Ligia Maxwell Pereira

Comparing the Pilates method with no exercise or lumbar stabilization for pain and functionality in patients with chronic low back pain: Systematic review and meta-analysis

Objective: To perform a systematic review with meta-analyses that evaluates the effectiveness of the Pilates method on the pain and functionality outcome in adults with non-specific chronic low back pain. Data sources: The search was performed in the following databases: Medline, Embase, AMED, Cinahl, Lilacs, Scielo, SportDiscus, ProQuest, Web of Science, PEDro, Academic Search Premier and the Cochrane Central Register of Controlled Trials from 1950 to 2011; the following keywords were used: ‘Pilates’, ‘Pilates-based’, ‘back exercises’, ‘exercise therapy’, ‘low back pain’, ‘back pain’ and ‘backache.’ Review methods: The inclusion criteria were studies that assessed the effects of the Pilates method on patients with chronic low back pain. Results: Five studies met the inclusion criteria. The total number of patients was 71 in the Pilates group and 68 in the control group. Pilates exercise did not improve functionality (standardized mean difference (SMD = –1.34; 95% confidence interval (CI) −2.80, 0.11; P = 0.07) or pain between Pilates and control groups (SMD = –1.99; 95% CI −4.35, 0.37; P = 0.10). Pilates and lumbar stabilization exercises presented no significant difference in functionality (mean difference (MD) = –0.31; 95% CI −1.02, 0.40; P = 0.39) or pain (MD = –0.31; 95% CI −1.02, 0.40; P = 0.39). Conclusion: The Pilates method did not improve functionality and pain in patients who have low back pain when compared with control and lumbar stabilization exercise groups.

Facial exercise therapy for facial palsy: systematic review and meta-analysis

The effectiveness of facial exercises therapy for facial palsy has been debated in systematic reviews but its effects are still not totally explained. Objective: To perform a systematic review with meta-analysis to evaluate the effects of facial exercise therapy for facial palsy. Data sources: A search was performed in the following databases: Cochrane Controlled Trials Register Library, Cochrane Disease Group Trials Register, MEDLINE, EMBASE, LILACS, PEDro, Scielo and DARE from 1966 to 2010; the following keywords were used: ‘idiopathic facial palsy’, ‘facial paralysis’, ‘Bell’s palsy’, ‘physical therapy’, ‘exercise movement techniques’, ‘facial exercises’, ‘mime therapy’ ‘facial expression’, ‘massage’ and ‘randomized controlled trials’. Review methods: The inclusion criteria were studies with facial exercises, associated or not with mirror biofeedback, to treat facial palsy. Results: One hundred and thirty-two studies were found but only six met the inclusion criteria. All the studies were evaluated by two independent reviewers, following the recommendations of Cochrane Collaboration Handbook for assessment of risk of bias (kappa coefficient = 0.8). Only one study presented sufficient data to perform the meta-analysis, and significant improvements in functionality was found for the experimental group (standardized mean difference (SMD) = 13.90; 95% confidence interval (CI) 4.31, 23.49; P = 0.005). Conclusion: Facial exercise therapy is effective for facial palsy for the outcome functionality.

Translation, cross-cultural adaptation and analysis of the psychometric properties of the lower extremity functional scale (LEFS): LEFS- BRAZIL

BACKGROUND There is a lack of questionnaires in Brazilian Portuguese to evaluate patient-reported lower limb function. OBJECTIVE To translate, cross-culturally adapt to the Brazilian population, and evaluate the psychometric properties of the Lower Extremity Functional Scale (LEFS). METHOD The LEFS was translated by two independent assessors and back-translated to English. Then, the LEFS-Brazil was tested on 20 patients who answered the questionnaire in the cross-cultural adaptation phase. For the evaluation of the psychometric properties, 100 patients answered the questionnaire. The reliability was tested by two independent assessors. The Medical Outcomes Study 36-item from Health Survey (SF-36) was used as the criterion method for construct validity. The sensitivity to change was tested for four consecutive weeks. RESULTS The internal consistency was α = 0.96. The intra-observer reliability was CCI (intraclass correlation coefficient) = 0.96 and CCI interobserver = 0.98; the Bland and Altman mean difference (d) intra-observer = -1.52 and d interobserver = 0.46. The correlation between the LEFS and SF-36 in the first week was the following: physical function r=0.82, physical role r=0.57, emotional role r=0.43 and mental health r=0.33. The LEFS was responsive when comparing the mean of the first week to the second, third and fourth weeks and comparing the second to the fourth week. The cut-off point was 11, and the area under the receiving operator curve was 0.96 95% CI [0.88;0.99], with sensitivity = 0.96, 1-specificity = 0 and standard error = 0.02. CONCLUSION The LEFS-Brazil is reliable, valid and responsive.

Electromyographic activity of selected trunk muscles in subjects with and without hemiparesis during therapeutic exercise.

The purpose of this study was to evaluate the trunk muscles activity of hemiparetic and control subjects during selected therapeutic exercises with surface electromyography (sEMG). The sEMG evaluation included 12 subjects presenting hemiparesis after having suffered a unilateral stroke and 12 apparently healthy subjects. A 16-channel sEMG system was used; data were band pass filtered from 20 to 450Hz. The signal was normalized through reference voluntary contraction (RVC) and presented in percentage. The exercises used in the evaluations were trunk flexion and trunk extension. Rectus abdominis presented greater activation on the paretic side of the experimental group than on the corresponding side of the control group (P=0.035) (Cohens d¯=0.94). During leg elevation, the non-paretic obliquus externus abdominis showed greater activation than in other exercises (P=0.019) (Cohens d¯=0.75). No inter-group differences were found for either erectus spinae activity or contraction onset. Experimental group subjects showed muscle activity alterations, principally in the rectus abdominis, indicating the occurrence of compensatory strategies.

The effect of physical training on heart rate variability in healthy children: a systematic review with meta-analysis.

The positive effects of physical training on heart rate variability (HRV) in healthy adults are widely recognized; however, the responsiveness to training in healthy children has not yet been established. The aim of this study was to determine the influence of physical training on HRV in prepubertal healthy children. Systematic computerized searches were performed from 1950 to 2012 in the following databases: Medline, Embase, Cinahl, Lilacs, Scielo, SportDiscus, ProQuest; Web of Science; PEDro; Academic Search Premier and the Cochrane Library. The key words used were: heart rate variability, autonomic nervous system, exercise training, physical activity, continuous exercise, intermittent exercise, children, prepubescent, adolescents, and healthy. Although the database search initially identified 6,164 studies, after removing duplicates and excluding by title the number was 148, however, only 2 studies were included in this systematic review. The meta-analysis compared the experimental group (n = 29) with the control group (n = 28) for the HRV parameters: RR intervals, SDNN, RMSSD, pNN50, LF (log), HF (log), LF/HF and Total Power (log). The meta-analysis demonstrated similar HRV indices between both the experimental and control groups. In conclusion, the available results from randomized controlled trials do not support the hypothesis that physical training improves HRV in healthy children[AUQ2].

Pilates versus general exercise effectiveness on pain and functionality in non-specific chronic low back pain subjects

Low back pain (LBP) is one of the most common causes of disability, and the Pilates method has been associated with improvements in symptoms. The purpose of this study was to assess the effectiveness of the Pilates method, when compared to general exercises, on pain and functionality after eight weeks (16 sessions, 2×/week) and a follow-up of three months, in subjects with non-specific chronic low back pain (NSCLBP). A randomised controlled trial composed of 22 subjects was proposed. Subjects were allocated into two groups: the Pilates group (PG) (n = 11) and the general exercise group (GEG) (n = 11). The PG protocol was based on the Pilates method and the GEG performed exercises to manage NSCLBP. There were no differences between the groups. When analysed over time, the GEG demonstrated improvements in functionality between baseline and the end of treatment (P = .02; Cohensd¯ = 0.34) and baseline and follow-up (P = .04; Cohensd¯ = 0.31). There were no differences between the Pilates and general exercises with regard to pain and functionality in NSCLBP subjects but general exercises were better than Pilates for increasing functionality and flexibility.

What is gold standard and what is ground truth

Clinical decision-making is complex and based upon accurate evaluation of clinical findings using di -agnostic tests and reference standard data. Given that many aspects of dental examination are not direct measures, but rely on indirect measures, it is impor-tant for clinicians to understand the basic principles and terms used to assess the accuracy of diagnostic tests and to appropriately evaluate published litera-ture regarding these tests. Luckily, there is a variety of readily available metric systems to assess the quality of diagnostic test studies and to help clinicians better understand evidence-based literature. Dentistry, or shall we say Clinical Dentistry, is be -coming more complex and patients have been better informed. Importantly, health care has also shifted focus to emphasize evidence-based practice (EBP). EBP is considered the gold standard for health profes -sional decision-making. No one can deny that the ac -tivities in the field of evidence-based Dentistry have grown exponentially in the last decade. However, we cannot forget that Pierre Fauchard (1678- 11761) may have been the first to warn the dental field about the concept of evidence, taking into consideration the practices of the time. Fauchard and James Lind (1716-1790) were both concerned about the health of sailors dying of scurvy and, for this reason, con-ceptualized a “clinical trial” involving the use of vi-tamin C to counteract the disease. The former even tested techniques for the removal of caries, dental restoration and implants.The true meaning of evidence-based Dentistry is grounded in a solid understanding and application of clinical epidemiology principles to reduce any confusion that may exist due to academic training. Epidemiology is defined as the “Science of making predictions about individual patients or a group, by recounting clinical events in similar patients in order to ensure that the predictions are correct”. Clinical epidemiology is “a subfield that applies the princi-ples and methods of epidemiology to study the oc-currence and outcomes of disease in people with a given illness”.

Kinematic Gait Analysis Using Inertial Sensors with Subjects after Stroke in Two Different Arteries

[Purpose] The aim of the present study was described the kinematic characteristics of gait in stroke patients with two different arteries involved. [Subjects and Methods] Two patients who had suffered a basilar (A) or middle (B) cerebral artery ischemic stroke were compared with a control (C). Seventeen inertial sensors were used with acquisition rate of 120 Hz. The participants walked 3 times on a 10 meter walkway. From the raw data, the three gait cycles from the middle of each trial were chosen and analyzed. [Results] During the stance phase, patients A and B had a lower hip angle at initial contact and maximum flexion angle during load response than the control. Patient A and the control subject had similar knee angle values at initial contact, and patient B presented a flexed position in the initial phase of the gait cycle. The maximum flexion angles during loading response were also higher for patient B. The sagittal plane excursion for the ankle joint was lower for patient B in comparison with the other subjects. [Conclusion] Differences during walking between patients who had stroke in different arteries may be related to an alternative compensatory strategy. Patient A and the control subject had similar gait cycle curves at all joints, while patient B showed a rigid synergic pattern.

Time-of-Day Effect on Hip Flexibility Associated with the Modified Sit-and- Reach Test in Males

Flexibility is a key component of physical fitness. It has been suggested that measures of physical fitness components may vary throughout the day. The aim of this study was to analyse the effects of the time of day on flexibility performance. 26 men (mean age=25.4 years, SD=2.5) were evaluated by hip flexion on kinematic analysis and also by an absolute score in the modified Sit-and-Reach test during a repeated measure design. This was done during 3 experimental sessions, which took place at 8:00 a.m., 1:00 p.m. and 6:00 p.m., in random order. All subjects were previously familiarized with the test parameters. There was a diurnal variation only in the modified Sit-and-Reach test score between 8:00 a.m and 6:00 p.m. (P=0.01). There was no significant difference in the hip kinematic analysis between hours. These findings suggest that flexibility performance in the modified Sit-and-Reach test, in absolute scores, is affected by the time of day, with higher performance in the evening.

Effect of traditional resistance training on blood pressure in normotensive elderly persons: a systematic review of randomized controlled trials and meta-analyses

1 Universidade Paranaense, Departamento de Ciências Biológicas Médicas e da Saúde, Francisco Beltrão. Cidade, PR, Brasil. 2 Universidade Estadual de Londrina, Laboratório de Biomecânica e Epidemiologia Clínica, Grupo de Pesquisa e Intervenção em Fisioterapia (PAIFIT). Londrina, PR, Brasil. 3 Grupo de Estudo e Pesquisa em Metabolismo, Nutrição e Exercício (GEPEMENE). Universidade Estadual de Londrina, Centro de Educação Física e Esporte. Londrina, PR, Brasil.