serum levels of proinflammatory biomarkers and CAMs are dependent upon the type, intensity, and CR intervention duration. CLINICAL REHABILITATION IMPACT: The group-based high-intensity aerobic interval training reduces significantly the proinflammatory biomarkers and cellular adhesion molecules in patients with chronic heart failure.

Musculoskeletal Pain and Musical Performance in First and Second Violinists of Professional Youth Chamber Orchestras: A Comparative Study.

OBJECTIVE: First and second violinists in orchestras use identical instruments, but the motor patterns used to execute the different notes may vary between the two groups and the biomechanical gestures may influence musculoskeletal complaints. The primary objective of this study was to compare the pain intensity and interference in musical performance of first and second violinists of professional youth chamber orchestras. Second, to investigate the correlation between pain and the musical practice profile in this population. METHODS: This cross-sectional study enrolled 74 violinists, aged 12 to 17 years, from three professional youth chamber orchestras in Brazil. Participants completed a validated self-administered questionnaire, the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians-Brazilian version (MPIIQM-Br). Variables related to musical practice profiles were also recorded. Data analysis applied t-tests for independent samples and Pearson's correlation coefficient. RESULTS: The sample of first violinists (n=39) presented 23 males and 16 females, and the second violinists (n=35) included 23 females and 12 males. The mean age was 13.9 yrs (SD 1.1) and 14.1 yrs (1.0) for the first and second violinist groups, respectively. Most participants (n=66, 89%) reported pain in at least one moment of their career, and 54 (76%) reported pain at the time of data collection. A higher pain prevalence was identified in the right shoulder (37.7%), in 28.2% of the second violinists and 9.4% of the first. The second violinists presented higher scores for most variables related to pain intensity and pain interference in performance (p < 0.05). A correlation was observed between time working at a professional level and the number of affected areas on the body pain map (r=0.30; 95% CI 0.23-0.42) and between the hours of daily practice and the number of affected areas on the body pain map (r=0.39; 95% CI 0.29-0.45). CONCLUSION: Second violinists had more complaints of pain and difficulty in playing their instrument compared to the first violinists. The study also found a correlation between the number of body areas with pain complaints and variables linked to the violinists' practice profile.

Craniocervical Posture Assessed With Photogrammetry and the Accuracy of Palpation Methods for Locating the Seventh Cervical Spinous Process: A Cross-sectional Study.

OBJECTIVE: The purpose of this study was to compare craniocervical posture assessed by photogrammetry using 2 distinct palpation methods for locating the spinous process of the seventh cervical vertebra (C7SP). METHODS: This cross-sectional study was conducted in 2 phases. In phase I (n = 42), the assessor's accuracy in locating the C7SP using the flexion-extension and the modified thorax-rib static methods was compared to radiography. In phase II (n = 68), the craniocervical posture was analyzed with photogrammetry after palpation using the 2 methods. Neck pain intensity and disability were also determined. RESULTS: The accuracy in locating the C7SP was higher using the modified thorax-rib static method (67%, 95% confidence interval [CI], 55-79) compared to the flexion-extension method (38%, 95% CI, 26-50, P = .016). Lower values of the craniocervical angle were obtained with the flexion-extension method than the modified thorax-rib static method (mean difference = -1.1°, 95% CI, -1.6 to -0.6, P < .001). However, both palpation methods resulted in similar classifications of participants as with or without forward head posture (P = .096). Weak correlations were observed between the craniocervical angle and neck pain intensity (ρ = -0.088 and -0.099, respectively) and disability (ρ = -0.231 and -0.249, respectively). CONCLUSION: Craniocervical angles obtained using palpation methods with different accuracies were different, although the magnitude of the difference was insufficient to lead to different classifications of a forward head posture in adults with mild neck pain and disability. Craniocervical posture was weakly correlated with neck-pain intensity and disability.

Group-based cardiac rehabilitation interventions. A challenge for physical and rehabilitation medicine physicians: a randomized controlled trial.

BACKGROUND: In recent decades, many studies are focused on different training modalities comparison in patients with cardiac diseases. High intensity aerobic interval training (HIAIT) has been considered as an alternative approach to moderate-intensity continuous training (MICT) in rehabilitation of patients with chronic heart failure (CHF). AIM: To highlight the superiority of the modified group-based HIAIT intervention (m-Ullevaal) compared to the moderate-intensity continuous training (MICT), also to encourage physical and rehabilitation medicine (PRM) physicians to apply the m-Ullevaal intervention in routine cardiac rehabilitation (CR) practice. DESIGN: А single-blind, prospective randomized controlled trial. SETTING: Medical Center of Rehabilitation and Sports Medicine, Plovdiv, Bulgaria outpatients were enrolled. POPULATION: One hundred and twenty subjects of both genders, mean age of 63.73±6.68 years, with stable CHF, NYHA classes II to IIIB, were randomly assigned to m-Ullevaal group (N.=60) or to MICT (N.=60) group. Both CR protocols were conducted throughout a 12-week period. METHODS: Functional exercise capacity (FEC), assessed with six-minute walk test, and peak oxygen uptake (VO2peak), left ventricular ejection fraction (LVEF), m-Borg's perceived exertion scale (mBPES), and quality of life (QoL) were outcome measures evaluated. RESULTS: Significant improvement in FEC (P<0.001), LVEF (P<0.001), mBPES and QoL (P<0.001), was observed 12 weeks after both CR interventions (T2). However, the participants performed m-Ullevaal protocol achieved a greater improvement compared to those performed MICT (P<0.001). CONCLUSIONS: The m-Ullevaal protocol seems to be more beneficial and more effective compared to MICT. PRM physicians can efficiently apply the m-Ullevaal protocol in CHF patients rehabilitation. CLINICAL REHABILITATION IMPACT: Group-based HIAIT interventions can be widely applied by PRM physicians in CHF patients rehabilitation.

Photogrammetric Variables Used by Physical Therapists to Detect Neck Pain and to Refer for Physiotherapeutic Intervention: A Cross-Sectional Study.

OBJECTIVE: The purpose of this study were as follows (1): to investigate photogrammetry variables that physiotherapists may detect by visually inspecting the static body posture that distinguishes young adults with or without neck pain, which may lead to referral to a physiotherapy intervention, and (2) to assess the reliability of postural assessment and clinical decision-making. METHODS: We conducted a cross-sectional, observational, balanced, controlled, single-blinded study. Fourteen physiotherapists aged 33 (6) years were recruited as raters for postural assessment of adults aged 28 (7) years with (n = 30) or without neck pain (n = 30). Photogrammetry was performed to quantify the static body posture alignments and angles. Visual inspection was performed to indicate the presence of postural misalignment and neck pain and to refer to physiotherapy intervention. RESULTS: Symptomatic participants showed low- to moderate-intensity neck pain, a high frequency of chronic neck pain, and low disability scores. Photogrammetry analysis revealed no statistically significant difference between groups. Classification of the participants according to the raters' visual inspection yielded sets of photogrammetry variables with significant differences, with a large variability among those sets. Intrarater and interrater reliability of photogrammetry varied from moderate to excellent (intraclass correlation coefficient2,1 = [0.502; 0.995]; intraclass correlation coefficient2,2 = [0.564; 0.996). Interrater reliability for visual inspection was no better than chance (κLight = -0.013 to 0.011; ι = -0.002). CONCLUSION: Neither photogrammetry nor visual inspection distinguished the presence of neck pain in young adults. Using visual inspection, physiotherapists had unreliable clinical decision-making owing to high variability of photogrammetry variables used to distinguish postural misalignments, the presence of neck pain, and whether to refer young adults for physiotherapy intervention.

Predictive models for the six-minute walk test considering the walking course and physical activity level.

BACKGROUND: In recent decades, space limitations in the clinical environment have forced health professionals to administer the six-minute walk test (6MWT) using a 20-m or even a 10-m course. However, course length and physical activity level (PAL) affect the test outcomes. AIM: To develop a reference equation for the 6MWT that takes into account the effects of course length and PAL on the walking distance. DESIGN: Cross-sectional study. SETTING: Federal University of the State of Rio de Janeiro. POPULATION: Two hundred fifteen healthy adults. METHODS: All subjects performed the 6MWT on 10-, 20- and 30-m courses. Eight regression models were constructed considering the association between the six-minute walking distance (6MWD) and heart rate, perceived effort (scores from the Borg's Perceived Exertion Scale-BPES), PAL (classification according to the International Physical Activity Questionnaire, IPAQ), as well as anthropometric and demographic variables. The models were analyzed for the coefficients of determination (R2) and statistical significance at P<0.05. RESULTS: A nonlinear increase in the means of the 6MWDs obtained using the three course lengths was observed (591±70, 652±79 and 678±85 m for course lengths of 10, 20 and 30 m, respectively, with P<0.001). The 6MWD correlated positively with the following variables: sex (r=0.20), body height (r=0.30), IPAQ classification (r=0.14), ΔBPES rating (r=0.25) and Δheart rate (HR, r=0.23), with P<0.001 for all. In contrast, the 6MWD correlated negatively with age (r=-0.23) and Body Mass Index (BMI, r=-0.18), with P<0.001 for both. The regression model with the highest coefficient of determination (adjusted R2=0.36) included the following variables: sex, age, BMI, course length (CL), BPES, HR, and IPAQ. CONCLUSIONS: The length of the course strongly impacts individual performance on the 6MWT in a predominantly young adult population. Furthermore, IPAQ-assessed PAL is an important independent predictor of 6MWD. CLINICAL REHABILITATION IMPACT: The incorporation of course length in the prediction of 6MWD allows the use of a prediction equation that includes the effects of different course sizes. PAL should be used in the prediction of 6MWD.

Patients with Subacromial Pain Syndrome Present no Reduction of Shoulder Proprioception: A Matched Case-Control Study.

BACKGROUND: Shoulder pain is common among patients with musculoskeletal pain and the prevalence of patients with subacromial pain syndrome (SAPS) is high. Despite the high prevalence, there is a lack of an extensive evaluation of the proprioception acuity in patients with SAPS. Knowledge of the proprioceptive deficit would assist clinicians in the proper treatment and may offer an alternative explanation for the mechanisms underlying SAPS, which are poorly understood. OBJECTIVE: To compare the proprioceptive function of the shoulder in patients with SAPS and matched controls. STUDY DESIGN: Matched case-control study. SETTING: Physical Functional Rehabilitation Service of an outpatient clinic. PARTICIPANTS: A total of 32 consecutive patients with SAPS who sought physical therapy for shoulder pain and 32 healthy participants (control group) matched for age, sex, and handedness. INTERVENTIONS: All participants completed a questionnaire containing sociodemographic information, pain intensity and characteristics, the Numerical Pain Rating Scale, and the Shoulder Pain and Disability Index. MAIN OUTCOME MEASUREMENTS: The proprioceptive assessment was performed through kinesthesia, passive joint position sense (PJPS), and the active joint position sense (AJPS). RESULTS: The groups showed no statistically significant differences in kinesthesia, PJPS, and AJPS for internal or external rotation. The proprioceptive acuity was not associated with pain intensity or functional disability in patients with SAPS. CONCLUSIONS: Participants with SAPS did not present proprioceptive deficits in a pain-free motion of medial and lateral rotation when compared to their matched controls. The proprioceptive deficit may not be involved with the mechanisms underlying SAPS and seems not to interfere with the clinical outcomes of patients with SAPS. LEVEL OF EVIDENCE: Level III.

Pragmatic Combinations of Acupuncture Points for Lateral Epicondylalgia are Unreliable in the Physiotherapy Setting.

This study describes the reliability of pragmatic combinations of acupuncture points for lateral epicondylalgia (LE) as prescribed by physiotherapists who were experts in acupuncture. Raters (n = 14; 33-59 years) independently prescribed acupuncture points for 30 simulated human patients with LE who were surveyed via a printed questionnaire. The frequency and cooccurrence of acupuncture points prescribed for patients with lateral epicondylitis were assessed. Absolute agreement and Light's kappa (κLight) with 95% confidence interval (CI) were used to quantify the interrater agreement. Raters prescribed 103 unique acupuncture points in different combinations with a median (min-max) of 5 (0-11) acupuncture points. The most prescribed acupuncture point was LI-11 (297 of 420; 71%), and the most common cooccurring acupuncture points were LI-11 and LI-4 (160 of 420; 38%). The absolute agreement for prescribing the acupuncture points ranged from 70% (point GB-20) to 0% (points LI-10, SP-6, LI-11, GB-34, LI-12, and LI-4). Point LR-3 showed the highest interrater reliability for prescribing the acupuncture points [κLight = 0.112, 95% CI = (0.055-0.194)], whereas point LI-4 showed the lowest reliability [κLight = -0.003, 95% CI = (-0.024 to 0.024)]. These findings suggest that pragmatic prescriptions of acupuncture points for LE are unreliable among physiotherapists who are experts in acupuncture. Explicit, high-level evidence-based rules for prescribing and teaching combinations of acupuncture points for LE are warranted.

Home-based exercise program in TSP/HAM individuals: a feasibility and effectiveness study.

OBJECTIVE: To investigate the feasibility and effectiveness of a home-based exercise program in TSP/HAM individuals. METHODS: Twenty-three TSP/HAM individuals divided in two groups according to Timed Up and Go (TUG) score (<20s vs ≥20s) performed a 20-week home-based exercise program. The primary outcomes were exercise adherence, maximum voluntary isometric contraction of lower limbs (MVIC), Barthel Index and SF-36. Secondary outcomes were adverse effects and barriers to exercise practice. RESULTS: MVIC and the social functioning domain in SF-36 improved significantly in TUG <20s group. The individuals in the TUG ≥20s group improved significantly their physical functioning domain in SF-36. The total adherence to the 20-week home-based exercise program was 90%. There were mild to moderate adverse events related to exercise program. There were no adverse events related to MVIC test. CONCLUSIONS: The home-based exercise program was feasible and effective in improving disability and quality of life in individuals with TSP/HAM.

Home-based exercise program in TSP/HAM individuals: a feasibility and effectiveness study / Programa de exercícios domiciliares em indivíduos com PET/MAH: um estudo de viabilidade e efetividade

ABSTRACT Objective To investigate the feasibility and effectiveness of a home-based exercise program in TSP/HAM individuals. Methods Twenty-three TSP/HAM individuals divided in two groups according to Timed Up and Go (TUG) score (<20s vs ≥20s) performed a 20-week home-based exercise program. The primary outcomes were exercise adherence, maximum voluntary isometric contraction of lower limbs (MVIC), Barthel Index and SF-36. Secondary outcomes were adverse effects and barriers to exercise practice. Results MVIC and the social functioning domain in SF-36 improved significantly in TUG <20s group. The individuals in the TUG ≥20s group improved significantly their physical functioning domain in SF-36. The total adherence to the 20-week home-based exercise program was 90%. There were mild to moderate adverse events related to exercise program. There were no adverse events related to MVIC test. Conclusions The home-based exercise program was feasible and effective in improving disability and quality of life in individuals with TSP/HAM.

RESUMO Objetivo Investigar a viabilidade e eficácia de um programa de exercícios domiciliares (PED) em indivíduos com PET/MAH. Métodos 23 indivíduos com PET/MAH divididos em dois grupos conforme teste Timed Up and Go - TUG (<20s vs ≥20s) realizaram o PED durante 20 semanas. Desfechos primários – adesão aos exercícios, contração isométrica voluntária máxima dos membros inferiores (CIVM), Índice de Barthel e SF-36. Desfechos secundários – ocorrência de eventos adversos e presença de barreiras à prática de exercícios. Resultados CIVM e componente “Aspectos Sociais” da SF-36 aumentaram significativamente no grupo TUG <20s. Os indivíduos do grupo TUG ≥20s aumentaram significativamente componente “Capacidade Funcional” da SF-36. A adesão ao PED foi de 90%. Foram observados eventos adversos de intensidade leve a moderada relacionados ao PED. Não foram encontrados eventos adversos relacionados à CIVM. Conclusões O PED é viável e eficaz em melhorar a incapacidade e a qualidade de vida de indivíduos com PET/MAH.

Locating the Seventh Cervical Spinous Process: Development and Validation of a Multivariate Model Using Palpation and Personal Information.

OBJECTIVE: The aim of this study was to develop and validate a multivariate prediction model, guided by palpation and personal information, for locating the seventh cervical spinous process (C7SP). METHODS: A single-blinded, cross-sectional study at a primary to tertiary health care center was conducted for model development and temporal validation. One-hundred sixty participants were prospectively included for model development (n = 80) and time-split validation stages (n = 80). The C7SP was located using the thorax-rib static method (TRSM). Participants underwent chest radiography for assessment of the inner body structure located with TRSM and using radio-opaque markers placed over the skin. Age, sex, height, body mass, body mass index, and vertex-marker distance (DV-M) were used to predict the distance from the C7SP to the vertex (DV-C7). Multivariate linear regression modeling, limits of agreement plot, histogram of residues, receiver operating characteristic curves, and confusion tables were analyzed. RESULTS: The multivariate linear prediction model for DV-C7 (in centimeters) was DV-C7 = 0.986DV-M + 0.018(mass) + 0.014(age) - 1.008. Receiver operating characteristic curves had better discrimination of DV-C7 (area under the curve = 0.661; 95% confidence interval = 0.541-0.782; P = .015) than DV-M (area under the curve = 0.480; 95% confidence interval = 0.345-0.614; P = .761), with respective cutoff points at 23.40 cm (sensitivity = 41%, specificity = 63%) and 24.75 cm (sensitivity = 69%, specificity = 52%). The C7SP was correctly located more often when using predicted DV-C7 in the validation sample than when using the TRSM in the development sample: n = 53 (66%) vs n = 32 (40%), P < .001. CONCLUSIONS: Better accuracy was obtained when locating the C7SP by use of a multivariate model that incorporates palpation and personal information.

Locating the Seventh Cervical Spinous Process: Accuracy of the Thorax-Rib Static Method and the Effects of Clinical Data on Its Performance.

OBJECTIVES: The aim of this study was to assess the thorax-rib static method (TRSM), a palpation method for locating the seventh cervical spinous process (C7SP), and to report clinical data on the accuracy of this method and that of the neck flexion-extension method (FEM), using radiography as the gold standard. METHODS: A single-blinded, cross-sectional diagnostic accuracy study was conducted. One hundred and one participants from a primary-to-tertiary health care center (63 men, 56 ± 17 years of age) had their neck palpated using the FEM and the TRSM. A single examiner performed both the FEM and TRSM in a random sequence. Radiopaque markers were placed at each location with the aid of an ultraviolet lamp. Participants underwent chest radiography for assessment of the superimposed inner body structure, which was located by using either the FEM or the TRSM. RESULTS: Accuracy in identifying the C7SP was 18% and 33% (P = .013) with use of the FEM and the TRSM, respectively. The cumulative accuracy considering both caudal and cephalic directions (C7SP ± 1SP) increased to 58% and 81% (P = .001) with use of the FEM and the TRSM, respectively. Age had a significant effect on the accuracy of FEM (P = .027) but not on the accuracy of TRSM (P = .939). Sex, body mass, body height, and body mass index had no significant effects on the accuracy of both the FEM (P = .209 or higher) and the TRSM (P = .265 or higher). CONCLUSIONS: The TRMS located the C7SP more accurately compared with the FEM at any given level of anatomic detail, although both still underperformed in terms of acceptable accuracy for a clinical setting.