Virtual reality-based therapy after anterior cruciate ligament injury effectively reduces pain and improves knee function, movement patterns, and dynamic balance: A systematic review and meta-analysis.

PURPOSE: Virtual reality-based therapy (VRBT) may be an effective physical therapy complement employed in the rehabilitation of patients with anterior cruciate ligament (ACL) injury. This study aims to assess the effectiveness of VRBT in improving pain, knee function, strength, proprioception, flexion range of motion (ROM), and dynamic balance after ACL injury. METHODS: We conducted this systematic review with meta-analysis following PRISMA criteria. Since inception to June 2024, we searched in PubMed Medline, WOS, SCOPUS, CINAHL and PEDro without publication date and language restrictions. Randomised controlled trials (RCTs), comprising only patients with ACL injury, that assess the effectiveness of VRBT compared to classical interventions on the outcomes of interest were included. PEDro scale was employed to analyze the methodological quality of the RCTs included. Cohen's standardised mean difference (SMD) and its 95% confidence interval (95% CI) was used to calculate the pooled effect in meta-analyses. RESULTS: Nine RCTs, providing data from 330 participants (26.96 ± 3.11 years, 85% males) were included. The RCTs included showed good methodological quality (PEDro scale = 6.88 points), being, performance and detection biases, the most common biases reported. Meta-analyses showed that VRBT was more effective than classical interventions in reducing pain (SMD = -1.15; 95% CI -1.85 to -0.45; p = 0.001; I2 = 0%), and increasing knee function (SMD = 1.71; 95% CI 0.93 to 2.5; p < 0.001; I2 = 0%), strength (SMD = 0.82; 95% CI 0.4-1.23; p < 0.001; I2 = 0%) and flexion ROM (SMD = 0.7; 95% CI 0.37-1.01; p < 0.001; I2 = 0%). Additionally, VRBT improved postero-medial (SMD = 0.46; 95% CI 0.01-0.9; p = 0.045; I2 = 15.1%) and postero-lateral CoP excursion (SMD = 0.75; 95% CI 0.3-1.21; p = 0.001; I2 = 0%), being effective in improving dynamic balance. CONCLUSION: VRBT is an effective physical therapy complement to be included in the ACL's rehabilitation programmes due to reduces pain and increases knee function, strength, ROM and dynamic balance after ACL injury. LEVEL OF EVIDENCE: Level II evidence.

Triagem otoneurológica em trabalhadores expostos à altura / Otoneurological screening in workers exposed to height / Triaje otoneurológica en trabajadores expuestos a la altura

O trabalho em altura está entre as principais causas de acidentes ocupacionais no Brasil e é o fator que apresenta o maior risco de morte no ambiente laboral. Objetivo: Avaliar a presença de sinais e sintomas otoneurológicos em trabalhadores expostos à altura, no Distrito Federal. Método: Trata-se de um estudo observacional, transversal, de triagem otoneurológica, com 46 trabalhadores da construção civil, expostos à altura, localizados no Distrito Federal. Resultados: 52,2% dos participantes apresentaram alterações significativas no teste de Fukuda e correlação estatisticamente relevante (valor-p< 0.05) entre a média da idade e as queixas de tontura e desequilíbrio. Conclusão: A triagem mostrou-se uma ferramenta prática rápida, de baixo custo e eficaz para avaliar as queixas, sinais, sintomas e alterações otoneurológicas que podem comprometer a segurança do trabalhador quanto ao risco de queda.

Working at height is among the leading causes of occupational accidents in Brazil and is the factor that presents the greatest risk of death in the workplace. Objective: To evaluate the presence of otoneurological signs and symptoms in workers exposed to heights in the Federal District. Method: This is an observational, cross-sectional study of otoneurological screening, with 46 construction workers exposed to heights, located in the Federal District. Results: 52.2% of the participants had significant alterations in the Fukuda test and a statistically relevant correlation (p-value < 0.05) between the mean age and complaints of dizziness and unbalance. Conclusion: The screening proved to be a quick, low-cost and effective practical tool to assess complaints, signs, symptoms, and otoneurological changes that may jeopardize the safety of the worker as to the risk of falling.

El trabajo en altura está entre las principales causas de accidentes laborales en Brasil y es el factor que presenta mayor riesgo de muerte en el lugar de trabajo. Objetivo: Evaluar la presencia de signos y síntomas otoneurológicos en trabajadores expuestos a la altura, en el Distrito Federal. Método: Se trata de un estudio observacional, transversal, de triaje otoneurológico, con 46 trabajadores de la construcción, expuestos a la altura, ubicados en el Distrito Federal. Resultados: el 52,2% de los participantes mostró cambios significativos en el test de Fukuda y una correlación estadísticamente relevante (valor p < 0,05) entre la edad promedio y las quejas de mareos y desequilibrio. Conclusión: El screening demostró ser una herramienta práctica rápida, de bajo costo y efectiva para evaluar quejas, signos, síntomas y cambios otoneurológicos que podrían comprometer la seguridad del trabajador frente al riesgo de caída.

Effects of pain exacerbation on postural control in women with patellofemoral pain during single leg squat: a cross-sectional study.

BACKGROUND: The center of pressure (COP) excursion parameters are recognized as risk factors for the etiology and development of patellofemoral pain (PFP). The purpose of the present study measures the effect of pain exacerbation on COP excursion, and the correlation between pain intensity and COP excursion in women with PFP during single leg squat (SLS). METHODS: Sixty patients with PFP participated in this cross-sectional study. The outcome measures were included pain intensity and COP excursion which evaluated in pre and post pain exacerbation during SLS. The COP parameters were evaluated during single leg squat in 60° of knee flexion. A paired t-test and MANOVA was used to compare pain intensity and COP excursion between the two conditions, respectively. Furthermore, A Pearson's correlation matrix was used to examine the relationship between pain intensity with COP excursion. RESULTS: Statistical analysis showed that pain intensity (t = - 16.655, p < 0.001) and COP excursion (Wilks' Lambda = 0.225, p < 0.001) with medium effect size increased after PFJ loading. In addition, an excellent positive correlation was observed between increased in pain intensity and COP excursion (P < 0.001, r > 0.80). CONCLUSION: After PFJ loading, women with PFP presented increases in the pain intensity, COP excursions, and sway velocity. In addition, there was an association between the increase in pain intensity and COP excursions. Clinicians aiming to improve postural control of patients with PFP could use kinesio taping as a short-term intervention and balance training to improvements in postural control at medium and long-term. Furthermore, emphasizing psychological factors to reducing kinesiophobia can be useful to restoring proper movement pattern, reducing pain and improving symptoms.

Brazilian Version of the Vestibular Activities and Participation Measure: Cross-Cultural Adaptation, Validity, and Reliability.

BACKGROUND: Vestibular Activities and Participation Measure (VAP) subscales assess the effect of vestibular disorders on activity and participation. This study aimed to perform the cross-cultural adaptation and assess the validity, internal consistency, reliability, and measurement error of the Brazilian version of VAP subscales. METHODS: The cross-cultural adaptation followed the translation, synthesis, back-translation, review by a committee of experts, and pretesting phases. Structural validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), while Spearman's correlation between VAP subscales and the Dizziness Handicap Inventory (DHI) was used to assess construct validity. Cronbach's alpha measured internal consistency. Intraclass correlation coefficient (ICC) assessed intra- and inter-rater reliability, and measurement error was calculated by using the standard error of measurement (SEM) and minimal detectable change (MDC). RESULTS: Additional information was included in the Brazilian version of the Vestibular Activities and Participation measure (VAP-BR) after approval by one of the developers of the instrument to improve the understanding among individuals. One factor was found in the EFA for each subscale with 50% explained variance. Regarding CFA, the subscales 1 (S1) and 2 (S2) presented, respectively, adequate model fit indices (ie, comparative fit index of 0.99 and 0.97, and standardized root mean square residual of 0.04 for both subscales), but a very low factor load in item 6 of S1 (0.08). Chronbach's alpha was 0.80 (S1) and 0.82 (S2). For intra-rater assessment, the S1 and S2 presented an ICC of 0.87 and 0.90, SEM of 0.01 and 1.16, and MDC of 0.39 and 0.46, respectively. When assessed by 2 different raters, SEM values were 1.03 and 1.53, and MDC values were 2.85 and 4.23 for S1 and S2, respectively; both subscales showed an ICC of 0.92. Correlations between DHI and VAP subscales presented coefficients above 0.57. CONCLUSION: The Brazilian version of VAP subscales presents good measurement properties and may assist health professionals in identifying activity limitations and participation restrictions in individuals with vestibular disorders.

Changes in lateral standing posture following orthognathic surgery: a cohort study.

Altering neuromuscular and musculoskeletal relationships also affects standing body posture, particularly in the head and neck areas. This prospective cohort study assessed the effects of orthognathic surgery on head posture in the lateral standing view. Thirty-one patients who underwent single-jaw orthognathic mandibular surgery were included. The patients underwent cephalometric and photographic evaluations of their habitual posture before and 6 months after surgery. The craniovertebral angle and Frankfort angle were determined and measured using MB-Ruler software. Mandibular positional changes were also measured by superimposing lateral cephalograms and recording changes in the menton point. All data were analysed by paired t-test. The craniovertebral angle increased significantly in patients with Class II malocclusion (P = 0.001) and decreased significantly in Class III patients (P = 0.004). Furthermore, the Frankfort angle was significantly increased in both Class II (P = 0.005) and Class III (P = 0.012) patients. The tendency towards forward head posture decreased in Class II patients, and the neck posture improved. Conversely, a slight but significant tendency towards a forward head posture was observed in Class III patients after surgery. Furthermore, the natural head position changed in both study groups, leading to a more upright head posture.

Vestibular Rehabilitation Using Dynamic Posturography: Objective and Patient-Reported Outcomes from a Randomized Trial.

OBJECTIVE: Balance deficits are common and debilitating. Standard treatments have limitations in addressing symptoms and restoring dynamic balance function. This study compares a rehabilitative computerized dynamic posturography (CDP) protocol, computerized vestibular retraining therapy (CVRT), with a home exercise program (HEP) for patients with objectively confirmed unilateral vestibular deficits (UVDs). STUDY DESIGN: Single-center, randomized, interventional trial, with 1-sided crossover. SETTING: A tertiary neurotology clinic. METHODS: Patients with UVDs and Dizziness Handicap Inventory (DHI) score >30 were randomized to receive either CVRT or HEP. After completion of treatment, the HEP group was crossed over to CVRT. Outcome measures were the sensory organization test (SOT) and 3 participants reported dizziness disability measures: the DHI, Activity-Specific Balance Confidence Scale (ABC) scale, and Falls Efficacy Score-International (FES-I). RESULTS: We enrolled 37 patients: 18 participants completed CVRT and 12 completed HEP, 11 of whom completed the crossover. Seven participants withdrew. The CVRT group demonstrated a greater improvement in SOT composite score than the HEP group (P = .04). Both groups demonstrated improvement in participant-reported measures but there were no differences between groups (DHI: P = .2604; ABC: P = .3627; FES-I: P = .96). Following crossover to CVRT after HEP, SOT composite (P = .002), DHI (P = .03), and ABC (P = .006) improved compared to HEP alone. CONCLUSION: CVRT and HEP were both associated with improved participant-reported disability outcomes. CVRT was associated with greater improvement in objective balance than HEP. Adding CVRT after HEP was superior to HEP alone. Multimodal CDP-based interventions, such as CVRT, should be considered as an adjunct to vestibular physiotherapy for patients with UVD.

Hearing, Balance, and Mortality: Sex-Specific Patterns in a Longitudinal Study.

OBJECTIVES: Assess the association of hearing on sex-specific overall mortality and death from acute cardiovascular disease and evaluate if these effects are modulated by postural balance. STUDY DESIGN: Cohort study. SETTING: Otolaryngology department at an academic hospital. METHODS: Patients underwent standard clinical examination, laboratory examination including stabilometry and audiometry. Pure tone average on the best hearing ear was calculated from 0.5, 1, 2, and 3 kHz. Cause of death was retrieved from the Norwegian Cause of Death Registry. RESULTS: A total of 1036 patients (58.8% women) were followed for 26 ± 3 years. In Cox regression analyses for overall mortality adjusted for age, past medical history, and vestibular disease, 10 dB increase in hearing threshold was associated with a 14% increase in mortality among men (hazard ratio 95% confidence interval: 1.02-1.28, P = .02), but no significant association was seen between hearing and mortality in women (0.92-1.15, P = .60). The same analyses for acute cardiovascular death found that a 10 dB increase in hearing threshold was associated with a 57% increase in hazard ratio in men (1.21-2.05, P < .001), but no significant effect of hearing on survival was seen in women (P = .71). Adjusting for postural balance did not change the association between hearing and mortality. CONCLUSION: This study finds hearing threshold is associated with overall mortality and acute cardiovascular death among men, with no such association observed among women. Our findings indicate important differences between men and women and suggest that such differences should be taken into consideration in audiological research.

Evaluación del riesgo de caídas en adultos mayores con Diabetes Mellitus tipo 2 / Evaluation of fall risk assessmentin in older adults with Type 2 Diabetes Mellitus / Avaliação do risco de quedas em idosos com Diabetes Mellitus tipo 2

Introducción: La diabetes mellitus 2 es una enfermedad frecuente en adultos mayores, con múltiples complicaciones que pueden llegar a afectar el equilibrio y la marcha e incrementar el riesgo de caída. Objetivo: Determinar el riesgo de caídas en dos grupos de adultos mayores, uno con padecimiento de DM2 y otro sin este padecimiento. Metodología: Estudio de enfoque cuantitativo, alcance descriptivo, diseño observacional, y de cohorte transversal; muestra poblacional de 120 adultos mayores en la ciudad de Guayaquil divididos en dos grupos: grupo A con 60 adultos mayores que no padecían DM2 y grupo B con 60 adultos mayores con DM2; que cumplen con los criterios de inclusión y a quienes se evalúan mediante las técnicas: observación, evaluación y entrevista; y los instrumentos: Escala de Berg, Mini-BESTest y formulario estándar. Se utilizó la prueba estadística Chi cuadrado para la comparación de los resultados obtenidos. Resultados: Los resultados indican que, en la determinación del riesgo de caídas, se encontraron diferencias estadísticamente significativas (p0.05). El estudio además encontró que los resultados obtenidos, en las dos pruebas de riesgo de caídas, difieren entre sí. Conclusiones: Los adultos mayores diabéticos presentan un mayor riesgo de caída a comparación de adultos mayores no diabéticos.

Introduction: Diabetes mellitus 2 is a common disease in older adults, with multiple complications that can affect balance and gait and increase the risk of falling. Objective: To determine the risk of falls in two groups of older adults, one with and the other without DM2. Methodology: Quantitative approach study, descriptive scope, observational design, and cross-sectional cohort; population sample of 120 older adults in the city of Guayaquil divided into two groups: group A with 60 older adults who did not suffer from DM2 and group B with 60 older adults with DM2; who meet the inclusion criteria and who are evaluated by means of the techniques: observation, evaluation and interview; and the instruments: Berg scale, Mini-BESTestest and standard form. The Chi-square statistical test was used to compare the results obtained. Results: The results indicate that, in the determination of the risk of falls, statistically significant differences (p0.05) were found. The study further found that the results obtained, in the two fall risk tests, differed from each other. Conclusions: Diabetic older adults present a higher risk of falling compared to non-diabetic older adults.

Introdução: O diabetes mellitus tipo 2 é uma doença comum em idosos, com múltiplas complicações que podem afetar o equilíbrio e a marcha e aumentar o risco de quedas. Objetivo: Determinar o risco de quedas em dois grupos de idosos, um com DM2 e outro sem essa condição. Metodologia: Estudo com abordagem quantitativa, escopo descritivo, desenho observacional e coorte transversal; amostra populacional de 120 idosos da cidade de Guayaquil dividida em dois grupos: grupo A com 60 idosos que não sofriam de DM2 e grupo B com 60 idosos com DM2; que atendam aos critérios de inclusão e que sejam avaliados pelas técnicas: observação, avaliação e entrevista; e os instrumentos: Escala de Berg, Mini-BESTest e formulário padrão. O teste estatístico Qui-quadrado foi utilizado para comparação dos resultados obtidos. Resultados: Os resultados indicam que, na determinação do risco de quedas, foram encontradas diferenças estatisticamente significativas (p0,05). O estudo também constatou que os resultados obtidos nos dois testes de risco de queda diferem entre si. Conclusões: Idosos diabéticos apresentam maior risco de queda em comparação aos idosos não diabéticos.

Optokinetic stimulation for the treatment of vestibular and balance disorders: a systematic review with meta-analysis.

OBJECTIVES: To analyse the effectiveness of optokinetic stimulation (OKS) for improving symptoms and function in patients with vestibular and balance disorders. METHODS: PubMed (MEDLINE), SCOPUS, Web of Science (WOS), CINAHL Complete, and PEDro databases were searched to identify randomized controlled trials (RCTs) that included patients with vestibular and balance disorders and compared the effects of OKS versus other interventions or no intervention on subjective or objective functional outcomes. Data were analysed by the standardized mean difference (SMD) and its 95% confidence interval. RESULTS: A total of 10 studies were selected including 468 patients, 177 of whom received OKS. There were no significant differences in scores on the Dizziness Handicap Inventory (DHI) (SMD = 0.02; 95% CI - 0.18 to 0.23; p = 0.83) or the visual analogue scale (VAS) for vertigo (SMD = 0.16; 95% CI - 1.25 to 1.58; p = 0.82). However, there were statistically significant differences in the timed up and go (TUG) test, with a large effect (SMD = - 1.13; 95% CI -2 to - 0.28; p = 0.009), and in the sensory organization test (SOT), with a medium effect (SMD = - 0.7; 95% CI - 1.21 to - 0.19; p = 0.007). Subgroup analysis showed significant effects of OKS on VAS (p = 0.017), TUG (p = 0.009) and SOT (p = 0.001) only in patients with balance disorders without vestibular disease (p > 0.05). CONCLUSIONS: OKS may improve dizziness intensity measured with VAS or dynamic balance measured whit TUG and SOT in patients with balance disorders not due to vestibular disease. The quality of the evidence was low or very low due to the small number of included studies. PROSPERO REGISTRY NUMBER: CRD42023445024.

The effect of dyskinesia on postural control, balance, gait, and fall risk in people with Parkinson's disease: a systematic review protocol

Dyskinesia affects the limbs, trunk, and head and is more prevalent in people with Parkinson's disease (PD) and a history of falls. More evidence about the effects of dyskinesia on postural control, balance, gait, and fall risk could help improve the quality of life of individuals with PD. This review aims to examine associations between dyskinesia and postural control, balance, gait, and fall risk in individuals with PD. Such information could lead to new approaches to quality of life improvement among individuals with PD. PubMed, CINAHL, PsycInfo, Scopus, and SciELO will be searched for longitudinal, cohort, and case-control studies published in English or Portuguese in any year that investigated the association between dyskinesia and postural control, balance, gait, and fall risk in individuals with PD. Two reviewers will independently evaluate the titles, abstracts, and full texts according to PRISMA guidelines to select eligible studies for the review. Data on participants, dyskinesia, postural control, balance, gait, and fall risk will be extracted and summarized in tables. Two reviewers will independently assess the methodological quality of each study using the Newcastle Ottawa quality assessment scale. Meta-analysis will not be performed. The results of this systematic review will offer insight into the effects of dyskinesia on postural control, balance, gait, and fall risk. Such information could significantly contribute to informed decisions about early motor intervention in individuals with PD. (AU)

Comparativo da especificidade das escalas de Tinetti e SPPB na avaliação de idosos saudáveis e com disfunções neuromotoras no sul de Goiás / Comparison of the specificity of the tinetti and sppb scales in the assessment of healthy elderly people and those with neuromotor dysfunctions in southern Goiás

Introdução: o aumento da população idosa no mundo e as alterações fisiológicas decorrentes desse processo refletem a necessidade de boas ferramentas de avaliação para a identificação precoce de possíveis declínios. Objetivo: comparar os achados da avaliação pelas escalas Short Physical Performance Battery (SPPB) e Índice de Equilíbrio e Marcha de Tinetti validadas no Brasil, verificando a especificidade de cada escala na avaliação de idosos saudáveis e com disfunções neuromotoras. Métodos: 76 indivíduos, 43 saudáveis e 33 com disfunção neuromotora, de ambos os sexos, com idade mínima de 60 anos, residentes nos municípios de Caldas Novas-GO, Itumbiara-GO e Goiatuba-GO, foram avaliados em dias alternados pelas escalas SPPB e Tinetti. Resultados: os grupos apresentaram pontuações maiores nas avaliações pelo Índice Tinetti, o que sugere maior sensibilidade da SPPB na avaliação da marcha e do equilíbrio desses indivíduos. Conclusão: SPPB mostrou-se mais específica que o Índice de Tinetti, sendo capaz de detectar alterações que o Índice Tinetti não foi capaz de encontrar.

Introduction: the increase in the elderly population in the world and the physiological changes resulting from this process reflect the need for good assessment tools for the early identification of possible declines. Objective: to compare the assessment findings by the Short Physical Performance Battery (SPPB) and Tinetti's Balance and Gait Index validated in Brazil, verifying the specificity of each scale in the assessment of healthy elderly people and those with neuromotor dysfunctions. Methods: 76 individuals, 43 healthy and 33 with neuromotor dysfunction, of both sexes, aged at least 60 years, living in the cities of Caldas Novas-GO, Itumbiara-GO and Goiatuba-GO, were evaluated on alternate days by the SPPB and Tinetti scales. Results: the groups presented higher scores in the evaluations by Tinetti, which suggests greater sensitivity of the SPPB in the evaluation of gait and balance of these individuals. Conclusion: SPPB was more specific than Tinetti, being able to detect changes that the Tinetti Index was not able to find.

Assessment of Mobility Trajectories Using Wearable Inertial Sensors During Autologous Hematopoietic Cell Transplant.

OBJECTIVE: This study aimed to characterize mobility patterns using wearable inertial sensors and serial assessment across autologous hematopoietic cell transplant (autoHCT) and investigate the relation between mobility and perceived function in patients with hematologic cancer. DESIGN: Prospective longitudinal study. SETTING: Hospital adult transplant clinic followed by discharge. PARTICIPANTS: 78 patients with hematological cancer receiving autoHCT. MAIN OUTCOME MEASURES: Mobility was measured across 3 clinical phases (pretransplant, pre-engraftment, and post-engraftment) in using inertial sensors worn during prescribed performance tests in the hospital. Perceived function was assessed using validated provider-reported (Eastern Cooperative Oncology Group [ECOG] Performance Status Scale) and patient-reported [European Organization for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC QLQ-C30]) measures. Trajectories of 5 selected mobility characteristics (turn duration, gait speed, stride time variability, double support time, and heel strike angle) across the clinical phases were also evaluated using piecewise linear mixed-effects models. RESULTS: Using Principal Components Analysis, 4 mobility patterns were identified pretransplant: Gait Limitation, Sagittal Sway, Coronal Sway, and Balance Control. Gait Limitation measured pretransplant was significantly inversely associated with perceived function reported by the provider- (ß = -0.11; 95% CI: -0.19, -0.02) and patient- (ß = -4.85; 95% CI: -7.72, -1.99) post-engraftment in age-adjusted linear regression models. Mobility characteristics demonstrated immediate declines early pre-engraftment with stabilization by late pre-engraftment. CONCLUSION: Patients with hematological cancer experiencing gait limitations pretransplant are likely to have worse perceived function post-engraftment. Mobility declines in early phases post-transplant and may not fully recover, indicating an opportunity for timely rehabilitation referrals. Wearable inertial sensors can be used to identify early mobility problems and patients who may be at risk for future functional decline who may be candidates for early physical rehabilitation.

The rationale and recommendations for inclusion of screening for benign paroxysmal positional vertigo in falls clinics.

BACKGROUND: There have been many studies linking falls and benign paroxysmal positional vertigo. This article collates those studies, and demonstrates how a community falls service fast-tracked patients with benign paroxysmal positional vertigo by implementing validated screening tools and recognised guidance. OBJECTIVE: This study aimed to explore whether routine screening of referrals to a community falls service can identify those with benign paroxysmal positional vertigo, for fast-tracked management. METHODS: Patients referred to a community falls service were screened for possible benign paroxysmal positional vertigo using the Dizziness Handicap Inventory, and triaged to a physiotherapy-led falls and benign paroxysmal positional vertigo assessment service. RESULTS: Twenty-five per cent of patients were fast-tracked to a falls and benign paroxysmal positional vertigo assessment service for management. The community falls service waiting list reduced by 25 per cent. CONCLUSION: The data support incorporating assessment and treatment of benign paroxysmal positional vertigo into routine practice within all falls services.

Effects of whole-body vibration on chronic ankle instability: a systematic review.

Background and objective: Chronic ankle instability (CAI) is one of the most common sports injuries, and whole-body vibration (WBV) training has been used lately as a potential rehabilitation modality for these patients. The authors conducted a systematic review and meta-analysis to assess whether WBV training positively affects patients with CAI. Materials and methods: The authors systematically searched four databases, including MEDLINE (PubMed), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials, for randomized and non-randomized trials evaluating the effects of WBV on individuals with CAI. The authors used Cochrane RoB2 to assess the risk of bias in randomized trials. A meta-analysis was conducted if three or more studies measured the same outcome. Effect estimates were pooled using a random-effects model. Results: Results were retrieved from seven articles encompassing 288 participants who had CAI. The reach distance of the Star Excursion Balance Test (SEBT) was regarded as the study's main finding. The authors saw a significant training effect on certain planes of motion on dynamic balance. The findings showed that the post-intervention measurements in the WBV group compared to control groups showed improvements in the posterolateral, posteromedial, and medial directions, respectively. There were also promising results on improvements in muscle activity, strength, and proprioception sense measurements with a great diversity in the reported parameters. Conclusion: The authors observed a significant WBV training effect on dynamic balance over posterolateral, posteromedial, and medial reach distances. These findings suggest future studies on the effects of WBV on muscle activity, strength, and proprioception in addition to dynamic and static balance.

Effects of percussion massage therapy, dynamic stretching, and static stretching on physical performance and balance.

BACKGROUND: Percussion massage therapy is a popular approach in sport medicine for physical therapists, but few researchers have investigated the comparison with other intervention methods. OBJECTIVE: This study aimed to examine the comparison of the effects of dynamic stretching, static stretching and percussive massage therapy on balance and physical performance in individuals. METHODS: The participants who were 18-25 years of age, able to perform performance tests, did not have any orthopedic surgery, did not have problems during running and sudden turning, and did not have a professional sports history were included in the study. Participants were assigned randomly to three groups as dynamic stretching (DS) (n= 16), static stretching (SS) (n= 16) and percussive massage therapy (PMT) (n= 16) groups. Horizontal jumping test, T drill test and balance measurements on a single leg with open and closed eyes of all participants were recorded before and after applications. RESULTS: When the values of the pre and post-treatment of all groups in the study were compared, significant improvements were observed in the t-test, horizontal jumping test and right/left foot balance with eyes open in DS group (p< 0.05). Significant improvements were observed in all values in the PMT group (p< 0.05). In the comparison of the differences between the groups, PMT group values were more significant than the SS group in all parameters. CONCLUSION: Percussive massage therapy would be an alternative that can be used to increase the performance and balance of individuals before exercise.

Effects of the Anchor System on Postural Balance of Women Undergoing Breast Cancer Treatment: A Clinical, Randomized, Controlled, and Crossover Trial.

OBJECTIVE: Investigate the effects of multisensory training with and without the anchor system on breast cancer survivors' postural balance and self-efficacy of falls. DESIGN: Clinical randomized, controlled, and crossover trial. SETTING: Teaching, Research, and Assistance Center in Mastectomized Rehabilitation. PARTICIPANTS: Eighty breast cancer survivors homogeneously distributed in the groups of adults and elderly affected, or not, by lymphedema. INTERVENTIONS: Participants were randomized to multisensory training with and without the anchor system involving 3 sessions per week for 12 weeks. After the 4-week washout period, the remaining therapeutic intervention was applied. MAIN OUTCOME MEASURES: The primary outcome was semi-static and dynamic balance as evaluated by baropodometry and Mini Balance Evaluation Systems Test, and the secondary outcome was self-efficacy of the fall episode as assessed by Falls Efficacy Scale - International in the pre-, post-immediate, and 4-week follow-up period. RESULTS: Both therapeutic interventions caused positive and significant effects on postural balance and self-efficacy of falls in the immediate period. The multisensory training with the anchor system induced significant functional retention in the short term, related to the clinical effect of small to moderate variation. CONCLUSIONS: Multisensory training with the anchor system is convenient for postural balance and self-efficacy for falls, regardless of age and upper limb volume, for breast cancer survivors.

Effect of crutch and walking-boot use on whole-body angular momentum during gait.

Crutches are the most prescribed ambulatory assistive device and are used for mobility and maintaining weight-bearing restrictions after injury or surgery. However, standard axillary crutches (SACs) can lead to overuse and other injuries and restrict upper limb movement. Hands-free crutches (HFC) do not restrict upper limb movement but their effect on balance control, with or without commonly prescribed walking boots, is poorly understood. The purpose of this study was to compare the effect of crutch type (SACs vs. HFC) and boot use on whole-body angular momentum (RAM), a measure of balance control. Participant's balance confidence, pain, comfort, and device preference were assessed. Seventeen participants were evaluated while walking without a crutch (NONE), with SACs, and with an HFC, and walked with and without a walking boot in each crutch condition. The gait pattern used with SACs resulted in significantly greater limb angular velocity (p < .05), and an 84% increase in RAM (p < .001) as compared to the HFC. There were no differences between the SAC and HFC for balance confidence, pain, or comfort, however most (71.1%) participants preferred the HFCs. These results suggest that individuals can better control angular momentum with the HFCs and thus may be less susceptible to loss of balance.

Functional tests and isokinetic knee assessment in street runner athletes correlation / Correlación entre pruebas funcionales y evaluación isokinética de rodilla en practicantes de carrera de calle / Correlação entre testes funcionais e avaliação isocinética do joelho em atletas corredores de rua

ABSTRACT Introduction: The assessment of biomechanical changes related to the lower limbs is necessary in clinical practice to measure the potential risks of injury and the influences on existing dysfunction. Biomechanical changes related to previous ankle injuries are known to influence the performance of the entire lower limb. Objective: The aim of this study was to correlate muscle strength tests, performance tests and ankle stability with the Single Hop Test (SHT). Methods: 82 amateur runners were evaluated with isokinetic tests of quadriceps and hamstring muscle strength, as well as Y Balance Test (YBT), Weight-bearing Lung Test (WBLT), and the SHT. Results: The results showed there was a significant correlation between the SHT and the YBT in subjects with hamstring/quadriceps ratio (I/Q ratio) <0.55, and the length of the unilateral SHT with the peak torque of ipsilateral knee extensors. Conclusion: The study was successful in correlating the functional tests in question with the results obtained in isokinetic dynamometry. Level of Evidence V; Cross-Sectional Study.

RESUMEN Introducción: La evaluación de los cambios biomecánicos relacionados con las extremidades inferiores es necesaria en la práctica clínica para medir los riesgos potenciales de lesión y las influencias sobre la disfunción existente. Se sabe que los cambios biomecánicos relacionados con lesiones previas de tobillo influyen en el rendimiento de toda la extremidad inferior. Objetivo: Correlacionar las pruebas de fuerza muscular, las pruebas de rendimiento y la estabilidad del tobillo con la prueba de salto simple (Single Hop Test, SHT). Métodos: Se evaluó a 82 corredores aficionados con pruebas isocinéticas de fuerza muscular de cuádriceps e isquiotibiales, además de pruebas como Y Balance Test (YBT), Weight-bearing Lung Test (WBLT) y la prueba SHT. Resultados: Los resultados mostraron que existía una correlación significativa entre el SHT y el YBT en sujetos con ratio isquiotibiales/cuádriceps (ratio I/Q) <0,55, y la longitud del SHT unilateral con el par máximo de los extensores de la rodilla ipsilateral. Conclusión: El estudio logró correlacionar las pruebas funcionales en cuestión con los resultados obtenidos en la dinamometría isocinética. Nivel de Evidencia V; Estudio Transversal.

RESUMO Introdução: A avaliação de alterações biomecânicas relacionadas aos membros inferiores é necessária na prática clínica para mensurar os riscos potenciais de alguma lesão e as influencias sobre uma disfunção existente. As alterações biomecânicas relacionadas a lesões prévias de tornozelo são conhecidas pela influência na performance de todo o membro inferior. Objetivo: Correlacionar testes de força muscular, testes de performance e estabilidade do tornozelo com o teste de salto simples (Single Hop Test - SHT). Métodos: Foram avaliados 82 corredores amadores com testes isocinéticos de força muscular de quadríceps e isquiotibiais, além de testes Y Balance Test (YBT), Weight-bearing Lung Test (WBLT), e o SHT. Resultados: Os resultados demonstraram haver correlação significativa entre o SHT e o YBT nos indivíduos com relação Isquiotibiais/Quadríceps (relação I/Q) <0,55, e o comprimento do SHT unilateral com o pico de torque de extensores de joelho ipsilateral. Conclusão: O estudo foi bem sucedido em correlacionar os testes funcionais em questão com os resultados obtidos na dinamometria isocinética. Nível de Evidência V; Estudo Transversal.

Effect of 12 weeks of strength training on the static balance of the elderly / Efeito de 12 semanas de treinamento de força sobre o equilíbrio estático de idosos

Abstract Aging has a direct impact on balance due to changes in sensory and motor response, sarcopenia, reduced muscle strength and range of motion that occur in the elderly. In this context, strength training (ST) programs are seen as a valuable strategy to minimize the deleterious effect of aging on strength production and balance in this population. The purpose of the study was to evaluate the effect of 12 weeks of progressive intensity ST on static balance variables in the elderly. The study included 23 elderly with an average age of 65±8.61 years, of both sexes, who performed a twelve-week strength training program, with a frequency of three times a week and with progressive intensity (60 - 85% of 1-RM). Balance was assessed before and after the intervention period, through stabilometric assessment on a force plate. After the intervention, there was a reduction in the anteroposterior amplitude (p=0.01), in the anteroposterior velocity (p=0.01) and in the total displaced area (p=0.04). It is concluded that the strength training can be used as a key tool to minimize the deleterious effect of aging on the maintenance of static balance.

Resumo O envelhecimento tem impacto direto no equilíbrio devido a alterações da resposta sensorial e motora, sarcopenia e redução da força muscular e da amplitude de movimento que ocorre nos idosos. Nesse contexto, programas de treinamento de força (TF) são vistos como valiosa estratégia para minimizar o efeito deletério do envelhecimento na produção de força e no equilíbrio dessa população. O objetivo do estudo foi avaliar o efeito de 12 semanas de TF com intensidade progressiva sobre as variáveis de equilíbrio estático em idosos. Participaram do estudo 23 idosos com idade média de 65±8,61 anos, de ambos os sexos, que realizaram um programa de TF de doze semanas, com frequência de três vezes por semana e com intensidade progressiva (60 - 85% de 1-RM). O equilíbrio foi avaliado antes e após o período de intervenção, por meio de avaliação estabilométrica em plataforma de força. Após a intervenção houve redução na amplitude anteroposterior (p=0,01), na velocidade anteroposterior (p=0,01) e na área total deslocada (p= 0,04). Conclui-se que o treinamento de força pode ser utilizado como ferramenta chave para minimizar o efeito deletério do envelhecimento na manutenção do equilíbrio estático.

Equilíbrio postural e fatores associados ao risco de quedas em idosos com diabetes mellitus tipo 2 / Postural balance and associated factors with the fall risk assessed in older adults with type 2 diabetes mellitus

Resumo Objetivo Identificar os fatores clínico-funcionais associados ao risco de quedas, avaliado pelo Mini-BESTest, em idosos com diabetes mellitus tipo 2 (DM2). Método Trata-se de um estudo transversal. Um total de 145 idosos com idade =60 anos foram avaliados por meio das variáveis sociodemográficas (sexo, faixa etária, estado civil, nível de educação e percepção geral da saúde, audição e visão) Mini-BESTest, Mini-Mental State Examination (MMSE), Escala de Depressão Geriátrica (GDS-15) e o teste Timed Up and Go (TUG) (dupla tarefa). Foi utilizado um modelo de regressão logística múltipla. Resultados O domínio de orientação sensorial apresentou a pontuação média mais elevada, seguido pelos domínios estabilidade na marcha, ajustes posturais antecipatórios e respostas posturais. Os fatores associados ao risco de quedas em idosos foram: percepção visual ruim/muito ruim OR 3.40 (1,50-7,72); presença de doenças respiratórias OR 8.00 (1,32-48,46); sensação de tontura OR 2.53 (1,10-5,80); e tempo do teste Timed Up and Go (TUG) (dupla tarefa) igual ou superior a 13,5 segundos OR 3.31 (1,03-10,64). Conclusão Os idosos deste estudo apresentaram um equilíbrio postural comprometido, principalmente no domínio das respostas posturais. O conhecimento dos fatores associados ao risco de quedas em idosos com DM2 permite uma orientação mais eficaz na avaliação, prevenção e intervenção, visando minimizar a ocorrência de quedas e preservar ou otimizar o equilíbrio postural. Diversos fatores influenciaram esse resultado, tais como sobrepeso, baixa atividade física e nível educacional, várias comorbidades, polifarmácia, diagnóstico de DM2 por mais de dez anos, percepção negativa da saúde geral e da visão, e sintomas depressivos.

Abstract Objective Identify clinical-functional factors associated to the risk of falls, assessed by Mini-BESTest in older adults with type 2 diabetes mellitus (T2DM). Method This cross-sectional study. A total of 145 older adults aged ≥60 years were evaluated through sociodemographic variables (sex, age group, married, education level, general health status hearing and vision), Mini-BESTest, Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15) and dual-task Timed Up and Go Test (TUG) Multiple logistic regression model was used. Results The sensory orientation domain presented the highest average score, followed by the gait stability, anticipatory postural adjustments and postural responses domains. Factors associated to the risk of falls in older adults are: poor/very poor visual perception OR 3.40 (1.50-7.72); have respiratory diseases OR 8.00 (1.32-48.46); feeling dizzy OR 2.53 (1.10-5.80); and TUGT (dual task) time equal to or greater than 13.5 seconds OR 3.31 (1.03-10.64). Conclusion Older adults in this study presented impaired postural balance, mainly in the postural responses domain. The knowledge of the factors associated with the risk of falls in older adults with T2DM allows for better guidance in prevention, assessment and intervention, in order to minimize the occurrence of falls and maintain or optimize postural balance. Several factors influenced this outcome, such as overweight, low physical activity and education, several comorbidities, polypharmacy, T2DM diagnosis for more than ten years, negative perception of general health and vision, and depressive symptoms.