[Reliability and concurrent validity of the app Goniometer Pro vs Universal Goniometer in the determination of passive knee flexion]. / Fiabilidad y validez concurrente de la app Goniometer Pro vs goniómetro universal en la determinación de la flexión pasiva de rodilla.

BACKGROUND: Smartphones have become a fundamental part of our society, not only everyday, but also professional, since many applications have emerged for the health field. The objective of the study was to analyze the reliability and concurrent validity of an app for iPhone in relation to traditional measurement. MATERIAL AND METHODS: A non-experimental, double-blind validation and descriptive study. On a sample of 21 subjects, four measurements of knee mobility were performed. Two using universal goniometer (GU) and two through the application Goniometer-Pro (G-Pro) for IPhone. The X-ray was used as a reference measure of the knee flexion angle and was analyzed by a single evaluator who compared this result with that of the other evaluators. RESULTS: The difference between the average intra-group values was 3.148o (± 2.669o) for GU and 2.476o (± 2.638o) for G-Pro. The inter-group mean difference reached 5.45o. The Inter-observer reliability was 0.990 for GU and 0.993 for G-Pro; as for validity, the values obtained were 0.976 for GU and 0.992 for G-Pro. CONCLUSIONS: The G-Pro app is a reliable tool with a high accuracy to measure the knee flexion angle. Its results are slightly superior and more accurate to those of traditional instruments.

ANTECEDENTES: Los teléfonos inteligentes se han convertido en una parte fundamental de nuestra sociedad, no sólo cotidiana, sino también profesional, pues han surgido numerosas aplicaciones para el ámbito sanitario. El objetivo del estudio fue analizar la fiabilidad y validez concurrente de una app para iPhone en relación con la goniometría tradicional. MATERIAL Y MÉTODOS: Estudio comparativo y descriptivo de validación no experimental a doble ciego. En una muestra de 21 sujetos se realizaron cuatro mediciones de movilidad de rodilla: dos mediante goniometría universal (GU) y dos mediante la aplicación Goniometer-Pro (G-Pro) para iPhone. La radiografía se empleó como medida de referencia del ángulo de flexión de rodilla y fue analizada por un único evaluador que comparó este resultado con el de los otros evaluadores. RESULTADOS: La diferencia entre los valores medios intragrupos fue de 3.148o (± 2.669o) para GU y 2.476o (± 2.638o) para G-Pro. La diferencia de medias intergrupos alcanzó 5.45o. La fiabilidad interobservador fue de 0.990 para GU y 0.993 para G-Pro; en cuanto a la validez, los valores obtenidos fueron 0.976 para GU y 0.992 para G-Pro. CONCLUSIONES: La app G-Pro es una herramienta fiable y con una elevada exactitud para medir el ángulo de flexión de la rodilla. Sus resultados son ligeramente superiores y más precisos a los de la goniometría tradicional.

[Top-down and bottom-up approaches for the treatment of unilateral spatial neglect in stroke patients: A systematic review]. / Enfoques top-down y bottom-up para el tratamiento de la heminegligencia espacial en sujetos con ictus: revisión sistemática.

OBJECTIVE: To evaluate the effectiveness of top-down and bottom-up approaches in the rehabilitation of unilateral spatial neglect in stroke patients. METHODOLOGY: We carried out a systematic review of randomized controlled trials from January of 2013 to March of 2017. The following databases were searched: Scopus, Science Direct, Web of Science, Pubmed and CINHAL. The methodological quality, level of scientific evidence and the strength of recommendation were evaluated. RESULTS: We included 13 studies (294 subjects): nine studies (188 patients) carried out therapies with a bottom-up approach such us eye patching, virtual reality, optokinetic stimulation, transcranial magnetic stimulation and prism adaption; three studies (94 patients) evaluated therapies with a top-down approach such us visual scanning, sensory feedback and mental practice; one study incorporated both approaches. Nine of these studies showed improvements in spatial neglect scales; five of these used bottom-up approaches, another three used top-down approaches and the remaining study combined both approaches. Disability was evaluated by nine studies, and only three reported improvements. Three studies reported significant improvements in motor function in the intervention groups. CONCLUSIONS: Top-down and bottom-up approaches could improve unilateral spatial neglect, disability and motor function in patients with stroke.

Enfoques top-down y bottom-up para el tratamiento de la heminegligencia espacial en sujetos con ictus: revisión sistemática / Top-down and bottom-up approaches for the treatment of unilateral spatial neglect in stroke patients: a systematic review

Objetivo: Evaluar la efectividad de los enfoques top-down (de arriba abajo) y bottom-up (de abajo arriba) en el tratamiento de la heminegligencia espacial en pacientes con ictus. Metodología: Se llevó a cabo una revisión sistemática de la literatura en busca de ensayos controlados y aleatorizados desde enero de 2013 hasta marzo de 2017. Se emplearon las siguientes bases de datos: Scopus, Science Direct, Web of Science, Pubmed y CINHAL. Se evaluaron la calidad metodológica, el nivel de evidencia científica y el grado de recomendación. Resultados: Se incluyeron 13 estudios (294 sujetos): nueve trabajos analizaron técnicas con enfoques bottom-up (188 participantes) como parches oculares, realidad virtual, estimulación optocinética, estimulación magnética transcraneal o adaptación al prisma; tres ensayos evaluaron procedimientos con un enfoque top-down (94 participantes) como escaneo visual, retroalimentación sensorial y práctica mental; y un estudio incorporó ambos enfoques. Nueve trabajos refirieron mejoras en escalas que evaluaban la heminegligencia espacial, cinco basándose en procedimientos bottom-up, tres utilizando técnicas top-down y uno de ellos combinando ambos enfoques. La discapacidad fue evaluada en nueve de los estudios, describiendo solo tres cambios positivos. Tres trabajos mostraron mejoras significativas en la función motora en los grupos de intervención. Conclusión: Los enfoques bottom-up y top-down podrían mejorar la heminegligencia espacial, la discapacidad y la función motora en sujetos con ictus

Objective: To evaluate the effectiveness of top-down and bottom-up approaches in the rehabilitation of unilateral spatial neglect in stroke patients. Methodology: We carried out a systematic review of randomized controlled trials from January of 2013 to March of 2017. The following databases were searched: Scopus, Science Direct, Web of Science, Pubmed and CINHAL. The methodological quality, level of scientific evidence and the strength of recommendation were evaluated. Results: We included 13 studies (294 subjects): nine studies (188 patients) carried out therapies with a bottom-up approach such us eye patching, virtual reality, optokinetic stimulation, transcranial magnetic stimulation and prism adaption; three studies (94 patients) evaluated therapies with a top-down approach such us visual scanning, sensory feedback and mental practice; one study incorporated both approaches. Nine of these studies showed improvements in spatial neglect scales; five of these used bottom-up approaches, another three used top-down approaches and the remaining study combined both approaches. Disability was evaluated by nine studies, and only three reported improvements. Three studies reported significant improvements in motor function in the intervention groups. Conclusions: Top-down and bottom-up approaches could improve unilateral spatial neglect, disability and motor function in patients with stroke

Fiabilidad y validez concurrente de la app Goniometer Pro vs goniómetro universal en la determinación de la flexión pasiva de rodilla / Reliability and concurrent validity of the app Goniometer Pro vs Universal Goniometer in the determination of passive knee flexion

Resumen: Antecedentes: Los teléfonos inteligentes se han convertido en una parte fundamental de nuestra sociedad, no sólo cotidiana, sino también profesional, pues han surgido numerosas aplicaciones para el ámbito sanitario. El objetivo del estudio fue analizar la fiabilidad y validez concurrente de una app para iPhone en relación con la goniometría tradicional. Material y métodos: Estudio comparativo y descriptivo de validación no experimental a doble ciego. En una muestra de 21 sujetos se realizaron cuatro mediciones de movilidad de rodilla: dos mediante goniometría universal (GU) y dos mediante la aplicación Goniometer-Pro (G-Pro) para iPhone. La radiografía se empleó como medida de referencia del ángulo de flexión de rodilla y fue analizada por un único evaluador que comparó este resultado con el de los otros evaluadores. Resultados: La diferencia entre los valores medios intragrupos fue de 3.148o (± 2.669o) para GU y 2.476o (± 2.638o) para G-Pro. La diferencia de medias intergrupos alcanzó 5.45o. La fiabilidad interobservador fue de 0.990 para GU y 0.993 para G-Pro; en cuanto a la validez, los valores obtenidos fueron 0.976 para GU y 0.992 para G-Pro. Conclusiones: La app G-Pro es una herramienta fiable y con una elevada exactitud para medir el ángulo de flexión de la rodilla. Sus resultados son ligeramente superiores y más precisos a los de la goniometría tradicional.

Abstract: Background: Smartphones have become a fundamental part of our society, not only everyday, but also professional, since many applications have emerged for the health field. The objective of the study was to analyze the reliability and concurrent validity of an app for iPhone in relation to traditional measurement. Material and methods: A non-experimental, double-blind validation and descriptive study. On a sample of 21 subjects, four measurements of knee mobility were performed. Two using universal goniometer (GU) and two through the application Goniometer-Pro (G-Pro) for IPhone. The X-ray was used as a reference measure of the knee flexion angle and was analyzed by a single evaluator who compared this result with that of the other evaluators. Results: The difference between the average intra-group values was 3.148o (± 2.669o) for GU and 2.476o (± 2.638o) for G-Pro. The inter-group mean difference reached 5.45o. The Inter-observer reliability was 0.990 for GU and 0.993 for G-Pro; as for validity, the values obtained were 0.976 for GU and 0.992 for G-Pro. Conclusions: The G-Pro app is a reliable tool with a high accuracy to measure the knee flexion angle. Its results are slightly superior and more accurate to those of traditional instruments.

Evaluación y mejora de la calidad asistencial en fisioterapia a pacientes con cefalea / Evaluation and improvement of healthcare quality in patients with headache attending physical theray

Fundamento: Evaluar el efecto de un ciclo de mejora en la atención a pacientes con cefalea en dos centros de Fisioterapia sobre la calidad asistencial y su asociación con la satisfacción percibida y su mejora clínica. Métodos: Para medir la calidad asistencial se observó el cumplimiento de quince criterios de calidad en las historias clínicas de todos los pacientes con diagnóstico de cefalea tensional, cervicogénica o migraña en dos centros de Fisioterapia entre 2010 y 2014. En 2015, tras introducir en uno de los centros (C1) medidas correctivas, se reevaluó la calidad asistencial en ambos centros, usando el otro como control (C2). Resultados: En la primera evaluación, en ambos centros se observó un número muy elevado de incumplimientos en todos los criterios. Tras el ciclo de mejora, en el C1 hubo un aumento significativo en el cumplimiento de los criterios de calidad, como la entrega de un calendario de cefalea, que pasó del 0% a un 100% de cumplimiento, o el uso de la escala HIT-6, que pasó del 30 a un 100%, Asimismo, hubo una mejor valoración en la calidad percibida por el paciente en el C1 respecto al C2, incluyendo una mejora en el estado de salud. Conclusiones: El uso de la metodología de mejora de la calidad, con iniciativa interna, obtuvo mejoras significativas tanto en la calidad de la atención prestada como en la percepción que tienen los usuarios de los servicios de fisioterapia, así como en la salud de los pacientes

Background: To evaluate the effects on healthcare quality following implementation of a program to improve care for individuals with headache in two physical therapy clinics and its association with outcomes and self-perceived improvement. Methods: We assessed healthcare quality by creating a questionnaire on fulfilment of fifteen quality criteria included in the clinical history of individuals suffering from tension-type, cervicogenic or migraine headaches seeking physical therapy between 2010 and 2014. In 2015, after applying a program to improve care in one center (C1), we reassessed the same fulfilment questionnaire in both centers, using the other center (C2) as control. Results: In the first evaluation there was a huge number of cases of non-compliance of all the criteria in both centers. After implementation of the care improvement program in C1 a significant improvement was observed in some items, as use of a headache diary, which rose from 0 to 100%, or use of the HIT-6 disability questionnaire, which rose from 30 to 100%. In addition, there was a significant improvement in self-perceived health status after implementation of the care program in C1. Conclusions: The implementation of a care improvement program was effective in improving healthcare quality for individuals with headache attending physical therapy services

[Evaluation and improvement of healthcare quality in patients with headache attending physical therapy]. / Evaluación y mejora de la calidad asistencial en fisioterapia a pacientes con cefalea.

BACKGROUND: To evaluate the effects on healthcare quality following implementation of a program to improve care for individuals with headache in two physical therapy clinics and its association with outcomes and self-perceived improvement. METHODS: We assessed healthcare quality by creating a questionnaire on fulfilment of fifteen quality criteria included in the clinical history of individuals suffering from tension-type, cervicogenic or migraine headaches seeking physical therapy between 2010 and 2014. In 2015, after applying a program to improve care in one center (C1), we reassessed the same fulfilment questionnaire in both centers, using the other center (C2) as control. RESULTS: In the first evaluation there was a huge number of cases of non-compliance of all the criteria in both centers. After implementation of the care improvement program in C1 a significant improvement was observed in some items, as use of a headache diary, which rose from 0 to 100%, or use of the HIT-6 disability questionnaire, which rose from 30 to 100%. In addition, there was a significant improvement in self-perceived health status after implementation of the care program in C1. CONCLUSIONS: The implementation of a care improvement program was effective in improving healthcare quality for individuals with headache attending physical therapy services.

[Neurophysiological advances in carpal tunnel syndrome: process of central sensitisation or local neuropathy]. / Avances neurofisiologicos en el sindrome del tunel del carpo: proceso de sensibilizacion central o neuropatia local.

INTRODUCTION: Carpal tunnel syndrome (CTS) is considered a simple entrapment of the median nerve at the carpal tunnel. In the last years, several studies have demonstrated the presence of peripheral and central sensitization mechanisms. AIM: To review the basis neurophysiology of peripheral and central sensitization by applying them to CTS and to determine their clinical repercussions. DEVELOPMENT: Several studies have revealed that patients with CTS exhibit somato-sensory changes in areas innervated by the median nerve and also in areas non-related with the median nerve. Individuals with CTS exhibited widespread mechanical and thermal pain hyperalgesia, although they suffered from unilateral symptoms. Further, patients also showed wide-spread impairments in vibration conduction, deficits in fine motor control and changes in the somato-sensory cortex. These evidences support the presence of a complex process of peripheral and central sensitization in patients with CTS which may constitute a negative prognosis factor for the management of these patients. CONCLUSIONS: The advances in neurosciences in the last years support the presence of peripheral and central sensitization mechanisms in CTS. These mechanisms justify the necessity of conceptual changes and in the management, both conservative and surgical, of this syndrome. Additionally, central sensitization can also play a relevant role in the prognosis of CTS since it can constitute a negative prognosis factor for its treatment.

[Characterisation of pain in patients with carpal tunnel syndrome according to electromyographic severity criteria]. / Caracterizacion del dolor en pacientes con sindrome del tunel del carpo segun criterios electromiograficos de gravedad.

INTRODUCTION: The symptoms of carpal tunnel syndrome (CTS) vary greatly and can depend on the severity of the clinical symptoms. AIMS: To characterise the description and self-perception of pain in a sample of patients with CTS and to determine whether that perception of pain differs among the patients on the basis of electrodiagnostic severity criteria. PATIENTS AND METHODS: The sample consisted of 92 females with CTS, who were classified as having mild, moderate or severe CTS, bearing in mind electrodiagnostic criteria. Different instruments were used in the study: a numerical scale (0-10) to evaluate the intensity of the pain, the McGill questionnaire to classify the descriptors that represent the quality of the pain, and the Boston questionnaire for assessing symptom severity and disability. RESULTS: The most representative descriptors were the presence of tingling (92%), heaviness (67%) and a feeling of swelling (64%). The women with mild CTS showed a longer history of pain than those with moderate and severe CTS (p < 0.05). There were no significant differences among the intensity of the pain, the disability questionnaire and most of the descriptors on the McGill questionnaire between the different groups of mild, moderate or severe CTS. The women with severe CTS described the pain as being periodic, repetitive and terribly unpleasant more often than those with mild or moderate CTS (p < 0.05). CONCLUSIONS: The presence of tingling and the feeling of heaviness are the most prevalent symptoms of CTS. There are no great differences in the quality of the pain among cases of mild, moderate or severe CTS.