Effectiveness of Therapeutic Exercise Models on Cancer-Related Fatigue in Patients With Cancer Undergoing Chemotherapy: A Systematic Review and Network Meta-analysis.

OBJECTIVE: To assess and compare the effectiveness of different exercise modalities in reducing cancer-related fatigue (CRF) in patients with cancer undergoing chemotherapy. Exercise intensities for selected exercise types were also compared. DATA SOURCES: We conducted a search in MEDLINE, Embase, CINAHL, Scopus, SPORTDiscus, and Web of Science from inception to October 15, 2021. STUDY SELECTION: Randomized controlled trials concerning the effectiveness of exercise modalities on CRF in patients with cancer undergoing chemotherapy were included. DATA EXTRACTION: Study characteristics were extracted using a structured protocol. Methodological quality was assessed employing the PEDro scale and risk of bias was assessed using the Revised Cochrane Risk of Bias Tool for Randomized Trials. The certainty of evidence was assessed based on Grading of Recommendations, Assessment, Development and Evaluation. The measure of effect used was the adjusted standardized mean difference (SMD) or Hedge's g, together with the corresponding 95% confidence intervals (CI). DATA SYNTHESIS: Forty-seven studies were included. Data were pooled employing a random-effects model. There was a trend that adding low-intensity aerobic and resistance exercise (SMD=1.28, 95% CI -0.18; 2.75, P=.086), or moderate-intensity aerobic and resistance exercise (SMD=0.85; 95% CI -0.12; 1.82, P=.087), was more effective than adding flexibility training to usual care (UC). There was also a trend that UC alone was less effective than adding moderate-intensity aerobic and resistance exercise (SMD=-0.47, 95% CI -0.96, 0.02, P=.060) to UC. CONCLUSIONS: The addition of low- to moderate-intensity aerobic and/or resistance exercise demonstrated a positive trend for improvement in CRF in patients with cancer undergoing chemotherapy, when compared with UC alone or UC with flexibility training.

Hypoalgesic effects of a blood flow restriction technique at moderate intensity with or without motor imagery: a single-blind randomized controlled trial.

PURPOSE: The main objective was to assess the hypoalgesic effect of adding blood flow restriction (BFR) training with or without motor imagery (MI) to moderate-intensity exercise. The secondary objective was to analyse the correlations of the pain pressure thresholds (PPTs) regarding perceived pain intensity, perceived fatigue, and cuff pressure discomfort. METHODS: A sample of 42 asymptomatic participants were randomly assigned to 3 groups: control group (CG), BFR group, and BFR with MI group. All participants performed a squat exercise at an intensity of 60% of 1RM. For the BFR groups, blood occlusion occurred at 80% of maximal arterial occlusive pressure. Local, bilateral, and distal PPT were assessed pre-intervention, post-intervention and 48 h post-intervention. The perceived fatigue was assessed post-intervention, and pain intensity was assessed only 48 h post-intervention. RESULTS: There were intragroup differences in the CG and BFR + MI group in the local PPT between the pre-intervention and post-intervention measurements (p = 0.039, d= -0.32 and p = 0.009, d= -0.46, respectively) and only in the CG in the bilateral PPT (p = 0.002, d= -0.41). The CG and BFR group showed significant differences at 48 h post-intervention, with a decrease in local PPT (p = 0.009, d = 0.51 and p = 0.049, d = 0.43, respectively) and bilateral PPT (p = 0.004, d = 0.53 and p = 0.021, d = 0.46, respectively). There was a negative moderate correlation between local PPT at the post-intervention time and perceived discomfort of the occlusion device only in the BFR group (r=-0.54, p = 0.045). CONCLUSION: Moderate-intensity resistance training with high occlusion did not generate hypoalgesia but did appear to generate a hyperalgesic response within 48 h after the intervention.

Effectiveness of Pain Neuroscience Education in Patients with Fibromyalgia: A Systematic Review and Meta-Analysis.

PURPOSE: To assess the effects of pain neuroscience education (PNE) on patients with fibromyalgia in terms of pain intensity, fibromyalgia impact, anxiety, and pain catastrophizing. METHODS: A systematic review with meta-analysis of randomized controlled trials was conducted. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated with RStudio software (RStudio, Boston, MA) for relevant outcomes and were pooled in a meta-analysis with the random effects model. RESULTS: A total of eight studies were included. The meta-analysis showed statistically significant differences in pain intensity with a moderate clinical effect in seven studies at the post-intervention assessment (SMD: -0.76; 95% CI: -1.33 to -0.19; P < 0.05) with evidence of significant heterogeneity (P < 0.05, I2 = 92%), but it did not show statistically significant differences in fibromyalgia impact, anxiety, and pain catastrophizing (P > 0.05). With regard to the follow-up assessment, only the fibromyalgia impact showed significant improvements, with a very small clinical effect in nine studies (SMD: -0.44; 95% CI: -0.73 to -0.14; P < 0.05) and evidence of significant heterogeneity (P < 0.05, I2 = 80%). After the application of a sensitivity analysis with the PNE face-to-face interventions, the meta-analysis showed a significant decrease in pain intensity, with a moderate clinical effect at the post-intervention and follow-up assessments without evidence of significant heterogeneity (P < 0.05, I2 = 10%). CONCLUSIONS: There is low-quality evidence that in patients with fibromyalgia, PNE can decrease the pain intensity in the post-intervention period and the fibromyalgia impact in the follow-up period. However, it appears that PNE showed no effect on anxiety and pain catastrophizing.

Effectiveness of HIIT in patients with cancer or cancer survivors: An umbrella and mapping review with meta-meta-analysis.

OBJECTIVE: To assess the available evidence on the effectiveness of high-intensity interval training (HIIT) in addition to first-choice cancer treatment on cardiorespiratory fitness (CRF), quality of life (QoL), adherence, and adverse effects of HIIT in patients with cancer or cancer survivors. METHODS: An umbrella review and meta-meta-analysis (MMA) was performed. A systematic search was conducted in MEDLINE, EMBASE, Cochrane Database, CINAHL, Scopus, SPORTDiscus, and Web of Science until August 2021. Article selection, quality assessment, and risk of bias assessment were performed by two independent reviewers. The MMA were performed with a random-effects model and the summary statistics were presented in the form of forest plot with a weighted compilation of all standardized mean differences (SMD) and corresponding 95% confidence interval (CI). RESULTS: Seven systematic reviews were included. Regarding CRF, the addition of HIIT to cancer treatment showed statistically significant differences with a small clinical effect, compared with adding other treatments (SMD = 0.45; 95% CI 0.24 to 0.65). There was no significant difference when compared with adding moderate-intensity continuous training (MICT) (SMD = 0.23; 95% CI -0.04 to 0.50). QoL showed positive results although with some controversy. Adherence to HIIT intervention was high, ranging from 54% to 100%. Regarding adverse effects, most of the systematic reviews reported none, and in the cases in which they occurred, they were mild. CONCLUSION: In conjunction with first-choice cancer treatment, HIIT has been shown to be an effective intervention in terms of CRF and QoL, as well as having optimal adherence rate. In addition, the implementation of HIIT in patients with cancer or cancer survivors is safe as it showed no or few adverse effects.

Effect of brain training through visual mirror feedback, action observation and motor imagery on orofacial sensorimotor variables: A single-blind randomized controlled trial.

OBJECTIVES: The main objective was to evaluate the effects of action observation (AO), visual mirror feedback (VMF) and motor imagery (MI), combined with an oro-facial exercise programme, on sensorimotor variables in asymptomatic participants. METHODS: We designed a randomised, single-blind, controlled trial that included 52 asymptomatic participants who were randomly assigned to 4 groups, 13 to each of the VMF, MI and AO groups and 13 to the control group (CG), which only performed the exercise programme. The primary outcomes were pain pressure sensitivity and tongue muscle strength. The secondary outcomes were maximum mouth opening, tongue length and the ability to generate mental motor images. Each group underwent a 3-session intervention using their respective exercise. Measurements were performed before starting the intervention and after each of the 3 sessions (pre, mid1, mid2 and post). RESULTS: ANOVA revealed significant changes in PPTs in the masseter muscle region in the MI and AO groups in the pre-post and mid1-post changes. ANOVA revealed significant differences in tongue muscle strength in the anterior direction only in the AO group in the pre-mid2 and pre-post changes. CONCLUSIONS: AO and MI, in conjunction with exercise, could induce changes in PPTs for the masseter muscle. In addition, only AO produced changes in tongue muscle strength. More research is needed to determine the role of brain representation techniques in the oro-facial region and transferring this exercise to the rehabilitation setting.

The Benefit of Exercise in Patients With Cancer Who Are Receiving Chemotherapy: A Systematic Review and Network Meta-Analysis.

OBJECTIVE: This study aimed to determine which therapeutic exercise-based intervention is most effective in improving cardiorespiratory fitness (CRF) in patients with cancer receiving chemotherapy. METHODS: The authors conducted a systematic review with network meta-analysis in MEDLINE (PubMed), Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus, SPORTDiscus, and Web of Science. The authors employed the Physiotherapy Evidence Database and the Revised Cochrane Risk of Bias Tool for Randomized Trials to assess the methodological quality and risk of bias, respectively. RESULTS: A total of 27 studies were included. Data were pooled using a random-effects model. Adding aerobic training (moderate to high intensity), with or without resistance training, to usual care versus usual care was statistically significant, with a small beneficial effect (aerobic training: standardized mean difference = 0.46; 95% CI= 0.17 to 0.75; aerobic and resistance training: standardized mean difference = 0.26; 95% CI = 0.00 to 0.52) for peak oxygen consumption at the postintervention assessment. CONCLUSION: Therapeutic exercise-based interventions to improve short-term CRF in patients with cancer receiving chemotherapy should include moderate- to high-intensity aerobic exercise, with or without resistance training. IMPACT: It is important to improve CRF in the oncological population due to its relationship with mortality. The results showed the benefit of exercise to improve cardiorespiratory fitness in the oncology population receiving chemotherapy treatment.

Pain memory in children: a systematic review and meta-analysis with a meta-regression.

ABSTRACT: The aim of this systematic review and meta-analysis was to analyze the accuracy of memory of pain and the variables that may influence it in children with acute, experimental, and chronic pain. We conducted a search in electronic databases from inception to February 11, 2022. Twelve observational studies and 3 randomized controlled studies were included in the study. The main outcome measure was the accuracy of the memory of the pain intensity (experienced/recalled). To compare the outcomes reported by the studies, we calculated the standardized mean difference (SMD) over time for the continuous variables. The overall meta-analysis showed a small effect size in favor of an overestimation of experienced pain intensity (SMD = 0.28). Subanalyzing per pain context, there was a small effect size in favor of overestimation in the clinical context (SMD = 0.33), but there was no evidence of any change in the accuracy of memory of pain in the experimental context (SMD = 0.07). The mean age of the participants and the proportion of girls significantly predicted the accuracy of the memory of pain. The period since the experienced pain measurement, the intensity of expected and recalled fear, trait anxiety, and anxiety sensitivity did not significantly predict the accuracy of the memory of pain. Children showed an overestimation in pain memory between the experienced and recalled intensity of acute pain, especially in a clinical context. Furthermore, only gender and age were predictors of the accuracy of pain memory. These results highlight the relevance of pain memory to medical practice and future research.

Effectiveness of exercise on pain intensity and physical function in patients with knee and hip osteoarthritis: an umbrella and mapping review with meta-meta-analysis.

PURPOSE: The aim of this review was to provide a qualitative and quantitative overview of the effects of exercise on pain, physical function, and quality of life for patients with knee and hip osteoarthritis. MATERIALS AND METHODS: This study was an umbrella and mapping review with meta-meta-analysis. Meta-analyses of randomized controlled trials were included. The methodological quality and risk of bias were evaluated using the Modified Quality Assessment Scale for Systematic Reviews and the Risk of Bias in Systematic Reviews tool. The quality of evidence was evaluated using the Physical Activity Guidelines Advisory Committee Grading Criteria. RESULTS: 41 meta-analyses were included, 43.9% of the studies had adequate methodological quality, and 56.1% of the studies had a low risk of bias. Moderate evidence was found that exercise decreases pain intensity (33 meta-analyses; SMD = -0.49; 95% CI -0.56 to -0.42), improves function (19 meta-analyses; SMD = -0.50; 95% CI -0.58 to -0.41), strength (6 meta-analyses; SMD = -0.57; 95% CI -0.70 to -0.44) and quality of life (SMD = -0.36; 95% CI -0.46 to -0.27) for patients with hip and knee osteoarthritis. CONCLUSION: Exercise is an effective intervention to decrease pain intensity and improve function in patients with hip and knee osteoarthritis.(PROSPERO, CRD42020221987).

Exercise in hip and knee osteoarthritis has shown improvement in pain, function, strength, and quality of life in different studies, but no differences have been observed in others.The meta-meta-analysis of the present article find that exercise produces significant improvements in pain, function, strength, and quality of life of patients with knee and/or hip osteoarthritis with a small effect size and significant heterogeneity.There is moderate evidence that exercise is effective in reducing pain and increasing function, strength, and quality of life of patients with knee and hip osteoarthritis.

The experience of vertigo: A systematic review of neuroimaging studies.

Our primary objective was to assess consistent activation and deactivation among healthy participants and patients reporting vertigo. Our secondary aim was to evaluate the influence of the stimulus and the direction of the perception of self-motion We realized a systematic review with an extensive data visualization. We included neuroimaging studies (e.g., functional magnetic resonance imaging [fMRI], positron emission tomography [PET] or near infrared spectroscopy [NIRS]) that have measured functional activity in human adults reporting vertigo and/or dizziness. We included 21 studies (n = 336 participants), ~ 64% male, age ranging from 18 to 80.5 years. The different stimuli used to induce vertigo: caloric stimulation, galvanic stimulation, visual stimulation or vibratory stimulus on neck muscles. We found a consistent activation of the insular cortex, inferior parietal lobule, putamen, cerebellum, anterior cingulate cortex, precentral gyrus, superior temporal gyrus and thalamus. Cortical and subcortical activation seems to have a contralateral pattern to the perception of self-movement. We found a deactivation pattern of structures related to the ventral and third visual pathway. Vertigo is an unpleasant and subjective experience which involves multiple vestibular and non-specific networks with the involvement of a cortico-basal ganglia- cerebellar-thalamic network.

Implementation of Online Behavior Modification Techniques in the Management of Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis.

PURPOSE: The main aim of this systematic review and meta-analysis (MA) was to assess the effectiveness of online behavior modification techniques (e-BMT) in the management of chronic musculoskeletal pain. METHODS: We conducted a search of Medline (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, APA PsychInfo, and Psychological and Behavioral Collections, from inception to the 30 August 2021. The main outcome measures were pain intensity, pain interference, kinesiophobia, pain catastrophizing and self-efficacy. The statistical analysis was conducted using RStudio software. To compare the outcomes reported by the studies, we calculated the standardized mean difference (SMD) over time and the corresponding 95% confidence interval (CI) for the continuous variables. RESULTS: Regarding pain intensity (vs. usual care/waiting list), we found a statistically significant trivial effect size in favor of e-BMT (n = 5337; SMD = -0.17; 95% CI -0.26, -0.09). With regard to pain intensity (vs. in-person BMT) we found a statistically significant small effect size in favor of in-person BMT (n = 486; SMD = 0.21; 95%CI 0.15, 0.27). With respect to pain interference (vs. usual care/waiting list) a statistically significant small effect size of e-BMT was found (n = 1642; SMD = -0.24; 95%CI -0.44, -0.05). Finally, the same results were found in kinesiophobia, catastrophizing, and self-efficacy (vs. usual care/waiting list) where we found a statistically significant small effect size in favor of e-BMT. CONCLUSIONS: e-BMT seems to be an effective option for the management of patients with musculoskeletal conditions although it does not appear superior to in-person BMT in terms of improving pain intensity.

Behavior Modification Techniques on Patients with Chronic Pain in the Context of COVID-19 Telerehabilitation: An Umbrella Review.

The aim of this systematic review (SR) of SRs was to assess the effectiveness of telerehabilitation based on behavior modification techniques (t-BMT) in patients with chronic musculoskeletal pain. We searched in PubMed, PEDro, Web of Science, CINAHL, PsycINFO, and Google Scholar (January 2022). The outcome measures were pain intensity, disability, psychological distress, pain-related fear of movement, disease impact, depressive symptoms, anxiety symptoms, and physical function. This review was previously registered on the international prospective register of systematic reviews PROSPERO (CRD42021262192). Methodological quality was analyzed using the AMSTAR and ROBIS scales, and the strength of evidence was established according to the Physical Activity Guidelines Advisory Committee grading criteria. Four SRs with and without meta-analyses covering 25 trials and involving 4593 patients were included. Of the three SRs that assessed pain intensity, two reported a significant decrease compared to usual care. Contradictory results were also found in the management of psychological distress, and of depressive and anxiety symptoms. However, two reviews found that t-BMT has significant effects on disability, and one review found that t-BMT seems to be effective for improving pain-related fear of movement and disease impact. Finally, one review found that t-BMT does not seem to be an effective modality to improve physical function. The quality of evidence was limited for all outcomes assessed. The results obtained showed that t-BMT was effective in improving disability, disease impact, and pain-related fear of movement, but it was not effective in improving physical function in patients with chronic pain. Mixed evidence was found for pain intensity, psychological distress, and depressive and anxiety symptoms, with a limited quality of evidence.

Effectiveness of Telematic Behavioral Techniques to Manage Anxiety, Stress and Depressive Symptoms in Patients with Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis.

Anxiety, depressive symptoms and stress have a significant influence on chronic musculoskeletal pain. Behavioral modification techniques have proven to be effective to manage these variables; however, the COVID-19 pandemic has highlighted the need for an alternative to face-to-face treatment. We conducted a search of PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, APA PsychInfo, and Psychological and Behavioural Collections. The aim was to assess the effectiveness of telematic behavioral modification techniques (e-BMT) on psychological variables in patients with chronic musculoskeletal pain through a systematic review with meta-analysis. We used a conventional pairwise meta-analysis and a random-effects model. We calculated the standardized mean difference (SMD) with the corresponding 95% confidence interval (CI). Forty-one randomized controlled trials were included, with a total of 5018 participants. We found a statistically significant small effect size in favor of e-BMT in depressive symptoms (n = 3531; SMD = -0.35; 95% CI -0.46, -0.24) and anxiety (n = 2578; SMD = -0.32; 95% CI -0.42, -0.21) with low to moderate strength of evidence. However, there was no statistically significant effect on stress symptoms with moderate strength of evidence. In conclusion, e-BMT is an effective option for the management of anxiety and depressive symptoms in patients with chronic musculoskeletal pain. However, it does not seem effective to improve stress symptoms.

Effects of Self-Efficacy and Outcome Expectations on Motor Imagery-Induced Thermal and Mechanical Hypoalgesia: A Single-Blind Randomised Controlled Trial.

The main aim of this study was to assess whether self-efficacy (SE) and outcome expectations (OEs) modulate the hypoalgesic effect induced by motor imagery (MI). A total of 75 asymptomatic participants were randomly assigned to the positive (SE+, OE+), negative (SE-, OE-) or non-expectation (CG) groups. Heat pain threshold (HPT) and pain pressure threshold (PPT) were the main variables. Cold detection threshold (CDT), warm detection threshold (WDT), heart rate (HR) and perceived fatigue were the secondary variables. The variables were assessed preintervention, immediately postintervention and 10 min postintervention, except for HR, which was measured continuously during the intervention. Regarding HPT, significant within-group pre-post differences were found in the OE+ group, with a low effect size (p = 0.01, d = -0.39). With regard to ΔPPT, significant intergroup differences were found in Δpost-pre between the SE+ and CG groups (p = 0.012, d = 1.04) and also between SE+ and OE- (p = 0.006, d = 1.08), both with a large effect size. CG, SE-, and OE- groups had poorer CDT and WDT. Regarding HR, significant intergroup differences were found in the postintervention measurement between OE+ and SE-, with a large effect size (p = 0.016, d = 1.34). Lastly, no between-group differences were found regarding perceived fatigue (p > 0.05). The results obtained showed that positive expectations have a slight influence on the increase in heat and mechanical pain detection thresholds. Positive and non-expectancy groups showed an autonomic activation. The results also showed that negative expectations led to poorer perceptual processes.

Effectiveness of Telerehabilitation in Physical Therapist Practice: An Umbrella and Mapping Review With Meta-Meta-Analysis.

OBJECTIVE: Telerehabilitation is an option that should be adapted as soon as possible to face the crisis caused by coronavirus disease 2019. An umbrella and mapping review with meta-meta-analysis (MMA) of the available scientific evidence was performed to determine whether telerehabilitation could be an effective alternative to conventional rehabilitation in physical therapist practice. METHODS: A systematic review of reviews and a synthesis of the findings of all systematic evidence published to date with a visual map and a meta-meta-analysis (MMA) were performed. A systematic search was realized in Cochrane Database of Systematic Reviews, MEDLINE (PubMed), and Google Scholar. Two independent reviewers performed a data analysis and assessed the quality of the included reviews, assessing the risk of bias using ROBIS. RESULTS: Twenty-nine articles that met the inclusion criteria were selected and divided according to the type of patient targeted for rehabilitation (patients with cardiorespiratory, musculoskeletal, and neurological conditions). The MMA regarding physical function between telerehabilitation and usual care rehabilitation did not reveal a statistically significant difference for patients with cardiorespiratory and musculoskeletal conditions. For patients with neurological conditions, the MMA revealed a statistically significant but negligible effect size in 6 reviews in favor of telerehabilitation (standardized mean difference = 0.18; 95% CI = 0.03-0.34). CONCLUSION: The results of the present review showed that telerehabilitation offers positive clinical results, even comparable to conventional face-to-face rehabilitation approaches. IMPACT: The advantages of lower cost and less interference by the rehabilitation processes in patients' daily life could justify implementing telerehabilitation in clinical settings in the coronavirus disease 2019 era.

Alexithymia and facial emotion recognition in patients with craniofacial pain and association of alexithymia with anxiety and depression: a systematic review with meta-analysis.

BACKGROUND: We aimed to determine the presence of alexithymia in patients with craniofacial pain (CFP) compared with asymptomatic individuals. Our secondary aims were to assess the relationship of alexithymia with anxiety and depression levels, as well as to assess the presence of facial emotion recognition deficit. METHODS: Medline, Scielo and Google Scholar were searched, with the last search performed in 8 September 2021. Standardized mean differences (SMDs) and 95% CIs were calculated for relevant outcomes and were pooled in a meta-analysis using the random effects model. In addition, meta-analyses of correlations and a meta-regression of alexithymia with depression and anxiety were performed. RESULTS: Regarding alexithymia, assessed through the Toronto Alexithymia Scale (TAS), the results showed significant differences, with higher values in patients compared with asymptomatic individuals, with a large clinical effect (SMD 0.46; 95% CI [0.22-0.71]; heterogeneity-Q 66.86; p < 0.001; inconsistency (I2) = 81%). We found statistically significant correlations with a small clinical effect of alexithymia with anxiety and depression. The meta-regression showed no significant association between the TAS and anxiety or depression. With respect to facial emotion recognition, the results showed statistically significant differences, with greater recognition difficulty in patients compared with asymptomatic individuals, with a large clinical effect (SMD -1.17; 95% CI [-2.01 to -0.33]; heterogeneity-Q 2.97; p = 0.080; I2 = 66%). CONCLUSIONS: Patients with CFP showed alexithymia with moderate evidence. There was also moderate evidence indicating that these patients had significant deficits in facial emotion recognition compared with asymptomatic individuals. Furthermore, alexithymia showed statistically significant correlations with anxiety and depression levels.

Effectiveness of motor imagery and action observation on functional variables: An umbrella and mapping review with meta-meta-analysis.

To assess the current evidence on motor imagery (MI) and action observation (AO) and their influence on functional variables. We conducted 3 meta-meta-analyses (MMA) to determine the effectiveness of MI and AO on arm functionality, performance on activities of daily living and gait mobility in stroke patients. For arm functionality, MMA revealed a statistically significant large effect size (standardised mean difference [SMD] = 1.05; 95 % CI 0.50-1.60; p<.001) but with evidence of heterogeneity (Q=55.67, p<.001, I2=93 %). For arm performance in activities of daily living, MMA revealed a significantly large effect size (SMD=1.76; 95 % CI 1.10-2.43; p<.001) but also with evidence of heterogeneity (Q=1.62, p=.44, I2=90 %). MMA showed no significant effects favouring intervention regarding gait mobility. The results of the systematic reviews showed that movement representation techniques combined with the usual treatment have a positive impact on improving function, with a very low to moderate quality of evidence for all variables except for range of motion in acute disorders and strength. MI and AO showed positive results for improving functional variables.

Craniocervical and Cervical Spine Features of Patients with Temporomandibular Disorders: A Systematic Review and Meta-Analysis of Observational Studies.

To assess neck disability with respect to jaw disability, craniocervical position, cervical alignment, and sensorimotor impairments in patients with temporomandibular disorders (TMD), a systematic review and meta-analysis of observational studies trials were conducted. The meta-analysis showed statistically significant differences in the association between neck disability and jaw disability (standardized mean difference (SMD), 0.72 (0.56-0.82)). However, results showed no significant differences for cervical alignment (SMD, 0.02 (-0.31-0.36)) or for the craniocervical position (SMD, -0.09 (-0.27-0.09)). There was moderate evidence for lower pressure pain thresholds (PPT) and for limited cervical range of motion (ROM). There was limited evidence for equal values for maximal strength between the patients with TMD and controls. There was also limited evidence for reduced cervical endurance and conflicting evidence for abnormal electromyographic (EMG) activity and motor control in TMD patients. Results showed a clinically relevant association between cervical and mandibular disability in patients with TMD. Regarding sensory-motor alterations, the most conclusive findings were observed in the reduction of PPT and cervical ROM, with moderate evidence of their presence in the patients with TMD. Lastly, the evidence on impaired motor control and cervical EMG activity in patients with TMD was conflicting.