A home-based tele-rehabilitation protocol for patients with hip fracture called @ctivehip.

Home-based tele-rehabilitation programs are under development and may be a future option for some patients. The objectives of this non-randomized clinical trial are to design a home-based multidisciplinary tele-rehabilitation protocol for patients with hip fracture, and to compare this protocol versus the home-based usual outpatient rehabilitation protocol. Seventy patients treated for an acute hip fracture, aged 65 years or older, with a high pre-fracture functional level (Functional Independence Measure score >90), without severe cognitive impairment, absence of terminal disease, discharged to their own home or a relativés home postoperatively, allowed weight-bearing, and with signed informed consent, will be allocated into a tele-rehabilitation group (n = 35) or a control group (n = 35). The inclusion criterion for the intervention group will be to have a caregiver with the ability to access the Internet who is willing to perform exercises and activities with the patient at home. The intervention includes a program of physical exercise and occupational therapy (five weekly sessions during 12 weeks), and recommendations for patients and their caregivers, all delivered through a website. The patient's functional level (Functional Independence Measure), quality of life (Euro-Qol), physical performance (Timed Up and Go), caregiver burden (Zarit Interview), and other descriptive data will be assessed at hospital discharge, 4 weeks, and 12 weeks. This project will add to the knowledge concerning the feasibility of tele-rehabilitation as an option to promote recovery of the pre-fracture functional level for some patients with a hip fracture. ClinicalTrials.gov Identifier: NCT02968589NCT.

Manejo de los síntomas asociados a la espasticidad en pacientes con esclerosis múltiple / Management of symptoms associated with spasticity in patients with multiple sclerosis

OBJETIVO: Describir el papel de la enfermería en el manejo de los síntomas asociados a la espasticidad en esclerosis múltiple (EM). MÉTODO: Se elaboró un estudio descriptivo mediante encuesta sobre la espasticidad en pacientes con EM, que se respondió mediante televotación anónima en una reunión nacional con personal de enfermería implicado en el manejo de estos pacientes. RESULTADOS: En opinión de los participantes, además de la fatiga el síntoma asociado a la espasticidad en EM más notificado por el paciente es la dificultad para caminar, seguido de espasmos y dolor. Los participantes opinan que es importante que enfermería tome: 1) un papel activo en la identificación de estos síntomas, 2) enfocarse en la detección de los factores desencadenantes o agravantes y 3) en prestar soporte en la valoración del nivel de espasticidad mediante el uso de escalas. Es importante informar del correcto uso de los fármacos antiespásticos, de cómo ajustar la dosis y de los efectos secundarios de los tratamientos, entre ellos, delta-9-tetrahidrocanabinol y cannabidiol (THC:CBD) en pulverización bucal, titulando sus dosis según cada paciente, y monitorizando su tolerabilidad, eficacia y adherencia. Aunque se suele disponer de medios para realizar el seguimiento de estos pacientes, todavía hay carencias importantes, entre ellas, la falta de un protocolo de seguimiento concreto. CONCLUSIONES: Enfermería actúa como pieza clave en el proceso de identificación de síntomas, formación y seguimiento de los pacientes con espasticidad en EM

OBJECTIVE: To describe the role of nurses in the management of symptoms related to spasticity in patients with multiple sclerosis (MS). METHOD: A descriptive study was developed based on a questionnaire on spasticity in MS PATIENTS: The questionnarie was completed through an anonymous tele-voting system at a national meeting with nurses involved in the management of these PATIENTS: RESULTS: Apart from fatigue, according to the opinion of the participants, the spasticity symptom associated with MS most notified by patients was difficulty in walking, followed by spasms and pain. Participants thought that it is important that nursing takes: 1) a role in identifying these symptoms, 2) should focus on the detection of the triggering or aggravating factors, and 3) on providing support in the assessment of the level of spasticity. It is important to inform about the correct use of anti-spasticity drugs, how to adjust the dosage and side effects of treatments, including cannabinoids via an oromucosal spray, titrating its doses according to each patient, and monitoring its tolerability, efficacy and adherence. Although there are usually resources to follow up these patients, there are still important gaps, including the lack of a specific follow-up protocol. CONCLUSIONS: Although all the participants are experts in the management of patients with MS, there is still diversity in the functions they perform, and the available resources they have in their hospitals. Nurses act as a key element in the process of identification of symptoms, training and monitoring of these patients with spasticity in EM

[Management of symptoms associated with spasticity in patients with multiple sclerosis]. / Manejo de los síntomas asociados a la espasticidad en pacientes con esclerosis múltiple.

OBJECTIVE: To describe the role of nurses in the management of symptoms related to spasticity in patients with multiple sclerosis (MS). METHOD: A descriptive study was developed based on a questionnaire on spasticity in MS patients. The questionnarie was completed through an anonymous tele-voting system at a national meeting with nurses involved in the management of these patients. RESULTS: Apart from fatigue, according to the opinion of the participants, the spasticity symptom associated with MS most notified by patients was difficulty in walking, followed by spasms and pain. Participants thought that it is important that nursing takes: 1) a role in identifying these symptoms, 2) should focus on the detection of the triggering or aggravating factors, and 3) on providing support in the assessment of the level of spasticity. It is important to inform about the correct use of anti-spasticity drugs, how to adjust the dosage and side effects of treatments, including cannabinoids via an oromucosal spray, titrating its doses according to each patient, and monitoring its tolerability, efficacy and adherence. Although there are usually resources to follow up these patients, there are still important gaps, including the lack of a specific follow-up protocol. CONCLUSIONS: Although all the participants are experts in the management of patients with MS, there is still diversity in the functions they perform, and the available resources they have in their hospitals. Nurses act as a key element in the process of identification of symptoms, training and monitoring of these patients with spasticity in EM.

Tratamiento de la incontinencia urinaria de esfuerzo mediante telerrehabilitación. Estudio piloto / Telerehabilitation to treat stress urinary incontinence. Pilot study

Fundamento y objetivo: Testar un nuevo dispositivo de telerrehabilitación para la incontinencia urinaria de esfuerzo (IUE) y hacer una valoración inicial de su eficacia. Pacientes y método: Estudio piloto controlado y aleatorizado en pacientes con IUE. En el grupo experimental (n = 10) la intervención consistió en entrenamiento de la musculatura del suelo pélvico, adiestramiento y tratamiento domiciliario con el dispositivo. En el grupo control (n = 9) se realizó tratamiento rehabilitador convencional. Las medidas de resultados (iniciales y a los 3 meses) fueron la calidad de vida específica y genérica determinada mediante: International Consultation Incontinence Questionnaire y King's Health Questionnaire, diario miccional, perineometría, satisfacción con el programa y grado de cumplimiento. Resultados: Ambos grupos presentaban características basales similares. No hubo diferencias estadísticamente significativas en ninguna medida de resultados entre ambos grupos al final del período de seguimiento. Los valores iniciales y finales de la perineometría del grupo experimental mostraron diferencias con significación estadística (23,06 frente a 32, p = 0,011). No se presentaron efectos adversos graves en ningún grupo. Conclusiones: El dispositivo testado es seguro y bien aceptado. Aunque hay indicios de su eficacia en el tratamiento rehabilitador de la IUE, son necesarios estudios más amplios para valorar adecuadamente sus ventajas (AU)

Background and objective: We aimed to test a new telerehabilitation device for stress urinary incontinence (SUI) in order to make an initial assessment of its effectiveness. Patients and method: Randomized, controlled pilot study. Intervention: experimental group (10 patients): pelvic floor muscle training, device training and home treatment with it; control group (9 patients): conventional rehabilitation treatment. Outcome measures (baseline and 3 months) overall and specific quality of life: International Consultation Incontinence Questionnaire and King's Health Questionnaire, bladder diary, perineometry, satisfaction with the program and degree of compliance. Results: Baseline characteristics were similar in both groups. There was no statistically significant difference for any outcome measures between groups at the end of the follow-up. The change in perineometry values at baseline and after the intervention was significant in the experimental group (23.06 to 32.00, P = .011). No group in this study had any serious adverse effects. Conclusions: The tested device is safe and well accepted. Although there is some evidence of its efficacy in the rehabilitation treatment of SUI, larger trials are needed to appropriately evaluate the potential advantages (AU)

[Telerehabilitation to treat stress urinary incontinence. Pilot study]. / Tratamiento de la incontinencia urinaria de esfuerzo mediante telerrehabilitación. Estudio piloto.

BACKGROUND AND OBJECTIVE: We aimed to test a new telerehabilitation device for stress urinary incontinence (SUI) in order to make an initial assessment of its effectiveness. PATIENTS AND METHOD: Randomized, controlled pilot study. INTERVENTION: experimental group (10 patients): pelvic floor muscle training, device training and home treatment with it; control group (9 patients): conventional rehabilitation treatment. Outcome measures (baseline and 3 months) overall and specific quality of life: International Consultation Incontinence Questionnaire and King's Health Questionnaire, bladder diary, perineometry, satisfaction with the program and degree of compliance. RESULTS: Baseline characteristics were similar in both groups. There was no statistically significant difference for any outcome measures between groups at the end of the follow-up. The change in perineometry values at baseline and after the intervention was significant in the experimental group (23.06 to 32.00, P=.011). No group in this study had any serious adverse effects. CONCLUSIONS: The tested device is safe and well accepted. Although there is some evidence of its efficacy in the rehabilitation treatment of SUI, larger trials are needed to appropriately evaluate the potential advantages.