Vanesa Abuín-Porras

Introduction: Transgender men undergoing testosterone-based gender-affirming therapy experience physiological changes that may influence pelvic floor structure and function; however, empirical evidence remains limited and heterogeneous. Objective: To analyze the relationship between pelvic floor function, sexual health, and biopsychosocial variables in transgender men receiving testosterone therapy. Materials and methods: A pilot cross-sectional observational study was conducted in 15 transgender men aged 18-45 years living in Spain and receiving testosterone therapy for at least 1 year. Data were collected using validated instruments (PFDI-20, ICIQ-SF, FSFI, STAI, PSS-14, and IPAQ-SF). Spearman’s rank correlation coefficient was calculated to assess correlations between continuous variables. Given the small sample size and sparse distribution of participants across categories, categorical variables were excluded from inferential analyses. A significance level of a=0.05 was considered. Results: Participants showed low levels of pelvic floor distress (median PFDI-20: 15.6; IQR=7.8-39.6; minimum: 0 maximum: 112), with 93.33% of them presenting mild symptoms. Urinary incontinence scores were low (median ICIQ-SF: 1; IQR=1-1). Sexual function varied widely (median FSFI: 27.1; IQR=19.3-31.6). Significant negative correlations were found between testosterone therapy duration and the orgasm (rS=-0.530, p=0.042) and satisfaction (rS=-0.610, p=0.016) domains of the FSFI. Age was negatively associated with pelvic floor distress and trait anxiety. Conclusions: Pelvic floor dysfunction and urinary symptoms were generally mild in this sample. Associations between testosterone exposure and specific sexual function domains suggest potentially heterogeneous effects over time. No significant correlations were observed between the psychological variables evaluated (perceived stress [PSS-14] and anxiety [STAI]) and indicators of sexual and pelvic floor dysfunction.

Background: Aromatase inhibitor–induced arthralgia (AIA) is a frequent adverse effect of endocrine therapy in breast cancer survivors, often leading to treatment modification or discontinuation. Non-pharmacological interventions have been proposed to manage AIA, but evidence remains fragmented. Objective: To synthesize recent randomized controlled trials (RCTs) evaluating the efficacy of non-pharmacological interventions for AIA. Methods: A systematic search of PubMed, Scopus, and Web of Science identified RCTs published between 2010 and 2025 assessing non-pharmacological strategies for AIA. Two reviewers independently performed study selection, data extraction, and quality appraisal using standardized criteria. Results: Eight RCTs met inclusion criteria, encompassing interventions such as acupuncture, structured exercise (aerobic, resistance, and Pilates), progressive relaxation, and neuromuscular taping. Acupuncture produced clinically meaningful reductions in pain intensity (mean differences 0.9-1.1 points on the Brief Pain Inventory), while exercise programs yielded moderate improvements in pain, function, and quality of life. Relaxation and taping interventions demonstrated smaller or less consistent effects. No eligible trials evaluated occupational therapy-based interventions. Conclusions: Acupuncture and structured exercise show the strongest evidence of benefit for managing AIA, though overall methodological quality remains moderate. Further well-designed trals with standardized outcomes and longer follow-up are needed to guide clinical implementation and to explore underrepresented approaches such as occupational therapy.

Background: Cancer-related pain is a frequent and disabling symptom that negatively affects function and quality of life. Physiotherapy interventions are increasingly used as adjuvant treatments to alleviate pain and improve functional recovery in oncology patients. Objective: To evaluate the scientific evidence on the effectiveness of physiotherapy interventions in reducing cancer-related pain and improving functional outcomes. Methods: A systematic review was conducted following PRISMA 2020 guidelines (PROSPERO ID: CRD42026542801). Searches were performed in PubMed, Cochrane, CINAHL, and PEDro databases between January 30 and February 15, 2025, including randomized controlled trials published in English or Spanish with PEDro scores ≥ 6. Results: Eight randomized controlled trials published between 2020 and 2024 met the inclusion criteria, encompassing 514 participants. Interventions included resistance and aerobic exercise, sensorimotor training, electrotherapy, and multimodal rehabilitation programs. Most studies reported significant reductions in pain intensity, improvements in functional capacity and quality of life, and no serious adverse effects. The methodological quality of the included trials was moderate to high. Conclusions: Physiotherapy interventions, particularly structured exercise and electrotherapy, appear to be effective and safe adjuvant strategies that may contribute to improvements in pain-related and functional outcomes in people with cancer. The available evidence predominantly addresses neuropathic pain associated with chemotherapy-induced peripheral neuropathy. Nevertheless, heterogeneity among protocols and small sample sizes limit the strength of conclusions, underscoring the need for additional high-quality randomized controlled trials. Systematic Review Registration: PROSPERO CRD42026542801.

Social determinants of health (SDH) significantly influence morbidity, mortality, and health equity. Although physiotherapy in Spain is mandated to address

Background: Dyspareunia and vaginal stenosis are common complications in gynecological cancer survivors. Despite the widespread use of passive vaginal dilator therapy, physiotherapy interventions like oncological perineal massage (MPO ^® ) have not been thoroughly evaluated. Objective: Tis study aims to compare the effectiveness of MPO ^® perineal massage versus standard passive vaginal dilator therapy in managing dyspareunia, vaginal stenosis, sexual function, and quality of life in women with gynecological cancer. Methods: A randomized controlled trial involving 35 women (MPO ^® group: n = 18; control group: n =17) was conducted. The participants underwent either MPO ^® massage or passive dilator therapy for 10 weeks, with assessments at baseline (T0), mid-treatment (T1), post-treatment (T2), and 6-month follow-up (T3). Outcomes included pain (VAS), vaginal stenosis (CTCAE 5.0), sexual function (FSM-2), and quality of life (EORTC QLQ-C30). Results: The MPO ^® group demonstrated significantly greater reductions in vaginal pain (median VAS: 8.5 at T0 to 0 at T3, p p ® vs. 35 to 32 in controls, p ® ) significantly improved pain, vaginal stenosis, sexual function, and quality of life in gynecological cancer survivors compared to passive dilator therapy. These findings support incorporating manual therapy techniques in comprehensive survivorship care in this population. Clinical Trial Registration: ClinicalTrials [ https://clinicaltrials.gov/study/NCT06432998 ], identifier NCT06432998.

Background and Objectives: Shoulder dysfunction is a frequent complication after cervical lymph node dissection in patients with head and neck cancer (HNC), leading to pain, reduced mobility, and impaired quality of life. Physiotherapy programs that include strength exercises have shown benefits in managing these sequelae, but the potential added value of neurodynamic mobilization techniques (NDMTs) remains unclear. This pilot randomized controlled trial was designed to examine whether a NDMTs program improves pain and shoulder-related function in HNC survivors with shoulder dysfunction, assessing trajectories during treatment and at short-term follow-up. Materials and Methods: A pilot, assessor-blinded, randomized, parallel-group clinical trial was conducted with 20 participants who had undergone HNC surgery and exhibited shoulder dysfunction. Participants were randomized to either a control group (strength exercises alone) or an experimental group (strength exercises plus NDMTs). Outcomes were assessed at baseline, mid-term (1 week), post-treatment, and 3 months post-treatment. The primary outcome was quality of life measured by the QLQ-H&N35 questionnaire. Secondary outcomes included pain intensity (VAS), disability (DASH), and handgrip strength. Results: Significant improvements were observed in the experimental group for all primary and secondary outcomes. The experimental group demonstrated improved quality of life (p = 0.009), lower pain intensity (p < 0.001), reduced disability (p < 0.001), and increased handgrip strength. Interaction effects for time and group were significant across multiple measures, favoring the NDMTs group. Conclusions: NDMTs are a promising addition to strength programs for improving shoulder dysfunction outcomes in HNC patients, with implications for both clinical practice and future research. Registered in ClinicalTrials: NCT05604235 prior to recruitment.

Background and Objectives: CrossFit is a discipline involving a wide range of overhead movements performed at high intensity and under accumulated fatigue that predispose to a high risk of shoulder complex injuries. This study aimed to compare ultrasonographic findings between symptomatic and asymptomatic shoulders in CrossFit athletes. Materials and Methods: A cross-sectional study was conducted to compare ultrasound parameters between the painful and non-painful shoulders in CrossFit athletes with unilateral subacromial shoulder pain. Assessed variables included subacromial subdeltoid bursa thickness, supraspinatus tendon thickness, the acromiohumeral distance, the coracoacromial ligament distance, the bicipital groove angle, cross-sectional area of the biceps brachii longus head tendon, as well as the serratus anterior and lower trapezius muscle thickness. Results: Twenty male CrossFit athletes (forty shoulders) with an average age of 25.70 ± 4.03 years participated in the study. A statistically significant increase was observed (p < 0.05) in the subacromial subdeltoid bursa thickness in the painful shoulder compared to the asymptomatic side. All other ultrasound parameters did not show statistically significant differences. Conclusions: Only subacromial subdeltoid bursa thickness differed significantly between sides. This isolated finding may not fully explain shoulder pain, which cannot be solely attributed to morphological changes. Further research is needed to determine the relationship between shoulder pain and ultrasound features in CrossFit athletes, as well as the role of ultrasound in predicting structural changes in pain conditions.

Background: The levator ani muscle (LAM) plays a crucial role in maintaining pelvic floor function, providing support to pelvic organs and assisting in physiological processes such as micturition and defecation. Ultrasound imaging, particularly M-mode ultrasound, has been increasingly employed in the evaluation of pelvic floor muscle activity. Objectives: The goal of the present study was to assess the intra- and inter-rater reliability of M-mode ultrasound measurements of LAM thickness, muscle activation speed, and contraction time during a 5-s sustained pelvic floor contraction in asymptomatic women. Methods: Thirty-four healthy nulliparous women aged 18 to 25 were recruited for this cross-sectional study. Transabdominal M-mode ultrasound was used to measure the intra- and inter-rater reliability of LAM thickness during maximum pelvic floor contraction. Each participant performed three pelvic floor contractions, with measurements repeated twice. Results: Intra-rater reliability ranged from poor to good reliability for LAM thickness (ICC = 0.621–0.899), with similar results for pelvic rise time and contraction velocity. Inter-rater reliability was excellent for LAM thickness (ICC = 0.910) but only fair for pelvic rise time and contraction velocity (ICC = 0.673–0.647). Conclusions: M-mode ultrasound imaging demonstrates excellent inter-rater reliability for LAM thickness measurement and fair intra-rater reliability for other functional variables. This technique appears to be a promising method for evaluating pelvic floor muscle activity.

Objective: This study aimed to establish an expert consensus on the use of dry needling for treating spasticity in stroke patients via the Delphi method. Design: A modified Delphi technique was conducted over four rounds. Setting: The study was guided by the NEUMUSK Group Research, Department of Physiotherapy, Faculty of Health Sciences. Ávila Catholic University, following the Checklist for Reporting of Survey Studies (CROSS). Participants: A total of 102 international experts in stroke rehabilitation and dry needling collaborated on this consensus study. Intervention: Panellists rated 35 key questions across rounds via a 6-point Likert scale. Questions that failed to reach 70% consensus were eliminated. Main measurements: Validated Likert scale responses to carry out the expert consensus. Results: There was a high level of consensus regarding the use of dry needling in the early spasticity and hypertonia phases of stroke rehabilitation (early spasticity defined as the first few weeks after stroke when increased muscle tone begins to appear), with 87% and 91% agreement, respectively. However, less consensus has been reached for its application in hypotonia. Local twitch responses have been identified as critical indicators of treatment success, and ultrasound-guided dry needling has been widely endorsed for its precision. The effects of dry needling were reported to last between 48 and 72 h. Conclusion: This study provides clear recommendations for the use of dry needling in stroke patients, particularly during the early stages of spasticity. While the short-term benefits are evident, further research is needed to optimize the treatment frequency and explore its role in different stages of recovery, such as hypotonia. This consensus will aid healthcare professionals in integrating dry needling into comprehensive stroke rehabilitation programmes.