Effect of muscle strengthening on perceived pain and static knee angles in young subjects with patellofemoral pain syndrome

The purpose of this pilot study was to determine the effects of strength training of the knee muscles on perceived pain and static knee angles in young subjects with patellofemoral pain syndrome (PFPS). Ten pa-tients, 100% female (mean age, 18.2\ub13.8 years), with unilateral PFPS (anterior knee pain for at least 3 months), received muscle strengthen-ing of the hip and knee (10 sessions over a period of 3 weeks). The out-come measures were perceived pain (visual analogue scale, VAS) and static knee angles (knee rotation measurer). All measures were collect-ed at pre-, postintervention, and at 1-month follow-up (VAS). Muscle strengthening reduced perceived pain after intervention in 90.8% in subjects and this result was maintained at 1-month follow-up (all, P=0.001). Regarding changes in static knee angles, no significant im-provements were found in internal and external rotation; valgus and varus; flexion and recurvatum (all, P>0.05). There was no significant difference between the symptomatic and healthy sides (all, P>0.05). Analyses of the correlation coefficients indicated no significant associ-ations between changes in perceived pain and static knee angles. The current study found that muscle strengthening addressed to the symp-tomatic knee reduced pain; however, perceived pain was not associat-ed with static knee angles in young subjects with unilateral PFPS

State of the art of current 3-D scoliosis classifications: a systematic review from a clinical perspective

Scoliosis is a complex three dimensional (3D) deformity: the current lack of a 3D classification could hide something fundamental for scoliosis prognosis and treatment. A clear picture of the actually existing 3D classifications lacks. The aim of this systematic review was to identify all the 3D classification systems proposed until now in the literature with the aim to identify similarities and differences mainly in a clinical perspective. After a MEDLINE Data Base review, done in November 2013 using the search terms "Scoliosis/classification" [Mesh] and "scoliosis/classification and Imaging, three dimensional" [Mesh], 8 papers were included with a total of 1164 scoliosis patients, 23 hyperkyphosis and 25 controls, aged between 8 and 20 years, with curves from 10\ub0 to 81\ub0 Cobb, and various curve patterns. Six studies looked at the whole 3D spine and found classificatory parameters according to planes, angles and rotations, including: Plane of Maximal Curvature (PMC), Best Fit Plane, Cobb angles in bodily plane and PMC, Axial rotation of the apical vertebra and of the PMC, and geometric 3D torsion. Two studies used the regional (spinal) Top View of the spine and found classificatory parameters according to its geometrical properties (area, direction and barycenter) including: Ratio of the frontal and the sagittal size, Phase, Directions (total, thoracic and lumbar), and Shift. It was possible to find similarities among 10 out of the 16 the sub-groups identified by different authors with different methods in different populations. In summation, the state of the art of 3D classification systems include 8 studies which showed some comparability, even though of low level. The most useful one in clinical everyday practice, is far from being defined. More than 20 years passed since the definition of the third dimension of the scoliosis deformity, now the time has come for clinicians and bioengineers to start some real clinical application, and develop means to make this approach an everyday tool

Gut microbiota and physical activity: Is there an evidence-based link?

The gut microbiota appears to be a significant contributor to musculoskeletal health and disease. Genetic background, age, gender, diet, lifestyle and socio-economic aspects are also important factors that contribute to musculoskeletal health, as well as to the normal balance of the intestinal microbiota. Through the production of a large and diverse pool of bioactive small molecules, the gut microbiota can in fact signal to extra-intestinal organs, establishing a systems-level connection with the host metabolic, endocrine, immune and nervous apparatus. The gut microbiota has therefore been extensively studied in recent years, for health promotion, disease prevention and disease treatment, as well as for exercise performance. Practically, physical activity is recommended as a useful tool to prevent disease and improve prognosis when an athlete gets sick or injured. Therefore, the findings of studies performed on athletes should not be automatically transferred to all subjects undertaking non-competitive exercise

Pressure algometry and palpation of the upper limb peripheral nervous system in subjects with hand osteoarthritis are repeatable and suggest central changes

Study Design: Case-control study. Introduction: A subset of patients with hand osteoarthritis (OA) shows evidence of central pain phenotypes. Purpose of the Study: To examine whether differences exist in experimental pain responses in the affected and nonaffected sides of patients with unilateral hand OA. To investigate the test-retest reliability of pressure algometry and manual digital palpation in patients with unilateral hand OA. Methods: The hand OA group consisted of 20 patients, and the control group consisted of 20 healthy subjects. Pressure pain threshold (PPT) measurements were made 2 times, consisting of 3 repeat trials, each using computerized algometry and manual digital palpation. Grip and key strength (dynamometer), pain (visual analog scale), and function (Disabilities of the Arm, Shoulder and Hand [short version]) were also measured. The 2-way analysis of variance was conducted to determine the differences between sides and groups. Intraclass correlation coefficient (ICC) and standard error of measurement were calculated. Results: Patients with hand OA had decreased PPTs over the thumb carpometacarpal joint as well as radial and median nerves compared with controls (all P <.01). No significant group effect by side interaction was detected for any measure. The minimal detectable change values needed to detect change in subjects with hand OA were C5-C6 joint (0.3-0.5 kg/cm2), carpometacarpal joint (0.3-0.5 kg/cm2), hamate bone (0.2-0.4 kg/cm2), radial nerve (0.2-0.8 kg/cm2), median nerve (0.3-0.6 kg/cm2), and ulnar nerve (0.2-0.4 kg/cm2) for PPT. Test-retest reliability was calculated for both hands of participants with OA (ICC, 0.98-0.99) and healthy participants (ICC, 0.74-0.99). Discussion: Although pressure algometry and manual digital palpation are techniques already used in previous studies and have been shown to be reproducible and moderately reliable for joint palpation, this current study suggests that pressure algometry and manual digital palpation could also be reliable methods of determining nerve sensitivity of the radial, ulnar and median nerves in subjects with hand OA. Conclusions: Hyperalgesia in patients with hand OA might be associated with clinical measures, and bilateral signs in unilateral OA could suggest central changes

Prevalence of Myofascial Trigger Points in Poststroke Patients With Painful Shoulders : A Cross-Sectional Study

Background: In patients with stroke, hemiplegic shoulder pain can be a major problem. One source of shoulder pain can be myofascial trigger points (MTrPs). Objective: To determine the prevalence of myofascial trigger points (MTrPs) and the correlation between MTrPs and pain and function in patients presenting with shoulder pain following a stroke. Design: Cross-sectional study. Setting: Department of Physical Therapy. Patients: Fifty patients with stroke with shoulder pain. Intervention: Not applicable. Main Outcome Measurements: The prevalence of the MTrPs located in infraspinatus, supraspinatus, teres minor, and upper trapezius was studied, using the diagnosis criteria recommended by Simons et al. The pressure pain threshold was also evaluated. Pain and function were assessed with the Visual Analogue Scale (VAS) and the Disability of the Arm, Shoulder and Hand (DASH) scale, respectively. Results: The prevalence of latent MTrPs was 68%, 92%, 40%, and 62% for supraspinatus, infraspinatus, teres minor, and upper trapezius muscle, respectively. The prevalence of active MTrPs was 34%, 50%, 12%, and 20% for supraspinatus, infraspinatus, teres minor, and upper trapezius muscle, respectively. Pain was moderately correlated with the prevalence of latent MTrPs (r = 0.35; P =.01) and active MTrPs (r = 0.31; P =.03) in the supraspinatus muscle. Disability was measured with the DASH scale and was moderately correlated with latent MTrPs in the infraspinatus (r = 0.31; P =.03) and active MTrPs of the supraspinatus (r = 0.32; P =.02). Conclusions: This study shows that the prevalence of MTrPs is high in patents following a stroke. MTrPs in this population are moderately associated with pain and function. Level of Evidence: II

The effect of amultimodal group programme in hospital workers with persistent low back pain: a prospective observational study

Background: Low Back Pain (LBP) is a very common disorder in hospital workers. Several studies examined the efficacy of multimodal interventions for health care providers suffering from LBP; nevertheless their results did not appear to be consistent. Objective: The aim of the study was to determine the effect of a multimodal group programme (MGP) on pain and disability in a sample of hospital workers with persistent LBP. Methods: A prospective cohort study was conducted to compare baseline measurements with changes over an eight-month period. The study focused on 109 workers suffering from persistent LBP with or without radiating pain: 62 nurses and 47 blue collars not involved in health care. The MGP consisted of six group sessions including supervised exercises, an athome programme and ergonomic advice. The primary outcome measurement was the level of disability recorded with the Roland & Morris Disability Questionnaire, while the secondary outcome measurement was the evaluation of lumbar physical discomfort with the Visual Analogue Scale. Data were analyzed using the Multiple Imputation method for dropouts. Results: At the short-term follow-up participants showed a statistically significant reduction (from baseline) of all outcome measurements, particularly for the nurses group. Moreover, about a third of the subjects showed clinically significant improvement. No significant reduction in pain and disability (from baseline) was observed at the mid-term follow-up in either group. Conclusions: An MGP dedicated to hospital workers seems to be partially useful only for short-term follow-up, particularly for health care providers

Tracking development assistance for health and for COVID-19: a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990-2050

Background The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings In 2019, health spending globally reached$8. 8 trillion (95% uncertainty interval [UI] 8.7-8.8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total,$40.4 billion (0.5%, 95% UI 0.5-0.5) was development assistance for health provided to low-income and middle-income countries, which made up 24.6% (UI 24.0-25.1) of total spending in low-income countries. We estimate that $54.8 billion in development assistance for health was disbursed in 2020. Of this,$13.7 billion was targeted toward the COVID-19 health response. $12.3 billion was newly committed and$1.4 billion was repurposed from existing health projects. $3.1 billion (22.4$2.4 billion (17.9%) was for supply chain and logistics. Only $714.4 million (7.7$1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd