Jesús Seco Calvo

Risk Factors for Low Back Pain in Childhood and Adolescence. A Systematic Review

Objectives: To identify factors associated with low back pain (LBP) in children and adolescents. Materials and Methods: A systematic review was conducted (Prospero CRD42016038186). Observational studies analyzing LBP risk factors among participants aged between 9 and 16 were searched for in 13 electronic databases and 8 specialized journals until March 31, 2016, with no language restrictions. In addition, references in the identified studies were manually tracked. All identified studies that included ≥50 participants aged 9 to 16, were reviewed. Their methodological quality was assessed by 2 reviewers separately, using validated tools, which scored, from worst to best, 0 to 100 for cross-sectional and 0 to 12 for cohort studies. A sensitivity analysis only included studies that had adjusted for confounders, had ≥500 participants, and had a methodological score of ≥50%. Results: A total of 5142 citations were screened and 61 studies, including 137,877 participants from 5 continents, were reviewed. Their mean (range) methodological scores were 74.56 (50 to 100) for cross-sectional studies and 7.36 (5 to 9) for cohort studies. The studies had assessed 35 demographic, clinical, biological, family, psychological, ergonomic, and lifestyle risk factors. The mean (range) prevalence of LBP ranged between 15.25% (3.20 to 57.00) for point prevalence and 38.98% (11.60 to 85.56) for lifetime prevalence. Results on the association between LBP and risk factors were inconsistent. In the sensitivity analysis, “older age” and “participation in competitive sports” showed a consistent association with LBP. Discussion: Future studies should focus on muscle characteristics, the relationship between body and backpack weights, duration of carrying the backpack, characteristics of sport practice, and which are the factors associated with specifically chronic pain.

Rehabilitation Versus no Intervention – Only a Continued Intensive Program Conducted Statistically Significant Improvements Motor Skills in Parkinson's Disease Patients

Parkinson’s disease (PD) is a degenerative disease characterised by movement disorder, which consists of bradykinesia (movement slowness), hypokinesia (reduced movement), tremor, rigidity and alterations in gait and posture; mood changes also constitute a main component of PD (Marsden, 1994), which is also related to postural instability and often to cognitive deficits (Carne, et al., 2005). Working memory —which is defined as the capacity to maintain, supervise and use inner information for behavioural self-control— is an essential cognitive skill which works as base for other more complex and executive functions affected by PD (Baddeley, 1992). Since 1987, the Parkinson Study Group has undertaken a series of random controlled tests. In these studies, researchers used standardized clinical scales to examine the impact of pharmaceutical interventions on the progression of PD symptoms (Carne, et al., 2005). Other authors (Hiroyuki, et al. 2003) have studied modifications in balance, demonstrating that balance exercises lead to improvement in the function of static balance and that gait exercises improve dynamic balance and wandering functions in fragile or dependent elderly patients(Hiroyuki, et al. 2003). Quantitative reduction of muscular strength in the back, hips, ankles, with damage in propioception —visual sense and the lowest support base— are the main cause of instability in patients with Parkinsons disease. Motor complications caused by the disease have an important effect on physical and functional capacity. Regarding gait, Herman et al., (Herman, et al. 2007), have evaluated the effects of 6 weeks of treadmill exercises, which allow rhythmic training of gait, functional mobility and quality of life in PD patients; the results obtained show the exercises’ potential to improve gait rhythmically in PD patients and suggest that a progressive and intensive training program in treadmill may be used to reduce gait alterations and falling risk, and increase the quality of life of such patients5. In this sense, some authors (Brichelto, et al. 2006) showed potential short-term effectiveness of gait-slowness training in PD patients. Positive results were documented by clinic position scales and gait objective evaluation. Quick loss of clinical advantage suggests that further researches are necessary for a more precise definition of optimum frequency and treatment duration (Brichelto, et al. 2006). In order to reduce bradykinesia, the combination of motor imagery and real practice of motor movement might