Christina Michailidou

Background: Preseason screening is widely used in handball to identify athletes at increased risk of injury, yet the prognostic value of different screening approaches remains unclear. The aim of this study was to systematically review the evidence on preseason screening tests and physical assessments in relation to subsequent injury outcomes in handball players. Methods: A systematic review was conducted according to PRISMA guidelines. PubMed, MEDLINE, CINAHL, and Scopus were searched on 14 March 2026. The first 100 results from Google Scholar were also screened, and backward citation searching was performed. Eligible studies included handball players and examined preseason or baseline screening, functional, musculoskeletal, or physical performance assessments in relation to prospectively recorded injury outcomes. Two independent reviewers performed study selection, data extraction, and risk-of-bias assessment using the QUIPS tool. Due to substantial heterogeneity in screening tools, injury outcomes, and follow-up procedures, meta-analysis was not performed. Results: Eight studies were included. Most were prospective cohorts involving adolescent, youth elite, or elite adult handball players. Shoulder-specific screening variables, particularly external rotation strength, strength imbalances, total rotational motion, and selected rotational adaptations, showed more consistent associations with subsequent shoulder-related outcomes. In contrast, broader movement-screening tools, including the Functional Movement Screen, the 9+ screening battery, and the upper quarter Y-Balance Test, generally showed limited associations with overall injury outcomes. Conclusions: Shoulder-specific preseason assessments may be more closely associated with subsequent shoulder-related outcomes than broader movement-screening tools, although the available evidence remains limited, heterogeneous, and derived exclusively from observational studies.

Background: Acute fatigue is frequently experienced during handball training and match play and may impair throwing performance; however, findings across studies are inconsistent. This systematic review and meta-analysis examined the acute effects of fatigue on throwing velocity and accuracy in handball. Methods: PubMed, MEDLINE Complete, CINAHL, and Scopus were searched from inception to 24 January 2026, supplemented by Google Scholar and citation tracking. Eligible studies included handball players exposed to an acute fatigue protocol with throwing-performance outcomes. Random-effects meta-analyses were conducted using standardized mean differences (Hedges’ g), oriented so that negative values indicated worse performance under fatigue. Results: Τen studies met the inclusion criteria for qualitative synthesis. For quantitative synthesis, 10 comparisons contributed to the throwing-velocity meta-analysis and 6 comparisons contributed to the throwing-accuracy meta-analysis. Fatigue showed a small-to-moderate tendency to reduce throwing velocity (g = −0.31, 95% CI −0.65 to 0.03; I² = 77.8%). For throwing accuracy, the pooled estimate suggested a possible decline under fatigue (g = −0.82, 95% CI −1.95 to 0.31), but heterogeneity was very high (I² = 95.8%) and findings were sensitive to influential effects. Conclusions: Acute fatigue showed a small-to-moderate tendency to reduce throwing velocity in handball players, with more consistent impairments observed during jump-shot tasks and after localized upper-limb fatigue protocols. In contrast, no robust conclusion can be drawn for throwing accuracy/precision because heterogeneity was extremely high and studies used substantially different outcome definitions, including hit counts, success percentages, points-based scores, and spatial error. Therefore, accuracy findings should be interpreted with considerable caution.

Background: Stretching exercises are strongly recommended as part of exercise training programs; however, their effects on blood pressure (BP) and other related cardiovascular parameters in adult individuals with elevated BP (pre-hypertension) or hypertension remain unclear. Methods: A systematic search was conducted in PubMed and databases accessed via the EBSCO platform up to 30 September 2025, following the PRISMA guidelines. An additional search of Scopus was performed on 8 April 2026. Studies eligible for inclusion were randomized controlled trials, randomized crossover trials, non-randomized clinical trials and single-arm trials investigating stretching interventions in adults with pre-hypertension and or hypertension. Risk of bias assessment was performed using RoB 2 for randomized trials and ROBINS-I for the non-randomized trials. A random-effect meta-analysis was performed when at least two studies reported sufficiently comparable BP outcomes. The quantitative synthesis was considered exploratory. Results: Eleven records published between 2014 and 2025 met the eligibility criteria and were included. All protocols used static stretching, although only a small number were clearly described as active stretching. The results were heterogeneous across the design, duration of intervention and outcomes. Chronic interventions more often reported favorable changes in indices of arterial stiffness, whereas acute interventions demonstrated more variable immediate BP responses. In the exploratory meta-analysis, the pooled estimate suggested a reduction in systolic blood pressure (SBP) in favor of stretching; however, this effect did not reach statistical significance (mean difference (MD) = −5.39 mmHg, 95% confidence interval (CI): −11.32 to 0.53; I² = 0%). For diastolic blood pressure (DBP), the pooled estimate favored stretching and reached statistical significance (MD = −3.93 mmHg, 95% CI: −7.25 to −0.60; I² = 0%). In sensitivity analyses including a third study, the pooled effects remained in favor of stretching for systolic BP (MD = −6.6 mmHg, 95% CI: −12.2 to −1.0; I² = 56%) and diastolic BP (MD = −5.4 mmHg, 95% CI: −7.1 to −3.7; I² = 8%). These pooled estimates should be interpreted with caution due to the small number of studies, heterogeneity in study design and participant characteristics, and overall limitations in methodological quality. Secondary findings suggested possible improvements in selected vascular parameters, including brachial–ankle pulse wave velocity, augmentation index, and cardio–ankle vascular index, whereas acute responses were more variable and protocol-dependent. Overall, the level of evidence was limited, with most randomized trials judged as having some concerns and non-randomized studies judged as having a critical risk of bias. Conclusions: Stretching interventions may improve BP and selected vascular parameters in adults with pre-hypertension and hypertension and may represent a practical adjunct within the non-pharmacological management of BP. However, the current evidence is limited by methodological heterogeneity, risk of bias, and the small number of studies available for quantitative synthesis. Therefore, the pooled findings should be considered exploratory and hypothesis-generating rather than definitive. Further high-quality randomized controlled trials are required to determine the optimal type, dose, and long-term clinical relevance of stretching interventions in this population.

Background and Objectives: Breast cancer remains the most frequently diagnosed malignancy among women worldwide. As survival rates continue to improve, rehabilitation interventions focusing on functional recovery and quality of life have become increasingly important. Emerging technologies such as virtual reality, augmented reality, and telerehabilitation have recently been integrated into physiotherapy programs. This systematic review aimed to evaluate the effectiveness of technology-assisted physiotherapy interventions on quality of life, psychological outcomes, and functional recovery in women with breast cancer. Materials and Methods: A systematic search was conducted in PubMed, CINAHL Complete, and MEDLINE Complete for randomized controlled trials published between January 2010 and March 2026. Studies were included if they investigated exercise-based physiotherapy interventions incorporating technological modalities such as virtual reality, augmented reality, mixed reality, robotics, or telerehabilitation. Outcomes included quality of life, fatigue, pain, upper limb function, and psychological health. Results: Six randomized controlled trials involving approximately 398 participants (mean age range: 30–60 years) were included in the qualitative synthesis. The studies included women across different stages of the disease trajectory, including postoperative patients and long-term survivors. Interventions comprised virtual reality-based exercise programs, Kinect-based mixed reality systems, augmented reality telerehabilitation platforms, and internet-based rehabilitation programs. Across studies, significant improvements were consistently observed within groups in outcomes such as quality of life, upper limb function, pain reduction, and shoulder range of motion (e.g., p < 0.001). However, between-group differences were not consistently statistically significant, with several studies reporting comparable improvements in both intervention and control groups. Conclusions: Technology-assisted physiotherapy interventions may support functional recovery and improve quality of life among women with breast cancer. However, the available evidence remains limited, with important methodological constraints, as improvements were predominantly observed within groups, while consistent between-group differences were not demonstrated. Therefore, the comparative effectiveness of these interventions over standard rehabilitation remains inconclusive, highlighting the need for further high-quality randomized controlled trials.

Background: Proprioceptive deficits, commonly quantified as joint position sense error (JPSE), are frequently reported in musculoskeletal conditions. Articular manual therapy may influence afferent input and sensorimotor integration. This review synthesised the effects of joint mobilization and/or high-velocity low-amplitude (HVLA) thrust manipulation on quantitative proprioception outcomes in humans. Methods: PubMed, Scopus, CINAHL, and MEDLINE Complete were searched (from inception to November 2025) for randomized or sham-controlled trials assessing proprioception after eligible articular manual therapy. Searches were limited to English-language publications. Risk of bias was assessed using Risk of Bias 2 (RoB 2). Random-effects meta-analysis (Hedges’ g) was conducted when outcomes and time points were comparable; pooling was possible for only one outcome/time-point comparison. Certainty of evidence was assessed using GRADE. Results: Database searches yielded 483 records; after duplicate removal, 371 records were screened. Eighteen full-text articles were assessed for eligibility, of which 11 were excluded, resulting in seven randomized clinical trials (2018–2025; total n = 350) evaluating spinal or peripheral mobilization/manipulation. No eligible randomized or sham-controlled trials meeting the prespecified criteria were identified before 2018. In chronic mechanical neck pain, cervical thrust manipulation improved cervical JPSE versus sham with large partial eta-squared effects (η²p = 0.23–0.36). Cervical mobilization improved left rotation JPSE (4.15 → 1.65° vs. 4.01→3.74°). In patellofemoral pain, lumbopelvic manipulation produced immediate reductions in knee JPSE at 60° (6.58 → 4.48° vs. 5.91 → 6.05°). Only one outcome/time-point was suitable for meta-analysis (knee JPSE at 60° flexion in patellofemoral pain; two trials), showing no statistically significant pooled effect (Hedges’ g = −0.21, 95% CI −1.36 to 0.94; I² ≈ 83%). Remaining outcomes could not be pooled due to heterogeneity and incompatible reporting. Conclusions: Evidence from seven randomized trials indicates that articular manual therapy (mobilization and/or HVLA thrust manipulation) can improve quantitative proprioceptive outcomes immediately post-intervention, particularly JPSE in neck and patellofemoral pain; however, effects are condition- and outcome-specific, and confidence is limited by heterogeneity and the predominance of narrative synthesis with sparse poolable data. Future adequately powered trials should standardize proprioception protocols, include longer follow-up, and report data to enable robust meta-analysis.

Obstructive sleep apnea (OSA) is the most prevalent sleep disorder caused by breathing difficulties, characterized by repeated episodes of airway blockage while sleeping. Various interventions have been used to improve the symptoms and overall health of individuals with OSA. However, few studies have focused on the impact of exercise on OSA. Objectives: The objective of this review was to evaluate the impact of exercise on individuals with OSA, providing an update on the exercise management of OSA. Methods: This review examined the current literature, including experimental studies and systematic reviews with meta-analysis, that investigated the impact of exercise (oropharyngeal exercises, respiratory muscle training, and therapeutic exercise training) in OSA patients. Studies were identified by searching databases (PubMed, CHINAL, EBSCO) using the following keywords: obstructive sleep apnea, OSA, exercise, oropharyngeal exercises, respiratory muscle training. Inclusion criteria were based on the PICO framework. Results: Forty-three studies were included in this review following the original search, all of which investigated the effects of exercise interventions in OSA. Most of the studies observed various significant health-related improvements following exercise interventions; however, none of them combined or compared all these exercise regimes together. In addition, there is limited information regarding the impact of exercise on sleep architecture. Conclusions: Overall, the findings suggest that exercise, regardless of its regime, benefits individuals with OSA.

Cerebrovascular accident is a neurological disease, characterised by acute onset that lasts for more than 24 h, leading to motor, sensory and cognitive impairments or even death. High‐intensity interval training is a type of aerobic training that presents an increase of the > 80% of maximum heart rate, aiming to improve VO ₂ peak, leading to improvements in various health‐related parameters. The purpose of this study was to examine the effectiveness of high‐intensity interval training on aerobic and functional capacity for poststroke survivors. Two investigators searched the electronic databases MEDLINE/PUBMED, Cochrane Controlled Trials Register and EBSCO, until August 2024. In this review, 11 studies met the eligible criteria and were included. The statistical analysis was conducted by pooling the mean, standard deviation, and 95% confidence intervals. For the establishment of meta‐analysis, the heterogeneity statistical index I ² was used. From the 11 included studies, 458 stroke survivors were extracted. HIIT yield improvements were observed in VO ₂ peak ( p value = 0.001, 95% CI: 1.72–4.06), 6MWT ( p value < 0.001, 95% CI = 38.55–149.41), 10MWT ( p value < 0.01, 95% CI = 0.20–0.36), BBS ( p value < 0.01, 95% CI = 3.43–7.51), EQ‐5D ( p value = 0.001, 95% CI = 3.67–15.13), and cognition ( p value = 0.009, 95% CI = 0.41–2.89). No significant difference was presented for HR ( p value = 0.58, 95% CI = −11.82–21.10), TUG ( p value = 0.055, 95% CI = −2.25 to 0.02) and step count ( p value = 0.71, 95% CI = −1479–2163). High‐intensity interval training is a safe rehabilitation method affecting positively the aerobic capacity and the majority of motor function of stroke survivors.