Dynamic Movement Assessment and Functional Movement Screening for injury prediction: a systematic review

A Dynamic Movement Assessment (DMA™) e o Functional Movement Screening (FMS™) são ferramentas utilizadas para classificar o risco de lesões musculoesqueléticas em indivíduos que praticam exercícios físicos. O objetivo da presente revisão sistemática foi avaliar a associação de DMA™ e FMS™ com o risco de lesões musculoesqueléticas em diferentes atividades físicas, categorizando por análise. Uma pesquisa sem filtros de idioma ou de tempo foi realizada em novembro de 2016 nas bases de dados MEDLINE, Google Scholar, SciELO, SCOPUS, SPORTDiscus, CINAHL e BVS, utilizando as palavras-chave: “predição de lesão”, “risco de lesão”, “sensibilidade”, “especificidade”, “functional movement screening” e “dynamic movement assessment”. Foram incluídos estudos prospectivos que analisaram a associação entre DMA™ e FMS™ com o risco de lesões musculoesqueléticas em atividades físicas. Foram extraídos dos estudos: perfil dos participantes, tamanho da amostra, critérios de classificação da lesão, tempo de seguimento e os resultados apresentados, subdivididos pelo tipo de análise estatística. O risco de viés foi realizado com a Escala Newcastle-Ottawa para estudos de coorte. Não foi encontrado nenhum estudo sobre a DMA™. Foram incluídos 20 estudos, que analisaram um ou mais dos seguintes indicadores: acurácia diagnóstica (VPP, VPN e AUC), razão de chances (OR) ou risco relativo (RR). O FMS™ apresentou sensibilidade=12-99%; especificidade=38-97%; VPP=25-91%; VPN=28-85%; AUC=0,42-0,68; OR=0.53-54.5; e RR=0,16-5,44. O FMS™ apresentou-se como um método preditor de lesões musculoesqueléticas. Entretanto, devido às limitações metodológicas dos estudos, seu uso indiscriminado deve ser evitado.Evaluación Dinámica del Movimiento™ (DMA™) y Detección del Movimiento Funcional ™ (FMS™) son herramientas para predecir el riesgo de lesiones musculoesqueléticas en individuos que practican actividades físicas. Esta revisión sistemática tuvo como objetivo evaluar la asociación de DMA™ y FMS™ con el riesgo de lesiones musculoesqueléticas en diferentes actividades físicas y categorizarlas por análisis. En noviembre de 2016 se llevó a cabo una investigación sin filtros de idioma o de tiempo en las bases de datos MEDLINE, Google Scholar, SciELO, SCOPUS, SPORTDiscus, CINAHL y BVS, utilizando las palabras clave: predicción de lesiones, riesgo de lesiones, sensibilidad, especificidad, detección del movimiento funcional y evaluación dinámica de movimientos. Se incluyeron estudios prospectivos que analizaron la asociación entre DMA™ y FMS™ con el riesgo de lesiones musculoesqueléticas en actividades físicas. Los datos extraídos de los estudios fueron: perfil del participante, tamaño de la muestra, criterios de clasificación de la lesión, tiempo de seguimiento y los resultados presentados, subdivididos por el tipo de análisis estadístico. El riesgo de sesgo se realizó con la Escala Newcastle-Ottawa para estudios de cohorte. No se encontró ningún estudio con DMA™. Se incluyeron un total de 20 estudios FMS™ que analizaron uno o más de los siguientes indicadores: precisión diagnóstica (VPP, VPN y ABC), odds ratios (OR) o riesgo relativo (RR). FMS™ mostró una sensibilidad = del 12 al 99%; especificidad = del 38 al 97%; VPP = del 25 al 91%; VPN = del 28 al 85%; ABC = 0,42 a 0,68; OR = 0,53 a 54,5; y RR = 0,16-5,44. El FMS™ ha demostrado ser un predictor de lesiones musculoesqueléticas. Sin embargo, debido a limitaciones metodológicas, se debe evitar su uso indiscriminado.Dynamic Movement Assessment™ (DMA™) and Functional Movement Screening™ (FMS™) are tools to predict the risk of musculoskeletal injuries in individuals who practice physical activities. This systematic review aimed to evaluate the association of DMA™ and FMS™ with the risk of musculoskeletal injuries, in different physical activities, categorizing by analysis. A research without language or time filters was carried out in November 2016 in MEDLINE, Google Scholar, SciELO, SCOPUS, SPORTDiscus, CINAHL and BVS databases using the keywords: “injury prediction”, “injury risk”, “sensitivity”, “specificity”, “functional movement screening”, and “dynamic movement assessment”. Prospective studies that analyzed the association between DMA™ and FMS™ with the risk of musculoskeletal injuries in physical activities were included. The data extracted from the studies were: participant’s profile, sample size, injury’s classification criteria, follow-up time, and the results presented, subdivided by the type of statistical analysis. The risk of bias was performed with Newcastle-Ottawa Scale for cohort studies. No study with DMA™ was found. A total of 20 FMS™ studies analyzing one or more of the following indicators were included: diagnostic accuracy (PPV, NPV and AUC), odds ratios (OR) or relative risk (RR). FMS™ showed a sensitivity=12 to 99%; specificity=38 to 97%; PPV=25 to 91%; NPV=28 to 85%; AUC=0.42 to 0.68; OR=0.53 to 54.5; and RR=0.16-5.44. The FMS™ has proven to be a predictor of musculoskeletal injuries. However, due to methodological limitations, its indiscriminate usage should be avoided

The effects of inspiratory muscle strengthening on MIP and quality of life of elderly nursing home patients. (Los efectos del beneficio de la fuerza del músculo inspiratorio en la PIM y la calidad de la vida de los pacientes mayores de la clínica de reposo.)

<b>Abstract</b><p align="justify">The objective of this study was to compare the effects of inspiratory muscle strengthening on maximal inspiratory pressure (MIP) and on quality of life among elderly nursing home patients. The study population was divided in two groups: experimental group- EG (n=21, 76.48 2.12 years) and control group- CG (n=13, 75.69 2.26 years). The World Health Organization Quality of Life Group (WHOQOL-100) questionnaire was used to evaluate the quality of life of the subjects. A Manovacuometer (analogical, with an operational interval of –150 to +150 cmH2O; Critical Med/USA-2002) was used to evaluate MIP. The study protocol consisted of a gradual increase in workload (50%-100%); the sessions lasted 20 minutes and were composed of 7 series of strengthening (2 minutes each) with a 1-minute interval between the series, 3 times a week for 10 weeks. Variance analysis of multivariate repeated measurements demonstrated significant differences only for MIP between CG (32,69±17,03 cmH2O versus 23,08±10,71 cmH2O) and EG (31,67±11,11 cmH2O versus 55,24±23,26 cmH2O), and the latter was higher than the former (p= 0,00000). Therefore, we concluded that inspiratory muscle strengthening led to an increase in MIP that did not improve quality of life. However, further studies should be done in this population to validate a quality of life questionnaire specific for the elderly.</p><b>Resumen</b><p align="justify">El objetivo de este estudio era comparar los efectos del músculo inspiratorio que consolidaban en la presión inspiratoria máxima (PIM) y en la calidad de la vida entre pacientes mayores de la clínica de reposo. Dividieron a la población del estudio en dos grupos: grupo experimental EG. (n=21,76.48 2.12 años) y grupo de control CG (n=13, 75.69 2.26 años). La calidad de la Organización Mundial de la Salud del cuestionario del grupo de la vida(WHOQOL-100) fue utilizada para evaluar la calidad de la vida de los temas. Un Manovacuometer (analógico, con un intervalo operacional - de 150 a +150 cmH2O; Med/USA-2002 crítico) fue utilizado para evaluar la MIP.El protocolo del estudio consistió en un aumento gradual en la carga de trabajo (50%-100%); las sesiones duraron 20 minutos y fueron compuestas de 7 series de consolidación (2 minutos cada uno) con un 1 intervalo minucioso entre la serie, 3 veces a la semana por 10 semanas. El análisis de variación de medidas repetidas multivariate demostró diferencias significativas solamente para la MIPS entre CG (32,69±17,03 cmH2O contra 23,08±10,71 cmH2O) y EG. (31,67±11,11 cmH2O contra 55,24±23,26 cmH2O), y el último era más alto que el anterior (p= 0.00000). Por lo tanto, concluimos que el músculo inspiratorio que consolidaba condujo a un aumento en la MIPS que no mejoró la calidad de la vida. Sin embargo, otros estudios se deben hacer en esta población para validar una calidad del específico del cuestionario de la vida para los ancianos.</p

Wii-Workouts on Chronic Pain, Physical Capabilities and Mood of Older Women: A Randomized Controlled Double Blind Trial

Chronic Low Back Pain (CLBP) is a public health problem and older women have higher incidence of this symptom, which affect body balance, functional capacity and behavior. The purpose of this study was to verifying the effect of exercises with Nintendo Wii on CLBP, functional capacity and mood of elderly. Thirty older women (68 ± 4 years; 68 ± 12 kg; 154 ± 5 cm) with CLBP participated in this study. Elderly individuals were divided into a Control Exercise Group (n = 14) and an Experimental Wii Group (n = 16). Control Exercise Group did strength exercises and core training, while Experimental Wii Group did ones additionally to exercises with Wii. CLBP, balance, functional capacity and mood were assessed pre and post training by the numeric pain scale, Wii Balance Board, sit to stand test and Profile of Mood States, respectively. Training lasted eight weeks and sessions were performed three times weekly. MANOVA 2 x 2 showed no interaction on pain, siting, stand-up and mood (P = 0.53). However, there was significant difference within groups (P = 0.0001). ANOVA 2 x 2 showed no interaction for each variable (P > 0.05). However, there were significant differences within groups in these variables (P 0.01). Capacity to Sit improved only in Experimental Wii Group (P = 0.04). In conclusion, physical exercises with Nintendo Wii Fit Plus additional to strength and core training were effective only for sitting capacity, but effect size was small

Wii-Workouts on Chronic Pain, Physical Capabilities and Mood of Older Women: A Randomized Controlled Double Blind Trial

Chronic Low Back Pain (CLBP) is a public health problem and older women have higher incidence of this symptom, which affect body balance, functional capacity and behavior. The purpose of this study was to verifying the effect of exercises with Nintendo Wii on CLBP, functional capacity and mood of elderly. Thirty older women (68 ± 4 years; 68 ± 12 kg; 154 ± 5 cm) with CLBP participated in this study. Elderly individuals were divided into a Control Exercise Group (n = 14) and an Experimental Wii Group (n = 16). Control Exercise Group did strength exercises and core training, while Experimental Wii Group did ones additionally to exercises with Wii. CLBP, balance, functional capacity and mood were assessed pre and post training by the numeric pain scale, Wii Balance Board, sit to stand test and Profile of Mood States, respectively. Training lasted eight weeks and sessions were performed three times weekly. MANOVA 2 x 2 showed no interaction on pain, siting, stand-up and mood (P = 0.53). However, there was significant difference within groups (P = 0.0001). ANOVA 2 x 2 showed no interaction for each variable (P > 0.05). However, there were significant differences within groups in these variables (P 0.01). Capacity to Sit improved only in Experimental Wii Group (P = 0.04). In conclusion, physical exercises with Nintendo Wii Fit Plus additional to strength and core training were effective only for sitting capacity, but effect size was small

Electrostimulation, response of the pelvic floor muscles, and urinary incontinence in elderly patients post prostatectomy

Objective: to investigate the response of the pelvic floor muscles (PFM), and urinary incontinence (UI), in patients having undergone a prostatectomy, after treatment using electrical stimulation. Materials and methods: this observational study was conducted in an outpatient urogynecologic physical therapy clinic of Hospital dos Servidores in Rio de Janeiro, Brazil from August to September 2012. Ten patients (aged, 64 ± 7 years) with urinary incontinence resulting from radical prostatectomy, having received surgery within six months of study entry, without urinary infection, and without metallic implants underwent electrical stimulation of the PFM, while in lateral decubitus position with knees and hips flexed. The parameters used were 65 Hz frequency, pulse width of 500 µs, biphasic current, intensity according to the tolerance level reported by the patient, perineal contraction time of four seconds, and rest time of eight seconds for 20 minutes twice a week, totaling 16 sessions of electrical stimulation with active-assisted contraction. Patients were evaluated before and after electrical stimulation through physical therapy evaluation of urinary incontinence, by being asked about the number of disposable guards used daily, using a visual analogue scale (VAS) to measure how the UI interfered with activities of daily living, and by electromyographic biofeedback to measure the work of the PFM. Data were analyzed using Students paired t-tests and a significance level of 0.05. Results: after 16 sessions of electrical stimulation, the electromyographic biofeedback evaluation showed a significant increase in muscle strength of 10.73 ± 8.64 to 17.16 ± 9.00 µV (t = -3.39, P = 0.008), a significant decrease in the number of diapers used before and after treatment (3.9 ± 1.2 to 1.8 ± 1.5, respectively; t = 5.16, P = 0.0006), and a significant decrease in the interference of urinary incontinence on daily activities of 9.6 ± 0.5 to 4.0 ± 3.8 (t = 5.15, P = 0.0006). Conclusion: electrical stimulation may represent a novel way to strengthen the pelvic floor muscles and decrease urinary incontinence resulting from radical prostatectomy

Electrostimulation, response of the pelvic floor muscles, and urinary incontinence in elderly patients post prostatectomy

Objective to investigate the response of the pelvic floor muscles (PFM), and urinary incontinence (UI), in patients having undergone a prostatectomy, after treatment using electrical stimulation. Materials and methods this observational study was conducted in an outpatient urogynecologic physical therapy clinic of Hospital dos Servidores in Rio de Janeiro, Brazil from August to September 2012. Ten patients (aged, 64 ± 7 years) with urinary incontinence resulting from radical prostatectomy, having received surgery within six months of study entry, without urinary infection, and without metallic implants underwent electrical stimulation of the PFM, while in lateral decubitus position with knees and hips flexed. The parameters used were 65 Hz frequency, pulse width of 500 µs, biphasic current, intensity according to the tolerance level reported by the patient, perineal contraction time of four seconds, and rest time of eight seconds for 20 minutes twice a week, totaling 16 sessions of electrical stimulation with active-assisted contraction. Patients were evaluated before and after electrical stimulation through physical therapy evaluation of urinary incontinence, by being asked about the number of disposable guards used daily, using a visual analogue scale (VAS) to measure how the UI interfered with activities of daily living, and by electromyographic biofeedback to measure the work of the PFM. Data were analyzed using Student’s paired t-tests and a significance level of 0.05. Results after 16 sessions of electrical stimulation, the electromyographic biofeedback evaluation showed a significant increase in muscle strength of 10.73 ± 8.64 to 17.16 ± 9.00 µV (t = -3.39, P = 0.008), a significant decrease in the number of diapers used before and after treatment (3.9 ± 1.2 to 1.8 ± 1.5, respectively; t = 5.16, P = 0.0006), and a significant decrease in the interference of urinary incontinence on daily activities of 9.6 ± 0.5 to 4.0 ± 3.8 (t = 5.15, P = 0.0006). Conclusion electrical stimulation may represent a novel way to strengthen the pelvic floor muscles and decrease urinary incontinence resulting from radical prostatectomy

Eletroestimulação e core training sobre dore arco de movimento na lombalgia

Introdução: Eletrotermofototerapia e cinesioterapia são opções para o tratamento de lombalgias. Exercícios voltados para a musculatura para vertebral visam ao aumento de força e arco de movimento (ADM). A eletroestimulação neuromuscular (EENM) incrementa a função muscular. Objetivos: Apurar a influência da EENM associada a um programa de core training (CT) sobre a lombalgia inespecífica crônica, com as variáveis de dor e ADM da coluna vertebral. Materiais e métodos: Foi realizado ensaio clínico controlado randomizado duplo cego, com 27 pacientes atendidos na Clínica-Escola FIT-UGF, com diagnóstico médico relacionado a lombalgias. Foram formados dois grupos aleatoriamente: controle ativo (CORE; n = 13) e experimental(CORE + EENM; n = 14). O questionário de McGill e a fotogrametria foram aplicados antes da primeira e após a última sessão de tratamentos para medir dor e ADM, respectivamente. Resultados: Os grupos eram homogêneos quanto à dor inicial (p = 0,99); a dor final do grupo CORE + EENM foi significativamente menor que a do grupo CORE (p = 0,03); a dor final do grupo CORE não apresentou diferença significativa em relação à inicial (p = 0,93); a dor final do grupo CORE + EENM foi significativamente menor que a inicial (p = 0,00). O ADM não apresentou diferença significativa intragrupos e intergrupos (p = 0,10). Conclusão: A aplicação de EENM em região lombar após CT foi eficaz, causando diminuição significativa da lombalgia inespecífica.Entretanto, não ocorreu diferença significativa do ADM entre os grupos

Pelvic floor muscle exercises with or without electric stimulation and post-prostectomy urinary incontinence: a systematic review

Introduction: Urinary incontinence (UI) after prostatectomy is difficult to treat and causes profound adverse impacts on the individuals quality of life. The main clinical treatments available for post-prostatectomy UI consist of behavioral techniques and physical therapy techniques, such as exercises, electrical stimulation and biofeedback for pelvic floor muscles (PFMs). Objective: To investigate the effectiveness of PFM exercises with or without electrical stimulation for reducing post-prostatectomy UI. Methods: We included only randomized controlled trials (RCTs) which used PFM exercises with or without electrical stimulation. The search was conducted in August of 2013 in the databases of the U.S. National Library of Medicine (MEDLINE), Scientific Electronic Library Online (SciELO), Physiotherapy Evidence Database (PEDro) and Virtual Health Library (VHL). We searched for RCTs published between 1999 and 2013. As keywords for our search, we used the following descriptors from the Health Sciences Descriptors (DeCS): urinary incontinence, pelvic diaphragm, prostatectomy, pelvic floor exercises, electrostimulation and electrical stimulation. We also used the following descriptors from the Medical Subject Headings (MeSH): electrical stimulation, pelvic floor, urinary incontinence, prostatectomy, physiotherapy and exercise therapy. Results: Of the 59 RCTs found, 26 were excluded as duplicates, and 28 were excluded for not displaying a minimum score of 5.0 on the PEDro Scale, which left us with five RCTs. Conclusion: PFM exercises can be effective for treating UI after radical prostatectomy, especially if begun soon after surgery. Associating electrical stimulation with PFM exercises did not show additional benefit for treating urinary incontinence. However, the selected studies presented some methodological weaknesses that may have compromised their internal validity

Pelvic floor muscle exercises with or without electric stimulation and post-prostectomy urinary incontinence: a systematic review

Abstract Introduction: Urinary incontinence (UI) after prostatectomy is difficult to treat and causes profound adverse impacts on the individual's quality of life. The main clinical treatments available for post-prostatectomy UI consist of behavioral techniques and physical therapy techniques, such as exercises, electrical stimulation and biofeedback for pelvic floor muscles (PFMs). Objective: To investigate the effectiveness of PFM exercises with or without electrical stimulation for reducing post-prostatectomy UI. Methods: We included only randomized controlled trials (RCTs) which used PFM exercises with or without electrical stimulation. The search was conducted in August of 2013 in the databases of the U.S. National Library of Medicine (MEDLINE), Scientific Electronic Library Online (SciELO), Physiotherapy Evidence Database (PEDro) and Virtual Health Library (VHL). We searched for RCTs published between 1999 and 2013. As keywords for our search, we used the following descriptors from the Health Sciences Descriptors (DeCS): urinary incontinence, pelvic diaphragm, prostatectomy, pelvic floor exercises, electrostimulation and electrical stimulation. We also used the following descriptors from the Medical Subject Headings (MeSH): electrical stimulation, pelvic floor, urinary incontinence, prostatectomy, physiotherapy and exercise therapy. Results: Of the 59 RCTs found, 26 were excluded as duplicates, and 28 were excluded for not displaying a minimum score of 5.0 on the PEDro Scale, which left us with five RCTs. Conclusion: PFM exercises can be effective for treating UI after radical prostatectomy, especially if begun soon after surgery. Associating electrical stimulation with PFM exercises did not show additional benefit for treating urinary incontinence. However, the selected studies presented some methodological weaknesses that may have compromised their internal validity

Intracavitary electrical stimulation as treatment for overactive bladder: systematic review

Introduction: Overactive bladder (OAB) is a clinical diagnosis of irritating urinary symptoms that influence on sufferers´ life quality. There are effective treatments described in literature, but most of them present adverse effects. One way of treatment is the use of electrical stimulation, which has been widely used, but studies show varying results. Objective: To verify if intracavitary electrical stimulation can be effective in patients with OAB. Methods: online databases were searched with specific descriptors to find randomized clinical trials on overactive bladder treated with intracavitary electrical stimulation. Only articles with score equal or higher than 5 in methodological PEDro scale were used and those that described intra and / or inter-group P-value. Results: 217 articles were found, but only 6 were analyzed by the selection criteria. The studies show that electrical stimulation promotes the reduction of urinary frequency, urinary incontinence, nocturia, urgency and the number of protectors used, and improvements in maximum cystometric bladder capacity, symptoms of OAB and quality of life. Conclusion: Electrical stimulation was effective in patients with OAB and can be used before any invasive treatment due to none side effects