El cuidado de familiares adultos. Cómo afecta a la salud y al bienestar del cuidador familiar? / Caring for adult relatives: what impact on health and well-being of the family caregiver

Introducción. El cuidado de un miembro de la familia con dependencia para los cuidados personales es un proceso complejo que afecta a la salud y al bien-estar del cuidador familiar. Objetivos. El objetivo de este estudio es identificar este impacto. Método. Se llevó a cabo una revisión integradora, respaldada por el Repositório Científico de Acesso Aberto de Portugal entre los años 2000 y 2012, en la que se tuvieron en cuenta todos los documentos completos accesibles. Se utilizó el método PI(CO)D. Para el análisis de los datos se solicitó la intervención de dos revisores independientes. Se utilizaron los indicadores del Joanna Briggs Institute para analizar la calidad metodológica de los estudios. Resultados. Se seleccionaron doce estudios principales. La mayoría de ellos se basaban en investigación observacional de tipo transversal/descriptivo, lo cual permite dibujar el perfil de los cuida-dores familiares e identificar sus necesidades y los factores relacionados con la carga. Los resultados muestran una mayor carga/estrés en los cuidadores familiares de personas con demencia y con un nivel elevado de dependencia. La mayor carga está relacionada con una mala percepción del estado de salud, de la satisfacción y de la calidad de vida del cuidador familiar. Los niveles de carga asociada, depresión emocional y estrés son más elevados en las mujeres que en los hombres. conclusiones. La naturaleza de los estudios utilizados permite identificar el impacto que supone el cuidado de un familiar con dependencia para los cui-dadores familiares. No obstante, es imposible analizar los resultados de mane-ra dinámica a lo largo de un periodo de tiempo. Es importante centrarse en la investigación basándose en los mejores datos clínicos disponibles para poten-ciar la toma de decisiones en la práctica clínica

IntroductIon. Caring for a family member dependent in self-care is a complex process with impact on health and well-being of the family caregiver. ObjectIve. This study aimed to identify this impact. Method. An integrative review was con-ducted supported on the Repositório Científico de Acesso Aberto de Portugal [Open Access Scientific Repository of Portugal], within the time period from 2000 to 2012 and considering all full text accessible documents. The PI(CO)D method was used. Two independent reviewers were invited to analyse data. The grids suggested by the Joanna Briggs Institute were used to analyse the methodological quality of the studies. Results. Twelve primary studies were selected. The majority of the studies were based on observational research of transversal/descriptive nature, enabling to trace the family caregivers' profile, to identify their needs and factors associated to bur-den. The results show increased burden/stress in family caregivers of persons with dementia and high dependency levels. Increased burden is associated with poor perception of the health status, satisfaction and quality of life of the family caregiver. Women show higher levels of associated burden, emotional depression and stress than men. Conclusions. The nature of the identified studies enables to identify the impact that caring for a dependent relative has on family caregivers. Notwithstanding, it is not possible to analyse the findings in a dynamic way throughout a period of time. It is important to focus on research based on the best clinical evidence available to enhance decision making in clinical practice

Effects of high-velocity, low-amplitude spinal manipulation on strength and the basal tonus of female pelvic floor muscles.

OBJECTIVE: Spinal manipulation with high-velocity and low-amplitude (HVLA) manipulation is frequently used for the treatment of lumbopelvic pain; however, the effect on the pelvic floor has been poorly studied in the past. The objective of this study was to quantify the intravaginal pressure (IVP) and the basal perineal tonus (BPT), measured in terms of pressure, before and after the HVLA manipulation in patients without neuromuscular and skeletal dysfunctions. METHODS: In this experimental, noncontrolled, nonrandomized study, IVP was obtained through a perineometer introduced into the volunteers' vagina while in dorsal horizontal decubitus. Forty young, healthy university volunteer women with no history of vaginal delivery participated. All voluntary contractions of the perineal muscles were measured in 3 different ways: phasic perineal contraction (PPC), tonic perineal contraction, and perineal contraction associated to accessory muscles. New pressure measurements were obtained immediately after the HVLA manipulation on the volunteers' sacrum. The pressures were registered and transcribed directly to a personal computer with specific software. RESULTS: The average IVPs obtained in millimeters of mercury before and after the HVLA manipulation were 56.01 (+/-25.54) and 64.65 (+/-25.63) for PPC, 445.90 (+/-186.84) and 483.14 (+/-175.29) for tonic perineal contraction, and 65.62 (+/-26.56) and 69.37 (+/-25.26) for perineal contraction associated to accessory muscles, respectively. There was significant statistical variation only for PPC (P = .0020) values. The BPT increased regardless of the type of contraction (P < .05). CONCLUSION: High-velocity and low-amplitude manipulation of the sacrum was associated with an increase of PPC and of BPT in women who had no associated osteoarticular diseases. These preliminary discoveries could be helpful in the future study of the treatment of women with perineal hypotony.