Efectividad de una aplicación de telerrehabilitación para tableta en pacientes con fractura de extremo distal del radio / Effectiveness of a tablet telerehabilitation application in patients with distal radius fracture

Introducción: Evaluar si, en pacientes con fractura de extremo distal del radio, los ejercicios domiciliarios realizados en una pantalla táctil de dispositivos tableta reducen el consumo de recursos presenciales y mejoran la recuperación clínica, comparado con el programa convencional de ejercicios domiciliarios prescrito en papel. Material y métodos: Ensayo clínico pragmático, multicéntrico, paralelo, de dos grupos y controlado, con evaluador cegado y análisis por intención de tratar. Reclutados cuarenta y seis pacientes con fractura de extremo distal del radio en dos hospitales del Sistema Sanitario Público de Andalucía (SSPA). Los participantes de los grupos experimental y control recibieron el mismo tratamiento de sesiones presenciales de fisioterapia. El grupo experimental recibió un programa de ejercicios domiciliario utilizando la aplicación para tableta ReHand y el grupo control recibió un programa de ejercicios domiciliario en papel. Variable principal: número de sesiones de fisioterapia registradas en la base de datos electrónica del SSPA. Variables secundarias: número de consultas de rehabilitación presenciales con un médico rehabilitador y variables clínicas como la funcionalidad, la fuerza de prensión, la destreza manual, el dolor y la amplitud de movimiento. Resultados: El grupo experimental necesitó menos sesiones de fisioterapia (DM: −16,94; IC del 95%: −32,5 a −1,38) y consultas de rehabilitación (DM: −1,7; IC del 95%: −3,39 a −0,02) en comparación con el grupo control. Conclusión: En pacientes con fractura de extremo distal del radio, la prescripción de ejercicios realizados en una pantalla táctil de dispositivos tipo tableta a través de ReHand redujo el número de sesiones de fisioterapia y de consultas de rehabilitación.(AU)

Introduction: To assess whether, in patients with distal radius fracture feedback-guided exercises performed on a tablet touchscreen reduce healthcare usage and improve clinical recovery, more than the conventional home exercise program prescribed on paper. Material and methods: A multicentre, parallel, two-group, pragmatic, controlled trial with assessor blinding and intention-to-treat analysis. Forty-six patients with distal radius fracture were recruited in Andalusian Public Health System. Participants in the experimental and control groups received the same in-patient physiotherapy sessions. Experimental group received a home exercise program using the ReHand tablet application and control group received an evidence-based home exercise program on paper. The primary outcome was the number of physiotherapy sessions tallied from hospitals data management system. Secondary outcomes included: the face-to-face rehabilitation consultations with a physiatrist, and clinical outcomes such as functional ability, grip strength, dexterity, pain intensity and range of motion. Results: The experimental group required fewer physiotherapy sessions (MD: −16.94; 95%CI: −32.5 to −1.38) and rehabilitation consultations (MD: −1.7; 95%CI: −3.39 to −0.02) compared to the control group. Conclusions: In patients with distal radius fracture, prescribing feedback-guided exercises performed on a tablet touchscreen provided by ReHand reduced number of physiotherapy sessions and rehabilitation consultations.(AU)

[Effectiveness of a tablet telerehabilitation application in patients with distal radius fracture]. / Efectividad de una aplicación de telerrehabilitación para tableta en pacientes con fractura de extremo distal del radio.

INTRODUCTION: To assess whether, in patients with distal radius fracture feedback-guided exercises performed on a tablet touchscreen reduce healthcare usage and improve clinical recovery, more than the conventional home exercise program prescribed on paper. MATERIAL AND METHODS: A multicentre, parallel, two-group, pragmatic, controlled trial with assessor blinding and intention-to-treat analysis. Forty-six patients with distal radius fracture were recruited in Andalusian Public Health System. Participants in the experimental and control groups received the same in-patient physiotherapy sessions. Experimental group received a home exercise program using the ReHand tablet application and control group received an evidence-based home exercise program on paper. The primary outcome was the number of physiotherapy sessions tallied from hospitals data management system. Secondary outcomes included: the face-to-face rehabilitation consultations with a physiatrist, and clinical outcomes such as functional ability, grip strength, dexterity, pain intensity and range of motion. RESULTS: The experimental group required fewer physiotherapy sessions (MD: -16.94; 95%CI: -32.5 to -1.38) and rehabilitation consultations (MD: -1.7; 95%CI: -3.39 to -0.02) compared to the control group. CONCLUSIONS: In patients with distal radius fracture, prescribing feedback-guided exercises performed on a tablet touchscreen provided by ReHand reduced number of physiotherapy sessions and rehabilitation consultations.

A Short-Term Resistance Training Circuit Improved Antioxidants in Sedentary Adults with Down Syndrome.

Previous studies have found aerobic training improved oxidative damage in people with Down syndrome (DS). However, there is a lack of information regarding the influence of resistance training on redox imbalance in this population. Accordingly, this study was conducted to determine the effect of resistance training (RT) on antioxidant defence system in sedentary adults with DS. Thirty-six male adults with DS were recruited through different community support groups. Eighteen were randomly assigned to perform a circuit RT program with 6 stations, 3 days/week for 12 weeks. Plasma total antioxidant status (TAS), reduced glutathione (GHS), ascorbate, serum α-tocopherol, and erythrocyte glutathione reductase activity were assessed. Plasma malondialdehyde (MDA) and carbonyl groups (CG) were assessed as markers of oxidative damage. Muscle strength was also measured. Dynamic torque of knee extensors and flexors as well as maximal handgrip strength was significantly improved after the completion of the training program. Plasma levels of TAS and erythrocyte glutathione reductase (GR) activity were significantly increased. Conversely, MDA and CG levels were significantly reduced. It was concluded RT improved antioxidant defence system and reduced oxidative damage in adults with DS. Further, long-term studies are required to determine whether the increased antioxidant system may improve clinical outcomes of adults with DS.

The role of daily physical activity and nutritional status on bone turnover in cystic fibrosis: a cross-sectional study.

BACKGROUND: Nutritional status and daily physical activity (PA) may be an excellent tool for the maintenance of bone health in patients with cystic fibrosis (CF). OBJECTIVE: To evaluate the relationship between nutritional status, daily physical activity and bone turnover in cystic fibrosis patients. METHOD: A cross-sectional study of adolescent and adult patients diagnosed with clinically stable cystic fibrosis was conducted. Total body, femoral neck, and lumbar spine bone mineral density (BMD) were determined by dual energy X-ray absorptiometry and bone metabolism markers ALP, P1NP, PICP, and ß-CrossLaps. PA monitoring was assessed for 5 consecutive days using a portable device. Exercise capacity was also determined. Serum 25-hydroxyvitamin D and vitamin K were also determined in all participants. RESULTS: Fifty patients (median age: 24.4 years; range: 16-46) were included. BMI had positive correlation with all BMD parameters, with Spearman's coefficients ranging from 0.31 to 0.47. Total hip bone mineral density and femoral neck BMD had positive correlation with the daily time spent on moderate PA (>4.8 metabolic equivalent-minutes/day; r=0.74, p<0.001 and r=0.72 p<0.001 respectively), daily time spent on vigorous PA (>7.2 metabolic equivalent-minutes/day; r=0.45 p<0.001), body mass index (r=0.44, p=0.001), and muscle mass in limbs (r=0.41, p=0.004). Levels of carboxy-terminal propeptide of type 1 collagen were positively associated with the daily time spent on moderate (r=0.33 p=0.023) and vigorous PA (r=0.53, p<0.001). CONCLUSIONS: BMI and the daily time spent on moderate PA were found to be correlated with femoral neck BMD in CF patients. The association between daily PA and biochemical markers of bone formation suggests that the level of daily PA may be linked to bone health in this patient group. Further research is needed to confirm these findings.

The role of daily physical activity and nutritional status on bone turnover in cystic fibrosis: a cross-sectional study

ABSTRACT Background Nutritional status and daily physical activity (PA) may be an excellent tool for the maintenance of bone health in patients with cystic fibrosis (CF). Objective To evaluate the relationship between nutritional status, daily physical activity and bone turnover in cystic fibrosis patients. Method A cross-sectional study of adolescent and adult patients diagnosed with clinically stable cystic fibrosis was conducted. Total body, femoral neck, and lumbar spine bone mineral density (BMD) were determined by dual energy X-ray absorptiometry and bone metabolism markers ALP, P1NP, PICP, and ß-CrossLaps. PA monitoring was assessed for 5 consecutive days using a portable device. Exercise capacity was also determined. Serum 25-hydroxyvitamin D and vitamin K were also determined in all participants. Results Fifty patients (median age: 24.4 years; range: 16-46) were included. BMI had positive correlation with all BMD parameters, with Spearman’s coefficients ranging from 0.31 to 0.47. Total hip bone mineral density and femoral neck BMD had positive correlation with the daily time spent on moderate PA (>4.8 metabolic equivalent-minutes/day; r=0.74, p<0.001 and r=0.72 p<0.001 respectively), daily time spent on vigorous PA (>7.2 metabolic equivalent-minutes/day; r=0.45 p<0.001), body mass index (r=0.44, p=0.001), and muscle mass in limbs (r=0.41, p=0.004). Levels of carboxy-terminal propeptide of type 1 collagen were positively associated with the daily time spent on moderate (r=0.33 p=0.023) and vigorous PA (r=0.53, p<0.001). Conclusions BMI and the daily time spent on moderate PA were found to be correlated with femoral neck BMD in CF patients. The association between daily PA and biochemical markers of bone formation suggests that the level of daily PA may be linked to bone health in this patient group. Further research is needed to confirm these findings.

Virtual Reality to Assess and Treat Lower Extremity Disorders in Post-stroke Patients.

INTRODUCTION: This article is part of the Focus Theme of Methods of Information in Medicine on "Methodologies, Models and Algorithms for Patients Rehabilitation". OBJECTIVES: To identify support of a virtual reality system in the kinematic assessment and physiotherapy approach to gait disorders in individuals with stroke. METHODS: We adapt Virtual Reality Rehabilitation System (VRRS), software widely used in the functional recovery of the upper limb, for its use on the lower limb of hemiplegic patients. Clinical scales have been used to relate them with the kinematic assessment provided by the system. A description of the use of reinforced feedback provided by the system on the recovery of deficits in several real cases in the field of physiotherapy is performed. Specific examples of functional tasks have been detailed, to be considered in creating intelligent health technologies to improve post-stroke gait. RESULTS: Both participants improved scores on the clinical scales, the kinematic parameters in leg stance on plegic lower extremity and walking speed > Minimally Clinically Important Difference (MCID). CONCLUSION: The use of the VRRS software attached to a motion tracking capture system showed their practical utility and safety in enriching physiotherapeutic assessment and treatment in post-stroke gait disorders.

Masticatory mechanosensitivity, mouth opening and impact of headache in subjects with a history of orthodontics use: a cross-sectional study.

BACKGROUND: The correlation between orthodontics and the development of signs and symptoms of temporomandibular disorders (TMD) is a major concern in the physical rehabilitation field. AIM: The aim of the study was to observe whether subjects with a history of orthodontics use show differences from subjects who have never used orthodontics in: 1) masseter and temporalis muscle mechanosensitivity; 2) maximal vertical mouth opening (VMO); and 3) the impact of headache on their quality of life. DESIGN: Cross-sectional study. SETTING: The study was carried out in the Faculty of Nursing, Physiotherapy and Podiatry of the University of Sevilla, Spain. POPULATION: All participants were pre graduate students from the University of Sevilla, Spain. The final sample comprised 65 subjects (N.=65) with a mean age of 21 ± 2.46 years (18-29) divided into two groups; orthodontics group (N.=31) and non-orthodontics group (N.=34). METHODS: All students followed the same testing protocol. Measurements were taken of the pressure pain threshold (PPT) in two locations of the masseter (M1, M2) and temporalis (T1, T2) muscles, the maximal VMO, and the incidence of headache (Headache Impact Test-6; HIT-6, Spanish version). RESULTS: The measured values of the masticatory muscle PPTs were lower in the non-orthodontics group. Besides, the maximal VMO and HIT-6 scores were better in the orthodontics group. Nevertheless, none of these intergroup differences were statistically significant (ANOVA test): (M1 P=0.790); (M2 P=0.329); (T1 P=0.249); (T2 P=0.440); (HIT-6 P=0.443); (VMO P=0.626). CONCLUSION: A previous history of orthodontics use does not seem to lead to any greater sensitivity of the masticatory muscles, limitations of vertical mouth opening, or greater impact of headache on the subject's quality of life. CLINICAL REHABILITATION IMPACT: There is no evidence enough to support either a positive or negative correlation between orthodontics and signs and symptoms of TMD. Pain is a subjective perception and it is influenced by several factors. It remains uncertain if the use of orthodontics might be one of them.

Effect of manual therapy techniques on headache disability in patients with tension-type headache. Randomized controlled trial.

BACKGROUND: Tension-type headache (TTH) is the most common type of primary headache however there is no clear evidence as to which specific treatment is most effective or whether combined treatment is more effective than individual treatments. AIM: To assess the effectiveness of manual therapy techniques, applied to the suboccipital region, on aspects of disability in a sample of patients with tension-type headache. DESIGN: Randomized Controlled Trial. SETTING: Specialized centre for headache treatment. POPULATION: Seventy-six (62 women) patients (age: 39.9 ± 10.9 years) with episodic chronic TTH. METHODS: Patients were randomly divided into four treatment groups: 1) suboccipital soft tissue inhibition; 2) occiput-atlas-axis manipulation; 3) combined treatment of both techniques; 4) control. Four sessions were applied over 4 weeks and disability was assessed before and after treatment using the Headache Disability Inventory (HDI). Headache frequency, severity and the functional and emotional subscales of the questionnaire were assessed. Photophobia, phonophobia and pericranial tenderness were also monitored. RESULTS: Headache frequency was significantly reduced with the manipulative and combined treatment (P<0.05), and the severity and functional subscale of the HDI changed in all three treatment groups (P<0.05). Manipulation treatment also reduced the score on the emotional subscale of the HDI (P<0.05). The combined intervention showed a greater effect at reducing the overall HDI score compared to the group that received suboccipital soft tissue inhibition and to the control group (both P<0.05). In addition, photophobia, phonophobia and pericranial tenderness only improved in the group receiving combined therapy (P<0.05). CONCLUSION: When given individually, suboccipital soft tissue inhibition and occiput-atlas-axis manipulation resulted in changes in different parameters related to the disability caused by TTH. However, when the two treatments were combined, effectiveness was noted for all aspects of disability and other symptoms including photophobia, phonophobia and pericranial tenderness. CLINICAL REHABILITATION IMPACT: Although individual manual therapy treatments showed a positive change in headache features, measures of photophobia, photophobia and pericranial tenderness only improved in the group that received the combined treatment suggesting that combined treatment is the most appropriate for symptomatic relief of TTH.

Short-term changes in median nerve neural tension after a suboccipital muscle inhibition technique in subjects with cervical whiplash: a randomised controlled trial.

OBJECTIVES: To assess the immediate effect of a suboccipital muscle inhibition (SMI) technique on: (a) neck pain, (b) elbow extension range of motion during the upper limb neurodynamic test of the median nerve (ULNT-1), and (c) grip strength in subjects with cervical whiplash; and determine the relationships between key variables. DESIGN: Randomised, single-blind, controlled clinical trial. SETTING: Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Spain. PARTICIPANTS: Forty subjects {mean age 34 years [standard deviation (SD) 3.6]} with Grade I or II cervical whiplash and a positive response to the ULNT-1 were recruited and distributed into two study groups: intervention group (IG) (n=20) and control group (CG) (n=20). INTERVENTIONS: The IG underwent the SMI technique for 4minutes and the CG received a sham (placebo) intervention. Measures were collected immediately after the intervention. MAIN OUTCOME MEASURES: The primary outcome was elbow range of motion during the ULNT-1, measured with a goniometer. The secondary outcomes were self-perceived neck pain (visual analogue scale) and free-pain grip strength, measured with a digital dynamometer. RESULTS: The mean baseline elbow range of motion was 116.0° (SD 10.2) for the CG and 130.1° (SD 7.8) for the IG. The within-group comparison found a significant difference in elbow range of motion for the IG [mean difference -15.4°, 95% confidence interval (CI) -20.1 to -10.6; P=0.01], but not for the CG (mean difference -4.9°, 95% CI -11.8 to 2.0; P=0.15). In the between-group comparison, the difference in elbow range of motion was significant (mean difference -10.5°, 95% CI -18.6 to -2.3; P=0.013), but the differences in grip strength (P=0.06) and neck pain (P=0.38) were not significant. CONCLUSION: The SMI technique has an immediate positive effect on elbow extension in the ULNT-1. No immediate effects on self-perceived cervical pain or grip strength were observed.

Tratamiento osteopático mediante la técnica manipulativa occipucio-atlas-axis y de inhibición de suboccipitales en la cefalea tensional / Technique in the osteopathic treatment of patients with tension-type headache atlanto-occipital joint manipulation and suboccipital inhibition

Introducción: La cefalea tensional tiene una elevada prevalencia, con repercusión en el ámbito laboral y social de los sujetos que la padecen. Objetivo: Evaluar la eficacia de varias intervenciones con terapia osteopática en pacientes con cefalea tensional. Material y Métodos: Se ha llevado a cabo un estudio a doble ciego, aleatorio, con 76 pacientes (81,6% mujeres) diagnosticados de cefalea tensional (edad media 39,9±10,9 años), distribuidos en cuatro grupos de estudio, integrados por 19 pacientes cada uno de ellos (tres grupos experimentales y un grupo de control). Los tratamientos aplicados a los grupos experimentales incluyen terapia osteopática con: 1) técnica de inhibición de suboccipitales (IS); 2) técnica manipulativa de occipucio-atlas-axis (OAA); 3) la combinación de ambas (IS+OAA). Se aplicaron 4 sesiones, (1 por semana), y seguimiento a los 30 días. Se evaluó antes, después del tratamiento y en el seguimiento, la movilidad cervical, el impacto producido por el dolor y la frecuencia e intensidad del dolor. Resultados: El grupo IS mejoró significativamente en el impacto del dolor (p=0,02). Los grupos OAA y IS+OAA, mejoraron en impacto e intensidad del dolor (p<0,001 a p=0,05), y en flexión y extensión suboccipital (p<0,001 a p=0,04). El grupo OAA mejoró también en las rotaciones cervicales (p=0,008 a p=0,007). El grupo IS+OAA obtuvo resultados significativos en la frecuencia e intensidad del dolor (p<0,001 a p=0,05). Conclusiones: Los tres tratamientos aplicados son eficaces en el impacto del dolor y en la intensidad del dolor. El tratamiento OAA es el más eficaz en la ganancia de la movilidad cervical, seguido del tratamiento IS. El tratamiento combinado IS+OAA, resulta más eficaz en la reducción de la frecuencia e intensidad del dolor (AU)

Introduction: The tension-type headache is extremely common, and has repercussions in both the work environment and the social life of the people who suffer from them. Objectives: To evaluate the efficiency of two manual therapy treatments in patients with tension-type headaches. Material and Methods: A random, double-blind trial was undertaken, with seventy-six (n=76) patients (81.6% women) diagnosed with tension-type headache (39.9 ± 10.9 years), distributed in four groups (n=19 each one), three experimental groups and one control group (without intervention). Interventions in experimental groups included osteopathic manual therapy with: 1) Suboccipital soft tissue Inhibition Technique (SIT); 2) Occiput-Atlas-Axis global manipulation (OAA); 3) The combination of both (SIT+OAA). Treatments were applied during four sessions (one per week), with follow-up at 30 days. Patients were evaluated before and after treatment and during follow-up, by monitoring cervical mobility, the impact of pain and the frequency and intensity of the headache. Results: The SIT group significantly improved the impact of the pain (p=0.02). The OAA group and the SIT+OAA group, improved the headache impact and intensity (p<0.001 to p=0.05), and suboccipital flexion and extension (p<0.001 to p=0.04). The OAA group also improved cervical rotations (p=0.008 to p=0.007). The SIT+OAA group obtained significant results in the frequency and intensity of the pain (p<0.001 to p=0.05). Conclusions: The three treatments applied were effective in the impact of headache and in pain intensity. The OAA treatment is the most effective in increasing cervical mobility, followed by the SIT treatment. The combined treatment SIT +OAA was the most effective in reducing the frequency and the intensity of the pain caused by tension-type headache(AU)