Use of cupping therapy in musculoskeletal disorders: A cross-sectional study on the profile, training, and practice of Brazilian physical therapists.

INTRODUCTION: Cupping therapy is a widely used technique in Brazilian physical therapy for the treatment of musculoskeletal disorders. However, there is limited scientific evidence to support its effectiveness. OBJECTIVE: To investigate the profile, training, clinical practice, and scientific updates of Brazilian Physical Therapists who use cupping therapy as a therapeutic resource for musculoskeletal disorders. METHODS: A cross-sectional study was conducted through an online questionnaire, including 646 Physical Therapists who use cupping therapy in their practice. All data were analysed descriptively. RESULTS: Cupping therapy is a technique that has been widely adopted in clinical practice by Physical Therapists, particularly among young, female professionals who have recently graduated from private universities. The primary reason for interest in this technique among these Physical Therapists is the high demand from patients. Additionally, it is often used in conjunction with other manual therapeutic techniques. They identified easy access, low cost, and ease of use as the key factors that make cupping therapy an attractive option. However, a lack of high-quality scientific evidence, as described in the literature, was identified as a major barrier to its use. CONCLUSION: The Physical Therapists included in this study use cupping therapy in their clinical practice, relying heavily on their own experience and the preferences of their patients, rather than utilizing the third pillar of evidence-based practice, which is to rely on the best available evidence. This study suggests that these Physical Therapists are currently implementing a technique without current scientific recommendations for its use in the treatment of musculoskeletal disorders.

Exploring patient experiences of participating in a real and sham dry cupping intervention for nonspecific low back pain: A qualitative study.

BACKGROUND: The current quality of evidence supporting dry cupping for individuals with chronic low back pain (CLBP) is low and suggests that nonspecific factors impact experiences reported by patients. Therefore, this study assessed the impacts of social and professional support on the experience of individuals with CLBP treated with dry cupping or sham. METHOD: This is an observational study with qualitative approach. Twenty-four individuals with CLBP who received dry cupping or sham in a previous clinical trial were invited. Data was collected using a semi-structured interview conducted by a trained researcher. Content analysis was used to analyze experiences, systematic procedures, and description of the content of messages. The dimensions of "pain", "general perceptions", and "perceived social and professional support" guided the analysis. RESULTS: Answers of both groups converged on similar perceptions, especially regarding pain. Physical condition was the most fragile aspect. We also observed an influence of perceived social and professional support on painful symptoms. Thus, the experience of individuals with CLBP treated with dry cupping or sham indicated that factors related to social and professional support impacted results. CONCLUSIONS: We observed that individuals with CLBP reported similar perceptions of the effects of dry cupping or sham treatment, indicating that contextual factors may influence the perception of these individuals regarding the treatment received.

Dry cupping therapy is not superior to sham cupping to improve clinical outcomes in people with non-specific chronic low back pain: a randomised trial.

QUESTION: What are the effects of dry cupping on pain intensity, physical function, functional mobility, trunk range of motion, perceived overall effect, quality of life, psychological symptoms and medication use in individuals with chronic non-specific low back pain? DESIGN: Randomised controlled trial with concealed allocation, intention-to-treat analysis and blinding of participants and assessors. PARTICIPANTS: Ninety participants with chronic non-specific low back pain. INTERVENTIONS: The experimental group (n = 45) received dry cupping therapy, with cups bilaterally positioned parallel to the L1 to L5 vertebrae. The control group (n = 45) received sham cupping therapy. The interventions were applied once a week for 8 weeks. OUTCOME MEASURES: Participants were assessed before and after the first treatment session, and after 4 and 8 weeks of intervention. The primary outcome was pain intensity, measured with the numerical pain scale at rest, during fast walking and during trunk flexion. Secondary outcomes were physical function, functional mobility, trunk range of motion, perceived overall effect, quality of life, psychological symptoms and medication use. RESULTS: On a 0-to-10 scale, the between-group difference in pain severity at rest was negligible: MD 0.0 (95% CI -0.9 to 1.0) immediately after the first treatment, 0.4 (95% CI -0.5 to 1.5) at 4 weeks and 0.6 (95% CI -0.4 to 1.6) at 8 weeks. Similar negligible effects were observed on pain severity during fast walking or trunk flexion. Negligible effects were also found on physical function, functional mobility and perceived overall effect, where mean estimates and their confidence intervals all excluded worthwhile effects. No worthwhile benefits could be confirmed for any of the remaining secondary outcomes. CONCLUSION: Dry cupping therapy was not superior to sham cupping for improving pain, physical function, mobility, quality of life, psychological symptoms or medication use in people with non-specific chronic low back pain. PROTOCOL REGISTRATION NUMBER: NCT03909672.

Does current evidence support the use of kinesiology taping in people with knee osteoarthritis?

OBJECTIVE: To analyze the current evidence about the effects of kinesiology taping (KT) with different amounts of tension in people with knee osteoarthritis (OA). DATA SOURCES: MEDLINE (via PUBMED), SciELO, COCHRANE Library, Scopus, PEDro, Web of Science and EMBASE were used as search databases. STUDY SELECTION: Two independent researchers searched these databases from inception until June 2020 using the descriptors "kinesiotaping", "kinesio taping", "kinesiotape", "tape", "taping", "kinesiology taping", "kinesiology tape", "kinesthetic taping" or "elastic therapeutic tape" associated with "knee osteoarthritis". We included clinical trials that compared the application of KT with and without tension in people with knee OA. DATE EXTRACTION AND QUALITY ANALYSIS: Data extraction included sample description, KT tension used in the study groups, duration of KT application, area of KT application, outcome measures and study methodological quality. The quality of the studies was evaluated by means of the Physiotherapy Evidence Database (PEDro) score. DATA SYNTHESIS: Of the 850 studies identified, eight met the inclusion criteria and were ultimately included in this review. Most studies had moderate quality, with a satisfactory PEDro score. Results showed that KT application with tension was not superior to the application without tension for the outcomes of pain, physical function, range of motion and muscle strength. Evidence for edema, balance and quality of life is still limited. CONCLUSION: Current evidence does not support the use of kinesiology taping in people with knee OA.

Effects of dry cupping on pain, function and quality of life in women with knee osteoarthritis: a protocol for a sham-controlled randomised trial.

INTRODUCTION: Knee osteoarthritis (KOA) is the most common cause of pain and disability worldwide. Dry cupping has been used as non-pharmacological approach to control pain and improve physical function. However, there is a lack of high-quality scientific evidence regarding its effects on this condition. This protocol describes a sham-controlled, randomised and simple blind study that aims to evaluate the effect of dry cupping on pain, function and quality of life in women with KOA. METHODS AND ANALYSIS: Sixty-two women diagnosed with KOA, based on American College of Rheumatology clinical criteria, and aged from 50 to 75 years, will be randomly distributed into two groups (31 per group): real and sham dry cupping. Both applications will occur with acrylic cups around the knee. The intervention will last 15 min, two times a week over six consecutive weeks, for a total of 12 sessions. Both groups will be assessed at four different times: before the intervention (T0), after 3 weeks intervention (T3), at the end of the protocol (T6) and 4 weeks after the interventions (follow-up: T10). The primary outcome will be pain intensity (Numerical Pain Rating Scale), and secondary outcomes will be knee-related health status (Western Ontario and McMaster Universities Osteoarthritis Index), functional capacity (8-step stair climb test, 40-metre fast-paced walk test and 30-second chair stand test), quality of life (Short-Form 36) and global perceived effect. ETHICS AND DISSEMINATION: This protocol was approved by the UFRN/FACISA Ethics Committee (number 3.737.688). The study results will be disseminated to the participants and submitted to a peer-reviewed journal and scientific meetings. TRIAL REGISTRATION NUMBER: NCT04331158.

Mat Pilates is as effective as aquatic aerobic exercise in treating women with fibromyalgia: a clinical, randomized and blind trial.

BACKGROUND: The mat Pilates method is the therapeutic modalities which can be used in fibromyalgia treatment. Although there are no well-designed studies that prove the effectiveness of the mat Pilates method in this population. The objective was to evaluate the effectiveness of the mat Pilates method for improving symptoms in women with fibromyalgia. METHODS: A single blind randomized controlled trial in which 42 women with fibromyalgia were randomized into two groups: mat Pilates and aquatic aerobic exercise. The exercises were performed twice a week for 12 weeks. Two evaluations were performed: one at baseline (T0), and another at 12 weeks after randomization (T12). The primary outcome was pain measured by the Visual Analogue Scale (VAS). Secondary outcomes were function (Fibromyalgia Impact Questionnaire), sleep (Pittsburgh Sleep Quality Index [PSQI]), quality of life (Short Form 36 [SF-36]), fear avoidance (Fear Avoidance Beliefs Questionnaire [FABQ-BR]) and pain catastrophizing (Pain-Related Catastrophizing Thoughts Scale [PRCTS]). RESULTS: There was improvement in both groups in relation to pain and function (p < 0.05). The aspects related to quality of life and the FABQ questionnaire only showed improvement in the mat Pilates group (p < 0.05). There was improvement in the PSQI and PRCTS variables only in the aquatic aerobic exercise group (p < 0.05), but no differences were observed between the groups for any of the evaluated variables. CONCLUSION: Significant improvements were observed in the two groups in relation to the disease symptoms, and no differences were observed between mat Pilates and aquatic aerobic exercise in any of the measured variables. TRIAL REGISTRATION: ClinicalTrials.gov Identifier (NCT03149198), May 11, 2017. Approved by the Ethics Committee of FACISA/UFRN (Number: 2.116.314).

Effects of insoles adapted in flip-flop sandals in people with plantar fasciopathy: a randomized, double-blind clinical, controlled study.

OBJECTIVE: To evaluate the effects of insoles adapted into flip-flop sandals on pain and function in individuals with plantar fasciopathy (PF). DESIGN: Randomized, double-blind controlled study. SETTING: Physiotherapy clinic of the Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil. SUBJECTS: Sixty-six patients of both genders with PF were randomized into two groups: sandal insole group (SI; n = 34), which received a pair of custom flip-flop sandals with insoles covered with smooth synthetic leather; and plain sandal group (PS; n = 32), which received an identical pair of flip-flop sandals, but without the insoles. INTERVENTIONS: Patients were instructed to wear the flip-flops for 12 weeks for at least 4 hours/day. MAIN MEASURES: Pain (visual analogue scale-VAS) in the morning and at the end of the day were considered primary outcomes. Function (Foot Function Index-FFI and Foot and Ankle Ability Measure-FAAM) and functional capacity (6-minute walk test-6MWT) were considered secondary outcomes. The outcomes were evaluated at baseline and immediately after the intervention by a blind assessor. RESULTS: Between-group differences were observed in terms of morning pain (mean difference (MD) = -1.82 cm; 95% confidence interval (CI) = -3.3 to -0.3; P = 0.016) and function (MD = -0.10; 95% CI = -0.19 to -0.01; P = 0.023) after the interventions with the SI group showing superior improvements in comparison to the PS group. CONCLUSION: The use of insoles adapted in flip-flop sandals for 12 weeks was effective at improving pain and function in individuals with PF. LEVEL OF EVIDENCE: 1b.

Zumba dancing can improve the pain and functional capacity in women with fibromyalgia.

INTRODUCTION: The importance of physical exercise for patients with fibromyalgia (FM) is very clear in the literature. Dancing is a type of aerobic exercise that has great acceptance. In addition to the beneficial effects of aerobic exercise, Zumba works on motor coordination and also has socializing as a part that should be included in patients with fibromyalgia. OBJECTIVES: To evaluate the effectiveness of Zumba dancing in improving pain, functional capacity, quality of sleep and quality of life of women with fibromyalgia. DESIGN: A pre-post treatment design. METHODS: We evaluated 19 women with fibromyalgia, selected by convenience. Data were collected in the second half of 2016. Zumba dancing was performed twice a week for 12 weeks. Patients were evaluated at week 0 (T0) and at week 12 (T12), by the following instruments: VAS (Visual Analogic Scale), Likert Scale, TUG (Timed Up an Go Test), 6MWT (Six-minute Walk Test), FIQ (Fibromyalgia Impact Questionnaire), PSQI (Pittsburgh Sleep Quality Index), ESS (Epworth Sleepiness Scale) and SF-36 quality of life. RESULTS: We found differences in pain (VAST0 = 6.21 and VAST12 = 4.53) with p = 0.001 and in the domain physical functioning of SF36 (T0 = 42.37 and T12 = 52.11) with p = 0.04. No differences were found for the other variables between the times. CONCLUSION: Zumba dancing as a form of treatment for three months for patients with fibromyalgia was effective in improving pain and physical functioning. Future controlled and randomized clinical trials should be performed to improve the evidence of Zumba dancing in women with fibromyalgia.