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Background: Temporomandibular disorders (TMDs) are conditions that involve the temporomandibular joints, masticatory muscles, and associated tissues, causing orofacial pain. Central sensitisation (CS) is a relevant part of the TMD pathophysiology. Migraine, psychological aspects, parafunctional oral habits and widespread pain are commonly associated with both TMD and CS and could confound the association between them., Objectives: To investigate the association between painful TMD and the Central Sensitisation Inventory (CSI) score, and to assess the presence of confounders in this association., Methods: Cross-sectional study that assessed women with and without orofacial pain complaints using telehealth. The TMD Pain Screener and an online physical examination determined the presence of painful TMD. The following questionnaires were applied: CSI, Headache Screening Questionnaire, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, Oral Behavior Checklist, Jaw Functional Limitation Scale and the Nordic musculoskeletal questionnaire. A single regression investigated the association between the CSI score and TMD, and a multiple regression investigated the effect of the other outcomes as possible confounders. Confounding was considered present when the association between TMD and the CSI score changed more than 10% after adding a possible confounder to the regression model., Results: Forty-two women with painful TMD and 53 without TMD were included. There was a significant association between the CSI score and the presence of painful TMD (R 2  = 0.639; p < 0.001). This association changed when the following outcomes were added to the model: presence of migraine, symptoms of depression, widespread pain and parafunctional oral habits., Conclusion: The positive association between TMD and the CSI score was confounded by migraine, symptoms of depression, widespread pain and parafunctional oral habits., (© 2024 John Wiley & Sons Ltd.)

Background: Resistance training with instability (REI) emerged as a promising training modality for older adults aiming to counteract age-related changes., Objectives: We compared the effects of 12 weeks of REI and traditional resistance exercise (RE) on muscle strength in older adults with cognitive impairment. We further explored if total training volume (TTV) significantly differs among training groups., Methods: This is a secondary analysis of the REI study. Participants were randomly assigned to REI (n=22) or RE (n=23). RE protocol involved moderate-intensity, free-weight, and machines-based resistance exercises (3 sets, 10-15 repetitions). REI received a similar training protocol, in which exercises were simultaneously performed with instability/unstable devices (e.g., squat exercise under a foam pad or Bosu ® ball). Maximal isometric strength and isokinetic parameters were assessed at baseline and after completion of a 12-week intervention through a hydraulic handgrip and isokinetic dynamometer, respectively. TTV (sets × repetitions × load) was computed based on external training load over the 12 weeks., Results: No differences were observed between groups ( p =.35) after the intervention. Over 12 weeks, REI and RE improved isometric handgrip strength ( p <.001) and isokinetic performance ( p =.04). We also did not find differences in the TTV between training groups ( p =.28)., Conclusion: We demonstrated that both REI and RE training induced similar gains in muscle strength. Combining unstable surfaces/instability devices did not hamper TTV, which may have clinical applications in the context of exercise for older adults., Competing Interests: CONFLICT OF INTEREST DISCLOSURES: We have read and understood the Canadian Geriatrics Journal’s policy on conflicts of interest disclosure and declare that we have none., (© 2024 Author(s).)

The effect of electromyographic (EMG) activity on agonist muscles during exercises performed on stable and unstable surfaces remains uncertain. We aimed to review the literature regarding the comparison of the EMG activity of the agonist muscles of exercises performed on stable and unstable surfaces. Eighty-six studies that evaluated the EMG activity of 1783 individuals during exercises for the lower limbs, upper limbs, and core were included. The EMG activities of the pectoralis major (SMD = 0.28 [95% CI 0.09, 0.47]) and triceps brachii muscles (SMD = 0.45 [95% CI 0.25, 0.66]) were significantly increased when the unstable device was added to the exercise. Likewise, the EMG activity of all core muscles showed a significant increase with the unstable surface during the exercises, such as the rectus abdominis (SMD = 0.51 [95% CI 0.37, 0.66]), external oblique (SMD = 0.44 [95% CI 0.28, 0.61]), internal oblique (SMD = 1.04 [95% CI 0.02, 2.07]), erector spinae (SMD = 0.37 [95% CI 0.04, 0.71]), and lumbar multifidus (SMD = 0.35 [95% CI 0.08, 0.61]). However, the lower limb muscles did not show greater EMG activity during the exercise with unstable surfaces compared to the stable surface. In conclusion, unstable conditions increase the EMG activity of some upper limb and core muscles compared to a stable surface.

Background: The minimal important difference is a valuable metric in ascertaining the clinical relevance of a treatment, offering valuable guidance in patient management. There is a lack of available evidence concerning this metric in the context of outcomes related to female urinary incontinence, which might negatively impact clinical decision-making., Objectives: To summarize the minimal important difference of patient-reported outcome measures associated with urinary incontinence, calculated according to both distribution- and anchor-based methods., Methods: This is a systematic review conducted according to the PRISMA guidelines. The search strategy including the main terms for urinary incontinence and minimal important difference were used in five different databases (Medline, Embase, CINAHL, Web of Science, and Scopus) in 09 June 2021 and were updated in January 09, 2024 with no limits for date, language or publication status. Studies that provided minimal important difference (distribution- or anchor-based methods) for patient-reported outcome measures related to female urinary incontinence outcomes were included. The study selection and data extraction were performed independently by two different researchers. Only studies that reported the minimal important difference according to anchor-based methods were assessed by credibility and certainty of the evidence. When possible, absolute minimal important differences were calculated for each study separately according to the mean change of the group of participants that slightly improved., Results: Twelve studies were included. Thirteen questionnaires with their respective minimal important differences reported according to distribution (effect size, standard error of measurement, standardized response mean) and anchor-based methods were found. Most of the measures for anchor methods did not consider the smallest difference identified by the participants to calculate the minimal important difference. All reports related to anchor-based methods presented low credibility and very low certainty of the evidence. We pooled 20 different estimates of minimal important differences using data from primary studies, considering different anchors and questionnaires., Conclusions: There is a high variability around the minimal important difference related to patient-reported outcome measures for urinary incontinence outcomes according to the method of analysis, questionnaires, and anchors used, however, the credibility and certainty of the evidence to support these is still limited., (© 2024. The Author(s).)

Background: Upper extremity Physical Performance Tests (PPTs) have been used in sports contexts to provide functional status of the athletes. However, whether these tests present appropriate measurement properties to be considered a valuable measurement is not clear., Objective: To systematically review the measurement properties of upper extremity PPTs in athletes., Methods: Databases (e.g., Medline, EMBASE, CINAHL, SPORTDiscus, CENTRAL) were searched in March 2021. Two reviewers independently rated the methodological quality using the 4-point Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Quality of evidence was graded by measurement property for each test, considering the adequacy, the sample size, and the methodological quality of the studies., Results: Fifteen studies were included with a pooled sample of 684 athletes. The PPTs analyzed were Arm-Jump Board Test, Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), Finger Hang Test, Medicine Ball Explosive Power Test, One-Arm Hop Test, Posterior Shoulder Endurance Test, Pull-Up Shoulder Endurance Test, Repetition to Failure Assessment, Seated Medicine Ball Throw Test (SMBT), Seated Single-Arm Shot-Put Test (SSPT), Shoulder Endurance Test, Two-Arm Bent Hang Test, Unilateral Seated Shot-Put Test, and Upper Limb Rotation Test. Evidence synthesis provided moderate and high-quality evidence for sufficient inter-session and intra-session reliability of the CKCUEST, respectively. There was moderate evidence for sufficient inter-session reliability of the SSPT and for insufficient validity of the SMBT., Conclusion: The CKCUEST and the SSPT are sufficiently reliable in athletes. More studies are needed to investigate other psychometric properties for these tests and other upper extremity PPTs., Competing Interests: Declaration of Competing Interest The authors have no relevant conflicts of interests to disclose., (Copyright © 2023 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Context: Lower extremity physical performance tests (PPTs) have been widely used in sports rehabilitation and are commonly performed in person. However, some situations may disrupt the in-person health care delivery, such as social distancing due to the pandemic, traveling, and living in remote locations. Those situations may require adjustments in planning and applying measurement tests, and telehealth has become an alternative. Nevertheless, the reliability of lower extremity PPT tests via telehealth is still unknown., Objectives: To verify the test-retest reliability, SEM, and the minimum detectable change (MDC95) of PPTs via telehealth., Methods: Fifty asymptomatic athletes completed 2 assessment sessions 7 to 14 days apart. The assessment via telehealth consisted of warm-up exercises followed by the single-, triple-, and side-hop tests, and the long jump test, in random order. Intraclass correlation coefficient, SEM, and MDC95 were calculated for each PPT., Results: Single-hop test showed good to excellent reliability, with SEM and MDC95 ranging from 6.06 to 9.24 cm and 16.79 to 25.61 cm, respectively. The triple-hop test showed excellent reliability, with SEM and MDC95 ranging from 13.17 to 28.17 cm and 30.72 to 78.07 cm, respectively. Side-hop tests showed moderate reliability, with SEM and MDC95 ranging from 0.67 to 1.22 seconds and 2.00 to 3.39 seconds, respectively. The long jump test showed excellent reliability, with SEM and MDC95 ranging from 5.34 to 8.34 cm and 14.80 to 23.11 cm, respectively., Conclusion: The test-retest reliability of those PPTs via telehealth was acceptable. The SEM and MDC were provided to assist clinicians in interpreting those PPTs.

Context: Physical performance tests (PPTs) and mobility tests have been widely used in sports rehabilitation. However, the feasibility of PPTs and mobility tests via telehealth is unknown., Objectives: To verify the feasibility of PPTs and mobility tests to assess athletes via telehealth., Design: This is a feasibility study., Participants: Athletes enrolled in a sports team or club for at least 2 years and with previous enrollment in a competitive league were recruited through advertisements on social media. The athletes included in this study (mean age = 25.9 y, from different sports) performed a battery of PPTs and mobility tests for the lower-extremity or upper-extremity and trunk, according to their sport modality., Main Outcome Measure: The feasibility was assessed with recruitment, success, and dropout rates. In addition, athletes' perceptions of easiness, satisfaction, and safety during the lower-extremity or upper-extremity and trunk PPTs and mobility tests were assessed., Results: Seventy-three athletes were included, between January and April 2021: 41 were allocated to the lower-extremity and 32 to the upper-extremity and trunk PPTs and mobility test, according to their sports modality. The overall dropout rate was 20.55%; >89% of the athletes agreed that the PPTs and mobility tests via telehealth were easy to perform, >78% were satisfied, and >75% felt safe during the assessments., Conclusion: This study indicated that these 2 batteries of performance and mobility tests via telehealth are feasible to assess the lower and upper-extremities, and the trunk of athletes, considering the adherence, athletes' perception of easiness, satisfaction, and safety.

Background: To interpret changes of muscle strength in older adults with Alzheimer's disease (AD), determining the reliability of outcome measures is necessary. Therefore, the purpose of the present study was to investigate the relative and absolute intra-rater reliability of concentric isokinetic measures of the knee and ankle muscle strength in community-dwelling older adults without and with AD in the mild and moderate stages., Methods: A methodological study was conducted. The participants were submitted to two isokinetic evaluations with an interval of three to seven days. The evaluations consisted of knee extension and flexion at 60°/s (five repetitions) and 180°/s (15 repetitions) and plantar flexion and dorsiflexion of the ankle at 30°/s (five repetitions). The measures of interest were peak torque, average peak torque and total work. The intraclass correlation coefficient two-way mixed model of a single-measure (ICC 3,1 ), standard error of measurement (SEM) and minimal detectable change at the 95% confidence interval (MDC 95 ) were calculated. The ICC 3,1 was interpreted based on Munro's classification. Standard error of measurement and MDC 95 were analyzed in absolute and relative values (percentage of error [SEM%] and change [MDC 95 %])., Results: A total of 62 older adults were included and allocated to the three groups: mild-AD (n = 22, 79.9 years, 15 female and seven male), moderate-AD (n = 20, 81.6 years, 15 female and five male) and without-AD (n = 20, 74.3 years, 10 female and seven male). The ICCs 3,1 of the measures of knee were high/very high in the three groups (0.71-0.98). The ICCs 3,1 of the measures of ankle were high/very high in the mild-AD group (0.78-0.92), moderate/high/very high in the moderate-AD group (0.63-0.93) and high/very high in the group without-AD (0.84-0.97). The measurements of knee extensors at 60°/s, knee extensors (peak torque and total work), with the exception of peak torque in the mild-AD group, and flexors (average peak torque) at 180°/s, and ankle dorsiflexors at 30°/s had the lowest of SEM% and MDC95% in the three groups., Conclusion: Concentric isokinetic measures are reliable for the assessment of knee and ankle muscle strength in community-dwelling older adults without and with AD in the mild and moderate stages., (© 2022. The Author(s).)

Background: The Headache Screening Questionnaire (HSQ) was created and validated to enable health professionals to screen for migraine and tension-type headaches., Objectives: The objective of this study was to translate and cross-culturally adapt the HSQ, creating the Brazilian version of the HSQ (HSQ-BR)., Design: This was a cross-sectional study., Method: The Brazilian version of the HSQ was developed following the processes of translation, synthesis, back-translation, expert committee review, and pre-testing. The translation phase involved two independent translators whose mother language was Brazilian Portuguese and who also were fluent in Dutch. The back-translation phase involved two independent translators whose mother language was Dutch and who also were fluent in Portuguese. The expert committee based their decisions on semantic, idiomatic, experiential, and conceptual equivalences. To verify the comprehension of the questionnaire, 60 subjects (73.3% women) with headaches with a mean age of 32.8 ± 12.0 years, participated in the pre-test phase., Results: During the translation process, some terms and expressions were changed to obtain cultural equivalence to the original HSQ. The process of translation and cross-cultural adaptation of the HSQ to the Brazilian culture and Portuguese language, including its scoring algorithms for migraine and tension-type headache, was successfully concluded, as the comprehension of each item of the questionnaire was over 90% on the pre-test., Conclusion: The HSQ-BR has been created., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objective: The purpose of this study was to evaluate the intra-rater between-days reliability of the joint position sense error (JPSE) test in asymptomatic men and women, as well as in women with neck pain., Methods: Fourteen asymptomatic men and 27 women (14 asymptomatic and 13 with neck pain) participated. The JPSE test was performed during right and left cervical rotation (10 trials for each side) in 2 sessions, with at least 7 days between them. The head repositioning error during the JPSE test (in degrees) was measured and used to calculate the intra-rater between-days reliability of the test, evaluated through the intraclass correlation coefficient and Bland-Altman analyses. Independent t tests were calculated to compare the head repositioning errors of asymptomatic women and men. The minimal detectable change was also calculated., Results: The neck pain group showed higher intraclass correlation coefficient values (0.866 and 0.773, good reliability) compared to the asymptomatic men (0.478 and 0.403, poor reliability) and to the asymptomatic women (-0.161 and 0.504, poor and moderate reliability, respectively) for both right and left cervical rotation, respectively. Considering Bland-Altman analyses, the neck pain group showed better agreement between the measurements for right cervical rotation than the asymptomatic groups., Conclusion: The results indicate that the methodology used to perform the JPSE test in this study may be a reliable way to assess the proprioception of women with neck pain in clinical settings., (Copyright © 2022. Published by Elsevier Inc.)

The aim was to systematically review the effects of gaming on pain-related fear, pain catastrophizing, anxiety, and depression in patients with chronic musculoskeletal pain. Databases (Medline, EMBASE, PsycInfo, CINAHL, Cochrane Central Register for Controlled Trials [CENTRAL], Web of Science, and SCOPUS) were searched from inception up to October 2021. Two reviewers independently selected randomized controlled trials that compared the effects of any gaming modality with other interventions or no treatment on pain-related fear, pain catastrophizing, anxiety, and depression. For data synthesis, Standardized Mean Differences (SMDs) and 95% confidence interval (CI) were calculated using a random-effects inverse variance model for meta-analysis according to the outcome of interest, comparison group, and follow-up period. The level of evidence was synthesized using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Thirteen studies were included with a total sample of 680 patients. Gaming was superior to other treatments and no treatment on reducing pain-related fear (SMD: -1.23; 95% CI: -2.02 to -0.44) and anxiety (SMD: -0.55; 95% CI: -1.01 to -0.09), respectively. Gaming was not superior to other treatments on reducing pain catastrophizing, anxiety, and depression, and it was not superior to no treatment on reducing pain-related fear, pain catastrophizing, and depression. Those findings were based on very low or low-quality evidence. In a conclusion, gaming modalities may have positive effects on some mental health outcomes. However, there were conflicting results with low-quality evidence, which indicates that more high-quality randomized controlled trials are needed.

Purpose: To systematically review the evidence about the effectiveness of manual therapy (MT) on pain intensity, frequency and impact of headache in individuals with tension-type headache (TTH)., Methods: Medline, Embase, Scopus, Web of Science, CENTRAL, and PEDro were searched in June 2020. Randomized controlled trials that applied MT not associated with other interventions for TTH were selected. The level of evidence was synthesized using GRADE, and Standardized Mean Differences (SMD) were calculated for meta-analysis., Results: Fifteen studies were included with a total sample of 1131 individuals. High velocity and low amplitude techniques were not superior to no treatment on reducing pain intensity (SMD = 0.01, low evidence) and frequency (SMD = -0.27, moderate evidence). Soft tissue interventions were superior to no treatment on reducing pain intensity (SMD = -0.86, low evidence) and frequency of pain (SMD = -1.45, low evidence). Dry needling was superior to no treatment on reducing pain intensity (SMD = -5.16, moderate evidence) and frequency (SMD = -2.14, moderate evidence). Soft tissue interventions were not superior to no treatment and other treatments on the impact of headache., Conclusion: Manual therapy may have positive effects on pain intensity and frequency, but more studies are necessary to strengthen the evidence of the effects of manual therapy on subjects with tension-type headache.Implications for rehabilitationSoft tissue interventions and dry needling can be used to improve pain intensity and frequency in patients with tension type headache.High velocity and low amplitude thrust manipulations were not effective for improving pain intensity and frequency in patients with tension type headache.Manual therapy was not effective for improving the impact of headache in patients with tension type headache.

Background: Migraines and tension-type headaches (TTH) are primary headaches that can be screened with the Headache Screening Questionnaire (HSQ). However, the HSQ scoring algorithms rely on manual calculation, which is laborious and carries a risk of human error., Objective: To develop an automated tool to calculate the output of the HSQ scoring algorithm and to determine the agreement between the automated and manual calculation., Design: A cross-sectional design was used., Methods: The automated tool was developed as a Microsoft Excel spreadsheet that was tested with all possible answers for the HSQ. An experienced researcher had access to answers to the HSQ from 163 people with headaches and manually applied the migraine and TTH algorithms to obtain the final scores and classifications. After that, the same answers were uploaded into the spreadsheet and scored by the automated algorithm. The agreement between manual and automated scoring was calculated for the total score using Intraclass Correlation Coefficients (ICC 2,1 ), Standard Error of Measurement (SEM), and Limits of Agreement. The agreement between the classification obtained by the automated tool and the classification obtained by manual calculation for migraine and TTH was calculated using weighted Kappas (k-values)., Results: The total score showed excellent agreement for migraine (ICC = 0.97, 95% CI = 0.96-0.98, SEM = 0.36) and good agreement for TTH (ICC = 0.87, 95% CI = 0.82-0.90, SEM = 0.55). The classification demonstrated excellent agreement for migraine (k-value = 0.93, 95% CI = 0.89-0.97) and for TTH (k-value = 0.78, 95% CI = 0.70-0.86)., Conclusion: Implementation of the automated tool in clinical practice is suggested when using the HSQ to screen patients with primary headaches., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Abstract: The objective of this review was to summarize the concept of clinical significance and associated methods focusing on the area of rehabilitation to provide a resource to rehabilitation researchers and clinicians. Studies were searched on electronic databases from inception until July 28, 2020, with no date or language limits. Manual searches as well as Scopus forward citation for relevant references were performed. Narrative synthesis of study results was performed. Definitions of the concepts related to clinical significance, ways of calculating, and interpreting each method were provided using rehabilitation examples. An explanation of methods to evaluate clinical significance (distribution, anchor, and opinion-based methods) and their advantages and disadvantages were also provided. Considering the limitations of statistical significance in assuring meaningfulness of results, clinical interpretation of research outcomes and the report of clinical significance in intervention trials should be a priority in rehabilitation research. When possible, the use of multiple methods (distribution, anchor, and opinion based) is recommended. Thus, clinical researchers are encouraged to present results in a manner that allow the rehabilitation professionals to easily interpret and implement those results in their clinical practice., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To systematically review the effectiveness of electromyographic biofeedback interventions to improve pain and function of patients with shoulder pain., Design: Systematic review of controlled clinical trials., Literature Search: Databases (Medline, EMBASE, CINAHL, PEDro, CENTRAL, Web of Science, and SCOPUS) were searched in December 2020., Study Selection Criteria: Randomized clinical trials that investigated the effects of electromyographic biofeedback for individuals with shoulder pain. Patient-reported pain and functional outcomes were collected and synthesized., Data Synthesis: The level of evidence was synthesized using GRADE and Standardized Mean Differences and 95% confidence interval were calculated using a random-effects inverse variance model for meta-analysis., Results: Five studies were included with a total sample of 272 individuals with shoulder pain. Very-low quality of evidence indicated that electromyographic biofeedback was not superior to control for reducing shoulder pain (standardized mean differences = -0.21, 95% confidence interval: -0.67 to 0.24, P  = 0.36). Very-low quality of evidence indicated that electromyographic biofeedback interventions were not superior to control for improving shoulder function (standardized mean differences = -0.11, 95% confidence interval: -0.41 to 0.19, P  = 0.48)., Conclusion: Electromyographic biofeedback may be not effective for improving shoulder pain and function. However, the limited number of included studies and very low quality of evidence does not support a definitive recommendation about the effectiveness of electromyographic biofeedback to treat individuals with shoulder pain.

Objective: To systematically review the effectiveness of manual therapy on fear-avoidance, kinesiophobia, and pain catastrophizing in patients with chronic musculoskeletal pain., Literature Search: Databases (Medline, EMBASE, CINAHL, PEDro, CENTRAL, Web of Science, and SCOPUS) were searched from inception up to March 2020., Study Selection Criteria: Two reviewers independently selected randomized controlled trials that investigated the effects of manual therapy associated or not with other interventions on fear-avoidance, kinesiophobia and pain catastrophizing in patients with chronic musculoskeletal pain., Data Synthesis: Standardized Mean Differences (SMD) and 95% confidence interval (CI) were calculated using a random-effects inverse variance model for meta-analysis according to the outcome of interest, comparison group and follow-up period. The level of evidence was synthesized using GRADE., Results: Eleven studies were included with a total sample of 717 individuals. Manual therapy was not superior to no treatment on reducing fear-avoidance at short-term (low quality of evidence; SMD = -0.45, 95% CI -0.99 to 0.09), and intermediate-term (low quality of evidence; SMD = -0.48, 95% CI -1.0 to 0.04). Based on very-low quality of evidence, manual therapy was not better than other treatments (SMD = 0.10, 95% CI -0.56 to 0.77) on reducing fear-avoidance, kinesiophobia (SMD = -0.12, 95% CI -0.87 to 0.63) and pain catastrophizing (SMD = -0.16, 95% CI -0.48 to 0.17) at short-term., Conclusion: Manual therapy may not be superior to no treatment or other treatments on improving fear-avoidance, kinesiophobia and pain catastrophizing, based on very low or low quality of evidence. More studies are necessary to strengthen the evidence of effects of manual therapy on pain-related fear outcomes., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objectives: The Bournemouth Questionnaire is a comprehensive and short form multidimensional instrument developed to evaluate the health status of individuals with low back pain. The objective of this study was to verify the construct validity and the test-retest reliability of the Brazilian version of Bournemouth Questionnaire in individuals with low back pain., Methods: This is a methodological study that included 65 patients with low back pain. The Brazilian Bournemouth Questionnaire was applied twice, and the test-retest reliability was assessed using intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimum detectable change (MDC), and internal consistency. The construct validity of the Brazilian Bournemouth Questionnaire was assessed using the numeric pain rating scale (NPRS) and also with the following questionnaires: Roland-Morris Questionnaire (RMDQ), Oswestry Disability Index (ODI), and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36)., Results: The total score of the Brazilian Bournemouth Questionnaire showed ICC of 0.82 (95% CI: 0.72, 0.90), Cronbach´s alpha of 0.85, SEM of 5.97, and MDC of 15.54, without evidence of ceiling and floor effects. The total score of the Brazilian Bournemouth Questionnaire was correlated to the NPRS for current (r = 0.64), highest (r = 0.49), and lowest (r = 0.67) pain as well as scores on the RMDQ (r = 0.58), ODI (r = 0.42), and SF-36 (r = -0.58)., Conclusion: The total score of the Brazilian version of the Bournemouth Questionnaire is valid and reliable to be used with patients with low back pain., (Copyright © 2020 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Physical therapy is regarded an effective treatment for temporomandibular disorders (TMD). Patients with TMD often report concomitant headache. There is, however, no overview of the effect of physical therapy for TMD on concomitant headache complaints., Objectives: The aim of this study is to systematically evaluate the literature on the effectiveness of physical therapy on concomitant headache pain intensity in patients with TMD., Data Sources: PubMed, Cochrane and PEDro were searched., Study Eligibility Criteria: Randomized or controlled clinical trials studying physical therapy interventions were included., Participants: Patients with TMD and headache., Appraisal: The Cochrane risk of bias tool was used to assess risk of bias., Synthesis Methods: Individual and pooled between-group effect sizes were calculated according to the standardized mean difference (SMD) and the quality of the evidence was rated using the GRADE approach., Results: and manual therapy on both orofacial region and cervical spine. There is a very low level of certainty that TMD-treatment is effective on headache pain intensity, downgraded by high risk of bias, inconsistency and imprecision., Limitations: The methodological quality of most included articles was poor, and the interventions included were very different., Conclusions: Physical therapy interventions presented small effect on reducing headache pain intensity on subjects with TMD, with low level of certainty. More studies of higher methodological quality are needed so better conclusions could be taken., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: There are insufficient studies providing Minimal Clinically Important Difference (MCID) for outcomes related to temporomandibular disorders (TMD)., Objectives: (1) To provide the MCID of outcomes related to TMD using the Global Rating of Change Scale (GRCS) as an anchor. (2) To verify which outcomes can predict a moderate or large response to the treatment., Study Design: Secondary analysis of a randomized controlled trial in subjects with TMD., Methods: Sixty-one women with TMD were divided into intervention and control groups. Visual Analogue Scale (VAS), Headache Impact Test (HIT-6), pressure pain thresholds (PPTs) of masticatory muscles, Mandibular Function Impairment Questionnaire (MFIQ), and Craniocervical Flexion Test (CCFT) were collected at baseline and 5-weeks follow-up., Results: Participants were divided based on their response to the treatment, according to the GRCS. MCID values were provided for subjects that moderately or largely improved to the treatment. MCID was between 0 and 1.90 for orofacial pain, around 2 points for the MFIQ, between 3 and 6.26 points for the HIT-6, around 0.2 kg/cm2 for the PPTs on masticatory muscles, around 2.5 mm for MMO and between 60 and 68 points for CCFT. Orofacial pain and HIT-6 were the most discriminative variables at determining whether patients would largely/moderately improve or would not improve after treatment., Conclusions: The values of MCID could be used as guidance for both clinical practice and research. Pain intensity and headache impact were the most predictive outcomes for improvement of the general health status of women with TMD., Competing Interests: Declaration of competing interest There is no conflict of interest to me declared., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: The Bournemouth questionnaire is a multidimensional instrument for evaluating health domains among patients with low back pain., Objective: The objective of this study was to translate and cross-culturally adapt the Bournemouth questionnaire for individuals with low back pain, to Brazilian Portuguese., Design and Settings: This was a cross-sectional study conducted at the Federal University of São Carlos., Methods: The Brazilian version of the Bournemouth questionnaire was developed following the processes of translation, back-translation, committee review and pre-testing. The translation phase involved two independent bilingual translators whose mother language was Brazilian Portuguese. The back-translation phase involved two independent translators whose mother language was English. In order to verify comprehension of the questionnaire, 44 individuals (43.1% men) with low back pain, and with mean age of 45.4 ± 13.8 years, participated in the pre-testing phase., Results: During the translation phase, some terms and expressions were changed to obtain cultural equivalence to the original Bournemouth questionnaire. In the pre-testing phase, each item of the questionnaire showed a comprehension level of over 90%., Conclusion: The Bournemouth questionnaire was translated and culturally adapted to the Portuguese language, to be used among individuals with low back pain.

Background: Studies exploring interventions targeting the cervical spine to improve symptoms in patients with temporomandibular disorders (TMD) are limited., Objectives: To determine whether mobilisation of the upper cervical region and craniocervical flexor training decreased orofacial pain, increased mandibular function and pressure pain thresholds (PPTs) of the masticatory muscles and decreased headache impact in women with TMD when compared to no intervention., Methods: In a single-blind randomised controlled trial, 61 women with TMD were randomised into an intervention group (IG) and a control group (CG). The IG received upper cervical mobilisations and neck motor control and stabilisation exercises for 5 weeks. The CG received no treatment. Outcomes were collected by a blind rater at baseline and 5-week follow-up. Orofacial pain intensity was collected once a week. A mixed ANOVA and Cohen's d were used to determine differences within/between groups and effect sizes., Results: Pain intensity showed significant time-by-group interaction (P < 0.05), with significant between-group differences at four and five weeks (P < 0.05), with large effect sizes (d > 0.8). The decrease in orofacial pain over time was clinically relevant only in the IG. Change in headache impact was significantly different between groups, and the IG showed a clinically relevant decrease after the treatment. No effects were found for PPT or mandibular function., Conclusion: Women with TMD reported a significant decrease in orofacial pain and headache impact after 5 weeks of treatment aimed at the upper cervical spine compared to a CG., (© 2018 John Wiley & Sons Ltd.)

Objective: To determine the reliability, measurement error, and construct validity of the Side Hop Test in male children and adolescents., Design: Intra-and inter-rater reliability and construct validity study., Settings: Soccer club., Participants: Thirty-six asymptomatic boys, 10-16 years old., Main Outcome: The intra and inter-rater reliability of the Side Hop Test were analyzed by Intraclass Correlation Coefficient (ICC), Standard Error of Measurement (SEM), and Minimum Detectable Change (MDC). The construct validity of the Side Hop Test in reference to the Single Hop Test, the Standing Long Jump Test, the Shuttle Run, and isometric muscle strength was analyzed., Results: The intra-rater ICC of the Side Hop Test ranged from 0.63 to 0.67, SEM ranged from 1.2 to 2.5 s, and MDC ranged from 2.8 to 5.7 s. The inter-rater ICC ranged from 0.83 to 0.91, SEM ranged from 0.6 to 0.8 s, and MDC ranged from 1.4 to 1.9 s. The Side Hop Test was significantly correlated (p < 0.05) with the Single Hop Test (r = -0.49) and the Standing Long Jump (r = -0.47)., Conclusion: The results support the use of the Side Hop Test to evaluate children and adolescents. The measurements showed good intra-rater and very good inter-rater reliability., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Previous studies evaluated 3D human jaw movements using kinematic analysis systems during mouth opening, but information on the reliability of such measurements is still scarce. The purpose of this study was to analyze within- and between-session reliabilities, inter-rater reliability, standard error of measurement (SEM), minimum detectable change (MDC) and consistency of agreement across raters and sessions of 3D kinematic variables during maximum mouth opening (MMO). Thirty-six asymptomatic subjects from both genders were evaluated on two different days, five to seven days apart. Subjects performed three MMO movements while kinematic data were collected. Intraclass correlation coefficient (ICC), SEM and MDC were calculated for all variables, and Bland-Altman plots were constructed. Jaw radius and width were the most reproducible variables (ICC>0.81) and demonstrated minor error. Incisor displacement during MMO and angular movements in the sagittal plane presented good reliability (ICC from 0.61 to 0.8) and small errors and, consequently, could be used in future studies with the same methodology and population. The variables with smaller amplitudes (condylar translations during mouth opening and closing and mandibular movements on the frontal and transversal planes) were less reliable (ICC<0.61) and presented larger SEM and MDC. Although ICC, SEM and MDC showed less between-session reproducibility than within-session and inter-rater, the limits of agreement were larger in inter-rater comparisons. In future studies care must be taken with variables collected on different days and with mandibular movements in the frontal and transversal planes., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: To investigate the effect of a rehabilitation program based on cervical mobilization and exercise on clinical signs and mandibular function in subjects with temporomandibular disorder (TMD)., Material and Methods: Single-group pre-post test, with baseline comparison., Subjects: Twelve women (22.08±2.23 years) with myofascial pain and mixed TMD according to the Research Diagnostic Criteria for Temporomandibular Disorders., Outcome Measures: Subjects were evaluated three times: twice before (baseline phase) and once after intervention. Self-reported pain, jaw function [according to the Mandibular Functional Impairment Questionnaire (MFIQ)], pain-free maximum mouth opening (MMO), and pressure pain thresholds (PPTs) of both masseter and temporalis muscles were obtained. Baseline and post-intervention differences were investigated, and effect size was estimated through Cohen's d coefficient., Results: Jaw function improved 7 points on the scale after the intervention (P=0.019), and self-reported pain was significantly reduced (P=0.009). Pain-free MMO varied from 32.3±8.8 mm to 38±8.8 mm and showed significant improvement (P=0.017) with moderate effect size when compared to the baseline phase. PPT also increased with moderate effect size, and subjects had the baseline values changed from 1.23±0.2 kg/cm2 to 1.4±0.2 kg/cm2 in the left masseter (P=0.03), from 1.31±0.28 kg/cm2 to 1.51±0.2 kg/cm2 in the right masseter (P>0.05), from 1.32±0.2 kg/cm2 to 1.46±0.2 kg/cm2 in the left temporalis (P=0.047), and from 1.4±0.2 kg/cm2 to 1.67±0.3 kg/cm2 in the right temporalis (P=0.06)., Conclusions: The protocol caused significant changes in pain-free MMO, self-reported pain, and functionality of the stomatognathic system in subjects with myofascial TMD, regardless of joint involvement. Even though these differences are statistically significant, their clinical relevance is still questionable.

There is a lack of knowledge about the effectiveness of manual therapy (MT) on subjects with temporomandibular disorders (TMD). The aim of this systematic review is to synthetise evidence regarding the isolated effect of MT in improving maximum mouth opening (MMO) and pain in subjects with signs and symptoms of TMD. MEDLINE(®) , Cochrane, Web of Science, SciELO and EMBASE(™) electronic databases were consulted, searching for randomised controlled trials applying MT for TMD compared to other intervention, no intervention or placebo. Two authors independently extracted data, PEDro scale was used to assess risk of bias, and GRADE (Grading of Recommendations Assessment, Development and Evaluation) was applied to synthetise overall quality of the body of evidence. Treatment effect size was calculated for pain, MMO and pressure pain threshold (PPT). Eight trials were included, seven of high methodological quality. Myofascial release and massage techniques applied on the masticatory muscles are more effective than control (low to moderate evidence) but as effective as toxin botulinum injections (moderate evidence). Upper cervical spine thrust manipulation or mobilisation techniques are more effective than control (low to high evidence), while thoracic manipulations are not. There is moderate-to-high evidence that MT techniques protocols are effective. The methodological heterogeneity across trials protocols frequently contributed to decrease quality of evidence. In conclusion, there is widely varying evidence that MT improves pain, MMO and PPT in subjects with TMD signs and symptoms, depending on the technique. Further studies should consider using standardised evaluations and better study designs to strengthen clinical relevance., (© 2015 John Wiley & Sons Ltd.)

Objective: Considering the high incidence of Temporomandibular Disorders (TMD) in the population aged 15-30 years and the fact that students are exposed to stressful psychosocial factors, the purposes of this study were: to verify clinical symptoms and jaw functionality in college students with TMD according to the anxiety/depression (A/D) level and to evaluate the correlation between A/D and functionality, maximum mouth opening (MMO) and pain and muscle activity., Material and Methods: Nineteen students with TMD diagnosed according to the Research Diagnostic Criteria for Temporomandibular Disorders underwent two assessments during an academic semester. The evaluations were based on questionnaires (MFIQ - Mandibular Function Impairment Questionnaire; HADS - Hospital Anxiety and Depression Scale), clinical measurements (MMO without pain, MMO and assisted MMO; palpation of joint and masticatory muscles), and electromyography. The HADS scores obtained in the two assessments were used to classify all data as either "high" or "low" A/D. Data normality, differences and correlations were tested with the Shapiro-Wilk test, Student's t-test (or the Wilcoxon test), and Spearman test, respectively. The alpha level was set at 0.05., Results: None of the clinical variables were significantly different when comparing low and high A/D data. In low A/D there was a significant correlation between HADS score and: MFIQ (P=0.005, r=0.61), and MMO without pain (P=0.01, r=-0.55)., Conclusions: Variation in A/D level did not change clinical symptoms or jaw functionality in college students with TMD. Apparently, there is a correlation between TMJ functionality and A/D level, which should be further investigated, taking into account the source of the TMD and including subjects with greater functional limitation.