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- Could socks play an active role in ankle sprain prevention? A preliminary investigationPublication . Torres, Rui; Mesquita, InêsAnkle sprain represents about 10% to 30% of all recorded musculoskeletal injuries, and is one of the most prevalent injuries in sports. Thus, any type of intervention based on prevention is extremely important to reduce its incidence. Aim of Study. To compare the immediate effect of three different types of socks, namely standard, compression, and Prevent Sprain Technology (PST) socks, on the dynamic unipodal balance and ankle joint position sense in healthy participants. Forty-two healthy adults, aged 20.34 ± 1.69 years old, volunteered to participate in the study. Participants were randomly assessed using three different sock models. The main measured outcomes selected for this study were the dynamic balance using the Biodex Balance System®, and the active ankle joint repositioning movement through the Biodex System Pro 4®. We used the Friedman test to compare the variables under study among the three conditions, with Dunn’s post-hoc analysis and a significance level of 0.05. In the Biodex Balance System® the participants had a lower Global Instability Index value with the PST socks compared to compression socks (p = 0.031), and standard socks (p = 0.005), but only lower anteroposterior (p = 0.042) and mediolateral (p = 0.026) instability indices when compared to standard socks. Regarding the ankle joint position sense, subjects with PST socks revealed lower absolute errors compared to standard socks (p = 0.007), smaller minimum errors compared to compression socks (p = 0.049), and smaller maximum errors compared to compression socks (p = 0.049) and standard socks (p = 0.008). Analysis of relative errors revealed a significant miss regarding the target joint position at higher inversion angles only with standard socks (which is potentially more dangerous) when compared to PST socks (p = 0.031), which error tends to be at lower inversion angles (which is potentially less dangerous). The PST socks seem to have a global positive influence on the mechanisms underlying the dynamic unipodal balance and active joint position sense, which could be an important tool for ankle sprain prevention.
- Cross-cultural adaptation and validation of the european portuguese version of the Western Ontario Shoulder Instability Index (WOSI)Publication . Torres, Rui; Faria, Sara Isabel; Cavalheiro, Luís Manuel; Ferreira, Pedro Lopes; Gonçalves, Rui SolesThe Western Ontario Shoulder Instability Index (WOSI) is a self-administered questionnaire specifically used to determine the impact of shoulder instability on quality of life. The aim of this study was to translate the WOSI into European Portuguese and analyze its validity and reliability in a population with shoulder instability. The WOSI was translated and culturally adapted from its original version into European Portuguese (WOSIPT). Internal consistency and test-retest analyses were conducted to determine the level of reliability of the scale. WOSI-PT, QuickDASH, and SF-12 questionnaires were applied to 81 patients with symptomatic shoulder instability to assess validity, and reliability was tested by randomly selecting 50 patients within 72 hours using a test-retest design. The reliability of the WOSI-PT was very high, with Cronbach´s alpha equal to 0.97 and an intraclass correlation coefficient of 0.98. Regarding the construct validity, the correlation between the WOSI-PT and QuickDASH was high and negative (-0.79). The correlations between WOSI-PT and SF-12 were positive, respectively, moderate with physical (0.66) and low with mental (0.34) health. WOSI-PT is a reliable and valid instrument for assessing the functional impact of shoulder joint instability on quality of life.
- The effects of adding a six-month Pilates exercise program to three months of traditional community-based pulmonary rehabilitation in individuals with COPD: A prospective cohort studyPublication . Barbosa, Marisela; Melo, Cristina; Torres, RuiPilates exercise may complement traditional pulmonary rehabilitation in individuals with chronic obstructive pulmonary disease (COPD). The objective was to analyze the effects of adding a six-month Pilates exercise program to a three-month pulmonary rehabilitation for individuals with COPD. Thirty-five participants with COPD (GOLD B) were assigned to the intervention (n=14) or control (n=21) group. Both groups received an initial three months of a pulmonary rehabilitation program. The intervention group further underwent six months of pilates. Participants were evaluated at baseline and at three, six, and nine months. Lung function and strength of respiratory muscles were defined as primary outcomes. Secondary outcomes included cardiac, physical function, and exacerbation episodes. There were no consistent statistically significant differences between groups for the lung function outcomes (p<0.05). Maximal inspiratory and expiratory pressure increased significantly at three months in both groups (p<0.05). It was significantly superior in the intervention group at nine months for maximal inspiratory pressure (p=0.005) and six and nine months for maximal expiratory pressure (p=0.027 and p<0.001, respectively). Changes in muscle strength (knee extension and handgrip) were comparable between groups (p>0.05), but exercise-induced fatigue and balance were significantly superior in the intervention group at the six- and nine-month follow-ups (p<0.05). Pilates exercise programs may be implemented to augment traditional pulmonary rehabilitation with the goal of improving the strength of respiratory muscles. Adding a Pilates exercise program to pulmonary rehabilitation resulted in superior strength of respiratory muscles, higher resistance to exercise-induced fatigue, and improved balance.
- Effect of Kinesio® taping on static and dynamic balance after anterior cruciate ligament reconstruction: A randomized controlled trialPublication . Sousa, João; Ribeiro, Fernando; Lopes, Mário; Gonçalves, Rui Soles; Torres, RuiAnterior cruciate ligament (ACL) rupture is one of the most common knee injuries among athletes (Evans and Nielson, 2022). ACL reconstruction is, in general, the solution for the rupture of ACL; the torn ligament is replaced with a tissue graft from another surrounding functional structure of the knee (Rochmania et al., 2012). The functional changes that occur after ACL reconstruction comprise deficits of muscle power, functional performance, joint proprioception, and balance (Ageberg, 2002). Evidence shows that even several months after a successful ACL reconstruction subjects still present motor control changes, influencing knee functionality (Furlanetto et al., 2016). Kinesio Taping (KT), which consists of the application of elastic adhesive bands to the skin (Oliveira et al., 2016), is frequently used in orthopedics, sports medicine, and neurological rehabilitation (Choi et al., 2016). It is used in several areas of physiotherapy to relieve pain (Nadali et al., 2014; Pamuk and Yucesoy, 2015), promote postural correction, stimulate muscle function (Cortesi et al., 2011; Lee et al., 2016; Scarborough et al., 1999), enhance gait (Choi et al., 2016; Lee et al., 2016, Yang et al., 2015), and improve balance (Bernardelli et al., 2019, Khalili et al., 2022). Despite being a technique commonly used during sports practice and in the rehabilitation of musculoskeletal and sport injuries, KT has little and insufficient evidence supporting its use to improve balance and postural control, particularly after a major musculoskeletal injury/surgery such as ACL reconstruction (Gholami et al., 2020). Moreover, only a few studies assessed the effect of KT in patients undergoing ACL reconstruction (Balki et al., 2016, Boguszewski et al., 2013; Laborie et al., 2015). Collectively, they evaluated the effects of the KT on the range of knee motion, oedema (Balki et al., 2016; Boguszewski et al., 2013), muscle strength (Balki et al., 2016), and pain (Balki et al., 2016; Boguszewski et al., 2013; Laborie et al., 2015). It is accepted that KT stimulates proprioception through cutaneous receptors by altering somatosensory information (Tamburella et al., 2014), which consequently increases the cortical excitability of the cortical motor areas of cerebral cortex (Oliveira et al., 2016). However, it is not known whether it influences balance and postural control after ACL reconstruction. We will test the application of KT for 24 h, to determine whether KT could be used to maximize balance and postural control during the rehabilitation process or when resuming sport practice to decrease the risk of re-injury. Thus, the purpose of this study was to assess the effects of KT on balance and postural control among young adults with ACL reconstruction.
- Community-based pulmonary rehabilitation programs in individuals with COPDPublication . Barbosa, Marisela; Andrade, Renato; Melo, Cristina; Torres, RuiCommunity-based pulmonary rehabilitation (PR) programs can be offered to patients with COPD, but the literature on its effects is still not well summarized. Our purpose was to investigate the health-, physical-, and respiratory-related effects of community-based PR in individuals with COPD as compared to control groups. The PubMed and Embase databases were searched up to May 17, 2021. We included randomized control trials that compared the effects of community-based PR as compared to control groups in individuals with COPD. The risk of bias was judged using the Cochrane Risk of Bias 2 (RoB2). Meta-analysis was performed using a random-effects model to estimate the standardized mean difference (SMD) with 95% CI of the mean changes from baseline between groups. The Grading of Recommendations Assessment, Development, and Evaluation was used to interpret certainty of results. We included 10 randomized control studies comprising a total of 9,350 participants with weighted mean age of 62.3 ± 2.38 y. The community-based interventions were based on exercise programs (resistance and/or endurance). All studies were judged as high risk and/or some concerns in one or more domains the risk of bias. All meta-analyses displayed very low certainty of evidence. The community-based PR interventions were significantly superior to control interventions in improving the St. George Respiratory Questionnaire Activity subscore (−0.40 [95% CI −0.72 to −0.08]; k = 5, n = 382) and total score (−0.73 [95% CI −1.29 to −0.18]; k = 4, n = 268) and the Chronic Respiratory Disease Questionnaire dyspnea subscore (0.36 [95% CI 0.03–0.69]; k = 6, n = 550). The mean changes from baseline were not different between the groups for all other outcomes. Community-based PR tended to result in superior health-related quality of life and symptoms than control interventions, but the findings were inconsistent across outcomes and with very low certainty of evidence. Further studies are warranted for stronger conclusions.
- Evidence-based physiotherapy and clinical guidelines: attitudes, knowledge and implementation among clinical educatorsPublication . Araújo, Fábio A.; Carvalhais, Alice; Stas, Hélène; Lopes, Sofia; Brochado, GabrielaEvidence-based physiotherapy (EBP) is now well established in the teaching curricula, leading to expectations that students will have opportunities to implement EBP steps during internships. However, the position of clinical educators towards EBP can act against this educational process. Our aims were to describe for the first time EBP domains in clinical Portuguese educators and to quantify associations between individual exposures with EBP-related outcomes. A cross-sectional mail survey to clinical educators from the physiotherapy course of CESPU was conducted. Two mailings were sent to 289 contacts (separately and three weeks apart). Sociodemographic and postgraduate information was collected as exposure variables and a questionnaire on EBP domains was created. There was a positive attitude towards EBP (all five questions ≥87%). Although 25% of the sample received no training in EBP, almost all of the participants reported knowing how to ‘ask’, ‘search’, and ‘critically appraise’. Only 60% of educators used clinical guidelines and less than half could integrate their recommendations into practice. Complementary training between 16h-30h/per year was positively associated with different aspects of EBP (all documented at p≤0.009), with decreasing trends in the strength of the associations after those intermediate values. Although the picture of EBP domains among clinical educators seemed quite regular in comparison with other samples, only 60% of them declared using clinical guidelines in their practice (vs. 86%). Clinical educators in physiotherapy seem to have a positive attitude towards EBP with high levels of previous training in the area. However, the use of Clinical Guidelines and how to integrate their recommendation into practice both need to be promoted. The target range for complementary training seems to be between 16-30h/per year. Out of this scenario, there appears to exist an excessive focus on the component of ‘clinical expertise’ of EBP.
- Home-based virtual reality exercise program during the maintenance stage of cardiac rehabilitation: A randomized controlled trialPublication . Vieira, Ágata; Melo, Cristina; Noites, Andreia; Machado, Jorge; Mendes, JoaquimHome-based virtual reality technology may become an alternative to cardiac rehabilitation. To evaluate the effects of a specific, home-based exercise program, performed either through a virtual reality (Kinect) or a conventional format (booklet) in the maintenance stage of cardiac rehabilitation for six months on functional muscle strength of the lower limbs, physical activity and exercise tolerance. This is a randomized clinical trial (ClinicalTrials.gov — NCT02753829) with individuals with coronary artery disease from a hospital in Porto, Portugal, randomly allocated to an experimental group “1” (EG1; n = 11), submitted to a virtual reality exercise program (Kinect); an experimental group “2” (EG2; n = 11), submitted to an exercise program described in a booklet (conventional format); or a control group (CG) (n=11), submitted to routine care. Parameters of functional muscle strength of the lower limbs (sit-to-stand test), physical activity (accelerometer) and exercise tolerance (stress test) were assessed and compared between the groups. Descriptive and inferential statistics were applied, with 95% with a significance level of 0.05. Significant improvements in functional muscle strength of the lower limbs were observed in EG1 compared to EG2, at three months (19.5 ± 7.7 versus 11.9 ± 4.7, p = 0.042), and at six months (23.0 ± 7.7 versus 14.6 ± 4.6, p = 0.027) of intervention. The program did not demonstrate superior results, in relation to the control group and among the different formats, in physical activity and effort tolerance. In relation to the functional muscle strength of the lower limbs, the virtual reality format showed significantly better results when compared to the conventional format only.
- Stroke rehabilitation pathways during the first year: A cost-effectiveness analysis from a cohort of 460 individualsPublication . Barbosa, Pedro; Szrek, Helena; Ferreira, Lara Noronha; Cruz, Vítor Tedim; Firmino-Machado, JoãoStroke burden challenges global health, and social and economic policies. Although stroke recovery encompasses a wide range of care, including in-hospital, outpatient, and community-based rehabilitation, there are no published cost-effectiveness studies of integrated post-stroke pathways. To determine the most cost-effective rehabilitation pathway during the first 12 months after a f irst-ever stroke. A cohort of people in the acute phase of a first stroke was followed after hospital discharge; 51 % women, mean (SD) age 74.4 (12.9) years, mean National Institute of Health Stroke Scale score 11.7 (8.5) points, and mode modified Rankin Scale score 3 points. We developed a decision tree model of 9 sequences of rehabilitation care organised in 3 stages (3, 6 and 12 months) through a combination of public, semi-public and private entities, considering both the individual and healthcare service perspectives. Health outcomes were expressed as quality-adjusted life years (QALY) over a 1-year time horizon. Costs included healthcare, social care, and productivity losses. Sensitivity analyses were conducted on model input values. From the individual perspective, pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective, followed by pathway 1 (Rehabilitation Centre » Community Clinic). From the healthcare service perspective, pathway 3 was the most cost-effective followed by pathway 7 (Outpatient Hospital » Private Clinic). All other pathways were considered strongly dominated and excluded from the analysis. The total 1-year mean cost ranged between €12104 and €23024 from the individual’s perspective and between €10992 and€31319 fromthe healthcare service perspective. Assuming a willingness-to-pay threshold of one times the national gross domestic product (€20633/QALY), pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective strategy from both the individual and healthcare service perspectives. Rehabilitation pathway data contribute to the development of a future integrated care system adapted to different stroke profiles.
- Exercise-related quality of life in subjects with asthma: A systematic reviewPublication . Pacheco, Diana R. R.; Silva, Manuel J. B.; Alexandrino, Ana Silva; Torres, Rui M. T.The purpose of this review was to analyze, based on a review of the current literature, the effects of physical activity on the quality of life (QoL) of subjects with asthma. The authors conducted a search of randomized controlled trials (RCTs) between January 2000 and August 2010 in a group of major databases of health sciences (Academic Search Complete, Directory of Open Access Journals, Elsevier—Science Direct, Highwire Press, PubMed, Scielo Global, Scirus, Scopus, SpringerLink, Taylor & Francis, and Wiley Interscience) with the keywords asthma, QoL, physical activity, exercise, training, and program in all possible combinations. Citations and references of each study selected were also examined. Of the 1075 studies identified, only 11 were included. Five of these studies were performed in children between the ages of 7 and 15 and the remaining studies were performed on adults. Intervention programs were divided into aerobic training programs and breathing exercises programs. All aerobic training programs showed improvements in QoL, demonstrating a positive influence of aerobic training on asthma. There is a noticeable trend in the benefit of aerobic training programs in the QoL for individuals with asthma. The breathing exercises programs were few and heterogeneous, making it difficult to reach a positive conclusion on whether it could be recommended for the improvement of QoL in this pathology. There is a great need for more RCTs with methodological rigor.
- Efeito imediato da técnica de rotação cervical grau II na sensação de posição articular em indivíduos com e sem dor não específicaPublication . Rodrigues, Elisa; Brochado, Gabriela; Moura Bessa, Isabel; Gonçalves, Paulo; Domingos, João; Crasto, CarlosA mobilização articular passiva em indivíduos com dor cervical possui eficácia reconhecida no alívio da dor e no aumento da amplitude articular, mas há poucos estudos sobre a sua influência na capacidade propriocetiva. Estudar o efeito imediato da técnica de rotação cervical grau II na sensação de posição articular, em jovens adultos com e sem dor cervical unilateral de origem não específica. Estudo quase experimental, duplamente cego, numa amostra de conveniência de 37 indivíduos (18 a 24 anos de ambos os sexos) divididos em 2 grupos: 22 sem dor e 15 com dor cervical. O instrumento Cervical Range of Motion foi utilizado para avaliar a sensação de posição articular ativa da cervical a 30⁰ de rotação, para a direita e para a esquerda, antes e imediatamente após a execução da técnica de mobilização articular de rotação cervical grau II de Maitland (quatro mobilizações de 30 segundos cada). O teste foi repetido seis vezes para cada lado. Calculou-se o erro absoluto e o erro variável utilizando-se o teste t para comparação entre os grupos e momentos com nível de significância de 5%. Apenas se observaram diferenças significativas entre grupos no erro variável na rotação esquerda após a realização da técnica e entre momentos na rotação esquerda e direita no grupo sem dor sendo, no entanto, de magnitudes iguais ou inferiores a 1⁰ em média. A técnica de rotação cervical grau II não parece produzir efeitos imediatos clinicamente relevantes na precisão e consistência do reposicionamento avaliada a 30⁰ de rotação.