Cardiopulmonary Response in Post-COVID-19 Individuals: A Cross-Sectional Study Comparing the Londrina Activities of Daily Living Protocol, 6-Minute Walk Test, and Glittre Activities of Daily Living Test.

This study addresses the imperative need for reliable assessment protocols in guiding rehabilitation interventions for individuals post-COVID-19, considering the enduring physiological effects of the virus. A cohort of 40 post-COVID-19 individuals underwent assessments using the Londrina ADL protocol, Glittre ADL test, and the 6-minute walk test (6MWT). Physiological parameters were recorded during and after each test, including heart rate, respiratory rate, and oxygen saturation. The post hoc comparisons between the pre-test and post-test cardiopulmonary response of the three tests showed significant differences, except diastolic blood pressure (6MWT vs. Londrina ADL protocol), heart rate (6MWT vs. Londrina ADL protocol), respiratory rate (6MWT vs. Londrina ADL protocol), blood oxygen level (SpO2) (6MWT vs. Londrina ADL protocol), dyspnea (Londrina ADL protocol vs. Glittre ADL test), and fatigue (Londrina ADL protocol vs. Glittre ADL test). The Londrina ADL protocol demonstrated cardio-pulmonary responses comparable to the Glittre ADL test, as well as the 6MWT, emphasizing its effectiveness in evaluating walking-related outcomes. The study concludes that the Londrina ADL protocol is a robust and practical tool for the routine clinical testing of daily living activities in post-COVID-19 individuals. While the 6MWT remains valuable for assessing walking-related outcomes, a combined approach employing the Londrina ADL protocol and 6MWT offers a comprehensive strategy for evaluating multifaceted functional capacities in this population.

Effectiveness of Cognitive Functional Therapy Versus Core Exercises and Manual Therapy in Patients With Chronic Low Back Pain After Spinal Surgery: Randomized Controlled Trial.

OBJECTIVE: Our aim was to investigate whether cognitive functional therapy (CFT) was more effective than core exercises and manual therapy (CORE-MT) in improving pain and function for patients with chronic low back pain after spinal surgery. METHODS: This study was a randomized controlled superiority trial in a university hospital and a private physical therapist clinic in Santa Catarina, Brazil. Eighty participants who were 18 to 75 years old and had chronic low back pain after spinal surgery received 4 to 12 treatment sessions of CFT or CORE-MT once per week for a maximum period of 12 weeks. Primary outcomes were pain intensity (numeric pain rating scale, scored from 0 to 10) and function (Patient-Specific Functional Scale, scored from 0 to 10) after intervention. RESULTS: We obtained primary outcome data for 75 participants (93.7%). CFT was more effective, with a large effect size, than CORE-MT in reducing pain intensity (mean difference [MD] = 2.42; 95% CI = 1.69-3.14; effect size [d] = 0.85) and improving function (MD = -2.47; 95% CI = -3.08 to -1.87; effect size = 0.95) after intervention (mean = 10.4 weeks [standard deviation = 2.17] after the beginning of treatment). The differences were maintained at 22 weeks for pain intensity (MD = 1.64; 95% CI = 0.98-2.3; effect size = 0.68) and function (MD = -2.01; 95% CI = -2.6 to -1.41; effect size = 0.81). CONCLUSION: CFT was more effective than CORE-MT, with large effect sizes, and may be an option for patients with chronic low back pain after spinal surgery. IMPACT: CFT reduces pain and improves function, with large effect sizes, compared with CORE-MT. The difference between CFT and CORE-MT was sustained at the midterm follow-up. Treatment with CFT may be an option for patients with chronic low back pain after spinal surgery.

Minimal-Resource Home Exercise Program Improves Activities of Daily Living, Perceived Health Status, and Shortness of Breath in Individuals with COPD Stages GOLD II to IV.

Home exercises (HE) with minimal resources seem to be useful in individuals with COPD. The objective was to evaluate the effects of HE, on activities of daily living (ADL), dyspnea, on the health status(CAT) and quality of life (HRQoL) of individuals with COPD GOLD II to IV. Quasi-experimental study of the effects of HE, for 2 months, 3 times a week. Individuals with COPD(n = 45) were recruited, 37 started the protocol(9 did not complete it). 28 individuals (mean age 62.04 ± 5.8 years, FEV1: 44.7 ± 2.25%, FEV1/FVC 59.8 ± 6.9%) were evaluated before and after training. We observed improvements in the ADL-Glittre (4.9 ± 1.4 vs 3.9 ± 1.1 min; mean difference: -0.9 ± 0.2 min [95%CI: -1.3 to -0.2]; p = 0.008), as well as the mMRC score(2.8 ± 1.1 vs 2.07 ± 0.81; mean difference: 0.7 ± 0.3 [95%CI: -1.20.18 to -0.2]; p = 0.009), and in the CAT (25.6 ± 4.8 vs 18.9 ± 3.1; mean difference: -6.6 ± 3.4 [95%CI: -10.6 to -1.6]; p = 0.042). Analyzing the mean change before and after the intervention, a weak correlation was observed between ADL-Glittre and mMRC (r = 0.35; [95% CI 0.09; 0.56]; p = 0.009); moderate between ADL-Glittre and CAT (r = 0.52; [95% CI 0.30; 0.69]; p < 0.001) and between ADL-Glittre and SGRQ (r = 0.50; [95% CI 0 .27; 0.67]; p < 0.001). Individuals with COPD can benefit from HE performed autonomously and with minimal resources, as this proposal improves functional capacity for ADL, health perception and dyspnea.

The care pathway of individuals with spinal disorders in a Health Care Network in the Federal District, Brazil: a retrospective study.

BACKGROUND: Understanding the care pathway is essential to identify how to effectively treat spinal disorders. However, there is no specific data on the pathway of these individuals in the Health Care Networks (HCN) in Brazil. OBJECTIVE: To investigate the pathway of individuals with non-specific spinal disorders (NSD) in the HCN in the Federal District, Brazil, and verify the interventions adopted, and to test whether sociodemographic and clinical variables predict the number of imaging tests, prescribed medication, and the first HCN access. METHODS: Retrospective study that analysed electronic records of 327 individuals with NSD between 2012 and 2018. Generalized linear models estimated the association between sociodemographic and clinical data and number of drugs prescribed and imaging tests requested. Multinomial logistic regression estimated the association between clinical and demographic variables and setting of first access. RESULTS: The median age was 57 years, and 75.5% were women. Emergency Department (ED) was the most accessed setting (43.7%), and back pain was the most prevalent condition (84.5%). Most individuals underwent imaging tests (60%) and drug prescriptions (86%). Physical exercises were prescribed to 13%, and 55% were referred to physical therapy. Women were more likely to first access the ED. CONCLUSION: The ED was the most used setting by people with NSD. Few participants received exercise prescriptions and half were referred to physical therapists. Individuals who used outpatient clinics and primary care received less drug prescriptions, and women were more likely to first access the ED. Increasing age was associated with greater chance of first accessing Outpatient Clinics.

Does the painDETECT questionnaire identify impaired conditioned pain modulation in people with musculoskeletal pain? - a diagnostic accuracy study.

BACKGROUND: People with neuropathic-like symptoms had more unfavourable pain features than people with nociceptive. Moreover, deficient conditioned pain modulation is common in people with neuropathic-like symptoms. PainDETECT questionnaire have been used to assess the central sensitisation sign and symptoms. However, whether the painDETECT questionnaire can identify the conditioned pain modulation's impairment is still unknown. Therefore, the current study aimed to evaluate the diagnostic accuracy of the painDETECT questionnaire in detecting the impairment of conditioned pain modulation in people with musculoskeletal pain. METHODS: We conducted a diagnostic accuracy comparing the painDETECT questionnaire (index method) with the cold pressor test, the psychophysical test used to assess the conditioned pain modulation (reference standard). We determined diagnostic accuracy by calculating sensitivity, specificity, predictive values, and likely hood ratios. RESULTS: We retrospectively enrolled 308 people with musculoskeletal pain in outpatient departments. Most participants were female (n 20 = 220, 71.4%) and had a mean age of 52.2 (± 15.0) years. One hundred seventy-three (56.1%) participants were classified as nociceptive pain, 69 (22.4%) as unclear, and 66 (21.4%) as neuropathic-like symptoms. According to the cold pressor test, 60 (19.4%) participants presented impairment of conditioned pain modulation. The cutoff point of 12 of the painDETECT questionnaire showed values of diagnostic accuracy below 70% compared to the cold pressor test, except for a negative predictive value [76.9 95% Confidence Interval (CI) 71.7 to 81.5]. The cutoff point 19 showed high specificity (78.6%, 95% CI 73.0 to 83.5), high negative predictive value (80.5%, 95% CI 78.1 to 82.7), and accuracy of 67.5% compared to the cold pressor test. CONCLUSION: The painDETECT questionnaire seems valuable for ruling out people with musculoskeletal pain and impairment of conditioned pain modulation.

Exploratory analysis of 5 supervised machine learning models for predicting the efficacy of the endogenous pain inhibitory pathway in patients with musculoskeletal pain.

OBJECTIVES: The identification of factors that influence the efficacy of endogenous pain inhibitory pathways remains challenging due to different protocols and populations. We explored five machine learning (ML) models to estimate the Conditioned Pain Modulation (CPM) efficacy. DESIGN: Exploratory, cross-sectional design. SETTING AND PARTICIPANTS: This study was conducted in an outpatient setting and included 311 patients with musculoskeletal pain. METHODS: Data collection included sociodemographic, lifestyle, and clinical characteristics. CPM efficacy was calculated by comparing the pressure pain thresholds before and after patients submerged their non-dominant hand in a bucket of cold water (cold-pressure test) (1-4 °C). We developed five ML models: decision tree, random forest, gradient-boosted trees, logistic regression, and support vector machine. MAIN OUTCOME MEASURES: Model performance were assessed using receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, precision, recall, F1-score, and the Matthews Correlation Coefficient (MCC). To interpret and explain the predictions, we used SHapley Additive explanation values and Local Interpretable Model-Agnostic Explanations. RESULTS: The XGBoost model presented the highest performance with an accuracy of 0.81 (95% CI = 0.73 to 0.89), F1 score of 0.80 (95% CI = 0.74 to 0.87), AUC of 0.81 (95% CI: 0.74 to 0.88), MCC of 0.61, and Kappa of 0.61. The model was influenced by duration of pain, fatigue, physical activity, and the number of painful areas. CONCLUSIONS: XGBoost showed potential in predicting the CPM efficacy in patients with musculoskeletal pain on our dataset. Further research is needed to ensure the external validity and clinical utility of this model.

Mediation Analysis in Manual Therapy Research.

Objective: The purpose of this study was to illustrate the applicability of mediation analysis in the manual therapy field by assessing whether pain intensity, duration of pain, or the change in systolic blood pressure mediated the heart rate variability (HRV) of patients with musculoskeletal pain who received manual therapy. Methods: A secondary data analysis from a 3-arm, parallel, randomized, placebo-controlled, assessor-blinded, superiority trial was performed. Participants were randomized into spinal manipulation, myofascial manipulation, or placebo groups. Cardiovascular autonomic control was inferred from resting HRV variables (low-high frequency power ratio; LF/HF) and blood pressure responsiveness to a sympathoexcitatory stimulus (cold pressor test). Pain intensity and duration were assessed. Mediation models analyzed whether pain intensity, duration, or blood pressure independently affected the improvement of the cardiovascular autonomic control of patients with musculoskeletal pain after intervention. Results: The first assumption of mediation was met for LF/HF with statistical evidence of a total effect of spinal manipulation, as compared with placebo on HRV outcomes (ß = 0.77 [0.17-1.30]); second and third assumptions showed no statistical evidence of a relationship between the intervention and pain intensity (ß = -5.30 [-39.48 to 28.87]), pain intensity, and LF/HF (ß = 0.00 [-0.01 to 0.01]). Conclusion: In this study of causal mediation analysis, the baseline pain intensity, duration of pain, and responsiveness of the systolic blood pressure to a sympathoexcitatory stimulus did not mediate the effects of the spinal manipulation on the cardiovascular autonomic control of patients with musculoskeletal pain. Accordingly, the immediate effect of spinal manipulation on the cardiac vagal modulation of patients with musculoskeletal pain may more likely be related to the intervention rather than the mediators investigated.

Factors associated with mortality in mechanically ventilated patients with severe acute respiratory syndrome due to COVID-19 evolution / Fatores associados à mortalidade em pacientes ventilados mecanicamente com síndrome respiratória aguda grave por evolução da COVID-19

ABSTRACT Objectives: To evaluate the factors associated with mortality in mechanically ventilated patients with acute respiratory distress syndrome due to COVID-19. Methods: This was a retrospective, multicenter cohort study that included 425 mechanically ventilated adult patients with COVID-19 admitted to 4 intensive care units. Clinical data comprising the SOFA score, laboratory data and mechanical characteristics of the respiratory system were collected in a standardized way immediately after the start of invasive mechanical ventilation. The risk factors for death were analyzed using Cox regression to estimate the risk ratios and their respective 95%CIs. Results: Body mass index (RR 1.17; 95%CI 1.11 - 1.20; p < 0.001), SOFA score (RR 1.39; 95%CI 1.31 - 1.49; p < 0.001) and driving pressure (RR 1.24; 95%CI 1.21 - 1.29; p < 0.001) were considered independent factors associated with mortality in mechanically ventilated patients with acute respiratory distress syndrome due to COVID-19. Respiratory system compliance (RR 0.92; 95%CI 0.90 - 0.93; p < 0.001) was associated with lower mortality. The comparative analysis of the survival curves indicated that patients with respiratory system compliance (< 30mL/cmH2O), a higher SOFA score (> 5 points) and higher driving pressure (> 14cmH2O) were more significantly associated with the outcome of death at 28 days and 60 days. Conclusion: Patients with a body mass index > 32kg/m2, respiratory system compliance < 30mL/cmH2O, driving pressure > 14cmH2O and SOFA score > 5.8 immediately after the initiation of invasive ventilatory support had worse outcomes, and independent risk factors were associated with higher mortality in this population.

RESUMO Objetivos: Avaliar os fatores associados à mortalidade em pacientes ventilados mecanicamente com síndrome o desconforto respiratório agudo por evolução da COVID-19. Métodos: Estudo de coorte retrospectiva, multicêntrica, que incluiu 425 pacientes adultos com COVID-19, ventilados mecanicamente, internados em 4 unidades de terapia intensiva. Foram coletados dados clínicos que compõem o escore SOFA, dados laboratoriais e características mecânicas do sistema respiratório, de forma padronizada, imediatamente após o início da ventilação mecânica invasiva. Os fatores de risco para óbito foram analisados por meio da regressão de Cox, para estimar as razões de risco, e seus respectivos IC95%. Resultados: Índice de massa corporal (RR de 1,17; IC95% 1,11 - 1,20; p < 0,001), escore SOFA (RR de 1,39; IC95% 1,31 - 1,49; p < 0,001) e driving pressure (RR de 1,24; IC95% 1,21 - 1,29; p < 0,001) foram considerados fatores independentes associados à mortalidade em pacientes ventilados mecanicamente com síndrome do desconforto respiratório agudo por COVID-19. Já a complacência do sistema respiratório (RR de 0,92; IC95% 0,90 - 0,93; p < 0,001) foi associada à menor mortalidade. A análise comparativa das curvas de sobrevida demonstra que pacientes com complacência do sistema respiratório (< 30mL/cmH2O), maior SOFA escore (> 5 pontos) e maior driving pressure (> 14cmH2O) apresentaram maior associação ao desfecho morte em 28 dias e 60 dias. Conclusão: Pacientes com índice de massa corporal > 32kg/m2, complacência do sistema respiratório < 30mL/cmH2O, driving pressure > 14cmH2O e SOFA escore > 5,8, imediatamente após o início da assistência ventilatória invasiva, apresentam piores desfechos no segmento, sendo fatores de risco independentes associados à maior mortalidade nessa população.

Osteopathy and physiotherapy compared to physiotherapy alone on fatigue in long COVID: Study protocol for a pragmatic randomized controlled superiority trial.

Objective: Fatigue is among the most common symptoms of the long-term effects of coronavirus (long COVID). This study aims to compare the effectiveness of osteopathic manipulative treatment (OMT) combined with physiotherapy treatment (PT) compared to PT alone on fatigue and functional limitations after two months post randomization in adults with long COVID. Methods: This is a study protocol for a two-arm, assessor-blinded, pragmatic randomized controlled superiority trial. Seventy-six participants will be randomly allocated to OMT + PT or PT. The PT includes usual care interventions including motor and respiratory exercises targeting cardiorespiratory and skeletal muscle functions. The OMT entails direct and indirect musculoskeletal, viceral and cranial techniques. Patients will be evaluated before and after a 2-month intervention program, and at 3-month follow-up session. Primary objectives comprise fatigue and functional limitations at 2-month post randomization as assessed by the fatigue severity scale and the Post-COVID Functional State scale. Secondary objectives comprise fatigue and functional limitations at 3 months, and the perceived change post-treatment as assessed by the Perceived Change Scale (PCS-patient). Registration: This protocol was registered (NCT05012826) and received ethical approval (38342520.7.0000.5235). Participant recruitment began in August 2021 and is expected to conclude in July 2023. Publication of the results is anticipated in 2023.

Effectiveness of Constraint-Induced Movement Therapy (CIMT) on Balance and Functional Mobility in the Stroke Population: A Systematic Review and Meta-Analysis.

Constraint-induced movement therapy (CIMT) is one of the most popular treatments for enhancing upper and lower extremity motor activities and participation in patients following a stroke. However, the effect of CIMT on balance is unclear and needs further clarification. The aim of this research was to estimate the effect of CIMT on balance and functional mobility in patients after stroke. After reviewing 161 studies from search engines including Google Scholar, EBSCO, PubMed, PEDro, Science Direct, Scopus, and Web of Science, we included eight randomized controlled trials (RCT) in this study. The methodological quality of the included RCTs was verified using PEDro scoring. This systematic review showed positive effects of CIMT on balance in three studies and similar effects in five studies when compared to the control interventions such as neuro developmental treatment, modified forced-use therapy and conventional physical therapy. Furthermore, a meta-analysis indicated a statistically significant effect size by a standardized mean difference of 0.51 (P = 0.01), showing that the groups who received CIMT had improved more than the control groups. However, the meta-analysis results for functional mobility were statistically insignificant, with an effect size of -4.18 (P = 0.16), indicating that the functional mobility improvements in the investigated groups were not greater than the control group. This study's findings demonstrated the superior effects of CIMT on balance; however, the effect size analysis of functional mobility was statistically insignificant. These findings indicate that CIMT interventions can improve balance-related motor function better than neuro developmental treatment, modified forced-use therapy and conventional physical therapy in patients after a stroke.

Use of the painDETECT to discriminate musculoskeletal pain phenotypes.

BACKGROUND: Musculoskeletal pain patients present similar pain characteristics regardless of the clinical diagnosis. PainDETECT questionnaire is useful for screening neuropathic-like symptoms in many musculoskeletal conditions. However, no previous studies compared pain phenotypes of patients with musculoskeletal pain using the painDETECT. Therefore, the current study aimed to compare the pain characteristics of patients with musculoskeletal pain classified according to the painDETECT as nociceptive pain, unclear, and neuropathic-like symptoms. METHODS: A cross-sectional study was conducted in 308 participants with musculoskeletal pain. Demographic and clinical characteristics of the participants were examined. Neuropathic-like symptoms, pain intensity, pain area, Central Sensitization-related sign and symptoms, functional limitation, and conditioned pain modulation were assessed in patients with musculoskeletal pain. Independent one-way analysis of variance (ANOVA) was used to test for between-group differences for the outcome measures with continuous variables and Pearson chi-square test verified between-group differences on the efficiency of the conditioned pain modulation. RESULTS: Participants had a mean age of 52.21 (±15.01) years old and 220 (71.42%) were females. One hundred seventy-three (56.16%) participants present nociceptive pain, 69 (22.40%) unclear, and 66 (21.42%) neuropathic-like symptoms. A one-way ANOVA showed differences for the pain intensity [F (2,305) = 20.097; p < .001], pain area [F (2,305) = 28.525; p < .001], Central Sensitization-related sign and symptoms [F (2,305) = 54.186; p < .001], and functional limitation [F (2,256) = 8.061; p < .001]. However, conditioned pain modulation was similarly impaired among the three groups (X2 = 0.333, p = 0.847). CONCLUSION: Patients with neuropathic-like symptoms revealed unfavorable pain characteristics compared to their counterparts, including pain intensity, generalized pain, Central Sensitization-related sign and symptoms, and functional limitation.

Concurrent validation of the centre of pressure displacement analyzed by baropodometry in patients with chronic non-specific low back pain during functional tasks.

INTRODUCTION: Low back pain is highly prevalent worldwide and in Brazil. Postural control is a functional limitation in patients with low back pain. Postural control can be investigated through the centre of pressure (CoP) displacement, using a baropodometry. However, there is a lack of validation data about posturography variables obtained from the baropodometer. This study aimed to investigate the concurrent validity of the displacement of CoP measured through baropodometer T-Plate® in patients with chronic non-specific low back pain during three tasks. METHOD: A validation study was conducted in 37 participants with chronic non-specific low back pain during three different tasks, including bipedal support, bipedal support holding bags, and bipedal squatting holding bags. The tasks were performed on a baropodometer (index method) placed on a force plate (criterion measure). Measurements included velocity, amplitude of displacement, and sway area. RESULTS: Weak to strong correlations were found in the three tasks between the baropodometer and the force plate for most variables. The Bland-Altman analyses revealed no substantive differences between the two methods for the standard deviation of amplitude mediolateral and sway area for the three tasks. There was a systematic bias for the mean velocity and the standard deviation of amplitude anteroposterior displacement in the three tasks. CONCLUSION: The baropodometer could be used to measure the displacement of the CoP in patients with chronic non-specific low back pain. Sway area showed an appropriate validity to measure postural stability of the participants using the baropodometer.

Lower limb muscle fatigability is not associated with changes in movement strategies for balance control in the upright stance.

BACKGROUND: Fatigue is a distressing symptom inversely related to postural stability in adults with neuromuscular and systemic diseases. However, there is no information about the effects of lower limb muscles fatigability on the movement strategies for balance control in the upright standing. METHODS: This study enrolled 41 healthy subjects (female/male: 22/19; age 23 ± 3 years; body mass index 25.4 ± 3.7 kg/m2). Participants underwent posturography and surface electromyography of the gastrocnemius medialis muscle during a sustained, fatiguing voluntary contraction of the gastrocnemius preceded and followed by quiet standing (120 s). Amplitude of electromyograms and fatigability were evaluated using the root mean square (RMS) value and both the RMS and spectral median frequency (fmed) slopes. Balance control was evaluated using the center-of-pressure elliptic area (Area) and average velocity (Vavg). Movement strategies for balance control were evaluated using the number of high-density regions (nHDR) and spatial patterns of the three-dimensional statokinesigram. RESULTS: Mean time to muscle fatigability was 258 ± 190 s. Area and Vavg but not nHDR increased after the fatiguing task. Single-centered spatial patterns were predominant in both tasks (pre-fatigue: n = 22/41; post-fatigue: n = 19/41), with no evidence of an association between the spatial patterns and tasks (γ = 0.237, 95%CI = [-0.338; 0.542]). CONCLUSIONS: Lower limb muscle fatigability increases postural instability, but it is not associated with changes in movement strategies for balance control in the upright stance.

Association Between Low Back Pain and Biomedical Beliefs in Academics of Physiotherapy.

STUDY DESIGN: Observational cross-sectional study. OBJECTIVE: To analyze the association between low back pain and biomedical beliefs in physiotherapy students of the first and last year. SUMMARY OF BACKGROUND DATA: There is a hypothesis that the presence of low back pain may be a risk factor for biomedical beliefs in physiotherapy academics. METHODS: Three hundred sixty-five students of first and last year of the physiotherapy course from three universities in city of Fortaleza completed a questionnaire with sociodemographic factors and a Pain Attitude and Beliefs Scale used to determine the orientation (biopsychosocial or biomedical approach) of practitioners to the management of people with low back pain. RESULTS: The mean age of participants was 23.57 ±â€Š4.77 years, with a predominance of females (80.27%, n = 239). Approximately 23.84% reported low back pain, 18.9% had undergone imaging tests at the site, and 36.71% reported that family members with low back pain also underwent these examinations. The means of the biopsychosocial subscale of the Pain Attitude and Belief Scale corresponded to 20.19 and 20.63 in the first and last year academics, respectively, whereas the biomedical subscale corresponded to 32.10 and 32.73 in the first and last year academics, respectively. There was no statistical difference between the scores of the first and last year students. Linear regression analyses showed that low back pain was associated with lower levels of biomedical beliefs in the students of the last year (beta coefficient = -2.17, 95% confidence interval = -3.95 to -0.3, P = 0.02). We did not find association between low back pain and levels of biomedical beliefs in academics of both years and with academics of the first year. Also, we did not find association between low back pain and levels of biopsychosocial beliefs. CONCLUSION: First and last year physical therapy students did not present a difference between biomedical and biopsychosocial beliefs. Although biomedical beliefs were prevalent in both groups, the academics of the last year who had low back pain presented lower levels of biomedical beliefs than the academics of the last year without low back symptoms. LEVEL OF EVIDENCE: 4.

Reliability and robustness of optimization properties for stabilization of the upright stance as determined using posturography.

Diagnostic value of static posturography depends on its methodological features, measurement properties, and on computational methods that extract meaningful information from the postural sway i.e. the center-of-pressure (CoP) displacements. In this study, we assessed the reliability and robustness of the postural system based on the optimization properties of the CoP signal: descending, local and global stability, and convergence. For the analysis, we used CoP data from 146 participants (104 [71%] female, age 46 ± 23 years, body mass index 23.6 ± 3.4 kg/m2) recorded while standing quietly on a foam surface without visual input. Reliability was estimated using the intraclass correlation coefficient from a single (ICC2,1) and averaged (ICC2,3) measurements. Robustness was assessed through main and interaction effects for the signal duration (60, 30 s), sampling frequency (100, 50 Hz), and lowpass filtering cutoff frequency (10, 5 Hz). The observed reliability depended on the use of average or single measurements as it was excellent for the stability property (ICC2,k ≥ 0.772); excellent-to-acceptable (ICC2,3 ≥ 0.540) or excellent-to-unacceptable (ICC2,1 ≥ 0.281) for the descending property; and excellent-to-unacceptable (ICC2,3 > 0.295; ICC2,1 > 0.122) for the convergence property. Robustness analysis showed large main effects of signal duration (ω2 ≤ 0.834, p < 0.001), sampling frequency (ω2 ≤ 0.526, p < 0.001), and the lowpass filter cutoff frequency (ω2 ≤ 0.523, p < 0.001) on the optimization properties; but all two-way and three-way effects varied from medium to trivial. Reliability is thus excellent to acceptable for deriving the descending, stability, and convergence properties from the average of three measurements. Those optimization properties are robust to the interaction but not the main effects of methodological sources of variation of posturography.

Lower-limb muscle strength, static and dynamic postural stabilities, risk of falling and fear of falling in polio survivors and healthy subjects.

INTRODUCTION: This study investigated the association between preserved lower-limb muscle strength, dynamic and static postural stability, risk of falling, and fear of falling in polio survivors. We also investigated whether these clinical features differ between polio survivors and healthy controls. Methods: This quasi-experimental study enrolled 16 polio survivors (13 underwent a complete-case analysis) and 12 age- and sex-matched healthy controls. Participants were assessed by the manual muscle test, Berg Balance Scale, force platform posturography, and Falls Efficacy Scale. Between-group mean differences with confidence intervals (MD, CI 95%) and Spearman's ρ are reported. Results: Compared to healthy controls, polio survivors presented reduced muscle strength (MD = -13, CI 95% -16 to -9 points), lower dynamic postural stability (MD = -14, CI 95% -19 to -8 points), and increased fear of falling (MD = 14, CI 95% 10-18 points) (all P < 0.001). In polio survivors, lower-limb muscle strength was correlated with dynamic (ρ = 0.760) and static postural stability (ρ = 0.738-0.351), risk of falling (ρ = -0.746), and fear of falling (ρ = -0.432). Dynamic postural stability was correlated with risk of falling (ρ = -0.841), fear of falling (ρ = -0.277), and static postural stability (ρ = -0.869 to -0.435; ρ = -0.361 to -0.200, respectively). Risk and fear of falling were also correlated (ρ = 0.464). Discussion: Polio survivors exhibited impaired dynamic postural stability but preserved static stability and increased risk of falling and fear of falling. Preserved lower-limb muscle strength, postural stability, fear of falling, and risk of falling are associated clinical features in this population.

Postural Control During Different Unipodal Positions in Professional Ballet Dancers.

Classical ballet involves the performance of complex movements that require high-level motor skills and good postural control. This study explored postural sway in passé en demi-pointe position in dancers and compared single-leg standing sway (with and without visual restriction) between dancers and non-dancers. Fourteen professional dancers and 14 sex- and age-matched volunteers who were not ballet dancers participated in the study. Participants stood on a force plate on the dominant leg in the following positions: 1. single-leg stance with eyes open (reference task) and with eyes closed and blindfolded for 35 seconds; and 2. passé en demi-pointe position with eyes open for 20 seconds (dancers only). The center of pressure signal was used to calculate the following variables: average velocity; anteroposterior and mediolateral velocity peaks; anteroposterior and mediolateral displacement ranges; average displacement; and ellipse area. Significant interaction effects (p < 0.001, η2 = 0.419) were observed between groups and postural tasks, with higher stabilometric values for the dancer group during the single-leg stance with eyes closed and blindfolded task, as evidenced by the average displacement of 241.0 cm in dancers and 147.1 cm in non-dancers (p = 0.025), and by the ellipse area of 9.5 cm2 for dancers and 4.9 cm2 for non-dancers (p = 0.001). In regard to the positions with eyes open, an increase was noted only in the average sway velocity and mediolateral velocity in passé en demi-pointe position compared with the single-leg stance with eyes open (p < 0.001). Greater postural sway might be interpreted as the result of either inadequate postural stability or exploratory behavior to maintain postural stability in more challenging tasks. It is concluded that professional ballet dancers show greater visual dependency for balance adjustment with reduced influence of the supporting base on postural sway.

Effects of diagnostic errors in pattern differentiation and acupuncture prescription: a single-blinded, interrater agreement study.

This study compared the interrater agreement for pattern differentiation and acupoints prescription between two groups of human patients simulated with different diagnostic outcomes. Patients were simulated using a dataset about zangfu patterns and separated into groups (n = 30 each) according to the diagnostic outcome determined by a computational model. A questionnaire with 90 patients was delivered to 6 TCM experts (4-year minimal of clinic experience) who were asked to indicate a single pattern (among 73) and 8 acupoints (among 378). Interrater agreement was higher for pattern differentiation than for acupuncture prescription. Interrater agreement on pattern differentiation was slight for both groups with correct (Light's κ = 0.167, 95% CI = [0.108; 0.254]) and incorrect diagnosis (Light's κ = 0.190, 95% CI = [0.120; 0.286]). Interrater agreement on acupuncture prescription was slight for both groups of correct (ι = 0.029, 95% CI = [0.015; 0.057]) and incorrect diagnosis (ι = 0.040, 95% CI = [0.023; 0.058], P = 0.075). Diagnostic performance of raters yielded the following: accuracy = 60.9%, sensitivity = 21.7%, and specificity = 100%. An overall improvement in the interrater agreement and diagnostic accuracy was observed when the data were analyzed using the internal systems instead of the pattern's labels.