Toward scientific dissemination of undergraduate thesis in physical therapy programs - a cross-sectional study.

BACKGROUND: The execution of undergraduate thesis is a period in which students have an opportunity to develop their scientific knowledge. However, many barriers could prevent the learning process. This cross-sectional study aimed to analyze the scientific dissemination of results from undergraduate theses in physical therapy programs and verify the existence of barriers and challenges in the preparation of undergraduate thesis. Second, to investigate whether project characteristics and thesis development barriers were associated with the dissemination of undergraduate thesis results. METHODS: Physical therapists who graduated as of 2015, from 50 different educational institutions, answered an online questionnaire about barriers faced during the execution of undergraduate thesis and about scientific dissemination of their results. RESULTS: Of 324 participants, 43% (n = 138) of participants disseminated their results, and the main form of dissemination was publishing in national journals (18%, n = 58). Regarding the barriers, 76% (n = 246) of participants reported facing some difficulties, and the main challenge highlighted was the lack of scientific knowledge (28%, n = 91). Chances of dissemination were associated with barriers related to scientific understanding and operational factors, such as the type of institution, institutional facilities, and involvement with other projects. CONCLUSION: Scientific knowledge seems to be a determining factor for the good development of undergraduate theses. In addition, it is clear the need to stimulate more qualified dissemination that reaches a larger audience. Changes in operational and teaching factors may improve the undergraduate thesis quality. However, the importance of rethinking scientific education within physical therapy programs draws attention.

Impaired Knee Muscle Capacity Is Correlated With Impaired Sagittal Kinematics During Jump Landing in Women With Patellofemoral Pain.

ABSTRACT: Nunes, GS, Barton, CJ, and Serrão, FV. Impaired knee muscle capacity is correlated with impaired sagittal kinematics during jump landing in women with patellofemoral pain. J Strength Cond Res 36(5): 1264-1270, 2022-Knee and hip muscle capacity is impaired in women with patellofemoral pain (PFP), but little is known about the rate of force development (RFD) at the knee. Impaired muscle capacity may contribute to reduced sagittal plane movement at the knee and hip during jump landing in women with PFP. This study aimed to (a) compare knee extensor muscle capacity (including RFD), and hip abductor and extensor muscle capacity between women with and without PFP; and (b) evaluate the relationship between hip/knee muscle capacity and sagittal kinematics during single-legged drop jump landing in women with PFP. Fifty-two physically active women (26 with PFP and 26 controls) participated. Rate of force development (in %/ms), isometric, concentric, and eccentric torque (in N·m·kg-1 × 100) were evaluated using isokinetic dynamometry, and knee and hip kinematics were evaluated using three-dimensional motion capture. Compared with the control group (CG), the PFP group (PFPG) presented lower isometric (12%, PFPG = 217.2 ± 46.0; CG = 246.5 ± 38.8; p = 0.02), concentric (21%, PFPG = 133.0 ± 42.6; CG = 169.2 ± 28.8; p < 0.01), and eccentric (17%, PFPG = 172.9 ± 56.7; CG = 208.4 ± 59.4; p = 0.03) knee extension torque; lower RFD until 30% (30%, PFPG = 0.57 ± 0.27; CG = 0.83 ± 0.37; p < 0.01) and 60% (31%, PFPG = 0.47 ± 0.24; CG = 0.67 ± 0.33; p = 0.01) of maximal isometric torque; and lower concentric hip abduction (13%, PFPG = 94.7 ± 19.1; CG = 108.4 ± 17.5; p = 0.01) and extension (17%, PFPG = 134.4 ± 34.3; CG = 162.6 ± 38.0; p < 0.01) torque. Significant correlations between reduced RFD for knee extension and reduced sagittal plane knee/hip range of motion during landing were identified (r = 0.39-0.49). In conclusion, women with PFP have impaired knee extensor isometric and dynamic strength, and RFD. Impaired knee extensor RFD is associated with a stiffer landing strategy (reduced movement).

Kinesio taping does not improve ankle functional or performance in people with or without ankle injuries: Systematic review and meta-analysis.

OBJECTIVE: To investigate whether Kinesio taping technique, applied to ankles of healthy people as a preventive intervention and people with ankle injuries, is superior to sham or alternative interventions on ankle function. DATA SOURCES: Medline, Embase, Amed, CINAHL, SPORTDiscus, Cochrane Library and Web of Science, from inception to August 2020. REVIEW METHODS: The terms "ankle" and "kinesio taping" were used in the search strategy. Included studies were randomized controlled trials (including crossover design) investigating Kinesio taping effects on ankle functional performance compared to any alternative or control/sham technique. RESULTS: From 5,572 studies, 84 met the eligibility criteria which evaluated 2,684 people. Fifty-eight meta-analyses from 44 studies were performed (participants in meta-analyses ranging from 27 to 179). Fifty-one meta-analyses reported ineffectiveness of Kinesio taping: moderate evidence for star excursion balance test (anterior direction), jump distance, dorsiflexion range of motion, and plantar flexion torque for healthy people (effect size = 0.08-0.13); low to very-low evidence for balance, jump performance, range of motion, proprioception, muscle capacity and EMG for healthy people; balance for older people; and balance and jump performance for people with chronic instability. Seven meta-analyses reported results favoring Kinesio taping (effect size[95% CI]): low to very-low evidence for balance (stabilometry, ranging from 0.42[0.07-0.77] to 0.65[0.29-1.02]) and ankle inversion (0.84[0.28-1.40]) for healthy people; balance for older people (COP velocity, 0.90[0.01-1.78]); and balance for people with chronic instability (errors, 0.55[0.06-1.04]). CONCLUSIONS: Current evidence does not support or encourage the use of Kinesio taping applied to the ankle for improvements in functional performance, regardless the population.

Acute Effects of Hip Mobilization With Movement Technique on Pain and Biomechanics in Females With Patellofemoral Pain: A Randomized, Placebo-Controlled Trial.

CONTEXT: People with patellofemoral pain (PFP) present altered lower-limb movements during some activities. Perhaps, joint misalignment in the hip is one of the reasons for altered movement patterns in people with PFP. Some mobilization techniques have been designed to address joint misalignments. OBJECTIVE: To investigate the acute effects of hip mobilization with movement (MWM) technique on pain and biomechanics during squats and jumps in females with and without PFP. DESIGN: Randomized, placebo-controlled trial. SETTING: Movement analysis laboratory. PATIENTS: Fifty-six physically active females (28 with PFP and 28 asymptomatic) were divided into 4 groups: experimental group with PFP, sham group with PFP, experimental group without PFP, and sham group without PFP. INTERVENTION(S): The experimental groups received MWM for the hip, and the sham groups received sham mobilization. MAIN OUTCOME MEASURES: Pain, trunk, and lower-limb kinematics, and hip and knee kinetics during single-leg squats and landings. RESULTS: After the interventions, no difference between groups was found for pain. The PFP experimental group decreased hip internal rotation during squats compared with the PFP sham group (P = .03). There was no other significant difference between PFP groups for kinematic or kinetic outcomes during squats, as well as for any outcome during landings. There was no difference between asymptomatic groups for any of the outcomes in any of the tasks. CONCLUSIONS: Hip mobilization was ineffective to reduce pain in people with PFP. Hip MWM may contribute to dynamic lower-limb realignment in females with PFP by decreasing hip internal rotation during squats. Therefore, hip MWM could be potentially useful as a complementary intervention for patients with PFP.

Ankle Sprain Has Higher Occurrence During the Latter Parts of Matches: Systematic Review With Meta-Analysis.

Context: Ankle sprains are common injuries in sports, but it is unclear whether they are more likely to occur in a specific period of a sporting game. Objective: To systematically review the literature investigating when in a match ankle sprains most likely occurred. Evidence Acquisition: The databases CINAHL, EMBASE, MEDLINE, and SPORTDiscus were searched up to August 2016, with no restriction of date or language. The search targeted studies that presented data on the time of occurrence of ankle sprains during sports matches. Data from included studies were analyzed as a percentage of ankle sprain occurrence by halftime and by quarters. Meta-analyses were run using a random effects model. The quality assessment tool for quantitative studies was used to assess the article's quality. Evidence Synthesis: The searches identified 1142 studies, and 8 were included in this review. A total of 500 ankle sprains were reported during follow-up time, which ranged from 1 to 15 years, in 5 different sports (soccer, rugby, futsal, American football, and Gaelic football). The meta-analyses, including all 8 studies, showed that the proportion of ankle sprains during the first half (0.44; 95% confidence interval [CI], 0.38-0.50) was smaller than the second half (0.56; 95% CI, 0.50-0.62). For the analyses by quarters, the proportion of ankle sprains in the first quarter (0.14; 95% CI, 0.09-0.19) was considerably smaller than the second (0.28; 95% CI, 0.24-0.32), third (0.25; 95% CI, 0.17-0.34), and fourth (0.29; 95% CI, 0.22-0.36) quarters. Conclusion: The results of this review indicate that ankle sprains are more likely to occur later in the game during the second half or during the latter minutes of the first half.

Reliability of muscle strength assessment in chronic post-stroke hemiparesis: a systematic review and meta-analysis.

BACKGROUND: Muscle weakness is the main cause of motor impairment among stroke survivors and is associated with reduced peak muscle torque. OBJECTIVE: To systematically investigate and organize the evidence of the reliability of muscle strength evaluation measures in post-stroke survivors with chronic hemiparesis. DATA SOURCES: Two assessors independently searched four electronic databases in January 2014 (Medline, Scielo, CINAHL, Embase). STUDY SELECTION: Inclusion criteria comprised studies on reliability on muscle strength assessment in adult post-stroke patients with chronic hemiparesis. DATA EXTRACTION: We extracted outcomes from included studies about reliability data, measured by intraclass correlation coefficient (ICC) and/or similar. The meta-analyses were conducted only with isokinetic data. RESULTS: Of 450 articles, eight articles were included for this review. After quality analysis, two studies were considered of high quality. Five different joints were analyzed within the included studies (knee, hip, ankle, shoulder, and elbow). Their reliability results varying from low to very high reliability (ICCs from 0.48 to 0.99). Results of meta-analysis for knee extension varying from high to very high reliability (pooled ICCs from 0.89 to 0.97), for knee flexion varying from high to very high reliability (pooled ICCs from 0.84 to 0.91) and for ankle plantar flexion showed high reliability (pooled ICC = 0.85). CONCLUSION: Objective muscle strength assessment can be reliably used in lower and upper extremities in post-stroke patients with chronic hemiparesis.

Reliability of Volumetry and Perimetry to Assess Knee Volume.

CONTEXT: The treatment of edema after a knee injury is usually 1 of the main objectives during rehabilitation. To assess the success of treatment, 2 methods are commonly used in clinical practice: volumetry and perimetry. OBJECTIVE: To investigate the intra- and interassessor reliability of volumetry and perimetry to assess knee volume. DESIGN: Cross-sectional. SETTING: Laboratory. PARTICIPANTS: 45 healthy participants (26 women) with mean age of 22.4 ± 2.8 y. MAIN OUTCOME MEASURES: Knee volume was assessed by 3 assessors (A, B, and C) with 3 methods (lower-limb volumetry [LLV], knee volumetry [KV], and knee perimetry [KP]). Assessor A was the most-experienced assessor, and assessor C, the least experienced. LLV and KV were performed with participants in the orthostatic position, while KP was performed with participants in supine. RESULTS: For the interassessor analysis, the ICC2,1 was high (.82) for KV and very high for LLV (.99) and KP (.99). For the intra-assessor analysis, ICC2,1 ranged from moderate to high for KV (.69-.83) and was very high for LLV (.99) and KP (.97-.99). CONCLUSION: KV, LLV, and KP are reliable methods, both intra- and interassessor, to measure knee volume.

Where do Physiotherapists Search for Information? Barriers in Translating Scientific Information into Clinical Practice.

INTRODUCTION: Comprehending scientific information have been reported as a barrier in evidence-based practice (EBP) adoption. This survey research aimed to verify the preferred sources of information for acquiring knowledge about physiotherapy and the association between types of information source and barriers in EBP implementation. METHODS: A total of 610 physiotherapists were included and answered an online questionnaire about the preferred sources for searching physiotherapy-related information and possible barriers in EBP implementation. RESULTS: Physiotherapists reported scientific resources as the preferred source of information, scientific databases (31%), followed by scientific articles (25%). The main barrier cited in EBP implementation was the difficulty in obtaining full-text articles (34%), followed by lack of statistical knowledge (30%). The use of peer-reviewed resources as the most preferred source of information is associated with the presence of issues in comprehending scientific information. DISCUSSION: Although the positive attitude toward the use of scientific information, the findings raised question regarding the proper translation of scientific information to clinical practice. The importance of scientific information seems to be a well-established attitude among physiotherapists. However, there is a clear need for strategies aiming to improve the understanding of scientific information and consequently facilitate EBP implementation.

Effect of kinesio taping on jumping and balance in athletes: a crossover randomized controlled trial.

The purpose of this crossover randomized controlled trial was to verify the effect of Kinesio Taping (KT) applied to the triceps surae with the aim to improve muscle performance during vertical jump (VJ), horizontal jump (HJ), and dynamic balance (DB) in healthy college athletes. The participants were 20 athletes (11 men) who competed in 4 different sports modalities (track and field, handball, volleyball, and soccer). Participants had a mean age of 22.3 ± 3.3 years, mean height of 1.74 ± 0.08 m, and mean body mass of 67.8 ± 10.1 kg. The intervention consisted of applying KT from the origin of the triceps surae to its insertion with the purpose of increasing muscle performance, and the placebo consisted of applying tape with nonelastic properties. There were no significant differences between KT and placebo conditions for height (m) in VJ (KT, 0.18 ± 0.06; placebo, 0.17 ± 0.06; p = 0.14), distance (m) in HJ (KT, 1.48 ± 0.3; placebo, 1.47 ± 0.3; p = 0.40), and DB in distance reached (m) in the star excursion balance test, normalized by lower limb length (anterior: KT, 90.0 ± 6.7; placebo, 89.5 ± 7.5; p = 0.56; posterolateral: KT, 92.5 ± 7.5; placebo, 93.2 ± 5.8; p = 0.52; posteromedial: KT, 98.3 ± 6.7; placebo, 98.7 ± 7.4; p = 0.69). The KT technique was not found to be useful in improving performance in some sports-related movements in healthy college athletes; therefore, KT applied to the triceps surae should not be considered by athletes when the sole reason of the application is to increase performance during jumping and balance.

Keep posting and following social media profiles about physical therapy, but be aware! A cross-sectional study of social media posts on Instagram and Twitter.

BACKGROUND: Social media is established as a communication channel that is useful to disseminate scientific information. While social media can disseminate high quality information, it can also facilitate the spread of false or misleading information. Furthermore, social media is considered a self-promotion environment that can have several aspects related to personal marketing. OBJECTIVE: To systematically search and review social media posts verifying whether the posts about physical therapy interventions reported sources of information; the presence of aspects suggesting conflicts of interest (COI); whether information was presented to facilitate knowledge acquisition; the reach of information posted; and the use and quality of the cited scientific references. METHODS: Searches were performed on Instagram and Twitter using #reabilitação for Portuguese posts, and #rehabilitation for English posts. The inclusion criteria were posts including terms related to physical therapy and presenting interventions along with their purposes. The searches and screening processes were performed by at least two independent researchers. RESULTS: Of 1,145 pre-selected posts, 632 posts were included, of which 14% cited references as source of information, 57% presented potential COI, and 9% facilitated knowledge acquisition. The posts received the mean ± SD of 88 ± 593 likes and profiles had a mean of 5,162 ± 37,240 followers. Considering the posts that cited references, most posts presented consistent information (51%) and 6% presented only positives outcomes (selection bias). Many references were of poor methodological quality (39%). CONCLUSION: The present study enlightens the fact that most posts on Instagram and Twitter regarding physical therapy interventions did not report or use sources to support the information disseminated. Also, most posts were not created to facilitate knowledge acquisition. REGISTRATION NUMBER: PROSPERO register database (CRD42021276941).

Effectiveness of Interventions Aimed at Changing Movement Patterns in People With Patellofemoral Pain: A Systematic Review With Network Meta-analysis.

OBJECTIVE: To summarize the effectiveness of interventions for changing movement during weight-bearing functional tasks in people with patellofemoral pain (PFP). DESIGN: Systematic review with network meta-analysis (NMA). LITERATURE SEARCH: Medline, Embase, CINAHL, SPORTDiscus, and Cochrane Library were searched from inception up to May 2023. STUDY SELECTION CRITERIA: Randomized controlled trials involving people with PFP and nonsurgical, nonpharmacological interventions on task kinematics were included. DATA SYNTHESIS: NMA was conducted for frontal knee movement data, and pairwise meta-analysis was used to pool data when NMA was not possible. Reduced movements were those changes that indicated movements occurring with less amplitude. The GRADE approach was used to grade the certainty of the evidence. RESULTS: Thirty-seven trials were included (n = 1235 participants). Combining knee/hip exercises with internal feedback had the strongest effect on reducing frontal knee movements (standardized mean difference [SMD] from NMA = -2.66; GRADE: moderate evidence). On pairwise comparisons, the same combination of interventions reduced frontal hip movements (SMD = -0.47; GRADE: moderate evidence) and increased sagittal knee movements (SMD = 1.03; GRADE: moderate evidence), with no effects on sagittal hip movements (GRADE: very low evidence), compared to knee/hip exercises alone. There was no effect for single applications of braces on the frontal knee movement (GRADE: very low evidence) and taping on movements of the knee, hip, and ankle (GRADE: very low to low evidence) compared to no intervention. CONCLUSION: Knee/hip exercises combined with internal feedback techniques may change knee and hip movements in people with PFP. The combination of these interventions can reduce frontal knee and hip movements, and can increase sagittal knee movements. J Orthop Sports Phys Ther 2023;53(12):1-13. Epub 14 September 2023. doi:10.2519/jospt.2023.11956.

Intra and interrater reliability for lower limb flexibility assessment using photogrammetry.

INTRODUCTION: Photogrammetry represents an advancement in the flexibility evaluation, and although it was highly explored for postural assessment, there is a scarcity of studies analyzing lower limb angular measurements using it. The purpose of this study is to verify the reliability of intrarater and interrarater photogrammetry in assessing lower limb flexibility. METHODS: This was a randomized cross-sectional observational study with test-retest design and a two-day interval. Thirty healthy, physically active adults were included. Three novice raters assessed the participants through flexibility tests of iliopsoas, hamstring, quadriceps and gastrocnemius on two occasions, and independently analyzed the captured images to establish reliability. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated. RESULTS: Intrarater reliability was excellent for iliopsoas (ICC = 0.96; SEM = 1.4; MDC = 3.8), hamstring (ICC = 0.99; SEM = 1.1; MDC = 3.1), quadriceps (ICC = 0.99; SEM = 0.8; MDC = 2.3) and gastrocnemius (ICC = 0.98; SEM = 0.9; MDC = 2.5). Interrater reliability was excellent for iliopsoas (ICC = 0.94; SEM = 1.7; MDC = 4.6) and gastrocnemius (ICC = 0.91; SEM = 2.1; MDC = 5.8), but good for hamstring (ICC = 0.90; SEM = 2.8; MDC = 7.9) and quadriceps (ICC = 0.85; SEM = 3.0; MDC = 8.3). CONCLUSIONS: The excellent intrarater and good to excellent interrater reliability suggest that photogrammetry assessment of lower limb flexibility by novice raters is reliable. However, clinicians should consider the higher threshold of range of motion change necessary to outweigh measurement error due to interrater variability.

Injuries and complaints in the Brazilian national volleyball male team: a case study.

BACKGROUND: The literature reports a vast amount of epidemiological information on injuries in volleyball athletes. However, little is known about the incidence of injuries in elite athletes of international level participating in major competitions, such as world championships and Olympic games. The objective of the study was to analyse the incidence of injuries in elite professional volleyball athletes, and the prevalence of complaints reported by athletes. METHODS: This is a case study in which data were collected between April 2018 and August 2021. All the athletes called to play for the Brazilian national male volleyball team during the analysis period participated. From the athletes' medical records, the occurrence of injuries (injurious events that lead to a time off from activities) and complaints (discomforts that did not lead to a time off from activities) were analysed. Frequency data were used to calculate incidence, prevalence and ratios. RESULTS: From 41 athletes who played for the team during the analysed period, 12 athletes had 28 injuries and 38 athletes reported 402 complaints. For injuries, an incidence of seven injuries/1,000 h of competition and two injuries/1,000 h of training was observed. The average recovery time of the athletes was 10 days. The regions with the highest prevalence of injuries were the knee (111/1,000 athletes) and ankle (69/1,000 athletes). For complaints, 402 complaints required 1,085 treatment sessions, with the regions with the highest prevalence of complaints being the knee (261/1,000 complaints) followed by the shoulders (236/1,000 complaints). Athletes aged above 23 years and those playing as middle blockers and outside hitters presented a higher prevalence of injuries and complaints. CONCLUSIONS: Almost one-third of the athletes had injuries and almost all athletes reported complaints during the study period. Injuries and complaints were more prevalent in the knees. Complaints caused a high demand for the healthcare team. To manage risk of injuries for overload, specific injury prevention strategies are needed and should be included as an essential component of the training plan for elite volleyball players.

Are Changes in Dynamic Knee Movement Control Related to Changes in Pain or Function in People With Knee Disorders? A Systematic Review and Meta-analysis.

OBJECTIVE: To study whether changes in dynamic knee valgus or varus were associated with changes in pain or function in people with knee disorders. DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: We searched the MEDLINE, Embase, CINAHL, SPORTDiscus, Cochrane Library, and Web of Science, from inception up to January 2023. STUDY SELECTION CRITERIA: We included randomized controlled trials investigating the effects of nonsurgical (including nonpharmacological) interventions for knee disorders on frontal and transverse plane knee and hip movements during functional tasks, which reported pain and/or function outcomes. DATA SYNTHESIS: The relationship between changes in kinematics and pain/function was analyzed using a 2-stage structural equation modeling approach. RESULTS: From 42 202 records, 48 trials met the eligibility criteria. For people with patellofemoral pain (25 trials, n = 894), there was moderate evidence that changes in the knee and hip movements were significantly correlated with changes in pain and function (r= -0.69 to 0.73), except for the knee transverse plane movements and for the relationship between hip transverse plane movement and function. For people with knee osteoarthritis (15 trials, n = 704) and anterior cruciate ligament injuries (8 trials, n = 198), the evidence was limited and uncertain. CONCLUSION: The relationship between changes in movement control and clinical outcomes was consistent in people with patellofemoral pain. For people with knee osteoarthritis or anterior cruciate ligament injuries, there was a paucity of evidence that precluded a proper evaluation of the relationship between dynamic knee movement control, and pain and function. J Orthop Sports Phys Ther 2023;53(7):1-14. Epub: 18 April 2023. doi:10.2519/jospt.2023.11628.

Indeed, Correlation Does Not Indicate Causation!

Author response to the JOSPT Letter to the Editor-in-Chief "Lower-Limb Kinematics and Clinical Outcomes: Correlation Does not Imply Causality" J Orthop Sports Phys Ther 2023;53(11):723-725. doi:10.2519/jospt.2023.0203-R.

Intraobserver and interobserver reliability of a method to measure ankle plantar-flexion range of motion in the hook-lying position.

CONTEXT: Physical therapists often have to measure ankle range of motion (ROM) to decide on intervention and investigate improvements. The most common method of measurement is goniometry, but it has been questioned due to its unsatisfactory levels of reliability. OBJECTIVE: To investigate the intraobserver and interobserver reliability of a new method of measuring plantar-flexion ROM. DESIGN: Prospective and descriptive. SETTING: Laboratory. PARTICIPANTS: 20 healthy participants (12 women and 8 men). MAIN OUTCOME MEASUREMENTS: Ankle plantar flexion was measured by 3 observers (A, B, and C) with 3 methods (goniometry, measurement in hook-lying position [MHP], and static-image analysis [SIA]). Observer A was the most experienced therapist, and C, the least. MHP was performed with the participant in the supine position, knees flexed, and first and fifth metatarsals in contact with the treatment table. SIA was recorded and analyzed in the same position. Goniometry was performed with participant seated, lower legs unsupported, and axis positioned on the lateral malleolus. RESULTS: For the interobserver analysis, the ICC2,1 was high for the MHP (.88), high for SIA (.87), and moderate for goniometry (.57). For the intraobserver analysis, the ICC2,1 was high or very high for MHP (.91-.92), high for SIA (.79-.83), and low to moderate for goniometry (.18-.60). CONCLUSION: MHP is inexpensive, fast, and more reliable than goniometry for measuring plantar-flexion ROM.

Is Postural Control Affected in People with Patellofemoral Pain and Should it be Part of Rehabilitation? A Systematic Review with Meta-analysis.

BACKGROUND: Growing evidence supports that exercise therapy is effective for patellofemoral pain (PFP) rehabilitation. Nevertheless, the improvements have been reported not to be sustained in the long term, suggesting that the current protocols may not comprehend all required functional factors to provide a consistent recovery. A potential neglected factor in treatment protocols for PFP is postural control. However, it is unclear whether this population presents balance impairments or the influence of postural control on pain and function during rehabilitation programmes. OBJECTIVE: To investigate whether (Q1) balance is impaired in people with PFP compared to controls, (Q2) conservative interventions are effective to improve balance in people with PFP, and (Q3) balance exercises are effective to improve pain and function in people with PFP. DATA SOURCES: Medline, Embase, CINAHL, SPORTDiscus, Web of Science and Cochrane Library, supplemented by hand searching of reference lists, citations and relevant systematic reviews in the field. METHODS: A systematic review with meta-analysis was conducted according to the Cochrane recommendations and reported according to the PRISMA statement recommendations. We included cross-sectional studies comparing balance between people with and without PFP; and randomised controlled trials verifying the effect of conservative intervention on balance and the effect of balance intervention on pain and function in people with PFP. The risk of bias was assessed using the Epidemiological Appraisal Instrument for cross-sectional studies and the Physiotherapy Evidence Database scale for randomised controlled trials. RESULTS: From 15,436 records, 57 studies (Q1 = 28, Q2 = 23, Q3 = 14) met the eligibility criteria. Meta-analyses indicated that people with PFP have worse anteroposterior (very low grade evidence, standardised mean difference [SMD] = 1.03, 95% CI 0.40-1.66) and mediolateral (moderate grade evidence, SMD = 0.87, 95% CI 0.31-1.42) balance compared to controls. Moderate grade evidence indicated that overall balance is not affected in people with PFP (SMD = 0.38, 95% CI - 0.05-0.82). Low to very low grade evidence indicates that interventions are ineffective for mediolateral (SMD = 0.01, 95% CI - 0.51-0.53) and overall (SMD = 0.49, 95% CI - 0.14-1.11) balance improvements, and low grade evidence indicates that interventions are effective to improve anteroposterior balance (SMD = 0.64, 95% CI 0.04-1.23). Moderate to low grade evidence indicated that balance interventions are effective to reduce pain (SMD = 0.82, 95% CI 0.26-1.38) and improve function (SMD = 0.44, 95% CI 0.09-0.80) when measured using questionnaires; and very low grade evidence indicated no efficacy for function measured via functional tests (SMD = 0.73, 95% CI - 0.16-1.61). CONCLUSION: People with PFP likely present balance deficits compared to asymptomatic people. There was insufficient evidence to support the efficacy of interventions to improve or modify balance in people with PFP. Also, there was insufficient evidence to support the efficacy of balance exercises to improve pain and function in people with PFP. Trial Registration The present systematic review was registered in PROSPERO (CRD42018091717).

Gluteal muscle activity during running in asymptomatic people.

BACKGROUND: Hip abductor muscle function is associated with running-related injuries. Previous electromyography (EMG) studies that reporting gluteal muscle activity when running have failed to account for the multiple segments of the gluteals, and have used surface electrodes, which may be contaminated by cross-talk of surrounding muscles. RESEARCH QUESTION: This study aimed to: (i) develop EMG profiles of gluteus medius (GMed - anterior, middle and posterior) and gluteus minimus (GMin - anterior and posterior) segments during running; (ii) compare the activation patterns of each gluteal segment between running and walking; and (iii) compare surface EMG signals of running and walking to fine wire EMG signals of middle GMed. METHODS: Ten physically active and asymptomatic people participated. Gluteal segment activation was assessed during running and walking over 10 m. Muscle activation was assessed using bipolar fine wire intramuscular EMG electrodes and GMed activation was also assessed using surface EMG. RESULTS: During running, all gluteal segments presented peak amplitude during the stance phase and anterior GMin presented additional second peak amplitude during the swing phase. All gluteal segments evaluated demonstrated consistently higher amplitudes during the stance and swing phases of running compared to walking. The mean amplitude assessed using surface EMG was 32-87% higher compared to fine wire during both phases for running and walking. SIGNIFICANCE: Greater activation of GMed segments during the stance phase and the increased anterior GMin activity during the swing phase indicate a potentially important role for pelvis and hip stabilization, respectively, which should be considered during development of targeted rehabilitation for running populations. The overestimated activation using surface electrodes highlights a limitation of using surface EMG during running and walking.

Cross-cultural adaptation and measurement properties of the Brazilian-Portuguese version of the Cincinnati Knee Rating System.

Purpose: To translate, culturally adapt, evaluate the measurement properties, and propose a new scoring system of the Cincinnati Knee Rating System for the Brazilian population.Materials and Methods: One hundred fifty people with anterior cruciate ligament injury completed Cincinnati Knee Rating System and Lysholm Knee Scoring Scale on three occasions: 1-week prior to surgery, 90-days after and 95-days after reconstruction. The measurement properties of the Brazilian-Portuguese Cincinnati Knee Rating System, internal consistency, construct validity, reproducibility, ceiling and floor effect and responsiveness, were tested.Results: Using the original scoring system (multiple scores), the internal consistency (Cronbach's α) varied between 0.54-0.79 (if item deleted = 0.07-0.73); the construct validity (Pearson's r) varied between 0.19-0.82 (related to Lysholm); the reliability (intraclass correlation coefficient) varied between 0.96-0.99; the standard error of measurement varied between 0.2-1.3 points; the minimum detectable change varied between 0.4-3.5 points; no ceiling or floor effect was detected, and responsiveness (effect size) varied between -0.3-2.7. Using the new proposed scoring system (single score), Cronbach's α was 0.78 (if item deleted = 0.65-0.71); the Pearson's r was 0.79 (related to Lysholm); the intraclass correlation coefficient was 0.99; the standard error of measurement was 0.5 points, the minimum detectable change was 1.3 points; no ceiling or floor effect was detected, and effect size was 1.4.Conclusions: The Brazilian-Portuguese Cincinnati Knee Rating System has adequate property measurement and can be used in a Brazilian population. The new proposed scoring system is appropriate.Implications for rehabilitationThe Brazilian-Portuguese Cincinnati Knee Rating System is a valid and reliable instrument which can identify consistent clinical changes over the time.The Brazilian-Portuguese Cincinnati Knee Rating System can be used to evaluate and to follow-up a Brazilian population with anterior cruciate ligament injuries and postoperative reconstruction.The new proposed score for Cincinnati Knee Rating System is appropriate and did not compromise the quality of the measurement properties.The new scoring system generates a unique score, creating a potentially simpler and faster clinical understanding of the patient's condition.