Nest positioning on motor development, sleep patterns, weight gain in preterm infants: systematic review.

The aim was to evaluate the effects of Nest Positioning (NP) on motor development, sleep patterns, and weight gain in preterm newborns (PTNB) hospitalized in a neonatal intensive care unit (NICU). This study was constructed based on PRISMA guideline criteria. Systematic research was carried out in electronic databases: MEDLINE via PubMed, Web of Science, Scopus, and VHL-BIREME following the PICOS strategy. Studies with PTNB populations who were hospitalized in the NICU and received therapeutic NP as an intervention strategy in this population were included in this study. We sought outcomes related to sleep patterns, weight gain, and motor development. After selection, 12 studies were included in this systematic review, of which 5 (41.7%) evaluated motor development as their primary outcome, 6 (50%) sleep-wake cycle patterns, and 1 (8.3%), weight gain and, subsequently, hospital discharge. Qualitative results indicate that prolonged exposure to decubitus variations may favor PTNB hospitalized in NICUs acquiring flexor postures, stimulate their midline, and increase their total sleep time. Studies reported no adverse effects regarding the use of NP. Evidence suggests that NP benefits motor development and sleep pattern in PTNB hospitalized in NICUs. IMPACT: Nest positioning improves sleep quality in preterm newborns hospitalized in neonatal intensive care unit. Nest positioning improves motor development in preterm newborns hospitalized in neonatal intensive care unit. No evidence of nest positioning on weight gain was observed. Half of the included clinical studies showed good methodological quality. Nesting positioning is a secure and cost-effective method.

Epidemiology of injuries in young volleyball athletes: a systematic review.

BACKGROUND: Volleyball is among the five most popular sports in the world. Regardless of level and age, volleyball athletes perform fast high-impact movements such as jumps, landings, and changes in direction, demanding motor and sensory skills to avoid injuries. The available scientific literature provides information regarding the incidence of injuries in volleyball, but the evidence of injuries in young volleyball athletes (12-18 years old) is not well defined. Therefore, a systematic review was conducted to investigate the incidence and prevalence of injuries in young volleyball players. METHODS: This systematic review was conducted according to the PRISMA recommendations and prospectively registered in PROSPERO (ID: CRD42022344623). An electronic search was conducted in the following databases: Web of Science, PubMed, and SportDiscuss via EBSCO in August 2022 and March 2023. Inclusion criteria followed the PICOS acronym: (P) youth volleyball players; (I) volleyball; (C) none; (O) incidence and/or prevalence of injury; and (S) cohort studies. The risk of bias was analysed using the adapted STROBE instrument. RESULTS: Five studies were included in the qualitative analysis. They had a mean methodological quality of 6 (range 4-8) on the modified STROBE scale. Injury incidence was presented in varying ways, ranging from 1.51 injuries/1000 player hours to 12.4 injuries/10,000 athlete exposures (AEs). The prevalence was 1.6 ± 1.7 per 100 AEs. A total sample of 3698 youth volleyball athletes predominantly females was found. The body sites with the highest rate of injuries were the ankle, the distal portion of the upper limbs (wrist/hand/fingers) and the knee, respectively. CONCLUSION: There was remarkable variability in the rate of injuries and the form of presentation between the studies. In addition, junior volleyball athletes had lower injury rates compared to other sports practised in high school, and older athletes had higher injury rates.

Conservative management following patellar dislocation: a level I systematic review.

BACKGROUND: Patellar instability is a common and disabling clinical condition. Treatment of acute primary patellar dislocation aims to reduce the risk of recurrence or painful subluxation and improve function. However, the actual clinical efficacy of any management modality following an acute dislocation has never been demonstrated in prospective or retrospective studies, and the optimal way in which the various management modalities should be used is at best unclear. METHODS: A search was conducted in PubMed, Bireme and Embase databases. Inclusion criteria followed the acronym PICOS, (P) subjects with patellar instability, (I) therapeutic interventions, (C) placebo or control or surgical treatments, (O) rate of dislocations and function, and (S) clinical trials. The Medical Subject Headings (MeSH) terms used were: (("patellar instability") OR ("patellar dislocation")) AND ((physiotherapy) OR (rehabilitation) OR ("conservative treatment") OR (therapy) OR (therapeutic)). The risk of bias was analysed using the PeDRO scale. RESULTS: Seven randomized controlled trials including 282 patients were considered. The quality of studies detailing the results of conservative treatment was higher than that of surgical procedures, but all studies have relatively low methodological quality. Four studies compared physiotherapeutic interventions with surgical procedures, and three studies compared conservative intervention techniques. CONCLUSION: An unstructured lower limb physical therapy programme evidences similar outcomes to specific exercises. Surgical management is associated with a lower rate of re-dislocation; however, whether surgery produces greater functional outcomes than conservative management is still unclear. The use of a knee brace with a limited range of motion, stretching and neuromuscular exercises are the most commonly recommended physiotherapy methodologies.

Which resistance training is safest to practice? A systematic review.

BACKGROUND: The combination of resistance training (RT) and aerobic training is believed to achieve the best effects. Several different aerobic training methods have emerged in combination with or as a substitute for traditional RT. This study wished to verify which RT is safest in terms of injury prevalence and incidence. Also, it ascertained the characteristics of the injured subjects, the level of severity of the injuries and what definitions of injuries the available studies use. METHODS: This systematic review followed the PRISMA recommendations and was registered in PROSPERO with the number CRD42021257010. The searches were performed in the PubMed, Cochrane and Web of Science, electronic databases using the Medical Subject Headings terms "Resistance training" or "Strength training" or "Crossfit" or "Weightlifting" or "Powerlifting" combined (AND) with "Injury" or "Injuries" or "Sprain" AND "Incidence" or "Prevalence" AND "Epidemiology" or "Epidemiological" in the title or abstract. The last search was performed on March 2023. To be included in the review, the studies had to be available as full text, be clinical trials focusing on epidemiological injuries of resistance training. There was no time limit for the selection of articles. To assess the quality of the studies, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used. RESULTS: The initial literature search resulted in 4982 studies. After reading the titles, abstracts and full text, 28 articles were selected for data extraction. Seventeen investigated the injuries in HIFT/CrossFit, three in powerlifting, three in strength training, three in weightlifting and one in strongman. In addition, one study examined the HIFT/CrossFit and weightlifting. The incidence of injuries presented in the studies ranged from 0.21/1000 h to 18.9/1000 h and the prevalence of injuries was 10% to 82%. In the quality assessment for STROBE, five studies were classified at level A, 21 at level B and two at level C. CONCLUSION: This systematic review showed that traditional strength training is the safest RT method, and strongman is the least safe regarding injuries. Few studies have been rated highly according to STROBE. Furthermore, few studies have been published on some RT methods. These two factors make it difficult to generalize the results.

Eccentric exercise is more effective than other exercises in the treatment of mid-portion Achilles tendinopathy: systematic review and meta-analysis.

Achilles tendinopathy (AT) is one of the most frequent overuse injuries in the ankle. The evidence base for its conservative management AT continues to evolve, but there is still a gap in the evidence for the efficacy of any modality of treatment in high-quality studies. This systematic review and meta-analysis investigated the efficacy of EE in improving pain and function in adult patients with mid-portion Achilles tendinopathy compared to other forms of exercise. A search was performed in PubMed, BIREME, SportDiscus, Cinahl, Web of Science and PEDro, in November 2022. The methodological quality was evaluated using the Risk of Bias 2 tool (RoB2) of the Cochrane collaboration, and the meta-analysis was performed using the Review Manager 5.1 program. 2024 articles were identified and eight fulfilled the inclusion criteria. RoB2 presented a final score with 62.5% of the studies presented "some concerns", and 37.5% (five and three articles, respectively) presenting "high risk" of bias. EE was effective for the managment of AT. The only variable for which a meta-analysis was possible was pain (five articles), analysed with the visual analogue scale/numerical visual scale. The mean difference (MD) in treatment effect using EE was - 1.21 (- 2.72 to - 0.30) with a 95% of confidence interval (CI), thus identifying a significant positive effect for the improvement of pain in patients with AT in whom EE was used. EE is effective in the management of AT. The meta-analysis shows the need for appropriately powered randomized controlled trials with better design, the use of standard outcome measures and well-planned protocols for conservative management of AT.Level of evidence: Level 1.Registration: CRD42018118016.

Epidemiology of High Intensity Functional Training (HIFT) injuries in Brazil.

BACKGROUND: High intensity functional training (HIFT), usually called CrossFit, is a physical training that has gained much popularity in the past few years. The risk of acute and overuse injuries in HIFT is unclear. This study evaluated the incidence of injuries in HIFT, characterizing severity, location, and associated risk factors. METHODS: This cross-sectional study was conducted between January and May 2021. HIFT practitioners were recruited through social media and answered an online questionnaire on training characteristics and injury history. RESULTS: A total of 606 subjects (264 male and 342 female) were included. The average age of the participants was 29.78 ± 7.14 years. The mean height was 169.60 ± 8.96 cm, and the mean body mass was 73.69 ± 13.11 kg. Overall, participants were involved in HIFT for an average of 25.36 ± 20.29 months. A total of 58.6% of participants took part in 5 to 6 training sessions per week, 31.7% practiced 5 to 6 h per week. 62.7% of the responders performed other physical activities in parallel, 98.2% performed warm-up before the training, and a formal cooldown was accomplished by 29.4% of participants. 6.8% of athletes followed individual worksheets. 45.9% of participants participated in competition. CONCLUSIONS: The overall rate of injuries was 3.51/1000 h. 59.2% of subjects experienced two or more injuries. The shoulder was involved in 21.3% of cases, lower back in 18.3%, and the knee in 13.4%. No difference was found in injury rate between males and females. Experienced athletes were more prone to injury compared to those who trained under 12 months. Approximately the half of injuries did not cause training interruption. No difference was found in injury rate between males and females. The purpose of the participant did not impact the injury rate, nor did the practice of warm-up and cooldown, the time of weekly training, the league and level of competition. Finally, the participation in other sports in parallel did not demonstrated association with the injury occurrence. TRIAL REGISTRATION: The present study was approved by the Ethics and Research Committee by Plataforma Brazil and follows the Resolution 466/2012/CNS/MS/CONEP.

Return to sport after conservative versus surgical treatment for pubalgia in athletes: a systematic review.

BACKGROUND: To assess the time required to return to sport (RTS) after conservative versus surgical treatment in athletes for pubalgia. METHODS: The PRISMA guidelines were followed. Pubmed, SportDiscus and Web of Science were last accessed on September 2022. All the studies investigating the time to RTS after conservative versus surgical treatment in athletes for pubalgia. RESULTS: In total, 33 studies were selected for full text assessment, and 10 studies were included in the qualitative analysis. Seven studies reported data on conservative management, two on surgical management and one compared both. A total of 468 subjects were included for analysis. 58.7% (275 of 468) were soccer players, 5.9% (28 of 468) runners, and 3.8% (18 of 468) hockey players. Two studies did not specify the type of sport. The quality of the studies detailing the results of conservative management was higher than surgical procedures. CONCLUSION: This review highlights that individuals undergoing surgery for pubalgia may return to sport earlier than those receiving conservative treatment. However, conservative management should be considered before surgical treatment is indicated.

Utilização clínica de testes e escalas funcionais: uma entrevista com Fisioterapeutas / Clinical use of tests and functional scale: an interview with Physiotherapists

Objetivo: Investigar a utilização das escalas e testes funcionais por fisioterapeutas brasileiros que atuam clinicamente na área ortopédica, traumatológica e/ou esportiva. Métodos: Para coleta de dados foi utilizado um questionário eletrônico, autoaplicável, elaborado pelos autores, divulgado por meio de redes sociais. Os participantes foram divididos em quatro grupos conforme suas respostas: grupo que utiliza testes e escalas funcionais (GTE); grupo que utiliza somente testes funcionais (GST); grupo que utiliza somente escalas funcionais (GSE); grupo que não utiliza nenhum (GN). Para análise de dados, foi realizada uma análise descritiva dos dados sociodemográficos e profissionais dos participantes. A associação entre variáveis qualitativas nominais foi avaliada por meio do teste Qui quadrado. Resultados: Do total de 100 voluntários participantes da pesquisa, 75 compuseram o GTE, 19 o GST, 1 o GSE e 5 o GN, demonstrando alto índice de utilização tanto de escalas quanto de testes funcionais na prática clínica. Não foram encontradas associações (p>0,05) entre o uso das ferramentas com características do profissional. As principais barreiras encontradas para não utilização das ferramentas foram a falta de tempo na sessão e o pouco conhecimento sobre os instrumentos. A maior parte dos participantes julga muito relevante o uso de avaliações funcionais na prática clínica. Conclusão: Os fisioterapeutas da amostra, em sua maioria, utilizam os testes e escalas funcionais na prática clínica. O principal uso dessas ferramentas é identificar as disfunções presentes nos pacientes durante as avaliações e as barreiras encontradas para não utilização são a falta de tempo e pouco conhecimento dos instrumentos.

Objective: to investigate the use of these tools by Brazilian physical therapists who work clinically in the orthopaedic, traumatological and sports areas, characterizing the professional and his possible relationship with the use of these instruments. Methods: For data collection, through social midias, a self-administered questionnaire online was applied. The participants were divided into four groups according to their answers: group that applied tests and functional scales (GTE); group that applied only functional tests (GST); group that applied only functional scales (GSE); group that did not use any (GN). For data analysis, a descriptive analysis of the sociodemographic and professional data of the participants was performed. The association between nominal qualitative variables was assessed by Chi-square test. Results: Of 100 volunteers participating in the research, 75 composed the GTE, 19 the GST, 1 the GSE and 5 the GN. Tests and scales are used by most professionals interviewed to follow the evolution of treatment and identify dysfunctions. As for the GSE, the main barriers found for not using it were the lack of time in the session and the little knowledge of the instruments. Most participants consider the use of functional assessments to be very relevant in clinical practice. Conclusion: Most orthopaedic, traumatological and sports physical therapists in the sample use tests and functional scales in clinical practice. Their main objective with these tools is to identify the dysfunctions present in patients during physical therapy assessments and the main barriers to not using them are time and little knowledge.

Quality Assessment of Neonatal Pain Scales Translated and Validated to Brazilian Portuguese: A Systematic Review of Psychometric Properties.

OBJECTIVES: The objective of this systematic review was to identify and describe the psychometric properties of neonatal pain scales that were translated into Brazilian Portuguese and to verify the methodological quality of these translation, transcultural adaptations and validation. DESIGN: The present study is a systematic review. A systematic search in the literature included studies of development, validation, and transcultural adaptation of neonatal pain scales to Brazilian Portuguese. The instruments must have been developed for health care professionals to evaluate neonatal pain and stress in full-term and preterm newborns. DATA SOURCES: The search strategy was conducted in PubMed, Web of Science, Scopus, and Scielo databases following The PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). REVIEW /ANALYSIS METHODS: A total of 1,479 publications were identified and 5 fulfilled the inclusion criteria, with 4 instruments evaluated. For the methodological quality analysis of the measurement properties of the instruments the Consensus-based Standards for Health Measurement Instruments (COSMIN) Risk of Bias checklist was used. The psychometric properties verified were internal consistency, content validity, reliability, and construct validity. RESULTS: Three instruments reviewed were inadequate and one was doubtful. CONCLUSIONS: The neonatal pain scales wich were cross culturally adapted to Brazilian Portuguese were shown to be of low methodological quality based on COSMIM checklist. Caution should be considered for clinical decisions about pain management judgment coming from these instruments.

Validation of Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS) in individuals with chronic ankle instability: a cross-sectional observational study.

BACKGROUND: Ankle sprain is the most common lower limb injury in physically active individuals. Loss of function, decreased postural control (PC), strength deficit, and reduced range of motion (ROM) are common after acute lateral ankle sprains. Some patients experienced long lasting symptoms, with recurrent sprains, and episodes of giving-way: a condition known as chronic ankle instability (CAI). Evaluating the function in patients with CAI in the clinical environment is important to identify the severity of the condition, in addition to allowing to assess the effectiveness of a given treatment. The aim of this study was to investigate the validation of the Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS) in terms of muscle strength, PC and ROM in adults with CAI. METHODS: This is a cross-sectional study. Individuals with CAI aged between 18 and 45 years were eligible. Individuals with CAI were identified using the Identification of Functional Ankle Instability (IdFAI). All patients filled in the FAAM and FAOS scores. Muscle strength was assessed by manual dynamometry, ROM by the Lunge test, PC by computerized posturography, modified Star Excursion Balance Test (mSEBT) and modified Balance Error Score System (mBESS). RESULTS: 50 participants were enrolled in the present study. The mean age of the patients was 27.2 ± 6.3 years, and the mean body mass index was 26.4 ± 4.8 kg/m2. 58% (29 of 50) were men and 42% (21 of 50) women. 18 individuals had unilateral (36%) and 32 bilateral (64%) CAI. The results of FAAM were associated with MCT, mSEBT, invertor muscles strength, plantar flexor muscles strength, dorsiflexor muscles strength, and external hip rotator muscles strength (P < 0.05). The results of FAOS were associated with mSEBT, invertor muscles strength, plantar flexor muscles strength, dorsiflexor muscles strength, evertor muscles strength, and external hip rotator muscles strength, and mBEES (P < 0.05). CONCLUSION: Both the FAAM and FAOS demonstrated validity to evaluate postural control and muscle strength in patients with CAI, while no association was found in relation to ankle dorsiflexion.

Function, strength, and muscle activation of the shoulder complex in Crossfit practitioners with and without pain: a cross-sectional observational study.

BACKGROUND: The shoulder joint is the most commonly injured joint in CrossFit practitioners, because of the high intensity and loads associated with this sport. Despite the large number of clinical cases, there is a shortage of studies that investigate influence of biomechanical aspects of upper limbs' injuries on CrossFit practitioners. This study hypothesized that there would be a difference in function, strength, and muscle activation between Crossfit practitioners with and without shoulder pain. METHODS: We divided 79 Crossfit practitioners into two groups according to whether they reported pain (n = 29) or no pain (n = 50) in the shoulder during Crossfit training. Muscle function, strength, and activation were assessed using the Disability Arm, Shoulder and Hand function questionnaire, Upper Quarter Y Balance Test and Closed Kinetic Chain Upper Extremity Stability Test shoulder tests, isometric muscle strength assessment by manual dynamometry and muscle activation by surface electromyography and pain report. RESULTS: The function based on questionnaire was associated with pain (p = 0.004). We observed a statistically significant difference between the two groups only in the surface electromyography activity of the lower trapezius, and in the variables of shoulder pain and function (p = 0.038). CONCLUSION: Crossfit practitioners with shoulder pain occurring during training showed good function and stability of the shoulder joint, but there was a reduction in the activation of stabilizing muscles, especially the lower trapezius. Trial registration Registro Brasileiro de Ensaios Clinico (Brasilian National Registry) with the ID: RBR-2gycyv.

Predictors for Screen Time Exposure among Children between 3 and 5 Years Old in Southern Brazil.

BACKGROUND: The use of technology is an increasingly common practice among preschoolers. Little is known about the relationship between screen time exposure (STE) and aspects related to family and the environment. AIM: The aim is to characterize STE in Brazilian children aged between 3 and 5 years. Furthermore, the objective of this study is to associate the STE of children and of their parents with sociodemographic variables. METHODS: Children aged between 3 and 5 years from southern Brazil and their parents participated in this study. To investigate STE, the researchers developed a specific questionnaire. To compare STE between age groups, the Kruskal-Wallis test was performed, followed by Dunn's post hoc test. Spearman's correlation and linear regression were used to correlate the variables. RESULTS: Children (n = 237) spend an average of 3.7 ± 0.8 h/day in front of screens. The STE of children had a moderately positive correlation with the STE of their parents (r = 0.4; p-value < 0.001). Only the variables of the children's and parents' STE had a significant and positive association. The model is significant (F = 6164, p-value < 0.001) and the residuals of the model met the necessary assumptions, with normal distribution, constant variance and without the presence of outliers. CONCLUSION: Children in southern Brazil remain in front of screens four times longer than the recommended amount of time. It was also found that the STE of parents directly influences that of their children.

Association between severity of hip chondrolabral injuries, dynamic hip muscle strength and quality of life: A cross-sectional study in patients with femoroacetabular impingement syndrome scheduled for hip arthroscopy.

BACKGROUND: We assessed the association between: the severity of hip chondral or labral pathology with dynamic hip muscle strength or quality of life in patients with femoroacetabular impingement syndrome scheduled for hip arthroscopy. We also assessed the association between dynamic hip muscle strength with quality of life. METHODS: Eighty-three participants with femoroacetabular impingement syndrome scheduled for hip arthroscopy were included. We measured dynamic hip abduction and adduction muscle strength with an isokinetic dynamometer (Nm/kg), and quality of life with the iHoT-33 questionnaire. The severity of hip chondrolabral pathologies was scored using the modified Beck classification. Linear regression analyses were conducted to assess the association between severity of hip chondral or labral pathology with dynamic hip muscle strength and quality of life. FINDINGS: The regression analyses showed no association between the (i) severity of hip chondral (adjusted r2: 0.14) or labral (adjusted r2: 0.08) pathology and quality of life (P > 0.05), (ii) between the severity of hip chondral or labral pathology and dynamic hip abduction and adduction muscle strength (P > 0.05). Significant correlation was observed for quality of life and hip abduction (adjusted r2:0.29; P < 0.001) or adduction (adjusted r2: 0.32; P < 0.001) muscle strength. INTERPRETATION: The severity of hip chondral or labral pathologies were not associated with quality of life or dynamic hip muscle strength in participants with femoroacetabular impingement syndrome. Greater dynamic hip abduction and adduction muscle strength were associated with better quality of life in participants with femoroacetabular impingement syndrome scheduled for hip arthroscopy.

Effects of Myofascial Self-Release on Range of Motion, Pressure Pain Threshold, and Hamstring Strength in Asymptomatic Individuals: A Randomized, Controlled, Blind Clinical Trial.

CONTEXT: Myofascial self-release is performed using a roller to exert pressure on the soft tissues and to promote effects similar to those of traditional massage. However, there is no standardization regarding its application, mainly in relation to time. OBJECTIVE: To evaluate the effects of myofascial self-release with a rigid roller on range of motion (ROM), pressure pain threshold (PPT), and hamstring strength in asymptomatic individuals following 2 different times of intervention. DESIGN: Randomized, controlled, blind, clinical trial comparing preintervention and immediately postintervention within 2 groups. SETTING: Institutional physiotherapy clinic. PARTICIPANTS: A total of 40 university students (18-30 y), who had no symptoms, participated. INTERVENTION: Foam roller for 30 seconds and 2 minutes for group 2. MAIN OUTCOME MEASURES: Hamstring PPT, knee-extension ROM, and peak knee-flexion torque measured before and immediately after the intervention. RESULTS: Both groups experienced a statistically significant increase in ROM compared with baseline (30 s and 2 min for group 2 P < .024). There were no statistically significant differences comparing peak knee-flexion torque or PPT. CONCLUSIONS: Hamstring myofascial self-release using a roller for 30 seconds or 2 minutes produced an increase in ROM in healthy individuals. PPT and peak knee-flexion isometric torque showed no effects.

Questionnaires and scales for assessment of ankle function: a systematic review of instruments translated and validated for Brazilian Portuguese.

PURPOSE: Several questionnaires have been used for functional evaluation. They must be translated and adapted transculturally, these instruments need to be valid, reliable, and sensitive according to the population. This review identified the questionnaires which were adapted transculturally in Brazilian Portuguese, to verify the methodological quality. METHODS: A search was performed in the PubMed, BIREME, SportDiscus, SciELO, Scopus, Science Direct, and Web of Science. The methodological quality was evaluated by the COnsensus-based Standards for Health Measurement INstruments (COSMIN) Risk of Bias checklist. For cross-cultural translation and adaptation studies, the properties of measurement of structural validity, internal consistency (IC), cross-cultural validity, reliability, measurement error, and criterion validity were analyzed. RESULTS: A total of 4564 articles were found; 10 fulfilled the inclusion criteria. The psychometrics properties verified were IC; criterion validity; reproducibility; floor/ceiling effect and responsiveness. Criterion validity was the best criterion evaluated. The main failures were related to sample size, and the most deficient properties were IC, reliability, and error of measure. CONCLUSIONS: The studies verified presented "inadequate" final score using COSMIN. Although specific questionnaires for ankle evaluation have been cross culturally validated in Brazilian Portuguese, their methodological quality was generally low, as verified through the analysis of their psychometric properties. IMPLICATIONS FOR REHABILITATION The questionnaires which were cross culturally adapted to Brazilian Portuguese were shown to be of low methodological quality. In using them careful consideration needs to be given to the psychometrics of each measure. Caution should be exercised in making clinical decisions drawn from the results.

Positioning Effects for Procedural Pain Relief in NICU: Systematic Review.

OBJECTIVES: To systematically review the literature regarding the effectiveness of different positioning methods for procedural pain relief in neonates admitted to the Neonatal Intensive Care Unit (NICU). DESIGN: A systemized search of the literature was carried out by means of two independent evaluators through the systematic search of electronic index databases. DATA SOURCES: A search for relevant studies was performed in four databases (Medline, Web of Science, Scopus, and BVS-BIREME). REVIEW/ANALYSIS METHODS: Manual searches were conducted on suitable references from the included articles, and 1,941 publications were eligible for the analysis. The flowchart for the articles' selection was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, and in relation to bias risks according to the Physiotherapy Evidence Database (PEDro) scale. RESULTS: Based on the inclusion criteria, only 20 publications remained. According to the PEDro scale, 75% of the studies presented good methodological quality, with scores between 6 and 8, and 5% scored ≤4 points. None of them were blinded in relation to the therapies, but all of them performed intergroup statistical comparisons. According to the results of this review, we recommend facilitated tucking by parents (FTP) in NICU of at least 30 minutes duration, starting 15 minutes before, during the painful procedure, and 15 minutes after to relieve pain and to stabilize the physiological, hormonal, and behavioral responses of the newborns. CONCLUSIONS: Positioning should be used as a nonpharmacological strategy for procedural pain relief in newborns. This review showed that facilitated tucking by parents for 30 minutes was the best position for pain relief in premature newborns during procedures in the NICU. Positioning is recommended as a nonpharmacological method for pain relief; FTP of at least 30 minutes duration should be the first positioning choice during procedures in the NICU.

Utilização de exergames e seus efeitos sobre a saúde física de pacientes com diagnóstico de câncer: uma revisão integrativa / Aplicabilidad de las ecuaciones de referencia brasileñas para la prueba de caminata de 6 minutos en pacientes con cáncer de pulmón / Use of exergaming and its effects on the physical health of patients diagnosed with cancer: an integrative review

RESUMO Este estudo teve como objetivo a busca de registros com diferenças significativas a respeito da saúde física de pacientes com câncer ao praticarem exergames. Utilizou-se como método a Revisão Integrativa de Literatura com as palavras chaves "Fisioterapia", "Realidade Virtual", "Wii", "Exergames" e "Câncer", em português e inglês, nas bases de dados PubMed, Science Direct, Medline, Scopus, Lilacs, SciELO, PEDro, Cochrane e Periódicos Capes. Os critérios de inclusão foram: estudos que utilizassem exergames em tratamentos clínicos e que apresentassem diferenças sobre a saúde física de pacientes com diagnóstico de câncer, de ambos os sexos, de todas as idades e tipos de câncer, publicados nos últimos 10 anos, em qualquer idioma. Dos 3172 artigos encontrados, apenas nove foram incluídos, sendo que esses avaliaram: desempenho físico, sedentarismo, funcionalidade de membros superiores, força muscular de membros inferiores e fadiga. Concluiu-se que os exergames demostraram ser ferramenta promissora para a saúde física de pacientes com diagnóstico de câncer.

RESUMEN El objetivo de este estudio fue verificar el impacto de diferentes ecuaciones de referencia brasileñas para la distancia recorrida en la prueba de caminata de 6 minutos (PC6min) en la evaluación de la capacidad de ejercicio funcional en pacientes con cáncer de pulmón (CP). Este estudio transversal incluyó a 48 pacientes con CP (promedio de edad de 60±12 años). Se evaluó las características sociodemográficas, clínicas y la capacidad funcional de los participantes para ejercitarse en la PC6min según los criterios internacionales. Se analizaron cinco ecuaciones. La distancia recorrida por los pacientes (503±102 metros) estuvo relativamente cerca de las distancias predichas por las ecuaciones de referencia (82-94% del predicho), aunque son estadísticamente menores (p<0,05 para todas).

ABSTRACT This study aimed to search for records with significant differences regarding the physical health of cancer patients when practicing exergaming. The integrative literature review was used as method with the keywords "Physiotherapy," "Virtual Reality," "Wii," "Exergames" and "Cancer," in Portuguese and English, in the following databases: PubMed, Science Direct, Medline, Scopus, Lilacs, SciELO, PEDro, Cochrane and Capes Journals. The inclusion criteria were studies that used exergaming in clinical treatments and presented differences on the physical health of patients diagnosed with cancer, of both sexes, of all ages and types of cancer, published in the last 10 years, in any language. Of the 3,172 articles found, only nine were included; they evaluated physical performance, sedentary lifestyle, upper limbs functionality, lower limbs muscle strength and fatigue. The review concluded that exergaming is a promising tool for the physical health of patients diagnosed with cancer.

Transcutaneous electrical nerve stimulation, acupuncture, and spinal cord stimulation on neuropathic, inflammatory and, non-inflammatory pain in rat models.

BACKGROUND: Transcutaneous electrical nerve stimulation (TENS), manual acupuncture (MA), and spinal cord stimulation (SCS) are used to treat a variety of pain conditions. These non-pharmacological treatments are often thought to work through similar mechanisms, and thus should have similar effects for different types of pain. However, it is unclear if each of these treatments work equally well on each type of pain condition. The purpose of this study was to compared the effects of TENS, MA, and SCS on neuropathic, inflammatory, and non-inflammatory pain models. METHODS: TENS 60 Hz, 200 µs, 90% motor threshold (MT), SCS was applied at 60 Hz, an intensity of 90% MT, and a 0.25 ms pulse width. MA was performed by inserting a stainless-steel needle to a depth of about 4-5 mm at the Sanyinjiao (SP6) and Zusanli (ST36) acupoints on a spared nerve injury (SNI), knee joint inflammation (3% carrageenan), and non-inflammatory muscle pain (intramuscular pH 4.0 injections) in rats. Mechanical withdrawal thresholds of the paw, muscle, and/or joint were assessed before and after induction of the pain model, and daily before and after treatment. RESULTS: The reduced withdrawal thresholds were significantly reversed by application of either TENS or SCS (P < 0.05). MA, on the other hand, increased the withdrawal threshold in animals with SNI and joint inflammation, but not chronic muscle pain. CONCLUSIONS: TENS and SCS produce similar effects in neuropathic, inflammatory and non-inflammatory muscle pain models while MA is only effective in inflammatory and neuropathic pain models.

Protocolo de mobilização associada à manipulação vertebral diminui dor lombar crônica. Um estudo preliminar clínico randomizado / Mobilization associated with vertebral manipulation protocol reduces chronic lumbar pain. A preliminary randomized clinical study

A dor lombar crônica é um problema osteomuscular de causa multifatorial, que afeta as atividades de vida diária, podendo levar a perda de capacidade funcional e qualidade de vida. Ainda com resultados pouco conclusivos de mobilização e manipulação sobre a dor e ADM em indivíduos com dor lombar, o objetivo deste estudo foi verificar os efeitos destas técnicas manuais na dor e mobilidade de indivíduos com dor lombar crônica. Foi realizado um estudo preliminar clínico, transversal, paralelo, controlado randomizado e cego. Os voluntários (n=16) foram divididos de maneira aleatória por envelopes, em dois grupos: grupo intervenção (G-INT), que receberam o tratamento de mobilização e manipulação vertebral e grupo placebo (G-PLA) sem o tratamento. Os voluntários realizaram avaliação dos desfechos de dor e mobilidade. Foram realizadas três sessões em cada paciente com um intervalo de um dia. As reavaliações foram realizadas após a última intervenção. Houve diferença estatisticamente significativa na END no grupo G-INT (pré - 5,33 ± 1,32, pós - 2,77 ± 1,85, p=0,03), com D de Cohen = 1,59, na comparação intragrupo. Para comparações intergrupos considerando o Δ pré e pós-intervenção foi observada diferença estatisticamente significativa na END (G-INT = -2,55 ± 1,13, G2 = -1,00 ± 0,81, com p=0,01), com D de Cohen = 1,58. A mobilização associada à manipulação mostrou-se significativamente eficaz no tratamento de dor lombar crônica.

Chronic low back pain is a multi-factorial musculoskeletal problem that affects activities of daily living, which can lead to loss of functional capacity and quality of life. Still with inconclusive results of mobilization and manipulation on pain and ROM in individuals with low back pain, the objective of this study was to verify the effects of these manual techniques on the pain and mobility of individuals with chronic low back pain. A preliminary clinical, cross-sectional, parallel, randomized controlled and blind study was carried out. The volunteers (n = 16) were randomly divided into envelopes, into two groups: intervention group (G-INT), who received spinal mobilization and manipulation treatment and placebo group (G-PLA) without treatment. The volunteers evaluated pain and mobility outcomes. Three sessions were performed on each patient with an interval of one day. Reassessments were carried out after the last intervention. There was a statistically significant difference in the END in the G-INT group (pre - 5.33 ± 1.32, post - 2.77 ± 1.85, p = 0.03), with Cohen's D = 1.59, in the comparison intragroup. For intergroup comparisons considering the Δ pre- and postintervention, a statistically significant difference was observed in the END (G-INT = -2.55 ± 1.13, G2 = -1.00 ± 0.81, with p = 0.01), with Cohen's D = 1.58. Mobilization associated with manipulation was shown to be significantly effective in treating chronic low back pain.

High-impact drop exercise alters mechanical properties in osteopenic bone / Exercício de queda altera as propriedades mecânicas em osso osteopênico / El ejercicio de caída altera las propiedades mecánicas en hueso osteopénico

ABSTRACT Introduction: Osteopenia is a reversible condition and precedes osteoporosis. Physical activity and mechanical loading appear to play an important role in the regulation of bone homeostasis, without the side effects of targeted drug therapy. However, there is controversy as to which type of stimulus promotes more effective adaptations with respect to mechanical properties of bones. Objective: To investigate the effects of high-impact drop training on bone structure after ovariectomy-induced osteopenia in 40 10-week-old female Wistar rats. Methods: Twenty female rats (prevention program) were randomly assigned into two groups (n=10): Ovariectomized sedentary (OVXs), and OVX trained (OVX+Dropt). OVX+Dropt animals began training 3 days after surgery. Another twenty female rats (treatment program) were randomly assigned to two other groups (n=10): Ovariectomized sedentary (OVXs), and OVX trained (OVX+Dropt). OVX+Dropt animals began training 60 days after surgery. The rats in the trained groups were dropped from 40 cm height 20 times/day, 5 days/week over a period of 12 weeks period. At the end, the biomechanical tests were analyzed. Results: The final load and stiffness of the left tibia in the trained groups were higher than in the sedentary groups (p<0.05). Conclusions: Dropping exercise induced favorable changes in bone mechanical properties. High-impact drop exercise is effective to prevent bone loss after ovariectomy even when osteopenia is already established.

RESUMO Introdução: A osteopenia é uma doença reversível e precede a osteoporose. A atividade física e a carga mecânica parecem desempenhar um papel importante na regulação da homeostase óssea, sem os efeitos colaterais da terapia medicamentosa direcionada. No entanto, é controverso qual tipo de estímulo promove adaptações mais eficazes com relação às propriedades mecânicas dos ossos. Objetivo: Investigar os efeitos do treinamento de queda com impacto sobre a estrutura óssea depois de osteopenia induzida por ovariectomia em 40 ratas Wistar com 10 semanas de idade. Métodos: Vinte ratas (programa de prevenção) foram distribuídas aleatoriamente em dois grupos (n = 10): Ovariectomizadas sedentárias (OVXs) e OVX treinadas (OVX + Dropt). Os animais OVX + Dropt começaram a treinar três dias após a cirurgia. Outras vinte ratas (programa de tratamento) foram alocadas aleatoriamente em outros dois grupos (n = 10): Ovariectomizadas sedentários (OVXs) e OVX exercitadas (OVX + Dropt). Os animais OVX + Dropt iniciaram o treinamento 60 dias após a cirurgia. As ratas nos grupos treinados foram deixadas cair 20 vezes/dia, 5 dias/semana, de altura de 40 cm durante um período de 12 semanas. Ao final, foram analisados os testes biomecânicos. Resultados: A carga final e a rigidez da tíbia esquerda nos grupos treinados foram maiores do que nos grupos sedentários (p < 0,05). Conclusões: O exercício de queda provocou alterações favoráveis nas propriedades mecânicas dos ossos. O exercício de queda com impacto é eficaz para prevenir a perda óssea após ovariectomia, mesmo quando a osteopenia já está estabelecida

RESUMEN Introducción: La osteopenia es una enfermedad reversible y precede a la osteoporosis. La actividad física y la carga mecánica parecen desempeñar un papel importante en la regulación de la homeostasis ósea, sin los efectos secundarios de la terapia farmacológica dirigida. Sin embargo, es controvertido qué tipo de estímulo promueve adaptaciones más eficaces con respecto a las propiedades mecánicas de los huesos. Objetivo: Investigar los efectos del entrenamiento de caída con alto impacto sobre la estructura ósea después de osteopenia inducida por ovariectomía en 40 ratas Wistar hembras de diez semanas de edad. Métodos: Se asignaron aleatoriamente veinte ratas (programa de prevención) en dos grupos (n = 10): Ovariectomizadas sedentarios (OVXs) y OVX entrenadas (OVX + Drope). Los animales OVX + Drope comenzaron a entrenar tres días después de la cirugía. Otras veinte ratas hembras (programa de tratamiento) fueron asignadas aleatoriamente a otros dos grupos (n = 10): Ovariectomizadas sedentarias (OVXs) y OVX entrenadas (OVX + Drope). Los animales OVX + Drope iniciaron el entrenamiento 60 días después de la cirugía. Las ratas en los grupos entrenados se dejaron caer de una altura de 40 cm 20 veces/día, 5 días/semana durante un período de 12 semanas. Al final, se analizaron las pruebas biomecánicas. Resultados: La carga y rigidez de la tibia izquierda en los grupos entrenados fueron mayores que en los grupos sedentarios (p < 0,05). Conclusiones: El ejercicio de caída provocó cambios favorables en las propiedades de los huesos. El ejercicio de caída con impacto es eficaz para prevenir la pérdida ósea después de la ovariectomía, incluso cuando la osteopenia ya está establecida.