RESUMO
Introducción: Evaluar si, en pacientes con fractura de extremo distal del radio, los ejercicios domiciliarios realizados en una pantalla táctil de dispositivos tableta reducen el consumo de recursos presenciales y mejoran la recuperación clínica, comparado con el programa convencional de ejercicios domiciliarios prescrito en papel. Material y métodos: Ensayo clínico pragmático, multicéntrico, paralelo, de dos grupos y controlado, con evaluador cegado y análisis por intención de tratar. Reclutados cuarenta y seis pacientes con fractura de extremo distal del radio en dos hospitales del Sistema Sanitario Público de Andalucía (SSPA). Los participantes de los grupos experimental y control recibieron el mismo tratamiento de sesiones presenciales de fisioterapia. El grupo experimental recibió un programa de ejercicios domiciliario utilizando la aplicación para tableta ReHand y el grupo control recibió un programa de ejercicios domiciliario en papel. Variable principal: número de sesiones de fisioterapia registradas en la base de datos electrónica del SSPA. Variables secundarias: número de consultas de rehabilitación presenciales con un médico rehabilitador y variables clínicas como la funcionalidad, la fuerza de prensión, la destreza manual, el dolor y la amplitud de movimiento. Resultados: El grupo experimental necesitó menos sesiones de fisioterapia (DM: −16,94; IC del 95%: −32,5 a −1,38) y consultas de rehabilitación (DM: −1,7; IC del 95%: −3,39 a −0,02) en comparación con el grupo control. Conclusión: En pacientes con fractura de extremo distal del radio, la prescripción de ejercicios realizados en una pantalla táctil de dispositivos tipo tableta a través de ReHand redujo el número de sesiones de fisioterapia y de consultas de rehabilitación.(AU)
Introduction: To assess whether, in patients with distal radius fracture feedback-guided exercises performed on a tablet touchscreen reduce healthcare usage and improve clinical recovery, more than the conventional home exercise program prescribed on paper. Material and methods: A multicentre, parallel, two-group, pragmatic, controlled trial with assessor blinding and intention-to-treat analysis. Forty-six patients with distal radius fracture were recruited in Andalusian Public Health System. Participants in the experimental and control groups received the same in-patient physiotherapy sessions. Experimental group received a home exercise program using the ReHand tablet application and control group received an evidence-based home exercise program on paper. The primary outcome was the number of physiotherapy sessions tallied from hospitals data management system. Secondary outcomes included: the face-to-face rehabilitation consultations with a physiatrist, and clinical outcomes such as functional ability, grip strength, dexterity, pain intensity and range of motion. Results: The experimental group required fewer physiotherapy sessions (MD: −16.94; 95%CI: −32.5 to −1.38) and rehabilitation consultations (MD: −1.7; 95%CI: −3.39 to −0.02) compared to the control group. Conclusions: In patients with distal radius fracture, prescribing feedback-guided exercises performed on a tablet touchscreen provided by ReHand reduced number of physiotherapy sessions and rehabilitation consultations.(AU)
Assuntos
Humanos , Masculino , Feminino , /reabilitação , Telerreabilitação , Administração Financeira , Terapia por Exercício , Modalidades de Fisioterapia , Força da Mão , Reabilitação , Estudos de Casos e Controles , Punho/cirurgia , Traumatismos do PunhoRESUMO
INTRODUCTION: To assess whether, in patients with distal radius fracture feedback-guided exercises performed on a tablet touchscreen reduce healthcare usage and improve clinical recovery, more than the conventional home exercise program prescribed on paper. MATERIAL AND METHODS: A multicentre, parallel, two-group, pragmatic, controlled trial with assessor blinding and intention-to-treat analysis. Forty-six patients with distal radius fracture were recruited in Andalusian Public Health System. Participants in the experimental and control groups received the same in-patient physiotherapy sessions. Experimental group received a home exercise program using the ReHand tablet application and control group received an evidence-based home exercise program on paper. The primary outcome was the number of physiotherapy sessions tallied from hospitals data management system. Secondary outcomes included: the face-to-face rehabilitation consultations with a physiatrist, and clinical outcomes such as functional ability, grip strength, dexterity, pain intensity and range of motion. RESULTS: The experimental group required fewer physiotherapy sessions (MD: -16.94; 95%CI: -32.5 to -1.38) and rehabilitation consultations (MD: -1.7; 95%CI: -3.39 to -0.02) compared to the control group. CONCLUSIONS: In patients with distal radius fracture, prescribing feedback-guided exercises performed on a tablet touchscreen provided by ReHand reduced number of physiotherapy sessions and rehabilitation consultations.
Assuntos
Telerreabilitação , Fraturas do Punho , Humanos , Terapia por Exercício , Modalidades de Fisioterapia , Força da MãoRESUMO
Objetivo. Determinar si la densidad mineral ósea (DMO) obtenida mediante densitometría de calcáneo permite discriminar mujeres mayores de 60 años con y sin fractura de muñeca. Material y método. Estudio retrospectivo de casos-control, estableciendo como hipótesis de trabajo el mayor riesgo de fracturas distales de antebrazo, en mujeres mayores de 60 años cuya densitometría de calcáneo refleja una T-score < 0,6. Desde el uno de octubre de 2003 hasta el 31 de marzo de 2004 se atendió a 66 mujeres mayores de 60 años con fractura distal de antebrazo, constituyendo los casos-muestra del estudio. De forma aleatoria se escogieron 60 mujeres con características similares a los casos y que no habían padecido fractura alguna, constituyéndose de esta manera el grupo control. La DMO se midió mediante absorciometría dual de rayos X (DEXA) en calcáneo (PIXI). Se utilizó para ello el equipo LUNAR (modelo 30200). Resultados. La media de la DMO medida obtenida mediante densitometría de calcáneo fue de 0,368 (0,273-0,542) para los pacientes con fractura distal de antebrazo, frente a 0,472 (0,289-0,668) para los pacientes sin fractura, estableciéndose diferencias significativas (p < 0,01). El cálculo de la odds ratio reflejó un riesgo de padecer fractura distal de antebrazo en mujeres mayores de 60 años con una T-score < 0,6 obtenida mediante PIXI en calcáneo de 10,67 veces superior respecto a mujeres del mismo grupo de edad con una T-score > 0,6. Conclusiones. La DMO de calcáneo mediante DEXA permite discriminar mujeres con y sin fractura de muñeca
Purpose. To determine whether bone mineral density (BMD) measured by means of calcaneal densitometry is a reliable means of discriminating between women over 60 with and without a wrist fracture. Materials and methods. This is a case-control retrospective study that established as its working hypothesis that women over 60 with a calcaneal densitometry T-score < 0.6 are at a higher risk of sustaining distal forearm fractures. Between 1 October 2003 and 31 March 2004, 66 women older than 60 presented with a distal forearm fracture; these women constituted the sample cases of our study. Sixty women with similar characteristics to the ones mentioned but who had not sustained a fracture were randomly selected to make up the control group. BMD was measured through dual-energy x-ray absortiometry (DEXA) of the calcaneus (PIXI). A Lunar device (model 30200) was used. Results. The average BMD as measured through calcaneal densitometry was 0.368 (0.273-0.542) for patients with a distal forearm fracture, as compared with 0.472 (0.289-0.668) for patients without a fracture, which constitutes a significant difference (p < 0.01). The odds ratio revealed that the risk of sustaining a distal forearm fracture in women over 60 with a PIXI calcaneal T-score < 0.6 is 10.67 times higher than in women in the same group but with a T-score > 0.6. Conclusions. Calcaneal BMD measured by a DEXA scan is a reliable way to discriminate between women with and without a wrist fracture (AU)
