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

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

Neural management plus advice to stay active on clinical measures and sciatic neurodynamic for patients with chronic sciatica: Study protocol for a controlled randomised clinical trial.

Advice to stay active is the primary management strategy for sciatica. Other conservative treatments such as neural management techniques may also contribute to sciatica recovery, but currently, the effects have not been robustly assessed. Thus, the aim of this study is to compare the effects of adding neural management to advice to stay active versus advice to stay active alone in improving pain intensity and functional limitation. Secondarily, to compare the effects of the experimental intervention in the sciatic neurodynamic, pain modulation, and psychosocial factors. A parallel-group, controlled, examiner-blinded superiority clinical trial randomised at a 1:1 allocation will be conducted in 210 participants with chronic sciatica. Patients will be recruited from outpatient physiotherapy clinics and community advertisements. The experimental group will receive neural mobilisation techniques and soft tissue mobilisation techniques for 30 minutes per session, 10 weekly sessions, plus advice to stay active on their activities of daily living, information on physical activity, imaging tests, and sciatica for 5 biweekly sessions lasting 25-30 minutes. The control group will receive advice to stay active only. The re-evaluation will be performed out after 5 weeks, 10 weeks, and 26 weeks after randomisation and primary endpoints will be pain intensity and functional limitation at 10 weeks. Secondary outcomes will include neuropathic symptoms, sciatic neurodynamic, pain modulation, and psychosocial factors. Adverse events and patient satisfaction will be assessed. Ethical approval has been granted from an Institutional Human Research Ethics Committee. Trial registration: Trial was prospectively registered in the Brazilian Registry of Clinical Trials (number: RBR-3db643c).

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

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

Prevalence and Risk Factors for Musculoskeletal Pain in Keyboard Musicians: A Systematic Review.

OBJECTIVE: To identify the prevalence and risk factors for musculoskeletal pain in keyboard musicians. DESIGN: Systematic review METHODS: A systematic review was conducted according to the MOOSE recommendations and it was registered with the PROSPERO database under registration number CRD42016042913. We included observational studies through the electronic databases PubMed, Scopus, ScienceDirect, Web of Science, Répertoire International de Littérature Musicale (RILM), Retrospective Index to Music Periodicals (RIPM), Scielo, and Google Scholar, with combinations of the keywords pianists, keyboard players, musculoskeletal pain, muscular disease, tendinitis, tendinopathy, observational, case-control, prevalence, and risk factors. Data from population, information about pain, and risk factors were extracted from studies that fulfilled the eligibility criteria. The methodological quality of the studies was classified through the Newcastle-Ottawa Scale. The risk of bias and quality of evidence was assessed using the GRADE system. RESULTS: Twelve articles (case-controls) were included for the qualitative synthesis. The quality of the studies was classified as fair (n = 6) and good (n = 6). Prevalence was observed between 25.8% and 77.0% of musculoskeletal pain among keyboard musicians, with a higher prevalence in wrists and hands (13.8%-65.8%), neck (9.8%-64.2%), and shoulders (9.8%-59.8%). The only consistent risk factor found in the 4 studies was being female, with OR ranging from 1.05-1.90. Age greater than 18 years; weekly training more than 20 hours; training for more than 60 minutes without a rest break; not having a habit of practicing sports; and playing despite the pain were also described as risks factors for musculoskeletal pain. It was not possible to perform the meta-analysis due to the heterogeneity of the studies. CONCLUSION: Keyboard musicians presented a high prevalence of musculoskeletal pain, especially in the upper extremity regions of the body. Female, ageing, playing behaviors, and sedentary lifestyle showed an increased likelihood to report musculoskeletal pain. LEVEL OF EVIDENCE: II.

Reproducibility of the low back clinical postural grouping in adolescents.

OBJECTIVE: The purpose of this study was to analyze the intra- and inter-rater reliability of the Low Back Clinical Postural Grouping (LBCPG). METHODS: Fifty-eight school adolescents were evaluated by lateral photography. The examiners classified the posture of the participants as: hyperlordotic, sway back, flat back or neutral. The intra- and inter-rater reliability were quantified by the percentage agreement between clinicians and the kappa coefficient with 95% confidence intervals (95% CI). RESULTS: The intra-rater percentage agreement was 91.4%, k = 0.87 (95% IC 0.77-0.98, p < 0.001) for the more experienced rater, and 86.2% k = 0.79 (IC 95% 0.62-0.96, p < 0.001) for the less experienced rater. The percentage agreement between clinicians was 55.17% k = 0.39 (95% CI: 0.23-0.55, p < 0.001). The agreement rose to 70.69%, k = 0.58 (95% CI 0.41-0.74, p < 0.001) when an optional second opinion of the raters was also considered. CONCLUSION: The LBCPG was reliable when used by the same clinician. The strategy of a second opinion could be used to improve the inter-rater reliability in epidemiological studies with large samples.

Osteocondroma de rodilla en un triatleta aficionado / Knee osteochondroma in an amateur triathlete

Introducción: El estudio describe correlaciones clínicas radiológicas después de la observación de la imagen de un Osteocondroma con localización rara en la región posterior de la rodilla, en un triatleta aficionado. Objetivos: Presentar el caso clínico atípico de dolor en la rodilla, y demostrar la aplicabilidad de los exámenes complementarios en la práctica clínica osteopática. Resultados: El triatleta aficionado sufrió la influencia del entrenamiento y de factores intrínsecos de la biomecánica, acarreando lesiones por sobrecarga, visualizadas en los exámenes de imagen y correlacionadas en el análisis de la marcha y las pruebas físicas. Conclusiones: El análisis de la marcha y el razonamiento clínico y radiológico deberían aplicarse para la interpretación del origen de los síntomas y en la decisión de la Terapia Manipulativa Osteopática (AU)

Introduction: The study describes clinical radiological correlations after observation of the image of an Osteochondroma with uncommon localization in the posterior region of the knee in an amateur triathlete. Objectives: Present the atypical clinical case of pain in the knee, and demonstrate the applicability of the supplementary exams in clinical osteopathic practice. Results: The amateur triathlete suffered the influence of training and intrinsic biomechanical factors, involving injuries due to strain, displayed in the imaging tests and correlated in walking tests and physical examinations. Conclusions: Walking tests and clinical and radiological analysis should be applied in order to interpret the origin of the symptoms and the Osteopathic Manipulative Therapy decision (AU)