Effects of Telerehabilitation on Pain and Disability in Patients with Chronic Neck Pain: A Systematic Review and Meta-Analysis.

(1) Background: This systematic review and meta-analysis explores the effectiveness of telerehabilitation in patients suffering from chronic neck pain, specifically on pain and disability. The research delves into an area of growing significance within the realm of healthcare, aiming to understand the impact of digital interventions on the rehabilitation process for individuals with prolonged neck pain. (2) Methods: The comprehensive review encompasses a wide array of studies evaluating the collective outcomes of numerous trials focused on telerehabilitation strategies. In this systematic review, PubMed/MEDLINE, Scopus, and Web of Science databases were systematically searched to identify studies on telerehabilitation's impact on pain. (3) Results: Eight studies met the inclusion criteria. Using the Downs and Black quality assessment, three studies were classified as good and five as fair. The authors identify specific modalities within telerehabilitation, such as remote exercise programs and virtual consultations, that contribute significantly to positive patient outcomes. Meta-analysis indicated a significant overall effect of telerehabilitation on pain reduction (MD = -1.27; 95% CI = -2.06; -0.47; p = 0.002). These findings support telerehabilitation's efficacy in pain management. (4) Conclusions: The synthesis of evidence presented in this systematic review and meta-analysis underscores the potential of telerehabilitation as an effective and accessible means of managing chronic neck pain, offering valuable insights for both healthcare practitioners and policymakers in advancing patient-centered care.

Association between Post-Hospitalization Psychological Distress, Exercise Capacity, Physical Function and Health Status in COVID-19 Survivors.

This study aims to determine whether post-hospitalization psychological distress is associated with exercise capacity, physical function and health status in COVID-19 survivors. In this observational study, hospitalized COVID patients were included and divided into two groups according to the mental component summary subscale of the 12-item Short-Form Health Survey. Patients with a score ≤ 45 were included in the psychological distress group, and patients with a score > 45 were included in the non-psychological distress group. The main variables were exercise capacity, physical function, and health status. Patients were evaluated at discharge, 3 months, and at 6 months follow-up. Finally, a total of 60 patients were included in the study. Significant differences were found in exercise capacity, physical function, and health status (p < 0.05), with worse results in the group with psychological distress at discharge and 3 months follow-up. At 6 months after discharge, COVID patients with psychological distress exhibited worse results in exercise capacity, physical function, and health status, being significant exercise capacity and physical function (p < 0.05). It can be concluded that COVID patients with psychological distress at hospital discharge reported worse exercise capacity, physical function and health status at hospital discharge, 3 months and 6 months follow-up.

The Effectiveness of Combined Exercise and Self-Determination Theory Programmes on Chronic Low Back Pain: A Systematic Review and Metanalysis.

Low back pain is a pervasive issue worldwide, having considerable prevalence and a significant impact on disability. As low back pain is a complicated condition with many potential contributors, the use of therapeutic exercise, combined with other techniques such as self-determination theory programmes, has the potential to improve several outcomes. The aim of this systematic review was to explore the effectiveness of combined exercise and self-determination theory programmes on chronic low back pain. This study was designed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A systematic search in three databases (PubMed/MEDLINE, Web of Science, and Scopus) was conducted from September to November 2023. After screening, a total of five random control trials with patients with chronic low back pain were included in this systematic review and meta-analysis. The results showed significant differences in disability (SMD = -0.98; 95% CI = -1.86, -0.09; p = 0.03) and in quality of life (SMD = 0.23; 95% CI = 0.02, 0.44; p = 0.03) in favour of the intervention group versus the control group.

Early Effects of a Pain-Informed Movement Program in Patients with Post-COVID-19 Condition Experiencing Persistent Pain: Protocol for a Randomized Controlled Trial.

(1) Background: The COVID-19 pandemic has generated 771 million confirmed cases. Of these patients, 60% have developed persistent symptoms including pain. This pain is a complex symptom that needs comprehensive therapeutic strategies to address it holistically. The main objective of this study will be to evaluate the early impact of the Pain Informed Movement (PIM) program in patients with post-COVID-19 conditions experiencing new-onset persistent pain. (2) Methods: A randomized, single-blind clinical trial will be performed. Patients will be randomly assigned (1:1) to the experimental or control group. The experimental group will undergo a PIM program consisting of low-intensity functional exercises, pain neuroscience education, and relaxation techniques. The control group will receive no intervention. (3) Results: The results will be published as a peer-reviewed article. (4) Conclusions: This study will provide a basis for future research to support the implementation of comprehensive therapeutic approaches in the care of patients with post-COVID-19 persistent pain.

Neurophysiological pain education for patients with symptomatic knee osteoarthritis: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the effectiveness of neurophysiological pain education in patients with symptomatic knee osteoarthritis considering pain-related variables. METHODS: A systematic review and meta-analysis was carried out according to the PRISMA guidelines. A search was conducted in PubMed, PEDro Database, Cochrane Library, Scopus, and Web of Science. Only randomized controlled trials enrolling patients ≥ 18 years of age with symptomatic knee osteoarthritis were included. The Downs and Black quality assessment tool was used to assess the quality of the articles, and the risk of bias was evaluated with the Cochrane Risk of Bias Assessment Tool. RESULTS: A total of 7 studies were included in the study. Most of the studies were rated as "fair" on the Downs and Black quality assessment tool, and in the category of "some concerns" according to the Cochrane Risk of Bias Assessment Tool. Neurophysiological pain education was conducted alone or combined with exercise, joint mobilizations, or self-management programs. The number of sessions ranged from 1 to 10. The meta-analysis results showed significant differences in favor of the intervention group in pain (MD = -0.49; 95% CI = -0.66; -0.32; p < 0.001) and catastrophization (MD = -1.81; 95% CI = -3.31, -0.3; p = 0.02). CONCLUSION, PRACTICE IMPLICATIONS: Neurophysiological pain education interventions in isolation or combined with exercise, joint mobilizations, or self-management programs have proven to significantly improve pain and catastrophization in patients with symptomatic knee osteoarthritis. These findings could provide clinicians with more information regarding the management of patients with symptomatic knee osteoarthritis.

Effectiveness of Self-Care Education for Chronic Neck Pain: A Systematic Review and Meta-Analysis.

Self-care programs for chronic neck pain are relevant to everyday life and can lead to long- term improvement. More studies on their effectiveness, key components and appropriate duration are needed. The aim of this study was to determine the effectiveness of self-care programs for patients with chronic neck pain. A systematic review and meta-analysis of randomized controlled trials was conducted according to the PRISMA guidelines. After searching in PubMed, Web of Science, Scopus and ScienceDirect, eleven studies met the inclusion criteria. Self-care education interventions typically consisted of education (i.e., pain neuro-science education or general educational concepts) accompanied by exercise or manual therapy. The most frequent components were addressing physical and psychological symptoms and engaging in self-care strategies. The least frequent ones were monitoring and recording symptoms and discussing with providers of medical care. The duration of the interventions ranged from three sessions to six months. Finally, individual and supervised modalities were the most frequent. After pooling the data, a meta-analysis was carried out according to four variables (i.e., pain, disability, kinesiophobia and catastrophization) and showed significant results (p < 0.05) in favor of self-care interventions. This systematic review and meta-analysis suggests that self-education interventions improve pain, psychological pain-related variables and disability in patients with chronic neck pain. The most frequently used components were addressing physical and psychological symptoms and engaging in self-care strategies. Future trials should focus on including other components, such as discussing symptoms with providers of medical care or self-monitoring symptoms. Additional areas of focus include more homogeneous doses and comparator treatments, as well as studies with better evidence to reach more solid conclusions.

Effect of Chest Physiotherapy on Quality of Life, Exercise Capacity and Pulmonary Function in Patients with Idiopathic Pulmonary Fibrosis: A Systematic Review and Meta-Analysis.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is one of the most deleterious diseases of the pulmonary fibrosis spectrum. Its clinical presentation includes irreversible loss of lung function, and increasing cough, dyspnea and impaired quality of life. Chest physiotherapy can improve ventilation capacity, gas exchange, dyspnea, exercise capacity and quality of life. The aim of this study was to review the evidence about chest physiotherapy in IPF, specifically meta-analyzing quality of life, exercise capacity and pulmonary function. METHODS: A wide search was conducted in PubMed, Embase, Cochrane and Web of Science for articles included until October 2023. PROSPERO Identifier: CRD42022333496. The Downs and Black scale and the Cochrane tool were employed to evaluate quality assessments and to assess the risk of bias. Data were pooled, and a meta-analysis was conducted. RESULTS: We selected 10 studies in which a chest physiotherapy program was performed with a total of 340 patients; of these, three articles were meta-analyzed. Significant effects in favor of chest physiotherapy were found for quality of life (MD = -8.60, 95% CI = -11.30, -5.90; p < 0.00001; I2 = 24%), exercise capacity (MD = 37.62, 95% CI = 15.10, 60.13; p = 0.001; I2 = 65%) and pulmonary function (MD = 7.86, 95% CI = 2.54, 13.17; p = 0.004; I2 = 80%). CONCLUSIONS: The systematic review showed significant results for the application of chest physiotherapy regarding pulmonary capacity, diffusion of gases and quality of life in IPF patients. The meta-analysis showed a significant improvement associated with applying chest physiotherapy in pulmonary function, exercise capacity and quality of life.

Efficacy and Safety of Respiratory Telerehabilitation in Patients with Long COVID-19: A Systematic Review and Meta-Analysis.

The aim of this review was to identify, map, and synthesize the extent and nature of research activity on the use of telerehabilitation to support Long COVID-19 rehabilitation and examine the efficacy and safety of respiratory telerehabilitation in patients with Long COVID-19. A systematic review and meta-analysis of randomized controlled trials were performed. We included controlled trials that tested the effect of respiratory telerehabilitation interventions in patients with Long COVID-19 versus no intervention, usual care, placebo, or face-to-face intervention. The data were pooled, and a meta-analysis was completed for quality of life, dyspnea, lung function, anxiety and depression, respiratory muscle strength, functional capacity, and lower limb strength. Finally, 10 studies were included. The meta-analysis results show significant differences in favor of respiratory telerehabilitation in quality of life (p = 0.02), dyspnea (p < 0.00001), respiratory muscle strength (p < 0.001), functional capacity (p < 0.0001), and lower limb strength (p = 0.01) but not in lung function (p = 0.28) and anxiety and depression (p = 0.55). In addition, there were no statistically significant differences in adverse effects (p = 0.06) between the telerehabilitation and comparator groups. The results suggest that these interventions can improve quality of life, reduce dyspnea, and increase respiratory and lower extremity muscle strength as well as functional capacity in patients with Long COVID-19.

Differences of Disabling Symptoms between Previously Hospitalized or Non-Hospitalized Currently Working Long-COVID Survivors One Year after Infection: A Descriptive Study.

This study aimed to describe the presence of disabling symptoms in currently working Long-COVID survivors by comparing the hospitalized and non-hospitalized one year after infection. Patients with Long-COVID syndrome (LCS) that have been infected by COVID-19 a year ago and were actually working were included. Participants that had been hospitalized due to COVID-19 were included in the LCS hospitalized group, and participants that had not been hospitalized were included in the LCS non-hospitalized group. The eligible patients were prompted to complete the latest self-report version of the COVID-19 Yorkshire Rehabilitation Screening Tool (C19-YRS). A total of 465 subjects were included in the study. Participants in the LCS hospitalized group were significantly older, had a significantly higher BMI, and had a significantly higher prevalence of women compared to the LCS non-hospitalized group. Additionally, participants in the LCS hospitalized group had obtained significantly worse results in symptom severity, functional disability, and global health perceived subscales of C19-YRS compared to the participants included in the LCS non-hospitalized group. We concluded that disabling symptoms are presented in patients with LCS at working age one year after infection and are higher in LCS hospitalized patients compared to LCS non-hospitalized patients.

Widespread distribution and altered pain processing in head and neck cancer survivors at long-term after treatment.

PURPOSE: Radiotherapy (RT) treatment in head and neck cancer (HNC) patients may induce long-term sequels as pain, which nowadays is not fully understand. Therefore, there is a need of characterization of pain features in HNC to enhance after oncology treatment management. Head and neck cancer survivors develop chronic pain after radiotherapy treatment. The purpose of the current study is to evaluate the presence of pain, pain distribution, and pain processing by means of patient reported outcomes and quantitative sensory testing. METHODS: Pain pressure threshold (PPT), temporal summation (TS), Brief Pain Inventory (BPI), Widespread Pain Index (WPI), The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and EuroQol5D5L were assessed in 20 head and neck cancer survivors (sHNC) and 20 health-related sex and age-matched controls. RESULTS: The sHNC present lower PPT values in both the affected and non-affected side than did the healthy controls, especially in the widespread pain in the body, an altered TS in both affected and non-affected side and lower scores in quality of life and arm dysfunction. CONCLUSIONS: Following radiotherapy treatment after 1 year, sHNC present widespread pain, hypersensitivity in the radiated area, altered pain processing, upper limb affection, and a QoL diminution. These data provide evidence that a peripheral and central sensitization is happening in sHNC. Future efforts should focus on preventing pain after oncologic treatment. The comprehension about pain and its features in sHNC enhance health professional understanding and allows to tailor an optimal patient-targeted pain treatment.

Agreement between telerehabilitation and face-to-face orofacial myofunctional assessment in persons with acquired brain injury.

BACKGROUND AND OBJECTIVE: Orofacial myofunctional disorders are common in persons with acquired brain injury. A new way for early detection of orofacial myofunctional disorders via information and communication technologies may improve accessibility. The purpose of this study was to evaluate the level of agreement between face-to-face and tele-assessment of an orofacial myofunctional protocol in a sample of persons with acquired brain injury. METHODS: A masked comparative evaluation was conducted in a local association of patients with acquired brain injury. Twenty-three participants (39.1% female, mean age of 54 years) with a diagnosis of acquired brain injury were included in the study. The patients followed a face-to-face and a real-time online assessment using the Orofacial Myofunctional Evaluation with Scores protocol. This is a protocol for evaluation with numerical scales that assess the physical characteristics and the main orofacial functions of patients including appearance, posture, and mobility of lips, tongue, cheeks, and jaws, respiration, mastication, and deglutition. RESULTS: The analysis showed excellent interrater reliability (ρ ≥ 0.85) for all the categories. In addition, most confidence intervals were narrow. CONCLUSIONS: This study reveals excellent interrater reliability of an orofacial myofunctional tele-assessment in patients with acquired brain injury in comparison with a traditional face-to-face evaluation.

Efficacy in urinary symptom burden, psychological distress, and self-efficacy of education-enhanced interventions in prostate cancer patients: a systematic review and meta-analyses.

BACKGROUND: Worldwide, prostate cancer is both the second-most diagnosed cancer and most common solid tumor in men. Prostate cancer patients present with a symptom burden that is compounded by the impact of medical oncology treatment, affecting different domains of their perceived health status. Education active techniques are a key role in chronic disease to increase participation in their recovery. PURPOSE: The purpose of the current review was to examine the efficacy of education-enhanced in urinary symptom burden, psychological distress, and self-efficacy in patients diagnosed with prostate cancer. METHODS: A wide search of the literature was conducted for articles from their inception to June 2022. Only randomized controlled trials were included. Data extraction and methodologic quality assessment of the studies were carried out by two reviewers. We previously registered the protocol of this systematic review on PROSPERO (CRD42022331954). RESULTS: A total of six studies were included in the study. After education-enhanced intervention showed significant improvements in any of perceived urinary symptom burden, one in psychological distress, and one in self-efficacy in the experimental group. The meta-analysis showed that education-enhanced interventions have a significant effect on depression. CONCLUSION: Education-enhanced could have positive effects on urinary symptom burden, psychological distress, and self-efficacy in prostate cancer survivors. Our review was unable to demonstrate the best timing to apply education-enhanced strategies.

Characteristics of Frailty in Perimenopausal Women with Long COVID-19.

The aim of this study was to compare the prevalence of risk factors for frailty between perimenopausal women with long COVID-19 syndrome, women having successfully recovered from COVID-19, and controls from the community. Women with a diagnosis of long COVID-19 and at least one symptom related to the perimenopausal period, women who had successfully recovered from COVID-19, and healthy women of comparable age were included in this study. Symptom severity and functional disability were assessed with the COVID-19 Yorkshire Rehabilitation Scale, and the presence of frailty was evaluated considering the Fried criteria. A total of 195 women were included in the study, distributed over the three groups. The long COVID-19 group showed a higher prevalence of perimenopausal symptoms and impact of COVID-19. Statistically significant differences were found between the long COVID-19 group and the other two groups for the frailty variables. When studying the associations between frailty variables and COVID-19 symptom impact, significant positive correlations were found. Perimenopausal women with long COVID-19 syndrome present more frailty-related factors and experience a higher range of debilitating ongoing symptoms. A significant relationship is shown to exist between long COVID-19 syndrome-related disability and symptoms and frailty variables, resulting in an increased chance of presenting disability.

Effects of non-pharmacological therapies on hand function and the ability to perform daily activities in people with systemic sclerosis: A systematic review and meta-analysis of randomized control trials.

BACKGROUND: Systemic sclerosis (SSc) is an autoimmune rheumatic disease. Individuals with a diagnosis of SSc describe repercussions on their activities of daily living and instrumental activities of daily living that affect their everyday functional capacity. The objective of this systematic review was to explore the effectiveness of non-pharmacological interventions to improve hand function and the ability to perform activities of daily living. METHODS: A systematic review was conducted on the Cochrane Library, Medline/PubMed, OTseeker, PEDro, Scopus, Web of Science up to September 10, 2022. Inclusion criteria were defined following PICOS recommendations (Populations, Intervention, Comparison and Outcome measures). Methodological quality was assessed with the Downs and Black Scale and risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). A meta-analysis of each outcome was performed. RESULTS: A total of 8 studies met the inclusion criteria, providing data on 487 individuals with SSc. The non-pharmacological intervention applied the most was exercise. The effects of non-pharmacological interventions were better than those of the waiting list or no treatment control conditions in both outcomes - hand function (mean difference [MD] = -6.98; 95% CI [-11.45, - 2.50], P = 0.002, I2 = 0%) and performance of daily activities (MD = -0.19; 95% CI [-0.33, - 0.04], P = 0.01, I2 = 0%). Moderate risk of bias was found in the majority of the studies included. CONCLUSION: There is emerging evidence that non-pharmacological interventions can improve hand function and performance of daily activities in individuals with a diagnosis of SSc. Given the moderate risk of bias found in the studies included, the results should be considered with caution.

Post-COVID Patients With New-Onset Chronic Pain 2 Years After Infection: Cross-Sectional Study.

BACKGROUND: Although pain is common in non-hospitalized post-COVID-19 syndrome, only a few studies have provided information on the pain experience of these patients. AIM: To identify the clinical and psychosocial profile associated with pain in non-hospitalized patients with post-COVID-19 syndrome. METHOD: In this study there were three groups: healthy control group, successfully recovered group, and post-COVID syndrome group. Pain-related clinical profile and pain-related psychosocial variables were collected. Pain-related clinical profile included: pain intensity and interference (Brief Pain Inventory), central sensitization (Central Sensitization Scale), insomnia severity (Insomnia Severity Index), and pain treatment. Pain-related psychosocial variables were: fear of movement and (re)injury (Tampa Scale for Kinesiophobia), catastrophizing (Pain Catastrophizing Scale), depression, anxiety and stress (Depression, Anxiety and Stress Scale), and fear-avoidance beliefs (Fear Avoidance Beliefs Questionnaire). RESULTS: In all, 170 participants were included in the study (healthy control group n = 58, successfully recovered group n = 57, and post-COVID syndrome group n = 55). Post-COVID syndrome group obtained significantly worse punctuation in pain-related clinical profile and psychosocial variables than the other two groups (p < .05). CONCLUSIONS: In conclusion, patients with post-COVID-19 syndrome have experienced high pain intensity and interference, central sensitization, increased insomnia severity, fear of movement, catastrophizing, fear-avoidance beliefs, depression, anxiety, and stress.

Barriers and applied activity, quality of life and self-efficacy in prostate cancer survivors 1 year after completing radiotherapy.

PURPOSE: The aims of the study were to assess self-reported physical activity (PA) levels, barriers to PA, quality of life and self-efficacy to manage chronic disease of prostate cancer survivor 1 year after radiotherapy treatment. METHODS: A cross-sectional case-control study was performed. Prostate cancer survivor patients treated with radiotherapy were recruited from the Radiation Oncology Service of the "Complejo Hospitalario Universitario" (Granada) and compared with age-matched healthy men. Outcomes included were perception of benefits for physical activity and potential barriers (Exercise Benefits/Barriers Scale), physical activity levels assessed by the International Physical Activity Questionnaire (IPAQ), quality of life (EuroQol five-dimension three-levels) and self-efficacy (Self-Efficacy to Manage Chronic Disease). RESULTS: A total of 120 patients were included in our study. Significant differences were found between groups with worse results for the prostate cancer patient group in the variable perception of the benefit of physical activity, potential barriers, and physical activity. Regarding quality of life and self-efficacy, significant differences were also observed between groups with a greater score in the control group. CONCLUSION: In conclusion, the results of this study reveal that self-reported PA levels, as measured using the IPAQ, were low in prostate cancer survivors after treatment. Results also showed worse perception of benefits for PA and potential barriers by the cancer survivors. Similarly, the quality of life and self-efficacy to manage chronic disease of prostate cancer survivors was lower.

Pain Experiences of People Diagnosed With Autism Spectrum Disorder: A Systematic Review of Case-Control Studies.

IMPORTANCE: Autism spectrum disorder (ASD) is one of the most prevalent neurodevelopmental disorders and is characterized by compromised social interactions, reduced verbal communication, stereotyped repetitive behaviors, restricted interests, and sensory abnormalities. Yet absent from the knowledge base is information about sensory abnormalities related to pain experiences. Exploring the pain experiences of people with ASD may provide occupational therapy practitioners with a baseline to determine areas of need and effective interventions. OBJECTIVE: To conduct a systematic review of the literature to summarize current evidence from case-control studies comparing sensory abnormalities with regard to pain experiences of people diagnosed and not diagnosed with ASD. DATA SOURCES: A systematic literature search of the CINAHL, Cochrane, MEDLINE (PubMed), OTseeker, and Web of Science databases, using MeSH terms and broad keywords. STUDY SELECTION AND DATA COLLECTION: A search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Newcastle-Ottawa Scale was used to evaluate the risk of bias of the included studies. FINDINGS: A total of 27 case-control studies involving 865 people with ASD and 864 control participants were included. Several methods were used to explore pain experiences, such as threshold detection or pain threshold. CONCLUSION AND RELEVANCE: The results indicate that people with ASD may have an abnormal sensory experience with regard to pain sensitivity. Occupational therapy practitioners should develop an intervention to focus on pain. What This Article Adds: This study adds to the body of literature indicating that people with ASD have sensory abnormalities with regard to pain experiences. Results highlight the need for occupational therapy interventions to focus on pain experiences.

Pain and Clinical Presentation: A Cross-Sectional Study of Patients with New-Onset Chronic Pain in Long-COVID-19 Syndrome.

The aim of this study was to evaluate the characteristics of pain (i.e., pain intensity, pain interference, clinical presentation) in Long-COVID-19 patients and compare the location of pain between successfully recovered COVID-19 patients and healthy matched controls. A cross-sectional case-control study was carried out. Long-COVID-19 patients, age- and sex-matched patients with a history of COVID-19 who had successfully recovered, and healthy controls were included. Outcomes included were pain characteristics (Brief Pain Inventory and Short-Form McGill Pain Questionnaire) and clinical presentation (Widespread Pain Index and Euroqol-5 Dimensions 5 Levels Visual Analogue Scale). Sixty-nine patients with Long-COVID-19 syndrome, sixty-six successfully recovered COVID-19 patients, and sixty-seven healthy controls were evaluated. Patients with Long-COVID-19 syndrome showed greater pain intensity and interference. In addition, they showed worse quality of life and greater widespread pain, with the most frequent locations of pain being the neck, legs, and head. In conclusion, patients with Long-COVID-19 syndrome show a high prevalence of pain, characterized by widespread pain of moderate intensity and interference, with the most frequent locations being the neck, legs, and head, significantly affecting the quality of life of these patients.

Relationship between patient functionality impairment and caregiver burden: is there a cut off point for the severe COPD patient?

BACKGROUND: Chronic obstructive pulmonary disease (COPD) patients experience a progressive limitation of their functionality accompanying their clinical evolution. Concretely, severe COPD patients usually require the figure of a caregiver. Caregiver burden has yet to be explored in other similar chronic diseases. The objective is to propose a cutoff point in different functional impairment aspects, to predict the presence of caregiver burden. METHODS: Severe COPD patients were divided into two groups according to the caregiver burden, measured with the Zarit Burden Interview (ZBI). The patients were assessed with the London Chest Activity of Daily Living (LCADL) scale, the Functional Independence Measure (FIM), and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). RESULTS: 70 COPD patients and their caregivers were included in this cross-sectional study. The ROC curve indicated a cutoff point of 19 in the LCADL scale (AUC = 0.722). Dependence in daily life activities had a cutoff point of 123 in the FIM (AUC = 0.776). Social participation in activities of daily living had a cutoff point of 37 in the WHODAS 2.0 (AUC = 0.739). CONCLUSION: Dyspnea related to functional status, dependence in daily life activities, and social participation in activities of daily living of severe COPD patients can predict caretaker burden.

Effects of Exercise-Based Interventions on Physical Activity Levels in Persons With Parkinson's Disease: A Systematic Review With Meta-analysis.

BACKGROUND AND PURPOSE: Parkinson's disease (PD) is the most common neurodegenerative movement disorder. Symptom severity leads to devastating consequences such as falls, immobility, impaired quality of life, and reduced general activity. Adopting a sedentary lifestyle creates a vicious circle, as physical inactivity can negatively affect the clinical domains of PD. Despite the recognition of the disease-modifying potential of physical activity (PA), achieving adequate exercise levels can be challenging for individuals with PD. This study aimed to investigate the repercussions of exercise-based interventions to improve PA levels in persons with PD through a systematic review with meta-analysis. METHODS: A search was conducted from database inception to February 2021 across 3 databases: PubMed, Web of Science, and Scopus. Randomized controlled trials were included if they involved persons with PD, outcome measures associated with PA levels, and an exercise-based intervention. Two reviewers performed independent data extraction and methodologic quality assessment of the studies using the Downs and Black quality checklist. RESULTS: A total of 6 studies were included in the study (1251 persons with PD). Four intervention types were identified: balance, strength, aerobic, and multimodal exercise (combination of several types of exercise programs). The meta-analysis showed that exercise interventions have a positive effect on PA (standard mean difference = 0.50, 95% CI =-0.02, 1.00; P = .06). The risk of bias was generally low. CONCLUSIONS: The findings support the use of exercise-based interventions (aerobic exercise, balance exercise, strength exercise, and/or multimodal exercise) to improve PA levels. However, the limited number of studies and the heterogeneity of the interventions do not allow us to draw a definitive conclusion.