Effects of therapeutic interventions on pain due to plantar fasciitis: A systematic review and meta-analysis.

OBJECTIVE: To determine the effects of different therapeutic interventions that have ever been evaluated in randomized controlled trials on pain due to plantar fasciitis. METHODS: We searched different electronic databases until September 2022. Mean differences (MDs) and 95% confidence intervals (CIs) were calculated. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the overall certainty evidence. RESULTS: A total of 236 studies met the study criteria, including 15,401 patients. Botulinum toxin MD -2.14 (CI: -4.15, -0.14), micronized dehydrated human amnion/chorion membrane injection MD -3.31 (CI: -5.54, -1.08), dry needling MD -2.34 (CI: -4.64, -0.04), low-dye taping MD -3.60 (CI: -4.16, -3.03), low-level laser therapy MD -2.09 (CI: -2.28, -1.90), myofascial releases MD -1.79 (CI: -2.63, -0.94), platelet-rich plasma MD -2.40 (CI: -4.16, -0.63), radiofrequency MD -2.47 (CI: -4.65, -0.29), and stretching MD -1.14 (CI: -2.02, -0.26) resulted in being effective treatments for pain when compared to the control in the short term. In the medium and long term, only extracorporeal shock wave therapy MD -0.97 (CI: -1.13, -0.81)/MD -2.49 (CI: -3.17, -1.82) was effective for improving pain when compared to the control. CONCLUSIONS: Considering the available studies, this systematic review and meta-analysis showed that different therapeutic interventions seem to be useful strategies for improving pain in patients with plantar fasciitis. In the medium and long term, only extracorporeal shock wave therapy was effective in improving pain when compared to the control.

Mielopatia ou paraparesia espástica tropical (HAM/TSP) e os domínios da SF-36 / Tropical spastic myelopathy/ paraparesis (HAM/TSP) and the SF-36 domains

Introdução: a paraparesia espástica tropical ou mielopatia associada ao HTLV (HAM/TSP) é umadoença infecciosa e inflamatória crônica, que pode interferir em vários aspectos da vida do indivíduo e, com isso, alterar sua qualidade de vida (QV). Objetivo: avaliar os domínios da escala SF-36 que mais contribuem para as alterações na qualidade de vida dos pacientes com HAM/TSP. Metodologia: nesse estudo observacional, transversal e quantitativo, realizado com 49 pacientes diagnosticados com HAM/TSP do setor de Neurociências do Ambulatório Professor Francisco Magalhães Neto, na cidade de Salvador, Bahia, Brasil, a qualidade de vida foi avaliada pelo questionário de saúde Short Form-36 (SF-36), no período de fevereiro de 2019 a julho de 2020, e de fevereiro de 2022 a abril de 2022. Os dados obtidos foram avaliados por análise estatística descritiva e testes de correlação de Pearson e Spearman. Resultados: foi observado que os menores escores do questionário SF-36, indicando pior qualidade de vida, foram relativos aos domínios vinculados às limitações físicas, capacidades funcionais e limitações emocionais, nessa ordem. Os melhores domínios, indicando melhor qualidade de vida, nessa população, foram saúde mental e aspectos sociais, demostrando que os pacientes com HAM/TSP relatam alterações físicas e emocionais em sua qualidade de vida. Conclusão:os domínios que mais alteraram a qualidade de vida dos pacientes com HAM/ TSP foram AF, CF e AE. Assim, utilizando-se da escala SF-36, profissionais de saúde podem identificar e intervir precocemente em domínios que comprometam a saúde física e emocional dos pacientes com HAM/TSP, alterando, consequentemente, sua qualidade de vida.

Introduction: tropical Spastic Paraparesis or HTLV-associated Myelopathy (HAM/TSP) is a chronic infectious and inflammatory disease that can interfere with various aspects of individuals life and, thereby alter their Quality of Life (QoL). Objective: to evaluate the domains of the sf-36 scale that most contribute to changes in the quality of life of patients with HAM/TSP. Methods: in this observational, cross-sectional and quantitative study carried out with 49 patients diagnosed with HAM/TSP from the Neuroscience sector of the Professor Francisco Magalhães Neto Ambulatory, in the city of Salvador, Bahia, Brazil, quality of life was assessed using the Short Form Health Questionnaire Form ­ 36 (SF-36), from February/19 to July/20 and from February/22 to April/22. Data obtained were evaluated by descriptive statistical analysis and Pearson and Spearman correlation tests. Results: it was observed that the lowest scores on the SF-36 questionnaire, indicating worse quality of life, were related to the domains linked to physical limitations, functional capacities and emotional limitations, in that order. The best domains, indicating better quality of life in this population, were mental health and social aspects, showing that patients with HAM/TSP report physical and emotional changes in their quality of life. Conclusion: the domains that most changed the quality of life of patients with HAM/TSP were PA, FC and EA. Thus using the SF-36 scale, health professionals can identify and intervene early in areas that compromise the physical and emotional health of patients with HAM/TSP, consequently altering their quality of life.

Center of gravity oscillations in HTLV-1-associated myelopathy/tropical spastic paraparesis / Oscilações do centro de gravidade na mielopatia associada ao HTLV-1/ paraparesia espástica tropical / Oscilaciones del centro de gravedad en la mielopatía asociada al HTLV-1/paraparesia espástica tropical

Abstract Introduction: Postural control in individuals with HTLV-1-associated myelopathy or tropical spastic paraparesis (HAM/TSP) is usually compromised, which increases the risk of falls, makes it difficult to perform activities of daily living, and impairs the quality of life. The profile of the center of gravity oscillations in this population is unknown and may aid in clinical follow-up and research. Objective: To compare the stabilometric values between HAM/TSP and uninfected individuals and verify the existence of correlations between stabilometric variables and the Berg Balance Scale (BBS). Method: A cross-sectional observational study was performed with infected individuals, classified as defined and likely (WHO criteria), compared to accompanying persons and seronegative relatives. A baropodometry platform (Footwork®) was used to obtain the oscillation values of the body's center of gravity in total oscillation area (TOA), anterior-posterior oscillation (APO) and lateral oscillation (LO). Mean values were correlated with BBS by Spearman's Correlation (5% alpha). Approved by the ethical committee of Escola Bahiana de Medicina e Saúde Pública under Opinion 49634815.2.0000.5628. Results: An asymmetric distribution of all the stabilometric variables analyzed in the HAM/TSP population was found, different from the uninfected group (p < 0.05). It was also possible to verify strong to moderate and inverse correlations between the variables of center of gravity oscillation with the scores obtained in BBS, especially for TOA and LO. Conclusion: People with HAM/TSP presented higher values for the center of gravity oscillations and these were correlated with the BBS in the balance evaluation.

Resumo Introdução: o controle postural em indivíduos com mielopatia associada ao HTLV-1 ou paraparesia espástica tropical (HAM/TSP) é geralmente comprometido, o que aumenta o risco de quedas, dificulta a realização de atividades de vida diária e prejudica a qualidade de vida. O perfil das oscilações do centro de gravidade nesta população é desconhecido e pode auxiliar no acompanhamento clínico e na pesquisa. Objetivo: comparar os valores estabilométricos entre pessoas com HAM/TSP e não infectados, e verificar a existência de correlações entre variáveis estabilométricas e a Escala de Equilíbrio Berg (EEB). Método: foi realizado um estudo observacional transversal com indivíduos infectados, classificados como definidos e prováveis (critérios da OMS), comparados com acompanhantes e familiares soronegativos. Uma plataforma de baropodometria (Footwork®) foi utilizada para obter os valores de oscilação do centro de gravidade do corpo em área de oscilação total (AOT), oscilação anteroposterior (OAP) e oscilação laterolateral (OLL). Os valores médios foram correlacionados com a BBS pela Correlação de Spearman (alfa 5%). Aprovado pelo Comitê de Ética da Escola Bahiana de Medicina e Saúde Pública sob o CAAE 49634815.2.0000.5628. Resultados: encontrou-se distribuição assimétrica de todas as variáveis estabilométricas analisadas na população com HAM/TSP, diferentes do grupo de não infectados (p < 0,05). Também foi possível verificar correlações de forte a moderada e inversas entre as variáveis de oscilação do centro de gravidade com os escores obtidos na EEB, especialmente para AOT e OLL. Conclusão: Pessoas com HAM/TSP apresentaram valores maiores para as oscilações do centro de gravidade e estas foram correlacionadas com a EEB na avaliação do equilíbrio.

Resumen Introducción: El control postural en individuos con mielopatía asociada al HTLV-1 o paraparesia espástica tropical (HAM/TSP) suele estar comprometido, lo que aumenta el riesgo de caídas, les dificulta en las actividades de la vida diaria y perjudica su calidad de vida. Conocer el perfil de las oscilaciones del centro de gravedad en esta población puede ayudar en el seguimiento clínico y la investigación. Objetivo: Comparar los valores estabilométricos entre personas con HAM/TSP y personas no infectadas, y verificar la existencia de correlaciones entre las variables estabilométricas y la Escala de Equilibrio de Berg (BBS). Método: Se realizó un estudio observacional transversal con individuos infectados, clasificados como definidos y probables (criterios de la OMS), comparados a acompañantes y familiares seronegativos. Se utilizó una plataforma de baropodometría (Footwork®) para obtener los valores de oscilación del centro de gravedad del cuerpo en el área de oscilación total (AOT), oscilación antero-posterior (OAP) y oscilación lateral-lateral (OLL). Los valores medios se correlacionaron con la BBS por la correlación de Spearman (alfa 5%). Estudio aprobado por el Comité de Ética de la Escuela Bahiana de Medicina y Salud Pública bajo CAAE 49634815.2.0000.5628. Resultados: Se encontró una distribución asimétrica de todas las variables estabilométricas analizadas en la población HAM/TSP diferente en el grupo no infectado (p <0,05). También fue posible verificar correlaciones de fuertes a moderadas e inversas entre las variables de oscilación del centro de gravedad con las puntuaciones obtenidas en la BBS, especialmente para AOT y OLL. Conclusión: Las personas con HAM/TSP presentaron valores más altos en las oscilaciones del centro de gravedad, las cuales se correlacionaron con la BBS en la evaluación del equilibrio.

A dominância de membros interfere no equilíbrio de força muscular do joelho de corredores recreacionais? / Does the limb dominance interfere with knee muscle strength balance in recreational runners?

Introdução: cerca de 5% da população brasileira pratica corrida de rua, e a falta de preparo físico das pessoas para esse esporte contribui para o aumento no índice de lesões, sendo o joelho uma das articulações mais acometidas. Sabendo que os parâmetros musculares interferem diretamente no desempenho e que a destreza de membros pode suscitar inferências relativas ao aumento de força no membro dominante, torna-se importante avaliar a força e a relação de equilíbrio muscular do joelho destes atletas tanto no membro dominante quanto no contralateral. Objetivo: verificar o equilíbrio muscular dos extensores e flexores de joelho dominante e não dominante em corredores recreacionais. Metodologia: foram incluídos 111 indivíduos com idade entre 18 e 65 anos, de ambos os sexos, praticantes de corrida há pelo menos 4 meses contínuos, sem histórico de lesão nos últimos 3 meses. Os participantes foram entrevistados e encaminhados para a coleta da força muscular isocinética dos grupos extensor e flexor do joelho com protocolo de 60°/s, 180°/s e 300°/s. As variáveis de interesse estudadas foram: membro dominante, tempo de prática de corrida, torque máximo, trabalho total e potência. Foram calculados os Índices de Deficiência Muscular (IDM) sendo admitido como referencial de equilíbrio até 10% na diferença entre os membros. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa do Instituto de Ciências da Saúde da Universidade Federal da Bahia, sob parecer de nº 2.621.166. Resultados: o IDM indicou que 54,1% dos extensores de joelho estavam equilibrados e que 55,9% dos flexores de joelho encontravam-se numa relação de desequilíbrio muscular. Conclusão: a dominância de membros não é um fator ligado ao desequilíbrio de forças no membro inferior. Este achado de desequilíbrio de força entre joelhos pode estar ligado à predisposição de lesão e deve orientar as equipes multiprofissionais de saúde a definir um trabalho preventivo de treinamento muscular e esportivo.

Introduction: about 5% of the Brazilian population practices street running and the lack of physical fitness for this sport contributes to the increase in the injury rate, with the knee being one of the most affected joints. Knowing that muscle parameters directly interfere performance and that limb dexterity may lead to inferences regarding strength increase in the dominant limb, it is important to evaluate the strength and balance ratio of these athletes' knee in both dominant and contralateral limbs. Objective: to verify muscle balance of dominant and non-dominant knee extensors and flexors in recreational runners. Methodology: 111 individuals aged between 18 and 65 years old, male and female, who have been running for at least 4 continuous months, with no history of injury in the last 3 months, were included. Participants were interviewed and referred for the collection of isokinetic muscle strength of the knee extensor and flexor groups with a protocol of 60°/s, 180°/s and 300°/s. The variables of interest studied were: dominant limb, running practice time, maximum torque, total work and power. Muscle deficiency indices (MDI) were calculated and accepted as a balance reference up to 10% in the difference between the limbs. The research was approved by the Research Ethics Committee of the Institute of Health Sciences of the Federal University of Bahia, under technical advice no 2.621.166. Results: the MDI indicated that 54.1% of the knee extensors were balanced and 55.9% of the knee flexors were in a muscular imbalance ratio. Conclusion: limb dominance is not a factor related to lower limb imbalance of forces. This finding of strength imbalance between knees may be associated to injury predisposition and should guide multidisciplinary health teams to define preventive work on muscle and sports training

Perfil estabilométrico de corredores recreacionais no município de Salvador (BA) / Stabilometric profile of recreational runners in the municipality of Salvador (BA)

Introdução: A corrida de rua associada aos benefícios à saúde tem sido a modalidade de escolha para os iniciantes em atividade física. A periodicidade dos treinos, o impacto repetitivo e a presença de terrenos irregulares são características que sobrecarregam o pé e o tornozelo. Para o corredor, uma simples alteração na mecânica do pé repercute no sistema tônico postural e contribui para instabilidade corporal. Dessa forma, os objetivos deste estudo são descrever o perfil estabilométrico e de treinamento de corredores recreacionais e verificar se o tempo e o volume de treinamento estão correlacionados com os dados estabilométricos ligados ao controle postural. Metodologia: A amostra foi composta por 50 corredores recreacionais selecionados por conveniência, com idade entre 18 e 65 anos, de ambos os sexos, sem lesão nos últimos três meses e sem histórico de cirurgias nos membros inferiores. Resultados: Referentes ao perfil de treinamento, os resultados mostraram uma mediana de 2 anos e 6 meses do tempo de treinamento e uma mediana de 20 km no volume de treinamento semanal. No que se refere ao perfil estabilométrico, a área de oscilação apresentou mediana de 46,7 mm2, a velocidade de oscilação teve média de 8,1mm/s e o desvio padrão foi de 1,2. Quanto à oscilação, a laterolateral revelou uma mediana de ­ 1,6 mm, e a anteroposterior uma mediana de ­ 1 mm. Conclusão: Não houve correlação entre o perfil de treinamento e o perfil estabilométrico. Concluímos que os dados apresentados no perfil do treinamento não estão associados à estabilidade corporal.

Introduction: Street running associated with health benefits has been the modality of choice for beginners in physical activity. The periodicity of training, the repetitive impact and the presence of irregular terrain are characteristics that overwhelm the foot and ankle. For the runner, a simple change in the foot mechanics affects the postural tonic system and contributes to body instability. In this way, the goals of this study are to describe the stabilometric and training profile of recreational runners and to verify if the training time and volume are correlated with the stabilometric data related to the postural control. Methodology: The sample consisted of 50 recreational runners, selected for convenience between the ages of 18 and 65, both sexes, without injury in the last 3 months and history of lower limb surgeries. Results: The training profile showed a median of 2 years and 6 months of training time and a median of 20 km in the weekly training volume. Regarding the stabilometric profile, the area of oscillation with a median of 46.7 mm2 has the oscillation velocity with a mean of 8.1 mm/s and a standard deviation of 1.2. As for lateral oscillation with a median of ­ 1.6 mm, has the anteroposterior oscillation with a median ­ 1 mm. Conclusion: There was no correlation between the training profile and the stabilometric profile. According to data presented in the training profile, these are not associated to body stability.

Efeitos da pressão positiva contínua e de dois níveis na via aérea em edema agudo de pulmão cardiogênico: uma revisão sistemática / Effects of continuous positive pressure and of two levels on the airline in acute cardiogenic lung edema: a systematic review

INTRODUÇÃO: O edema agudo de pulmão cardiogênico (EAPC) representa uma importante causa de insuficiência respiratória aguda podendo ser atenuada com a instalação de ventilação mecânica não-invasiva (VNI). OBJETIVO: Comparar pressão positiva contínua (CPAP) e pressão positiva de dois níveis (BIPAP) na via aérea em pacientes adultos com EAPC, quanto à função pulmonar, ao tempo de permanência, suas complicações e a dispneia através de uma revisão sistemática. METODOLOGIA: Ensaios clínicos controlados e randomizados (ECR), revisados por dois revisores independentes, conforme recomendações PRISMA, nas bases de dados PubMed e Biblioteca Cochrane. Incluídos estudos originais que utilizaram a CPAP e a BIPAP em pacientes com EAPC publicados na língua inglesa. A Escala PEDro foi utilizada para analisar a qualidade metodológica dos estudos e a Cochrane Collaboration para análise de risco de viés. RESULTADOS: Foram incluídos 13 artigos, publicados entre os anos 1997 e 2014. Os níveis de CPAP variaram entre 5 e 20 cmH2O nos estudos, e BIPAP apresentou-se com pressão inspiratória positiva (IPAP) entre 8 e 20 cmH2O e pressão expiratória positiva (PEEP) entre 3 e 10 cmH2O. Os estudos apresentaram CPAP e BIPAP sem diferença estatisticamente significante para a melhora da função pulmonar (FR, PaO2 e PaCO2), tempo de internamento, taxas de mortalidade, entubação e infarto agudo do miocárdio (IAM); mostrando-se como modalidades igualmente eficazes. CONCLUSÃO: CPAP e a BIPAP garantem os mesmos efeitos para melhora da função pulmonar, não mantém relação com a permanência da internação e complicações, e melhoram o quadro de dispneia.

INTRODUCTION: Acute cardiogenic lung edema (EAPC) represents an important cause of acute respiratory failure and can be attenuated with the installation of non-invasive mechanical ventilation (NIV). OBJECTIVE: To compare the use of continuous positive pressure (CPAP) and two-way positive airway pressure (BIPAP) in adult patients with acute pulmonary edema of pulmonary function, length of stay and complications, and dyspnea through a systematic review METHODOLOGY: Systematic review of randomized controlled trials (RCTs) performed by two independent reviewers, as recommended by the PRISMA platform, in the PubMed and Cochrane Library databases. Original studies using CPAP and BIPAP were used in patients with acute cardiogenic lung edema published in English. The PEDro Scale was used to analyze the methodological quality of the studies and Cochrane Collaboration. RESULTS: We included 13 articles, published between 1997 and 2014. CPAP levels ranged from 5 to 20 cmH2O in the studies, and BIPAP presented positive inspiratory pressure (IPAP) between 8 and 20 cmH2O and positive expiratory pressure (EPAP) between 3 and 10 cmH2O. The studies presented CPAP and BIPAP without statistically significant difference for the improvement of the pulmonary function (FR, PaO2 and PaCO2), permanence of hospitalization, mortality rates, intubation and acute myocardial infarction (AMI); as equally effective modalities. CONCLUSION: CPAP and BIPAP guarantee the same effects to improve pulmonary function, does not maintain relation with the permanence of hospitalization and complications, namely: mortality, intubation and AMI, and improve dyspnea.

Efeitos da posição prona em pacientes com síndrome do desconforto respiratório agudo: uma revisão sistemática / Effects of prone position on patients with acute respiratory distress syndrome: a systematic review

INTRODUÇÃO: A síndrome do desconforto respiratório agudo (SDRA) é caracterizada por resposta inflamatória da membrana alvéolo capilar a injúrias pulmonares diretas ou indiretas, cursando com redução de complacência e presença de infiltrados pulmonares. Tal condição provoca alterações na mecânica pulmonar e nas trocas gasosas, gerando hipoxemia. OBJETIVO: Revisar sistematicamente ensaios clínicos randomizados que investigaram os efeitos da posição prona e suas repercussões na oxigenação, mecânica respiratória, mortalidade e ocorrência de eventos adversos em pacientes com SDRA. MATERIAIS E MÉTODOS: Revisão sistemática da literatura, seguindo as recomendações PRISMA. As buscas foram realizadas nas bibliotecas de dados PubMed, BVS, PEDro e SciELO, por dois revisores independentes. Incluído estudos ensaio clínico randomizado que apresentavam intervenção a terapia de posicionamento em prono, que compararam a ventilação na posição prona com a supina. Os desfechos analisados foram oxigenação, mecânica respiratória, mortalidade e ocorrência de eventos adversos, através de análise descritiva. A qualidade metodológica dos estudos foi avaliada pela escala PEDro. Foram incluídos os ensaios clínicos randomizados RESULTADOS: Foram analisados 8 artigos, com média 6 na escala PEDro. Os estudos demonstraram resultados positivos na oxigenação, pouca influência na mecânica respiratória, melhora nas taxas de mortalidade e alta prevalência de efeitos adversos, minimizados com a capacitação da equipe. Destaco a variedade metodológica e dos desfechos como limitação da pesquisa. CONCLUSÃO: A posição prona é capaz de promover efeitos benéficos na oxigenação, complacência, mortalidade e queda de eventos adversos em indivíduos com SDRA. Entretanto, destaca-se a necessidade de realização de novos ensaios clínicos sobre o tema, que ofereçam amostras satisfatórias e metodologias semelhantes.

INTRODUCTION: The acute respiratory distress syndrome (ARDS) is characterized by an inflammatory response of the alveolar-capillary membrane to direct or indirect pulmonary injuries with a reduction in to complacency and the presence of pulmonary infiltrates. Such condition causes changes in lung mechanics and gas exchange, causing hypoxemia. OBJECTIVE: To systematically review randomized clinical trials investigating the effects of the disease and its repercussions on oxygenation, respiratory mechanics, mortality and occurrence of adverse events in patients with ARDS. MATERIALS AND METHODS: Systematic review of the literature, following PRISMA recommendations. The searches were performed in the PubMed, BVS, PEDro and SciELO data libraries by two independent reviewers. Included studies randomized clinical trial that presented intervention to positioning therapy in prone, comparing ventilation in prone position with supine. The methodological quality of the studies was evaluated by the PEDro scale. The outcomes analyzed were oxygenation, respiratory mechanics, mortality and occurrence of adverse events, through descriptive analysis. RESULTS: Eight articles were analyzed, with an average of 6 on the PEDro scale. Studies have shown positive oxygenation results, low respiratory mechanics influence of respiratory mechanics, improved in mortality rates and high of adverse effects minimized with team training. I highlight the methodological variety and outcomes as a limitation of the research. CONCLUSION: The prone position is capable of promoting beneficial effects in oxygenation, compliance, mortality and reduction of adverse events in individuals with ARDS. However, it is noteworthy the need to perform new clinical trials on the subject, which offer satisfactory samples and similar methodologies.

Effects of upper limb resistance exercise on aerobic capacity, muscle strength, and quality of life in COPD patients: a randomized controlled trial.

OBJECTIVE:: To evaluate the effects of upper limb resistance exercise on the functional capacity, muscle function, and quality of life in patients with chronic obstructive pulmonary disease. SETTING:: Clinical School of Physiotherapy in a Public University of Brazil. SUBJECTS:: 58 patients were recruited; of these, 7 were excluded and 51 individuals were enrolled. INTERVENTION:: Control group performed warm-up, aerobic exercise, inspiratory muscle training, and session stretching, followed by massage therapy. The treatment group performed warm-up, aerobic exercise, inspiratory muscle training, three sets of upper limb resistance exercise, and session stretching, followed by massage therapy. Total three sessions per week for eight weeks. PRIMARY OUTCOME MEASURES:: 6-minute walk test, respiratory and peripheral muscle strength, dyspnea, and quality of life. Normality of the data was tested using the Shapiro-Wilk test; paired analysis of variance was used for intergroup analyses. RESULTS:: 51 patients (25 in the control group and 26 in the treatment group); 41% of the subjects were men. Mean forced expiratory volume was 2.6 ± 0.6 L, and mean body mass index was 27.3 ± 7.0 kg/m2. The upper limb resistance exercise resulted in significantly greater benefit in terms of exercise capacity (88.5 ± 81.9 m, P = 0.043), inspiratory muscle strength (22.9 ± 24.2 cm H2O, P = 0.001), upper limb muscle strength (2.3 ± 3.1 kg, P = 0.027), and quality of life scores (-15.3 ± 10.9 points, P = 0.000). CONCLUSION:: Upper limb resistance exercise improved the exercise capacity, respiratory muscle strength, and quality of life.

Impact of Pulmonary Rehabilitation on Exercise Tolerance and Quality of Life in Patients With Idiopathic Pulmonary Fibrosis: A SYSTEMATIC REVIEW AND META-ANALYSIS.

BACKGROUND: Patients with pulmonary fibrosis are living longer and present with an increasing number of comorbidities over time. Pulmonary rehabilitation, as a nonpharmacological approach, may be promising in these patients, although there is limited information on the impact of pulmonary rehabilitation on exercise tolerance and quality of life. Thus, conducting a systematic review and meta-analysis, the purpose of this study was to determine the effects of pulmonary rehabilitation on exercise tolerance and quality of life in patients with idiopathic pulmonary fibrosis. METHODS: We searched MEDLINE, Cochrane Library, Embase, Scielo, PEDro, and CINAHL (from the earliest date available to June 2016) for trials. Study selection included randomized controlled trials (RCTs) that examined the effects of pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis. Two reviewers selected studies independently. Data were extracted from published RCTs. Study quality was evaluated using the PEDro scale. Weighted mean differences, standard mean differences, and 95% CIs were calculated. RESULTS: We analyzed data from 5 RCTs comparing a pulmonary rehabilitation group with a control group. Pulmonary rehabilitation improved exercise tolerance weighted mean differences (44 m; 95% CI, 5.3-82.8) compared with no exercise. The meta-analyses also showed significant improvement in symptoms, impact, and total score from the St George's Respiratory Questionnaire for participants in pulmonary rehabilitation compared with control. No serious adverse events were reported. CONCLUSION: Pulmonary rehabilitation is effective in increasing exercise tolerance and improving quality of life in patients with idiopathic pulmonary fibrosis.

Stabilization exercise compared to general exercises or manual therapy for the management of low back pain: A systematic review and meta-analysis.

AIM: We performed a systematic review with a meta-analysis to examine the efficacy of stabilization exercises versus general exercises or manual therapy in patients with low back pain. DESIGN: We searched MEDLINE, Cochrane Controlled Trials, Scielo, and CINAHL (from the earliest date available to November 2014) for randomized controlled trials that examined the efficacy of stabilization exercises compared to general exercises or manual therapy on pain, disability, and function in patients with low back pain. Weighted mean differences (WMD) and 95% confidence intervals were calculated. RESULTS: Eleven studies met the inclusion criteria (413 stabilization exercises patients, 297 general exercises patients, and 185 manual therapy patients). Stabilization exercises may provide greater benefit than general exercise for pain reduction and improvement in disability. Stabilization exercise improved pain with a WMD of -1.03 (95% CI: -1.29 to -0.27) and improved disability with a WMD of -5.41 (95% CI: -8.34 to -2.49). There were no significant differences in pain and disability scores among participants in the stabilization exercise group compared to those in the manual therapy group. CONCLUSIONS: Stabilization exercises were as efficacious as manual therapy in decreasing pain and disability and should be encouraged as part of musculoskeletal rehabilitation for low back pain.

Effects of the FIFA 11 training program on injury prevention and performance in football players: a systematic review and meta-analysis.

OBJECTIVE: To investigate the effects of FIFA 11 training on injury prevention and performance in football players. DESIGN AND METHODS: Systematic review and meta-analysis. We conducted a systematic search using four databases (CINAHL, Cochrane Library, EMBASE, and PubMed) to find controlled trials evaluating the effects of FIFA 11 on injury prevention and performance among football players. Weighted mean differences, standard mean differences, risk ratios, and 95% confidence intervals were calculated, and heterogeneity was assessed using the I2 test. RESULTS: We analyzed 11 trials, including 4700 participants. FIFA 11 resulted in a significant reduction in injury risk (risk ratio = 0.69; 95% confidence interval, 0.49-0.98; P = 0.02) and improvements in dynamic balance (weighted mean difference = 2.68; 95% confidence interval, 0.44-4.92; P = 0.02) and agility (standard mean difference = -0.36; 95% confidence interval, 0.70-0.02; P = 0.04). The meta-analysis indicated a non-significant improvement in jump height (standard mean difference = 0.25; 95% confidence interval, 0.08-0.59; P = 0.14) and running sprint (standard mean difference = -0.24; 95% confidence interval, 0.58-0.10; P = 0.17) in the FIFA 11 group. CONCLUSIONS: FIFA 11 can be considered as a tool to reduce the risk of injury. It may improve dynamic balance and agility and can be considered for inclusion in the training of football players.

Analysis of the psychometric properties of the American Orthopaedic Foot and Ankle Society Score (AOFAS) in rheumatoid arthritis patients: application of the Rasch model.

OBJECTIVE: To tested the reliability and validity of Aofas in a sample of rheumatoid arthritis patients. METHODS: The scale was applicable to rheumatoid arthritis patients, twice by the interviewer 1 and once by the interviewer 2. The Aofas was subjected to test-retest reliability analysis (with 20 Rheumatoid arthritis subjects). The psychometric properties were investigated using Rasch analysis on 33 Rheumatoid arthritis patients. RESULTS: Intra-Class Correlation Coefficient (ICC) were (0.90

Effects of Respiratory Muscle Training on Respiratory Function, Respiratory Muscle Strength, and Exercise Tolerance in Patients Poststroke: A Systematic Review With Meta-Analysis.

OBJECTIVE: To examine the effects of respiratory muscle training on respiratory function, respiratory muscle strength, and exercise tolerance in patients poststroke. DATA SOURCES: We searched MEDLINE, Cochrane Library, Embase, SciELO, Physiotherapy Evidence Database (PEDro), and CINAHL (from the earliest date available to November 2015) for trials. STUDY SELECTION: Randomized controlled trials (RCTs) that examined the effects of respiratory muscle training versus nonrespiratory muscle training in patients poststroke. Two reviewers selected studies independently. DATA EXTRACTION: Extracted data from the published RCTs. Study quality was evaluated using the PEDro Scale. Weighted mean differences (WMDs), standard mean differences (SMDs), and 95% confidence intervals (CIs) were calculated. DATA SYNTHESIS: Eight studies met the study criteria. Respiratory muscle training improved maximal inspiratory pressure WMDs (7.5; 95% CI, 2.7-12.4), forced vital capacity SMDs (2.0; 95% CI, 0.6-3.4), forced expiratory volume at 1 second SMDs (1.2; 95% CI, 0.6-1.9), and exercise tolerance SMDs (0.7; 95% CI, 0.2-1.2). No serious adverse events were reported. CONCLUSIONS: Respiratory muscle training should be considered an effective method of improving respiratory function, inspiratory muscle strength, and exercise tolerance in patients poststroke. Further research is needed to determine optimum dosages and duration of effect.

Combined Exercise and Inspiratory Muscle Training in Patients With Heart Failure: A SYSTEMATIC REVIEW AND META-ANALYSIS.

PURPOSE: Studies have reported the benefits of exercise and inspiratory muscle training (IMT) in patients with heart failure (HF); however, there is no meta-analysis on the effects of the combination of exercise and IMT in patients with HF. The objective of this study was to determine whether combined exercise/IMT was more effective than conventional exercise on exercise capacity, respiratory muscle strength, and quality of life in patients with HF. METHODS: This is a systematic review and meta-analysis. We searched MEDLINE, LILACS, CINAHL, EMBASE, PEDro, and the Cochrane Central Register of Controlled Trials (from the earliest date available to April 2015) for randomized controlled trials, examining effects of combined exercise/IMT versus conventional exercise on exercise capacity, respiratory muscle strength, and quality of life measurements in patients with HF. Two reviewers selected studies independently. Weighted mean differences and 95% CIs were calculated. RESULTS: Three studies met the study criteria. Combined exercise/IMT resulted in improvement in maximal inspiratory pressure weighted mean differences (20.89 cm H2O; 95% CI, 14.0-27.78) and Minnesota Living with Heart Failure Questionnaire weighted mean differences (4.43; 95% CI, 0.72-8.14). Nonsignificant difference was observed in peak (Equation is included in full-text article.)O2 for participants in the combined exercise/IMT group compared with the conventional exercise group. No serious adverse events were reported. CONCLUSIONS: Combined exercise/IMT may improve maximal inspiratory pressure and quality of life in patients with HF and should be considered for inclusion in cardiac rehabilitation programs.

Análise das propriedades psicométricas do American Orthopaedic Foot and Ankle Society Score (Aofas) em pacientes com artrite reumatoide: aplicação do modelo Rasch / Analysis of the psychometric properties of the American Orthopaedic Foot and Ankle Society Score (AOFAS) in rheumatoid arthritis patients: application of the Rasch model

Resumo Objetivo: Testar a confiabilidade e a validade do escore Aofas em uma amostra de pacientes com artrite reumatoide. Métodos: A escala foi aplicada a pacientes com artrite reumatoide, duas vezes pelo entrevistador 1 e uma vez pelo entrevistador 2. O Aofas foi submetido a exame de confiabilidade teste-reteste (com 20 indivíduos com artrite reumatoide). As propriedades psicométricas foram investigadas pela análise Rasch em 33 pacientes com artrite reumatoide. Resultados: O coeficiente de correlação intraclasse (CCI) foi de 0,90 < CCI < 0,95 (p < 0,001) para a confiabilidade intraexaminador e 0,75 < CCI < 0,91 (p < 0,001) para a confiabilidade interexaminador. O índice de separação dos indivíduos foi de 1,9 e 4,75 para os itens. Isso demonstra que os pacientes se dividiam em três níveis de habilidade e os itens foram divididos em seis níveis de dificuldades. A análise Rasch mostrou que oito itens foram satisfatórios. Foi identificado um item errôneo, que mostrou percentuais acima dos 5% permitidos pelo modelo estatístico. Além disso, o modelo Rasch sugeriu a revisão do item 8 original. Conclusões: Os resultados sugerem que a versão brasileira do Aofas apresenta confiabilidade adequada, validade de constructo e estabilidade de resposta. Esses resultados indicam que a escala de tornozelo-retropé Aofas apresenta um potencial significativo de aplicabilidade clínica em indivíduos com artrite reumatoide. Outros estudos em populações com outras características já estão em andamento.

Abstract Objective: To tested the reliability and validity of Aofas in a sample of rheumatoid arthritis patients. Methods: The scale was applicable to rheumatoid arthritis patients, twice by the interviewer 1 and once by the interviewer 2. The Aofas was subjected to test-retest reliability analysis (with 20 Rheumatoid arthritis subjects). The psychometric properties were investigated using Rasch analysis on 33 Rheumatoid arthritis patients. Results: Intra-Class Correlation Coefficient (ICC) were (0.90 < ICC < 0.95; p < 0.001) for intra-observer reliability and (0.75 < ICC < 0.91; p < 0.001) for inter-observer reliability. Subjects separation rates were 1.9 and 4.75 for the items, showing that patients fell into three ability levels, and the items were divided into six difficulties levels. The Rasch analysis showed that eight items was satisfactory. One erroneous item have been identified, showing percentages above the 5% allowed by the statistical model. Further Rasch modeling suggested revising the original item 8. Conclusions: The results suggest that the Brazilian versions of Aofas exhibit adequate reliability, construct validity, response stability. These findings indicate that Aofas Ankle-Hindfoot scale presents a significant potential for clinical applicability in individuals with rheumatoid arthritis. Other studies in populations with other characteristics are now underway.

Aerobic capacity and health-related quality of life in adults HIV-infected patients with and without lipodystrophy

Abstract Introduction HIV infection and its therapy which can affect their aerobic capacity and health-related quality of life of patients. Objective We conducted a cross-sectional study to determine if aerobic capacity and health related quality of life was decreased in HIV-infected patients receiving highly active antiretroviral therapy and comparing patients with and without lipodystrophy. Research design and methods HIV-infected patients older than 18 years, and in current use of highly active antiretroviral therapy drugs, were evaluated for blood count, fasting total cholesterol, high density lipoprotein, triglycerides, glucose, HIV viral load and CD4/CD8 counts, body composition, peak oxygen consumption (peak VO2) and metabolic equivalent. Health related quality of life was assessed by using Short Form-36 (SF-36). Statistical analysis was carried out using SPSS version 20.0. Results A total of 63 patients with mean age of 43.1 ± 6.4 years were evaluated, of these 34 (54%) had lipodystrophy. The average peak VO2 (31.4 ± 7.6 mL kg−1 min−1) was significantly lower (p < 0.01) than expected values (37.9 ± 5.6 mL kg−1 min−1) according to the characteristics of the patients. The lipodystrophy group presented with a significant difference in muscle mass, body fat, peak VO2 and metabolic equivalent and in functional capacity domains of SF-36. Conclusion Aerobic capacity values were reduced in HIV-infected patients under highly active antiretroviral therapy when compared to predicted values. Lipodystrophy was associated with reduced aerobic capacity and higher frequency of metabolic syndrome. Lifestyle modification should be a priority in the management of chronic HIV disease.

Impact of Exercise Training in Aerobic Capacity and Pulmonary Function in Children and Adolescents After Congenital Heart Disease Surgery: A Systematic Review with Meta-analysis.

The aim of the study was to examine the effects of exercise training on aerobic capacity and pulmonary function in children and adolescents after congenital heart disease surgery. We searched MEDLINE, Cochrane Controlled Trials Register, EMBASE, (from the earliest date available to January 2015) for controlled trials that evaluated the effects of exercise training on aerobic capacity and pulmonary function (forced expiratory volume in 1 s and forced vital capacity) in children and adolescents after congenital heart disease surgery. Weighted mean differences and 95 % confidence intervals (CIs) were calculated,, and heterogeneity was assessed using the I (2) test. Eight trials (n = 292) met the study criteria. The results suggested that exercise training compared with control had a positive impact on peak VO2. Exercise training resulted in improvement in peak VO2 weighted mean difference (3.68 mL kg(-1) min(-1), 95 % CI 1.58-5.78). The improvement in forced expiratory volume in 1 s and forced vital capacity after exercise training was not significant. Exercise training may improve peak VO2 in children and adolescents after congenital heart disease surgery and should be considered for inclusion in cardiac rehabilitation. Further larger randomized controlled trials are urgently needed to investigate different types of exercise and its effects on the quality of life.

Aerobic capacity and health-related quality of life in adults HIV-infected patients with and without lipodystrophy.

INTRODUCTION: HIV infection and its therapy which can affect their aerobic capacity and health-related quality of life of patients. OBJECTIVE: We conducted a cross-sectional study to determine if aerobic capacity and health related quality of life was decreased in HIV-infected patients receiving highly active antiretroviral therapy and comparing patients with and without lipodystrophy. RESEARCH DESIGN AND METHODS: HIV-infected patients older than 18 years, and in current use of highly active antiretroviral therapy drugs, were evaluated for blood count, fasting total cholesterol, high density lipoprotein, triglycerides, glucose, HIV viral load and CD4/CD8 counts, body composition, peak oxygen consumption (peak VO2) and metabolic equivalent. Health related quality of life was assessed by using Short Form-36 (SF-36). Statistical analysis was carried out using SPSS version 20.0. RESULTS: A total of 63 patients with mean age of 43.1±6.4 years were evaluated, of these 34 (54%) had lipodystrophy. The average peak VO2 (31.4±7.6mLkg(-1)min(-1)) was significantly lower (p<0.01) than expected values (37.9±5.6mLkg(-1)min(-1)) according to the characteristics of the patients. The lipodystrophy group presented with a significant difference in muscle mass, body fat, peak VO2 and metabolic equivalent and in functional capacity domains of SF-36. CONCLUSION: Aerobic capacity values were reduced in HIV-infected patients under highly active antiretroviral therapy when compared to predicted values. Lipodystrophy was associated with reduced aerobic capacity and higher frequency of metabolic syndrome. Lifestyle modification should be a priority in the management of chronic HIV disease.

Effects of Combined Aerobic and Resistance Exercise on Exercise Capacity, Muscle Strength and Quality of Life in HIV-Infected Patients: A Systematic Review and Meta-Analysis.

BACKGROUND: Many HIV-infected patients demonstrate disability and lower aerobic capacity. The inclusion of resistance training combined with aerobic exercise in a single program is known as combined aerobic and resistance exercise (CARE) and seems to be an effective strategy to improve muscle weakness, as well as aerobic capacity in HIV-infected patients. We performed a meta-analysis to investigate the effects of CARE in HIV-infected patients. METHODS: We searched MEDLINE, Cochrane Controlled Trials Register, EMBASE, CINAHL (from the earliest date available to august 2014) for controlled trials that evaluated the effects of CARE in HIV-infected patients. Weighted mean differences (WMD) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I2 test. RESULTS: Seven studies met the study criteria. CARE resulted in improvement in Peak VO2 WMD (4.48 mL·kg-1·min-1 95% CI: 2.95 to 6.0), muscle strength of the knee extensors WMD (25.06 Kg 95% CI: 10.46 to 39.66) and elbow flexors WMD (4.44 Kg 95% CI: 1.22 to 7.67) compared with no exercise group. The meta-analyses also showed significant improvement in Health status, Energy/Vitality and physical function domains of quality of life for participants in the CARE group compared with no exercise group. A nonsignificant improvement in social function domain of quality of life was found for participants in the CARE group compared with no exercise group. CONCLUSIONS: Combined aerobic and resistance exercise may improve peak VO2, muscle strength and health status, energy and physical function domains of quality of life and should be considered as a component of care of HIV-infected individuals.