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Background: While low back pain (LBP) is the leading cause of disability worldwide, its clinical objective assessment is currently limited. Part of this syndrome arises from the abnormal sensorimotor control of back muscles, involving increased muscle fatigability (i.e., assessed with the Biering–Sorensen test) and abnormal muscle activation patterns (i.e., the flexion–extension test). Surface electromyography (sEMG) provides objective measures of muscle fatigue development (median frequency drop, MDF) and activation patterns (RMS amplitude change). This study therefore assessed the sensitivity and validity of a novel and flexible sEMG system (NSS) based on PEVA electrodes and potentially embeddable in textiles, as a tool for objective clinical LBP assessment. Methods: Twelve participants wearing NSS and a commercial laboratory sEMG system (CSS) performed two clinical tests used in LBP assessment (Biering–Sorensen and flexion–extension). Erector spinae muscle activity was recorded at T12-L1 and L4-L5. Results: NSS showed sensitivity to sEMG changes associated with fatigue development and muscle activations during flexion–extension movements (p < 0.05) that were similar to CSS (p > 0.05). Raw signals showed moderate cross-correlations (MDF: 0.60–0.68; RMS: 0.53–0.62). Adding conductive gel to the PEVA electrodes did not influence sEMG signal interpretation (p > 0.05). Conclusions: This novel sEMG system is promising for assessing electrophysiological indicators of LBP during clinical tests. [ABSTRACT FROM AUTHOR]

Background: We noted that patients with thoracic outlet syndrome (TOS) have elevation of the ipsilateral scapula and named this the scapular elevation sign (SES). The aim was to determine the prevalence of SES in a normal cohort, compare SES with other provocative tests and to determine the treatment effect on SES. Methods: First, normal asymptomatic subjects were prospectively assessed to determine the prevalence of SES in a normal cohort. Second, patients with TOS were retrospectively examined for the presence of SES and four provocative tests: supraclavicular pressure, scalene test, elevated arm stress test (EAST) and the military brace manoeuvre. All patients were initially treated non-surgically. Surgery was offered to patients with persistent symptoms at 6 months. Patients were re-examined for the presence of the SES after treatment. Results: The prevalence of SES in our normal cohort was 4% (2/53). Our study cohort included 20 patients with TOS. The SES was positive in 18 patients (90%). Supraclavicular pressure was positive in 11 (55%), scalene test in 13 (65%), EAST in 9 (45%) and military brace manoeuvre in 11 patients (55%). Following non-surgical treatment, six patients had symptom resolution, three had improvement, nine persistent symptoms and two were lost to follow-up. The SES was positive in one out of six patients with symptom resolution, two out of three patients with improvement and in all nine patients with persistent symptoms. Patients with persistent symptoms underwent surgery with symptom resolution in eight and improvement in one patient. The SES remained positive in two patients after surgical treatment. Conclusions: The SES is simple and sensitive, does not rely on variations in performance of the test and suitable for diagnosis and assessment of outcomes of TOS. Level of Evidence: Level III (Diagnostic) [ABSTRACT FROM AUTHOR]

The Overhead Squat (OHS) and Single-Leg Squat (SLS) are two clinical tests used by practitioners to identify high-risk biomechanical movement patterns. Several published studies have reported sex differences in SLS performance; however, few have investigated variations during the OHS and none has measured kinematics with a marker-less motion capture system. Therefore, this study aimed to compare biomechanical movement patterns between male and female collegiate athletes during OHS and SLS testing. Seventy-five females and 58 male athletes completed OHS and SLS. A Microsoft Kinect sensor using Athletic Movement Assessment software (PhysiMax®) was used to measure kinematics. For the OHS, males displayed greater peak knee frontal plane projection angles (FPPA) (M:26°±10°, F:20°±8°; P < 0.05), peak hip flexion (M:-94°±14°, F:-87°±15°; P < 0.05), and peak trunk flexion angles (M:11°±11°, F:6°±9°; P < 0.05). For the SLS (dominant-limb), males displayed greater peak trunk flexion (M:32°±6°, F:27°±7°; P < 0.05). For the non-dominant limb, females displayed greater peak knee FPPA (F:-12°±9°, M:-8°±9°; P < 0.05) whereas males displayed greater peak trunk flexion angles (M:32°±5°, F:27°±7°; P < 0.05). These findings suggest the need for practitioners to develop sex-specific corrective exercise programmes in effort to improve lower extremity kinematics in athletes. [ABSTRACT FROM AUTHOR]

Background: While low back pain (LBP) is the leading cause of disability worldwide, its clinical objective assessment is currently limited. Part of this syndrome arises from the abnormal sensorimotor control of back muscles, involving increased muscle fatigability (i.e., assessed with the Biering–Sorensen test) and abnormal muscle activation patterns (i.e., the flexion–extension test). Surface electromyography (sEMG) provides objective measures of muscle fatigue development (median frequency drop, MDF) and activation patterns (RMS amplitude change). This study therefore assessed the sensitivity and validity of a novel and flexible sEMG system (NSS) based on PEVA electrodes and potentially embeddable in textiles, as a tool for objective clinical LBP assessment. Methods: Twelve participants wearing NSS and a commercial laboratory sEMG system (CSS) performed two clinical tests used in LBP assessment (Biering–Sorensen and flexion–extension). Erector spinae muscle activity was recorded at T12-L1 and L4-L5. Results: NSS showed sensitivity to sEMG changes associated with fatigue development and muscle activations during flexion–extension movements (p < 0.05) that were similar to CSS (p > 0.05). Raw signals showed moderate cross-correlations (MDF: 0.60–0.68; RMS: 0.53–0.62). Adding conductive gel to the PEVA electrodes did not influence sEMG signal interpretation (p > 0.05). Conclusions: This novel sEMG system is promising for assessing electrophysiological indicators of LBP during clinical tests.

Background: Lumbar spinal stenosis causes considerable disability in everyday life; its incidence is increasing due to aging in the world population. First-line treatment is generally conservative, but rehabilitation outcome is still unclear; the aim of this systematic review was to define which domains need to be evaluated for the lumbar stenosis physiotherapy approach, further specifying if the literature suggests patient-centred or objective measures. Methods: A systematic review of the literature according to the PRISMA statement was carried out; the PICO model was used to draw research questions. RCTs about the rehabilitation of lumbar spinal stenosis conducted in the last five years were considered includible, with no difference in terms of stenosis location. The following databases were screened through specific search strings: PubMed, EBSCO, PEDro, Cochrane Database, Scopus, and Google Scholar; two independent researchers assessed results and a third opinion was requested to solve conflicts. Critical appraisal of the included studies was conducted through Pedro Jadad scores. The following data were extracted: author and year, country, sample, intervention, outcome domains, and tools. Results: From 10,069 records, three RCTs were included in the final review stage; they all showed high methodological quality. It is recommended for physiotherapists dealing with lumbar spinal stenosis to assess five main domains: disability, pain, clinical tests, mental wellbeing and kynesiophobia, and quality of life. Domains were mainly assessed through self-reported questionnaires/scales, while objective tests evaluate general lower limb movements, the active range of motion, or the muscles’ endurance. Conclusion: This five-domain evaluation model is reliable and can be practised in each rehabilitation setting (home, outpatient, and hospital); sustainability is guaranteed by the prevalent employment of self-reported tools. Future studies should evaluate the best questionnaire/scale for each domain, especially the definition of a gold standard for pain assessment in patients with lumbar stenosis as this is a challenge for the future.

Background: While the promotion of the beneficial effects of melatonin (MEL) ingestion on the modulation of oxidative stress is widespread, less attention is given to the biological influence that it could exert on the results of hematology and clinical chemistry parameters. This study was undertaken to assess the effects of acute MEL ingestion on these parameters during a maximal running exercise. Methods: In double blind randomized design, 12 professional soccer players [age: 17.54 ± 0.78 yrs, body mass: 70.31 ± 3.86 kg, body height: 1.8 ± 0.08 m; maximal aerobic speed (MAS): 16.85 ± 0.63 km/h; mean ± standard deviation], all males, performed a diurnal (17:00 h ± 30 h) running exercise test (RET) at 100% of their MAS following either MEL or placebo ingestion. Blood samples were obtained at rest and following the RET. Results: Compared to placebo, MEL intake decreased post-exercise biomarkers of liver damage (aspartate aminotransferase, p<0.001; alanine aminotransferase, p<0.001; gamma-glutamyltransferase; p<0.05) and improved post-exercise renal function markers (i.e., creatinine, p<0.001). However, lipid profile, glucose, lactate and leukocyte were not affected by MEL ingestion. Regarding the time to exhaustion, no difference was found between MEL (362.46 ± 42.06 s) and PLA (374.54 ± 57.97 s) conditions. Conclusion: The results of this investigation clearly attest that MEL ingestion before a maximal running exercise might protect athletes from liver damage and perturbation in renal function biomarkers. However, this study comprises an acute MEL supplementation and no assessment on chronic effects or circadian rhythm the day before was done. [ABSTRACT FROM AUTHOR]

Background: Lumbar spinal stenosis causes considerable disability in everyday life; its incidence is increasing due to aging in the world population. First-line treatment is generally conservative, but rehabilitation outcome is still unclear; the aim of this systematic review was to define which domains need to be evaluated for the lumbar stenosis physiotherapy approach, further specifying if the literature suggests patient-centred or objective measures. Methods: A systematic review of the literature according to the PRISMA statement was carried out; the PICO model was used to draw research questions. RCTs about the rehabilitation of lumbar spinal stenosis conducted in the last five years were considered includible, with no difference in terms of stenosis location. The following databases were screened through specific search strings: PubMed, EBSCO, PEDro, Cochrane Database, Scopus, and Google Scholar; two independent researchers assessed results and a third opinion was requested to solve conflicts. Critical appraisal of the included studies was conducted through Pedro Jadad scores. The following data were extracted: author and year, country, sample, intervention, outcome domains, and tools. Results: From 10,069 records, three RCTs were included in the final review stage; they all showed high methodological quality. It is recommended for physiotherapists dealing with lumbar spinal stenosis to assess five main domains: disability, pain, clinical tests, mental wellbeing and kynesiophobia, and quality of life. Domains were mainly assessed through self-reported questionnaires/scales, while objective tests evaluate general lower limb movements, the active range of motion, or the muscles' endurance. Conclusion: This five-domain evaluation model is reliable and can be practised in each rehabilitation setting (home, outpatient, and hospital); sustainability is guaranteed by the prevalent employment of self-reported tools. Future studies should evaluate the best questionnaire/scale for each domain, especially the definition of a gold standard for pain assessment in patients with lumbar stenosis as this is a challenge for the future. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to evaluate the diagnostic accuracy of the clinical tests used to assess the injuries of anterior cruciate ligament. Methods Electronic data bases including Science Direct, PubMed and Google Scholar were searched using related keywords with the aim of finding the articles that clinically evaluated the injuries of anterior cruciate ligament. The quality of the articles was evaluated by Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) scale. Results Ten articles were selected for final analysis. Regarding patient selection domain in risk of bias phase, an equal proportion was seen among low, unclear, and high risk. Regarding index test in risk of bias phase, 80% of the articles had low risk. Considering reference standard in risk of bias phase, 70% of the articles presented a low risk. Considering flow and timing domain in risk of bias phase, 40 % of articles showed either unclear or high risk. Also, for patient selection domain in applicability concerns, half of the articles had a low risk. Regarding index test in applicability concern phase, 80% of articles presented a low risk. Considering reference standard domain of articles in applicability concern phase, 40% had either unclear or low risk. Conclusion Despite the routine use of clinical tests for evaluating injuries of anterior cruciate ligament, due to factors such as different clinical experience and knowledge of the examiners, different time from ligament rupture, and different position of the patient during examination, there is still no consensus on using a test for diagnosis.

Vestibular dysfunction is a disturbance of the body's balance system. The control of balance and gait has a particular influence on the quality of life. Currently, assessing patients with these problems is mainly subjective. New assessment options using wearables may provide complementary and more objective information. Posturography makes it possible to determine the extent and type of posture dysfunction, which makes it possible to plan and monitor the effectiveness of physical rehabilitation therapy. This study evaluates the effectiveness of non-instrumental clinical tests and the instrumental mobile posturography MediPost device for patients with unilateral vestibular disorders. The study group included 40 patients. A subjective description of the symptoms was evaluated using a questionnaire about the intensity of dizziness using the Dizziness Handicap Inventory (DHI) and Vertigo Syndrome Scale—short form (VSS-sf). The clinical protocol contained clinical tests and MediPost measurements using a Modified Clinical Test of Sensory Interaction on Balance. All patients underwent vestibular rehabilitation therapy (VRT) for four weeks. The non-instrumental measurement results were statistically significant, and the best was in the Timed Up and Go test (TUG). In MediPost, condition 4 was the most valuable. This research demonstrated the possibilities of using an instrumental test (MediPost) as an alternative method to assess balance. [ABSTRACT FROM AUTHOR]

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BACKGROUND: Falls are an impactful problem for people with Parkinson's disease (PwPD), impairing the functional capacity and quality of life. Although some predictors of fall risk have been evidenced, the investigation of functional capacity components individual and combined is needed to a more detailed approach to identify fall risk prediction. AIM: To verify the ability of individual and combined functional capacity components in predicting fall risk in PwPD. METHOD: Ninety-six individuals participated in this cohort study. Functional capacity was assessed by Berg Balance Scale, Timed Up and Go, Six-Minute Walk, and Sit-to-Stand tests. The participants who fell at least once during the prospective follow-up of 12 months were considered fallers. A trained evaluator registered the fall’s occurrence weekly. Mann-Whitney U, t-tests, and chi-square tests were used to compare fallers versus non-fallers. Receiver Operating Characteristics curves of functional capacity components (individual and combined) were performed to predict fall risk. RESULTS: Thirty-six (37.5%) PwPD were classified as fallers, being recorded 56 falls, and 60 (62.5%) as nonfallers. There are no differences in functional capacity components between groups. The combined functional capacity components were not able to predict fall risk in PwPD (area under the curve = 0.52; p = 0.77). These components were also unable to predict fall risk when analyzed individually. CONCLUSION: Our results indicated that functional capacity components, individual and combined, are not good predictors of fall risk in PwPD. The multifactorial characteristics of falls and the falls classification might affect the fall risk prediction and should be further investigated. [ABSTRACT FROM AUTHOR]

Background: Individuals with stroke face a distinct set of challenges, barriers and facilitators that need to be understood to streamline efficacy of stroke clinical trials and improve participant retention. Few long-term stroke rehabilitation trials have evaluated participant perception of their laboratory experience. Methods: We collected data regarding trial satisfaction from 33 individuals with stroke who participated in 12 sessions of treadmill training which included pre, post and follow-up non-invasive brain stimulation and clinical assessments. We evaluated factors such as overall trial satisfaction, burden of testing, perceived benefits, perceived barriers, and perceived support using a participant satisfaction questionnaire (PSQ) that assessed participants’ overall trial experience. Results: 97% of our participants found participating in the study to be rewarding and would recommend it to other persons with stroke. Transcranial magnetic stimulation (TMS) testing was found to be the major perceived burden of participation while travelling to the lab was found to be the major perceived barrier to participation. Significant correlations were found between various items of the PSQ and clinical assessments. Conclusions: This study helped us get a preliminary perspective into the benefits and barriers faced by persons with stroke enrolled in a 4-week long clinical trial. We observed that participant satisfaction was driven by various factors including functional status, personal relevance to the research, perceptive physical and mental health improvements, interaction with research personnel, and ease of testing protocols.

The management of SARS-CoV-2 has not yet been clearly determined and is based on potential therapies evaluated during the SARS-CoV and MERS-CoV outbreaks. An emerging potential therapeutic approach currently being evaluated in numerous clinical trials is the remdesivir agent, which acts on COVID-19 by interfering with key steps in the virus replication cycle. It is considered a therapeutic option to be evaluated against COVID-19, based on data on its in vitro and in vivo activity against MERS-CoV and SARS-CoV coronaviruses.In this work, we provide an overview of remdesivir’s discovery, mechanism of action, and the current studies exploring its clinical effectiveness. Recommendations for its use against COVID-19 infection are also summarized.

Vestibular dysfunction is a disturbance of the body’s balance system. The control of balance and gait has a particular influence on the quality of life. Currently, assessing patients with these problems is mainly subjective. New assessment options using wearables may provide complementary and more objective information. Posturography makes it possible to determine the extent and type of posture dysfunction, which makes it possible to plan and monitor the effectiveness of physical rehabilitation therapy. This study evaluates the effectiveness of non-instrumental clinical tests and the instrumental mobile posturography MediPost device for patients with unilateral vestibular disorders. The study group included 40 patients. A subjective description of the symptoms was evaluated using a questionnaire about the intensity of dizziness using the Dizziness Handicap Inventory (DHI) and Vertigo Syndrome Scale—short form (VSS-sf). The clinical protocol contained clinical tests and MediPost measurements using a Modified Clinical Test of Sensory Interaction on Balance. All patients underwent vestibular rehabilitation therapy (VRT) for four weeks. The non-instrumental measurement results were statistically significant, and the best was in the Timed Up and Go test (TUG). In MediPost, condition 4 was the most valuable. This research demonstrated the possibilities of using an instrumental test (MediPost) as an alternative method to assess balance.

Background: Patients with femoroacetabular impingement syndrome (FAIS) are offered hip arthroscopic surgery to decrease hip pain, improve their function, and decrease development of hip osteoarthritis (OA). Nonetheless, long-term follow-up data are few. Purpose: To investigate patient-reported outcomes, clinical tests, reoperations, and radiographic status 5 years after primary hip arthroscopy in patients with FAIS. Study Design: Case series; Level of evidence, 4. Methods: A total of 60 patients (age, 36 ± 9 years; 63% female) diagnosed with FAIS were included in the study and followed for 5 years after hip arthroscopy. Follow-up included Copenhagen Hip and Groin Outcome Score (HAGOS); Hip Sports Activity Scale; and clinical tests (flexion, adduction, internal rotation [FADIR]; flexion, abduction, external rotation [FABER]; and psoas muscle/tendon major pain provocation). Radiographic evaluation included lateral joint-space width (LJSW) and Tönnis classification for hip OA. Reoperations and conversion to total hip replacement (THR) were recorded. We calculated the proportion of patients who exceeded the minimal important change (MIC), achieved the Patient Acceptable Symptom State (PASS), and were within the 95% reference interval of age- and sex-matched persons with no hip problems. Changes were investigated using paired t tests. Results: Compared with preoperatively, all HAGOS subscales were improved substantially 5 years after surgery (mean, ≥21 points; P <.001), and 67% to 89% of patients reported improvements exceeding MIC. Between 56% and 80% achieved PASS, but only 7% to 24% reached the 95% reference interval for the HAGOS subscales. A total of 36% had a positive FADIR test and 25% had a positive FABER test, which were improvements compared with preoperatively (P <.001 for both). Patients with a positive FADIR test had significantly worse HAGOS subscales. Six patients (10%) had a THR since their primary hip arthroscopy. In the remaining patients, the mean LJSW was decreased (-0.4 mm; P =.043), and hip OA had worsened in 9 patients (23%; P =.003). Conclusion: Five years after surgery, the majority of patients experienced HAGOS improvements exceeding MIC while also showing an acceptable PASS. However, clinical tests, participation in physical activities, and quality of life indicated that many patients still experience hip problems. Registration: NCT04590924 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Low back pain (LBP) is common. Motor-control-dysfunctions (MCD) might play an important role in the development of LBP. Find reliable and valid clinical tests to identify MCD in patients with LBP. PubMed and Medline Library databases were searched over a period of ten years till November 2019. Studies examining clinical tests for MCD published in English or German were included. Studies examining clinical outcome, apparatus-based tests or acute pain were excluded. The inclusion/exclusion was determined by stated criteria and consensus between two reviewers. The risk of bias was examined by the critical appraisal tool (Brink and Louw, 2012). The studies were assessed according to aim, population and methods and by implementing criteria from literature (Landies and Koch, 1977 ; Portney and Watkins, 2015). Nine studies (376 patients, 23 tests) met the inclusion criteria. 22 tests examined interrater reliability, five measured intra-rater-reliability, and five assessed the construct/discriminative validity. Fifteen tests showed good/very good interrater-reliability. The intra-rater-reliability ranged from moderate to good. Two studies evaluated construct validity with good results, and one discriminative validity with poor results. Tests with good reliability should be considered for validity testing Of all the tests reviewed, two can be recommended for clinical use. All the other tests should undergo further evaluation or be reconsidered. Relevant studies might be missed, since they were older than ten years, not included in the searched databases, be published in other languages, or were not picked up by the set criteria. [ABSTRACT FROM AUTHOR]

Abstract Background Dexterity impairments caused by carpal tunnel syndrome (CTS) make working and daily activities challenging. We aimed to investigate: i) the relationship between dexterity and nerve conduction studies (NCS) in workers with classic symptoms presentation; ii) the ability of the Functional Dexterity Test (FDT) to discriminate different levels of CTS severity as classified by NCS; iii) the diagnostic accuracy of a clinical battery composed of the FDT, Phalen’s test and Tinel’s sign. Methods In a convenience sample of individuals diagnosed with CTS, we correlated FDT net scores with the NCS-based classification by means of Spearman’s (rho) test. Discriminative ability of the FDT was assessed by ANOVA, and a ROC curve determined cutoff thresholds. Sensitivity, specificity, and likelihood ratios (LRs) were used to investigate the diagnostic accuracy of the clinical battery. Results Data from 180 hands were collected. The FDT was significantly correlated (rho = 0.25, p

To compare trunk muscle endurance among females and males with and without patellofemoral pain (PFP), and to investigate the correlations between trunk muscle endurance and performance of the single leg hop test (SLHT) and forward step-down test (FSDT). Cross-sectional. Laboratory-based study. 110 females and 38 males with PFP, 61 females and 31males without PFP. Anterior and lateral trunk muscle endurance were assessed with the prone and bilateral side-bridge tests, respectively. Performance during the SLHT and FSDT was also assessed. Lower anterior and lateral trunk muscle endurance were identified in females (p <.001; d = −0.74 to −0.86), but not in males (p ≥.806; d = −0.04 to 0.05) with PFP as compared to sex-matched controls. Moderate to large, positive correlations between anterior and lateral trunk muscle endurance with performance in the SLHT and FSDT were identified in females (r =.27 to.50; p <.004) and males (r = 0.27 to 0.59; p <.031) with PFP and females without PFP (r = 0.26 to 0.40; p <.044). Our findings highlight that assessing trunk muscle endurance is advised in females with PFP. Trunk muscle endurance of individuals with PFP may have a role in the performance of hopping and stepping down tasks. • Females with PFP have lower trunk muscle endurance compared to controls. • Males with PFP have no differences in trunk muscle endurance compared to controls. • Trunk muscle endurance is correlated with hopping and stepping down performance. [ABSTRACT FROM AUTHOR]

Context: The forward-step-down (FSD) test may be used to identify underlying pathologies related to lower-extremity injuries. However, research on its interrater reliability is limited. Objective: To assess the interrater reliability of the FSD test with a broad cohort of clinicians and to compare the level of agreement with an expert panel. Design: Single-measure, interrater reliability. Setting: Annual conference of the Israeli Physical Therapy Society. Participants: 15 healthy subjects who performed the FSD test and 142 physical therapists (PTs) who evaluated performance. Methods: Each subject performed the FSD while being videoed. Six videos were selected by an expert panel for analysis. After viewing the videos, FSD performance was rated by 142 PTs, as well as by the expert panel, using a 3-level scale. Main Outcome Measures: Interrater reliability determined by intraclass correlation coefficient (ICC) and percentage of agreement with the expert panel. Results: Fair to good reliability and acceptable agreement were found for the entire sample of raters (ICC -.61, agreement 74%). The percentage of agreement was greater in the subgroup of raters who were familiar with the FSD than in those who were not (78.08% vs 69.32%, respectively, P = .004). Years of work experience did not affect the percentage of agreement (P = .141). Conclusions: Fair to good interrater reliably of the FSD test was demonstrated by a broad cohort of PTs. The findings support the clinical utility of the FSD test as an assessment tool for quality of movement. [ABSTRACT FROM AUTHOR]

Background: Previous systematic reviews and meta-analyses on the diagnostic accuracy of shoulder clinical tests do not reach conclusions regarding subscapularis tears. Purpose: To compare the diagnostic accuracy of commonly used clinical tests for subscapularis tears. Study Design: Systematic review; Level of evidence, 3. Methods: An electronic literature search was conducted using Medline, Embase, and the Cochrane Library/Central. Eligibility criteria were original clinical studies reporting the diagnostic accuracy of clinical tests to diagnose the presence of rotator cuff tears involving the subscapularis. Results: The electronic literature search returned 2212 records, of which 13 articles were eligible. Among 8 tests included in the systematic review, the lift-off test was most frequently reported (12 studies). Four tests were eligible for meta-analysis: bear-hug test, belly-press test, internal rotation lag sign (IRLS), and lift-off test. The highest pooled sensitivity was 0.55 (95% CI, 0.28-0.79) for the bear-hug test, while the lowest pooled sensitivity was 0.32 (95% CI, 0.13-0.61), for the IRLS. In all tests, pooled specificity was >0.90. Conclusion: Among the 4 clinical tests eligible for meta-analysis (bear-hug test, belly-press test, IRLS, and lift-off test), all had pooled specificity >0.90 but pooled sensitivity <0.60. No single clinical test is sufficiently reliable to diagnose subscapularis tears. Registration: PROSPERO (CRD42019137019). [ABSTRACT FROM AUTHOR]

Purpose: Clinical diagnosis of posterosuperior rotator cuff tears remains uncertain due to a lack of evidence-based consensus. This review aimed to compare the diagnostic accuracy of commonly used clinical tests for posterosuperior rotator cuff tears. Methods: The authors conducted an electronic literature search using Medline, Embase and the Cochrane library/Central, to identify original clinical studies reporting diagnostic accuracy of clinical tests to diagnose the presence of posterosuperior rotator cuff tears involving the infraspinatus, supraspinatus and/or teres minor. Results: The electronic literature search returned 1981 records, of which 14 articles were eligible. Among 17 tests included in the systematic review, 6 tests were eligible for meta-analysis: drop arm sign, Jobe test, external rotation lag sign, Hawkins–Kennedy test, Neer test and painful arc abduction test. According to QUADAS-2 criteria, risk of bias was low in 1 study, moderate in 2 and high in 4. The highest pooled sensitivity was 0.77 (CI 0.67–0.85), for the Jobe test, while the lowest pooled sensitivity was 0.38 (CI 0.01–0.98), for the drop arm sign. Conclusions: The Jobe test had the best pooled sensitivity, while the drop arm sign had the best pooled specificity. As no single clinical test is sufficiently reliable to diagnose posterosuperior rotator cuff tears, clinicians should consider various combinations of patient characteristics and clinical tests, as well as imaging modalities, to confirm diagnosis and select the appropriate treatment option. More reliable clinical diagnosis of posterosuperior rotator cuff tears could reduce the reliance on magnetic resonance imaging or arthrography and their associated costs and waiting times. Level of evidence: Level II [ABSTRACT FROM AUTHOR]

Background Pompe Disease (PD) is a rare inherited metabolic myopathy, caused by lysosomal-α-glucosidase (GAA) deficiency, which leads to glycogen accumulation within the lysosomes, resulting in cellular and tissue damage. Due to the emergence of a disease modifying treatment with recombinant GAA there has been a large increase in studies of late onset Pompe Disease (LOPD) during the last decade. Methods The present study evaluates muscle quality in 10 patients with LOPD receiving treatment with enzyme replacement therapy and in 10 age and gender matched healthy controls applying T1-weighted Dixon MR imaging and isokinetic dynamometry. Muscle quality was determined by muscle strength in relation to muscle size (contractile cross-sectional area, CSA) and to muscle quality (fat fraction). A follow-up evaluation of the patients was performed after 8–12 months. Patient evaluations also included: six-minute walking test (6MWT), forced vital capacity, manual muscle testing and SF-36 questionnaire. Results Fat fraction of knee flexors (0.15 vs 0.07, p

The aim of this study was to examine the associations between physical activity level and composite indices of femoral neck strength in a group of young overweight and obese Lebanese men. Eighty overweight and obese (body mass index (BMI) > 25 kg/m2) young men whose ages range between 18 and 35 years participated in this study. Weight and height were measured, and BMI was calculated. Body composition and femoral neck (FN) bone mineral density were measured by dual-energy X-ray absorptiometry (DXA). Compressive strength index (CSI), bending strength index (BSI) and impact strength index (ISI) were calculated. Physical activity level was evaluated by the global physical activity questionnaire (GPAQ). Maximum oxygen consumption (VO 2 max, in L/min) was measured using a valid device. Weight, BMI, fat mass and fat mass percentage were negatively correlated to CSI, BSI and ISI. Physical activity level (h/week) was positively correlated to CSI, BSI and ISI while VO 2 max (mL/min/kg) was positively correlated to CSI and ISI. The positive associations between physical activity and composite indices of femoral neck strength (CSI, BSI and ISI) remained significant after adjustment for body weight. Our study conducted on overweight and obese men shows that physical activity level is a positive determinant of composite indices of femoral neck strength. In overweight men, increasing physical activity level may help to prevent osteoporotic fractures later in life. [ABSTRACT FROM AUTHOR]

The management of SARS-CoV-2 has not yet been clearly determined and is based on potential therapies evaluated during the SARS-CoV and MERS-CoV outbreaks. An emerging potential therapeutic approach currently being evaluated in numerous clinical trials is the remdesivir agent, which acts on COVID-19 by interfering with key steps in the virus replication cycle. It is considered a therapeutic option to be evaluated against COVID-19, based on data on its in vitro and in vivo activity against MERS-CoV and SARS-CoV coronaviruses. In this work, we provide an overview of remdesivir's discovery, mechanism of action, and the current studies exploring its clinical effectiveness. Recommendations for its use against COVID-19 infection are also summarized. [ABSTRACT FROM AUTHOR]

Background. Pompe Disease (PD) is a rare inherited metabolic myopathy, caused by lysosomal-α-glucosidase (GAA) deficiency, which leads to glycogen accumulation within the lysosomes, resulting in cellular and tissue damage. Due to the emergence of a disease modifying treatment with recombinant GAA there has been a large increase in studies of late onset Pompe Disease (LOPD) during the last decade. Methods. The present study evaluates muscle quality in 10 patients with LOPD receiving treatment with enzyme replacement therapy and in 10 age and gender matched healthy controls applying T1-weighted Dixon MR imaging and isokinetic dynamometry. Muscle quality was determined by muscle strength in relation to muscle size (contractile cross-sectional area, CSA) and to muscle quality (fat fraction). A follow-up evaluation of the patients was performed after 8-12 months. Patient evaluations also included: six-minute walking test (6MWT), forced vital capacity, manual muscle testing and SF-36 questionnaire. Results. Fat fraction of knee flexors (0.15 vs 0.07, p < 0.05) and hip muscles (0.11 vs 0.07, p < 0.05) were higher in patients than controls. In patients, contractile CSA correlated with muscle strength (knee flexors: r = 0.86, knee extensors: r = 0.88, hip extensors: r = 0.83, p < 0.05). No correlation was found between fat fraction and muscle strength. The fat fraction of thigh muscles did not correlate with scores from the clinical tests nor did it correlate with the 6MWT. During follow-up, the contractile CSA of the knee extensors increased by 2%. No other statistically significant change was observed. Quantitative MRI reflects muscle function in patients with LOPD, but larger long-term studies are needed to evaluate its utility in detecting changes over time. [ABSTRACT FROM AUTHOR]

Purpose: Investigate characteristics of elderly persons who have exercised regularly over time. Are there differences between persons working out with a physiotherapist and those with subscription at a fitness center? Design: Cross-sectional study. Material: 105 persons over 70 years who have exercised regularly for at least 1 year. The median age (range) was 74 (70-90) years. Method: Questionnaires and physical tests (strength, endurance, balance, mobility). Results: Median (range) number of years with exercise was 20 (1-70) years. 64% reported musculoskeletal disorders and 46% were women. Reported duration, intensity and frequency of training was largely in accordance with recommendations from health authorities. Most participants did endurance- and strength exercises, but only about 50% did balance-exercises. A larger proportion of the group exercising with the physiotherapists reported medical reasons as motivation for exercise. No between group differences were found on physical tests. Conclusion: The results showed that the participants reported training in accordance with the Norwegian Health authorities’ recommendations. No differences were found in elderly training with physiotherapists and those attending a fitness center, except for the motivation for training. Balance and mobility exercises have less focus and should be encouraged to a greater extent also in active elderly.

Abstract Background Magnetic resonance imaging (MRI) is being used extensively in the search for pathoanatomical factors contributing to low back pain (LBP) such as Modic changes (MC). However, it remains unclear whether clinical findings can identify patients with MC. The purpose of this explorative study was to assess the predictive value of six clinical tests and three questionnaires commonly used with patients with low-back pain (LBP) on the presence of Modic changes (MC). Methods A retrospective cohort study was performed using data from Dutch military personnel in the period between April 2013 and July 2016. Questionnaires included the Roland Morris Disability Questionnaire, Numeric Pain Rating Scale, and Pain Self-Efficacy Questionnaire. The clinical examination included (i) range of motion, (ii) presence of pain during flexion and extension, (iii) Prone Instability Test, and (iv) straight leg raise. Backward stepwise regression was used to estimate predictive value for the presence of MC and the type of MC. The exploration of clinical tests was performed by univariable logistic regression models. Results Two hundred eighty-six patients were allocated for the study, and 112 cases with medical records and MRI scans were available; 60 cases with MC and 52 without MC. Age was significantly higher in the MC group. The univariate regression analysis showed a significantly increased odds ratio for pain during flexion movement (2.57 [95% confidence interval (CI): 1.08–6.08]) in the group with MC. Multivariable logistic regression of all clinical symptoms and signs showed no significant association for any of the variables. The diagnostic value of the clinical tests expressed by sensitivity, specificity, positive predictive, and negative predictive values showed, for all the combinations, a low area under the curve (AUC) score, ranging from 0.41 to 0.53. Single-test sensitivity was the highest for pain in flexion: 60% (95% CI: 48.3–70.4). Conclusion No model to predict the presence of MC, based on clinical tests, could be demonstrated. It is therefore not likely that LBP patients with MC are very different from other LBP patients and that they form a specific subgroup. However, the study only explored a limited number of clinical findings and it is possible that larger samples allowing for more variables would conclude differently.

CONTEXT: A large number of special tests have been described to examine the shoulder. It is unknown which combination of clinical tests might be optimal for the diagnosis of rotator cuff tears. AIMS OF OUR STUDY: To estimate the diagnostic accuracy of history and clinical tests and to find out which combination of clinical tests is best in diagnosing supraspinatus tendon tears. SETTINGS AND DESIGN: Diagnostic test accuracy study. METHODOLOGY: One hundred and thirty-four patients with shoulder pain were evaluated with history-taking and clinical tests and magnetic resonance imaging of the shoulder. STATISTICAL ANALYSES: Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratios were calculated with a 2 × 2 table. RESULTS: The combination of Neer test, painful arc test, and full can test yielded 100% sensitivity and 100% specificity in diagnosing supraspinatus tears of any type. CONCLUSIONS: Our study shows that individual clinical tests have moderate diagnostic value for the diagnosis of supraspinatus tears. Diagnostic value improves significantly when clinical tests are combined together. Neer test, painful arc test, and full can test form the best combination in diagnosing supraspinatus tears of any type.

Seated postural control is essential for wheelchair users to maintain proper position while performing activities of daily living. Clinical tests are commonly used to measure seated postural control, yet they are subjective and lack sensitivity. Lab-based measures are highly sensitive but are limited in scope and restricted to research settings. Establishing a valid, reliable, and accessible measurement tool of seated postural control is necessary for remote, objective assessments. Therefore, the purpose of this study was to examine the validity, reliability, and sensitivity of smartphone-based postural control assessments in wheelchair users. Eleven participants (age: 35.4 ± 17.9) completed two experimental visits 1-week apart consisting of three clinical tests: Trunk Control Test (TCT), Function in Sitting Test (FIST), and Tee-shirt Test, as well as, standardized instrumented balance tasks that manipulated vision (eyes open and closed), and trunk movement (functional reach and stability boundary). During these tasks, participants held a smartphone instrumented with a research-grade accelerometer to their chest. Maximum and root mean square (RMS) acceleration in the medial-lateral (ML) and anterior-posterior (AP) axes were derived. Participants were grouped into non-impaired and impaired postural groups based on FIST scores. Spearman rank-order correlations were conducted between the two devices' outcome measurements and between these measures and those of the clinical tests. Receiver operating characteristic (ROC) curves and the area under the curves (AUC) were determined to distinguish participants with and without impaired postural control. The reliability of outcome variables was assessed using inter-class correlations. Strong correlations between outputs derived from the smartphone and research-grade accelerometer were seen across balance tasks (ρ = −0.75–1.00; p ≤ 0.01). Numerous significant moderate correlations between clinical test outcomes and smartphone and research-grade RMS ML accelerometry were seen (ρ = −0.62 to 0.83 (p ≤ 0.044)]. On both devices, the AUC for ROC plots were significant for RMS ML sway during the eyes open task and functional stability boundary (p < 0.05). Reliability of smartphone accelerometry was comparable to the research-grade accelerometer and clinical tests. This pilot study illustrated that smartphone-based accelerometry may be able to provide a valid and reliable assessment of seated postural control and have the ability to distinguish between those with and without impaired postural control.

Context: People with patellofemoral pain (PFP) may have lower performance during the forward step-down and single-leg hop with their painful (unilateral complaints) or most painful (bilateral complaints) limb when compared to pain-free controls. Yet, no study has investigated the appropriateness of using the pain-free/less painful limb as a reference standard in clinical practice or whether deficits might be present depending on the laterality of pain., Objective: To compare performance scores and proportion of side-to-side limb symmetry during the forward step-down and single-leg hop tests among people with unilateral and bilateral PFP, and pain-free controls., Design: Cross-sectional study., Setting: Laboratory., Patients or Other Participants: Fifty-two young adults (18-35 years old) with unilateral PFP, 72 with bilateral PFP, and 76 controls., Main Outcome Measure(s): Group-by-limb interactions on the performance during the step- down (repetitions) and hop test (distance [cm] normalized by the limb length) were investigated using a repeated-measures analysis of covariance controlling for sex. Pairwise comparisons were interpreted using effect sizes. A Chi-square test was used to compare the proportion of symmetry/asymmetry (cutoff point of ≥ 90% for symmetries indices) across groups and tests., Results: Main effects for groups (small-to-medium effects) but not limbs indicated lower performance of both limbs of individuals with unilateral and bilateral PFP compared to controls during forward step-downs and single-leg hop tests. No significant differences for the proportion of symmetry/asymmetry were identified across groups (p ≥ 0.05), which further suggests an impaired physical performance of the contralateral limb., Conclusions: Our results indicate bilateral deficits in the physical performance of people with unilateral and bilateral PFP when compared to pain-free controls during the forward step-down and single-leg hop tests. Limb symmetries indices greater than 90% should be interpreted with caution, as they may overstate the physical performance by not assuming bilateral deficits., Competing Interests: Conflicts Of Interest: We affirm that we have no other conflicts of interest (e.g., personal associations or involvement) that have played a role in the design, execution, analysis and interpretation of data or writing of this manuscript.

Background: Dexterity impairments caused by carpal tunnel syndrome (CTS) make working and daily activities challenging. We aimed to investigate: i) the relationship between dexterity and nerve conduction studies (NCS) in workers with classic symptoms presentation; ii) the ability of the Functional Dexterity Test (FDT) to discriminate different levels of CTS severity as classified by NCS; iii) the diagnostic accuracy of a clinical battery composed of the FDT, Phalen's test and Tinel's sign.Methods: In a convenience sample of individuals diagnosed with CTS, we correlated FDT net scores with the NCS-based classification by means of Spearman's (rho) test. Discriminative ability of the FDT was assessed by ANOVA, and a ROC curve determined cutoff thresholds. Sensitivity, specificity, and likelihood ratios (LRs) were used to investigate the diagnostic accuracy of the clinical battery.Results: Data from 180 hands were collected. The FDT was significantly correlated (rho = 0.25, p <  0.001) with NCS. The FDT was able to discriminate subjects with severe/extreme NCS findings, and two thresholds (0.29-0.36) were identified. Adding the FDT to the provocative tests improved the overall diagnostic accuracy (specificity: 0.97, CI95% 0.83-0.99; LR+: 14.49, CI95% 2.09-100.53).Conclusions: Sensorimotor impairments related to CTS can affect hand dexterity. The FDT discriminated patients with severe NCS involvement. Positive results on the clinical battery (Phalen, Tinel, and FDT) could help to confirm the CTS diagnosis, showing a very high specificity and LR+. On the contrary, the low sensitivity is not able to rule out CTS in individuals with negative results. [ABSTRACT FROM AUTHOR]

Multimodal imaging (MMI) allows a more granular grading of age‐related macular degeneration (AMD) disease severity, with many novel risk factors having been recently identified. With this imaging information, we are better able to counsel our patients with more accurate and individualized progression scenarios. MMI also allows identification of anatomical features that increase our understanding of disease processes involved in progression to late AMD. Treatment protocols for neovascular AMD (nAMD) depend largely on the optical coherence tomography (OCT) appearance to determine disease activity, which allows us to individualize treatment. In geographic atrophy (GA), new intervention trials require the ability to define the extent of GA, so that GA growth rate can be determined. This is achieved through fundus autofluorescence (FAF) imaging, which allows greater accuracy of border identification, as well as revealing FAF patterns predictive of growth rates. As we strive to bring interventions earlier in the disease course, OCT imaging provides an ability to identify the first signs of atrophy, which may serve as novel surrogate biomarkers for GA, thereby facilitating trials. In the future, the use of artificial intelligence (AI) to automatically identify relevant features on MMI could further enhance our ability to determine disease severity, predict progression and assist in identifying disease activity parameters to support clinical decision making when treating nAMD. Newer developments may allow frequent, remote capturing of images, reducing clinic visits, detecting progression and monitoring neovascular activity in‐between clinic visits. Being aware of these new imaging insights in AMD, greatly enhance our clinical management of AMD. [ABSTRACT FROM AUTHOR]

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Breast cancer is the second leading cause of death in the world. Breast cancer research is focused towards its early prediction, diagnosis, and prognosis. Breast cancer can be predicted on omics profiles, clinical tests, and pathological images. The omics profiles comprise of genomic, proteomic, and transcriptomic profiles that are available as high‐dimensional datasets. Survival prediction is carried out on omics data to predict early the onset of disease, relapse, reoccurrence of diseases, and biomarker identification. The early prediction of breast cancer is desired for the effective treatment of patients as delay can aggravate the staging of cancer. In this study, extreme learning machine (ELM) based model for breast cancer survival prediction named eBreCaP is proposed. It integrates the genomic (gene expression, copy number alteration, DNA methylation, protein expression) and pathological image datasets; and trains them using an ensemble of ELM with the six best‐chosen models suitable to be applied on integrated data. eBreCaP has been evaluated on nine performance parameters, namely sensitivity, specificity, precision, accuracy, Matthews correlation coefficient, area under curve, area under precision–recall, hazard ratio, and concordance Index. eBreCaP has achieved an accuracy of 85% for early breast cancer survival prediction using the ensemble of ELM with gradient boosting. [ABSTRACT FROM AUTHOR]

Objective: To determine whether clinical correlates of knee osteoarthritis (OA) affect the outcome of intraarticular steroid injections (IASI) in symptomatic knee OA.Methods: Men and women aged ≥ 40 years with painful knee OA who participated in an open-label trial of IASI completed questionnaires and clinical examination. The Outcome Measures in Rheumatology (OMERACT)-Osteoarthritis Research Society International (OARSI) criteria were used to assess response to therapy in the short term (within 2 weeks). Among those who initially responded, those whose pain had not returned to within 20% of the baseline Knee Injury and Osteoarthritis Outcome Score pain score at 6 months were characterized as longer-term responders. Log-binomial regression was used to examine factors associated with outcome.Results: One hundred ninety-nine participants were included, of whom 146 (73.4%) were short-term and 40 (20.1%) longer-term responders. Compared to short-term nonresponders, participants with these characteristics were more likely to be short-term responders: medial joint line tenderness [relative risk (RR) 1.42, 95% CI 1.10-1.82], medial and lateral joint line tenderness (RR 1.38, 95% CI 1.03-1.84), patellofemoral tenderness (RR 1.27, 95% CI 1.04-1.55), anserine tenderness (RR 1.27, 95% CI 1.06-1.52), and a belief that treatment would be effective [RR/unit increase (range 0-10) = 1.05 (1.01-1.09)]. Aspiration of joint fluid (RR 0.79, 95% CI 0.66-0.95) and previous ligament/meniscus injury (RR 0.63, 95% CI 0.44-0.91) were associated with a reduced risk of being a short-term responder. Compared to initial nonresponders and those whose pain recurred within 6 months, participants with a higher number of pain sites [RR/unit increase (range 0-10) = 0.83, 95% CI 0.72-0.97], chronic widespread pain (RR 0.32, 95% CI 0.10-0.98), perceived chronicity of disease [RR/unit increase (range 0-10) = 0.86, 95% CI 0.78-0.94], and a higher depression score [RR/unit increase (range 0-21) = 0.89, 95% CI 0.81-0.99] were less likely to be longer-term responders.Conclusion: Among patients with symptomatic knee OA, tenderness around the knee was associated with better short-term outcome of IASI. However, clinical-related factors did not predict longer-term response, while those with chronic widespread pain and depressive symptoms were less likely to obtain longer-term benefits. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate whether adolescent elite female and male handball players with shoulder muscle weakness, deficits in shoulder rotation range of motion (ROM) or in joint position sense (JPS), or scapular dyskinesis in the preseason had a higher rate of new shoulder injuries compared to players without these characteristics. DESIGN: Prospective cohort study. METHODS: We studied 344 uninjured players (452 player-seasons, 50% female). We measured their shoulder strength in isometric external rotation (1ER), isometric internal rotation (HR), isometric abduction, and eccentric external rotation, as well as their shoulder ROM, JPS, and scapular dyskinesis, during the preseason. Players were monitored weekly regarding match and training hours and shoulder injuries during 1 or 2 seasons. We used multivariable Cox proportional hazard models to calculate hazard rate ratios related to the first Injury and 95% confidence intervals (CIs). RESULTS: During 2 seasons, the participants reported 48 new shoulder injuries. In female players, the hazard rate ratio was 2.37 (95% Cl: 1.03,5.44) for 1ER weakness and 2.44 (95% Cl: 1.06, 5.51) for HR weakness. The hazard rate ratio was 0,85 (95% Cl: 0.39,1.83) for an lER/IIR ratio of less than 0.75 and 1.53 (95% Cl: 0.36,6.52) for scapular dyskinesis. In male players, the hazard rate ratio was 1,02 (95% Cl: 0.44,2.36) for 1ER weakness, 0.74 (95% Cl: 0.31,1.75) for HR weakness, 2.0 (95% Cl: 0.68, 5.92) for an IER/IIR ratio of less than 0.75, and 3.43 (95% Cl: 1,49,7.92) for scapular dyskinesis. There were no associations between new shoulder injuries and deficits in ROM or JPS. CONCLUSION: In adolescent elite handball, male players with preseason scapular dyskinesis and female players with preseason HR or 1ER shoulder weakness had an increased shoulder injury rate. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate walking and health among woman age 75 yr or older, in the associations between the highest step up performed without support by an individual and balance, walking, and health among women age 75+. Records of the highest step, balance, walking, and health were made for 307 women age 75-93 yr living in the community. Eighty percent managed to climb steps higher than 20 cm. There was a statistically significant negative relationship between age and stair-climbing capacity. The highest steps registered were significantly and independently associated with a short time on the timed up-and-go test, long functional reach, low body weight, lack of perceived difficulty walking outdoors, low number of "missteps" when walking in a figure of 8, longer time in one-leg stance, ability to carry out tandem stance, no walking aids outdoors, and not being afraid of falling. These variables together explained 67% of the variance in the step-height score. [ABSTRACT FROM AUTHOR]