Actualización del tratamiento de fisioterapia en el abordaje de la endometriosis. Una revisión sistemática / Update on physiotherapy treatment in endometriosis: A systematic review

La endometriosis es una patología ginecológica crónica e inflamatoria caracterizada por la presencia de tejido endometrial fuera del útero. Entre las manifestaciones clínicas están el dolor pélvico crónico, la fatiga, la dismenorrea, la dispareunia, la infertilidad, la disuria y la disquecia. La fisioterapia puede formar parte del tratamiento sintomático de la endometriosis, es por ello, que con esta revisión se pretende analizar la bibliografía científica para evaluar el efecto de la fisioterapia en este padecimiento. Se realizó una búsqueda bibliográfica durante las dos primeras semanas del mes de diciembre de 2022 en las bases de datos PubMed, Medline, Scopus, Web of Science, Physiotherapy Evidence Database (PEDro), Cumulative Index to Nursing and Allied Health Literature (CINAHL) y Enfermería-Fisioterapia-Podología (ENFISPO). Se emplearon los descriptores «Endometriosis» «Physical Therapy Modalities», «Physiotherapy», «Physiotherapist», «Physical therapy» y «Physical rehabilitation». Los resultados se limitaron a estudios clínicos aleatorizados publicados en inglés o español. Se obtuvieron un total de 943 artículos, de los cuales seis fueron seleccionados tras aplicar los criterios de elegibilidad. Las investigaciones seleccionadas desarrollaron diferentes intervenciones de fisioterapia con técnicas tales como la electroterapia con estimulación nerviosa transcutánea (TENS) y láser pulsado de alta intensidad (HILT), el entrenamiento de relajación muscular progresiva, la actividad física aeróbica, la terapia manual y el ejercicio terapéutico a través del yoga. La fisioterapia parece aportar beneficios en cuanto a la reducción del dolor pélvico y mejora de la calidad de vida en mujeres con endometriosis.(AU)

Endometriosis is a chronic, inflammatory gynecological pathology characterized by the presence of endometrial tissue outside the uterus. Clinical manifestations include chronic pelvic pain, fatigue, dysmenorrhea, dyspareunia, infertility, dysuria and dyschezia. Physical therapy can be part of the symptomatic treatment of endometriosis; therefore, this review aims to analyze the scientific literature to evaluate the effect of physical therapy in endometriosis. A bibliographic search was carried out during the first two weeks of December 2022 in the databases PubMed, Medline, Scopus, Web of Science, PEDro, CINAHL and ENFISPO. The descriptors “Endometriosis” “Physical Therapy Modalities”, “Physiotherapy”, “Physiotherapist”, “Physical therapy” and “Physical rehabilitation” were used. Results were limited to randomized clinical studies published in English or Spanish. A total of 943 results were obtained, of which 6 were selected after applying the eligibility criteria. The selected studies develop different physiotherapy interventions with techniques such as electrotherapy with TENS and high intensity pulsed laser, progressive muscle relaxation training, aerobic training, manual therapy, and therapeutic exercise through yoga. Physiotherapy appears to provide benefits in terms of reducing pelvic pain and improving quality of life in women with endometriosis.(AU)

Uso terapéutico del método de restricción de flujo sanguíneo para la mejora de la fuerza muscular. Una revisión sistemática / Therapeutic use of the blood flow restriction training on muscle strength. A systematic review

Introducción: El método de restricción de flujo sanguíneo implica la ejecución de ejercicio de resistencia de baja intensidad combinado con restricción de flujo sanguíneo proporcionada por un manguito inflable o un torniquete colocado proximal al músculo. El objetivo de este trabajo es analizar la bibliografía científica actual para conocer el uso del método de restricción de flujo sanguíneo para la mejora de la fuerza muscular. Material y métodos: Se llevó a cabo una búsqueda bibliográfica en las bases de datos científicas PubMed, Medline, Cinhal, Sport Discus, Scopus, Web of Science y PEDro. Los descriptores empleados fueron: «Physical Therapy Modalities», «Physical Therapy», «Rehabilitation», «Muscle Strength», «Blood Flow Restriction Training» y «Blood Flow Restriction». Se incluyeron ensayos clínicos aleatorizados publicados en los últimos 5 años. Resultados: Se analizaron 13 artículos que fueron agrupados en tres tipos de población de estudio sobre los que se analiza la restricción del flujo sanguíneo: sujetos con patología de rodilla, en personas mayores y en personas sin patología. Se observaron mejoras significativas para la fuerza muscular con la aplicación de restricción de flujo sanguíneo en los tres grupos de estudio. Conclusión: La restricción de flujo sanguíneo ha demostrado ser un método válido en fisioterapia para la mejora de la fuerza muscular en sujetos con patología de rodilla, en personas mayores y en personas sanas. Se puede considerar un método eficaz para ganar fuerza muscular y a su vez ser una alternativa a los programas de mejora de la fuerza convencionales. (AU)

Introduction: Restriction blood flow training implies low intensity endurance exercises combined with blood flow restriction by an inflatable cuff or tourniquet placed proximal to the muscle. The aim of this study is to analyze the scientific literature about the use of restriction blood flow training to improve muscle strength. Material and methods: A systematic search was carried out in Pubmed, Medline, Cinahl, Sport Discus, Scopus, Web Of Science and PEDro. The descriptors used were «Physical Therapy Modalities», «Physical Therapy», «Rehabilitation», «Muscle Strength», «Blood Flow Restriction Training» and «Blood Flow Restriction». Randomized clinical trials published in the last 5years were included. Results: Thirteen articles were studied in this systematic review, grouped into three types of study population on which blood flow restriction was analyzed: subjects with knee pathology, elderly people and people without pathology. Significant improvements in muscle strength were observed with the application of blood flow restriction in all three study groups. Conclusion: Blood flow restriction has proven to be a valid method in physical therapy for the improvement of muscle strength in subjects with knee pathology, in elderly people and in healthy people. It can be considered an effective method to gain muscle strength and at the same time be an alternative to conventional strength improvement programs. (AU)

Therapeutic Exercise Combined or not with Pelvic Floor Muscle Training for Urinary Incontinence

Introduction: The most used physiotherapy treatment is the pelvic floor muscle training. Other factors are involved in the control of urination, such as the management of abdominal pressure and the activity of the muscles and fascia of the lumbopelvic region and this could be trained through generalized therapeutic exercise, which is defined as an intervention aimed at restoring musculoskeletal, cardiopulmonary and neurological function. The objective of this review is to evaluate the effects of therapeutic exercise, combined or not with analytical training of the pelvic floor muscles, on urinary incontinence in women over 18 years of age, by reviewing the scientific literature. Objective: To assess the effects of therapy exercise other than or combined with pelvic floor muscle training on urinary incontinence in women over 18 years. Material and Methods: An article research was done between 11th January and 7th February, 2021 on the following databases: Pubmed, Medline, Cinahl, Web Of Science, Sport Discus and PEDro using the search terms “Urinary Incontinence” and “Exercise Therapy”. Results: An average of 245 results were obtained, of which 10 were selected after applying the eligibility criteria. The interventions of the analyzed articles are divided into two groups. First, a group where muscles of the abdominal-pelvic-perineal region are worked (hypopressives, yoga and strength of the abdominal muscles, resisted hip rotation...). Secondly, another group where muscles in general are worked (weight training, flexibility, balance and toning and cardiovascular training). Conclusion: Urinary incontinence treated with therapy exercise other than the pelvic floor muscles training, or combined with it, suggest improvements in symptoms (AU)

Introducción: El tratamiento de fisioterapia más usado para la incontinencia es el ejercicio terapéutico mediante el entrenamiento específico de la musculatura del suelopélvico. En el control de la micción intervienen otros factores como la gestión de la presión abdominal y la actividadde los músculos y la fascia de la región lumbopélvica y estose podría entrenar mediante el ejercicio terapéutico generalizado, el cual se define como una intervención destinadaa restaurar la función musculoesquelética, cardiopulmonary neurológica. El objetivo de esta revisión es evaluar losefectos del ejercicio terapéutico, combinado o no con el entrenamiento analítico de la musculatura de suelo pélvico,sobre la incontinencia urinaria en mujeres mayores de 18años, mediante la revisión de la bibliografía científica.Material y Métodos: Se realizó una búsqueda deartículos entre el 11 de enero y el 7 de febrero del 2021en las bases de datos: Pubmed, Medline, Cinahl, Web OfScience, Sport Discus y PEDro empleando los términos debúsqueda “Urinary Incontinence” y “Exercise Therapy”.Resultados: Se obtuvieron un total de 245 resultados, de los cuales 10 fueron seleccionados tras aplicar loscriterios de elegibilidad. Las intervenciones de los artículos analizados se dividen en dos grupos, aquellos que trabajan musculatura de la región abdomino-pelvi-perineal(hipopresivos, yoga y fuerza de la musculatura abdominal,rotación de cadera resistida…) y otro grupo donde se realizaun trabajo generalizado de la musculatura (entrenamientocon pesas, flexibilidad, equilibrio y tonificación y entrenamiento cardiovascular).Conclusión: La incontinencia urinaria tratada conejercicio terapéutico distinto al entrenamiento de la musculatura del suelo pélvico, o combinado con él, parece obtenermejoras en la sintomatología (AU)

[Benefits of robotics in gait rehabilitation in cerebral palsy: A systematic review]. / Beneficios de la robótica en la rehabilitación de la marcha en la parálisis cerebral: una revisión sistemática.

BACKGROUND AND AIM: Cerebral palsy is the most common motor disability in childhood, with an estimated incidence of two out of every 1,000 live births. The impairment mostly affects gait. The aim of rehabilitation programmes is to enhance independence in affected individuals, especially mobility. To do this, robot-assisted gait rehabilitation programmes have been developed. Therefore, this study aimed to identify the benefits of robotics in gait rehabilitation in cerebral palsy. MATERIAL AND METHODS: We performed a literature search using the MeSH terms «cerebral palsy¼, «robotics¼ and «gait¼. RESULTS: After applying the selection criteria, we obtained 10 research studies and three protocols analysing the benefits of robotics in cerebral palsy and demonstrating that their use provides major advantages.

Assessment of male urinary incontinence postprostatectomy through the Consultation on Incontinence Questionnaire-Short Form.

OBJECTIVE: The objective of this study is to assess the correlation between the urinary incontinence results of the ICIQ-SF, and those obtained in the 1-hour and 24-hour pad tests, in a sample of men that underwent prostatectomy. MATERIAL AND METHODS: A prospective observational study was carried out in patients from the Integrated Management Area of Vigo (EOXI de Vigo) who underwent prostatectomy and suffered from urinary incontinence in the post-surgery period. Loss of urine was assessed by means of the 1-hour and 24-hour pad tests and the ICIQ-SF. A comparative analysis of the questionnaire findings was performed for both urinary incontinence tests. RESULTS: A correlation is observed between the ICIQ-SF and the amount of urine loss in the 1-hour and the 24-hour pad tests. However, the severity of urine loss established by instruments is less consistent. The 24-hour pad test is the one that obtained better correlation with the ICIQ-SF. CONCLUSIONS: The ICIQ-SF should be validated in a male population after prostatectomy in order to reinterpret the severity values observed in the different instruments studied. LEVEL OF EVIDENCE: 4.

[What is the best exercise for rehabilitation of abdominal diastasis rehabilitation?] / ¿Cuál es el mejor ejercicio para la rehabilitación de la diástasis abdominal?

The aim of this study was to analyse the scientific literature to identify the different types of exercises that influence inter-rectus distance with a view to subsequently including them in the treatment of diastasis rectus abdominis. A search made in the CINHAL, PEDRo, Pubmed, and Scopus databases. Fourteen valid articles were included in the analysis. The articles were divided into 2 groups: those analysing exercise with an immediate effect and those presenting an exercise programme with a delayed effect (long term); the most commonly used exercise was the curl-up. There is a lack of consensus on the effects of the different types of exercises evaluated on inter-rectus distance. However, curl ups decrease inter-rectus distance when it is checked immediately. Abdominal muscle training through an exercise programme helps to reduce inter-rectus distance but the optimal exercises to include in an exercise programme remain to be elucidated.

[Circumstances that may decrease the reliability of instruments to assess male urinary incontinence]. / Circunstancias que pueden disminuir la fiabilidad de los instrumentos para valorar la incontinencia urinaria masculina.

OBJECTIVE: To identify situations that may alter the results of the 1-hour and 24-hour Pad test and the short-form International Consultation in Incontinence Questionnaire (SF-ICIQ). PARTICIPANTS: Five physiotherapists, who conducted the interviews and treatment of 81 patients undergoing radical prostatectomy. METHOD: A qualitative descriptive phenomenological study was carried out, using a focus group technique with five people (4 women and 1 man) responsible for the treatment and assessment of patients with urinary incontinence after prostatectomy. Recordings were transcribed and the Atlas.ti7 programme was used to carry out the coding of the variables. RESULTS: Important factors were identified in the use of measuring instruments for the diagnosis and assessment of urinary incontinence in all the tools used. CONCLUSIONS: Some situations can modify the objectivity of the various tests for the assessment of urinary incontinence. Some of the factors identified were lower fluid intake, less activity, use of manual clamp or urinals to avoid leakage, as well as the interference of certain drugs.

Correlation between the 1-hour and 24-hour pad test in the assessment of male patients with post-prostatectomy urinary incontinence.

INTRODUCTION: This study is aimed at studying the correlation between the 1-hour and 24-hour pad tests for urinary incontinence following prostatectomy; the second objective is to check whether the severity level established by both tests is adequate for male urinary incontinence. MATERIAL AND METHODS: The study population includes patients who had undergone prostatectomy at a single center between February 2015 and December 2016, using 159 measurements consisting of 24-hour and 1-hour pad tests, belonging 45 patients. Both tests have been performed according to the protocol standardized by the International Continence Society. Once all the data have been obtained, the levels marked by each of the pads have been established, and the statistical analysis has started. RESULTS: The relationship between the amounts recorded in grams by the two test is highly significant (P=0.000), however, when comparing the incontinence levels established by each test (mild, moderate and severe), discrepancies have been found. The median of the severe cases in the 24-hour pad test was 389.5 grams, and in the 1-hour pad test was 92 grams. So, patient's loss values are well above the cut-off point defined for severe urinary incontinence in both 24-hour (50 grams) and 1-hour pad test (75 grams). CONCLUSIONS: There is a diagnostic discrepancy between the 24-hour pad test and the 1-hour pad test in terms of defined urinary incontinence severity levels. In our opinion, these levels should be redefined for male urinary incontinence since the amount of urine loss is well above the threshold established for severe incontinence. LEVEL OF EVIDENCE: 4.