[Efficacy of tele-rehabilitation in patients with chronic obstructive pulmonary disease: a systematic review].

The COVID-19 pandemic has required the use of new technologies to carry out rehabilitation sessions for COP D remotely. The aim of this systematic review was to analyse the available evidence on the efficacy of telerehabilitation in COPD patients. PubMed, WOS, PEDro and Cochrane databases were consulted. The systematic review included nine clinical trials, 55.5% of which display good methodological quality. The most commonly used rehabilitation methods were applications or software for real-time video-calls, visualisation of exercises and recording progress. TR was as effective as outpatient pulmonary rehabilitation, with greater benefits in functional capacity, self-efficacy, mental health, exacerbations and emergency care visits, offering a cost-effective option with high patient satisfaction. The small number of studies and the variety of rehabilitation methods examined limit the value of the evidence obtained.

Eficacia de la tele-rehabilitación en pacientes con enfermedad pulmonar obstructiva crónica: una revisión sistemática / Efficacy of tele-rehabilitation in patients with chronic obstructive pulmonary disease: a systematic review

La pandemia de la COVID-19 ha requerido el uso de nuevas tecnologías para realizar las sesiones de rehabilitación en la EPOC de manera telemática. El objetivo de esta revisión sistemática fue analizar la evidencia disponible sobre la eficacia de la telerehabilitación en pacientes con EPOC. Se consultaron las bases de datos PubMed, WOS, PEDro y Cochrane. La revisión incluyó nueve ensayos clínicos, el 55,5% con buena calidad metodológica. Los métodos de telerehabilitación más utilizados fueron las aplicaciones o software para realizar video-llamadas a tiempo real, visualizar los ejercicios y registrar los progresos conseguidos. La telerehabilitación fue tan eficaz como la rehabilitación pulmonar ambulatoria, obteniendo mayores beneficios en capacidad funcional, autoeficacia, salud mental, exacerbaciones y visitas a urgencias, siendo una opción rentable y con alta satisfacción del paciente. El pequeño número de estudios y la variedad de métodos de telerehabilitación limitan el valor de la evidencia obtenida.(AU)

The COVID-19 pandemic has required the use of new technologies to carry out rehabilitation sessions for COP Dremotely. The aim of this systematic review was to analyse the available evidence on the efficacy of telerehabilitation in COPD patients. PubMed, WOS, PEDro and Cochrane data bases were consulted. The systematic review included nine clinical trials, 55.5% of which display good methodological quality. The most commonly used rehabilitation methods were applications or software for real-time video-calls, visualisation of exercises and recording progress. TR was as effective as outpatient pulmonary rehabilitation, with greater benefits in functional capacity, self-efficacy, mental health, exacerbations and emergency care visits, offering a cost-effective option with high patient satisfaction. The small number of studies and the variety of rehabilitation methods examined limit the value of the evidence obtained.(AU)

Physical therapy in Down syndrome: systematic review and meta-analysis.

BACKGROUND: Down syndrome is the most common chromosomal abnormality, with a worldwide incidence of around 0.1% in live births. It is related to several conditions in which the physical therapy could take action-preventing co-morbidities. This study aims to evaluate the effectiveness of physical therapy in Down syndrome, to know and compare the effectiveness of different physical therapy interventions in this population. METHODS: A systematic review and a meta-analysis of randomised controlled trials were conducted. The search was performed during June 2018 in the following databases: PubMed, Web of Science, Physiotherapy Evidence Database and Scopus. The studies were selected using predefined inclusion and exclusion criteria. The Physiotherapy Evidence Database scale evaluated the quality of the methods used in the studies. Subsequently, the data were extracted, and statistical analysis was performed when possible. RESULTS: A total of 27 articles were included, of which nine contributed information to the meta-analysis. Statistical analysis showed favourable results for the strength of upper and lower limbs [standardised mean difference (SMD) = 1.46; 95% confidence interval (CI): (0.77-2.15); and SMD = 2.04; 95% CI: (1.07-3.01)] and mediolateral oscillations of balance [SMD = -3.30; 95% CI: (-5.34 to -1.26)]. CONCLUSIONS: The results show the potential benefit of certain types of physical therapy interventions, specifically in strength and balance, in people with Down syndrome. There are still many aspects to clarify and new lines of research.

Benefits of hippotherapy in children with cerebral palsy: A narrative review.

Children with cerebral palsy display disorders in pelvic movement and require effective rehabilitation. There is evidence to support the hippotherapy due to improvements in balance. The aim of this narrative review was to summarise the grades of recommendation regarding the benefits of hippotherapy in children with cerebral palsy. DATA SOURCES AND EXTRACTION: We searched electronic databases, limiting the searches to studies published between 2004 and February 2017. The selected documents were classified according to the strength of recommendation provided by Duodecim (the Finnish medical society). The methodological quality of the selected studies was evaluated using the PEDro scale. RESULTS: 18 studies (four graded A, eight graded B and six graded C) showed clinical changes in the outcomes of gross motor function, sitting independently, speed of walking, length of stride and postural alignment of the head in children with cerebral palsy. Study quality was poor to good (mean PEDro Score of 6 out of 10). Benefits were identified in relation to psychological factors, as well as positive effects on quality of life and the performance of daily life activities. CONCLUSIONS: Gains were also observed in postural alignment and the balance of head and trunk. Moreover, there were improvements in quality of life and the activities of daily life, such as jumping, balance, strength and ascending and descending stairs.

Efecto de la rehabilitación respiratoria asociada a suplementación nutricional sobre la actividad física en pacientes con bronquiectasias: estudio aleatorizado / The effect of pulmonary rehabilitation associated with nutritional supplementation on physical activity in patients with bronchiectasis: randomized trial

Introducción: la actividad física está fuertemente relacionada con la mortalidad y la situación respiratoria en patologías respiratorias como la enfermedad pulmonar obstructiva crónica (EPOC) y la fibrosis quística (FQ). Los programas de rehabilitación respiratoria (RR) han demostrado mejorar el grado de actividad física en pacientes con EPOC. No existen trabajos específicos en pacientes con bronquiectasias (BQ). Objetivos: comparar el efecto sobre la actividad física de la RR durante 12 semanas, comparado con RR más un suplemento hiperproteico enriquecido en beta-hidroxi-beta-metilbutirato (HMB) en pacientes con BQ no debidas a FQ. Material y métodos: estudio prospectivo aleatorizado, en el que se aplica un programa de RR estructurado a pacientes con BQ durante tres meses. A uno de los grupos, además, se le asoció un suplemento hiperproteico con HMB. Se valoró el grado de actividad física en situación basal, a los tres y seis meses mediante acelerómetro wGT3X (ActiGraph) y cuestionario IPAQ. Se analizaron los datos mediante una Anova de medidas repetidas (intención de tratar). Resultados: se incluyeron 30 pacientes con BQ no debidas a FQ (15 en cada rama) sin diferencias en variables clínicas entre los grupos. Después de la intervención, un porcentaje significativo de pacientes incrementaron la actividad física medida mediante el cuestionario IPAQ en el grupo suplementado a los 3 y 6 meses. No se observaron diferencias significativas en función del tipo de intervención. En ambos grupos se observó un discreto aumento de la actividad física de intensidad moderada medida por acelerómetro, a los 3 y 6 meses, pero no alcanzó significación estadística. Conclusiones: la RR, unida a suplementación nutricional en pacientes con BQ no debidas a FQ, aumentó el nivel de actividad física medida mediante el cuestionario IPAQ (a los 3 y 6 meses). Sin embargo, no alcanzó la significación estadística mediante acelerómetro. Son necesarios más estudios que evalúen la validez de los diferentes instrumentos de medida

Introduction: physical activity is closely related to mortality and respiratory status for respiratory diseases such as chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF).Pulmonary rehabilitation (PR) programs have been shown to improve the level of physical activity in COPD patients. There are no specific studies on patients with bronchiectasis. Objectives: study the effect of PR on physical activity over 12 weeks, in comparison with PR plus a hyperproteic supplement enriched in beta-hydroxy-beta-methylbutyrate (HMB) in patients with non CF bronchiectasis. Material and methods: prospective, randomized study in which a structured PR program is applied in bronchiectasis patients for three months. Additionally, one of the groups received a hyperproteic supplement with HMB. The degree of physical activity was evaluated at baseline and after three and six months using the wGT3X (ActiGraph) accelerometer and the IPAQ (International Physical Activity Questionnaire).Data was analyzed using a repeated measures ANOVA (intention to treat). Results: 30 patients with non-CF bronchiectasis (15 in each group)were included, without differences in clinical variables between groups. After intervention, a significant percentage of patients in the supplement group increased their average physical activity according to the IPAQ after 3 and 6 months. Significant differences depending on type of intervention were not observed. A slight increase in average moderate intensity physical activity measured by accelerometer was observed at 3 and 6 months, but it did not reach statistical significance. Conclusions: PR, along with nutritional supplements, in non-CF bronchiectasis patients increased the level of physical activity measured by the IPAQ (at 3 and 6 months).However, it did not reach statistical significance according to accelerometer measurements. Further studies are needed to evaluate the validity of the different measurement instruments

Reflexiones sobre la relación entre los valores cardiopulmonares y otros parámetros relacionados con la salud / Views on the relationship between cardiopulmonary values and other health-related parameters

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Cambios hematológicos tras un programa de promoción de actividad física en sujetos inactivos. Ensayo aleatorizado controlado / Hematological changes after a program promoting physical activity in inactive subjects. A randomized, controlled trial

Objetivo: Comparar los cambios antropométricos y bioquímicos en personas inactivas, que realizan un programa de actividad física frente a los que no lo realizan desde los Centros de Atención Primaria. Métodos Cien personas inactivas de ambos sexos, mayores de 55 años fueron aleatorizadas a un grupo experimental (n = 50) y a un grupo control (n = 50). Se realizó un programa de promoción de actividad física siguiendo los criterios del Colegio Americano de Medicina del Deporte, de 60 min cada sesión, 2 sesiones por semana, durante 3 meses. Las medidas antropométricas incluyeron el índice de masa corporal y el porcentaje graso, y como variables bioquímicas el perfil lipídico, hematíes y la creatina kinasa. Resultados Completaron el estudio 75 personas. Esta investigación no presentó cambios significativos a nivel antropométrico, ni en las variables bioquímicas del perfil lipídico. Sí se observaron efectos clínicamente relevantes en la concentración de los hematíes de las mujeres que realizaron dicho programa. Conclusiones El efecto clínico global fue pequeño en las personas que realizaron el programa, pero relevante para la salud de la población. Esta intervención produce efectos a corto plazo en la bioquímica de las personas inactivas

Objective: Compare anthropometry and biochemical changes in inactive people who participate in a physical activity program versus those who do not from the Primary Health Care Centers. Methods: One hundred inactive subjects of both genders, 55 years and older, from Torremolinos ,Spain were randomized into an experimental group (n = 50) and a control group (n = 50). A program promoting physical activity was carried out following the American Medical Society for Sport’s Medicine criteria. The program included sessions a week for 3 months. Anthropometric measurements included body mass index and fat percentage, and such as biochemical measures: the lipid profile, erythrocytes, and creatine kinase. Results: Seventy-five persons completed the study. This research did not show significant changes to anthropometric or biochemical outcomes of the lipid profile. However, therewere clinically relevant effects regarding red blood cells concentration in the women who participated in this program. Conclusions: Overall clinical effect was small in those participating in the program, but relevant for the health of the population. This program has short-term effects on biochemistry results of inactive subjects

Correlaciones entre los valores cardiopulmonares, bioquímicos y antropométricos en personas inactivas en Atención Primaria / Relationships among the cardiopulmonary, biochemical and anthropometry values for inactive subjects in Primary Care

Introducción. La inactividad física es uno de los mayores problemas de salud del siglo XXI . El objetivo de este estudio es medir la relación y el grado de contribución entre la función cardiopulmonar, la bioquímica y la antropometría en los pacientes inactivos. Material y métodos. El diseño es transversal y se realizaron 150 valoraciones en Atención Primaria y Comunitaria. Resultados. En las correlaciones bivariadas el porcentaje graso y la creatina cinasa fue significativa y positivamente relacionada con la capacidad vital forzada. En el análisis multivariante, el mejor modelo para la composición corporal es determinado por el porcentaje graso como variable dependiente, y la frecuencia cardiaca al final de la ergometría, el colesterol de alta densidad y la capacidad vital forzada como variables independientes. Conclusión. Las relaciones significativas de carácter débil encontradas en esta población orientan sobre la necesidad de seguir buscando diferentes estrategias para aumentar la actividad física y mantener estilos de vida saludables(AU)

Introduction. Physical inactivity is one of the major public health problem of the twenty-first century. The purpose of this study was to measuring the relationship and grade of contribution among the cardiopulmonary function, blood biochemical parameters and anthropometry for inactive people treated in Primary Care Centers. Material and methods. This study is cross-sectional and consisting of 150 evaluations in Primary and Community Care Centers. Results. In the bivariate relationships the percentage of body fat and the creatine kinase were significantly positively related to forced vital capacity. In the multivariate regression analysis the best model for body composition is determinated by the percentage fat as the dependent outcome and predictors outcomes of final heart rate of exercise testing, high density lipoprotein cholesterol and forced vital capacity. Conclusion. The weak relationships that were found in this population, guidance on possible improvements that would be necessary to continue looking for increase physical activity and maintain active lifestyles(AU)

Efectividad de la hidroterapia en las personas con enfermedad pulmonar obstructiva crónica / Effectiveness of hydrotherapy in people with chronic obstructive pulmonary disease

Introducción. El objetivo de este estudio es detectar los niveles de evidencia y grados de recomendación de la intervención acuática terapéutica en personas con enfermedad pulmonar obstructiva crónica (EPOC) basado en una revisión sistemática. Diseño. La bases de datos revisadas son las siguientes: Medline, Web of Knowledge, CINAHL, PsycInfo, Sport Discus, SCOPUS, Oaister, DOAJ, Cochrane, EMBASE y Pedro. Material y método. Los límites de la búsqueda son ensayos clínicos aleatorios, estudios cohortes y estudios de casos que fueron publicados desde 1996 hasta 2010. Los documentos seleccionados fueron clasificados según los grados de recomendación de la sociedad finlandesa DUODECIM. La calidad metodológica de los dieciséis ensayos seleccionados se evaluó usando la lista Delphi. Resultados. Dos documentos primarios mostraron cambios clínicos en el cuestionario de calidad de vida específico para enfermos respiratorios. Las personas que realizaron ejercicio incremental en el agua presentaron cambios funcionales en la distancia recorrida en la prueba de test de marcha, en la capacidad vital forzada y en el volumen espiratorio forzado. La intervención acuática terapéutica que se recomienda es a una intensidad del 50 al 90% del VO2max, con una frecuencia de dos a cinco días a la semana, con sesiones de 30 a 50 minutos, durante un período de tratamiento desde 8 a 24 semanas de duración y una variabilidad de la temperatura del agua desde 29°C hasta 38°C. En futuros estudios sería posible hacer subgrupos de los pacientes en función de sus condiciones físicas de partida para mejorar los resultados de la intervención (AU)

Introduction. The aim of this study is to detect the levels of evidence and grades of recommendation of therapeutic aquatic exercise interventions in patients with chronic obstructive pulmonary disease (COPD) based on a systematic review. Design. The following databases were reviewed: Medline, Web of Knowledge, CINAHL, PsycInfo, Sport Discus, SCOPUS, Oaister, DOAJ, Cochrane, EMBASE and Pedro. Material and methods. A search for randomized clinical trials, cohort studies and case studies published 1996 to 2010 was made. The documents selected were classified according to the grades of recommendation of the DUODECIM Finnish society. Methodological quality of the 16 trials selected was assessed using the Delphi list. Results. Two primary documents showed clinical changes on the quality of life of questionnaire aimed at respiratory patients. Those subjects who performed incremental exercise in the water showed functional changes in the distance walked in the walking test, in forced vital capacity and forced expiratory volume. The incremental therapeutic water exercise recommended in the articles had an intensity ranging from 50% to 90% of VO2max with a frequency of two to five days a week. The sessions ranged from 30 to 50minutes within a treatment period going from 8 to 24 weeks with water temperature varying from 29°C to 38°C. In future studies, subgroups of the patients can be made based on their initial physical condition in order to improve the outcomes of the intervention (AU)

Revisión de ensayos clínicos sobre rehabilitación respiratoria en enfermos pulmonares obstructivos crónicos / Review about clinical control trials of respiratory rehabilitation in chronic obstructive pulmonary disease

Objetivo: Comparar los tipos de entrenamiento físico para pacientes con enfermedad pulmonar obstructiva crónica (EPOC) y analizar cuál es el más efectivo. Diseño: Revisión sistemática de la literatura médica sobre el tema. Estrategia de búsqueda Se realizó una búsqueda sistemática de los estudios relevantes publicados desde 1999 hasta 2009 en la base de datos de Medline. Selección de estudios: los límites de búsqueda son ensayos clínicos aleatorios. Los criterios de selección son artículos que muestran tipos de entrenamiento en seco o agua para pacientes con EPOC y que incluían las variables funcionales y clínicas siguientes: datos espirométricos, consumo de oxígeno y cuestionarios de calidad de vida, respectivamente. La calidad metodológica fue medida con la lista Delphi. Un total de 38 artículos fueron incluidos en la revisión sistemática y solo 9 superaron los criterios de selección. Resultados: La mayoría de los artículos defienden el ejercicio físico aeróbico resistido incremental, con una intensidad que va del 90-50% de la VO2máx, con una frecuencia entre 2-4 días a la semana, la sesión desde 30-60 min y un periodo de tratamiento desde 8-12 semanas de duración. Todos los artículos incluyen pacientes con EPOC grave y que habían dejado de fumar antes de comenzar la intervención de ejercicio físico. Los valores del tamaño del efecto en el cuestionario respiratorio y el VO2 máx no mostraron diferencias significativas. Conclusión: Existe una clara tendencia de los autores a presentar el trabajo de ejercicio físico aeróbico incremental como el de mayor efectividad en el tratamiento de los pacientes con EPOC (AU)

Objective: Compare the effectiveness various exercises training programmes in the rehabilitation of chronic obstructive pulmonary disease (COPD) patients. Desing: A systematic literature review of random control trials. Search strategy We conducted a systematic search to identify relevant studies published between 1999 and 2009 in Medline database. Selection of studies The search limits were randomised controlled trial. The selection criteria were trials using exercise training in patients with COPD on dryland or water and included the following clinical and functional outcomes: lung function, oxygen uptake and quality of life questionnaire, respectively. Methodological quality of randomized controlled trials was assessed using the Delphi list. The literature search delivered a total of 38 studies, however only nine reach eligibility selection. Results: Most trials used incremental aerobic resistance exercises at an intensity ranging from 90 to 50% of VO2max. Frequency was two or four days a weeks, in sessions of 30 to 60min over a period of 8 to 12 weeks. All studies include persons with severe COPD who had stopped smoking before beginning the intervention. The effect of exercise training in CRQ and VO2max was not significant. In summary, the systematic review shows a clear tendency toward the use of incremental physical workload as the most effective in the treatment of patients with COPD (AU)