Does scoliosis-specific exercise treatment in adolescence alter adult quality of life?

Objective. Health-related quality of life in adults, who in adolescence participated in a scoliosis-specific exercise program, was not previously studied. Design. Cross-sectional study, with retrospective data collection. Material and Methods. Homogenous groups of 68 persons (43 women) aged 30.10 (25–39) years, with mild or moderate scoliosis, and 76 (38 women) able-bodied persons, aged 30.11 (24–38) years, who 16.5 (12–26) years earlier had completed scoliosis-specific exercise or observation regimes, participated. Their respiratory characteristics did not differ from predicted values. The WHOQOL-BREF questionnaire, Oswestry Disability Questionnaire, and pain scale (VAS) were applied. Results. The transformed WHOQOL-BREF scores ranged from 54.6 ± 11.19 in the physical domain in the mild scoliotic subgroup to 77.1 ± 16.05 in the social domain in the able-bodied subgroup. The ODQ values did not generally exceed 5.3 ± 7.53. Inter- and intragroup differences were nonsignificant. Age, marital status, education, and gender were significantly associated with the ODQ scores. Significant association between the ODQ and WHOQOL-BREF social relationships domain scores with the participation in exercise treatment was found. Conclusions. Participants with the history of exercise treatment generally did not differ significantly from their peers who were only under observation. This study cannot conclude that scoliosis-specific exercise treatment in adolescence alters quality of life in adulthood

Mental Health of Adults Treated in Adolescence with Scoliosis-Specific Exercise Program or Observed for Idiopathic Scoliosis

Objective. To examine general mental health in adult males and females, who in adolescence participated in a scoliosis-specific therapeutic exercise program or were under observation due to diagnosis of scoliosis. Design. Registry-based, cross-sectional study with retrospective data collection. Methods. Sixty-eight subjects (43 women) aged 30.10 (25–39) years, with mild or moderate scoliosis (11–36° Cobb angle), and 76 (38 women) nonscoliotic subjects, aged 30.11 (24–38) years, participated. The time period since the end of the exercise or observation regimes was 16.5 (12-26) years. Beck Depression Inventory (BDI) and General Health Questionnaire (GHQ-28) scores were analyzed with the χ2 and U tests. Multiple regression analyses for confounders were also performed. Results. Intergroup differences of demographic characteristics were nonsignificant. Scoliosis, gender, participation in the exercise program, employment, and marital status were associated with BDI scores. The presence of scoliosis and participation in the exercise program manifested association with the symptoms. Higher GHQ-28 “somatic symptoms” subscale scores interacted with the education level. Conclusions. Our findings correspond to the reports of a negative impact of the diagnosis of scoliosis and treatment on mental health. The decision to introduce a therapeutic program in children with mild deformities should be made with judgment of potential benefits, risks, and harm

Non-Surgical Interventions for Adolescents with Idiopathic Scoliosis: An Overview of Systematic Reviews

Non-surgical interventions for adolescents with idiopathic scoliosis remain highly controversial. Despite the publication of numerous reviews no explicit methodological evaluation of papers labeled as, or having a layout of, a systematic review, addressing this subject matter, is available.Analysis and comparison of the content, methodology, and evidence-base from systematic reviews regarding non-surgical interventions for adolescents with idiopathic scoliosis.Systematic overview of systematic reviews.Articles meeting the minimal criteria for a systematic review, regarding any non-surgical intervention for adolescent idiopathic scoliosis, with any outcomes measured, were included. Multiple general and systematic review specific databases, guideline registries, reference lists and websites of institutions were searched. The AMSTAR tool was used to critically appraise the methodology, and the Oxford Centre for Evidence Based Medicine and the Joanna Briggs Institute's hierarchies were applied to analyze the levels of evidence from included reviews.From 469 citations, twenty one papers were included for analysis. Five reviews assessed the effectiveness of scoliosis-specific exercise treatments, four assessed manual therapies, five evaluated bracing, four assessed different combinations of interventions, and one evaluated usual physical activity. Two reviews addressed the adverse effects of bracing. Two papers were high quality Cochrane reviews, Three were of moderate, and the remaining sixteen were of low or very low methodological quality. The level of evidence of these reviews ranged from 1 or 1+ to 4, and in some reviews, due to their low methodological quality and/or poor reporting, this could not be established.Higher quality reviews indicate that generally there is insufficient evidence to make a judgment on whether non-surgical interventions in adolescent idiopathic scoliosis are effective. Papers labeled as systematic reviews need to be considered in terms of their methodological rigor; otherwise they may be mistakenly regarded as high quality sources of evidence.CRD42013003538, PROSPERO

Praktyka oparta na dowodach – zasady i kierunki rozwoju Evidence Based Practice w fizjoterapii

Objective. Evidence Based Medicine (EBM) is the “conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients” and integrating individual clinical expertise with the best available evidence from systematic research and patients’ preferences. Interventions which have not been well-researched tend to be seen as ineffective. Standards of conduct, publications and appraisal of clinical trials have been established. Access to evidence and tools to its development and critical appraisal are provided by specialized journals, databases, textbooks, courses, online guidelines and research centres. Clinical Evidence is a priority in contemporary health care, including physical medicine and rehabilitation. World Confederation for Physiotherapy and leading national organizations recognize the need for development towards evidence based practice (EBP).Aims. To provide rationale for and information about EBP in physiotherapy and to review available and WCPT’s recommended clinical evidence resources in physiotherapy. Essential elements (synthesizing, assessing and implementing the evidence) and hierarchies of its sources are presented.Data Sources and Selection. EBP’s elements, objectives and standards of proficiency are described in accordance with WCPT’s, other professional organizations’ and health care institutions’ papers and documents. EBM and EBP philosophy backgrounds are based on primary publications in British Medical Journal, other recognized EBM and EBP initiatives and sources of clinical evidence (Centre of Evidence, Oxford, Bandolier Evidence Based Health Care, CEBP, PEDro, Medycyna Praktyczna) and physiotherapy scientific journals.Conclusions. EBP, being a combination of art and science, provides opportunities to improve physical therapy and patient care, promoting EB standards of care and continuous professional development. Physiotherapists and health service managers need to encourage EBP.Założenia. Evidence Based Medicine (EBM) – „medycyna oparta na faktach naukowych” polega na integracji wiarygodnych danych naukowych, prawidłowego rozpoznania klinicznego oraz preferencji i wyborów pacjenta w podejmowaniu decyzji klinicznych. EBM umożliwia też weryfikację i zastępowanie nieefektywnych lub szkodliwych metod diagnostycznych i terapeutycznych metodami skutecznymi. W oparciu o idee EBM wypracowano standardy prowadzenia, publikowania i oceny wyników badań naukowych, powstały specjalistyczne czasopisma, bazy danych, podręczniki, kursy i przewodniki internetowe oraz centra naukowe. Zasady i postulaty EBM są w pełni aktualne w obszarze fizjoterapii, gdzie wypracowanie rzetelnych standardów postępowania wydaje się koniecznością. Cele. Przedstawienie znaczenia idei fizjoterapii opartej na dowodach naukowych (Evidence Based Practice) oraz działań i dorobku światowych instytucji ochrony zdrowia, środowisk akademickich i organizacji zawodowych w dziedzinie EBP w fizjoterapii. Źródła i wybór informacji. Wykorzystano publikacje Światowej Konfederacji Fizjoterapii (World Confederation for Physical Therapy, WCPT) i innych organizacji fizjoterapeutycznych i instytucji kierujących ochroną zdrowia, dotyczące zasad wdrażania EBP i standardów zawodowych. Idee EBM i EBP scharakteryzowano na podstawie tekstów źródłowych w British Medical Journal, renomowanych organizacji EBM, EBP i Clinical Evidence (Oxford Centre for Evidence Based Medicine, Bandolier Evidence Based Health Care, CEBP, PEDro, Medycyna Praktyczna) i czasopismach naukowych z dziedziny fizjoterapii. Omówiono zasady i elementy EBP oraz reguły ich wdrażania, a także sposoby tworzenia, pozyskiwania, syntezy i krytycznej oceny wiedzy o dowodach naukowych i faktach klinicznych (clinical evidence). Wnioski. Idea EBP jest szansą rozwoju fizjoterapii, służąc weryfikacji metod terapii, wprowadzaniu zasad kształcenia ustawicznego i rozwojowi wiedzy. Środowisko zawodowe oraz podmioty kierujące opieką zdrowotną powinny doceniać i wspierać rozwój EBP

Programy ćwiczeń fizycznych w skoliozach idiopatycznych a Evidence-Based Practice – analiza przeglądów systematycznych i przeglądów krytycznych

Objectives: The prevalence of adolescent idiopathic scoliosis is estimated at 2-3% of 10-16 year olds. The deformity may follow with pulmonary complications, decreased physical capacity, and an impaired health-related quality of life. Both surgical and conservative treatments are debatable. The paper presents an appraisal of systematic and critical reviews regarding scoliosis-specific exercises con¬ducted in individuals with adolescent idiopathic scoliosis - studies representing the highest level of evidence, according to the prin¬ciples of Evidence-Based Practice.Search strategy: MEDLINE/PubMed, as well as specific databases of systematic reviews: Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness (DARE), and Physiotherapy Evidence Database (PEDro), were examined. Then a hand search of the reference lists of included papers was conducted.Selection criteria: Based on titles and abstracts, and then on full texts, systematic reviews (with or without a meta-analysis) or reviews with a critical appraisal of included studies, were selected as eligible. Narrative reviews, expert opinions, clinical practice guidelines, original studies, and papers not dealing with scoliosis-specific exercises were excluded.Findings: Eighteen reports, out of 161 retrieved, met the selection criteria. The best reviews (according to the SIGN criteria of the levels of evidence) did not report on any convincing evidence for or against the effectiveness of scoliosis-specific exercises. The less rigorous reviews are more positive, although the more critical papers also have flaws. Conclusions: Despite the fact that the first systematic analysis on this subject of interest was published twenty years ago, and recently a rigorous Cochrane review has been released, the effectiveness of scoliosis-specific exercises remains questionable, while the clinical evidence for these interventions continues to be poor.Cele: Młodzieńcza skolioza idiopatyczna występuje u 2-3% dzieci w wieku 10-16 lat. Wtórnie mogą występować ograniczenia czynności płuc, obniżenie wydolności wysiłkowej, a także obniżenie jakości życia związanej ze zdrowiem. Metody leczenia operacyjnego i zachowawczego są przedmiotem kontrowersji. Praca przedstawia omówienie wyników badań systematycznych, dotyczących stosowania programów specjalistycznych ćwiczeń fizycznych u pacjentów z młodzieńczą skoliozą idiopatyczną, które zgodnie z zasadami praktyki opartej na aktualnych doniesieniach naukowych powinny być najbardziej niezawodnym źródłem odpowiedzi na pytanie kliniczne.Źródła informacji: Przeszukiwano bibliograficzną bazę danych MEDLINE/PubMed, bazy przeglądów systematycznych: Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness (DARE) i bazę Physioterapy Evidence Database (PEDro). Dodatkowo dokonano ręcznego przeszukiwania w wybranych odnalezionych pracach.Wybór badań: Na podstawie tytułów, a następnie streszczeń i pełnych tekstów prac włączano przeglądy systematyczne, bez względu czy zawierają metaanalizę danych, i przeglądy krytyczne mające niektóre cechy badania systematycznego piśmiennictwa. Wyłączano prace oryginalne, przeglądy narracyjne, opinie ekspertów, przewodniki praktyki klinicznej oraz prace niedotyczące programów specyficznych ćwiczeń fizycznych. Nie stosowano limitów daty publikacji. 35Wyniki: Spośród stu sześćdziesięciu jeden odnalezionych prac osiemnaście spełniło kryteria włączenia do analizy. Autorzy prac o najwyższym poziomie wiarygodności metodologii, szacowanej według kryteriów SIGN, nie znaleźli silnych dowodów na skuteczność lub brak skuteczności programów ćwiczeń. Autorzy prac o słabszej metodologii wskazują na dowody skuteczności stosowania ćwiczeń, chociaż prace dostarczające wniosków krytycznych również mają słabe elementy.Wnioski: Pomimo upływu dwudziestu lat od publikacji pierwszego przeglądu systematycznego dotyczącego leczenia zachowawczego skolioz, ostatni wysokiej jakości metodologicznej przegląd wciąż nie dostarczył mocnych wniosków o skuteczności programów ćwiczeń w skoliozach

No Recommendation Is (at Least Presently) the Best Recommendation: An Updating Quality Appraisal of Recommendations on Screening for Scoliosis

Recommendations addressing screening for scoliosis differ substantially. Systematically developed guidelines are confronted by consensus and opinion-based statements. This paper elaborates on the issue of the standards of development and reporting of current guidelines and recommendation statements, as well as on the methodological quality of the corresponding evidence syntheses. The SORT classification and the AMSTAR 2 tool were used for those purposes, respectively. Publications included in the analysis differed substantially in terms of their methodological quality. Based on the SORT and AMSTAR 2 scores, the 2018 US PSTF recommendation statement and systematic review on screening for scoliosis are trustworthy and high-quality sources of evidence and aid for decision making. The recommendation statement on insufficient evidence to formulate any recommendations is, paradoxically, very informative. Significantly, updated opinion-based position statements supporting screening for scoliosis acknowledged the importance of research evidence as a basis for recommendation formulation and are more cautious and balanced than formerly. Expert opinions, not built on properly presented analyses of evidence, are at odds with evidence-based practice. Nonetheless, contemporary principles of screening programs, especially those addressing people’s values and preferences, and the possible harms of screening, remain underrepresented in both research and recommendations addressing screening for scoliosis

Torze kolenních extenzorových svalů během izometrických cvičení a ruská elektrická stimulace po zranění kolenních vazů Knee extensor muscles' torque during isometric exercises and russian electrical stimulation following a knee ligament injury

Dobrovolné izometrické cvičení (VOL) i neuromuskulární elektrická stimulace (NMES) jsou metody rozvoje statické svalové síly. Používají se v programech pro rozvoj síly u zdravých svalů a také pro zotavování svalové funkce za určitých ortopedických podmínek. Obě metody se používají pro zpomalování svalové atrofie a ztráty síly v důsledku imobilizace kolena po zranění (Eriksson & Häggmark, 1979; Ingemann-Hansen & Halkjær-Kristensen, 1985; Johnson, 1988; Wigerstad-Lossing, Tromby, Jonsson, Morelli, Peterson, & Rentröm, 1988). NMES může vyvolat záškuby nebo tetanické svalové kontrakce, a to v závislosti na frekvenci proudových impulsů. Během tetanické stimulace jsou hlavními rysy nácvikových režimů: 1) cyklus zapnutí/vypnutí (pracovní cyklus), tvořený dobou kontrakce a dobou uvolnění; 2) počet kontrakcí; 3) intenzita kontrakcí (dána proudovou amplitudou nebo tolerancí subjektu). Voluntary isometric exercise (VOL) and neuromuscular electrical stimulation (NMES) are both methods of static muscle strength and girth training. They are applied in strength training programs to healthy muscle as well as for muscle function recovery under certain orthopaedic conditions. Both methods are used to retard muscle atrophy and strength loss resulting from post injury knee immobilization (Eriksson & Häggmark, 1979; Ingemann-Hansen & Halkjær-Kristensen, 1985; Johnson, 1988; Wigerstad-Lossing, Tromby, Jonsson, Morelli, Peterson, & Rentröm, 1988). NMES can elicit twitch or tetanic muscle contractions, determined by current pulse frequency. During tetanic stimulation, the main features of training regimes are: 1) on/off cycle (or duty cycle), made up of the time of contraction plus rest time; 2) the number of contractions; 3) the intensity of contractions (determined by the current amplitude and/or the subject’s tolerance)

Content (PICO) characteristics of included reviews.

<p>AIS – adolescent idiopathic scoliosis; FEV₁– forced expiratory volume in 1 second; NA – not addressed; NNT - Number Needed to Treat; OM – outcome measure; QoL – quality of life; SIR – “scoliosis inpatient rehabilitation”; SR – systematic review;</p>1<p>series of updates, analysed in concert or separately, depending on how the authors addressed individual study characteristics (also explained in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0110254#pone.0110254.s001" target="_blank">Table S1</a>);</p>2<p>SSE – scoliosis specific exercise: “curve-specific movements performed with a therapeutic aim of reducing the deformity” <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0110254#pone.0110254-Romano2" target="_blank">[33]</a>;</p>3<p>OMT - Osteopathic manipulative treatment, defined in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0110254#pone.0110254-Posadzki1" target="_blank">[7]</a> as “the therapeutic application of manually guided forces by an osteopathic physician to improve physiologic function and/or support homeostasis that has been altered by somatic dysfunction”;</p>4<p>recommendations related to surgically treated patients not analysed here;</p>5<p>malloclusion – “Imperfect positioning of the teeth when the jaws are closed” [<a href="http://www.oxforddictionaries.com/definition/english/malocclusion" target="_blank">http://www.oxforddictionaries.com/definition/english/malocclusion</a>].</p><p>Content (PICO) characteristics of included reviews.</p