ABSTRACT
O estudo objetivou comparar diferentes estratégias de supervisão durante 12 semanas de um programa de exercícios domiciliares sobre a função cognitiva de idosos saudáveis. Foi realizado um ensaio clínico, no qual participaram idosos comunitários de ambos os sexos, que foram divididos em dois grupos com diferentes estratégias de supervisão: supervisionado virtualmente por videoconferências durante todas as sessões de treino, ou supervisionado por mensagens de texto. A intervenção para ambos os grupos consistiu em um programa ofertado por meio de vídeos-aula, com frequência de três sessões semanais e duração de 12 semanas. Os desfechos foram avaliados remotamente por videoconferência. Para avaliar a cognição global foi utilizado o Montreal Cognitive Assessment (MoCA) e para o controle inibitório o Stroop test. Foi feita uma análise inferencial, com intenção de tratar, de modelos mistos por simetria composta, considerando intervalos de confiança (IC) a 95% e um nível de significância de 5%. Trinta e oito participantes foram randomizados e alocados em um dos grupos (81,6% mulheres, média de idade de 68,39 ± 6,48 anos, massa corporal média de 69,82 ± 12,15 kg, altura média de 1,59 ± 0,06 m, índice de massa corporal médio de 27,82 ± 4,88 kg/m²; e 94,7% com mais de 12 anos de estudo). Não houve diferenças estatisticamente entre os grupos (p>0,05) e não foram observados efeitos ao longo do tempo nas comparações intra-grupos (p>0,05). Concluiu-se que a supervisão utilizada neste estudo não promove ganhos cognitivos adicionais ao programa de exercícios domiciliares supervisionado por mensagens de texto em idosos saudáveis.
The study aimed to compare different supervision strategies during 12 weeks of a home exercise program on the cognitive function of healthy older adults. A clinical trial was conducted in which community-dwelling older adults of both genders participated. They were divided into two groups with different supervision strategies: those virtually supervised by videoconferences during all training sessions or those supervised by text messages. The intervention for both groups consisted of a program offered through video lessons, with a frequency of three weekly sessions and a duration of 12 weeks. Outcomes were assessed remotely via videoconference. The Montreal Cognitive Assessment (MoCA) was used to assess global cognition, and the Stroop test was used for inhibitory control. An intention-to-treat inferential analysis of mixed models by compound symmetry was performed, considering 95% confidence intervals (CI) and a significance level of 5%. Thirty-eight participants were randomized and allocated to one of the groups (81.6% women, mean age 68.39 ± 6.48 years, mean body mass 69.82 ± 12.15 kg, mean height 1.59 ± 0.06 m, mean body mass index of 27.82 ± 4.88 kg/m²; and 94.7% with more than 12 years of study). There were no statistically significant differences between groups (p>0.05), and no effects over time were observed in intra-group comparisons (p>0.05). It was concluded that both supervision methods used in this study did not provide additional cognitive gains to the home exercise program in healthy older adults.
ABSTRACT
OBJETIVO: Determinar las razones de la escasa derivación, acceso, y adherencia a programas de ejercicio supervisado (PES) en pacientes con claudicación intermitente (CI) y la costo-efectividad de estos programas a nivel Internacional. MÉTODOS: Se utilizaron las fuentes de datos de PubMed y ScienceDirect. Se incluyeron revisiones con acceso completo, publicados desde el año 2010, que incluían como mínimo 3 artículos de tipo cuantitativo. RESULTADOS: Se incluyeron 5 Revisiones asociadas a los resultados del ejercicio supervisado, su costo-efectividad, la baja derivación y adherencia a PES de los pacientes con CI. En cuanto a la costo-efectividad los resultados indican que los PES fueron rentables con un ICER de £711 a £1.608 por QALY ganado al compararlos con ejercicio no supervisado, y al compararlos con la cirugía de revascularización (CR) no hay diferencia significativa en QALY ganados, sin embargo, el costo por QALY fue 381.694 más alto para la CR. Por otro lado, las principales razones de la subutilización de los PES, es que los pacientes se resisten a asistir, ya que involucra un esfuerzo y responsabilidad, además de tener problemas de reembolso, teniendo baja adherencia. Sumado a esto, el interés personal de los médicos por realizar intervenciones que involucran pago por servicio produce una baja derivación (45% de cirujanos en Europa refieren menos del 50% de sus pacientes). CONCLUSIÓN: Las principales dificultades para adoptar los PES serían una carencia en la destinación de recursos, falta de centros, dificultad de traslado, falta de tiempo, o de interés por parte de los pacientes, además de incentivos financieros a otras alternativas de tratamiento por sobre PES lo que limita su derivación.
OBJECTIVE: To determine the reasons for the limited derivation, access and adherence to supervised exercise programs (SEP) in patients with intermittent claudication (IC) and the cost-effectiveness of these programs internationally. METHODS: PubMed and ScienceDirect databases were searched. Revisions with full access, published since 2010, which included at least 3 quantitative type articles. RESULTS: 5 reviews were included, these were associated with the results of the supervised exercise, its cost-effectiveness, the low referral and adherence to programs of patients with IC. Regarding cost-effectiveness, the results indicated that SEP were more cost-effective with an ICER of £711 to £1.608 per QALY gained when compared with unsupervised exercise, and that when compared with revascularization surgery (RC) there was no significant difference in QALYs, however the cost per QALY was 381.694 higher for the RC. On the other hand, the main reasons for the underutilization of SEP are that patients are reluctant to attend, since it involves effort and responsibility, in addition to having reimbursement problems, therefore having low adherence. Added to this, the personal interest of doctors in performing interventions that involve payment for service produce a low referral (45% of surgeons in Europe refer less than 50% of their patients) CONCLUSION: The main difficulties in adopting the SEP would be a lack in the allocation of resources, lack of centers, difficulty of transportation, lack of time or lack of interest from patients, in addition to financial incentives to other treatment alternatives over SEP, which limits their referral.
Subject(s)
Humans , Directly Observed Therapy/economics , Directly Observed Therapy/statistics & numerical data , Exercise Therapy/economics , Intermittent Claudication/therapy , Referral and Consultation/statistics & numerical data , Patient Compliance , Cost-Benefit Analysis , Exercise Therapy/methods , Exercise Therapy/statistics & numerical data , Treatment Adherence and Compliance , Health Services Misuse , Intermittent Claudication/rehabilitationABSTRACT
Background: Shoulder Impingement Syndrome (SIS) is a major contributing factor for shoulder pain. Although many therapists use Kinesio Taping (KT) and Manual Therapy (MT) for SIS, no such studies in combination with Supervised Exercise Therapy (SET) have been conducted in the context of Saudi Arabia. Thus, the purpose of this study is to compare the effectiveness of KT and MT with SET in patients with SIS. Methods: Randomized controlled trial. Thirty-two subjects were assigned into two groups (KT with SET and MT with SET). The following outcome measures were measured at baseline, three weeks and six weeks. The outcome measurements are pain intensity by a numerical pain rating scale (NPRS), Active range of motion in the shoulder (AROM) by goniometry, and the functions of the shoulder measured through Shoulder Pain and Disability Index (SPADI). A simple descriptive statistical analysis was adopted to describe the patient-specific demographic characteristics with respect to outcome parameters. Within-group and between groups comparison were analyzed using ANOVA, and Scheffes’ posthoc tests by using SPSS 21.0. Results: Sixteen subjects completed treatment in each group. No differences were identified between groups at baseline. In ANOVA, it was shown that both groups significantly (p<0.05) decreased pain intensity, improved function and increased shoulder AROM in the 3rd week, and 6th week. However, post hoc analysis results suggested that the KT, in conjunction with SET, had a higher proportion of change on 3rd week, of the pain intensity, SPADI, and AROM. Conclusion: KT with SET has been found to be more effective than the MT with SET in the 3rd week and had the same effect in the 6th week of the treatment. When an immediate effect is expected, KT may be a better choice of treatment in the management of SIS.
ABSTRACT
Supervised exercise training (SET) has been the first-line treatment for peripheral arterial disease (PAD),and its curative effect has been widely recognized by scholars both at home and abroad.Beingthe carrier of SET therapy,exercise prescription has an inestimable effect.This paper aims to make a comprehensive review about the clinical application of exercise prescription in treating PAD patients and to introduce its latest progress in research.