Efectividad de la fisioterapia respiratoria combinada con higienepostural en niños con afectación neurológica crónica / Effectiveness of respiratory physiotherapy combined with postural education in children with chronic neurological diseases

Fundamento:Los niños con afectación neurológica crónica presentan discapacidad motora y aumento de morbilidad y mortalidad por causa respiratoria. El objetivo fue evaluar si se benefician de fisioterapia respiratoria e higiene postural a corto y medio plazo.Pacientes y métodos:Estudio cuasi-experimental con realización de seis sesiones quincenales de fisioterapia y talleres de higiene postural a niños de 0 a 6 años con afectación neurológica crónica y respiratoria. Se evaluaron variables clínicas respiratorias, secreciones expectoradas, reagudizaciones respiratorias y calidad de vida mediante cuestionario PedsQL. Las evaluaciones fueron realizadas al inicio, al final de la intervención y a los tres meses de la misma.Resultados:Tras la intervención, en los 30 niños se observó una mejora significativa (p<0,001) respecto al inicio en la media de saturación de oxígeno (98,3 vs 94,37%), frecuencia cardiaca (103,6 vs 126,03 latidos/minuto), frecuencia respiratoria (34,27 vs 42,13 respiraciones/minuto) y volumen de secreciones (28,17 vs 45,33 mL). Esta mejoría se mantuvo a los tres meses de finalizada la intervención. La media de reagudizaciones respiratorias disminuyó (p<0,001) respecto a los seis meses previos: hospitalizaciones (0,5 vs 1,6), visitas a urgencias (1,53 vs 2,59) y a pediatría de atención primaria (5,03 vs 7). La puntuación media del cuestionario PedsQL incrementó significativamente (p<0,001) tras la intervención, tanto para salud física (un 27%, hasta 73,43) como mental (un 12% hasta 70,09).Conclusiones:La fisioterapia respiratoria combinada con higiene postural mejora el estado clínico y la calidad de vida en niños con afectación neurológica crónica, por lo que podría recomendarse en la práctica clínica habitual.(AU)

Background: Children with chronic neurological diseases present motor disability and increased respiratory morbidity and mortality. The aim of this study was to assess whether children with chronic neurological impairment benefit from respiratory physiotherapy and postural hygiene. Methods: Quasi-experimental study in which six fortnightly respiratory physiotherapy sessions and workshops on postural hygiene were carried out on children aged 0 to 6 years with chronic neurological disease and respiratory impairment. A PedsQL questionnaire assessed respiratory clinical variables, expectorated secretions, respiratory exacerbations and quality of life. Assessments were performed at baseline, post-intervention, and at a 3-month follow-up. Results: After physiotherapy sessions, all participants (n=30) experienced a significant (p<0.001) improvement in average oxygen saturation (94.37 to 98.3%), heart rate (126.03 to 103.6 beats/minute) and respiratory rate (42.13 to 34.27 breaths/minute), as well as a decrease in secretions (from 45.33 to 28.17 mL). This improvement was maintained after a 3-month follow-up. The average respiratory exacerbations decreased (p<0.001) compared to the previous six months: hospitalizations (from 1.6 to 0.5), visits to the emergency department (from 2.59 to 1.53) and to primary care Pediatric consultations (from 7 to 5.03). The mean score on the PedsQL questionnaire demonstrated a significant increase(p<0.001) in the quality of life after the intervention for physical (27%, to 73.4) and mental health (12%, to 70.09%). Conclusion: Respiratory physiotherapy combined withpostural hygiene is effective for the clinical status andquality of life in children with chronic neurological diseases, and therefore could be introduced in habitual clinicalpractice.(AU)

[Effectiveness of respiratory physiotherapy combined with postural education in children with chronic neurological diseases].

BACKGROUND: Children with chronic neurological diseases present motor disability and increased respiratory morbidity and mortality. The aim of this study was to assess whether children with chronic neurological impairment benefit from respiratory physiotherapy and postural hygiene. METHODS: Quasi-experimental study in which six fortnightly respiratory physiotherapy sessions and workshops on postural hygiene were carried out on children aged 0 to 6 years with chronic neurological disease and respiratory impairment. A PedsQL questionnaire assessed respiratory clinical variables, expectorated secretions, respiratory exacerbations and quality of life. Assessments were performed at baseline, post-intervention, and at a 3-month follow-up. RESULTS: After physiotherapy sessions, all participants (n=30) experienced a significant (p<0.001) improvement in average oxygen saturation (94.37 to 98.3%), heart rate (126.03 to 103.6 beats/minute) and respiratory rate (42.13 to 34.27 breaths/minute), as well as a decrease in secretions (from 45.33 to 28.17 mL). This improvement was maintained after a 3-month follow-up. The average respiratory exacerbations decreased (p<0.001) compared to the previous six months: hospitalizations (from 1.6 to 0.5), visits to the emergency department (from 2.59 to 1.53) and to primary care Pediatric consultations (from 7 to 5.03). The mean score on the PedsQL questionnaire demonstrated a significant increase (p<0.001) in the quality of life after the intervention for physical (27%, to 73.4) and mental health (12%, to 70.09%). CONCLUSION: Respiratory physiotherapy combined with postural hygiene is effective for the clinical status and quality of life in children with chronic neurological diseases, and therefore could be introduced in habitual clinical practice.

Spanish translation and validation of the Scale for Contraversive Pushing to measure pusher behaviour.

INTRODUCTION: The aim of this study was to develop and validate a Spanish-language version of the Scale for Contraversive Pushing, used to diagnose and measure pusher behaviour in stroke patients. METHODS: Translation-back translation was used to create the Spanish-language Scale for Contraversive Pushing; we subsequently evaluated its validity and reliability by administering it to a sample of patients. We also analysed its sensitivity to change in patients identified as pushers who received neurological physiotherapy. RESULTS: Experts indicated that the content of the scale was valid. Internal consistency was very good (Cronbach's alpha of 0.94). The intraclass correlation coefficient showed high intra- and interobserver reliability (0.999 and 0.994, respectively). The Kappa and weighted Kappa coefficients were used to measure the reliability of each item; the majority obtained values above 0.9. Lastly, the differences between baseline and final evaluations of pushers were significant (paired sample t test), showing that the scale is sensitive to changes obtained through physical therapy. CONCLUSIONS: The Spanish-language version of the Scale for Contraversive Pushing is valid and reliable for measuring pusher behaviour in stroke patients. In addition, it is able to evaluate the ongoing changes in patients who have received physical therapy.

Traducción y validación española de la Scale for Contraversive Pushing (SCP) para la valoración del comportamiento empujador / Spanish translation and validation of the Scale for Contraversive Pushing to measure pusher behaviour

Introducción: El objetivo de este estudio es traducir y validar al español la Scale for Contraversive Pushing, usada para diagnosticar y medir el comportamiento empujador en pacientes que han sufrido un ictus.MétodosSe realizó una traducción-retrotraducción de la Scale for Contraversive Pushing para la población española y, posteriormente, se evaluó la validez y fiabilidad de la misma a partir de una muestra de pacientes. Además, se analizó la sensibilidad al cambio en pacientes que resultaron ser empujadores y recibieron tratamiento de fisioterapia neurológica.ResultadosLas respuestas de los expertos indicaron que la escala era válida en cuanto a su contenido. La consistencia interna, medida a través del alfa de Cronbach, obtuvo un resultado de 0,94. La fiabilidad intraobservador e interobservador, calculada por medio del coeficiente de correlación intraclase, presentó un valor de 0,999 y 0,994 respectivamente. Cuando se analizó la fiabilidad de cada ítem, por medio del coeficiente de kappa o kappa ponderado, la mayoría de ellos obtuvo una puntuación superior a 0,9. Por último, las diferencias obtenidas entre la valoración inicial y final de los pacientes empujadores fueron significativas (t de Student pareada), objetivando que la escala era sensible a los cambios obtenidos tras un tratamiento de fisioterapia.ConclusionesLa Scale for Contraversive Pushing es válida y fiable para medir el comportamiento empujador en pacientes que han sufrido un ictus. Además, es capaz de evaluar los cambios ocurridos en los pacientes, tras recibir tratamiento de fisioterapia. (AU)

Introduction: The aim of this study was to develop and validate a Spanish-language version of the Scale for Contraversive Pushing, used to diagnose and measure pusher behaviour in stroke patients.MethodsTranslation–back translation was used to create the Spanish-language Scale for Contraversive Pushing; we subsequently evaluated its validity and reliability by administering it to a sample of patients. We also analysed its sensitivity to change in patients identified as pushers who received neurological physiotherapy.ResultsExperts indicated that the content of the scale was valid. Internal consistency was very good (Cronbach's alpha of 0.94). The intraclass correlation coefficient showed high intra- and interobserver reliability (0.999 and 0.994, respectively). The Kappa and weighted Kappa coefficients were used to measure the reliability of each item; the majority obtained values above 0.9. Lastly, the differences between baseline and final evaluations of pushers were significant (paired sample t test), showing that the scale is sensitive to changes obtained through physical therapy.ConclusionsThe Spanish-language version of the Scale for Contraversive Pushing is valid and reliable for measuring pusher behaviour in stroke patients. In addition, it is able to evaluate the ongoing changes in patients who have received physical therapy. (AU)

[Spanish translation and validation of the Burke Lateropulsion Scale to measure pusher behaviour]. / Traduccion y validacion al castellano de la Burke Lateropulsion Scale para la valoracion del comportamiento empujador.

INTRODUCTION: Pusher behaviour is an alteration of postural control and the perception of the midline which occurs in some patients after suffering a stroke and it has important functional consequences, so its evaluation is essential. AIM: To translate into Spanish and to validate the Burke Lateropulsion Scale (BLS), used to evaluate the signs of pusher behaviour in patients. PATIENTS AND METHODS: To achieve the proposed objectives, a translation-back translation into Spanish of the scale was performed and the validity and reliability of a sample of post-stroke patients was evaluated. In addition, sensitivity to change was evaluated in patients who turned out to be pushers and received physiotherapy treatment. RESULTS: The experts' answers indicated that the scale was valid in terms of its content to evaluate pusher behaviour in a sample of patients. Cronbach's alpha obtained a result of 0.91. The evaluation of inter-observer and intra-observer reliability gave an overall intraclass correlation coefficient result of 0.99. When the reliability of each item was evaluated by means of the weighted kappa coefficient, most of the results exceeded 0.9. Finally, on evaluating the sensitivity to change on the scale in the sample of pusher patients, the results showed that the BLS is sensitive to the changes which occur after receiving neurological physiotherapy treatment for items related to standing, transfers and walking. CONCLUSIONS: The BLS scale is valid and reliable for measuring pusher behaviour in patients who have suffered a stroke and is sensitive to changes after neurological physiotherapy treatment.

TITLE: Traduccion y validacion al castellano de la Burke Lateropulsion Scale para la valoracion del comportamiento empujador.Introduccion. El comportamiento empujador es una alteracion del control postural y la percepcion de la linea media que ocurre en algunos pacientes principalmente tras sufrir un ictus y tiene importantes consecuencias funcionales, por lo que su evaluacion resulta imprescindible. Objetivo. Traducir y validar al castellano la Burke Lateropulsion Scale (BLS), usada para evaluar los signos del paciente con comportamiento empujador. Pacientes y metodos. Se realizo una traduccion-retrotraduccion al castellano de la escala y se evaluo su validez y fiabilidad en una muestra de 50 pacientes que habian sufrido un ictus. Ademas, se evaluo su sensibilidad al cambio en los pacientes empujadores que recibieron tratamiento de fisioterapia neurologica. Resultados. Las respuestas de los expertos indicaron que la escala era valida en cuanto a su contenido para evaluar el comportamiento empujador. El alfa de Cronbach obtuvo un resultado de 0,91. La evaluacion de la fiabilidad interobservador e intraobservador dio como resultado global un coeficiente de correlacion intraclase de 0,99. Al evaluar la fiabilidad de cada item por medio del coeficiente kappa ponderado, la mayoria de los resultados fueron superiores a 0,9. La evaluacion de la sensibilidad al cambio de la escala en los pacientes empujadores demostro que la BLS resulta sensible a los cambios que se producen tras recibir tratamiento de fisioterapia neurologica en los items referidos a la bipedestacion, las transferencias y la marcha. Conclusiones. La BLS es valida y fiable para medir el comportamiento empujador en pacientes que han sufrido un ictus y resulta sensible a los cambios tras un tratamiento de fisioterapia neurologica.

Spanish translation and validation of the Scale for Contraversive Pushing to measure pusher behaviour. / Traducción y validación española de la Scale for Contraversive Pushing (SCP) para la valoración del comportamiento empujador.

INTRODUCTION: The aim of this study was to develop and validate a Spanish-language version of the Scale for Contraversive Pushing, used to diagnose and measure pusher behaviour in stroke patients. METHODS: Translation-back translation was used to create the Spanish-language Scale for Contraversive Pushing; we subsequently evaluated its validity and reliability by administering it to a sample of patients. We also analysed its sensitivity to change in patients identified as pushers who received neurological physiotherapy. RESULTS: Experts indicated that the content of the scale was valid. Internal consistency was very good (Cronbach's alpha of 0.94). The intraclass correlation coefficient showed high intra- and interobserver reliability (0.999 and 0.994, respectively). The Kappa and weighted Kappa coefficients were used to measure the reliability of each item; the majority obtained values above 0.9. Lastly, the differences between baseline and final evaluations of pushers were significant (paired sample t test), showing that the scale is sensitive to changes obtained through physical therapy. CONCLUSIONS: The Spanish-language version of the Scale for Contraversive Pushing is valid and reliable for measuring pusher behaviour in stroke patients. In addition, it is able to evaluate the ongoing changes in patients who have received physical therapy.

Estudio piloto comparativo de las expectativas del enfermo y la familia relacionadas con la autonomía personal en cuidados paliativos / No disponible

Introducción: el conseguir o mantener el mejor estado de salud o de calidad de vida para el paciente al final de una enfermedad, es una labor de los cuidados paliativos. Son muchos los estudios que intentan relacionar el bajo nivel de autonomía con una menor y peor supervivencia, de ahí la importancia de trabajar desde todos los puntos de mira del paciente: autonomía e independencia, familia... y no sólo el tratamiento de síntomas de la enfermedad. Objetivos: este estudio piloto plantea como objetivo: "comparar las expectativas del enfermo y la familia relacionadas con la autonomía personal del enfermo". Intenta desenmascarar en primer lugar: "la importancia que tanto el enfermo como la familia confieren a la dependencia funcional ocasionada por el progreso de la enfermedad", en segundo y tercer lugar: “explorar las expectativas personales del enfermo y la familia, con respecto a la autonomía personal", y "valorar las diferencias de esas expectativas entre el enfermo y el cuidador". Material y métodos: es un artículo descriptivo, en el que se han elaborado dos cuestionarios (Anexos 1 y 2), con indicadores que valoran las expectativas de ambos, el paciente y su cuidador, en relación a la autonomía del enfermo. Este cuestionario ha sido respondido por los pacientes y sus familiares que pertenecían a una unidad de cuidados paliativos y que no estaban diagnosticados de deterioro cognitivo. Las preguntas relacionan el grado de autonomía del paciente, con las preocupaciones que aparecen entre ambos, durante el proceso de esta enfermedad. Resultados: enfrentando las preocupaciones que manifiestan tanto familia y enfermo, en relación a lo que el cuidador cree que es lo más importante para su familiar destacamos, las relacionadas con el hecho de que esté solo, la evolución de la enfermedad y el dolor que pueda desencadenar el proceso. Por el contrario, las principales inquietudes por parte del enfermo son, en primer lugar, que su familia sufra, seguido de estar solo, y a continuación ser dependiente para las actividades básicas de la vida diaria (ABVD) y tener dolor. Por lo tanto las percepciones y expectativas que el cuidador tiene de su familiar y viceversa, no son las mismas. Conclusión: las conclusiones son claras, todo cuidador que tenga a su familiar en una unidad de cuidados paliativos, ayuda en alto grado a la realización de las ABVD, incluso aunque no sea estrictamente necesario. Cabe destacar que esta implicación de los cuidadores se debe a motivos relacionados con el apoyo emocional. Ambos, familia y cuidador, valoran como muy importante la preocupación que tiene el uno por el otro y viceversa (AU)

Introduction: to gain or maintain better health or quality of life for the patient at the end of a disease is the work of palliative care. Many studies attempt to link a low level of autonomy with shorter, worse survival, hence the importance of our work from all points of view on patient autonomy and independence, and not just treat the symptoms of the disease. Objectives: this pilot study is "to compare the patient and family expectations regarding patient personal autonomy". To try first to unmask "the importance that both the patient and the family give to functional dependence as caused by disease progression"; in the second and third place: "to explore the personal expectations of patients and families about personal autonomy", and "to value differences in expectations between patients and caregivers". Material and methods: a descriptive article with the development of two questionnaires (Annex 1 and 2), and indicators that assess the expectations of both the patient and primary caregiver in relation to patient autonomy. This questionnaire was answered by patients and their families in a palliative care unit and with no cognitive impairment. Questions regarding patient autonomy degree, and concerns reported during disease. Results: the concerns expressed by both family and patient in relation to what the caregiver feels is more important to the patient should be addressed. In contrast, the main concerns for the sick are, first, that their family is suffering, followed by their being alone, becoming dependent of ADL, and pain. Therefore the perceptions and expectations of caregivers and patients regarding each other, are not the same. Conclusions: clearly, any caregiver with a family member in a palliative care unit helps greatly in ADL performance, even if not strictly necessary. Importantly, this involvement of carers results from reasons related to emotional support. Both patients and caregivers assessed their concern for each other as highly relevant (AU)

[The prognostic value of cholesterol levels in malnourished patients with esophageal carcinoma]. / Interés pronóstico de los niveles de colesterol en pacientes malnutridos con carcinoma esofágico.

A variety of clinical calculations, including serum cholesterol, have been used as parameters of prognostic value in surgical populations, but there are few studies aimed at patients with esophageal carcinoma. In a set of patients with established esophageal cancer, cholesterol and triglyceride levels were recorded, along with the following parameters: age, sex, body weight, serum albumin, total lymphocytes, and hemoglobin concentration. Manual grip strength was measured, along with delayed cutaneous hypersensitivity response, and the type of surgical treatment was distinguished (palliative versus radical). Total complications and postoperative hospitalisation time are the main indicators used in our study for the surgical results. Patients were divided into two groups: those with serum cholesterol levels over 150 mg/dl (Group I) and those under that figure (Group II). Most nutritional and functional values were lower in Group II patients, for whom the radical surgery rate was also lower, with greater postoperative morbidity. It was concluded that 1): Cholesterol depletion is associated with nutritional and immunological alterations and 2) post-surgical results are poorer in patients with levels below 150 mg/dl.