The Effects of Pain Neuroscience Education with Conventional Physical Therapy on Chronic Plantar Fasciitis: A Case Study

Background and Purpose: Plantar Fasciitis (PF) is a condition that affects the foot and causes complaints such as pain and stiffness. The most common symptom of this condition is pain. There are many treatment options to deal with this condition, such as conservative therapy, medications, and surgical interventions in rare cases. This case study aims to investigate the potential impact of pain neuroscience education (PNE), combined with a conventional Physical Therapy (PT) program on a 37-year-old-patient with chronic plantar fasciitis. Case description: A 37-year-old male health care professional presented to an outpatient physical therapy clinic with a diagnosis of chronic PF for around two years. The participant had tried several treatment options with no improvement of his symptoms. After undergoing a physical therapy evaluation, he was given a plan of care for twelve sessions by a skilled physical therapist for a six-week period, with each session consisting of 30 minutes of conventional PT, followed by 5 to 15 minutes of PNE. Results: After completing the prescribed plan of care, the patient reported a reduction in subjective symptoms via the Visual Analog Scale (VAS). He also reported improvement with symptoms and functional independence via the Foot Function Index (FFI). The patient reported no change in the quality of sleep via Pittsburg Sleep Quality Index (PSQI). Lastly, he demonstrated no objective improvement in foot pressure with the Navicular Drop Test. Discussion: This case report indicates that PNE, combined with conventional PT for PF can have a positive impact on subjective pain and foot function. PNE should involve many topics about the physiology of pain and the nervous system and should be administered by a certified therapeutic pain specialist. Further studies are recommended to investigate the impact of this intervention in combination with traditional PT for PF in larger populations.

Tendency to Avoid Physical Activity and Sport:Associations with Weight Stigma,and Psychological Distress in a Two-Wave Longitudinal Study

Background:Physical inactivity is a major public health problem worldwide that results in physical and mental health problems.One major issue for physical inactivity is weight stigma(WS),especially perceived WS,which could lead to a tendency to avoid physical activity(PA).To better understand the association between perceived WS and PA,knowledge of the likely mediators in this association such as weight bias internalization(WBI)and psychological distress were investigated in the present study.Methods:Using a two-wave longitudinal study and convenient sampling,388 Taiwan residents participants(55%females;mean age=29.7 years[SD±6.3])completed two surveys six months apart.Body mass index(BMI),Perceived Weight Stigma Scale(PWSS),Weight Bias Internalization Scale(WBIS),Depression,Anxiety,Stress Scale(DASS-21),and Tendency to Avoid Physical Activity and Sport Scale(TAPAS)were assessed.Results:A mediation model controlling for age,gender,and BMI with 5000 bootstrapping resamples was performed.Perceived WS exerted significant direct effects on WBI(β=0.25;p<0.001),psychological distress(β=0.15;p=0.003),and tendency to avoid PA(β=0.10;p=0.027);WBI exerted a significant direct effect on tendency to avoid PA(β=0.47;p<0.001).Standardized indirect effects of WBI and psychological distress on the association between perceived WS and tendency to avoid PA were 0.12 and 0.01,respectively.Conclusion:Given the direct association of perceived WS on the tendency to avoid PA and the mediating role of WBI in this association,interventions addressing perceived WS and WBI may contribute to promoting PA.Therefore,health interventionists(both when planning and executing PA programs)need to consider weight stigmawhen encouraging physical activity.

Effectiveness of a Group Exercise Class vs. Home Exercise Program as a Follow-up to Physical Therapy for Older Adults with High Fall Risk

This quasi-experimental study compared the results of a traditional model of physical therapy(PT)care to a PT wellness model known as GroupHab.The traditional model included discharge from PT with a home exercise program(HEP)to be self-administered with or without the addition of a community-based exercise program.The wellness model included participation in a PT-designed and supervised group exercise program(GroupHab class)in an outpatient clinical setting following discharge from PT.Independent t-tests were used to compare the number of falls,exercise frequency,and exercise duration between the two groups.A repeated measures,analysis of variance(RM-ANOVA)compared changes in balance confidence scores both within and between groups,and a multivariate analysis of variance(MANOVA)analyzed group differences across multiple quality of life ratings using the SF-20.All data were analyzed at the 0.05 alpha level using SPSS 24 statistical software.Our results showed a significantly greater reduction in recurrent falls among the GroupHab wellness group compared to the HEP group(t=2.811,p=0.009).The resulting odds ratio for subsequent falls was 2.2 among HEP participants and 0.2 among GroupHab participants.Exercise adherence was also greater for those who participated in the GroupHab class.They documented greater exercise frequency(t=-3.253,p=0.002)and more exercise minutes(t=-7.188,p<0.001)than those who participated in the HEP.When comparing changes in the participants’balance confidence,we found an average increase of 5%among GroupHab participants compared to a 6%decrease among HEP participants(F=16.877,p<0.001,power=0.981).Although our multivariate analysis of the SF-20 scores revealed no significant difference overall(F=0.768,p=0.73),the univariate analyses showed significantly greater improvements among GroupHab participants in selected areas of physical function.These results suggest that at-risk older adults who are discharged into a functionally-based group exercise class are less likely to experience recurrent falls and are more likely to have more confidence in their balance than those who are discharged with a standard HEP and/or use of community-based exercise classes.

The minimal clinically important difference for gait speed in significant unilateral vestibular hypofunction after vestibular rehabilitation

Gait speed is a valid measure of both physical function and vestibular health.Vestibular rehabilitation is useful to improve gait speed for patients with vestibular hypofunction,yet there is little data to indicate how changes in gait speed reflect changes in patient-reported health outcomes.We determined the minimal clinically important difference in the gait speed of patients with unilateral vestibular hypofunction,mostly due to deafferentation surgery,as anchored to the Dizziness Handicap Index and the Activities Balance Confidence scale,validated using regression analysis,change difference,receiveroperator characteristic curve,and average change methods.After six weeks of vestibular rehabilitation,a change in gait speed from 0.20 to 0.34 m/s with 95%confidence was required for the patients to perceive a significant reduction in perception of dizziness and improved balance confidence.

Whole Body Vibration:The Effect of Position and Frequency on Perceived Exertion in Healthy,Active Adults

Whole Body Vibration(WBV)is a new exercise trend in fitness and performance enhancement.WBV platforms oscillate over a range of frequencies and amplitudes;however no study to date has examined the experience of perceived exertion with differences in vibration frequency and static or dynamic body position,nor examined the difference between sexes based on position and frequency during WBV.The purpose of this study was to assess the effects of position and frequency on perceived exertion during WBV in healthy,active adults.A convenience sample of 39 healthy young adults who participated in moderated exercise was blinded and randomly allocated to six WBV conditions composed of different frequency and position combinations.The participants received instruction,provided informed consent,participated in a warm-up session,and then reported rating of perceived exertion for each WBV condition.A 2×3 within-subjects multivariate approach ANOVA was conducted against an alpha of 0.05.A statistically significant main effect of position(p=0.004)and significant main effect of frequency(p=0.025)were found.Significant marginal means were found between the frequencies of 0 Hz and 50 Hz(p=0.007).Statistically significant differences were found between sexes for all combinations.

Investigation of Leisure Time,Life and Sleep Quality in University Students

Objective:This study aimed to determine the physical activity level of university students,to compare them according to gender and to investigate the effect of physical activity level on sleep and quality of life.Materials and Methods:The research is of an analytical-cross-sectional type.In total,288(181 F,107 M)university students with a mean age of 19.59±2.00 years participated in the study.Height,weight and waist circumference measurements were taken.Participants were asked a questionnaire to determine their socio-demographic characteristics and exercise,the Pittsburgh Sleep Quality Index(PSQI)for assessing sleep quality,Godin Leisure Time Exercise Questionnaire to measure 1-week total physical activity level and SF-36(Brief)to assess the quality of life.Quality of Life Questionnaires were applied by face-to-face questionnaire method.Results:39% of the students were active,18% were moderately active,and 43% were not active enough.When the data of girls and boys were compared,only the height,body weight,waist circumference,Body Mass Index(BMI)and Godin Leisure Time Exercise Questionnaire,SF 36 had a significant difference in emotional role difficulty results in favor of men(p<0.00).Social functioning and general health perception(r=0.116;r=0.119)of the SF-36 quality of life questionnaire were found to be positively correlated with the energy/vitality component of Godin leisure time questionnaire and SF-36 quality of life questionnaire(r=0.121).There was a low positive correlation between sleep quality and all components of the SF-36 quality of life questionnaire(0.168<r<0.333).Conclusion:As a result,only 39% of university students are active and spend more time on computers and phones.Boys had a physically more active lifestyle than girls.In the young population,physical activity did not affect sleep quality,but sleep quality affected quality of life.For health and quality life,the participation of individuals in regular exercise should be encouraged,physical activity programs should be organized and motivated in universities.

Psychological Impacts of COVID-19 Pandemic on the Brazilian Population: Occupational Analysis

Context and objectives :The unexpected pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affected several activities and exposed workers, students and the large mass of unemployed people to an economic and psychological pressure that could lead to various problems, such as anxiety, fear, depression and insomnia, consequently causing impairment of quality of life. Method: A cross-sectional study was conducted using the COVID-19 Peri-Traumatic Distress Index (CPDI) and the Fear of COVID-19 Scale (FCV-19S) to measure peri-traumatic stress and fear, such as psychological reactions during the 2019 coronavirus disease (COVID-19) pandemic. An online spreadsheet was used as a data collection tool to send the questionnaire and scales to a sample of 1,844 participants. Data were analyzed in groups of health professionals, students and teachers, and an analysis was performed between unemployed and employed people in order to evaluate the impact of employment on the population’s mental health. Results: All groups presented from moderate to high CPDI and FCV-19S scores, and students and unemployed people had higher levels of stress and fear. Conclusion: COVID-19 pandemic had a significant impact on the Brazilian population, with students and the unemployed showing the highest rates of stress and fear.

Evaluation of Fear and Peritraumatic Distress during COVID-19 Pandemic in Brazil

COVID-19 pandemic continues to spread exponentially worldwide, especially in America. At the end of August 2020, Brazil is one of the most affected countries with more than three and a half million cases and up to 114,250 deaths. This study aims to assess the fear and peri-traumatic stress during the COVID-19 pandemics in Brazil, to enhance infection control methods, appropriate interventions, and public health policies. A cross-sectional survey has been conducted from April 12th to 18th using the Peri-Traumatic Distress Scale (CPDI) and the Fear Scale (FCV-19S) aiming to measure the peri-traumatic stress and fear as psychological reactions during the COVID-19 pandemic. For that purpose, an online spreadsheet was used to send the questionnaire and scales to a sample of 1844 participants as a collecting information tool. Significant positive relationship (r = 0.660, p < 0.001) and internal consistencies on CPDI and FCV-195 scales (Cronbach Alfa scores 0.90 and 0.88 respectively) were shown. Results highlight significant gender differences as in both scales women’s mean scores are higher showing that it is paramount that women’s voices were represented in policy spaces as socially constructed gender roles place them in a strategic position to enhance multi-level interventions (primary and secondary effects of COVID-19), equitable policies, and new approaches to control the pandemic.

Effect of Kinesio Taping on Hand Function in Hemiparetic Patients

Introduction: Cerebrovascular accident (CVA) is the second most frequent cause of death in the world. Nevertheless, most victims do survive and need treatment, and hand function is one that has to be dealt with in the rehabilitation process. Kinesio&reg?Taping (KT) is a bandaging method that can be applied along the muscle fibers to provide stimulation. Studies have shown its efficacy in providing afferent stimuli to weakened muscles, thus eliciting contraction with greater recruiting of motor units and inducing neuroplasticity. Benefits to the paresthesia hand have not been reported. Objective: Investigate the effects of KT on hand function in hemiparetic patients. Material and Methods: An evaluator-blinded, randomized clinical trial involving stroke victims was carried out in a physical therapy outpatient clinic. One group underwent KT intervention and the other was a control group. The Modified Ashworth Scale (MAS) and the Box and Block Test (BBT) were used as assessment tools. A data entry form was used in the Epi-info 7 software and descriptive statistics was thus calculated. The software BioStat 5.0 was employed when doing statistical tests. Associations were regarded as statistically significant when p 0.05. Results: Eight individuals were randomly assigned to two groups. All those who had received treatment with KT had spasticity improved by one point, but there was no significant improvement in BBT. Conclusion: KT was effective when it came to improving spasticity and it may be an option in rehab, but it had no effect on gross manual dexterity. Nevertheless, it can be of help as part of a functional training program.

Pulmonary Thromboembolism in a Soccer Player after COVID-19 Infection: Case Report

Background:Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),which causes COVID-19,is characterized by an increased risk of thromboembolic events.However,more than 80%of patients are asymptomatic or have only minor/mild symptoms.In addition,diagnosing thromboembolism in athletes is challenging,as symptoms can be confused with musculoskeletal complaints or physical deconditioning.Case presentation:Here we report the case of a previously healthy 34-year-old professional soccer player with COVID-19 infection and genetic predisposition to thrombosis.At baseline,he was fit,had no symptoms,did not require hospital admission due to a COVID-19 infection,and was started on a five-day course of azithromycin and dexamethasone therapy.After 10 days of returning to professional activity,he developed pulmonary embolism following a COVID-19 infection during a physical exercise session.Angiotomography showed positive acute and subacute pulmonary thromboembolism,being treated with rivaroxaban 20 mg/day continuously.The shared decision-making between the medical team and the athlete was not to return to professional soccer,given the quantifiable risk.Considerations:This case illustrates the potential risk of COVID-19-induced pulmonary thromboembolism,which can be affected by genetic predisposition and dexamethasone therapy or the consequences of COVID-19.In this clinical period,the athlete’s condition may be overlooked due to the masking effects of other clinical conditions and physical abnormalities.The residual effects of COVID-19 disease can appear late,requiring caution and follow-up by the medical team before releasing the athlete into a training program.

Effect of strength training on knee proprioception in patients with knee osteoarthritis:A systematic review and meta-analysis

Proprioception is significantly impaired in knee osteoarthritis(KOA),contributing to reduced functionality.Strength training(ST)is essential in KOA by improving muscle strength,although it may also be effective in improving proprioception.The purpose was to determine the effect of ST on knee proprioception in KOA patients.Pubmed,CINAHL,Scopus,WOS,and PEDro were searched for randomized controlled trials(RCTs)(inception to March 2023).Comparisons for ST were physical exercise different from ST,non-exercise-based interventions,and no intervention.Methodological quality was assessed using the PEDro scale,and risk of bias(RoB)using the Cochrane tool.Meta-analyses were performed by comparison groups using the standardized mean difference(SMD)(Hedge's g)with random effects models,also considering subgroups by proprioception tests.Finally,six RCTs were included.The mean PEDro score was 6.3,and the highest proportion of biases corresponds to per-formance,selection,and detection.The meta-analysis indicated that only when compared with non-intervention,ST significantly improved knee proprioception for the joint position sense(JPS)(activeþpassive),JPS(passive),and threshold to detect passive motion(TTDPM)subgroups(g=-1.33[-2.33,-0.32],g=-2.29[-2.82,-1.75]and g=-2.40[-4.23,-0.58],respectively).However,in the knee JPS(active)subgroup,ST was not significant(g=-0.72[-1.84,0.40]).In conclusion,ST improves knee proprioception compared to non-intervention.However,due to the paucity of studies and diversity of interventions,more evidence is needed to support the effectiveness of ST.Future RCTs may address the limitations of this review to advance knowledge about pro-prioceptive responses to ST and contribute to clinical practice.

Healing Wounds under Mechanical Stress: A Case Example

This paper challenges the concept that the essential element in wound healing is to offload pressure. We suggest a change in approach that recognizes the integumentary system as one which, like all other body systems, adapts to the stresses put upon it. We use a clinical case example to illustrate the use of intentional mechanical stress to promote wound healing and include a review of the relevant literature. The intent of this publication is to call for a new look at clinical practice regarding wound healing and to call for future research directed at investigation of this theory.

Psychological Impacts Related to Stress and Fear during the COVID-19 Pandemic: Cardiovascular Diseases, Diabetes and Psychological Disorders as Risk Factors

Background and Aims: Patients and the general public are under insurmountable psychological pressure which may lead to various psychological problems, such as anxiety, fear, depression, and insomnia, causing, consequently, the impaired quality of life. Psychological crisis intervention plays a pivotal role in the overall deployment of health-related quality of life and disease control. A novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARS- CoV-2), a pathogen of the new coronavirus disease (COVID-19), has affected several sector activities, including people’s health. To enhance infection control methods, appropriate interventions, and public health policies, the present study aims to assess the fear and peri-traumatic stress during the COVID-19 inBrazil. Method: A cross-sectional survey has been conducted from April 12th to 18th from 2020, using the Peri-Traumatic Distress Scale (CPDI) and the Fear Scale (FCV-19S) aiming to measure the peri-traumatic stress and fear as psychological reactions during the COVID-19 pandemic. For that purpose, an online spreadsheet was used to send the questionnaire and scales to a sample of 1844 participants as a collecting information tool. After the data analysis, the individuals were separated into 4 groups: Group 1 (1232) population without chronic health conditions;group 2 (298) patients with previous psychological suffering, group 3 (229) patients with cardiovascular diseases, group 4 (71) patients with diabetes. For analysis, G1 were considered control for comparison with groups 2, 3 and 4. Results: All the groups showed the CPDI and FCV-19S increased in comparison with the G1 group. Concerning CPDI, the G 3 was increased when compared to G1, G2 and G4. The G3 had the FCV-19S higher in comparison with G1, G2 and G4. The Wilcoxon-Mann-Whitney test showed a statistical difference between the control group in comparison with 2 and 3 groups (Mann-Whitney p < 0.05). Conclusion: The COVID-19 pandemic had a significant impact on the Brazilian population, with patients with heart disease and hypertension presenting the highest numbers of stress and fear, with numbers comparable and even higher than those who reported previous psychological distress.

Exercise-induced hypoalgesia in chronic neck pain: A narrative review

Chronic neck pain(CNP)is a worldwide health problem with several risk factors.One of the most widely used treatments for managing this condition is therapeutic exercise,which could generate a response called exerciseinduced hypoalgesia(EIH).There is no consensus on the best exercise modality to induce hypoalgesia.Therefore,this review aims to analyze and synthesize the state-of-the-art about the hypoalgesic effect of exercise in subjects with CNP.We included articles on EIH and CNP in patients older than 18 years,with pain for more than three months,where the EIH response was measured.Articles that studied CNP associated with comorbidities or measured the response to treatments other than exercise were excluded.The studies reviewed reported variable results.Exercise in healthy subjects has been shown to reduce indicators of pain sensitivity;however,in people with chronic pain,the response is variable.Some investigations reported adverse effects with increased pain intensity and decreased pain sensitivity,others found no clinical response,and some even reported EIH with decreased pain and increased sensitivity.EIH is an identifiable,stimulable,and helpful therapeutic response in people with pain.More research is still needed on subjects with CNP to clarify the protocols and therapeutic variables that facilitate the EIH phenomenon.In addition,it is necessary to deepen the knowledge of the intrinsic and extrinsic factors that influence EIH in people with CNP.