An m-Health telerehabilitation and health education program on physical performance in patients with hip fracture and their family caregivers: Study protocol for the ActiveHip+ randomized controlled trial.

Telerehabilitation interventions administered via a smartphone may provide new feasible and effective rehabilitation options at home for patients with hip fracture. However, to date, no such interventions have been shown to be effective in the recovery key health outcomes of these patients. The present multicentre randomized controlled trial (RCT) aims to test the effect of the ActiveHip+ m-Health system in the recovery of physical performance, functional level, quality of life, and other health-related outcomes in both patients with hip fracture and their family caregivers. A total of 104 patients older than 65 years, with hip fracture, and their family caregivers will be randomized into the ActiveHip+ rehabilitation (N = 52) or the control group (N = 52). ActiveHip+ is a 12-week smartphone-based rehabilitation program conducted in Granada and Cádiz (Spain) that includes: (1) 24 sessions of physical exercise and 12 sessions of occupational therapy; (2) seven educational modules for patients and for caregivers; and (3) general recommendations in activities of daily living. The control group will receive the usual rehabilitation protocol offered by the Andalusian Public Healthcare System. The primary outcome is the patient's physical performance, while the secondary outcomes are the patient's functional level, quality of life, pain, fear of falling, fitness perception, pre-fracture functional level, emotional status, and caregiver burden. The present project will substantially contribute to the existing knowledge by testing for the first time the efficacy and feasibility of a multidisciplinary m-Health system in the rehabilitation of patients with hip fracture.

[Use of topical pharyngeal anaesthesia in esophagogastroduodenoscopy in unsedated patients]. / Anestesia tópica faríngea en endoscopia digestiva para pacientes no sedados.

AIM: Evaluation of effect on tolerance of topical pharyngeal anaesthesia with a lidocaine spray in esophagogastroduodenoscopy (EGD), and possible secondary factors that could influence it. METHODS: A prospective, experimental, randomized, open-label study was performed in our Endoscopy Unit during January 2010. Outpatients (109) were recruited prospectively and randomized between two groups: L group (52), who received lidocaine (50 mg Xilonibsa 10% before examination), and C group (57) who did not. Sedated patients were not included in this study. Age, sex, Mallampati index (lower I and II; higher III and IV), endoscopist, complications and score (0-100; visual analogue scale) was recorded after each EGD. RESULTS: There were no statistical differences between the two groups as regards patient tolerance. However in stratified analysis the application of lidocaine modified the results in two out of the six endoscopists and improved the scores in patients with a higher Mallampati Index (L group 61.8 ± 24 and C group 47.7 ± 32). Significant differences were also observed in the scores on patient tolerance between the endoscopist (operator dependent factor), regardless of the use of topical pharyngeal anaesthesia or not. CONCLUSIONS: The systematic use of lidocaine in EGD is safe but does not improve the tolerance in all outpatients. Only the Mallampati index has been identified as a prognosis factor of good response to lidocaine administration. Additionally the nursing-endoscopist could be a very important factor in the scores obtained independently of lidocaine.

Anestesia tópica faríngea en endoscopia digestiva para pacientes no sedados / Use of topical pharyngeal anaesthesia in esophagogastroduodenoscopy in unsedated patients

Objetivo. Evaluación de los efectos en la tolerancia global en las esofagogastroduodenoscopias (EGD) mediante el uso de anestesia tópica faríngea (ATF) y definición de posibles factores secundarios que puedan influenciar en ella. Método. Estudio experimental, aleatorizado, prospectivo, no ciego, en el que se incluyó a 109 pacientes con indicación diagnóstica de EGD. Se distribuyeron de forma aleatoria en dos grupos: grupo L (pacientes a los que se aplicó previamente lidocaína en spray al 10%; 50mg), y grupo C (sin administración de ATF previa). No se administró sedación intravenosa en ninguno de los grupos. La tolerancia se evaluó tras la exploración mediante escala visual analógica (0-100). Resultados. No se detectaron diferencias estadísticamente significativas en cuanto a una mejor tolerancia de los pacientes a la EGD con el uso de ATF (p>0,05). Únicamente se observaron diferencias significativas a favor de una mejor tolerancia percibida con el uso de ATF en el subgrupo de pacientes con índices de Mallampati elevados (III/IV: L, 61,8±24 y C, 47,7±32; p<0,05). También se observaron diferencias significativas en cuanto a una distinta valoración de la tolerancia por parte del paciente en función del endoscopista realizador (factor dependiente del operador), sin clara relación con el uso de ATF. Conclusiones. No se observó una mejor tolerancia de la EGD con la aplicación de ATF, salvo en los pacientes que presentaban índices de Mallampati elevados. Además, se observaron variaciones en la tolerancia percibida por los pacientes en función del facultativo encargado de realizar la prueba (AU)

Aim Evaluation of effect on tolerance of topical pharyngeal anaesthesia with a lidocaine spray in esophagogastroduodenoscopy (EGD), and possible secondary factors that could influence it. Methods. A prospective, experimental, randomized, open-label study was performed in our Endoscopy Unit during January 2010. Outpatients (109) were recruited prospectively and randomized between two groups: L group (52), who received lidocaine (50mg Xilonibsa 10% before examination), and C group (57) who did not. Sedated patients were not included in this study. Age, sex, Mallampati index (lower I and II; higher III and IV), endoscopist, complications and score (0-100; visual analogue scale) was recorded after each EGD. Results. There were no statistical differences between the two groups as regards patient tolerance. However in stratified analysis the application of lidocaine modified the results in two out of the six endoscopists and improved the scores in patients with a higher Mallampati Index (L group 61.8±24 and C group 47.7±32). Significant differences were also observed in the scores on patient tolerance between the endoscopist (operator dependent factor), regardless of the use of topical pharyngeal anaesthesia or not. Conclusions. The systematic use of lidocaine in EGD is safe but does not improve the tolerance in all outpatients. Only the Mallampati index has been identified as a prognosis factor of good response to lidocaine administration. Additionally the nursing-endoscopist could be a very important factor in the scores obtained independently of lidocaine (AU)