[Percutaneous posterior tibial nerve electrostimulation in urge urinary incontinence and faecal incontinence]. / Electroestimulación del nervio tibial posterior en incontinencia urinaria de urgencia e incontinencia fecal.

OBJECTIVE: The main aim of this study was to assess the efficacy of percutaneous posterior tibial nerve electrostimulation (P-PTNS) in urge urinary incontinence (UUI) and faecal incontinence (FI) refractory to first-line treatment. A secondary aim was to identify predictors of treatment response. To do this, we performed a 2-year analytical, longitudinal and prospective study in patients with UUI and FI treated with P-PTNS. MATERIAL AND METHODS: We included patients with UUI and FI who were treated with P-PTNS and who completed the bladder/faecal incontinence diary and severity and quality of life questionnaires. We excluded patients with neurogenic UUI and those who abandoned treatment or did not complete the questionnaires. We assessed demographic and clinical variables (micturition/defecation habits pre- and postreatment), severity scales before and after treatment (ICIQ-SF, Sandvick and Wexner), subjective improvement and quality of life (IQOL and FIQL pre- and postreatment). The statistical analysis was conducted using SPSS v19. RESULTS: The sample consisted of 21 patients divided into 2 groups: -UUI group, 9 patients. After P-PTNS, there was a statistically significant improvement in diurnal (p=.018) and nocturnal (p=.016) urinary frequency, urgencies/day (p=.018), urine leakage/day (p=.027), ICIQ-SF and Sandvick (p=.018), and IQOL (p=.012). This improvement was related to exercise (p=.039) and prolapse (p=.05). -Group FI, 12 patients. After P-PTNS, there was a statistically significant improvement in defecation frequency (p=.027), incontinence (p=.012), Wexner scale (p=.007), and FIQL in its 4 dimensions (lifestyle, behaviour, embarrassment p=.005; and depression p=.008). This improvement was related to age (p=.048), time since onset (p=.044) and prolapse (p=.026). CONCLUSIONS: The P-PTNS is effective in UUI and FI refractory to conventional treatment. Treatment response is affected by several factors.

[Capsular hydrodilatation versus kinesitherapy as initial treatment of finger capsulitis]. / Hidrodilatación capsular versus cinesiterapia como tratamiento inicial en las capsulitis de dedos.

INTRODUCTION: To evaluate the effectiveness of early capsular ultrasound-guided hydrodilatation (HD) of the proximal interphalangeal or metacarpophalangeal joints in reducing joint stiffness and shortening kinesitherapy, as well as in improving hand functionality. MATERIAL AND METHODS: We performed a one-year quasi-experimental pretest-posttest study with a control group in patients with proximal interphalangeal or metacarpophalangeal capsulitis in complex regional pain syndrome stages 2 or 3. Inclusion criteria consisted of age over 18 years, visual analogue scale<4 points and the absence of prior treatment. The control group received only kinesitherapy and the experimental group received capsular HD before kinesitherapy. There were 10 patients per group. The main measures were range of motion, active grip, Spanish validated Michigan Hand Outcomes Questionnaire and the number of kinesitherapy sessions required. RESULTS: At baseline, the range of motion of the proximal proximal interphalangeal joint was 20° worse in the experimental group (P=.01). There were no statistically significant differences in the other baseline characteristics. Immediate gain in range of motion after HD was 61.71% (P=.024). No significant improvements were observed in functionality except in active grip after 2 weeks of HD (P=.02) and one month later compared with the control group (P=.014). The number of kinesitherapy sessions required was 19.6±10.42 (95% CI) in the HD group and 29.4±8.11 (95% CI) in the control group (P>.05). CONCLUSIONS: Capsular HD could be considered as an initial treatment in finger joint stiffness because of the significant immediate improvement in range of motion. It is also an innovative technique in these joints with a short learning curve. The technique can be safely and effectively performed in a physiatry consulting room.

Correlation between physical examination and intraoperative findings in shoulder disease treated by arthroscopy. Statistical analysis of 150 patients. / Correlación entre la exploración física y los hallazgos intraoperatorios de patología de hombro tratada mediante artroscopia. Análisis estadístico de 150 pacientes.

INTRODUCTION: Only a few clinical exploratory manoeuvres are truly discriminatory and useful in shoulder disease. The aim of this study is to correlate the physical examination results of the shoulder with the true diagnosis found by arthroscopy. METHODS: A retrospective case series of 150 patients with the most common surgical conditions of the shoulder. Data were collected on the suspicion of each pathology, the physical examination of the patient, and the actual discovery of the disease during arthroscopic surgery. RESULTS: The Bankart examination manoeuvres of the lesion show the best results, with a 92.1% positive prediction value (PPV), a 99.1% negative predictive value (NPV), followed by the impingement syndrome, with a PPV of 94.4%, and total cuff rupture with a PPV of 92.3%.Exploration of the superior labrum anterior to posterior (SLAP) lesion had an NPV of 99.1%. CONCLUSION: Physical examination is sufficient to diagnose or rule out Bankart. A positive physical examination provides the complete rupture of the rotator cuff, and requires further studies. The patients suspected of subacromial syndrome only need an NMR if the physical tests are negative. The conclusions drawn from this work can have a significant impact on both cost savings (by reducing forward tests), and saving time in certain cases in which, after appropriate physical examination, surgery may be indicated without losing time in intermediate steps.

Resultados en salud a largo plazo de un programa estructurado de rehabilitación respiratoria en pacientes con enfermedad pulmonar obstructiva crónica / Long-term health results of a structured respiratory rehabilitation program in patients with COPD

Introducción. La enfermedad pulmonar obstructiva crónica (EPOC) constituye una patología de gran impacto en nuestra sociedad siendo la disnea el síntoma principal. Los programas de rehabilitación respiratoria pretenden disminuir la morbimortalidad y aumentar la calidad de vida. Nuestro objetivo es analizar la efectividad a largo plazo de un programa de rehabilitación respiratoria en cuanto a calidad de vida, adherencia al tratamiento y morbimortalidad. Material y métodos. Estudio observacional transversal sobre una cohorte prospectiva. Incluye a pacientes con EPOC grado III y IV de GOLD estabilizados que han completado el programa de rehabilitación respiratoria. Se diseña un cuestionario recogiendo percepción de disnea, aparición de exacerbaciones, mortalidad, adherencia al tratamiento y calidad de vida medidas con los cuestionarios ansiedad-depresión, Saint George Respiratory Questionnaire (SGRQ) y Chronic Respiratory Questionary (CRQ) al inicio y al año del tratamiento. Resultados. Se aprecia disminución de la percepción de disnea al mes del tratamiento. La media del número de exacerbaciones fue 4,06 y el porcentaje de mortalidad del 5,9% al año de tratamiento. Un 78,9% de pacientes continuaron el entrenamiento domiciliario, obteniéndose mejores resultados al realizarlo más de 3 días en semana. La media de la mejoría de calidad de vida fue positiva en los cuestionarios ansiedad/depresión, en la escala SGRQ y en algunas áreas de la escala CRQ. Conclusiones. La intervención sanitaria centrada en un programa de rehabilitación respiratoria es útil a largo plazo para el beneficio en salud, observándose una mejoría en la autonomía para las actividades de la vida diaria y en la autopercepción de calidad de vida (AU)

Introduction. Chronic obstructive pulmonary disease (COPD) has a huge impact in Spain. The main symptom is dyspnea. Pulmonary rehabilitation aims to decrease morbidity and mortality and increase quality of life. The aim of our study was to assess the long-term effectiveness of a respiratory rehabilitation program in enhancing quality of life and treatment adherence and in reducing mortality and morbidity. Material and methods. A cross-sectional observational study was carried out in a prospective cohort of patients with stable grade III and IV COPD, as measured by the GOLD scale. The participants completed a pulmonary rehabilitation program. A questionnaire was designed to collect perceptions of dyspnea, exacerbations, mortality, treatment adherence, and quality of life, measured with anxiety-depression questionnaires, the Saint George Respiratory Questionnaire (SGRQ) and the Chronic Respiratory Questionnaire (CRQ) before and 1 year after of treatment. Results. The perception of dyspnea decreased after a month of treatment. At 1 year, the number of exacerbations was 4.06 and mortality was 5.9%. A total of 78.9% of the patients continued training at home and obtained better results if they trained 3 days per week or more. Quality of life showed improvement in the anxiety-depression questionnaires, SGRQ scale, and in some areas of the CRQ scale. Conclusions. The pulmonary rehabilitation program produced long-term benefits for health, improving autonomy in activities of daily living and self-perceived quality of life (AU)