Physical Therapists' Choices, Views and Agreements Regarding Non-Pharmacological and Non-Surgical Interventions for Knee Osteoarthritis Patients: A Mixed-Methods Study.

Objective/Aims: The aims of this study are to collect the most common non-pharmacological and non-surgical interventions used by the Portuguese physical therapists in their knee osteoarthritis patients, and to deeper understand the factors associated to their intervention choices. Methods: This study incorporated a mixed-methods design. For the quantitative data it was choose an e-survey (with 25 close-end questions, plus general information of the study and a clinical vignette), retrieving sociodemographic and self-reported practice on knee osteoarthritis information. It was analysed response frequencies and associations between variables with logistic regression analyses. For the qualitative data, it was chosen to perform semi-structured interviews in purposefully selected physical therapists to include different sociodemographic factors and survey responses regarding the physical therapists' interventions chosen. After the interviews, the audios were collected, anonymised, transcribed verbatim, and the texts explored by the thematic approach. Results: From the 277 PTs that shown interest in participating in the study, 120 fully completed the questionnaire and, from those, 10 participated in the interviews. The most chosen interventions included Resistance Exercise, Manual Therapy, Nutrition/Weight Loss, Self-care/Education, Stretching and Aquatic Exercise. Furthermore, it seems that PTs' individual characteristics (age, experience, and clinical reasoning), patient's characteristics (clinical findings and preferences), and work-related factors (facility type, work environment and available resources) are the main actors responsible for an intervention chosen. Conclusions: In the Portuguese PTs context the most important interventions are Exercise, Manual Therapy, Nutrition/Weight Loss, and Self-care/Education; these interventions chosen may be influenced by PT, patient and work-related factors.

Effects of Self-myofascial Release Instruments on Performance and Recovery: An Umbrella Review.

Introduction: Currently, the use of self-myofascial release (SMR) instruments is not uncommon in our society, especially in sports. The most common SMR instruments are foam rollers, roller massagers, and balls. Regardless of the instrument used, the main objectives are to enhance performance and recovery. Nevertheless, many studies point out that there is still a lack of robust scientific evidence documenting the exact mechanisms that explain its true effects, therefore some authors affirm that the reported benefits are anecdotal in nature. Objective: This overview aims to summarize, from systematic reviews, the effectiveness of SMR instruments on performance and recovery. Material and Methods: This study followed the PRISMA principles. Systematic reviews were found on the electronic databases according to an established P (healthy active individuals) I (SMR using instruments) C (other treatment, placebo, sham, or no treatment) O (performance and recovery) S (systematic reviews) search strategy. Additionally, methodological analysis was performed using R-AMSTAR. Results: Initially, it was found 15 systematic reviews. However, after methodological analysis, only 7 systematic reviews had sufficient quality to be included. From those, it was found that SMR using instruments is beneficial to enhancing short-term flexibility-related and recovery-related outcomes. Inconstant data was reported in muscular-related outcomes. Nevertheless, beyond pain during SMR, no major adverse effects were found. Different effects between time, pressure and other instrument characteristics were also found. Conclusion: SMR using instruments can be a safe intervention used in sports to enhance performance and recovery from previous training/competition or between matches.

Measuring evidence-based practice in physical therapy: a mix-methods study.

BACKGROUND: Evidence-based practice (EBP) is considered the "holy grail" to manage patients by health practitioners (such as physical therapists). However, sometimes, patients are not treated with the best interventions for their condition. Although studies already explored the facilitators and barriers for this issue, they increase in the level of importance if the information gathered are context appropriated. As the profession is relatively new in Portugal, currently little is known about the implementation of EBP in Portuguese physical therapists context. So, the aim of this study is to know if the Portuguese physical therapists use an EBP, and collect and deeper understand the factors, barriers and facilitators associated with EBP. METHODS: This study incorporated a mixed-methods design (quantitative and qualitative). In an attempt to ensure the correct population sample, a national professional association e-mail database and the e-mails of past students from national schools were requested. For the quantitative data it was choose an e-survey, adapted from the EBP: Beliefs, Attitudes, Knowledge, and Behaviors of Physical Therapists Portuguese version questionnaire, consisted of 55 close-ended questions. It was analyzed response frequencies and associations between variables with logistic regression analyses. For the qualitative data, it was choose to perform semi-structured interviews in purposefully selected physical therapists to include different sociodemographic factors (especially those found to be statistically significant in the logistic regression) and survey responses regarding the physical therapists' beliefs, attitudes, knowledge, and behaviors. The interviews were performed in an online software, where only audio contact was performed. The audios were anonymized and verbatim transcribed, and the texts explored by the thematic approach. RESULTS: From the 277 physical therapists that shown interest in participating in the study, 193 fully completed the questionnaire and, from those, 10 participated in the interviews. The Portuguese physical therapists reported positive beliefs, attitudes, knowledge, and behaviors regarding EBP. Among the physical therapists characteristics it seems that age (younger therapists), education (participating in continuing education courses; belonging to practice-orientated organizations; having a doctorate degree; pursuing a higher academic degree; and being a clinical instructor), and workplace (working for someone else account; and academic sector) are the main factors in the Portuguese EBP implementation. The Portuguese physical therapists, beyond the physical therapists individual characteristics and workplace, also stated that evidence, patients, clinical experience, schools, country and physical therapy characteristics, may behave as facilitators or barriers when performing an EBP.

Reproducibility of isokinetic strength assessment of knee muscle actions in adult athletes: Torques and antagonist-agonist ratios derived at the same angle position.

The current study aimed to examine the reliability of the conventional and functional ratios derived from peak torques (PTs) and those obtained from the combination of knee flexors torque at the angle of knee extensors PT. Twenty-six male athletes (mean of 24.0±0.7 years) from different sports completed a test-to-test variation in isokinetic strength (Biodex, System 3) within a period of one week. Anthropometry and body composition assessed by Dual Energy X-ray Absorptiometry were also measured. The proposed isokinetic strength ratio measurements appeared to be highly reliable: conventional ratio at PT angle (intra-class correlation, ICC = 0.98; 95% confidence interval; 95%CI: 0.95 to 0.99); functional extension ratio at PT angle (ICC = 0.98; 95%CI: 0.96 to 0.99); and, functional flexion ratio at PT angle (ICC = 0.95; 95%CI: 0.89 to 0.98). Technical error of measurement (TEM) and associated percentage of the coefficient of variation (%CV) were as follows: conventional ratio at PT angle (TEM = 0.02; %CV = 4.1); functional extension ratio at PT angle (TEM = 0.02; %CV = 3.8); and, functional flexion ratio at PT angle (TEM = 0.03; %CV = 3.6). The current study demonstrated that the traditional and new obtained simple and combined isokinetic indicators seem highly reliable to assess muscle strength and function in adult male athletes. A single testing session seems to be sufficiently to obtain these isokinetic strength indicators.

Reproducibility of estimated optimal peak output using a force-velocity test on a cycle ergometer.

The current study aimed to examine the reproducibility of estimated peak power and estimated pedal velocity in a multi-trial 10-s all-out cycling test among adult athletes (n = 22; aged 23.50±4.73 years). Stature, sitting height and body mass were measured. Leg length was estimated as stature minus sitting height. Body volume was obtained from air displacement plethysmography and was subsequently used to calculate body density. Fat mass and fat-free mass were derived. The short-term power outputs were assessed from the force-velocity test (FVT), using a friction-braked ergometer on two separated occasions. Differences between repeated measurements were examined with paired t-test and effect sizes calculated. No significant differences were found between session 1 (898 W, 142 rpm) and session 2 (906 W, 142 rpm). Test-retest procedure showed acceptable reliability for estimated peak power output [technical error of measurement (TEM) = 31.9 W; % coefficient of variation (CV) = 3.5; intra-class correlation coefficient (ICC) = 0.986] and pedal velocity (TEM = 5.4 rpm, %CV = 3.8, ICC = 0.924). The current study demonstrated a reasonable reproducibility of estimated peak power and pedal velocity outputs in non-elite male athletes and supports that a familiarization session including a complete FVT protocol is not required.

Feasibility of a Home-Based Therapeutic Exercise Program in Individuals With Knee Osteoarthritis.

OBJECTIVES: This study aims to evaluate the feasibility and potential benefits of a four-week home-based therapeutic exercise program for individuals with osteoarthritis (OA) of the knee. PATIENTS AND METHODS: Feasibility outcomes, namely the recruitment rate, retention rate, exercise adherence and adverse events, as well as pain, knee muscle strength, range of motion, functional mobility, physical function, and postural sway were assessed on 15 individuals (4 males, 11 females; mean age 62.8±2.5 years; range 55 to 83 years) with knee OA before and after a four-week home-based therapeutic exercise program. RESULTS: The main results indicated that this program was feasible, as indicated by recruitment, adherence, and safety outcomes. The retention rate was 80% and the overall exercise adherence for those completing the program was 93%. The exercise program improved significantly pain intensity (visual analog scale: 5.8±2.8 to 3.8±2.4 cm, p=0.006), functional mobility, muscle strength, and physical function (Knee injury and OA Outcome Score-Physical Function Short-form: 53.8±21.0 to 41.3±13.9 points, p=0.011). CONCLUSION: This home-based therapeutic exercise program is feasible for individuals with OA of the knee and seems to improve pain intensity, functional mobility, muscle strength, and physical function.

Quality of life, school backpack weight, and nonspecific low back pain in children and adolescents / Qualidade de vida, peso das mochilas escolares e lombalgia não específica em crianças e adolescentes

OBJECTIVES: To describe the degree of disability, anthropometric variables, quality of life (QoL), and school backpack weight in boys and girls aged 11-17 years. The differences in QoL between those who did or did not report low back pain (LBP) were also analyzed. METHODS: Eighty-six girls (13.9 ± 1.9 years of age) and 63 boys (13.7 ± 1.7 years of age) participated. LBP was assessed by questionnaire, and disability using the Roland-Morris Disability Questionnaire. QoL was assessed by the Pediatric Quality of Life Inventory (PedsQL). Multivariate analyses of variance and covariance were used to assess differences between groups. RESULTS: Girls reported higher disability than boys (p = 0.01), and lower QoL in the domains of physical (p < 0.001) and emotional functioning (p < 0.01), psychosocial health (p = 0.02) and physical health summary score (p < 0.001), and on the total PedsQL score (p < 0.01). School backpack weight was similar in both genders (p = 0.61) and in participants with and without LBP (p = 0.15). After adjustments, participants with LBP reported lower physical functioning (p < 0.01), influencing lower physical health summary score (p < 0.01). CONCLUSIONS: Girls had higher disability and lower QoL than boys in the domains of physical and emotional functioning, psychosocial health, and physical health summary scores, and on the total PedsQL score; however, similar school backpack weight was reported. Participants with LBP revealed lower physical functioning and physical health summary score, yet had similar school backpack weight to those without LBP. .

OBJETIVOS: Descrever o grau de incapacidade, as variáveis antropométricas, a qualidade de vida (QV) e o peso das mochilas escolares em meninos e meninas com 11-17 anos. Também são analisadas as diferenças na QV entre os que relataram ou não lombalgia (LBP). MÉTODOS: 86 meninas (13,9 ± 1,9 anos) e 63 meninos (13,7 ± 1,7 anos) participaram. A LBP foi avaliada por um questionário e a incapacidade pelo Questionário Roland-Morris. A QV foi avaliada pelo Questionário Pediátrico sobre Qualidade de Vida (PedsQL). As análises de variância e de covariância multivariadas foram usadas para avaliar as diferenças entre os grupos. RESULTADOS: As meninas relataram maior incapacidade do que os meninos (p = 0,01) e menor QV nos domínios de funcionamento físico (p < 0,001) e emocional (p < 0,01), no escore sumário de saúde psicossocial (p = 0,02) e saúde física (p < 0,001) e no escore total no PedsQL (p < 0,01). O peso das mochilas escolares era semelhante para ambos os sexos (p = 0,61) e para os participantes com e sem LBP (p = 0,15). Após ajustes, os participantes com LBP relataram menor funcionamento físico (p < 0,01), o que influenciou um menor escore sumário de saúde física (p < 0,01). CONCLUSÕES: As meninas tiveram maior incapacidade e menor QV do que os meninos nos domínios de funcionamento físico e emocional, nos escores sumários de saúde psicossocial e física e no escore total no PedsQL; contudo, foi relatado um peso semelhante das mochilas escolares. Os participantes com LBP revelaram menor funcionamento físico e escore sumário de saúde física, mesmo carregando mochilas escolares de mesmo peso do que aqueles sem LBP. .

Quality of life, school backpack weight, and nonspecific low back pain in children and adolescents.

OBJECTIVES: To describe the degree of disability, anthropometric variables, quality of life (QoL), and school backpack weight in boys and girls aged 11-17 years. The differences in QoL between those who did or did not report low back pain (LBP) were also analyzed. METHODS: Eighty-six girls (13.9 ± 1.9 years of age) and 63 boys (13.7 ± 1.7 years of age) participated. LBP was assessed by questionnaire, and disability using the Roland-Morris Disability Questionnaire. QoL was assessed by the Pediatric Quality of Life Inventory (PedsQL). Multivariate analyses of variance and covariance were used to assess differences between groups. RESULTS: Girls reported higher disability than boys (p = 0.01), and lower QoL in the domains of physical (p < 0.001) and emotional functioning (p < 0.01), psychosocial health (p = 0.02) and physical health summary score (p < 0.001), and on the total PedsQL score (p < 0.01). School backpack weight was similar in both genders (p = 0.61) and in participants with and without LBP (p = 0.15). After adjustments, participants with LBP reported lower physical functioning (p < 0.01), influencing lower physical health summary score (p < 0.01). CONCLUSIONS: Girls had higher disability and lower QoL than boys in the domains of physical and emotional functioning, psychosocial health, and physical health summary scores, and on the total PedsQL score; however, similar school backpack weight was reported. Participants with LBP revealed lower physical functioning and physical health summary score, yet had similar school backpack weight to those without LBP.

Reliability and validity of PedsQL for Portuguese children aged 5-7 and 8-12 years.

BACKGROUND: Pediatric Quality of Life Inventory (PedsQL) is a measure to assess health-related quality of life (HRQoL) in children and adolescents. It is formed by 23 items adapted to children age and includes a parent proxy report version. With four multidimensional subscales and three summary scores, it measures health as defined by WHO. The concepts measured by this instrument are 'physical functioning' (8 items), 'emotional functioning' (5 items), 'social functioning' (5 items) and 'school functioning' (5 items). It also measures a 'total scale score' (23 items), a 'physical health summary score' (8 items) and a 'psychosocial health summary score' (15 items). The aim of this paper is to present the main results of the cultural adaptation and validation of the PedsQL into European Portuguese. METHODS: The Portuguese version was the result of a forward-backward translation process, with a cognitive debriefing analysis, guaranteeing face validity and semantic equivalence. Children aged 5-7 and 8-12 were randomly selected and were asked to fill a socio-demographic data survey and the Portuguese versions of PedsQL and KINDL, another HRQoL measure for children and adolescents. They were divided into three groups, healthy children, children with type I diabetes and children with spina bifida. RESULTS: A total of 179 children and 97 parents were recruited. PedsQL demonstrated good levels of reproducibility (r > 0.95 in all versions) and acceptable levels of internal consistency with Cronbach's alpha at 0.70 on most scales. Concordance values between children's and parents' perceptions ranged between 0.36 and 0.78 and the correlations with KINDL questionnaire were excellent, supporting concurrent validity. CONCLUSIONS: The Portuguese version of the PedsQL demonstrated acceptable psychometric properties for future research and clinical practice for children aged 5-12.

Assessment of reliability in isokinetic testing among adolescent basketball players.

BACKGROUND: The reproducibility of day-to-day testing of isokinetic concentric and eccentric muscular actions among adolescent basketball players aged 14 to 16 years and relationships of mean within-subject variation in two isokinetic testing sessions with chronological age, biological maturation (estimated age at peak height velocity), training experience, body size, lower-body morphology, and initial strength performance were evaluated. MATERIAL AND METHODS: The sample included 27 basketball players who completed replicate test sessions of 5 repetitions of reciprocal concentric and eccentric knee extensions and flexions at 60º s(-1). A randomly selected subsample of 8 players completed a third testing session to confirm reliability estimates. RESULTS: Coefficients of variation (CV) between sessions 1 and 2 ranged from 8.1% to 17.4%, and intraclass coefficients (ICCs) ranged from 0.72 to 0.89. For sessions 1 and 3, CVs ranged from 3.9% to 6.0%, and ICCs ranged from 0.95 to 0.99. The initial level of strength of eccentric knee flexion (r=-0.43) and eccentric knee extension (r=-0.42) were correlated (P<0.05) with eccentric knee extension within-variation between two sessions. Training experience (r=-0.37, P<0.05) and initial values of concentric knee flexion (r=-0.62, P<0.01) were correlated with concentric knee flexion within-subject differences. Within-subject variation of eccentric knee extension was correlated (P<0.05) with chronologic age (r=0.41), estimated age at peak height velocity (r=-0.38), body size (r=0.41 to 0.47), and leg volume (r=0.39). CONCLUSIONS: Familiarization sessions may improve the reliability of concentric and eccentric knee isokinetic strength testing at 60º s(-1) in adolescent basketball players. Age, maturity status, and training experience of young athletes should be considered when testing knee isokinetic strength at 60º s(-1).