Remotely delivered physiotherapy is as effective as face-to-face physiotherapy for musculoskeletal conditions (REFORM): a randomised trial.

QUESTION: Is remotely delivered physiotherapy as good or better than face-to-face physiotherapy for the management of musculoskeletal conditions? DESIGN: Randomised controlled, non-inferiority trial with concealed allocation, blinded assessors and intention-to-treat analysis. PARTICIPANTS: A total of 210 adult participants with a musculoskeletal condition who presented for outpatient physiotherapy at five public hospitals in Sydney. INTERVENTION: One group received a remotely delivered physiotherapy program for 6 weeks that consisted of one face-to-face physiotherapy session in conjunction with weekly text messages, phone calls at 2 and 4 weeks, and an individualised home exercise program delivered through an app. The other group received usual face-to-face physiotherapy care in an outpatient setting. OUTCOME MEASURES: The primary outcome was the Patient Specific Functional Scale at 6 weeks with a pre-specified non-inferiority margin of -15 out of 100 points. Secondary outcomes included: the Patient Specific Functional Scale at 26 weeks; kinesiophobia, pain, function/disability, global impression of change and quality of life at 6 and 26 weeks; and satisfaction with service delivery at 6 weeks. RESULTS: The mean between-group difference (95% CI) for the Patient Specific Functional Scale at 6 weeks was 2.7 out of 100 points (-3.5 to 8.8), where a positive score favoured remotely delivered physiotherapy. The lower end of the 95% CI was greater than the non-inferiority margin. Whilst non-inferiority margins were not set for the secondary outcomes, the 95% CI of the mean between-group difference ruled out clinically meaningful differences. CONCLUSION: Remotely delivered physiotherapy with support via phone, text and an app is as good as face-to-face physiotherapy for the management of musculoskeletal conditions. TRIAL REGISTRATION: ACTRN12619000065190.

Effectiveness of interventions for school-aged-children and adolescents with fetal alcohol spectrum disorder: a systematic review and meta-analysis.

PURPOSE: To describe allied health and educational interventions and their effectiveness for children and adolescents with fetal alcohol spectrum disorder (FASD). To appraise the quality and strength of studies. METHODS: Electronic databases were searched between 2005 and March 2022, identifying non-pharmacological studies supporting function, activity, or participation for FASD participants aged 5-18 years using any quantitative research design. Outcomes were coded using International Classification of Functioning, Disability and Health, family of Participation Related Constructs and behaviour categories. Multi-level random-effects meta-analysis examined intervention effects. Study methodological quality was evaluated using Cochrane risk of bias tools, RoBiNT, AMSTAR 2 and NHMRC Hierarchy levels of evidence. Certainty of findings were synthesised using GRADE approach. RESULTS: The systematic review included 25 studies with 735 participants, 10 of which were analysed by meta-analysis. Body function and structure, activity, behaviour, and sense of self outcomes were pooled. A small, positive effect favouring interventions was found (g = 0.29, 95% CI = 0.15-0.43), however the GRADE certainty was rated as low. No participation outcomes were identified. CONCLUSIONS: Some interventions targeting body function and structure, activity and behaviour outcomes were effective. Evidence of interventions that support children's and adolescent's participation as an outcome is lacking.Implications for rehabilitationTo address participation outcomes for children and adolescents with fetal alcohol spectrum disorder (FASD), it is important to understand their participation needs and directly measure these.Interventions identified targeted body function and structure, activity, and behaviour outcomes.Participation outcomes of children's/adolescent's attendance, involvement and preferences were not identified.A combination of individual- and context-focused interventions is recommended to maximise rehabilitation outcomes for children and adolescents with FASD.

Análise de lacunas e perspectivas sobre programas de doação de corpos: relato de experiência no Brasil / Gap analysis and perspectives on body donation programs: experience report in Brazil

Resumo: Introdução: As recomendações internacionais reforçam o estímulo à prática da doação voluntária para a disponibilidade de corpos destinados à formação de profissionais de saúde, substituindo o sistema de corpos não reclamados nas instituições de ensino superior (IES). Relato de experiência: Este trabalho reuniu informações sobre programas de doação de corpos (PDC) brasileiros, analisou lacunas e fatores impeditivos à doação do corpo, e propôs estratégias para ampliar as informações sobre o cadastro de participantes em PDC e a efetivação da doação. Discussão: No Brasil existem 39 PDC em funcionamento - seis no Nordeste, quatro no Centro-Oeste, um no Norte, 11 no Sul e 17 no Sudeste - e duas comissões de distribuição de corpos para ensino. O cadastro como participante no PDC pode agilizar as providências documentais, mas não garante a doação na ocasião da morte. No geral, as IES recebem o corpo doado e a documentação necessária. Quando o óbito acontece no município da IES, é possível ter o translado do corpo providenciado por parcerias com funerárias e prefeitura. Conclusão: Embora a legislação tenha regulamentado desde 2002 a doação do próprio corpo em vida, é necessária a implementação de campanhas de esclarecimento à população geral sobre essa possibilidade, além de mecanismos que possam promover a celeridade nos prazos de para obtenção das documentações com a finalidade de doação de corpo para fins científicos, a isenção das taxas cartoriais e a viabilização do translado do corpo doado por carro de funerária das prefeituras, sem custo. O apoio da IES por meio do cadastro do PDC como atividade de extensão universitária colabora para assegurar aspectos éticos relacionados à participação dos doadores no programa em vida, no que se refere ao tratamento com respeito e dignidade dos doadores e de suas famílias.

Abstract: Introduction: International recommendations reinforce the practice of voluntary donation for providing bodies for the training of health professionals, replacing the system of unclaimed bodies in medical courses (MC). Experience report: This work gathered information on Brazilian body donation programs (BDP), analyzed gaps and difficulties to the effectiveness of body donation, and proposed strategies to expand the information offered on the registration of participants in BDP and the effectiveness of the donation. Discussion: In Brazil, there are 39 BDP - six in the Northeast, four in the Midwest, one in the North, 11 in the South, and 17 in the Southeast - and two committees for body donation. Documents may be easily available through registration during life as a participant in the BDP, but it does not guarantee donation. In general, Brazilian's institutions receive the donated body along with the documentation. When the death occurs in the same city of the institution, it is possible to have the transfer of the body provided by partnerships with funeral services and the city hall. There is no fee to be paid or received either for registration during life or for donation after death. Conclusion: Although the legislation has regulated the donation of body in life since 2002, it is necessary to implement campaigns to inform about the donation, in addition to mechanisms that can promote speed in the deadlines for obtaining documentation for the purpose of donating body for scientific purposes, the exemption of notary fees and the possibility of transporting the body donated with no fees by funeral home of municipal governments. The MC support through the registration of the PDC as an extension activity collaborates to ensure ethical aspects related to the participation of donors in the living program, with regard to the treatment with respect and dignity of donors and their families.

Protocol for a process evaluation: face-to-face physiotherapy compared with a supported home exercise programme for the management of musculoskeletal conditions: the REFORM trial.

INTRODUCTION: The REFORM (REhabilitation FOR Musculoskeletal conditions) trial is a non-inferiority randomised controlled trial (n=210) designed to determine whether a supported home exercise programme is as good or better than a course of face-to-face physiotherapy for the management of some musculoskeletal conditions. The trial is currently being conducted across Sydney government hospitals in Australia. This process evaluation will run alongside the REFORM trial. It combines qualitative and quantitative data to help explain the trial results and determine the feasibility of rolling out supported home exercise programmes in settings similar to the REFORM trial. METHODS AND ANALYSIS: Two theoretical frameworks underpin our process evaluation methodology: the Realist framework (context, mechanism, outcomes) considers the causal assumptions as to why a supported home exercise programme may be as good or better than face-to-face physiotherapy in terms of the context, mechanisms and outcomes of the trial. The RE-AIM framework describes the Reach, Effectiveness, Adoption, Implementation and Maintenance of the intervention. These two frameworks will be broadly used to guide this process evaluation using a mixed-methods approach. For example, qualitative data will be derived from interviews with patients, healthcare professionals and stakeholders, and quantitative data will be collected to determine the cost and feasibility of providing supported home exercise programmes. These data will be analysed iteratively before the analysis of the trial results and will be triangulated with the results of the primary and secondary outcomes. ETHICS AND DISSEMINATION: This trial will be conducted in accordance with the National Health and Medical Research Council National Statement on Ethical Conduct in Human Research (2018) and the Note for Good Clinical Practice (CPMP/ICH-135/95). Ethical approval was obtained on 17 March 2017 from the Northern Sydney Local Health District Human Research Ethics Committee (trial number: HREC/16HAWKE/431-RESP/16/287) with an amendment for the process evaluation approved on 4 February 2020. The results of the process evaluation will be disseminated through publications in peer-reviewed journals and presentations at scientific conferences. TRIAL REGISTRATION NUMBER: ACTRN12619000065190.

How Information on Superfoods Changes Consumers' Attitudes: An Explorative Survey Study.

Increasing interest in healthy habits has created the market for what is commonly called "superfoods." The goal of this study was to explore Swiss consumers' initial and final attitudes toward superfoods as well as their change in attitude toward those foods after being provided selected information. A questionnaire survey was conducted to explore the individual traits of the respondents. The attitudes were assessed at the beginning and end of the survey. Four multiple regression analyses were performed. The results showed that consumers perceiving superfoods' health benefits and expressing an interest in organic foods were associated with initial and positive attitudes. These predictors remained significantly related to the positive attitude at the end of the survey. Sociodemographic predictors (age and place of residence) were significant factors, with older people and individuals who lived in urban centers showing a higher propensity to improve their attitudes toward superfoods. Individuals with lower perceptions about the benefits of superfoods being healthy and lower levels of cultural participation showed a negative attitude change. Given that this study aims to shed light on the variables that influence the behavior of Swiss consumers toward the superfoods trend, it fills a significant gap in the literature.

Defining Growing Pains: A Scoping Review.

BACKGROUND AND OBJECTIVES: Up to one third of children may be diagnosed with growing pains, but considerable uncertainty surrounds how to make this diagnosis. The objective of this study was to detail the definitions of growing pains in the medical literature. METHODS: Scoping review with 8 electronic databases and 6 diagnostic classification systems searched from their inception to January 2021. The study selection included peer-reviewed articles or theses referring to "growing pain(s)" or "growth pain(s)" in relation to children or adolescents. Data extraction was performed independently by 2 reviewers. RESULTS: We included 145 studies and 2 diagnostic systems (ICD-10 and SNOMED). Definition characteristics were grouped into 8 categories: pain location, age of onset, pain pattern, pain trajectory, pain types and risk factors, relationship to activity, severity and functional impact, and physical examination and investigations. There was extremely poor consensus between studies as to the basis for a diagnosis of growing pains. The most consistent component was lower limb pain, which was mentioned in 50% of sources. Pain in the evening or night (48%), episodic or recurrent course (42%), normal physical assessment (35%), and bilateral pain (31%) were the only other components to be mentioned in more than 30% of articles. Notably, more than 80% of studies made no reference to age of onset in their definition, and 93% did not refer to growth. Limitations of this study are that the included studies were not specifically designed to define growing pains. CONCLUSIONS: There is no clarity in the medical research literature regarding what defines growing pain. Clinicians should be wary of relying on the diagnosis to direct treatment decisions.

Face-to-face physiotherapy compared with a supported home exercise programme for the management of musculoskeletal conditions: protocol of a multicentre, randomised controlled trial-the REFORM trial.

INTRODUCTION: Exercise, support and advice are considered core components of management for most musculoskeletal conditions and are typically provided by physiotherapists through regular face-to-face treatments. However, exercise can be provided remotely as part of a home exercise programme, while support and advice can be provided over the telephone. There is initial evidence from trials and systematic reviews to suggest that remotely provided physiotherapy can be used to manage a variety of musculoskeletal conditions safely and effectively. METHODS AND ANALYSIS: The aim of this single-blind randomised controlled non-inferiority trial is to determine whether a supported home exercise programme is as good as or better than face-to-face physiotherapy for the treatment of musculoskeletal conditions. Two hundred and ten participants will be recruited from five public hospitals in Sydney, Australia. Participants will be randomised to either the supported home exercise group or the face-to-face physiotherapy group. Participants allocated to the supported home exercise group will initially receive one face-to-face session with the trial physiotherapist and will then be managed remotely for the next 6 weeks. Participants allocated to the face-to-face physiotherapy group will receive a course of physiotherapy as typically provided in Sydney government hospitals. The primary outcome is function measured by the Patient Specific Functional Scale at 6 weeks. There will be nine secondary outcomes measured at 6 and 26 weeks. Separate analyses will be conducted on each outcome, and all analyses will be conducted on an intention-to-treat basis. A health economic evaluation will be conducted from a health funder plus patient perspective. ETHICS AND DISSEMINATION: Ethical approval was obtained on the 17 March 2017 from the Northern Sydney Local Health District HREC, trial number HREC/16HAWKE/431-RESP/16/287. The results of this study will be submitted for publication to peer-reviewed journals and be presented at national and international conferences. Recruitment commenced in March 2019, and it is anticipated that the trial will be completed by December 2021. This trial will investigate two different models of physiotherapy care for people with musculoskeletal conditions. TRIAL REGISTRATION NUMBER: CPMP/ICH-135/95. PROTOCOL VERSION: The most recent version of the protocol is V.1.2 dated November 2019.

Examining patient activation and other factors associated with changes in pain and function following best evidence osteoarthritis care.

Objectives: The primary objective was to examine baseline patient activation as a prognostic factor for changes in pain and function following participation in an osteoarthritis management program. The secondary objective was to examine other prognostic factors from existing literature (e.g. employment, functional performance, depression, comorbidities). Method: One-hundred-and-eleven participants with knee osteoarthritis were assessed at 0-, 12- and 26-weeks in this prospective clinical cohort. Demographic variables, timed-up-and-go (TUG), patient activation measure (PAM-13), Depression Anxiety Stress Scale and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were collected. Multivariable linear regression examined relationships between prognostic factors and pain and function at 12- and 26-weeks. Results: Complete 12- and 26-week data were available for 89 and 74 participants respectively, 66 â€‹% female, 66.8 (SD 10.0) years, 74 â€‹% unemployed, 66 â€‹% finished high school or higher, 12 â€‹% on joint arthroplasty waitlists. Baseline PAM-13 scores were not associated with changes in pain or function at 12- or 26-weeks. Employment status (ߠ​= â€‹9.17 (95 â€‹% CI 2.11, 16.24), p â€‹= â€‹0.01) and TUG (ߠ​= â€‹-1.20 (95 â€‹% CI -1.91, -0.49), p â€‹< â€‹0.01) were associated with changes in pain at week-12. Employment status (ߠ​= â€‹11.60 (95 â€‹% CI 5.31, 17.90), p â€‹< â€‹0.01) and TUG (ߠ​= â€‹-1.10 (95%CI -1.78, -0.43), p â€‹< â€‹0.01) were associated with 12-week function. Baseline TUG (ߠ​= â€‹-1.32 (95 â€‹% CI -2.40, -0.23), p â€‹= â€‹0.02) was associated with week-26 WOMAC function. Conclusions: Baseline PAM-13 scores were not associated with changes in pain and function at any timepoint. Employment status and TUG were associated with changes in pain and function at 12-weeks, TUG was associated with 26-week function.

Salivary alpha-amylase and hormones levels of young adults with different body composition.

The aim of this study was to assess the differences in salivary biomarker levels of young adults classified according to body fat accumulation. One hundred and thirty-four volunteers were evaluated (mean age 21 ± 2 years). Body composition was calculated through skinfold thickness: supra-iliac, biceps, and triceps, sub-scapular. Body fat percentage (BF%) was used to classify subjects according to fat tissue accumulation: normal-weight (n = 37, 19 females, 18 males), overweight (n = 42, 30 females, 12 males), and obese (n = 55, 42 females, 13 males). Saliva samples were collected 30 min after awakening to determine salivary levels of 17-beta-estradiol. For salivary cortisol and alpha-amylase activity (sAA) three samples were obtained, just after awakening, 30 min after awakening and at bedtime. Oral contraceptive intake was considered for the female group. The results showed that overweight and obese females using oral contraceptive presented lower levels of 17-ß-estradiol than normal-weight females. In overweight and obese males, sAA levels were higher 30 min post-awakening when compared with the normal-weight group. The comparison of sAA levels within time showed no difference for males; obese females showed significant higher values at bedtime than 30 min post-awakening. The salivary cortisol concentration showed higher values at morning decreasing significantly at bedtime for all groups. Concluding, differences in 17-ß-estradiol and sAA levels were found in females and males, respectively, according to body fat accumulation, showing the usefulness of salivary biomarkers in the study of systemic conditions. PRACTICAL APPLICATIONS: Saliva is an advantageous biological fluid in innovative methods for diagnosis. Besides being a noninvasive method, salivary steroid measurements have the potential to provide a convenient assessment of serum free steroid concentrations.

Analysis of the stomatognathic system of children according orthodontic treatment needs.

PURPOSE: The present study evaluated electromyographic activity (EMG), masticatory performance, and tongue strength in children without and with orthodontic treatment needs. PATIENTS AND METHODS: A total of 90 children were screened and divided into the following groups: Group I (no treatment needed; mean age: 8.00 ± 0.43 years; n = 26), Group II (few malocclusions, treatment needed; mean age: 8.89 ± 0.43 years; n = 28), and Group III (slight-to-borderline treatment needed; mean age: 8.44 ± 0.22 years; n = 36). Orthodontic treatment need was classified on the basis of IOTN-DHC (Index of Orthodontic Treatment Need - Dental Health Component). The electromyographic Trigno EMG Systems was used for muscle analysis and the Iowa Oral Pressure Instrument (IOPI) was used to measure tongue strength. Data were analyzed using normality tests and one-way analysis of variance with a Bonferroni post hoc test (p ≤ 0.05). RESULTS: EMG in almost all mandibular movements was higher in Group III with statistically significant differences compared to position at rest: right masseter (p = 0.03); protrusion: left temporal (p = 0.02); saliva swallowing: left temporal (p = 0.05) and water swallowing: orbicularis oris mouth, right upper segment (p = 0.05). Lower masticatory performance was found in Group III, but the difference compared to Group I and II was not significant. There were no significant differences between the groups in terms of tongue strength. CONCLUSIONS: Children with borderline orthodontic treatment needs show functional disorders of the stomatognathic system.

Effect of Spirulina addition on the physicochemical and structural properties of extruded snacks

Abstract Nowadays the demand for practical food like snacks increases worldwide, however the nutritional value in most these formulations is reduced. Due to its chemical composition with high protein concentration, the microalga Spirulina has been used on the production of enriched foods. The present study aimed to evaluate the effects of Spirulina sp. LEB 18 addition on snacks formulations and extrusion conditions on the physicochemical and structural properties of snacks. Protein concentration and physical properties such as expansion index, bulk density, hardness, water absorption index, water solubility index and color were determined. The results showed that the addition of Spirulina sp. LEB 18, temperature in the last zone of the extruder and feed moisture influenced the product responses. The increase in feed moisture increased the hardness, bulk density and water absorption index of the snacks. Higher concentrations of microalga produced snacks with higher protein content, total color difference (ΔE) and compact structure. The addition of 2.6% Spirulina produced snacks with up to 11.3% protein and with adequate physical and structural properties for consumption. Thus, snacks containing Spirulina are an alternative to the demand for healthy food of practical consumption.

Fine motor skills in a population of children in remote Australia with high levels of prenatal alcohol exposure and Fetal Alcohol Spectrum Disorder.

BACKGROUND: Many children in the remote Fitzroy Valley region of Western Australia have prenatal alcohol exposure (PAE). Individuals with PAE can have neurodevelopmental impairments and be diagnosed with one of several types of Fetal Alcohol Spectrum Disorder (FASD). Fine motor skills can be impaired by PAE, but no studies have developed a comprehensive profile of fine motor skills in a population-based cohort of children with FASD. We aimed to develop a comprehensive profile of fine motor skills in a cohort of Western Australian children; determine whether these differed in children with PAE or FASD; and establish the prevalence of impairment. METHODS: Children (n = 108, 7 to 9 years) were participants in a population-prevalence study of FASD in Western Australia. Fine motor skills were assessed using the Bruininks-Oseretsky Test of Motor Proficiency, which provided a Fine Motor Composite score, and evaluated Fine Manual Control (Fine Motor Precision; Fine Motor Integration) and Manual Coordination (Manual Dexterity; Upper-Limb Coordination). Descriptive statistics were reported for the overall cohort; and comparisons made between children with and without PAE and/or FASD. The prevalence of severe (≤ 2nd percentile) and moderate (≤16th percentile) impairments was determined. RESULTS: Overall, Fine Motor Composite scores were 'average' (M = 48.6 ± 7.4), as were Manual Coordination (M = 55.7 ± 7.9) and Fine Manual Control scores (M = 42.5 ± 6.2). Children with FASD had significantly lower Fine Motor Composite (M = 45.2 ± 7.7 p = 0.046) and Manual Coordination scores (M = 51.8 ± 7.3, p = 0.027) than children without PAE (Fine Motor Composite M = 49.8 ± 7.2; Manual Coordination M = 57.0 ± 7.7). Few children had severe impairment, but rates of moderate impairment were very high. CONCLUSIONS: Different types of fine motor skills should be evaluated in children with PAE or FASD. The high prevalence of fine motor impairment in our cohort, even in children without PAE, highlights the need for therapeutic intervention for many children in remote communities.

Influence of anthropometry, TMD, and sex on molar bite force in adolescents with and without orthodontic needs.

PURPOSE: Bite force has been studied as representative of functional indices of mastication and its value may have diagnostic significance in disorders of the musculoskeletal system of facial bones. This study aimed to evaluate bite force in adolescents with and without orthodontic needs considering presence of temporomandibular disorders (TMD) as well as anthropometry: craniofacial dimensions and body mass index (BMI). METHODS: A total of 80 subjects were screened (61 females, 19 males; 18 ± 3 years old). Unilateral molar bite force was measured using a digital dynamometer with a fork thickness of 12 mm. Direct anthropometry was used to quantify craniofacial measurements. Dental Health Component of the Index of Orthodontic Treatment Need (IOTN-DHC) and the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were used to classify samples according to malocclusion and to TMD, respectively. Data were analyzed using normality tests, Mann-Whitney U test, and multiple linear regression analyses with stepwise backward elimination, controlling for the presence of malocclusion and TMD (p ≤ 0.05). RESULTS: The cephalic index was greater in females with malocclusion and the longitudinal cranial diameter was reduced in females with malocclusion. BMI was not different between normal and malocclusion groups for either gender. Bite force was negatively related with vertical dimension of the face, and positively related with facial width and facial index. The model explained 32% of bite force variability, considering the sample size (coefficient of determination R 2 = 0.324). CONCLUSIONS: Even when orthodontic needs and TMD signs and symptoms are present, stronger bite force is still observed in males and in subjects with smaller anterior facial heights and wider facial widths.

An app with remote support achieves better adherence to home exercise programs than paper handouts in people with musculoskeletal conditions: a randomised trial.

QUESTION: Do people with musculoskeletal conditions better adhere to their home exercise programs when these are provided to them on an app with remote support compared to paper handouts? DESIGN: Randomised, parallel-group trial with intention-to-treat analysis. PARTICIPANTS: Eighty participants with upper or lower limb musculoskeletal conditions were recruited to the trial. Each participant was prescribed a 4-week home exercise program by a physiotherapist at a tertiary teaching hospital in Australia. Participants were randomly assigned via a computer-generated concealed block randomisation procedure to either intervention (n=40) or control (n=40) groups. INTERVENTION: Participants in the intervention group received their home exercise programs on an app linked to the freely available website www.physiotherapyexercises.com. They also received supplementary phone calls and motivational text messages. Participants in the control group received their home exercise programs as a paper handout. OUTCOME MEASURES: Blinded assessors collected outcome measures at baseline and 4 weeks. The primary outcome was self-reported exercise adherence. There were five secondary outcomes, which captured functional performance, disability, patient satisfaction, perceptions of treatment effectiveness, and different aspects of adherence. RESULTS: Outcomes were available on 77 participants. The mean between-group difference for self-reported exercise adherence at 4 weeks was 1.3/11 points (95% CI 0.2 to 2.3), favouring the intervention group. The mean between-group difference for function was 0.9/11 points (95% CI 0.1 to 1.7) on the Patient-Specific Functional Scale, also favouring the intervention group. There were no significant between-group differences for the remaining outcomes. CONCLUSION: People with musculoskeletal conditions adhere better to their home exercise programs when the programs are provided on an app with remote support compared to paper handouts; however, the clinical importance of this added adherence is unclear. TRIAL REGISTRATION: ACTRN12616000066482. [Lambert TE, Harvey LA, Avdalis C, Chen LW, Jeyalingam S, Pratt CA, Tatum HJ, Bowden JL, Lucas BR (2017) An app with remote support achieves better adherence to home exercise programs than paper handouts in people with musculoskeletal conditions: a randomised trial. Journal of Physiotherapy 63: 161-167].

Prevalence and profile of Neurodevelopment and Fetal Alcohol Spectrum Disorder (FASD) amongst Australian Aboriginal children living in remote communities.

BACKGROUND: Despite multiple risk factors for neurodevelopmental vulnerability, few studies have assessed neurodevelopmental performance of Australian Aboriginal children. An important risk factor for neurodevelopmental vulnerability is prenatal alcohol exposure (PAE), which places children at risk for Fetal Alcohol Spectrum Disorder (FASD). AIMS: This study assesses neurodevelopment outcomes in a population of Australian Aboriginal children with and without PAE. METHODS AND PROCEDURES: Children born in 2002/2003, and living in the Fitzroy Valley, Western Australia between April 2010 and November 2011, were eligible (N=134). Sociodemographic and antenatal data, including PAE, were collected by interview with 127/134 (95%) consenting parents/caregivers. Maternal/child medical records were reviewed. Neurodevelopment was assessed by clinicians blinded to PAE in 108/134 (81%) children and diagnoses on the FASD spectrum were assigned. OUTCOMES AND RESULTS: Neurodevelopmental disorder was documented in 34/108 children (314.8 per 1000). Any diagnosis on the FASD spectrum was made in 21/108 (194.4 per 1000) children (95% CI=131.0-279.0). CONCLUSIONS AND IMPLICATIONS: Neurodevelopmental impairment with or without PAE is highly prevalent among children in the Fitzroy Valley. Rates of diagnoses on the FASD spectrum are among the highest worldwide. Early intervention services are needed to support developmentally vulnerable children in remote communities.

Masticatory muscle activity evaluation by electromyography in subjects with zygomatic implants

BACKGROUND: Zygomatic implants are an alternative treatment in the rehabilitation of atrophic maxilla to promote stability in the stomatognathic system. The aim of this study was to compare the electromyographic (EMG) activity of masseter and temporalis muscles in controls and in individuals with complete implant-supported dentures anchored in the zygomatic bone. MATERIAL AND METHODS: Fifty-four volunteers of both genders (mean age 52.5 years) were selected and distributed into two groups: Individuals with zygomatic implant (ZIG; n=27) and fully dentate patients (CG; n=27). MyoSystem-BR1 was used to assess masseter and temporalis muscles EMG activity in different mandibular movements: protrusion, clenching, maximal voluntary contraction (MVC) with Parafilm M(R), right and left laterality and chewing (peanuts and raisins). Data was processed, normalized (MVC) and analyzed using the SPSS 21.0. Student t-test (P ≤ 0.05) was used for group comparison. RESULTS: The results were statistically significant (P ≤ 0.05) for protrusion, clenching, right and left laterality and raisin chewing. For the mandibular posture conditions, the ZIG obtained higher EMG activity patterns when compared to CG. For the masticatory performance during chewing of peanuts and raisins, the ZIG showed higher EMG mean values when compared to CG. CONCLUSIONS: The zygomatic implant promoted an active response of the muscle fibers (hyperactivity) during both mandibular posture and chewing conditions, probably due to the absence of periodontal receptors, which play a significant role for preparing a bolus for swallowing

Plagiocephaly and Developmental Delay: A Systematic Review.

OBJECTIVE: Deformational plagiocephaly (includes plagiocephaly and brachycephaly) is a common pediatric condition. Infants who present with altered head shape often experience developmental delay. It is uncertain how common developmental delay is in infants with plagiocephaly and how sustained this is, when present. This review explores the association between plagiocephaly and developmental delay to guide clinical practice. STUDY DESIGN: A systematic review was conducted. MEDLINE, EMBASE, CINAHL, and PEDro databases were searched. Data from relevant studies were extracted regarding study: sample, follow-up, design, and findings. Methodological quality of each study was rated using a critical appraisal tool. RESULTS: The search recovered 1315 articles of which 19 met the inclusion criteria. In the included studies, the children's ages ranged from 3 months to 10 years. Study limitations included selection bias, nonblinding of assessors, and reuse of the same study population for multiple papers. Most papers (11/19) rated "moderate" on methodological quality. A positive association between plagiocephaly and developmental delay was reported in 13 of 19 studies, including 4 of 5 studies with "strong" methodological quality. Delay was more frequently in studies with children ≤24 months of age (9/12 studies) compared with >24 months of age (3/7 studies). Motor delay was the most commonly affected domain reported in high-quality papers (5/5 studies). CONCLUSION: This review suggests plagiocephaly is a marker of elevated risk of developmental delays. Clinicians should closely monitor infants with plagiocephaly for this. Prompt referral to early intervention services such as physiotherapy may ameliorate motor delays and identify infants with longer term developmental needs.

Graphomotor skills in children with prenatal alcohol exposure and fetal alcohol spectrum disorder: A population-based study in remote Australia.

BACKGROUND/AIM: Few studies have examined graphomotor skills in children with prenatal alcohol exposure (PAE) or fetal alcohol spectrum disorder (FASD). METHODS: Graphomotor skills were assessed in 108 predominantly Australian Aboriginal children aged 7.5-9.6 years in remote Western Australia using clinical observations (pencil grasp; writing pressure) and standardised assessment tools (the Evaluation Tool of Children's Handwriting; and the Miller Function and Participation Scales - The Draw-a-Kid Game). Skills were compared between children (i) without PAE, (ii) PAE but not FASD and (iii) FASD. RESULTS: Most children used a transitional pencil grasp and exerted heavy handwriting pressure (83.3% and 30.6% of the cohort). The percentage of letters (M = 62.9%) and words (M = 73.3%) written legibly was low. Children with FASD were more likely than children without PAE to use a cross-thumb grasp (P = 0.027), apply heavy writing pressure (P = 0.036), be unable to write a sentence (P = 0.041) and show poorer word legibility (P = 0.041). There were no significant differences between groups for drawing outcomes, although some children with FASD drew pictures that appeared delayed for their age. There were no significant differences between children without PAE and those with PAE but who were not diagnosed with FASD. CONCLUSIONS: Overall, graphomotor skills were poor in this cohort, but children with FASD performed significantly worse than children without PAE. Findings suggest the need for improved occupational therapy services for children in remote regions and evaluation of graphomotor skills in children with PAE.

Interventions to improve gross motor performance in children with neurodevelopmental disorders: a meta-analysis.

BACKGROUND: Gross motor skills are fundamental to childhood development. The effectiveness of current physical therapy options for children with mild to moderate gross motor disorders is unknown. The aim of this study was to systematically review the literature to investigate the effectiveness of conservative interventions to improve gross motor performance in children with a range of neurodevelopmental disorders. METHODS: A systematic review with meta-analysis was conducted. MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, PEDro, Cochrane Collaboration, Google Scholar databases and clinical trial registries were searched. Published randomised controlled trials including children 3 to ≤18 years with (i) Developmental Coordination Disorder (DCD) or Cerebral Palsy (CP) (Gross Motor Function Classification System Level 1) or Developmental Delay or Minimal Acquired Brain Injury or Prematurity (<30 weeks gestational age) or Fetal Alcohol Spectrum Disorders; and (ii) receiving non-pharmacological or non-surgical interventions from a health professional and (iii) gross motor outcomes obtained using a standardised assessment tool. Meta-analysis was performed to determine the pooled effect of intervention on gross motor function. Methodological quality and strength of meta-analysis recommendations were evaluated using PEDro and the GRADE approach respectively. RESULTS: Of 2513 papers, 9 met inclusion criteria including children with CP (n = 2) or DCD (n = 7) receiving 11 different interventions. Only two of 9 trials showed an effect for treatment. Using the least conservative trial outcomes a large beneficial effect of intervention was shown (SMD:-0.8; 95% CI:-1.1 to -0.5) with "very low quality" GRADE ratings. Using the most conservative trial outcomes there is no treatment effect (SMD:-0.1; 95% CI:-0.3 to 0.2) with "low quality" GRADE ratings. Study limitations included the small number and poor quality of the available trials. CONCLUSION: Although we found that some interventions with a task-orientated framework can improve gross motor outcomes in children with DCD or CP, these findings are limited by the very low quality of the available evidence. High quality intervention trials are urgently needed.

Gross motor performance in children prenatally exposed to alcohol and living in remote Australia.

AIM: This study aimed to determine the gross motor (GM) performance of Aboriginal children living in remote Australia. The relationship between GM skills, prenatal alcohol exposure (PAE) and fetal alcohol spectrum disorders (FASD) was explored. METHODS: A population-based observation study was conducted in 2011 to assess motor performance in children living in the Fitzroy Valley, Western Australia, using the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2). BOT-2 data were retrospectively analysed using recently developed software enabling separation of fine and GM outcomes. RESULTS: A total of 108 children (98.1% Aboriginal; 53% male, mean age: 8.7 years) were assessed. Half (52.2%) were exposed to at least 'risky' levels of PAE, and 21 (19%) were diagnosed with an FASD. The mean GM composite score of the cohort (47.0 ± 8.4) approached the BOT-2 normative mean (50.0 ± 10) and was similar between children with and without PAE (P = 0.27). This mean score, however, was significantly lower in children with FASD than without (mean difference: -5.5 ± 20.6; P = 0.006). Compared with children without FASD, children with FASD had significant impairment in subtests for running speed and agility (mean difference ± standard deviation (SD): -2.4 ± 8.1; P = 0.003) and strength (mean difference ± SD:-2.8 ± 9.9; P = 0.004) and (ii) a higher proportion than expected had overall GM impairment (≤2 SD: 9.5%; ≤1 SD: 23.8%). In groups with PAE, no PAE and no FASD, GM function approached expected population norms. CONCLUSIONS: A higher than expected proportion of children with FASD had GM scores that indicated impairment and need for therapy. Evaluation of GM performance should routinely be included in FASD assessment to determine strategies to optimise child development.