Effectiveness of physical therapy interventions in women with dyspareunia: a systematic review and meta-analysis.

BACKGROUND: Dyspareunia is defined as the occurrence of pain during or after sexual intercourse, which directly affects physical, sexual, and mental health. This condition can lead to depression, anxiety, and low self-esteem in women who experience it. OBJECTIVES: The aim of this research was to evaluate the effectiveness of physical therapy interventions for the treatment of female dyspareunia. DESIGN: A systematic review and meta-analysis was conducted. METHOD: Search of publications was conducted in Scopus, Medline, Pubmed, Cinahl and Web of Science. Treatment effects were defined as standardized mean difference and their 95% confidence intervals. Statistical heterogeneity was assessed using Crohan's Q test and quantified using the I2 index. RESULTS: Of the 19 articles selected, six applied multimodal physiotherapy treatments; five, electrotherapy; three, Thiele's massage; two, interdisciplinary interventions or pelvic floor muscle training; and one, extracorporeal shockwave therapy. The meta-analysis showed significant results for the variables pain and quality of life with the interventions based on electrotherapy and electrotherapy combined with pelvic floor muscle training. These interventions did not show significant results for the improvement of sexual function. CONCLUSIONS: Physiotherapy techniques are effective and procedures have been identified with reliable results in improving pain and quality of life in patients with dyspareunia. One of the most important aspects is the strengthening of the perineal musculature and the application of Transcutaneous Electrical Nerve Stimulation. Furthermore, manual trigger point release therapy and Thiele massage, optimize and guarantee the reduction of pain intensity. PROSPERO REGISTRATION: CRD42021236155.

Cultural adaptation and validation of the "Pregnancy Physical Activity Questionnaire" for the Portuguese population.

BACKGROUND: The lack of instruments to assess the level of physical activity in pregnant women, led to the development of the PPAQ (Pregnancy Physical Activity Questionnaire), a self-administered questionnaire, which has already been translated in several countries and has already been used in several studies. AIM(S): Translate and adapt the PPAQ into Portuguese and test its reliability and validity. METHODS: An analytical observational study was carried out. Linguistic and semantic equivalence was performed through translation and back-translation and content validity was tested by a panel of experts. To test reliability, a test-retest was performed on a sample of 184 pregnant women, with an interval of 7 days and the ICC was used. To test the criterion validity, Pearson's correlation coefficient (r) was used between the PPAQ and the accelerometer, in a sample of 226 pregnant women. FINDINGS: The questionnaire was considered comprehensive. The ICC values of Reliability were: total score (0.77); sedentary activities (0.87); light-intensity activities (0.76); moderate-intensity activities (0.76); vigorous-intensity activities (0.70). For criterion validity was obtained a coefficient correlation of r = -0.030, considered weak and negative, for total activity. DISCUSSION: This study describes the translation and validation process of the PPAQ questionnaire from English to Portuguese. The final version of the PPAQ was considered as a valid instrument in terms of content to measure physical activity and was referred to as being simple to apply and easy to understand. CONCLUSION: The PPAQ has content validity, excellent reliability and weak criterion validity, as in the original version.

Efficacy of percutaneous electrolysis for the treatment of tendinopathies: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the efficacy of percutaneous electrolysis for the treatment of patients with tendinopathies. DATA SOURCES: A systematic search of publications was conducted in Pubmed, Cinahl, Medline, Scopus and Web of Science. METHODS: The Oxford 2011 Levels of Evidence and the Jadad scale were used to assess the quality of studies. The mean and standard deviation were obtained for each study group and used to calculate the effect size. The DerSimonian and Laird method was used to develop a random-effects model. RESULTS: Of the 14 articles, four applied percutaneous electrolysis to the knee, three to the shoulder, three to the elbow, two to the hip and two to the ankle and foot. A meta-analysis on intensity of pain (evaluated with algometer and the Visual Analogue Scale) was performed on studies comparing percutaneous electrolysis with a control group, indicating that the groups treated with percutaneous electrolysis had better results (p = 0.01). Although percutaneous electrolysis did not overcome the analgesic effect achieved by corticosteroid injections. CONCLUSIONS: The percutaneous electrolysis is effective for the treatment of tendinopathies. The combination of this technique with eccentric training has proven to be one of the most effective treatments to date for improving pain. PROSPERO Registration: CRD42021230005.

Does Electroacupuncture Treatment Reduce Pain and Change Quantitative Sensory Testing Responses in Patients with Chronic Nonspecific Low Back Pain? A Randomized Controlled Clinical Trial.

Chronic nonspecific low back pain is common and one of the most disabling conditions in the world. There is moderate evidence that chronic low back pain patients present altered functional connectivity in areas related to pain processing. Quantitative sensory testing is a way of clinical measure of these alterations. Although there is not enough evidence, there are some reports that electroacupuncture is supposedly more effective in relieving pain than acupuncture because the addition of electric current could optimize the effects of traditional technique. Thus, the objective of this randomized clinical trial was to verify if electroacupuncture treatment reduces pain and changes quantitative sensory testing responses in patients with chronic nonspecific low back pain. Patients were evaluated before and after 10 sessions regarding pain (11-point numerical rating pain scale) and quantitative sensory testing (pressure pain threshold, temporal summation, and conditioned pain modulation). There were 1 treatment group (electroacupuncture (EA)) and three different control groups (CTR 1, CTR 2, and CTR 3). A total of 69 patients participated in the study. No significant differences were found in pain intensity or quantitative sensory testing responses when comparing electroacupuncture group to the three control groups. There was a significant reduction in both resting and movement pain intensity in groups EA, CTR 1, and CTR3. Although ten sessions of electroacupuncture have diminished pain intensity in both resting and movement, it could not change significantly quantitative sensory testing and diminish central sensitization in patients with chronic nonspecific low back pain. The implications of this study involve the fact that, maybe, in chronic nonspecific low back pain, electroacupuncture should be associated with other treatments that target central sensitization.

Does electrode placement influence tens-induced antihyperalgesia in experimental inflammatory pain model?

BACKGROUND: Transcutaneous electrical nerve stimulation (TENS) is a treatment commonly used for managing pain; however, the ideal placement of the electrodes is not fully understood. OBJECTIVE: To investigate the best way to apply TENS electrodes in an experimental inflammatory pain model. METHOD: Knee joint inflammation was induced in rats, followed by administration of low-frequency TENS (4Hz) under anesthesia for five days. Animals were randomly allocated to five groups according to electrode placement (n=6, each): dermatome, contralateral, paraspinal, acupoint, and control. INTERVENTIONS: Low-frequency TENS at sensory intensity and 100µs pulse duration. Withdrawal thresholds to mechanical (von Frey) and thermal stimuli and joint edema were assessed before induction of inflammation and immediately before and after application of TENS. RESULTS: Reduced paw withdrawal threshold and thermal latency that occur 24h after the induction of inflammation were significantly reversed by the administration of TENS in all groups when compared with sham treatment or with the condition before TENS treatment. No difference was observed in the edema measurement. CONCLUSION: These results offer more options for practitioners to choose the area of the body most commodious for electrode placement, depending on the clinical condition of the patient, because the effect was similar at all sites. In addition, there was a loss of the effectiveness of TENS in reversing mechanical and thermal hyperalgesia on the fifth day, suggesting the development of the tolerance phenomenon.