Validity and reliability of the Niigata PPPD Questionnaire in a Western population.

PURPOSE: To analyze the psychometric properties of the Niigata Questionnaire (NPQ) for use in a European population with persistent postural-perceptual dizziness (PPPD). METHODS: Observational study included 140 patients with different vestibular conditions. Construct validity, internal consistency and concurrent validity were analyzed. Intra-class correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable change (MDC) were calculated. Receiver operating characteristic (ROC) curve was used to test diagnostic values. RESULTS: Of the 140 patients, 47 had a diagnosis of PPPD. Factorial analysis showed a single-factor structure and concurrent validity analysis showed strong correlations with other instruments. Cronbach alpha coefficients of 0.938 for the total score, 0.869 for the standing and gait subscale, 0.803 for the subscale of movements and 0.852 for the visual stimulation subscale were obtained. The reproducibility was substantial except for the standing subscale, which could be considered moderate. For the standing, movement and visual stimulation subscales and for the total score, the SEM was 3.27, 2.41, 2.50 and 6.63, respectively, and the MDC was 6.40, 4.72, 4.91 and 12.99, respectively. The NPQ total score showed an area under the curve (AUC) of 0.661, a sensitivity of 72.34 and a specificity of 55.91 for discriminating between PPPD and other vestibular disorders. CONCLUSIONS: The NPQ is feasible for use in a Western population and presents a uni-factorial structure, high internal consistency and strong correlation with other instruments. The reliability can be considered substantial. The NPQ has low accuracy in discriminating between subjects with or without PPPD.

Effects of global postural reeducation on postural control, dynamic balance, and ankle range of motion in patients with hallux abducto valgus. A randomized controlled trial.

Hallux abducto valgus (HAV) is a common musculoskeletal disorder that has been addressed surgically. Nevertheless, the manual therapy approach may play an important role in the management of this condition. The present study aimed to determine the effectiveness of global postural reeducation (GPR) in subjects with symptomatic mild to moderate HAV in static postural control, dynamic stability, and ankle dorsiflexion range of motion (DFROM). A total of 80 patients with mild to moderate symptomatic HAV were allocated to the intervention group (GPR) or control group (CG) (no treatment) for 8 weeks. Outcome measures were assessed at baseline at 4 and 8 weeks including static postural control (Romberg test), dynamic balance (Star Excursion Balance Test [SEBT]), and ankle DFROM (Weight-Bearing Lunge Test [WBLT]). No improvements were observed at 4 weeks, but there were improvements at 8 weeks in: static postural control mediolateral displacement (X) of center of pressure (CoP) in both eyes open (EO) and eyes closed (EC): XEO (t(36) = 2.892, p = .006, d = 0.67); XEC (t(68) = 2.280, p = .026, d = 054); and velocity (V) of CoP displacement: VEO (t(68) = 2.380, p = .020, d = 0.57); VEC (t(36) = 2.057, p = .047, d = 0.37). It were also improvements in: WBLT (t(36) = -2.869, p = .007, d = 0.54) and SEBT at three directions (anterior, ANT; posteromedial, PM; and posterolateral, PL): SEBT.ANT (t(36) = -2.292, p = .028, d = 0.23); SEBT.PM (t(36) = -4.075, p < .001, d = 0.43); SEBT.PL (t(62) = -3.506, p = .001, d = 0.34). The present study showed that GPR compared to the CG might be effective in enhancing ankle function including postural control, dynamic balance, and DFROM.

Relationship between Respiratory Muscle Function and Postural Stability in Male Soccer Players: A Case-Control Study.

The important role of postural stability in exercise performance has been determined by several authors. Despite this, few studies have analyzed the relationship between respiratory muscles' strength and postural stability in athletes. For this reason, the aim of this study was to investigate the relationship between postural stability and respiratory muscles' function in male soccer players. A case-control study was conducted over twenty-eight healthy men (18 soccer players; 10 non-athletes). Inspiratory muscle strength (MIP) and respiratory resistance (MVV) were obtained through a digital spirometer. Stability variables were obtained in standing position on a stabilometric platform and in open and closed eyes conditions. The area and length of the center of pressures and displacements in the X and Y range were analyzed. Pearson's coefficient was used to measure the linear correlation between MIP, MVV and stabilometric variables. In the soccer players' group, MIP and MIP % predictive were inversely correlated with length (r = -0.535 and r = -0.585; p < 0.05) and X range (r = -0.527 and r = -0.560; p < 0.05), whereas MVV was directly correlated with length (r = 0.606; p < 0.01) and Y range (r = 0.558; p < 0.05). Our results show that the greater the inspiratory muscle strength, the less displacement of the pressure center, while at higher respiratory rates there is greater displacement.

Misperception of Visual Verticality in Patients with Primary Headache Disorders: A Systematic Review with Meta-Analysis.

Migraine and tension-type headache (TTH) are the two most prevalent primary headache disorders (PHDs) that may involve visual and vestibular impairments, neck pain, and postural unsteadiness. The perception of visual verticality (VV) has been studied in patients diagnosed with PHD to assess balance disorders showing varying findings. Our study aimed to assess the VV perception in patients diagnosed with PHD in comparison to healthy controls. A systematic review with meta-analysis was carried out in PubMed MEDLINE, Scopus, WOS, CINAHL, and SciELO. The Cohen standardized mean difference (SMD) was used to estimate the differences between exposed and healthy controls. Seven studies with 816 participants were included. The quality of included studies, according to the Newcastle-Ottawa Scale (NOS), was moderate (mean score of 5.2). Patients diagnosed with PHD showed a moderate misperception of VV as assessed with the subjective visual vertical (SVV) test (SMD = 0.530; 95% CI = 0.225, 0.836; p < 0.001). Specifically, a misperception of the SVV was found in patients with migraine (SMD = 0.369; 95% CI = 0.1, 0.638; p = 0.007) and with TTH (SMD = 1.122; 95% CI = 0.540, 1.704; p < 0.001). This review shows a misperception of VV in patients with migraine and TTH when assessed with the SVV test, being higher in patients with TTH, although the THH sample size was low.

Manual therapy versus therapeutic exercise in non-specific chronic neck pain: study protocol for a randomized controlled trial.

BACKGROUND: The underlying mechanisms of non-specific chronic neck pain relapses are not clear, but they could be associated with a deficit and alteration of neck muscles propioception that play a decisive role in cervical joint position, motor control of the head, and postural stability. Numerous treatments for non-specific chronic neck pain have been described in the scientific literature. However, few studies analyze its influence on postural stability, since these alterations are not fully described, and various theories emerge about the reasons that cause it. Our primary aim is to analyze the differences in postural stability, pain, cervical disability, and the relation between them produced by a treatment based on manual therapy and another based on therapeutic exercise. METHODS: The short-term and mid-term changes produced by different therapies on subjects with non-specific chronic neck pain will be studied. The sample will be randomly divided into three groups: manual therapy, therapeutic exercise, and placebo. As dependent variables of the study, we will take (1) Overall Balance Index, measured through a dynamic stabilometric platform; (2) pain, based on the visual analog scale and the Pressure Pain Threshold; (3) cervical disability, through the neck disability index. The findings will be analyzed statistically considering a 5% significance level (p ≤ 0.05). DISCUSSION: Our study aims to provide knowledge about postural stability and its relationship with pain in subjects with non-specific chronic neck pain. Analyzing the results produced by different types of therapy will allow us to draw conclusions about the mechanisms, structural or central, that may elicit these alterations. TRIAL REGISTRATION: Brazilian Clinical Trials Registry, RBR-2vj7sw . Registered on 28 November 2018.

La técnica de músculo-energía aplicada en el segmento C7-T1 no modifica la tensión arterial de los pacientes hipertensos. Análisis de seguridad clínica / The muscle energy technique, applied to the c7-t1 segmemt has no effect on blood pressure in patients with hypertension clinical safety analysis

Introducción: La hipertensión arterial (HTA) es una enfermedad crónica caracterizada por el incremento continuo de las cifras de presión arterial. Desde la osteopatía, estos últimos años se ha intentado analizar sus causas, encontrar técnicas seguras para tratar pacientes con hipertensión arterial, además de obtener resultados positivos en los valores de presión arterial tras la aplicación de diferentes técnicas. Objetivos: Analizar la eficacia de la técnica de músculo-energía (TEM) aplicada sobre C7 en pacientes hipertensos en relación a la tensión arterial. Analizar si es segura la técnica de músculo-energía aplicada sobre C7 en pacientes con hipertensión arterial. Material y métodos: Ensayo clínico aleatorizado (ECA), experimental, cegado y controlado. Sesenta y un pacientes (n=61) con hipertensión se distribuyeron aleatoriamente en dos grupos experimental (n=31) y control (n=30). Se realizó una valoración inicial (Pre-intervención) y una final (Post-intervención) analizando los cambios de la tensión arterial sistólica (TAS) y de la tensión arterial diastólica (TAD) en pacientes hipertensos. Los test previos aplicados fueron los de Mitchell, Jackson y Klein. La técnica de intervención utilizada para el estudio fue la técnica de músculo-energía en el segmento vertebral C7-T1 para disfunciones osteopáticas raquídeas. Resultados: No se encontraron diferencias significativas en la variación de TAS y TAD entre los individuos del grupo control y del grupo experimental en ninguna de las cuatro variables de mejora de la tensión arterial. Conclusiones: La aplicación de la técnica de musculo-energía sobre el segmento vertebral C7-T1 es una técnica segura aplicada sobre pacientes hipertensos

Introduction: AHT (arterial hypertension) is a chronic disease, characterised by a continual rise in blood pressure. In recent years, in osteopathy, attempts have been made to analyse the causes of AHT, to find safe techniques for treating patients with AHT and to obtain positive results in changes to blood pressure after applying the different techniques. Objectives: to analyse the effectiveness of the muscle energy technique (MET), applied to the C7 segment in patients with hypertension in terms of changes in blood pressure. To analyse whether the muscle energy technique applied to the C7 segment in patients with arterial hypertension is safe. Materials and Methods: Randomized clinical trial (RCT), experimental, blinded and controlled. Sixty one (n=61) patients with hypertension were randomly distributed into two groups: an experimental group (n=31) and a control group (n=30). An initial assessment (pre-intervention) and a final assessment (post-intervention) were carried out, analysing changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) in patients with hypertension. The tests previously used were the Mitchell, Jackson and Klein tests. The intervention technique used for the study was the muscle energy technique, applied to the spinal segment C7-T1 for spinal somatic dysfunctions. Results: No significantdifferences in variations in SBP or DBP were found between the subjects in the control group and the experimental group for any of the four variables, measuring improvements in blood pressure. Conclusions: The muscle energy technique is a safe technique to apply to the C7-T1 vertebral segment in patients with hypertension

Eficacia del procedimiento osteopático de musculoenergía en la hipertensión arterial / The effectiveness of the osteopathic muscle energy technique in treating arterial hypertension

Introducción: La hipertensión arterial (HTA) es una enfermedad crónica, caracterizada por el incremento de las cifras normales de presión arterial, cuya incidencia está aumentando en los últimos años a nivel mundial y es responsable de elevados costes socio-sanitarios. Objetivos: Determinar la existencia de evidencias publicadas en relación a la eficacia y seguridad de diferentes técnicas osteopáticas respecto a la hipertensión arterial, así, como analizar la indicación de la técnica de musculoenergía (TEM) en esta enfermedad. Valorar la existencia de evidencias publicadas sobre la gravedad de la HTA por su extensión epidemiológica y sus costes socio-sanitarios. Además de analizar la calidad en la escala JADAD de los ensayos clínicos aleatorizados (ECAs) revisados. Material y métodos: Se lleva a cabo una revisión sistemática en las bases de datos Pubmed, Scopus y Teseo, además de una selección de artículos en revistas biomédicas. Aplicamos criterios de selección (inclusión y exclusión) y análisis de elección por título, resumen, palabras clave y texto completo. Resultados: Fueron seleccionados 38 artículos de los 227 incluidos, que reunieron los criterios requeridos. El 50 % de los artículos analizados obtuvo un resultado aceptable respecto a la calidad metodológica de la escala JADAD. Conclusiones: Queda evidenciada la relevancia de la HTA como enfermedad, así como las posibilidades que ofrece la osteopatía para reducir los gastos socio-sanitarios que ésta supone, además de disponer de procedimientos terapéuticos considerados por su seguridad y eficacia

Introduction: arterial Hypertension (AHT) is a chronic disease, characterised by an increase in the normal levels of blood pressure. It has become more common in recent years across the world and is responsible for an increase in spending on health care. Objectives: to determine whether or not there exists any evidence in the literature to support or refute the effectiveness and safety of applying different osteopathic techniques to treat arterial hypertension. Secondly to analyse the indications of applying the muscle energy technique (MET) to treat this disease. And thirdly to assess whether or not there exists any evidence in the literature related to the seriousness of AHT, based on its epidemiology and the implications it has on the cost of health care. We will also use the JADAD scale to assess the quality of the randomized clinical trials we review. Materials and Methods: we carried out a systemic review of the Pubmed, Scopus and Teseo databases, as well as a selection of articles in biomedical journals. We applied certain selection criteria (inclusion and exclusion), followed by eligibility criteria, assessing the articles based on title, abstract, key words and the complete text. Results: 38 articles, that met the required criteria, were selected from the 227 that were included. We scored each of the articles using the JADAD scale for methodological quality and 50% of the articles had an acceptable score. Conclusions: the relevance of AHT as a disease is evident to see, as are the possibilities that osteopathy offers for reducing the healthcare costs that AHT brings and treating the disease using safe and effective procedures

Análisis de la frecuencia cardiaca en hipertensos tras la manipulación con impulso en C7 / Analysis of heart frequency in hypertension after handling with a C7 impulse

Introducción: La hipertensión arterial es la principal causa de morbilidad de la mayoría de los países, afectando al 20% de la población adulta, causando elevados costes a la sociedad. En los últimos años el interés y la sensibilización social en este tema, particularmente en el campo de la osteopatía, han derivado en estudios sobre las variables de frecuencia cardiaca que permitan analizar sus causas y fomentar nuevas técnicas para su tratamiento. Objetivos: Determinar si la manipulación a alta velocidad en el séptimo nivel cervical (C7) en pacientes hipertensos es segura y no modifica la frecuencia cardiaca, tras la intervención. Material y métodos: Estudio aleatorio, experimental, cegado y controlado. Sesenta y uno (n=61) pacientes con hipertensión se distribuyeron aleatoriamente en dos grupos, experimental (n=32) y control (n=29). Se realizó una valoración inicial (Pre-intervención) y una final (Post-intervención) analizando los cambios de la frecuencia cardiaca. Se realizaron evaluaciones previas, mediante los Test de Mitchell, Jackson y Klein. La técnica de intervención aplicada fue la maniobra de impulso (thrust) C7-D1 en decúbito prono, para disfunción en ERS o FRS. Resultados: En los pacientes del grupo experimental, no observamos una reducción significativa tras la manipulación experimental, en la frecuencia cardiaca medida en el brazo izquierdo, en la frecuencia cardiaca pico, en la frecuencia cardiaca de pie, ni en la frecuencia cardiaca en descanso. Conclusiones: La técnica de thrust sobre el segmento cervical C7-D1 aplicada en pacientes hipertensos no reduce significativamente los valores de la frecuencia cardiaca y por tanto es una técnica segura, que podría aplicarse sobre estos pacientes (AU)

Introduction: High blood pressure is the main cause of morbidity in most countries, affecting 20% of the adult population and causing high costs to society. In recent years interest and social awareness in this area, particularly in the field of osteopathy, has led to studies on the variables of heart rate that allow them to analyze their causes and to promote new techniques for treatment. Objective: To determine if high speed manipulation at the seventh cervical level (C7) in hypertensive patients is safe and does not modify the heart rate after intervention. Material and methods: A randomized, experimental, blinded and controlled study. Sixty-one (n = 61) patients with hypertension were randomized into two groups; experimental (n = 32) and control (n = 29). An initial assessment (pre-intervention) and an end assessment (post-intervention) were performed, analyzing changes in heart rate. Previous evaluations were performed using the Mitchell, Jackson and Klein Test. The applied intervention technique was the C7-D1 thrust maneuver in the prone position for dysfunction in ERS or FSR. Results: In patients in the experimental group, we did not observe a significant reduction after experimental manipulation in the heart rate measured in the left arm, the peak heart rate, the standing heart rate, or the resting heart rate. Conclusions: The thrust technique on the cervical segment C7-D1 applied in hypertensive patients does not significantly reduce heart rate values and, therefore, is a safe technique that could be applied to these patients (AU)