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    Monitoring modifiable injury risk factors over an in-season mesocycle in semi-professional female field hockey players.
    (BMC Sports Science, Medicine and Rehabilitation, 2024) Sánchez Migallón, Violeta; Moreno Pérez, Víctor; Terrón Manrique, Pablo; Fernández Ruiz, Vicente; Blake, Catherine; Navandar, Archit; López Samanés, Álvaro
    Objective This study aimed to determine changes of modifiable injury risk factors and fatigue parameters during a mesocycle (4 months of the competitive season) in semi-professional female field hockey players (Spanish 2nd Division). Methods Fourteen female field hockey players (age: 22.6 ± 4.9 years) participated in the study over 4 months of the competitive season (September–December 2019). The players were tested each month for their: maximal isometric knee flexion, hip adduction, and abduction muscle strength; passive straight leg raise and ankle dorsiflexion range of motion (ROM); countermovement jump height; and perceptual fatigue (through a perceived well-being questionnaire). Results Statistical differences were reported in isometric knee flexion torque in the dominant and non-dominant limb (p = < 0.001, ηp2 = 0.629,0.786 respectively), non-dominant isometric hip abductors torque (p = 0.016, ηp2 = 0.266) and isometric hip adductors torque in dominant and non-dominant limbs (p = < 0.001, ηp2 = 0.441–546). Also, significant differences were reported in the straight leg raise test (p = < 0.001, ηp2 = 0–523, 0.556) and ankle dorsiflexion (p = 0.001, ηp2 = 0.376, 0.377) for the dominant and non-dominant limb respectively. Finally, the jump height measured showed significant differences (p = <.001, ηp2 = 0.490), while no differences were reported in perceived well-being parameters (p = 0.089–0.459). Conclusion Increments in isometric muscle strength and fluctuations in ROM values and vertical jumping capacity are reported over an in-season mesocycle (i.e., 4 months of the competitive season). This information can be used to target recovery strategies to make them more efficient.
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    Is ankle taping effective to limit the ankle dorsiflexion in a single-training session? An observational study in semi-professional basketball players.
    (Sao Paulo Medical Journal, 2024) Romero-Morales, Carlos; Pedraza-García, Isabel; López-López, Daniel; Berlanga, L. A.; De la Cruz, Blanca; Calvo Lobo, César
    BACKGROUND: Ankle taping (AT) is effective in preventing ankle sprain injuries in most common sports and is employed in rehabilitation and prevention sports. OBJECTIVE: This study aimed to investigate the effectiveness of AT to restricting excessive frontal plane ankle movements in semi-professional basketball players throughout the training session. DESIGN AND SETTING: A cross-sectional study was performed at the Universidad Europea de Madrid. METHODS: Forty male and female semi-professional basketball players were divided into two groups. The ankle dorsiflexion range of motion (ROM) and interlimb asymmetries in a weight-bearing lunge position were evaluated at four time points: 1) with no tape, 2) before practice, at 30 min of practice, and 3) immediately after practice. RESULTS: In male basketball players, no differences were observed in the right and left ankles between the baseline and 30 min and between baseline and 90 min of assessment. In female athletes, significant differences were reported between baseline and pre-training assessments for the right ankle and also significant differences between baseline and 90 min in both ankles. CONCLUSIONS: Ankle taping effectively decreased the ankle dorsiflexion ROM in male and female basketball players immediately after application. However, ROM restriction was very low after 30 and 90 min, as assessed in a single basketball practice. Therefore, the classic taping method should be revised to develop new prophylactic approaches, such as the implementation of semi-rigid bracing techniques or the addition of active stripes during training or game pauses.
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    Reliability of Panoramic Ultrasound in Assessing Rectus Femoris Size, Shape, and Brightness: An Inter-Examiner Study.
    (Bioengineering, 2024) Buffet García, Jorge; Plaza-Manzano, Gustavo; Varol, Umut; Ríos-León, Marta; Díaz-Arribas, María José; Álvarez González, Javier; Sánchez Jorge, Sandra; Valera-Calero, Juan Antonio
    Extended field-of-view ultrasound (US) imaging, also known as panoramic US, represents a technical advance that allows for complete visualization of large musculoskeletal structures, which are often limited in conventional 2D US images. Currently, there is no evidence examining whether the experience of examiners influences muscle shape deformations that may arise during the glide of the transducer in panoramic US acquisition. As no studies using panoramic US have analyzed whether two examiners with differing levels of experience might obtain varying scores in size, shape, or brightness during the US assessment of the rectus femoris muscle, our aim was to analyze the inter-examiner reliability of panoramic US imaging acquisition in determining muscle size, shape, and brightness between two examiners. Additionally, we sought to investigate whether the examiners’ experience plays a significant role in muscle deformations during imaging acquisition by assessing score differences. Shape (circularity, aspect ratio, and roundness), size (cross-sectional area and perimeter), and brightness (mean echo intensity) were analyzed in 39 volunteers. Intraclass correlation coefficients (ICCs), standard error of measurements (SEM), minimal detectable changes (MDC), and coefficient of absolute errors (CAE%) were calculated. All parameters evaluated showed no significant differences between the two examiners (p > 0.05). Panoramic US proved to be reliable, regardless of examiner experience, as no deformations were observed. Further research is needed to corroborate the validity of panoramic US by comparing this method with gold standard techniques.
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    Association between Gray-Scale Ultrasound Imaging and Serological Creatine Kinase for Quantifying Exercise-Induced Muscle Damage: An Observational Study.
    (Bioengineering, 2024) Buffet García, Jorge; Vicente Campos, Davinia; López Redondo, Mónica; Sánchez Jorge, Sandra; Álvarez González, Javier; Plaza-Manzano, Gustavo; Seijas-Fernández, Tamara; Valera-Calero, Juan Antonio
    Limited evidence has verified if ultrasound imaging (US) can detect post-exercise muscle damage based on size, shape, and brightness metrics. This study aimed to analyze the correlation between creatine kinase (CK) concentration and (as a biomarker of muscle damage) changes in US gray-scale metrics after an exercise-induced muscle damage protocol. An observational study was conducted at a private university lab located in Madrid. Twenty-five untrained and asymptomatic volunteers were enrolled in this study. Baseline demographic data and body composition metrics were collected. In addition, the rectus femoris US data and CK concentration were assessed at baseline and after inducing muscle damage (24 and 48 h later). After calculating time differences for all the outcomes, the correlation between the changes observed with US and biomarkers was assessed. Significant CK concentration increases were found 24 h (p = 0.003) and 48 h (p < 0.001) after exercise. However, no significant changes in muscle size, shape, or brightness were found in any location (p > 0.05 for all). In addition, no significant associations were found between CK changes and US changes (p > 0.05 for all). Gray-scale US is not a sensitive tool for detecting muscle damage, as a protocol of exercise-induced muscle damage confirmed with CK produced no significant gray-scale US changes after 24 or 48 h. In addition, US and CK changes after 24 and 48 h were not associated with each other.
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    Perception and use of flywheel resistance training amongst therapists in sport.
    (Frontiers in Sports and Active Living, 2023) De Keijzer, Kevin L.; Raya-González, Javier; Samané; López Samanés, Álvaro; Moreno Pérez, Víctor; Beato, Marco
    Flywheel (isoinertial) resistance training is a valid strength training method that has been incorporated in sport for decades, yet little is known about how therapists working in sport apply flywheel resistance training. We aimed to describe and understand current application and perception of flywheel resistance training amongst therapists working in sport. Seventy- three therapists (13 ± 10 years of experience) started part of this survey with 52 completing the entire electronic questionnaire. Nine multiple choice questions on application and perceptions of flywheel training (prerequisites, use of technology, barriers, and upper- and lower-body exercises) preceded two 6-point Likert scale statements on strength and reduction of injury likelihood. Most therapists (47/73) either used or intended to use flywheel training with their athletes and stated familiarisation would be a priority prior to initiating training. Although more than half suggested they were confident flywheel training could enhance strength (27/52) and muscular prehabilitation outcomes (40/52), many remained unsure. Nonetheless, it appears that therapists would mostly include flywheel training within prehabilitation (40/52) or during the later stages of rehabilitation (37/52). To monitor progress, therapists slightly prefer power (30/52) over velocity outputs, while few would not use them at all. Although therapists would prescribe most exercises - the squat, rotational exercise, and unilateral leg curl would be the most selected. Meanwhile, therapists reported remain most unsure or would avoid prescribing the lateral squat and unilateral hip extension. The biggest perceived barriers to flywheel training are equipment cost/space, evidence, and scheduling. The investigation provides valuable insight into the application and perception of flywheel training amongst therapists working in sport.
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    Plant-Based Nutrition: Exploring Health Benefits for Atherosclerosis, Chronic Diseases, and Metabolic Syndrome—A Comprehensive Review.
    (Nutrients, 2023) Peña-Jorquera, Humberto; Cid-Jofré, Valeska; Landaeta-Díaz, Leslie; Petermann-Rocha, Fanny; Martorell, Miquel; Zbinden Foncea, Hermann; Ferrari, Gerson; Jorquera-Aguilera, Carlos; Cristi-Montero, Carlos
    Atherosclerosis, chronic non-communicable diseases, and metabolic syndrome are highly interconnected and collectively contribute to global health concerns that reduce life expectancy and quality of life. These conditions arise from multiple risk factors, including inflammation, insulin resistance, impaired blood lipid profile, endothelial dysfunction, and increased cardiovascular risk. Adopting a plant-based diet has gained popularity as a viable alternative to promote health and mitigate the incidence of, and risk factors associated with, these three health conditions. Understanding the potential benefits of a plant-based diet for human health is crucial, particularly in the face of the rising prevalence of chronic diseases like diabetes, hypertension, dyslipidemia, atherosclerosis, and cancer. Thus, this review focused on the plausible advantages of consuming a type of food pattern for the prevention and/or treatment of chronic diseases, emphasizing the dietary aspects that contribute to these conditions and the evidence supporting the benefits of a plant-based diet for human health. To facilitate a more in-depth analysis, we present separate evidence for each of these three concepts, acknowledging their intrinsic connection while providing a specific focus on each one. This review underscores the potential of a plant-based diet to target the underlying causes of these chronic diseases and enhance health outcomes for individuals and populations.
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    Body Composition and Demographic Features Do Not Affect the Diagnostic Accuracy of Shear Wave Elastography.
    (Bioengineering, 2023) Varol, Umut; Valera-Calero, Juan Antonio; Fernández-de-las-Peñas, César; Buffet García, Jorge; Plaza-Manzano, Gustavo; Navarro-Santana, Marcos José
    Shear-wave elastography (SWE) is an imaging method that can be used to estimate shear wave speed and the Young’s modulus based on the measured shear wave speed under certain conditions. Up to date, no research has analyzed whether body composition factors contribute to ultrasound attenuation, refraction, reflection, and, consequently, SWE measurement errors. Therefore, this study aimed to analyze the association between demographic and body composition features with SWE errors for assessing the anterior scalene stiffness (which is a key structure in patients with neck pain and nerve compressive syndromes). Demographic (sex, age, height, weight, and body mass index), body composition (water volume, fat mass, and lean mass), and anterior scalene muscle stiffness (Young’s modulus and shear wave speed) data were collected from a sample of asymptomatic subjects. After calculating the absolute SWE differences between trials and the reliability estimates, a correlation matrix was generated to quantify the association among all the variables. A total of 34 asymptomatic subjects (24 males) were included in the analyses. Test–retest reliability was excellent for assessing the Young’s modulus and shear wave velocity (ICC = 0.912 and 0.923, respectively). No significant associations were found between age, height, weight, body mass index, body fat, lean mass, or water volume with SWE errors (p > 0.05). However, the Young’s modulus error was associated with the stiffness properties (p < 0.01), whereas shear wave speed was associated with none of them (all, p > 0.05). A detailed procedure can reliably assess the AS muscle stiffness. None of the sociodemographic or body composition features assessed were correlated with SWE errors. However, baseline stiffness seems to be associated with Young’s modulus error.
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    Ultrasonographic reliability and repeatability of simultaneous bilateral assessment of diaphragm muscle thickness during normal breathing.
    (Quantitative Imaging in Medicine and Surgery, 2023) Molina-Hernández, Nerea; López Chicharro, José; Becerro-de-Bengoa-Vallejo, Ricardo; Losa-Iglesias, Marta Elena; Rodríguez-Sanz, David; Vicente Campos, Davinia; Marugán-Rubio, Daniel; Gutiérrez-Torre, Samuel Eloy; Calvo Lobo, César
    Background: The diaphragm is considered the main muscle involved in breathing and also linked to trunk stabilization functions. Up to date, rehabilitative ultrasound imaging (RUSI) has been the most used technique to evaluate unilaterally the transcostal diaphragm thickness. Nevertheless, the inspiratory activity of both hemi-diaphragms is bilaterally performed at the same time, and its simultaneous evaluation with a thoracic orthosis could improve its assessment as well as its re-education with visual biofeedback of both hemi-diaphragms at the same time. The purpose was to evaluate the reliability and repeatability of simultaneous thickness measurements of both hemi-diaphragms bilaterally during normal breathing using a thoracic orthosis that allowed bilateral fixation of both right and left ultrasound probes. Methods: The study was conducted in 46 healthy subjects, whose diaphragm thickness was measured bilaterally and simultaneously in the anterior axillary line during relaxed breathing with a designed thoracic orthosis and 2 ultrasound tools. Intra-examiner (same examiner), inter-examiner (2 examiners), intrasession (1 hour) and inter-session (1 week) reliability and repeatability between each pair of measurements of diaphragm muscle thickness were analyzed during normal breathing. Results: Reliability and repeatability for intra-session evaluations using the thoracic orthosis were excellent to evaluate simultaneous thickness of both hemi-diaphragms by bilateral probes fixation (intraclass correlation coefficient =0.919–0.997; standard error of measurement =0.002–0.007 cm; minimum detectable change =0.006–0.020 cm), without systematic errors (P>0.05) between each pair of measurements. Nevertheless, inter-session evaluations varied from good to excellent using the bilateral probes fixation (intraclass correlation coefficient =0.614–0.984; standard error of measurement =0.006–0.028 cm; minimum detectable change =0.017–0.079 cm), although some systematic errors were presented (P<0.05). Conclusions: Good to excellent reliability and repeatability was shown for simultaneous thickness measurements of both hemi-diaphragms bilaterally during normal breathing. Despite systematic errors were presented for some inter-examiner assessments, the use of the thoracic orthosis that allowed bilateral fixation of ultrasound probes could be recommended for simultaneous hemi-diaphragms breathing re-education by visual biofeedback.
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    A Randomized Controlled Trial to Evaluate the Impact of an Exercise Therapy Program Based on Sports in People with Acquired Brain Injury: Discover Study Protocol.
    (Journal of Clinical Medicine, 2023) Gutiérrez Suárez, Andrea; Pérez-Rodríguez, Marta; García-Hernández, Juan José; Rodríguez-Romero, Beatriz
    Introduction: Acquired brain injury (ABI) constitutes a significant and growing global public health concern. People with ABI often face a range of physical and psychosocial challenges that span the domains of “body structure and function”, “activity”, and “participation”, as defined by the International Classification of Functioning, Disability, and Health. Multidisciplinary approaches based on exercise therapy with social leisure activities are essential to improve physical recovery and health-related quality of life after injury. Methods: Adults with ABI, aged > 18 years, in the subacute or chronic stage (within more than one month after the injury) will be recruited through a rehabilitation center. Adults will be randomized to receive either a racket sports-based exercise therapy program combined with usual care (sET) or usual care alone (UC) using a random number sequence with a 1:1 allocation ratio. sET intervention consists of an 8-week exercise therapy program focusing on different racket sports skills, 1 h in duration, 2 days/week. It will be delivered by a physiotherapist in tailored, face-to-face, group-based sessions. Primary outcomes will be the health-related quality of life (SF-36) and upper extremity motor function (Fugl-Meyer Assessment-Upper Extremity Scale). Discussion: The study proposes an intervention that combines sports-based exercise therapy with usual care. It aims to determine whether this intervention improves the health-related quality of life and upper limb motor function in adults with ABI compared with usual care alone. The results of this study may have clinical implications for the rehabilitation of this population.
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    The Effect of a Hydroxytyrosol-Rich, Olive-Derived Phytocomplex on Aerobic Exercise and Acute Recovery.
    (Nutrients, 2023) Roberts, Justin D.; Lillis, Joseph B.; Marqués Pinto, Jorge; Chichger, Havovi; López-Samanes, Alvaro; Del Coso, Juan; Zacca, Rodrigo; Willmott, Ashley G. B.
    Abstract: There is current scientific interest in naturally sourced phenolic compounds and their potential benefits to health, as well as the effective role polyphenols may provide in an exercise setting. This study investigated the chronic effects of supplementation with a biodynamic and organic olive fruit water phytocomplex (OliPhenolia® [OliP]), rich in hydroxytyrosol (HT), on submaximal and exhaustive exercise performance and respiratory markers of recovery. Twenty-nine recreationally active participants (42 ± 2 yrs; 71.1 ± 2.1 kg; 1.76 ± 0.02 m) consumed 2 × 28 mL·d −1 of OliP or a taste- and appearance-matched placebo (PL) over 16 consecutive days. Participants completed a demanding, aerobic exercise protocol at ~75% maximal oxygen uptake ( . VO2max) for 65 min 24 h before sub- and maximal performance exercise tests prior to and following the 16-day consumption period. OliP reduced the time constant (τ) (p = 0.005) at the onset of exercise, running economy (p = 0.015) at lactate threshold 1 (LT1), as well as the rating of perceived exertion (p = 0.003) at lactate turnpoint (LT2). Additionally, OliP led to modest improvements in acute recovery based upon a shorter time to achieve 50% of the end of exercise . VO2 value (p = 0.02). Whilst OliP increased time to exhaustion (+4.1 ± 1.8%), this was not significantly different to PL (p > 0.05). Phenolic compounds present in OliP, including HT and related metabolites, may provide benefits for aerobic exercise and acute recovery in recreationally active individuals. Further research is needed to determine whether dose-response or adjunct use of OliP alongside longer-term training programs can further modulate exercise-associated adaptations in recreationally active individuals, or indeed support athletic performance.
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    Dietary Nitrate Ingestion Does Not Improve Neuromuscular Performance in Male Sport Climbers.
    (Journal of Human Kinetics, 2023) Berlanga, L. A.; López Samanés, Álvaro; Martín López, Julio; Martinez de la Cruz, Rubén; Garcés Rimón, Marta; Roberts, Justin; Bertotti, Gabriele
    Beetroot juice (BJ) is commonly used as an ergogenic aid in endurance and team sports, however, the effect of this supplement on climbing performance is barely studied. The purpose of the current study was to investigate the effect of acute BJ ingestion on neuromuscular and biochemical variables in amateur male sport climbers. Ten physically active sport climbers (28.8 ± 3.7 years) underwent a battery of neuromuscular tests consisting of the half crimp test, the pull-up to failure test, the isometric handgrip strength test, the countermovement jump (CMJ) and the squat jump (SJ). Participants performed the neuromuscular test battery twice in a cross-over design separated by 10 days, 150 min after having consumed either 70-mL of BJ (6.4 mmol NO3-) or a 70-mL placebo (0.0034 mmol NO3-). In addition, nitrate (NO3-) and nitrite (NO2-) saliva concentrations were analysed, and a side effect questionnaire related to ingestion was administrated. No differences were reported in particular neuromuscular variables measured such as the CMJ (p = 0.960; ES = 0.03), the SJ (p = 0.581; ES = −0.25), isometric handgrip strength (dominant/non dominant) (p = 0.459–0.447; ES = 0.34–0.35), the pull-up failure test (p = 0.272; ES = 0.51) or the maximal isometric half crimp test (p = 0.521–0.824; ES = 0.10–0.28). Salivary NO3- and NO2- increased significantly post BJ supplementation compared to the placebo (p < 0.001), while no side effects associated to ingestion were reported (p = 0.330–1.000) between conditions (BJ/placebo ingestion). Acute dietary nitrate supplementation (70-mL) did not produce any statistically significant improvement in neuromuscular performance or side effects in amateur sport climbers.
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    Reproducibility of Anterior Scalene Stiffness Measurement with Shear Wave Elastography: An Inter-Examiner Reliability Study.
    (Ultraschall in der Medizin, 2023) Varol, Umut; Sánchez-Jiménez, Elena; Valera-Calero, Juan Antonio; Plaza-Manzano, Gustavo; Fernández-de-las-Peñas, César; Navarro-Santana, Marcos José; Acebes Sánchez, Jorge; Ortega-Santiago, Ricardo; Sánchez Jorge, Sandra
    Purpose: Although previous studies highlighted the clinical relevance of the anterior scalene muscle (AS) in patients with neck pain or nerve compressive syndromes, evidence reporting the diagnostic accuracy of shear wave elastography (SWE) for assessing the AS stiffness properties is lacking. This study aimed to analyze the SWE inter-examiner reliability for calculating the Young’s modulus and shear wave speed of the AS muscle in asymptomatic subjects. Material and Methods: Using a linear transducer, ultrasound images of the antero-lateral neck region at C7 level were acquired in 35 healthy volunteers by one experienced examiner and one novel examiner. After codifying the images to blind the participant identity, trial and side, Young’s modulus and shear wave speed were obtained by an independent experienced rater in randomized order. Intra-class correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable changes (MDC) and coefficient of variation (CV%) were calculated. Results: The AS metrics assessed showed no side-to-side differences (p>0.05). Sex differences were found for muscle size (p=0.002), but muscle brightness and stiffness were similar (p>0.05). Inter-examiner reliability was good for determining the AS muscle stiffness (ICC = 0.881 for Young’s modulus and 0.850 for shear wave speed). Conclusion: The obtained results suggest that assessing the AS stiffness properties in asymptomatic subjects is a reliable procedure. Further studies should verify the SWE capacity for discriminating healthy and clinical populations and identify potential factors contributing to the variance of measurement errors.
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    Intra-rater and inter-rater reliability of rehabilitative ultrasound imaging of cervical multifidus muscle in healthy people: Imaging capturing and imaging calculation.
    (Musculoskeletal Science and Practice, 2020) Valera-Calero, Juan A.; Sánchez Jorge, Sandra; Álvarez González, Javier; Ortega-Santiago, Ricardo; Cleland, Joshua; Fernández-de-las-Peñas, César; Arias-Buría, José L.
    Background: Studies have analyzed muscle morphometry of cervical multifidus by using ultrasound imaging, but its reliability is not clearly determined. Objective: To investigate intra- and inter-rater reliability of imaging capturing (probe assessment/patient positioning) and imaging calculation (scan assessment) of cervical multifidus cross sectional area (CSA) by considering the assessor's experience in asymptomatic individuals. Design: Reliability study. Methods: The CSA of C4/C5 cervical multifidus was assessed in 16 asymptomatic subjects. Two examiners performed the imaging capture and also repeated the procedure (probe placement/patient positioning) twice with a 10-min period between each. Other two raters conducted imaging calculations of CSA. Intra-examiner imaging capturing reliability, each rater (experienced and novice) calculated multifidus CSA of both images obtained by each examiner. Inter-examiner imaging capturing reliability, each rater calculated the CSA obtained by each examiner at the first imaging attempt. For imaging calculation reliability, each rater calculated multifidus CSA of all images captured by both examiners. Intra-class correlation coefficients (ICC) and standard error of measurement (SEM) were calculated. Results: Intra- (ICC3,1 0.988-0.996, SEM 0.3%-0.7%) and inter- (ICC3,2 0.958-0.965, SEM 2.6%-3.2%) examiner reliability of imaging capturing was excellent. Intra- and inter-rater reliability of imaging calculation was also excellent for both raters (experienced/novice). No significant differences between experienced or novice examiners or testers were found. Conclusions: This study found that intra- and inter-examiner/rater reliability of imaging capturing (probe assessment/patient positioning) and imaging calculation (scan assessment) of the cervical multifidus CSA at C4/C5 level was excellent in asymptomatic subjects.
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    A Procedure for Measuring Anterior Scalene Morphology and Quality with Ultrasound Imaging: An Intra- and Inter-rater Reliability Study.
    (Ultrasound in Medicine and Biology, 2023) Valera-Calero, Juan Antonio; Gómez-Sánchez, Sonia; Fernández-de-las-Peñas, César; Plaza-Manzano, Gustavo; Sánchez Jorge, Sandra; Navarro-Santana, Marcos José
    Objective Ultrasound (US) imaging is an essential tool for clinicians because of its cost-effectiveness and accessibility for assessing multiple muscle metrics including muscle quality, size and shape. Although previous studies highlighted the importance of the anterior scalene muscle (AS) in patients with neck pain, studies analyzing the reliability of US measurements for this muscle are lacking. This study aimed to develop a protocol for assessing AS muscle shape and quality measured with US and investigating its intra- and inter-examiner reliability. Methods Through use of a linear transducer, B-mode images of the anterolateral neck region at the C7 level were acquired in 28 healthy volunteers by two examiners (one experienced and one novel). Cross-sectional area, perimeter, shape descriptors and mean echo-intensity were measured twice by each examiner in randomized order. Intra-class correlation coefficients (ICCs), standard errors of measurement and minimal detectable changes were calculated. Results Results indicated no muscle side-to-side asymmetries (p > 0.05). Gender differences were found for muscle size (p < 0.01), but muscle shape and brightness were comparable (p > 0.05). Intra-examiner reliability was good to excellent for all metrics for the experienced and (ICC >0.846) and novel (ICC >780) examiners. Although inter-examiner reliability was good for most of the metrics (ICC >0.709), the estimates for assessing solidity and circularity were unacceptable (ICC <0.70). Conclusion This study found that the described ultrasound procedure for locating and measuring anterior scalene muscle morphology and quality is highly reliable in asymptomatic individuals.
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    Skin Bioimpedance Analysis to Determine Cellular Integrity by Phase Angle in Women with Fibromyalgia: A Cross-Sectional Study.
    (Biomedicines, 2023) Vicente Campos, Davinia; Sánchez Jorge, Sandra; Martí, Luis; Buffet, Jorge; Mendoza Laiz, Nuria; Rodriguez-Sanz, David; Becerro-de-Bengoa-Vallejo, Ricardo; Chicarro, J. L.; Calvo Lobo, César
    Oxidative stress has been proposed as a significant part of the pathogenesis of fibromyalgia, and the phase angle in bioelectrical impedance analysis has been explored as a potential technique to screen oxidative abnormalities. This study recruited 35 women with fibromyalgia and 35 healthy women, who underwent bioelectrical impedance analysis and maximum isometric handgrip strength tests. Women with fibromyalgia showed lower bilateral handgrip strength (right hand: 16.39 ± 5.87 vs. 27.53 ± 4.09, p < 0.001; left hand: 16.31 ± 5.51 vs. 27.61 ± 4.14, p < 0.001), as well as higher body fat mass (27.14 ± 10.21 vs. 19.94 ± 7.25, p = 0.002), body fat percentage (37.80 ± 8.32 vs. 30.63 ± 7.77, p < 0.001), and visceral fat area (136.76 ± 55.31 vs. 91.65 ± 42.04, p < 0.01) compared with healthy women. There was no statistically significant difference in muscle mass between groups, but women with fibromyalgia showed lower phase angles in all body regions when compared with healthy control women (right arm: 4.42 ± 0.51 vs. 4.97 ± 0.48, p < 0.01; left arm: 4.23 ± 0.48 vs. 4.78 ± 0.50, p < 0.001; trunk: 5.62 ± 0.77 vs. 6.78 ± 0.84, p < 0.001; right leg: 5.28 ± 0.56 vs. 5.81 ± 0.60, p < 0.001; left leg: 5.07 ± 0.51 vs. 5.69 ± 0.58, p < 0.001; whole body: 4.81 ± 0.47 vs. 5.39 ± 0.49, p < 0.001). Moreover, whole-body phase-angle reduction was only predicted by the presence of fibromyalgia (R 2 = 0.264; β = 0.639; F(1,68) = 24.411; p < 0.001). Our study revealed significantly lower phase angle values, lower handgrip strength, and higher fat levels in women with fibromyalgia compared to healthy controls, which are data of clinical relevance when dealing with such patients.
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    Changes in stiffness at active myofascial trigger points of the upper trapezius after dry needling in patients with chronic neck pain: a randomized controlled trial.
    (Acupuncture in Medicine, 2022) Valera-Calero, Juan Antonio; Sánchez Jorge, Sandra; Buffet García, Jorge; Varol, Umut; Fernández-de-las-Peñas, César; Álvarez González, Javier
    Background/objective: Since, to our knowledge, the effects of dry needling (DN) on active myofascial trigger point (MTrP) stiffness have not been analyzed previously with shear wave elastography (SWE), our aim was to compare the effects of a single session of DN and sham DN applied to the most active MTrP located in the upper trapezius muscle on clinical outcomes. Methods: A randomized, double-blinded sham-controlled trial was conducted; 60 patients were randomized into an experimental (DN) or sham (sham DN) group. Baseline data including sociodemographic and clinical characteristics were collected. SWE and pain pressure thresholds (PPTs) at the MTrP and a control point located 3 cm laterally were the main outcomes assessed before and 10 min after the interventions. Results: Patients receiving DN interventions experienced greater increases in the control point PPTs immediately after receiving the intervention compared with sham DN (p < 0.05), but no differences were found for the MTrP (p > 0.05). Post-intervention PPT improvements were found at both locations for both groups (p < 0.01). No significant changes for either MTrP or control locations were found for SWE outcomes in either group (all ps > 0.05). No significant withingroup SWE differences were found in the DN or sham DN groups (p > 0.05). Conclusion: A single session of DN or sham DN applied to active MTrPs located in the upper trapezius muscle produced no detectable changes in stiffness at the MTrP or control locations. Real DN induced an immediate analgesic response at both MTrP and control locations, while sham DN induced an immediate MTrP response. Trial registration number: NCT04832074 (
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    A novel mobile phone and tablet application for automatized calculation of pain extent.
    (Computers in Biology and Medicine, 2023) Valera-Calero, Juan Antonio; López-Zanoni, Darío; Sánchez Jorge, Sandra; Fernández-de-las-Peñas, César; Navarro-Santana, Marcos José; Calvo-Moreno, Sofía Olivia; Plaza-Manzano, Gustavo
    Background: Pain drawings (PDs) are used for assessing pain extent as a complementary outcome to other pain measurements, consisting of shading a body chart template to report the location and extent of pain. However, the accuracy and reliability of digital PDs remain controversial due to the heterogeneity of methods used. This study aimed to develop an easy-to-use application for assessing its diagnostic accuracy in comparison with the classic paper-and-pencil method. Methods: A test-retest reliability study was conducted, recruiting 95 patients with musculoskeletal pain symptoms. Participants shaded 2 sets of 3 different PDs (paper-and-pencil PD, digital PD using the finger and digital PD using the digital stylus). Intraclass correlation coefficients (ICC), standard error of measurement and minimal detectable changes (MDC) were calculated for each method. Finally, repeated measure analysis of variance assessed the mean differences between trials and methods and the convergent validity between methods was calculated using Pearson’s correlation coefficients. Results: All methods were excellently reliable (all, ICC>0.94). However, digital PDs obtained higher ICCs (ICC≥0.970) and greater accuracy to detect whether changes reflect a real change and are not due to a measurement errors (MDC = 0.72%– 0.80 % for digital PDs versus MDC = 1.13 % for paper-and-Pencil PDs). No significant score differences were found among the instruments for assessing pain extent (p > 0.05). Finally, the PAIN EXTENT app showed adequate convergent validity (r > 0.850). Conclusion: The PAIN EXTENT app is a fast and easy-to-use instrument compatible with operative systems and devices commonly used for assessing and monitoring pain extent in the clinical and research settings.
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    Correlation between Body Composition and Inter-Examiner Errors for Assessing Lumbar Multifidus Muscle Size, Shape and Quality Metrics with Ultrasound Imaging.
    (Bioengineering, 2023) Varol, Umut; Sánchez-Jiménez, Elena; Alyette Adélaïde Leloup, Emma; Navarro-Santana, Marcos José; Fernández-de-las-Peñas, César; Sánchez Jorge, Sandra; Valera-Calero, Juan Antonio
    Ultrasound imaging (US) is widely used in several healthcare disciplines (including physiotherapy) for assessing multiple muscle metrics such as muscle morphology and quality. Since measuring instruments are required to demonstrate their reliability, accuracy, sensitivity, and specificity prior to their use in clinical and research settings, identifying factors affecting their diagnostic accuracy is essential. Since previous studies analyzed the impact of sociodemographic but not body composition characteristics in US errors, this study aimed to assess whether body composition metrics are correlated with ultrasound measurement errors. B-mode images of the lumbar multifidus muscle at the fifth lumbar vertebral level (L5) were acquired and analyzed in 49 healthy volunteers by two examiners (one experienced and one novel). Cross-sectional area, muscle perimeter and mean echo intensity were calculated bilaterally. A multivariate correlation matrix was calculated for assessing the inter-examiner differences with body composition metrics. Results demonstrated excellent reliability (intraclass correlation coefficient, ICC > 0.9) for assessing the muscle cross-sectional area and perimeter, and good reliability for assessing the muscle shape and mean echo intensity (ICC > 0.7). Inter-examiner errors for estimating muscle size were correlated with participants’ age (p value, p < 0.01), weight (p < 0.05), total and trunk lean mass (both, p < 0.01) and water volume (p < 0.05). Greater shape descriptors and mean brightness disagreements were correlated with older ages (p < 0.05) and total lean mass (p < 0.05). No correlations between age and body composition metrics were found (p > 0.05). This study found US to be a reliable tool for assessing muscle size, shape and mean brightness. Although aging showed no correlations with body composition changes in this sample, it was the main factor correlated with US measurement errors.
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    Situation of Physiotherapy Clinics in the Community of Madrid in Relation to the Concept of Sustainability: A Survey Study.
    (Sustainability, 2022) Sánchez Ibáñez, Alejandro; Franco Hidalgo-Chacón, María de las Mercedes; Sánchez-Romero, Eleuterio A.; Cuenca-Zaldivar, Juan Nicolas
    Introduction: Nowadays, it is increasingly urgent to regulate the use of the natural resources of our planet. From the field of physiotherapy, it is necessary to address this issue to ensure that our centers comply as much as possible with the Sustainable Development Goals (SDGs). Objective: To analyze the current situation in physiotherapy clinics in the Community of Madrid so as to identify whether their managers are aware of the concept of sustainability and its levels of application. Material and Methods: A survey study was carried out with the collaboration of 52 physiotherapy clinics in the Community of Madrid (Spain) to collect relevant data on sustainability. The questions were designed by experts in physiotherapy and sustainability with the aim of obtaining as much information as possible, analyzing the knowledge of sustainability and part of the goals established in the 2030 agenda. The procedures were conducted following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and checklist, in addition to following the Declaration of Helsinki. The study was approved by the Local Ethics Committee of the European University of Madrid, Madrid, Spain (CIPI/22.016). Results: A total of 35 questions were answered by 52 physiotherapy clinics in the Autonomous Community of Madrid (Spain) that completed the survey. In addition to the results of each question related to the concept of sustainability, significant differences were observed in the proportion of emotions detected with the NRC dictionary in the question about how waste is removed from the center (p = 0.002 and 0.008, respectively) with a higher proportion of positive feelings with emotions of joy, anticipation, confidence and surprise expressed by participants from clinics of less than 90 m2, while in those from clinics of more than 90 m2, negative feelings predominated with emotions of disgust, fear or sadness; in both cases, the effect of size was large and significant. Conclusions: Most of the physiotherapy clinics in the Community of Madrid that participated in the study are aware of the concept of sustainability. However, in practice, they do not sufficiently apply sustainability protocols in their clinics.
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    Low Intensity Respiratory Muscle Training in COVID-19 Patients after Invasive Mechanical Ventilation: A Retrospective Case-Series Study.
    (Biomedicines, 2022) Villelabeitia Jaureguizar, Koldobika; Calvo Lobo, César; Rodríguez-Sanz, David; Vicente Campos, Davinia; Castro-Portal, José Adrián; López Cañadas, Marta; Becerro-de-Bengoa-Vallejo, Ricardo; López Chicharro, José
    Worldwide, healthcare systems had to respond to an exponential increase in COVID-19 patients with a noteworthy increment in intensive care units (ICU) admissions and invasive mechanical ventilation (IMV). The aim was to determine low intensity respiratory muscle training (RMT) effects in COVID-19 patients upon medical discharge and after an ICU stay with IMV. A retrospective case-series study was performed. Forty COVID-19 patients were enrolled and divided into twenty participants who received IMV during ICU stay (IMV group) and 20 participants who did not receive IMV nor an ICU stay (non-IMV group). Maximal expiratory pressure (PEmax), maximal inspiratory pressure (PImax), COPD assessment test (CAT) and Medical Research Council (MRC) dyspnea scale were collected at baseline and after 12 weeks of low intensity RMT. A greater MRC dyspnea score and lower PImax were shown at baseline in the IMV group versus the non-IMV group (p < 0.01). RMT effects on the total sample improved all outcome measurements (p < 0.05; d = 0.38–0.98). Intragroup comparisons after RMT improved PImax, CAT and MRC scores in the IMV group (p = 0.001; d = 0.94–1.09), but not for PImax in the non-IMV group (p > 0.05). Between-groups comparison after RMT only showed MRC dyspnea improvements (p = 0.020; d = 0.74) in the IMV group versus non-IMV group. Furthermore, PImax decrease was only predicted by the IMV presence (R2 = 0.378). Low intensity RMT may improve respiratory muscle strength, health related quality of life and dyspnea in COVID-19 patients. Especially, low intensity RMT could improve dyspnea level and maybe PImax in COVID-19 patients who received IMV in ICU.