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It is a challenge to manage and assess heart failure with preserved left ventricular ejection fraction (HFpEF) patients. Six-Minute Walk Test (6MWT) is used in this clinical population as a functional test. The objective of the study was to assess gait and kinematic parameters in HFpEF patients during the 6MWT with an inertial sensor and to discriminate patients according to their performance in the 6MWT: (1) walk more or less than 300 m, (2) finish or stop the test, (3) women or men and (4) fallen or did not fall in the last year. A cross-sectional study was performed in patients with HFpEF older than 70 years. 6MWT was carried out in a closed corridor larger than 30 m. Two Shimmer3 inertial sensors were used in the chest and lumbar region. Pure kinematic parameters analysed were angular velocity and linear acceleration in the three axes. Using these data, an algorithm calculated gait kinematic parameters: total distance, lap time, gait speed and step and stride variables. Two analyses were done according to the performance. Student’s t-test measured differences between groups and receiver operating characteristic assessed discriminant ability. Seventy patients performed the 6MWT. Step time, step symmetry, stride time and stride symmetry in both analyses showed high AUC values (>0.75). More significant differences in velocity and acceleration in the maximum Y axis or vertical movements. Three pure kinematic parameters obtained good discriminant capacity (AUC > 0.75). The new methodology proved differences in gait and pure kinematic parameters that can distinguish two groups according to the performance in the 6MWT and they had discriminant capacity.

The study’s purpose was to assess the reliability of the LIS2DH12 in two different positions, using the commercial sensor Actigraph GT9X as a reference instrument. Five participants completed two gait tests on a treadmill. Firstly, both sensors were worn on the wrist and around the thigh. Each test consisted of a 1 min walk for participants to become accustomed to the treadmill, followed by a 2 min trial at ten pre-set speeds. Data from both sensors were collected in real-time. Intraclass correlation coefficient (ICC) was used to evaluate the equality of characteristics obtained by both sensors: maximum peaks, minimum peaks, and the mean of the complete signal (sequence of acceleration values along the time) by each axis and speed were extracted to evaluate the equality of characteristics obtained with LIS2DH12 compared to Actigraph. Intraclass correlation coefficient (ICC) was extracted, and a standard deviation of the mean was obtained from the data. Our results show that LIS2DH12 measurements present more reliability than Actigraph GT9X, ICC > 0.8 at three axes. This study concludes that LIS2DH12 is as reliable and accurate as Actigraph GT9X Link and, therefore, would be a suitable tool for future kinematic studie This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No. 823871 (iGame). Partial funding for open access charge: Universidad de Málaga

Background: The 6-Min Walking Test (6MWT) has been proposed to assess functional aerobic capacity in patients with heart failure, but many older adults with heart failure cannot complete it. The adequacy of the 5-repetition Sit-To-Stand (5-STS), a simpler test than 6MWT, to assess the functional aerobic capacity in older adults with heart failure has not been evaluated. Objectives: This study aimed to assess the usefulness of 5-STS in estimating maximal oxygen uptake (VO2 peak) in older adults with heart failure with preserved ejection fraction (HFpEF). Methods: A cross-sectional study was carried out. Patients 70 years and older with HFpEF were included. A bivariant Pearson correlation and subsequent multivariate linear regression analysis were used to analyze the correlations between the 5-STS and the estimated VO2 peak. Results: Seventy-six patients (80.74 (5.89) years) were recruited. The 5-STS showed a moderate and inversely correlation with the estimated VO2 peak (r = −0.555, p < 0.001). The 5-STS explained 40.4% of the variance in the estimated VO2 peak, adjusted by age, sex, and BMI. When older adults were stratified by BMI, the 5-STS explained 70% and 31.4% of the variance in the estimated VO2 peak in older adults with normal weight and overweight/obesity, respectively. Conclusions: The 5-STS may be an easy tool to assess functional aerobic capacity in older adults with HFpEF, especially for those with normal weight.

ObjectivesAlthough exercise is considered the preferred approach for tendinopathies, the actual load that acts on the tendon in loading programmes is usually unknown. The objective of this study was to review the techniques that have been applied in vivo to estimate the forces and strain that act on the human tendon in dynamic exercises used during rehabilitation.DesignScoping review.Data sourcesEmbase, PubMed, Web of Science and Google Scholar were searched from database inception to February 2021.Eligibility criteriaCross-sectional studies available in English or Spanish language were included if they focused on evaluating the forces or strain of human tendons in vivo during dynamic exercises. Studies were excluded if they did not evaluate tendon forces or strain; if they evaluated running, walking, jumping, landing or no dynamic exercise at all; and if they were conference proceedings or book chapters.Data extraction and synthesisData extracted included year of publication, study setting, study population characteristics, technique used and exercises evaluated. The studies were grouped by the types of techniques and the tendon location.ResultsTwenty-one studies were included. Fourteen studies used an indirect methodology based on inverse dynamics, nine of them in the Achilles and five in the patellar tendon. Six studies implemented force transducers for measuring tendon forces in open carpal tunnel release surgery patients. One study applied an optic fibre technique to detect forces in the patellar tendon. Four studies measured strain using ultrasound-based techniques.ConclusionsThere is a predominant use of inverse dynamics, but force transducers, optic fibre and estimations from strain data are also used. Although these tools may be used to make general estimates of tendon forces and strains, the invasiveness of some methods and the loss of immediacy of others make it difficult to provide immediate feedback to the individuals.

Background Balance and strength training are frequent strategies to address lower limb injuries, including ankle injuries, which are usually performed in single-leg stance on global instability devices, producing generalized muscular activation of the lower limb. In this context, new specific instability devices arise from the need to selectively work the ankle, specifically the peroneus longus. This study aimed to compare the EMG muscle activation of the peroneus longus, as well as other lower limbs muscles, in a single-leg stance on different balance training devices (BOSU, wobble board, power board, and Blackboard) in standing or squatting positions. Methods Twenty healthy recreationally trained subjects participated in the study. Subjects performed three repetitions of 15 s (one for familiarization and two for measurement) in standing and squatting positions on the floor, BOSU, wobble board, power board, and Blackboard. Surface electromyography (EMG) was used to record activity of the peroneus longus, soleus, gastrocnemius medialis, tibialis anterior, rectus femoris, and gluteus maximus. Results The main outcome was that no differences were found for the peroneus longus normalized EMG, neither between devices (p = 0.09) nor between conditions (p = 0.11), nor in the interaction between them (p = 0.16). For the normalized EMG of the other muscles, there were multiple differences between devices and conditions. Of the devices studied, the Blackboard was the one that implied a lower activation of the lower limb muscles and a lower degree of instability, activating the peroneus longus similarly to global instability devices. The BOSU and wobble board achieved high levels of EMG muscle activation for most muscles of the lower limbs. Therefore, they should be considered as potential devices for work in highly unstable conditions or when high activation levels are sought.

There are a large number of mobile applications that allow the monitoring of health status. The quality of the applications is only evaluated by users and not by standard criteria. This study aimed to examine depression-related applications in major mobile application stores and to analyze them using the rating scale tool Mobile Application Rating Scale (MARS). A search of digital applications for the control of symptoms and behavioral changes in depression was carried out in the two reference mobile operating systems, Apple (App Store) and Android (Play Store), by means of two reviewers with a blind methodology between September and October 2019 in stores from Spain and the United Kingdom. Eighteen applications from the Android Play Store and twelve from the App Store were included in this study. The quality of the applications was evaluated using the MARS scale from 1 (inadequate) to 5 (excellent). The average score of the applications based on the MARS was 3.67 ± 0.53. The sections with the highest scores were “Functionality” (4.51) and “Esthetics” (3.98) and the lowest “Application Subjective quality” (2.86) and “Information” (3.08). Mobile Health applications for the treatment of depression have great potential to influence the health status of users; however, applications come to the digital market without health control.

IntroductionHigh-load resistance training has shown positive effects in pain and function in lower limb tendinopathies. However, some authors suggest that current exercise programmes produce an increase in tolerance to load and exercise in general but without fixing some existing issues in tendinopathy. This may indicate the need to include training aspects not currently taken into account in the current programmes. The main objective of this study will be to compare the effect of a common exercise protocol for the three predominant lower limb tendinopathies (Achilles, patellar and gluteal), based on an individualised control of the dose and training of specific aspects of the neuromuscular system versus the current best practice for each location.Methods and analysisThis study will be conducted among people with mid-portion Achilles, patellar or gluteal tendinopathy. The participants allocated to the experimental group will perform a 14-week innovative common therapeutic exercise programme. Participants allocated to the control group will carry out a 14-week exercise programme based on the best current practice for each of the studied locations. The Victorian Institute of Sports Assessment questionnaire will be considered the primary outcome. Pain, central sensitisation, fear avoidance behaviour, quality of life, treatment satisfaction, lower-limb strength and function, and high-density electromyography profile will be evaluated as secondary outcomes. Outcomes will be assessed at baseline, 7 weeks, after the intervention (week 14), 26 weeks and 52 weeks.Ethics and disseminationThe study has been approved by the Portal de Ética de la Investigación Biomédica de Andalucía Ethics Committee (1221-N-19). All participants will be informed about the purpose and content of the study and written informed consent will be completed. The results of this study will be published in a peer-reviewed journal and will be disseminated electronically and in print.Trial registration numberNCT03853122; Pre-results.

BackgroundSubacromial pain syndrome is one of the most frequent injuries in overhead athletes, and it takes place when the acromiohumeral distance (AHD) is narrowed. Conservative treatment is the first approach to this syndrome, being shoulder taping one of the most used techniques. Although there are quite a few studies that analyse the effect of taping on the AHD, most of them do not include sham tapings. This study aimed to examine if the Relocation of the humeral head (RHH) taping produced an increase in the AHD in healthy recreationally weightlifter males, quantifying the change that may be due to a placebo effect.MethodsThe design of this study was a two-group pretest-posttest, in which eighteen healthy recreationally weightlifter males were measured. in a laboratory of the University of Valencia. RHH using rigid or sham taping was randomly applied to the participants. The AHD was measured and registered before and after the application of the taping for both groups by a blinded examiner using ultrasound.ResultsThere were no significant differences between pre and post measures in the sham group (p= 0.51). The experimental group showed a significant AHD increase of 9.2% (10.75 ± 1.89vs11.74 ± 1.82, respectively, withpp

Changes in body composition and muscle dysfunction are common in metastatic breast cancer (MBC). Ultrasound imaging (US) offers reliable information about muscle and fat tissue architecture (thickness) and quality (echo-intensity). This study aimed to analyze the responsiveness of thickness and echo-intensity and its possible relationship with functional and patient reported-outcomes (PRO) in MBC patients after an exercise intervention. A prospective study was conducted in 2019. A 12-week exercise program was performed, including aerobic exercise and strength training. Measurements were made at baseline and after intervention. Thickness and echo-intensity were obtained from the quadriceps and biceps brachii and brachialis (BB). Mean differences were calculated using the T-Student parametric test for dependent samples of the differences in the means before and after the intervention (p = 0.05; 95% CI). Data from 13 MBC patients showed that some US muscle variables had significant differences after intervention. Best correlations were found between the quality of life questionnaire (QLQ-BR23) PRO and variables from BB muscle thickness in contraction (r = 0.61, p

Central sensitization symptoms and pain-related fear avoidance are two common problems in breast cancer survivors. Non-pharmacologic interventions such as therapeutic exercise and patient education can be effective in this population. This study aimed to: (1) analyze the benefits of a therapeutic exercise and educational program on central sensitization symptoms and pain-related fear avoidance in breast cancer survivors, and (2) explore the association between pain-related fear avoidance and central sensitization symptoms. A single group pre-post intervention study was conducted. Patients were recruited from the service of Medical Oncology of the University Clinical Hospital Virgen de la Victoria, in Málaga (Spain). The intervention consisted of a therapeutic exercise and educational program that lasted 12 weeks, twice a week, for 1 hour. Two instruments were used: the Spanish version of the Central Sensitization Inventory and the Spanish Fear Avoidance Components Scale. A total of 82 breast cancer survivors participated in the study. Pre-post change on Central Sensitization Inventory was statistically significant (p = .007). There was a trend towards a significant difference for the Spanish Fear Avoidance Components Scale (p = .062). There was a statistically significant correlation between pain-related fear avoidance and central sensitization symptoms (r = 0.536, p The current study has provided preliminary evidence on the benefits of this intervention in pain-related fear avoidance and central sensitization symptoms in breast cancer survivors. The Spanish version of the Central Sensitization Inventory and the Spanish Fear Avoidance Components Scale demonstrated responsiveness to change.

The epidemiology of injuries in female soccer has been studied extensively in several national leagues. Even so, data on the first division Spanish league are limited. The objective of this study was to describe the epidemiology of the first division of the Spanish Women’s Soccer League and to analyze data in relation to game position, circumstance, or the moment of injury. Fifteen teams and 123 players participated in the study. Players’ characteristics and their injuries (location, type, diagnosis, circumstance, and moment) were collected. Injuries were described by their frequencies (number and percentage) and incidence rates (IR) with 95% confidence intervals (CIs). Lower limb injuries accounted for 86.8% of total injuries. Anterior cruciate ligament (ACL) and meniscus injuries occurred in totality in non-contact circumstance (0.35/1000 h, 95% CI, 0.18 to 0.62 and 0.23/1000 h, 95% CI, 0.10 to 0.45, respectively). Match injury IRs (19.02/1000 h, 95% CI, 14.89 to 23.97) were significantly higher than training (1.70/1000 h, 95% CI, 1.27 to 2.22). As a conclusion, structures such as the ACL or meniscus are most commonly injured in the non-contact circumstance in the first division of the Spanish Women’s Soccer League. In addition, match situations involve a greater risk of injury than training, increasing the risk to the ankle and knee injuries as the season progresses.

In 2018, the European Working Group on Sarcopenia in Older People (EWGSOP) updated the definition and the diagnosis criteria of sarcopenia. Previous systematic reviews have shown the effect of exercise on sarcopenia including people with different sarcopenia diagnostic criteria.This systematic review and meta-analysis aims to summarise and synthesise the evidence about the effect of exercise on muscle mass, strength and physical performance in older adults with sarcopenia according to the EWGSOP criteria.Major electronic databases were searched for articles published until September 2020. Randomised controlled trials (RCTs) and non-randomised interventional studies examining the effect of exercise on muscle mass, strength or physical performance in adults older than 60 years with sarcopenia according to the EWGSOP criteria were included.Four RCTs and three non-randomised interventional studies with a total of 235 patients with sarcopenia were included. Five of the seven included studies reported a low risk of bias. Exercise showed a large effect on physical performance (d = 1.21, 95%CI [0.79 to 1.62]; P 0.001), a medium effect on muscle strength (d = 0.51, 95%CI [0.25 to 0.76]; P 0.001), and no effect on muscle mass (d = 0.27, 95%CI [-0.05 to 0.58]; P = 0.10).The present systematic review showed an effect of exercise on physical performance and muscle strength but an inconsistent effect on muscle mass. The grading of recommendations assessment, development and evaluation criteria showed a low level of evidence in muscle mass, a low or moderate level of evidence in muscle strength and a high level of evidence in physical performance.

Digital health interventions may improve different behaviours. However, the rapid proliferation of technological solutions often does not allow for a correct assessment of the quality of the tools. This study aims to review and assess the quality of the available mobile applications (apps) related to interventions for low back pain. Two reviewers search the official stores of Android (Play Store) and iOS (App Store) for localisation in Spain and the United Kingdom, in September 2019, searching for apps related to interventions for low back pain. Seventeen apps finally are included. The quality of the apps is measured using the Mobile App Rating Scale (MARS). The scores of each section and the final score of the apps are retrieved and the mean and standard deviation obtained. The average quality ranges between 2.83 and 4.57 (mean 3.82) on a scale from 1 (inadequate) to 5 (excellent). The best scores are found in functionality (4.7), followed by aesthetic content (mean 4.1). Information (2.93) and engagement (3.58) are the worst rated items. Apps generally have good overall quality, especially in terms of functionality and aesthetics. Engagement and information should be improved in most of the apps. Moreover, scientific evidence is necessary to support the use of applied health tools.

ObjectiveThe objective of this study is to summarise and analyse the current literature about what progression criteria are applied in loading exercise programmes in lower limb tendinopathies and their evidence and effectiveness.DesignSystematic review.MethodsPubMed, Embase, Scopus and PEDrowere searched from inception to 24 September 2020. The inclusion criteria were randomised controlled trials that included patients with midportion Achilles, patellar or gluteal tendinopathy; assessed function, pain or performance; included at least one group where progressive physical exercise was administered as monotherapy; included at least a control group. We excluded studies that included subjects with previous tendon surgical treatment; studies with control group that conducted a supplemented modality of the exercise performed in the intervention group. A narrative synthesis was conducted. Cohen’s d and the percentage of change of main clinical and performance outcomes were obtained. Methodological quality was assessed using the PEDro scale.ResultsThirty studies that described progression criteria were included. Six types of criteria grouped in two categories were identified and included in a new classification proposal: pain as a primary criterion (evoking and avoid-pain based), and pain and symptom control as a secondary criterion (conditioning stages, fatigue-based, subjective perception and temporary linear increase). Most of the studies applied a pain-based criterion. Criteria based on conditioning stages were also commonly applied. Other criteria such as fatigue, a temporary linear increase, or the subjective perception of the patient’s abilities were occasionally applied.ConclusionsThere is a predominant use of pain-based criteria, but the utilisation of these criteria is not supported by strong evidence. This review evidences the need for studies that compare the same exercise programme using different progression criteria. A new classification of the existing progression criteria is proposed based on the use of pain as the primary or secondary criterion.PROSPERO registration numberCRD42018110997.

BACKGROUND There are a large number of mobile applications that allow monitoring of health status. The quality of the applications is only evaluated by users and not by standard criteria. OBJECTIVE To examine depression-related applications in major mobile application stores and analyse them using the rating scale tool MARS. METHODS A search of digital applications for the control of symptoms and behavioral changes in depression was carried out in the two reference mobile operating systems Apple (App Store) and Android (Play Store) by means of two independent reviewers between September and October 2019. The search was performed on the two operating systems in the regions of Spain and the United Kingdom. Eighteen applications from the Android Play Store and twelve from the App Store were included in this study. The quality of the applications was evaluated using the MARS scale. Descriptive statistics (mean and standard deviation) were applied for the values of each section and the final score of the applications. RESULTS The average score of the applications ranged from 2.38 to 4.6 (3.67 ± 0.53) applying the MARS scale, ranging from 1 (inadequate) to 5 (excellent). The sections with the highest scores were Functionality (4.51) and Esthetics (3.98) and those with the lowest App Subjective quality (2.86) and Information (3.08). CONCLUSIONS MHealth apps (such as apps for the treatment of depression) have great potential to influence in the health status of users. Apps come to the digital market from mobile app stores without any kind of health control.

Background Hospital porters are possibly exposed to the greatest mechanical loads within the hospital environment. However, the evidence about preventive strategies in this population is scarce. Objective To investigate the effect of a workplace-based progressive resistance-training program on musculoskeletal pain among hospital porters. Method A total of 37 hospital porters (27 women, 10 men) participated. Participants allocated to the intervention group performed five brief resistance training sessions/week, for 9 weeks during working hours at the hospital. Intensity was progressively increased. Participants allocated to the control group maintained their usual physical activity. The primary outcome was pain assessed with the patient global impression of pain change scale. Secondary outcome measures were average pain intensity, work ability, use of analgesics, and physical function. Additionally, perceived general changes were evaluated at follow-up: wellness, satisfaction at work, desire to exercise, motivation to eat healthy, energy to be with family and friends, and socialization with colleagues. Results For the primary outcome, the intervention group showed lower general pain (p

Introduction: High levels of absenteeism have become one of the main problems in university education, due to the difficulty it causes in the implementation of basic active strategies such as self-guided learning. The gamified education tool Kahoot has become one of the most popular methods of gamification in the classroom environment. The aim of this study was to compare the levels of absenteeism obtained with the introduction of a gamified education methodology using Kahoot versus the traditional methodology of individual or group written tasks. Methodology: The Kahoot tool was used as a gamified education strategy on the Kinesitherapy subject of the Degree in Physiotherapy of the University of Valencia, with a total of 100 students enrolled. All the sessions included a presentation of contents. In addition, half of the ten sessions included the use of a gamification intervention, answering ten questions at the end of the session using Kahoot. Class attendance was assessed using the number of students who attended each class. The effectiveness of both options was evaluated by comparing means between the number of students attending the classes in which the Kahoot tool was used versus the number of students in the classes in which a traditional methodology was applied. Results: The analysis of the mean differences in class attendance revealed a statistically significant increase (p = .004) in the number of students present in the sessions with Kahoot (mean 70.8 (25.3)) with respect to the sessions without gamification (mean 52.6 (21.2)). In terms of percentage, there was a significant reduction in absenteeism in classes with Kahoot (mean 29.2%) compared to classes with a traditional approach (mean 47.4%). Conclusions: Based on the results in class attendance, Kahoot can be used as a gamified education tool to improve the participation and reducing the absenteeism in university studies of Physiotherapy. Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech.

Background Ankles and knees are commonly affected in people with hemophilia and thus are targets for prevention or rehabilitation. However, to our knowledge, no studies have evaluated muscle activity and safety during exercises targeting the lower limbs in people with hemophilia; this lack of information hinders clinical decision-making. Objective The aim of this study was to compare the tolerability of, safety of, and muscle activity levels obtained with external resistance (elastic or machine)-based and non–external resistance-based lower limb exercises in people with hemophilia. Design This was a cross-sectional study. Methods Eleven people who had severe hemophilia and were undergoing prophylactic treatment participated. In a single experimental session, participants performed knee extension and ankle plantar flexion during 3 exercise conditions in random order: elastic band-based resistance (elastic resistance), machine-based resistance (machine resistance), and no external resistance. Exercise intensities for the 2 external resistance-based conditions were matched for perceived exertion. Muscle activity was determined using surface electromyography (EMG) for the rectus femoris, biceps femoris, gastrocnemius lateralis, and tibialis anterior muscles. Participants were asked to rate exercise tolerability according to a scale ranging from “very well tolerated” to “not tolerated” and to report possible adverse effects 24 and 48 hours after the session. Results No adverse effects were reported, and exercise tolerability was generally high. In the knee extension exercise, the rectus femoris normalized EMG values during the elastic resistance and machine resistance conditions were similar; 29% to 30% higher activity was obtained during these conditions than during the non–external resistance condition. In the ankle plantar flexion exercise, the gastrocnemius lateralis normalized EMG value was 34% higher during the machine resistance condition than without external resistance, and the normalized EMG values during the elastic resistance and other conditions were similar. Limitations The small sample size and single training session were the primary limitations of this study. Conclusions Exercises performed both with elastic bands and with machines at moderate intensity are safe, feasible, and efficient in people with severe hemophilia, providing comparable activity levels in the agonist muscles.

Most of the studies evaluating core muscle activity during exercises have been conducted with healthy participants. The objective of this study was to compare core muscle activity and tolerability of a variety of dynamic and isometric exercises in patients with non-specific low back pain (NSLBP). 13 outpatients (average age 52 years, all with standing or walking work in their current or latest job) performed 3 consecutive repetitions at 15-repetition maximum during different exercises in random order. Surface electromyography was recorded for the rectus abdominis, external oblique and lumbar erector spinae. Patients rated tolerability of each exercise on a 5-point scale. The front plank with brace, front plank and modified curl-up can be considered the most effective exercises in activating the rectus abdominis, with a median normalized EMG (nEMG) value of 48% (34&ndash, 61%), 46% (26&ndash, 61%) and 50% (28&ndash, 65%), respectively. The front plank with brace can be considered the most effective exercise in activating the external oblique, with a nEMG of 77% (60&ndash, 97%). The squat and bird-dog exercises are especially effective in activing the lumbar erector spinae, with nEMG of 40% (24&ndash, 87%) and 29% (27&ndash, 46%), respectively. All the exercises were well tolerated, except for the lateral plank that was mostly non-tolerated. In conclusion, the present study provides a variety of dynamic and isometric exercises, where muscle activity values and tolerability can be used as guide to design evidence-based exercise programs for outpatients with NSCLBP.

BACKGROUND There are several mobile health (mHealth) apps in mobile app stores. These apps enter the business-to-customer market with limited controls. Both, apps that users use autonomously and those designed to be recommended by practitioners require an end-user validation to minimize the risk of using apps that are ineffective or harmful. Prior studies have reviewed the most relevant aspects in a tool designed for assessing mHealth app quality, and different options have been developed for this purpose. However, the psychometric properties of the mHealth quality measurement tools, that is, the validity and reliability of the tools for their purpose, also need to be studied. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) initiative has developed tools for selecting the most suitable measurement instrument for health outcomes, and one of the main fields of study was their psychometric properties. OBJECTIVE This study aims to address and psychometrically analyze, following the COSMIN guideline, the quality of the tools that are used to measure the quality of mHealth apps. METHODS From February 1, 2019, to December 31, 2019, 2 reviewers searched PubMed and Embase databases, identifying mHealth app quality measurement tools and all the validation studies associated with each of them. For inclusion, the studies had to be meant to validate a tool designed to assess mHealth apps. Studies that used these tools for the assessment of mHealth apps but did not include any psychometric validation were excluded. The measurement tools were analyzed according to the 10 psychometric properties described in the COSMIN guideline. The dimensions and items analyzed in each tool were also analyzed. RESULTS The initial search showed 3372 articles. Only 10 finally met the inclusion criteria and were chosen for analysis in this review, analyzing 8 measurement tools. Of these tools, 4 validated ≥5 psychometric properties defined in the COSMIN guideline. Although some of the tools only measure the usability dimension, other tools provide information such as engagement, esthetics, or functionality. Furthermore, 2 measurement tools, Mobile App Rating Scale and mHealth Apps Usability Questionnaire, have a user version, as well as a professional version. CONCLUSIONS The Health Information Technology Usability Evaluation Scale and the Measurement Scales for Perceived Usefulness and Perceived Ease of Use were the most validated tools, but they were very focused on usability. The Mobile App Rating Scale showed a moderate number of validated psychometric properties, measures a significant number of quality dimensions, and has been validated in a large number of mHealth apps, and its use is widespread. It is suggested that the continuation of the validation of this tool in other psychometric properties could provide an appropriate option for evaluating the quality of mHealth apps.

IntroductionLower limb tendinopathies have high rates of incidence and prevalence. Their symptomatology affects the functional capacity of people to exercise and work, being an important cause of economic and social burden. The evidence from the last decades points to therapeutic exercise as the first-line treatment in tendinopathies due to its good short-term and long-term clinical outcomes. However, there is no consensus about how the load progression should be managed throughout the therapeutic exercise programmes.Methods and analysisThis systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The present protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO). The search will be performed through PubMed and Scopus by two reviewers, including references, from inception to 31 August 2019. It will include randomised controlled trials that: included patients with Achilles, patellar or gluteal tendinopathy; assessed pain, function or performance; and included at least one group where progressive physical exercise was administered as monotherapy. The quality of the studies included will be assessed using the Physiotherapy Evidence Database scale. The Grading of Recommendations, Assessment, Development and Evaluation Working Group approach will be used to assess the quality of the evidence. A meta-analysis will be performed if there is sufficient homogeneity across the interventions and outcomes measures to ensure pooling.Ethics and disseminationEthical approval is not necessary for this systematic review protocol. Regardless of its nature, the results obtained in this study will be published in a peer-reviewed journal and presented at a relevant conference.PROSPERO registration numberCRD42018110997