Effectiveness of Whey Protein Supplementation during Resistance Exercise Training on Skeletal Muscle Mass and Strength in Older People with Sarcopenia: A Systematic Review and Meta-Analysis.

OBJECTIVE: To determine the effectiveness of whey protein (WP) supplementation during resistance exercise training (RET) vs. RET with or without placebo supplementation on skeletal muscle mass, strength, and physical performance in older people with Sarcopenia. METHODS: Electronic searches in the PubMed, Embase, Scopus, Web of Science, LILACS, SPORTDiscus, Epistemonikos, and CINAHL databases were performed until 20 January 2023. Randomized clinical trials conducted on sarcopenic adults aged 60 or older were included. The studies had to compare the effectiveness of the addition of supplements based on concentrated, isolated, or hydrolyzed whey protein during RET and compare it with RET with or without placebo supplementation on skeletal muscle mass and strength changes. The study selection process, data extraction, and risk of bias assessment were carried out by two independent reviewers. RESULTS: Seven randomized clinical trials (591 participants) were included, and five of them provided data for quantitative synthesis. The overall pooled standardized mean difference (SMD) estimate showed a small effect size in favor of RET plus WP for skeletal muscle mass according to appendicular muscle index, with statistically significant differences compared with RET with or without the placebo group (SMD = 0.24; 95% CI, 0.05 to 0.42; p = 0.01; I2 = 0%, p = 0.42). The overall pooled mean difference (MD) estimate showed a significant difference of +2.31 kg (MD = 2.31 kg; 95% CI, 0.01 to 4.6; p = 0.05; I2 = 81%, p < 0.001) in handgrip strength in the RET plus WP group compared with the RET group with or without placebo. The narrative synthesis revealed discordance between the results of the studies on physical performance. CONCLUSIONS: WP supplementation during RET is more effective in increasing handgrip strength and skeletal muscle mass in older people with Sarcopenia compared with RET with or without placebo supplementation. However, the effect sizes were small, and the MD did not exceed the minimally important clinical difference. The quality of the evidence was low to very low according, to the GRADE approach. Further research is needed in this field.

Effectiveness of Glenohumeral Joint Mobilization on Range of Motion and Pain in Patients With Rotator Cuff Disorders: A Systematic Review and Meta-Analysis.

OBJECTIVE: The purpose of this study was to determine the effectiveness of glenohumeral joint mobilization (JM) on range of motion and pain intensity in patients with rotator cuff (RC) disorders. METHODS: An electronic search was performed in the MEDLINE, CENTRAL, Embase, PEDro, LILACS, CINAHL, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that investigated the effect of glenohumeral JM techniques with or without other therapeutic interventions on range of motion, pain intensity, and shoulder function in patients older than 18 years with RC disorders. Two authors independently performed the search, study selection, and data extraction, and assessed risk of bias. Grades of Recommendation Assessment, Development and Evaluation ratings were used to evaluate the quality of evidence in this study. RESULTS: Twenty-four trials met the eligibility criteria, and 15 studies were included in the quantitative synthesis. At 4 to 6 weeks, for glenohumeral JM with other manual therapy techniques vs other treatments, the mean difference (MD) for shoulder flexion was -3.42° (P = .006), abduction 1.54° (P = .76), external rotation 0.65° (P = .85), and Shoulder and Pain Disability Index score 5.19 points (P = .5), and standard MD for pain intensity was 0.16 (P = .5). At 4 to 5 weeks, for the addition of glenohumeral JM to an exercise program vs exercise program alone, the MD for the visual analog scale was 0.13 cm (P = .51) and the Shoulder and Pain Disability Index score was -4.04 points (P = .01). CONCLUSION: Compared with other treatments or an exercise program alone, the addition of glenohumeral JM with or without other manual therapy techniques does not provide significant clinical benefit with respect to shoulder function, range of motion, or pain intensity in patients with RC disorders. The quality of evidence was very low to high according to Grades of Recommendation Assessment, Development and Evaluation ratings.

Effectiveness of scapular mobilization in patients with primary adhesive capsulitis: A systematic review and meta-analysis.

BACKGROUND: The aim of this study was to determine the effectiveness of scapular mobilization on range of motion, shoulder disability, and pain intensity in patients with primary adhesive capsulitis (AC). METHODS: An electronic search was performed in the MEDLINE, EMBASE, SCOPUS, CENTRAL, LILACS, CINAHL, SPORTDiscus, and Web of Science databases up to March 2023. The eligibility criteria for selected studies included randomized clinical trials that included scapular mobilization with or without other therapeutic interventions for range of motion, shoulder disability, and pain intensity in patients older than 18 years with primary AC. Two authors independently performed the search, study selection, and data extraction, and assessed the risk of bias using the Cochrane Risk of Bias 2 tool. RESULTS: Six randomized clinical trials met the eligibility criteria. For scapular mobilization versus other therapeutic interventions, there was no significant difference in the effect sizes between groups: the standard mean difference was -0.16 (95% confidence interval [CI] = -0.87 to 0.56; P = .66) for external rotation, -1.01 (95% CI = -2.33 to 0.31; P = .13) for flexion, -0.29 (95% CI = -1.17 to 0.60; P = .52) for shoulder disability, and 0.65 (95% CI = -0.42 to 1.72; P = .23) for pain intensity. CONCLUSIONS: Scapular mobilization with or without other therapeutic interventions does not provide a significant clinical benefit regarding active shoulder range of motion, disability, or pain intensity in patients with primary AC, compared with other manual therapy techniques or other treatments; the quality of evidence was very low to moderate according to the grading of recommendation, assessment, development and evaluation approach.

Does acupuncture provide pain relief in patients with osteoarthritis knee? An overview of systematic reviews.

BACKGROUND: Knee osteoarthritis (OA) is the most common condition that causes pain and disability in adults over 50 years old. The application of acupuncture, as a method of complementary intervention, could be beneficial for pain relief and knee function in patients with knee OA. OBJECTIVE: Analyze the effectiveness of acupuncture versus control interventions in patients with knee OA. METHODS: An electronic search was performed in the MEDLINE (via PubMed), EMBASE, PEDro, Cochrane CENTRAL, CINAHL, Web of Science and LILACS databases. The eligibility criteria for selecting systematic reviews included clinical trials that compared acupuncture versus control interventions for pain intensity in patients with knee OA. RESULTS: A total of 15 systematic reviews met the eligibility criteria for the quantitative synthesis. In the short term, the mean difference (MD) for pain intensity was -0.32 cm (95% CI = -0.57 to -0.08, p = 0.01). There was a very low quality of evidence according to the GRADE rating. In the short term, the mean difference (MD) for knee function was -8.74 points (95% CI = -13.36 to -4.12, p ≤ 0.001). There was low quality of evidence according to the GRADE rating. All differences were in favor of acupuncture. CONCLUSION: At short-term, there was low to very low evidence and there were statistically significant differences in pain intensity and knee function in favor of acupuncture versus control interventions in patients with knee OA. However, these differences were not clinically important. For the acupuncture versus sham, in the short-term, no differences clinical neither statistically significant to favor of acupuncture in pain intensity and knee function.

Effectiveness of aloe vera in patients with type 2 Diabetes Mellitus and pre-diabetes: An overview of systematic reviews.

BACKGROUND AND AIMS: The effects of aloe vera are inconsistent and unclear. The aim of this study is to analyze the effects of aloe vera in metabolic profiles. METHODS: An electronic search of systematic reviews (SRs) was performed in seven databases up to June 2021. RESULTS: Four SRs met the eligibility criteria. In T2DM, SMD for FBG = -5.61 (p < 0.001). For HbA1c, MD = -0.95 (p = 0.02). In pre-diabetes, SMD for FBG = -1.41 (p = 0.02). For HbA1c, MD = -0.31 (p = 0.02). For TG, MD = -4.99 (p = 0.000). CONCLUSION: There exist a moderate to high quality of evidence in favor of the effects of aloe vera in patients with T2DM and pre-diabetes.

Effects of therapeutic alliance on clinical outcomes in patients with symptomatic knee osteoarthritis undergoing an exercise program: A randomized clinical trial protocol.

BACKGROUND: Previous evidence has shown that seniors physical therapists applying electrotherapy and an enhanced therapeutic alliance in their sessions can positively influence the levels of analgesia of patients with chronic low back pain. It is currently unknown if these effects can be achieved in people with symptomatic knee osteoarthritis when receiving treatment focused on therapeutic exercise. AIM: To determine the effects of different therapeutic alliance levels during the application of a therapeutic exercise program on pain intensity and pressure pain threshold in patients with symptomatic knee osteoarthritis. METHOD: This will be a randomized, parallel, two-arm, clinical trial. An intervention of three sessions of therapeutic exercise will be applied for one week. Patients aged 45 to 65 years old with a clinical and radiographic diagnosis of knee osteoarthritis will participate. Also, patients with a pain intensity of at least three months duration and 3 to 8 points in a numerical rating scale will be included. Patients will be randomly assigned to a therapeutic exercise experimental group with an enhanced therapeutic alliance (e.g., active listening, personalized conversation, empathy) or limited therapeutic alliance (e.g., one-way verbalization, brief interaction). Physical therapists will be trained in delivering these two levels of the therapeutic alliance. The pressure pain thresholds at the symptomatic knee and the pain intensity will be measured before and after the intervention. DISCUSSION: The results of this research will determine the impact of the therapeutic alliance as a nonspecific relevant factor during the application of a therapeutic exercise program in the treatment of patients with symptomatic knee osteoarthritis. CLINICAL TRIALS REGISTRATION NUMBER: NCT04390932.

ANTECEDENTES: Evidencia previa ha demostrado que los fisioterapeutas expertos que aplican electroterapia junto con una alianza terapéutica mejorada pueden influir positivamente en los niveles de analgesia de los pacientes con dolor lumbar crónico. Actualmente se desconoce si estos efectos se pueden lograr en personas con artrosis de rodilla sintomática cuando reciben un tratamiento basado en ejercicio terapéutico. OBJETIVO: Determinar los efectos de diferentes niveles de alianza terapéutica durante la aplicación de un programa de ejercicio terapéutico sobre la intensidad del dolor y el umbral del dolor a la presión en pacientes con artrosis de rodilla sintomática. MÉTODO: Este será un ensayo clínico aleatorizado, paralelo, de dos brazos. Se aplicará una intervención de tres sesiones de ejercicio terapéutico durante una semana. Participarán personas de 45 a 65 años con diagnóstico clínico y radiográfico de artrosis de rodilla sintomática, con intensidad del dolor entre 4-7 puntos en la escala numérica del dolor con al menos 3 meses de duración. Los participantes serán asignados al azar a un grupo experimental de ejercicio terapéutico con una alianza terapéutica mejorada (por ejemplo, escucha activa, conversación personalizada, empatía) o alianza terapéutica limitada (por ejemplo, verbalización unidireccional, breve interacción). Se capacitará a los fisioterapeutas para brindar estos dos niveles de alianza terapéutica. Los umbrales del dolor a la presión en la rodilla sintomática y la intensidad del dolor se medirán antes y después de la intervención. DISCUSIÓN: Los resultados de esta investigación determinarán el impacto de la alianza terapéutica como factor inespecífico durante la aplicación de un programa de ejercicio terapéutico en el tratamiento de pacientes con artrosis de rodilla sintomática. NÚMERO DE REGISTRO DE ENSAYOS CLÍNICOS: NCT04390932.