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Although creatine supplementation is well-known to increase exercise performance in acute high-intensity exercises, its role in aerobic performance based on VO2max is more controversial. Thus, we performed a systematic review and meta-analysis on the effects of creatine supplementation on VO2max. PubMed, Cochrane, Embase, and ScienceDirect were searched for randomized controlled trials (RCTs) reporting VO2max in creatine supplementation and placebo groups before and after supplementation. We computed a random-effects meta-analysis on VO2max at baseline, within groups following supplementation, on changes on VO2max between groups, and after supplementation between groups. Sensitivity analyses and meta-regression were conducted. We included 19 RCTs for a total of 424 individuals (mean age 30 years old, 82% men). VO2max did not differ at baseline between groups (creatine and placebo). Participants in both groups were engaged in exercise interventions in most studies (80%). Using changes in VO2max, VO2max increased in both groups but increased less after creatine supplementation than placebo (effect size [ES] = −0.32, 95%CI = −0.51 to −0.12, p = 0.002). Comparisons after creatine supplementation confirmed a lower VO2max in the creatine group compared to the placebo group (ES= −0.20, 95%CI = −0.39 to −0.001, p = 0.049). Meta-analysis after exclusion from meta-funnel resulted in similar outcomes in a subgroup of young and healthy participants. Meta-regressions on characteristics of supplementation, physical training, or sociodemographic were not statistically significant. Creatine supplementation has a negative effect on VO2max, regardless of the characteristics of training, supplementation, or population characteristics. Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2021.2008864. [ABSTRACT FROM AUTHOR]

• Upper-extremity musculoskeletal disorders are a prevalent public health issue. • A short spa therapy intervention did not improve function more than self-management. • Adherence to home exercise was greater for self-management than spa therapy. • Self-management interventions may reduce disability and pain. Musculoskeletal disorders (MSDs) are common in the workplace and are a public health issue. Persistent pain despite conservative treatment or surgery may lead to poor long-term outcomes. To compare the effect of a combined 6-day program of exercise, self-management workshops and spa therapy with self-management on functional capacity in personal and professional daily life at 3 months in people with musculoskeletal disorders. We conducted a prospective, randomized controlled trial. Participants were employed (any type of work) and aged between 18 and 65 years, with latent or symptomatic upper extremity MSDs, with or without a history of sick leave. They were randomized to participate in 6 days (2 h per day) of spa therapy, exercise, and self-management workshops immediately (intervention) or at 3 months (control). The control group performed self-management until 3 months. The primary outcome was the score on the self-reported Quick Disability of Arm-Shoulder-Hand (QuickDASH) at 3 months. The primary analysis was conducted using analysis of covariance with baseline QuickDASH score as the covariate. In total, 150 participants were randomized (85 % women): 78 to the control group and 72 to the intervention group. At 3 months, the QuickDASH total and work scores did not differ between groups (effect-size [ES] = -0.15, 95 %CI, -0.38 to 0.09, p = 0.215, and ES = -0.11, 95 % CI, -0.35 to 0.12, p = 0.343). However, QuickDASH sport/performing arts score was significantly different between randomization groups at 3 months (ES =-0.25, 95 % CI, -0.48 to -0.02, p = 0.035). This study provided no evidence in favor of a short-course, personalized self-management, intensive spa therapy intervention over self-management alone for the management of upper-extremity MSDs. Trial registration: ClinicalTrials.gov (NCT02702466) retrospectively registered. [ABSTRACT FROM AUTHOR]

Purpose: This study determined the impact of menstrual status on bone tissue in elite post-pubertal female soccer players over an entire season. Methods: Fifty-one elite female soccer players participated. At baseline, forty-one were assigned to the low hormonal androgenic profile (low-HAPL) and 10 to the high hormonal androgenic profile (high-HAPL). Results: An 8-month training program led to increased bone mineral density content (p<0.05). The low-HAPL athletes improved the Narrow neck average cortical thickness (ACT) by 1.4% and reduced the corresponding Buckling ratio (BR) by 2.6%, thus decreasing the fracture risk (p<0.05). The high-HAPL athletes decreased the Narrow neck ACT by 5.4% and increased the BR by 2.6%, increasing fracture risk (p<0.05). Differences were assigned as being "very likely beneficial" for the low-HAPL athletes, supported by very large (d=3.41) and large (d=1.58) effect sizes for the Narrow neck ACT and BR, respectively. Conclusion: A season of soccer training has induced bone geometry improvements in adolescent females. Bone health parameters improved in the two clusters. However, high-HAPL athletes decreased its resistance to loading compare to low-HAPL athletes. Even if female players do not present clinical symptoms related to their hormonal status, sport medicine physicians should pay attention to their structural bone fragility. [ABSTRACT FROM AUTHOR]

Background: Whiplash-associated disorders have been the subject of much attention in the scientific literature and remain a major public health problem. Objective: Measure the impact of a validated information booklet on the fear-avoidance beliefs of emergency physicians and their approach to management regarding the treatment of whiplash-associated disorders. Methods: A prospective cluster randomized controlled study conducted with a sample of emergency medicine physicians. Fear-avoidance beliefs were measured using The Whiplash Belief Questionnaire (WBQ) and Fear-Avoidance Beliefs Questionnaire (FABQ). We assessed the approach to management based on the prescription of pharmacological and non-pharmacological treatments based on the advice given to patients. The validated information booklet was the French version of The Whiplash Book. A set of questionnaires was sent to participants pre- and post-intervention. The experimental intervention was the provision of The Whiplash Book. The control arm did not receive any training or information. Results: Mean fears and beliefs scores on inclusion were high: WBQ = 19.09 (± 4.06); physical activity FABQ = 11.45 (± 4.73); work FABQ = 13.85 (± 6.70). Improvement in fear-avoidance beliefs scores being greater in the intervention group was further confirmed by the variation in WBQ (-20 [-32; -6] vs. -6 [-16; 9]; p = 0.06), physical activity FABQ (-70 [-86; -50] vs. -15 [-40; 11]; p < 0.001), and work FABQ (-40 [-71; 0] vs. 0 [-31; 50]; p = 0.02). The emergency physicians' initial approach to management was not consistent with current guidelines. Reading the French version of The Whiplash Book could contribute to changing their approach to management in several areas on intra-group analysis. Conclusion: The French version of The Whiplash Book positively influenced fear-avoidance beliefs among emergency physicians. [ABSTRACT FROM AUTHOR]

Background: According to the fear avoidance model, beliefs and thoughts can modify the outcome of patient with low back pain. The Back Belief Questionnaire (BBQ)–a 14 items scale–assesses these consequences of low back pain. Objective: To test the psychometric properties of the French version of the BBQ. Methods: The BBQ was translated using the forward–backward translation process. Throughout three repeated evaluation time points (D1, D7 and D30), various aspects of validity were analysed: acceptability, quality of items, unidimentionality, internal consistency, temporal stability (between D1 and D7), responsiveness (between D7 and D30), and construct validity comparing it to other validated scales. Results: One hundred and thirty-one patients were enrolled and 128 were analyzed. The acceptability and the quality of the items were excellent. The scale was unidimensional and reliable (internal consistency: Cronbach’s α = 0.8). The responsiveness was moderate but in line with other scores. The BBQ was, as expected, convergent with day-to-day activities and fear avoidance (FABQ and Tampa), disability (Quebec and Dallas scores), or anxiety and depression (HAD); and not correlated with pain. Best correlations were found with Tampa and FABQ. The temporal stability (test-retest reliability) was poor. However, similar changes were observed in near conceptual score (FABQ), which confirmed that clinical status may have not been stable and suggesting sensitivity to early changes for BBQ. Conclusions: The BBQ showed good psychometric properties to assess false beliefs and related fear in French or English LBP populations and can be used either for evaluation in international trials or as a part of self-care training. [ABSTRACT FROM AUTHOR]

Background: Creatine is the most widely used supplementation to increase performance in strength; however, the most recent meta-analysis focused specifically on supplementation responses in muscles of the lower limbs without regard to upper limbs. Objective: We aimed to systematically review the effect of creatine supplementation on upper limb strength performance. Methods: We conducted a systematic review and meta-analyses of all randomized controlled trials comparing creatine supplementation with a placebo, with strength performance measured in exercises shorter than 3 min in duration. The search strategy used the keywords 'creatine', 'supplementation', and 'performance'. Independent variables were age, sex and level of physical activity at baseline, while dependent variables were creatine loading, total dose, duration, time interval between baseline (T0) and the end of the supplementation (T1), and any training during supplementation. We conducted three meta-analyses: at T0 and T1, and on changes between T0 and T1. Each meta-analysis was stratified within upper limb muscle groups. Results: We included 53 studies (563 individuals in the creatine supplementation group and 575 controls). Results did not differ at T0, while, at T1, the effect size (ES) for bench press and chest press were 0.265 (95 % CI 0.132-0.398; p < 0.001) and 0.677 (95 % CI 0.149-1.206; p = 0.012), respectively. Overall, pectoral ES was 0.289 (95 % CI 0.160-0.419; p = 0.000), and global upper limb ES was 0.317 (95 % CI 0.185-0.449; p < 0.001). Meta-analysis of changes between T0 and T1 gave similar results. The meta-regression showed no link with characteristics of population or supplementation, demonstrating the efficacy of creatine independently of all listed conditions. Conclusion: Creatine supplementation is effective in upper limb strength performance for exercise with a duration of less than 3 min, independent of population characteristics, training protocols, and supplementary doses or duration. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal disorders (MSDs) constitute a major occupational health problem in the working population, substantially impacting the quality of life of employees. They also cause considerable economic cost to the healthcare system, with, notably, the reimbursement of treatments and compensation for lost income. MSDs manifest as localized pain or functional difficulty in one or more anatomical areas, such as the cervical spine, shoulder, elbow, hand, and wrist. Although prevalence varies depending on the region considered and the method of assessment, a prevalence of 30% is found in different epidemiological studies. The disease needs to be prevented, not only for medical and economic reasons, but also for legal reasons, owing to the requirement of assessing occupational risks. The strategy envisaged may thus revolve around active, multimodal prevention that has employees fully involved at the heart of their care. Although physical exercise is widely recommended, few studies with a good level of evidence have enabled us to base a complete, well-constructed intervention on exercise that can be offered as secondary prevention in these disorders. Methods: A prospective, multicenter, comparative (intervention arm vs. control arm), randomized (immediate vs. later treatment) study using Zelen's design. This study falls under active prevention of MSDs of the upper extremities (UE-MSDs). Participants are workers aged between 18 and 65 years with latent or symptomatic MSDS, with any type of job or workstation, with or without an history of sick leave. The primary aim is to show the superiority at 3 months of a combination of spa therapy, exercise, and self-management workshops for 6 days over usual care in the management of MSDs in terms of employee functional capacity in personal and professional daily life. Secondary aims are to assess the benefit of the intervention in terms of pain, quality of life, and accumulated duration of sick leave. Discussion: This randomized controlled trial is the first that will aim to evaluate multidisciplinary management of UE-MSDs using nonpharmacological treatment combining exercise, self-management, and spa therapy. The originality of this intervention lies, in its short, intensive format, which is compatible with remaining in work; and in its multidisciplinary approach. This trial has the potential to demonstrate, with a good level of evidence, the benefits of a short course of spa therapy combined with a personalized self-management program on the functional capacity, pain, and quality of life of employees in their daily life. [ABSTRACT FROM AUTHOR]

Aims/hypothesis: To describe barriers to physical activity (PA) in type 2 diabetes patients and their general practitioners (GPs), looking for practitioner’s influence on PA practice of their patients. Methods: We conducted a cross-sectional study on GPs (n = 48) and their type 2 diabetes patients (n = 369) measuring respectively barriers to prescribe and practice PA using a self-assessment questionnaire: barriers to physical activity in diabetes (BAPAD). Statistical analysis was performed accounting hierarchical data structure. Similar practitioner’s patients were considered a cluster sharing common patterns. Results: The higher the patient’s BAPAD score, the higher the barriers to PA, the higher the risk to declare practicing no PA (p<0.001), low frequency and low duration of PA (p<0.001). A high patient’s BAPAD score was also associated with a higher risk to have HbA1c ≥7% (53 mmol/mol) (p = 0.001). The intra-class correlation coefficient between type 2 diabetes patients and GPs was 34%, indicating a high cluster effect. A high GP’s BAPAD score, regarding the PA prescription, is predictive of a high BAPAD score with their patients, regarding their practice (p = 0.03). Conclusion/interpretation: Type 2 diabetes patients with lower BAPAD score, thus lower barriers to physical activity, have a higher PA level and a better glycemic control. An important and deleterious cluster effect between GPs and their patients is demonstrated: the higher the GP’s BAPAD score, the higher the type 2 diabetes patients’ BAPAD score. This important cluster effect might designate GPs as a relevant lever for future interventions regarding patient’s education towards PA and type 2 diabetes management. [ABSTRACT FROM AUTHOR]

Background: Creatine is the most widely used supplementation to increase strength performance. However, the few meta-analyses are more than 10 years old and suffer from inclusion bias such as the absence of randomization and placebo, the diversity of the inclusion criteria (aerobic/endurance, anaerobic/strength), no evaluation on specific muscles or group of muscles, and the considerable amount of conflicting results within the last decade. Objective: The objective of this systematic review was to evaluate meta-analyzed effects of creatine supplementation on lower limb strength performance. Methods: We conducted a systematic review and meta-analyses of all randomized controlled trials comparing creatine supplementation with a placebo, with strength performance of the lower limbs measured in exercises lasting less than 3 min. The search strategy used the keywords 'creatine supplementation' and 'performance'. Dependent variables were creatine loading, total dose, duration, the time-intervals between baseline (T0) and the end of the supplementation (T1), as well as any training during supplementation. Independent variables were age, sex, and level of physical activity at baseline. We conducted meta-analyses at T1, and on changes between T0 and T1. Each meta-analysis was stratified within lower limb muscle groups and exercise tests. Results: We included 60 studies (646 individuals in the creatine supplementation group and 651 controls). At T1, the effect size (ES) among stratification for squat and leg press were, respectively, 0.336 (95 % CI 0.047-0.625, p = 0.023) and 0.297 (95 % CI 0.098-0.496, p = 0.003). Overall quadriceps ES was 0.266 (95 % CI 0.150-0.381, p < 0.001). Global lower limb ES was 0.235 (95 % CI 0.125-0.346, p < 0.001). Meta-analysis on changes between T0 and T1 gave similar results. The meta-regression showed no links with characteristics of population or of supplementation, demonstrating the creatine efficacy effects, independent of all listed conditions. Conclusion: Creatine supplementation is effective in lower limb strength performance for exercise with a duration of less than 3 min, independent of population characteristic, training protocols, and supplementary doses and duration. [ABSTRACT FROM AUTHOR]

• Clinical practice guidelines for non-specific low back pain do not recommend the use of non-rigid lumbar supports despite several positive randomized controlled studies. • Non-rigid lumbar supports showed greater improvements in function and pain than the comparator. • Insufficient data prevented a comparison of the efficiency for acute, subacute and recurrent low back pain and meta-regression of responder phenotypes. • Further studies are needed to assess which patients can benefit the most from non-rigid lumbar supports based on patient phenotype and characteristics of low back pain. Clinical practice guidelines for non-specific low back pain do not recommend the use of non-rigid lumbar supports (NRLSs) despite the publication of several positive randomized controlled studies. We conducted a systematic review with meta-analysis to assess the efficacy of NRLSs in the treatment and prevention of non-specific low back pain. We searched for reports of randomized controlled trials in PubMed, Cochrane Library, EMBASE, Science Direct and Pedro databases. Data were analyzed by disease stage (acute, subacute, and chronic) and type of prevention (primary and secondary). The analysis of methodological quality involved the Physiotherapy Evidence Database (PEDro) scale. Of the 1581 records retrieved, only 4 full-text articles were included, with 777 patients: 378 in the NRLS group, and 348 in the control group. NRLSs conferred greater amelioration of disability (effect size −0.54, 95% CI −0.90; −0.17) and pain (−0.29, −0.46; −0.12) than standard management. Insufficient data prevented a comparison of the efficiency for acute, subacute and recurrent low back pain as well as meta-regression of responder phenotypes (sociodemographic and other patient characteristics). We demonstrated the overall efficacy of NRLSs for both disability and pain. However, further studies are needed to assess which patients can benefit the most from lumbar supports based on patient phenotype and the characteristics of low back pain. PROSPERO (CRD42018109855). [ABSTRACT FROM AUTHOR]

Objectives: To show the superiority of eccentric versus concentric strengthening in terms of improving quadriceps strength in knee osteoarthritis (OA), a randomized controlled study was conducted to perform 12 sessions of either eccentric or concentric isokinetic muscle strengthening over 6 weeks. Methods: We recruited males and females, aged between 40 and 70 years, with predominantly unilateral femorotibial OA. Exclusion criteria were having a prosthesis, inflammatory arthritis or flare-up of OA, symptomatic patellofemoral OA, cardiovascular or pulmonary disease that could be a contraindication to the study treatment, and any pathology that could cause muscle weakness. The primary endpoint was the between-group difference in change in maximum concentric isokinetic knee extension peak torque (PT) at 60°/s on the OA side at 6 weeks. Secondary endpoints were between-group difference in change in concentric hamstring PT at 60°/s; eccentric quadriceps and hamstring PT at 30°/s; 10 m and 200 m walking speeds; pain and functional status (WOMAC score) at 6 weeks and 6 months. Results: The sample consisted of 11 females and 27 males, with a mean age of 57.7 ± 7.52 years and a body mass index (BMI) of 25.95 ± 3.93 kg/m2. Quadriceps strength increased more at 6 weeks in the concentric than the eccentric group with no statistical difference. There was a rate of 25% major adverse events in the eccentric group. Conclusions: Eccentric training resulted in a smaller improvement in quadriceps strength than concentric training and was associated with a high risk of muscle injury, particularly to the hamstring muscles. [ABSTRACT FROM AUTHOR]

Objective French validation of two different (10 and 19 items) Return To Work Self-Efficacy Scale (RTWSE). RTWSE are self-questionnaires designed to evaluate workers’ beliefs with chronic low back pain of their current ability to return to work according to 4 domains: relations with supervisor and co-workers, pain management, and activity restriction. Material/patients and methods The first step consisted of translation/back translation and cultural adaptation according to the validated methodology. The second stage was a prospective validation on 60 patients with chronic low back pain who filled out the 2 RTWSE scales (10 and 19 items). The following data were collected: pain, job's stress and satisfaction (Visual Analog Scale) and Disability (Quebec), physical activity (IPAQ) and the levels of anxiety and depression (HAD). A test/retest procedure was performed 3 and 21 days later. The statistical analyses focused on acceptability, internal consistency (Cronbach's alpha and Principal Component Analysis), test-retest reproducibility (concordance coefficients), external validity (correlation coefficients), correlation between the two scales (Spearman's correlation). Results The RTWSE scale is a culturally acceptable version for French patients with chronic low back pain. The Cronbach's alpha was 0.89 for the 10-item scale and 0.90 for the 19-item scale. Reproductibility was correct (concordance coefficients: 0.92 for 10-item scale and 0.86 for 19-item scale). External validity and responsiveness to change were good. Correlation between the 10-item scale and the 19-item scale was correct (Spearman's correlation: 0.69). Discussion – conclusion The use of a rigorous methodology allowed the validation of the RTWSE scale in the French language. This tool can be used in routine practice and clinical research for evaluating the return to work within a chronic low back pain population. [ABSTRACT FROM AUTHOR]

Objective We aimed to evaluate the place of lumbar support in the management of nonspecific low back pain. Material and methods We conducted a systematic review with the following databases: Pubmed, Cochrane Library, Science Direct and Pedro. The search strategy used the keywords low back pain; lumbar orthosis; lumbar belt; back support; lumbar support; lumbar brace. To be included, studies needed to have one or more keywords selected. The search was limited to French and English articles. The major exclusion criterion was studies included rigid orthotics of the trunk. High Authority of health statement was used to check the quality of reporting. Data were also analyzed according to stages of the disease (acute, subacute, and chronic) and in prevention (primary and secondary). Results We included 28 studies. Quality assessment was heterogeneous. The systematic review showed no official recommendations for lumbar support prescription among the general population. Lumbar support was effective on function, pain, and relative time intervals for dispensing medication with subacute low back pain. It was also effective with probability of low back pain recurrence in secondary prevention. Orthosis’ benefits were not highlighted probably due to the lack of observance, which was a limiting factor. It is a bias because observance was not systematically studied in the literature. To our knowledge, there is no meta-analysis because evaluation criteria are heterogeneous. Discussion/Conclusion To date, there is no proof to prescribe lumbar support in the management of low back pain general population. An individual prescription would be discussed for subacute low back pain or in secondary prevention. Further studies with a higher quality assessment are necessary in order to identify phenotypes of patients’ responders to lumbar support. The function would be preferred as a main assessment criterion. [ABSTRACT FROM AUTHOR]

We report a longitudinal survey of a 53-year-old man suffering from right knee osteoarthritis who has undergone total knee replacement (TKR). We aimed at evaluating the effect of a short preoperative isokinetic strengthening program on the functional status, pain, and quadriceps and hamstrings strength before and after TKR. The patient performed a 4-week (6 sessions) preoperative isokinetic strengthening program of the quadriceps and hamstrings. The findings for the concentric strength at 60 ∘ /s, 6-minute walk test (6MWT), and Knee injury and Osteoarthritis Outcome Score (KOOS) were recorded. At baseline the patient presented with an overall KOOS score of 44%, a 6MWT of 444 m, a 63% and 21% strength deficits of the quadriceps and hamstrings, respectively. Following the strengthening program, the quadriceps strength of the operated limb improved (+ 121 Nm; + 83%), but the function as reflected by the KOOS score remained unchanged. Following the TKR, the concentric isokinetic strength of the quadriceps reappeared altered (63% of deficit) despite pain and functional improvements. This case report underlines the importance of functional evaluation rather than the maximal strength to assess the effectiveness of TKR. However, further studies are necessary to conceptualize the meaning of maximal strength measurement and the impact of associated deficits, if any. [ABSTRACT FROM AUTHOR]

Background: Mental disorders in the workplace are a major public health problem. Knowledge of the impact of the psychosocial work environment on mental and behavioral disorders can assist occupational physicians in the identification and description of occupational risk situations, and help to define priority actions. However, no classification for occupational exposure factors is currently available. We aimed to build a thesaurus of “Organizational, Relational, Ethical and other Contributing Factors” (FOREC) linked with the onset of mental and behavioral disorders. Methods: The French Agency for Food, Environmental and Occupational Health and Safety (ANSES) initiated and supervised a multidisciplinary working group consisting of the representatives of the main French occupational and public health actors. All decisions were accepted on a consensus basis. This collaborative work led to the classification of occupational exposure factors for mental and behavioral disorders in the workplace. To test this thesaurus in clinical practice, a French multicenter study was implemented. Patients were workers referred to the Occupational Disease Centers for mental health issues at work. Factors contributing to mental and behavioral disorders among workers were identified and coded retrospectively from the worker’s point of view using the FOREC thesaurus. Results: We recruited 323 workers, aged 44.9±9.2 years, of which 31.3% were men. The most commonly encountered disorders were generalized anxiety disorders (106 workers, 32.8%) and moderate depressive episodes (86 workers, 26.7%). We identified 1357 factors, i.e. an average of 4.2 factors per worker. Among them, 575 (42.4%) were relational and 515 (37.9%) were organizational. All factors identified during consultations were described in the thesaurus. Conclusions: We built the first thesaurus of “Organizational, Relational, Ethical and other Contributing Factors” (FOREC) that may help to generate profiles of mental and behavioral disorders at work. Encoding and describing these exposure factors, as well as using a worldwide standardized and shared terminology, will help to identify specific workplace prevention programs. [ABSTRACT FROM AUTHOR]