Effectiveness of Kinesio Taping in Patients With Chronic Nonspecific Low Back Pain: A Systematic Review With Meta-analysis.

STUDY DESIGN: Systematic review. OBJECTIVE: To investigate the effects of Kinesio Taping (KT) in patients with nonspecific low back pain. SUMMARY OF BACKGROUND DATA: KT is widely used in patients with low back pain. METHODS: We conducted searches on PubMed, EMBASE, PEDro, SciELO, and LILACS up to February 26, 2018. We included only randomized controlled trials (RCTs) in adults with chronic nonspecific low back pain that compared KT to no intervention or placebo as well as RCTs that compared KT combined with exercise against exercise alone. The methodological quality and statistical reporting of the eligible trials were measured by the 11-item PEDro scale. The quality of the evidence was assessed using the GRADE classification. We considered pain intensity and disability as the primary outcomes. Whenever possible, the data were pooled through meta-analysis. RESULTS: We identified 11 RCTs for this systematic review (pooled n = 743). Two clinical trials (pooled n = 100) compared KT to no intervention at the short-term follow-up. Four studies compared KT to placebo (pooled n = 287) at short-term follow-up and two trials (pooled n = 100) compared KT to placebo at intermediate-term follow-up. Five trials (pooled n = 296) compared KT combined with exercises or electrotherapy to exercises or spinal manipulation alone. No statistically significant difference was found for most comparisons. CONCLUSION: Very low to moderate quality evidence shows that KT was no better than any other intervention for most the outcomes assessed in patients with chronic nonspecific low back pain. We found no evidence to support the use of KT in clinical practice for patients with chronic nonspecific low back pain. LEVEL OF EVIDENCE: 1.

McKenzie Method of Mechanical Diagnosis and Therapy was slightly more effective than placebo for pain, but not for disability, in patients with chronic non-specific low back pain: a randomised placebo controlled trial with short and longer term follow-up.

BACKGROUND: The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) is one of the exercise approaches recommended by low back pain (LBP) guidelines. We investigated the efficacy of MDT compared with placebo in patients with chronic LBP. METHODS: This was a prospectively registered, two-arm randomised placebo controlled trial, with a blinded assessor. A total of 148 patients seeking care for chronic LBP were randomly allocated to either MDT (n=74) or placebo (n=74). Patients from both groups received 10 treatment sessions over 5 weeks. Patients from both groups also received an educational booklet. Clinical outcomes were obtained at the end of treatment (5 weeks) and 3, 6 and 12 months after randomisation. Primary outcomes were pain intensity and disability at the end of treatment (5 weeks). We also conducted a subgroup analysis to identify potential treatment effect modifiers that could predict a better response to MDT treatment. RESULTS: The MDT group had greater improvements in pain intensity at the end of treatment (mean difference (MD) -1.00, 95% CI -2.09 to -0.01) but not for disability (MD -0.84, 95% CI -2.62 to 0.93). We did not detect between-group differences for any secondary outcomes, nor were any treatment effect modifiers identified. Patients did not report any adverse events. CONCLUSION: We found a small and likely not clinically relevant difference in pain intensity favouring the MDT method immediately at the end of 5 weeks of treatment but not for disability. No other difference was found for any of the primary or secondary outcomes at any follow-up times. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT02123394).

Prevalência de dor musculoesquelética em praticantes de caminhada: um estudo transversal / La prevalencia de dolor musculo esquelético en practicantes de caminatas: estudio transversal / Prevalence of musculoskeletal pain in walkers: a cross-sectional study

O presente estudo teve como objetivo verificar a prevalência de dor de origem musculoesquelética em praticantes de caminhada e os possíveis fatores associados. Trata-se de um estudo transversal, realizado por meio de um formulário aplicado aos praticantes de caminhada em parques comuns à prática desta atividade. O formulário utilizado foi composto de questões sobre informações pessoais dos participantes, a rotina da prática de caminhada, o histórico de lesões e a presença de dor musculoesquelética no momento da entrevista. Foi realizada uma análise descritiva das características dos participantes e utilizado o teste t independente, teste de Mann-Whitney e teste de qui-quadrado para a comparação dos dados entre os participantes com dor e sem dor no momento da entrevista. Foram entrevistados 136 praticantes de caminhada, sendo que a prevalência de dor musculoesquelética foi de 8%. A articulação do joelho foi a região mais acometida pela dor entre os participantes (45%). Entre as variáveis analisadas, a presença de lesões prévias nos últimos 12 meses demostrou uma associação estatisticamente significativa (p<0,05) com a presença de dor atual. Podemos concluir que a prevalência de dor musculoesquelética em praticantes de caminhada é baixa, porém esteve diretamente associada à presença de lesões prévias nos últimos 12 meses.

Este artículo tuvo el propósito de verificar la prevalencia de dolor musculo esquelético en practicantes de caminatas y los posibles factores asociados a esta práctica. Se trata de estudio transversal, que se realizó mediante un cuestionario aplicado a los practicantes de caminatas en parques y lugares que son comunes a esta actividad. El cuestionario se componía por informaciones personales de los practicantes, la rutina de la práctica, el historial de lesiones y la presencia de dolor musculo esquelético durante la entrevista. Para ello, se ha hecho un análisis descriptivo de las características de los participantes, y se han utilizados la prueba t independiente, la prueba de Mann-Whitney y la prueba de Chi Cuadrado para la comparación de los datos entre los participantes con y sin dolor en la ocasión de la entrevista. Se han entrevistados 136 practicantes de caminatas, y el 8% fue la prevalencia de dolor musculo esquelético encontrada. La zona más afectada por el dolor entre los participantes fue la articulación de rodilla (45%). Entre las variables evaluadas, se ha demostrado que la presencia de lesiones previas de los últimos 12 meses está asociada estadísticamente (p<0,05) a la presencia de dolor actual. Se concluyó que es baja la prevalencia de dolor musculo esquelético en practicantes de caminatas, sin embargo se la asocia a la presencia de lesiones previas de los últimos 12 meses.

The aim of this study was to determine the prevalence of musculoskeletal pain in walkers and the associated factors. This is a cross sectional study, conducted through a questionnaire applied to walkers in parks in which this activity is commonly seen. The form used was composed of questions about personal information, walking practice routine, injury history and the presence of musculoskeletal pain during the interview. We performed a descriptive analysis of the characteristics of the participants and used the independent t test, Mann-Whitney's test e chi-square test for the comparison of data between participants with and without pain at the moment of the interview. We interviewed 136 walkers, and the prevalence of musculoskeletal pain was 8%. The knee joint was the most affected region by pain between the participants (45%). Among the variables analyzed, the presence of previous injuries in the last 12 months showed a statistically significant association (p<0.05) with the presence of pain. We can conclude that the prevalence of musculoskeletal pain in walkers was low, however, it was directly associated with previous injuries in the last 12 months.

Tratamento fisioterapêutico para epicondilite lateral: uma revisão sistemática / Physiotherapy treatment for tennis elbow: a systematic review

INTRODUÇÃO: Embora o tratamento conservador ainda seja a melhor conduta inicial para a epicondilite lateral do cotovelo, há pouca evidência científica de que o tratamento fisioterapêutico altere o curso natural da doença e seja efetiva no tratamento dessa patologia. OBJETIVO: Avaliar a efetividade e a segurança das diversas intervenções fisioterapêuticas utilizadas no tratamento conservador da epicondilite lateral. MATERIAIS E MÉTODOS: Foram incluídos apenas ensaios clínicos aleatorizados e quase aleatorizados que utilizaram pelo menos uma modalidade fisioterapêutica como uma das intervenções. Foi realizada uma busca nas bases de dados eletrônicos MEDLINE; Embase; LILACS e SciELO até dezembro de 2010. Não houve restrição do período de publicação dos artigos. Com o objetivo de aumentar a sensibilidade e a precisão, a estratégia de busca utilizada foi adaptada para cada base de dados. Foi utilizada a pontuação da escala PEDro para avaliação da qualidade metodológica dos ensaios clínicos aleatorizados. RESULTADOS: 26 artigos foram incluídos na revisão sistemática e a avaliação da maioria desses artigos apresentou qualidade metodológica satisfatória (6,4 pontos). Em relação aos aspectos mensurados, todos os artigos avaliaram a dor, 18 (69%) examinaram a força de preensão e 11 (42%) a função dos pacientes. Quanto à duração do acompanhamento dos pacientes apenas nove (35%) artigos realizaram acompanhamento a longo prazo. CONCLUSÃO: A melhor opção para o tratamento da epicondilite lateral parece ser a combinação de modalidades terapêuticas, o que condiz com a realidade clínica do fisioterapeuta. Porém, mais ensaios clínicos com boa qualidade metodológica são necessários para determinar a efetividade da maioria das modalidades terapêuticas encontradas.

INTRODUCTION: Although conservative treatment is still the best initial management for lateral epicondylitis, there is little scientific evidence that physical therapy change the natural history of disease and is effective for treating this condition. Objective: evaluate the effectiveness and safety of different physical therapy interventions used in the conservative treatment of lateral epicondylitis. MATERIALS AND METHODS: We included only randomized controlled trials and quasi-randomized studies that used at least one modality of physical therapy as an intervention. We performed a search of electronic databases MEDLINE, Embase, LILACS and SciELO by December 2010. There was no restriction of the period and publication of articles aiming to increase the sensitivity and accuracy; the search strategy used was adapted for each database. We used the score of the PEDro scale for assessing the methodological quality of randomized controlled trials. RESULTS: 26 articles were included in the systematic review, and the evaluation of most of these articles had satisfactory methodological quality (6.4 points). Regarding the aspects measured, all articles evaluated pain, 18 (69%) examined the grip strength and 11 (42%) examined the patient's function. The duration of follow-up, only nine (35%) articles made long-term monitoring. CONCLUSION: The best option for the treatment of lateral epicondylitis seems to be a combination of therapeutic modalities, which agrees with clinical reality of the physiotherapists. However, more clinical trials with good methodological quality are needed to determine the effectiveness of most therapeutic modalities found.