Progressive multifocal leukoencephalopathy: a retrospective study of the last 12 years in a tertiary-care hospital.

Our study aims to report on the demographic, incidence rate (IR), clinical, and microbiological characteristics of PML patients diagnosed in our tertiary-care hospital over the past 12 years. In this retrospective observational study, we reviewed all requests for JCPyV PCR in CSF from patients with suspected PML. We collected demographic, clinical, and microbiological data of patients diagnosed with PML. Since 2018, real-time quantitative PCR has been used, whereas prior to 2018, samples were sent to our National Reference Center for qualitative diagnosis. Thirteen patients were diagnosed with PML, with 10 of them having a definitive diagnosis and 3 classified as a possible diagnosis with negative PCR results. Eleven patients had advanced HIV, one had non-Hodgkin's lymphoma, and one had systemic lupus erythematosus. Most of the white matter lesions were located at the cerebral level, although the parenchyma and cerebellum were also affected. The most frequent symptoms were behavioral disorders and hemiparesis. The viral load of JCPyV in cerebrospinal fluid was < 1000 copies/mL in three patients. Six patients received compassionate treatment, and all six patients with definitive PML diagnosis died. Although advanced HIV patients were the most affected by PML in our study, it should also be considered in patients with other underlying diseases. While current PCR tests offer high sensitivity and specificity, false negatives can occur. The prognosis of the disease remains poor, and early multidisciplinary diagnosis-including clinical, microbiological, and neuroimaging assessments-remains crucial for improving neurological damage and prognosis.

Short-Term Effect of Spinal Manipulation on the Magnitude of Exophoria in Adults Who Are Asymptomatic: A Randomized Controlled Trial.

OBJECTIVE: This study aimed to assess the immediate and short-term effects of cervical spinal manipulation (SM), compared with a placebo, on the magnitude of near and distance exophoria in adults with asymptomatic exophoria. METHODS: In this single-blind, randomized controlled trial, individuals with a clinical diagnosis of horizontal exophoria confirmed with the prism alternating cover test (PACT) were allocated to a single intervention session using a high-velocity, low-amplitude cervical SM technique or a sham intervention (manual contact under the head). Outcomes were the magnitude of horizontal heterophoria, as a measure of binocular vision efficiency at near (40 cm) or distance (4 m) fixation, using the PACT. Evaluations were made at baseline, immediately after intervention, and at a 1-week follow-up. RESULTS: From May to September 2021, 44 volunteers (23 women), with a mean age of 35 (SD = 9.5) years, were recruited and equally distributed into the study groups. All participants completed follow-up assessments, and no adverse events were reported. There was a significant time × group interaction for exophoria at near vision, but not at distance fixation. The SM group showed a significant decrease of near exophoria compared with the control group at the 1-week follow-up (mean difference = -1.09 prism diopters; 95% CI = -0.20 to -1.98 prism diopters). CONCLUSION: The use of cervical SM therapy resulted in a significant reduction of the magnitude of horizontal exophoria at near vision (medium effect size), compared with the placebo, in young adults who are asymptomatic. However, these effects were not observed at distance fixation and should be considered cautiously due to the pre-post design with a single intervention session and the short-term follow-up. IMPACT: The findings suggest short-term benefits of SM therapy can manage undiagnosed ocular convergence disorders, although changes were not clinically relevant.

Age related changes in the Q angle of non-professional football players.

Background: Football practice involves a great muscular demand, leading to the development of the lower limbs that, on occasions, can cause deviations from the normal anthropometric values. The quadriceps angle (Q angle) is a value often taken as a reference for the alignment of the lower limbs. Objective: To observe the changes of the Q angle in young football players, because of muscular effort, analyzing the differences between four groups of different ages and to determine whether the playing position might influence these variations. Methods: A cross sectional study was carried out with 104 male subjects divided into four groups according to age: under 8 years-old, 8-17 years-old, 17-21 years-old and over 21 years-old. A photograph was taken in standing position and the Q angle was plotted with KINOVEA® software. As for the reliability of the measurements, intraclass intra and interobserver coefficient were 0.958 and 0.860 respectively. The study was conducted in mid-season. Results: Q angle value is greater in those under 8 years of age and decreases gradually and significantly (p < 0.005) until 17-21 years of age, where it stabilizes at values of 5.73° ± 2.78 for right Q angle and 5.88° ± 2.55 for left Q angle. Two way ANOVA demonstrated a significant group*position interaction for goalkeepers with a medium effect size in both angles (p < 0.001) with a medium effect (η2 Right Q angle = 0.31; η2 Left Q angle = 0.37). The values remain unchanged in subjects over 21 years of age (p > 0.005), except for goalkeepers, who suffered a difference in the evolution of the angle within their age category (p < 0.005) and with a high effect size with the other positions (value > 0.8) except forward (value < 0.5). Conclusion: This study determines that the Q angle in football players decreases with growth, reaching values below 15° at the end of development. Playing positions only influence players over the age of 21, and the Q-angle of goalkeepers is greater than that of other players.

Dropout rate in randomised controlled trials of balance and gait rehabilitation in multiple sclerosis: is it expected to be different for virtual reality-based interventions? A systematic review with meta-analysis and meta-regression.

To assess and meta-analyse the pooled dropout rate from the randomised control trilas that use virtual reality for balance or gait rehabilitation in people with multiple sclerosis. A systematic review of randomised control trials with meta-analysis and meta-regressions was performed. A search was conducted in PubMed, Scopus, Web of Science, the Physiotherapy Evidence Database, the Cochrane Database, CINHAL, LILACS, ScienceDirect, and ProQuest. It was last updated in July 2022. After the selection of studies, a quality appraisal was carried out using the PEDro Scale and the Revised Cochrane risk-of-bias tool for randomised trials. A descriptive analysis of main characteristics and dropout information was performed. An overall proportion meta-analysis calculated the pooled dropout rate. Odds ratio meta-analysis compared the dropout likelihood between interventions. The meta-regression evaluated the influence of moderators related to dropout. Sixteen studies with 656 participants were included. The overall pooled dropout rate was 6.6% and 5.7% for virtual reality and 9.7% in control groups. The odds ratio (0.89, p = 0.46) indicated no differences in the probability of dropouts between the interventions. The number, duration, frequency, and weeks of sessions, intervention, sex, multiple sclerosis phenotype, Expanded Disability Status Scale score, and PEDro score were not moderators (p > 0.05). Adverse events were not reported and could not be analysed as moderators. Dropouts across the virtual reality and control comparators were similar without significant differences. Nonetheless, there is a slight trend that could favour virtual reality. Standardisation in reporting dropouts and adverse events is recommended for future trials. PROSPERO database, registration number ID CRD42021284989. Supplementary Information: The online version contains supplementary material available at 10.1007/s10055-022-00733-4.

Measuring Mechanical Properties of Spastic Muscles After Stroke. Does Muscle Position During Assessment Really Matter?

OBJECTIVE: To investigate the influence of muscle position (relaxed vs stretched) on muscle mechanical properties and the ability of myotonometry to detect differences between sides, groups, and sites of testing in patients with stroke. We also analyzed the association between myotonometry and clinical measures of spasticity. DESIGN: Cross-sectional study. SETTING: Outpatient rehabilitation units including private and public centers. PARTICIPANTS: Seventy-one participants (20 subacute stroke, 20 chronic stroke, 31 controls) were recruited (N=71). INTERVENTION: Muscle mechanical properties were measured bilaterally with a MyotonPRO at muscle belly and musculotendinous sites during 2 protocols (muscle relaxed or in maximal bearable stretched position). MAIN OUTCOME MEASURES: Muscle tone and stiffness of the biceps brachii and gastrocnemius. Poststroke spasticity was evaluated with the Modified Tardieu Scale (MTS). A mixed-model analysis of variance was used to detect differences in the outcome measures. RESULTS: The analysis of variance showed a significant effect of muscle position on muscle mechanical properties (higher tone and stiffness with the muscle assessed in stretched position). Measurements with the stretched muscle could help discriminate between spastic and nonspastic sides, but only at the biceps brachii. Overall, there was a significant increase in tone and stiffness in the chronic stroke group and in myotendinous sites compared with muscle belly sites (all, P<.05). No correlations were found between myotonometry and the MTS. CONCLUSIONS: Myotonometry assessment of mechanical properties with the muscle stretched improves the ability of myotonometry to discriminate between sides in patients after stroke and between people with and without stroke.

Comparison of the Performance of Two Galactomannan Detection Tests: Platelia Aspergillus Ag and Aspergillus Galactomannan Ag Virclia Monotest.

The use of nonculture-based biomarkers such as the determination of galactomannan is sought for the diagnosis of invasive aspergillosis. To investigate the comparative yield of two tests for the detection of galactomannan in patients with or without proven or probable invasive aspergillosis. Overall, 327 samples (327 patients) were analyzed in a retrospective/prospective study performed in 3 hospitals in Madrid, comparing the determination results in serum or bronchoalveolar lavage of two techniques for galactomannan detection, namely, Platelia Aspergillus Ag (Bio-Rad) and Aspergillus galactomannan Ag Virclia Monotest (Vircell S.L.), following the manufacturer's instructions. Both techniques can automate the process, but the second technique has the advantage of individual processing and assembly of each sample without the need for the additional expense of single-dose strips in controls. In total, 288 of the 327 tests performed showed concordant results between both techniques. The agreement between both methods was к = 0.722, and the correlation between indices was ρ = 0.718. Only 39 samples showed discordant results. In those 39 cases, there were 15 patients with proven or probable invasive aspergillosis criteria. For the samples with clinical criteria as a reference, the areas under the curve of the receiver operating characteristic (ROC) curve were 0.962 for Platelia and 0.968 for VirClia. The VirClia test has been proven to be an alternative for diagnosis due to its friendlier automated format than that of the usual Platelia routine test. The VirClia test also allows individual action and, therefore, a more immediate clinical response. IMPORTANCE Invasive mycoses are increasingly present in immunosuppressed or hospitalized patients with serious illnesses, leading to high rates of morbidity and mortality. Invasive aspergillosis is an infection caused, in a percentage greater than 50%, by the genus Aspergillus. It is vitally important to make an early diagnosis that leads to the application of antifungals in the initial stage of the infection. Therefore, tools are required to help with the early diagnosis of the infection. This comparative study of two enzyme immunoassays is based on the detection of galactomannan antigen in serum and bronchoalveolar lavage samples. A new design based on chemiluminescence and presented in an automated single-dose format is compared to a conventional ELISA technique marketed for years. The results obtained from the prospective and retrospective study indicate a high correlation and degree of agreement between both techniques, as well as in their diagnostic performance.

Impact of lack of face-to-face schooling during COVID-19 confinement on family quality of life of children with disabilities and typical development.

OBJECTIVE: The aim of this study was to analyze the impact of the lack of face-to-face schooling during the COVID-19 confinement on the family quality of life of children aged 3-6 years with hemiplegia, obstetrical brachial palsy, and typical development. MATERIALS AND METHODS: An observational and cross-sectional study, using an online survey hosted in Google Forms from October to December 2020, was performed in families with children with infantile hemiplegia, obstetrical brachial palsy, and typical development aged 3-6 years living in Spain. The quality of life and family impact (measured through Pediatric Quality of Life Questionnaires, PedsQL™) were evaluated, as well as the affected upper limb side, the presence of other associated problems, the parents' job, lack of use of the affected upper limb, and the type of online intervention using different channels: phone calls, emails, and video calls. Family expectations on the treatment and on their acquired capacity to solve problems related to their children were also measured. RESULTS: A total of 93 families participated in the study and the children's quality of life and family impact obtained a strong correlation in three populations: infantile hemiplegia (r = 0.844), obstetrical brachial palsy (r = 0.513), and typical development (r = 0.904). There was no association between quality of life and online intervention (phone calls and emails were selected), p > 0.05. CONCLUSION: The deprivation of schooling coupled with home confinement due to the COVID-19 pandemic had a greater impact on the quality of life of children with disabilities: infantile hemiplegia and obstetrical brachial palsy than on typically developing children and on their families. However, the online intervention did not produce improvements in quality of life, which could be a consequence of using emails or phone calls instead of video calls to interact with the families.

Immersive Virtual Reality and Vestibular Rehabilitation in Multiple Sclerosis: Case Report.

BACKGROUND: Dizziness and imbalance are common and disabling symptoms in patients with multiple sclerosis (MS) and are caused by a central, peripheral, or mixed vestibulopathy. Central vestibular disorder is the most frequently reported vestibular problem in the MS population due to demyelination. Vestibular rehabilitation ameliorates these symptoms and their repercussions and improves quality of life. Immersive virtual reality (VRi) is an emerging tool in this field; however, no previous research has been performed studying its effects in MS. OBJECTIVE: The aim of this study was to apply a VRi vestibular training protocol to a patient with MS and assess the effects induced by the experimental intervention. METHODS: This case study included a 54-year-old woman with relapsing-remitting MS. We developed a standardized VRi exercise protocol for vestibular rehabilitation based on the gold-standard Cawthorne-Cooksey vestibular training protocol. The 20-session intervention was made up of 10 initial sessions and 10 advanced sessions. Each 50-minute session was performed two to three times per week for 7 weeks. Four evaluations were carried out over the study period: at baseline (T0), between initial and advances phases (T1), postintervention (T2), and 1 month after the experimental procedure (T3). The research outcomes were dizziness, balance, gait, impact of fatigue, quality of life, repercussions in muscular tone, and usability of the head-mounted display device. RESULTS: After implementing the VRi vestibular protocol, improvements were seen in the following patient parameters: Dizziness Handicap Inventory score (62 points at T0; 4 points at T2); Berg Balance Scale score (47 points at T0; 54 points at T2); instrumented Timed Up and Go time (8.35 seconds at T0; 5.57 seconds at T2); muscular tone of the erector spinae, rectus femoris, and soleus; Modified Fatigue Impact Scale score (61 points at T0; 37 points at T2); and Multiple Sclerosis Quality of Life-54 values (67.16% in the physical health area at T2; 33.56% in the mental health area at T2). The patient rated the usability of the system as 90%, based on the System Usability Scale, and gave the system a grade of A. CONCLUSIONS: Although further research is needed, this study provided initial evidence that the first VRi vestibular protocol for the MS population can improve dizziness, balance, gait, impact of fatigue, quality of life, and muscular tone through an exergame intervention. This study may help establish a standardized VRi protocol for vestibular rehabilitation.

Feasibility and safety of an immersive virtual reality-based vestibular rehabilitation programme in people with multiple sclerosis experiencing vestibular impairment: a protocol for a pilot randomised controlled trial.

INTRODUCTION: Vestibular system damage in patients with multiple sclerosis (MS) may have a central and/or peripheral origin. Subsequent vestibular impairments may contribute to dizziness, balance disorders and fatigue in this population. Vestibular rehabilitation targeting vestibular impairments may improve these symptoms. Furthermore, as a successful tool in neurological rehabilitation, immersive virtual reality (VRi) could also be implemented within a vestibular rehabilitation intervention. METHODS AND ANALYSIS: This protocol describes a parallel-arm, pilot randomised controlled trial, with blinded assessments, in 30 patients with MS with vestibular impairment (Dizziness Handicap Inventory ≥16). The experimental group will receive a VRi vestibular rehabilitation intervention based on the conventional Cawthorne-Cooksey protocol; the control group will perform the conventional protocol. The duration of the intervention in both groups will be 7 weeks (20 sessions, 3 sessions/week). The primary outcomes are the feasibility and safety of the vestibular VRi intervention in patients with MS. Secondary outcome measures are dizziness symptoms, balance performance, fatigue and quality of life. Quantitative assessment will be carried out at baseline (T0), immediately after intervention (T1), and after a follow-up period of 3 and 6 months (T2 and T3). Additionally, in order to further examine the feasibility of the intervention, a qualitative assessment will be performed at T1. ETHICS AND DISSEMINATION: The study was approved by the Andalusian Review Board and Ethics Committee, Virgen Macarena-Virgen del Rocio Hospitals (ID 2148-N-19, 25 March 2020). Informed consent will be collected from participants who wish to participate in the research. The results of this research will be disseminated by publication in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER: NCT04497025.

Combined intensive therapies at home in spastic unilateral cerebral palsy with high bimanual functional performance. What do they offer? A comparative randomised clinical trial.

BACKGROUND: Children with unilateral spastic cerebral palsy (USCP) receive different treatments, including the application of modified constraint induced movement therapy (mCIMT) or bimanual intensive therapy (BIT) to increase affected upper limb functionality. The aim of this study was to compare the effectiveness of two protocols with different proportions and orders of mCIMT/BIT within combined intensive home-therapy in children with USCP (6-8 years old) with high bimanual functional performance, applied by the family. METHODS: The protocols were performed on 20 children with an average age of 7.12 years [standard deviation (SD): 0.70], allocated to two different combined therapies. The protocols were designed by 100 h of dose for 10 weeks: 80 h of mCIMT followed by 20 h of BIT (mCIMT-B group) and 80 h of BIT followed by 20 h of mCIMT (BIT-mCI group). Bimanual functional performance was measured with Assisting Hand Assessment Scale (AHA) and the affected upper limb-use experience with Children's Hand-use Experience Questionnaire (CHEQ). Parent satisfaction and expectations with therapy were measured using a specific questionnaire. There were five assessment timepoints (week 0, week 4, week 8, week 10 and week 34). RESULTS: There were no statistically significant (p > 0.05) inter- and intra-group changes in the bimanual functional performance of both groups. The affected upper limb-use experience obtained significant changes in BIT-mCI group, with statistically significant differences in the pairwise comparisons between week 0-10 and week 4-10 (p = 0.028) for use of the affected hand and the use of the affected hand to grasp between week 4 and week 8 (p = 0.028). Grasp efficacy and discomfort acquired statistically significant differences only in the BIT-mCI group for pairwise comparisons week 0-week 10/week 4-week 10 (p = 0.035). Although task execution time compared with a typically developing child of the same age obtained statistically significant differences only in the group mCIMT-B for pairwise comparisons week 0-week 8 (p = 0.03), week 0-week 10 (p = 0.03), week 4-week 8 (p = 0.04) and week 4-week 10 (p = 0.03). Family satisfaction and expectations acquired an increase between week 0 and week 10 (p ⩽ 0.02). CONCLUSION: Applying 80 h of BIT for 8 weeks in children with high bimanual functional performance USCP (6-8 years old), executed at home with family involvement would be sufficient to obtain improvements in affected upper limb-use experience, without the need to use combined protocols of 100 h. However, no statistically significant increase in bimanual functional performance would be obtained, with the basal situation of the child being a factor to consider for the execution of mCIMT and BIT.Registration number and name of trial registry: [ClinicalTrials.gov identifier: NCT03465046].

[Evolution of COVID-19 at nursing homes from the second wave to vaccination. Description of a coordination program between Primary Care, Geriatrics and Public Health.] / Evolución de la COVID-19 en las residencias de personas mayores desde la segunda ola hasta la vacunación. Descripción de un programa de coordinación entre Atención Primaria, Geriatría y Salud Pública.

OBJECTIVE: Nursing homes have suffered in a particularly pronounced way from the effects of COVID-19 so it is very convenient to know the evolution in them of the disease and the impact of SARS-CoV2 vaccination The objective of this study was to analyze COVID-19 pandemic evolution from the start of the second wave to the end of the vaccination campaign at the nursing homes. A coordination program between Primary Care and Geriatrics and Public Health services was activated. METHODS: 2,668 seniors were followed at 39 nursing homes. Data from new cases, active cases, mortality and place of treatment of COVID-19 were collected. A descriptive analysis was performed with the measurement of the absolute number of positive SARS-CoV-2 cases and the frequency distribution. RESULTS: Between August 7th 2020 and February 26th 2021, 30 outbreaks occurred at 21 nursing homes. 300 people tested positive for SARS-CoV-2 (11% of total residents). The daily average of active cases was 27,166 were hospitalized (55%). 66 patients died (22% of those infected), 54 of them (78%) at the hospital. 1,984 PCR tests were performed. The temporary profile of new cases did not follow a distribution "in waves" as in the community. Thirty-seven days after the start of the second dose of vaccination, there were no active cases until March 1st, when new cases were under study for possible vaccine leakage. CONCLUSIONS: The incidence of COVID-19 at nursing homes after the first wave of the pandemic has apparently been lower. The transmission in these centers has followed a different distribution than at community. Mass vaccination has achieved the practical disappearance of the disease.

OBJETIVO: Los centros residenciales han sufrido de una manera especialmente acusada los efectos de la COVID-19 por lo que es muy conveniente conocer la evolución en ellos de la enfermedad y el impacto de la vacunación frente al SARS-CoV2. El objetivo de este estudio fue conocer la evolución de la pandemia de COVID-19 desde el comienzo de la segunda ola hasta el final del proceso de vacunación en las residencias de personas mayores de un área sanitaria, en la cual se activó un programa de coordinación entre Atención Primaria y los servicios de Geriatría y Salud Publica. METODOS: Se siguió a 2.668 personas mayores en 39 residencias. Se recogieron datos de casos nuevos, activos, fallecidos y lugar de tratamiento de la COVID-19. Se realizó un análisis descriptivo con la medición del número absoluto de casos positivo de SARS-CoV-2 y la distribución de frecuencias. RESULTADOS: Entre el 7 de agosto de 2020 y el 26 de febrero de 2021 se produjeron 30 brotes en 21 residencias. Se detectaron 300 casos positivos de SARS-CoV-2 (11% de los residentes totales). La media diaria de casos activos fue 27. Fueron hospitalizados 166 (55%). Fallecieron 66 pacientes (22% de los infectados), 54 de ellos (78%) en el hospital. Se realizaron 1.984 test PCR. El perfil temporal de aparición de casos nuevos no siguió una distribución "en olas" como en la comunidad. Treinta y siete días después del inicio de la segunda dosis de vacunación, no existieron casos activos hasta el 1 de marzo en que aparecieron nuevos casos en estudio por posible escape vacunal. CONCLUSIONES: La incidencia de la COVID-19 en las residencias de personas mayores tras la primera ola de la pandemia es aparentemente inferior. La transmisión en estos centros sigue una distribución diferente a la de la comunidad. El efecto de la vacunación masiva consigue la práctica desaparición de la enfermedad.

Validity and reliability of myotonometry for assessing muscle viscoelastic properties in patients with stroke: a systematic review and meta-analysis.

There is a lack of consensus about the measurement of the muscle viscoelastic features in stroke patients. Additionally, the psychometric properties of the most-commonly used clinical tools remain controversial. Our objective is to investigate the validity and reliability of myotonometry to assess viscoelastic muscle features in stroke survivors. Pubmed, PEDro, Scopus and Cinahl were systematically searched to include studies reporting the psychometric properties of myotonometric devices used in people after stroke. The QUADAS-2 and the COSMIN checklists were used to assess the methodological quality of the studies and the psychometric properties of myotonometry. Nine studies were included in the qualitative synthesis and data from five of these were pooled in a meta-analysis. Overall, low to moderate risk of bias and applicability concerns were observed. Pooled data from intra-rater reliability for muscle tone showed a mean coefficient of correlation of 0.915 (95% CI: 0.880-0.940, I 2 = 69.2%) for upper limbs, and a mean coefficient of 0.785 (95%CI: 0.708-0.844, I 2 = 4.02%) for lower limbs. Myotonometry seems to be a valid and reliable complementary tool to assess muscle viscoelastic properties in stroke survivors, although definite conclusions about concurrent validity need further research.

Epley manoeuvre for posterior semicircular canal benign paroxysmal positional vertigo in people with multiple sclerosis: protocol of a randomised controlled trial.

INTRODUCTION: Vestibular disorders in multiple sclerosis (MS) could have central or peripheral origin. Although the central aetiology is the most expected in MS, peripheral damage is also significant in this disease. The most prevalent effect of vestibular peripheral damage is benign paroxysmal positional vertigo (BPPV). Impairments of the posterior semicircular canals represent 60%-90% of cases of BPPV. The standard gold treatment for this syndrome is the Epley manoeuvre (EM), the effectiveness of which has been poorly studied in patients with MS. Only one retrospective research study and a case study have reported encouraging results for EM with regard to resolution of posterior semicircular canal BPPV. The aim of this future randomised controlled trial (RCT) is to assess the effectiveness of EM for BPPV in participants with MS compared with a sham manoeuvre. METHODS AND ANALYSIS: The current protocol describes an RCT with two-arm, parallel-group design. Randomisation, concealed allocation and double-blinding will be conducted to reduce possible bias. Participants and evaluators will be blinded to group allocation. At least 80 participants who meet all eligibility criteria will be recruited. Participants will have the EM or sham manoeuvre performed within the experimental or control group, respectively. The primary outcome of the study is changes in the Dix Hallpike test. The secondary outcome will be changes in self-perceived scales: Dizziness Handicap Inventory and Vestibular Disorders Activities of Daily Living Scale. The sample will be evaluated at baseline, immediately after the intervention and 48 hours postintervention. ETHICS AND DISSEMINATION: The study was approved by the Andalusian Review Board and Ethics Committee of Virgen Macarena-Virgen del Rocio Hospitals (ID 0107-N-20, 23 July 2020). The results of the research will be disseminated by the investigators to peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT04578262.

Feedback-guided exercises performed on a tablet touchscreen improve return to work, function, strength and healthcare usage more than an exercise program prescribed on paper for people with wrist, hand or finger injuries: a randomised trial.

QUESTION: In people with bone and soft tissue injuries of the wrist, hand and/or fingers, do feedback-guided exercises performed on a tablet touchscreen hasten return to work, reduce healthcare usage and improve clinical recovery more than a home exercise program prescribed on paper? DESIGN: Randomised, parallel-group trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS: Seventy-four workers with limited functional ability due to bone and soft tissue injuries of the wrist, hand and/or fingers. INTERVENTION: Participants in the experimental and control groups received the same in-patient physiotherapy and occupational therapy. Participants in the experimental group received a home exercise program using the ReHand tablet application, which guides exercises performed on a tablet touchscreen with feedback, monitoring and progression. Participants in the control group were prescribed an evidence-based home exercise program on paper. OUTCOME MEASURES: The primary outcome was the time taken to return to work. Secondary outcomes included: healthcare usage (number of clinical appointments); and functional ability, pain intensity, and grip and pinch strength 2 and 4 weeks after randomisation. RESULTS: Compared with the control group, the experimental group: returned to work sooner (MD -18 days, 95% CI -33 to -3); required fewer physiotherapy sessions (MD -7.4, 95% CI -13.1 to -1.6), rehabilitation consultations (MD -1.9, 95% CI -3.6 to 0.3) and plastic surgery consultations (MD -3.6, 95% CI -6.3 to -0.9); and had better short-term recovery of functional ability and pinch strength. CONCLUSION: In people with bone and soft-tissue injuries of the wrist, hand and/or fingers, prescribing a feedback-guided home exercise program using a tablet-based application instead of a conventional program on paper hastened return to work and improved the short-term recovery of functional ability and pinch strength, while reducing the number of required healthcare appointments. TRIAL REGISTRATION: ACTRN12619000344190.

Concurrent Validity of Digital Vascular Auscultation for the Assessment of Blood Flow Obliteration on the Radial Artery in Healthy Subjects.

This study aimed to determine the validity of digital vascular auscultation for the assessment of changes in the radial pulse in healthy subjects, using Doppler sonography as a validated test referent. Sixty-one non-symptomatic subjects (mean age of 52.5 ± 16.1 years) were assigned and evaluated under one of the following conditions: In condition 1, blood flow of the radial artery was not modified; for condition 2, blood flow of the radial artery was modified using a pressure sleeve around the humerus. The radial pulse was then measured three times with each diagnostic tool by three different blinded evaluators. Both instruments demonstrated a high association between the identification of blood flow modifications or not and the assigned condition (p < 0.001). A strong concordance between the two devices when detecting the "changes" or "no changes" in blood flow was demonstrated (k = 0.936, p < 0.001). Stethoscope sensitivity was 95%, and specificity was 99%. In conclusion, digital vascular auscultation seems to be a valid technique to examine blood flow changes of the radial artery in non-symptomatic subjects, and it could be useful for physical therapists when combined with provocative tests for the screening of possible thoracic outlet syndrome in patients.

Pacientes con hepatitis C perdidos en el sistema: aspectos éticos-legales y resultados de su búsqueda / No disponible

INTRODUCCIÓN: se conoce la existencia de pacientes con hepatitis C perdidos en el sistema, pero se desconocen su prevalencia y características. Además, su identificación colisiona con la barrera de la protección de datos. MÉTODOS: se presentó un protocolo de identificación y contacto al Comité de Ética Asistencial. Se obtendrían las serologías anti-VHC+ de Microbiología entre 2010-18. Se analizaría su situación en la base de datos hospitalaria y regional. Se clasificarían: a) hepatitis C crónica, si última determinación de ARN-VHC+; b) hepatitis C curada, si última determinación de ARN-VHC- tras 12 semanas de tratamiento; c) hepatitis C posible, si anti-VHC+ sin determinación de ARN-VHC. Se considerarían perdidos aquellos con hepatitis C crónica o posible sin seguimiento en Digestivo o Medicina Interna. Se contactaría con ellos mediante correo postal y, posteriormente, por teléfono para ofrecerles tratamiento. RESULTADOS: el Comité de Ética consideró que el protocolo cumplía los principios bioéticos de autonomía, beneficencia, no maleficencia y justicia, y que el contacto era éticamente deseable. Sobre 4.816 serologías anti-VHC+ identificamos 677 pacientes perdidos (14,06 %; IC 95 %: 13,2-15,2): edad 54 años, 61 % hombres, 12 % extranjeros y 95 % monoinfectados. Se consumieron 1,3 minutos en el estudio de cada serología. Un 25 % de las perdidas habían sido solicitadas por Digestivo o Medicina Interna. De los 677 perdidos, 228 (33,7 %) tenían también ARN-VHC+ y 449 (66,3 %) solo tenían solicitada la serología. CONCLUSIÓN: un número importante de pacientes con hepatitis C se encuentran perdidos en el sistema. Su búsqueda y contacto es posible desde el punto de vista ético-legal

No disponible

Patients with hepatitis C lost to follow-up: ethical-legal aspects and search results.

INTRODUCTION: data on the prevalence and characteristics of hepatitis C patients lost to follow-up are lacking. In addition, the identification of this population clashes with data protection regulations. METHODS: the identification and contact protocol was submitted to the Health Care Ethics Committee. The protocol was based on anti-HCV serology test results for 2010-2018, which were obtained from the Microbiology Department. In addition, the situation of the patients in the hospital and regional database was analyzed, based on the following classification: a) chronic hepatitis C, if the last HCV RNA determination was positive; b) cured hepatitis C, if the last HCV RNA determination was negative after 12 weeks of treatment; and c) possible hepatitis C, if anti-HCV antibodies were positive with no result for HCV RNA. Lost patients were defined as those with chronic or possible hepatitis C and no follow-up in the Digestive Diseases or Internal Medicine Departments. The patients were contacted by postal mail and then by telephone, so that they could be offered treatment. RESULTS: the Ethics Committee considered that the protocol fulfilled the bioethical principles of autonomy, beneficence, non-maleficence and justice and that contact was ethically desirable. From 4,816 positive anti-HCV serology results, 677 patients were identified who were lost to follow-up (14.06 %; 95 % CI, 13.2-15.2). The mean age was 54 years, 61 % were male, 12 % were foreign born and 95 % were mono-infected. The study of each serology result took 1.3 minutes. One-quarter (25 %) of the losses corresponded to the Digestive Diseases and Internal Medicine Departments. Of the 677 losses, serology testing had only been ordered for 449 patients (66.3 %) and the remaining 228 (33.7 %) also had a positive HCV RNA result. CONCLUSION: a large number of patients with hepatitis C are lost to follow-up. Searching for and contacting these patients is legally and ethically viable.

Effectiveness of Vestibular Training for Balance and Dizziness Rehabilitation in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis.

Postural instability and dizziness are commonly observed in people with multiple sclerosis (PwMS). The aim of this systematic review was to evaluate the evidence for the use of vestibular rehabilitation, in comparison with other exercise interventions or no intervention, to treat balance impairments and dizziness in PwMS. An electronic search was conducted by two independent reviewers in the following databases: MEDLINE (Pubmed), Scopus, the Physiotherapy Evidence Database (PEDro), Web of Science (WOS), Lilacs, CINHAL and the Cochrane Database of Systematic Reviews (CDSR). A quality assessment was performed using the PEDro scale and the Cochrane Risk of Bias Tool. When possible, the data were pooled in a meta-analysis (95%CI). This systematic review followed the PRISMA guideline statement and was registered in the PROSPERO database (CRD42019134230). Seven studies were included, with a total of 321 participants analysed. Compared with no intervention, vestibular rehabilitation was more effective for balance development (SMD = 2.12; 95% CI = 0.49, 3.75; p = 0.01; I2 = 89%) and dizziness symptoms improvement (SMD = -17.43; 95% CI = -29.99, -4.87; p= 0.007; I2= 66%). Compared with other exercise interventions, improvements in favour of the experimental group were observed, but statistical significance for the differences between groups was not reached.

Exercises using a touchscreen tablet application improved functional ability more than an exercise program prescribed on paper in people after surgical carpal tunnel release: a randomised trial.

QUESTION: In people who have undergone surgical carpal tunnel release, do sensorimotor-based exercises performed on the touchscreen of a tablet device improve outcomes more than a conventional home exercise program prescribed on paper? DESIGN: Randomised, parallel-group trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: Fifty participants within 10 days of surgical carpal tunnel release. INTERVENTION: Each participant was prescribed a 4-week home exercise program. Participants in the experimental group received the ReHand tablet application, which administered and monitored exercises via the touchscreen. The control group was prescribed a home exercise program on paper, as is usual practice in the public hospital system. OUTCOME MEASURES: The primary outcome was functional ability of the hand, reported using the shortened form of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Secondary outcomes were grip strength, pain intensity measured on a 10-cm visual analogue scale, and dexterity measured with the Nine-Hole Peg Test. Outcomes were measured by a blinded assessor at baseline and at the end of the 4-week intervention period. RESULTS: At Week 4, functional ability improved significantly more in the experimental group than the control group (MD -21, 95% CI -33 to -9) on the QuickDASH score (0 to 100). Although the mean estimates of effect on the secondary outcome also all favoured the experimental group, none reached statistical significance: grip strength (MD 5.6 kg, 95% CI -0.5 to 11.7), pain (MD -1.4 cm, 95% CI -2.9 to 0.1), and dexterity (MD -1.3 seconds, 95% CI -3.7 to 1.1). CONCLUSION: Use of the ReHand tablet application for early rehabilitation after carpal tunnel release is more effective in the recovery of functional ability than a conventional home exercise program. It remains unclear whether there are any benefits in grip strength, pain or dexterity. TRIAL REGISTRATION: ACTRN12618001887268.