Marcos de Noronha

Kinesio Taping does not decrease swelling in acute, lateral ankle sprain of athletes: a randomised trial

QUESTION Does Kinesio Taping reduce swelling in athletes who have suffered an acute, lateral ankle sprain? DESIGN Randomised controlled trial with concealed allocation, intention-to-treat analysis and blinded assessment. PARTICIPANTS Thirty-six athletes who participated regularly in one of seven different sports modalities and suffered an acute ankle sprain. INTERVENTION The experimental group received Kinesio Taping application for 3 days, which was designed to treat swelling. The control group received an inert Kinesio Taping application. OUTCOME MEASURES For the comparison between groups, the swelling was measured via volumetry, perimetry, relative volumetry and two analyses of the difference in volume and perimetry between ankles of each participant. Data were collected immediately after the 3 days of intervention and at follow-up, which was 15 days post intervention. RESULTS At 3 days after intervention, there were no differences between groups for swelling in volumetry (MD -2 ml, 95% CI -28 to 32); perimetry (MD 0.2 cm, 95% CI -0.6 to 1.0); relative volumetry (MD 0.0 cm, 95% CI -0.1 to 0.1); and the other analyses. At day 15 follow-up, there were no significant between-group differences in outcomes. CONCLUSION The application of Kinesio Taping, with the aim of stimulating the lymphatic system, is ineffective in decreasing acute swelling after an ankle sprain in athletes. TRIAL REGISTRATION Brazilian Registry of Clinical Trials, RBR-32sctf.

Kinesio Taping does not improve the symptoms or function of older people with knee osteoarthritis: a randomised trial

QUESTION Does Kinesio Taping reduce pain and swelling, and increase muscle strength, function and knee-related health status in older people with knee osteoarthritis? DESIGN Randomised, controlled trial with concealed allocation, intention-to-treat analysis and blinded assessment. PARTICIPANTS Seventy-six older people with knee osteoarthritis. INTERVENTION The experimental group received three simultaneous Kinesio Taping techniques to treat pain, strength and swelling. The control group received sham taping. All participants kept the taping on for 4 days. OUTCOME MEASURES The outcomes were: concentric muscle strength of knee extensors and flexors, measured by isokinetic dynamometry with an angular velocity of 60 deg/second normalised for body mass [(Nm/kg) x 100 (%)]; pressure pain threshold via digital pressure algometry (kgf/cm(2)); lower-limb swelling via volumetry (l) and perimetry (cm); physical function via the Lysholm Knee Scoring Scale (0 = worst to 100=best); and knee-related health status via the Western Ontario and McMaster (WOMAC) osteoarthritis index (0=best to 96=worst). Outcomes were measured at Day 4 (end of the taping period) and Day 19 (follow-up) after the start of the treatment. RESULTS At Day 4, there were no significant between-group differences for knee extensor muscle strength (MD -1%, 95% CI -7 to 5), knee flexor muscle strength (MD 2%, 95% CI -3 to 7), the pressure pain threshold at any measured point, volumetry (MD 0.05 L, 95% CI -0.01 to 0.11), perimetry at any measured point, Lysholm score (MD -4 points, 95% CI -9 to 2), or WOMAC score (MD -2 points, 95% CI -8 to 4). The lack of significant between-group difference was also seen at the follow-up assessment on Day 19. CONCLUSION The Kinesio Taping techniques investigated in this study provided no beneficial effects for older people with knee osteoarthritis on any of the assessed outcomes. TRIAL REGISTRATION Brazilian Registry of Clinical Trials, RBR-36r3t5. [Wageck B, Nunes GS, Bohlen NB, Santos GM, de Noronha M (2016) Kinesio Taping does not improve the symptoms or function of older people with knee osteoarthritis: a randomised trial.Journal of Physiotherapy62: 153-158].

Reliability of muscle strength assessment in chronic post-stroke hemiparesis: a systematic review and meta-analysis

Background: Muscle weakness is the main cause of motor impairment among stroke survivors and is associated with reduced peak muscle torque. Objective: To systematically investigate and organize the evidence of the reliability of muscle strength evaluation measures in post-stroke survivors with chronic hemiparesis. Data Sources: Two assessors independently searched four electronic databases in January 2014 (Medline, Scielo, CINAHL, Embase). Study Selection: Inclusion criteria comprised studies on reliability on muscle strength assessment in adult post-stroke patients with chronic hemiparesis. Data Extraction: We extracted outcomes from included studies about reliability data, measured by intraclass correlation coefficient (ICC) and/or similar. The meta-analyses were conducted only with isokinetic data. Results: Of 450 articles, eight articles were included for this review. After quality analysis, two studies were considered of high quality. Five different joints were analyzed within the included studies (knee, hip, ankle, shoulder, and elbow). Their reliability results varying from low to very high reliability (ICCs from 0.48 to 0.99). Results of meta-analysis for knee extension varying from high to very high reliability (pooled ICCs from 0.89 to 0.97), for knee flexion varying from high to very high reliability (pooled ICCs from 0.84 to 0.91) and for ankle plantar flexion showed high reliability (pooled ICC = 0.85). Conclusion: Objective muscle strength assessment can be reliably used in lower and upper extremities in post-stroke patients with chronic hemiparesis.

Current evidence demonstrates similar effects of kilohertz-frequency and low-frequency current on quadriceps evoked torque and discomfort in healthy individuals: a systematic review with meta-analysis.

Abstract Background: Neuromuscular electrical stimulation (NMES) is widely utilized to enhance muscle performance. However, the optimal NMES waveform with respect to treatment effect has not been established. Objective: To investigate the effects of kilohertz-frequency alternating current (KFAC) and low-frequency pulsed current (PC) on quadriceps evoked torque and self-reported discomfort. Data sources: PubMed, The Cochrane Library, EMBASE, MEDLINE, Physiotherapy Evidence Database (PEDro), SinoMed, ISI Web of Knowledge, and CINAHL were searched for randomized controlled trials (RCTs) and quasi-randomized controlled trials (QRCTs). Study selection: Two reviewers independently selected potential studies according to the inclusion criteria, extracted data, and assessed methodological quality. Data extraction and synthesis: Studies were eligible if they compared KFAC versus PC interventions. Studies that included outcome measures for percentage of maximal isometric voluntary contraction (%MIVC) torque and self-reported discomfort level were eligible for evaluation. Seven studies involving 127 individuals were included. The methodological quality of eligible trials was moderate, with a mean of 5 on the 10-point PEDro scale. Overall, PC was no better than KFAC in terms of evoked torque and there was no difference in self-reported discomfort level. Conclusion: KFAC and PC have similar effects on quadriceps evoked torque and self-reported discomfort level in healthy individuals. The small number and overall methodological quality of currently available studies included in this meta-analysis indicate that new RCTs are needed to better determine optimal NMES treatment parameters.

Are virtual reality technologies effective in improving lower limb outcomes for patients following stroke – a systematic review with meta-analysis

Background: Stroke is one of the leading causes of disability worldwide with many survivors restricted to their immediate environment secondary to various impairments. Objectives: To review existing studies assessing effects of virtual reality (VR) on lower limb outcomes in stroke patients. Data sources: We searched MEDLINE, CINAHL, EMBASE, PEDro, and Cochrane Library from their beginning to August 2015. Eighteen meta-analyses were performed using weighted mean differences (WMD) and standardized mean differences (SMD) and 95% confidence intervals (CI) to summarize results. Study selection: Randomized control trials using VR interventions within adult stroke populations for lower limb outcomes. Trials were screened by two independent authors for eligibility and bias. Data extraction: Trials were grouped according to acute–subacute and chronic stroke populations and outcomes were classified as functional balance, static balance, functional gait/mobility, spatiotemporal gait parameters, or motor function. Results: 22 studies with 552 participants were included. Significant differences in favor of VR group were found for functional balance (SMD 0.42, 95% CI 0.11–0.73), gait velocity (WMD 0.12, 95% CI 0.03–0.22), cadence (WMD 11.91, 95% CI 2.05–21.78), and stride length (WMD 9.79, 95% CI 0.74–18.84) within the chronic population. Conclusions: VR improves functional balance and various aspects of gait in chronic populations. Evidence also suggests that VR is just as effective as conventional therapy, hence its’ use in practice is determined by affordability, and patient/practitioner preferences.

Translation into Portuguese of questionnaires to assess knee injuries.

The aim of this systematic review was to review the quality of the translation and the measurement properties from questionnaires that assess injuries of the knee. We included questionnaires that were developed in foreign language and have been translated and validated into Portuguese. The databases used were CINAHL, SPORTDiscus, LILACS, PUBMED and SCIELO and the final search resulted in a total of 868 studies included, from which 16 were eligible. Most included questionnaires presented all steps expected in a translation process; however there were some deficiencies in measurement properties among the questionnaires. The VISA-P Brazil was the best questionnaire when analyzing translation process and measurement properties tested. It was the only questionnaire that tested all measurement properties investigated and presented adequate values for all of them. KOS-ADLS was the best questionnaire translated to Portuguese from Portugal. Among all, the VISA-P Brazil is the best questionnaire to be used with Brazilian Portuguese speakers when the condition is related to patellar tendinopathy and the LEFS is the best questionnaire for other general conditions of the knee. For Portuguese from Portugal, the best questionnaire is the KOS-ADLS, and like the LEFS it does not target any specific injury.

Noninvasive ventilation and exercise tolerance in heart failure: A systematic review and meta-analysis

Background: Patients with heart failure (HF) usually develop exercise intolerance. In this context, noninvasive ventilation (NIV) can help to increase physical performance. Objective: To undertake a systematic review and meta-analysis of randomized controlled trials that evaluated the effects of NIV on exercise tolerance in patients with HF. Method: Search Strategy: Articles were searched in the following databases: Physiotherapy Evidence Database (PEDro), Scientific Electronic Library Online (SciELO), and MEDLINE. Selection Criteria: This review included only randomized controlled trials involving patients with HF undergoing NIV, with or without other therapies, that used exercise tolerance as an outcome, verified by the distance travelled in the six-minute walk test (6MWT), VO2peak in the cardiopulmonary test, time spent in testing, and dyspnea. Data Collection and Analysis: The methodological quality of the studies was rated according to the PEDro scale. Data were pooled in fixed-effect meta-analysis whenever possible. Results: Four studies were selected. A meta-analysis including 18 participants showed that the use of NIV prior to the 6MWT promoted increased distance, [mean difference 65.29 m (95% CI 38.80 to 91.78)]. Conclusions: The use of NIV prior to the 6MWT in patients with HF may promote increased distance. However, the limited number of studies may have compromised a more definitive conclusion on the subject.

Manual therapy for childhood respiratory disease: a systematic review.

OBJECTIVE This study reviewed the scientific evidence available on the effects of manipulative techniques on children with respiratory diseases. METHOD Three databases (SciELO, PEDro, and MEDLINE) were searched for clinical trials on the effects of manual therapy techniques on children and adolescents with respiratory diseases. The relevant studies were chosen by 2 independent researchers who assessed their abstracts and selected the studies that met the criteria for a complete and structured review. RESULTS Of the 1147 relevant titles, 103 titles were selected for abstract assessment, and of these, 24 were selected for a full-text review. After critical analysis, 8 studies were included in the review and 16 were excluded for the following reasons: 1 covered only conventional therapy, 7 were not about the studied theme, and 8 included adults. Of the 8 studies included in the present review, 5 consisted of asthmatic children and the others of children with the following conditions: cystic fibrosis, bronchiolitis, recurrent respiratory infections, among others. Only 2 studies did not identify positive results with the use of manual therapy. The other 6 studies found some benefit, specifically in spirometric parameters, immunologic tests, anxiety questionnaire, or level of salivary cortisol. CONCLUSION The use of manual techniques on children with respiratory diseases seems to be beneficial. Chiropractic, osteopathic medicine, and massage are the most common interventions. The lack of standardized procedures and limited variety of methods used evidenced the need for more studies on the subject.

Is a sphygmomanometer a valid and reliable tool to measure the isometric strength of hip muscles? A systematic review.

Abstract Background: Muscle strength measurement is a key component of physiotherapists’ assessment and is frequently used as an outcome measure. A sphygmomanometer is an instrument commonly used to measure blood pressure that can be potentially used as a tool to assess isometric muscle strength. Objective: To systematically review the evidence on the reliability and validity of a sphygmomanometer for measuring isometric strength of hip muscles. Method: A literature search was conducted across four databases. Studies were eligible if they presented data on reliability and/or validity, used a sphygmomanometer to measure isometric muscle strength of the hip region, and were peer reviewed. The individual studies were evaluated for quality using a standardized critical appraisal tool. Results: A total of 644 articles were screened for eligibility, with five articles chosen for inclusion. The use of a sphygmomanometer to objectively assess isometric muscle strength of the hip muscles appears to be reliable with intraclass correlation coefficient values ranging from 0.66 to 0.94 in elderly and young populations. No studies were identified that have assessed the validity of a sphygmomanometer. Conclusion: The sphygmomanometer appears to be reliable for assessment of isometric muscle strength around the hip joint, but further research is warranted to establish its validity.

The validity and reliability of the sphygmomanometer for hip strength assessment in Australian football players

ABSTRACT Objectives: To investigate the intra-rater and inter-rater reliability of the sphygmomanometer for the assessment of the adductor squeeze test and isometric hip abduction strength and to investigate the concurrent validity of the sphygmomanometer for the assessment of hip muscular strength. Method: Thirty-two healthy adult male community Australian football players (age 23.9 ± 4.5 years) were assessed by two blinded raters that measured the strength of the adductor squeeze test and isometric hip abduction, using a commercially available sphygmomanometer. Concurrent validity was calculated using handheld dynamometry as the reference standard. Results: Moderate to high intra-rater reliability (ICC = 0.61 to 0.92) and high inter-rater reliability (ICC = 0.77 to 0.91) were found. High concurrent validity (Pearson’s r = 0.77 to 0.91) was established. Sixteen of the participants reached the maximal reading of the sphygmomanometer, demonstrating a ceiling effect. Conclusions: A sphygmomanometer is a cost-efficient device that appears to be both reliable and valid for the assessment of hip strength, offering clinicians an alternate and easily accessible option to obtain objective strength data. A ceiling effect may limit the application of the sphygmomanometer as a strength measurement device in stronger individuals.