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Background: Osteoarthritis (OA) is the most common and prevalent musculoskeletal disease associated with population aging, negatively impacting function and quality of life. A consequence of knee OA is quadriceps muscle weakness. Musculoskeletal rehabilitation using low load exercises, associated with Blood Flow Restriction (BFR) may be a useful alternative to high load exercises when those cannot be tolerated. Several systematic reviews have reported inconclusive results due to discrepancies in study findings, heterogeneity of results, evaluated time points, and research questions explored. Objective: To perform an overview of systematic reviews with meta-analyses, synthesizing the most recent evidence on the effects of muscle strength training with BFR for knee OA. Methodology: Systematic reviews that include primary controlled and randomized clinical trials will be considered for inclusion. Articles will be considered only if they present a clear and reproducible methodological structure, and when they clearly demonstrate that a critical analysis of the evidence was carried out using instrumented analysis. Narrative reviews, other types of review, overviews of systematic reviews, and diagnostic, prognostic and economic evaluation studies will be excluded. Studies must include adults aged 40 years and older with a diagnosis of knee OA. Two authors will perform an electronic search with guidance from an experienced librarian. The following databases will be searched: PubMed via MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), PEDro, Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCO host, Web of Science, and the gray literature. The search strategy used in the databases will follow the acronym PICOS (population, intervention, comparison, outcome, and study design). Screening (i.e., titles and abstracts) of studies identified by the search strategy will be selected using Rayyan (http://rayyan.qcri.org). The quality assessment will be performed using the "Assessment of Multiple Systematic Reviews" (AMSTAR-2) tool. Systematic Review Registration: PROSPERO, CRD42022367209.

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AIM: To identify risk factors for falls in older adults with Type 2 Diabetes Mellitus (T2DM). METHODS: The eligible studies identified factors associated with the risk of falls in older adults with T2DM. We searched PubMed, Cinahl, Web of Science, Scopus, and the Cochrane Library databases. The review has been updated and the last review date was November 30, 2023 (CRD42020193461). RESULTS: Twelve studies met the inclusion criteria, and eight studies were included in the meta-analysis. These studies included a total of 40,778 older adults with T2DM, aged 60 to 101 years. The risk of developing the outcome falls in older adults with T2DM is 63% higher compared to the risk in older adults without T2DM (HR 1.63; 95% CI [1.30 - 2.05]). The overall chance of falling in older adults with T2DM is 59% higher than that of non-diabetic older adults (OR 1.59; 95% CI [1.36 -1.87]), and in older adults with T2DM who take insulin the chance of falling is 162% higher (OR 2.62; 95% CI [1.87 - 3.65]). No results on diabetic polyneuropathy were found in the studies. CONCLUSION: Older adults with T2DM present a higher risk of falls compared to non-diabetics. Among the included older adults with T2DM, the most important factor associated with a higher risk of falls was insulin use. TRIAL REGISTRATION: Registered in the International Prospective Register of Systematic Reviews (CRD42020193461).

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STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVES: The objective was to summarize the effectiveness of Inspiratory Muscle Training (IMT) on the quality of life in individuals with Spinal Cord Injury (SCI). METHODS: An online systematic literature search was conducted in the following databases: PubMed/MEDLINE, PubMed CENTRAL, EMBASE, ISI Web of Science, SciELO, CINAHL/SPORTDiscus, and PsycINFO. Randomized and non-randomized clinical studies investigating the effectiveness of IMT in quality of life were included in the present study. The results used the mean difference and 95% confidence interval for maximal inspiratory pressure (MIP), forced expiratory volume in 1 s (FEV1), maximal expiratory pressure (MEP), and the standardized mean differences for the quality of life and maximum ventilation volume. RESULTS: The search found 232 papers, and after the screening, four studies met the inclusion criteria and were included in the meta-analytical procedures (n = 150 participants). No changes were demonstrated in the quality of life domains (general health, physical function, mental health, vitality, social function, emotional problem, and pain) after IMT. The IMT provided a considerable effect over the MIP but not on FEV1 and MEP. Conversely, it was not able to provide changes in any of the quality of life domains. None of the included studies evaluated the IMT effects on the expiratory muscle maximal expiratory pressure. CONCLUSION: Evidence from studies shows that inspiratory muscle training improves the MIP; however, this effect does not seem to translate to any change in the quality of life or respiratory function outcomes in individuals with SCI.

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INTRODUCTION: The handheld dynamometer has been validated to measure muscle strength in different muscle groups. However, to date, it has not been tested in individuals who experience pain induced by hip osteoarthritis. The current study aimed to evaluate the intra- and inter-rater reliability, agreement, and minimal detectable change of the Lafayette handheld dynamometer, model 1165, to assess the peak force (Pk) and average peak force (Af) of hip muscles in individuals with symptomatic hip osteoarthritis. METHODS: Twenty participants with hip osteoarthritis (mean ± SD age: 58.7±15.3 years; body mass index: 28.8±4.2 kg/m2) and pain intensity on the Visual Analogue Scale ≥ 4 (8.05±1.2) were recruited to participate in this study. Pk and Af of hip flexors (seated position), abductors and adductors (supine position), and extensors (prone position) were collected in a single day by two independent raters, each one obtaining test and retest in randomly ordered separate sessions. RESULTS: The intra-rater intraclass correlation coefficient (ICC) was classified as good (>0.75) or excellent (≥0.90) for all muscle groups and all inter-rater ICCs were classified as excellent. Rater A had a lower standard error of measurement compared to rater B, ranging from 0.15 to 0.58 kilogram-force (Kgf) compared with 0.34 to 1.25 kg, respectively. However, the inter-rater comparison showed a minimal detectable change (MDC) of < 10% for all Pk and Af measures for hip adductors and extensors. Finally, the inter-rater Bland-Altman analysis demonstrated good agreement for abductors, adductors, and extensors. CONCLUSION: Despite pain and dysfunction related to hip osteoarthritis, the mean of two measures using a handheld dynamometer was shown to be a reliable tool to assess hip muscle strength, with good to excellent intra- and inter-rater ICCs, satisfactory agreement, and small values for MDC.

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BACKGROUND: Biofeedback has been used by rehabilitation professionals in the treatment of poststroke function impairments. PURPOSE: Investigate the efficacy of any type of biofeedback intervention for the treatment of upper limb function in individuals following stroke. STUDY DESIGN: Systematic review of literature with meta-analysis. METHODS: Literature searches were conducted using MESH terms and text words in PubMed, Lilacs, Scielo, Scopus, PEDro, and Web of Science databases. The main outcome was improvement in upper limb's motor function and motor function in activities of daily living. We calculated the Mean Difference and Standardized Mean Difference for the assessment scales reported as primary outcome. The methodological quality of included studies was assessed using PEDro scale. The overall quality of the evidence was assessed using GRADE system. RESULTS: From 1360 articles identified, 16 were included in the review (09 in the meta-analysis). Three forest plots of hemiparesis and one of hemiplegia showed that biofeedback therapy associated with conventional therapy has a greater improvement in participants upper limb motor function when compared to isolated conventional therapy. Two forest plots of hemiparesis and one of hemiplegia showed no superiority in participants improvement for biofeedback associated with conventional therapy when compared to isolated conventional therapy. CONCLUSION: Biofeedback therapy associated with conventional therapy showed a small clinical effect when associated to conventional therapy and very low quality of evidence. Although further research with higher quality evidence is needed.

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Abstract Musculoskeletal symptoms (MS) can derive from injuries or dysfunctions that affect biological tissues such as muscles, bones, and nerves, among others. Military Firefighters (MF) exercise their activities exposed to varied and complex biological conditions, in which the physical demands are intense. Shift work is another remarkable characteristic of the career, which is associated with sleep disorders. Our objective was to estimate the association between the risk of chronification of MS and sleep quality in MF with MS. Our study is a Cross-Sectional Observational Study, whose sample was composed of 753 BM from the Federal District. The analysis was performed with a Sample Characterization Questionnaire, Örebro Musculoskeletal Symptoms Screening Questionnaire (OMPSQ) and the Pittsburgh Sleep Quality Index (PSQI), answered remotely. Statistical analysis used the Spearman Correlation test, p<0.05. The correlation between OMPSQ and PSQI was rated moderate, demonstrating that sleep quality has an influence on the chronification process. The average of the evaluation of Sleep Quality through the PSQI is 8.79, indicating that military personnel present a deficient quality of sleep. There was a correlation between the PSQI score and the OMPSQ of 0.542 (p<0.001), a moderate correlation between the variables. We conclude that MF show correlation between SM and sleep quality, indicating a moderate relationship between the variables, where sleep quality explains 25% of SM. We found that most MF were classified as Low Risk for chronification of SM.

Resumo Os sintomas musculoesqueléticos (SM) podem derivar de lesões ou disfunções que afetam tecidos biológicos como músculos, ossos, nervos, entre outros. Os Bombeiros Militares (BM) exercem suas atividades expostos a condições biológicas variadas e complexas, nas quais as demandas físicas são intensas. O trabalho em turno é outra característica marcante na carreira, o qual está associado a distúrbios do sono. Nosso objetivo foi estimar a associação entre o risco de cronificação de SM e a qualidade do sono em BM com SM. Nosso estudo é um Estudo Observacional Transversal, cuja amostra foi composta por 753 BM do Distrito Federal. A análise foi realizada com um Questionário de Caracterização Amostral, Questionário Örebro de Triagem de Sintomas Musculoesqueléticos (OMPSQ) e com o Índice de Qualidade do Sono de Pittsburgh (PSQI), respondidos remotamente. A análise estatística utilizou o teste de Correlação Spearman, p<0,05. A correlação entre OMPSQ e PSQI foi classificada em moderada, demonstrando que a qualidade do sono apresenta influência no processo de cronificação. A média da avaliação da Qualidade do Sono através do PSQI é de 8,79, indicando que militares apresentam uma qualidade do sono deficitária. Houve correlação entre a pontuação no PSQI e o OMPSQ de 0,542 (p<0.001), correlação moderada entre as variáveis. Concluímos que os BM apresentam correlação entre os SM e a qualidade do sono, indicando uma relação moderada entre as variáveis, onde a qualidade de sono explica 25% dos SM. Verificamos que a maioria dos BM foram classificados como Baixo Risco de cronificação de SM.

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Introdução: As operações laparoscópicas têm aumentado anualmente, bem como os casos de prevalência das hérnias da parede abdominal. Com isso, as técnicas de se realizar as operações, bem como certos procedimentos vem sendo estudados. Uma das questões debatidas é a respeito do tipo de fixação da tela. Objetivo: Avaliar as técnicas de fixação da tela na cirurgia laparoscópica ventral da hérnia inguinal. Método: Trata-se de um estudo de revisão sistemática. Três bases de dados foram consultadas: Cochrane Database of Systematic Reviews (CDSR), EMBASE e PUBMED. Durante as buscas foram utilizados descritores com vocabulário controlado e text words. Resultados: Em relação ao desenho do estudo 1 revisão incluiu apenas ECA, 2 ECA e ECNA e 1 combinou a inclusão de ECA e estudos observacionais. Em relação ao tipo de fixação 2 estudos compararam os efeitos da fixação por tacha vs. cola de fibrina e outros 2 a comparação da fixação do grampo vs. cola de fibrina. De todos os desfechos de metanálise avaliados, apenas a redução da dor inguinal crônica pela fixação por cola de fibrina foi estatisticamente superior ao método de fixação mecânico em 3 dos 4 estudos. Conclusão: Os achados mostram que a diferença entre as técnicas de fixação da tela na cirurgia laparoscópica ventral da hérnia inguinal é que a fixação por cola diminui a incidência de dor crônica pós-operatória.

Introduction: Laparoscopic operations have increased annually, as well as the prevalence of abdominal wall hernias. With this, the techniques of performing the operations, as well as certain procedures, have been studied. One of the debated questions is about the type of fixation of the mesh. Objective: To evaluate mesh fixation techniques in ventral laparoscopic surgery for inguinal hernia. Method: This is a systematic review. Three databases were consulted: Cochrane Database of Systematic Reviews (CDSR), EMBASE and PUBMED. During the searches, descriptors with controlled vocabulary and text words were used. Results: Regarding the study design, 1 review included only ACE, 2 ACE and ECNA and 1 combined the inclusion of ACE and observational studies. Regarding the type of fixation, 2 studies compared the effects of stud fixation vs. fibrin glue and 2 others comparison of staple vs. fibrin glue. Of all the meta-analysis outcomes evaluated, only the reduction of chronic groin pain by fibrin glue fixation was statistically superior to the mechanical fixation method in 3 of 4 studies. Conclusion: The findings show that the difference between mesh fixation techniques in laparoscopic ventral inguinal hernia surgery is that glue fixation decreases the incidence of postoperative chronic pain.

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Issue: The findings in literature indicate inconsistency in the complications caused by the implant of electrodes in the cochlea; vestibular alterations and balance disorders are mentioned as the most likely. Purpose: To evaluate, in literature, through the results of multiple vestibular function tests, the effects of cochlear implant surgery on postural stability in adult patients and to analyze. Hypothesis: From the PICO strategy, where the Population focuses on adults, Intervention is cochlear implant surgery, Comparisons are between implanted patients, and Outcomes are the results of the assessment of cochlear function, the research question was formulated: Are there deficits in vestibular function in adults undergoing cochlear implant placement? Method: Systematic review based on cohort, case-control, and cross-sectional observational studies. Information sources: Databases between 1980 and 2021, namely, PubMed, Cinahl, Web Of Science, Cochrane, and Scopus. Search strategy using Mesh terms: "Adult," "Cochlear Implant," "Postural Balance," "Posturography," "Cochlear Implant," "Dizziness," "Vertigo," "Vestibular Functional Tests,"and "Caloric Tests." Populational inclusion criteria: studies with adult patients; intervention: cochlear implant placement surgery; comparison: analysis of a vestibular function with vestibular test results and pre- and postoperative symptoms; outcome: studies with at least one of the vestibular function tests, such as computerized vectoelectronystagmography (VENG), vestibular-evoked myogenic potentials (VEMPs), caloric test, video head impulse test (VHIT), head impulse test (HIT), videonystagmography, (VNG) and static and dynamic posturography. Exclusion criteria: studies without records of pre- and postoperative data collection and studies with populations under 18 years of age. Screening based on the reading of abstracts and titles was performed independently by two reviewers. In the end, with the intermediation of a third reviewer, manuscripts were included. Risk of bias analysis, performed by two other authors, occurred using the JBI "Critical Appraisal Checklist." Results: Of the 757 studies, 38 articles met the inclusion criteria. VEMP was the most commonly used test by the studies (44.7%), followed by the caloric test (36.8%) and vHIT (23.6%). Most studies performed more than one test to assess vestibular function. Conclusion: Among all vestibular tests investigated, the deleterious effects on vestibular function after cochlear implant surgery were detected with statistical significance (P < 0.05) using VEMP and caloric test. Comparing abnormal and normal results after implant surgery, the vestibular apparatus was evaluated as having abnormal results after cochlear implant surgery only in the VEMP test. The other tests analyzed maintained a percentage mostly considered normal results. Systematic review registration: identifier: CRD42020198872.

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BACKGROUND: Imbalance between flexor and extensor muscles of the trunk could negatively influence spinal stability. OBJECTIVES: Investigate the strength balance between flexor and extensor muscles of the trunk in military firefighters with non-specific chronic low back pain (NSCLBP). METHODS: One hundred and two male firefighters were assessed in an isokinetic dynamometer at 120°/s and 60°/s to investigate the balance ratio between flexor and extensor (F/E) muscles. RESULTS: An F/E ratio of 0.72 (SD: 0.22; 95% CI: 0.67-0.76; SEM: 0.02) was observed at 60°/s and 0.94 (SD: 0.41; 95% CI: 0.85-1.03; SEM: 0.04) at 120°/s. The mean peak torque of the extensor muscles was 343.1 N.m/Kg (SD: 94.87; 95% CI: 322.8-363.5; SEM: 10.23) at 60°/s and 270.5 N.m/Kg (SD: 113; 95% CI 246.3-294.8; SEM: 12.18) at 120°/s. The mean peak torque of the flexor muscles was 232.4 N.m/Kg (SD: 53.86; 95% CI 220.8-243.9; SEM: 5.81) at 60°/s and 223.8 N.m/Kg (SD: 66.34; 95% CI 209.6-238.1; SEM: 7.15) at 120°/s. All torques generated by the extensor muscles were higher than the flexor muscles (p < 0.05). CONCLUSIONS: Firefighters with NSCLBP presented a normal F/E balance ratio and higher strength of extensor muscles of the trunk.

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Exercise interventions have been recommended for people with non-specific low back pain. The literature is scarce regarding the effects of exercise on muscle strength, endurance, and electrical activity of lumbar extensor muscles. Electronic searches were carried out from May 2020 until August 2020 in the following databases: PUBMED, CENTRAL, EMBASE, PEDro, SPORTDiscus, Scielo, and LILACS. Only randomized controlled trials with passive and active control groups were included. The methodological quality of the included studies was performed using the Physiotherapy Evidence Database Scale. Eight studies, involving 508 participants, were included in metanalytical procedures. Exercise interventions demonstrated superior effects on muscle activity (Electromyography) when compared with active controls (p < 0.0001). Exercise interventions demonstrated superior effects on muscle endurance (Sorensen Test) when compared with passive (p = 0.0340) and active controls (p = 0.0276). Exercise interventions demonstrated superior effects on muscle strength (Machine) when compared with passive controls (p = 0.0092). Exercise interventions can improve muscle strength, endurance, and electrical activity in people with non-specific low back pain.

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