Protocols Used by Occupational Therapists on Shoulder Pain after Stroke: Systematic Review and Meta-Analysis.

INTRODUCTION: Shoulder pain as a consequence after a stroke has multifactorial causes and can prevent the functional return of the upper limb. In addition, the effectiveness of clinical protocols applied by occupational therapists remains uncertain. OBJECTIVE: To identify the main treatments currently used by occupational therapists for pain in the shoulder after a stroke. METHOD: Articles in English published between 2015 and 2019, of the randomized clinical trial type, with populations that stroke survivors a stroke and sequelae of shoulder pain were selected. The terms and combinations used were "shoulder pain and stroke and occupational therapy," in the electronic databases, Directory of Open Access Journals (DOAJ), Occupational Therapy Systematic Evaluation of Evidence (OTseeker), and PubMed. Statistical Review Manager (version 5.3) established the significance level P ≤ 0.05. RESULTS: Thirty-nine articles were found, but only four met the inclusion criteria. Electrical stimulation, therapeutic bandaging, and dry needling were eventually employed. For the meta-analysis, pain was the primary outcome, and range of motion (ROM) and upper limb function were secondary. Pain, ROM (external rotation, abduction, and flexion), and manual function were compared, and the meta-analysis showed improvement in the treatment group in clinical trials: pain (MD -2.08; 95% CI -3.23, -0.93; P = 0.0004), ROM (MD 4.67; 95% CI 1.54, 7.79; P = 0.0003), and manual function (MD 1.84; 95% CI 0.52, 3.16; P = 0.006). CONCLUSION: Dry needling, California tripull taping (CTPT), and functional electrical stimulation controlled by brain-machine interface (BCI-FES) are proved effective in shoulder pain and functionality.

Can Creatine Supplementation Interfere with Muscle Strength and Fatigue in Brazilian National Level Paralympic Powerlifting?

The aim of the present study was to analyze the effect of creatine (Cr) supplementation on peak torque (PT) and fatigue rate in Paralympic weightlifting athletes. Eight Paralympic powerlifting athletes participated in the study, with 25.40 ± 3.30 years and 70.30 ± 12.15 kg. The measurements of muscle strength, fatigue index (FI), peak torque (PT), force (kgf), force (N), rate of force development (RFD), and time to maximum isometric force (time) were determined by a Musclelab load cell. The study was performed in a single-blind manner, with subjects conducting the experiments first with placebo supplementation and then, following a 7-day washout period, beginning the same protocol with creatine supplementation for 7 days. This sequence was chosen because of the lengthy washout of creatine. Regarding the comparison between conditions, Cr supplementation did not show effects on the variables of muscle force, peak torque, RFD, and time to maximum isometric force (p > 0.05). However, when comparing the results of the moments with the use of Cr and placebo, a difference was observed for the FI after seven days (U3: 1.12; 95% CI: (0.03, 2.27); p = 0.02); therefore, the FI was higher for placebo. Creatine supplementation has a positive effect on the performance of Paralympic powerlifting athletes, reducing fatigue index, and keeping the force levels as well as PT.