The Role of Rehabilitative Ultrasound Imaging Technique in the Lumbopelvic Region as a Diagnosis and Treatment Tool in Physiotherapy: Systematic Review, Meta-Analysis and Meta-Regression.

Rehabilitative ultrasound imaging (RUSI) technique seems to be a valid and reliable tool for diagnosis and treatment in physiotherapy and has been widely studied in the lumbopelvic region the last three decades. The aims for this utility in clinical settings must be review through a systematic review, meta-analysis and meta-regression. A systematic review was designed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with PROSPERO registration and per review in all phases of the process using COVIDENCE, analysis of risk of bias and meta-analysis using REVMAN, and meta-regression calculation using STATA. Database screening provided 6544 references, out of which 321 reported narrative synthesis, and 21 reported quantitative synthesis, while only 7 of them provided comparable data to meta-analyze the variables pain and muscle thickness. In most cases, the forest plots showed considerable I2 heterogeneity indexes for multifidus muscle thickness (I2 = 95%), low back pain (I2 = 92%) and abdominal pain (I2 = 95%), not important for transversus abdominis muscle thickness (I2 = 22%), significant heterogenity (I2 = 69%) depending on the subgroup and not important internal oblique muscle thickness (I2 = 0%) and external oblique muscle thickness (I2 = 0%). Meta-regression did not provide significant data for the correlations between the variables analyzed and the intervention, age, and BMI (Body Mass Index). This review reveals that RUSI could contribute to a high reliability of the measurements in the lumbopelvic region with validity and reliability for the assessments, as well as showing promising results for diagnosis and intervention assessment in physiotherapy compared to the traditional model, allowing for future lines of research in this area.

Evaluation of the Lower Trapezius Muscle Using Ultrasound Panoramic View (a Novel Approach): An Intra- and Inter-Rater Reliability Study.

The panoramic view ultrasound remains uncommon in clinical practice, probably because of its difficulty, high-cost, and lack of research. Morphological changes in muscles have been demonstrated to be related to symptomatology and provide data of interest for clinical assessment. Thus, the aim of this study was to evaluate the measurement reliability of the length of the lower trapezius muscle with the panoramic view ultrasound using a novel tool, SIG_VIP®. Twenty healthy volunteers were measured by two expert sonographers using the SIG_VIP® tool with a novel approach. Statistical analyses were performed with the R software. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman plots were calculated. All the results indicated good intra-rater reliability (ICC3,1, 0.92 to 0.96; SEM, 0.59 to 0.85; MDC, 1.64 to 2.35) and inter-rater reliability (ICC3,2, 0.84 to 0.89; SEM, 1.22 to 1.53; MDC, 3.39 to 4.25). The novel system used with the described methodology can reliably measure the length of the inferior fibers of the trapezius muscle. Further research must be conducted to evaluate the reliability in patients and how pathology is related to the length of the lower trapezius muscle.

Adaptation and transcultural translation into Spanish of the Patient-Rated Tennis Elbow Evaluation Questionnaire.

The purpose of this study was to perform the translation and cross-cultural adaptation of the Patient-Rated Tennis Elbow Evaluation Questionnaire to Spanish language and evaluate its reliability and validity. The translation and cultural adaptation into Spanish was done in accordance with the published guidelines. One-hundred fifty Spanish-speaking patients with unilateral chronic lateral epicondylalgia competed the questionnaire. Test-retest reliability was established by the intraclass correlation coefficient. Internal consistency was established with Cronbach's α. To establish convergent validity, we used the Disabilities of the Arm, Shoulder, and Hand Questionnaire using the Spearman's correlation coefficient. Error estimation in the measurements was calculated with the standard error of measurement. Our results showed a high internal consistency (Cronbach's α = .96) and high test-retest reliability (intraclass coefficient = .9; .89-.94; P < .001). The Spearman's correlation coefficient (r = .765; P < .001) showed a good relationship between the Spanish version of the Patient-Rated Tennis Elbow Evaluation Questionnaire and the Disabilities of the Arm, Shoulder, and Hand Questionnaire. The standard error of measurement (11.9%) showed little variability of measurements. In conclusion, the Spanish version of the Patient-Rated Tennis Elbow Evaluation Questionnaire is a valid and reliable tool that can be used to assess lateral epicondylalgia in Spanish-speaking individuals in order to implement the best treatment and reduce time with pain and disability.

Benefits of adding stretching to a moderate-intensity aerobic exercise programme in women with fibromyalgia: a randomized controlled trial.

OBJECTIVE: To investigate the effects of adding stretching to a moderate-intensity aerobic exercise programme in women with fibromyalgia. DESIGN: Randomized controlled trial. SUBJECTS: Sixty-four female patients who were diagnosed with fibromyalgia syndrome based on the American College of Rheumatology criteria were recruited (mean age: 54.27 ± 6.94 years). INTERVENTIONS: The control group (n = 32) underwent supervised moderate-intensity cycling (50%-70% of the age-predicted maximum heart rate) three times per week for 12 weeks. The experimental group (n = 32) underwent the same exercise programme plus a stretching programme once per week for 12 weeks. MAIN MEASURES: The main measures of this study were sleep quality assessed by the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale, the impact of fibromyalgia on quality of life assessed by the Fibromyalgia Impact Questionnaire, and pain perception assessed by the visual analogue scale at baseline, after 4 weeks, and after 12 weeks. RESULTS: The experimental group experienced significant improvements at 4-week measure compared with control group: Pittsburgh Sleep Quality Index (P < 0.001); Epworth Sleepiness Scale (P = 0.002); Fibromyalgia Impact Questionnaire (0.93 ± 7.39, P < 0.001); and visual analogue scale (0.52 ± 0.05, P < 0.001). Also at 12-week measure, experimental group experienced significant improvements compared with control group: Pittsburgh Sleep Quality Index (P < 0.001), Epworth Sleepiness Scale (P < 0.001); Fibromyalgia Impact Questionnaire (1.15 ± 9.11, P < 0.001); and visual analogue scale (0.81 ± 0.62, P < 0.001). CONCLUSION: Adding stretching to a moderate-intensity aerobic exercise programme increased sleep quality, decreased the impact of fibromyalgia on the quality of life, and reduced pain compared with just a moderate-intensity aerobic exercise programme in our sample of women with fibromyalgia.

Visceral Origin: An Underestimated Source of Neck Pain. A Systematic Scoping Review.

The diagnosis of neck pain is challenging. Many visceral disorders are known to cause it, and clinical practice guidelines recommend to rule them out during neck pain diagnosis. However, the absence of suspicion of any cause impedes one from establishing that specific aetiology as the final diagnosis. To investigate the degree of consideration given to visceral aetiology, a systematic search of trials about neck pain was carried out to evaluate their selection criteria. The search yielded 309 eligible articles, which were screened by two independent reviewers. The PEDro scale score was used to assess the methodological quality of the studies. The following information was retrieved: number of authors affiliated to a clinical or non-clinical institution, number of citations in the Web of Science, study aims, characteristics of participants, and eligibility criteria. The top 15 most cited trials, and the 15 most recent studies about treatment efficacy in neck pain, published in first quartile journals of the Journal Citation Reports, were selected. Females represented 67.5% of participants. A single study was of poor methodological quality (4/10). Based on the eligibility criteria of the articles that were systematically reviewed, it would appear that visceral aetiology was not considered in eighty percent of the trials on neck pain, showing a low level of suspicion both in research and clinical settings.

Immediate and Short-Term Effects of Kinesio Taping Tightness in Mechanical Low Back Pain: A Randomized Controlled Trial.

BACKGROUND: There is controversy regarding the best technique for applying Kinesio Taping (KT), and the theory supporting that skin convolutions may explain its efficacy has recently been challenged. OBJECTIVE: To compare the immediate and short-term effectiveness of KT tightness on mechanosensitivity and spinal mobility in nonspecific low back pain (LBP), and to observe the influence of gender in the outcome measures. DESIGN: Double-blind, randomized, controlled trial. SETTING: University-based clinical research center. PARTICIPANTS: A total of 75 individuals with a mean age of 33 years (±7.4 years), 60% female and 40% male, with nonspecific LBP were recruited and randomly assigned to 1 of the following study groups: standard KT tension (n = 26), increased KT tension (n = 25), and no KT tension (n = 24). INTERVENTIONS: All participants received a two I-strip taping over the paravertebral muscles for 24 hours. Paper-off tension (15%-25% of the available stretch) was used in the standard KT group, which was increased to 40% in the increased KT tension group. The rest of participants received a taping procedure with no KT tension. Measurements were taken at baseline, immediately after the taping, 24 hours after the taping, and after KT removal. MAIN OUTCOME MEASURES: The primary outcome included pressure pain thresholds over the erector spinae and gluteus medius muscles. The secondary outcome was lumbar mobility (assessed with a digital inclinometer, and back-saver sit-and-reach, finger-to-floor, and sit-and-reach tests). RESULTS: In the between-groups analysis of the mean score changes after baseline assessment, no significant differences were found for any of the outcome measures (P > .05) except the left back-saver sit-and-reach test (P = .03). A statistically significant interaction group × gender × time was observed only for mechanosensitivity values (P = .02 for the gluteus and P = .01 for the erector spinae). CONCLUSION: KT tightness does not seem to influence pain sensitivity and lumbar mobility in chronic LBP in either the immediate or short term. LEVEL OF EVIDENCE: II.

Role of upper cervical spine in temporomandibular disorders.

BACKGROUND: Temporomandibular disorders (TMDs) are prevalent multifactorial pathologies in which the actual role of the cervical region position is controversial. OBJECTIVE: To analyze the relationship between the position of the upper cervical rachis and the symptoms of TMD. METHODS: Sixty women were recruited to this study. All of them completed a questionnaire and were subjected to a temporomadibular exploration to create two different groups: a TMD Group (n= 30) - women who suffered TMD symptoms according to the evaluation; and a control group (n= 30) - women who were free from TMD symptoms. Two X-ray examinations were performed in all the women: a lateral one and a frontal one with mouth open to assess the C1-C0 distance and the craniocervical angle. RESULTS: ANOVA showed that the TMD and control women had similar C1-C0 distances and craniocervical angles (p> 0.05). Pearson correlation did not indicate any relationship between the craniocervical position and the symptomatology of TMD (r=- 0.070). CONCLUSIONS: TMD symptomatology is unrelated to alterations in craniocervical position (C0-C1 distance and craniocervical angle). Women with and without TMD showed a similar prevalence of alteration in the craniocervical position.

Effectiveness of a Treatment Involving Soft Tissue Techniques and/or Neural Mobilization Techniques in the Management of Tension-Type Headache: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the effects of a protocol involving soft tissue techniques and/or neural mobilization techniques in the management of patients with frequent episodic tension-type headache (FETTH) and those with chronic tension-type headache (CTTH). DESIGN: Randomized, double-blind, placebo-controlled before and after trial. SETTING: Rehabilitation area of the local hospital and a private physiotherapy center. PARTICIPANTS: Patients (N=97; 78 women, 19 men) diagnosed with FETTH or CTTH were randomly assigned to groups A, B, C, or D. INTERVENTIONS: (A) Placebo superficial massage; (B) soft tissue techniques; (C) neural mobilization techniques; (D) a combination of soft tissue and neural mobilization techniques. MAIN OUTCOMES MEASURES: The pressure pain threshold (PPT) in the temporal muscles (points 1 and 2) and supraorbital region (point 3), the frequency and maximal intensity of pain crisis, and the score in the Headache Impact Test-6 (HIT-6) were evaluated. All variables were assessed before the intervention, at the end of the intervention, and 15 and 30 days after the intervention. RESULTS: Groups B, C, and D had an increase in PPT and a reduction in frequency, maximal intensity, and HIT-6 values in all time points after the intervention as compared with baseline and group A (P<.001 for all cases). Group D had the highest PPT values and the lowest frequency and HIT-6 values after the intervention. CONCLUSIONS: The application of soft tissue and neural mobilization techniques to patients with FETTH or CTTH induces significant changes in PPT, the characteristics of pain crisis, and its effect on activities of daily living as compared with the application of these techniques as isolated interventions.

Manual therapy in joint and nerve structures combined with exercises in the treatment of recurrent ankle sprains: A randomized, controlled trial.

BACKGROUND: Recurrent ankle sprains often involve residual symptoms for which subjects often perform proprioceptive or/and strengthening exercises. However, the effectiveness of mobilization to influence important nerve structures due to its anatomical distribution like tibial and peroneal nerves is unclear. OBJETIVES: To analyze the effects of proprioceptive/strengthening exercises versus the same exercises and manual therapy including mobilizations to influence joint and nerve structures in the management of recurrent ankle sprains. STUDY DESIGN: A randomized single-blind controlled clinical trial. METHOD: Fifty-six patients with recurrent ankle sprains and regular sports practice were randomly assigned to experimental or control group. The control group performed 4 weeks of proprioceptive/strengthening exercises; the experimental group performed 4 weeks of the same exercises combined with manual therapy (mobilizations to influence joint and nerve structures). Pain, self-reported functional ankle instability, pressure pain threshold (PPT), ankle muscle strength, and active range of motion (ROM) were evaluated in the ankle joint before, just after and one month after the interventions. RESULTS: The within-group differences revealed improvements in all of the variables in both groups throughout the time. Between-group differences revealed that the experimental group exhibited lower pain levels and self-reported functional ankle instability and higher PPT, ankle muscle strength and ROM values compared to the control group immediately after the interventions and one month later. CONCLUSIONS: A protocol involving proprioceptive and strengthening exercises and manual therapy (mobilizations to influence joint and nerve structures) resulted in greater improvements in pain, self-reported functional joint stability, strength and ROM compared to exercises alone.

Experienced versus Inexperienced Interexaminer Reliability on Location and Classification of Myofascial Trigger Point Palpation to Diagnose Lateral Epicondylalgia: An Observational Cross-Sectional Study.

The purpose was to evaluate the interexaminer reliability of experienced and inexperienced examiners on location and classification of myofascial trigger points (MTrPs) in two epicondylar muscles and the association between the MTrP found and the diagnosis of lateral epicondylalgia (LE). Fifty-two pianists (some suffered LE) voluntarily participated in the study. Three physiotherapists (one inexperienced in myofascial pain) examined, located, and marked MTrPs in the extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC) muscles. Forearms were photographed and analyzed to establish the degree of agreement on MTrPs diagnosis. Data showed 81.73% and 77.88% of agreement on MTrP classification and 85.58% and 72.12% on MTrP location between the expert evaluators for ECRB and EDC, respectively. The agreement on MTrP classification between experienced and inexperienced examiners was 54.81% and 51.92% for ECRB and 50.00% and 55.77% for EDC. Also, agreement on MTrP location was 54.81% and 60.58% for ECRB and 48.08% and 48.08% for EDC. A strong association was found between presence of relevant MTrPs, LE diagnosis, and forearm pain when the examiners were experts. The analysis of location and classification of MTrPs in the epicondylar muscles through physical examination by experienced evaluators is reliable, reproducible, and suitable for diagnosing LE.

Reliability and minimal detectable change of three functional tests: forward-lunge, step-up-over and sit-to-stand.

[Purpose] To examine the intrasession and intersession reliability and the absolute reliability of three functional dynamic tests-forward-lunge, step-up-over and sit-to-stand tests-using computerized dynamic posturography. [Subjects and Methods] An intra-test and test-retest, repeated measure study was designed. Forty-five healthy subjects twice carried out the forward-lunge test, step-up-over test, and sit-to-stand test on two days, one week apart. The intrasession and intersession reliabilities as judged by the intraclass correlation coefficient (ICC) and the minimal detectable change of the three functional tests were calculated. [Results] Excellent to very good intrasession reliability of the forward-lunge test (ICC range of 0.9-0.8) was found. Very good to good intrasession reliability of the step-up-over test (ICC range of 0.9-0.5) was found and very good intrasession reliability of the sit-to-stand test (ICC range of 0.8-0.7) was found. The minimal detectable change at the 95% confidence level of most of the measures was lower than 30%. [Conclusion] The forward-lunge, step-up-over and sit-to-stand tests are reliable measurement tools.

Diastasis of symphysis pubis and labor: Systematic review.

Symphysis pubis diastasis (SPD) is an infrequent complication of labor that can impair womens' general health through failure of the passive stability of the pelvic girdle. Although conservative approaches are often used to decrease symptoms and interpubic separation, notably few studies have analyzed the effect of these methods on managing the symptoms of women with SPD. The purpose of this study was to review the available literature on the conservative treatment of SPD during pregnancy and labor. A computer-based search using PubMed, PEDro, and CINAHL was performed up to November 2014. We selected all studies that considered women with SPD during pregnancy or labor and treated them with conservative methods and excluded those that included surgical intervention. Eighteen studies were selected, most of which were case reports. Although the overall results of conservative treatment were unclear because of the type and design of the obtained studies, most of the studies reported bed rest in the lateral decubitus position and a pelvic girdle as basic treatments. Additionally, the few clinical trials reported recommended additional physiotherapy, including strengthening and stabilizing exercises, to reduce SPD symptoms.

A Decade of Progress Using Virtual Reality for Poststroke Lower Extremity Rehabilitation: Systematic Review of the Intervention Methods.

OBJECTIVE: To develop a systematic review of the literature, to describe the different virtual reality (VR) interventions and interactive videogames applied to the lower extremity (LE) of stroke patients, and to analyse the results according to the most frequently used outcome measures. MATERIAL AND METHODS: An electronic search of randomized trials between January 2004 and January 2014 in different databases (Medline, Cinahl, Web of Science, PEDro, and Cochrane) was carried out. Several terms (virtual reality, feedback, stroke, hemiplegia, brain injury, cerebrovascular accident, lower limb, leg, and gait) were combined, and finally 11 articles were included according to the established inclusion and exclusion criteria. RESULTS: The reviewed trials showed a high heterogeneity in terms of study design and assessment tools, which makes it difficult to compare and analyze the different types of interventions. However, most of them found a significant improvement on gait speed, balance and motor function, due to VR intervention. CONCLUSIONS: Although evidence is limited, it suggests that VR intervention (more than 10 sessions) in stroke patients may have a positive impact on balance, and gait recovery. Better results were obtained when a multimodal approach, combining VR and conventional physiotherapy, was used. Flexible software seems to adapt better to patients' requirements, allowing more specific and individual treatments.