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Dorina Ianc, Carmen Serbescu, Marius Bembea, Laurent Benhamou, Eric Lespessailles and Daniel Courteix

We investigated the effects of calcium supplementation and physical practice on the bone ultrasound properties and trabecular microarchitecture in children. 160 children aged 8−11 were randomly allocated to active or nonactive groups and to receive either a calcium-phosphate or a placebo powder for 6 months. Skeletal status was assessed using an ultrasound technique, which measures the speed of sound (Ad-SoS, m/s) at the phalanx. Bone microarchitecture was characterized by fractal analysis measured on calcaneus radiographs and the result expressed as the Hmean parameter, that has been shown to a good reliability of the bone texture quality. After 6 months, the calcium group had significantly gained Ad-SoS compared to the placebo group (P = 0.01) and Hmean increase was greater in the active than the nonactive group (P < 0.05). Exercise and calcium supplementation had a differential effect on the bone tissue, calcium being rather linked to a systemic effect whereas exercise has acted better onto the skeletal stressed site.

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Francisco Alvarez-Barbosa, Jesús del Pozo-Cruz, Borja del Pozo-Cruz, Antonio García-Hermoso and Rosa María Alfonso-Rosa

, activities of daily living , random allocation and randomized controlled trial ( RCT ). The search queries for the eight electronic databases are shown in Supplementary Material (available online). Study Selection The inclusion criteria (a) were RCT investigating the effects of WBV in

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Ruben Barakat, Mireia Pelaez, Rocio Montejo, Ignacio Refoyo and Javier Coteron

Background:

In spite of an extensive knowledge of the physiologic features of exercise during pregnancy, we still lack a comprehensive understanding of the effects of different types, intensities and duration of exercise throughout pregnancy on maternal and fetal well being. The aim of the current study was to examine the influence of an aerobic exercise program throughout pregnancy on gestational age at the moment of delivery.

Methods:

This study was a randomized controlled trial. Three hundred and twenty Caucasian (Spanish) healthy pregnant women with singleton gestation were randomly assigned to either an exercise (n = 160) or a control (n = 160) group. Gestational age (weeks) and other outcomes were measured. The exercise program included 85 sessions (general fitness class, 3 times/week, 55–60 min/session from weeks 8–10 to weeks 38–39 of pregnancy).

Results:

Two hundred and ninety women were analyzed (exercise group EG, n = 138, control group CG, n = 152). The mean gestational age did not differ between groups (EG= 39.7± 1.3 vs CG= 39.6 ± 1.1 weeks, P = .81). Relative to preterm deliveries in EG we found 6 (4.3%) and 11 (7.2%) in CG, (P = .73).

Conclusions:

A supervised program of moderate exercise performed throughout pregnancy is not a risk of preterm delivery for healthy pregnant women.

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Alyce T. Barnes, Ronald C. Plotnikoff, Clare E. Collins and Philip J. Morgan

Background:

The aim was to assess the feasibility and preliminary efficacy of a community-based physical activity (PA) intervention targeting mothers and daughters.

Methods:

A randomized controlled trial of 48 primary school-aged girls and their 40 mothers were randomized to (i) Mothers And Daughters Exercising for Life (MADE4Life) (n = 21 mothers, n = 25 daughters) or (ii) wait-list control (n = 19 mothers, n = 23 daughters). The 8-week program involved 8 sessions; 25-minute separate mothers and daughters education sessions and 60-minutes PA together. Assessments were at baseline, postintervention and 3-month postintervention. Primary outcome measure was daughters’ moderateto-vigorous physical activity (MVPA) (accelerometer). Secondary outcomes included accelerometer-assessed light/moderate/vigorous PA, BMI, waist circumference, body composition, blood pressure, resting heart rate, sedentary behaviors and mothers’ self-reported PA, parenting measures, and cognitions. Intention-to-treat analysis used linear mixed models.

Results:

Recruitment and retention goals were exceeded. Attendance rates, program acceptability and satisfaction were high. There was no significant group-by-time effect for daughters’ %MVPA (–0.08; 95%CI –1.49, 1.33, d = –0.03) or other secondary outcomes for girls (postintervention range d = 0.01 to –0.46). Significant intervention effects were found for mothers’ %VPA (P = .04, d = 0.25) and role modeling (P = .02, d = 0.66).

Conclusion:

MADE4Life was both feasible and acceptable. Although very small effect sizes were found for the daughters, significant changes were seen for mothers (d = 0.25 to 0.66). Future fully powered trials targeting PA in mothers and daughters is warranted.

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Jake Pearson, David Rowlands and Ruth Highet

Context:

Achilles tendinopathy is a common and often debilitating condition, and autologous blood injection is a promising treatment option.

Objective:

To determine whether autologous blood injection added to standard management was effective in alleviating symptoms of Achilles tendinopathy.

Design:

A prospective randomized controlled trial.

Setting:

Private sports medicine clinic.

Patients:

33 patients (18 women, 15 men) of mean age 50 y (SD 9) with 40 cases of Achilles tendinopathy of mean duration of 11 mo (SD 7).

Intervention:

Participants were randomized to blind peritendinous autologous blood injection added to standard treatment (eccentric-loading exercises) or standard treatment alone for 12 wk.

Main Outcome Measure:

Victorian Institute of Sport Assessment for Achilles (VISA-A) score and ratings of discomfort during and after the injection were measured at baseline and 6 and 12 wk. Analytically derived effect-size thresholds of 5 (small) and 15 (moderate) VISA-A units were used as the reference values for clinical inference.

Results:

Improvements in VISA-A of 7.7 units (95%CL: ± 6.7) and 8.7 units (± 8.8) were observed in the treatment and control groups, respectively, at 6 wk relative to baseline, with no clear effect of blood injection. At 12 wk VISA-A score improved to 18.9 units (± 7.4) in the treatment group, revealing a blood-injection effect of 9.6 units (± 11.5), relative to a comparatively unchanged condition in control (9.4 units; ± 9.0). Predictors of response to treatment were unremarkable, and a 21% rate of postinjection flare was the only noteworthy side effect.

Conclusions:

There is some evidence for small short-term symptomatic improvements with the addition of autologous blood injection to standard treatment for Achilles tendinopathy, although double-blinded studies with longer follow-up and larger sample size are required.

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Kathleen Geist, Claire Bradley, Alan Hofman, Rob Koester, Fenella Roche, Annalise Shields, Elizabeth Frierson, Ainsley Rossi and Marie Johanson

Study Design:

Randomized controlled trial.

Objectives:

The aim of this study was to determine the effects of dry needling on hamstring extensibility and functional performance tests among asymptomatic individuals with hamstring muscle tightness.

Background:

Dry needling has been shown to increase range of motion in the upper quarter and may have similar effects in the lower quarter.

Methods:

27 subjects with hamstring extensibility deficits were randomly assigned to side of treatment (dominant or nondominant) and group (blunt needling or dry needling). The first session included measurement of hamstring extensibility and performance on 4 unilateral hop tests, instruction in home hamstring stretching exercises and needling distal to the ischial tuberosity and midbellies of the medial and lateral hamstrings. A second session, 3–5 days following the first session, included outcome measures and a second needling intervention, and a third session, 4–6 weeks following the first session, included outcome measures only. A 2 × 3 × 2 ANOVA was used to statistically analyze the data.

Results:

Hamstring extensibility showed a significant side × time interaction (P < .05). The single hop for distance, timed 6-meter hop, and the crossover hop test had a significant main effect of time (P < .05). The triple hop for distance showed a significant side × time × group interaction (P < .05).

Conclusions:

It does not appear dry needling results in increased extensibility beyond that of stretching alone in asymptomatic individuals. Our study findings suggest that dry needling may improve certain dimensions of functional performance, although no clear conclusion can be made. Level of Evidence: Intervention, level 2b.

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Sean M. Burfeind and Nicole Chimera

Context:

Athletes participating in upper-extremity-dominant sports such as softball and volleyball are at increased risk for glenohumeral-joint pain and injury. For these athletes, an integral part of many injuryprevention and -rehabilitation programs includes improving joint proprioception. One way to measure joint proprioception is through the reproduction of joint angles, or joint-reposition sense (JRS). Kinesiology tape is purported to enhance neuromuscular feedback; therefore, it may influence JRS. However, conflicting findings and the lack of research in the upper extremity warrant further investigation.

Objective:

To determine the effects of kinesiology tape on shoulder-joint proprioception by actively reproducing joint angles, or measurement of JRS.

Design:

Randomized controlled trial.

Setting:

College laboratory.

Participants:

9 men and 7 women 24 ± 3 y old.

Intervention:

SpiderTech kinesiology tape precut Shoulder Spider was applied to the shoulder of participants block randomized to the experimental group, following product-specific instructions, to measure its influence on JRS compared with a control group.

Main Outcome Measurement:

JRS-error scores in shoulder flexion, extension, internal rotation, and external rotation (ER).

Results:

There was a significant interaction between groups pre- to postintervention resulting in decreased JRS errors in flexion (P = .04) and ER (P = .03) in the experimental compared with the control group. The 95% confidence intervals suggest a clinically relevant difference in the variability of JRS errors between postintervention movements for the experimental group in flexion and ER, such that the control group demonstrated much more variability in JRS errors than the experimental group.

Conclusions:

After the application of kinesiology tape the JRS errors were smaller in flexion and ER. This may be of clinical significance in improving proprioception and thus improving joint stability. Additional research should determine the effectiveness of kinesiology tape in reducing joint injury.

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Cynthia J. Wright, Shelley W. Linens and Mary S. Cain

Context:

There is minimal patient-oriented evidence regarding the effectiveness of interventions targeted to reduce symptoms associated with chronic ankle instability (CAI). In addition, clinicians aiming to prioritize care by implementing only the most effective components of a rehabilitative program have very little evidence on comparative efficacy.

Objective:

To assess the comparative efficacy of 2 common ankle rehabilitation techniques (wobble-board [WB] balance training and ankle strengthening using resistance tubing [RT]) using patient-oriented outcomes.

Design:

Randomized controlled trial.

Setting:

Laboratory.

Patients:

40 patients with CAI randomized into 2 treatment groups: RT and WB. CAI inclusion criteria included a history of an ankle sprain, recurrent “giving way,” and a Cumberland Ankle Instability Tool (CAIT) score ≤25.

Interventions:

Participants completed 5 clinician-oriented tests (foot-lift test, time-in-balance, Star Excursion Balance Test, figure-of-8 hop, and side-hop) and 5 patient-oriented questionnaires (CAIT, Foot and Ankle Ability Measure [FAAM], Activities of Daily Living [ADL] and FAAM Sport scale, Short-Form 36 [SF-36], and Global Rating of Function [GRF]). After baseline testing, participants completed 12 sessions over 4 wk of graduated WB or RT exercise, then repeated baseline tests.

Main Outcome Measures:

For each patient- and clinician-oriented test, separate 2 × 2 RMANOVAs analyzed differences between groups over time (alpha set at P = .05).

Results:

There was a significant interaction between group and time for the FAAM-ADL (P = .04). Specifically, the WB group improved postintervention (P < .001) whereas the RT group remained the same (P = .29). There were no other significant interactions or significant differences between groups (all P > .05). There were significant improvements postintervention for the CAIT, FAAM-Sport, GRF, SF-36, and all 5 clinician-oriented tests (all P < .001).

Conclusions:

A single-exercise 4-wk intervention can improve patient- and clinician-oriented outcomes in individuals with CAI. Limited evidence indicates that WB training was more effective than RT.

Level of Evidence:

Therapy, level 1b.

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Jocelyn Kernot, Lucy Lewis, Tim Olds and Carol Maher

additional secondary aim was to assess the feasibility and engagement of the MSIU program. Methods Overview A 3-arm cluster randomized controlled trial (allocation ratio 1∶1∶1) was undertaken in Adelaide, South Australia, between September 2013 and October 2014. Postpartum women were recruited in teams, with

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Chien-Chih Chou, Kuan-Chou Chen, Mei-Yao Huang, Hsin-Yu Tu and Chung-Ju Huang

postintervention, participants were asked to complete the Stroop and determination tests. The sample size was estimated using a meta-analysis that reported a small to moderate positive effect of PA on EFs based on randomized controlled trials (i.e., Hedges’ g  = .24 in de Greeff et al. ( 2018 ); effect size [ES