Techniques for Registration of Myoelectric Activity of Women's Pelvic Floor Muscles: A Scoping Review.

INTRODUCTION AND HYPOTHESIS: Surface electromyography is commonly applied to measure the electrophysiological activity of the neuromuscular system. However, there is no consensus regarding the best protocol to assess pelvic floor muscles. METHODS: A scoping literature review was carried out in six databases, using MeSH descriptors. It included studies with electromyographic assessment in adult women presenting or not with pelvic floor dysfunction. The results were presented in categories to contribute to the development of a protocol considering the most used parameters for non-invasive assessment of myoelectric activity of pelvic floor muscles. RESULTS: A total of 1,074 articles were identified, and 146 studies were selected for analysis. The intravaginal probe was used in 80.8% of the studies, the bipolar sensor with metallic plates placed on both sides of the vagina was the most frequent (71.3%), with a reference electrode positioned on the anterior superior iliac spine (33.5%). The supine position with hip and knee flexed (45.2%) was the most frequent position used. Of the studies, 44.5% normalized the data by maximum voluntary contraction (MVC) whereas 44.5% performed an average of 3 MVCs. CONCLUSIONS: The most frequently used protocol for the pelvic floor is the bipolar intracavitary probe with metal plates positioned at 3-9 o'clock and introduced distally to the vaginal introitus with the volunteer in the supine position and the hip and knee flexed with the reference placed on the anterior-superior iliac spine.

The effectiveness of different types of acupuncture to reduce symptoms and disability for patients with orofacial pain. A systematic review and meta-analysis.

PURPOSE: To determine the effectiveness of different types of acupuncture in reducing pain, improving maximum mouth opening and jaw functions in adults with orofacial pain. METHODS: Six databases were searched until 15 June 2023. The Cochrane risk of bias tool and GRADE were employed to evaluate bias and overall evidence certainty. RESULTS: Among 52 studies, 86.5% (n = 45) exhibited high risk of bias. Common acupoints, including Hegu LI 4, Jiache ST 6, and Xiaguan ST 7, were used primarily for patients with temporomandibular disorder [TMDs]. Meta-analyses indicated that acupuncture significantly reduced pain intensity in individuals with myogenous TMD (MD = 26.02 mm, I2=89%, p = 0.05), reduced tenderness in the medial pterygoid muscle (standardised mean differences [SMD] = 1.72, I2 = 0%, p < 0.00001) and jaw dysfunction (SMD = 1.62, I2 = 88%, p = 0.010) in mixed TMD when compared to sham/no treatment. However, the overall certainty of the evidence was very low for all outcomes as evaluated by GRADE. CONCLUSION: The overall results in this review should be interpreted with caution as there was a high risk of bias across the majority of randomized controlled trial (RCTs), and the overall certainty of the evidence was very low. Therefore, future studies with high-quality RCTs are warranted evaluating the use of acupuncture in patients with orofacial pain.

Acupuncture could potentially reduce subjective pain intensity and sensitivity of masticatory muscles, improve mouth opening, and reduce dysfunction in orofacial pain, specifically in patients with temporomandibular disorder (TMD).Acupuncture points such as LI4, ST6, ST7, GB20, SI19, ST36 were the most commonly used acupuncture points to treat patients with orofacial pain, especially TMDs.Clinicians can use the information in this review with caution to develop an effective and appropriate treatment regimen for the acupuncture treatment of patients with TMDs.

INTENTION TO TREAT ANALYSIS IN CLINICAL RESEARCH: BASIC CONCEPTS FOR CLINICIANS.

ABSTRACT: This review presents a comprehensive summary and critical evaluation of Intention to Treat (ITT) analysis, with a particular focus on its application to randomized controlled trials (RCTs) within the field of rehabilitation. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a methodological review that encompassed electronic and manual search strategies to identify relevant studies. Our selection process involved two independent reviewers who initially screened titles and abstracts and subsequently performed full-text screening based on established eligibility criteria. Additionally, we included studies from manual searches that were already cataloged within the first author's personal database. The findings are synthesized through a narrative approach, covering fundamental aspects of ITT, including its definition, common misconceptions, advantages, disadvantages, and key recommendations. Notably, the health literature offers a variety of definitions for ITT, which can lead to misinterpretations and inappropriate application when analyzing RCT results, potentially resulting in misleading findings with significant implications for healthcare decision-making. Authors should clearly report the specific ITT definition used in their analysis, provide details on participant dropouts, and explain upon their approach to managing missing data. Adherence to reporting guidelines, such as the Consolidated Standards of Reporting Trials (CONSORT) for RCTs, is essential to standardize ITT information, ensuring the delivery of accurate and informative results for healthcare decision-making.

Beliefs and concerns about pain were associated with craniofacial pain experienced within 24 hours: cross-sectional study / Crenças e preocupações sobre a dor têm associação à dor craniofacial experimentada nas últimas 24 horas: estudo transversal

ABSTRACT BACKGROUND AND OBJECTIVES: Although craniofacial pain has been associated with negative psychological aspects, how the patient's perception of their own illness could influence craniofacial pain is not elucidated yet. Therefore, this study aims to identify the main factors and beliefs about the illness that could influence pain intensity and pain duration in people who experienced craniofacial pain in the last 24 hours. METHODS: This cross-sectional study comprised undergraduate students, aged between 18 and 40 years old, who experienced self-reported craniofacial pain in the last 24 hours. Participants answered questions regarding body functions, activities and participation, and personal factors based on the International Classification of Functioning (ICF); In addition, questions from the Brief Illness Perceptual Questionnaire (Brief IPQ) were applied. The analysis was carried out with a single and multiple regression model. RESULTS: The sample comprised 87 volunteers. Pain intensity and duration experienced in the last 24 hours were associate by concerns about the presence of an illness and the need for treatment. Pain intensity was specifically associated with the importance of treatment and the extent to which the patient is concerned about their pain (R2=0.108). Pain duration was associated with how much the individual is worried about their illness (R2=0.1459). CONCLUSION: Both pain intensity and duration experienced in the last 24 hours are associated with concerns regarding the presence of an illness and beliefs related to such illness treatment, which reinforces the influence of psychosocial aspects on pain perception.

RESUMO JUSTIFICATIVA E OBJETIVOS: Embora a dor craniofacial seja associada a aspectos psicológicos negativos, ainda não está totalmente elucidado como a percepção do paciente sobre sua própria doença pode influenciá-la. Portanto, este estudo teve como objetivo identificar os principais fatores e as crenças sobre a doença que podem influenciar a intensidade e a duração da dor em pessoas que sentiram dor craniofacial nas últimas 24 horas. MÉTODOS: Estudo transversal composto por universitários, com idade entre 18 e 40 anos, que relataram dor craniofacial nas últimas 24 horas. Os voluntários responderam a perguntas sobre funções corporais, atividades e participação e fatores pessoais com base na classificação da Classificação Internacional de Funcionalidades (CIF). Além disso, foram aplicadas questões do Questionário de Percepção de Doenças Versão Breve (Brief IPQ). A análise foi realizada com um modelo de regressão simples e múltiplo. RESULTADOS: A amostra foi composta por 87 voluntários. A intensidade e a duração da dor sentida nas últimas 24 horas foram influenciadas pela preocupação com a presença de doença e com a necessidade de tratamento. A intensidade da dor foi associada à importância do tratamento e à preocupação do paciente com sua dor (R2=0,108). A duração da dor associou-se à preocupação do indivíduo com sua doença (R2=0,1459). CONCLUSÃO: Tanto a intensidade quanto a duração da dor vivenciadas nas últimas 24 horas são influenciadas pela preocupação com a presença de doença e crenças relacionadas ao seu tratamento, o que reforça a influência dos aspectos psicossociais na percepção da dor.

Effectiveness of Manual Trigger Point Therapy in Patients with Myofascial Trigger Points in the Orofacial Region-A Systematic Review.

The objective was to compile, synthetize, and evaluate the quality of the evidence from randomized controlled trials (RCTs) regarding the effectiveness of manual trigger point therapy in the orofacial area in patients with or without orofacial pain. This project was registered in PROSPERO and follows the PRISMA guidelines. Searches (20 April 2021) were conducted in six databases for RCTs involving adults with active or latent myofascial trigger points (mTrPs) in the orofacial area. The data were extracted by two independent assessors. Four studies were included. According to the GRADE approach, the overall quality/certainty of the evidence was very low due to the high risk of bias of the studies included. Manual trigger point therapy showed no clear advantage over other conservative treatments. However, it was found to be an equally effective and safe therapy for individuals with myofascial trigger points in the orofacial region and better than control groups. This systematic review revealed a limited number of RCTs conducted with patients with mTrPs in the orofacial area and the methodological limitations of those RCTs. Rigorous, well-designed RCTs are still needed in this field.

Effectiveness of Biofeedback in Individuals with Awake Bruxism Compared to Other Types of Treatment: A Systematic Review.

Excessive masticatory muscle activity is generally present in awake bruxism, which is related to increased anxiety and stress. It has been hypothesized that biofeedback could potentially manage awake bruxism, however, its effectiveness has not been empirically analyzed in a systematic manner. Therefore, this systematic review was designed to determine the effectiveness of biofeedback compared to other therapies in adults with awake bruxism. Extensive searches in five databases looking for randomized controlled trials (RCTs) that included biofeedback to manage awake bruxism were targeted. The risk of bias (RoB) assessment was conducted using the Cochrane RoB-2 tool. Overall, four studies were included in this systematic review, all of which used the electromyographic activity of the masticatory muscles during the day and night as the main endpoint. Auditory and visual biofeedback could reduce the excessive level of masticatory muscle activity in a few days of intervention. The majority of the included studies had a high RoB and only one study had a low RoB. The standardization of the biofeedback protocols was also inconsistent, which makes it difficult to establish the ideal protocol for the use of biofeedback in awake bruxism. Thus, it is proposed that future studies seek to reduce methodological risks and obtain more robust samples.

Oral health quality of life is associated to jaw function and depression in patients with myogenous temporomandibular dysfunction.

OBJECTIVE: To determine which factors influence and better differentiate between good and poor oral health-related quality of life (OHRQoL) in patients with myogenous TMD and which cut-off could predict a good/poor OHRQoL. METHODS: Fifty-eight women with myogenous TMD were included. Factors of interest were collected (i.e., demographic variables, depression symptoms (Symptom Checklist-90 R (RDC/TMD)), pain intensity (Visual Analog Scale), jaw function (Mandibular Functional Limitation Questionnaire), and OHRQoL (Oral Health Impact Profile-14). A multivariable regression model, logistic regression, and receiver operating curve (ROC) analyses were conducted. RESULTS: Depression symptoms (ß = 0.139) and jaw function (ß = 0.478) were significantly associated with OHRQoL in the multivariable model. The best model to discriminate between good/poor OHRQoL included only jaw function (AUC = 0.90), with the best cut-off of 17 points (sensitivity: 0.93; specificity: 0.79). CONCLUSION: Depression symptoms and jaw function were significantly associated with OHRQoL. The best model and cut-off to discriminate good/poor OHRQoL included only jaw function.

What are the best parameters of low-level laser therapy to reduce pain intensity and improve mandibular function in orofacial pain? A systematic review and meta-analysis.

PURPOSE: To determine the effectiveness of laser therapy for managing patients with orofacial pain (OFP). In addition, to determine which parameters provide the best treatment effects to reduce pain, improve function, and quality of life in adults with OFP. METHODS: Systematic review. Searches were conducted in six databases; no date or language restrictions were applied. Studies involving adults with OFP treated with laser therapy were included. The risk of bias (RoB) was performed with the Revised Cochrane RoB-2. A meta-analysis was structured around the OFP type, and outcomes. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessed the overall certainty of the evidence. RESULTS: Eighty-nine studies were included. Most studies (n = 72, 80.9%) were considered to have a high RoB. The results showed that laser therapy was better than placebo in improving pain, maximal mouth open (MMO), protrusion, and tenderness at the final assessment, but with a low or moderate level of evidence. The best lasers and parameters to reduce pain are diode or gallium-aluminum-arsenide (GaAlAs) lasers, a wavelength of 400-800 or 800-1500 nm, and dosage of <25 J/cm2. CONCLUSIONS: Laser therapy was better than placebo to improve pain, MMO, protrusion, and tenderness. Also, it was better than occlusal splint to improve pain, but not better than TENS and medication.Implications for rehabilitationLaser therapy was found to be good in improving pain, maximal mouth opening, jaw protrusion, and tenderness at the end of the treatment.For patients with all types of temporomandibular disorders (TMDs) (myogenous, arthrogenous, and mixed), the following lasers and parameters are recommended: diode or gallium-aluminum-arsenide (GaAlAs) laser, wavelength of 400-800 or 800-1500 nm, and a dosage <25 J/cm2.For patients with arthrogenous TMDs, the following lasers and parameters are recommended: Diode laser and a wavelength between 400 and 800 nm.For patients with myogenous TMDs, the following lasers and parameters are recommended: diode laser, wavelength between 800 and 1500 nm, and dosage of <25 J/cm2.For patients with mixed TMDs, the following lasers and parameters are recommended: diode, GaAlAs, or infrared laser, a wavelength of 800-1500 nm, a dosage >100 J/cm2, and an application time between 15 and 30 s or >60 seconds.

Selection, Confounding, and Attrition Biases in Randomized Controlled Trials of Rehabilitation Interventions: What Are They and How Can They Affect Randomized Controlled Trials Results? Basic Information for Junior Researchers and Clinicians.

ABSTRACT: A thorough knowledge of biases in intervention studies and how they influence study results is essential for the practice of evidence-based medicine. The objective of this review was to provide a basic knowledge and understanding of the concept of biases and associated influence of these biases on treatment effects, focusing on the area of rehabilitation research. This article provides a description of selection biases, confounding, and attrition biases. In addition, useful recommendations are provided to identify, avoid, or control these biases when designing and conducting rehabilitation trials. The literature selected for this review was obtained mainly by compiling the information from several reviews looking at biases in rehabilitation. In addition, separate searches by biases and looking at reference lists of selected studies as well as using Scopus forward citation for relevant references were used. If not addressed appropriately, biases related to intervention research are a threat to internal validity and consequently to external validity. By addressing these biases, ensuring appropriate randomization, allocation concealment, appropriate retention techniques to avoid dropouts, appropriate study design and statistical analysis, among others, will generate more accurate treatment effects. Based on their impact on clinical results, a proper understanding of these concepts is central for researchers, rehabilitation clinicians, and other stakeholders working on this field.

The presence of migraine symptoms was associated with a higher likelihood to present eating disorders symptoms among teenage students.

OBJECTIVE: To investigate the association between migraine and signs and symptoms of eating disorders among teenagers. And as secondary objectives: to investigate the prevalence of eating disorders signs and symptoms and to identify the prevalence of migraine among teenagers. METHODS: Cross-sectional study was carried out in public schools which included adolescents aged 11-18 years, of both sexes. For eating disorders evaluation two self-reported questionnaires were used: Eating Attitudes Test-26 (EAT-26) and The Bulimic Investigatory Test of Edinburg (BITE). The presence and characterization of headache were verified following the International Classification of Headache Disorders (ICHD-II). RESULTS: 607 adolescents (388 females) with mean age of 13.9 years (95% CI: 13.7; 14) were included. The eating disorders symptoms based on EAT-26 (p = 0.041) and the bulimia nervosa symptoms (p = 0.014) evaluation were more prevalent among teenagers with migraine compared with non-migraine. Also, in multivariate analysis, the adjusted odds ratio (OR) to present bulimia nervosa symptoms is 1.85 times higher among females than males. And, the adjusted OR to present bulimia nervosa symptoms among teenagers with migraine is 1.51 times (OR) higher than among non-migraine. CONCLUSIONS: The presence of migraine symptoms were associated with a higher likelihood to present eating disorders symptoms among teenagers, especially in females, that was associated with a 1.85-fold increase in the risk to present bulimia nervosa symptoms. LEVEL OF EVIDENCE: III, Evidence obtained from cross-sectional study.

Understanding Clinical Significance in Rehabilitation: A Primer for Researchers and Clinicians.

ABSTRACT: The objective of this review was to summarize the concept of clinical significance and associated methods focusing on the area of rehabilitation to provide a resource to rehabilitation researchers and clinicians. Studies were searched on electronic databases from inception until July 28, 2020, with no date or language limits. Manual searches as well as Scopus forward citation for relevant references were performed. Narrative synthesis of study results was performed. Definitions of the concepts related to clinical significance, ways of calculating, and interpreting each method were provided using rehabilitation examples. An explanation of methods to evaluate clinical significance (distribution, anchor, and opinion-based methods) and their advantages and disadvantages were also provided. Considering the limitations of statistical significance in assuring meaningfulness of results, clinical interpretation of research outcomes and the report of clinical significance in intervention trials should be a priority in rehabilitation research. When possible, the use of multiple methods (distribution, anchor, and opinion based) is recommended. Thus, clinical researchers are encouraged to present results in a manner that allow the rehabilitation professionals to easily interpret and implement those results in their clinical practice.

Neck and back muscle chains hypomobility in women with migraine.

OBJECTIVE: To compare the mobility of neck and back flexor and extensor muscle chains in women with migraine, chronic migraine and headache-free. METHODS: This is a cross-sectional study. The muscle chain test was performed based on the theoretical assumptions of the Busquet method, in women with migraine (MG, n = 24), chronic migraine (CMG, n = 36) and headache-free (CG, n = 27). The evaluation of neck and back mobility was performed by an examiner expert in the Busquet method with the aid of cervical range of motion (CROM®) device (neck muscles) and the Tiltmeter® application (back muscles). RESULTS: Compared to woman headache-free, women with migraine (MD = -12° [CI95% = -19°, -5°] and chronic migraine (MD = -15° [CI95% = -21°, -8°] present reduced mobility in the neck extensor muscle chain. Also, in the back extensor muscle chain, migraine vs headache-free (MD = -9° [CI95% = -15°, -2°]) and chronic migraine vs headache-free (MD = -10° [CI95% = -16°, -4°]) and in the back flexor muscle chain, migraine vs headache-free (MD = -6° [CI95% = -10°, -0.1°]) and chronic migraine vs headache-free (MD = -7 [CI95% = -11°, -2°]), with an effect sizes varying between 1.19 e 2.38. No difference was found between groups for neck flexor muscle chain. CONCLUSION: Women with migraine and chronic migraine have hypomobility of the neck and back extensor muscle chains, and of the back flexor chain.

Intrarater and Interrater Reliability of the Flexion Rotation Test and Cervical Range of Motion in People With Migraine.

OBJECTIVE: The aim of this study was to determine the reliability, standard error of measurement (SEM), and smallest detectable change (SDC) of the flexion rotation test (FRT) and cervical range of motion (CROM) assessed with the CROM device in individuals with and without migraine. METHODS: Twenty-five women with migraine (mean age, 35 years; standard deviation, 10 years) and 25 comparable headache-free women (mean age, 32 years; standard deviation, 11 years) participated in this study. C1/C2 mobility was assessed with the FRT, whereas global cervical range of motion was calculated using a CROM device. To assess the interrater reliability, tests were conducted on the same day at 20-minute intervals, by 2 independent assessors, and they were repeated after a 1-week interval by the same assessor to evaluate the intrarater reliability. The mean value of 3 repetitions was used to calculate the intraclass correlation coefficient ICC(2,k), SEM, and SDC. RESULTS: The intrarater reliability was excellent (ICC > 0.83), and interrater reliability ranged from substantial to excellent (ICC > 0.77) for the FRT. The SEM ranged from 2.44° to 2.85°, and the SDC from 6.78° to 7.9°. Intrarater and interrater reliability for cervical range of motion was substantial to excellent (ICC > 0.65), with the SEM ranging from 2.03° to 5.46° and the SDC from 5.6° to 15.14°. CONCLUSION: The results demonstrate that FRT and global cervical range of motion with a CROM device show high reliability in individuals with migraine. In addition, the SEM and SDC were relatively small. Both assessments can be used for clinical evaluation of the cervical spine in individuals with migraine.