The effects of rhythmic auditory stimulation on functional ambulation after stroke: a systematic review.

BACKGROUND: Several studies have reported the effect of rhythmic auditory stimulation (RAS) on functional ambulation in stroke patients, yet no systematic overview has yet been published. This study aims to synthesize the available evidence describing changes in stroke patients after RAS intervention for functional ambulation and the use of walking assistive devices, and to find out if the effect of RAS and music-based RAS differs depending on the lesioned area. METHODS: The PubMed, PEDro, Cochrane Central Register of Controlled Trials, Web of Science, Scopus and CINAHL electronic databases were searched for reports evaluating the effect of RAS on walking in stroke patients, applying the PICOS criteria for the inclusion of studies. RESULTS: Twenty one articles were included (948 stroke survivors). Most studies were of good methodological quality according to the PEDro scale, but they had a high risk of bias. The most consistent finding was that RAS improves walking and balance parameters in stroke patients in all phases compared to baseline and versus control groups with conventional treatment. Functional ambulation and the use of walking assistive devices were inconsistently reported. Several studies also suggest that RAS may be as good as other complementary therapies (horse-riding and visual cueing). CONCLUSIONS: Despite the beneficial effects of RAS, the question remains as to whether it is better than other complementary therapies. Given the heterogeneity of the interventions, the interventions in control groups, the varied durations, and the different outcome measures, we suggest that care should be taken in interpreting and generalizing findings. PROSPERO REGISTRATION: CRD42021277940.

Effects of a Music-Based Rhythmic Auditory Stimulation on Gait and Balance in Subacute Stroke.

Gait and balance impairments are common after stroke. This study aimed to evaluate the effect of a music-based rhythmic auditory stimulation (RAS) in combination with conventional physiotherapy on gait parameters and walking ability in subacute stroke. This single-blind, historical controlled trial, included 55 patients who had suffered a stroke within the three weeks prior to enrolment. Patients from 2018 (n = 27) were assigned as the historical control group whereas 2019 patients (n = 28) received music-based RAS three times a week. Both groups received 11 h of conventional physiotherapy per week during hospitalization. Primary outcomes were gait and balance parameters (Tinetti test and Timed Up&Go test) and walking ability (Functional Ambulation Category scale). Secondary outcomes were trunk control, assistive devices, functional independence (Functional Independence Measure, Barthel index), and stroke severity and disability (modified Rankin scale, National Institutes of Health Stroke Scale). Results: No between-group differences were identified for gait and balance parameters nor for secondary outcomes. Significant between-group differences were observed in the Functional Ambulation Category: the intervention group (Δmean ± SD; 3.43 ± 1.17) showed greater improvement (p = 0.002) than the control group (Δmean ± SD; 2.48 ± 1.09). Compared with conventional physiotherapy alone, our results suggest that the walking ability of subacute stroke patients might be improved with music-based RAS combined with conventional physiotherapy, but this treatment is not more effective than conventional physiotherapy in obtaining gait and balance gains.

Niveles de ansiedad en enfermos hospitalizados afectados de cardiopatía isquémica / Anxiety levels of hospitalized patients with ischemic heart disease

Objetivo. Evaluar el nivel de ansiedad de los pacientes diagnosticados de cardiopatía isquémica en el ingreso y en el alta hospitalaria. Material y método. Estudio longitudinal con pacientes hospitalizados por cardiopatía isquémica en el Hospital Universitari Josep Trueta de Girona. Se estudiaron variables sociodemográficas, características y gravedad de la enfermedad y nivel de ansiedad mediante el inventario State-Trait Anxiety Inventory (STAI) Estado (E) y Rasgo (R) al ingreso y alta. Los datos se analizaron mediante el programa SPSS 19.0. Se realizaron modelos de regresión lineal para estudiar las variables asociadas a la ansiedad estado al ingreso y alta. Resultados. Se estudiaron 72 pacientes, 72 % hombres y 28 % mujeres, con edad media de 62.5 (DS = 4), jubilados (42 %), con diagnóstico de infarto (76 %) y con algún tipo de antecedente psiquiátrico (27 %). Las mujeres presentaron puntuaciones superiores de ansiedad respecto a los hombres en el STAI E al alta (p = 0.034), STAI R al ingreso (p = 0.008) y STAI R al alta (p = 0.008). Los participantes con menos estudios presentaron mayor ansiedad. Los pacientes con antecedentes de ansiedad, depresión o ambos presentaron mayor ansiedad STAI R al ingreso (p = 0.006) y los que tuvieron complicaciones tenían puntuaciones más elevadas de STAI R al alta (p = 0.007). En los modelos de regresión lineal, el STAI E al ingreso y al alta se asoció con el STAI R al ingreso (p = 0.000). Conclusiones. Los pacientes con cardiopatía isquémica presentan niveles moderados de ansiedad. El ser mujer, tener un menor nivel de estudios, presentar antecedentes de trastorno mental, presentar complicaciones intrahospitalarias y puntuaciones elevadas de ansiedad rasgo son factores relacionados con la ansiedad estado. El conocimiento de estos factores permitirá intervenciones enfermeras para mejorar el bienestar y la calidad de vida de las personas hospitalizadas (AU)

Objective. To evaluate anxiety levels in hospitalized patients with ischemic heart disease during admission and discharge. Materials and methods. Longitudinal study of hospitalized patients with ischemic heart disease at the University Hospital Josep Trueta in Girona. Sociodemographic variables, characteristics and disease severity, together with levels of anxiety measured through the State-Trait Anxiety Inventory (STAI) State (E) and Trait (R) at admission and discharge were studied. Data was analysed using SPSS 19.0 software. Linear regression models were performed to study the variables associated to state anxiety upon admission and discharge. Results. 72 patients, 72 % male and 28 % female, with a mean age of 62.5 (SD = 4), retired (42 %), with a diagnosis of infarction (76 %) and with some type of psychiatric history (27 %). were studied. Women showed higher anxiety scores than men in the STAI E at discharge (p = 0.034), STAI R at admission (p = 0.008) and STAI R at discharge (p = 0.008). Participants with lower levels of studies reported greater anxiety levels. Patients with a history of anxiety disorders, depression or both, experienced higher anxiety STAI R at admission (p = 0.006). Patients with complications had STAI R scores higher at discharge (p = 0.007). In linear regression models, the STAI E at admission and discharge was associated with STAI R at admission (p = 0.000). Conclusions. Patients with ischemic heart disease have moderate levels of anxiety. The female gender, lower levels of education, a history of mental disorders, presenting hospital complications and high scores of trait anxiety are factors related to state anxiety. Knowledge of these factors will allow nursing interventions to improve the well being and life quality of these hospitalized patients (AU)

Modelo de atención al parto dirigido por matronas frente al dirigido por matronas y obstetras en el Hospital Dr. Josep Trueta de Girona / Model of care in normal childbirth, attended by midwives, compared with a medicalized care model attended by midwives and obstetricians

OBJETIVO: Analizar el modelo de atención al parto normal, dirigido por matronas, comparándolo con el modelo de atención al parto intervenido (eutócico, instrumental o por cesárea), atendido por matronas y obstetras. METODOLOGÍA: Estudio prospectivo y longitudinal realizado en el Hospital Universitario Dr. Josep Trueta de Girona entre marzo y mayo de 2010, con mujeres en proceso de parto. Se estudiaron variables sociodemográficas de las mujeres en fase de parto, su satisfacción con el proceso de parto, el estado de salud de los recién nacidos al nacer, y las complicaciones y reingresos hospitalarios de las madres o los recién nacidos durante el primer mes post-alta. El análisis estadístico se realizó con el programa SPSS 15.0 para Windows. RESULTADOS: La muestra de estudio estuvo formada por 99 mujeres en proceso de parto con una media de edad de 30,3 años. El 31,3% de ellas tuvieron un parto normal, no intervenido, y en este modelo de atención el grado de satisfacción de la mujer fue mayor. No se observaron diferencias en las variables bioquímicas ni en el estado de salud de los recién nacidos según el tipo de parto, excepto en el test de Apgar a los 5 minutos, que fue superior en los recién nacidos en un parto normal. Tampoco hubo diferencias en las complicaciones, ni maternas ni neonatales, entre los dos modelos de atención. CONCLUSIONES: No se constataron diferencias significativas entre las madres de uno y otro grupo en relación con su salud y bienestar durante el primer mes post-alta. En cuanto a los bebés, los nacidos de partos normales presentaron puntuaciones iguales o superiores en el test de Apgar a los 5 minutos

OBJECTIVE: To analyze the model of care in normal childbirth, attended by midwives, compared with a medicalized care model (attended by midwives and obstetricians) in vaginal, instrumental or caesarean delivery studying the health and wellbeing of mothers and newborns at delivery, birth plan assess, the satisfaction of users and complications and readmissions of women and newborns post-discharge in the two models. METHODS: Prospective and longitudinal study conducted at the Dr. Josep Trueta University Hospital of Girona from March to May 2010 of women going into labour. We studied the sociodemographic variables of women, satisfaction with the process of childbirth, health status of infants at birth, and complications and hospital readmissions of mothers and newborns during the first month post-discharge. Statistical analysis was performed using SPSS 15.0 for Windows. RESULTS: We studied 99 women in labour with a mean age of 30.3 years. 31.3% of pregnant women had a natural birth (non-medicalized), with a higher satisfaction score in this model. We observed no differences in biochemical variables and heath status of newborns according to the type of delivery, except that the Apgar score at 5 minutes of natural birth newborns was higher than in newborns that had medicalized deliveries. There were no differences when comparing complications between the two models of care in either the mothers or the newborn babies. CONCLUSIONS: There were no significant differences between the two models of care in the mothers with regards to health and wellness, during the first month post discharge. Newborns of normal deliveries showed a similar or higher score on the variables of wellbeing and absence of fetal distress

Incontinencia urinaria en el paciente con ictus agudo / Urinary incontinence in patients suffering acute ictus

Presentamos el trabajo ganador del Primer Premio Ausonia Incontinencia, en la convocatoria correspondiente al año 1999. En él se analiza la prevalencia de incontinencia urinaria en enfermos diagnosticados de ictus en fase aguda a los tres meses, a los seis y al año. También se investigan los factores asociados a la incontinencia en la fase aguda del ictus, cómo influye la incontinencia en la evolución del paciente, y cómo afecta el medio donde se lleva a cabo la rehabilitación (domicilio o institución) a la hora de recuperarse el enfermo. Sus resultados confirman que la incontinencia urinaria en fase aguda es un factor predictivo, independientemente del mal pronóstico funcional a medio y largo plazo, y que su potencia pronóstica es superior a la de la gravedad del déficit neurológico al ingreso (AU)