Effectiveness of visceral fascial therapy targeting visceral dysfunctions outcome: systematic review of randomized controlled trials.

BACKGROUND: Fascial Therapy is an ancient and widespread practice throughout the world. These approaches are very common in osteopathic practice and taught in workshops for professionals from different areas of health care, including Physiotherapy. This type of treatment is quite specialized and centered on the therapist. However, there is a lack of high-quality and low-risk bias studies that justify the use of this practice. Despite this, there is little scientific evidence about the effectiveness of Fascial Therapy to treat some visceral disorders. The purpose of this study was to critically appraise the scientific literature concerning the clinical efficacy of techniques used in Fascial Therapy targeting the visceral system. METHODS: This systematic review included randomized controlled trials in any language or date of publication. All primary outcomes reported were included. The methodological quality and statistical reporting of each eligible trial were evaluated using the version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). This systematic review provided a synthesis of current evidence on the effects of Fascial Therapy in patients with visceral disorders and/or pain. A total of 11 studies were included, with five of them covering gastrointestinal dysfunction, two covering cardiorespiratory dysfunction, two covering musculoskeletal dysfunction, and two covering urogenital dysfunction. RESULTS: Fascial Therapy targeting the visceral system has been shown to be effective in reducing pain over the long term in people with low back pain when combined with standard physical therapy and effective in reducing gastroesophageal reflux symptoms over the short term. Considering the overall bias, six studies were at high risk of bias, two studies had some concerns and only three studies were at low risk of bias. Of the three studies with a low risk of bias, only two showed positive results and were effective in improving the studied outcome. CONCLUSION: This systematic review shows that currently, there is poor evidence for the efficacy of the techniques used in Fascial Therapy targeting the visceral system, and this information can help healthcare professionals in decision-making related to the use of Fascial Therapy targeting the visceral system in patients with visceral disorders and/or pain.

Effects of visceral manipulation associated with pelvic floor muscles training in women with urinary incontinence: A randomized controlled trial.

AIMS: To compare the effects of manual visceral therapy (MVT) associated with pelvic floor muscle training (PFMT) on urinary incontinence (UI) symptoms, vaginal resting pressure, and maximum voluntary contraction of the pelvic floor muscles (PFM). METHODS: A double-blinded randomized controlled trial of 5 weeks duration with two active intervention arms: PFMT + MVT and PFMT + manual sham therapy (MST). Participants were women over 18 years of age with complaint or diagnosis of UI symptoms. The primary outcome was the severity of UI symptoms, assessed by the International Consultation on Incontinence Questionnaire - Short Form. The secondary outcomes measures included the vaginal resting pressure and the maximum voluntary contraction of PFM assessed by digital manometry. RESULTS: Fifty-two incontinent women participated in the study. There was no significant difference between groups in UI symptoms (F (1.74, 86.9) = 0.406; p = 0.638), vaginal resting pressure (mean difference -1.5 cmH20 [95% confidence interval [CI] -4.5 to 1.5; p = 0.33]), and maximum voluntary contraction of PFM (median 0.0 cmH20 [25%-75% interquartile range 0.0-5.6; p = 0.12]) after the intervention period. CONCLUSIONS: Combining MVT with PFMT was not more effective than PFMT alone in reducing UI symptoms, in change vaginal resting pressure and maximum voluntary contraction of PFM. Due to the limitations of the study, further investigations are still needed to confirm these findings.

Analysis of isokinetic muscle function and postural control in individuals with intermittent claudication

BACKGROUND: Intermittent claudication (IC) is a debilitating condition that mostly affects elderly people. IC is manifested by a decrease in ambulatory function. Individuals with IC present with motor and sensory nerve dysfunction in the lower extremities, which may lead to deficits in balance. OBJECTIVE: This study aimed to measure postural control and isokinetic muscle function in individuals with intermittent claudication. METHOD: The study included 32 participants of both genders, 16 IC participants (mean age: 64 years, SD=6) and 16 healthy controls (mean age: 67 years, SD=5), which were allocated into two groups: intermittent claudication group (ICG) and control group (CG). Postural control was assessed using the displacement and velocity of the center of pressure (COP) during the sensory organization test (SOT) and the motor control test (MCT). Muscle function of the flexor and extensor muscles of the knee and ankle was measured by an isokinetic dynamometer. Independent t tests were used to calculate the between-group differences. RESULTS: The ICG presented greater displacement (p =0.027) and speed (p =0.033) of the COP in the anteroposterior direction (COPap) during the MCT, as well as longer latency (p =0.004). There were no between-group differences during the SOT. The ICG showed decreased muscle strength and power in the plantar flexors compared to the CG. CONCLUSION: Subjects with IC have lower values of strength and muscle power of plantiflexores, as well as changes in postural control in dynamic conditions. These individuals may be more vulnerable to falls than healthy subjects.

Analysis of isokinetic muscle function and postural control in individuals with intermittent claudication.

BACKGROUND: Intermittent claudication (IC) is a debilitating condition that mostly affects elderly people. IC is manifested by a decrease in ambulatory function. Individuals with IC present with motor and sensory nerve dysfunction in the lower extremities, which may lead to deficits in balance. OBJECTIVE: This study aimed to measure postural control and isokinetic muscle function in individuals with intermittent claudication. METHOD: The study included 32 participants of both genders, 16 IC participants (mean age: 64 years, SD=6) and 16 healthy controls (mean age: 67 years, SD=5), which were allocated into two groups: intermittent claudication group (ICG) and control group (CG). Postural control was assessed using the displacement and velocity of the center of pressure (COP) during the sensory organization test (SOT) and the motor control test (MCT). Muscle function of the flexor and extensor muscles of the knee and ankle was measured by an isokinetic dynamometer. Independent t tests were used to calculate the between-group differences. RESULTS: The ICG presented greater displacement (p =0.027) and speed (p =0.033) of the COP in the anteroposterior direction (COPap) during the MCT, as well as longer latency (p =0.004). There were no between-group differences during the SOT. The ICG showed decreased muscle strength and power in the plantar flexors compared to the CG. CONCLUSION: Subjects with IC have lower values of strength and muscle power of plantiflexores, as well as changes in postural control in dynamic conditions. These individuals may be more vulnerable to falls than healthy subjects.

Predictive values at risk of falling in physically active and no active elderly with Berg Balance Scale.

BACKGROUND: The consequences of falls are a major cause of autonomy and independence loss among the elderly. In this context, the Berg Balance Scale (BBS) has been widely used to detect the risk of falls in elderly. OBJECTIVE: To evaluate the predictive value of the BBS for fall risk in physically active and inactive elderly subjects. METHODS: The sample included 188 older adults with a mean age of 66 (±9) years. Of these, 91 participated in a regular physical activity program and 96 did not. We analyzed the cut-off scores of 45, 47, 49, 51 and 53 in both groups regarding the sensitivity (S), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of the test, including the positive likelihood ratio (PLR) and negative likelihood ratio (RVN) for diagnosing the risk of falls. RESULTS: The mean BBS score was 54.7 in physically active subjects and 50.8 in inactive subjects, which was statistically significant (ρ=0.001). The best cut-off was a score of 49 for physically inactive subjects, with a sensitivity of 91% and a specificity of 92%. On the other hand, the BBS had low sensitivity (from 0 to 15%) and high specificity (between 83% and 100%) for physically active subjects at the cut-off points analyzed. CONCLUSION: The scale did not achieve sufficient sensitivity to individual differences among physically active older people with higher levels of functional balance ability.

Predictive values at risk of falling in physically active and no active elderly with Berg Balance Scale / Valores preditivos para o risco de queda em idosos praticantes e não praticantes de atividade física por meio do uso da Escala de Equilíbrio de Berg

BACKGROUND: The consequences of falls are a major cause of autonomy and independence loss among the elderly. In this context, the Berg Balance Scale (BBS) has been widely used to detect the risk of falls in elderly. OBJECTIVE: To evaluate the predictive value of the BBS for fall risk in physically active and inactive elderly subjects. METHODS: The sample included 188 older adults with a mean age of 66 (±9) years. Of these, 91 participated in a regular physical activity program and 96 did not. We analyzed the cut-off scores of 45, 47, 49, 51 and 53 in both groups regarding the sensitivity (S), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of the test, including the positive likelihood ratio (PLR) and negative likelihood ratio (RVN) for diagnosing the risk of falls. RESULTS: The mean BBS score was 54.7 in physically active subjects and 50.8 in inactive subjects, which was statistically significant (ρ=0.001). The best cut-off was a score of 49 for physically inactive subjects, with a sensitivity of 91 percent and a specificity of 92 percent. On the other hand, the BBS had low sensitivity (from 0 to 15 percent) and high specificity (between 83 percent and 100 percent) for physically active subjects at the cut-off points analyzed. CONCLUSION: The scale did not achieve sufficient sensitivity to individual differences among physically active older people with higher levels of functional balance ability.

CONTEXTUALIZAÇÃO: Umas das principais causas da perda da autonomia e independência do idoso são as consequências geradas pelas quedas. Nesse contexto, a Escala de Equilíbrio de Berg (EEB) vem sendo amplamente utilizada para detectar o risco de queda em idosos. Objetivo: Analisar os valores preditivos para o risco de queda em idosos praticantes e não-praticantes de atividade física por meio do uso da EEB. MÉTODOS: Participaram 188 idosos, com média de idade de 66 (±9) anos. Desses, 91 participavam de projetos de atividades físicas, e 96 não praticavam atividade física regularmente. Foram analisados os pontos de corte 45, 47, 49, 51 e 53 em ambos os grupos, quanto à sensibilidade (S), especificidade (E), valor preditivo positivo (VPP) e negativo (VPN) do teste, razão de verossimilhança positiva (RVP) e negativa (RVN) para diagnóstico do risco de queda. RESULTADOS: Evidenciou-se que a média do escore da EEB nos praticantes de atividade física foi de 54,7 pontos; enquanto que, entre os não-praticantes, foi de 50,8, obtendo-se diferença significativa entre os grupos (ρ=0,001). Nos sujeitos não-praticantes de atividade física, o melhor ponto de corte foi em 49 pontos, apresentando S de 91 por cento e E de 92 por cento, enquanto a EEB apresentou baixa S, variando entre 0 por cento e 15 por cento, e alta E, variando entre 83 por cento e 100 por cento nos sujeitos praticantes de atividade física regular nos pontos de corte analisados. CONCLUSÃO: A escala não alcançou S suficiente para diferenças individuais entre idosos com altos níveis de capacidade de equilíbrio dentre aqueles que praticam atividades físicas regularmente.

Avaliação mecânica da resistência de faixas elásticas / Mechanical evaluation of the resistance of elastic bands

CONTEXTUALIZAÇÃO: As faixas elásticas são frequentemente utilizadas em programas de treinamento resistivo, entretanto a seleção da progressão entre os níveis de resistência elástica é feita de maneira subjetiva em virtude da deficiência de dados quantitativos que expressem o valor da resistência em função da tração do material. OBJETIVOS: Investigar a resistência elástica gerada em cada um dos oito níveis de resistências das faixas elásticas em 100 por cento de alongamento e quantificar a variação existente de um nível para outro. MÉTODOS: A amostra foi constituída de 80 corpos de prova, retirados dos oito níveis de resistência. O ensaio de tração nos corpos de prova modelo C foi realizado conforme a norma técnica ASTM D 412-06ª pela máquina universal de ensaios DL EMIC 3000. Cada ciclo de tração foi realizado na velocidade de 500 mm/seg. Para a análise estatística, utilizou-se o teste Anova one-way com nível de significância de ρ<0,05. RESULTADOS: A amostra apresentou diferença significativa da resistência elástica no espectro de níveis avaliados, exceto entre as resistências suaves (amarelo) e médias (vermelho). A análise da variação da resistência entre as faixas mostra que a dourada (máximo) oferece 5,13 vezes mais resistência que a branca (extrasuave), e a maior variação na progressão encontra-se entre as faixas preta e cinza. Além disso, o módulo de Young apresentou comportamento linear entre as diferentes cores. CONCLUSÕES: Os resultados mostraram que a variação da resistência elástica e da rigidez do material são progressivas entre os diferentes níveis. Além disso, os dados sugerem a possibilidade de progressão da faixa branca para a vermelha, eliminando a amarela na prescrição de exercícios de fortalecimento.

BACKGROUND: Elastic bands are frequently used for resistance training, however the selection of the bands to progress through the levels of elastic resistance is done in a subjective manner. This is due to the lack of quantitative data on the value of the material's resistance as a function of its tension. Objectives: To investigate the elastic resistance generated by each of the eight color-coded resistance levels of elastic bands, using 100 percent elongation, and to quantify the resistance variation from one level to the next. METHODS: Tensile testing was performed in compliance with ASTM Standard D412-06a. The sample consisted of 80 die-cut test specimens (Die C) taken from the eight color-coded resistance levels. The sample was submitted to tensile testing in the universal testing machine EMIC DL-3000. Each of the tension cycles was performed at a speed of 500mm/sec. Statistical analysis was done using one-way ANOVA, with a significance level of p<0.05. RESULTS: The sample showed a significant difference between all levels of resistance, except for the yellow (thin) and red (medium) elastic bands. The variation in resistance between the bands shows that the gold (max) band offers 5.13 times more resistance than the tan (extra thin) band, and that the greatest variation in progressive resistance is between the black and the silver bands. In addition, Young's modulus showed linear behavior between the different colors. CONCLUSIONS: The results showed that the elastic resistance and stiffness of the material exhibits a linear and progressive variation. In addition, the data suggested the possibility of progressing from the tan band to the red band, skipping the yellow band, when prescribing resistance exercises.