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Current evidence suggests that up to 70% of COVID-19 survivors develop post-COVID symptoms during the following months after infection. Fatigue and dyspnea seem to be the most prevalent post-COVID symptoms. To analyze whether a tele-rehabilitation exercise program is able to improve self-perceived physical exertion in patients with post-COVID fatigue and dyspnea. Sixty-eight COVID-19 survivors exhibiting post-COVID fatigue and dyspnea derived to four Primary Health Care centers located in Madrid were enrolled in this quasi-experimental study. A tele-rehabilitation program based on patient education, physical activity, airway clearing, and breathing exercise interventions was structured on eighteen sessions (3 sessions/week). Self-perceived physical exertion during daily living activities, dyspnea severity, health-related quality of life and distance walked and changes in oxygen saturation and heart rate during the 6-Minute walking test were assessed at baseline, after the program and at 1- and 3-months follow-up periods. Daily living activities, dyspnea severity and quality of life improved significantly at all follow-ups (p<0.001). Additionally, a significant increase in oxygen saturation before and after the 6-Minute Walking test was found when compared with baseline (P<0.001). Heart rate adaptations at rest were found during the follow-up periods (P = 0.012). Lower perceived exertion before and after the 6-Minute Walking test were also observed, even if larger distance were walked (P<0.001). Tele-rehabilitation programs could be an effective strategy to reduce post-COVID fatigue and dyspnea in COVID-19 survivors. In addition, it could also reduce the economic burden of acute COVID-19, reaching a greater number of patients and releasing Intensive Unit Care beds for prioritized patients with a severe disease.

Low back pain (LBP) is a significant global health challenge due to its high prevalence, and chronicity and recurrence rates, with projections suggesting an increase in the next years due to population growth and aging. The chronic and recurrent nature of LBP, responsible for a significant percentage of years lived with disability, underscores the need for effective management strategies, including self-management strategies advocated by current guidelines, to empower patients and potentially improve healthcare efficiency and clinical outcomes. Therefore, the aim of this study was to analyze the added value of face-to-face visits in patients with chronic LBP undergoing a self-management program based on therapeutic exercises on pain intensity, disability, quality of life and treatment adherence and satisfaction. A randomized clinical trial was conducted, allocating 49 patients into a experimental group with a mobile health (mHealth) app usage and face-to-face sessions and 49 patients into an active control group without face-to-face sessions. Pain intensity, disability and quality of life were assessed at baseline, 4 weeks postintervention and 12 weeks postintervention. Patients’ satisfaction and adherence were assessed at the end of the study. The multivariate general model revealed no statistically significant time × group interaction for any outcome (p > 0.0068) but mental quality of life (p = 0.006). Within-group differences revealed significant improvements for all the clinical indicators (all, p < 0.001). Patients allocated to the experimental group reported greater satisfaction and adherence (both, p < 0.001) compared to the control group. The use of mHealth apps such as Healthy Back® as part of digital health initiatives may serve as a beneficial approach to enhance the management of LBP.

Optoelectronic motion capture systems provide objective and high-resolution measurements of upper limb kinematics. The hand-to-mouth movement is closely related to motor development in children. The “Rab Hand-to-Mouth protocol” (BTS Bioengineering) is widely used; however, its seated configuration constrains elbow posture and may limit the ecological validity of the movement. In this study, we propose a methodological adaptation of the protocol in a standing position to allow a more physiological elbow configuration and to increase the dynamic range of elbow and shoulder motion. The objective was to characterize kinematic patterns of the hand-to-mouth movement in typically developing children aged 4 to 9 years using this adapted setup. This study was designed as a descriptive analysis and does not aim to provide formal validation of the standing protocol against the original seated configuration. An observational study that included 40 children was conducted. Motion data were acquired using eight optoelectronic cameras (sampling frequency: 250 Hz) and 17 reflective markers placed on the trunk and upper limbs. Kinematic patterns and spatiotemporal parameters were computed using dedicated motion analysis software. No significant differences were observed between dominant and non-dominant limbs in spatiotemporal parameters, whereas kinematic differences were minimal and limited to trunk rotation, as identified by Statistical Parametric Mapping (SPM). Some isolated statistically significant associations with age were identified in specific spatiotemporal variables; however, these variables showed low coefficients of determination (R2), indicating limited explanatory power of age. Overall, kinematic parameters did not exhibit consistent age-related patterns. These findings provide preliminary descriptive data for hand-to-mouth kinematics in a standing condition, which may contribute to the future development of assessment protocols. However, the limited sample size and the absence of pathological populations restrict the direct generalization of these findings. Future studies should evaluate the applicability of this approach in clinical cohorts and explore its integration into sensor-based and data-driven models for movement analysis.

The study aimed to investigate the effects of footwear on the electromyographic (EMG) activity of pelvic floor muscles (PFMs) and internal oblique (IO) muscles during running at different speeds. The study also aimed to explore the correlation between EMG activity of PFMs and IO muscles and participants’ morphological characteristics. Ten nulliparous female runners were included in the study. The participants ran for 90 s at speeds of 9, 11, and 13 km/h wearing both traditional and minimalist shoes. EMG outcomes were presented as a percentage of maximum voluntary contraction (%MVC). Comparative analysis was conducted using the Wilcoxon rank test. Correlational analysis was performed using the Rho–Spearman correlation coefficient. The %MVC for the IO muscles was significantly lower when using minimalist shoes compared to traditional shoes (p = 0.04). No statistically significant differences were found for the PFMs (p > 0.05). The study also observed large correlations between age and %MVC of the PFMs and IO muscles (rho = −0.64; p = 0.04). Minimalist shoes decreased the activity of IO muscles in female runners. However, no significant differences in EMG activity of PFMs were found when comparing traditional and minimalist footwear. The long-term effects of minimalist footwear on EMG activity of PFMs and IO muscles, as well as their relationship to morphological characteristics, require further investigation.

Muscle fatigue is defined as a reversible decline in performance after intensive use, which largely recovers after a resting period. Surface electromyography (EMG), ultrasound imaging (US) and dynamometry are used to assess muscle activity, muscle morphology and isometric force capacity. This study aimed to assess the convergent validity between these three methods for assessing muscle fatigue during a manual prehension maximal voluntary isometric contraction (MVIC). A diagnostic accuracy study was conducted, enrolling 50 healthy participants for the measurement of simultaneous changes in muscle thickness, muscle activity and isometric force using EMG, US and a hand dynamometer, respectively, during a 15 s MVIC. An adjustment line and its variance (R2) were calculated. Muscle activity and thickness were comparable between genders (p > 0.05). However, men exhibited lower force holding capacity (p < 0.05). No side-to-side or dominance differences were found for any variable. Significant correlations were found for the EMG slope with US (r = 0.359; p < 0.01) and dynamometry (r = 0.305; p < 0.01) slopes and between dynamometry and US slopes (r = 0.227; p < 0.05). The sample of this study was characterized by comparable muscle activity and muscle thickness change between genders. In addition, fatigue slopes were not associated with demography or anthropometry. Our findings showed fair convergent associations between these methods, providing synergistic muscle fatigue information.

Background and Objectives: Dry needling (DN) is a technique that involves inserting a thin filament needle through the skin to target myofascial trigger points for the treatment of musculoskeletal pain and dysfunction. Despite its efficacy in a broad plethora of musculoskeletal pain conditions, its safety remains a topic of debate among clinicians and researchers. The aim of this study was to provide an overview of the current practice of DN through a national survey, focusing on the frequency of its use and the incidence of adverse events (AEs), considering factors including physiotherapist experience, clinical workload, the extent of training received by practitioners, and the use of ultrasound guidance. Materials and Methods: An online cross-sectional survey was conducted. Respondents were licensed physical therapists (PTs) working in Spain. The survey covered demographics, professional data, frequency of adverse effects, and if they use ultrasound routinary for guiding interventions. Results: A total of 422 PTs participated in the study, mostly having 21–60 h of DN training (38.6%), less than 2 years of experience (36%), and not using ultrasound during the interventions (85.5%). Post-needling soreness and bent needles were the most common AEs, with most severe events rarely reported. Adverse event frequencies varied significantly based on training hours, experience, patient percentage treated with DN, and weekly clinical dedication. Clinicians with more hours of DN training or fewer years of experience reported higher incidences of certain complications. Conclusions: DN is a common intervention among PTs, with minor AEs frequently occurring and major AEs being less common but still significant. The accidental puncture of non-desired structures highlights the necessity for improve training on anatomical landmarks, needle insertion depth, cross-sectional anatomy education, and patient monitoring. To ensure safe practice, emphasize comprehensive training, adhere to safety protocols, exercise caution, and prioritize the use of ultrasound-guide is encouraged.

Background Atrial fibrillation (AF) in association with native valvular heart disease (VHD) is very common and both entities perpetuate each other due to volume and pressure overload. In 2017, the new EHRA classification (Evaluated Heartvalves, Rheumatic or Artificial) was proposed: EHRA 1 (mechanical prostheses or moderate/severe mitral stenosis), EHRA 2 (native valvular involvement or biological prosthesis) and EHRA 3 (without valve disease). The objective was to analyze the clinical characteristics as well as adverse events in the follow‐up of AF patients under oral anticoagulation classified according EHRA classification. Methods A multicenter retrospective observational descriptive study was designed and collected clinical, analytical, echocardiographic characteristics as well as adverse events in the follow‐up of patients with AF who start oral anticoagulation. Results 1.399 patients were included (mean age 75.3 ± 9.9 years; 659 (47.1%) male), of whom, 63% were classified as EHRA 2. After a median follow‐up of 910 (IQR 730−1018) days, native EHRA 2 patients had higher event rates/patient‐year as well as a higher total rate of adverse events such as cardiovascular mortality (5.5% vs. 1.1% event/patient‐year; 8.7% vs. 1.1% p < 0.001) and major adverse cardiovascular events (MACE) (8.9% vs. 3.4% event/patient‐year; 14.2% vs. 3.1% p < 0.001), compared with EHRA 3 patients. Multivariate logistic regression analysis showed that native EHRA 2 group was independently associated with all major adverse events. Conclusion In anticoagulated AF patients, those with native valve involvement (EHRA 2) have a worse prognosis than patients without valve involvement (EHRA 3). The presence of native valvular disease is shown as an independent risk factor for all‐cause mortality, major bleeding, cardiovascular mortality, ACS, heart failure, and MACE. In anticoagulated AF patients, those with native valve involvement (EHRA 2) have a worse prognosis than patients without valve involvement (EHRA 3). The presence of native valvular disease is shown as an independent risk factor for adverse outcomes.

In the last decade, minimalist shoes have gained popularity as an alternative to traditional shoes. The aim of the present study was to determine the short-term effects of minimalist shoes in femur range of motion (ROM) and cadence. The secondary objectives were the assessment of the electromyographic activity of the pelvic floor muscles (PFM) in nulliparous women. A randomized, prospective cross-over clinical trial design was used for the study. A total of 51 participants were randomly allocated into a two-sequence crossover design (AB/BA crossover design). Femur ROM, cadence and PFM activity were recorded. The femur ROM at 6 km/h was greater with the minimalist shoes by 1.62 degrees than with the traditional ones ( p  = 0.001). There was a main effect of the type of shoe ( p  = 0.015) systematically observing a higher running cadence with the minimalist shoe compared to the traditional one. Electromyographic activity of the PFM revealed significant differences for 11 km/h for the total average ( p  = 0.027) and the minimum peaks at 9 km/h ( p  = 0.011) and 11 km/h ( p  = 0.048) for the minimalist shoe with respect to the traditional shoes. Minimalist shoes produce immediate effects on the biomechanical variables of running. An increase was observed in the femur ROM at 6 km/h and in the cadence at 11 km/h with the use of minimalist shoes. The use of minimalist shoes increased the electromyographic activation of the PFM in the minimum peaks at speeds of 9 and 11 km/h and in the total average at speeds of 11 km/h compared to the traditional shoe.

Background and Objectives: Whole-body vibration (WBV) therapy presents controversial evidence regarding its effectiveness in improving lower limb functional capacity in children with cerebral palsy (CP), particularly when applied continuously as an adjunct to a physiotherapy program with demonstrated efficacy. This study aimed to evaluate the effectiveness of adding WBV to an intensive therapeutic exercise and functional training program in improving lower limb functional capacity in children with spastic CP. Materials and Methods: Thirty children with spastic CP were randomly assigned to a control or experimental group. Both groups completed a 4-week intensive therapeutic exercise and functional training program (4 sessions/week). The experimental group additionally received daily WBV. Results: Both groups showed significant improvements in all analysed variables at 1, 2, and 6 months post-treatment (p < 0.001). However, no significant between-group differences were found for primary (GMFM-88 D: p = 0.80; GMFM-88 E: p = 0.91) or secondary outcomes in relation to muscle tone and strength, and balance. A trend toward greater improvement was observed in the experimental group but without statistical significance. Conclusions: The addition of WBV to an intensive program of therapeutic exercise and functional training does not yield additional benefits in motor function, spasticity, gait capacity, lower limb muscle strength, or balance compared to intensive physiotherapy and functional training alone in children with spastic CP. The significant within-group improvements can be attributed to the intensive physiotherapy intervention, comprising therapeutic exercises and functional training.

Background/Objectives: Muscle tissues are a common source of symptoms related to low back pain (LBP), with myofascial trigger points (MTrPs) being a significant contributor. Since previous meta-analyses support interventions targeting MTrPs for reducing pain and improving functional disability in patients with LBP, this review aimed to synthesize current knowledge on the prevalence of MTrPs in LBP patients. Methods: To conduct this systematic review, data were collected from PubMed, Cochrane, and Web of Science. Published articles at any time up to February 2025 that comprised descriptive, observational, or experimental studies in English/Spanish language reporting the prevalence of active or latent MTrPs in patients with LBP were eligible. After assessing the methodological quality, a structured and qualitative synthesis was conducted using a standardized form that captured participant characteristics, evaluated muscles, the number or percentage of active and latent MTrPs in each group, clinical features, summarized results, and conclusions. Results: Nine articles with acceptable methodological quality were included. The prevalence of active MTrPs in patients with LBP was quadratus lumborum (ranging from 30% to 55%), gluteus medius (from 34% to 45%), piriformis (42%), psoas (from 5% to 10%), and lumbar iliocostalis (from 33% to 38%). Latent MTrPs were most common in the gluteus medius (74%) and quadratus lumborum (14–17%), with the piriformis, psoas, and lumbar iliocostalis also affected. Conclusions: Active and latent MTrPs are common in muscles such as the quadratus lumborum, gluteus medius, and iliocostalis in individuals with LBP, with prevalence varying by pain chronicity and etiology. MTrPs in the gluteal region are more frequent in lumbosacral radiculopathy, suggesting a neurogenic-like component. Since the subjectivity of manual palpation and study heterogeneity limit generalizability of the results, future research should standardize diagnostic criteria of MTrPs to ensure the consistency of results.