An Exploration of Perceived Barriers to Evidence-Based Practice among Physiotherapy Students during Clinical Placement—A Descriptive Cross-Sectional Study

Introduction: Teaching evidence-based practice (EBP) has become part of the standard curriculum for health care students and professionals. Teaching EBP skills should be emphasized in entry level physiotherapy education as physiotherapists are expected to practice in an evidence-based way. Identifying barriers to the application of EBP in clinical placement plays an important role in developing physiotherapy programs. The present study aimed to explore physiotherapy students’ perceived barriers toward the use of EBP during their clinical placements. Methods: A cross-sectional study was conducted among third-year physiotherapy students at the Faculty of Health Sciences University of Ljubljana, Slovenia. Participants were asked to complete a self-reported questionnaire that was developed by the researcher based on previously developed surveys. The analyses applied included descriptive statistics and calculation of frequencies, percentages, means and standard deviations of the participating students’ scores. Results: Fifty final-year undergraduate students with a mean age of 23.7 (±4.3, range 23 - 27) years participated in the study. Majority of participants reported lack of formal training, poor ability to critically appraise research evidence, insufficient time, their clinical supervisors, or other therapists not using EBP when treating patients as barriers towards practicing EBP. Conclusions: Physiotherapy students face many challenges in terms of training, organizational, and personal barriers toward the use of EBP during clinical placement. Lack of formal training, lack of research skills, insufficient time and their clinical supervisors or other therapists not using EBP when treating patients, emerged as top barriers. This fact underlines the importance of teaching students EBP skills, which would enable them to use EBP when working with patients.

Effectiveness of Musculoskeletal Emergency Physiotherapy Practitioners

Relevance and Method: The purpose of this project was to evaluate the effectiveness of the Emergency Physiotherapy Practitioner (EPP) service against quality care indicators identified as part of the “gold standard” for emergency care in England. The study was prospective and evaluated time to initial assessment, total time in the emergency department and un-planned re-attendance rate within a seven-day period for all patients seen by the EPP’s over a period of one year. Outcomes: One thousand and seven patients were seen by EPPs in the emergency department. The median wait time for treatment by an EPP was 34.5 minutes (95th percentile = 122). Regional median wait time was 45 minutes (95th percentile = 138). National median wait time was 55 minutes (95th percentile = 192). Median total time spent in ED for patients seen by EPPs was 99 minutes (95th percentile = 224). Regional median total time in ED was 223 (95th percentile = 239). Nationally median total time in ED was 136 minutes (95th percentile = 336). Three percent of patients seen by an EPP returned to the ED, compared to 6% regionally and 7.5% nationally. Conclusions: EPPs excelled in all three indicators and exceeded regional and national figures. The re-return rate met the current standard of being less than 5%. It could be justified that the addition of the EPPs to the emergency department was an efficient and effective service development.

Device-measured physical activity and sedentary time in the Nordic countries:A scoping review of population-based studies

Purpose:The purpose of this scoping review was to summarize and describe the methodology and results from population-based studies of physical activity and sedentary time measured with devices in the Nordic countries(Denmark,Finland,Iceland,Norway,and Sweden)and published in 2000 or later.Methods:A systematic search was carried out in PubMed and Web of Science in June 2023 using predefined search terms.Results:Fourteen unique research projects or surveillance studies were identified.Additionally,2 surveillance studies published by national agencies were included,resulting in a total of 16 studies for inclusion.National surveillance systems exist in Finland and Norway,with regular survey waves in school-aged children/adolescents and adults.In Denmark,recent nationally representative data have been collected in school children only.So far,Sweden has no regular national surveillance system using device-based data collection.No studies were found from Iceland.The first study was conducted in 2001 and the most recent in 2022,with most data collected from 2016 to date.Five studies included children/adole scents 6-18 years,no study included preschoolers.In total 11 studies included adults,of which 8 also covered older adults.No study focused specifically on older adults.The analytical sample size ranged from 205 to 27,890.Detailed methodology is presented,such as information on sampling strategy,device type and placement,wear protocols,and physical activity classification schemes.Levels of physical activity and sedentary time in children/adolescents,adults,and older adults across the Nordic countries are presented.Conclusion:A growing implementation of device-based population surveillance of physical activity and sedentary behavior in the Nordic countries has been identified.The variety of devices,placement,and data procedures both within and between the Nordic countries highlights the challenges when it comes to comparing study outcomes as well as the need for more standardized data collection.

Paraspinal strength and electromyographic fatigue in patients with sub-acute back pain and controls:Reliability,clinical applicability and between-group differences

BACKGROUND Paraspinal muscle strength and fatigue are considered important in low back pain(LBP)prevention and rehabilitation.High reliability of paraspinal strength and electromyographic(EMG)-fatigue parameters has not been universally reported.Moreover,the discriminative validity of these parameters requires further exploration,under the threat of potentially poor reliability of the methods examined.AIM To investigate the reliability and discriminative validity of paraspinal strength and EMG-related fatigue in subjects with recurrent LBP and healthy participants.METHODS Test-retest measurements were performed in 26 healthy and 66 LBP volunteers,for reliability.Paraspinal isometric maximal and mean strength were determined with a maximum voluntary isometric contraction(MVIC)protocol,performed in a custom-made device.For the fatigue test,participants performed a 60% MIVC level continuous isometric contraction of the paraspinals,in conjunction with EMG analysis from 4 muscle sites of the lumbar spine.Initial median frequency(IMF),the median frequency slope(MFslope),as well as the root mean square(RMS)slope EMG parameters were used as fatigue measures.Data were analysed with repeated measures ANOVA for test-retest differences.For reliability,the intraclass correlation coefficient(ICC3,1),standard error of the measurement(SEM)and the smallest detectable difference(SDD)were reported.Group-related differences for fatigue measures were analysed with a Multivariate Analysis of Covariance,with age,weight and strength as covariates.RESULTS Isometric strength presented statistically significant between-day differences(P<0.01),however these did not exceed 10%(healthy:7.2%/LBP-patients:9.7%)and ICC reliability values were excellent,yet test-retest error was increased for the patient group(healthy:ICC3,1:0.92-0.96,SEM:5.72-5.94 Hz,SDD:18.51%-18.57%/LBP-patients:ICC3,1:0.91-0.96,SEM:6.49-6.96,SDD:30.75%-31.61%).For the frequency data,IMF reliability was excellent(healthy:ICC3,1:0.91-0.94,SEM:3.45-7.27 Hz,SDD:9.56%-20.14%/patients:ICC3,1:0.90-0.94,SEM:6.41-7.59 Hz,SDD:17.75%-21.02%)and of MF raw and normalised slopes was good(healthy:ICC3,1:0.78-0.82,SEM:4.93-6.02 Hz,SDD:13.66-16.67%/LBP-patients:ICC3,1:0.83-0.85,SEM:6.75-7.47 Hz,SDD:18.69%-20.69%).However,the reliability for RMS data presented unacceptably high SDD values and were not considered further.For discriminative validity,less MVIC and less steep MFslopes were registered for the patient group(P<0.01).CONCLUSION Reliability and discriminative ability of paraspinal strength and EMG-related frequency parameters were demonstrated in healthy participants and patients with LBP.

Assessing the quality of studies in meta-analyses: Advantages and limitations of the Newcastle Ottawa Scale

One of the most important points in the meta-analyses is certainly represented by the assessment of the quality of the studies included in such research. The meta-analyses are considered the highest level of evidence in science. Also for this reason, the quality of the studies included should be accurately evaluated by standardized tools. The overall results of the metaanalysis depend indeed also on a rigorous evaluation of the studies quality. Among all the possible tools for this complex evaluation, the Newcastle Ottawa Scale(NOS) is one of the most used worldwide, above all for observational studies. In this review, we will discuss the strengths and limitation of the NOS, also on the basis of the branch of science in which it has been applied.

Effects of functional training on geometric indices of heart rate variability

Background： Geometric methods provide an analysis of autonomic modulation using the geometric properties of the resulting pattern, and represent an interesting tool in the analysis of heart rate variability （HRV）. The aim of this study was to evaluate the impact of functional training on cardiac autonomic modulation in healthy young women using the geometric indices of HRV. Methods： Data were analyzed from 29 women, and were stratified into a functional training group （FTG, n = 13; 23.00 ± 2.51 years; 21.90± 2.82 kg/m2） and a control group （CG, n = 16; 20.56 ± 1.03 years; 22.12±3.86 kg/m2）. The FTG received periodized functional training for 12 weeks. The cardiac autonomic modulation of both groups was evaluated before and after this training, and a qualitative analysis was performed using the Poincar6 plot. Results： There was a significant increase in the difference of the triangular index （RRTri）, SDI, SD2, and RR intervals in the FTG as compared to the CG, and the qualitative analysis from the Poincar6 plot showed an increase in the dispersion of beat-to-beat and long-term RR intervals in the functional group after training. No changes were observed in the triangular interpolation of RR interval histogram （TINN） or SD1/SD2. Conclusion： Functional training had a beneficial impact on autonomic modulation, as characterized by increased parasympathetic activity and overall variability, thus highlighting the clinical usefulness of this type of training.

Direct anterior approach vs Hardinge in obese and nonobese osteoarthritic patients:A randomized controlled trial

BACKGROUND The increased prevalence of obesity has resulted in orthopedic surgeons being likely to face many patients with a high body mass index(BMI)who warrant total hip arthroplasties(THAs)over the coming years.Studies'findings considered the postoperative clinical,and functional outcomes in these patients are controversial,and selecting the most appropriate surgical approach remains debatable.AIM To compare pain-levels,functionality,and quality-of-life in obese and nonobese osteoarthritic patients who have undergone primary total hip arthroplasty through either direct-anterior-approach(DAA)or Hardinge-approach.METHODS One hundred and twenty participants(>50 years)were divided into four groups according to the surgical approach(DAA or Hardinge)and patients'BMI(nonobese<30 kg/m^(2)vs obese≥30 kg/m^(2)).Outcomes were measured preoperatively and postoperatively(6^(th)and 12^(th)week).Pain was measured with Face Pain Scale-Revised(FPS-R).Functionality was measured with Timed Up&Go(TUG)test and Modified Harris Hip Score-Greek version(MHHS-Gr).Quality-of-life was evaluated with the 12-item-International Hip Outcome Tool-Greek version(iHOT12-Gr)(Clinical Trial Identifier:ISRCTN15066737).RESULTS DAA vs Hardinge:(week 6)DAA-patients showed 12.2% less pain,more functionality(14.8% shorter TUG-performance time,21.5% higher MHHS-Gr),and 38.16% better quality-of-life(iHOT12-Gr)compared to Hardinge-patients(all P values<0.001).These differences were further increased on week 12(all P values≤0.05).DAA-obese vs Hardinge-obese:(week 6)DAA-obese patients had less pain,shorter TUG-performance time,better MHHS-Gr and iHOT12-Gr scores than Hardinge-obese(all P values<0.01).(Week 12)Only the TUG-performance time of DAA-obese was significantly shortened(22.57%,P<0.001).DAAnonobese vs DAA-obese:no statistically significant differences were observed comparing the 6th and 12th weeks'outcomes.CONCLUSION DAA-groups reported less pain,more functionality and better quality-of-life,compared to the Hardinge-groups.The DAA benefited obese and nonobese patients,similarly yet faster,suggesting that it should be the more preferred choice for obese patients,instead of Hardinge.However,more comparative studies with more extended follow-up periods are needed to confirm our results and better evaluate all patients'long-term outcomes.

Self-compassion and resilience mediate the relationship between childhood exposure to domestic violence and posttraumatic growth/stress disorder during COVID-19 pandemic

BACKGROUND Studies have indicated that childhood exposure to domestic violence is a common factor in posttraumatic growth(PTG)and posttraumatic stress disorder(PTSD),but it is unclear whether PTG and PTSD share a common/different underlying mechanism.AIM To explore the common/different underlying mechanism of PTG and PTSD.METHODS Between February 12 and 17,2020,a nationwide cross-sectional online survey was conducted in China among 2038 university students,and a self-administered questionnaire was used for the data collection.The data included demographic characteristics,such as age,gender,and subjective social economic status,and childhood exposure to domestic violence scale that was selected from the Chinese version of revised Adverse Childhood Experiences Question,Self-compassion Scale,Connor–Davidson Resilience Scale,Posttraumatic Growth Inventory,and the Abbreviated PTSD Checklist-Civilian version.A structural equation model was used to test the hypotheses.RESULTS Exposure to domestic violence was significantly associated with PTG and PTSD via a 1-step indirect path of self-compassion(PTG:β=-0.023,95%CI:-0.44 to-0.007;PTSD:β=0.008,95%CI:0.002,0.014)and via a 2-step indirect path from self-compassion to resilience(PTG:β=-0.008,95%CI:-0.018 to-0.002;PTSD:β=0.013,95%CI:0.004-0.024).However,resilience did not mediate the relationship between exposure to domestic violence and PTG and PTSD.CONCLUSION PTG and PTSD are common results of childhood exposure to domestic violence,which may be influenced by self-compassion and resilience.

Multicomponent Assessment of the Geometrical Uncertainty and Consequent Margins in Prostate Cancer Radiotherapy Treatment Using Fiducial Markers

The aim is to compute all sources of geometrical uncertainty in prostate radiotherapy using fiducial markers and determine the safety treatment margins. Based on the markers position, correlations between prostate rotation/deformation and rectal and bladder fillings as well as changes in prostate volume during the treatment course are analyzed. The study includes 375 pre-treatment CBCT images from 15 prostate cancer patients treated with hypofractionated radiotherapy. The position coordinates of the markers were obtained from each image acquisition. In addition, rectum and bladder were outlined on CBCTs. The intrafractional error was estimated by an additional post-treatment CBCT acquired on alternate days. Tau-Kendall analysis was performed to correlate organ fillings with prostate rotation/deformation. Delineation uncertainty was assessed from contours of 10 patients performed by two radiation oncologists and repeated twice. The CT contouring was assisted by a multiparametric MR approach combining a T2-weighted with diffusion-weighted imaging, and a gradient recalled echo for fiducial marker identification. Uncertainty associated to treatment unit was estimated from phantom measurements. The obtained clinical margins were 4.4, 7.3, 5.1 mm in the Left-Right, Superior-Inferior, and Anterior-Posterior directions, respectively, being the contouring the most important contribution. The mechanical limitations of the beam delivery system and the associated imaging device entailed errors of the same order as prostate motion, rotation or deformation. Weak correlations between variation of the rectal volume and the presence of rotations/deformations were found (correlation coefficient 0.182, p = 0.001 for rotations around lateral axis;correlation coefficients 0.1, p < 0.05 for deformations). The distance between markers decreased with session number, becoming more pronounced from fraction 13 and reaching 1 - 1.8 mm at the end of the treatment. In summary we have determined the optimal treatment margins based on geometrical uncertainty assessment using van Herk formalism. An appropriate preparation of rectum and bladder involves minimizing the effect of prostate rotations/deformations. The prostate tends to decrease in size during the treatment which could influence treatment re-planning strategies.

The International Classification of Functioning, Disability and Health as Applied to Parkinson’s Disease: A Literature Review

Objective: The objective was to describe and quantify the development of the use of the International Classification of Functioning, Disability and Health (ICF), and portray the different components that have been used in the case of Parkinson’s disease (PD). Method: A literature review was carried out as from articles published in the electronic databases PubMed, Cochrane, SciELO (Scientific Electronic Library Online) and PEDro (Physiotherapy Evidence Database). The following descriptors were used: “Parkinson disease”, “ICF”, “Doença de Parkinson” and “CIF”, combining them by the use of “and”. The search covered the period from October 2014 to March 2015. Results: 50 scientific articles were found, which were evaluated by means of a thematic interpretive reading of the title and summary, finally arriving at 4 articles which related ICF to PD. In sequence the contents of the 4 articles were evaluated: organizing the author, year published, type of study, objective, methodology, ICF domains described, sample, main results and conclusions with respect to the use of ICF in PD patients, into a frame. Conclusions: The choice of ICF items provides an exact description of the functionality and incapacity domains in PD. However, it was evident that ICF had been little used to classify PD patients and help in the elaboration of intervention programs for these patients.

Physical activity and chronic back conditions:A population-based pooled study of 60,134 adults

Background:Little is known about the association between different types of physical activity(PA)and chronic back conditions(CBCs)at the population level.We investigated the association between levels of total and type-specific PA participation and CBCs.Methods'.The sample comprised 60,134 adults aged>16 years who participated in the Health Survey for England and Scottish Health Survey from 1994 to 2008.Multiple logistic regression models,adjusted for potential confbunders,were used to examine the association between total and type-specific PA volume(walking,domestic activity,sport/exercise,cycling,football/rugby,running/jogging,manual work,and housework)and the prevalence of CBCs.Results'.We found an inverse association between total PA volume and prevalence of CBCs.Compared with inactive participants,the fully adjusted odds ratio(OR)for very active participants(≥15 metabolic equivalent h/week)was 0.77(95%confidence interval(CI):0.69—0.85).Participants reporting≥300 min/week of moderate-intensity activity and≥75 min/week of vigorous-intensity activity had 24%(95%CI:6%—39%)and 21%(95%C1:11%—30%)lower odds of CBCs,respectively.Higher odds of CBCs were observed for participation in high-level manual domestic activity(OR=1.22;95%CI:1.00-1.48).Sport/exercise was associated with CBCs in a less consistent manner(e.g.,OR=1.18(95%CI:1.06—1.32)for low levels and OR=0.82(95%CI:0.72—0.93)for high levels of sport/exercise).Conclusion'.PA volume is inversely associated with the prevalence of CBCs.

Grounded theory qualitative approach from Foucault's ethical perspective:Deconstruction of patient self-determination in the clinical setting

This paper aims to explain the construction of the autonomous subject from Foucault's ethical perspective for the qualitative analysis of interprofessional relationships,patient-professional relationships,and moral ethics critique.Foucault tried to break loose from the self,which is merely the result of a biopol-itical subjectivation and constituted an interpersonal level.From this,different elements involved in the decision-making capacity of patients in a clinical setting were analysed.Firstly,the context in which decision-making occurs has been explained,distinguishing between traditional practices involved in self-care and the more modern conceptions that make certain possible transformations.Secondly,an attempt is made to explain the formation of the medicalisation of society using the transformations of what Foucault called"techniques of the self".Finally,the ethical framework for a subject's"self-creation",insisting more on the exercises of self-subjectivation,reinforcing the ethics of the self by itself,the"care of the self",has been explained.The role of the patient is understood as an autonomous subject to the extent that the clinical institution and the professionals involved comprehend how the patient’s autonomy in the clinical environment is constituted.All these elements could generate grounded theory on the qualitative methodology of this phenomenon.The current ethical model based on universal principles is not useful to provide a capacity for patients decision-making,relegating to the background their opinions and beliefs.Consequently,a new ethical perspective emerges that aims to return the patient to the fundamental axis of attention.

Experience of implanting fiducial markers for 504 cases with body malignant solid tumors

Objective:The purpose of the study is to investigate the technical points,effects and complications of fiducial marker implantation within target areas before the CyberKnife treatment on body malignant solid tumors.Methods:Five hundred and four cases of patients with body malignant solid tumors accepted fiducial implantation within target areas under CT guidance before the treatment of CyberKnife.Observe the complications and effect.Results:Among the 504 cases,500 cases successfully accepted the implantation(a success rate of 99.2%).158 patients felt pain at the punctured sites and 3 patients had tachycardia.33 patients had abdominal pain after the surgery due to a small amount of bleeding in the needle passage during liver puncturing process.Among the 19 lung cancer patients who accepted lung paracentesis,1 case had light pneumothorax and 1 case got light haemothorax.Among the 453 patients who accepted liver paracentesis,6 had fiducial migration.Conclusion:The method of fiducial implantation within target areas before treating body malignant solid tumor with CyberKnife is minimally invasive and comparatively secure.

The Enjoyment of Physical Activity Determines Body Mass Index in Young People with Physical Disabilities

Objective: This study aimed to 1) compare the body mass index (BMI) and patterns of out-of-school activity participation in young people with and without physical disabilities, and 2) examine the relationship between BMI and the activity participation patterns among young people with physical disabilities. Methods: Thirty-nine young persons with physical disabilities (mean age ± standard deviation: 18.79 ± 1.99 years) and 70 healthy individuals (mean age ± standard deviation: 18.64 ± 0.74 years) participated in the study. The diversity, intensity, companionship, location and enjoyment of participation in activities were evaluated using the Children’s Assessment of Participation and Enjoyment (CAPE) scale. Body height and weight were obtained and BMI was calculated. Results: People with physical disabilities, regardless of their gender, had significantly lower CAPE-derived scores in almost all types of activity than the control participants (p < 0.05). Moreover, BMI was significantly higher in the group with physical disabilities than in the control group (p < 0.001). Regression analysis further showed that the CAPE score for physical activity explained 17.2% of the variance in BMI (p = 0.021). Conclusion: Young people with physical disabilities generally had lower levels of activity participation and a higher BMI than their healthy counterparts. The perception of enjoyment during physical activities was an important determinant of BMI in this group of participants.

Physiotherapeutic techniques used in the management of patients with peripheral nerve injuries

Peripheral nerve injuries affect a wide range of functional,manual and social function,and frequently lead to constant disabilities.After complete transection of nerve,axonal degeneration process gives rise to a variety of symptoms including hyperesthesia,reduced or altered sensation,pain and atrophy（Lee and Wolfe,2000）.With an array of choices for surgical and treating peripheral nerve injuries, there is also, a lot of new, coherent strategies on rehabilitation and physiotherapy protocols - which should be indispensable after injury. Physiotherapy, with a view to compensate dysfunctions relieves in sensory symptoms and creates grater neuroplasticital potential, forms essential part of the treatment for people after peripheral nerve injuries （Inoue et al., 2003）.

Management of Patients with COVID-19 Infection in Acute Settings: A Position Paper for Cardiopulmonary Physiotherapists by the Association of Clinical and Academic Physiotherapists of Nigeria

Coronavirus Disease-2019 (COVID-19) refers to a clinical disorder caused by a new coronavirus that emerged in late 2019. According to the European Centre for Disease Prevention and Control, as of June 23 2020, over 15 million confirmed cases of patients with COVID-19 have been reported globally, out of which over 600,000 deaths were recorded. The management of patients with COVID-19 is critical. This position paper was prepared through online search for the available guideline in the literature to serve as treatment guidelines for Nigerian physiotherapists and possibly physiotherapists in Sub-Saharan Africa region.

Inter- and Intra-Rater Reliability of the Australian Spasticity Assessment Scale in Adults with Acquired Brain Injury

Objective: This study investigated the inter- and intra-rater reliability of the Australian Spasticity Assessment Scale (ASAS) in adults with unilateral hypertonia following acquired brain injury. The ASAS has been shown to be superior to other clinical tools for the assessment of spasticity in children with cerebral palsy but reliability has not been previously examined in adults. Method: Four muscle groups were rated on one occasion by four assessors using the ASAS in sixteen adults with unilateral hypertonia following acquired brain injury. Twelve participants returned one week later for reassessment by the same assessors. Results: Overall inter-rater reliability of the ASAS using a quadratic weighted Kappa was moderate (Kqw 0.58) with ranges from moderate to good (Kqw 0.42 - 0.70). Agreement between raters was greatest for soleus muscle and least for wrist flexors. Overall intra-rater reliability of each of the four raters was moderate to good (Kqw 0.48 - 0.79). Agreement within raters was greatest for soleus muscle and least for biceps muscle. Conclusions: The ASAS may represent an appropriate alternative to the clinical scales currently used to assess spasticity;however inter and intra-rater reliability data from this investigation are lower than those which have previously been reported by experienced users of the ASAS in children with cerebral palsy. Further investigation with a larger sample size is warranted before any firm conclusions may be drawn about the reliability and validity of this tool to assess spasticity in adults with acquired brain injury.

Effects and correlates of continuous training programme on psychosocial status and white blood cell count in men with essential hypertension: A randomized controlled trial

Aim: The aim of this study was to determine the effect and relationship of continuous training programme on WBCc and psychosocial status of black African (Nigerian) subjects with hypertension. Methods: Nigerian subjects with diagnosis of hypertension attending the hypertensive clinic of Murtala Muhammed Specialist Hospital (MMSH), Kano, Nigeria form the population for the study. 217 subjects with mild to moderate (systolic blood pressure [SBP] between 140-180 & diastolic blood pressure [DBP] between 90-109 mmHg) essential hypertension were age matched and randomly grouped into continuous (112) & control groups (105). The continuous group involved in an 8 weeks continuous training (60%-79% HR max) of between 45 minutes to 60 minutes, 3 times per week, while the controls group remain sedentary. SBP, DBP, WBCc, VO2max and psychosocial status were assessed. Student t test and Pearson correlation test were used in data analysis. Results: The study revealed a significant beneficial effect of continuous training programmes on VO2max, SBP, DBP, WBCc and psychosocial status (p < 0.05). Psychosocial status and WBCc were positively and negatively correlated respectively with VO2max at p < 0.01. Conclusions: This study supports the recommendations of moderate intensity (continuous) training program as an adjunct multi-therapy in blood pressure, inflammatory and psychosocial stress management in hypertension.

Tuberculosis Arthritis of the Sternoclavicular Joint

Tuberculosis remains a public health problem in developing country particularly in Tunisia. Bone location of tuberculosis infection is increasing and is often misdiagnosed due to the weakness of clinical presentation in early stages. Sternoclavicular joint tuberculosis is rare and unusual location of this disease. However, antibiotherapy and surgical debridement is still the basis of treatment. We report a case of sternoclavicular joint tuberculosis with a follow up of four years. The patient was treated surgically and put under antibiotherapy during twelve months. The site was sterilized. We report this case to show that debridement and antibiotherapy still efficient in tuberculous bone affection no matters the location.

Efficacy of Customized Foot Orthoses in Children Aged 6 - 7 Years Old with Symptomatic Flexible Flat Foot (SFFF)

Introduction: Pediatric Flat Foot (PFF) is a deviation consisting of loss of the Medial Longitudinal Arch in children. Purpose: Aim of this study is to collect information on the recent literature and to investigate through clinical assessment and parental observations the effectiveness of the use of foot orthotics by children with SFFF. Method: 20 children aged 6 - 7 years old with mobility difficulties were evaluated before and after a six-month treatment with orthotics regarding pain, post-game pain, fatigue during game, balance impairment, gait deviations, falls, clumsiness, activity avoidance and worn soles. Results: Study results indicate that foot orthotics (FOs) appears to have a positive impact on the advance of pain, post game pain, gait deviations and worn insoles. It is implied that orthoses have a great potential as a treatment for SFFF. Thorough comprehension of the literature evidence, as well as composition of supplementary studies of larger pediatric populations is essential in order to reach a consensus on the use of foot orthotics (FOs) by children SFFF.