Evaluación de las características y la mejoría funcional de pacientes con accidente vascular cerebral y fractura de fémur en un programa de rehabilitación intensiva de un centro sociosanitario / Evaluation of the characteristics and functional improvement of patients with stroke and hip fracture in an intensive rehabilitation program in a geriatric centre

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Evaluación del tratamiento de la espasticidad en España: estudio 5E / An assessment of the management of spasticity in Spain: the 5E Study

Introducción. Aunque la espasticidad es una secuela que presenta una incidencia alta, hay una carencia de estudios que evalúen su manejo terapéutico en España. Objetivo. Evaluar el tratamiento de la espasticidad en España. Pacientes y métodos. Estudio epidemiológico, observacional, multicéntrico y retrospectivo en el que participaron 49 servicios de rehabilitación de hospitales públicos y privados. Resultados. Se incluyeron 235 pacientes, con espasticidad del miembro superior (MS) o inferior (MI), que realizaron una visita basal válida y al menos una visita de seguimiento. De los pacientes incluidos en el estudio, 148 (62,9%) tenían espasticidad postictus; 79 (33,6%), espasticidad del MI; 38 (16,1%), del MS; y 118 (50,3%), de ambos. En la visita basal, la escala modificada de Ashworth, la goniometría, la escala analógica visual para el dolor y la escala de Tardieu se habían realizado en 164 (69,8%), 99 (42,1%), 85 (36,2%) y 26 (11,1%) pacientes, respectivamente. Un 93,8% (intervalo de confianza al 95%: 81,4-97,6%) de los centros definió los objetivos del tratamiento de forma exacta, y un 52% de los objetivos fueron consensuados con el paciente. La toxina botulínica tipo A se administró a 186 (79,1%) pacientes; 49 (20,9%) se trataron con antiespásticos orales, y 93 (39,6%), con fisioterapia. Conclusiones. La mayoría de los pacientes incluidos presentaban espasticidad postictus. Además, la toxina botulínica tipo A era el tratamiento más comúnmente aplicado a los pacientes con espasticidad. Los resultados demuestran que el tratamiento de la espasticidad varía considerablemente entre los diferentes centros participantes en el estudio (AU)

Introduction. Although spasticity is a disabling complication of high incidence, there is a lack of either regional or national epidemiological studies in Spain evaluating its management. Aim. To evaluate the management of spasticity in Spain. Patients and methods. An epidemiological, observational, multicenter, and retrospective study involving 49 rehabilitation services of public and private hospitals was designed. Results. Two hundred and thirty-five patients from 49 centers, with evidence of upper (UL) or lower limb (LL) spasticity with one valid baseline visit and at least one follow-up visit, were included. Among the patients included in the study 148 (62.9%) have post stroke spasticity; 79 (33.6%) have LL spasticity, 38 (16.1%) UL, and 118 (50.3%) in both. At baseline, Modified Ashworth Scale, goniometry, Visual Analog Scale for pain and Tardieu Scale had been performed in 164 (69.8%), 99 (42.1%), 85 (36.2%), and 26 (11.1%) patients, respectively. A 93.8% (IC 95%: 81.4-97.6%) of the centers accurately defined the treatment goals and 52% of the objectives were agreed with the patient. Botulinum A toxin was administered in 186 (79.1%) of patients; 49 (20.9%) patients were treated with oral antispastic medications and 93 (39.6%) were under physiotherapy treatment. Conclusions. Most of the patients have post-stroke spasticity. Moreover, botulinum A toxin was the most commonly treatment applied to patients with spasticity. The results demonstrate that the management of spasticity varies significantly across the different centers participating in the study (AU)

Effectiveness of an exercise program on postural control in frail older adults.

BACKGROUND: Exercise programs have proved to be helpful for frail older adults. This study aimed to investigate the effects of an exercise program with a focus on postural control exercises in frail older adults. METHOD: Twenty-six older adults (76.7 ± 4.9 years) deemed clinically stable, chosen from the Falls Unit, University Hospital Mútua Terrassa, Barcelona, Spain, participated in this single-group study. Volunteers' postural control was evaluated using the Timed Up and Go test (TUG) and the Guralnik test battery, and their static and dynamic posturography were evaluated using the Synapsys Posturography System(®). These evaluations were performed before and after the intervention program, which included an educational session and two weekly 1-hour sessions over an 8-week period of stretching exercises, proprioception, balance, and motor coordination. Data were analyzed using the Student's t-test or the Wilcoxon test, with a significance level of 5%. RESULTS: The TUG and Guralnik tests did not show significant differences. Concerning static posturography, there was improvement in the base of support (P = 0.006), anteroposterior displacement with eyes open (P = 0.02) and closed (P = 0.03), and the total amplitude of the center of pressure with eyes closed (P = 0.02). Regarding dynamic posturography, a decrease of the oscillation speed in the anteroposterior direction (P = 0.01) was observed in individuals with their eyes open. CONCLUSION: The program used in this study was safe and was able to promote some improvement in postural control, especially in the anteroposterior direction and in the base of support. However, it is noteworthy that further improvements could be obtained from a program of longer duration and greater frequency.

[Clinical practice guidelines for the treatment of spasticity with botulinum toxin]. / Guía de práctica clínica del tratamiento de la espasticidad con toxina botulínica.

INTRODUCTION: Spasticity is an important medical and social problem with a high rate of incidence both in childhood, where it is mainly a result of infantile cerebral palsy, and in adults, where it is frequently brought about by a cerebrovascular accident, traumatic brain injury, spinal cord injury or multiple sclerosis, among other pathologies. It gives rise to important problems that have a significant effect on the quality of life of patients and their caregivers. Clinical practice guidelines (CPG) are instruments that help professionals, administrators and planners to make decisions that can improve clinical outcomes. DEVELOPMENT: Due to the complexity of spasticity, its evaluation and treatment should be carried out by specialised units using a multidisciplinary approach. One of the first-line treatment options is botulinum toxin type A (BTA). For this treatment to be successful and to be able to evaluate the patient's progress, it is advisable to have a work protocol that includes the knowledge and tools necessary to use BTA in the most suitable way and in agreement with the available scientific evidence. All these factors led the Spasticity Unit to consider the need to draw up a set of CPG. CONCLUSIONS: These CPG have been in use at the Hospital Universitari Mutua de Terrassa for 15 years, and are updated on a regular basis. This has enabled us to carry out a standardised selection of spastic patients and to establish a clear-cut set of treatment goals. It has also allowed us to implement a suitable plan regarding follow-up, the adjuvant therapies needed for each of the patients and an evaluation of results that is as objective as possible.

Guía de práctica clínica del tratamiento de la espasticidad con toxina botulínica / Clinical practice guidelines for the treatment of spasticity with botulinum toxin

Introducción. La espasticidad constituye un problema médico y social de incidencia y trascendencia elevada tanto en la infancia, debido principalmente a la parálisis cerebral infantil, como en el adulto, a consecuencia de un accidente cerebrovascular, traumatismo craneoencefálico, lesión medular o esclerosis múltiple, entre otras patologías. Ocasiona problemas importantes que de forma significativa influyen en la calidad de vida del paciente y de sus cuidadores. Las guías de práctica clínica (GPC) son instrumentos que ayudan a los profesionales, gestores y planificadores a tomar decisiones que pueden mejorar los resultados clínicos. Desarrollo. Debido a la complejidad de la espasticidad, su valoración y tratamiento deberían hacerse por unidades especializadas, con un enfoque multidisciplinar. Una de las opciones de tratamiento de primera línea es la toxina botulínica tipo A (TBA). Para que este tratamiento sea un éxito y se pueda evaluar la evolución del paciente, es recomendable disponer de un protocolo de trabajo que recoja el conocimiento y las herramientas necesarias para usar la TBA de forma apropiada y de acuerdo con la evidencia científica disponible. Todos estos factores condujeron a que la Unidad de Espasticidad se plantease la realización de una GPC. Conclusiones. En el Hospital Universitari Mútua de Terrassa se utiliza esta GPC desde hace 15 años, con actualizaciones periódicas; eso nos ha permitido realizar una selección estandarizada del paciente espástico, el establecimiento claro de unos objetivos del tratamiento y la instauración de un plan apropiado de seguimiento, así como las terapias adyuvantes necesarias para cada uno de los pacientes y una valoración lo más objetiva posible de los resultados (AU)

Introduction. Spasticity is an important medical and social problem with a high rate of incidence both in childhood, where it is mainly a result of infantile cerebral palsy, and in adults, where it is frequently brought about by a cerebrovascular accident, traumatic brain injury, spinal cord injury or multiple sclerosis, among other pathologies. It gives rise to important problems that have a significant effect on the quality of life of patients and their caregivers. Clinical practice guidelines (CPG) are instruments that help professionals, administrators and planners to make decisions that can improve clinical outcomes. Development. Due to the complexity of spasticity, its evaluation and treatment should be carried out by specialised units using a multidisciplinary approach. One of the first-line treatment options is botulinum toxin type A (BTA). For this treatment to be successful and to be able to evaluate the patient’s progress, it is advisable to have a work protocol that includes the knowledge and tools necessary to use BTA in the most suitable way and in agreement with the available scientific evidence. All these factors led the Spasticity Unit to consider the need to draw up a set of CPG. Conclusions. These CPG have been in use at the Hospital Universitari Mútua de Terrassa for 15 years, and are updated on a regular basis. This has enabled us to carry out a standardised selection of spastic patients and to establish a clear-cut set of treatment goals. It has also allowed us to implement a suitable plan regarding follow-up, the adjuvant therapies needed for each of the patients and an evaluation of results that is as objective as possible (AU)