Dynamic analysis of muscles and the internal structure of the peripheral nerve as biomarkers of amyotrophic lateral sclerosis: A pilot study with ultrasound imaging.

INTRODUCTION: The aim of this study was to determine the behaviour of ultrasound biomarkers of fascicle density and muscle strength in patients with amyotrophic lateral sclerosis (ALS). METHODS: We conducted an observational, cross-sectional pilot study of 14 patients with ALS (28.6% women) and 14 controls. Bilateral cross-sectional ultrasound scans were performed in the abductor pollicis brevis (APB) and tibialis anterior (TA) muscles, with recording of muscle thickness (MT) at rest and in contraction, and the difference in thickness. In the median, sciatic, and common peroneal nerves, we analysed the cross-sectional area (CSA), number of fascicles (NF) and fascicle density (FD). Analyses were nested by laterality. RESULTS: Intra- and interrater agreement regarding NF was very good, with a minimum detectable error of < 0.7%. In patients with ALS, MT was lower in the APB both at rest (P = .003; g-Hedges = 1.03) and in contraction (P = .017; g-Hedges = 0.78) and in TA at rest (P = .002; g-Hedges = 0.15) and in contraction (P = .001; g-Hedges = 0.46), with lower thickening capacity. In the nerves, patients displayed lower CSA, with lower NF and higher FD. Significant correlations were found between MT of the ABP and Medical Research Council (MRC) scores for muscle strength (r = 0.34; r2 = 12%; P = .011) and with revised ALS Functional Rating Scale scores (r = 0.44; r2 = 19%; P < .001). The difference in TA thickening correlated with MRC scores (r = 0.30; r2 = 15%; P = .003) and with revised ALS Functional Rating Scale scores (r = 0.26; r2 = 7%; P = .049). NF in the sciatic nerve showed a significant correlation with MRC scores (r = 0.35; r2 = 12%; P = .008). CONCLUSION: MT measurements derived from dynamic testing together with NF and FD may be useful biomarkers for monitoring patients with ALS and establishing a prognosis.

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.

[Translation and cross-cultural adaptation of the Gross Motor Function Measure to the Spanish population of children with cerebral palsy]. / Traducción y adaptación transcultural del Gross Motor Function Measure a la población española de niños con parálisis cerebral.

INTRODUCTION: The Gross Motor Function Measure (GMFM) is a measure designed to assess changes in gross motor function over time in children with cerebral palsy. It is an observation instrument, valid, reliable and responsive, widely used both in research and in clinical practice. AIM: To perform the translation and cross-cultural adaptation to the Spanish population of the GMFM. SUBJECTS AND METHODS: The forward-backward translation methodology was used, subjecting the resulting versions to a qualitative analysis of equivalence. Both the score sheet and the instructions were translated through strategies of omission, incorporation, substitution of words or contribution of examples. In addition, understandability, applicability and feasibility were assessed through a pilot study in which assessors and subjects with a heterogeneous profile participated. RESULTS: The items that generated the most difficulty were those that included clinical terms or expressions whose use is not considered natural or equivalent in the Spanish language. Although 57% and 58% of the items of forward and backward translation, respectively, were classified as «partially equivalent¼, no correction was necessary since the modifications made came from the cultural and linguistic adaptation of the items to the Spanish population. CONCLUSIONS: The Spanish version maintains the highest degree of equivalence concerning the original English version and is understandable by all professionals regardless of their professional experience or geographic origin.

TITLE: Traducción y adaptación transcultural del Gross Motor Function Measure a la población española de niños con parálisis cerebral.Introducción. El Gross Motor Function Measure (GMFM) es un instrumento diseñado para evaluar los cambios en la función motora gruesa producidos a lo largo del tiempo en niños con parálisis cerebral. Se trata de un instrumento de observación válido, fiable y sensible, ampliamente utilizado tanto en investigación como en la práctica clínica. Objetivo. Realizar la traducción y adaptación transcultural a la población española de la herramienta de evaluación GMFM. Sujetos y métodos. Se utilizó la metodología de traducción directa e inversa, sometiendo las versiones resultantes a un análisis cualitativo de la equivalencia. Se tradujeron tanto la hoja de puntuación como las instrucciones mediante estrategias de omisión, incorporación, sustitución de palabras o aportación de ejemplos. Además, se valoraron la comprensibilidad, la aplicabilidad y la viabilidad mediante un estudio piloto en el que participaron evaluadores y sujetos con un perfil heterogéneo. Resultados. Los ítems que generaron más dificultad fueron los que incluían términos clínicos o expresiones cuyo uso no se considera natural o equivalente en la lengua española. Aunque el 57% y 58% de los ítems de la traducción directa e inversa, respectivamente, fueron calificados como «parcialmente equivalentes¼, no fue necesaria ninguna corrección porque las modificaciones realizadas provenían de la adaptación cultural y lingüística de los ítems a la población española. Conclusiones. La versión española mantiene el máximo grado de equivalencia con respecto a la versión original en inglés y se garantiza la comprensibilidad por parte de todos los profesionales independientemente de su experiencia profesional o procedencia geográfica.

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.

New insights into the pathophysiology of fasciculations in amyotrophic lateral sclerosis: An ultrasound study.

OBJECTIVE: To describe the fasciculation pattern in ALS and to analyse its clinical and pathophysiological significance. METHODS: Ultrasound of 19 muscles was performed in 44 patients with a recent diagnosis (<90 days) of ALS. The number of fasciculations was recorded in each muscle and the muscle thickness and strength were additionally measured in limb muscles. A subgroup of patients were electromyographically assessed. RESULTS: US was performed in 835 muscles and EMG was available in 263 muscles. US detected fasciculations more frequently than EMG. Fasciculations were widespread, especially in upper limbs onset patients and in the cervical region. Fasciculations' number inversely associated with ALSFR-R and body mass index (BMI) and directly with BMI loss and upper motor neuron (UMN) impairment. Our statistical model suggest that fasciculations increase with the initial lower motor neuron (LMN) degeneration, reach their peak when the muscle became mildly to moderately weak, decreasing afterwards with increasing muscle weakness and atrophy. CONCLUSIONS: Our study suggests that both UMN and LMN degeneration trigger fasciculations causing BMI loss. The degree of LMN impairment could account for differences in fasciculations' rates within and between muscles. SIGNIFICANCE: In ALS, fasciculations could explain the link between hyperexcitability and BMI loss.

Relationship between jumping abilities and skeletal muscle architecture of lower limbs in humans: Systematic review and meta-analysis.

The aim of this study was to examine the influence of skeletal muscle architecture (SMA) features measured by 2-D ultrasonography on jumping performance in humans. A systematic review and meta-analysis was conducted, registry number: CRD42016043602. The scientific literature was systematically searched in eight databases, last run on March 14th, 2017. Cross-sectional studies focused on the association between SMA features and vertical jumping performance were selected. A random-effects model was used to analyze the influence of lower-limb SMA and maximal jump height. A total of 11 studies were included in the qualitative synthesis and 6 studies were selected for meta-analysis. 250 correlations were reviewed across studies. The vast majority were either not statistically significant (185; 74%), weak or very weak (169; 68%) for different jump modalities; counter-movement jump (CMJ), squat jump (SJ), and drop jump. There was insufficient data to perform meta-analysis on muscles other than vastus lateralis for CMJ and SJ. The meta-analyses did not yield any significant association between vastus lateralis SMA and SJ height. Only a significant overall association was shown between vastus lateralis thickness and CMJ height (summary-r = 0.28; 95% confidence interval (CI) = -0.05 to 0.48; p = .059) for a 90% CI level. No differences were found between summary-r coefficients for SMA parameters and jump height during both jumps (CMJ: χ2 = 2.43; df   = 2; p = .30; SJ: χ2 = 0.45; df = 2; p = .80) with a low heterogeneity ratio. Current evidence does not suggest a great influence of lower-limb SMA on vertical jumping performance in humans.

Bilateral deficit in explosive force related to sit-to-stand performance in older postmenopausal women.

The purpose of this study was to determine whether the bilateral deficit (BLD) for maximal voluntary force (MVF) and rate of force development (RFD) influences sit-to-stand in older postmenopausal women. Fourteen women performed unilateral and bilateral maximal voluntary contractions during isometric leg-extension. The MVF and RFD over consecutive 50ms periods (0-50, 50-100 and 100-150ms) after force onset and the time to sit-to-stand test were calculated. There was only a BLD for RFD 0-50ms and 50-100ms. The time of sit-to-stand was moderately correlated to BLD for RFD 0-50ms (r=0.505; 95% CI: -0.035 to 0.817; P=0.06), but after controlling for physical activity level the relationship was stronger and statistically significant (r=0.605; 95% CI: 0.109 to 0.859; P=0.029). These results suggest that the BLD for explosive force (0-50ms) might represent a performance-limiting factor for sit-to-stand transfer in postmenopausal women and could be dependent of the physical activity level. Trial registered at Clinical Trials Gov.: NCT02434185.

Relación entre escalas de espasticidad y escalas de independencia y estado funcional en pacientes con parálisis cerebral / Relationship between spasticity scales and independence and functional status scales in patients with cerebral palsy

Objetivos: Conocer las posibles correlaciones entre las escalas más utilizadas en la valoración de la espasticidad con aspectos más globales en cuanto a independencia y funcionalidad. Material y método: Estudio descriptivo, observacional y transversal. Participaron 10 adultos con parálisis cerebral y espasticidad a los que se les valoró con 10 escalas y pruebas funcionales para la espasticidad, independencia y funcionalidad. Se modificaron bajo los mismos parámetros algunas de las variables para reducir su número final y realizar el análisis estadístico. Para el estudio de las correlaciones se calculó el coeficiente de correlación Rho de Spearman con un error alfa del 5%.ResultadosEn cuanto a escalas de espasticidad, las más comunes han tenido nulas o bajas correlaciones con las escalas del estado funcional, discapacidad o independencia personal utilizadas (la escala modificada de Tardieu solo con la escala de Rankin modificada rho = 0,77 e índice de Barthel rho = -0,69 y la escala modificada de Ashworth solo con la escala de Palisano rho = 0,79 y la escala de Rankin modificada rho = 0,64). Otras, como la escala de Oswestry y la escala del tono aductor de las caderas, han obtenido altas correlaciones con prácticamente todas las escalas de independencia y funcionalidad (rho entre 0,86-0,65). Conclusiones: Se justifica el uso en la valoración del paciente con parálisis cerebral de la escala de Oswestry y la escala del tono aductor de las caderas ya que, además de medir parámetros relacionados directamente con la espasticidad, podrían ofrecer información relacionada con la independencia funcional en estos pacientes. Las escalas de Ashworth modificada o Tardieu modificada dan información muy selectiva

Objectives: To know the possible correlations between the scales used most in the measurement of spasticity with global independence and functionality aspects. Material and methods: Descriptive, observational and cross-sectional study. Ten adult patients with cerebral palsy and spasticity who were evaluated with ten scales and functional tests for spasticity, independence and functionality participated. Some of the variables were modified using the same parameters to reduce their final number and carry out the statistical analysis. The Spearman Rho correlation coefficient with an alpha error of 5% was calculated to study the correlations. Results: Regarding scales in terms of spasticity, the most common showed no or low correlations with other scales of functional status, disability, or personal independence used (the modified Rankin scale only with the modified Tardieu scale (rho = 0.77) and the Barthel index (rho = 0.69) and the modified Ashworth scale only with the Palisano scale (rho = 0.79) and the modified Rankin scale (rho = 0.64). Others, such as the Oswestry scale and the adductor tone of the hips scale, obtained high correlations with almost all the independence and functional status scales (rho between 0.86 and 0.65). Conclusions: To use in the assessment of the patient with cerebral palsy, the Oswestry and hip adductor tone scales is justified, because they can give information about spasticity and also about functional independence. The modified Ashworth scale and the modified Tardieu scale, give very selective information

Evolución de la estructura y la objetividad científica de los artículos publicados en la revista Fisioterapia (1979-2008) / Evolution of the structure and scientific objectivity of the articles published on the journal of Fisioterapia (1979-2008)

Introducción: La forma de adecuar conceptualmente el cuerpo de conocimientos de la fisioterapia debe fundamentarse en la aplicación del método científico. Por tanto, la evaluación de la actividad científica de los artículos publicados proporciona uno de los mejores indicadores acerca del cómo se está construyendo el conocimiento en la profesión. Objetivos: Analizar los primeros 30 años de publicación de la revista Fisioterapia, para conocer cómo han evolucionado los artículos originales publicados en relación con su estructura organizativa, su objetividad en la exposición de contenidos y el uso de recursos de estadísticos. Material y método: Estudio observacional descriptivo. La muestra de estudio: 781 artículos publicados entre 1979 y 2008. Las variables estudiadas en cada artículo se organizaron en sobre la base de 3 dimensiones de análisis: a) estructura científica de los artículos publicados; b) análisis de la objetividad/subjetividad de los artículos, y c) instrumentos estadísticos. Resultados: La organización y la estructura científica de los artículos publicados mejoran en cada uno de los periodos históricos analizados. Los últimos 15 años (1994-2008) muestran una tendencia creciente al uso de análisis descriptivos y estadística inferencial. Los valores de subjetividad en el contenido de los artículos desde el inicio de la publicación 74% (1979-1983) han disminuido progresivamente hasta valores del 2,2% para el último periodo (2004-2008). Conclusiones: La estructura científica y la objetividad de los artículos publicados han experimentado una mejora progresiva, que sobre todo se ha acentuado durante el último periodo de estudio (2004-2008)

Introduction: Conceptual adaptation of the body of knowledge of physiotherapy should be based on the application of the scientific method. Thus, evaluating the scientific activity of published articles provides one of the best indicators on how knowledge is being constructed in the profession. Objectives: This paper has aimed to analyze the first thirty years of publication of the journal of «Fisioterapia» (Physiotherapy), in order to know how the published original articles have evolved in relation to their organizational structure, their objectivity in the presentation of contents and their use of statistical resources. Material and method: A descriptive observational study was performed. The study sample included 781 articles published between 1979 and 2008. The variables studied in each article were organized into three dimensions of analysis: a) scientific structure of articles published, b) analysis of the objectivity / subjectivity of the articles, and c) Statistical tools. Results: The organization and scientific structure of the articles published have improved in each one of the historical periods being studied. The last fifteen years (1994-2008) have shown a clear and growing trend towards the use of numerical and descriptive analysis as well as the incorporation of inferential statistics tests. The content subjectivity values of the articles from when publication began -74% (1979-1983)- have been progressively decreasing until reaching 2.2% for the last period studied (2004-2008). Conclusions: The scientific structure and objectivity of the articles published have shown a growing improvement, this being especially pronounced during the last study period (2004-2008)

Intervención con terapia ocupacional en pacientes penitenciarios con esquizofrenia paranoide: estudio experimental no controlado / Occupational therapy intervention in penitentiary patients with paranoid schizophrenia: Non-controlled trial study

Objetivo: Comprobar los cambios en las dimensiones de ansiedad y depresión de pacientes penitenciarios con esquizofrenia paranoide tras un programa de terapia ocupacional. Material y métodos: Se diseñó un estudio cuasi experimental con una muestra de 8 hombres (edad media ± desviación estándar 40,1 ± 8,2 años), extraídos de un conjunto de 25 pacientes diagnosticados de esquizofrenia paranoide internados en un hospital psiquiátrico. Se utilizaron la Escala de Ansiedad de Hamilton y la Escala de Calgary para Depresión en Esquizofrenia. El protocolo de terapia ocupacional se desarrolló diariamente durante 2 meses y medio. Se hizo un análisis estadístico descriptivo y se utilizó la prueba de Wilcoxon para evaluar los cambios en las puntuaciones de ansiedad y depresión (intervalo de confianza del 95%) con SPSS 19.0. Resultados: Se encontraron cambios favorables en las dimensiones de ansiedad psíquica y somática (p = 0,008). En la puntuación total de la ansiedad, se encontraron mejorías significativas (p = 0,008), con una mediana antes de la intervención de 18 puntos (RIQ = 9 puntos) a una mediana de 4 puntos (RIQ: 4 puntos), con un descenso del 25% en la puntación. La puntuación en depresión pasó de 7,0 puntos medianos (RIQ = 6,5 puntos) a 1,0 punto (RIQ = 1 punto) después de la intervención (p = 0,008), que supuso un 15% menos en la puntuación de depresión. Conclusiones: La intervención con un programa de terapia ocupacional actuó favorablemente sobre la ansiedad y la depresión de pacientes con esquizofrenia paranoide internados en el centro penitenciario

Objective: To check for changes in dimensions of anxiety and depression in penitentiary patients with paranoid schizophrenia after a program of occupational therapy. Material and methods: Quasi-experimental study with a sample of 8 men (mean age 40.1 years; S.D. 8.2 years) extracted from a set of 25 patients diagnosed with paranoid schizophrenia admitted to the penitentiary psychiatric hospital. We used Hamilton Anxiety Scale and the Calgary Scale for Depression in Schizophrenia. The occupational therapy protocol was carried out daily for two and a half months. After, a descriptive statistical analysis was performed and the Wilcoxon test was used to evaluate changes in anxiety and depression scores (95% confidence interval) with SPSS 19.0. Results: We found favorable changes in the dimensions of psychic and somatic anxiety (P=.008).Significant improvements were found in the total score of anxiety (P=.008), with a median before the intervention of 18 pts. (IQR = 9 pts.) changing to a median of 4 points (IQR = 4.0 pts) with a 25% decline in the score. Depression score decreased from 7.0 median points (RIQ = 6.5 pts.) to 1.0 pts (RIQ = 1 pts.) after the intervention (P = .008), which meant a score of 15% less for depression. Conclusions: Intervention with an occupational therapy program may reduce anxiety and depression of paranoid schizophrenic patients hospitalized in the penitentiary

Caracterización de la base intelectual de la fisioterapia a través del análisis de cocitación de documentos / Characterization of the intellectual basis of physiotherapy through the co-citation analysis of documents

Antecedentes: Los análisis de cocitación permiten la visualización de miles de documentos citantes y de referencias citadas, que pueden representar la base intelectual de una disciplina. El objetivo del estudio fue identificar la base intelectual de la fisioterapia. Material y método Análisis de cocitación de documentos en 3 revistas internacionales (Physical Therapy, Physiotherapy, Australian Journal of Physiotherapy) de impacto en el área de fisioterapia entre los años 2000-2011. Se recuperaron 2.795 artículos con 77.894 citaciones desde SCIex con Citespace II-v.2.2.R9 en subperíodos de un año. Resultados Se localizaron un total de 237 documentos citados con una media ± desviación estándar de citas recibidas de 16,1 ± 13,72 citas). El año de publicación medio se situó en 1997 ± 8,1 años. El 42,8% (89) de los documentos citados pertenecían a revistas de fisioterapia con 73 (82%) documentos citados de Physical Therapy, seguida de 7 (7,9%) documentos citados de Australian Journal of Physiotherapy. El modelo de grafo detectado se ajusta a un modelo de potencia donde existe una gran masa de documentos con pocas citaciones y una pequeña masa de documentos que acumulan la mayor parte de las citaciones. Estos documentos son de índole metodológica o de guía de práctica clínica. Conclusión La base intelectual de la fisioterapia muestra que es una disciplina joven que se apoya en otras áreas de conocimiento con un área de interés especialmente orientada hacia la «práctica basada en pruebas»

Background: Co-citation analyses make it possible to visualize thousands of citing documents and cited references that may represent the intellectual basis of a discipline. This study has aimed to identify the intellectual basis of physiotherapy. Material and method: Document co-citation analysis in three international impact journals (Physical Therapy, Physiotherapy, Australian Journal of Physiotherapy) in the area of physiotherapy between 2000-2011. 2583 Items recovered included 77894 citations from SCIex with Citespace II-v.2.2.R9 in sub-periods of one year. Results: A total of 237 documents cited were located with an average of 16.1 citations received (S.D. 13.72 citations). Mean year of publication was 1997 (S.D.: 8.1 years). Of the documents cited, 42.8% (89) belonged to physiotherapy journals with 73% (82) cited documents from Physical Therapy and 7 (7.9%) from Australian Journal of Physiotherapy. The graph model detected adjusts to a power model in which there is a large number of documents with few citations and a small number of documents that accumulate the most citations. These documents can be classified as methodological or clinical practice guideline type. Conclusion: The intellectual basis of physiotherapy analyzed through document co-citation shows that it is a young discipline that relies on other areas of knowledge with an area of interest oriented towards the evidence-based practice

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)

El factor de impacto como criterio para la evaluación de la producción y la calidad científica / The impact factor as a criterion for the evaluation of scientific production and quality

Introducción. En muchos países ha aparecido una creciente preocupación por la calidad del rendimiento y la producción científica de los investigadores y académicos, así como por los aspectos de su evaluación. La productividad científica se considera un indicador de la actividad científica de un área o disciplina. Gran parte de los estudios bibliométricos están basados en el análisis de las citaciones. El factor de impacto se define como el cociente entre el número de citas que recibe una revista en un año concreto respecto al número de artículos publicados en la misma revista durante los dos años previos. Objetivo. El objetivo de la revisión fue identificar el papel del factor de impacto como criterio de evaluación de la producción científica y su calidad, aplicado a las publicaciones periódicas, las instituciones y los investigadores particulares. Material y método. Se realizó una búsqueda en las bases de datos MEDLINE, Academic Search Premier y Sportdiscus, utilizando los descriptores «Journal Impact Factor, Impact Factor and Bibliometrics, Academies and Institutes, Research». Conclusiones. Existe una gran controversia respecto al uso del factor de impacto en los procesos de evaluación de la calidad de la producción científica de las revistas, las instituciones y los investigadores, pero la escasez de criterios e indicadores alternativos aceptados por la comunidad científica y las comisiones de evaluación provoca que el factor de impacto sea, prácticamente, el único indicador aceptado y utilizado de forma amplia, especialmente en Europa (AU)

Introduction. Currently, there is increasing concern regarding the quality of scientific performance and productivity of the investigators and academicians and aspects of their evaluation. Scientific productivity is considered an indicator of scientific activity of a discipline. Most bibliometrics studies are based on citation analysis. The impact factor is defined as the quotient between the number of citations received by a journal in a specific year compared to the number of articles published in the same journal during the previous two years. Objective. The objective of this review has been to identify the impact factor as an evaluation criterion of scientific productivity and its quality, applied to periodic publications, institutions and researchers. Material and methods. To do so, we carried out a search in the data bases MEDLINE, Academic Search Premier and Sportdiscus, using the descriptors Journal Impact Factor, Impact Factor and Bibliometrics, Academies and Institutes, Research. Conclusions. We found that there is great controversy regarding the use of the impact factor in the evaluation procedures of the quality of scientific productivity of the journals, institutions and researchers. However, the few criteria and alternative indicators accepted by the scientific community and the evaluation committees makes the impact factor to be practically the only one that is accepted and used, especially in Europe (AU)

Arquitectura y organización interna del hueso ante la aplicación de diferentes estímulos mecánicos / Architecture and internal bone organization and different mechanical stimulus application

Objetivo: Ante la ausencia de una pauta clara en la prescripción del ejercicio para prevenir o reducir los efectos de la osteoporosis, el propósito de este trabajo es realizar una revisión bibliográfica no sistemática sobre los estudios de los últimos 10 ańos que relacionan el comportamiento del hueso ante la aplicación de estímulos mecánicos. Nos interesa diferenciar los tipos de ejercicio usados con más frecuencia y verificar si los efectos se producen en las zonas en que más impacta la osteoporosis. Material y método: Se consultaron monografías generales sobre biología, histología y anatomía óseas. La búsqueda de artículos científicos ser realizó en la base de datos MEDLINE y en la plataforma digital EBSCO HOST. Los límites aplicados a la búsqueda fueron: artículos en inglés o espańol, publicados entre 1997 y 2006, con resumen y realizados con poblaciones humanas. Resultados: Se han encontrado pocas referencias sobre la microarquitectura ósea, pero aportan datos importantes. La mayor parte de los artículos aplican programas de ejercicios específicos destinados favorecer la osteogénesis y nos dan cifras de densidad mineral ósea como factor de medición de osteoporosis. Los ejercicios más utilizados son los aeróbicos (resistencia, fuerza) y los de alto impacto (saltos). Los aeróbicos parecen tener mayor éxito en la columna lumbar y los de alto impacto podrían actuar más específicamente en el cuello femoral. Al cesar el entrenamiento, los efectos acumulados del ejercicio van desapareciendo. Conclusiones: Son necesarios más trabajos con seres humanos que relacionen la estructura interna del hueso y la aplicación de estímulos mecánicos. Los métodos de predicción de osteoporosis basados en técnicas de análisis trabecular pueden tener importantes implicaciones clínicas. La concienciación desde la escuela como prevención primaria es una opción que puede dar buenos resultados y es fácil de aplicar. Una actuación de calidad requiere personalizar los ejercicios y adecuar la práctica a quienes participan en los programas, además de promover hábitos saludables y tener continuidad

Objectives: Due to the lack of a clear guideline for the prescription of exercise to preventor reduce the effects of osteoporosis, this work has aimed to make non-systematicbibliographic review on the studies of last the ten years that relate the behavior of thebone with the application of mechanical stimuli. We want to differentiate the types ofexercise used most frequently and to verify if the effects are produced on the zones ofgreatest impact in the osteoporosis. Material and method: General monographs on bone biology, histology and anatomy wereconsulted. The search for scientific articles was made through MEDLINE database andEBSCO HOST digital platform. The limits applied to the search were: articles in English orSpanish published between 1997 and 2006, with summary and conducted in humanpopulations. Results: Few references were found on bone microarchitecture, however they contributedimportant data. Most of the articles applied programs of specific exercises aimedat increasing osteogenesis and provided bone mineral density (BMO) as a factor ofmeasurement of osteoporosis. Aerobic exercises (resistance, force) and high-impactexercise (jumps) are the most used. Aerobic exercises seem to be more successful on thelumbar column and those of high impact could act more specifically on the femoral neck.When the training is discontinued, the accumulated effects of the exercise begin to disappear. Conclusions: More works are necessary on humans that relate the internal structure of thebone and the application of mechanical stimuli. The methods of predicting osteoporosisbased on the analysis of bone trabeculae may have important clinical implications.Awareness from school as primary prevention appears to be an option that may providegood results and is easy to apply. The exercises must be personalized and the practiceadapted to those who participate in the programs are necessary to obtain a quality actionand it is also necessary to promote healthy habits that are continuous over time

Aplicación en fisioterapia de la valoración cuantitativa de las características morfoecogénicas del tendón de Aquiles / Application of quantitative measurements of morphology-echogenicity characteristics of the Achilles tendon in physical therapy

Objetivo. Establecer valores medios de normalidad del grosor, circularidad y ecogenicidad del tendón de Aquiles en su tercio medio como referencia para anticipar procesos patológicos y cuantificar objetivamente los beneficios de las acciones fisioterápicas de prevención y recuperación. Método. Estudio descriptivo transversal. Se realiza la exploración ecográfica del tendón de Aquiles, previo consentimiento informado, a una muestra de 30 varones, entre los 20 y los 35 años de edad. Se realizan 3 cortes transversales a 20, 40 y 60 mm del calcáneo y se hallan las variables grosor, circularidad y ecogenicidad media. Para el estudio de fiabilidad se calcula el coeficiente de correlación intraclase. El análisis de resultados se realiza mediante análisis de varianza de un factor, la prueba T2 de Tamhane y el test de correlación de Pearson con un intervalo de confianza del 95 %. Resultados. Existen diferencias significativas en todos los cortes para la variable grosor (p # 0,01) y entre la circularidad del tendón de Aquiles a 20 y 60 mm y a 40 y 60 mm. Se observa una correlación significativa de la ecogenicidad (p # 0,01) entre 20 y 40 mm (r = 0,560), entre 20 y 60 mm (r = 0,345) y entre 40 y 60 mm (r = 0,562). Están correlacionados el grosor y la circularidad (p # 0,001) a 20 mm (r = 0,470), a 40 mm (r = 0,720) y a 60 mm (r = 0,822). Conclusión. La ecogenicidad (p > 0,05) y el grosor (p < 0,05) del tendón de Aquiles disminuyen conforme nos alejamos de su inserción. Éste se hace más circular en su tercio medio

Purpose. To establish mean values of morpho-echogenic characteristics of the Achilles tendon to get an objective reference parameter of the benefits in physical therapy interventions and injury prevention. Subjects and method. This is a cross-sectional and observational study. We obtained three transverse scans of each Achilles tendon of 30 men, from 20 to 35 years old, at 20, 40 and 60 mm from the calcaneus. Thickness, roundness and mean echogenicity variables were calculated. One way ANOVA, Tamhane test and Pearson correlation coefficient are used to analyze data with a confidence interval of 95 %. Results. There are significant differences in all the scans for thickness (p # 0.01) and roundness at 20 and 60 mm from calcaneus and 40 and 60 mm. There are significant correlations between echogenicity at 20 and 40 mm (r = 0.560), 20 and 60 mm (r = 0.345) and 40 and 60 mm (r = 0.562). There is correlation between thickness and roundness (p # 0.001) at 20 mm (r = 0.470), 40 mm (r = 0.720) and 60 mm (r = 0.822). Conclusions. Echogenicity (p > 0.05) and Achilles tendon thickness (p < 0.05) decrease in the distal part from the calcaneus insertion. Achilles tendon roundness is greater in the middle part (AU)