The Effects of Brief Guided Imagery on Patients Suffering From Chronic Back Pain: An A-B Design Study.

BACKGROUND: Guided imagery (GI) is a non-pharmacological method used to reduce pain, stress, and anxiety. AIMS: This study aimed to evaluate the impact of brief GI on symptoms of chronic back pain in adults treated in the Rheumatology clinic. DESIGN: A-B design study. SETTINGS & PARTICIPANTS: A sample of 35 women with chronic back pain were recruited at the Rheumatology Outpatient Clinic of Barzilai Medical Center in Ashkelon, Israel. METHODS: All subjects completed questionnaires at recruitment (T1), and after 8-10 weeks, they completed questionnaires again before the first intervention (T2). The intervention included five brief GI group meetings every 2-3 weeks, one hour each (3-5 subjects per group). Participants learned 6 GI exercises and were asked to practice brief guided imagery exercises at least once daily. Then, questionnaires were completed the third time (T3). OUTCOME MEASURES: MOQ - Modified Oswestry Low Back Pain Disability Questionnaire, STAI - State-Trait Anxiety Inventory, FABQ - Fear-Avoidance Beliefs Questionnaire, NPRS - Numerical Pain Rating Scale (average pain over the last week). RESULTS: Compared with the period without intervention, NPRS (Δ = 2.53, standard error [SE] = 0.43, p < .001), STAI (Δ = 8.41, SE = 1.95, p < .001), and MOQ (Δ = 0.06, SE = 0.02, p = .019) reported significantly lower levels after brief guided imagery training. However, no statistically significant change was found in FABQ. CONCLUSIONS: The brief guided imagery intervention may help alleviate chronic back pain, help decrease anxiety, and improve daily activity in women who suffer from chronic low back pain.

The effect of vitamin D deficiency and supplementation on urinary incontinence: scoping review.

INTRODUCTION AND HYPOTHESIS: Vitamin D receptors are found in skeletal and smooth muscle cells throughout the body, specifically in the bladder detrusor muscle. We reviewed the current literature on the association between vitamin D deficiency and urinary incontinence (UI), and whether vitamin D supplementation plays a role in the treatment of UI symptoms. METHODS: We performed a scoping review of all available studies. PubMed, Google Scholar, and PEDro databases were searched from inception until August 2020 with the keywords "urinary incontinence," "pelvic floor disorders," "lower urinary tract symptoms," "overactive bladder," and various terms for vitamin D. No language restrictions were imposed. The reference lists of all retrieved articles were also searched. RESULTS: The search revealed 12 studies of different research methodologies after elimination. In 6 out of the 7 cross-sectional studies reviewed, a significant association between vitamin D deficiency or insufficiency and the onset and severity of UI was found. In 2 out of the 3 prospective studies included, no association between vitamin D intake and UI was found; however, both randomized controlled trials that were reviewed found that vitamin D supplementation is effective for the treatment of UI. CONCLUSIONS: The existing literature supports an association between low levels of serum vitamin D and UI. Initial evidence regarding the effect of vitamin D supplementation on UI is accumulating, yet additional, comprehensive research is warranted to establish these findings.

Developing a grading scale for the evaluation of degenerative changes in uncovertebral (Luschka) joints.

The study aimed to develop a grading scale for evaluating degenerative changes in uncovertebral joints (UVJs) found on computed tomography (CT) scans, and assess the intra- and inter-rater reliability of this scale. The study included 50 subjects (average age 55.12 ± 13.76 years) referred for CT examinations due to cervical complaints. Three researchers developed a reading protocol using a semiquantitative grading scale of UVJ degenerative changes. CTs were read and reread several times to refine the protocol. Subsequently, the reader read and reread 20 CTs (C3-C7 bilateral, altogether 200 UVJs) 2 weeks apart in order to assess the intra-rater reliability. The second reader, after the training, read the same 20 CTs (yet, C4-C6 bilateral, altogether 120 UVJs) in order to assess the inter-rater reliability. The additional 30 CTs were evaluated to analyze the prevalence and associations between the studied parameters. The final grading scale included joint space narrowing, osteophyte, subchondral sclerosis, subchondral cyst, hypertrophy, cortical erosion, and vacuum phenomenon. The intra-rater agreement ranged from very good in joint space narrowing (k = 0.757), osteophyte grade (k = 0.748), subchondral cyst (k = 0.716), hypertrophy (k = 0.728), vacuum phenomenon (k = 0.712) to good (k = 0.544) in subchondral sclerosis, and fair in cortical erosion (k = 0.36). For the overall UVJ degeneration grade, the intra-rater agreement was very good (k = 0.616) and the inter-rater reliability was good (k = 0.468). 77.6% of the evaluated UVJs exhibited some degenerative changes. Our grading scale is the first to evaluate UVJs presenting good-very good intra-rater and inter-rater reliability which can be utilized in further clinical studies and assess degenerative changes in UVJs.

A comprehensive approach to risk factors for upper arm morbidities following breast cancer treatment: a prospective study.

BACKGROUND: Breast cancer surgery frequently causes deficiencies in shoulder functioning. The study pourpode is to identify risk factors for prolonged pain, reduction in function, and decrease in range of motion (ROM) in BC patients. METHODS: A prospective cohort study was designed in a private hospital; between October 2018 and April 2019 with a follow-up of 6 months. Patients following BC surgery, were divided by arm morbidities, and the different risk facrors were evaluated using univariate analysis and logistic regression. RESULTS: A total of 157 patients were included in the study. Risk factors for functional disabilities included; pain levels during hospitalization NPRS 1.2 (±0.8) compared to patients with no disabilities 0.5 ± 0.7 (p = .006), the size of tumors more than 1.4 ± 0.8 cm. compared with no morbidities 0.8 ± 0.9 cm. (p = .046), and breast reconstructions (p = .030). Risk factors for prolonged pain includes mastectomy (p = .006), breast reconstruction (p = .011), more than three dissected lymph nodes (p = .002), the presence of preoperative pain (p < .001), in-hospital pain (p < .001), axillary web syndrome (p < .001) and lymphedema (p < .001). Risk factors for decreased ROM were more than three dissected lymph nodes (p = .027), radiation (p = .018), and the size of dissected tissue (p = .035). Postoperative physical therapy appears to reduce the incidence of prolonged pain (p = .013) and regular physical activity may reduce long term functional disabilities (p = .021). CONCLUSIONS: Upper arm morbidity following BC treatments affect up to 70% of the patients. Identifying the different risk and beneficial factors may improve awareness among physicians to refer patients to early rehabilitation programs and thus avoid chronic morbidity and improve the course of recovery. TRIAL REGISTRATION: The study was registered in Clinical trial with the ID number: NCT03389204 .

Reliability of Trigger Point Evaluation in the Lower Leg Muscles.

BACKGROUND: Myofascial trigger point diagnosis is a clinical palpatory skill dependent on the patient's subjective response. The inter- and intra-rater reliability of trigger point physical evaluation in the lower leg muscles has rarely been reported. Previous reliability studies suffered from the Kappa paradox. OBJECTIVE: To evaluate the inter- and intra-rater reliability of trigger point recognition in the lower leg muscles implying a specific method to overcome the first Kappa paradox. DESIGN: A reliability study with pre-second examiner exclusion to correct prevalence index. SETTING: Physical therapy outpatient clinic, Beer-Sheva, Israel. SUBJECTS: In sum, 86 soldiers aged 18-30 referred for physical therapy with a diagnosis of musculoskeletal pain consented to take part in this study; 26 were excluded for lacking trigger points, leaving 60 subjects for analysis (31 women, 29 men). METHODS: Both legs were evaluated, and the results were analyzed separately for symptomatic (N = 87) and asymptomatic legs (N = 31). Each subject was evaluated three times, twice by one examiner, and once by a second examiner. Dichotomous findings including palpable taut-band, tenderness, referred pain, and relevance of referred pain were recorded. RESULTS: Inter-rater reliability for active trigger points ranged from 0.49 to 0.75 (median: 0.52) and intra-rater reliability ranged from 0.41 to 0.84 (median: 0.65) and. For total trigger points intra-rater reliability ranged from 0.52 to 0.79 (median: 0.67), and inter-rater reliability ranged from 0.44 to 0.77 (median: 0.66). CONCLUSIONS: Physical examination is a reliable method of trigger point evaluation in lower leg muscles, and it can be used as a diagnostic method for trigger point evaluation.

Effect of Guided Imagery on Pain and Health-Related Quality of Life in Musculoskeletal Medicine: a Comprehensive Narrative Review.

PURPOSE OF REVIEW: Guided imagery (GI) is a non-pharmacological method used to reduce pain, stress, and anxiety. No comprehensive review has yet investigated the application of GI in musculoskeletal medicine, its various types, and potential mechanisms. The aim of this comprehensive narrative review was to examine the types of GI used in musculoskeletal medicine and GI effect on pain and health-related quality of life. RECENT FINDINGS: A comprehensive narrative review of the English language scientific literature. PubMed, Google Scholar, ProQuest, and PEDro databases were searched from inception until August 2020 using keywords related to GI, musculoskeletal disorders, pain, and health-related quality of life. The search results generated 133 articles. After a critical analysis, 12 publications were included in this review. GI characteristics and protocols varied significantly between studies. Based on the reviewed studies, we advocate GI as a safe, non-invasive technique that can assist in managing pain, depression, stress, fatigue, anxiety, reducing medication use, improving general well-being, wellness, and quality of life in patients with musculoskeletal disorders. We recommend further investigations of GI mechanisms.

Pattern of thoracic osteophytes development and the association between calcification of the aorta and thoracic osteophytes: CT study.

INTRODUCTION: Our aim was use state-of-the-art computed tomography (CT) to assess the prevalence and size of osteophytes in the thoracic spine; the effect of the thoracic aorta on osteophyte development; and the relationship between thoracic aortic calcification and osteophytes. METHODS: Thoracic CT scans of 100 individuals taken at the T4-T12 spinal levels were examined to determine the numbers and sizes of osteophytes on the right/left side of the vertebrae. Calcific deposits in the thoracic aorta (TAC) at each thoracic vertebral level were assessed. The mean length of the thoracic osteophytes on each side, the total thoracic osteophyte score (TTOS), and the numbers of osteophytes were calculated. RESULTS: The sample comprised 44 males/56 females (mean age 66.45 ± 9.37). TAC was observed in 54 subjects. Osteophytes were significantly larger on the right side than the left at each spinal level. The largest osteophytes on both sides were at the T9, T10, and T11 levels. After adjustment for age, no significant association was found between sex and TTOS on the left (F = 0.277, p = .600) or right (F = 3.856, p = .052). The right TTOS was significantly associated with TAC after adjustment for age and sex (p = .018). CONCLUSIONS: Osteophytes in the thoracic spine are prevalent in older adults, with number and size increasing with age in both sexes. Osteophytes are significantly less prominent on the left side than the right, probably because of the proximity of the aorta. TTOS and TAC occurred in the same individuals after adjustment for age and sex, suggesting a possible common etiology.

Finger length ratio in longevity populations.

OBJECTIVES: The purpose of this study was to compare the prevalence of finger length ratio between three longevity populations (Abkhazians, Azerbaijanis, and Georgians) and one nonlongevity population (Russians), as well as between a longevity and nonlongevity sample within one ethnic group (Abkhazians). METHODS: In a cross-sectional observational study, we compared the prevalence of finger length ratio in longevity vs nonlongevity samples. RESULTS: A negative relationship was observed between longevity index and prevalence of type 1 (feminine type) ratio. In longevity samples, the prevalence of type 1 ratio was lower and the prevalence of type 3 (masculine type) ratio was higher than in the nonlongevity sample of Russians. This difference was statistically significant (P < .001) in both males and females. A similar difference between longevity and nonlongevity samples was exhibited in the Abkhazian samples. In males and females, a significantly higher prevalence of type 1 and lower type 3 finger ratios (P < .001) were shown in the nonlongevity samples. CONCLUSIONS: Finger length ratio pattern in longevity populations differs from that of nonlongevity populations. In longevity samples, the prevalence of type 1 ratio was lower and the prevalence of type 3 ratio was higher vs the nonlongevity sample. A similar type of difference was seen in the longevity and nonlongevity samples belonging to one ethnic group, the Abkhazians. Previous studies found that the type 1 finger length ratio was related to important morbidities that have a potential for shortening the life span. This can be one of the most plausible explanations for our findings.

The influence of knee bolster on lumbar spinal stenosis parameters on MR images.

OBJECTIVE: To estimate the effect of the knee bolster use during an MRI on lumbar spinal stenosis parameters and low back pain-related disability. METHODS: A repeated-measurement study of 27 males and 19 females with mean age 55.78 ± 14.36, referred for an MRI of the lumbar spine due to low back pain, performed with and without standard knee bolster. A radiologist evaluated the lumbar lordosis Cobb's angle, the cross-sectional area of the right and left intervertebral foramina and spinal canal at L1-L2, L2-L3, L3-L4 spinal levels. Spinal symptoms were evaluated by the Oswestry Disability Questionnaire. RESULTS: The Cobb angle of lumbar lordosis was found significantly greater on an MRI performed without knee bolster than with bolster (47.30 ± 9.90 vs. 42.57 ± 10.62, p < 0.001). The cross-sectional area of the intervertebral foramina and spinal canal at all evaluated levels was smaller when performed without knee bolster than with bolster. However, differences were significant only at the L1-L2 level and in the spinal canal at all evaluated levels. The Cobb angle, measured with and without knee bolster, showed significant positive correlations with back pain while standing and walking. The spinal canal area without knee bolster showed greater correlations with the Oswestry score parameters than with knee bolster. CONCLUSIONS: MR images at evaluated spinal levels taken without knee bolster showed greater correlations of the spinal canal cross-sectional area with the Oswestry score than ones with knee bolster. Thus, one may prefer MR images acquired without a bolster below the knee compared to an MRI with a knee bolster.

Heritability estimation of 2D:4D finger ratio in a Chuvashian population-based sample.

OBJECTIVES: The purpose of this study was to evaluate the familial correlations and heritability of 2D:4D ratio traits using a large population-based sample of ethnically homogeneous pedigrees from Chuvasha and Bashkortostan Autonomies of the Russian Federation. METHODS: We calculated the familial correlations and performed a heritability analysis of 2D:4D ratio traits in a sample of 1541 subjects (803 men and 738 women, mean age 47.78 ± 16.89 years, range 18-90 years). RESULTS: Familial correlations of 2D:4D ratio traits showed no significant correlation for spouses; however, parent-offspring (0.15-0.28, P < .001) and sibling correlations (0.13-0.38, P < .009) were found to be significant. Heritability (H2 ) of visual classification of 2D:4D ratio was 0.36 for the left and 0.28 for the right hand; finger ratio was 0.55 and 0.66, respectively; the ray ratio was 0.49 and 0.59, respectively, thus indicating the existence of a clear familial aggregation of 2D:4D ratio variation in the Chuvashian pedigrees, which cannot be explained only by common environmental effects. DISCUSSION: Results of our study suggest familial aggregations of finger ratio variation (for all traits) in Chuvashian pedigrees. No evidence of assortative mating was found.

Cross-sectional area of lumbar spinal muscles and vertebral endplates: a secondary analysis of 91 computed tomography images of children aged 2-20.

Spinal muscle cross-sectional area has been highly associated with spinal pathology. Despite the medium-high prevalence of spinal pathology in children, there is very limited knowledge regarding muscle size and growth pattern in individuals younger than 20 years of age. The aim of this study is to analyze the change in size and symmetry of spinal muscles (erector spinae, multifidus, psoas and quadratus lumborum) in children 2-20 years of age. We studied reformatted images from 91 abdominal computed tomographic scans of children aged 2-20 years, from an existing imaging dataset. The cross-sectional area of the muscles was bilaterally measured parallel to the upper endplate of the lumbar vertebrae L3-L5 and at true horizontal for S1. The cross-sectional area of the upper vertebral endplate was measured at spinal levels L3-L5. Results were analyzed according to six groups based on children's age: 2-4 years (group 1), 5-7 years (group 2), 8-10 years (group 3), 11-13 years (group 4), 14-16 years (group 5) and 17-20 years (group 6). Vertebral endplate and spinal muscles cross-sectional area increased with age. Two patterns were observed: Endplate, psoas and quadratus lumborum increased up to our 6th oldest age group (17-20), and multifidus and erector spinae reached their largest size in the 5th age group (14-16). The epaxial muscles (erector spinae and multifidus) reached their maximal cross-sectional area before skeletal maturity (18-21 years of age). The hypaxial muscles (psoas and quadratus lumborum) continued to increase in size at least until spinal maturity. Contributing factors for the differences in developmental pattern between the epaxial and hypaxial muscles might include functional, embryological and innervation factors. In conclusion, this research is the first to describe the cross-sectional area of spinal muscles in children. Future longitudinal studies are needed for further understanding of muscle development during childhood and adolescence. LEVEL OF EVIDENCE: level 2b, Retrospective cohort study.

Association Between Knee Osteoarthritis and Functional Changes in Ankle Joint and Achilles Tendon.

Increasing evidence has shown that biomechanical forces often drive the progression of knee osteoarthritis (OA). Attention should be given to the changes in adjacent joints and their relation to knee OA. The purpose of the present study was to examine the changes in Achilles tendon thickness of individuals with knee OA and to evaluate the correlation between Achilles tendon thickness and knee OA severity in a case-control prospective observational study. A total of 93 participants with no previous ankle injuries were recruited. Of the 93 participants, 63 had knee OA of the medial compartment and 30 served as controls. The subjects underwent a clinical examination that included measurements of weight, height, Achilles tendon thickness, and 1-leg heel rise. The subjects also underwent a computerized gait test and completed the Hebrew version of the Western Ontario and McMaster Osteoarthritis Index and 36-item short-form (SF-36) health survey. Significant difference was found in Achilles tendon thickness between the subjects with knee OA and the healthy controls (17.1 ± 3.4 versus 15.1 ± 3.1; p = .009). Significant differences were also found between the 2 groups in the 1-leg heel rise test, Western Ontario and McMaster Osteoarthritis Index scores, SF-36 scores, and all gait measures. Significant correlations were found between the Achilles tendon thickness and the following measures: weight (r = 0.46), body mass index (r = 0.55), Kellgren and Lawrence OA severity grade (r = 0.25), 1-leg heel rises (r = -0.50), and SF-36 score (r = -0.25). Subjects with knee OA presented with a thicker Achilles tendon compared with the healthy controls. Furthermore, a significant correlation between Achilles tendon thickness and knee OA severity was found. A comprehensive assessment of the Achilles tendon and ankle joint should be a part of the knee OA evaluation process.

Finger Length Ratio and Body Composition In Chuvashians.

Very few studies that evaluated the association between fi nger length ratio and body composition in adult population showed very diverse results. We carried out a radiographic study on a large population sample who had participated in a Chuvashian skeletal aging study investigating different aspects of skeletal aging. The aims of this study were to evaluate the association between 2D:4D ratio and various indices of body composition in Chuvashian males and females. The study sample included 802 males (mean age 46.98±17.10 years) and 783 females (mean age 48.65±16.62 years). Single plain radiographs of both hands were taken. Each hand was classifi ed according to whether the index fi nger was longer (Type 1), equal to (Type 2) or shorter than the ring fi nger (Type 3) by visual comparison of the soft tissue outline of the fi nger ends on the radiograph. Anthropometry, including body weight, stature, and six circumferences from the body trunk and extremities were taken from each participant. We found no evidence of substantial associations between visually assessed fi nger length ratio and adult BMI, WC, hip and chest circumferences, WHT and WCR for men and women. These results suggest that associations between fi nger length ratio and hormone-related diseases and disorders can be interpreted directly, independent of any mediating effects of adult body composition parameters.

Position Statement of the Israeli Society for Musculoskeletal Medicine on Intramuscular Stimulation for Myofascial Pain Syndrome-A Delphi Process.

OBJECTIVE: To develop consensus on a position paper on the use of intramuscular stimulation (IMS) for the treatment of myofascial pain syndrome (MPS) by physicians in Israel. METHODS: The Israeli Society of Musculoskeletal Medicine ran a modified Delphi process to gather opinions from a multidisciplinary expert panel. Eight experts in the treatment of MPS were chosen and asked to participate, and six participated. The position paper was iterated three times. RESULTS: After three iterations, general consensus was reached by all six experts. The general statement that was agreed on was: "IMS is one of the preferred treatments for myofascial pain syndrome. The treatment is evidence-based, effective, safe, and inexpensive. The position of the Israeli Society of Musculoskeletal Medicine is that the treatment should be taught and used by all primary care physicians and those physicians in other areas of medicine who deal with pain in their work." CONCLUSIONS: The position paper is a basis for clinical work and education programs for physicians interested in a better understanding and ability to treat patients with a musculoskeletal complaint or manifestation of disease.

Adaptive Changes in Basal Metabolic Rate in Humans in Different Eco-Geographical Areas.

Our aim was to establish whether the human basal metabolic rate (BMR) shifts towards the reduction of vital functions as an adaptation response to extreme environmental conditions. Data was collected in arid and Extreme North zones. The arid zone samples included Bedouins living in the Sinai Peninsula in Egypt, Turkmen students, the Pedagogical University of Chardzhou, Turkmenistan born Russians and Russian soldiers. Soldiers were divided into 3 groups according to the length of their tour of duty in the area: 1st group: up to six months, 2nd group: up to 2 years and the 3rd group: 3-5 years. The Extreme North samples comprised Chukchi natives, 1st generation Russian immigrants born in the area and 3 groups of soldiers comparable to the soldiers from Turkmenistan. BMR values of the new recruits had the highest values of total and relative BMR (1769 ± 16 and 28.3 ± 0.6, correspondingly). The total and relative BMR tended to decrease within a longer adaptation period. The BMR values of officers who served >3 years in Turkmenistan were very similar to the Turkmenistan born Russians (1730 ± 14 vs. 1726 ± 18 and 26.5 ± 0.6 vs. 27.3 ± 0.7, correspondingly). Similarly, in Chukotka, the highest relative BMR was found in the new recruits, serving up to 6 months (28.1 ± 0.7) and was significantly (p < 0.05) lower in the Russians serving in Chukotka over 1.5 years (27.1 ± 0.3). The BMR was virtually similar in Russian officers serving > 3 years, compared to the middle-aged Chukchi or Chukotka-born Russians (25.8 ± 0.5 vs. 25.6 ± 0.5 and 25.5 ± 0.6, correspondingly). The BMR parameters demonstrated a stronger association with body weight than with age. In extreme environmental conditions, migrant populations showed a decrease in BMR, thus reducing its vital functions. The BMR reduction effect with the adequate adaptive transformation is likely to be the key strategy for developing programs to facilitate human and animal adaptation to extreme factors. This process is aimed at preserving the optimum energy balance and homeostasis while minimizing stress on the body's vital functions.

Rehabilitation versus Nursing Home Nurses' Low Back and Neck-Shoulder Complaints.

PURPOSE: To compare the prevalence of those complaints in nurses working in rehabilitation departments and nursing homes, and to evaluate factors associated with them. DESIGN: A cross-sectional study in rehabilitation and in nursing home departments. METHODS: Data were obtained from questionnaires relating to basic demographics, prevalence of musculoskeletal complaints, potentially harmful positions and actions and job satisfaction. FINDINGS: Multivariate analyses demonstrated higher work-related musculoskeletal complaints for nurses in rehabilitation than nursing home nurses (p=.012 for low back pain; p<.001 for neck-shoulder pain). Trunk bending, static posture, repetitive tasks, and recognition of superiors were associated with low back pain. Freedom to choose work techniques and degree of diversity at work were associated with neck-shoulder pain. CONCLUSIONS: Differences between the nurse groups as to work tasks might be a reason for differences in musculoskeletal complaints. Further comparisons between nurses working in different fields might reveal more accurate potential risk factors for work-related musculoskeletal complaints. CLINICAL RELEVANCE: Instruction for static/awkward posture avoidance, by using mechanical aids and designing a friendlier environment, should be part of a nursing staff injury prevention strategy.

Sexual function in post-stroke patients: considerations for rehabilitation.

INTRODUCTION: While the rehabilitation goals of post-stroke patients include improving quality of life and returning to functional activities, the extent to which sexual activity is addressed as part of the standard rehabilitation process is unknown. Moreover, the specific sexual concerns of stroke patients, including the effect of stroke on intimate relationships and sexuality of the partner, the ability to physically engage in sex, and the effect of psychological components such as role identity, depression, and anxiety on sexuality, all warrant examination by rehabilitation professionals. AIM: The aim of this study is to examine the existing literature on sexuality and stroke patients in order to better understand how the sexual lives of stroke patients and their partners are affected and to provide recommendations to rehabilitation professionals for addressing sexuality as part of treatment. METHODS: Narrative review, PubMed, PEDro, ISI Web of Science, and Google Scholar databases (inception-December 2012) were searched for the key words "stroke," "sexual dysfunction," "sexuality," "quality of life," and their combination. All relevant articles in English and secondary references were reviewed. MAIN OUTCOME MEASURES: We report the results of the literature review. RESULTS: Sexual dysfunction and decreased sexual satisfaction are common in the post-stroke population and are related to physical, psychosocial, and relational factors. However, they are not adequately addressed in post-stroke rehabilitation. CONCLUSIONS: As sexual function is an important component to quality of life and activities of daily living, physicians and rehabilitation specialists, including physical, occupational, and speech therapists, should receive training in addressing sexuality in the treatment of post-stroke patients. Sexologists and sex therapists should be an integral part of the rehabilitation team.

The underlying mechanism, efficiency, and safety of manual therapy for functional gastrointestinal disorders: A narrative review.

INTRODUCTION: Functional gastrointestinal disorders encompass a range of conditions resulting from complicated gut-brain interactions, which can negatively impact sufferers' lives. They are prevalent in clinical practice and the community, with a lifetime prevalence of almost 40 % worldwide. The challenge in diagnosing these disorders lies in the non-specificity of symptoms and the absence of reliable biomarkers. The existing literature suggests a multidisciplinary approach, including cognitive-behavioral therapy, dietary changes, psychotropic drug therapy, and improving gastrointestinal motility. Manual therapy applied to the abdomen and adjacent areas can potentially enhance gastrointestinal motility. OBJECTIVES: This review aims to examine the types of manual interventions, their mechanisms, efficiency, and safety in managing functional disorders of the digestive system. METHODS: We searched PubMed and Google Scholar in English from May 2022 to February 2023 with no date restriction. We prioritized systematic reviews, meta-analyses, and clinical trials and did not exclude any data sources. RESULTS AND CONCLUSION: s: Initial evidence suggests that manual interventions on the abdomen and adjacent areas are effective in managing functional gastrointestinal disorders, with no reported adverse events and relatively low costs. However, further studies with rigorous scientific methodology are needed to understand better the unknown dimensions influencing the outcomes observed with abdominal massage and its positive impact on patients. Manual abdominal techniques are a promising therapy option for functional gastrointestinal disorders, and their efficacy, safety, and cost-effectiveness should be further explored.

The mouth-opening muscular performance in adults and elderlies with and without dysphagia: A systematic review and meta-analysis.

OBJECTIVES: To characterize mouth-opening muscular performance (MOMP) in adults and elderly individuals with dysphagia and healthy controls. METHODS: We searched the PubMed, EMBASE, CINAHL, Cochrane, Scopus, and Web of Science databases from inception to Jan. 26, 2023. Two independent researchers considered the titles, abstracts, and full texts of potentially eligible papers from 1451 search results. Twenty-five studies that evaluated mouth-opening maximal strength (MOMS) in healthy adults, elderly individuals, and patients with dysphagia met the inclusion criteria. RESULTS: We found comparable, reliable values with significant sex differences in maximal mouth opening strength (MMOS) in the meta-analysis for healthy elderly patients (females 5.31 ± 0.47 kg vs. males 7.04 ± 0.70 kg; mean difference of 0.84 kg). Age has also emerged as an essential factor in reducing strength. There was a significant reduction in the MMOS score in the only study that compared dysphagic individuals to healthy elderly individuals. In another study, the MMOS score was comparable to the meta-analysis of healthy elderly individuals. CONCLUSIONS: Both sex and age play significant roles in the MMOS. There is no reliable data on the normal mouth-opening strength and endurance of healthy adults, patients with dysphagia, or individuals with other relevant clinical problems.

Physical and psychosocial work demands associated with pain and disability among skilled male Arab waiters.

BACKGROUND: Physical and psychosocial demands (e.g., serving, cleaning, fulfilling orders) can lead to work-related musculoskeletal pain (WRMSP). OBJECTIVE: To assess the prevalence of WRMSP in the upper quadrant and lower back among skilled male Arab waiters; to evaluate the disability related to WRMSP; to evaluate the association between work demands and WRMSP with related disability. METHODS: 100 skilled male Arab waiters working full-time, aged 18-60, participated in the cross-sectional study. Participants completed basic demographics and working conditions; the NDI; QuickDASH; the OswestryQ; workload, burnout, and job satisfaction at work; the adjusted NordicQ; and the TaskQ, compiled especially for this study. RESULTS: A 12-month pain prevalence, pain frequency, and work avoidance were high: neck- 42%, 60.5%, 89.5%; shoulders -53%, 78.2%, 94.4%; elbows- 46%, 78.6%, 83.3%; lower back- 45%, 44%, 78.7%, respectively. Pain prevalence in at least one site was 83%. The OswestryQ, QuickDASH, and NDI revealed mild-moderate pain and disability (14.85/50, 25.54/75, 13.74/50, respectively). Burnout score was positively associated with OswestryQ, QuickDASH, and NDI. Job satisfaction was negatively associated with 12 months of pain in the lower back, hands, arms, shoulders, and hands (NordicQ). TaskQ was positively associated with OswestryQ. CONCLUSION: Male Arab waiters who work in physically and psychologically challenging conditions report high levels of WRMSP with a high frequency and related work avoidance. Many of them must keep their jobs as they are their families' primary or sole providers. It is possible that they are trying to prevent more severe disabilities in the future by ensuring temporary rest and pain prevention.