Effectiveness of aquatic versus land physiotherapy in the treatment of peripheral neuropathies: a randomized controlled trial.

OBJECTIVE: To compare the effects on gait and balance of aquatic physiotherapy versus on-land training, in the context of an inpatient rehabilitation treatment tailored for peripheral neuropathies. DESIGN: Parallel-group, single-center, single-blind randomized controlled trial. SUBJECTS AND SETTING: Consecutive patients affected by peripheral neuropathy admitted in our Neuro-Rehabilitation Unit. INTERVENTIONS: Patients received a four-week rehabilitation program composed by daily sessions of conventional physiotherapy and three sessions/week of specific treatment (aquatic vs. on-land). MAIN MEASURES: Primary outcome measures were Berg Balance Scale and Dynamic Gait Index. Secondary outcome measures were Neuropathic Pain Scale, Overall Neuropathy Limitations Scale, Functional Independence Measure, Functional Ambulation Classification, Conley Scale and Medical Research Council Scale score for the strength of hip and ankle flexor and extensor muscles. For each scale, we calculated the difference between the scores at discharge and admission and compared it between the two groups. RESULTS: Forty patients were enrolled: 21 in the water-based rehabilitation group and 19 in the land-based one. Patients were similar between groups. When comparing the groups, we found that "in-water" patients had a significant better improvement in the Dynamic Gait Index score (6.00 (4.00, 7.25) vs. 4.00 (1.25, 6.00), P = 0.0433). On the opposite, the "on-land" group showed a better improvement of the Functional Ambulation Classification score (1.0 (0.75, 1.0) vs. 1.0 (1.0, 2.0), P = 0.0386). CONCLUSION: Aquatic physiotherapy showed an effect comparable to the land-based rehabilitation on gait and balance dysfunctions of neuropathic patients.

Objective and subjective consequences of pandemic-related study program changes for the perception of the practical year - a comparison of medical students in Germany with and without a second national board examination.

Background: Due to SARS-CoV-2, the Bavarian Ministry of Health decided in April 2020 to postpone the second national board examination in human medicine and to bring forward the start of the practical year (in German: Praktisches Jahr, further abbreviated with PJ) from May to April 2020. The different tertial times made it necessary for affected students to reorganise the PJ and rendered the preparation for the national board examination that had already taken place obsolete. As a result, students had to prepare for it again after the PJ and take it together with the third national board examination. Research question: How do students affected by the early PJ differ in their perception of the practical year and in their psychological well-being from the comparison groups with a regular PJ schedule? Methodology: The study is based on quantitative data from the Dean of Studies Office of the Medical Faculty of Ludwig-Maximilians-Universität München (LMU) and an online survey. The sample consists of LMU students who started the early PJ in April 2020 (n=86) and two comparison groups: The cohort of LMU students who started their PJ regularly in May 2019 (n=50), and students from other German universities who started their PJ regularly in May 2020 (n=98) and took the second national board examination in human medicine in spring 2020. Results: For students affected by the early PJ, there were measurable negative effects on the choice of training institutions, the quality of the PJ content, preparation for the national board examinations, and career planning. Compared to regular students from other federal states, affected students reported higher psychological stress, with comparable resilience. Conclusion: It can be assumed that the insights gained apply to the entirety of medical students in the affected federal states of Bavaria and Baden-Württemberg. As a conclusion, we make the recommendation to include the position of the students in decisions of great consequence.

Dor crônica sob a ótica comportamental: compreensão e possibilidades de intervenção / Chronic pain under behavioral optics: understanding and intervention possibilities / Dolor crónica bajo la óptica comportamental: comprensión y posibilidades de intervención

A média da população brasileira que se queixa ou sofre de dor crônica é ampla e tem-se caracterizado em um grande desafio para as ciências da saúde. Portanto o objetivo deste trabalho foi realizar uma análise conceitual a respeito da compreensão da dor crônica sob a perspectiva comportamental, abordando técnicas de intervenção psicológicas utilizadas para o manejo da dor. Para tanto, foi realizada uma busca na literatura por meio de artigos e livros, que relatam a aplicabilidade das teorias comportamentais no tratamento da dor crônica e alguns estudos científicos que corroboram a eficácia dessa teoria para o manejo da dor. A partir da literatura encontrada, conclui-se que as teorias comportamentais contribuem para o entendimento e tratamento da dor crônica, tendo em vista que contingências ambientais podem ter um papel de destaque no início, na gravidade e na manutenção da dor. Acredita-se, portanto, que esses achados possam ser de grande valia para os profissionais contribuindo com melhores práticas no âmbito da saúde.

The average Brazilian population which suffers or complaints about chronic pain is wide and is a major challenge to medicine and psychology. The purpose of this work is to perform a conceptual analysis on the understanding of the chronic pain from a behavioral perspective, addressing techniques of psychological intervention used for pain management. Therefore, a literature search was executed through articles and books, which relate the applicability of behavioral theories in the treatment of chronic pain, and some scientific studies that corroborate for the effectiveness of this theory for pain management. From the literature found, we conclude that behavioral norms contribute to the understanding of chronic pain, regarding environmental problems and thoughts may play an important role in the origin, severity, and management of pain. We, therefore, believe that these conclusions may be of great utility for professionals, contributing to best practices in the health scope.

La media de la población brasileña que se queja o sufre de dolor crónico es amplia y se ha caracterizado en un gran desafío a la medicina ya la psicología. Por lo tanto el objetivo de este trabajo fue realizar un análisis conceptual acerca de la comprensión del dolor crónico bajo la perspectiva comportamental, abordando técnicas de intervención psicológicas utilizadas para el manejo del dolor. Para ello se realizó una búsqueda en la literatura por medio de artículos y libros, que relatan la aplicabilidad de las teorías comportamentales en el tratamiento del dolor crónico y algunos estudios científicos que corroboran la eficacia de esta teoría para el manejo del dolor. A partir de la literatura encontrada, se concluye que a las teorías comportamentales contribuyen para el entendimiento del dolor crónico teniendo en vista que contingencias ambientales y pensamientos pueden tener un papel destacado al inicio, en la gravedad, y en el mantenimiento del dolor. Se cree, por lo tanto, que estos hallazgos pueden ser de gran valor para los profesionales contribuyendo con mejores prácticas en el ámbito de la salud.