A home-based exercise program for temporomandibular joint osteoarthritis: pain, functionality, and joint structure.

OBJECTIVES: Osteoarthritis (OA) is the most prevalent and disabling joint disease in the world. Temporomandibular joint (TMJ) exercise is a widely used treatment and could be a beneficial and long-term tool for treating TMJ OA. The present study aims to evaluate the effects of therapeutic exercise in the conservative treatment of TMJ OA. MATERIALS AND METHODS: A single-group experimental pre-post test was performed. We included patients who met the diagnostic criteria for TMJ OA. Outcome variables were pain intensity (visual analogue scale), functionality (Helkimo index), and structural changes (ultrasound). Follow-up periods were at months 1, 3, and 6. The intervention included a home-based program with thermotherapy, manual therapy, and therapeutic exercise during the entire follow-up period. RESULTS: We included 15 patients and 26 joints, all women with a median age of 57 years (range, 49-62 years). Median change in pain intensity on joint palpation, mouth opening, and at rest at the first month was 47.5 mm, 51 mm, and 60 mm, respectively, and 48 mm, 49.5 mm, and 42.5 mm, at six months (P=0.001). The Helkimo index showed significant improvement in medians from baseline severe dysfunction (17 points) to minimal dysfunction at three and six months (2 points) (P=0.001). Ultrasound showed improved disc position. CONCLUSION: This study demonstrated significant improvements in pain, function, and joint disc position and represents a valuable tool for the long-term treatment of patients with TMJ OA.

The yawning gap between osteoporosis diagnosis and treatment after a fragility fracture in Mexico.

This study shows a diagnostic and therapeutic gap for osteoporosis in patients with fragility fractures of the hip, distal radius, and vertebrae. Patients with fragility fractures treated in Mexico fail to receive an osteoporosis diagnosis, referral, and follow-up treatment. The therapeutic gap is higher than reported in other countries. INTRODUCTION: Osteoporosis is a highly prevalent and disabling disease. While there is typically a gap between osteoporosis diagnosis and treatment after a fragility fracture, this gap has not been measured in Mexico. The study aimed to describe and quantify the gap between osteoporosis diagnosis and treatment after an incident fragility fracture. MATERIALS AND METHODS: A descriptive and 3-year retrospective chart review study was conducted on patients over the age of 50 with a diagnosis of an incident acute low-energy fracture of either the hip, distal radius, or vertebrae. RESULTS: We included 838 patients with a mean age of 76.3 ± 12.2 years. The sample was mostly women (665 participants, 79.4%); 589 (70.3%) had a hip fracture, 173 (20.6%) had a distal radius fracture, and 76 (9.1%) had a vertebral fracture. Only 28 (3.3%) had a previous diagnosis and were taking a pharmacological treatment for osteoporosis; 11 (1.3%) received their diagnosis while hospitalized. Immediately after the fracture, and 1 and 3 years later, 144 (17.1%), 71 (8.4%), and 96 (11.4%) respectively received a pharmacological treatment, 195 (23.2%), 65 (7.7%), and 45 (5.3%) supplementation, and 16 (1.9%), 16 (1.9%), and 21 (2.5%) a non-pharmacologic treatment. No significant differences in treatment prescriptions were found after a second or third fracture. CONCLUSION: The study quantifies the too high frequency of failure to diagnose and treat osteoporosis in patients with fragility fractures. Measures should be established to reduce the yawning gap between osteoporosis diagnosis and treatment after a fragility fracture.

Bone mineral density and low bone mass in severely burned patients: A retrospective cohort study.

INTRODUCTION: Severe burns can alter bone metabolism through different mechanisms. Despite prior published studies describing the association between burns and a decrease in bone mineral density (BMD), no clinical guidelines currently exist recommending the systematic evaluation of bone health in patients after severe burns. This study aims to describe the BMD of individuals with severe burn injuries and healthy controls and determine the frequency of low-to-normal bone mass (LNBM) and BMD below the expected range for age (BEA). MATERIALS AND METHODS: We conducted a retrospective cohort of patients with either severe thermal or electrical burns and healthy controls paired by gender and age. We performed a dual-energy X-ray absorptiometry at least 90 days after the burn and collected data from each patient's clinical evaluation and clinical file. RESULTS: A total of 77 patients (64 men and 13 women) and their paired controls were included in the study (age [mean ± standard deviation, SD]: 30.37 ± 8.66 years). Patients participated in the study an average of 315 ± 438 days after their burn. The BMD (grs/cm2) in total hip burned vs controls was: 0.998 ± 0.135 vs 1.059 ± 0.12 (p = 0.004); femoral neck 0.876 ± 0.121 vs 0.915 ± 0.097 (p = 0.031), spine 0.977 ± 0.127 vs 1.003 ± 0.076 (p = 0.132).The Z-scores for total hip were - 0.06 ± 1.05 vs 0.41 ± 0.80 (p = 0.002); for neck -0.39 ± 0.89 vs -0.01 ± 0.77 (p = 0.005); and for spine -0.75 ± 1.11 vs -0.32 ± 0.73 (p = 0.005). The proportion of subjects with BMD BEA in burns vs controls was 5.2 vs 1.2% (p = 0.05) in total hip, 3.9 vs 0% (p = 0.045) in the neck, and 18.2 vs 1.2% (p = 0.001) in the spine. The logistic regression model found-in burn patients vs controls-an OR of 9.83 for BMD BEA (CI 95%: 2.17-44.45, p = 003), OR = 4.05 for electrical burns (CI 95%: 1.72-20.89, p = 004) and OR = 15.16 for thermal burns (CI 95%: 2.91-79.00, p = 001). The model also found an OR = 2.48 for LNBM (CI 95%: 1.25-4.93, p = 0.009). The burn variables associated with BMD BEA at any site in the patients were BMI >25 Kg/m2 with an OR = 0.180 (CI 95%: 0.046-0.710, p = 0.014); and the lower limb amputation with an OR = 7.33 (CI 95%; 1.12-48.33, p = 0.038). Five burn patients had a fragility fracture. CONCLUSION: BMD was significantly lower in severely burned patients than in controls, and the proportion BMD BEA cases was significantly higher in the burn patient sample. Severe burns are a strong independent predictor of bone loss, and this risk is maintained for an extended period after the burn.

Disease-related factors associated with exercise adherence in postmenopausal women with osteoporosis.

OBJECTIVES: Exercise is the most widely-used intervention for reducing bone loss and the incidence of falls and fractures in osteoporosis patients. However, disease-related changes can alter these patients' adherence to exercise programs. This study attempted to describe the factors influencing exercise adherence in a group of postmenopausal women with osteoporosis. METHODS: We conducted a retrospective cohort of postmenopausal women with osteoporosis. We collected data from each patient's last clinical evaluation, as well as from their clinical file of the previous year. RESULTS: A total of 288 women were included in the study, with an average age of 69.45 (Standard deviation ± 9.2 years). Around a quarter, 76 (26.3%), of the patients did not adhere to exercise, 91 (31.5%) did partially, and 121 (41.9%) did completely. In univariate analysis, the variables significantly associated with exercise adherence were age, height, spine pain intensity, joint pain, and prevalent fracture. In a logistic regression model, pharmacological treatment for osteoporosis and polypharmacy were associated with exercise adherence, while poor balance and hyperkyphosis were associated with non-adherence. CONCLUSION: Pharmacological treatment, polypharmacy, poor balance, and hyperkyphosis all appear to be associated with exercise adherence. As these findings are the significant predictors of exercise engagement, it is necessary to explore balance and postural changes and emphasize the importance of postural and balance training prescription in this group of patients.

Prevalence of clinical and radiological osteoarthritis in knee, hip, and hand in an urban adult population of Mexico City / Prevalencia clínica y radiológica de osteoartritis de rodillas, caderas y manos en una población urbana adulta de la Ciudad de México

INTRODUCTION: Osteoarthritis (OA) is the most prevalent articular disease worldwide, and its prevalence is highly variable depending on the classification criteria, population studied, and/or affected joints considered. Reporting epidemiologic data about clinical and radiological OA prevalence in Mexico has not been done before. PATIENTS AND METHODS: A descriptive cross-sectional study was carried out with participants of Mexico City, and included both men and women above 40 years of age. All participants were evaluated with radiological and clinical criteria for OA. RESULTS: Two hundred and four individuals participated in the study: 80 men (39.2%) and 124 women (60.8%). The average age was 57.4±10.9 years. Using clinical criteria alone, 36 participants were found to have hand OA (17.6%; 95% CI, 13-23.4), 37 with hip OA (18.1%; 95% CI 13.4-24), and 40 with knee OA (19.6%; 95% CI 14.7-25.6). When radiological criteria were used, 51 individuals were reported as having hand OA (25%; 95% CI 19.5-31), 54 with hip OA (26.5%; 95% CI 20.8-32.9), and 52 with knee OA (25.5%; 95% CI 20-31.8). When clinical criteria were used and then corroborated with radiological criteria, the prevalence was 28 individuals with hand OA (13.7%; 95% CI 9.6-19), 31 with hip OA (15.1%; 95% CI 10.9-20.7), and 36 with knee OA 36 (17.6%; 95% CI 12.2-26.2). DISCUSSION: The prevalences found in this study are greater than those found in other studies in Mexico that only report clinical criteria

INTRODUCCIÓN: La osteoartritis (OA) es la enfermedad articular más prevalente a nivel mundial; la prevalencia reportada es muy variable ya que depende de los criterios de clasificación, la población estudiada y/o las articulaciones afectadas. Previamente no se habían reportado datos epidemiológicos sobre la prevalencia clínica y radiológica de la OA en México. PACIENTES Y MÉTODOS: Se realizó un estudio descriptivo y transversal, se incluyeron participantes de cualquier sexo mayores de 40 años de la Ciudad de México, todos ellos fueron evaluados con criterios radiológicos y clínicos para la OA. RESULTADOS: Se analizaron 204 individuos, 80 varones (39,2%) y 124 mujeres (60,8%). La edad promedio fue de 57,4±10,9 años. Usando solo criterios clínicos, 36 participantes tuvieron OA de mano (17,6%, IC 95%, 13-23,4), 37 con OA de cadera (18,1%, IC 95% 13,4-24) y 40 con OA de rodilla (19,6% IC 95% 14,7-25,6). Cuando se utilizaron los criterios radiológicos, se informó que 51 individuos tenían OA de mano (25%: IC 95% 19,5-31), 54 con OA de cadera (26,5% IC 95% 20,8-32,9) y 52 con OA de rodilla (25,5%; IC 95% 20-31,8). Al utilizar criterios clínicos y luego corroborados por criterios radiológicos, la prevalencia fue de 28 individuos con OA de mano (13,7% IC 95% 9,6-19), 31 con OA de cadera (15,1% IC 95% 10,9-20,7) y 36 con OA de rodilla 36 (17,6%; IC 95% 12,2-26,2). DISCUSIÓN: Las prevalencias encontradas en este estudio son mayores a las encontradas en otros estudios en México que solo reportan criterios clínicos

Prevalence of clinical and radiological osteoarthritis in knee, hip, and hand in an urban adult population of Mexico City.

INTRODUCTION: Osteoarthritis (OA) is the most prevalent articular disease worldwide, and its prevalence is highly variable depending on the classification criteria, population studied, and/or affected joints considered. Reporting epidemiologic data about clinical and radiological OA prevalence in Mexico has not been done before. PATIENTS AND METHODS: A descriptive cross-sectional study was carried out with participants of Mexico City, and included both men and women above 40 years of age. All participants were evaluated with radiological and clinical criteria for OA. RESULTS: Two hundred and four individuals participated in the study: 80 men (39.2%) and 124 women (60.8%). The average age was 57.4±10.9 years. Using clinical criteria alone, 36 participants were found to have hand OA (17.6%; 95% CI, 13-23.4), 37 with hip OA (18.1%; 95% CI 13.4-24), and 40 with knee OA (19.6%; 95% CI 14.7-25.6). When radiological criteria were used, 51 individuals were reported as having hand OA (25%; 95% CI 19.5-31), 54 with hip OA (26.5%; 95% CI 20.8-32.9), and 52 with knee OA (25.5%; 95% CI 20-31.8). When clinical criteria were used and then corroborated with radiological criteria, the prevalence was 28 individuals with hand OA (13.7%; 95% CI 9.6-19), 31 with hip OA (15.1%; 95% CI 10.9-20.7), and 36 with knee OA 36 (17.6%; 95% CI 12.2-26.2). DISCUSSION: The prevalences found in this study are greater than those found in other studies in Mexico that only report clinical criteria.

Glenohumeral osteoarthritis: overview, therapy, and rehabilitation.

PURPOSE: Glenohumeral osteoarthritis (GHOA) is a common cause of pain and functional disability of the shoulder. Despite the limited evidence, there are several options for the treatment of this pathology. The aim of this article is to provide current information on the characteristics of the disease and the pathophysiology, evidence based on medical and surgical treatments with emphasis on the rehabilitation process. METHODS: It was performed with an extensive literature review, mainly clinical practice guidelines, randomized controlled trials, reviews, focusing on the rehabilitation management. RESULTS: There are few clinical practice guidelines that address GHOA as a pathology with unique characteristics. Evidence based treatment recommendations are mostly supported by low-quality evidence and experts' opinions, with few high levels of evidence studies guiding treatment decisions. CONCLUSIONS: Despite the lack of good quality evidence, rehabilitation programs have proven to be efficient and reliable, and this revision provides information and recommendations in this field. Implication of Rehabilitation Glenohumeral osteoarthritis is a common cause of pain and functional disability of the shoulder There are few clinical practice guidelines that address Glenohumeral Osteoarthritis as a pathology with unique characteristics, and recommendations for rehabilitation and therapeutic exercise are poor The paper provides current information on the characteristics of the disease, its rehabilitation process, and could be of interest for rehabilitation professionals to direct their practices in this field.

¿Es tiempo de exigir publicidad basada en la evidencia?

Claims made in current advertising for medical products is not necessarily scientifically proven, yet at the same time clinicians are required to adopt evidence-based practices and undergo periodic certifications. This is a clear contradiction. It is crucial to begin to reflect on the need to regulate information presented in the media and to place greater emphasis on patient well-being and safety instead of on third-party interests. The medical community must demand stricter regulations and evidence-based advertising policies.

Proposal and Evaluation of a Telerehabilitation Platform Designed for Patients With Partial Rotator Cuff Tears: A Preliminary Study.

OBJECTIVE: To propose and evaluate the effectiveness of a telerehabilitation platform designed for patients with rotator cuff (RC) tears. METHODS: During the first study phase, a virtual service platform that included information on RC tear pathology, joint care, and a series of instructions regarding therapeutic exercise was designed and created. Subsequently, in the clinical phase, a quasi-experimental study was performed. The platform was tested on patients and evaluated at baseline and at 1, 2, 3, and 6 months with respect to their pain levels and functionality on the Constant-Murley (CM) scale. RESULTS: Eleven patients were included, 5 women and 6 men, with a median age of 55 years (range, 42-68 years). Pain diminished from a baseline value of 64 mm (range, 40-80 mm) to 16 mm (range, 0-30 mm) at 6 months (p<0.001). Points on the CM scale rose from a baseline value of 54 points (range, 51-66 points) to 85 points (range, 70-100 points) at 6 months (p=0.001). Functionality in daily living and work activities, movement, and strength exhibited significant changes at 6 months (p<0.05). CONCLUSION: Significant changes were observed in pain and functionality in this group of participants who used a telerehabilitation platform. To the best of our knowledge, this is the first study that included a specific program for RC tears.

Knee muscle strength correlates with joint cartilage T2 relaxation time in young participants with risk factors for osteoarthritis.

The objective of this study is to correlate T2 relaxation time (T2RT), measured by magnetic resonance imaging (MRI) with quadriceps and hamstring strength in young participants with risk factors for knee osteoarthritis (OA). A descriptive cross-sectional study was conducted with participants between 20 and 40 years of age, without diagnosis of knee OA. Their T2 relaxation time was measured through MRI, and their muscle strength (MS) was measured with an isokinetic dynamometer. Seventy-one participants were recruited, with an average age of 28.3 ± 5.5 years; 39 (55 %) were females. Negative correlations were found between T2RT and quadriceps peak torque (QPT) in males in the femur r = -0.46 (p = 0.01), tibia r = -0.49 (p = 0.02), and patella r = -0.44 (p = 0.01). In women, correlations were found among the femur r = -0.43 (p = 0.01), tibia r = -0.61 (p = 0.01), and patella r = -0.32 (p = 0.05) and among hamstring peak torque (HPT), in the femur r = -0.46 (p = 0.01), hamstring total work (HTW) r = -0.42 (p = 0.03), and tibia r = -0.33 (p = 0.04). Linear regression models showed good capacity to predict T2RT through QPT in both genders. The present study shows that early changes in femoral, tibial, and patellar cartilage are significantly correlated with MS, mainly QPT, and that these early changes might be explained by MS, which could play an important role in pre-clinical phases of the disease.

Water-based Tai Chi: theoretical benefits in musculoskeletal diseases. Current evidence.

Tai Chi is a low-impact and moderate intensity exercise that has shown positive effects in patients with musculoskeletal disorders. Recently have been developed clinical studies on the benefits of Tai Chi techniques combined with hydrotherapy. Both types of treatment include physical training of balance, mobility, strength, coordination and sensory input that could complement each other. This report aims to present the current evidence about the benefits of the combination of water based Tai Chi in musculoskeletal diseases in order to establish whether the combined intervention is better than Tai Chi or hydrotherapy alone.

Efectos de la colchicina e indometacina en la pulpitis producida experimentalmente en el cobayo / Effects of colchicine and indomethacin in experimentally produced pulpitis in guinea pigs

Este estudio se realizó en cobayos machos, a los cuales se les provocó pulpitis mediante la realización de cavidades clase V en los dientes incisivos. Se les aplicó indometacina y colchicina a razón de 7 mg/kg de peso respectivamente, por vía intraperitoneal. Previa anestesia se sacrificó a los animales infiltrando formol al 10 por ciento en el ventrículo izquierdo para la fijación de las células inflamatorias. Por medio de la disección del maxilar y la mandíbula se obtuvieron los dientes incisivos y se realizaron los cortes histopatológicos correspondientes para la cuantificación de las células inflamatorias con un objetivo de 400 X. Encontramos que la pulpitis tratada con indometacina se elevó contra lo esperado cuando se utiliza la colchicina, pese a mostrar pulpitis en menor grado que con indometacina, aumentó (a nivel polimorfonucleares). La colchicina, por otra parte, actuó sobre histiocitos y linfocitos. Por lo tanto, es posible afirmar que ambos medicamentos sí bloquean el desarrollo de la pulpitis puesto que la indometacina actuó sobre linfocitos

Efectos de la colchicina e indometacina en la pulpitis producia experimentalmente en el cobayo / Effects of colchicine and indomethacine on experimentally produced pulpitis in guinea pigs

Este estudio fue realizado en cobayos machos, a los cuales se les provocó pulpitis mediante la realización de cavidades clase V en los dientes incisivos. Se les aplicó indometacina y colchicina a razón de 7 mg/kg de peso y 2 mg/kg de peso respectivamente, por vía intraperitoneal. Previa anestesia se sacrificaron a los animales infiltrando formol al 10 por ciento en el ventrículo izquierdo para la fijación de las células inflamatorias. Por medio de la disección del maxilar y mandíbula se obtuvieron los dientes incisivos y se realizaron los cortes histopatológicos correspondientes para la cuantificación de las células inflamatorias con un objetivo de 400X. Se encontró que la pulpitis tratada con indometacina se elevó contra lo esperado. Cuando se utiliza la cochicina, pese a mostrar pulpitis en menor grado que con indometacina, aumentó ésta a nivel de polimorfonucleares. La colchicina por otra parte actuó sobre histiocitos y linfocitos, por lo tanto es posible afirmar que ambos medicamentos sí bloquean el desarrollo de la pulpitis, puesto que la indometacina actuó sobre linfocitos