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GrE showed reduced molar angulation increases at T1 and reduced molar angulation decreases at T2 when compared with Gr6. At T2, the net increase of the upper intercanine distance in GrE was still significant compared with Gr6, indicating a more stable expansion in the anterior area.

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This study was an 8-month controlled trial to evaluate the effectiveness of a workplace educational and physical programme in reducing headache and neck and shoulder pain. Central registry office employees (n = 192; study group) and 192 peripheral registry office and central tax office employees (controls) in the city of Turin, Italy were given diaries for the daily recording of pain episodes. After 2 months, the study group only began the educational and physical programme. The primary end-point was the change in frequency of headache and neck and shoulder pain expressed as the number of days per month with pain, and as the proportion of subjects with a >or= 50% reduction of frequency (responder rate). The number of days of analgesic drug consumption was also recorded. Diaries completed for the whole 8 months were available for 169 subjects in the study group and 175 controls. The baseline frequency of headache (days per month) was 5.87 and 6.30 in the study group and in controls; frequency of neck and shoulder pain was 7.12 and 7.79, respectively. Mean treatment effects [days per month, 95% confidence interval (CI)] on comparing the last 2 months vs. baseline were: headache frequency -2.45 (-3.48, -1.43); frequency of neck pain -2.62 (-4.09, -1.16); responder rates (odds ratio, 95% CI) 5.51 (2.75, 11) for headache, 3.10 (1.65, 5.81) for neck and shoulder pain, and 3.08 (1.06, 8.90) for days with analgesic drug consumption. The study suggests that an educational and physical programme reduces headache and neck and shoulder pain in a working community.

BackgroundNoninvasive physical management is often prescribed for headache and neck pain. Systematic reviews, however, indicate that the evidence of its efficacy is limited. Our aim was to evaluate the effectiveness of a workplace educational and physical program in reducing headache and neck/shoulder pain.Methodology/Principal FindingsCluster-randomized controlled trial. All municipal workers of the City of Turin, Italy, were invited to participate. Those who agreed were randomly assigned, according to their departments, to the intervention group (IG) or to the control group and were given diaries for the daily recording of pain episodes for 1 month (baseline). Subsequently, only the IG (119 departments, 923 workers) began the physical and educational program, whereas the control group (117 departments, 990 workers) did not receive any intervention. All participants were again given diaries for the daily recording of pain episodes after 6 months of intervention. The primary outcome was the change in the frequency of headache (expressed as the proportion of subjects with a ≥50% reduction of frequency; responder rate); among the secondary outcomes there were the absolute reduction of the number of days per month with headache and neck/shoulder pain. Differences between the two groups were evaluated using mixed-effect regression models. The IG showed a higher responder rate [risk ratio, 95% confidence interval (CI)] for headache (1.58; 1.28 to 1.92) and for neck/shoulder pain (1.53; 1.27 to 1.82), and a larger reduction of the days per month (95% CI) with headache (−1.72; −2.40 to −1.04) and with neck/shoulder pain (−2.51; −3.56 to −1.47).ConclusionsThe program effectively reduced headache and neck/shoulder pain in a large working community and appears to be easily transferable to primary-care settings. Further trials are needed to investigate the program effectiveness in a clinical setting, for highly selected patients suffering from specific headache types.Trial RegistrationClinicalTrials.gov NCT00551980

Background To review and meta-analyse the evidence about the prevalence of barriers to evidence-based practice (EBP) reported in physiotherapy. Methods Two independent investigators conducted an extensive electronic search in EMBASE, PubMed, Scopus, Web of Science and CINAHL databases from their inception to July 2020 and included the retrieved articles if they investigated barriers to EBP among physiotherapy professionals. Subsequently, they extracted data and assessed the methodological quality using a scale described in a similar previous study. Outcome for meta-analysis was frequency of each reported barrier. Sub-analyses were performed grouping studies based on countries where surveys were performed, classified as either developed or developing countries. Results Twenty-nine articles were included in the systematic reviews and meta-analysis. Risk of bias assessment of included studies showed a median score: 4 points (interquartile range: 3-4). The findings of meta-analysis revealed that lack of time was the most frequently reported barrier (53.0% [95%CI 44.0-62.0]), followed by language (36.0% [95%CI 16.0-62.0]), lack of access (34.0% [95%CI 23.0.27]) and lack of statistical skills (31.0% [95%CI 20.0-44.0]). Lack of skills and lack of generalizability were declared as a barrier by 27.0% [95%CI 18.0-38.0] and 23.0% [95%CI 15.0-33.0] of responders, respectively. Lack of support and lack of interest are less frequent, with 16.0% [95%CI 11.0-24.0] and 9.0% [95%CI 6.0-15.0] of responses, respectively. Barriers reported in investigations performed in developed countries were less frequent when compared to those performed in developing countries. Conclusion Organizational issues and methodological skills seem key issues to allow the implementation of EBP, suggesting the need to adopt or enhance organizational and training strategies to facilitate the implementation of the EBP. Quantitative synthesis showed high heterogeneity for all analyses and, therefore, pooled data should be interpreted with caution.

BackgroundPain suffered by the young patient is the most frequent symptom during orthodontic treatment and is the one that most frightens children and causes worry in their families.AimTo investigate pain perception and function impairment during the first week of activation of two palatal expansion screws.DesignA total of 101 subjects were randomly divided into two groups: RME group included patients treated with the standard hyrax expansion screw and LEAF group included patients treated with Leaf Expander appliance. Pain intensity was assessed via the Wong‐Baker scale. A questionnaire on oral function impairments was also compiled by the patients.ResultsThe Pain Scale analysis showed that patients in the RME group suffered from a significantly higher level of pain than those in the LEAF group (88.6% vs 25%, P < .01). RME group showed highest pain indexes from day 1 to day 4 (51.4% RME vs 9.7% LEAF suffered at least once from strong pain in the first 4 days, P < .01). Furthermore, oral functions were similarly affected in both groups.ConclusionsPain reported during maxillary arch expansion is influenced by clinical activation protocol and by the screw type. Patients treated with Leaf Expander reported significantly lower pain level in the first 7 days of treatment.

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