Painful procedures and analgesia in hospitalized newborns: A prospective longitudinal study

Objective

To identify the type and frequency of stressful and painful procedures, the use of pharmacological and non-pharmacological strategies; to identify relationships between demographic and clinical variables with frequency of procedures and pain management.

Effects of a short-term of whole-body,high-intensity,intermittent training program on morphofunctional parameters

BackgroundFew studies have analyzed the application of high-intensity interval training (HIIT) using exercises with body weight among the morphofunctional parameters.AimTo analyze and compare the effects of six weeks of high-intensity intermittent calisthenic training (HIICT) and moderate intensity, continuous exercise (MICT) on body composition, hypertrophy, and strength.Materials and methodsTwenty-five active, healthy adults were randomized in either the HIIT group (n = 14) or the MICT group (n = 11). The HIIT group performed high-intensity intermittent calisthenic training based on full body exercise. The training session involved 5 min of warm-up followed by 20 sets of 30s all-out exercise and 30 s of passive recovery between sets. Jumping jack, mountain climber, burpee and squat jump were used. The MICT group performed continuous moderate running (5 min of warm-up followed by 20 min of running with intensity fixed at 80% of maximum heart rate). Training for both groups was performed three times weekly on nonconsecutive days. All subjects underwent anthropometric measurements and functional tests. Muscle thickness was also measured.ResultsThere were no significant changes observed in any anthropometric measurements in both groups. Regarding the functional tests, the analysis of the percentage changes revealed advantages of HIICT over MICT in push-ups only (p = 0.02). The muscular thickness of lower and upper limbs did not present significant differences in the pre- and post-times or between groups (p > 0.05).ConclusionWhen compared to MICT, HIIT improved push-up effects, without generating significant changes in body composition and muscle thickness.     

Allocation Concealment and Intention-To-Treat Analysis Do Not Influence the Treatment Effects of Physical Therapy Interventions in Low Back Pain Trials: a Meta-epidemiologic Study

ObjectiveTo evaluate if allocation concealment and intention-to-treat (ITT) analysis influence the treatment effects of physical therapy interventions in low back pain (LBP) trials.Data SourcesWe searched on PubMed, Embase, Cochrane Database of Systematic Reviews, Physiotherapy Evidence Database (PEDro), and CINAHL up to February 2017.Study SelectionWe included LBP trials that compared physical therapy interventions to placebo or no intervention or minimal intervention with pain or disability outcomes.Data ExtractionInformation about allocation concealment and ITT analysis was extracted from PEDro and pain and disability outcomes converted to a 0-100 scale. A meta-regression was performed to evaluate the influence of these methodological features of interest on treatment effects. Other covariates included in the meta-regression were sample size and sequence generation.Data SynthesisWe identified 128 eligible trials (pooled N=20,555 participants). A total of 44.5% of the trials achieved allocation concealment, while 32% performed ITT analysis. Meta regression analyses showed no influence of allocation concealment on treatment effects for pain (regression coefficient 0.009; 95% confidence interval [CI] -2.91 to 2.91) and disability (regression coefficient 1.13; 95% CI -1.35 to 3.62), and no influence of ITT analysis for pain (regression coefficient 1.38; 95% CI -1.73 to 4.50) or disability (regression coefficient 1.27; 95% CI -1.39 to 3.64). For the other covariates, there was also no clinically significant influence on the treatment effects.ConclusionThere is no influence of allocation concealment or ITT analysis on treatment effects of physical therapy interventions for pain and disability in LBP trials.     

Understanding and interpreting confidence and credible intervals around effect estimates

IntroductionReporting confidence intervals in scientific articles is important and relevant for evidence-based practice. Clinicians should understand confidence intervals in order to determine if they can realistically expect results similar to those presented in research studies when they implement the scientific evidence in clinical practice. The aims of this masterclass are: (1) to discuss confidence intervals around effect estimates; (2) to understand confidence intervals estimation (frequentist and Bayesian approaches); and (3) to interpret such uncertainty measures.ContentConfidence intervals are measures of uncertainty around effect estimates. Interpretation of the frequentist 95% confidence interval: we can be 95% confident that the true (unknown) estimate would lie within the lower and upper limits of the interval, based on hypothesized repeats of the experiment. Many researchers and health professionals oversimplify the interpretation of the frequentist 95% confidence interval by dichotomizing it in statistically significant or non-statistically significant, hampering a proper discussion on the values, the width (precision) and the practical implications of such interval. Interpretation of the Bayesian 95% confidence interval (which is known as credible interval): there is a 95% probability that the true (unknown) estimate would lie within the interval, given the evidence provided by the observed data.ConclusionsThe use and reporting of confidence intervals should be encouraged in all scientific articles. Clinicians should consider using the interpretation, relevance and applicability of confidence intervals in real-world decision-making. Training and education may enhance knowledge and skills related to estimating, understanding and interpreting uncertainty measures, reducing the barriers for their use under either frequentist or Bayesian approaches.     

Communicating vessels volumeter to measure upper extremity lymphedema after breast cancer: reliability and criterion validity compared to the gold standard

BackgroundThe traditional overflow method for measuring limb volume remains the gold standard, but many disadvantages still inhibit its routine use in clinical practice.ObjectiveTo assess the intra-rater and inter-rater reliability and criterion validity of the ‘communicating vessels volumeter’ (CVV) for volume measurement of lymphedematous upper extremities (LUE) by using the overflow volumeter (OV) as the reference standard.MethodsTwelve LUE of 12 women undergoing mastectomy for breast cancer were measured three times each by three raters using both methods, totaling 216 volume measurements. Criterion validity was estimated by 33 volume measurements of one cylinder of known volume by three raters using both methods, totaling 198 measurements.ResultsMeasurement time was short with both CVV and OV. The intraclass correlation coefficient_3,1 was high for both CVV and OV in intra-rater (0.99 vs 0.99) and inter-rater (0.99 vs 0.99) analyses. The bias between methods was low (7.50 mL; 0.40%) and the limits of agreement were narrow (?5.80 to 6.50%). The volumes were statistically equal with a strong correlation (R² = 0.98) between methods. CVV was more accurate than OV (0.00 vs 0.02%) in cylinder measurements.ConclusionThe high intra-rater and inter-rater reliability rates of CVV were comparable to those of OV, and the volumes resulting from LUE measurements were statistically equal in the two methods. Criterion validity rates indicated that CVV measurements were closer to the actual value of the cylinder than those obtained with the OV.     

Correlation Between Chronic Neck Pain and Heart Rate Variability Indices at Rest: A Cross-sectional Study

ObjectiveThe purpose of this study was to correlate the heart rate variability (HRV) indices with variables of pain that were experienced by individuals with chronic neck pain.MethodsThis was a blinded cross-sectional study. Individuals with chronic neck pain (n = 15) and healthy participants (n = 15), both sedentary and between 18 and 45 years of age, were included. The neck pain was assessed with the Numerical Rating Scale at rest and during cervical movements, Neck Disability Index, Catastrophic Thoughts about Pain Scale, and Tampa Scale of Kinesiophobia. The HRV indices (linear and nonlinear) were used for assessment of autonomic function at rest (in supine, sitting, and standing positions).ResultsWe observed significant correlations between the NRS, Neck Disability Index, and Catastrophic Thoughts about Pain Scale with the linear and nonlinear HRV indices (P < .05, r ≥ 0.362), so that the worst HRV indices are associated with conditions of more intense and disabling neck pain.ConclusionThe HRV indices were significantly associated with pain intensity, disabilty, and catastrophizing in individuals with chronic neck pain.     

The pilates method in the function of pelvic floor muscles: Systematic review and meta-analysis

BackgroundMany Pilates instructors believe that the method can produce significant improvement in the resistance of pelvic floor muscles, but it is known that about 49% of women who can contract this muscle do not perform an adequate contraction and cannot increase urethral closure pressure.ObjectivesTo evaluate the response of the Pilates method in the function of the pelvic floor muscles, compared to the control group, in healthy women.Search methodsThe following databases were searched from October to December 2016: PUBMED, SCIELO, LILACS, MEDLINE, WEB OF SCIENCE and CINAHL via PERIÓDICOS CAPES, without restriction of language and year of publication.Selection criteriaRandomized (RCTs), quasi-randomized, and non-randomized clinical trials assessing the effectiveness of the Pilates method for the fuction of pelvic floor muscles in healthy women were included.Data collection and analysisTwo reviewers independently selected the studies, assessed the risk of bias and performed the data extraction. Primary outcomes were the method of evaluation of strength, function, coordination, and symmetry of contraction of the pelvic floor muscles.Results4434 articles were identified and 2 articles were selected to compose this review and the meta-analysis. No between-group difference was demonstrated for the pelvic floor muscle function as measured by perineometry (p = 0.32).ConclusionsNo evidence showed a modification of the function of pelvic floor muscles in healthy women practicing the Pilates method.     

Neuromuscular electrical stimulation to improve gross motor function in children with cerebral palsy: a meta-analysis

ObjectiveTo systematically review the effectiveness of neuromuscular electrical stimulation (NMES) as an adjuvant therapy to improve gross motor function in children with spastic cerebral palsy.MethodsMEDLINE, EMBASE, Cochrane CENTRAL, PEDro and Scopus were searched. We included randomized controlled trials examining the effects of NMES combined with other therapies on gross motor function as assessed by the Gross Motor Function Measure (GMFM) and its functional dimensions. Two reviewers independently screened, extracted data, assessed the risk of bias (PEDro) and quality of the evidence (GRADE).ResultsSix randomized controlled trials (pooled n = 174) were included in the meta-analysis. NMES combined with other therapies presented medium effect size to improve gross motor function in children with cerebral palsy in comparison with conventional physical therapy or neurodevelopmental therapy. Our sensitivity analysis showed that NMES combined with other therapies was effective to improve GMFM-sitting and standing dimensions but not GMFM-walking dimension.ConclusionLow-quality evidence suggests that NMES may be used as adjuvant therapy to improve sitting and standing dimensions of GMFM in children with spastic cerebral palsy.     

Knee extensor muscles strength indicates global lower-limb strength in individuals who have suffered a stroke: A cross-sectional study

ObjectivesThis study had three aims: (1) to evaluate the relationships between the paretic knee extensor muscle strength and global lower-limb strength in individuals who had suffered a sub-acute/chronic stroke, (2) to determine whether global lower-limb strength, sex, body mass index, or age could predict knee extensor muscle strength, and 3) to investigate whether the results obtained via a Modified Sphygmomanometer Test (MST) would be similar to those obtained using a hand-held dynamometer.MethodsThis was a cross-sectional study, performed at a research laboratory, at participants’ homes, or at outpatient clinics. Forty-two individuals with a sub-acute stroke and 45 individuals with a chronic stroke participated. Maximum isometric strength of the paretic lower-limb muscles (i.e. hip, knee, and ankle flexors/extensors, hip abductors) was measured using the MST and a hand-held dynamometer.ResultsSignificant and high correlation coefficients were found between knee extensor muscle strength and global lower-limb strength as measured by the combined strength values of 6 lower limb muscle groups in individuals with sub-acute (0.81 ≤ r ≤ 0.88; p < 0.05) and chronic (0.82 ≤ r ≤ 0.85; p < 0.05) stroke. Step-wise multiple regression analysis revealed that only global lower-limb strength was retained in the model and accounted for 66–78% and 67–72% (p < 0.001) of the variance in knee extensor muscle strength at the sub-acute and chronic phases post-stroke, respectively. The results obtained via the MST were similar to those obtained using the hand-held dynamometer.ConclusionParetic knee extensor muscles strength, assessed using a MST or a hand-held dynamometer, indicates global lower-limb strength in individuals with a sub-acute or chronic stroke.