The aim of this meta-analysis was to evaluate the evidence of the effect of pelvic floor muscle training on urinary incontinence after radical prostatectomy.
A bibliographic search was conducted in ...four databases. Studies were grouped according to the intervention program(muscle training versus control and individual home-based versus physiotherapist-guided muscle training).
Eight studies were selected for meta-analysis after satisfying the selection criteria. The data show that pelvic floor muscle training improves continence rate in the short (RR=2.16; p<0.001), medium (RR=1.45; p=0.001) and long term (RR=1.23; p=0.019) after surgery. The number of randomized controlled trials and the heterogeneity in the study population and type of pelvic floor muscle training were the main limitations.
Programs including at least three sets of 10 repetitions of muscle training daily appear to improve continence rate after radical prostatectomy. Our meta-analysis shows that muscle training programs for urinary incontinence provide similar results to those of physiotherapist-guided programs, therefore being more cost-effective.
Introduction
Children with infantile hemiplegia with low or very low bimanual functional performance have great impediments to spontaneously use their affected upper limb, which affects their ...performance of day‐to‐day activities and their quality of life.
Objective
To determine whether the order of application and the dose of modified constraint‐induced movement therapy within a combined (hybrid) protocol influences the results of bimanual functional performance of the affected upper limb and the quality of life of children with congenital hemiplegia (5 to 8 years old) with low/very low bimanual functional performance.
Design
Single‐blinded randomized controlled trial.
Participants
Twenty‐one children with congenital hemiplegia (5 to 8 years old) were recruited from two public hospitals and an infantile hemiplegia association in Spain.
Interventions
The experimental group (n = 11) received 100 hours of intensive therapies for the affected upper limb: 80 hours of modified constraint‐induced movement therapy and 20 hours of bimanual intensive therapy. The control group (n = 10) received the same dose with 80 hours of bimanual intensive therapy and 20 hours of modified constraint‐induced movement therapy. The protocol was provided 2 hours per day, 5 days per week, for 10 weeks.
Outcome Measures
The primary outcome was bimanual functional performance, measured with the Assisting Hand Assessment, and the second outcome was quality of life, measured with the Pediatric Quality of Life Inventory Cerebral‐Palsy module (PedsQL v. 3.0, CP module). Four assessments were performed: Weeks 0, 4, 8, and 10.
Results
The experimental group obtained an increase of 22 assisting hand assessment (AHA) units at week 8 with the application of modified constraint‐induced movement, in contrast with the control group, which obtained an increase of 3.7 AHA units after bimanual intensive therapy. At week 10, the control group showed its greatest increase in bimanual functional performance, with 10.6 AHA units after modified constraint‐induced movement therapy. Regarding quality of life, the greatest improvement occurred after modified constraint‐induced movement, with 13.1 points in the experimental group (80 hours) and 6.3 points in the control group (20 hours). The protocol interaction was statistically significant for bimanual functional performance (p = .018) and quality of life (p = .09).
Conclusions
Modified constraint‐induced movement therapy is more beneficial than bimanual intensive therapy for improving upper limb functioning and quality of life in children with congenital hemiplegia showing low/very low bimanual performance.
ClinicalTrials.gov Identifier
NCT03465046.
Correct blinding is essential for preventing potential biases. The aim of this study was to assess the blinding of participants and a therapist following treatment with transcranial direct current ...stimulation in subjects with fibromyalgia using James’ and Bang’s blinding indexes. Eighty subjects were randomly allocated either active or sham stimulation groups in an intervention of five sessions lasting 20 min each. A questionnaire was delivered to both the therapist and patients after the last session to record their guess of which treatment had been applied. No differences between the groups were noted at baseline in terms of demographic or clinical data. James’ BI was 0.83 (CI 95%: 0.76–0.90) for the patients and 0.55 (CI 95%: 0.45–0.64) for the therapist. Bang’s BI for subjects was −0.08 (CI 95%: −0.24–0.09) and −0.8 (CI 95%: −0.26–0.1) for the active and sham transcranial direct current stimulation groups, respectively. Bang’s BI for the therapist was 0.21 (CI 95%: −0.02–0.43) and 0.13 (CI 95%: −0.09–0.35) for the active and sham transcranial direct current stimulation groups, respectively. Protocols of active and sham transcranial direct current stimulation applied in this study have shown satisfactory blinding of the therapist and subjects with fibromyalgia.
Fecal incontinence severely impacts on quality of life, causing stigmatization and social exclusion. Posterior tibial nerve stimulation (PTNS) is one technique used for treatment. This systematic ...review aims to assess the effectiveness of PTNS for the treatment of fecal incontinence. A literature review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration. Pubmed, Scopus, Web of Knowledge and PEDro databases were searched for both randomized clinical trials and cases series. The outcome variables were treatment effectiveness, severity of incontinence and quality of life; all were measured in the short, mid and long-term after performing both percutaneous and transcutaneous PTNS. Twenty-three studies met the selection criteria. Two clinical trials found significant differences in treatment effectiveness compared to the placebo response. Fifteen cases series observed significant differences in terms of effectiveness, severity and quality of life. All clinical trials achieved a reduction in the number of incontinence episodes and an increase in the deferral time for defecation. Optimal results were achieved by interventions consisting of one or two weekly sessions of a 30-60 minutes duration and the use of pulse widths of 200 µs and frequencies of 10-20 Hz. Percutaneous stimulation did not demonstrate better results compared to transcutaneous application. PTNS is an effective technique for the treatment of fecal incontinence, although long-term interventions are required in order to prolong its effects in the long-term.
RESUMEN La incontinencia fecal supone un importante impacto en la calidad de vida, produciendo estigmatización y exclusión social. La electroestimulación del nervio tibial posterior se emplea como ...técnica de tratamiento de la misma. La presente revisión sistemática tiene por objeto evaluar la eficacia de esta técnica en el tratamiento de la incontinencia fecal. La búsqueda bibliográfica en PubMed, Scopus, Web of Knowledge y PEDro se desarrolló siguiendo la declaración Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), e incluyó ensayos clínicos aleatorizados y series de casos. Las medidas de resultado fueron la eficacia del tratamiento, la severidad de la incontinencia y la calidad de vida, tanto para la estimulación percutánea como transcutánea a corto, medio y largo plazo. Veintitrés estudios reunieron los criterios de selección. Dos ensayos clínicos obtuvieron diferencias significativas respecto al placebo, en términos de eficacia del tratamiento. Quince series de casos concluyeron con mejoras significativas en términos de eficacia, severidad y calidad de vida. Todos los ensayos clínicos y series de casos consiguieron reducir los episodios incontinentes y aumentar el tiempo de aplazamiento de la defecación. Programas de una o dos sesiones por semana, de 30 a 60 minutos, con anchura de pulso de 200 microsegundos y frecuencias de 10-20 hertzios son los óptimos para obtener estos resultados. No se ha demostrado superioridad de la estimulación percutánea frente a la transcutánea. La ENTP resulta efectiva en el tratamiento de la incontinencia fecal aunque se requieren tratamientos a largo plazo para consolidar los efectos de la técnica.
Fibromyalgia is a chronic disease that causes pain and affects patients' quality of life. Current treatments focus on pharmacological therapies for pain reduction. However, patients' psychological ...well-being is also affected, with depression and pain catastrophizing being common. This research addresses the clinicians' need to assess the influence of mental health factors on FM severity compared to pain factors.
A co-development study between FM clinicians and data scientists analyzed data from 166 FM-diagnosed patients to assess the influence of mental health factors on FM severity in comparison to pain factors. The study used the Polysymptomatic Distress Scale (PDS) and Fibromyalgia Impact Questionnaire (FIQ) as FM severity indicators and collected 15 variables including regarding demographics, pain intensity perceived, and mental health factors. The team used an author's developed framework to identify the optimal FM severity classifier and explainability by selecting a number of features that lead to obtaining the best classification result. Machine learning classifiers employed in the framework were: decision trees, logistic regression, support vector machines, random forests, AdaBoost, extra trees, and RUSBoost. Explainability analyses were conducted using the following explainable AI techniques: SHapley Additive exPlanations (SHAP), Partial Dependence Plot (PDP), and Mean Decrease Impurity (MDI).
A balanced random forest with 6 features achieved the best performance with PDS (AUC_ROC, mean = 0.81, std = 0.07). Being FIQ the target variable, due to the imbalance in FM severity levels, a binary and a multiclass classification approaches were considered achieving the optimal performance, respectively, a logistic regression classifier (AUC_ROC, mean = 0.83, std = 0.08) with 6 selected features, and a random forest (AUC_ROC, mean = 0.91, std = 0.04) with 8 selected features. Next, the explainability analysis determined mental health factors were found to be more relevant than pain perceived factors for FM severity.
This study's findings, validated by clinicians, are potentially aligned with FM international guidelines that promote non-pharmacological interventions such as promoting mental well-being of FM patients.
The aim of the study is to examine the effectiveness of extracorporeal shockwave therapy in reducing pain, improving functionality, joint range of motion, quality of life, fatigue, and health status ...self-perception in people with myofascial pain syndrome.
PubMed, the Cochrane Library, CINAHL, the Physiotherapy Evidence Database, and SPORTDiscus were systematically searched for only randomized clinical trials published up to June 2, 2022. The main outcome variables were pain, as reported on the visual analog scale and pressure pain threshold, and functionality. A quantitative analysis was conducted using the inverse variance method and the random effects model.
Twenty-seven studies were included ( N = 595 participants in the extracorporeal shockwave therapy group). The effectiveness of extracorporeal shockwave therapy for relieving pain was superior for the extracorporeal shockwave therapy group compared with the control group on the visual analog scale (MD = -1.7 cm; 95% confidence interval = -2.2 to -1.1) and pressure pain threshold (mean difference = 1.1 kg/cm 2 ; 95% confidence interval = 0.4 to 1.7) and functionality (standardized mean difference = -0.8; 95% confidence interval = -1.6 to -0.04) with high heterogeneity. However, no differences were found between extracorporeal shockwave therapy and other interventions as dry needling, exercises, infiltrations, and lasers interventions.
Extracorporeal shockwave therapy is effective in relieving pain and improving functionality in patients with myofascial pain syndrome compared with control and ultrasound therapy.
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.
Upon completion of this article, the reader should be able to: (1) Determine the effectiveness of radial and focal extracorporeal shockwaves on pain perception, the pressure pain threshold, and functionality in people with myofascial pain syndrome; (2) Describe the intervention protocol of extracorporeal shockwave therapy to improve pain perception in people with myofascial pain syndrome; and (3) Describe the advantages and disadvantages of extracorporeal shockwave therapy versus other intervention such as dry needling.
Advanced.
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Advanced.
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
To estimate the association between daytime napping and cognitive and physical sport performance and fatigue after normal sleep and partial sleep deprivation (less sleep duration than necessary).
...Systematic review and meta-analysis.
The PubMed, Scopus, Web of Science, Cochrane Central, SportDiscus and PsycINFO databases.
Randomised controlled trials on the effect of daytime napping on sport performance and fatigue available from inception to 2 December 2022. Standardised mean differences (SMD) and their 95% compatibility intervals (CI) were estimated with the DerSimonian-Laird method through random effect models.
In the 22 included trials, 291 male participants (164 trained athletes and 127 physically active adults) aged between 18 and 35 years were studied. When performed after a normal night of sleep, napping from 12:30 hours to 16:50 hours (with 14:00 hours being the most frequent time) improved cognitive (SMD=0.69, 95% CI: 0.37 to 1.00; I
=71.5%) and physical performance (SMD=0.99, 95% CI: 0.67 to 1.31; I
=89.1%) and reduced the perception of fatigue (SMD=-0.76, 95% CI: -1.24 to -0.28; I
=89.5%). The positive effects of napping were also confirmed after partial sleep deprivation. Overall, the benefits were higher with a nap duration between 30 and <60 min and when the time from nap awakening to test was greater than 1 hour.
After a night of normal sleep or partial sleep deprivation, a daytime nap between 30 and <60 min has a moderate-to-high effect on the improvement of cognitive performance and physical performance and on the reduction of perceived fatigue.
CRD42020212272.
Today, it is common for software projects to collect measurement data through development processes. With these data, defect prediction software can try to estimate the defect proneness of a software ...module, with the objective of assisting and guiding software practitioners. With timely and accurate defect predictions, practitioners can focus their limited testing resources on higher risk areas. This paper reports the results of three empirical studies that uses an automated genetic defect prediction framework. This framework generates and compares different learning schemes (preprocessing + attribute selection + learning algorithms) and selects the best one using a genetic algorithm, with the objective to estimate the defect proneness of a software module. The first empirical study is a performance comparison of our framework with the most important framework of the literature. The second empirical study is a performance and runtime comparison between our framework and an exhaustive framework. The third empirical study is a sensitivity analysis. The last empirical study, is our main contribution in this paper. Performance of the software development defect prediction models (using AUC, Area Under the Curve) was validated using NASA-MDP and PROMISE data sets. Seventeen data sets from NASA-MDP (13) and PROMISE (4) projects were analyzed running a NxM-fold cross-validation. A genetic algorithm was used to select the components of the learning schemes automatically, and to assess and report the results. Our results reported similar performance between frameworks. Our framework reported better runtime than exhaustive framework. Finally, we reported the best configuration according to sensitivity analysis.
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