Objective To assess the effectiveness and safety of different preparations and doses of non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and paracetamol for knee and hip osteoarthritis pain and physical function to enable effective and safe use of these drugs at their lowest possible dose. Design Systematic review and network meta-analysis of randomised trials. Data sources Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, regulatory agency websites, and ClinicalTrials.gov from inception to 28 June 2021. Eligibility criteria for selecting studies Randomised trials published in English with ≥100 patients per group that evaluated NSAIDs, opioids, or paracetamol (acetaminophen) to treat osteoarthritis. Outcomes and measures The prespecified primary outcome was pain. Physical function and safety outcomes were also assessed. Review methods Two reviewers independently extracted outcomes data and evaluated the risk of bias of included trials. Bayesian random effects models were used for network meta-analysis of all analyses. Effect estimates are comparisons between active treatments and oral placebo. Results 192 trials comprising 102 829 participants examined 90 different active preparations or doses (68 for NSAIDs, 19 for opioids, and three for paracetamol). Five oral preparations (diclofenac 150 mg/day, etoricoxib 60 and 90 mg/day, and rofecoxib 25 and 50 mg/day) had ≥99% probability of more pronounced treatment effects than the minimal clinically relevant reduction in pain. Topical diclofenac (70-81 and 140-160 mg/day) had ≥92.3% probability, and all opioids had ≤53% probability of more pronounced treatment effects than the minimal clinically relevant reduction in pain. 18.5%, 0%, and 83.3% of the oral NSAIDs, topical NSAIDs, and opioids, respectively, had an increased risk of dropouts due to adverse events. 29.8%, 0%, and 89.5% of oral NSAIDs, topical NSAIDs, and opioids, respectively, had an increased risk of any adverse event. Oxymorphone 80 mg/day had the highest risk of dropouts due to adverse events (51%) and any adverse event (88%). Conclusions Etoricoxib 60 mg/day and diclofenac 150 mg/day seem to be the most effective oral NSAIDs for pain and function in patients with osteoarthritis. However, these treatments are probably not appropriate for patients with comorbidities or for long term use because of the slight increase in the risk of adverse events. Additionally, an increased risk of dropping out due to adverse events was found for diclofenac 150 mg/day. Topical diclofenac 70-81 mg/day seems to be effective and generally safer because of reduced systemic exposure and lower dose, and should be considered as first line pharmacological treatment for knee osteoarthritis. The clinical benefit of opioid treatment, regardless of preparation or dose, does not outweigh the harm it might cause in patients with osteoarthritis. Systematic review registration PROSPERO number CRD42020213656

To create a rehabilitation protocol following reconstruction of the posterior cruciate ligament (PCL), through a literature review. The literature review was conducted in the Medline and Embase databases, to search for data on biomechanical concepts and analyses relating to the posterior cruciate ligament of the knee. The search strategy was set up using the following rules: problem or injury in association with anatomical location terms; or surgical intervention procedure in association with rehabilitation terms. We began the process in this manner and subsequently introduced restrictions on certain terms to improve the search specificity. To design the protocol, a table was created for better data assessment, basedRev Bras Ortop. 2012;47(4):421-7 on the time that elapsed between surgery and the start of physiotherapy. A rehabilitation protocol was created to improve weight-bearing control in the initial weeks after surgery, with the aid of a knee brace. Our aim was to achieve gains in total range of motion of the knee, which should be attained by the third month, thereby avoiding contractures resulting from the tissue healing process. Strengthening exercises and sensory-motor training were guided accordingly, thus avoiding overload on the graft and respecting the healing phases. The protocol proposed through this review was based on the current evidence relating to this subject.

Objective: Hand-held dynamometry is a quantitative and accessible means of determining the isometric force of muscle groups. Methods: A total of 52 women aged 20–29 years with no complaints of hip pain who were sedentary or sporadically active and had a body mass index of 18.5–24.99 kg/m2 were included. All participants underwent bilateral assessments using hand-held dynamometry of the flexor, extensor, adductor, and abductor muscles as well as the internal and external rotator hip muscles. All hip movements were measured. All contraction data collected by the dynamometer are expressed in kilograms, normalized according to body weight, and expressed as percentages. Results: The flexor muscles exhibited an isometric muscle force of 38.54% of body weight versus a muscle force of 27.04% for the extensor muscles, 16.89% for the adductors, 16.85% for the abductors, and 17.09% for the external rotators, and 23.82% for the internal rotators. Conclusion: Standardization of isometric strength values according to body weight proved feasible. This result is important for clinical practice since it allows the establishment of patterns of normality and criteria for discharge, return to sports, or assessment of the impact of injuries in terms of loss of muscle strength. Level of evidence: III, Development of diagnostic criteria on consecutive patients (with universally applied reference “gold” standard).

The ability to recognize the body parts blindfolded is called body schema. Chronic pain disrupts cognitive function and could lead to an altered body schema. Commonly competitive athletes have chronic pain, but still train and compete. The goal of this study was to assess the body schema of competitive athletes with chronic pain. Pain was measured with the McGill Pain Questionnaire. To assess the body schema, the Image Marking Procedure was used to assess the capacity of the participants to project their bodies in space. Neuropsychological performance was assessed with the Grooved Pegboard Test. There was no difference in body schema between groups; neuropsychological performance indicated better scores in the athlete group. This study showed that despite chronic pain, the athlete group presented unaltered body schema and better neuropsychological performance, perhaps explained by self-selection.

The aim of this review is to evaluate studies about gait training and exercise interventions applied to patients following chronic stroke on gait and balance. The studies included in this review were random clinical trials, including only chronic post-stroke individuals that evaluated gait and balance outcomes and with a PEDro scale score ≥ 7.0. Eight studies were selected. The results suggest gait and balance will only be affected in chronic post-stroke patients if training sessions last at least 30 minutes, are repeated three times a week, and maintained for at least five weeks. Gait training affects how chronic post-stroke individuals walk. They will probably walk faster and with a lower risk of falling; however, it is unclear whether the consequences of these procedures affect the quality of life.