Validation of the Spanish version of the migraine disability assessment questionnaire (MIDAS) in university students with migraine.

BACKGROUND: The Migraine Disability Assessment (MIDAS) questionnaire is widely used to determine the degree of migraine-related disability of subjects. So far, and to the best of our knowledge, no Spanish version of this tool has been validated. The questionnaire comprises seven items, with the first five constituting the main scale while the sixth and seventh items referring, respectively, to the frequency and intensity of headache. The present study aims to analyze the clinimetric properties of the Spanish version of the MIDAS questionnaire in a population of university students. METHODS: We performed a cross-sectional study of validation for this measuring instrument. A total of 153 subjects participated in the study. We analyzed construct validity using factor analysis, test-retest reliability by the Intraclass Correlation Coeficient (ICC), internal consistency, and concurrent validity with respect to the 12-Item Short Form Health Survey (SF-12). RESULTS: Factor analysis revealed a two-factor structure. The questionnaire has good reliability for the MIDAS main-scale score ([ICC = 0.81; 95% CI: 0.63-0.90]), excellent reliability for headache frequency (ICC = 0.90; 95%; CI: [0.79-0.95]), and moderately good reliability for headache intensity (ICC = 0.63; 95% CI: [0.34-0.80]). The analysis also yielded good internal consistency results (α Cronbach = 0.797) and a moderate correlation between MIDAS-main scale and the physical component summary of SF-12 (Rho = - 0.326; p <  0.001). CONCLUSIONS: The Spanish version of the MIDAS questionnaire is a valid and reliable tool to measure migraine-related disability in university subjects. The two additional items provide information that could help clinicians in making decisions.

Exercise alone or combined with dietary supplements for sarcopenic obesity in community-dwelling older people: A systematic review of randomized controlled trials.

Sarcopenic obesity (SO) represents a major public health concern. Physical activity has been recommended to minimize functional decline in the elderly and it may also be relevant to SO management. The purpose of this systematic review of randomized controlled trials (RCTs) was to investigate the effects of different exercise modalities, alone or combined with nutritional supplementation, on body composition, muscle strength and physical function in healthy community-dwelling older adults with SO. A literature search was performed using the PubMed, SCOPUS, CINAHL and Cochrane Plus databases. The main inclusion criteria were that the papers were English-language reports of RCTs involving healthy community-dwelling adults aged ≥60 years with SO. The initial search identified 2073 publications from the 4 databases and 72 additional records; 42 full-text records were assessed for eligibility and 8 articles were finally included. The search was conducted from December 1, 2017 to January 8, 2018. The types of exercises were resistance and aerobic training, either alone or combined, and whole-body electromyostimulation. Protein supplementation was included in three studies. The diversity of the methodologies employed and of the results observed does not allow us to reach a clear conclusion. Whereas five of the studies reported improvements in obesity, results were contradictory concerning muscle mass. Increases in muscle strength appeared especially with resistance training and do not seem to be linked to protein supplementation. On the other hand, improvements in physical function were reported in programs combining aerobic and resistance training with nutritional supplementation. We believe that it is of the utmost importance that a certain degree of homogeneity is kept concerning the methods and criteria used in the diagnosis of SO, so that the effects of specific physical exercise programs, whether alone or combined with nutritional supplements, can be assessed with precision.

Sarcopenia and sarcopenic obesity in Spanish community-dwelling middle-aged and older women: Association with balance confidence, fear of falling and fall risk.

OBJECTIVES: To analyze the association of sarcopenia, obesity, and sarcopenic obesity (SO) with fear of falling (FoF) and balance confidence in a Spanish sample of middle-aged and older community-dwelling women. STUDY DESIGN AND OUTCOME MEASURES: A total of 235 women (69.21±7.56 years) participated in this study. Body composition (bioelectrical impedance analysis), hand-grip strength, and physical performance (gait speed) were evaluated for the diagnosis of sarcopenia, obesity, and SO. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale. The Activities-Specific Balance Confidence Scale (ABC) and the Falls Efficacy Scale-International (FES-I) were employed to assess FoF and balance confidence, respectively. Scores of >26 on the FES-I and <67% on the ABC were used to identify women at risk of falling. The independent associations of sarcopenia, obesity and SO with FoF, balance confidence, and fall risk were evaluated by multivariate linear and logistic regressions, adjusting for potential confounding variables. RESULTS: 27.23% and 18.72% of women presented with sarcopenia and SO, respectively. Gait speed, body mass index (BMI), and fall history were independently associated with ABC score (adjusted-R2=0.152) and fall risk (ABC) (adjusted-R2=0.115). FES-I score was independently associated (adjusted-R2=0.193) with fall history, gait speed, BMI, and depression, which, together with obesity (BMI) and SO, remained independent factors for fall risk measured as FES-I score (adjusted-R2=0.243). CONCLUSION: In community-dwelling middle-aged and older Spanish women, BMI, gait speed, and fall history were independently associated with FoF, balance confidence, and fall risk. Depression was related only to FoF, and, together with obesity (BMI) and SO, was an independent predictor of fall risk as assessed by the FES-I.

Immediate effects of spinal manipulation on nitric oxide, substance P and pain perception.

Previous studies have analyzed the effects of spinal manipulation on pain sensitivity by using several sensory modalities, but to our knowledge, no studies have focused on serum biomarkers involved in the nociceptive pathway after spinal manipulation. Our objectives were to determine the immediate effect of cervical and dorsal manipulation over the production of nitric oxide and substance P, and establishing their relationship with changes in pressure pain thresholds in asymptomatic subjects. In this single-blind randomized controlled trial, 30 asymptomatic subjects (16 men) were randomly distributed into 3 groups (n = 10 per group): control, cervical and dorsal manipulation groups. Blood samples were extracted to obtain serum. ELISA assay for substance P and chemiluminescence analysis for nitric oxide determination were performed. Pressure pain thresholds were measured with a pressure algometer at the C5-C6 joint, the lateral epicondyle and the tibialis anterior muscle. Outcome measures were obtained before intervention, just after intervention and 2 h after intervention. Our results indicated an increase in substance P plasma level in the cervical manipulation group (70.55%) when compared with other groups (p < 0.05). This group also showed an elevation in the pressure pain threshold at C5-C6 (26.75%) and lateral epicondyle level (21.63%) immediately after the intervention (p < 0.05). No changes in nitric oxide production were observed. In conclusion, mechanical stimulus provided by cervical manipulation increases substance P levels and pressure pain threshold but does not change nitric oxide concentrations. Part of the hypoalgesic effect of spinal manipulation may be due to the action of substance P.

Changes in biochemical markers of pain perception and stress response after spinal manipulation.

STUDY DESIGN: Controlled, repeated-measures, single-blind randomized study. OBJECTIVES: To determine the effect of cervical or thoracic manipulation on neurotensin, oxytocin, orexin A, and cortisol levels. BACKGROUND: Previous studies have researched the effect of spinal manipulation on pain modulation and/or range of movement. However, there is little knowledge of the biochemical process that supports the antinociceptive effect of spinal manipulation. METHODS: Thirty asymptomatic subjects were randomly divided into 3 groups: cervical manipulation (n = 10), thoracic manipulation (n = 10), and nonmanipulation (control) (n = 10). Blood samples were extracted before, immediately after, and 2 hours after each intervention. Neurotensin, oxytocin, and orexin A were determined in plasma using enzyme-linked immuno assay. Cortisol was measured by microparticulate enzyme immuno assay in serum samples. RESULTS: Immediately after the intervention, significantly higher values of neurotensin (P<.05) and oxytocin (P<.001) levels were observed with both cervical and thoracic manipulation, whereas cortisol concentration was increased only in the cervical manipulation group (P<.05). No changes were detected for orexin A levels. Two hours after the intervention, no significant differences were observed in between-group analysis. CONCLUSION: The mechanical stimulus provided by spinal manipulation triggers an increase in neurotensin, oxytocin, and cortisol blood levels. Data suggest that the initial capability of the tissues to tolerate mechanical deformation affects the capacity of these tissues to produce an induction of neuropeptide expression. J