A Thematic Survey on the Reporting Quality of Randomized Controlled Trials in Rehabilitation: The Case of Multiple Sclerosis.

BACKGROUND AND PURPOSE: Optimal reporting is a critical element of scholarly communications. Several initiatives, such as the EQUATOR checklists, have raised authors' awareness about the importance of adequate research reports. On these premises, we aimed at appraising the reporting quality of published randomized controlled trials (RCTs) dealing with rehabilitation interventions. Given the breadth of such literature, we focused on rehabilitation for multiple sclerosis (MS), which was taken as a model of a challenging condition for all the rehabilitation professionals.A thematic methodological survey was performed to critically examine rehabilitative RCTs published in the last 2 decades in MS populations according to 3 main reporting themes: (1) basic methodological and statistical aspects; (2) reproducibility and responsiveness of measurements; and (3) clinical meaningfulness of the change. SUMMARY OF KEY POINTS: Of the initial 526 RCTs retrieved, 370 satisfied the inclusion criteria and were included in the analysis. The survey revealed several sources of weakness affecting all the predefined themes: among these, 25.7% of the studies complemented the P values with the confidence interval of the change; 46.8% reported the effect size of the observed differences; 40.0% conducted power analyses to establish the sample size; 4.3% performed retest procedures to determine the outcomes' reproducibility and responsiveness; and 5.9% appraised the observed differences against thresholds for clinically meaningful change, for example, the minimal important change. RECOMMENDATIONS FOR CLINICAL PRACTICE: The RCTs dealing with MS rehabilitation still suffer from incomplete reporting. Adherence to evidence-based checklists and attention to measurement issues and their impact on data interpretation can improve study design and reporting in order to truly advance the field of rehabilitation in people with MS.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A424 ).

Exercise-based cardiac rehabilitation and parasympathetic function in patients with coronary artery disease: a systematic review and meta-analysis.

PURPOSE: The effects of exercise-based cardiac rehabilitation (CR) on parasympathetic modulation are controversial. This systematic review and meta-analysis aims to (a) determine the effect of exercise-based CR on heart-rate-derived indices associated with cardiac parasympathetic modulation in resting and post-exercise conditions in coronary artery disease (CAD) patients and (b) identify the possible moderator variables of the effect of exercise-based CR on parasympathetic modulation. METHODS: We searched CENTRAL and Web of Science up to November 2018 for the following terms: adult CAD patients, controlled exercise-based CR interventions and parasympathetic modulation measured in resting (vagal-related heart rate variability [HRV] indices of the root mean square of the differences in successive in RR interval [RMSSD] and high frequency [HF]) and post-exercise (heart rate recovery [HRR]) pre- and post-intervention. We estimated a random-effects model of standardised mean difference (SMD) and mean difference (MD) for vagal-related HRV indices and HRR, respectively. We assessed the influence of categorical and continuous variables. RESULTS: The overall effect size showed significant differences in RMSSD (SMD+ = 0.30; 95% confidence interval [CI] = 0.12-0.49) and HRR (MD+ = 5.35; 95% CI = 4.08-6.61 bpm) in favour of the exercise-based CR group. The overall effect size showed no differences in HF between groups (SMD+ = 0.14; 95% CI, -0.12-0.40). Heterogeneity analyses reached statistical significance, with high heterogeneity for HF (p < 0.001; I2 = 70%) and HRR (p < 0.001; I2 = 85%). Analysis of the moderator variables showed that the effect on HRR is greater in young patients (p = 0.008) and patients treated with percutaneous intervention (p = 0.020). CONCLUSIONS: Exercise-based CR improves the post-exercise parasympathetic function, with greater effects in younger CAD patients and in those who were revascularised with percutaneous intervention. The effects on resting parasympathetic function are more controversial due to methodological inconsistencies in measuring HRV, with the use of RMSSD recommended instead of HF because its results show higher consistency. Future studies involving women, focusing on methodological issues, and performing other training methods are needed to increase our knowledge about this topic.

Are the Current Cardiac Rehabilitation Programs Optimized to Improve Cardiorespiratory Fitness in Patients? A Meta-Analysis.

Previous meta-analyses have shown that high-intensity interval training (HIIT) is more suitable than moderate continuous training (MCT) for improving peak oxygen uptake (VO2peak) in patients with coronary artery disease. However, none of these meta-analyses have tried to explain the heterogeneity of the empirical studies in optimizing cardiac rehabilitation programs. Therefore, our aims were (a) to estimate the effect of MCT and HIIT on VO2peak, and (b) to find the potential moderator variables. A search was conducted in PubMed, Scopus, and ScienceDirect. Out of the 3,110 references retrieved, 29 studies fulfilled the selection criteria to be included in our meta-analysis. The mean difference was used as the effect size index. Our results showed significant enhancements in VO2peak after cardiac rehabilitation based on MCT and HIIT (mean difference = 3.23; 95% confidence interval [2.81, 3.65] ml·kg-1·min-1 and mean difference = 4.61; 95% confidence interval [4.02, 5.19] ml·kg-1·min-1, respectively), with greater increases after HIIT (p < .001). Heterogeneity analyses reached statistical significance with moderate heterogeneity for MCT (p < .001; I2 = 67.0%), whereas no heterogeneity was found for the effect of HIIT (p = .220; I2 = 22.0%). Subgroup analyses showed significant between-group heterogeneity of the MCT-induced effect based on the training mode (p < .001; I2 = 90.4%), the risk of a new event (p = .010; I2 = 77.4%), the type of cardiovascular event (p = .009; I2 = 84.8%), the wait time to start cardiac rehabilitation (p = .010; I2 = 76.6%), and participant allocation (p = .002; I2 = 89.9%). Meta-regressions revealed that the percentages of patients undergoing a revascularization procedure (B = -0.022; p = .041) and cardiorespiratory fitness at baseline (B = -0.103; p = .025) were inversely related to the MCT-induced effect on the VO2peak.

A Bayesian Network approach to study the relationships between several neuromuscular performance measures and dynamic postural control in futsal players.

PURPOSE: The purpose of this study was to analyse the relationship between several parameters of neuromuscular performance with dynamic postural control using a Bayesian Network Classifiers (BN) based analysis. METHODS: The y-balance test (measure of dynamic postural control), isokinetic (concentric and eccentric) knee flexion and extension strength, isometric hip abduction and adduction strength, lower extremity joint range of motion (ROM) and core stability were assessed in 44 elite male futsal players. A feature selection process was carried out before building a BN (using the Tabu search algorithm) for each leg. The BN models built were used to make belief updating processes to study the individual and concurrent contributions of the selected parameters of neuromuscular performance on dynamic postural control. RESULTS: The BNs generated using the selected features by the algorithms correlation attribute evaluator and chi squared reported the highest evaluation criteria (area under the receiver operating characteristic curve [AUC]) for the dominant (AUC = 0.899) and non-dominant (AUC = 0.879) legs, respectively. CONCLUSIONS: The BNs demonstrated that performance achieved in the y-balance test appears to be widely influenced by hip and knee flexion and ankle dorsiflexion ROM measures in the sagittal plane, as well as by measures of static but mainly dynamic core stability in the frontal plane. Therefore, training interventions aimed at improving or maintaining dynamic postural control in elite male futsal players should include, among other things, exercises that produce ROM scores equal or higher than 127° of hip flexion, 132.5° of knee flexion as well as 34° and 30.5° of ankle dorsiflexion with the knee flexed and extended, respectively. Likewise, these training interventions should also include exercises to maintain or improve both the static and dynamic (medial-lateral plane) core stability so that futsal players can achieve medial radial error values lower than 6.69 and 8.79 mm, respectively.

Updated systematic review and meta-analysis on the role of isometric resistance training for resting blood pressure management in adults.

BACKGROUND AND METHOD: This meta-analysis sought to: quantify the effects of isometric resistance training (IRT) on the magnitude of change in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and resting heart rate in adults; and examine whether the magnitude of change in SBP, DBP, MAP and heart rate was different with respect to the patient demographic characteristics and IRT parameters. To be included in the meta-analysis, studies had to be randomized controlled trials lasting 2 or more weeks, investigating the effects of IRT on blood pressure in adults. The methodological quality of the studies selected was evaluated using the PEDro scale. For each main outcome measure, an average effect size and its respective 95% confidence intervals were calculated. RESULTS: A total of 16 articles (492 participants) fulfilled the selection criteria (mean quality score in the PEDro scale of 5.9). Compared with control groups, IRT groups showed statistically significant (P < 0.05) and clinically relevant (>2 mmHg) positive effects on the SBP (-5.23 mmHg) and MAP (-2.9 mmHg). IRT groups also showed statistically significant, but not clinically relevant reduction in DBP (-1.64 mmHg). Furthermore, IRT groups did not report any statistically significant and clinically relevant (>5 bpm) effect on resting heart rate (-0.08 bpm). CONCLUSION: The analysis of moderator variables showed that none of them exhibited a statistically significant relationship with the positive effects of IRT for lowering blood pressure. Therefore, IRT may be considered an appropriate nonpharmacologic treatment for lowering SBP and MAP.

Are core exercises important to functional training protocols? / ¿Es importante incluir ejercicios específicos del core en protocolos de Entrenamiento Funcional? / É importante incluir exercícios específicos do core em protocolos de Treinamento Funcional?

Objective: Our aim is to analyze the effects of 12 weeks of functional training with and without core exercises on core functional and performance indicators. Method: This is a three-arm randomized controlled trial, which will take place over 12 weeks. Participants will be randomly grouped into three training programs, namely: functional training group, which will perform global, multi-articular, and functional exercises, with no exercises for the core; functional training + core group, which will perform a similar protocol to the functional training group, but with the inclusion of specific exercises for the core region; and core training group, which will only perform specific exercises for the core. In both moments, tests will be carried out in the following order: McGill's torso muscular endurance test battery, unilateral hip bridge endurance test, sit up test, isometric dead lift, push up, sit to stand, functional movement screen, handgrip test, countermovement maximal vertical jump test, one repetition maximum in bench press, row and leg press, T- run agility test, Yo-Yo test. Discussion: These findings will provide new evidence to aid physical education professionals in decision-making regarding exercise prescription. Conclusion: We hypothesize that the inclusion of exercises specifically targeting the trunk in functional training protocols will lead to higher functional and core performance. Conclusion: We hypothesize that the inclusion of exercises specifically targeting the trunk in functional training protocols will lead to higher functional and core performance

Objetivo: Analizar los efectos de 12 semanas de entrenamiento funcional con y sin ejercicios específicos del core, sobre indicadores funcionales y de rendimiento. Método: Este será un ensayo aleatorizado compuesto por tres grupos y con una duración de 12 semanas. Los participantes serán agrupados aleatoriamente en programas de entrenamiento funcional, a saber: grupo de entrenamiento funcional, que realizará ejercicios globales, multi-articulares y funcionales, pero sin ejercicios para el núcleo; entrenamiento funcional + grupo core, que realizará un protocolo similar al grupo de entrenamiento funcional, pero con ejercicios específicos para la región central; y grupo de entrenamiento de core, que sólo realizará ejercicios específicos para el core. En ambos momentos, las pruebas se realizar en el siguiente orden: Batería de prueba de resistencia muscular del tronco de McGill, prueba unilateral de elevación pélvica, Sit Up test, Isometric dead lifth, push up, sit to stand, functional movement screen, handgrip test, countermovement maximal vertical jump test, una repetición máxima en los ejercicios de press de banca, prensa y remada, teste T de agilidad y Yo-Yo. Discusión: Estos hallazgos proporcionarán nuevas evidencias para la toma de decisiones por el profesional de la educación física en la prescripción de ejercicios. Conclusión: Nosotros hipotetizamos que la inclusión de ejercicios focalizados específicamente para el core en protocolos de entrenamiento funcional producirá un mayor rendimiento funcional y del core

Objetivo: Analisar os efeitos de 12 semanas de treinamento funcional com e sem exercícios específicos do core sobre indicadores funcionais e de desempenho. Método: Este será um ensaio randomizado composto por três grupos de intervenção e duração de 12 semanas. Os participantes serão agrupados aleatoriamente em programas de treinamento funcional, a saber: grupo de treinamento funcional, que realizará exercícios globais e multiarticulares e funcionais, mas sem exercícios para o núcleo; treinamento funcional + core, que realizará um protocolo similar ao grupo de treinamento funcional, mas com exercícios específicos para a região central; e grupo de treinamento básico, que só executará exercícios específicos para o núcleo. Em ambos os momentos, os testes serão realizados na seguinte ordem: bateria de teste de resistência muscular do tronco de McGill, teste unilateral de elevação pélvica, sit up test, isometric dead lifth, push up, sit to stand, functional movement screen, handgrip test, countermovement maximal vertical jump test, uma repetição máxima nos exercícios supinos reto, remada e leg press, teste T de agilidade e Yo-Yo. Discussão: Esses achados fornecerão novas evidências para a tomada de decisões pelo profissional da Educação Física na prescrição de exercícios. Conclusão: Nós hipotetizamos que a inclusão de exercício com foc especificamente no tronco em protocolos de treinamento funcional levará a um maior desempenho funcional e básico. Conclusão: Nós hipotetizamos que a inclusão de exercício com foc especificamente no tronco em protocolos de treinamento funcional levará a um maior desempenho funcional e básico

A Preventive Model for Muscle Injuries: A Novel Approach based on Learning Algorithms.

INTRODUCTION: The application of contemporary statistical approaches coming from Machine Learning and Data Mining environments to build more robust predictive models to identify athletes at high risk for injury might support injury prevention strategies of the future. PURPOSE: The purpose was to analyze and compare the behavior of numerous machine learning methods to select the best-performing injury risk factor model to identify athlete at risk for lower extremity muscle injuries (MUSINJ). METHODS: A total of 132 male professional soccer and handball players underwent a preseason screening evaluation that included personal, psychological, and neuromuscular measures. Furthermore, injury surveillance was used to capture all the MUSINJ occurring in the 2013/2014 seasons. The predictive ability of several models built by applying a range of learning techniques were analyzed and compared. RESULTS: There were 32 MUSINJ over the follow-up period, 21 (65.6%) of which corresponded to the hamstrings, 3 to the quadriceps (9.3%), 4 to the adductors (12.5%), and 4 to the triceps surae (12.5%). A total of 13 injures occurred during training and 19 during competition. Three players were injured twice during the observation period so the first injury was used, leaving 29 MUSINJ that were used to develop the predictive models. The model generated by the SmooteBoost technique with a cost-sensitive ADTree as the base classifier reported the best evaluation criteria (area under the receiver operating characteristic curve score, 0.747; true positive rate, 65.9%; true negative rate, 79.1) and hence was considered the best for predicting MUSINJ. CONCLUSIONS: The prediction model showed moderate accuracy for identifying professional soccer and handball players at risk for MUSINJ. Therefore, the model developed might help in the decision-making process for injury prevention.

Dynamic trunk muscle endurance profile in adolescents aged 14-18: Normative values for age and gender differences.

BACKGROUND: The selection and validation of age- and gender-specific criterion-referenced cut-points for abdominal endurance are still unclear. OBJECTIVE: To stablish normative values for abdominal endurance in adolescents by age and gender using the Bench Trunk Curl-up Test (BTC). Additionally, the reliability of the BTC was analyzed. METHODS: Two hundred and sixteen untrained high school students (104 males - 112 females) were grouped into five age strata. Participants performed the BTC twice with a rest period of 72 h. Descriptive statistics and percentile scores were determined for each gender/age strata. RESULTS: Males showed higher BTC scores than females (males: 90.07 ± 32.65 repetitions; females: 73.43 ± 27.74 repetitions), but no significant differences between age strata nor age * gender interaction were found. Significant differences for the BTC scores between sessions were found (T1 = 72.06 ± 26.28 repetitions; T2 = 81.44 ± 31.27 repetitions). The ICC was 0.82, whereas the typical error was 17.2%. CONCLUSIONS: Gender, but not age, is an important factor when abdominal endurance is compared between adolescents. Finally, the BTC is a reliable test, supporting the findings of this study. However, an extensive familiarization period to reduce the learning effect is necessary.