Key Points: Lademirsen, an anti–microRNA-21 therapy, was generally well-tolerated in adults with Alport syndrome at risk of rapid disease progression. There were no significant differences between lademirsen-treated and placebo-treated participants in eGFR at any timepoint. The proportions of participants with prespecified reductions in eGFR at weeks 24 and 48 were not significantly different for lademirsen versus placebo. Background: Preclinical models of disease have suggested that targeting microRNA-21 (miRNA-21) may slow the decline in kidney function in individuals with Alport syndrome (AS). The objective of this study was to investigate the effects of the anti–miRNA-21 oligonucleotide, lademirsen, on rate of eGFR decline in adults with AS at risk of rapid disease progression. Methods: This study was a phase 2 trial of lademirsen, with a randomized, double-blind, placebo-controlled period followed by an open-label period. Adults with AS, eGFR >35 to <90 ml/min per 1.73 m², and evidence of rapidly progressive kidney dysfunction were randomized 2:1 to lademirsen 110 mg subcutaneously once weekly or placebo for 48 weeks. After a planned interim analysis (after 24 of 43 randomized participants completed the week 48 study visit or discontinued before week 48), the trial was terminated for futility. Results: Forty-three adults with AS (26 men, 17 women) participated (mean age 34 years), and 28 (lademirsen: n=19; placebo: n=9) completed 48 weeks of double-blind treatment. All participants in both groups developed treatment-emergent adverse events, mainly respiratory tract infections, headache, dizziness, metabolic/electrolyte disturbances, and anemia. Treatment was discontinued in three lademirsen-treated participants in the double-blind period and one participant in the open-label period, owing to treatment-emergent adverse events. The least squares mean eGFR slope (95% confidence interval) over 48 weeks in the lademirsen and placebo groups was −5 (−8.7 to −1.1) and −5 (−10.2 to 0.8) ml/min per 1.73 m² per year, respectively. No significant differences between groups were identified in eGFR at any timepoint or in proportion of participants with prespecified reductions in eGFR at week 24 or 48. Conclusions: While anti–miRNA-21 therapy with lademirsen was generally well-tolerated with an acceptable safety profile, no meaningful improvement in rate of kidney function decline in adults with AS at risk of rapidly progressive disease was observed. Clinical Trial registration number: NCT02855268.

Patients with fibromyalgia syndrome (FMS) have a nonspecific postural balance disorder and a greater prevalence of falls. Objective: to clarify which aspects of maintaining balance are associated with the impact of the disorder and with balance confidence. Methods: A total of 182 persons with FMS agreed to participate in this study. After re-evaluation, 57 fully met inclusion criteria: age 40–70 years and moderate-severe impact of the illness according to the Fibromyalgia Impact Questionnaire (FIQ). All participants underwent a posture control analysis with a stabilometric platform, an evaluation of the perception of verticality and an exploration of the vestibular system via functional tests. Additionally, they self-completed questionnaires about balance confidence, central sensitization, pain catastrophizing, kinesiophobia, dizziness and days with episodes of instability. Results: The FIQ was associated with central sensitization and dizziness, which explained 56% of its variance (AdjR2 = 0.566), while days with instability, kinesiophobia and dizziness also explained more than half of the variance of the balance confidence scale (AdjR2 = 0.527). A high percentage of positive responses was found for functional tests (>50%) and a high dispersion in the stabilometric parameters. Conclusion: the detection of factors susceptible to intervention, such as disability due to dizziness, takes on special relevance in patients with FMS.

Background: Kahoot! is an educational tool allowing teachers to create a series of gamified tests with the aim of reinforcing educational content, thus improving the teaching-learning process. The objective of this project is to evaluate the acquisition of content through gamified tests with Kahoot! and reward cards compared to the traditional teaching methodology (contents not reinforced). Methods: This Physiotherapy Teaching Innovation Project (PTIP) was carried out in four subjects of the Degree in Physiotherapy at the University of Jaén (Spain). The teachers responsible for each subject were instructed in the use of Kahoot! and reward cards. These teachers randomly selected the contents that were going to be reinforced with Kahoot! while the other 50% of the contents would not be reinforced. In the final exam of each subject, the results related to the reinforced contents were compared with those non-reinforced and the degree of satisfaction of the students with the experience was evaluated. Results: A total of 313 students participated in this PTIP. In all subjects, we determined a significant increase in the number of correct answers in an improvement range from 7% (95% CI 3.85 to 9.38) to more than 20% (95% CI 17.61 to 26.86) in favor of the questions that alluded to reinforced content using Kahoot! compared to the non-reinforced contents. More than 90% of the participants considered the use of Kahoot! useful and motivating. Our findings showed that Kahoot! motivated more than 65% of students to study daily. Conclusions: The students obtained better academic results in the questions related to contents reinforced with tests through Kahoot! and reward cards compared to those non-reinforced, showing that this methodology can be an effective tool to promote retention and content assimilation.

Balance problems are one of the most frequent symptoms in patients with Fibromyalgia Syndrome (FMS). However, the extent and nature of this balance disorder are not known. The objective of this work was to determine the best evidence for the alteration of postural balance in patients with FMS and analyze differences with healthy controls. To meet this objective, a systematic review with meta-analysis was performed. A bibliographical search was carried out in PubMed Medline, Scopus, Web of Science, CINAHL and SciELO. Observational studies that assessed postural balance in patients with FMS compared to healthy subjects in baseline conditions, were selected. In a random-effect model, the pooled effect was calculated with the Standardized Mean Difference (SMD) and its 95% confidence interval (CI). Nineteen studies reporting data of 2347 participants (95% female) were included. FMS patients showed poor balance with a large effect on static (SMD = 1.578; 95% CI = 1.164, 1.992), dynamic (SMD = 0.946; 95% CI = 0.598, 1.294), functional balance (SMD = 1.138; 95% CI = 0.689, 1.588) and on balance confidence (SMD = 1.194; 95% CI = 0.914, 1.473). Analysis of the Sensory Organization Test showed large alteration of vestibular (SMD = 1.631; 95% CI = 0.467, 2.795) and visual scores (SMD = 1.317; 95% CI = 0.153, 2.481) compared to healthy controls. Patients with FMS showed worse scores for different measures of postural balance compared to healthy controls. Concretely, FMS patients appear to have poor vestibular and visual scores with a possible somatosensory dependence.

Digital and interactive health interventions (DIHIs), such as virtual-reality-based therapy (VRBT) and smartphone-app-based therapy (SABT), may be useful for reducing the impact of the signs and symptoms of breast cancer (BC) in women. The aim of this meta-analysis was to explore the effect of DIHIs on improving pain, anxiety, depression, quality of life (QoL), and upper extremity (UE) disability-related lymphedema in women with BC. Methods: We searched PubMed Medline, Web of Science, Scopus, CINAHL, Physiotherapy Evidence Database, and SciELO for the period ending February 2022. We included studies that assessed the effect of DIHIs on UE motor disability, pain, anxiety, depression, and QoL in women with BC. The effect size was calculated using Cohen’s standardized mean difference (SMD) and its 95% confidence interval (95% CI). Results: Twenty studies providing data from 1613 women with BC were included. With respect to UE disability, DIHIs increased flexion (SMD, 1.92; 95%CI: −1.16, 2.68), abduction (SMD, 1.66; 95%CI: 0.91, 2.42), external rotation shoulder range of motion (SMD, 1.1; 95%CI: 0.36, 1.85), UE function (SMD, −0.72; 95%CI: −1.31, −0.13), and handgrip strength (SMD, 0.4; 95%CI: 0.21, 0.59). DIHIs reduced pain (SMD, −0.8; 95%CI: −1.31, −0.26), anxiety (SMD, −1.02; 95%CI: −1.71, −0.34), and depression (SMD, −1.57; 95%CI: −3.1, −0.08). Finally, DIHIs increased overall health (SMD, 0.6; 95%CI: 0.31, 0.89). Conclusions: Right at the end of therapy, DIHIs are effective at improving UE function, pain, anxiety, depression, and QoL in women with BC. VRBT has a greater effect than SABT for the assessed outcomes.

Dry needling (DN) is an invasive physiotherapy technique employed for reducing myofascial pain. To compare the effectiveness of dry needling (DN) versus manual therapy (MT) in improving pain, active maximal mouth opening (AMMO) and cervical disability in patients with myofascial pain from temporomandibular disorders (TMDs) were investigated against these treatments. A single-blind, randomized controlled trial was carried out. Individuals (n = 50) with TMDs were randomly allocated in a 1:1 ratio to the DN (n = 25) or MT group (n = 25). Each group received three sessions, separated by 4 days, of either DN or MT. Outcomes were assessed according to pain intensity (Numeric Pain Rating Scale), AMMO (cm), disability (Neck Disability Index), and pressure–pain threshold (PPT) (digital algometry) from the active myofascial trigger points. In both groups, pain and neck disability were significantly lower at the end of treatment compared with those measured at baseline (pain: −2.52 with 95% CI: −3.43 to −1.60 for DN group; pain: −2.92 with 95% CI: −3.77 to −2.07 for MT group; disability: −3.2 with 95% CI: −4.31 to −2.09 for DN group; disability: −2.68 with 95% CI: −3.56 to −1.79 for MT group), but not were not lower after the first session, without differences between the groups. AMMO was significantly higher after the first session (0.16 with 95% CI: 0.03 to 0.29 for DN group; 0.30 with 95% CI: 0.20 to 0.41 for MT group) and at the end of treatment in both groups (0.27 with 95% CI: 0.14 to 0.41 for DN group; 0.37 with 95% CI: 0.22 to 0.52 for MT group) compared with the baseline measurements. Finally, PPT results for the masseter and pterygoid muscles were significantly higher at the end of treatment in both groups (without statistically significant differences between groups), but not after the first session. The assessed therapies, DN and MT, are equally effective in improving pain, AMMO, cervical disability, and PPT in the muscles directly involved in the temporomandibular joint biomechanics of patients with myofascial TMDs.