Effectiveness of non-invasive therapies on pain, maximum grip strength, disability, and quality of life for lateral elbow tendinopathy: A systematic review and meta-analysis.

BACKGROUND: Lateral elbow tendinopathy is a common musculoskeletal disorder. Effectiveness of non-invasive therapies for this health condition are unclear. OBJECTIVE: To investigate the effectiveness of non-invasive therapies on pain, maximum grip strength, disability, and quality of life for lateral elbow tendinopathy. METHODS: Searches were conducted on MEDLINE, Embase, CINAHL, AMED, PEDro, Cochrane Library, SPORTDiscus and PsycINFO without language or date restrictions up to May 3rd, 2023. Randomized trials investigating the effectiveness of any non-invasive therapy compared with control or other invasive interventions were included. Two independent reviewers screened eligible trials, extracted data, and assessed the risk of bias of included trials and certainty of the evidence. RESULTS: Twenty-two different therapies investigated in 47 randomized trials were included in the quantitative analysis. Moderate certainty evidence showed that betamethasone valerate medicated plaster may reduce disability (mean difference -6.7; 95% CI -11.4, -2.0) in the short-term when compared with placebo. Low certainty evidence showed that acupuncture may reduce disability (MD -9.1; 95% CI -11.7, -6.4) in the short-term when compared with sham. Moderate to very low certainty of evidence also showed small to no effect of non-invasive therapies on pain intensity, maximum grip strength, and disability outcomes in the short-term compared to control or invasive interventions. Most therapies had only very low certainty of evidence to support their use. CONCLUSIONS: Decision-making processes for lateral elbow tendinopathy should be carefully evaluated, taking into consideration that most investigated interventions have very low certainty of evidence. There is an urgent call for larger high-quality trials.

One step at a time. Shaping consensus on research priorities and terminology in telehealth in musculoskeletal pain: an international modified e-Delphi study.

BACKGROUND: Telehealth has emerged as an alternative model for treatment delivery and has become an important component of health service delivery. However, there is inconsistency in the use of terminologies and a lack of research priorities in telehealth in musculoskeletal pain. The purpose of this international, multidisciplinary expert panel assembled in a modified three-round e-Delphi survey is to achieve a consensus on research priorities and for the standard terminology for musculoskeletal pain telehealth practice. METHODS: In this international modified e-Delphi survey, we invited an expert panel consisting of researchers, clinicians, consumer representatives, industry partners, healthcare managers, and policymakers to participate in a three-round e-Delphi. Expert panels were identified through the Expertscape website, PubMed database, social media, and a snowball approach. In Round 1, potential research priorities and terminologies were presented to panel members. Panel members rated the agreement of each research priority on a 5-point Likert scale and an 11-point numerical scale, and each terminology on a 5-point Likert scale for the "telehealth in musculoskeletal pain " field over rounds. At least 80% of the panel members were required to agree to be deemed a consensus. We analyzed the data descriptively and assessed the stability of the results using the Wilcoxon matched-pairs signed rank test. RESULTS: We performed an international e-Delphi survey from February to August 2022. Of 694 invited people, 160 panel members participated in the first round, 133 in the second round (83% retention), and 134 in the third round (84% retention). Most of the panel members were researchers 76 (47%), clinicians 57 (36%), and consumer representatives 9 (6%) of both genders especially from Brazil 31 (19%), India 22 (14%), and Australia 19 (12%) in the first round. The panel identified fourteen telehealth research priorities spanned topics including the development of strategies using information and communication technology, telehealth implementation services, the effectiveness and cost-effectiveness of telehealth interventions, equity of telehealth interventions, qualitative research and eHealth literacy in musculoskeletal pain conditions from an initial list of 20 research priorities. The consensus was reached for "digital health" and "telehealth" as standard terminologies from an initial list of 37 terminologies. CONCLUSION: An international, multidisciplinary expert consensus recommends that future research should consider the 14 research priorities for telehealth musculoskeletal pain reached. Additionally, the terms digital health and telehealth as the most appropriate terminologies to be used in musculoskeletal telehealth research. REGISTER: Open Science Framework ( https://osf.io/tqmz2/ ).

Crucial workload variables in female-male elite Brazilian Beach Handball: An exploratory factor analysis.

This study aimed to identify the most important variables of male and female beach handball workload demands and compare them by sex. A total of 92 elite Brazilian beach handball players (54 male: age 22.1 ± 2.6 years, height 1.8 ± 0.5 m, weight 77.6 ± 13.4 kg; and 38 female: age 24.4 ± 5.5 years, height 1.7 ± 0.5 m, weight 67.5 ± 6.5 kg) were analyzed in 24 official matches during a four-day congested tournament. From 250 variables measured by the inertial measurement unit, fourteen were extracted for analysis using Principal Component Analysis as selection criteria. Five Principal Components (PC) were extracted that explained 81.2-82.8% of total variance (overview of workload demands during beach handball). Specifically, 36.2-39.3% was explained by PC1 (DistanceExpl, Distance, Distance4-7 km/h, and Acc), 15-18% by PC2 (AccMax, Acc3-4 m/s, Dec4-3 m/s), 10.7-12.9% by PC3 (JumpsAvg Take-Off, JumpsAvg Landing and PLRT), 8-9.4% by PC4 (Distance> 18.1 km/h, SpeedMax), and 6.7-7.7% by PC5 (HRAvg and Step Balance). Sex-related differences were found in the PC distribution of variables, as well as in selected variables (HRAvg, Dec4-3 m/s, Acc3-4 m/s, JumpsAvg Take-Off, JumpsAvg Landing, AccMax, Distance, Distance4-7 km/h, Acc, SpeedMax) with higher values in male players (p < .05). In conclusion, the sex-related PC distribution and workload demands in beach handball should consider for training design and injury prevention programs.

Prevention of low back and pelvic girdle pain during pregnancy: a systematic review and meta-analysis of randomised controlled trials with GRADE recommendations.

BACKGROUND: Low back (LBP) and pelvic girdle pain (PGP) during pregnancy are related to high direct and indirect costs. It is important to clarify evidence regarding interventions to manage and prevent these conditions. OBJECTIVE: Investigate the efficacy and acceptability of the interventions to prevent LBP and PGP during pregnancy. DATA SOURCES: Searches were conducted up to January 6th, 2021 in the MEDLINE, PEDro, Cochrane Library, SPORTDiscus, CINAHL, AMED, Embase and PsycInfo databases STUDY ELIGIBILITY CRITERIA: (1) Pregnant women without LBP and/or PGP; (2) any prevention strategy on incidence of LBP and PGP and sick leave; (3) comparison to control; (4) quasi and randomised controlled trial. STUDY APPRAISAL AND SYNTHESIS METHODS: Two reviewers performed screening, data extraction and methodological quality assessments. Meta-analysis was performed and Relative Risks (RRs) and 95% confidence intervals (CIs) were reported. RESULTS: Six randomised controlled trials involving 2231 participants were included in the review. Evidence of moderate quality was found that "stand-alone" exercise is acceptable to pregnant women with lumbopelvic pain (LBPP) (RR 0.60 [95%CI 0.42-0.84]) and prevents episodes of LBP (RR 0.92 [95%CI 0.85-0.99]) in the long-term. Moderate to very-low quality evidence was found detailing the lack of efficacy of other interventions in the prevention of these problems in the short and long-term. LIMITATIONS: Small number of trials included. CONCLUSIONS: Efficacy of prevention strategies for episodes of LBPP and the use of sick leave during pregnancy is not supported by evidence of high quality. Current evidence suggests that exercise is acceptable and promising for the prevention of LBP in the long-term. However, further high-quality trials with larger samples are needed. CONTRIBUTION ON PAPER.

Functional decline in people with diabetes: Bidirectional relationships between body function and activity-participation components in a two-wave longitudinal structural equation modeling.

This study examined the impact of diabetes over time. The sample included 68 people with diabetes used a three-year longitudinal design to test a model of functional decline. Indicators of the body function and activity and participation components of the International Classification of Functioning, Disability and Health (ICF) were derived from the Nordic Musculoskeletal Questionnaire, World Health Organization Quality of Life-Brief version (WHOQOL-BREF), and Participation Scale. On the basis of the ICF framework, it is hypothesized and found that there is an interaction between the body function and the activity and participation components, which, in turn, are predictors of future functional capability. The structural equation analyses confirmed that at both T1 and T2 pain measures are associated with physical, psychological, and social functioning; environmental factors mediate the relationship between these two constructs. Moreover, the activity and participation component at T1 predicted the body function component at T2. The main finding suggests that functional consequences of diabetes are complex and multifactorial. The significant functional decline in people with diabetes in just three years is worrying. The theoretical and practical implications of these findings are discussed.

Efficacy of Hip Strengthening on Pain Intensity, Disability, and Strength in Musculoskeletal Conditions of the Trunk and Lower Limbs: A Systematic Review with Meta-Analysis and Grade Recommendations.

To investigate the efficacy of hip strengthening on pain, disability, and hip abductor strength in musculoskeletal conditions of the trunk and lower limbs, we searched eight databases for randomized controlled trials up to 8 March 2022 with no date or language restrictions. Random-effect models estimated mean differences (MDs) with 95% confidence intervals (CIs), and the quality of evidence was assessed using the GRADE approach. Very low quality evidence suggested short-term effects (≤3 months) of hip strengthening on pain intensity (MD of 4.1, 95% CI: 2.1 to 6.2; two trials, n = 48 participants) and on hip strength (MD = 3.9 N, 95% CI: 2.8 to 5.1; two trials, n = 48 participants) in patellofemoral pain when compared with no intervention. Uncertain evidence suggested that hip strengthening enhances the short-term effect of the other active interventions on pain intensity and disability in low back pain (MD = -0.6 points, 95% CI: 0.1 to 1.2; five trials, n = 349 participants; MD = 6.2 points, 95% CI: 2.6 to 9.8; six trials, n = 389 participants, respectively). Scarce evidence does not provide reliable evidence of the efficacy of hip strengthening in musculoskeletal conditions of the trunk and lower limbs.

Comparative efficacy and acceptability of non-pharmacological interventions in fibromyalgia: Protocol for a network meta-analysis.

INTRODUCTION: Although several non-pharmacological interventions have been tested in the management of Fibromyalgia (FM), there is little consensus regarding the best options for the treatment of this health condition. The purpose of this network meta-analysis (NMA) is to investigate the comparative efficacy and acceptability of non-pharmacological interventions for FM, in order to assist clinical decision making through a ranking of interventions in relation to the most important clinical outcomes in these patients. METHODS AND ANALYSIS: We will perform a systematic search to identify randomised controlled trials of non-pharmacological interventions endorsed in guidelines and systematic reviews. Information sources searched will include major bibliographic databases without language or date restrictions (MEDLINE, Cochrane Library, EMBASE, AMED, PsycINFO and PEDro). Our primary outcomes will be pain intensity, patient-reported quality of life (QoL), and acceptability of treatment will be our secondary outcome. Risk of bias of the included trials will be assessed using the Cochrane risk of bias tool (RoB2). For each pairwise comparison between the different interventions, we will present mean differences (MDs) for pain intensity and QoL outcomes and Relative Risks (RRs) for acceptability, both with respective 95% confidence intervals (CIs). Initially, standard pairwise meta-analyses will be performed using a DerSimonian-Laird random effects model for all comparisons with at least two trials and then we will perform a frequentist NMA using the methodology of multivariate meta-analysis assuming a common heterogeneity parameter, using the mvmeta command and network suite in STATA. In the NMA, two different types of control group, such as placebo/sham and no intervention/waiting list will be combined as one node called "Control". The competing interventions will be ranked using the P-score, which is the frequentist analogue of surface under the cumulative ranking curve (SUCRA) for the outcomes of interest at immediate- (intervention duration of up to 2 weeks), short- (over 2 weeks up to 12 weeks) and long-terms (over 12 weeks). The confidence in the results from NMA will be assessed using the Confidence in Network Meta-analysis (CINeMA) framework. ETHICS AND DISSEMINATION: This work synthesises evidence from previously published studies and does not require ethics review or approval. A manuscript describing the findings will be submitted for publication in a peer-reviewed scientific journal. REGISTRATION: OSF (DOI: 10.17605/OSF.IO/7MS25) and registered in the PROSPERO database (CRD42020216374).

Qualidade dos instrumentos que avaliam Atividade e Participação de pessoas com distrofia muscular: uma revisão sistemática de medidas de resultado relatadas pelos pacientes.

OBJETIVO: Identificar os instrumentos de avaliação para pessoas com distrofia muscular e investigar a qualidade/nível de evidência de suas propriedades de medidas. MÉTODOS: Uma revisão sistemática de medidas de resultado relatadas pelos pacientes foi conduzida nas bases de dados MEDLINE, Embase, AMED, DiTA e PsycINFO em agosto de 2020. Foram incluídos estudos psicométricos que investigaram a validade, confiabilidade e responsividade de instrumentos de medida que avaliam atividade e participação para distrofia muscular de qualquer tipo (Duchenne, becker, cinturas, facioescapuloumeral, congênita e miotônica) e idade. Dois revisores independentes selecionaram os estudos, extraíram dados e avaliaram a qualidade e nível de evidência dos instrumentos de medida seguindo o checklist COnsensus-based Standards for the Selection of health status Measurement INstruments (COSMIN). RESULTADOS: A busca identificou 6675 referências; um total de 46 estudos com 28 instrumentos de medida de condição-específica ou genéricos foram incluídos. As propriedades de medidas da maioria dos instrumentos tiveram resultados suficientes (68.8%) ou indeterminados (25.7%) de acordo com o COSMIN. A qualidade da evidência das propriedades de medidas foi moderada (23.8%) ou baixa (22.6%) de acordo com o Grading of Recommendations Assessment, Development, and Evaluation (GRADE). INTERPRETAÇÃO: Existem poucos instrumentos de medida de alta qualidade que tiveram suas propriedades adequadamente medidas. O instrumento com maior qualidade é o Muscular Dystrophy Functional Rating Scale. O Motor Function Measure (instrumento genérico), Duchenne Muscular Dystrophy Upper-limb Patient-reported Outcome Measure, North Star Ambulatory Assessment e Myotonic Dystrophy Type 1 Activity and Participation Scale for Clinical Use (específicos) também são recomendados.

A qualidade do ambiente domiciliar influencia nas habilidades funcionais de crianças na primeiríssima infância? / ¿Influye la calidad del entorno del hogar en las habilidades funcionales de niños en la primera infancia? / Does the quality of the home environment influence the functional abilities of infants in early childhood?

RESUMO A literatura extensamente associa o desenvolvimento infantil à qualidade da estimulação ambiental. Entretanto, são escassos os estudos que verificam se tal associação tem relação com as habilidades funcionais da criança. Este estudo tem por objetivo investigar quais oportunidades no ambiente domiciliar estão associadas e explicam às habilidades funcionais de mobilidade e função social de crianças na primeiríssima infância. Trata-se de um estudo transversal e exploratório feito com 74 crianças entre 6 e 18 meses. Para avaliar as oportunidades presentes no ambiente domiciliar, foi utilizado o instrumento affordances in the home environment motor development - infant scale. Para avaliar as habilidades funcionais das crianças, foi utilizado o inventário de avaliação pediátrica de incapacidade. Observou-se que a mobilidade das crianças pode ser explicada em 45,6% (R² ajustado=0,45) e a função social em 30% (R² ajustado=0,30) pela quantidade de brinquedos de motricidade grossa, pelos equipamentos e pela variedade de estimulação presente no ambiente domiciliar. Conclui-se que posições, brinquedos e materiais que mantêm a criança mais restrita e menos ativa exercem influência negativa. Por outro lado, brinquedos que oportunizam um maior deslocamento e interação favorecem as habilidades funcionais de mobilidade e função social.

RESUMEN La literatura ha asociado ampliamente el desarrollo infantil con la calidad de la estimulación en el entorno. Sin embargo, pocos estudios han verificado si esta asociación está relacionada con las habilidades funcionales del niño. Este estudio tiene como objetivo analizar y explicar qué oportunidades en el entorno del hogar están asociadas con las habilidades funcionales de movilidad y función social de niños en la primera infancia. Se trata de un estudio transversal y exploratorio, realizado con 74 niños de los 6 a los 18 meses de edad. Para evaluar las oportunidades presentes en el entorno del hogar, se utilizó el instrumento affordances in the home environment motor development - infant scale. Para evaluar las habilidades funcionales de los niños, se utilizó el inventario para la evaluación pediátrica de la discapacidad. Se observó que la movilidad de los niños se puede explicar en un 45,6% (R² ajustado=0,45) y la función social en un 30% (R² ajustado=0,30) por la cantidad de juguetes de motricidad gruesa, equipos y por la variedad de estimulación presente en el entorno del hogar. Se concluye que las posiciones, juguetes y materiales que mantienen al niño más restringido y menos activo ejercen una influencia negativa. Por otro lado, los juguetes que aportan mayor movilidad e interacción favorecen las habilidades funcionales de movilidad y función social del niño.

ABSTRACT The literature associates child development with the quality of the environment stimulation. However, few studies verify if this is associated with the infant's functional abilities. This study aims to assess which opportunities in the home environment are associated with functional mobility skills and social function of infants in early childhood and explain them. This is a cross-sectional and exploratory study with 74 infants aged from six to 18 months. The affordances in the home environment motor development - infant scale instrument was used to evaluate the opportunities in the home environment. The pediatric evaluation of disability inventory was used to assess the infants' functional abilities. We observed that infants' mobility can be explained in 45.6% (Adjusted R²=0.45) and social function in 30% (Adjusted R²=0.30) by the amount of gross motor skills toys, equipment and variety of stimulation in the home environment. We concluded that positions, toys, and materials that keep the infant more restricted and less active have a negative effect. On the other hand, toys that offer greater displacement and interaction favor the functional mobility skills and social function.

Quality of instruments assessing activity and participation of people with muscular dystrophy: A systematic review of participant-reported outcome measures.

AIM: To identify the standardized assessment scales for people with muscular dystrophy and investigate the quality/level of evidence of their measurement properties. METHOD: A systematic review of patient-reported outcome measures was conducted on the MEDLINE, Embase, AMED, DiTA, and PsycINFO databases in August 2020. We included psychometric studies that investigated the validity, reliability, and responsiveness of instruments assessing activity and participation for muscular dystrophy of any type (Duchenne, Becker, limb-girdle, facioscapulohumeral, congenital, and myotonic) or age. Two independent reviewers selected the studies, extracted data, and evaluated the instruments' quality and level of evidence following the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. The study followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) 2020 guidelines. RESULTS: The searches identified 6675 references; a total of 46 studies with 28 condition-specific or general instruments were included. The measurement properties of most instruments had sufficient (68.8%) or indeterminate (25.7%) results according to COSMIN. The quality of evidence of the measurement properties was moderate (23.8%) or low (22.6%) according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). INTERPRETATION: There is a lack of high-quality instruments whose psychometric properties are adequately measured. The highest quality instrument is the Muscular Dystrophy Functional Rating Scale. The Motor Function Measure (general instrument), Duchenne Muscular Dystrophy Upper-limb Patient-reported Outcome Measure, North Star Ambulatory Assessment, and Myotonic Dystrophy Type 1 Activity and Participation Scale for Clinical Use (specific) are also recommended. WHAT THIS PAPER ADDS: There are 28 available instruments for activity and participation of people with muscular dystrophy. The evidence quality is moderate or low because of imprecision and indirectness. The Muscular Dystrophy Functional Rating Scale is the highest quality instrument. The Motor Function Measure is the second most recommended instrument. The Duchenne Muscular Dystrophy Upper-limb Patient-reported Outcome Measure, North Star Ambulatory Assessment, and Myotonic Dystrophy Type 1 Activity and Participation Scale for Clinical Use are also recommended.

Analysis of Informative Content on Cerebral Palsy Presented in Brazilian-Portuguese YouTube Videos.

Aims: To describe the characteristics of the most accessed YouTube videos in Brazilian-Portuguese on cerebral palsy (CP), and to analyze content of informational videos about this topic.Methods: This was a cross-sectional study. Searching on YouTube website was conducted by two independent examiners between November and December 2019, using the keywords "Paralisia Cerebral" sorted by videos' number of views. Videos that did not present content related to CP or duplicate videos were excluded. The interaction parameters and content characteristics of the included videos were extracted. To access the trustworthiness and quality of informational videos, the modified Discern checklist and the Global Quality Score was used.Results: Following the eligibility criteria 90 videos were included. Fifty-three (53) were classified as experiential videos and 37 as informational videos. Informational videos presented multi-topics about different aspects of CP. This group of videos presented moderate trustworthiness due to the lack of scientific evidence content. Informational videos had good quality and generally good flow.Conclusion: YouTube presented a large number of videos about CP in Brazilian-Portuguese. Informational videos are useful for patients and healthcare providers; however, it is necessary to included information about scientific evidence, as a strategy to facilitate and promote knowledge translation.

Sport-Specific Skills Differentiate Performance Levels Better Than Anthropometric or Physiological Factors in Beach Handball.

Beach handball is characterized by high- and low-intensity efforts on an unstable surface. Players are expected to display high levels of physical performance on sand, though there are no data concerning success in elite players. Purpose: This study aimed to address anthropometric, fitness, and sport-specific skills components in beach handball, by comparing elite national team beach handball players (world champions) to sub-elite players (playing at a regular club). Method: A total of 91 senior players (more than 21 years old) of both genders (19 world champions) were assessed for anthropometry, 5-m acceleration, 15-m sprint, handgrip strength, horizontal jump, and three specific sport-specific skills (ball velocities in standing, inflight and spin throwing) at a beach court. Anthropometric, physiological, and sport-specific skill test variables were analyzed as a multiple dependent variable using a multivariate analysis of variance (MANOVA) with sex and level (elite vs sub-elite) as the fixed factors. SPSS (25.0) was used, significance was assumed at p < .05. Results: The results highlighted that for male and female athletes, horizontal jump, 6-m standing, spin, and inflight throwing discriminated between elite and sub-elite groups (p < .001). Conclusion: The study suggests that the factors which differentiate between elite and sub-elite performers in beach handball are horizontal jump and technical ability via the performance of specific throwing skills, rather than anthropometric or any other physical variables, irrespective of sex. These findings highlight some of the relevant physical capacities and skills that need to be developed over the years of preparation of top-level beach handball players.

Fibromyalgia in social media: content and quality of the information analysis of videos on the YouTube platform.

To evaluate the fibromyalgia (FM) content in YouTube videos and verify if American College of Rheumatology (ACR) guidelines are being met. The videos were searched with the keyword "Fibromyalgia." Two independent researchers evaluated and coded specific characteristics of the videos. The popularity of the videos, the presentation properties, and content related to FM according to the ACR criteria were analyzed. Of the 200 videos included, the majority were presented by health professionals, 61.5%. Most videos covered more than one subject, 38.5%. The videos presented by health professionals were the most viewed. Following the ACR guidelines, 38% defined FM, 24% described the etiology, 19.5% described the diagnostic criteria and 52% presented recommended management strategies. The results indicate that users mainly watch videos published by health professionals. Most of the published videos do not follow the information recommended by the ACR guidelines. Therefore, videos should be interpreted with caution, not being the most appropriate resource for health education for patients with FM. Most of the videos published on YouTube about FM do not meet the ACR guidelines for FM.

Popular videos related to low back pain on YouTube™ do not reflect current clinical guidelines: a cross-sectional study.

BACKGROUND: Quality of low back pain (LBP) information offered on YouTube ™ is unclear. OBJECTIVE: To describe the current low back pain information available on YouTube ™ and determine if these videos report information that aligns with clinical guidelines. Further analysis explored whether specific features of the videos explain their popularity. METHODS: A cross-sectional observational study was conducted on videos related to LBP on YouTube™ with the 200 most viewed videos using the term "low back pain." The videos were independently viewed and assessed by two researchers for specific video characteristics, LBP specific content, and compliance with guidelines. The association between video characteristics or content with popularity (i.e., views, likes, dislikes, and comments) was investigated using regression models. RESULTS: The median number of views was 2 018 167. Only 59 (29.5%) of the videos reported at least one diagnostic recommendation from clinical guidelines, and only 100 (50%) reported a treatment recommendation that aligned with clinical guidelines. Apart from year of upload, no variables were identified that were independently associated with popularity or engagement of the videos. CONCLUSION: The information related to LBP offered on YouTube™ is often not evidence-based and there is the tendency to prioritize information on interventions rather than understanding the LBP process. Factors related to engagement with content about LBP on YouTube™ remains uncertain, indicating further need for knowledge translation in this field.

Effect of Robot-Assisted Therapy on Participation of People with Limited Upper Limb Functioning: A Systematic Review with GRADE Recommendations.

BACKGROUND: Previous studies have suggested that robot-assisted therapy (RT) is effective in treating impairment and that it may also improve individuals' participation. OBJECTIVE: To investigate the effect of RT on the participation of individuals with limited upper limb functioning (PROSPERO: CRD42019133880). Data Sources: PEDro, Embase, MEDLINE, CINAHL, Cochrane, AMED, and Compendex. Inclusion Criteria. We selected randomized or quasirandomized controlled studies comparing the effects of RT with minimal or other interventions on participation of individuals with limited upper limb functioning. Data Extraction and Synthesis. Methodological quality of the included studies was assessed using the 0-10 PEDro scale, and effect estimates were reported using standardized mean differences (SMDs) with 95% confidence intervals (CIs), and the certainty of the current evidence was assessed using the GRADE. RESULTS: Twelve randomized controlled studies involving 845 participants were included. The estimates of medium effects between RT and minimal intervention (MI) at a short-term follow-up were pooled, but there are no short-term effects between RT and OI. Standardized differences in means were as follows: 0.6 (95% CI 0.1 to 1.2) and 0.2 (95% CI -0.0 to 0.4). There were also no effects of additional RT in the short- or medium-term follow-up periods. Standardized differences in means were as follows: -0.6 (95% CI -1.1 to -0.1) and 0.2 (95% CI -0.3 to 0.8). The methodological quality of the included studies potentially compromised the effect estimates of RT. The existing evidence was very low-quality with many confounding variables between studies. CONCLUSIONS: For patients with upper limb neurological dysfunction, low-quality evidence supports RT over MI in terms of improving individual participation in the short term. The existing low- to very low-quality evidence does not support RT over OI in either the short- or medium-term follow-up periods with respect to community participation.

Effectiveness of conservative therapy on pain, disability and quality of life for low back pain in pregnancy: A systematic review of randomized controlled trials.

BACKGROUND: Efficacy of conservative therapy for low back pain in pregnancy (PLBP) is unclear. OBJECTIVE: To investigate the efficacy of conservative therapy on pain, disability, and quality of life in PLBP. METHODS: The protocol of this systematic review was prospectively registered at PROSPERO (CRD42020164640). Search strategy was conducted on six databases up to August 24 2020 without date or language restrictions. Minimal intervention (i.e., placebo, sham, waiting list or no intervention) was the comparator of interest. Selection of randomized controlled trials, data extraction and methodological quality assessment of included trials were conducted independently by two reviewers. The PEDro scale (0-10) was used to assess methodological quality. Effect sizes for specific therapies were pooled when possible, using random-effects models. The quality of the evidence was assessed using the Grading of Recommendations Assessment (GRADE) approach. RESULTS: Ten included trials provide uncertain evidence (low to very low quality) about the effects of auriculotherapy, education, exercise, exercise plus education, oil treatment, and osteopathy in pain, disability, and quality of life at short- and long-term. At short-term, mean differences (MDs) and 95% confidence intervals (CI) on a 0-10 points pain intensity scale were: for oil treatment, 2.8 points (2.6, 3.1) (n = one trial, 114 participants); for auriculotherapy, 1.6 points (1.2, 2.0) (n = one trial, 112 participants); for exercise, 2.2 points (-1.8, 6.2) (n = three trials, 297 participants). CONCLUSION: There is an urgent need for larger high-quality trials investigating effects of conservative therapy in pain, disability, and quality of life in this population.

Environmental and personal factors that explain functional abilities and caregiver assistance on children aged 6 to 18 months: a cross-sectional study

Abstract Aims: This study investigated environmental and personal factors that explain functional skills and caregiver assistance in young infants/toddlers. Methods: A cross-sectional study was conducted involving seventy-four children with typical development between 6 and 18 months of age. Functioning skills were evaluated using the Pediatric Evaluation of Disability Inventory, and the home environment was evaluated using the Affordances in the Home Environment for Motor Development-Infant Scale. Statistical analyses were performed by regression models. Results: Child's age explained 45% of self-care (β = 0.68); child's age (β = 0.72), attending daycare (β = 0.33) explained 71% of mobility, and child's age (β = 0.80) and breastfeeding duration (β = 0.17) explained 69% of social function. With regards to caregiver assistance, child's age (β = 0.46), attending daycare (β = 0.20) and number of siblings (β = -0.22) explained 31% of self-care; child's age (β = 0.62) and attending daycare (β = 0.34) explained 56% of mobility; and child's age (β = 1.91) and total AHEMD-IS score (environment) (β = 2.63) explained 30% of social function. Conclusion: Daycare, breastfeeding duration, number of siblings, stimulation at home, and age explained functional skills and caregiver assistance to toddlers/infants.

Physical fitness profile in elite beach handball players of different age categories.

BACKGROUND: The aims of this study were to compare anthropometric and fitness variables of high-level beach handball players across Under-19 (U-19), Under-21 (U-21) and senior male categories, and between male and female senior players; and to test the correlations among those measures. METHODS: A total of 70 high-level players (53 male of different ages) were evaluated for 5-m acceleration, 15-m sprint, horizontal jump, handgrip strength, specific beach handball throwing velocities, and anthropometric variables. Differences between age groups were tested using ANOVA. Independent t-test was used to compare fitness variables between male and female elite athletes, and Pearson partial correlation coefficients were calculated between each of the fitness variables using BMI and age as covariates. SPSS Software was used, and the level of significance was set at 95%. RESULTS: The U-21 athletes better performed on horizontal jump and 6-m throw than the U-19 athletes. Senior athletes showed better performance on horizontal jump than U-19 athletes (P≤0.05). Positive correlation was seen for handgrip on dominant and non-dominant hands and 6-m throwing speed, and for handgrip on dominant hand and inflight velocity (P≤0.05). Negative correlations were observed between horizontal jump and 5-m acceleration, and 15-m sprint (P≤0.01 and P≤0.05, respectively). CONCLUSIONS: Male athletes better performed than women in all the fitness tests. The study, for the first time, showed physical fitness comparisons between beach handball elite male athletes of different ages and between genders. These are key steps for coaches and athletes and may support future beach handball studies and practice.

Efficacy of conservative therapy in older people with nonspecific low back pain: A systematic review with meta-analysis and GRADE recommendations.

PURPOSE: This systematic review aimed to investigate the effectiveness of conservative therapy in older people with nonspecific low back pain. MATERIALS AND METHODS: Searches were conducted on Medline, Amed, Embase, Cochrane, Psycinfo and Pedro databases up to 2020. Risk of bias were assessed using the 0-10 PEDro scale. Weighted mean differences (WMDs) or mean differences (MDs) with 95 % confidence intervals (CIs) were reported for each conservative therapy, and strength of the current evidence was assessed using the GRADE approach. RESULTS: Eleven original trials were included investigating effects on disability, pain, coping, quality of life, strength, balance, depression, falls, sleep quality, mobility, body mass index, percentage body fat, trunk muscle mass and waist-to-hip ratio. Moderate quality evidence showed short-term effects of trigger point acupuncture on disability (WMD = 5.0 points [95 % CI 3.5-6.4] on a 25-point scale) and pain (WMD = 35.9 points [95 % CI 22.2-49.7] on a 101-point scale), and of exercise on disability (WMD = 1.7 points [95 % CI 0.3-3.0]) when compared with control (placebo, sham, waiting list or no intervention). Moderate quality evidence showed no short-term effect of exercise on coping (95 % CI -5.0 to 14.6). Moreover, evidence for other important outcomes in older people is scarce and we did not find any trial investigating pharmacological therapies. CONCLUSION: Findings support partially exercise and trigger point acupuncture to improve disability and/or pain. Future trials with appropriate sample sizes are likely to impact on the estimates and need to clarify medium- and long-term effects.

Genetic and environmental variation in educational attainment: an individual-based analysis of 28 twin cohorts.

We investigated the heritability of educational attainment and how it differed between birth cohorts and cultural-geographic regions. A classical twin design was applied to pooled data from 28 cohorts representing 16 countries and including 193,518 twins with information on educational attainment at 25 years of age or older. Genetic factors explained the major part of individual differences in educational attainment (heritability: a2 = 0.43; 0.41-0.44), but also environmental variation shared by co-twins was substantial (c2 = 0.31; 0.30-0.33). The proportions of educational variation explained by genetic and shared environmental factors did not differ between Europe, North America and Australia, and East Asia. When restricted to twins 30 years or older to confirm finalized education, the heritability was higher in the older cohorts born in 1900-1949 (a2 = 0.44; 0.41-0.46) than in the later cohorts born in 1950-1989 (a2 = 0.38; 0.36-0.40), with a corresponding lower influence of common environmental factors (c2 = 0.31; 0.29-0.33 and c2 = 0.34; 0.32-0.36, respectively). In conclusion, both genetic and environmental factors shared by co-twins have an important influence on individual differences in educational attainment. The effect of genetic factors on educational attainment has decreased from the cohorts born before to those born after the 1950s.