Results of a self-management program added to standard physical therapy in chronic neck pain.

OBJECTIVE: To evaluate the effectiveness of a self-management treatment added to a physical therapy program compared to a physical therapy program in patients with chronic neck pain. METHODS: Fifty-three patients with chronic neck pain were randomly allocated to a physical therapy intervention (control group) or an individualized self-management combined with physical therapy intervention (experimental group). Both interventions were developed over a four-week period. Outcome measures included were Disability, Fear-Avoidance Beliefs, Health-Related Quality of Life, Pain, and Anxiety and Depression. All outcomes were measured before and after the treatment and at three-month follow-up. RESULTS: There were not significant differences between groups at baseline. After the intervention both groups obtained better results in the Neck Disability Index but there were not significant differences between them (p > 0.05). At follow-up, the self-management group obtained significant better results compared to the control group (95 % CI: -5.20(-6.8 to -1.5), p = 0.032). CONCLUSIONS: An individualized self-management program added to a physical therapy program led to a greater improvement in disability at 3 months follow up compared to a physical therapy program alone. Catastrophizing, pain, and health-related quality of life improved significantly after the intervention and at follow-up compared to the standard care alone. PRACTICAL IMPLICATIONS: This study indicates that physical therapy for patients with chronic neck pain preferably should include self-management education.

Efectividad de la terapia acuática en pacientes con accidente cerebrovascular: una revisión sistemática / Effectiveness of aquatic therapy in stroke patients: A systematic review

Antecedentes y objetivos: A pesar del avance científico existe una gran cantidad de pacientes con discapacidad tras sufrir un accidente cerebrovascular. Desde la fisioterapia y la terapia acuática se han llevado a cabo diferentes investigaciones. El objetivo de este estudio fue revisar de forma sistemática la efectividad de la terapia acuática en el tratamiento del paciente con accidente cerebrovascular. Métodos: Se llevaron a cabo búsquedas en las bases de datos PubMed, Scopus y Web Of Science sobre terapia acuática y su efectividad. Se seleccionaron ensayos clínicos aleatorizados sin limitación en el tiempo y publicados en inglés o español. Se evaluó la calidad de los artículos seleccionados con la escala Physiotherapy Evidence Database. Resultados: Trece ensayos clínicos aleatorizados cumplieron los criterios de selección. Se incluyeron un total de 336 participantes, de los cuales un 64% habían sufrido un incidente isquémico. Ciento noventa y siete participantes se encontraban en fase crónica. Las intervenciones se llevaron a cabo en una piscina terapéutica en 11 de los estudios y en una piscina de natación en 2. Se evaluaron los efectos de las intervenciones sobre: equilibrio, marcha, función cardiorrespiratoria, fuerza muscular, función muscular, tono muscular, funcionalidad y calidad de vida. Conclusión: La terapia acuática es efectiva en el tratamiento de pacientes con accidente cerebrovascular en todas las variables analizadas

Background and objectives: Despite scientific advances there are a great number of patients with disability after suffering stroke. Previous studies have investigated the effects of physiotherapy and aquatic therapy. The objective of this study was to systematically review the effectiveness of aquatic therapy in the treatment of stroke patients. Methods: The searches were performed in PubMed, Scopus, and Web of Science, and the topic was aquatic therapy and its effectiveness on stroke patients. Randomised controlled trials were selected without limitation over time, and published in English or Spanish. The quality of the selected articles was evaluated using the Physiotherapy Evidence Database scale. Results: A total of 13 randomised controlled trials met the selection criteria. A total of 336 participants were included, of whom 64% had suffered an ischaemic event, with 197 participants in the chronic phase. The interventions were carried out in therapeutic pool in 11 of the studies, with 2 using swimming pool. The effects of interventions were assessed on: balance, gait, cardiorespiratory function, muscle strength, muscle function, muscle tone, functionality, and an evaluation of the quality of life. Conclusion: Aquatic therapy is effective in the treatment of stroke patients in all the variables analysed

Relación entre el perfil clínico y la tensión neural en personas con dolor cervical crónico / Relationship between clinical profile and neural tension in people with chronic neck pain

Introducción y objetivos: El dolor cervical crónico (DCC) confluye con una gran variedad de signos y síntomas, tales como la tensión neural y las alteraciones conductuales. Este estudio pretende evaluar la relación entre la tensión neural y el perfil clínico de los pacientes con DCC. Materiales y métodos: Se llevó a cabo un estudio observacional de corte transversal. Se incluyeron 25 pacientes con DCC y 25 personas sin dolor. Se evaluó el perfil clínico incluyendo las variables físicas (dolor, discapacidad), y las variables psicológicas y/o comportamentales (ansiedad, depresión, calidad de vida, miedo al movimiento y conductas de miedo-evitación). La tensión neural se midió a través de pruebas de neurodinamia. Resultados: Los sujetos con DCC presentaron una alteración significativa de la tensión neural, en comparación con las personas sin dolor. Se halló una correlación significativa entre los test de neurodinamia y las conductas y creencias sobre el dolor, así como su interferencia en la vida diaria. Adicionalmente se mostró una relación significativa entre las creencias y actitudes sobre el dolor y la intensidad e interferencia del mismo, la discapacidad y el estado de salud percibido. Conclusiones: Los pacientes con DCC muestran peores resultados que el grupo sin dolor en los test de neurodinamia del miembro superior. La neurodinamia se relaciona con las variables psicológicas y comportamentales medidas

Introduction and objectives: Chronic neck pain includes a wide variety of signs and symptoms, such as neural tension and behavioural changes. The aim of this study was to evaluate the relationship between neural tension and the clinical profile of patients with chronic neck pain. Materials and methods: We carried out a cross-sectional observational study. We included 25 patients with chronic neck pain and 25 without pain. The clinical profile was evaluated including physical variables (pain, disability), and psychological and / or behavioural variables (anxiety, depression, quality of life, fear of movement and fear-avoidance behaviours). Neural tension was measured through neurodynamic tests. Results: The subjects with chronic neck pain had worse neural tension results compared with the controls. A significant correlation was found between the neurodynamic tests and the psychological and behavioural variables. Additionally, there was a significant relationship between beliefs and attitudes about pain and daily life interference, disability and perceived health status. Conclusions: The patients with chronic neck pain had worse results than the painless group in the upper limb neurodynamic tests. Neurodynamics related to the psychological and behavioural variables

Efectos del kinesiotape en el equilibrio y la marcha en mayores inactivos / The effects of kinesio tape on balance and gait of inactive older adults

Objetivo: Evaluar los efectos de la aplicación de un vendaje neuromuscular de kinesiotape (KT) de manera inmediata y a las 48h en miembros inferiores en personas mayores inactivas. Método: Estudio cuasiexperimental. Un total de 23 personas mayores inactivas (un 69,6% mujeres; un 34,4% hombres) formaron parte de este estudio con una edad media de 72,74 ± 6,67 años y con un índice de masa corporal de 27,08 ± 3,85 kg/m2. Las variables fueron equilibrio estático, equilibrio dinámico y calidad de la marcha. Las evaluaciones se llevaron a cabo en 3 fases: 1) previa a la colocación del KT, 2) tras la colocación inmediata del KT, 3) después de 48h. Resultados: Se encontraron diferencias entre la evaluación previa a la colocación del KT y la evaluación inmediata a la colocación del KT en: 6 Minutos Marcha (p = 0,011), Levántate y anda (p = 0,004), Mini-Best test (p = 0,024); y diferencias entre la evaluación previa a la colocación del KT y la evaluación a las 48 h fueron encontradas en las pruebas: 6 Minutos Marcha (p = 0,046), Levántate y anda (p < 0,001), Mini-Best test (p = 0,001). Conclusión: Se demuestra que la aplicación del KT inmediatamente mejora el equilibrio estático, el equilibrio dinámico y la calidad de la marcha. Además, el KT mejora el equilibrio a las 48 h de haber sido colocado cuando se compara con los valores iniciales. Uno de los hallazgos clínicos más relevantes es que el equilibrio mejora y se mantiene durante 48 h tras su aplicación en personas mayores de la comunidad

Aim: To investigate the effects of applying a neuromuscular kinesiotape(TM) (KT) immediately, and at 48 hours in the lower limbs of inactive older adults. Methods: A quasi-experimental study was conducted on a total of 23 inactive older adults (69.6% females and 34.4% males), with a mean age of 72.74 ± 6.67 years and body mass index of 27.08 ± 3.85 Kg/m2. The outcomes were standing balance, dynamic balance, and quality of walking. The evaluations were carried out in 3 stages: 1) before applying the KT, 2) immediately after applying the KT, 3), after 48 hours. Results: The differences between before applying the KT and immediately after applying the KT, were found in the Six Minutes Walking Test (P = .011), Time Up and Go Test (P = .004), Mini-Best test (P=.024), with differences also being found between before applying the KT and 48h after applying it, in the Six Minutes Walking Test (P = .046), Time Up and Go Test (P < .001), and Mini-Best test (P < .001). Conclusion: It has been shown demonstrated that the applying of KT immediately, increases static balance, dynamic balance, and quality of walking. Moreover, the KT improved balance after it had been applied for 48 h when compared with the pre-test. One of the most clinically important findings is that balance improvements were retained during 48 h in elderly people living in the community

Capacidades físicas y motoras de miembro superior y su relación con la independencia funcional en parálisis cerebral infantil / Physical and motor skills of upper limb and its relation with functional independence in childhood cerebral palsy

Objetivo: Analizar las capacidades físicas de miembro superior y su relación con el nivel funcional en parálisis cerebral infantil (PCI). Material y métodos: Estudio descriptivo. Los participantes fueron niños diagnosticados de PCI escolarizados en colegios de educación especial. Las capacidades física y motora fueron evaluadas mediante la destreza manual, fuerza y rango de movimiento activo. Resultados: La muestra final estuvo compuesta por 31 niños con PCI escolarizados. Se dividieron en 2 grupos según el nivel funcional de los miembros superiores mediante la escala MACS. El grupo de menor afectación (n=18) englobaba los valores I y II de la MACS, mientras que el grupo de mayor afectación recogió los valores III, IV y V (n=13). Se encontraron diferencias significativas entre grupos en las variables GMFCS (p = 0,009), capacidad de movilidad evaluada con el PEDI (p = 0,016), en la destreza manual de la mano dominante evaluada con Nine Hole Peg Test (p=0,004), fuerza de la pinza de la mano no dominante (p=0,042), rango de movimiento activo de la articulación de la muñeca de ambas manos, postura al escribir y total de números escritos. Conclusiones: Los niños con PCI presentan una afectación de las capacidades motoras y funcionales. La afectación de la fuerza de la pinza digital, la destreza y la movilidad activa de la muñeca mostraron gran repercusión en la ejecución de las actividades de la vida diaria. Estrategias terapéuticas centradas en estas habilidades pueden resultar en mejores tasas de independencia funcional

Objective: to analyse upper limb physical and motor skills of and their relation with functional independence in childhood cerebral palsy. Material and methods: Descriptive survey. Participants were children diagnosed with childhood cerebral palsy (CCP) enrolled in special education schools. Physical and motor skills were evaluated through manual dexterity, strength and active range of motion. Results: The final sample consisted of 31 children with CCP. They were divided in two groups according to the functional level of the upper limbs using MACS scale. The less affected group (n=18) encompassed the MACS's values I and II, while the group most affected collected values III, IV and V (n=13). Significant differences were found between groups in the variables GMFCS (P=.009), assessed mobility capacity using PEDI (P =.016) in the manual dexterity of the dominant hand assessed Nine Hole Peg Test (P=.004), clamp force of the non-dominant hand (P=.042), active range of motion of the wrist joint in both hands, typing position and total numbers written. Conclusions: Children with CCP show a motor and functional skills’ affectation. The strength of the digital clamp's affectation, the dexterity and the wrist's active mobility showed great impact on the implementation of the Activities of Daily Living. Therapeutic strategies focusing on these skills can result in best rates of functional independence

Modificaciones musculoesqueléticas en mujeres embarazadas con dolor lumbopélvico / Postural modifications in the last trimester of pregnancy: Comparison between women with and without lumbopelvic pain

Objetivo: Evaluar la postura en el plano sagital, el equilibrio dinámico y la estabilidad lumbopélvica en mujeres embarazadas sobre la base de la presencia o ausencia de dolor lumbopélvico durante el último trimestre de embarazo. Material y método: Estudio observacional en el que se completó un seguimiento de 6 semanas en mujeres embarazadas durante el tercer trimestre de gestación. Se incluyó a 26 mujeres embarazadas (14 con dolor lumbopélvico y 12 sin dolor lumbopélvico; edad 34,36 ± 3,13 y 32,70 ± 3,50 años, respectivamente). La valoración postural en el plano sagital se realizó con el dispositivo Spinal Mouse®, el equilibrio dinámico con el test mini-Balance Evaluation Systems y la estabilidad lumbopélvica con el test Active Straight Leg Raising. Resultados: El grupo de mujeres con dolor lumbopélvico mostró mayores valores de inclinación del sacro (p = 0,036) y menor equilibrio dinámico (p = 0,049) a las 6 semanas de seguimiento. Adicionalmente, el grupo con dolor mostró menor estabilidad lumbopélvica en la valoración inicial y a las 6 semanas (p<0,05) respecto al grupo de embarazadas sin dolor. Conclusión: Las mujeres con dolor lumbopélvico presentan una mayor inclinación del sacro y una menor puntuación en equilibrio dinámico. Asimismo, su estabilidad lumbopélvica se encuentra significativamente disminuida en comparación con mujeres sin dolor lumbopélvico en el tercer trimestre del embarazo

Objective: To evaluate posture in the sagittal plane, dynamic balance and lumbopelvic stability in pregnant women depending on the presence or absence of lumbopelvic pain during the last trimester of pregnancy. Material and method: Observational study with a 6-week follow-up in pregnant women during the third trimester of pregnancy. We included 26 pregnant women (14 with lumbopelvic pain and 12 without lumbopelvic pain; age 34.36 ± 3.13 and 32.70 ± 3.50 years, respectively). The postural evaluation in the sagittal plane was carried out with the Spinal Mouse®, dynamic balance was evaluated with the mini-Balance Evaluation Systems test and the Active Straight Leg Raising test was used to evaluate lumbopelvic stability. Results: The group of women with lumbopelvic pain showed higher values of inclination of the sacrum (P = .036) and less dynamic balance (P = .049) at 6 weeks of follow-up. In addition, the group with lumbopelvic pain showed lower lumbopelvic stability in the evaluation at baseline and at 6 weeks (P < .05) compared with the group of pregnant women without lumbopelvic pain. Conclusion: Women with lumbopelvic pain have a greater inclination of the sacrum and a lower score in dynamic balance. Additionally, lumbopelvic stability is significantly decreased compared with women without lumbopelvic pain in the third trimester of pregnancy

Results of a Pilates exercise program in patients with chronic non-specific low back pain: a randomized controlled trial.

OBJECTIVE: To investigate the effects of a Pilates exercise program on disability, pain, lumbar mobility, flexibility and balance in patients with chronic non-specific low back pain. DESIGN: Randomized controlled trial. SETTING: University laboratory. PARTICIPANTS: A total of 54 patients with chronic non-specific low back pain. INTERVENTION: Patients were randomly allocated to an experimental group ( n=27) included in a Pilates exercise program or to a control group ( n=27) receiving information in a form of a leaflet. MAIN OUTCOME MEASURES: Disability (Roland-Morris Disability Questionnaire and Oswestry Disability Index), current, average and pain at it least and at its worst (Visual Analogue Scales), lumbar mobility (modified Shober test), flexibility (finger-to-floor test) and balance (single limb stance test) were measured at baseline and after the intervention. RESULTS: A between-group analysis showed significant differences in the intervention group compared to the control group for both disability scores, the Rolland-Morris questionnaire (mean change±standard deviation of 5.31±3.37 and 2.40±6.78 respectively and between-groups mean difference of 3.2 ± 4.12, p=0.003) and the Oswestry Disability Index ( p<0.001), current pain ( p=0.002) and pain at it least ( p=0.033), flexibility (0.032) and balance (0.043). CONCLUSIONS: An 8-week Pilates exercise program is effective in improving disability, pain, flexibility and balance in patients with chronic non-specific low back pain.

Effects of manual therapy on treatment duration and motor development in infants with severe nonsynostotic plagiocephaly: a randomised controlled pilot study.

PURPOSE: Despite growing evidence regarding nonsynostotic plagiocephaly and their repercussions on motor development, there is little evidence to support the use of manual therapy as an adjuvant option. The aim of this study was to evaluate the effects of a therapeutic approach based on manual therapy as an adjuvant option on treatment duration and motor development in infants with severe nonsynostotic plagiocephaly. METHODS: This is a randomised controlled pilot study. The study was conducted at a university hospital. Forty-six infants with severe nonsynostotic plagiocephaly (types 4-5 of the Argenta scale) referred to the Early Care and Monitoring Unit were randomly allocated to a control group receiving standard treatment (repositioning and an orthotic helmet) or to an experimental group treated with manual therapy added to standard treatment. Infants were discharged when the correction of the asymmetry was optimal taken into account the previous clinical characteristics. The outcome measures were treatment duration and motor development assessed with the Alberta Infant Motor Scale (AIMS) at baseline and at discharge. RESULTS: Asymmetry after the treatment was minimal (type 0 or 1 according to the Argenta scale) in both groups. A comparative analysis showed that treatment duration was significantly shorter (p < 0.001) in the experimental group (109.84 ± 14.45 days) compared to the control group (148.65 ± 11.53 days). The motor behaviour was normal (scores above the 16th percentile of the AIMS) in all the infants after the treatment. CONCLUSIONS: Manual therapy added to standard treatment reduces the treatment duration in infants with severe nonsynostotic plagiocephaly.

Valoración del dolor crónico de hombro en población mayor: un enfoque biopsicosocial / Assessment of chronic shoulder pain in the elderly population: A biopsychosocial approach

Introducción. La prevalencia de dolor crónico de hombro entre la población mayor es muy alta. Los objetivos de este estudio fueron establecer el perfil clínico del paciente con dolor crónico de hombro incorporando un enfoque biopsicosocial a la valoración del paciente y examinar la interacción entre discapacidad y variables físicas y psicológicas. Material y métodos. Estudio descriptivo en el que se incluyeron 70 personas mayores de 60 años que acudieron al Servicio de Rehabilitación del Hospital por presentar dolor crónico inespecífico de hombro con duración de los síntomas superior a 3 meses, sin comorbilidades motoras asociadas a la extremidad superior. Un fisioterapeuta valoró las variables físicas referentes al rango de movimiento, la dinamometría, la algometría y la intensidad del dolor. Los participantes completaron un cuestionario de creencias de evitación por temor, kinesiofobia y de percepción de discapacidad. La interacción entre estas variables se estableció mediante un análisis correlacional. Resultados. Se encontró una correlación negativa significativa (p < 0,05) entre las variables físicas y en los aspectos psicológicos relativos al cuestionario de evitación por temor y la escala de kinesiofobia. Una correlación significativa (p < 0,001) se encontró entre discapacidad y las variables físicas y psicológicas. Conclusión. Nuestros resultados apoyan la existencia de una relación entre discapacidad y variables físicas y psicológicas en el dolor crónico de hombro. Estos hallazgos refuerzan la idea de que una aproximación biopsicosocial es necesaria para adecuar la terapéutica al paciente (AU)

Introduction. The prevalence of chronic shoulder pain within the elderly population is very high. This study has aimed to establish the clinical profile of patients with chronic shoulder pain, incorporating a biopsychosocial approach for the assessment and to study the relationship between disability and physical and psychological variables. Material and methods. A descriptive survey in which 76 participants aged over 60 years old who came to rehabilitation in the hospital with non-specific chronic shoulder pain without motor comorbidities associated to the upper limbs and with a duration of more than 3 months was performed. A physical therapist assessed the physical variables regarding range of motion, dynamometry, algometry, and pain intensity. The participants also filled out a questionnaire on fear-avoidance beliefs, kinesiophobia, and perception of disability. A correlation analysis was conducted to determine the interaction between these variables. Results. A significant negative significant (P < .05) correlation was found between the physical variables and psychological aspects regarding the fear avoidance questionnaire and the Kinesiophobia scale. There was a significant correlation (P < .001) between disability and physical and psychological variables. Conclusion. Our results support the existence of a strong association between disability and psychological and physical variables in chronic shoulder pain. These findings reinforce the idea that a biopsychosocial approach is necessary to adapt the therapy to the patient (AU)

The effects of a physiotherapy programme on patients with a pleural effusion: a randomized controlled trial.

OBJECTIVE: To investigate the effects of a physiotherapy protocol on patients with pleural effusion. DESIGN: Randomized controlled trial. SETTING: University hospital. PARTICIPANTS: A total of 104 consecutive inpatients with a medical diagnosis of pleural effusion. INTERVENTION: Patients were randomly allocated to a control group receiving standard treatment (medical treatment and drainage) or an intervention group treated with physiotherapy added to standard treatment. The physiotherapy programme included deep breathing exercises, mobilizations and incentive spirometry. MAIN OUTCOME MEASURES: Spirometric predicted values and chest radiographs were measured before treatment and at discharge and the length of hospital stay was recorded. Assessors were blinded to the intervention. RESULTS: A comparative analysis showed a significant improvement of spirometric parameters in the intervention group; pre-to-post hospitalization predicted values showed significant changes in vital capacity (73.1 ± 12.6% to 72.13 ± 13.7 %, P<0.001 ), forced expiratory volume in first second (72.13 ± 13.7% to 78.98 ± 16.9%, P<0.001) and forced expiratory flow at 25-75 % (64.8 ± 35.1% to 76.78 ± 35.3%, P=0.198) compared to the control group that showed no significant changes across treatment. The radiographic findings showed better scores on the affected side of the thorax at discharge in the physiotherapy group. Length of hospital stay was also significantly (P=0.014) shorter in the intervention group (26.7 ± 8.8 days) compared to the control group (38.6 ± 10.7 days). CONCLUSIONS: A physiotherapy programme added to standard treatment improves the spirometric parameters and the radiological findings and reduces the hospital stay in patients with a pleural effusion.

The influence of body mass index on the functional prognosis of patients with hip fracture.

BACKGROUNDS AND AIMS: To examine the contribution of patient body mass index to functional status, physical independence and emotional distress in various age groups (third and fourth age) of female hip-fracture patients. METHODS: A sample of 123 older females (>65 years) admitted in a major regional hospital with a diagnosis of hip fracture participated in this cross-sectional study. The outcome measures used in this study were body mass index (BMI), the Modified Barthel Index, the Goldberg General Health Questionnaire, the Tinetti Mobility Test and a survey collecting data from participants 24-72 h after admission. For our analysis, patients were divided into two groups according to their age: <80 years (third age) and >81 years (fourth age). In addition, three groups were made according to patients' body mass index <24 h prior to surgery: a normal weight group, an overweight group and an obese group. An ANCOVA was performed with age group as a between-subjects variable (third age, fourth age) and gender, educational level, marital status, type of fracture, type of surgery, presence of other fractures and BMI as covariates. RESULTS: Patients in the third-age group obtained significantly higher values in the Barthel Index (P = 0.040) and the Tinetti Mobility Test (P = 0.001) and lower values in the Goldberg General Health Questionnaire (P = 0.035) compared to the fourth-age group. When BMI was considered, significance was maintained only in the Tinetti Mobility Test. CONCLUSIONS: The BMI could be a relevant mediator of the relationship between functional decline and the aging process in the transition between third to fourth age in females.

Clinical profile and evolution of infants with deformational plagiocephaly included in a conservative treatment program.

PURPOSE: The aim of this study was to evaluate the results of a conservative intervention in infants with plagiocephaly according to their specific clinical profile. METHODS: Prospective clinical trial in which 104 infants with plagiocephaly accompanied or not by congenital or positional torticollis were referred to Early Care and Monitoring Unit (USAT) of San Cecilio Hospital in Granada, between 2009 and 2012. All the infants, grouped into three categories of severity, were included in the physiotherapy protocol until adequate craniofacial morphology and motor development were achieved. The study included an assessment of parents and infants. Parents were assessed with a questionnaire about the mother's medical history and birth-related issues. The assessment of infants included anthropometric measures, a positional assessment, the observation of the head, the assessment of severity, and motor development. RESULTS: Birth characteristics were similar in the total sample but showed different clinical profiles according to treatment aspects. More specifically, infants with severe plagiocephaly were referred to treatment later and spent more time in treatment; use of an orthotic helmet was also more prevalent in this category. There were also significant differences (P < 0.05) in the acquisition of specific gross motor skills depending on the severity of plagiocephaly. CONCLUSION: The findings suggest that the physiotherapy protocol presented is effective to correct plagiocephaly. Severity of plagiocephaly is a marker that should be taken into account when designing actions aimed at improving gross motor skill development.