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- Beyond low back pain! The influence of physical activity on mental health, reflected in the functionality of people with low back painPublication . Parolini, Franciele; Becker, Klaus; Goethel, Márcio; Fernandes, Ricardo J.; Fonseca, Hélder; Ervilha, Ulysses F.; Vilas-Boas, João Paulo; Santos, RubimPsychological factors play a crucial role in the experience of acute low back pain and may influence functional outcomes. However, the interplay between these factors and levels of physical activity remains poorly understood. This cross-sectional observational study examined the relationship between psychological variables and functional disability in individuals with acute low back pain, considering different levels of physical activity. Data were collected from 1021 participants through an online platform between 8 June 2022 and 8 April 2023. Standardized instruments were used to assess functional limitations, emotional distress (depression, anxiety, and stress), daily pain catastrophizing, and physical activity levels. A canonical correlation analysis was conducted to explore the multivariate associations between psychological and functional variables. There was a statistically significant association between higher levels of emotional distress and greater functional impairment related to low back pain. This association was observed in both the light-physical-activity group (canonical coefficient = 0.266; p = 0.017), the moderate-physical-activity group (0.237; p = 0.092), and the vigorous-physical-activity group (0.177; p = 0.013). Participants engaging in vigorous physical activity exhibited more favorable psychological profiles and lower functional disability compared to those with lower levels of activity. Regular and vigorous physical activity appears to be a protective factor for mental health and may help reduce functional disability in individuals with acute low back pain. These findings underscore the importance of considering physical activity levels when addressing psychological and functional outcomes in this population.
- Age-related influence on reliability and learning effect in the assessment of lower limb strength using sit-to-stand tests: A cross-sectional studyPublication . Vilarinho, Rui; Montes, António Mesquita; Melo, Cristina; Mesquita Montes, AntónioDecreased muscle strength, especially in the muscles of lower limbs, is an important risk factor for early age‐related decline in physical function, morbidity, hospitalization, and mortality.1 This evidence should be a stimulus for healthcare professionals to include the assessment of muscular strength as a priority in the community due to its substantial value in predicting future health status.2 For this purpose, sit‐to‐stand tests represent one of the simple and valid options to quantify lower limb strength,3 and two of the most used are the 1‐min sit‐to‐stand (1MSTS)4 and the 5 times sit‐to‐stand (5TSTS).5 To standardize the use of 1MSTS and 5TSTS, it is important to explore whether a similar reliability and learning effect exist between adults and older adults in community settings. Since aging may cause a significant reduction in motor skill acquisition,6 it is important to carefully consider whether performances on these tests are the same for repeated measurement over time (test‐retest) and if a practice test is needed according to age. Another reason to establish the reliability and learning effect, before recommending the use of the sit‐to‐stand tests for adults and older adults, is because significantly different performances have been found between these populations.7,8 With this research, we aimed to determine the within‐day test‐ retest reliability and the learning effect of the 1MSTS and 5TSTS in adults (
- Preparing the certification of software as a medical device: a european regulatory analysis and case study on the Clynx®PlatformPublication . Mesquita Montes, António; Pinto, Joana F.; Silva, Hugo P. da; Chambel, Gonçalo; Clemente, Carolina; Silva, Diogo C. F.; Montes, António M.; Simões, Daniela; Silva, Diogo C. F.The primary objective of this study is the preparation of the certification of the Clynx® Platform, a physiotherapy software, as a Class IIa medical device software in accordance with the regulatory framework outlined in Medical Device Regulation 2017/745 (MDR). The methodology involves a comprehensive analysis of European Union medical device regulations and guidelines, with a specific focus on the certification process essential for obtaining a Conformité Européenne (CE) marking for Class IIa medical device software. This section explores the intricate aspects of the certification process, emphasizing the compilation of Technical Documentation, the nuances of Clinical Evaluation, and the establishment of a Quality Management System. The approach aligns closely with the stipulations of MDR 2017/745. The study includes an industry case study featuring the Clynx® Platform, developed by Clynx® Health. Insights derived from the MDR are applied to categorize an in-development version of the software as a Class IIa medical device. The preparation of certification of this product involves the meticulous creation of Intended Use, Classification, General and Safety Performance Requirements, and Clinical Evaluation files, the presentation of an experimental protocol to validate the software’s technical performance for inclusion in the Clinical Evaluation, and a description of an Internal Audit performed on the Quality Management System. The certification of Class IIa medical device software necessitates the compilation of thorough Technical Documentation, including an extensive Clinical Evaluation, and the implementation of a robust Quality Management System. The certification process is conducted in collaboration with Notified Bodies, ensuring adherence to the stringent requirements set forth by the regulatory framework.
- Measurement properties of the incremental step test for people with chronic obstructive pulmonary disease: a cross-sectional studyPublication . Gonçalves, Tânia; Winck, João Carlos; Silva, Fátima; Caneiras, Cátia; Montes, António Mesquita; Vilarinho, Rui; Mesquita Montes, António; Vilarinho, RuiThe new incremental step test (IST) is a field test that was developed for people with chronic obstructive pulmonary disease (COPD), based on the characteristics of the incremental shuttle walk test (ISWT); however, its measurement properties still need to be determined. We aimed, first, to assess the construct validity (through the comparison with the ISWT), within-day reliability and measurement error of the IST in people with COPD; and, second, to identify whether the participants have a learning effect in the IST. Cross-sectional study, conducted according to COnsensus-based Standards for the selection of health status Measurement INstruments guidelines. A family health unit in Portugal, April 2022 to June 2023. 63 participants (67.5±10.5 years) attended two sessions to perform two IST and two ISWT, separately. Spearman’s correlations were used to compare the best performances between the IST and the ISWT. Intraclass correlation coefficient (ICC2,1) was used for reliability, and the SE of measurement (SEM), minimal detectable change at 95% CI (MDC95) and Bland and Altman 95% limits of agreement (LoA) were used for measurement error. The learning effect was explored with the Wilcoxon signed-rank test. The IST was significant and strongly correlated with the ISWT (0.72<ρ<0.74, p<0.001), presented an ICC2,1 of 0.95 (95% CI 0.92 to 0.97), SEM=11.7 (18.9%), MDC95=32.4 (52.2%) and the LoA were −33.61 to 31.48 for the number of steps. No difference was observed between the number of steps of the two attempts of the IST (p>0.05). The IST can be suggested as a valid and reliable test to assess exercise capacity in people with COPD, with no learning effect when two IST are performed on the same day. The measurement error of the IST is considered indeterminate.
- Normative values and reference equations of the 4-meter gait speed test for Portuguese adults: a cross-sectional studyPublication . Silva, Sara; Vilarinho, Rui; Festas, Clarinda; Santos, Fátima; Montes, António Mesquita; Jácome, Cristina; Mesquita Montes, António; Vilarinho, RuiTo determine the normative values and reference equations of the 4-Meter Gait Speed Test (4MGS) at usual and maximal speed for Portuguese adults. We also assessed the participant experience during the performance of the 4MGS. A cross-sectional study was conducted with individuals without disabilities. Sociodemographic, anthropometric, smoking habits and physical activity (Brief Physical Activity Assessment Tool [BPAAT]) data were collected. Individuals performed 3 repetitions of 4MGS at usual and maximal speeds, and the best performances were recorded. Speed values were calculated by age and sex. Stepwise multiple regressions were used for the reference equations. Participants rated their comfort from 0 (‘not comfortable at all’) to 5 (‘very comfortable’) for each modality and indicated their preferences. A total of 287 individuals (62.4% female; 47.8 ± 19.5 years) were recruited. Speed was significantly reduced after the sixth decade of life compared with the other decades (p < 0.001). Reference equations were: Usual speed = 1.598 – (0.006 x age) + (0.060 x BPAAT classification), R2= 27% and Maximal speed = 2.272 – (0.010 x age) + (0.157 x sex) + (0.73 x BPAAT classification), R2= 38%. Most participants felt ‘very comfortable’ performing the 4MGS at usual speed (94.8%), maximal speed (75.6%) and no preference in 4MGS modalities (69%). Speed is significantly affected by age. For the reference equations, age and physical activity explain the results of usual speed, and both associated with sex explain the results of maximal speed. Most participants were highly comfortable and expressed no preference in 4MGS modalities.
- Cochlear hair cell regeneration based on stem cells: A systematic reviewPublication . Costa, Vítor Bruno; Tomé, David; Çirtlik, Zeynep Yağmur; Öztürk, Yaren; Clemêncio, Filomena; Pitt-Byrne, Theresa; Tomé, David; Costa Clemêncio, Filomena MariaAccording to the World Health Organization (WHO), by 2050 at least 700 million people will need access to hearing care and hearing rehabilitation services. The search for cell or gene therapies has been intensifying, and stem cell therapy looks a promising candidate to support hearing regeneration and reduce these numbers. The aim of this study is to provide an overview of current advances in stem cellbased therapies for cochlear hair cell regeneration and the processes being developed for future applicability. Identification and review of all articles in the databases PubMed, Web of Science, and PLoS One using the terms stem cell, auditory hair cell regeneration, and mammalian during February 2023 and following the PRISMA guidelines. 50 articles were obtained, published between 2003 and 2022 and were systematically analyzed. The current research quantity is limited and further studies are needed, particularly in human tissue. The simultaneous use of cell therapy and gene therapy may lead to more promising results. Moreover, advances in cochlear hair cell regeneration with stem cells suggest there is a realistic potential to make the technique a useful future therapy.
- European Portuguese version of the Mini-BESTest: a cross-cultural adaptation and psychometric measurements in individuals with sensorimotor impairmentsPublication . Freitas, Marta; Pinho, Francisco; Cruz-Martins, Natália; Pinho, Liliana; Silva, Sandra; Figueira, Vânia; Vilas-Boas, João Paulo; Silva, Augusta; Ferreira Silva, Maria AugustaThis study aimed to translate and cross-culturally adapt the Mini-BESTest into European Portuguese and to evaluate its psychometric properties in individuals with sensorimotor impairments. A cross-sectional cross-cultural adaptation and validation study was conducted according to the COSMIN guidelines and the STROBE statement. The study included 100 participants with sensorimotor impairments who were able to walk 6 m. Cronbach’s alpha and item-total correlations were used to assess internal consistency. Interpretability was assessed by examining floor and ceiling effects and skewness. To investigate construct validity, Spearman correlation coefficients and Bland-Altman analysis were performed to compare the Berg Balance Scale and the Mini-BESTest Inter- and intra-rater reliability were assessed by calculating the ICC, SEM and MDC based on video recordings of the participants during the Mini-BESTest assessments. The European Portuguese Mini-BESTest showed good internal consistency (Cronbach’s α = 0.892) and no significant floor or ceiling effects. Excellent inter- and intra-rater reliability (ICC = 0.97) were also demonstrated, with MDC of 2.58 and 2.57, respectively. Furthermore, this instrument showed a significant correlation with the BBS (r = 0.902). Bland-Altman analysis showed small absolute differences. The European Portuguese Mini-BESTest is comparable to the original English version in terms of validity and reliability and is therefore highly recommended for use by Portuguese-speaking professionals to assess postural control.
- Methylphenidate and P300 in attention deficit hyperactivity disorder: A systematic review and meta-analysisPublication . Barroso, Beatriz C. R.; Mendonça, Fabiana; Mazer, Prune; Prata, Catarina; Pinto, Joana O.; Mazer, Prune; Pinto, Joana OMethylphenidate (MPH) is a stimulant medicine often used to treat attention deficit hyperactivity disorder (ADHD), as it may positively affect behaviour and brain activity. This work aims to systematise the current literature about the effects of MPH on the amplitude of P300 in individuals with ADHD. A systematic review and meta-analysis of empirical studies measuring P300 amplitude and comparing MPH administration to either a pre-MPH condition or healthy controls was conducted, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Our results revealed no overall (n = 13) significant differences between individuals diagnosed with ADHD and medicated with MPH and controls. Although, a moderation analysis by region found differences between both groups on frontal sites. When comparing the pre- and post-effects of MPH on the same individuals (n = 17), it appears that P300 amplitude tends to increase post-administration in central and posterior regions. In this second meta-analysis, a moderation by task revealed a larger effect size for go/no-go. In general, MPH was found to increase P300 amplitude in ADHD, somewhat normalising this aspect of their brain activity. The main limitations of the included studies are the insufficiently explained dosages and the skewness for male participants. Future research directions are discussed.
- Presence of pain shows greater effect than tendon structural alignment during landing dynamicsPublication . Silvia, Ortega-Cebrián; Silva, Diogo C. F.; Carneiro, Daniela F.; Zárate, Victor; Alves, Leonel A. T.; Guedes, Diana C.; Zárate-Tejero, Carlos A.; Cadellans-Arróniz, Aïda; Montes, António Mesquita; Mesquita Montes, António; Silva, Diogo C. F.; C. Guedes, Diana"Eccentric loading during landing is considered a key factor in the development of patellar tendinopathy and is associated with stiff landings and patellar tendinopathy. This study aims to investigate the relationship between tendon structure, presence of pain, and sex differences in landing kinematics and kinetics during countermovement jumps (CMJ) and tuck jump tests (TJT) in professional volleyball players. Professional volleyball players aged 18 to 30 years old (14 females and 25 males) participated in a cross-sectional study. Data included the Victorian Institute of Sport Assessment Patellar Tendon (VISA-P) questionnaire; patellar tendon ultrasound characterization tissue (UTC) scans, in order to identify groups with misaligned tendon fibers (MTF) or aligned tendon fibers (ATF); and biomechanical assessments for CMJ and TJT. The joint angle (JA) at the lower limb was measured at peak ground reaction force (peak_vGRF) and maximal knee flexion (max_KF). A general linear model was used to evaluate joint JA differences between tendon alignment, pain, and sex variables. Sample t-tests compared peak_vGRF, load time, load rate, and area based on tendon alignment, pain presence, sex, and jump. The statistical significance of p-value is >0.05, and the effect size (ES) was also calculated. The MTF group revealed decreased knee JA during TJT at peak_vGRF (p = 0.01; ES = −0.66) and max_KF (p = 0.02; ES = −0.23). The presence of pain was associated with increased JA during the CMJ, particularly at peak_vGRF and max_KF for trunk, hip, and ankle joints. Females showed decreased peak_vGRF than males. Landing with misaligned tendon fibers showed longer load times compared to aligned tendon fibers (p = 0.021; ES = −0.80). The TJT exhibited a greater load rate than the CMJ (p = 0.00; ES = −0.62). Pain is a critical factor influencing greater JA during landing, particularly at the trunk, hip, and ankle joints in CMJ. Misaligned tendon fibers compromise landing dynamics by increasing trunk JA during TJT. Kinetics varied significantly by sex and jump type, while pain and tendon structure revealed limited differences. "
- Feasibility of 3D body tracking from monocular 2D video feeds in musculoskeletal telerehabilitationPublication . Clemente, Carolina; Chambel, Gonçalo; Silva, Diogo C. F.; Montes, António Mesquita; Pinto, Joana F.; Silva, Hugo Plácido da; Mesquita Montes, António; Silva, Diogo C. F.Musculoskeletal conditions affect millions of people globally; however, conventional treatments pose challenges concerning price, accessibility, and convenience. Many telerehabilitation solutions offer an engaging alternative but rely on complex hardware for body tracking. This work explores the feasibility of a model for 3D Human Pose Estimation (HPE) from monocular 2D videos (MediaPipe Pose) in a physiotherapy context, by comparing its performance to ground truth measurements. MediaPipe Pose was investigated in eight exercises typically performed in musculoskeletal physiotherapy sessions, where the Range of Motion (ROM) of the human joints was the evaluated parameter. This model showed the best performance for shoulder abduction, shoulder press, elbow flexion, and squat exercises. Results have shown a MAPE ranging between 14.9% and 25.0%, Pearson’s coefficient ranging between 0.963 and 0.996, and cosine similarity ranging between 0.987 and 0.999. Some exercises (e.g., seated knee extension and shoulder flexion) posed challenges due to unusual poses, occlusions, and depth ambiguities, possibly related to a lack of training data. This study demonstrates the potential of HPE from monocular 2D videos, as a markerless, affordable, and accessible solution for musculoskeletal telerehabilitation approaches. Future work should focus on exploring variations of the 3D HPE models trained on physiotherapy-related datasets, such as the Fit3D dataset, and post-preprocessing techniques to enhance the model’s performance.