Efectividad de la inhibición suboccipital combinada con corriente interferencial en pacientes con cefalea tensional crónica: un ensayo clínico controlado aleatorizado / Effectiveness of suboccipital muscle inhibition combined with interferential current in patients with chronic tension-type headache: a randomised controlled clinical trial

Introducción: Se ha demostrado que la terapia manual reduce los síntomas autoreportados en pacientes con cefalea tensional crónica (CTC). Sin embargo, la aplicación simultánea de la técnica de inhibición muscular suboccipital y corriente interferencial no se ha investigado previamente. Este estudio evalúa la efectividad de la inhibición muscular suboccipital y la corriente interferencial en comparación con los cuidados habituales sobre el dolor, la discapacidad y el impacto de la cefalea en pacientes con CTC.MétodosLos pacientes se asignaron al azar al grupo de cuidados habituales (n = 13) o experimental (n = 12) que consistió en 20 minutos de inhibición muscular suboccipital y corriente interferencial dos veces por semana durante cuatro semanas. El resultado primario fue el dolor, y los resultados secundarios incluyeron la discapacidad producida por el dolor de cabeza y el impacto del dolor de cabeza que se valoraron por un evaluador cegado al inicio y después de cuatro semanas.ResultadosLos análisis mostraron diferencias entre los grupos a favor del grupo experimental a las cuatro semanas para la discapacidad producida por el dolor de cabeza (Neck Disability Index: g-Hedges = 1,01; p = 0,001; Headache Disability Inventory: g-Hedges = 0,48; p = 0,022) e impacto del dolor de cabeza (HIT-6: g-Hedges = 0,15; p = 0,037) pero no para el dolor autoreportado (Numerical Rating Scale: g-Hedges = 1,13; p = 0,18).ConclusionesLa aplicación simultánea de inhibición muscular suboccipital y corriente interferencial en pacientes con CTC no reduce significativamente el dolor autoreportado a las cuatro semanas. Sin embargo, mejora la discapacidad y el impacto del dolor de cabeza en la vida diaria. Estas mejoras superaron el mínimo cambio clínicamente importante de las mediciones, destacando su relevancia clínica. (AU)

Introduction: Manual therapy has been shown to reduce self-reported symptoms in patients with chronic tension-type headache (CTTH). However, simultaneous application of suboccipital muscle inhibition and interferential current has not previously been investigated. This study evaluates the effectiveness of combined treatment with suboccipital muscle inhibition and interferential current compared to standard treatment for pain, disability, and headache impact in patients with CTTH.MethodsPatients were randomly allocated to receive either standard treatment (n = 13) or the experimental treatment (n = 12), consisting of 20 minutes of suboccipital muscle inhibition plus interferential current twice weekly for 4 weeks. The primary outcome was improvement in pain, and secondary outcomes included improvement in headache-related disability and reduction in headache impact, which were assessed at baseline and at 4 weeks by a blinded rater.ResultsStatistical analysis showed improvements in the experimental treatment group at 4 weeks for headache-related disability (Neck Disability Index: Hedges’ g = 1.01, P = .001; and Headache Disability Inventory: Hedges’ g = 0.48, P = .022) and headache impact (6-item Headache Impact Test: Hedges’ g = 0.15, P = .037) but not for self-reported pain (numerical rating scale: Hedges’ g = 1.13, P = .18).ConclusionsCombined treatment with suboccipital muscle inhibition and interferential current in patients with CTTH did not significantly improve self-reported pain but did reduce disability and the impact of headache on daily life at 4 weeks. These improvements exceed the minimum clinically important difference, demonstrating the clinical relevance of our findings. (AU)

Effectiveness of suboccipital muscle inhibition combined with interferential current in patients with chronic tension-type headache: a randomised controlled clinical trial.

INTRODUCTION: Manual therapy has been shown to reduce self-reported symptoms in patients with chronic tension-type headache (CTTH). However, simultaneous application of suboccipital muscle inhibition and interferential current has not previously been investigated. This study evaluates the effectiveness of combined treatment with suboccipital muscle inhibition and interferential current compared to standard treatment for pain, disability, and headache impact in patients with CTTH. METHODS: Patients were randomly allocated to receive either standard treatment (n = 13) or the experimental treatment (n = 12), consisting of 20 minutes of suboccipital muscle inhibition plus interferential current twice weekly for 4 weeks. The primary outcome was improvement in pain, and secondary outcomes included improvement in headache-related disability and reduction in headache impact, which were assessed at baseline and at 4 weeks by a blinded rater. RESULTS: Statistical analysis showed improvements in the experimental treatment group at 4 weeks for headache-related disability (Neck Disability Index: Hedges' g = 1.01, P = .001; and Headache Disability Inventory: Hedges' g = 0.48, P = .022) and headache impact (6-item Headache Impact Test: Hedges' g = 0.15, P = .037) but not for self-reported pain (numerical rating scale: Hedges' g = 1.13, P = .18). CONCLUSIONS: Combined treatment with suboccipital muscle inhibition and interferential current in patients with CTTH did not significantly improve self-reported pain but did reduce disability and the impact of headache on daily life at 4 weeks. These improvements exceed the minimum clinically important difference, demonstrating the clinical relevance of our findings.

Effectiveness of suboccipital muscle inhibition combined with interferential current in patients with chronic tension-type headache: a randomised controlled clinical trial. / Efectividad de la inhibición suboccipital combinada con corriente interferencial en pacientes con cefalea tensional crónica: un ensayo clínico controlado aleatorizado.

INTRODUCTION: Manual therapy has been shown to reduce self-reported symptoms in patients with chronic tension-type headache (CTTH). However, simultaneous application of suboccipital muscle inhibition and interferential current has not previously been investigated. This study evaluates the effectiveness of combined treatment with suboccipital muscle inhibition and interferential current compared to standard treatment for pain, disability, and headache impact in patients with CTTH. METHODS: Patients were randomly allocated to receive either standard treatment (n = 13) or the experimental treatment (n = 12), consisting of 20 minutes of suboccipital muscle inhibition plus interferential current twice weekly for 4 weeks. The primary outcome was improvement in pain, and secondary outcomes included improvement in headache-related disability and reduction in headache impact, which were assessed at baseline and at 4 weeks by a blinded rater. RESULTS: Statistical analysis showed improvements in the experimental treatment group at 4 weeks for headache-related disability (Neck Disability Index: Hedges' g = 1.01, P = .001; and Headache Disability Inventory: Hedges' g = 0.48, P = .022) and headache impact (6-item Headache Impact Test: Hedges' g = 0.15, P = .037) but not for self-reported pain (numerical rating scale: Hedges' g = 1.13, P = .18). CONCLUSIONS: Combined treatment with suboccipital muscle inhibition and interferential current in patients with CTTH did not significantly improve self-reported pain but did reduce disability and the impact of headache on daily life at 4 weeks. These improvements exceed the minimum clinically important difference, demonstrating the clinical relevance of our findings.

Análisis ecográfico de las modificaciones en la velocidad del flujo sanguíneo en la arteria vertebral producidas por el movimiento de rotación cervical máxima / Ultrasonography analysis of vertebral artery blood flow velocity changes on produced by the maximal cervical rotation

Objetivos Los test premanipulativos para la insuficiencia vertebrobasilar (TPIBV) suelen incorporar la rotación cervical para comprobar la solvencia de las arterias vertebrales (AV), aunque las investigaciones acerca del efecto de la rotación en el flujo de la AV discrepan y arrojan dudas en cuanto a la validez de las pruebas. Como un primer paso en esta línea el objetivo fue comprobar el efecto de la rotación cervical en los parámetros hemodinámicos de la AV en sujetos sanos. Material y método Se contó con 10 mujeres voluntarias sanas de 18 a 23 años (media: 20,3; DT: 1,64 años) a las que se le realizaron ecografías Doppler bilaterales en el segmento de la AV suboccipital (AV3) en la posición de rotación neutra, contralateral y homolateral. Se calcularon la velocidad del pico sistólico (VPS), velocidad del pico diastólico (VPD), velocidad media (VM) e índice de resistencia (IR). Los datos se analizaron con una ANOVA de medidas repetidas y las comparaciones se realizaron con la corrección de Bonferroni (SPSS v15.0; IC del 95%).Resultados No se detectaron diferencias estadísticamente significativas en cuanto a la lateralidad y la rotación cervical ni en VPS (FVPS=0,935; p=0,47) ni en VPD (FVPD=1,067; p=0,39), ni en VM (FVM=1,172; p=0,34), ni en IR (FIR=1,183; p=0,33). Debe destacarse la baja potencia de los análisis (entre el 30 y el 38%) por lo que la ausencia de diferencias debe considerarse con precaución. Conclusiones Los parámetros hemodinámicos de la AV no se modificaron en sujetos sanos con las rotaciones cervicales, cuestión que debe ser investigada en sujetos con insuficiencia vertebrobasilar (AU)

Objectives The pre-manipulative vertebrobasilar insufficiency tests (PVBIT) generally incorporate cervical rotation to verify the solvency of the vertebral arteries (VA). However, research on the effect of rotation on VA blood flow differ and question the validity of the tests. The first aim of this study was to verify the effect of cervical rotation on the hemodynamic parameters of the VAs in healthy subjects. Material and method Ten healthy female volunteers, aged 18 to 23 years (mean: 20.3, SD: 1.64 years), were subjected to bilateral Doppler ultrasonographies over the suboccipital segment of the AV (AV3) with neutral, contralateral and ipsilateral cervical rotation positions. We calculated peak systolic velocity (PSV), peak diastolic velocity (PDV), mean velocity (MV) and resistance index (RI). The data were analyzed with repeated measures ANOVA and comparisons were made with Bonferroni correction (SPSS v15.0, C.I. 95%).Results No statistically significant differences were detected regarding lateralization or rotation in the values of PSV (FPSV=0.935, P=.47), or PDV (FPDV=1.067, P=.39), or MV (FMV=1.172, P=.34), or RI (FRI=1.183, P=.33). The low power of analysis (between 30 and 38%) should be noted and thus the absence of differences should be observed with caution. Conclusions Hemodynamic parameters of the VA did not change with cervical rotations in healthy women so that this question should be studied in patients with vertebrobasilar insufficiency (AU)

Análisis discriminante del patrón textural ecográfico con matrices de concurrencia como nueva herramienta para el estudio del tendón / Discriminant analysis of the ultrasonographic textural pattern with co-occurrence matrices as a new tool for ultrasonographic of tendon

ObjetivoEvaluar el poder clasificatorio por grupo de edad y sexo de modelos discriminantes (MD) a partir de la ecotextura del tendón de Aquiles (TA).Material y métodosSe diseñó un estudio de observacional, transversal sobre 103 sujetos (49 mujeres y 54 hombres) con edades comprendidas entre los 18 y los 53 años (media = 29,8; desviación estándar = 0,86). Se tomaron ecografías transversales bilaterales a 20 mm de la inserción del TA con un ecógrafo Sonosite-Titan (L38 a 5-10 Hz). Se obtuvieron 60 variables texturales a partir de las matrices de concurrencia del nivel de gris (GLCM): contraste, homogeneidad, uniformidad, entropía y correlación para tres escalas (1, 5 y 10 píxeles) y dos orientaciones (0° y 90°) con el programa ImageJ 1.43. Se realizó un análisis multidimensional discriminante exploratorio con el método de inclusión forzosa con SPSS 15.0 (IC del 95%).ResultadosEn el MD global la sensibilidad fue del 74% y la especificidad del 91% para el grupo de edad. En el MD de mujeres la sensibilidad fue del 90% y la especificidad del 97%, mientras que en el MD de los hombres fueron del 96 y el 99%, respectivamente. Tras las validaciones cruzadas entre mujeres y hombres, las sensibilidades se redujeron a un 30%, lo que sugiere que el comportamiento ecotextural del TA en hombres y en mujeres es diferente.ConclusiónEl análisis multivariante de la ecotextura del TA con GLCM mostró una buena sensibilidad y especificidad en la clasificación de los sujetos según el grupo de edad, que mejoraron cuando los modelos se segmentaron según el sexo(AU)

AbstractObjectiveThe aim of this study was to evaluate the classification power as the age and sex of discriminant models (DM) generated from the echo-texture of the Achilles tendon (AT).Materials and methodsThe design was an observational, cross-sectional study report on 103 subjects (49 females and 54 males) 18 to 53 years old (mean = 29.8, SD = 0.86). We took bilateral transverse ultrasonographies at 20 mm from the insertion of the AT. Sixty variables were obtained from grey level co-occurrence matrices (GLCM): contrast, homogeneity, uniformity, entropy and correlation for three scales (1, 5 and 10 pixels) and two orientations (0° and 90°) with ImageJ 1.43 software. Multidimensional discriminant models were performed with forced inclusion method (CI95%).ResultsThe global MD for classification by age group showed a sensitivity of 74% and a specificity of 91%. In the DM women's ultrasound pattern sensitivity increased to 90% and specificity 97%, while sensitivity and specificity of ultrasound pattern DM men were 96% and 99% respectively. When cross-validations were performed for models of women and men, the sensitivities of the models were reduced to 30%, suggesting that the AT echotextural behavior is different.ConclusionMultidimensional analysis of Achilles tendon echotexture with GLCM showed good sensitivity and specificity in the classification of subjects by age group that improved when the models were segmented by gender(AU)