Is Irritable Bowel Syndrome Considered as Comorbidity in Clinical Trials of Physical Therapy Interventions in Fibromyalgia? A Scoping Review

Evidence supports the presence of comorbid conditions, e.g., irritable bowel syndrome (IBS), in individuals with fibromyalgia (FM). Physical therapy plays an essential role in the treatment of FM; however, it is not currently known whether the IBS comorbidity is considered in the selection criteria for clinical trials evaluating physiotherapy in FM. Thus, the aim of the review was to identify whether the presence of IBS was considered in the selection criteria for study subjects for those clinical trials that have been highly cited or published in the high-impact journals investigating the effects of physical therapy in FM. A literature search in the Web of Science database for clinical trials that were highly cited or published in high-impact journals, i.e., first second quartile (Q1) of any category of the Journal Citation Report (JCR), investigating the effects of physical therapy in FM was conducted. The methodological quality of the selected trials was assessed with the Physiotherapy Evidence Database (PEDro) scale. Authors, affiliations, number of citations, objectives, sex/gender, age, and eligibility criteria of each article were extracted and analyzed independently by two authors. From a total of the 412 identified articles, 20 and 61 clinical trials were included according to the citation criterion or JCR criterion, respectively. The PEDro score ranged from 2 to 8 (mean: 5.9, SD: 0.1). The comorbidity between FM and IBS was not considered within the eligibility criteria of the participants in any of the clinical trials. The improvement of the eligibility criteria is required in clinical trials on physical therapy that include FM patients to avoid selection bias

Final report of the project Time allocation and technology : a gender approach for the Portuguese context

Este relatório teve a colaboração de Alexandra Murariu e Sandra MatosFundação para a Ciência e a Tecnologia (FCT

ZONA FRANCA DE MANAUS E PROTOCOLO DE NAGOYA: uma análise das possibilidades de Desenvolvimento Regional

O artigo analisa os fundamentos da falta de integração nacional brasileira, em específico a que ocorre na região Norte, discutindo as políticas econômicos para a Amazônia Legal até o período da redemocratização, são analisadas as perspectivas do desenvolvimento regional com a existência da Zona Franca de Manaus. Assim, Objetiva-se discutir se a legislação e as políticas públicas tem garantido o desenvolvimento da região, discute-se também o recente Decreto Legislativo nº 136 de 2020 que trata do Protocolo Adicional de Nagoya, instrumento específico da Convenção sobre Biodiversidade Biológica. O método utilizado foi o dedutivo e o estudo concluí pela necessidade de políticas e legislação mais efetiva para garantir o desenvolvimento, sugerindo a aprovação de Emenda Constitucional que ratifique as possibilidades legais para o desenvolviment

Avaliação da percepção e satisfação da imagem corporal em usuários do Programa Academia da Cidade em Belo Horizonte Minas Gerais

A percepção da imagem corporal é uma construção multidimensional resultante de uma representação mental que os individuos têm a respeito do tamanho e forma do corpo, sendo essa influenciada por fatores biológicos, históricos, sociais e culturais. Tais fatores, podem causar a distorções da própria imagem. Esta distorção poderia influenciar as pessoas a buscarem estratégias possivelmente prejudiciais à sua saúde, demonstrando assim, um possível grau de insatisfação. Uma das maneiras de prevenir e melhorar as estratégias planejadas e a vinculações de informações para a população em geral, é a percepção real do próprio corpo. Assim, o objetivo do presente estudo foi de avaliar a percepção e satisfação da imagem corporal em usuários do programa Academia da Cidade (PAC). Participaram da pesquisa 111 usuários do PAC, com idades entre 18 e 59 anos. Para a avaliação da imagem corporal foi utilizado uma Escala de Silhuetas com 15 silhuetas por gênero. Os participantes foram solicitados a escolherem uma silhueta que representasse seu tamanho atual e uma silhueta que representasse o seu tamanho idealizado. Quando analisados os dados para classificar a autopercepção, nota-se que apenas 25% da amostra conseguiram classificar de forma correta a silhueta atual e 75% da amostra classificaram suas silhuetas de forma errônea. Quanto a satisfação, 80% da amostra demonstraram estar insatisfeitos. Em conclusão, o estudo demonstrou que ocorrem distorções da percepção da imagem corporal pela amostra avaliada. Observa-se também que existe insatisfação com o peso corporal tanto nos homens quanto nas mulheres

Myofascial Trigger Points, Pain, Disability, and Sleep Quality in Patients with Chronic Nonspecific Low Back Pain

[EN] Objective: To investigate the difference in the presence of trigger points (TrPs) between patients with chronic nonspecific low back pain (LBP) and healthy people, and to determine the relationship of TrPs with the intensity of ongoing pain, disability, and sleep quality. Design: A cross-sectional study. Setting: The role of TrPs in LBP has not been determined. Patients: Forty-two patients with nonspecific LBP (50% women), aged 23-55 years old, and 42 age- and sex-matched controls participated. Outcome measures: TrPs were bilaterally explored within the quadratus lumborum, iliocostalis lumborum, psoas, piriformis, gluteus minimus, and gluteus medius muscles in a blinded design. TrPs were considered active if the subject recognized the local and referred pain as familiar symptoms, and TrPs were considered latent if the pain was not recognized as a familiar symptom. Pain measures were collected with a numerical pain rate scale, disability was assessed with the Roland-Morris questionnaire, and sleep quality was determined with the Pittsburgh Sleep Quality Index. Results: Patients with nonspecific LBP exhibited a greater disability and worse sleep quality than healthy controls (P < 0.001). Patients with nonspecific LBP exhibited a mean of 3.5 ± 2.3 active TrPs. Further, patients with nonspecific LBP showed a greater (P < 0.001) number of latent TrPs (mean: 2.0 ± 1.5) than healthy controls (mean: 1.0 ± 1.5). Active TrPs in the quadratus lumborum, iliocostalis lumborum, and gluteus medius muscles were the most prevalent in patients with nonspecific LBP. A greater number of active TrPs was associated with higher pain intensity (rs = 0.602; P < 0.001) and worse sleep quality (rs = 0.338; P = 0.03). Conclusions: The local and referred pain elicited by active TrPs in the back and hip muscles contributes to pain symptoms in nonspecific LBP. Patients had higher disability and worse sleep quality than controls. The number of active TrPs was associated with pain intensity and sleep quality. It is possible that a complex interaction among these factors is present in patients with nonspecific LBP

Validity of the Isometric Contraction Test of the Masticatory Muscles for Diagnosis of Muscular Temporomandibular Disorders

In recent years, the Diagnostic Criteria for Temporomandibular Pain Disorders (DC/TMD) has been questioned, mainly because of the dependence on the muscular pressure needed to be applied during the clinical examination. Therefore, it is necessary to establish improvements in diagnostic strategies for DC/TMD of axis I. The aim of this study was to determine the validity of the Isometric Contraction Test of the masticatory muscles (ICTest) to diagnose DC/TMD of axis I. Forty (n = 40) patients with muscular TMD (myalgia in any of its subtypes), as well as forty age and sex matched controls, participated. They were diagnosed according to DC/TMD of axis I and performed the ICTest in a single session. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and positive (LR+) and negative likelihood ratios (LR−) of the ICTest compared with the DC/TMD of axis I were calculated. The ICTest showed a specificity of 95% for the diagnosis of myalgia, and between 94.9% and 96.8% for all subtypes in relation to the DC/TMD of axis I. For sensitivity, lower values were obtained, that is, 90.0% for myalgia, and losing sensitivity depending on the type of myalgia. The LR+ was over 10 for all diagnoses, with the exception of myofascial pain with referral, which was lower. When addressing the LR−, the myofascial diagnosis was the only one below 0.2. According to the results, the ICTest could be considered a valid procedure to diagnose subjects with muscular TMD in a clinical setting

Paravertebral Muscle Mechanical Properties and Spinal Range of Motion in Patients with Acute Neck or Low Back Pain: A Case-Control Study

Our aims were to identify potential differences in muscle mechanical properties (MMPs) of cervical and lumbar tissues and in spinal range of motion (ROM) between patients with acute low back pain (LBP) or acute neck pain (NP) and healthy controls, and to identify if ROMs and MMPs are able to identify subjects among the three groups. Clinical variables (pain, disability, fear of movement, kinesiophobia, quality of life), MMPs and ROMs were obtained in 33 subjects with acute LBP, 33 with acute NP, and 33 healthy control subjects. Between-groups differences and explanatory models to discriminate groups depending on MMPs and ROMs were calculated. The results showed that cervical tone was higher in patients with acute NP than in controls, while cervical decrement was higher in both spinal pain groups. Patients with acute NP showed reduced cervical flexion when compared to acute LBP and control groups, and also cervical rotation, but just against controls. Furthermore, lumbar flexion was reduced in patients with acute LBP when compared to those with acute NP. Cervical decrement was able to discriminate spinal pain individuals from controls in a multinominal regression (R2: Cox–Snell estimation = 0.533; Nagelkerke estimation = 0.600). Lumbar flexion differentiated patients with acute LBP and controls, whereas cervical flexion differentiated patients with acute NP and controls. This study supports a tendency of the affectation of other spinal regions when only one is affected

Influence of Spinal Movements Associated with Physical Evaluation on Muscle Mechanical Properties of the Lumbar Paraspinal in Subjects with Acute Low Back Pain

This research aimed to identify changes in muscle mechanical properties (MMPs) when a standardized sequence of movements is performed and to determine the influence of acute low back pain (LBP) and age on the MMPs. Socio-demographic, clinical variables and MMPs were collected in 33 patients with LBP and 33 healthy controls. A 2 × 2 × 2 (group × age × time) analysis of variance (ANOVA) mixed model was used to determine the effect of the study factors on the different MMPs. There were no significant triple interactions. After the movements, tone and stiffness increased 0.37 Hz and 22.75 N/m, respectively, in subjects <35 years, independent of their clinical status. Relaxation showed differences by age in healthy subjects and creep in LBP subjects. Furthermore, elasticity was higher in <35 years (p < 0.001) without the influence of any other factor. In conclusion, sequenced movements can modify tone and stiffness as a function of age, while age-associated changes in viscoelastic characteristics depends on pain but not on movements. The MMPs should be assessed, not only at the beginning of the physical examination at rest, but also along the patient’s follow-up, depending on their pain and age, in a clinical setting

Test-retest reliability of the isometric contraction test (IC test) of the masticatory muscles in subjects with and without temporomandibular muscle disorders

Recently, the DC/TMD has become an essential tool for the diagnosis of temporomandibular disorders (TMD). However, as they fail to include functional activities, new assessment proposals have emerged, such as the isometric contraction test (IC test) of the masticatory muscles, which uses muscle contractions to identify muscular TMD. Objective: This study aimed to determine the test-retest reliability of the IC test. Methods: A total of 64 participants (40 women and 24 men) completed the IC test administered by two different physical therapists on two non-consecutive days. Cohen’s kappa (k), PABAK, and percent agreement (PA) between days were estimated. Results: The IC test showed good to excellent test-retest reliability values (k&gt;0.77; PABAK&gt;0.90), both globally and individually for the muscles evaluated, and PA&gt;90%, therefore above the thresholds for clinical applicability. However, the global assessment of myofascial pain and the evaluation of the medial pterygoid muscle showed slightly lower reliability values. Conclusion: The IC test is reliable for the assessment of subjects with muscular TMD, both in terms of the global assessment and the evaluation of each muscle, which supports its clinical applicability. Care should be taken when assessing myofascial pain globally and when evaluating the medial pterygoid in all types of pain

Gardens and Tourism for and beyond economic profit

Gardens and Tourism for and beyond economic profit é o segundo volume da Collection of Gardens and Landscape Studies, coordenada por Ana Duarte Rodrigues. Conta com textos de Alexandra Gago da Câmara, Ana Duarte Rodrigues, António Lamas, Antonio Perla de las Parras, Celso Mangucci, Desidério Batista, Filipe Benjamim, Ignacio Rodriguez Somovilla, Jean-Paul Brigand, Maria Isabel Donas Botto, Nuno Oliveira, Paulo Carvalho, Susana Silva e Victoria Soto Caba. Assumindo uma perspectiva multidisciplinar das áreas da história da arte, arquitectura paisagista, literatura e geografia, e reunindo académicos e profissionais que operam na área do Garden Tourism, este livro constitui um trabalho inaugural nos estudos de jardins e paisagem. Certamente que constitui um balanço baseado em casos de estudo das potencialidades do turismo de jardins em Portugal, mas também aponta caminhos e hipóteses de trabalho num futuro próximo. Constitui um convite a que todos os interessados na preservação e promoção deste património se unam para criar as ferramentas necessárias à sua dinamização e salvaguarda para o futuro