Pain Experiences of People Diagnosed With Autism Spectrum Disorder: A Systematic Review of Case-Control Studies.

IMPORTANCE: Autism spectrum disorder (ASD) is one of the most prevalent neurodevelopmental disorders and is characterized by compromised social interactions, reduced verbal communication, stereotyped repetitive behaviors, restricted interests, and sensory abnormalities. Yet absent from the knowledge base is information about sensory abnormalities related to pain experiences. Exploring the pain experiences of people with ASD may provide occupational therapy practitioners with a baseline to determine areas of need and effective interventions. OBJECTIVE: To conduct a systematic review of the literature to summarize current evidence from case-control studies comparing sensory abnormalities with regard to pain experiences of people diagnosed and not diagnosed with ASD. DATA SOURCES: A systematic literature search of the CINAHL, Cochrane, MEDLINE (PubMed), OTseeker, and Web of Science databases, using MeSH terms and broad keywords. STUDY SELECTION AND DATA COLLECTION: A search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Newcastle-Ottawa Scale was used to evaluate the risk of bias of the included studies. FINDINGS: A total of 27 case-control studies involving 865 people with ASD and 864 control participants were included. Several methods were used to explore pain experiences, such as threshold detection or pain threshold. CONCLUSION AND RELEVANCE: The results indicate that people with ASD may have an abnormal sensory experience with regard to pain sensitivity. Occupational therapy practitioners should develop an intervention to focus on pain. What This Article Adds: This study adds to the body of literature indicating that people with ASD have sensory abnormalities with regard to pain experiences. Results highlight the need for occupational therapy interventions to focus on pain experiences.

Uso de eSalud para promover la actividad física en los supervivientes de neoplasias torácicas: revisión sistemática y metaanálisis / The use of eHealth to promote physical activity in thoracic malignancies survivors: A systematic review and meta-analysis

Antecedentes: Las tasas de supervivencia para muchas formas de neoplasias torácicas han mejorado durante las últimas décadas. Sin embargo, muchos supervivientes tienen que hacer frente a los efectos secundarios del tratamiento del cáncer durante un tiempo prolongado. La actividad física (AF) ha sido propuesta como estrategia terapéutica para combatir los efectos del tratamiento del cáncer, pudiendo ser eSalud una buena manera de animar a los pacientes a practicarla. Objetivo: Explorar los efectos de eSalud en la promoción de la AF entre las neoplasias torácicas. Métodos: Se realizó una búsqueda de los artículos adecuados utilizando las bases de datos de PubMed, Web of Science y Scopus, mediante una combinación de títulos de temas médicos. Resultados: Se identificaron 4.781 artículos en total, de los cuales 10 cumplieron los criterios de elegibilidad. Se describieron diferentes intervenciones de eSalud en estos estudios: aplicación para móviles (app) (n = 3), sitio web (n = 2), correo electrónico (n = 2), aplicación para web y móvil (n = 1), asesoramiento telefónico (n = 1) y página online (n = 1). Todos los estudios reportaron mejoras en cuanto a AF y 8/10 estudios reportaron cambios estadísticamente significativos. Conclusión: Nuestros resultados muestran que los programas de eSalud son útiles para promover la AF en los supervivientes de neoplasias torácicas, en comparación con la no intervención, el tratamiento convencional o el enfoque dietético. Además, este metaanálisis reveló también que eSalud es un buen modo de mejorar el nivel de AF en los supervivientes de neoplasias torácicas.(AU)

Background: Survival rates for many forms of thoracic malignancies have improved over the past few decades, however, many survivors are coping with the side effects of cancer treatment for longer. Physical activity (PA) has been proposed as a therapeutic strategy to combat the effects of treatment in cancer survivors and eHealth could be a good way to encourage patients to practice it. Objective: To explore the effects of eHealth in the promotion of PA among thoracic malignancies. Methods: Suitable articles were searched using PubMed, Web of Science and Scopus databases using a combination of medical subject headings. Results: In total, 4781 articles were identified, of which ten met eligibility criteria. Different eHealth interventions were described in these studies: mobile application (app) (n = 3), website (n = 2), email (n = 2), web and mobile application (n = 1), telephone counseling (n = 1) and online sheet (n = 1). All studies reported improvements in PA, with 8/10 studies reporting statistically significant changes. Conclusion: Our results show that eHealth programs are useful to promote PA in malignancy thoracic survivors, compared to no intervention, conventional treatment or a dietary approach. Moreover, the meta-analysis also revealed eHealth is a good way to improve the level of PA in thoracic malignancies survivors.(AU)

Effects of Exercise-Based Interventions on Physical Activity Levels in Persons With Parkinson's Disease: A Systematic Review With Meta-analysis.

BACKGROUND AND PURPOSE: Parkinson's disease (PD) is the most common neurodegenerative movement disorder. Symptom severity leads to devastating consequences such as falls, immobility, impaired quality of life, and reduced general activity. Adopting a sedentary lifestyle creates a vicious circle, as physical inactivity can negatively affect the clinical domains of PD. Despite the recognition of the disease-modifying potential of physical activity (PA), achieving adequate exercise levels can be challenging for individuals with PD. This study aimed to investigate the repercussions of exercise-based interventions to improve PA levels in persons with PD through a systematic review with meta-analysis. METHODS: A search was conducted from database inception to February 2021 across 3 databases: PubMed, Web of Science, and Scopus. Randomized controlled trials were included if they involved persons with PD, outcome measures associated with PA levels, and an exercise-based intervention. Two reviewers performed independent data extraction and methodologic quality assessment of the studies using the Downs and Black quality checklist. RESULTS: A total of 6 studies were included in the study (1251 persons with PD). Four intervention types were identified: balance, strength, aerobic, and multimodal exercise (combination of several types of exercise programs). The meta-analysis showed that exercise interventions have a positive effect on PA (standard mean difference = 0.50, 95% CI =-0.02, 1.00; P = .06). The risk of bias was generally low. CONCLUSIONS: The findings support the use of exercise-based interventions (aerobic exercise, balance exercise, strength exercise, and/or multimodal exercise) to improve PA levels. However, the limited number of studies and the heterogeneity of the interventions do not allow us to draw a definitive conclusion.

Smartphone-based follow-up of upper airway symptoms in head and neck cancer survivors one year after radiation therapy.

BACKGROUND: Improvements in treatment of head-and-neck cancer (HNC) have resulted in improved long-term survival rates so there is a growing interest in long-term consequences. OBJECTIVE: The aim was to perform a smartphone-based assessment to analyse the upper airway dysfunction-related symptoms in HNC 1 year after radiotherapy (RT) during social distancing due to COVID-19. METHODS & PROCEDURES: Smartphone-based assessment on upper airway function 1 year after RT was performed. Upper airway functions include perceived impact of voice on quality of life (Voice Handicap Index, VHI-30), swallowing (Functional Oral Intake, FOIS; and Swallowing Quality of Life questionnaire, SWAL-QOL) and sleep-disordered breathing (Pittsburgh Sleep Quality Index, PSQI) assessments. Additionally, quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. OUTCOMES & RESULTS: The HNC group presented worse results in the VHI-30 scale, in the three subscales (p < 0.001). Swallowing function also presented worse results in the HNC group, with a lower score in the FOIS questionnaire (p < 0.001) and a poorer score in the SWAL-QOL (p < 0.001). Regarding to the sleep-disordered breathing, the HNC group presented poorer scores in all subscales (p < 0.05). The HNC group also presented worse scores in quality of life. CONCLUSION: Our findings showed that HNC survivors presented a poorer upper airway function and a worse quality of life. This population needs to be systematically screened for those function impairments. WHAT THIS PAPER ADDS: What is already known on the subject Head-and-neck cancer radiotherapy treatment is anatomically related to the upper airway, involved in several functions such as breathing, swallowing and speech that could be affected by the treatment. Public health restrictions caused by the COVID-19 pandemic have made it difficult, and in many cases impossible, to see patients in person and complete assessments that are often crucial to improve their approach. Telephone interviews appear to be largely equivalent to face-to-face interviews, which could solve these problems. What this paper adds to existing knowledge The aim of this study was to perform a smartphone-based assessment to analyse the upper airway dysfunction-related symptoms in head-and-neck cancer survivors 1 year after radiotherapy treatment. Our findings showed that head-and-neck cancer survivors who have been treated with radiotherapy presented a poorer upper airway function, with subjective speech and voice problems, swallowing and sleep-disordered breathing compared to a control group matched for age and sex 1 year after the treatment. What are the potential or actual clinical implications of this work? The results of this study will allow a better approach to treatment of head-and-neck cancer survivors.

The use of eHealth to promote physical activity in thoracic malignancies survivors: A systematic review and meta-analysis.

BACKGROUND: Survival rates for many forms of thoracic malignancies have improved over the past few decades, however, many survivors are coping with the side effects of cancer treatment for longer. Physical activity (PA) has been proposed as a therapeutic strategy to combat the effects of treatment in cancer survivors and eHealth could be a good way to encourage patients to practice it. OBJECTIVE: To explore the effects of eHealth in the promotion of PA among thoracic malignancies. METHODS: Suitable articles were searched using PubMed, Web of Science and Scopus databases using a combination of medical subject headings. RESULTS: In total, 4781 articles were identified, of which ten met eligibility criteria. Different eHealth interventions were described in these studies: mobile application (app) (n = 3), website (n = 2), email (n = 2), web and mobile application (n = 1), telephone counseling (n = 1) and online sheet (n = 1). All studies reported improvements in PA, with 8/10 studies reporting statistically significant changes. CONCLUSION: Our results show that eHealth programs are useful to promote PA in malignancy thoracic survivors, compared to no intervention, conventional treatment or a dietary approach. Moreover, the meta-analysis also revealed eHealth is a good way to improve the level of PA in thoracic malignancies survivors.

Balance Ability and Occupational Performance in Patients With Parkinson's Disease and On-Medication-State Freezing of Gait.

PURPOSE: The aim of this study was to examine balance ability and occupational performance in patients with Parkinson's disease (PD) and on-medication-state freezing of gait (FOG). DESIGN: A cohort study with three groups was conducted. METHODS: Seven patients with PD and on-medication-state FOG with optimized pharmacological therapy; seven patients with PD matched by age, gender, length of time since diagnosis, and Hoehn and Yahr stage; and seven controls were included. Outcomes included balance and occupational performance. Nonparametric analyses were used. FINDINGS: Significant differences were found between the two subgroups of patients with PD in the Timed Up & Go Test when adding a cognitive task, dual-task interference, and self-confidence in balance. CONCLUSIONS: Patients with PD and on-medication-state FOG had lower scores on dual-task interference and self-confidence than matched PD patients. CLINICAL RELEVANCE: The assessment and rehabilitation approach for patients with PD and on-medication-state FOG should include balance confidence and dual-task interference.

Effects of an active intervention based on myofascial release and neurodynamics in patients with chronic neck pain: a randomized controlled trial.

BACKGROUND: While neck pain can be severely disabling and costly, treatment options have shown moderate evidence of effectiveness. OBJECTIVE: The objective of this study was to explore the effects of a 4-week active program based on myofascial release and neurodynamics on trigger point (TrP) examination, pain, and functionality in patients with chronic neck pain. METHODS: Randomized controlled trial. A total of 40 patients with chronic neck pain were randomly allocated to an experimental or a control group (n = 20). The primary outcome measure was TrP examination. Secondary outcomes were pain, assessed with the Brief Pain Inventory and a visual analogue scale, and functionality, evaluated with the Neck Outcome Score. RESULTS: A between-group analysis showed significant differences (p < .05) in the percentage of active TrPs in the following muscles: suboccipital (50 vs. 92.4% in the right muscle and 37.5 vs. 89.6% in the left muscle), left scalene and levator scapulae. Significant differences (p < .05) were also found in pain severity, average pain, and functionality (i.e. symptoms, sleep, and participation). CONCLUSIONS: A 4-week self-administered program for patients with chronic neck pain was effective in reducing the presence of active TrPs. Pain severity, average pain, and some aspects of functionality also improved significantly after the intervention.

Exploring perceived occupational balance in women with fibromyalgia. A descriptive study.

BACKGROUND: People with chronic pain conditions such as fibromyalgia may experience occupational limitations and imbalances in their basic and instrumental occupations of daily living, leisure, work, and social participation. OBJECTIVE: To describe occupational balance in persons with fibromyalgia and to analyze whether it is associated with self-reported disability and self-efficacy to manage symptoms. METHODS: A cross-sectional study was carried out. Individuals with fibromyalgia were invited to participate. Occupational balance was assessed with the Occupational Balance Questionnaire; self-reported disability was assessed with the World Health Organization Disability Assessment Schedule, WHODAS 2.0-12; and self-efficacy was evaluated with the 8-item version of the Arthritis Self-Efficacy Scale. Data were analyzed using multiple linear regression with a forward stepwise procedure. RESULTS: One hundred women with fibromyalgia were included. Occupational balance was 26.96 ± 12.09; however, scores differed between the mild disability group and the moderate disability group (33.11 ± 9.99 vs. 20.29 ± 10.61, p < 0.001). Multiple linear regression analyses revealed that self-reported disability and self-reported pain management explained 58.1% of the variance in occupational balance. CONCLUSION: Women with fibromyalgia showed low occupational balance. Self-reported disability and self-reported pain management were associated with occupational balance. SIGNIFICANCE: Occupational therapy practitioners can design intervention programs focussing on occupational balance and self-efficacy to manage symptoms.

Global functional impairment in head and neck cancer survivors after completing radiotherapy treatment.

PURPOSE: Improvements in diagnosis and treatment of head and neck cancer (HNC) patients have resulted in improved long-term survival rates. However, a variety of symptoms and comorbidities, often secondary to the cancer and its treatments, are experienced by a relevant number of survivors. So, the aim of this study was to determine the global functional impairment in HNC survivors 1 year after radiotherapy treatment. MATERIALS AND METHODS: A descriptive case-control study was performed. HNC survivors were recruited from San Cecilio Clinical University Hospital in Granada. The main variables included were functionality and quality of life. RESULTS: 30 HNC survivors were included in our study. Significant differences were found in the WHO-DAS 2.0 test, with a worse score in the HNC group in most subscales (p < 0.05), and poorer scores in the COMP test, performance (p < 0.001) and satisfaction (p < 0.001). Significant differences were also found in most QLQ-30 subscales (p < 0.05) and the QLQ-H&N35. In regard to the EQ-5D, significant differences were found between groups, with worse results in the HNC group (p < 0.05). CONCLUSION: HNC survivors presented a poorer global function and a worse quality of life and health status 1 year after the radiotherapy treatment. Moreover, a good correlation was found between functionality and quality of life outcomes.IMPLICATIONS FOR REHABILITATIONA worse quality of life and health status are shown in head and neck survivors 1 year after radiotherapy.Global functionality is related to quality of life outcomes in head and neck cancer survivors.There is a need to recognise the need for and to provide longer term rehabilitation.

Psychological distress prior to surgery is related to symptom burden and health status in lung cancer survivors.

PURPOSE: Patients with lung cancer experience a variety of distressing symptoms which could adversely affect quality of life. The aim of this study was to determine whether psychological distress prior to surgery is associated to health status and symptom burden in lung cancer survivors. METHODS: A longitudinal observational study with 1-year follow-up was carried out. Health status was measured by the WHO Disability Assessment Scale (WHO-DAS 2.0), the Euroqol-5 dimensions (EQ-5D) and the Pittsburgh Sleep Quality Index (PSQI). Symptoms severity included dyspnoea (Multidimensional Profile of Dyspnoea); pain (Brief Pain Inventory); fatigue (Fatigue Severity Scale); and cough (Leicester Cough Questionnaire). RESULTS: One hundred seventy-four lung cancer patients were included. Patients in the group with psychological distress presented a worse self-perceived health status, functionality and sleep quality. The group with psychological distress also presented higher dyspnoea, fatigue and pain. CONCLUSION: Patients with psychological distress prior surgery present with a greater symptom burden and a poorer self-perceived health status, lower functionality and sleep quality, than patients without distress 1 year after the lung resection.

High-intensity interval training effects in cardiorespiratory fitness of lung cancer survivors: a systematic review and meta-analysis.

PURPOSE: To assess the exercise intervention focused on high-intensity interval training (HIIT) in lung cancer survivors. DESIGN: We performed a literature search using PubMed, Web of Science, and Science Direct (last search March 2021). Quality assessment and risk of bias were assessed using the Downs and Black scale and the Cochrane tool. PARTICIPANTS: A total of 305 patients of 8 studies were assessed, with their mean age ranging from 61 ± 6.3 to 66 ± 10 years in the exercise group and from 58.5 ± 8.2 to 68 ± 9 years in the control group. METHODS: A systematic review and meta-analysis of randomized controlled trials and pilot randomized controlled trials was performed. We included controlled trials testing the effect of HIIT in lung cancer survivors versus the usual care provided to these patients. The data were pooled and a meta-analysis was completed for cardiorespiratory fitness (VO2peak). RESULTS: We selected 8 studies, which included 305 patients with lung cancer: 6 studies were performed around surgical moment, one study during radiotherapy's treatment, and other during target therapy. After pooling the data, exercise capacity was included in the analysis. Results showed significant differences in favour to HIIT when compared to usual care in cardiorespiratory fitness (standard mean difference = 2.62; 95% confidence interval = 1.55, 3.68; p < 0.00001). CONCLUSIONS AND IMPLICATIONS: The findings indicated a beneficial effect of HIIT for improving cardiorespiratory fitness in lung cancer patients in early stages around oncological treatment moment. Nevertheless, this review has several limitations, the total number of studies was low, and the stage and subtype of lung cancer patients were heterogeneous that means that the conclusions of this review should be taken with caution. Review registration: PROSPERO Identifier: CRD42021231229.

Efficacy of Web-Based Supportive Interventions in Quality of Life in COPD Patients, a Systematic Review and Meta-Analysis.

BACKGROUND: Adults living with Chronic Obstructive Pulmonary Disease (COPD) often have difficulties when trying to access health care services. Interactive communication technologies are a valuable tool to enable patients to access supportive interventions to cope with their disease. The aim of this revision and meta-analysis is to analyze the content and efficacy of web-based supportive interventions in quality of life in COPD. METHODS: Medline (via PubMed), Web of Science, and Scopus were the databases used to select the studies for this systematic review. A screening, analysis, and assessment of the methodological quality was carried out by two independent researchers. A meta-analysis of the extracted data was performed. RESULTS: A total of 9 of the 3089 studies reviewed met the inclusion criteria. Most repeated web content elements were educational and involved communication with healthcare professional content. Finally, seven of the nine studies were included in a quantitative analysis. Web-based supportive interventions significantly improved quality of life when added to usual care (SMD = -1.26, 95% CI = -1.65, -0.86; p < 0.001) but no significant differences were found when compared with an autonomous pedometer walking intervention (p = 0.64) or a face-to-face treatment (p = 0.82). CONCLUSION: This systematic review and meta-analysis suggests that web-based supportive interventions may complement or accompany treatments in COPD patients due to the advantages of online interventions. The results obtained should be treated with caution due to the limited number of studies in this area and methodological weaknesses.

Reduced exercise capacity and self-perceived health status in high-risk patients undergoing lung resection.

BACKGROUND: Lung resection represents the main curative treatment modality of non-small cell lung cancer. Patients with high-risk to develop postoperative pulmonary complications have been classified as "high-risk patients." Characterizing this population could be important to improve their approach and rehabilitation. AIM: To identify the differences between high and low-risk patients in exercise capacity and self-perceived health status after hospitalization. METHODS: A longitudinal observational prospective cohort study was carried out. Patients undergoing lung resection were recruited from the "Hospital Virgen de las Nieves" (Granada) and divided into two groups according to the risk profile criteria (age ≥ 70 years, forced expiratory volume in 1 s ≤ 70% predicted, carbon monoxide diffusion capacity ≤ 70% predicted or scheduled pneumonectomy). Outcomes included were exercise capacity (Fatigue Severity Scale, Unsupported Upper-Limb Exercise, handgrip dynamometry, Five Sit-to-stand test, and quadriceps hand-held dynamometry) and patient-reported outcome (Euroqol-5 dimensions 5 Levels Visual Analogue Scale). RESULTS: In total, 115 participants were included in the study and divided into three groups: high-risk, low-risk and control group. At discharge high-risk patients presented a poorer exercise capacity and a worse self-perceived health status (P < 0.05). One month after discharge patients in the high-risk group maintained these differences compared to the other groups. CONCLUSION: Our results show a poorer recovery in high-risk patients at discharge and 1 mo after surgery, with lower self-perceived health status and a poorer upper and lower limb exercise capacity. These results are important in the rehabilitation field.

A Feasibility and Efficacy Randomized Controlled Trial of Two Exercise Programs in Severe AECOPD Patients with Resting Hypoxemia.

Resting hypoxemia is the most severe stage of Chronic Obstructive Pulmonary Disease (COPD). Due to their impairments during the exacerbation, these patients are limited to traditional exercise rehabilitation and are excluded from the majority of the studies. The aim of this study was to assess the feasibility and the efficacy of two exercise programs in Acute Exacerbation of COPD (AECOPD) patients with resting hypoxemia. In this randomized clinical trial, patients hospitalized due to an acute exacerbation of COPD with hypoxemia at rest were included. Patients were randomly assigned into three groups. A Control Group (pharmacological treatment), a Global Exercise Group (GEG), and a Functional Electrostimulation Group (FEG). Patients were treated during the hospitalization period. The main outcomes were lower limb strength (assessed by a dynamometer), balance (assessed by the one leg standing balance test), health related quality of life (assessed by the EQ-5D), adverse events and adherence. At the end of the intervention, there were significant differences in all the variables in favour of the experimental groups (p < 0.05). We concluded that conducting an exercise program is feasible and improves lower limb strength, balance, and health related quality of life in AECOPD patients with resting hypoxemia.

Symptom severity is associated with signs of central sensitization in patients with asthma.

INTRODUCTION: Asthma is characterized by recurrent episodes of wheezing, dyspnoea, chest tightness and cough. In addition to respiratory symptoms, previous studies have reported the presence of pain. OBJECTIVE: To analyse the nociceptive processing of young adults with well-controlled asthma. METHODS: A cross-sectional case-control study was performed. Patients diagnosed with persistent well-controlled asthma were recruited from the 'Complejo Hospitalario Universitario' (Granada). Main outcomes included pain processing, measured by the pressure-pain thresholds (PPTs) and temporal summation and latency of pain; symptoms, including cough (Leicester Cough Questionnaire) and dyspnoea (Borg scale); and catastrophic cognitions about breathlessness, assessed by the Breathlessness Catastrophizing Scale (BCS). RESULTS: Seven-two participants were finally recruited in our study. Patients with asthma presented lower pressure thresholds (p < 0.05) and significant differences in latency and summation tests. These patients also presented a greater cough level, with significant differences in all subscales (p < 0.05). Significant differences were also found in the BCS between groups (p < 0.001). CONCLUSION: Our results show a decrease of PPTs and a greater pain intensity in latency and summation tests, suggesting an abnormal pain processing in patients with asthma.

The Caregiver Burden Inventory as a Sleep Disturbance Screening Tool for Parents of Children with Autism Spectrum Disorder.

PURPOSE: The study was conducted to explore the degree to which caregiver burden is associated with sleep quality in parents of children with autism spectrum disorder, and to determine a statistically valid cutoff score for the Caregiver Burden Inventory (CBI) in order to identify parents of risk of poor sleep quality. DESIGN AND METHODS: We conducted a cross-sectional analysis. We assessed caregiver burden with the CBI, sleep quality with the Pittsburgh Sleep Quality Index, emotional status with the Hospital Anxiety and Depression Scale, and impact on family with the Impact on Family Scale. Caregiver burden was evaluated with a logistic regression analysis. The best fit model was used in a receiver operating characteristic analysis. Likelihood ratios and post-test probabilities were calculated. RESULTS: A total of 116 parents were included in this study. Higher caregiver burden was associated with a reduction in sleep quality in the logistic regression analysis (p < 0.001). The area under the curve for the univariate burden test model (best fit) was 76.70 (p < 0.001). The cutoff score for poor sleep quality was caregiver burden ≥26.50. The post-test probability of poor sleep quality increased to 82.02% from a pre-test probability of 76.72%. CONCLUSIONS: Our findings suggest that caregiver burden is associated with sleep quality among parents of children with autism spectrum disorder. The findings suggest that a CBI cutoff score of 26.50 may help to detect risk of poor sleep quality in parents of children with autism spectrum disorder.

Respiratory disturbances in fibromyalgia: A systematic review and meta-analysis of case control studies.

Background: Fibromyalgia is a debilitating syndrome characterized by diffuse and chronic musculoskeletal pain.Objective: To perform a systematic review and meta-analysis of case-control studies to explore the respiratory disturbances among persons with fibromyalgia.Study appraisal and synthesis method: This review was performed in accordance with PRISMA guidelines (PROSPERO; identification number CRD: 42,020,196,835). We systematically searched seven electronic databases for articles published before December 2020.Eligibility criteria: Case-control studies comparing adults with fibromyalgia syndrome and healthy individuals with regard to the respiratory disturbances.Results: A total of six studies were included in the quantitative analysis. Pooled analysis showed that persons with fibromyalgia reported reduced chest expansion (MD -0.72, 95% CI, -1.70 to 0.27, I2 = 95%, p = 0.016), maximum expiratory pressure (MD -10.67, 95% CI, -18.62 to -2.72, I2 = 77%, p = 0.009), maximum inspiratory pressure (MD 11.04, 95% CI, -14.45 to -7.62, I2 = 0%, p < 0.001) and maximal voluntary ventilation (MD 11.79, 95% CI, -16.80 to -7.78, I2 = 0%, p < 0.001).Conclusion: Persons with fibromyalgia experience respiratory disturbances, such as reduced chest expansion, maximum expiratory pressure, maximum inspiratory pressure, and maximal voluntary ventilation.

Ventilatory Impairments Associated with Parkinson's Disease: A Systematic Review and Meta-Analysis.

BACKGROUND: The peripheral and central repercussions of Parkinson's disease (PD) affect the neuromuscular system producing a loss of muscle strength that can influence the respiratory system. Although several studies have examined various respiratory aspects of PD, to the best of our knowledge no study to date has systematically reviewed the existing data. OBJECTIVES: To examine the available literature related to the respiratory impairment in PD patients. METHODS: We used PRISMA guidelines when reporting this review. We searched Pubmed, Cinhal, SciELO, and Cochrane Library, from inception until August 2018. Main variables assessed were forced vital capacity percent predicted (FVC%) and forced expiratory volume in 1 s percent predicted (FEV1%) for PD patients. RESULTS: Six studies were included in this systematic review and meta-analysis. The obtained results concluded that PD patients present poorer pulmonary function when compared to healthy controls. When PD patients were compared between ON and OFF states, the results reviewed are in favour of the ON state. In the meta-analysis performed for FVC% and FEV1%, the results fail to find significant differences between PD patients and controls (p = 0.336 and p = 0.281, respectively), and between PD ON and OFF states (p = 0.109 and p = 0.059, respectively). CONCLUSIONS: We conclude that PD patients have impaired respiratory capacities that are related to the PD severity, time since diagnosis, and OFF state. Adequate follow-up of the respiratory function and studies focused on PD phenotypes have to be considered in future studies.

Speech and language therapy treatment on hypokinetic dysarthria in Parkinson disease: Systematic review and meta-analysis.

OBJECTIVE: To assess the effect of speech and language therapy (SLT) on Hypokinetic dysarthria (HD) in Parkinson's disease. DESIGN: Systematic review and meta-analysis of randomized controlled trials. METHODS: We performed a literature search of randomized controlled trials using PubMed, Web of Science, Science Direct and Cochrane database (last search October 2020). Quality assessment and risk of bias were assessed using the Downs and Black scale and the Cochrane tool. The data were pooled and a meta-analysis was completed for sound pressure levels, perceptual intelligibility and inflection of voice fundamental frequency. RESULTS: We selected 15 high to moderate quality studies, which included 619 patients with Parkinson's disease. After pooling the data, 7 studies, which compared different speech language therapies to no treatment, control groups and 3 of their variables, (sound pressure level, semitone standard deviation and perceptual intelligibility) were included in the analysis.Results showed significant differences in favor of SLT for sound pressure level sustained phonation tasks (standard mean difference = 1.79; 95% confidence interval = 0.86, 2.72; p ⩽ 0.0001). Significant results were also observed for sound pressure level and semitone standard deviation in reading tasks (standard mean difference = 1.32; 95% confidence interval = 1.03, 1.61; p ⩽ 0.0001). Additionally, sound pressure levels in monologue tasks showed similar results when SLT was compared to other treatments (standard mean difference = 0.87; 95% confidence interval = 0.46, 1.28; p ⩽ 0.0001). CONCLUSION: This meta-analysis suggests a beneficial effect of SLT for reducing Hypokinetic Dysarthria in Parkinson's disease, improving perceptual intelligibility, sound pressure level and semitone standard deviation.

Deficits underlying handgrip performance in mildly affected chronic stroke persons.

BACKGROUND: Knowledge of the deficits underlying handgrip performance is fundamental for the development of targeted interventions. OBJECTIVES: The purpose of this study was to evaluate maximal handgrip strength, fatigue resistance, grip work, and muscle fatigue in mildly affected stroke persons. METHODS: We conducted a prospective observational study. A total of 20 individuals after a first unilateral ischemic/hemorrhagic chronic stroke (months poststroke: mean 33.64 ± 19.60), mildly affected according to functional score (FIM: 112.71 ± 16.14) and with arm motor impairment (upper-extremity Fugl-Meyer score: mean 57.07 ± 7.82 on the contralesional side); and 20 sex and age-matched controls were included. The outcomes assessed were maximal handgrip strength evaluated through maximal voluntary contraction, fatigue resistance defined as the seconds during which grip strength dropped to 50% of its maximum and gripwork, which was calculated using the equation grip work = maximal grip strength * 0.75 * fatigue resistance. Muscle fatigue was assessed using surface electromyography during a sustained contraction over 50% of maximal voluntary contraction. RESULTS: Persons with stroke demonstrated significantly reduced handgrip performance regarding maximal handgrip strength, resistance to fatigue, grip work, and muscle fatigue for the contralesional hand. In addition, a reduced grip resistance and muscle fatigue was shown for the ipsilesional hand compared with controls. We found no effect of the hemispheric side of the lesion on the grip performance measures assessed. CONCLUSIONS: Our findings provide evidence that handgrip performance remain impaired after 6 months after stroke, and may serve as a target for interventions to improve these abilities after stroke.