Background: Multiple sclerosis is a chronic inflammatory auto-immune disease with various symptoms, which requires comprehensive multidisciplinary treatment for distinct and individualized conditions. Reviews on this population address treatment alternatives (i.e., pharmaceutical and rehabilitation). Orthotic interventions are seldom mentioned or mentioned briefly in conjunction with physiotherapy interventions. Aim: This study aims to critically appraise and summarize current evidence regarding orthotic interventions for multiple sclerosis population with lower limb deficiencies. Methods: This study uses umbrella review protocol for systematic reviews. 5 databases were used (CINAHL, Cochrane, PubMed, Scopus, Web of Science). From 44 reviews, 6 systematic reviews were obtained using JBI appraisal tool. Methodological quality is appraised using AMSTAR II, data were extracted via JBI data extraction form for umbrella reviews. 2 articles were excluded and the evidence quality of the remaining 4 articles were appraised via GRADE. Results: 2 out of 4 investigated the effect of foot orthoses, whilst the remaining investigated FES devices. 3 out of 4 articles scored “Critically low” in methodological quality, 1 scored “High”. The evidence quality of the different outcomes ranges from "Very low” to “High”. Conclusion: Foot orthoses reported an increase RoM in ankle and knee joints. FES intervention found an increase in speed and endurance during gait and increased RoM of ankle and knee. However, more studies with higher quality are needed to establish clinical recommendations. / Bakgrund: Multipel skleros är en kroniskt inflammatorisk auto-immun sjukdom med komplexa symtom som kräver en omfattande multidisciplinär behandlingsplan för att främja positiva, måluppnående behandlingsresultat. Artiklar gällande denna populationen kollar på behandlings alternativ (som medicinska och rehabilitering). Ortos interventioner nämns kort men ofta vid sidan av diskuterade medicinska interventionerna eller som komplement till fysioterapin. Syfte: Denna studie syftar att kritiskt värdera och summera den nuvarande evidensen gällande användningen av ortoser som intervention för brister i lägre extremiteters funktion för patienter med multipel skleros. Metod: Sökningen genomfördes i 5 databaser (CINAHL, Cochrane, PubMed, Scopus, Web of Science). Från 44 artiklar, var 6 studier behöriga efter JBI utvärderings verktyg. Metodologisk kvalitet var testat genom AMSTAR II, data var framtagen genom ” JBI data extraktion form for Umbrella reviews”. 2 artiklar var exkluderade ytterligare och evidens kvalitén av de kvarstående 4 artiklarna var testat med GRADE. Resultat: Två av de fyra inkluderade studierna studerade användningen av fotortoser medans de kvarvarande studerade FES-enheter. Tre av fyra studier fick betyget ”Critically low” gällande metodologisk kvalitet, en fick betyget ”High”. Evidens kvaliten av interventionernas resultat varierade mellan ”Very low” till ”High”. Sammanfattning: Fotortoser rapporterade en chans att öka rörlighets omfånget i ankel och knä. FES-enhet visade en ökning av hastighet och uthållighet vid gång samt öka rörelseomfånget i ankel och knä. Denna studie konstaterar att det behövs fler starka studier för att kunna skapa kliniska rekommendationer gällande ortoser för nedre extremiteter för MS patienter.

Background: Fibromyalgia (FM) disorder commonly involves musculoskeletal widespread pain and other symptoms like fatigue, sleep disruption, depression and anxiety and is associated with disability, work disability and high health care utilization. An integrated approach combining pharmacological and non-pharmacological treatments is advised to manage the disorder. Among the non-pharmacological interventions exercise has been shown to help; however, details about effectiveness of different types of interventions remain unknown. Objectives: The objective of this dissertation was to synthesize the evidence on the effectiveness of: a) Aquatic exercise interventions for adults with FM as reported in randomized control trials (RCTs), and b) any physical activity interventions for adults with FM as reported in systematic reviews. This was done by conducting a Cochrane systematic review of an aquatic training intervention and second, synthesizing the effectiveness of a variety of exercise interventions. Methods: For the Cochrane systematic review, nine electronic databases were searched. Selection criteria included full text publication of a RCT including an aquatic exercise intervention (AQ) (exercise in water was >50% of the full intervention) and provision of between-group outcome data. Pairs of reviewers independently screened and selected articles, assessed risk of bias, and extracted data on 24 outcomes. Effects of the interventions were evaluated using mean, standardized mean differences and 95% confidence interval (MD/SMD [95% CI]). Specific computer software designed for meta-analysing and evaluating the quality of evidence were used (i.e RevMan, GradePro). The second review, the synthesis of a variety of exercise interventions or umbrella systematic review, inspected six electronic databases for the January 1st 2007 to March 31st 2012 period. We included systematic Cochrane and non-Cochrane reviews that reported on the effects of any physical activity intervention for adults with FM. Pairs of reviewers independently screened and selected articles, assessed quality of the reviews using a valid and reliable tool (AMSTAR tool), and extracted data on four outcomes. Effects of the interventions were evaluated using standardized mean differences and 95% confidence intervals (SMD [95% CI]). We planned to use RevMan software for meta-analysis but due to heterogeneity of the reviews this was not done. Results: The Cochrane review examined 16 aquatic exercise training studies (n = 881). Nine studies compared aquatic exercise to control, five studies compared aquatic exercise to land-based exercise, and two compared aquatic to a different aquatic program. The aquatic vs control studies provided low to moderate quality evidence suggesting that aquatic training is beneficial for wellness, symptoms and fitness in adults with FM. The aquatic vs land group results suggested very low to low quality evidence that there are no differences in benefits between aquatic and land-based exercise except in muscle strength (very low quality evidence favoring land). In examining aquatic vs aquatic meta-analyses was not possible and only one difference in a major outcome was found. The umbrella systematic review synthesis of information (n-= nine systematic reviews) found positive results for diverse exercise interventions on pain, multidimensional function, and self-reported physical function and no conclusive evidence for new (to FM) physical activity mode (i.e. qigong, tai chi). There are however, methodological weaknesses in some of the reviews which reduce applicability of the research to clinical practice. Adverse effects reported suggest there was no serious harm performing physical activity for individuals with FM. Conclusions: Exercise interventions have the potential to positively impact individuals with FM including several outcomes like quality of life, physical functioning and pain. While some interventions had statistically significant results, methodological limitations prevented us from arriving at conclusions regarding particular elements and modes of exercise that will help inform health professional’s clinical practice. On the other hand, some preliminary analysis showed that variables like age, disease duration, disease severity and pain intensity warrant further exploration. A rigorous scientific process (or quality research) as the precursor of quality evidence is crucial for validity and credibility of the information and our future understanding of the effectiveness of exercise interventions for individuals with FM.

Contexte : Les espaces publics, tels que les parcs, les espaces verts et bleus, sont cités comme des infrastructures favorisant l'activité physique, la santé mentale et le bien-être. Cependant, les caractéristiques précises des espaces publics qui sont significativement associées à la santé ne sont pas clairement identifiées. Cette recherche vise à fournir une mise à jour rigoureuse des connaissances scientifiques sur les associations entre les caractéristiques des espaces publics et la santé physique et mentale. Méthode : Nous avons réalisé une méta-revue afin de synthétiser, comparer et contraster les données probantes issues de recensions systématiques, en tenant compte de la qualité méthodologique des recensions incluses à l'aide de l’outils AMSTAR. 2977 références ont été identifiées par la recherche bibliographique dans 6 bases de données. Deux examinatrices ont indépendamment effectué la sélection des études et un total de 15 recensions systématiques sont incluses dans la méta-revue (représentant 213 études primaires). Résultats : quand les espaces publics sont considérés de manière générale, sans spécifier leur type ou leurs caractéristiques, les données probantes sur leur relation avec la santé physique et mentale sont peu concluantes. Cependant, lorsque les caractéristiques des espaces sont spécifiées, les associations sont davantage significatives. Ces dernières soutiennent une relation favorable ou à tendance favorable entre : 1) La quantité d'espaces verts (présence dans le quartier de végétation, de biodiversité, d’espaces verts calmes, sereins et naturels) et la santé mentale / bien-être chez les adultes. 2) La proximité des parcs et la présence de certains équipements (ex. terrains de jeux, sentiers) et l'activité physique dans les parcs chez les enfants et les adolescents, mais pas avec l'activité physique mesurée globalement. 3) Les espaces bleus (comme les zones côtières) et l'activité physique, la santé mentale et le statut pondéral. Les données sont peu concluantes quant à la proximité des parcs, la densité et la qualité des espaces publics associés à la santé physique et mentale. Les résultats concernant l'activité physique semblent indiquer que les associations positives décrivent davantage un contexte pour l'activité physique qu'un impact possible de l'accès aux espaces publics sur la quantité d'activité physique globale. Les associations positives ont également tendance à être spécifiques aux groupes d’âge pour la plupart des indicateurs. Conclusion: il est prouvé que certaines caractéristiques spécifiques des espaces publics sont associées à une meilleure santé. Cette méta-revue fournit des outils aux professionnels de la planification et du design urbain sur la façon de concevoir les espaces publics pour promouvoir la santé physique et mentale. / Background: Public open spaces (POS), such as parks, green and blue spaces, are cited as infrastructures to promote physical activity, mental health and well-being. However, precise characteristics of POS significantly associated to health are not clearly identified. This research aims to provide a rigorous update of scientific knowledge on associations between characteristics of POS, and physical and mental health indicators. Method: We undertaken an umbrella review to synthetize, compare and contrast evidence from systematic reviews, taking into account the methodological quality of included reviews using an adapted AMSTAR scale. Research in 6 databases returned 2977 citations. Two reviewers independently completed study selection resulting in 15 included systematic reviews (representing 213 primary studies). Results: The evidence of a favorable relationship between broadly defined or unspecified POS and physical and mental health is inconclusive. However, when characteristics of POS are specified, evidence for relationships is clearer. There is a favorable trend or a consistent favorable relationship between: 1) quantity of greenspaces (spaces with vegetal elements and biodiversity in the neighborhood, calm, serein and natural greenspaces) and mental health/wellbeing in adults. 2) proximity to parks and the presence of certain amenities (e.g. adventurous playgrounds) and park-based physical activity in children and adolescent, but not with overall physical activity. 3) blue spaces (such as coastal areas) and physical activity, mental health and weight status. There are some inconsistencies for parks proximity, density and quality of POS association with physical and mental health indicators. Results regarding physical activity seem to mean that studies with positive associations mostly describe a context for physical activity more than a possible impact of POS access on overall physical activity. Positive associations also tend to be age specific for most of indicators. Conclusion: There is evidence that some specific characteristics of POS are associated with better health. This umbrella review provides useful tools to urban planning and design practitioners on how to design POS to promote physical and mental health.