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Silvia Regina Pinheiro Malheiros,1 Talita Dias da Silva,2 Francis Meire Favero,2 Luiz Carlos de Abreu,1 Felipe Fregni,3 Denise Cardoso Ribeiro,4 Carlos Bandeira de Mello Monteiro1,4,5 1School of Medicine of ABC, Santo Andre, Brazil; 2Department of Medicine, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil; 3Center for Neurosciences, University of São Paulo, São Paulo, Brazil; 4Post-graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of São Paulo, São Paulo, Brazil; 5School of Arts, Sciences and Humanities, University of São Paulo, São Paulo, Brazil Aims: Two specific objectives were established to quantify computer task performance among people with Duchenne muscular dystrophy (DMD). First, we compared simple computational task performance between subjects with DMD and age-matched typically developing (TD) subjects. Second, we examined correlations between the ability of subjects with DMD to learn the computational task and their motor functionality, age, and initial task performance.Method: The study included 84 individuals (42 with DMD, mean age of 18±5.5 years, and 42 age-matched controls). They executed a computer maze task; all participants performed the acquisition (20 attempts) and retention (five attempts) phases, repeating the same maze. A different maze was used to verify transfer performance (five attempts). The Motor Function Measure Scale was applied, and the results were compared with maze task performance.Results: In the acquisition phase, a significant decrease was found in movement time (MT) between the first and last acquisition block, but only for the DMD group. For the DMD group, MT during transfer was shorter than during the first acquisition block, indicating improvement from the first acquisition block to transfer. In addition, the TD group showed shorter MT than the DMD group across the study.Conclusion: DMD participants improved their performance after practicing a computational task; however, the difference in MT was present in all attempts among DMD and control subjects. Computational task improvement was positively influenced by the initial performance of individuals with DMD. In turn, the initial performance was influenced by their distal functionality but not their age or overall functionality. Keywords: computer task, motor learning, Duchenne muscular dystrophy, movement time

Purpose: The present systematic review assessed the level of evidence for the association between relaxin levels and pregnancy-related pelvic girdle pain (PPGP) during pregnancy.Methods: PRISMA guidelines were followed to conduct this systematic review. Electronic search was carried out using six different databases. Observational cohorts, cross-sectional or case-control studies focused on the association between relaxin levels and PPGP during pregnancy were included. Studies selection was conducted by two reviewers who screened firstly for titles, then for abstracts and finally for full articles. Risk of bias was assessed using the Newcastle-Ottawa scale and the quality of evidence by the guidelines proposed by the Cochrane back review group.Results: 731 references were identified. Six articles met the inclusion criteria and were considered for this systematic review. The main reason for the studies exclusion was PPGP related to gynaecological reasons. Five studies were case-control and one study was a prospective cohort. Four studies were ranked as high while two were ranked as low quality. Among the high quality studies, three found no association between PPGP and relaxin levels.Conclusions: Based on these findings, the level of evidence for the association between PPGP and relaxin levels was found to be low. PPGP assessment and controlling for risk factors were found to increase bias leaving uncertainty in interpretation of these findings and a need for further research. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To offer a three-dimensional description of the scapular kinematics and scapulohumeral rhythm (SHR) in healthy subjects during quasi-static shoulder abduction. To analyze and compare the influence of loaded and unloaded conditions on scapula kinematics and SHR. DESIGN: Eleven subjects were analyzed using videogrammetry and the application of mathematical modelling during quasi-static shoulder abduction positions (intervals of approximately 30 degrees). MAIN OUTCOME MEASUREMENTS: Scapular kinematic data under unloaded and loaded conditions. RESULTS: The scapula presented external rotation, upward rotation and posterior tilting during the studied movement. Analyzing the scapulohumeral rhythm, different behaviours were observed in the scapular movement planes. Loading condition increased scapular upward rotation and posterior tilt at 60 degrees and 90 degrees of abduction (p>0.01). CONCLUSIONS: Analyzed scapular kinematics and scapulohumeral rhythm showed differences between adopted loading conditions. The clinical applications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Owing to their similarities with giant exoplanets, brown dwarf companions of stars provide insights into the fundamental processes of planet formation and evolution. From their orbits, several brown dwarf companions are found to be more massive than theoretical predictions given their luminosities and the ages of their host stars 1-3 . Either the theory is incomplete or these objects are not single entities. For example, they could be two brown dwarfs each with a lower mass and intrinsic luminosity 1,4 . The most problematic example is Gliese 229 B (refs.  5,6 ), which is at least 2-6 times less luminous than model predictions given its dynamical mass of 71.4 ± 0.6 Jupiter masses (M Jup ) (ref.  1 ). We observed Gliese 229 B with the GRAVITY interferometer and, separately, the CRIRES+ spectrograph at the Very Large Telescope. Both sets of observations independently resolve Gliese 229 B into two components, Gliese 229 Ba and Bb, settling the conflict between theory and observations. The two objects have a flux ratio of 0.47 ± 0.03 at a wavelength of 2 μm and masses of 38.1 ± 1.0 and 34.4 ± 1.5 M Jup , respectively. They orbit each other every 12.1 days with a semimajor axis of 0.042 astronomical units (AU). The discovery of Gliese 229 BaBb, each only a few times more massive than the most massive planets, and separated by 16 times the Earth-moon distance, raises new questions about the formation and prevalence of tight binary brown dwarfs around stars., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Purpose: To investigate the test-retest reliability and construct validity of the Brief Pain Inventory-Short Form (BPI-SF) in individuals with rotator cuff-related shoulder pain (RCRSP)., Methods: Sixty-one participants with RCRSP completed the BPI-SF twice with an interval of two to seven days and Shoulder Pain and Disability Index (SPADI) at the initial visit. The BPI-SF pain severity subscale, pain interference subscale, and stand-alone pain severity items were analysed using intraclass correlation coefficients (ICCs) and minimal detectable change at the 95% confidence interval (MDC 95 ). The construct validity of BPI-SF was assessed against SPADI using Pearson's correlation., Results: The BPI-SF pain severity and pain interference subscales presented moderate test-retest reliability (ICC = 0.73, 0.53) and MDC 95 were 2.05 and 2.36. All stand-alone BPI-SF pain severity items presented a moderate reliability (ICC = 0.62, 0.70). BPI-SF interference items presented poor to moderate reliability (ICC = 0.39, 0.68). The correlation coefficients between the BPI-SF and SPADI subscales or total scores were large ( r  = 0.61, 0.75)., Conclusions: BPI-SF pain severity and pain interference subscales have a moderate reliability in individuals with RCRSP. BPI-SF pain severity and interference subscales showed high construct validity in individuals with RCRSP. MDC 95 values are useful metrics for interpreting a true change in BPI-SF scores following interventions in individuals with RCRSP.

The Neotropical freshwater stingrays of Potamotrygon genus present a unique and complex natural history and biogeographical pattern that can be traced to a marine origin and the colonization of the continental environment during the Miocene. During the evolution of potamotrygonids, several species of the parasitic fauna coevolved and co-opted concomitantly to their hosts during the colonization of the new environments. One striking example can be observed during the colonization of the upper Paraná River region. However, few studies explored the ecological and taxonomic aspects of potamotrygonid parasites. In this work, we investigate aspects of the ecology and taxonomy of the species of Monogenea and Cestoda that are parasites the species of freshwater stingrays of the genus Potamotrygon in the upper Paraná River. Our results indicate that at least six species of parasites are present in potamotrygonids in the region. Two of the observed parasites are putative new species and three of the parasitic species were identified for the first time in the region, hence expanding their geographic distributions. We quantified ecological aspects at different levels of communities for the collected parasite species. We compared the diversity in different locations and hosts and performed an exploratory analysis to investigate the differences in parasite abundance. Additionally, an identification key for the Monogenea and Cestoda species of the sampled region is provided., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jumma Miranda Araujo Chagas reports financial support was provided by CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico - Brazil (Process nº 163765/2015-4). If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Patients are key stakeholders of clinical research, and their perspectives are relevant for researchers when planning and conducting clinical trials. Numerous aspects of trial process can influence participants' experiences. Their experiences within a trial can impact retention rates. Poor treatment adherence may bias treatment effect estimates. One way to improve recruitment and adherence is to design trials that are aligned with patients' needs and preferences. This study reports a process evaluation of the Otago MASTER feasibility trial., Objectives: Our aims were to investigate the patients' perceptions of the trial interventions through individual interviews., Methods: Twenty-five participants were recruited for the feasibility trial and were allocated to two groups: tailored or standardised exercise. Sixteen participants agreed to take part in individual semi-structured interviews. Interviews were transcribed verbatim, and all interviews were analysed thematically using an iterative approach., Results: Our key findings suggest participants: (1) took part in the study to access healthcare services and contribute to research; (2) valued interventions received; (3) reported certain barriers and facilitators to participate in the trial; and (4) highlighted areas for improvement when designing the full trial., Conclusion: Participants volunteered to access healthcare and to contribute to research. Participants valued the personalised care, perceived that their engagement within the trial improved their self-management and self-efficacy behaviour, valued the time spent with clinicians, and the empathetic environment and education received. Facilitators and barriers will require careful consideration in the future as the barriers may impact reliability and validity of future trial results., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Inadequate reporting of fidelity to interventions in trials limits the transparency and interpretation of trial findings. Despite this, most trials of non-drug, non-surgical interventions lack comprehensive reporting of fidelity. If fidelity is poorly reported, it is unclear which intervention components were tested or implemented within the trial, which also hinders research reproducibility. This protocol describes the development process of a reporting guideline for fidelity of non-drug, non-surgical interventions (ReFiND) in the context of trials., Methods: The ReFiND guideline will be developed in six stages. Stage one: a guideline development group has been formed to oversee the guideline methodology. Stage two: a scoping review will be conducted to identify and summarize existing guidance documents on the fidelity of non-drug, non-surgical interventions. Stage three: a Delphi study will be conducted to reach consensus on reporting items. Stage four: a consensus meeting will be held to consolidate the reporting items and discuss the wording and structure of the guideline. Stage five: a guidance statement, an elaboration and explanation document, and a reporting checklist will be developed. Stage six: different strategies will be used to disseminate and implement the ReFiND guideline., Discussion: The ReFiND guideline will provide a set of items developed through international consensus to improve the reporting of intervention fidelity in trials of non-drug, non-surgical interventions. This reporting guideline will enhance transparency and reproducibility in future non-drug, non-surgical intervention research., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Although recent studies in nonhuman primates have provided evidence that transcranial magnetic stimulation (TMS) activates cells within the reticular formation, it remains unclear whether descending brain stem projections contribute to the generation of TMS-induced motor evoked potentials (MEPs) in skeletal muscles. We compared MEPs in muscles with extensive direct corticomotoneuronal input (first dorsal interosseous) versus a prominent role in postural control (gastrocnemius) to determine whether the amplitudes of early and late MEPs were differentially modulated by cortical suppression. Suprathreshold TMS was applied with and without a preceding suprathreshold TMS pulse at two interstimulus intervals (50 and 80 ms). H reflexes in target muscles were also tested with and without TMS conditioning. Early and late gastrocnemius MEPs were differentially modulated by cortical inhibition, the amplitude of the early MEP being significantly reduced by cortical suppression and the late MEP facilitated. The amplitude of H reflexes in the gastrocnemius was reduced within the cortical silent period. Early MEPs in the first dorsal interosseous were also reduced during the silent period, but late MEPs were unaffected. Independent modulation of early and late MEPs in the gastrocnemius muscle supports the idea that the MEP is generated by multiple descending pathways. Suppression of the early MEP is consistent with transmission along the fast-conducting corticospinal tract, whereas facilitation of the late MEP suggests transmission along a corticofugal, potentially cortico-reticulospinal, pathway. Accordingly, differences in late MEP modulation between the first dorsal interosseous and gastrocnemius reflect an increased role of corticofugal pathways in the control of postural muscles. NEW & NOTEWORTHY Early and late portions of the response to transcranial magnetic stimulation (TMS) in a lower limb postural muscle are modulated independently by cortical suppression, late motor evoked potentials (MEPs) being facilitated during cortical inhibition. These results suggest a cortico-brain stem transmission pathway for late portions of the TMS-induced MEP.

Background: Evidence supporting type and dosage of joint mobilizations and rationale for selecting joint mobilization dosage for patients with rotator cuff-related shoulder pain are limited., Objectives: This scoping review aimed to systematically map the type and dosage of joint mobilizations used in previous trials for managing patients with rotator cuff-related shoulder pain; and summarize the rationale for adopting a specific joint mobilization dosage., Methods: We searched six databases. We included randomised controlled trials using joint mobilization for patients with rotator cuff-related shoulder pain. We extracted data regarding technique, treatment joint mobilization dosages and rationale for a specific dosage., Results: We included 32 studies. Most studies did not or partially report technique (67%) and within-session dosage (64%) of passive joint mobilization. Overall treatment was fully reported in 95% of studies. The dosage used for passive joint mobilization was heterogeneous (ranging from grade I to grade V). Most studies (85%) did not or partially report technique of mobilization with movement (MWM), whereas within-session and overall treatment dosages were fully reported in more than 85% of studies. Three sets of 10 repetitions were commonly used within-session dosage for MWM. We found very limited information on the rationale for selecting dosage of joint mobilization., Conclusion: We found limited information about the dosage or the rationale for selecting joint mobilization, with a heterogeneous dosage being tested across trials. Our findings highlight the importance of detailed reporting for dosage and rationale for selecting a specific dosage of joint mobilization., (Copyright © 2023. Published by Elsevier Ltd.)

Objective: Musculoskeletal (MSK) causes of chest pain are considered common in emergency care, yet management is limited, reported outcomes are poor and prevalence data in New Zealand are lacking. The present study aims to estimate the prevalence of MSK chest pain in New Zealand EDs and describe the characteristics of MSK chest pain cases., Methods: A retrospective chart review was conducted based on de-identified clinical notes extracted from four hospitals within the South Island of New Zealand from 3 months spanning 1 March to 31 May 2021. Individual cases were categorised to the single best-fitting cause of chest pain using systems-based categorisation, based primarily on the doctors' documented final impression., Results: A total of 1344 cases were categorised in the present study. MSK chest pain had a prevalence of 15% (range 11-31%) of chest pain presentations across all study sites. This represented the second most common system responsible for chest pain, after the cardiovascular system. The mean age of MSK chest pain cases was 46.9 (standard deviation [SD] 19.1) years, compared to 55.5 (SD 19.7) years in all cases. Age and gender-specific data, data from rural hospitals and MSK sub-type data are presented., Conclusions: These data provide a conservative estimate of MSK chest pain prevalence in EDs within the South Island of New Zealand. The findings highlight MSK chest pain as common in emergency care, providing a basis and justification for further research to improve management and outcomes for people with MSK chest pain., (© 2023 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.)

Objective: To explore whether pain beliefs and functional strength mediate the treatment effect of manual therapy (MT) and exercise therapy (ET) on the Western Ontario and McMaster Osteoarthritis Index (WOMAC) composite scores and its subscales in individuals with hip and/or knee osteoarthritis in the MOA trial., Design: Secondary analysis of a randomised controlled trial that compared the incremental effects of supervised MT and ET in addition to usual care in patients with osteoarthritis of the hip or knee. 206 participants enrolled in the MOA trial were analysed. The primary outcome measure was the WOMAC composite score after 1 year., Results: Pain belief mediated the effect of MT (b: -10.7, 95 ​% CI: -22.3, -0.9), ET (b: -14.5 95%CI: -26.0, -4.4). Functional strength did not mediate the effect of MT, ET, or MT ​+ ​ET. Mediation sensitivity analyses suggest findings are likely to change if small confounding between those mediators and WOMAC composite score is present., Conclusions: We identified possible mediators of MT and ET. Future confirmatory studies could be designed to assess the mechanisms through which manual therapy and exercise cause improvements in pain and function scores in patients with hip or knee osteoarthritis., Competing Interests: At the end of the text, under a subheading “Conflict of interest statement” all authors must disclose any financial and personal relationships with other people or organisations that could inappropriately influence (bias) their work. Examples of potential conflicts of interest include employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and research grants or other funding., (© 2024 The Author(s).)

Introduction: Mobilisation with movement (MWM) is commonly used for treating patients with rotator cuff-related shoulder pain (RCRSP). However, the evidence supporting MWM efficacy for improving shoulder range of motion (ROM) and pain in patients with RCRSP is limited. It is also unclear whether higher volume MWM leads to better clinical outcomes compared with lower volume MWM in patients with RCRSP. The primary aim of this study is to assess the effect of MWM on the angular onset of pain during shoulder abduction in patients with RCRSP., Methods and Analysis: Sixty participants with RCRSP will be randomised to receive either MWM or sham MWM intervention. The primary outcome is the angular onset of pain during shoulder abduction, and secondary outcomes are pain intensity at the angular onset of pain during shoulder abduction, maximum shoulder ROM, pain intensity during maximum shoulder abduction, pressure pain threshold, mechanical temporal summation, global rating of change scale (GROC) and Brief Pain Inventory-Short Form (BPI-SF). The angular onset of pain and the pain intensity at that range will be assessed at baseline, after 1 set and 3 sets of 10 repetitions of MWM or sham MWM. The GROC will be measured immediately after receiving 3 sets of interventions and on day 3 after interventions. The BPI-SF will be measured on days 1, 3, 5 and 7 after interventions. Other secondary outcomes will be assessed at baseline and after 3 sets of interventions. A linear mixed effects model with a random intercept will be used to compare changes in the outcome measures between MWM and sham MWM interventions., Ethics and Dissemination: This study has been approved by the University of Otago Ethics Committee (Ref. H21/117). Findings from this study will be disseminated through presentations at international and national conferences and will be submitted for publication in a peer-reviewed journal., Trial Registration Number: ACTRN 12621001723875., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The number of researchers and clinicians using movement-evoked pain and sensitivity to movement-evoked pain to assess shoulder pain has increased. However, the intrarater test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain in people with rotator cuff-related shoulder pain (RCRSP) is still unknown., Objective: We examined the intrarater test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain in participants with RCRSP., Methods: Seventy-four participants with RCRSP performed five trials of active shoulder abduction to elicit pain under two experimental conditions: active shoulder abduction to the onset of pain and maximum range of motion (ROM). The primary outcome measures were pain intensity and ROM. Test-retest reliability of movement-evoked pain and sensitivity to movement-evoked pain was examined using intraclass correlation coefficient (ICC 3,1 ) and minimal detectable change (MDC 90 )., Results: The reliability of movement-evoked pain under both experimental conditions was good to excellent (ICC: 0.81 to 0.95), while the reliability of sensitivity to movement-evoked pain was poor in both conditions (ICC≤0.45). The MDC 90 for pain intensity was 1.6 and 1.8 during shoulder abduction to the onset of pain and maximum ROM, respectively. The MDC 90 for ROM was 17.5° and 11.2° during shoulder abduction to the onset of pain and maximum ROM condition, respectively., Conclusion: This study confirms movement-evoked pain testing during active shoulder abduction to the onset of pain or maximum ROM condition is reliable to assess pain associated with movement in patients with RCRSP. The minimal detectable change score of movement-evoked pain can guide clinicians and researchers on how to interpret changes in these outcomes., Competing Interests: Conflicts of interest None., (Copyright © 2023 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

The gold standard exercise for recruitment of the lower trapezius is the Y prone exercise which is performed above 90° of shoulder elevation. However, clinicians often prescribe exercises that avoid high elevation postures during early stages of rehabilitation. Comparatively little data exists on relative muscle recruitment during lower arm elevation exercises. This study examined the EMG activity of four shoulder girdle muscles during four exercises accomplished below 90° of shoulder elevation and compared them to the Y prone while considering sex effects. Variance across exercises of the ratio between upper trapezius and lower trapezius was also explored. 32 healthy participants completed standardized muscle-specific MVCs and two repetitions of each exercise. The side lying external rotation and the wall slide exercises produced the highest peak EMG for the lower trapezius, both 33 and 29% lower than the Y Prone. For the upper trapezius to lower trapezius ratio, the side lying external rotation elicited the lowest value, followed by the Y prone and wall slide (53 and 59% respectively higher). Sex influenced some EMG values, typically interacting with exercise type. Thus, side lying external rotation and the wall slide are recommended for targeting the lower trapezius muscle during early rehabilitation., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objectives: This study reports a process evaluation of the Otago MASTER (MAnagement of Subacromial disorders of The shouldER) feasibility trial. This mixed-methods, process evaluation study was conducted parallel to the Otago MASTER feasibility trial. Our aims were to investigate: (1) supervised treatment fidelity of the interventions and (2) clinicians' perceptions of the trial interventions through a focus group., Design: Nested process evaluation study using a mixed-methods approach., Setting: Outpatient clinic., Participants: Five clinicians (two men, three women) aged 47-67 years, with clinical experience of 18-43 years and a minimum of postgraduate certificate training, were involved with the delivery of interventions within the feasibility trial. We assessed treatment fidelity for supervised exercises through audit of clinicians' records and compared those with the planned protocol. Clinicians took part in a focus group that lasted for approximately 1 hour. The focus group was transcribed verbatim and focus group discussion was analysed thematically using an iterative approach., Results: The fidelity score for the tailored exercise and manual therapy intervention was 80.3% (SD: 7.7%) and for the standardised exercise intervention, 82.9% (SD: 5.9%). Clinicians' perspectives about the trial and planned intervention were summarised by one main theme 'conflict experienced between individual clinical practice and the intervention protocol', which was supported by three subthemes: (1) programme strengths and weaknesses; (2) design-related and administrative barriers; and (3) training-related barriers., Conclusion: This mixed-methods study assessed supervised treatment fidelity of interventions and clinicians' perceptions on planned interventions tested in the Otago MASTER feasibility trial. Overall, treatment fidelity was acceptable for both intervention arms; however, we observed low fidelity for certain domains within the tailored exercise and manual therapy intervention. Our focus group identified several barriers clinicians faced while delivering the planned interventions. Those findings are of relevance for planning the definite trial and for researchers conducting feasibility trials., Trial Registration Number: ANZCTR: 12617001405303., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Bovine mastitis is an inflammation of the mammary gland in response to invasion by opportunistic agents. Due to the high economic importance of dairy production and the complexity related to animal health, the objective of this work was to identify and evaluate the antibacterial resistance profile of samples of mastitis milk, milking hand and milking equipment from small rural dairy farms belonging to the northwest region of the state of Paraná, Brazil. Five small, non-technical dairy farms in the municipalities of Boa Esperança, Juranda and Tapejara, all belonging to the northwest region of the state of Paraná, Brazil, were selected. The properties had Holstein and/or crossbred herds, carried out a bucket-by-foot milking system and all had the presence of animals with subclinical mastitis confirmed by the California Mastitis Test. Samples of sterile swabs from the milking insufflators, the milking hand and milk samples were collected-and later, isolation tests and phenotypic characterization of the samples, sensitivity tests to antimicrobials and phenotypic tests for the detection of beta-producing strains were performed with extended-spectrum beta-lactamase (ESBL), molecular identification of Staphylococcus aureus isolates and mec A gene research. Of the 199 samples collected from the 15 selected properties in the municipalities of Boa Esperança, Tapejara and Juranda, 72 (36.20%) were classified as multiresistant. Isolated from milkers' hands and milking machines, which phenotypically produce extended-spectrum beta-lactamase (ESBL), the presence of the mec A gene was also observed in 11 isolates of Staphylococcus spp. of milk samples, machines and milking hands. Mastitis can be spread to the herd through the milking process by the milkers' instruments and hands, and adequate management measures can prevent its transmission and the conscious use of antibiotics decreases the prevalence of multidrug-resistant pathogens. In this work, different pathogenic bacteria were detected in mastitic milk, milking equipment and milking hand with a high percentage (36.20%) of isolates classified as multidrug resistant. In addition, the presence phenotypically (ESBL) and molecularly ( mec A gene) of isolates carrying resistance genes was also verified. These results directly reflect on the health of the animals, the health of the workers and the health of the respective environment, which can enable the continuity of the propagation of the etiological agents involved in the mastitis infection. The awareness of producers and workers on these properties about the disease, transmission, sanitary aspects and adequate management and treatment are essential for improving milk production and production efficiency.

Objectives: This study aimed to identify the knowledge about the different characteristics of and the use of extrinsic feedback (EF) by Brazilian physical therapists., Methods: This is a cross-sectional study, and we used an internet-based survey with questions about knowledge and application of extrinsic feedback in clinical practice. We analyzed the responses in relation to the best available evidence on motor control and learning. We recruited Brazilian registered physical therapists from different regions in Brazil. Participants' demographics and survey responses were analyzed using descriptive statistics., Results: Two hundred and forty-six Brazilian physical therapists participated in the study. Most participants affirmed not knowing the definition of EF (55.69%), confirmed using some form of EF in their clinical practice (86.59%), and reported using it in 50% to 90% of their patients (26.42%). Brazilian physical therapists reported using mainly summary feedback (69.10%) with external focus of attention (63.41%). Participants reported using concurrent feedback (82.83%) and delivered it after every exercise repetition (63.82%). Most participants (43.09%) did not assess learning retention. Answers were similar regardless of education level or time from graduation., Conclusions: The results of this survey suggest that Brazilian physical therapists do not have sufficient knowledge about the different characteristics of EF; however, they do consider EF useful and use it for most of their patients. Brazilian physical therapists adopted adequate content characteristics of EF but not adequate use of timing characteristics of EF.

Background: Hip torque ratios are considered a useful measure for patients with hip pain. However, evidence regarding this measure for patients with femoroacetabular impingement syndrome is scarce. The primary aim of this study was to compare hip external-internal rotation and abduction-adduction torque ratios between patients with femoroacetabular impingement syndrome and asymptomatic individuals. The secondary aim was to compare hip torque ratios between the asymptomatic group and femoroacetabular impingement syndrome patients grouped according to the severity of symptoms and functional limitations., Methods: Hip abduction-adduction and external-internal rotation torque ratios of 134 individuals with femoroacetabular impingement syndrome and 134 asymptomatic matched controls was assessed through isokinetic testing. Severity of symptoms and functional limitations was assessed through the iHOT-33. Mann Whitney U and Kruskall-Wallis tests were used to compare hip torque ratios between asymptomatic individuals and patients with femoroacetabular impingement syndrome and to patients with femoroacetabular impingement syndrome with different severities of symptoms and functional limitations., Findings: No differences were identified in hip abduction-adduction (U = 7659.5, p = 0.192) and external-internal rotation (U = 8787.5, p = 0.764) torque ratios between patients with femoroacetabular impingement syndrome and asymptomatic individuals. Hip abduction-adduction torque ratio was higher (p = 0.0127) in patients with a severe state (median = 1.80, IQR = 0.61) when compared to asymptomatic individuals (median = 1.52, IQR = 0.45) (moderate effect size, r = 0.45)., Interpretation: Patients with severe symptoms and functional limitations related to FAI syndrome presented greater hip abduction-adduction torque ratio than asymptomatic individuals, suggesting a decreased adduction torque capacity relative to abduction torque in this subgroup of femoroacetabular impingement., Competing Interests: Declaration of Competing Interest The authors confirm that they have no financial or involvement with any commercial organization that has a direct financial interest in any matter included in this manuscript. Ethics approval: This study was approved by the local ethical committee with the protocol number of CAAE 96023618.0.0000.0118 (Brazil). All individuals provided written informed consent before participating in the study., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Flaxseed oil (FO) is an alpha linolenic acid source important for growth and body development. However, there is little literature on the role of FO in critical stages of bone development and formation., Objective: This study evaluated the influence of a diet containing FO on rat femurs., Methods: After birth, mothers and pups were divided into control and flaxseed groups (n = 6 pups each) fed diets containing 7% soybean oil (C) or 7% FO. At 21 days, pups were weaned and separated from the mothers, and control or experimental diets were continued. At 67 days, the following were analyzed: osteocalcin and osteoprotegerin (OPG) levels, bone mineral density (BMD) and content, and bone area; the dimension, BMD, head radiodensity, and biomechanical proprieties of the right femur; and histomorphometric parameters of the left femur., Results: Compared to the C group, the FO group presented ( p  < 0.05) a lower body mass (-3.7%) and medullary area (-10.1%) and higher osteocalcin (+36.7%), OPG (+52.5%), femur width (+3.8%), absolute mass (+2.3%), femur BMD (+3.6%), head radiodensity (+6.1%), maximum force (+7.4%), breaking strength (+17.3), and cortical thickness (+7.0)., Conclusion: The FO diet contributed to femur quality in healthy male Wistar rats.

Objectives: The aim of this study was to assess whether it was feasible to conduct a full trial comparing a tailored versus a standardised exercise programme for patients with shoulder subacromial pain., Design: Two-arm, patient-blinded and assessor-blinded, randomised controlled feasibility trial., Methods: Twenty-eight participants with shoulder subacromial pain were randomly allocated into one of two intervention groups-tailored or standardised exercise. Participants in the tailored exercise programme received exercises and manual therapy tailored to their scapular and shoulder movement impairments. Participants in the standardised exercise programme received progressive strengthening exercise. The primary outcome measures were (1) the participant recruitment rate; (2) the proportion of participants enrolled from the total number screened; (3) drop-out rates; and (4) adherence to the rehabilitation programme. Other outcome measures were: (5) pain levels; (6) Patient-Specific Functional Scale; (7) the Shoulder Pain and Disability Index; and (8) pain self-efficacy. We compared changes in pain and disability scores between groups using a repeated mixed-model analysis of variance. Since this is a feasibility study, we did not adjust alpha for multiple comparisons, and considered 75% CI as the probability threshold at 3-month follow-up. Health-related quality of life was assessed using the Short-Form 12 and quality-adjusted life years (QALYs) were estimated., Results: The recruitment rate was 3 participants per month, the proportion of participants enrolled was 23%, the drop-out rate was 14% and the overall adherence to the rehabilitation programme was 85%. No between-group differences were found for most outcome measures. Adverse events (n=2, only in the tailored group) were minor in nature and included skin injury or pain following taping., Conclusions: Our feasibility trial showed that additional strategies are required for improving recruitment, enrolment and minimising drop-out of participants into the trial and making it feasible to conduct a full trial., Trial Registration Number: ANZCTR: 12617001405303., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Rotator cuff-related shoulder pain is the most common diagnosis of shoulder pain, which ranks as the third most common musculoskeletal disorder. The first-line treatment for patients with rotator cuff-related shoulder pain is physiotherapy, and joint mobilisation is widely used in conjunction with other modalities. The type and dosage of joint mobilisations could influence treatment outcomes for patients with rotator cuff-related shoulder pain, although research evidence is inconclusive., Objectives: To (1) systematically search, identify and map the reported type and dosage of joint mobilisations used in previous studies for the management of patients with rotator cuff-related shoulder pain; and (2) summarise the rationale for adopting a specific joint mobilisation dosage., Methods and Analysis: We will follow the methodological framework outlined by Arksey and O'Malley and report the results as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guideline. Two authors will independently screen and extract data from the six databases: PubMed, Scopus, Web of Science, CINAHL, Cochrane Library and SPORTDiscus, with publication date from their inceptions to 25 August 2021. A third author will be consulted if the two authors disagree about the inclusion of any study in the review. We will summarise the results using descriptive statistics and qualitative thematic analysis., Ethics and Dissemination: Ethical approval is not required for this protocol. Mapping and summarising the reported type and dosage of joint mobilisations for patients with rotator cuff-related shoulder pain from previous studies will provide a foundation for further optimal selection of type and dosage of joint mobilisations for treating patients with rotator cuff-related shoulder pain. The review is part of an ongoing research that focuses on joint mobilisation for patients with rotator cuff-related shoulder pain. The results will be disseminated through presentations at academic conferences and a peer-reviewed publication., Competing Interests: Competing interests: DQ is a private physiotherapist and works at Back in Motion. The other authors do not have competing interests., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Causal mediation analysis is one way to bridge this gap by exploring the causal pathways of a given intervention. The aim of this study was to assess whether scapular motion, position, and periscapular muscle strength are mediators for pain and shoulder disability outcomes following a scapular stabilization intervention for patients with subacromial pain syndrome., Methods: Sixty patients were randomized into two groups: scapular stabilization or periscapular strengthening exercises. The intervention consisted of three sessions per week for 8 weeks. The primary outcome measures were pain and disability and the following outcome measures were considered as potential mediators: scapular motion, scapular position, periscapular muscle strength, age, duration of symptoms, and side of the complaint. A model-based inference approach with bootstrap simulations was used to estimate the average causal mediation effect, average direct effect, and the average total effect from the data of a randomized clinical trial that evaluated the effect of adding scapular stabilization exercises to a scapulothoracic strengthening program in people with subacromial pain syndrome., Results: The results demonstrated that none of the putative mediators were influenced by the intervention. However, muscle strength of serratus anterior, upper, middle, and lower trapezius muscles was associated with shoulder disability., Conclusion: Scapular kinematic and periscapular muscle strength did not mediate the effect of scapular stabilization exercises on shoulder pain or disability scores in subjects with subacromial pain syndrome. Muscle strength of serratus anterior, upper, middle and lower trapezius were associated with shoulder disability scores at 8-weeks follow-up., (© 2022. The Author(s).)

Objective: To systematically review measurement properties, including acceptability, feasibility, and interpretability, and current uses of the Patient-Specific Functional Scale (PSFS)., Design: Systematic review of a patient-reported outcome measure using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) guidelines., Literature Search: We searched 11 databases from January 2010 to July 2020 for articles on measurement properties or use of PSFS., Study Selection Criteria: Published primary articles without language restrictions., Data Synthesis: Two independent reviewers screened all records, extracted data, and performed risk of bias assessments using COSMIN guidelines. We qualitatively synthesized findings for each measurement property in musculoskeletal and nonmusculoskeletal conditions, and 2 reviewers independently performed Grading of Recommendations Assessment, Development and Evaluation assessments. This study was preregistered with the Open Science Framework (https://doi.org/10.17605/OSF.IO/42UZT)., Results: Of the 985 articles screened, we included 57 articles on measurement properties and 255 articles on the use of PSFS. The PSFS had sufficient test-retest reliability in musculoskeletal (22 studies, 845 participants, low-to-moderate certainty) and nonmusculoskeletal conditions (6 studies, 197 participants, very low certainty), insufficient construct validity as a measure of physical function (21 studies, 2 945 participants, low-to-moderate certainty), and sufficient responsiveness (32 studies, 13 770 participants, moderate-to-high certainty). The standard error of measurement ranged from 0.35 to 1.5. The PSFS was used in 87 unique health conditions, some without prior evidence of validity., Conclusion: The PSFS is an easy-to-use, reliable, and responsive scale in numerous musculoskeletal conditions, but the construct validity of PSFS remains uncertain. Further study of the measurement properties of the PSFS in nonmusculoskeletal conditions is necessary before clinical use. J Orthop Sports Phys Ther 2022;52(5):262-275. Epub: 05 Feb 2022. doi:10.2519/jospt.2022.10727 .

Dipyrone is an analgesic and antipyretic drug commonly used in many countries. Although generally not recommended during pregnancy, it is known that many women use dipyrone during the gestational period. In this study, we investigated the endocrine and reproductive effects of dipyrone in female and male offspring rats exposed in utero from gestational days 10-21. Pregnant rats were treated with dipyrone at 25, 75, and 225 mg/kg/day via oral gavage. Developmental landmarks-anogenital index (AGI), number of nipples, vaginal opening, first estrus, and preputial separation-were evaluated in the offspring. Reproductive parameters, including estrous cycle regularity, daily sperm production, weight and histopathology of reproductive organs, steroid hormone levels, and gene expression of selected markers of reproductive function were assessed at adulthood. At the highest dose, dipyrone induced a significant increase in postimplantation losses/fetal death and delayed parturition in dams. Offspring exposed in utero to the highest dose also exhibited significant changes in some early life markers of endocrine disruption, in particular increased AGI in females, indicating a proandrogenic effect, and increased rate of retained nipples in males, indicating an antiandrogenic response. No changes were observed in markers of puberty onset or reproductive parameters at adulthood. These results suggest that exposure to therapeutically relevant doses of dipyrone may induce mild endocrine disruptive effects that can be detected in late pregnancy and early life. Such effects may be relevant considering dipyrone use by pregnant women and the possibility of coexposures with other endocrine disruptors., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Society of Toxicology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Until the mid-2000s, qualitative research has been virtually absent from running injury research. A handful of studies have been recently published regarding the attitudes and perceptions of runners and coaches toward injury development. Footwear is frequently perceived as a risk factor for running related injuries, but empeirical evidence fails to support such beliefs. The reasons why runners choose specific footwear warrants formal investigation to further understand the links between footwear and running related injuries. This study aimed to investigate the factors influencing runners choices of footwear. Interviews were conducted with 12 runners. Recordings from the interviews were transcribed verbatim and themes were developed using thematic analysis. Findings revealed 15 unique factors that influence runner's choices of footwear for running. These factors were grouped into three main themes: personal footwear characteristic preferences, other people and economic considerations. Runners largely gather information about their footwear choices from past experiences and people they trust and admire. They also emphasized the complexity of footwear choices due to availability and the constant changes preset within the footwear industry. This research adds to the growing body of knowledge to better understand the wider running injury system. Further studies are needed to establish how runners perceptions of their footwear impact injury rates and to develop effective injury prevention strategies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ramsey, Lamb and Ribeiro.)

Background The primary aim of this study was to compare knee and hip dynamic muscle strength of individuals with femoroacetabular impingement (FAI) syndrome scheduled for hip arthroscopy with healthy controls. Our secondary aim was to compare hip and knee muscle strength between male and female patients with FAI syndrome. Methods One hundred and thirty-four individuals with femoroacetabular impingement syndrome scheduled for hip arthroscopy and 134 healthy controls matched for sex and age (within 5 years range) underwent an isokinetic assessment of knee extension and flexion and hip abduction, adduction, external rotation and internal rotation dynamic muscle strength. Two MANOVAs were conducted to compare isokinetic peak torque and total work between groups and sexes. Findings Individuals with femoroacetabular impingement syndrome demonstrated lower values of all variables representing knee and hip isokinetic peak torque and total work measures when compared to healthy controls, with differences ranging from 0.09 Nm/kg (95%CI: 0.06-0.12 Nm/kg) to 0.64 Nm/kg (95%CI: 0.49-0.79 Nm/kg). Female participants from both FAI syndrome and control group showed less knee and hip muscle strength compared to male participants. There was no significant interaction between group and sex regarding knee or hip isokinetic peak torque and total work (p > 0.05). Interpretation Individuals with femoroacetabular impingement syndrome scheduled for hip arthroscopy present impairments in knee or hip dynamic muscle strength when compared to controls. Female participants present less knee and hip muscular strength compared to male participants, these between-sex differences are similar for both FAI syndrome and control group participants., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Context: Altered knee joint mechanics may be related to quadriceps muscle strength, time since surgery, and sex following anterior cruciate ligament reconstruction (ACLR). The aim of this study was to investigate the association between knee moments, with participant-related factors during stair navigation post-ACLR., Design: Cross-sectional study., Methods: A total of 30 participants (14 women) with ACLR, on average 7.0 (SD 4.4) years postsurgery were tested during stair ascent and descent in a gait laboratory. Motion capture was conducted using a floor-embedded force plate and 11 infrared cameras. Quadriceps concentric and eccentric muscle strength was measured with an isokinetic dynamometer at 60°/s, and peak torques recorded. Multiple regression analyses were performed between external knee flexion and adduction moments, respectively, and quadriceps peak torque, sex, and time since ACLR., Results: Higher concentric quadriceps strength and female sex accounted for 55.7% of the total variance for peak knee flexion moment during stair ascent (P < .001). None of the independent variables accounted for variance in knee adduction moment (P = .698). No significant associations were found for knee flexion and adduction moments during for stair descent., Conclusion: Higher quadriceps concentric strength and sex explains major variance in knee flexion moments during stair ascent. The strong association between muscle strength and external knee flexion moments during stair ascent indicate rehabilitation tailored for quadriceps may optimize knee mechanics, particularly for women.

Objective: To investigate effects of foot progression angle (FPA) modification on the first and second peaks of external knee adduction moment (EKAM) and knee adduction angular impulse (KAAI) in individuals with and without medial knee osteoarthritis (OA) during level walking., Methods: PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and SPORTDiscus were searched from inception to February 2020 by 2 independent reviewers. Included studies compared FPA modification (toe-in or toe-out gait) interventions to lower EKAM and/or KAAI with natural walking. Studies were required to report the first or second peaks of EKAM or KAAI., Results: Sixteen studies were included, and >85% of included patients were graded with Kellgren/Lawrence grade II-IV knee OA. Toe-in gait reduced the first EKAM peak (standardized mean difference [SMD] -0.75 [95% confidence interval (95% CI) -1.05, -0.45]) and KAAI (SMD -0.46 [95% CI -0.86, -0.07]), while toe-out gait reduced the second EKAM peak (SMD -1.04 [95% CI -1.34, -0.75]) in healthy individuals. For patients with knee OA, toe-out gait reduced the second EKAM peak (SMD -0.53 [95% CI -0.75, -0.31]) and KAAI (SMD -0.26 [95% CI -0.49, -0.03]), while toe-in gait did not affect both EKAM peaks and KAAI., Conclusion: Discrepancy in biomechanical effects of FPA modification was demonstrated between individuals with and without medial knee OA. Compared with natural walking, both toe-in and toe-out gait may be more effective in lowering EKAM and KAAI in healthy individuals. Toe-out gait may reduce EKAM and KAAI in patients with mild-to-severe knee OA. There is insufficient data from patients with early-stage knee OA, indicating that future research is required., (© 2020, American College of Rheumatology.)

The International Classification of Functioning, Disability and Health (ICF) features associated tools, the Brief and Comprehensive ICF Core Sets. These are designed to be universally applicable, but have limited evidence of content validity (i.e. comprehensiveness and relevance) in low income, non-Western countries. In this cross-sectional study, we aimed to assess the content validity of the ICF Core Sets in Nepal. We interviewed 161 participants with stroke, spinal cord injury (SCI), chronic obstructive pulmonary disease (COPD), and musculoskeletal conditions and asked them to identify activities they had difficulty performing due to their health condition. We mapped 544 participant responses to the ICF and assessed if these ICF categories were represented in the respective ICF core sets. The Comprehensive Core Sets for stroke, COPD, SCI, and musculoskeletal conditions contained more items identified by participants than the respective Brief Core Sets (e.g., 89% vs. 26% in stroke). Among ICF categories that represented at least 5% of participants' responses, the Brief Core Sets covered 40%-71% of participants' responses whereas the Comprehensive Core Sets covered 67%-100% of responses. This is the first study to evaluate the content validity of the ICF Brief and Comprehensive core sets in Nepali individuals with stroke, SCI, MSK conditions, and COPD. The Comprehensive Core Sets for stroke, COPD, and SCI have adequate content validity for use in clinical practice and research in Nepal; the Brief Core Sets may not adequately meet local and individual needs unless supplemented with additional ICF categories., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The Back Pain Attitudes Questionnaire (Back-PAQ) was developed to evaluate attitudes and beliefs of the general public, people with back pain, and healthcare professionals about the spine., Objectives: To translate and cross-culturally adapt the Back-PAQ (34-item and 10-item versions) into Brazilian-Portuguese (Back-PAQ-Br) and test its measurement properties in a Brazilian sample., Methods: The cross-cultural adaptation and testing of the measurement properties followed the recommendations of international guidelines. Members of the general public, people with back pain, and healthcare professionals, for a total of 139 individuals, took part in the assessment of internal consistency, construct validity, and ceiling and floor effects. The Hospital Anxiety and Depression Scale (HADS) and the Brazilian-Portuguese version of the Tampa Scale of Kinesiophobia (TSK) were used to evaluate construct validity. Test-retest reproducibility was determined on 77 participants. Retest was performed a minimum of 1 week and a maximum of 2 weeks from the original test., Results: There was very high agreement between translators (88.2%). The Back-PAQ-Br showed excellent internal consistency (Cronbach's alpha 0.92) and excellent reproducibility (ICC 0.94; SEM 5.14 points on a 136 point scale), with a smallest detectable change (90% confidence level) of 11.93 points. There was strong correlation between Back-PAQ-Br and TSK (r = -0.72) and very weak correlation between Back-PAQ-Br and HADS (r = -0.23 for both depression and anxiety domains). No ceiling/floor effects were observed., Conclusion: The translation process and cross-cultural adaptation had very high agreement between translators. The Back-PAQ-Br has excellent measurement properties that are similar to the properties of the original version., (Copyright © 2020 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Limited passive ankle dorsiflexion range has been associated with increased knee valgus during functional tasks. Increased knee valgus is considered a contributing factor for musculoskeletal disorders in the lower limb. There is conflicting evidence supporting this association. The extent of passive ankle dorsiflexion range is associated with dynamic ankle dorsiflexion range and the way how these variables are related to lower limb or trunk kinematics is unclear., Research Question: What is the association between passive ankle dorsiflexion range or dynamic ankle dorsiflexion range with shank, thigh, pelvis or trunk movements during the single-leg squat?, Methods: This is a cross-sectional study with a convenience sample. Thirty uninjured participants performed the single-leg squat with their dominant limb. Ankle, shank, thigh, pelvis and trunk 3D kinematics were recorded. Passive ankle dorsiflexion range was assessed through the weight-bearing lunge test and the dynamic ankle dorsiflexion range was defined as the ankle dorsiflexion range of motion in the sagittal plane during the single-leg squat., Results: Greater passive ankle dorsiflexion range was associated with smaller thigh internal rotation (r= -0.38). Greater dynamic ankle dorsiflexion range was associated with smaller trunk flexion (r = 0.59) and pelvis anteversion (r= -0.47). Passive ankle dorsiflexion range and dynamic ankle dorsiflexion range were not associated., Significance: Greater passive ankle dorsiflexion range seems to be associated with a better lower limb alignment during the single-leg squat, while dynamic ankle dorsiflexion range seems to reflect different lower limb and trunk kinematic strategies., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: We assessed the association between: the severity of hip chondral or labral pathology with dynamic hip muscle strength or quality of life in patients with femoroacetabular impingement syndrome scheduled for hip arthroscopy. We also assessed the association between dynamic hip muscle strength with quality of life., Methods: Eighty-three participants with femoroacetabular impingement syndrome scheduled for hip arthroscopy were included. We measured dynamic hip abduction and adduction muscle strength with an isokinetic dynamometer (Nm/kg), and quality of life with the iHoT-33 questionnaire. The severity of hip chondrolabral pathologies was scored using the modified Beck classification. Linear regression analyses were conducted to assess the association between severity of hip chondral or labral pathology with dynamic hip muscle strength and quality of life., Findings: The regression analyses showed no association between the (i) severity of hip chondral (adjusted r 2 : 0.14) or labral (adjusted r 2 : 0.08) pathology and quality of life (P > 0.05), (ii) between the severity of hip chondral or labral pathology and dynamic hip abduction and adduction muscle strength (P > 0.05). Significant correlation was observed for quality of life and hip abduction (adjusted r 2 :0.29; P < 0.001) or adduction (adjusted r 2 : 0.32; P < 0.001) muscle strength., Interpretation: The severity of hip chondral or labral pathologies were not associated with quality of life or dynamic hip muscle strength in participants with femoroacetabular impingement syndrome. Greater dynamic hip abduction and adduction muscle strength were associated with better quality of life in participants with femoroacetabular impingement syndrome scheduled for hip arthroscopy., (Copyright © 2021. Published by Elsevier Ltd.)

Objective: To compare self-report and functional outcomes between participants with anterior cruciate ligament reconstruction (ACLR) with age and activity matched controls., Design: Cross-sectional study., Setting: University laboratory-based study., Participants: Twenty-five participants (30.8 ± 9.7 years; 13 women), two to ten years post anterior cruciate ligament reconstruction; 24 controls (31.0 ± 10 years, 13 women)., Main Outcome Measures: Knee Osteoarthritis and Injury Outcome Score (KOOS), Tegner, Marx Activity and Fear of Re-injury scales, and SF-12; isokinetic quadriceps and hamstring peak torque and single-leg hop distance., Results: There were no between-groups differences for the Tegner and the Marx Activity Scales. The ACLR group had lower KOOS dimensions (p < 0.001), SF-12 Physical Component Scores (p = 0.008), and higher Fear of Reinjury Scores (<0.001) than the controls. No significant differences were found for physical performance measures between the ACLR and the control groups. Significant between-side differences for the ACLR group were evident for concentric quadriceps (p < 0.001) and concentric hamstring peak torque (p = 0.002), and hop distance (p < 0.001)., Conclusion: Knee-specific symptoms and function, activity and quality of life were lower, and fear of re-injury was higher for participants with ACLR than controls. Side-to-side thigh muscle strength and hop distance deficits were evident for the ACLR group., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objectives: To review the reporting of monitoring and implementation of interventions in a selection of trials that assessed the effectiveness of manual therapy and exercise in the management of shoulder subacromial pain., Design: A review of trials assessing the effectiveness of manual therapy and exercise in the management of patients with shoulder subacromial pain., Methods: We included in our review a selection of 10 trials that were included in a Cochrane review and compared manual therapy and exercise intervention with another intervention. Trials were assessed independently by two reviewers using two checklists: the Template for Intervention Description and Replication (TIDieR) and the Health Behavior Change Consortium treatment fidelity (National Institutes of Health Behaviour Change Consortium/NIHBCC)., Results: TIDieR overall scores for individual trials ranged from 11.1% to 45% and fidelity scores ranged from 7% to 50%. On average, trials scored the following within each domain of NIHBCC: study design 51%; training of providers 8%; treatment delivery 15%; treatment receipt 14% and treatment enactment 2.5%., Conclusions: Little information about the monitoring, implementation and reporting of interventions was provided by trials and that is a barrier for implementing or replicating these interventions. The lack of information regarding the implementation of interventions needs to be taken into account when assessing whether effectiveness of interventions was impacted by their design or due to deviations from the protocol within trials., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The Patient-Specific Functional Scale (PSFS) is a routinely used measure of physical function with a 0-10 response scale. We aimed to develop verbal response options for the PSFS, pre-test it for use in a multilingual, low-literacy country- Nepal, and compare preference and error rates between numeric and verbal scale. We hypothesized that a verbal scale would be preferred by respondents and yield fewer errors., Method: We interviewed 42 individuals with musculoskeletal, neurological, and cardiopulmonary conditions to understand how people describe varying levels of physical ability. Transcripts were thematically analyzed, and through consensus, we developed two sets of verbal responses for the PSFS. Next, we pre-tested the scales on an additional 119 respondents following which participants were asked to specify their preferred scale. Error rates were analyzed retrospectively using pre-specified criteria., Results: Participants described their ability in terms of the quality (95%) and the quantity of task performance (88%). Although the verbal scales were preferred over the numeric scale (50% versus 12%), there was no significant difference in error rates between numeric (34%) and verbal scales (32% and 36%). Higher error rates were associated with greater age, fewer years of education, and inexperience with numeric scales., Conclusion: Despite a higher preference for verbal scale, 1 out of 3 patients made errors in using the PSFS, even with an interview format. The error rates were higher among participants with low literacy. The findings raise questions about the utility of PROMs in countries with low literacy rates.

Objective: To compare knee angles and moments between the injured and contralateral knee in participants with anterior cruciate ligament reconstruction, and compared with uninjured controls while navigating steps., Design: Cross-sectional study., Setting: University laboratory-based study., Participants: Twenty-five participants (30.8 ± 9.7 years; 13 women) with anterior cruciate ligament reconstruction (2-10 years post-surgery), and 24 controls (31.0 ± 10 years, 13 women)., Main Outcome Measures: Three-dimensional motion analysis was used to record peak knee angles and external moments during step ascent and descent in three planes, along with spatiotemporal variables., Results: During step ascent, the reconstructed knee exhibited significantly: (1) lower peak flexion angles compared to the controls (P = 0.005); (2) lower flexion moments (P < 0.001) compared to contralateral side and controls. No significant differences were found in the frontal and transverse planes between groups and sides. During step descent, no significant differences in angles and moments were found., Conclusions: Side-to-side asymmetries and lower knee flexion angles and external knee flexion moments were evident in participants with anterior cruciate ligament reconstruction and compared to controls. These findings suggest that incomplete recovery and compensatory or protective changes in neuromuscular control and joint function may persist 2-10 years post-surgery., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: The primary aim was to investigate the effect of inferior shoulder mobilization on scapular and shoulder muscle activity during resisted shoulder abduction in asymptomatic individuals., Methods: This was a lab-based, repeated-measures, crossover, randomized controlled study. Twenty-two participants were recruited. The order of experimental conditions was randomized. Each participant performed 5 repetitions of resisted shoulder abduction before and after the control and mobilization (grade +IV inferior shoulder mobilization, 3 sets, 60 seconds) conditions. Surface electromyography recorded the muscle activity of anterior, middle, and posterior deltoid; supraspinatus; infraspinatus; upper and lower trapezius; serratus anterior; and latissimus dorsi muscles., Results: Muscle activity levels reduced for infraspinatus (11.3% MVIC, 95% CI: 1.7-20.8), middle (22.4% MVIC, 95% CI: 15.9-28.8) and posterior deltoid (8.7 % MVIC, 95% CI: 4.6-12.9), and serratus anterior (-28.1% MVIC, 95% CI: 15.6-40.8) muscles after the mobilization condition during the eccentric phase of shoulder abduction. No carryover effects were observed, and within-session reliability was excellent (intraclass correlation coefficient scores ranging from 0.94 to 0.99)., Conclusion: Our findings suggest that inferior glenohumeral mobilization reduces activity levels of some scapular and shoulder muscles. Given the exploratory nature of our study, changes in muscle activity levels may have been found by chance. Confirmatory studies are required., (Copyright © 2020. Published by Elsevier Inc.)

Background: Adolescents with chronic kidney disease have a hard time adhering to hemodialysis as a therapy, indicating a need to establish new alternatives for motivation and adherence to treatment., Objective: The objective of this study was to develop and evaluate a serious game to stimulate and motivate adolescents undergoing hemodialysis., Methods: We describe the technological production followed by a qualitative analysis. We invited 8 adolescents undergoing hemodialysis in the city Goiânia, located in the midwest of Brazil, to participate. The final convenience sample included 7 (87.5% of the target population) adolescents. The process was conducted in 3 phases: creation of a serious game, evaluation of its use, and observation of its motivating effect on behavioral modification with a focus on acquiring the necessary competence for self-care., Results: An app (Bim) in the modality of a serious game was developed to be used during hemodialysis; the player was encouraged to take care of a character with daily actions during his or her treatment. The game was made available to adolescents aged 10-14 years. Mobile devices were offered during the hemodialysis treatment for a period of 30-40 minutes, 3 times a week for 60 days. The usage definitions of the game were freely chosen by the participants. The qualitative evaluation of the use of the Bim app showed that it encompasses scenarios and activities that enable the exercise of daily actions for the treatment of patients. The behavioral evaluation showed that the Bim app worked as a motivating stimulus for behavioral adherence to hemodialysis requirements., Conclusions: The easy-to-access app interface showed good operability for its users. The description of the character and proposed activities contributed to motivation and ability to cope with hemodialysis care., (©Cristina Célia De Almeida Pereira Santana, Ana Tereza Vaz De Souza Freitas, Gilson Oliveira Barreto, Igor Sousa De Avelar, Renata Mazaro-Costa, Gina Nolêto Bueno, Diuly Caroline Ribeiro, Gabriela Damasceno Silva, Alessandra Vitorino Naghettini. Originally published in JMIR Serious Games (http://games.jmir.org), 14.09.2020.)

Diclofenac is a non-steroidal anti-inflammatory drug widely used by the general population and, although generally contraindicated during pregnancy, it is also used by some pregnant women. This study investigated endocrine, reproductive and behavioral effects of diclofenac in male and female offspring rats exposed in utero from gestational days 10-20. Pregnant rats were treated with diclofenac at doses of 0.2, 1 and 5 mg/kg/day via oral gavage. Anogenital distance (AGD), number of nipples, and developmental landmarks of puberty onset - vaginal opening (VO), first estrus (FE) and preputial separation (PPS) - were evaluated in the offspring. At adulthood, behavioral and reproductive parameters were assessed. Male and female rats were tested in the elevated plus maze test to assess locomotor activity and anxiety-like behaviors, while male rats were also evaluated in the partner preference test. No significant effects were observed on AGD and number of nipples in both males and females. Diclofenac treatment induced an overall delay in developmental landmarks of puberty onset in male and female offspring, which reached statistical significance for PPS at the lowest diclofenac dose. Prenatal exposure to all tested doses abolished the preference of male rats for an estrous female, suggesting an impairment of brain masculinization. No changes were observed on male or female reproductive parameters at adulthood. Overall, our results indicate that prenatal exposure to therapeutically relevant doses of diclofenac may have an impact in the pubertal development of rats and negatively affect male partner preference behavior., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To assess the association between changes in pain or function with changes in scapular dyskinesis in participants with subacromial shoulder pain., Method: Forty-four participants with subacromial shoulder pain were assessed at baseline and 8 weeks later. The outcome measures included 'pain at rest' and 'pain during movement' using Numeric Pain Rating Scale (NPRS), shoulder function using Patient Specific Functional Scale (PSFS), and observation of scapular movement pattern using the scapular dyskinesis test. Robust paired t-tests were used to compare scores between baseline and follow-up. Repeated measures correlation coefficient was used to assess the association between changes in pain or function with changes in scapular dyskinesis scores., Results: A fair association was found between improvement in function and improvement in scapular dyskinesis (correlation coefficient = -0.4, 95% CI: -0.6 to -0.1). No associations were found between changes in 'pain at rest' (correlation coefficient = -0.1, 95% CI: -0.2 to 0.2) or 'pain during movement' (correlation coefficient = 0.28, 95% CI: 0.0 to 0.5) with changes in scapular dyskinesis., Conclusion: Our findings showed improvement in function is associated with improvement in scapular dyskinesis scores. Future studies should explore whether there is causal effect between improvement in scapular dyskinesis and function., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: Patients with neck pain commonly have altered activity of the neck muscles. The craniocervical flexion test (CCFT) is used to assess the function of the deep neck flexor muscles in patients with musculoskeletal neck disorders. Systematic reviews summarizing the measurement properties of the CCFT are outdated. The objective of this study was to systematically review the measurement properties of the CCFT for assessing the deep neck flexor muscles., Methods: The data sources MEDLINE, EMBASE, Physiotherapy Evidence Database, Cochrane Central Register of Controlled Trials, Scopus, and Science Direct were searched in April 2019. Studies of any design that reported at least 1 measurement property of the CCFT for assessing the deep neck flexor muscles were selected. Two reviewers independently extracted data and rated the risk of bias of individual studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk-of-bias checklist. The overall rating for each measurement property was classified as "positive," "indeterminate," or "negative." The overall rating was accompanied with a level of evidence., Results: Fourteen studies were included in the data synthesis. The ratings were positive, and the level of evidence was moderate for interrater and intrarater reliability and convergent validity. There was conflicting rating and level of evidence for discriminative validity. Measurement error was indeterminate, with an unknown level of evidence. Responsiveness was negative, with a limited level of evidence. A limitation of this study was that only papers published in English were included., Conclusions: The CCFT is a valid and reliable test that can be used in clinical practice as an assessment test. Because of the conflicting and low-quality evidence, caution is advised when using the CCFT as a discriminative test and as an outcome measure. Future better-designed studies are warranted., (© The Author(s) 2020. Published by Oxford University Press on behalf of American Physical Therapy Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)