[Efficacy of Music Therapy in Functional Recovery of the Upper Limb After a Stroke: a Systematic Review and Meta-Analysis]. / Eficacia de la terapia musical en la recuperación funcional del miembro superior después de un ictus: una revisión sistemática y meta-análisis.

INTRODUCTION: Formal therapeutic interventions based on music have been used in rehabilitation to stimulate the brain functions involved in movement. OBJECTIVE: The objective of this study was to conduct a systematic review and meta-analysis following the PRISMA recommendations on the effectiveness of music therapy in improving the functionality of the upper limb in patients with hemiparesis secondary to stroke. METHODS: A search of the Pubmed, clinicaltrials.gov and Cochrane databases was performed in September 2018. The articles included in this review had to meet the following criteria: randomised controlled trials with therapeutic interventions that evaluated improvement in manual dexterity, measured with the box and block test in patients older than 18 years with a residual deficit secondary to an ischaemic or haemorrhagic stroke in the previous months. RESULTS: Of 371 studies analysed, six were included in the study and subsequent meta-analysis with a total of 149 patients. The musical interventions improved the functionality of the parietal limb in patients with stroke compared with that in controls who received conventional treatment. This effect was statistically significant in the meta-analysis, with a difference in the standardised mean in the box and block test of 0.40 (95% CI 0.09 - 0.72). CONCLUSIONS: Musical interventions could be beneficial for the functional recovery of the upper extremity. These results are encouraging but a greater number of clinical trials are required to confirm these findings before their subsequent implementation in clinical practice.

Incidencia y factores predictivos del delírium en pacientes neurológicos hospitalizados / Incidence and predictive factors of delirium in hospitalised neurological patients

Introducción: El delírium es una afección con una prevalencia elevada entre los pacientes ingresados (10-30%), con importantes implicaciones pronósticas. Existen pocos estudios prospectivos de incidencia en España y la mayoría se han realizado en plantas quirúrgicas o en unidades de cuidados intensivos. Nuestro objetivo es conocer su incidencia en una planta de neurología y describir las características de estos pacientes. Métodos: Se ha realizado un estudio longitudinal descriptivo, incluyendo a todos los pacientes ingresados en la planta de neurología durante 8 semanas, realizándose la escala CAM para el diagnóstico de delírium el primero, segundo y quinto días de ingreso y recogiéndose de cada paciente datos demográficos, antecedentes patológicos, analíticos (incluyendo marcadores inflamatorios), toma de fármacos anticolinérgicos, situación cognitiva y funcional al ingreso, causa de ingreso, tiempo de estancia y eventos durante la misma. Resultados: Se estudió a 115 pacientes con una incidencia de delírium del 16,52%. Se observó una relación significativa con la edad, la situación cognitiva al ingreso valorada por el test de Pfeiffer, la situación funcional al ingreso medida por la escala Canadiense, la insuficiencia renal, los antecedentes de ACV, la toma de fármacos con actividad anticolinérgica, VSG y PCR. Se observó, además, una mayor estancia media en estos pacientes. Conclusiones: Estos resultados confirman una alta incidencia de esta afección en nuestro medio y, aunque son necesarios más estudios, con muestras mayores, destacamos la importancia de unos factores de riesgo que podrían contribuir a una detección precoz de pacientes en riesgo de desarrollar delírium durante el ingreso, permitiendo actividades preventivas y un tratamiento precoz de estos pacientes (AU)

Intruduction: Delirium is a condition with a high prevalence in hospitalised patients (10%-30%), and it has important prognostic implications. There are few prospective studies of the incidence of delirium in Spain, and most of these were carried out in surgical wards or intensive care units. Our objective is to calculate the incidence of delirium in a neurological department and describe characteristics of affected patients. Methods: Longitudinal descriptive study including all patients admitted to the neurology department in an 8-week period. The CAM score for diagnosing delirium was recorded on the first, second and fifth day of hospitalisation and we recorded demographic data, medical history, analytical data (including inflammatory markers), use of anticholinergic treatments, cognitive and functional state at admission, reason for admission, length of stay, and other events during hospitalisation. Results: We studied 115 patients and found an incidence of delirium of 16.52%. There was a significant correlation between delirium and age, cognitive state at admission according to the Pfeiffer test, functional situation at admission according to the Canadian Neurological Scale, kidney failure, history of stroke, anticholinergic treatment, erythrocyte sedimentation rate, and C-reactive protein. These patients were also hospitalised for longer periods of time. Conclusions: These results confirm a high incidence of delirium in our geographical area. Although additional studies with larger samples are needed, we would like to emphasise the importance of several risk factors which may enable early detection of patients who are at risk for developing delirium during hospitalisation. This would permit preventive action and early treatment for these patients (AU)

Incidence and predictive factors of delirium in hospitalised neurological patients.

INTRODUCTION: Delirium is a condition with a high prevalence in hospitalised patients (10%-30%), and it has important prognostic implications. There are few prospective studies of the incidence of delirium in Spain, and most of these were carried out in surgical wards or intensive care units. Our objective is to calculate the incidence of delirium in a neurological department and describe characteristics of affected patients. METHODS: Longitudinal descriptive study including all patients admitted to the neurology department in an 8-week period. The CAM score for diagnosing delirium was recorded on the first, second and fifth day of hospitalisation and we recorded demographic data, medical history, analytical data (including inflammatory markers), use of anticholinergic treatments, cognitive and functional state at admission, reason for admission, length of stay, and other events during hospitalisation. RESULTS: We studied 115 patients and found an incidence of delirium of 16.52%. There was a significant correlation between delirium and age, cognitive state at admission according to the Pfeiffer test, functional situation at admission according to the Canadian Neurological Scale, kidney failure, history of stroke, anticholinergic treatment, erythrocyte sedimentation rate, and C-reactive protein. These patients were also hospitalised for longer periods of time. CONCLUSIONS: These results confirm a high incidence of delirium in our geographical area. Although additional studies with larger samples are needed, we would like to emphasise the importance of several risk factors which may enable early detection of patients who are at risk for developing delirium during hospitalisation. This would permit preventive action and early treatment for these patients.