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Zhang Y, Luo Y, Wu Q, Han M, Wang H, Kang F. Effect of Transcutaneous Auricular Vagus Nerve Stimulation on Conditioned Pain Modulation in Trigeminal Neuralgia Patients. Pain Ther 2024:10.1007/s40122-024-00654-x. [PMID: 39259413 DOI: 10.1007/s40122-024-00654-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 08/27/2024] [Indexed: 09/13/2024] Open
Abstract
INTRODUCTION Conditioned pain modulation (CPM) is a quantitative estimation of the capacity for endogenous pain modulation. Reduced CPM enables chronic painful event development or exacerbates pre-existing pain symptoms. Emerging reports indicate that patients with trigeminal neuralgia (TN) have dysregulated endogenous pain modulation. Transauricular vagus nerve stimulation (taVNS) is known to alleviate both acute and chronic pain symptoms. Its role in modulation or management of TN remains unknown. Here, we evaluated the taVNS efficacy in modulating CPM among TN patients. Conclusions from this investigation may facilitate establishment of novel non-invasive adjunctive approaches to treating TN patients. METHODS All research work was conducted at the First Affiliated Hospital of the University of Science and Technology of China (Anhui Provincial Hospital). In all, we recruited 62 study participants, 31 TN patients and 31 healthy volunteers, for a 2-day experimental test. At the beginning of the experiment (Day 1), all subjects received 30 min of active taVNS. On Day 2, they received sham taVNS with the same duration and intensity. Meanwhile, technicians documented participant pressure pain thresholds (PPT) and CPM values at baseline, and at 15 and 30 min post-active or sham taVNS. RESULTS A 30-min active taVNS exposure substantially elevated the PPT and CPM effect (P < 0.05) among TN patients, and we also observed a notable rise in the PPT and CPM effect (P < 0.05) among healthy controls. Additionally, there were no serious adverse events from the administered treatment. CONCLUSION Exposure to 30 min of active taVNS strongly augmented the CPM effect and elevated the PPT among TN patients and healthy controls. These effects were not observed with sham stimulation. Despite the limitations inherent to survey studies, such as duration and compliance biases, we consider that taVNS is a promising, safe, and cost-effective therapy. In future investigations, we recommend assessment of long-term taVNS application and its effects on CPM and clinical pain. TRIAL REGISTRATION ChiCTR2300078673 ( www.Chictr.org.cn ).
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Affiliation(s)
- Yu Zhang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Yiyuan Luo
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Qixing Wu
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Mingming Han
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Haitao Wang
- School of Integrated Chinese and Western Medicine, Anhui University of Chinese Medicine, Hefei, People's Republic of China.
| | - Fang Kang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China.
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Talbot LA, Wu L, Morrell CH, Bradley DF, Ramirez VJ, Scallan RM, Zuber PD, Enochs K, Hillner J, Fagan M, Metter EJ. Nonpharmacological Therapies for Musculoskeletal Injury in Military Personnel: A Systematic Review/Meta-Analysis. Mil Med 2024; 189:e1890-e1902. [PMID: 38345098 DOI: 10.1093/milmed/usae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/23/2023] [Accepted: 01/25/2024] [Indexed: 08/31/2024] Open
Abstract
INTRODUCTION Musculoskeletal (MSK) injury is an inherent risk for military personnel that can potentially impact job performance, productivity, and military readiness. Evidence is needed to show the efficacy of nonpharmacological, self-managed therapies to reduce MSK symptoms at common injury sites that are feasible for use during expeditionary operations and home stations. This systematic review and meta-analysis identified, summarized, and synthesized available evidence from randomized and non-randomized trials on the effectiveness of self-managed, home-use therapies to improve pain, muscle strength, and physical performance in military personnel with MSK injuries, when compared to controls. METHODS The electronic databases of MEDLINE ALL Ovid, Embase.com, Cochrane Library, Scopus, Clinicaltrial.gov, and CINAHL Complete via EBSCO were systematically searched for relevant reports published in English. Utilizing the Covidence platform and consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, multiple reviewers, using pre-determined data fields, screened for eligibility, assessed risk of bias (RoB), and performed data extraction. Evaluation of treatment effectiveness was determined using multilevel mixed-effects meta-analysis. RESULTS The database and register search yielded 1,643 reports that were screened for eligibility. After screening of titles/abstracts and full texts, 21 reports were identified for evidence synthesis. Of these, two reports were excluded and two described the same study, resulting in a final list of 18 studies (19 reports). For quality assessment, the overall RoB for the 18 studies was categorized as 33.3% low risk, 55.6% with some concerns, and 11.1% high risk. Across the five domains of bias, 70% of the reports were classified as low risk. This systematic review found that the differences in interventions, outcome measures, and design between the studies were associated with a substantial degree of heterogeneity (I2 = 60.74%), with a small overall improvement in outcomes of the interventions relative to their specific control (standard mean difference 0.28; 95% CI, 0.12 to 0.45). There were varying degrees of heterogeneity for individual body regions. This was due, in part, to a small number of studies per bodily location and differences in the study designs. For the neck/shoulder, heterogeneity was moderate, with the clearest positive effect being for physical performance outcomes via other medical devices. For the back, there was substantial heterogeneity between studies, with modest evidence that pain was favorably improved by other medical devices and exercise interventions. For the leg, one study showed a clear large effect for other medical devices (shockwave treatment) on pain with substantial heterogeneity. The best evidence for positive effects was for the knee, with mainly negligible heterogeneity and some benefits from bracing, electrotherapy, and exercise. CONCLUSION Evidence showed small beneficial effects in pain, strength, and physical performance by individual body regions for some interventions, compared to controls. The best evidence for a positive effect was for the knee. The findings suggest that some benefit may be obtained by including several treatments during deployment in austere environments and prolonged casualty care scenarios of military personnel with MSK injuries. Further research is warranted to better assess the potential benefits of using these treatments during deployments in austere environments as part of an individualized, multimodal approach for MSK injuries.
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Affiliation(s)
- Laura A Talbot
- Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN 38163, USA
| | - Lin Wu
- Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN 38163, USA
| | - Christopher H Morrell
- Department of Mathematics and Statistics, Loyola University Maryland, Baltimore, MD 21210, USA
| | - David F Bradley
- Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN 38163, USA
- Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Vanessa J Ramirez
- Military Performance Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Ross M Scallan
- AMEDD Student Detachment, JBSA, Fort Sam Houston, TX 78234, USA
| | - Pilar D Zuber
- Department of Public Health Sciences, University of North Carolina at Charlotte, College of Health and Human Services, Charlotte, NC 28223, USA
| | - Kayla Enochs
- Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN 38163, USA
| | - Jesse Hillner
- Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN 38163, USA
| | - Mathias Fagan
- Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN 38163, USA
| | - E Jeffrey Metter
- Department of Neurology, University of Tennessee Health Science Center, College of Medicine, Memphis, TN 38163, USA
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Sim A, McNeilage AG, Gholamrezaei A, Rebbeck T, Ashton-James C. Impact of healthcare interventions on distress following acute musculoskeletal/orthopaedic injury: a scoping review of systematic reviews. BMJ Open 2024; 14:e085778. [PMID: 39025825 PMCID: PMC11261706 DOI: 10.1136/bmjopen-2024-085778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 06/28/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Musculoskeletal injuries can cause distress, and distress is associated with delayed recovery. Numerous interventions have been developed to facilitate recovery from injury, and several systematic reviews evaluate the efficacy of these interventions for reducing psychological distress. OBJECTIVES This scoping review aims to map the synthesised evidence for the relationship between treatment interventions and distress-related outcomes following acute injury. The objectives were (1) to describe the types of interventions that have been evaluated in relation to distress-related outcomes following accidental injury, (2) to examine the scope of distress-related outcomes that have been measured in relation to these interventions and (3) to explore the range of clinical professions that deliver these interventions. DESIGN We searched nine electronic databases and grey literature (to 21 April 2022). We included any systematic review reporting on the relationship between interventions delivered in the time following injury and distress-related outcomes. Data relevant to the specific objectives of this scoping review were extracted and described using narrative synthesis. RESULTS From 8412 systematic reviews imported for screening, 8266 unique records were screened. 179 were selected for full-text review. 84 systematic reviews were included in the study. Interventional types were pharmacological, psychological, exercise based, physical/manual therapies, virtual reality based, multimodal and workplace based. Interventions were delivered digitally, face to face and using virtual reality by a variety of healthcare professionals, including doctors, nurses, psychologists and physiotherapists. The most frequently reported distress-related variables included anxiety, depression, post-traumatic stress disorder diagnosis. CONCLUSION A wide range of interventions may help to mitigate distress following acute accidental musculoskeletal or orthopaedic injury. Even interventions that were not designed to reduce distress were found to improve distress-related outcomes. In view of the important role of distress in recovery from injury, it is recommended that distress-related variables are measured as core outcomes in the evaluation of treatments for acute injuries.
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Affiliation(s)
- Alison Sim
- The University of Sydney, Sydney, Australia
| | | | - Ali Gholamrezaei
- Faculty of Medicine and Health, The University of Sydney - Camperdown and Darlington Campus, Sydney, New South Wales, Australia
| | - Trudy Rebbeck
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Claire Ashton-James
- Pain Management, The University of Sydney, Sydney, New South Wales, Australia
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Reddy J, Singhal R, Gaikwad AP, Patel D, Patel P, Gandhi SK. Unraveling the Potential of Electroanalgesia: A Literature Review of Current Therapeutics. Cureus 2024; 16:e61122. [PMID: 38919207 PMCID: PMC11198869 DOI: 10.7759/cureus.61122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 06/27/2024] Open
Abstract
Neuropathic pain (NP), arising from dysfunction in the neurological system, poses a significant challenge in pain management due to its intricate origin and unpredictable response to conventional treatments. Electroanalgesia, a collection of techniques such as transcutaneous electric nerve stimulation (TENS), peripheral electrical nerve stimulation (PENS), spinal cord stimulation (SCS), deep brain stimulation (DBS), and electroacupuncture (EA), presents a potential alternative or complementary approach. This review brings together evidence from 56 studies to evaluate the effectiveness and safety of electroanalgesia in chronic NP. It discusses the mechanisms underlying NP, the indications for electroanalgesia, and the techniques utilized, emphasizing the diverse applications and potential benefits. However, despite its potential uses, electroanalgesia has its limitations, including variable effectiveness and potential adverse effects. Furthermore, the review recognizes the limitations of the methodology and the need for further research to refine treatment protocols and enhance the understanding of electroanalgesia's role in comprehensive pain management strategies.
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Affiliation(s)
- Jyothsna Reddy
- Department of Internal Medicine, The Tamil Nadu Dr. M.G.R. (M.G.Ramachandran) Medical University, Chennai, IND
| | - Rohan Singhal
- Department of Internal Medicine, Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, IND
| | - Anand P Gaikwad
- Department of Internal Medicine, King Edward Memorial Hospital, Mumbai, IND
| | - Diya Patel
- Department of Internal Medicine, Gujarat Medical Education and Research Society, Sola, Ahmedabad, IND
| | - Priyansh Patel
- Department of Internal Medicine, Medical College Baroda, Vadodara, IND
| | - Siddharth Kamal Gandhi
- Department of Internal Medicine, Shri M.P. (Meghaji Pethraj) Shah Government Medical College, Jamnagar, IND
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Valenza-Peña G, Martín-Núñez J, Heredia-Ciuró A, Navas-Otero A, López-López L, Valenza MC, Cabrera-Martos I. Effectiveness of Self-Care Education for Chronic Neck Pain: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2023; 11:3161. [PMID: 38132051 PMCID: PMC10743108 DOI: 10.3390/healthcare11243161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/04/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
Self-care programs for chronic neck pain are relevant to everyday life and can lead to long- term improvement. More studies on their effectiveness, key components and appropriate duration are needed. The aim of this study was to determine the effectiveness of self-care programs for patients with chronic neck pain. A systematic review and meta-analysis of randomized controlled trials was conducted according to the PRISMA guidelines. After searching in PubMed, Web of Science, Scopus and ScienceDirect, eleven studies met the inclusion criteria. Self-care education interventions typically consisted of education (i.e., pain neuro-science education or general educational concepts) accompanied by exercise or manual therapy. The most frequent components were addressing physical and psychological symptoms and engaging in self-care strategies. The least frequent ones were monitoring and recording symptoms and discussing with providers of medical care. The duration of the interventions ranged from three sessions to six months. Finally, individual and supervised modalities were the most frequent. After pooling the data, a meta-analysis was carried out according to four variables (i.e., pain, disability, kinesiophobia and catastrophization) and showed significant results (p < 0.05) in favor of self-care interventions. This systematic review and meta-analysis suggests that self-education interventions improve pain, psychological pain-related variables and disability in patients with chronic neck pain. The most frequently used components were addressing physical and psychological symptoms and engaging in self-care strategies. Future trials should focus on including other components, such as discussing symptoms with providers of medical care or self-monitoring symptoms. Additional areas of focus include more homogeneous doses and comparator treatments, as well as studies with better evidence to reach more solid conclusions.
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Affiliation(s)
| | | | | | | | - Laura López-López
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Av. De la Ilustración, 60, 18016 Granada, Spain; (G.V.-P.); (J.M.-N.); (A.H.-C.); (M.C.V.); (I.C.-M.)
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Ramirez MM, Shepherd MH, Melnick SJ, Hanebuth C, Bazemore C, Couce L, Hendren S, Horn ME. Patient-reported outcome measures in physical therapy practice for neck pain: an overview of reviews. J Patient Rep Outcomes 2023; 7:97. [PMID: 37782344 PMCID: PMC10545655 DOI: 10.1186/s41687-023-00637-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 09/13/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Understanding which patient-reported outcome measures are being collected and utilized in clinical practice and research for patients with neck pain will help to inform recommendations for a core set of measures that provide value to patients and clinicians during diagnosis, clinical decision-making, goal setting and evaluation of responsiveness to treatment. Therefore, the aim of this study was to conduct a review of systematic reviews using a qualitative synthesis on the use of patient-reported outcome measures (PROMs) for patients presenting with neck pain to physical therapy. METHODS An electronic search of systematic reviews and guideline publications was performed using MEDLINE (OVID), Embase (Elsevier), CINAHL Complete (EBSCOhost), and Web of Science (Clarivate) databases to identify reviews that evaluated physical therapy interventions or interventions commonly performed by a physical therapist for individuals with neck pain and included at least one patient-reported outcome measure. The frequency and variability in which the outcome measures were reported among the studies in the review and the constructs for which they measured were evaluated. The evaluation of a core set of outcome measures was assessed. Risk of bias and quality assessment was performed using A Measurement Tool to Assess systematic Reviews 2. RESULTS Of the initial 7,003 articles, a total of 37 studies were included in the final review. Thirty-one PROMs were represented within the 37 reviews with eleven patient-reported outcome measures in three or more reviews. The eleven PROMs assessed the constructs of disability, pain intensity, psychosocial factors and quality of life. The greatest variability was found amongst individual measures assessing psychosocial factors. Assessment of psychosocial factors was the least represented construct in the included studies. Overall, the most frequently utilized patient reported outcome measures were the Neck Disability Index, Visual Analog Scale, and Numeric Pain Rating Scale. The most frequently used measures evaluating the constructs of disability, pain intensity, quality of life and psychosocial functioning included the Neck Disability Index, Visual Analog Scale, Short-Form-36 health survey and Fear Avoidance Belief Questionnaire respectively. Overall risk of bias and quality assessment confidence levels ranged from critically low (2 studies), low (12 studies), moderate (8 studies), and high (15 studies). CONCLUSION This study identified a core set of patient-reported outcome measures that represented the constructs of disability, pain intensity and quality of life. This review recommends the collection and use of the Neck Disability Index and the Numeric Pain Rating Scale or Visual Analog Scale. Recommendation for a QoL measure needs to be considered in the context of available resources and administrative burden. Further research is needed to confidently recommend a QoL and psychosocial measure for patients presenting with neck pain. Other measures that were not included in this review but should be further evaluated for patients with neck pain are the Patient Reported Outcomes Measurement Information System (PROMIS) Physical function, PROMIS Pain Interference and the Optimal Screening for Prediction of Referral and Outcome Yellow Flag (OSPRO-YF) tool.
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Affiliation(s)
- Michelle M Ramirez
- Department of Population Health Sciences, Department of Orthopaedic Surgery, Duke University School of Medicine, 215 Morris Street, Suite 200, Durham, NC, 27708, USA.
| | - Mark H Shepherd
- Department of Physical Therapy, Bellin College, 3201 Eaton Rd, Greenbay, WI, 54311, USA
| | - S Jacob Melnick
- Doctor of Physical Therapy Program, Hawai'i Pacific University, 500 Ala Moana Blvd, Honolulu, HI, 96813, USA
| | - Cannon Hanebuth
- Division of Physical Therapy, Duke University School of Medicine, DUMC Box 104002, Durham, NC, 27710, USA
| | - Caroline Bazemore
- Division of Physical Therapy, Duke University School of Medicine, DUMC Box 104002, Durham, NC, 27710, USA
| | - Logan Couce
- Sugar House Health Center, University of Utah, 1280 E. Stringham Ave, Salt Lake City, UT, 84106, USA
| | - Steph Hendren
- Research & Education Librarian, Duke University Medical Center Library & Archives, Seeley G. Mudd Bldg., 103, Durham, NC, 27710, USA
| | - Maggie E Horn
- Department of Orthopaedic Surgery, Division of Physical Therapy, Department of Population Health Sciences, Duke University School of Medicine, DUMC Box 104002, Durham, NC, 27710, USA
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Martins-de-Sousa PH, Fidelis-de-Paula-Gomes CA, Pontes-Silva A, Henrique MFP, Araujo GGC, Kalatakis-Dos-Santos AE, Damasceno KLB, Dibai-Filho AV. Additional effect of transcutaneous electrical nerve stimulation in a therapeutic exercise program for sedentary with chronic neck pain: A double-blind randomized controlled trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2023; 28:e1978. [PMID: 36252091 DOI: 10.1002/pri.1978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/02/2022] [Accepted: 10/09/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE To evaluate the additional effect of high frequency (HF) or low frequency (LF) transcutaneous electrical nerve stimulation (TENS) in a specific therapeutic exercise program for the treatment of patients with chronic neck pain. METHODS A randomized controlled trial. Sixty participants of both sexes and with chronic neck pain were randomized into three groups: therapeutic exercise group + placebo TENS (n = 20), therapeutic exercise group + HF TENS (n = 20) and therapeutic exercise group + low TENS frequency (n = 20). The following assessment instruments were used: Numerical Pain Rating Scale, Neck Disability Index, Pain-Related Catastrophizing Thoughts Scale and Tampa Scale for Kinesiophobia. Participants were evaluated before the interventions, after eight treatment sessions and 1 month after the end of treatment. Primary outcome was disability measured after the eight treatment sessions. Secondary outcomes were pain intensity, catastrophizing, and kinesiophobia after eight treatment sessions and pain intensity 4 weeks after the end of the treatment sessions. RESULTS The three groups were similar at baseline for personal and clinical characteristics. Regarding the main study analyses, there were no significant (p > 0.05) or clinical (d < 0.80) differences between the groups for the main variable (disability), nor for the secondary variables (pain intensity, catastrophizing and kinesiophobia). CONCLUSION HF or LF TENS, compared to placebo TENS, does not provide additional clinical benefits to an exercise program for patients with chronic neck pain.
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Affiliation(s)
| | | | - André Pontes-Silva
- Postgraduate Program in Adult Health, Universidade Federal do Maranhão, São Luís, Maranhão, Brazil
| | | | | | | | | | - Almir Vieira Dibai-Filho
- Postgraduate Program in Adult Health, Universidade Federal do Maranhão, São Luís, Maranhão, Brazil.,Postgraduate Program in Physical Education, Universidade Federal do Maranhão, São Luís, Maranhão, Brazil
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