Evolución del dolor en pacientes con sensibilización central y artrosis tras artroplastia de rodilla / Pain evolution in patients with central sensitization and osteoarthritis after knee arthroplasty

Introducción: En pacientes con artrosis de rodilla se ha identificado un 30% de asociación de dolor de sensibilización central (DSC). El objetivo es analizar la persistencia de DSC en pacientes tras artroplastia de rodilla y su correlación con la intensidad del dolor, funcionalidad y los factores determinantes asociados, además de evaluar la exploración física como instrumento de valoración. Material y métodos: Estudio cuasiexperimental antes-después de pacientes intervenidos de artroplastia total de rodilla. Se analiza la evolución de variables subjetivas (características del dolor, cuestionarios painDETECT, WOMAC y escala visual numérica) y de exploración física (hiperalgesia térmica, alodinia, hipoestesia, algometría y goniometría), tres meses antes y tres y seis meses después de la cirugía mediante el test de ANOVA de medidas repetidas para las cuantitativas y el Q de Cochran para las cualitativas. Se utilizó la prueba de Spearman para la correlación de los cuestionarios, del PD-Q y variables de exploración y para el modelo multivariante del PD-Q con determinantes clínicos. Resultados: Sesenta y siete pacientes completaron el estudio. La evolución de las variables cuantitativas y cualitativas fue significativa, con correlación entre cuestionarios. En el modelo multivariante lineal de PD-Q se obtuvo relación significativa de antecedentes de limitación movilidad en flexión, dolor musculoesquelético crónico y la asociación de depresión y tiempo. Conclusiones: Un porcentaje significativo de pacientes con artrosis de rodilla tras artroplastia persistieron con probable DSC, correlacionándose con intensidad y funcionalidad. La limitación de movilidad y comorbilidad crónica previas podrían ser determinantes de DSC, siendo la exploración y anamnesis, herramientas útiles en consulta.(AU)

IntroductionIn patients with knee osteoarthritis, a group of 30% has been identified with central pain sensitization (CPS). The aim is to analyze the persistence of CPS in patients after knee arthroplasty and its correlation with pain intensity, functionality, determining factors and to evaluate physical examination as an assessment instrument.Material and methodsQuasi-experimental before–after study of patients operated on total knee arthroplasty. The evolution of subjective variables (pain characteristics, painDETECT questionnaire, WOMAC and Numerical Rating Scale) and physical examination (thermal hyperalgesia, allodynia, hypoesthesia, algometry and goniometry) 3 months before and 3 and 6 months after surgery are analysed using repeated measures ANOVA test for the quantitative ones and Cochran's Q for the qualitative ones. Spearmen test was used for the correlation of the questionnaires, the PD-Q and exploration variables and for the multivariate model of the PD-Q with clinical determinants. Results: Sixty-seven patients completed the study. The evolution of the quantitative and qualitative variables was significant, with a correlation between questionnaires. In the linear multivariate model of PD-Q, a significant relationship was obtained from personal history of flexion limitation, chronic musculoskeletal pain and the association between depression and time. Conclusions: A significant percentage of patients with knee osteoarthritis after arthroplasty persisted with probable CPS, correlating with intensity and functionality. The limitation of mobility and previous chronic comorbidity could be determinants of CPS, with anamnesis and exploration being useful tools in consultation.(AU)

[Pain evolution in patients with central sensitization and osteoarthritis after knee arthroplasty]. / Evolución del dolor en pacientes con sensibilización central y artrosis tras artroplastia de rodilla.

INTRODUCTION: In patients with knee osteoarthritis, a group of 30% has been identified with central pain sensitization (CPS). The aim is to analyze the persistence of CPS in patients after knee arthroplasty and its correlation with pain intensity, functionality, determining factors and to evaluate physical examination as an assessment instrument. MATERIAL AND METHODS: Quasi-experimental before-after study of patients operated on total knee arthroplasty. The evolution of subjective variables (pain characteristics, painDETECT questionnaire, WOMAC and Numerical Rating Scale) and physical examination (thermal hyperalgesia, allodynia, hypoesthesia, algometry and goniometry) 3 months before and 3 and 6 months after surgery are analysed using repeated measures ANOVA test for the quantitative ones and Cochran's Q for the qualitative ones. Spearmen test was used for the correlation of the questionnaires, the PD-Q and exploration variables and for the multivariate model of the PD-Q with clinical determinants. RESULTS: Sixty-seven patients completed the study. The evolution of the quantitative and qualitative variables was significant, with a correlation between questionnaires. In the linear multivariate model of PD-Q, a significant relationship was obtained from personal history of flexion limitation, chronic musculoskeletal pain and the association between depression and time. CONCLUSIONS: A significant percentage of patients with knee osteoarthritis after arthroplasty persisted with probable CPS, correlating with intensity and functionality. The limitation of mobility and previous chronic comorbidity could be determinants of CPS, with anamnesis and exploration being useful tools in consultation.

[Percutaneous tibial nerve stimulation in urge urinary incontinence: A prospective study]. / Estimulación percutánea del nervio tibial en la incontinencia urinaria de urgencia: estudio prospectivo.

OBJECTIVE: To assess the efficacy of percutaneous tibial nerve stimulation and its effectiveness over time in urge urinary incontinence. MATERIALS AND METHODS: We performed a longitudinal, observational, prospective study without a control group that included patients diagnosed with urge urinary incontinence who met the inclusion/exclusion criteria. Patients were treated with 12 sessions of percutaneous tibial nerve stimulation by electroacupuncture. Baseline and post-treatment data were collected from medical records. Patients were assessed by a telephone interview after the treatment. The variables studied were sociodemographic variables, time until interview, the Sandvick and ICIQ-SF questionnaires, daytime urinary frequency, night-time urinary frequency, use of absorbent material and drug treatment. A descriptive analysis of the variables was performed and patient outcomes were analysed with generalised linear mixed models by SPSS v. 25 statistics software. RESULTS: A total of 32 women were included (mean age 58.69±8.96). All variables significantly improved after treatment: Sandvick by 4.38 points (95% CI: 2.68-6.08, P<.001), ICIQ-SF by 8.55 points (95% CI: 5.89-11.22, P<.001), daytime urinary frequency by 2.10 points (95% CI: 1.04-3.16, P<.001) and night-time urinary frequency by 1.31 points (95%CI: 0.58-2.04, P<.001). However, 16.34±9.72 months after treatment, these improvements diminished but without reaching baseline levels. CONCLUSIONS: Percutaneous tibial nerve stimulation by electroacupuncture is effective for the treatment of urge urinary incontinence. Although its effect diminishes over time, the improvement over the baseline situation is maintained during the follow-up period.

El registro de los diagnósticos enfermeros en cuidados paliativos. Revisión sistemática de la literatura castellana / No disponible

Objetivos: el objetivo principal de esta revisión es conocer los diagnósticos enfermeros relacionados con cuidados paliativos a través de la revisión electrónica y manual de trabajos publicados. Material y métodos: revisión sistemática de la literatura basada en la búsqueda bibliográfica electrónica y manual de artículos escritos en castellano que relacionen diagnósticos de enfermería con cuidados paliativos. Las bases de datos consultadas fueron BDENF y Cuiden y las palabras claves utilizadas fueron NANDA, diagnósticos enfermería y paliativos. En la búsqueda manual, se revisaron las comunicaciones y ponencias presentadas en los congresos nacionales de cuidados paliativos y las publicaciones en la revista Medicina Paliativa desde enero de 2004 hasta diciembre de 2009. Resultados: se seleccionaron 8 trabajos que cumplían con los criterios de inclusión: 3 descriptivos, 2 comunicaciones pósteres y 3 ponencias en congresos. Se excluyeron 2 estudios. Se describen las características principales de cada uno de los trabajos. Todos ellos concluyen con un listado de diagnósticos enfermeros prevalentes para utilizar en los planes de cuidados aplicables en diferentes niveles asistenciales (domicilio, unidad de cuidados paliativos o ambos). Conclusiones: el escaso número de trabajos, las limitaciones propias de los artículos retrospectivos y el bajo número de registros de pacientes incluidos, no permiten interpretar como definitivos estos resultados. Todos los autores tienen la clara intención de realizar una lista con los diagnósticos más prevalentes en cuidados paliativos oscilando en número desde 9 hasta 14. La suma de diagnósticos hace referencia tanto a la esfera física (21 de 35), emocional (9 de 35), sociofamiliar (3/35) y espiritual (2 de 35). En conjunto, por tanto, estos trabajos responden a la visión multidimensional propia de los cuidados paliativos (AU)

Objectives: the main objective of this review was to know the nursing diagnoses related to palliative care through the electronic and manual review of published relevant papers. Material and methods: a systematic review of the literature based on an electronic and manual bibliographical search of Spanish written papers relating nursing diagnoses and palliative care. The searched databases were BDENF and Cuiden. Key words inc1uded NANDA, nursing diagnoses, and palliative. On the manual search, oral communications and major Spanish palliative care meetings were reviewed, Papers published in the Medicina Paliativa journal from January 2004 to December 2009 were reviewed too. Results: eight papers according to the inclusion criteria were selected: 3 of them were descriptive, 2 were poster communications, and 3 were plenary session proceedings. Two papers were excluded. The main characteristics of each paper are described. All papers include a list of prevalent nursing diagnoses to be used in care plans with application at all levels (home, palliative care unit or both). Conclusions: we cannot take these results as definitive due to the limitations of retrospective papers, the small number of studies found, and the small number of patients included. The authors have a clear aim of making a checklist (9 to 14 diagnoses) with the most prevalent diagnoses in palliative care. The diagnoses recorded refer to the physical (21 of 35), emotional (9 of 35), social and family (3 of 35), and spiritual (2 of 35) domains. Regarding the papers included, they provide an overview of the multidimensional approach required in palliative care (AU)

Calidad de vida y cuidados paliativos: ¿qué dimensiones podemos mejorar? / No disponible

Objetivo: conocer si la intervención de un equipo de soporte hospitalario (UFISS), mejora la calidad de vida de los pacientes atendidos según la escala Palliative Outcome Scale (POS). Sujetos y método: estudio prospectivo mediante la aplicación de la escala POS al ingreso y alta de los pacientes atendidos por el equipo de Cuidados Paliativos del Hospital Universitario Arnau de Vilanova entre octubre 2006 y enero 2007. Criterios exclusión: sólo una sola valoración; intervención inferior a cinco días; pacientes en situación agónica; evaluaciones con falta de datos. Otras variables estudiadas: edad, sexo y servicio de procedencia. Análisis estadístico con test no paramétrica de la U de Mann-Whitney y diferencia antes y después con test de signos de Wilcoxon. Significación de p < 0,05. Resultados: de los 115 pacientes valorados, 50 cumplían los criterios de inclusión. El 60% eran hombres. Media de edad de 67,5 años (16). Los pacientes provenían de servicios médicos (86%). El resultado global del POS mejora de forma significativa tras la intervención de la UFISS(p < 0,05). También mejoran: dolor (p < 0,01), otros síntomas (p < 0,05),información (p < 0,05), tiempo perdido con tratamientos (p < 0,05), y la manera en cómo se han abordado los asuntos pendientes (p < 0,05). Corregido cada ítem del POS por sexo, edad (menor y mayor de 70 años) y servicio que los deriva, encontramos que los resultados son similares, exceptuando el caso de paciente > 70 años, en los cuales mejora significativamente su nivel de angustia. Conclusiones: la intervención del equipo de UFISS de Cuidados Paliativos mejora significativamente la calidad de vida de los pacientes atendidos. Las áreas que mejoran son el dolor, otros síntomas, la información, el tiempo perdido y la forma de tratar los asuntos pendientes (AU)

Objective: to describe whether an intervention by a Palliative Care Supportive Team in a University Hospital can improve quality of life (QL)as assessed by the Palliative Outcome Scale (POS). Patients and methods: a longitudinal, prospective survey using POS during the first visit and at discharge in all patients treated by our palliative care team (October 2006 to January 2007). Exclusion criteria:1) patients with only one assessment, (survival less than 1 week or first assessment prior to the study period). 2) Assessments with any missing data. 3) Patients in their last hours of life. 4) Assessments with missing data. Other variables we analyzed were: age, sex, and referring department. For patient analyses by groups we used the Mann-Whitney non parametrical U-test, and to establish differences before and after the intervention we used Wilcoxon's test. The level of significance we used was p < 0.05. Results: during the study, of all 115 newly treated patients, 50 were selected for the analysis; 60% were men, average age was 67.5; 86% were referred by medical specialists. Global POS improvement was significant after the palliative care intervention (p < 0.05). The dimensions that improved most were: pain (p < 0.01); other symptoms (p < 0.05); information(p < 0.05), wasted time (p < 0.05), and the way problems were resolved(p < 0.05). A POS analysis by sex, age (younger or older than 70), and ward of origin showed no differences except for anxiety, which improved especially among patients over 70, even though this item did not affect final results. Conclusions: a) a palliative care intervention by a supportive team improves QL for patients; and b) pain, other symptoms, information, waste of time, and the way outstanding matters were dealt with are the QL dimensions that improved most (AU)