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ABSTRACT Obstructive sleep apnea (OSA) is a public health problem with a great economic impact. It is estimated that the prevalence of patients with OSA ranges from 4% to 6% of men and 2% to 4% of women in the general population. Strong evidence suggests that both sleep disorders and heart failure (HF) are related. Continuous positive airway pressure (CPAP) is the gold standard non-pharmacological treatment for this population. However, there is still a gap in the literature and its effects in patients with OSA and HF are not entirely clear. This study aimed to evaluate, by randomized clinical trials, the effects of positive pressure on cardiorespiratory function in patients with OSA and HF. Randomized clinical trials were included, with publication in the MEDLINE, PEDro, Cochrane Library, SciELO and PubMed databases and the risk bias was assessed using the PEDro scale. Six articles were included in this study, involving 165 participants. Our findings demonstrate that CPAP in the treatment of OSA in patients with HF promotes an increase in left ventricular ejection fraction, oxygen saturation and a reduction in blood pressure, apnea/hypopnea indices and awakenings from sleep during the night. We conclude that treatment with CPAP promotes an improvement in cardiorespiratory outcomes in patients with OSA and HF, improving the prognosis and reducing the risk of sudden death. However, their data must be cautiously interpreted considering the bias of the studies and their limitations.
RESUMEN La apnea obstructiva del sueño (APS) es un problema de salud pública con gran impacto económico. Se estima que la prevalencia de portadores de AOS es del 4% al 6% en los hombres y del 2% al 4% en las mujeres en la población general. Existe una fuerte evidencia de que tanto los trastornos del sueño como la insuficiencia cardíaca (IC) tienen una asociación entre sí. La presión positiva continua en las vías respiratorias (CPAP) es el tratamiento no farmacológico estándar de oro para esta población. Sin embargo, aún existe un vacío en la literatura y sus efectos en pacientes con AOS e IC no están del todo claros. Ante esto, el objetivo de este estudio es evaluar, mediante ensayos clínicos aleatorizados, los efectos de la CPAP sobre la función cardiorrespiratoria en pacientes con AOS e IC. Se incluyeron seis ensayos clínicos aleatorizados, con publicación en las bases de datos MEDLINE, PEDro, Cochrane Library, SciELO y PubMed, con un total de 165 participantes. El riesgo de sesgo se evaluó mediante la escala PEDro. Nuestros hallazgos demuestran que la CPAP en el tratamiento de la AOS en pacientes con IC promueve un aumento de la fracción de eyección del ventrículo izquierdo y de la saturación de oxígeno, y una reducción de la presión arterial, de los índices de apnea/hipopnea y de los despertares nocturnos. Se concluye que el tratamiento con CPAP promueve una mejora en los resultados cardiorrespiratorios en pacientes con AOS e IC, mejorando el pronóstico y reduciendo el riesgo de muerte súbita. Sin embargo, sus datos deben interpretarse con cautela considerando el sesgo de los estudios y sus limitaciones.
RESUMO A apneia obstrutiva do sono (AOS) é um problema de saúde pública de grande impacto econômico. Estima-se que a prevalência de portadores de AOS seja de 4% a 6% entre os homens e de 2% a 4% entre as mulheres da população em geral. Há fortes evidências de que os distúrbios do sono e a insuficiência cardíaca (IC) estão relacionados. A pressão positiva contínua nas vias aéreas (CPAP) é o tratamento não farmacológico padrão ouro para essa população. No entanto, ainda há uma lacuna na literatura, e seus efeitos em pacientes com AOS e IC não estão plenamente estabelecidos. Assim, o objetivo deste estudo foi avaliar através da revisão de ensaios clínicos randomizados os efeitos da CPAP na função cardiorrespiratória em pacientes com AOS e IC. Foram incluídos seis ensaios clínicos randomizados, publicados nas bases de dados MEDLINE, PEDro, Cochrane Library, SciELO e PubMed, totalizando 165 participantes. O risco de viés foi avaliado através da escala PEDro. Nossos achados demonstraram que a CPAP no tratamento da AOS em pacientes com IC promove um aumento da fração de ejeção do ventrículo esquerdo e da saturação de oxigênio e uma redução da pressão arterial, dos índices de apneia/hipopneia e dos despertares durante a noite. Concluímos que o tratamento com CPAP promove uma melhora nos desfechos cardiorrespiratórios em pacientes com AOS e IC, beneficiando o prognóstico e reduzindo os riscos de morte súbita. Porém, os resultados devem ser interpretados com cautela, considerando o viés dos estudos e suas limitações.
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Objective To evaluate levels of pain, range of motion, hip isometric peak torque, and functional task performance in patients 6 months after total hip arthroplasty (THA) and to compare them to asymptomatic control participants (CG). Methods We recruited participants with unilateral THA due to hip osteoarthritis (OA) within a median of 6 months who had not developed postoperative complications. We assessed the pain levels, hip range of motion, peak isometric torque, self-reported assessment (Harris Hip Score) and objectively measured function (Timed Up & Go Test [TUG]) of the patients. The THA group was compared with a group of asymptomatic participants ≥50 years old recruited in the community. Comparisons are presented as mean differences (MDs) and 95% confidence intervals (CIs). Results A total of 23 participants were included in each group. Pain levels were low in the THA group (1.48 [1.60]), and 91.3% of the patients reported to be satisfied with the surgical procedure. Participants in the THA group reported significantly lower objectively measured (THA 12.2 [10.0-21.6]; CG 9.0 [6.7-12.2]) and self-reported function (THA 78.5 [43.8-93.9]; CG 100.0 [95.8-100.0]) compared with CG. The THA group also had significantly reduced range of motion for flexion ( p < 0.001), internal ( p < 0.001) and external rotation ( p = 0.003) movements and reduced peak torque for flexion ( p < 0.001), extension ( p < 0.001), abduction ( p < 0.001) and adduction ( p = 0.024) movements compared with participants of the CG. Conclusions Despite reporting overall low pain scores and satisfaction with the surgery, the patients present with functional limitations, limited range of motion, and reduced muscle strength 6 months after THA. Evidence Level 3b.
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Abstract Objective To evaluate levels of pain, range of motion, hip isometric peak torque, and functional task performance in patients 6 months after total hip arthroplasty (THA) and to compare them to asymptomatic control participants (CG). Methods We recruited participants with unilateral THA due to hip osteoarthritis (OA) within a median of 6 months who had not developed postoperative complications. We assessed the pain levels, hip range of motion, peak isometric torque, self-reported assessment (Harris Hip Score) and objectively measured function (Timed Up & Go Test [TUG]) of the patients. The THA group was compared with a group of asymptomatic participants ≥50 years old recruited in the community. Comparisons are presented as mean differences (MDs) and 95% confidence intervals (CIs). Results A total of 23 participants were included in each group. Pain levels were low in the THA group (1.48 [1.60]), and 91.3% of the patients reported to be satisfied with the surgical procedure. Participants in the THA group reported significantly lower objectively measured (THA 12.2 [10.0-21.6]; CG 9.0 [6.7-12.2]) and self-reported function (THA 78.5 [43.8-93.9]; CG 100.0 [95.8-100.0]) compared with CG. The THA group also had significantly reduced range of motion for flexion (p< 0.001), internal (p< 0.001) and external rotation (p= 0.003) movements and reduced peak torque for flexion (p< 0.001), extension (p< 0.001), abduction (p< 0.001) and adduction (p= 0.024) movements compared with participants of the CG. Conclusions Despite reporting overall low pain scores and satisfaction with the surgery, the patients present with functional limitations, limited range of motion, and reduced muscle strength 6 months after THA. Evidence Level 3b
Resumo Objetivo Avaliar os níveis de intensidade da dor, amplitude de movimento, pico de torque isométrico do quadril e desempenho da tarefa funcional em pacientes 6 meses após a artroplastia total do quadril (ATQ), e comparar estes valores com os de participantes assintomáticos do grupo controle (GC). Métodos Recrutamos participantes com ATQ unilateral devida a osteoartrite (OA) do quadril, dentro de uma mediana de tempo de 6 meses, que não tinham desenvolvido complicações pós-operatórias. Os participantes foram avaliados quanto à intensidade da dor, à amplitude de movimento do quadril, ao pico de torque isométrico, à autoavaliação (questionário de avaliação do quadril Harris Hip Score [HHS, na sigla em inglês) e à função medida objetivamente por meio do teste Timed Up and Go (TUG, na sigla em inglês). O grupo ATQ foi comparado com um grupo de participantes assintomáticos com idade ≥ 50 anos recrutados na comunidade. As comparações são apresentadas como diferenças médias (DMs) e intervalos de confiança (ICs) de 95%. Resultados Cada grupo contou com 23 participantes. A intensidade da dor foi baixa no grupo ATQ (1,48 [1,60]), sendo que 91,3% dos pacientes relataram estar satisfeitos com o procedimento cirúrgico. Os participantes do grupo ATQ relataram uma função medida objetivamente significativamente menor (ATQ 12,2 [10,0-21,6]; GC 9,0 [6,7-12,2]) e a função autoavaliação (ATQ 78,5 [43,8-93,9]; GC 100,0 [95,8-100,0]), em comparação com o GC. O grupo ATQ também teve reduzida de forma significativa a amplitude de movimento para flexão (p< 0,001), os movimentos internos (p< 0,001) e de rotação externa (p= 0,003). O grupo ATQ também apresentou pico de torque reduzido para flexão (p< 0,001), extensão (p <0,001), movimentos de abdução (p< 0,001) e adução (p = 0,024) em comparação com os participantes do GC. Conclusões Apesar de informarem escores gerais de dor de baixa intensidade e satisfação com a cirurgia, os pacientes apresentaram limitações funcionais, amplitude de movimento limitada e redução da força muscular após 6 meses do procedimento cirúrgico de ATQ. Nível de Evidência3B.
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Humanos , Satisfação Pessoal , Complicações Pós-Operatórias , Medição da Dor , Osteoartrite do Quadril/cirurgia , Estudos Transversais , Amplitude de Movimento Articular , Artroplastia de Quadril , Articulação do Quadril/cirurgiaRESUMO
RESUMO Este estudo teve como objetivo verificar os efeitos da educação ao paciente (EP) em pacientes com disfunções musculoesqueléticas do membro superior (MS) para os desfechos de dor e/ou funcionalidade. Dois revisores realizaram independentemente buscas nas bases de dados PubMed, Cochrane, PEDro, SciELO e LILACS, considerando o período desde o início das publicações nessas bases até abril de 2021. Foram incluídos ensaios clínicos randomizados com seres humanos com disfunções musculoesqueléticas no MS; que tenham realizado intervenção com EP; e com desfechos de dor e/ou funcionalidade. Os revisores, separadamente, determinaram a elegibilidade dos estudos, extraíram dados e avaliaram a qualidade metodológica por meio da escala PEDro. Oito estudos foram incluídos nesta revisão, totalizando 603 participantes. A EP teve resultados superiores em três dos estudos no alívio da dor e/ou melhora da função em relação ao grupo comparativo. Sugere-se que a EP é mais eficaz quando associada a exercícios.
RESUMEN Este estudio tuvo como objetivo verificar los efectos de la educación del paciente (EP) en individuos con trastornos musculoesqueléticos del miembro superior (MS) sobre los resultados de dolor y/o funcionalidad. Dos revisores realizaron búsquedas de forma independiente en las bases de datos PubMed, Cochrane, PEDro, SciELO y LILACS, desde el comienzo de las publicaciones en estas bases hasta abril de 2021. Se incluyeron ensayos clínicos aleatorizados con seres humanos con trastornos musculoesqueléticos en el MS; que han sido intervenidos con EP; y con resultados de dolor y/o funcionalidad. Los revisores determinaron de forma independiente la elegibilidad del estudio, extrajeron los datos y evaluaron la calidad metodológica mediante la escala PEDro. En esta revisión se incluyeron ocho estudios con un total de 603 participantes. La EP tuvo resultados superiores en tres de los estudios en cuanto al alivio del dolor o la mejora de la función en el grupo comparativo. Aparentemente, la EF es más efectiva cuando se combina con ejercicio.
ABSTRACT This study verifies the effects of patient education (PE) in patients with musculoskeletal disorders of the upper limb (UL) on pain and/or functionality. The PubMed, Cochrane, PEDro, SciELO, and LILACS databases were independently searched by two reviewers, from the beginning of the publications until April 2021. We included randomized clinical trials with individuals with musculoskeletal disorders of the UL with pain and/or functionality outcomes, who have undergone intervention with PE. Reviewers independently determined study eligibility, extracted data, and assessed methodological quality using the PEDro scale. We included eight studies, totaling 603 participants. Compared to the controlled group, the PE intervention showed better results in three studies for pain relief and/or functionality improvement. Apparently, PE is more effective when combined with exercise.
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RESUMO O movimento de remada representa 51,4% do tempo total de prática do surfe, gerando alta demanda muscular do complexo do ombro. Apesar disso, há uma lacuna na literatura sobre a prevalência de dor e discinese escapular (DE) em surfistas. Este estudo teve o objetivo de avaliar a prevalência de dor no ombro em surfistas amadores do estado do Rio Grande do Sul, no Brasil. Trata-se de estudo observacional descritivo transversal. Foram incluídos 21 homens, com idade entre 18 e 42 anos, que praticassem surfe há no mínimo dois anos. Os desfechos avaliados foram DE estática, DE dinâmica, dor no ombro - através da escala numérica da dor -, comprimento do músculo peitoral menor, e escore no The Western Ontario Shoulder Instability Index. As variáveis contínuas foram apresentadas em média e desvio-padrão. As variáveis categóricas foram expressas em percentual. Associações dos dados foram testadas através do teste qui-quadrado e do teste de correlação de Pearson. A DE estava presente em 71,4% da amostra, tendo uma maior prevalência a discinesia do tipo I (57,1%), e 42,9% apresentaram dor no ombro durante o momento da avaliação. DE foi observada na maioria da população estudada, enquanto dor foi apresentada por pouco menos da metade dos participantes. Embora a DE seja um achado muito prevalente em surfistas amadores, não foi observada correlação com dor e redução da qualidade de vida.
RESUMEN El movimiento del remo representa el 51,4% del tiempo total de práctica de surf, generando una alta demanda muscular del complejo del hombro. Sin embargo, existe una brecha en la literatura sobre la prevalencia del dolor y la discinese escapular (DE) en los surfistas. Este estudio tuvo como objetivo evaluar la prevalencia de DE y dolor de hombro en surfistas aficionados del estado de Rio Grande do Sul, Brasil. Estudio observacional descriptivo transversal. Se incluyeron 21 hombres de 18 a 42 años que habían surfeando durante al menos 2 años. Los resultados evaluados fueron DE estática, DE dinámica, dolor de hombro usando la escala numérica de dolor, longitud del pectoral menor y puntaje en The Western Ontario Shoulder Instability Index. Las variables continuas se presentaron como media y desviación estándar. Las variables categóricas se expresaron como porcentaje. Las asociaciones de datos se probaron utilizando la Prueba Chi-cuadrado y el Coeficiente de Correlación de Pearson. La DE estaba presente en el 71,4% de la muestra, con una mayor prevalencia de discinesia tipo I (57,1%) y el 42,9% tenía dolor de hombro durante la evaluación. DE se observó en la mayoría de la población de estudio, mientras que el dolor en poco menos de la mitad de los participantes. Aunque el DE es un hallazgo muy frecuente en los surfistas, no hubo correlación con el dolor y la reducción de la calidad de vida.
ABSTRACT The paddling movement represents 51.4% of total surfing practice time, generating high muscle demand for the shoulder complex. Despite this, there is a gap on the literature on the prevalence of pain and scapular dyskinesis (SD) in surfers. This study sought to evaluate the prevalence of SD and shoulder pain in amateur surfers in the state of Rio Grande do Sul, Brazil. It is a cross-sectional descriptive observational study. The sample consisted of 21 men, aged between 18 and 42 years, surfing for at least two years. The outcomes evaluated were static SD, dynamic SD, shoulder pain - by the numerical pain rating scale -, pectoralis minor muscle length, and score on the Western Ontario Shoulder Instability Index. Continuous variables were expressed in mean and standard deviation. Categorical variables were expressed as percentages. Data associations were tested through chi-square test and Pearson correlation test. SD was present in 71.4% of the sample, with a higher prevalence of Type I dyskinesia (57.1%), and 42.9% presented shoulder pain during evaluation. SD was observed in most of the studied population, while pain was present in just under half of the participants. Although SD is a very prevalent find in amateur surfers, no correlation was observed between pain and reduced life quality.
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RESUMO Dentre as diferentes intervenções fisioterapêuticas existentes, a terapia com laser de baixa intensidade (LBI) é altamente utilizada em distúrbios musculoesqueléticos. Evidências sugerem que o LBI é eficaz na modulação de mediadores inflamatórios, contribuindo para o reparo tecidual e sendo, portanto, indicado para o tratamento de condições inflamatórias em geral. Contudo, resultados heterogêneos foram relatados sobre sua eficácia em tendinopatias de ombro. Assim, o objetivo deste estudo foi revisar sistematicamente ensaios clínicos randomizados sobre os efeitos do LBI na dor e na funcionalidade de pacientes com tendinopatia de ombro. Dois revisores realizaram independentemente buscas nas bases de dados PubMed, SciELO, Cochrane e PEDro. Foram incluídos ensaios clínicos randomizados, com seres humanos diagnosticados com tendinopatia de ombro e submetidos ao LBI, com desfechos de dor e/ou funcionalidade. A avaliação do risco de viés de cada estudo foi realizada por meio da escala PEDro. Oito estudos (73%) foram considerados com menor risco de viés, e três (27%) foram considerados com alto risco de viés. Onze estudos, totalizando 486 participantes, foram incluídos nesta revisão. O LBI reduz de forma estatisticamente significativa a dor em 45% dos estudos, e apenas um estudo apresentou aumento estatisticamente significativo na funcionalidade. Futuras revisões sistemáticas sobre o efeito combinado de LBI e exercícios, assim como sobre o efeito da terapia de LBI com dosagens recomendadas no tratamento de tendinopatias de ombro, são ainda necessárias.
RESUMEN Entre las diferentes intervenciones fisioterapéuticas existentes, la terapia con láser de baja intensidad (LBI) es muy utilizada en el tratamiento de los trastornos musculoesqueléticos. Las evidencias apuntan que la LBI es eficaz en la modulación de mediadores inflamatorios, contribuyendo a la reparación de tejidos, y está indicada para el tratamiento de afecciones inflamatorias en general. Sin embargo, se han informado resultados heterogéneos sobre su eficacia en las tendinopatías del hombro. Este trabajo tuvo como objetivo revisar sistemáticamente ensayos clínicos aleatorios sobre los efectos de la LBI acerca del dolor y la funcionalidad de pacientes con tendinopatía del hombro. Dos revisores realizaron de forma independiente búsquedas en las bases de datos PubMed, SciELO, Cochrane y PEDro. Se incluyeron los ensayos clínicos aleatorios de humanos diagnosticados con tendinopatía del hombro sometidos a terapia con láser como tratamiento, con medidas de dolor y/o resultados funcionales. La evaluación del riesgo de sesgo de cada estudio se realizó mediante la escala PEDro. Ocho estudios (73%) se consideraron de menor riesgo de sesgo, y tres (27%) se consideraron de alto riesgo de sesgo. Once estudios, con un total de 486 participantes, se incluyeron en esta revisión. La LBI redujo de manera significativa el dolor estadísticamente en el 45% de los estudios y solo uno mostró un aumento estadísticamente significativo en la funcionalidad. Todavía se necesitan revisiones sistemáticas adicionales del efecto combinado de la LBI con ejercicios, así como el efecto de la LBI con las dosis recomendadas en el tratamiento de la tendinopatía del hombro.
ABSTRACT Among the various existing physiotherapeutic interventions, low-level laser therapy (LLLT) is broadly used for treating musculoskeletal disorders. Evidence suggests that LLLT is effective in modulating inflammatory mediators, contributing to tissue repair and thus being indicated for the treatment of inflammatory conditions in general. However, heterogeneous results have been reported regarding its efficacy for shoulder tendinopathies. Thus, the aim of this study was to systematically review randomized controlled trials on the effects of LLLT on pain and function outcomes of patients with shoulder tendinopathy. Two reviewers independently searched the PubMed, SciELO, Cochrane, and PEDro databases. We included randomized controlled trials of humans diagnosed with shoulder tendinopathy and treated with LLLT, with outcome measures of pain and/or function. The risk of bias of each study was assessed using the PEDro scale. Eight studies (73%) were considered as having low risk of bias and three (27%) were considered as having high risk. Eleven studies, involving 486 participants, were included in this review. LLLT showed statistically significant pain reduction in 45% of the studies, and only one study demonstrated a statistically significant increase in function. Further systematic reviews are still needed for assessing the additive effect of LLLT with exercise, as well as the effect of LLLT using recommended dosages in the treatment of shoulder tendinopathy.
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OBJECTIVE: Patients with neck pain commonly have altered activity of the neck muscles. The craniocervical flexion test (CCFT) is used to assess the function of the deep neck flexor muscles in patients with musculoskeletal neck disorders. Systematic reviews summarizing the measurement properties of the CCFT are outdated. The objective of this study was to systematically review the measurement properties of the CCFT for assessing the deep neck flexor muscles. METHODS: The data sources MEDLINE, EMBASE, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials, Scopus, and Science Direct were searched in April 2019. Studies of any design that reported at least 1 measurement property of the CCFT for assessing the deep neck flexor muscles were selected. Two reviewers independently extracted data and rated the risk of bias of individual studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk-of-bias checklist. The overall rating for each measurement property was classified as "positive," "indeterminate," or "negative." The overall rating was accompanied with a level of evidence. RESULTS: Fourteen studies were included in the data synthesis. The ratings were positive, and the level of evidence was moderate for interrater and intrarater reliability and convergent validity. There was conflicting rating and level of evidence for discriminative validity. Measurement error was indeterminate, with an unknown level of evidence. Responsiveness was negative, with a limited level of evidence. A limitation of this study was that only papers published in English were included. CONCLUSIONS: The CCFT is a valid and reliable test that can be used in clinical practice as an assessment test. Because of the conflicting and low-quality evidence, caution is advised when using the CCFT as a discriminative test and as an outcome measure. Future better-designed studies are warranted.
Assuntos
Lista de Checagem , Movimento/fisiologia , Músculos do Pescoço/fisiopatologia , Exame Físico , Humanos , Cervicalgia , Avaliação de Resultados em Cuidados de Saúde , Reprodutibilidade dos TestesRESUMO
OBJECTIVE: To compare the effects of two different mobilization techniques and a placebo intervention applied to the thoracic spine on heart rate variability (HRV) and pressure pain threshold (PPT) in asymptomatic individuals. METHODS: Sixty healthy asymptomatic subjects aged between 18 and 40 years old were randomized to a single session of one of the three interventions: posterior-to-anterior (PA) rotatory thoracic passive accessory intervertebral mobilization (PAIVM) (PA group), unilateral thoracic PA in slump position (SLUMP group) or placebo intervention (Placebo group). HRV and PPT at C7 and T4 spinous process, first dorsal interossei muscles bilaterally, and muscle belly of tibialis anterior bilaterally were measured before and immediately after the intervention. A univariate analysis of covariance (ANCOVA) adjusted for baseline values assessed the effect of "Group". Pairwise comparisons with Bonferroni adjustment for multiple comparisons were performed. RESULTS: There were no significant between-group differences for HRV. A significant between-group difference for PPT in the ipsilateral tibia was found favoring the SLUMP group in comparison with the PA group. There were no significant between-group differences for PPT in the other landmarks. CONCLUSION: A single treatment of thoracic PAIVM in prone lying and slump position did not alter PPT and HRV compared to placebo in asymptomatic subjects.
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Frequência Cardíaca/fisiologia , Manipulação da Coluna/métodos , Limiar da Dor/fisiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Método Simples-Cego , Vértebras Torácicas , Adulto JovemRESUMO
INTRODUCTION: Neck pain is the leading cause of years lived with disability worldwide and it accounts for high economic and societal burden. Altered activation of the neck muscles is a common musculoskeletal impairment presented by patients with neck pain. The craniocervical flexion test with pressure biofeedback unit has been widely used in clinical practice to assess function of deep neck flexor muscles. This systematic review will assess the measurement properties of the craniocervical flexion test for assessing deep cervical flexor muscles. METHODS AND ANALYSIS: This is a protocol for a systematic review that will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. MEDLINE (via PubMed), EMBASE, PEDro, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus and Science Direct will be systematically searched from inception. Studies of any design that have investigated and reported at least one measurement property of the craniocervical flexion test for assessing the deep cervical flexor muscles will be included. All measurement properties will be considered as outcomes. Two reviewers will independently rate the risk of bias of individual studies using the updated COnsensus-based Standards for the selection of health Measurement Instruments risk of bias checklist. A structured narrative synthesis will be used for data analysis. Quantitative findings for each measurement property will be summarised. The overall rating for a measurement property will be classified as 'positive', 'indeterminate' or 'negative'. The overall rating will be accompanied with a level of evidence. ETHICS AND DISSEMINATION: Ethical approval and patient consent are not required since this is a systematic review based on published studies. Findings will be submitted to a peer-reviewed journal for publication. PROSPERO REGISTRATION NUMBER: CRD42017062175.
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Músculos do Pescoço/fisiopatologia , Cervicalgia , Crânio/fisiopatologia , Análise e Desempenho de Tarefas , Humanos , Movimento/fisiologia , Projetos de Pesquisa , Revisões Sistemáticas como AssuntoRESUMO
PURPOSE: To systematically review the effectiveness of Physiotherapy interventions combined with extrinsic feedback (EF) compared to Physiotherapy interventions alone or control for the management of neck pain and disability. METHODS: Randomized clinical trials were searched and retrieved from six databases, from inception through August 2016. Risk of bias of included studies was assessed using the PEDro scale. When possible data were pooled and Meta-analyses were conducted. The quality and strength of evidence for each outcome was assessed using the GRADE approach. RESULTS: Eight studies (n = 677) were included in the review. The pooled estimates suggested Physiotherapy intervention + EF was not superior to Physiotherapy intervention alone for disability (MD = -0.38; 95%CI = -0.91 to 0.18; I2 = 82%), but was superior for pain (MD = -0.37; 95%CI = -0.73 to -0.01; I2 = 68%). Physiotherapy intervention + EF was not superior than control for disability scores (SMD = -3.94; 95%CI = -12.06 to 4.18; I2 = 92%). Physiotherapy intervention + EF intervention was more effective than control for pain scores at short-term (SMD = -1.44; 95%CI = -2.25 to-0.63; I2 = 50%). Most studies did not specify nor use the ideal characteristics of EF. CONCLUSION: There is very low quality of evidence that Physiotherapy intervention + EF is more effective than Physiotherapy intervention alone or control for short-term pain, but not for disability. Physiotherapy intervention plus EF was more effective than Physiotherapy alone for acute neck pain, but not for chronic pain or disability. There was high risk of bias within included studies. Future studies are likely to change the estimates of the effects of Physiotherapy intervention plus EF on neck rehabilitation.
