Immediate effects of TECAR therapy on lower limb to decrease hypertonia in chronic stroke survivors: a randomized controlled trial.

PURPOSE: To analyze immediate effects of TECAR therapy (TT) to reduce lower limb hypertonia and improve functionality in chronic post-stroke. MATERIALS AND METHODS: It is a single-blind randomized controlled clinical trial. A total of 36 chronic stroke survivors were divided into two groups. The experimental group received a single 30-minute session of TT with functional massage (FM) on lower limb. The control group received a single 30-minute session sham treatment of TT plus FM. The primary outcome measure was hypertonia (Modified Ashworth Scale, MAS). Secondary outcomes were gait speed (4-Meter Walk-Test), standing knee-flexion (Fugl-Meyer Assessment Scale IV-item), change in weight bearing ankle dorsiflexion (Ankle Lunge Test, ALT), and functional lower limb strength (5-Times Sit-to-Stand Test). All measurements were performed at baseline, immediately and 30-minutes after treatment. RESULTS: There was a group-time interaction in MAS-knee (p = 0.044), MAS-ankle (p = 0.018) and ALT (p = 0.016) between T1 and T0 (p<.0001) and T2 and T0 (p<.0001) for the experimental group. There was a significant increase in ALT between T1 and T0 (p = 0.003) in the control group. CONCLUSIONS: A single session of TT performed at the same time as FM immediately reduces plantar-flexors and knee-extensor muscle hypertonia and increases change in weight bearing ankle dorsiflexion in chronic stroke survivors.

Capacitive and resistive electric transfer (TECAR) therapy may improve ankle mobility in stroke survivors.TECAR therapy may improve knee mobility in post-stroke.TECAR therapy may reduce lower limb muscle tone in stroke survivors.TECAR therapy could be used in combination with physiotherapy as a safe technique for the immediate reduction of hypertonia in stroke survivors.

Effect of a Home-Base Core Stability Exercises in Hereditary Ataxia. A Randomized Controlled Trial. A Pilot Randomized Controlled Trial.

BACKGROUND: Core stability exercises (CSE) have been shown to be effective in improving trunk function in several neurological diseases, but the evidence is scarce on Hereditary Ataxias (HA). OBJECTIVE: To evaluate the effectiveness of a 5-week home-based CSE program in terms of ataxia severity, trunk function, balance confidence, gait speed, lower limb motor function, quality of life, health status and falls rate in HA individuals at short- and long-term. METHODS: This is an assessor-blind randomized controlled clinical trial parallel group 1:1. The individuals were divided in experimental group (EG) performed standard care in addition to CSE, and control group (CG) performed standard care alone. The CSE home-program was conducted 1-h/day, 5-day/week for 5-week. The assessment was performed at baseline, endpoint (5-week), and follow-up (10-week). The primary outcomes were ataxia severity assessed by the Scale for the Assessment and Rating of Ataxia and trunk function assessed by Spanish-version of Trunk Impairment Scale 2.0. The secondary outcomes were balance confidence assessed by Activities-specific Balance Confidence (ABC), gait speed by 4-meter walk test (4-MWT), the lower limb motor function by 30-s sit-to-stand, quality of life by EuroQol 5-dimension 5-level (EQ-5D-5L), health-status by EQ-5D and falls rate. RESULTS: Twenty-three HA individuals were recruited (51.8 ± 11.10 years). Statistically significant group-time interaction was shown in ABC (F:5.539; P = 0.007), EQ-5D-5L Total (F:4.836; P = 0.013), EQ 5D (F:7.207; P = 0.006). CONCLUSIONS: No statistical differences between groups for ataxia severity and trunk function were observed. However, were differences for balance confidence, gait speed, quality of life, and falls rate in HA individuals.

The Effects of Soft-Tissue Techniques and Exercise in the Treatment of Patellar Tendinopathy-Systematic Review and Meta-Analysis.

BACKGROUND: Patellar tendinopathy is a degenerative clinical disorder that causes load-related pain in the lower pole of the patella or patellar tendon. It predominantly affects young male athletes engaged in sports involving repetitive tendon loading, particularly explosive jumping. The combination of manual techniques with therapeutic exercise is hypothesized to provide greater benefits than exercise alone. OBJECTIVE: The aim of this study is to analyze the scientific evidence regarding the effects of soft-tissue techniques combined with therapeutic exercise versus therapeutic exercise alone on pain intensity and function in individuals with patellar tendinopathy. METHODS: A systematic review with meta-analysis was conducted following the PRISMA guidelines. PubMed, Lilacs, IBECS, CENTRAL, WOS, SciELO, Academic Search, CINAHL, SportDiscus, PEDro, and Google Scholar databases were consulted. Randomized controlled trials and quasi-randomized trials focusing on the effects of soft-tissue techniques combined with therapeutic exercise (experimental group) versus therapeutic exercise alone (control group) on pain and function in individuals aged 16 years and older with patellar tendinopathy were selected. The Cochrane tool for risk-of-bias assessment and the PEDro scale for methodological quality were used. RESULTS AND DISCUSSION: A total of six studies (n = 309; age range = 16-40 years), considered to have a low risk of bias and moderate-to-high methodological quality, were included. The results showed improvements in function in the experimental group (mean of 60% on the Visa-P scale) and pain in the experimental group (mean decrease of 2 points in the VAS scale). There were improvements in 50% of the studies when comparing variables between the experimental and control groups. CONCLUSIONS: The combination of manual techniques, such as dry needling, percutaneous electrolysis, transverse friction massage, and stretching, along with a squat on a 25° inclined plane, appears to be effective in the treatment of patellar tendinopathy. Static stretching of the quadriceps before and after the squat five times per week, along with dry needling or percutaneous electrolysis sessions twice a week for 8 weeks, is recommended. However, future studies analyzing groups with passive techniques versus therapeutic exercise are needed to standardize the treatment and establish the optimal dose.

Immediate Effects of TECAR Therapy on Gastrocnemius and Quadriceps Muscles with Spastic Hypertonia in Chronic Stroke Survivors: A Randomized Controlled Trial.

BACKGROUND: The aim of this study was to assess changes in muscle properties after a single session of capacitive and resistive energetic transfer (TECAR) therapy on spastic gastrocnemius and quadriceps muscles in chronic post-stroke. METHODS: A total of 36 chronic stroke survivors with lower limb hypertonia were enrolled in a double-blind randomized controlled trial. The experimental group (n = 18) received a single 30 min session of TECAR therapy in combination with functional massage (FM) on the gastrocnemius and quadriceps muscles. The control group (n = 18) received a sham treatment of TECAR therapy (without electrical stimulation) in combination with real FM. The primary outcome was muscle tone of the lower limb muscles assessed with the Modified Ashworth Scale (MAS). The secondary outcomes were goniometric degrees of the MAS (goniometer), neuromuscular properties of the gastrocnemius/quadriceps (myotonometer), and passive range of motion (inclinometer). All measurements were performed at baseline (T0), immediately after treatment (T1), and at 30 min post-treatment (T2) by a blinded assessor. RESULTS: The MAS score ankle dorsiflexion significantly decreased at T0-T1 (p = 0.046), and the change was maintained at T0-T2 (p = 0.019) in the experimental group. Significant improvements were noted in the passive range of motion for knee flexion (p = 0.012) and ankle dorsiflexion (p = 0.034) at T2. In addition, knee flexion improved at T1 (p = 0.019). CONCLUSION: A single session of Tecar therapy at the same time with FM on the gastrocnemius and rectus femoris immediately reduces muscle tone and increases the passive range of motion of both ankle and knee in chronic stroke survivors. There were no significant changes in the neuromuscular properties measured with myotonometer.

Motor rehabilitation after stroke: European Stroke Organisation (ESO) consensus-based definition and guiding framework.

PURPOSE: To propose a consensus-based definition and framework for motor rehabilitation after stroke. METHODS: An expert European working group reviewed the literature, attaining internal consensus after external feedback. FINDINGS: Motor rehabilitation is defined as a process that engages people with stroke to benefit their motor function, activity capacity and performance in daily life. It is necessary for people with residual motor disability whose goal is to enhance their functioning, independence and participation. Motor rehabilitation operates through learning- and use-dependent mechanisms. The trajectory of motor recovery varies across patients and stages of recovery. Early behavioral restitution of motor function depends on spontaneous biological mechanisms. Further improvements in activities of daily living are achieved by compensations. Motor rehabilitation is guided by regular assessment of motor function and activity using consensus-based measures, including patient-reported outcomes. Results are discussed with the patient and their carers to set personal goals. During motor rehabilitation patients learn to optimize and adapt their motor, sensory and cognitive functioning through appropriately dosed repetitive, goal-oriented, progressive, task- and context-specific training. Motor rehabilitation supports people with stroke to maximize health, well-being and quality of life. The framework describes the International Classification of Functioning, Disability and Health in the context of stroke, describes neurobiological mechanisms of behavioral restitution and compensation, and summarizes recommendations for clinical assessment, prediction tools, and motor interventions with strong recommendations from clinical practice guidelines (2016-2022). CONCLUSIONS: This definition and framework may guide clinical educators, inform clinicians on current recommendations and guidelines, and identify gaps in the evidence base.

Assessment of the 4-meter walk test test-retest reliability and concurrent validity and its correlation with the five sit-to-stand test in chronic ambulatory stroke survivors.

BACKGROUND: The 4-meter walk test (4-MWT) is a widely used measure to assess gait speed in the elderly but has not been validated for stroke survivors to date. OBJECTIVES: To assess the test-retest reliability and concurrent validity of the 4-MWT compared to the 10-meter walk test (10-MWT) as a measure of gait speed in chronic post-stroke. SECONDARY OUTCOME MEASURE: to assess the correlation of both gait measures with the 5 times sit-to-stand test (5TSTS). METHODS: A cross-sectional observational study was conducted. Reliability was assessed by intraclass correlation coefficient (ICC2,1), standard error of measurement (SEM) and minimal detectable change (MDC-95%). Bland & Altman analysis was used to quantify agreement between the 4-MWT and the 10-MWT. Two consecutive walking trials of the 4-MWT and 10-MWT followed by 5TSTS were performed all on the same day. A single researcher made all measurements. RESULTS: Thirty-six chronic ambulatory post-stroke (average age 58.56 ± 11.28 years) were analyzed at their self-selected walking speed with a dynamic start. The 4-MWT showed excellent concurrent validity and test-retest reliability: ICC2.1 = 0.991 (95% CI: 0.983, 0.996); SEM= 0.032 and MDC- 95% = 0.090 m/second) with a strong positive correlation with the 10-MWT (r = 0.957, p < 0.001). The Bland & Altman analysis showed a concordance of -0.05 m/second bias (p = 0.039) (95% limits of agreement: 0.20 to -0.29 m/second). The paired t-test showed no statistically significant difference in the mean of both walking tests (p < 0.091). However, there was only moderate correlation between the two gait assessments and the 5TSTS. CONCLUSIONS: This study indicates excellent test-retest reliability concurrent validity and strong correlation between 4-MWT and 10-MWT with a dynamic start at comfortable speed. The 4-MWT could be used as a measure of gait speed in both outpatients and home settings in chronic ambulatory stroke survivors.

Available apps for stroke telerehabilitation during corona virus disease 2019 confinement in Spain.

PURPOSE: Stroke is one of the leading causes of disability in the adult population. It is feasible to think about the use of telerehabilitation devices, such as the smartphone, to respond to the growing demand, even in isolation cases, such as during confinement due to coronavirus disease in 2020. It is intended to explore the available Apps for Spanish-speaking patients with Stroke for a specific sensory-motor rehabilitation process. MATERIALS AND METHODS: A search of the available apps in Google Play and Apple Store was carried out using the keywords "Stroke", "hemiplegia" and "hemiparesis". The Apps detected have been described and evaluated by an anonymous survey among stroke survivors. RESULTS: Nine Apps have been identified and explored, four of which are available in Spanish: "NeuroRHB", "Stroke Hope Health4TheWorld", "9zest stroke recovery" and "Farmalarm". Twelve survivors with stroke have participated in the anonymous survey evaluating with the best score the App "Farmalarm". CONCLUSIONS: There are few specific Apps for the Stroke rehabilitation of sensory-motor impairments, and with important limitations that prevent their incorporation into clinical practice. The creation and adaptation of Apps for health professionals such as physiotherapists and occupational therapists and their users are recommended.Implications for rehabilitationIt is necessary to create and adapt specific telerehabilitation tools to address sensory-motor disorders.Telerehabilitation should be introduced in the clinical practice of physiotherapy and occupational therapy.Telerehabilitation via App can be a solution, easily accessible by patients, to reduce healthcare inequality, intensify the rehabilitation process and provide continuity after discharge from the hospital.

Influence of Core-Stability Exercises Guided by a Telerehabilitation App on Trunk Performance, Balance and Gait Performance in Chronic Stroke Survivors: A Preliminary Randomized Controlled Trial.

Stroke is one of the main causes of disability. Telerehabilitation could face the growing demand and a good strategy for post-stroke rehabilitation. The aim of this study is to examine the possible effects of therapeutic exercises performed by an App on trunk control, balance, and gait in stroke survivors. A preliminary 12-week randomized controlled trial was developed. Thirty chronic stroke survivors were randomly allocated into two groups. Both groups performed conventional physiotherapy, in addition to, the experimental group (EG) had access to a telerehabilitation App to guide home-based core-stability exercises (CSE). Trunk performance was measured with the Spanish-Trunk Impairment Scale (S-TIS 2.0) and Spanish-Function in Sitting Test. Balance and gait were measured with Spanish-Postural Assessment Scale for Stroke patient, Berg Balance Scale and an accelerometer system. In EG was observed an improvement of 2.76 points in S-TIS 2.0 (p = 0.001). Small differences were observed in balance and gait. Adherence to the use of the App was low. CSE guided by a telerehabilitation App, combined with conventional physiotherapy, seem to improve trunk function and sitting balance in chronic post-stroke. Active participation in the rehabilitation process should be increased among stroke survivors. Further confirmatory studies are necessary with a large sample size.

Telerehabilitation for balance rehabilitation in the subacute stage of stroke: A pilot controlled trial.

BACKGROUND: Telerehabilitation has been proposed as an effective strategy to deliver post-stroke specific exercise. OBJECTIVE: To assess the effectiveness and feasibility of core stability exercises guided by a telerehabilitation App after hospital discharge. METHODS: Extension of a prospective controlled trial. Subacute stage stroke survivors were included at the time of hospital discharge where they had participated in a previous 5-week randomized controlled trial comparing conventional physiotherapy versus core stability exercises. After discharge, patients from the experimental group were offered access to telerehabilitation to perform core stability exercises at home (AppG), while those from the control group were subject to usual care (CG). The Spanish-version of the Trunk Impairment Scale 2.0 (S-TIS 2.0), Function in Sitting Test (S-FIST), Berg Balance Scale (BBS), Spanish-version of Postural Assessment for Stroke Patients (S-PASS), the number of falls, Brunel Balance Assessment (BBA) and Gait were assessed before and after 3 months intervention. RESULTS: A total of 49 subjects were recruited. AppG showed greater improvement in balance in both sitting and standing position and gait compared with CG, although no statistically significant differences were obtained. CONCLUSION: Core stability exercises Telerehabilitation as a home-based guide appears to improve balance in post-stroke stage. Future studies are necessary to confirm the effects as well as identifying strategies to increase telerehabilitation adherence.

The Effectiveness of Additional Core Stability Exercises in Improving Dynamic Sitting Balance, Gait and Functional Rehabilitation for Subacute Stroke Patients (CORE-Trial): Study Protocol for a Randomized Controlled Trial.

BACKGROUND: Trunk impairment produces disorders of motor control, balance and gait. Core stability exercises (CSE) are a good strategy to improve local strength of trunk, balance and gait. Methods and analysis: This is a single-blind multicenter randomized controlled trial. Two parallel groups are compared, and both perform the same type of therapy. A control group (CG) (n = 110) performs conventional physiotherapy (CP) (1 h per session) focused on improving balance. An experimental group (EG) (n = 110) performs CSE (30 min) in addition to CP (30 min) (1 h/session in total). EG is divided in two subgroups, in which only half of patients (n = 55) perform CSE plus transcutaneous electrical nerve stimulation (TENS). Primary outcome measures are dynamic sitting, assessed by a Spanish version of Trunk Impairment Scale and stepping, assessed by Brunel Balance Assessment. Secondary outcomes are postural control, assessed by Postural Assessment Scale for Stroke patients; standing balance and risk of fall assessed by Berg Balance Scale; gait speed by BTS G-Walk (accelerometer); rate of falls, lower-limb spasticity by Modified Ashworth Scale; activities of daily living by Barthel Index; and quality of life by EQ-5D-5L. These are evaluated at baseline (T0), at three weeks (T1), at five weeks (end of the intervention) (T2), at 17 weeks (T3) and at 29 weeks (T4). Study duration per patient is 29 weeks (a five-week intervention, followed by a 24-week post-intervention).

The Immediate Effect of Informational Manual Therapy for Improving Quiet Standing and Bodily Pain in University Population.

BACKGROUND: The Informational Manual Therapy (IMT) is a therapeutic touch. This study aims to assess the effect of IMT on quiet standing, pain and health status in university population. METHODS: An experiment was conducted on subjects utilizing a comparative paired analysis both before and after the intervention. One IMT session was performed on 57 healthy individuals aged from 18 to 65 years. The primary outcome was quiet standing assessed by the Satel 40 Hz stabilometric force platform. Secondary outcomes were bodily pain assessed by the 36-Item Short Form Survey (SF-36) and health status by EQ-5D-3L. The primary outcome was evaluated before and immediately after treatment. RESULTS: The individuals were divided into 3 age groups, 18-35 (52.6%), 35-50 (29.8%) and 51-65 (17.6%). Statistically significant differences were immediately observed after the session ended when comparing the pre-post quiet stance scores in a number of length parameters: L, Lx, Ly and stabilometry amplitude on Y-axis with eyes open and closed. Significant differences were also found when testing bodily pain (SF-36) and anxiety (5Q-5D-3L). CONCLUSION: One session of IMT produced positive effects when testing quiet standing with eyes open and eyes closed, as well as a significant reduction in pain and anxiety for those tested. Further research is suggested.

Análisis del ajuste de mascarillas autofiltrantes en combinación con las mascarillas quirúrgicas para la protección del profesional sanitario en su atención a pacientes afectos de SARS-COV-2 a partir de un estudio experimental / Analysis of the adjustment of self-filtering masks in combination with surgical masks for the protection of health professionals in the care of patients sffected by SARS-COV-2 from an experimental study

Introducción: Un componente importante del equipo de protección individual (EPI) frente al SARS-CoV-2 son las mascarillas quirúrgicas y las mascarillas autofiltrantes (FFP). La norma europea EN 149 establece y clasifica las mascarillas autofiltrantes en tres niveles de protección dependiendo del porcentaje de fuga del total de partículas en suspensión del aire exterior hacia el aire interior FFP1, FFP2, FFP3. El objetivo de este e ensayo de laboratorio es determinar y cuantificar el nivel de ajuste de las mascarillas autofiltrantes FFP2 combinadas con las mascarillas quirúrgicas mediante series de pruebas de ajuste (fit test). Material y Métodos: Se utilizó el equipo medidor de ajuste de mascarillas FFP modelo PortaCount® Pro + 8038 compatible con las normas y metodología de la OSHA (Occupational Safety and Health Administration) de los EEUU. Se realizaron series de pruebas de ajuste sobre diferentes modelos de mascarillas autofiltrantes FFP2 con y sin mascarilla quirúrgica para diferentes situaciones de respiración del trabajador participante en este experimento. Resultados: El uso de la mascarilla quirúrgica sobre una mascarilla autofiltrante FFP2 aporta una mejora en la protección respiratoria determinante, incrementando el factor de ajuste hasta de +200 (el factor de ajuste mínimo debe ser 100). Conclusiones: Las mascarillas quirúrgicas cuando se usan conjuntamente con las mascarillas autofiltrantes, podrían mejorar significativamente el grado de ajuste de todas las mascarillas autofiltrantes proporcionando una mayor eficacia de filtración y una mayor protección al usuario frente a la exposición a aerosoles (AU)

Introduction: Frontline healthcare workers have a high risk of exposure to SARS-CoV-2 coronavirus, which causes COVID-19. The use of appropriate personal protective equipment (PPE) is essential to prevent this occupational disease. Surgical masks and filtering face piece (FFP) respirators are important parts of this PPE. European standard EN 149 establishes three protection levels for FFP respirators (FFP1, FFP2, FFP3), depending on the particle infiltration degree through their materials, and these, in turn, are based on their filtration effectiveness. The aim of this laboratory test is to determine and quantify the filtration and fit rate of different FFP respirators, singly and in combination with surgical masks, by performing a series of fit tests and consequently, to check whether this combination improves protection levels for healthcare workers who care for COVID-19 patients. Material and Methods: Several FFP respirators and surgical masks, singly and in combination, were fit tested with a PortaCount Pro + 8038, which fulfills OSHA standards, in a series of tests performed on healthcare workers in seven different breathing situations when taking care on COVID-19 patients, in order to determine and quantify their fit to the workers' face. Results: Wearing a surgical mask together with a highly efficient FFP respirator provided increased respiratory protection. Interestingly, one of these highly efficient FFP models, combined with a surgical mask, achieved a protection factor over 200 (whereas 100 is the minimum required protection factor). Conclusions: Surgical masks, when used together with a FFP2 respirator, could significantly improve the degree of fit of all self-filtering face piece by providing greater filtration efficiency and greater user protection from exposure to aerosols (AU)

[Analysis of the Adjustment of Self-Filtering Masks in Combination with Surgical Masks for the Protection of Health Professionals in the Care of Patients Affected by SARS-COV-2 from an Experimental Study]. / Análisis del ajuste de mascarillas autofiltrantes en combinación con las mascarillas quirúrgicas para la protección del profesional sanitario en su atención a pacientes afectos de SARS-COV-2 a partir de un estudio experimental.

INTRODUCTION: Frontline healthcare workers have a high risk of exposure to SARS-CoV-2 coronavirus, which causes COVID-19. The use of appropriate personal protective equipment (PPE) is essential to prevent this occupational disease. Surgical masks and filtering face piece (FFP) respirators are important parts of this PPE. European standard EN 149 establishes three protection levels for FFP respirators (FFP1, FFP2, FFP3), depending on the particle infiltration degree through their materials, and these, in turn, are based on their filtration effectiveness. The aim of this laboratory test is to determine and quantify the filtration and fit rate of different FFP respirators, singly and in combination with surgical masks, by performing a series of fit tests and consequently, to check whether this combination improves protection levels for healthcare workers who care for COVID-19 patients. MATERIAL AND METHODS: Several FFP respirators and surgical masks, singly and in combination, were fit tested with a PortaCount Pro + 8038, which fulfills OSHA standards, in a series of tests performed on healthcare workers in seven different breathing situations when taking care on COVID-19 patients, in order to determine and quantify their fit to the workers' face. RESULTS: Wearing a surgical mask together with a highly efficient FFP respirator provided increased respiratory protection. Interestingly, one of these highly efficient FFP models, combined with a surgical mask, achieved a protection factor over 200 (whereas 100 is the minimum required protection factor). CONCLUSIONS: Surgical masks, when used together with a FFP2 respirator, could significant ly improve the degree of fit of all self-filtering face piece by providing greater filtration efficiency and greater user protection from exposure to aerosols.

INTODUCCIÓN: Un componente importante del equipo de protección individual (EPI) frente al SARS-CoV-2 son las mascarillas quirúrgicas y las mascarillas autofiltrantes (FFP). La norma europea EN 149 establece y clasifica las mascarillas autofiltrantes en tres niveles de protección dependiendo del porcentaje de fuga del total de partículas en suspensión del aire exterior hacia el aire interior FFP1, FFP2, FFP3. El objetivo de este e ensayo de laboratorio es determinar y cuantificar el nivel de ajuste de las mascarillas autofiltrantes FFP2 combinadas con las mascarillas quirúrgicas mediante series de pruebas de ajuste (fit test). MATERIAL Y MÉTODOS: Se utilizó el equipo medidor de ajuste de mascarillas FFP modelo PortaCount® Pro + 8038 compatible con las normas y metodología de la OSHA (Occupational Safety and Health Administration) de los EEUU. Se realizaron series de pruebas de ajuste sobre diferentes modelos de mascarillas autofiltrantes FFP2 con y sin mascarilla quirúrgica para diferentes situaciones de respiración del trabajador participante en este experimento.  RESULTADOS: El uso de la mascarilla quirúrgica sobre una mascarilla autofiltrante FFP2 aporta una mejora en la protección respiratoria determinante, incrementando el factor de ajuste hasta de +200 (el factor de ajuste mínimo debe ser 100). CONCLUSIONES: Las mascarillas quirúrgicas cuando se usan conjuntamente con las mascarillas autofiltrantes, podrían mejorar significativamente el grado de ajuste de todas las mascarillas autofiltrantes proporcionando una mayor eficacia de filtración y una mayor protección al usuario frente a la exposición a aerosoles.

The Effectiveness of Massage Therapy for Improving Sequelae in Post-Stroke Survivors. A Systematic Review and Meta-Analysis.

OBJECTIVE: To assess the effect of therapeutic massage for improving sequelae in stroke survivors. METHODS: A systematic review of the nine medical databases from January 1961 to December 2020 was carried out. The bibliography was screened to identify randomized controlled clinical trials (RCTs). Two reviewers independently screened references, selected relevant studies, extracted data and assessed the risk of bias using the PEDro scale. The primary outcome was upper and lower limb motor function and spasticity. RESULTS: A total of 3196 studies were identified and 18 RCT were finally included (1989 individuals). A meta-analysis of RCTs in the comparison of Chinese massage (Tuina) plus conventional physiotherapy versus conventional physiotherapy was performed. The mean difference (MD) in the subacute stage on upper limb motor-function using the Fugl Meyer Assessment was 2.75; (95% confidence interval (CI) from 0.97 to 4.53, p = 0.002, I2 = 36%). The MD on upper limb spasticity using modified Ashworth scale was -0.15; (95% CI from -0.24 to -0.06, p < 0.02, I2 = 0%).The MD on lower limb spasticity was -0.59; (95% CI from -0.78 to -0.40, p < 0.001, I2 = 0%) in the endpoint. CONCLUSIONS: Therapeutic massage, especially Tuina, in addition to conventional therapy is effective for improving motor function and for reducing spasticity in stroke survivors.

The effectiveness of diacutaneous fibrolysis on pain, range of motion and functionality in musculoskeletal disorders: A systematic review and meta-analysis.

OBJECTIVE: To assess the effectiveness of diacutaneous fibrolysis in reducing musculoskeletal disorders symptoms such as pain, range of motion and functionality. DATA SOURCES: A systematic review of MEDLINE, Cochrane, PEDro and Science Direct was conducted until September 2020. REVIEW METHODS: Computerized search strategy was performed to identify randomized controlled trials applying diacutaneous fibrolysis, on subjects with musculoskeletal disorders. Eligible articles and data extraction were conducted independently by two reviewers. Methodology quality and risk of bias were assessed by Risk of Bias 2 tool from the Cochrane Collaboration and Physiotherapy Evidence Database. Outcomes assessed were pain intensity, range of motion and functionality. RESULTS: Search strategy identified 98 potential randomized control trials and six studies involving 386 participants, were finally included. Diacutaneous fibrolysis intervention added to usual physiotherapy treatment was compared to control group. Pain intensity immediately after treatment showed a pooled Standard Mean Difference (SMD) of -0.58 with 95% confidence interval (CI) from -1.12 to -0.04, and in the longest follow-up SMD was -0.63 with 95% CI (-1.21 to -0.05). Functionality showed a pooled SMD of -1.02 with 95% CI (-1.67 to -0.36) immediately after intervention and a SMD of -0.84 with 95% CI (-1.54 to -0.14). Range of motion could not be included in the quantitative synthesis. CONCLUSION: Diacutaneous fibrolysis is an effective treatment, when combined with conventional physiotheraphy, reducing pain immediately after treatment and long term follow-up and improving function in both, short and long term in musculoskeletal disorders.

Validity and Reliability of the Satel 40 Hz Stabilometric Force Platform for Measuring Quiet Stance and Dynamic Standing Balance in Healthy Subjects.

BACKGROUND: A force platform must have validity and reliability for optimal use. The objective of this study was to analyze the validity and the reliability of the Satel 40 Hz stabilometric force platform. METHODS: A study of instrumental validity and reliability, involving a cross-sectional correlational and comparative analysis was performed. To determine the validity, four certified weights located on three axes were used and the ability of the stabilometric force platform to detect changes in the position of the different axes was observed. A test-retest was performed to analyze the reliability. Forty-two symptom-free volunteers participated in the study. Assessments were taken in a standing static position and in a dynamic position, with the eyes open and closed. Three measurements were taken and the intra-class correlation coefficient (ICC) was calculated. RESULTS: The validity increased as the weight increased for all the variables measured in the stabilometric parameters (p < 0.05). The reliability was shown to be good to excellent for the two visual conditions. The positional variables obtained a higher ICC. The variable with the best ICC was the Y mean in OE (ICC 0.874 and a p < 0.001). All the values showed an increase in a dynamic situation. CONCLUSION: The findings support the reliability and validity of the Satel 40 Hz stabilometric force platform. The platform could be recommended to evaluate static and dynamic standing balance in healthy adult individuals. Guidelines for treatment and the level of quality of stabilometry could be obtained from its use.

The effectiveness of extracorporeal shock wave therapy for improving upper limb spasticity and functionality in stroke patients: a systematic review and meta-analysis.

OBJECTIVE: To assess the effectiveness of Extracorporeal Shock Wave Therapy for reducing spasticity and improving functionality of the upper limb in stroke survivors. DATA SOURCES: A systematic review of MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, PEDro, REHABDATA, Scielo, Scopus, Web of Science, Tripdatabase and Epistemonikos from 1980 to April 2020 was carried out. REVIEW METHODS: The bibliography was screened to identify randomized controlled clinical trials that applied extracorporeal shock waves to upper limb spastic muscles in post-stroke individuals. Two reviewers independently screened references, selected relevant studies, extracted data and assessed risk of bias using the PEDro scale. The primary outcome was spasticity and functionality of the upper limb. RESULTS: A total of 1,103 studies were identified and 16 randomized controlled trials were finally included (764 individuals) were analyzed. A meta-analysis was performed and a beneficial effect on spasticity was found. The mean difference (MD) on the Modified Ashworth Scale for comparison extracorporeal shock wave versus sham was -0.28; with a 95% confidence interval (CI) from -0.54 to -0.03. The MD of the comparison of extracorporeal shock wave plus conventional physiotherapy versus conventional physiotherapy was -1.78; 95% CI from -2.02 to -1.53. The MD for upper limb motor-function using the Fugl Meyer Assessment was 0.94; 95% CI from 0.42 to 1.47 in the short term and 0.97; 95% CI from 0.19 to 1.74 in the medium term. CONCLUSION: The extracorporeal shock wave therapy is effective for reducing upper limb spasticity. Adding it to conventional therapy provides an additional benefit.

The effectiveness of extracorporeal shock wave therapy to reduce lower limb spasticity in stroke patients: a systematic review and meta-analysis.

Objective: To assess the effectiveness of Extracorporeal Shock Wave Therapy (ESWT) to reduce lower limb spasticity in adult stroke survivors.Data Sources: A systematic review of Medline/Pubmed, CENTRAL, CINAHL, PEDro database, REHABDATA, Scielo, Scopus, Web of Science, Trip Database, and Epistemonikos from 1980 to December 2018 was carried out.Review Methods: The bibliography was screened to identify clinical trials (controlled and before-after) that used ESWT to reduce spasticity in stroke survivors. Two reviewers independently screened references, selected relevant studies, extracted data, and assessed risk of bias by PEDro scale. The primary outcome was spasticity.Results: A total of 12 studies (278 participants) were included (5 randomized controlled trials, 1 controlled trial, and 6 before-after studies). A meta-analysis was performed by randomized controlled trials. A beneficial effect on spasticity was found. The mean difference (MD) was 0.58; 95% confidence interval (CI) 0.30 to 0.86 and also in subgroup analysis (short, medium, and long term). The MD for range of motion was 1.81; CI -0.20 to 3.82 and for lower limb function the standard mean difference (SMD) was 0.34; 95% CI -0.09 to 0.77. Sensitivity analysis demonstrated a better beneficial effect for myotendinous junction. MD was 1.5; 95% CI -2.44 to 5.44 at long-term (9 weeks).Conclusion: The ESWT (radial/focused) would be a good non-invasive rehabilitation strategy in chronic stroke survivors to reduce lower limb spasticity, increase ankle range of motion, and improve lower limb function. It does not show any adverse events and it is a safe and effective method.

The Efficacy of the proprioceptive neuromuscular facilitation (PNF) approach in stroke rehabilitation to improve basic activities of daily living and quality of life: a systematic review and meta-analysis protocol.

INTRODUCTION: Proprioceptive neuromuscular facilitation (PNF) is a widely used rehabilitation concept, although its efficacy has not yet been demonstrated in stroke survivors. The aim of this systematic review is to identify, assess and synthesise the potential benefits of using PNF to improve the activities of daily living (ADL) and quality of life (QoL) of individuals with stroke. METHODS AND ANALYSIS: A systematic electronic search will be conducted in MEDLINE, Embase, CENTRAL and PEDro. We will include randomised or quasi-randomised controlled trials of PNF interventions conducted in stroke survivors up to April 2017. Two review authors will independently select relevant studies and will extract data using the Cochrane handbook for systematic reviews of interventions approach and the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The methodological quality will be assessed by using the PEDro scale. Finally, with the permitted numeric data, we will carry out a meta-analysis. ETHICS AND DISSEMINATION: Ethical considerations will not be required. Results will be disseminated in a peer-review journal. This systematic review aims to examine the effects of PNF (neurophysiological approach) in order to clarify its efficacy in improving ADL and QoL in the rehabilitation process of stroke survivors. PROSPERO REGISTRATION NUMBER: CRD42016039135.

Validation and reliability of the Spanish version of the Function in Sitting Test (S-FIST) to assess sitting balance in subacute post-stroke adult patients.

BACKGROUND: Function in Sitting Test (FIST) is a clinical functional assessment of sitting balance validated in adults with stroke. For a major use of this, the test is recommended to be translated in Spanish-speaking countries. OBJECTIVES: Translate to Spanish the FIST and determine its intra-rater and inter-rater reliabilities and concurrent validity as a measure of sitting balance in adult individuals with stroke. METHODS: The original version was translated into Spanish and was agreed by a team of experts. A back-translation into English was subsequently performed and sent to the original author, who approved this version named from now Spanish version of Function in Sitting Test (S-FIST). Sixty post-stroke patients' performance was recorded on a videotape. These videos were then used to carry out four measurements to assess the intra-rater and inter-rater reliabilities; two of these were performed by the same rater and the third and fourth by a second and third rater. RESULTS: The S-FIST meets the following requirements: good construct validity and high correlation with Spanish version of Trunk Impairment Scale 2.0 (S-TIS 2.0) scores (r = 0.791) Spearman's rank, high internal consistency (Cronbach's α-coefficient = 0.97), and high intra-rater and inter-rater reliabilities for the summed scores assessed by intra-class correlation coefficient were 0.999 and 0.997, respectively. CONCLUSIONS: The S-FIST is valid and reliable and can be recommended for use in the evaluation of dynamic and sitting balance and trunk control in future research and clinical practice on post-stroke patients. Guidelines for treatment and level of quality of trunk activity can be derived from its use.