App-based telerehabilitation program for older adults on waiting list for physiotherapy after hospital discharge: a feasibility pragmatic randomized trial

Abstract Background Inactivity while waiting for outpatient physiotherapy worsens the physical deconditioning of older adults after hospital discharge. Exercise programs can minimize the progression of deconditioning. In developing countries, telerehabilitation for older adults on the waiting list is still in the early stages. This study aimed to evaluate the feasibility of the study procedures of a telerehabilitation program for older adults waiting for outpatient physiotherapy after hospital discharge. Methods This pragmatic randomized controlled trial recruited older adults (≥ 60 years) with several clinical diagnoses on the waiting list for outpatient physiotherapy in the Brazilian public health system after hospital discharge. The telerehabilitation group (n = 17) received a personalized program of multicomponent remote exercises using a smartphone app. The control group (n = 17) followed the usual waiting list. We assessed recruitment and dropout rates, safety, adherence, and satisfaction. The preliminary effects were verified on clinical outcomes. Results We recruited 5.6 older adults monthly; dropouts were 12%. No serious adverse events were associated with the telerehabilitation program. The weekly adherence was 2.85 (1.43) days, and in 63.3% of the weeks the participants were enrolled, they performed the exercise program at least twice a week. Participants rated the telerehabilitation program as 9.71 (0.21), and the safety of remote exercises without professional supervision as 8.6 (2.2) on a 0–10 scale. Conclusions The telerehabilitation program using a smartphone app was safe and presented high participants’ satisfaction and adequate adherence, recruitment, and dropout rates. Therefore, the definitive study can be conducted with few modifications. Trial registration Brazilian Registry of Clinical Trials (ReBEC), RBR-9243v7. Registered on 24 August 2020. https://ensaiosclinicos.gov.br/rg/RBR-9243v7

Efeito dos exercícios de fortalecimento e alongamento sobre a rigidez tecidual passiva

Introdução: Níveis excessivos ou reduzidos de rigidez passiva dos músculos, tendões, ligamentos e fáscias podem estar relacionados à ocorrência de disfunções de movimento e ao desenvolvimento de lesões musculoesqueléticas. O tratamento dessas condições comumente envolve a aplicação de técnicas voltadas para alterar a rigidez, tais como fortalecimento ou alongamento. Objetivo: Realizar uma revisão crítica da literatura para investigar os efeitos de exercícios de fortalecimento e alongamento sobre a rigidez tecidual passiva. Materiais e métodos: Foi realizada consulta aos bancos de dados Medline, Scielo , Lilacs e PEDro. Foram incluídos estudos experimentais realizados em animais ou humanos, sem limite de data. Resultados: Foram selecionados 20 estudos que investigaram o efeito do fortalecimento sobre a rigidez passiva e 13 que pesquisaram o efeito de programas de alongamento sobre a rigidez passiva. Conclusão: Os estudos sugerem que exercícios de fortalecimento de alta intensidade são capazes de aumentar os níveis de rigidez tecidual tanto em animais quanto em humanos. O aumento da área de secção transversa e modificações na composição dos tecidos são alguns dos mecanismos responsáveis por esse aumento. Em relação ao fortalecimento muscular em posição alongada e ao fortalecimento excêntrico em toda amplitude com carga moderada, os resultados são insuficientes para afirmar sobre o real efeito dessas técnicas em reduzir os níveisde rigidez. Por fim, programas de alongamento estático ou do tipo contrai-relaxa parecem reduzir a rigidez tecidual quando realizados por meio de protocolos de longa duração e/ou alta frequênci

Efeito dos exercícios de fortalecimento e alongamento sobre a rigidez tecidual passiva

INTRODUÇÃO: Níveis excessivos ou reduzidos de rigidez passiva dos músculos, tendões, ligamentos e fáscias podem estar relacionados à ocorrência de disfunções de movimento e ao desenvolvimento de lesões musculoesqueléticas. O tratamento dessas condições comumente envolve a aplicação de técnicas voltadas para alterar a rigidez, tais como fortalecimento ou alongamento. OBJETIVO: Realizar uma revisão crítica da literatura para investigar os efeitos de exercícios de fortalecimento e alongamento sobre a rigidez tecidual passiva. MATERIAIS E MÉTODOS: Foi realizada consulta aos bancos de dados Medline, Scielo, Lilacs e PEDro. Foram incluídos estudos experimentais realizados em animais ou humanos, sem limite de data. RESULTADOS: Foram selecionados 20 estudos que investigaram o efeito do fortalecimento sobre a rigidez passiva e 13 que pesquisaram o efeito de programas de alongamento sobre a rigidez passiva. CONCLUSÃO: Os estudos sugerem que exercícios de fortalecimento de alta intensidade são capazes de aumentar os níveis de rigidez tecidual tanto em animais quanto em humanos. O aumento da área de secção transversa e modificações na composição dos tecidos são alguns dos mecanismos responsáveis por esse aumento. Em relação ao fortalecimento muscular em posição alongada e ao fortalecimento excêntrico em toda amplitude com carga moderada, os resultados são insuficientes para afirmar sobre o real efeito dessas técnicas em reduzir os níveis de rigidez. Por fim, programas de alongamento estático ou do tipo contrai-relaxa parecem reduzir a rigidez tecidual quando realizados por meio de protocolos de longa duração e/ou alta frequência

The sleep as a predictor of musculoskeletal injuries in adolescent athletes

Objectives: Sleep is essential for musculoskeletal and cognitive recovery. Adolescent athletes tend to sleep poorly compared to adults and it may predispose them to sports injuries. Our aims are to estimate whether the quantity/quality of sleep are associated with sports injuries in adolescent athletes and to compare the quantity/quality of sleep between the training and competition seasons, and the school vacation period. Material and Methods: It was a cohort study with 19 track and field athletes of both sexes, aged between 12 and 21 years. We evaluated their sleep-wake habit through actigraphy during three phases: 1 - mid-season, 2 - competition, and 3 - school vacation. The previous six months injury history and the occurrence of injuries in a six-month follow-up were recorded. Logistic regression and variance analysis were performed. The significance level used was 0.05. Results: Wake after sleep onset (WASO) predicted previous injuries (OR=1.144) and time awake (TA) predicted injury occurrence (OR=0.974). TA decreased from phase 2 to phase 3 (p=0.004), total sleep time (TST) increased from phase 2 to phase 3 (p=0.012), and WASO decreased between phases 1 and 2 (p=0.001) and between phases 1 and 3 (p=0.025). Conclusion: Our study demonstrated that the quantity and quality of sleep were associated with musculoskeletal injuries in adolescent track and field athletes. Previous injuries were predicted by WASO and the occurrence of injuries was predicted by TA. Furthermore, during the vacation period they had lower TA and WASO, and higher TST than on school days

Myofascial Stiffness of Plantar Fascia and Achilles Tendon in Individuals with Plantar Fasciopathy: An Observational Cross-Sectional Study

Background Assessment of myofascial tissue stiffness have a role in identifying physical impairments in plantar fasciopathy (PF). It is still unclear which specific functional and tissue differences exist between individuals with PF. Aim To compare myofascial stiffness of plantar fascia, Achilles tendon, and triceps surae between symptomatic and asymptomatic limbs in individuals with PF and between individuals with and without PF. Methods Thirty nine individuals diagnosed with PF and individuals with no history of PF were recruited. Myofascial stiffness of the plantar fascia, Achilles tendon, and triceps surae, range of motion, and clinical tests were performed. Mean difference (MD) and 95% confidence interval (CI) were calculated. Results Individuals with PF showed lower mean stiffness in Achilles tendon insertion (MD = −1.00 N/mm; 95%CI: -1.80,-0.21) on the symptomatic limb compared to the corresponding symptomatic limb in control group, a lower mean stiffness in plantar fascia (MD = −0.16 N/mm; 95%CI: -0.30, −0.01) on the symptomatic limb compared to asymptomatic limb, and a lower mean stiffness in the region 3 cm above the Achilles tendon insertion (MD = −0.79; 95%CI: -1.59, −0.00) compared to control. Individuals with PF showed fewer repetitions in heel rise test (MD = −3.97 reps; 95%CI: -5.83, −2.12) and in the step-down test (MD = −5.23 reps; 95%CI: -7.02, −3.44) compared to control. Conclusions Individuals with PF present reduced stiffness in Achilles tendon insertion and plantar fascia. The reduced stiffness was more evident in Achilles tendon in individuals with PF compared to individuals without PF. Individuals with PF showed lower performance in clinical tests

Prevalence and incidence of injuries in para athletes: A systematic review with meta-analysis and GRADE recommendations

Objective To investigate prevalence, incidence and profile of musculoskeletal injuries in para athletes. Design Systematic review. Data sources Searches were conducted in MEDLINE, EMBASE, AMED, SPORTSDiscus, CINAHL and hand searching. Eligibility criteria Studies were considered if they reported prevalence or incidence of musculoskeletal injuries in para athletes. Study selection, data extraction and analysis followed the protocol. Meta-analyses were conducted to estimate the prevalence and incidence rate among studies and subgroup analyses investigated whether methodological quality and sample size of the studies influenced on the estimated injury prevalence and incidence. The Grading of Recommendations Assessment, Development and Evaluation system determined the strength of evidence. Results Forty-two studies were included. The prevalence of musculoskeletal injuries was 40.8% (95% CI 32.5% to 49.8%). Because of imprecision, indirectness and inconsistency, the strength of evidence was very low quality. The incidence of musculoskeletal injuries was 14.3 injuries per 1000 athlete-days (95% CI 11.9 to 16.8). The strength of evidence was low quality because of imprecision and indirectness. The subgroup analyses revealed that the sample size influenced on estimated injury prevalence and methodological quality influenced on estimated incidence. Injuries were more prevalent in the shoulder, for non-ambulant para athletes, and in the lower limbs, for ambulant para athletes. Summary/conclusion Para athletes show high prevalence and incidence of musculoskeletal injuries. Current very low-quality and low-quality evidence suggests that future high-quality studies with systematic data collection, larger sample size and specificities of para athletes are likely to change estimates of injury prevalence and incidence in para athletes