Ventilatory, phonatory and swallowing impairments in advanced neuromuscular disease patients / Alteraciones ventilatorias, fonatorias y deglutorias en pacientes con enfermedad neuromuscular avanzada

Purpose: To analyze the ventilatory, phonatory and swallowing impairments and their relation with physical status in a group of advanced Neuromuscular Disease (NMD).Methods: A cross-sectional observational study was utilized 48 participants from the Association of NMD of Granada (Granada, España), university clinical research, University of Granada. A total of 24 advanced NMD patients and 24 healthy controls matched for age and sex were recruited. Advanced NMD patients were divided in two groups according to the level of their overall physical status (NMD higher physical status group or NMD lower physical status group). Hand grip strength, ventilatory, phonatory and swallowing features were analyzed.Results: There were significant differences (p<.05) among NMDs groups in ventilatory function. There were significant differences (p<.05) between NMDs groups in ventilatory, phonatory and swallowing function. Finally, there were significant differences (p<.05) among advanced NMDs groups in swallowing function and orofacial evaluation. Conclusion: Patients with lower physical status have higher risk of suffer ventilatory, phonatory and swallowing complications after diagnosis of NMD.(AU)

Propósito: Analizar las alteraciones ventilatorias, fonatorias y deglutorias y su relación con el estado físico en un grupo de Enfermos Neuromusculares (ENM) avanzados.Métodos: Se realizó un estudio observacional transversal con 48 participantes de la Asociación de ENM de Granada (Granada, España), y de la facultad de ciencias de la salud de la Universidad de Granada. Se reclutaron un total de 24 pacientes con ENM avanzada y 24 controles sanos emparejados por edad y sexo. Los pacientes con ENM avanzada se dividieron en dos grupos según el nivel de su estado físico general (grupo de ENM de mayor estado físico o grupo de ENM de menor estado físico). Se analizó la fuerza de agarre de las manos y las características ventilatorias, fonatorias y deglutorias.Resultados:Se encontraron diferencias significativas (p<0,05) entre los grupos de ENM en la función ventilatoria. También, se observaron diferencias significativas (p<0,05) entre los grupos de ENM en la función fonatoria y deglutoria. Por último, existieron diferencias significativas (p<0,05) entre los grupos de ENM avanzados respecto a la condición miofuncional orofacial.Conclusiones: Los pacientes con menor estado físico tienen mayor riesgo de sufrir complicaciones ventilatorias, fonatorias y deglutorias tras el diagnóstico de ENM.(AU)

Agreement between telerehabilitation and face-to-face orofacial myofunctional assessment in persons with acquired brain injury.

BACKGROUND AND OBJECTIVE: Orofacial myofunctional disorders are common in persons with acquired brain injury. A new way for early detection of orofacial myofunctional disorders via information and communication technologies may improve accessibility. The purpose of this study was to evaluate the level of agreement between face-to-face and tele-assessment of an orofacial myofunctional protocol in a sample of persons with acquired brain injury. METHODS: A masked comparative evaluation was conducted in a local association of patients with acquired brain injury. Twenty-three participants (39.1% female, mean age of 54 years) with a diagnosis of acquired brain injury were included in the study. The patients followed a face-to-face and a real-time online assessment using the Orofacial Myofunctional Evaluation with Scores protocol. This is a protocol for evaluation with numerical scales that assess the physical characteristics and the main orofacial functions of patients including appearance, posture, and mobility of lips, tongue, cheeks, and jaws, respiration, mastication, and deglutition. RESULTS: The analysis showed excellent interrater reliability (ρ ≥ 0.85) for all the categories. In addition, most confidence intervals were narrow. CONCLUSIONS: This study reveals excellent interrater reliability of an orofacial myofunctional tele-assessment in patients with acquired brain injury in comparison with a traditional face-to-face evaluation.

Uso de eSalud para promover la actividad física en los supervivientes de neoplasias torácicas: revisión sistemática y metaanálisis / The use of eHealth to promote physical activity in thoracic malignancies survivors: A systematic review and meta-analysis

Antecedentes: Las tasas de supervivencia para muchas formas de neoplasias torácicas han mejorado durante las últimas décadas. Sin embargo, muchos supervivientes tienen que hacer frente a los efectos secundarios del tratamiento del cáncer durante un tiempo prolongado. La actividad física (AF) ha sido propuesta como estrategia terapéutica para combatir los efectos del tratamiento del cáncer, pudiendo ser eSalud una buena manera de animar a los pacientes a practicarla. Objetivo: Explorar los efectos de eSalud en la promoción de la AF entre las neoplasias torácicas. Métodos: Se realizó una búsqueda de los artículos adecuados utilizando las bases de datos de PubMed, Web of Science y Scopus, mediante una combinación de títulos de temas médicos. Resultados: Se identificaron 4.781 artículos en total, de los cuales 10 cumplieron los criterios de elegibilidad. Se describieron diferentes intervenciones de eSalud en estos estudios: aplicación para móviles (app) (n = 3), sitio web (n = 2), correo electrónico (n = 2), aplicación para web y móvil (n = 1), asesoramiento telefónico (n = 1) y página online (n = 1). Todos los estudios reportaron mejoras en cuanto a AF y 8/10 estudios reportaron cambios estadísticamente significativos. Conclusión: Nuestros resultados muestran que los programas de eSalud son útiles para promover la AF en los supervivientes de neoplasias torácicas, en comparación con la no intervención, el tratamiento convencional o el enfoque dietético. Además, este metaanálisis reveló también que eSalud es un buen modo de mejorar el nivel de AF en los supervivientes de neoplasias torácicas.(AU)

Background: Survival rates for many forms of thoracic malignancies have improved over the past few decades, however, many survivors are coping with the side effects of cancer treatment for longer. Physical activity (PA) has been proposed as a therapeutic strategy to combat the effects of treatment in cancer survivors and eHealth could be a good way to encourage patients to practice it. Objective: To explore the effects of eHealth in the promotion of PA among thoracic malignancies. Methods: Suitable articles were searched using PubMed, Web of Science and Scopus databases using a combination of medical subject headings. Results: In total, 4781 articles were identified, of which ten met eligibility criteria. Different eHealth interventions were described in these studies: mobile application (app) (n = 3), website (n = 2), email (n = 2), web and mobile application (n = 1), telephone counseling (n = 1) and online sheet (n = 1). All studies reported improvements in PA, with 8/10 studies reporting statistically significant changes. Conclusion: Our results show that eHealth programs are useful to promote PA in malignancy thoracic survivors, compared to no intervention, conventional treatment or a dietary approach. Moreover, the meta-analysis also revealed eHealth is a good way to improve the level of PA in thoracic malignancies survivors.(AU)

Smartphone-based follow-up of upper airway symptoms in head and neck cancer survivors one year after radiation therapy.

BACKGROUND: Improvements in treatment of head-and-neck cancer (HNC) have resulted in improved long-term survival rates so there is a growing interest in long-term consequences. OBJECTIVE: The aim was to perform a smartphone-based assessment to analyse the upper airway dysfunction-related symptoms in HNC 1 year after radiotherapy (RT) during social distancing due to COVID-19. METHODS & PROCEDURES: Smartphone-based assessment on upper airway function 1 year after RT was performed. Upper airway functions include perceived impact of voice on quality of life (Voice Handicap Index, VHI-30), swallowing (Functional Oral Intake, FOIS; and Swallowing Quality of Life questionnaire, SWAL-QOL) and sleep-disordered breathing (Pittsburgh Sleep Quality Index, PSQI) assessments. Additionally, quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. OUTCOMES & RESULTS: The HNC group presented worse results in the VHI-30 scale, in the three subscales (p < 0.001). Swallowing function also presented worse results in the HNC group, with a lower score in the FOIS questionnaire (p < 0.001) and a poorer score in the SWAL-QOL (p < 0.001). Regarding to the sleep-disordered breathing, the HNC group presented poorer scores in all subscales (p < 0.05). The HNC group also presented worse scores in quality of life. CONCLUSION: Our findings showed that HNC survivors presented a poorer upper airway function and a worse quality of life. This population needs to be systematically screened for those function impairments. WHAT THIS PAPER ADDS: What is already known on the subject Head-and-neck cancer radiotherapy treatment is anatomically related to the upper airway, involved in several functions such as breathing, swallowing and speech that could be affected by the treatment. Public health restrictions caused by the COVID-19 pandemic have made it difficult, and in many cases impossible, to see patients in person and complete assessments that are often crucial to improve their approach. Telephone interviews appear to be largely equivalent to face-to-face interviews, which could solve these problems. What this paper adds to existing knowledge The aim of this study was to perform a smartphone-based assessment to analyse the upper airway dysfunction-related symptoms in head-and-neck cancer survivors 1 year after radiotherapy treatment. Our findings showed that head-and-neck cancer survivors who have been treated with radiotherapy presented a poorer upper airway function, with subjective speech and voice problems, swallowing and sleep-disordered breathing compared to a control group matched for age and sex 1 year after the treatment. What are the potential or actual clinical implications of this work? The results of this study will allow a better approach to treatment of head-and-neck cancer survivors.

The use of eHealth to promote physical activity in thoracic malignancies survivors: A systematic review and meta-analysis.

BACKGROUND: Survival rates for many forms of thoracic malignancies have improved over the past few decades, however, many survivors are coping with the side effects of cancer treatment for longer. Physical activity (PA) has been proposed as a therapeutic strategy to combat the effects of treatment in cancer survivors and eHealth could be a good way to encourage patients to practice it. OBJECTIVE: To explore the effects of eHealth in the promotion of PA among thoracic malignancies. METHODS: Suitable articles were searched using PubMed, Web of Science and Scopus databases using a combination of medical subject headings. RESULTS: In total, 4781 articles were identified, of which ten met eligibility criteria. Different eHealth interventions were described in these studies: mobile application (app) (n = 3), website (n = 2), email (n = 2), web and mobile application (n = 1), telephone counseling (n = 1) and online sheet (n = 1). All studies reported improvements in PA, with 8/10 studies reporting statistically significant changes. CONCLUSION: Our results show that eHealth programs are useful to promote PA in malignancy thoracic survivors, compared to no intervention, conventional treatment or a dietary approach. Moreover, the meta-analysis also revealed eHealth is a good way to improve the level of PA in thoracic malignancies survivors.

Balance Ability and Occupational Performance in Patients With Parkinson's Disease and On-Medication-State Freezing of Gait.

PURPOSE: The aim of this study was to examine balance ability and occupational performance in patients with Parkinson's disease (PD) and on-medication-state freezing of gait (FOG). DESIGN: A cohort study with three groups was conducted. METHODS: Seven patients with PD and on-medication-state FOG with optimized pharmacological therapy; seven patients with PD matched by age, gender, length of time since diagnosis, and Hoehn and Yahr stage; and seven controls were included. Outcomes included balance and occupational performance. Nonparametric analyses were used. FINDINGS: Significant differences were found between the two subgroups of patients with PD in the Timed Up & Go Test when adding a cognitive task, dual-task interference, and self-confidence in balance. CONCLUSIONS: Patients with PD and on-medication-state FOG had lower scores on dual-task interference and self-confidence than matched PD patients. CLINICAL RELEVANCE: The assessment and rehabilitation approach for patients with PD and on-medication-state FOG should include balance confidence and dual-task interference.

Global functional impairment in head and neck cancer survivors after completing radiotherapy treatment.

PURPOSE: Improvements in diagnosis and treatment of head and neck cancer (HNC) patients have resulted in improved long-term survival rates. However, a variety of symptoms and comorbidities, often secondary to the cancer and its treatments, are experienced by a relevant number of survivors. So, the aim of this study was to determine the global functional impairment in HNC survivors 1 year after radiotherapy treatment. MATERIALS AND METHODS: A descriptive case-control study was performed. HNC survivors were recruited from San Cecilio Clinical University Hospital in Granada. The main variables included were functionality and quality of life. RESULTS: 30 HNC survivors were included in our study. Significant differences were found in the WHO-DAS 2.0 test, with a worse score in the HNC group in most subscales (p < 0.05), and poorer scores in the COMP test, performance (p < 0.001) and satisfaction (p < 0.001). Significant differences were also found in most QLQ-30 subscales (p < 0.05) and the QLQ-H&N35. In regard to the EQ-5D, significant differences were found between groups, with worse results in the HNC group (p < 0.05). CONCLUSION: HNC survivors presented a poorer global function and a worse quality of life and health status 1 year after the radiotherapy treatment. Moreover, a good correlation was found between functionality and quality of life outcomes.IMPLICATIONS FOR REHABILITATIONA worse quality of life and health status are shown in head and neck survivors 1 year after radiotherapy.Global functionality is related to quality of life outcomes in head and neck cancer survivors.There is a need to recognise the need for and to provide longer term rehabilitation.

Impacts of tailored, rehabilitation nursing care on functional ability and quality of life in hospitalized elderly patients after rib fractures.

OBJECTIVES: We aimed to analyze the effects of a tailored rehabilitation nursing care program on functional ability and quality of life in patients with conservative treatment for rib fractures. DESIGN: Randomized controlled trial. SETTING: Inpatient rehabilitation hospital. SUBJECTS: Rib fracture patients treated conservatively were randomized into two groups (experimental and control group). INTERVENTIONS: Patients in control group received Treatment as Usual (TAU) and patients included in experimental group received TAU and an added tailored rehabilitation nursing care program (RNT). MAIN MEASURES: At baseline, and end of hospitalization treatment, the functional ability was assessed with the Barthel Index, and the quality of life was evaluated with the EuroQol-5D. Additionally, the outcomes were assessed at six-month follow-up. RESULTS: A total of 80 patients were included in the study, whose mean age was 77.19 SD 7.71 in the RNT group and 75.55 SD 9.46 in the TAU group. Our data showed a significant difference in the post-treatment gains in overall quality of life (74.25 SD 20.62 vs 60.28 SD 20.54), and functional ability (71.79 SD 23.85 vs 69.41 SD 24.30) between the RNT group and the TAU group (P < 0.05). Compared to the TAU group, the RNT group also showed a significant improvement in functional ability and quality of life at six-month follow-up. CONCLUSIONS: A tailored rehabilitation nursing care program added to the conservative treatment during hospitalization can improve the functional ability and quality of life of patients after rib fractures at discharge and at six-month follow-up. TRIAL REGISTRATION: ClinicalTrial.gov Identifier: NCT04168996.

Speech and language therapy treatment on hypokinetic dysarthria in Parkinson disease: Systematic review and meta-analysis.

OBJECTIVE: To assess the effect of speech and language therapy (SLT) on Hypokinetic dysarthria (HD) in Parkinson's disease. DESIGN: Systematic review and meta-analysis of randomized controlled trials. METHODS: We performed a literature search of randomized controlled trials using PubMed, Web of Science, Science Direct and Cochrane database (last search October 2020). Quality assessment and risk of bias were assessed using the Downs and Black scale and the Cochrane tool. The data were pooled and a meta-analysis was completed for sound pressure levels, perceptual intelligibility and inflection of voice fundamental frequency. RESULTS: We selected 15 high to moderate quality studies, which included 619 patients with Parkinson's disease. After pooling the data, 7 studies, which compared different speech language therapies to no treatment, control groups and 3 of their variables, (sound pressure level, semitone standard deviation and perceptual intelligibility) were included in the analysis.Results showed significant differences in favor of SLT for sound pressure level sustained phonation tasks (standard mean difference = 1.79; 95% confidence interval = 0.86, 2.72; p ⩽ 0.0001). Significant results were also observed for sound pressure level and semitone standard deviation in reading tasks (standard mean difference = 1.32; 95% confidence interval = 1.03, 1.61; p ⩽ 0.0001). Additionally, sound pressure levels in monologue tasks showed similar results when SLT was compared to other treatments (standard mean difference = 0.87; 95% confidence interval = 0.46, 1.28; p ⩽ 0.0001). CONCLUSION: This meta-analysis suggests a beneficial effect of SLT for reducing Hypokinetic Dysarthria in Parkinson's disease, improving perceptual intelligibility, sound pressure level and semitone standard deviation.