Efectividad de la intervención motora temprana en el desarrollo motor de los niños con parálisis cerebral entre 3 y 5 años de edad. Revisión sistemática / Effectiveness of early motor interventions in children with cerebral palsy between 3 to 5 years of age: Systematic review

La intervención motora temprana es esencial en niños con parálisis cerebral; sin embargo, se desconoce su efectividad entre los 3 y los 5años. El objetivo fue determinar la efectividad de la intervención motora temprana en el desarrollo motor de dicha población. Se realizó una revisión sistemática de literatura acerca de intervenciones motoras tempranas realizada en diferentes bases de datos como Pubmed/Medline, PEDro, OTSeeker, Embase y LILACS. Finalmente se seleccionaron 18 artículos, de los cuales 4 presentaron cambios a favor del grupo experimental en los desenlaces desarrollo motor global y función motora manual, con la terapia de integración sensorial y la terapia de movimiento inducido por restricción, respectivamente; no obstante, los resultados no fueron estadísticamente significativos y el nivel de evidencia fue bajo. La intervención motora temprana podría incluirse con precaución para la mejoría del desarrollo motor global y la función manual. Es necesario realizar estudios de mayor calidad metodológica. (AU)

Early motor intervention is essential in children with cerebral palsy; however, it is unknown its effectiveness between 3 to 5years. The objective was to determinate the effectiveness of early motor intervention in the motor development of this population. A systematic literature search was performed in Pubmed/Medline, PEDro, OTSeeker, Embase, and LILACS. Finally, 18 articles were selected, of which 4 showed favorable changes in the experimental group in the outcomes of overall motor development and manual motor function, with sensory integration therapy and movement-induced restriction therapy, respectively; however, the results were not statistically significant, and the level of evidence was low. Early motor intervention could be cautiously considered for improving overall motor development and manual function. Higher-quality methodological studies are necessary. (AU)

Desplazamiento de los catéteres para bloqueo continuo del nervio supraescapular tras fisioterapia: estudio en cadáveres / Dislodgment of continuous suprascapular nerve block catheters after physiotherapy: A cadaver study

Antecedentes: Los bloqueos continuos de los nervios periféricos son de uso común para el manejo del dolor. Sin embargo, la incidencia de desplazamiento o migración del catéter es dudosa, pudiendo ser infraestimada y no denunciarse. Nuestro objetivo fue evaluar el posicionamiento del extremo del catéter supraescapular antes y después de la manipulación rutinaria y simulada mediante fisioterapia de hombro en un modelo cadavérico anatómico.MétodoSe colocaron 8 catéteres para bloqueo continuo y ecoguiado del nervio supraescapular en cadáveres frescos criopreservados. La tomografía computarizada (TC) confirmó la localización de la punta del catéter tras la inyección de 1ml de medio de contraste. Realizamos una serie de movimientos estandarizados de hombro durante una sesión simulada de fisioterapia de hombro en cadáveres. Tras ello, administramos 1ml de azul de metileno a través de los catéteres, y seguidamente realizamos disecciones para identificar con precisión la localización de las puntas del catéter y compararlas con su localización previa a la «fisioterapia».ResultadosLa imagen de la TC confirmó la localización en todos los casos de los extremos del catéter en la muesca supraescapular. Sin embargo, tras la fisioterapia, se encontró que 2 catéteres (25%) habían migrado y, en especial, uno fue localizado en el músculo supraespinoso y el otro en el músculo trapecio.ConclusiónNuestros hallazgos sugieren que el desplazamiento del catéter puede producirse en cerca del 25% de los casos tras la manipulación mediante fisioterapia simulada. Sin embargo, es necesaria más investigación para determinar la incidencia real de los desplazamientos del catéter en la práctica clínica. (AU)

Background: Continuous peripheral nerve blocks are commonly used for pain management. However, the incidence of catheter dislodgement or migration is unclear, and may be underestimated and underreported. Our objective was to assess suprascapular catheter tip positioning before and after routine simulated shoulder physiotherapy manipulation in an anatomical cadaver model.MethodEight ultrasound-guided continuous suprascapular nerve block catheters were placed in cryopreserved fresh cadavers. Computed tomography (CT) confirmed the location of the catheter tip after injection of 1ml of contrast medium. We performed a series of standardized shoulder movements during a simulated shoulder physiotherapy session in cadavers. Following this, we administered 1ml of methylene blue through the catheters, and then performed anatomical dissections to accurately identify the location of the catheter tips and compare them to their placement prior to the ‘physiotherapy’ResultCT imaging confirmed the location of the catheter tips at the suprascapular notch in all cases. However, following physiotherapy, 2 catheters (25%) were found to have migrated - specifically, 1 was located in the supraspinatus muscle, and the other was located in the trapezius muscle.ConclusionOur findings suggest that catheter dislodgement may occur in approximately 25% of cases following simulated physiotherapy manipulation. However, further research is needed to determine the read incidence of catheter dislodgement in clinical practice. (AU)

Efectividad de la entrevista motivacional en la atención fisioterápica de los trastornos musculoesqueléticos de la espalda / Effectiveness of the motivational interview in the physiotherapy care of musculoskeletal disorders of the back: A quasi-experimental study

Objetivo: Evaluar la efectividad de la entrevista motivacional (EM) junto al tratamiento fisioterapéutico habitual en pacientes con trastornos musculoesqueléticos (TME) de la espalda en atención primaria (AP). Métodos: Estudio cuasiexperimental en pacientes que iniciaron su tratamiento en el año 2020 en una unidad de fisioterapia tras diagnóstico médico de TME en la espalda, con seguimiento prospectivo de 2grupos con actuación terapéutica: grupo experimental (GE) y grupo de control (GC). Se empleó la EM solo en el GE. A ambos grupos se les entrevistó telefónicamente a los 3y 6meses de finalizar el tratamiento fisioterápico, preguntando por el cumplimiento de pautas domiciliarias y por la percepción subjetiva del estado de salud (escala de Barthel). Se ajustaron modelos de regresión lineales (coeficiente de regresión, IC del 95%) y logísticos (OR, IC del 95%). Resultados: La población de estudio fue de 154 personas (76,6% mujeres). La salud percibida fue significativamente mejor (p<0,001) en el GE que en el GC, tanto a los 3meses de seguimiento (7,4 versus 5,0, respectivamente) como a los 6(7,1 versus 4,6, respectivamente). Hubo una fuerte asociación entre percepción de salud y cumplimiento (coeficiente de regresión 3,0 [IC del 95%=2,5-3,4]). La asociación entre la EM y el cumplimiento terapéutico se mantuvo tras ajustes multivariados (OR a 6meses=383,6 [IC del 95% = 31,0-4.742,4]). Conclusiones: la incorporación de la EM como complemento de los tratamientos de fisioterapia es una herramienta factible y efectiva para mejorar el cumplimiento de las pautas domiciliarias y la percepción subjetiva de salud. (AU)

Objective: To evaluate the effectiveness of motivational interviewing (MI) combined with the usual physiotherapy treatment in patients with back musculoskeletal disorders (MSD) in primary care (PC). Methods: Quasi-experimental study with 2groups with therapeutic action (control group and experimental group) and prospective follow-up, in a physiotherapy unit in PC, in patients who began their treatment in 2020, with a medical diagnosis of MSD in the back. MI was used only in the face-to-face visits of the experimental group. Both groups were interviewed by telephone about 3and 6months after finishing the physiotherapy treatment. For this purpose, the Barthel scale was used for the subjective perception of the state of health, and the scale of compliance with home guidelines. Linear (regression coefficient, 95% CI) and logistic (OR, 95% CI) regression models were fitted. Results: The study population was 154 people (76.6% women). Perceived health was significantly better (P<.001) in the experimental group than in the control group, both at 3(7.4 versus 5.0, respectively) and at 6months of follow-up (7.1 versus 4.6, respectively). There was a strong association between perceived health and compliance (regression coefficient 3.0 [95% CI=2.5–3.4]). The strong association between MI and treatment adherence was maintained after multivariate adjustments (6-month OR=383.6 [95% CI 31.0–4742.4]). Conclusions: MI is a feasible and effective complement to physiotherapy treatments to improve compliance with home recommendations and subjective perception of health. (AU)

Efectividad de los protocolos de fisioterapia para pacientes con dolor lumbar crónico. Una revisión sistemática / Effectiveness of physiotherapy protocols for patients with chronic low back pain: A systematic review

Introducción: El dolor lumbar crónico es una de las principales causas de incapacidad laboral en el mundo. Requiere un abordaje interdisciplinario para la evolución del paciente. Hasta el momento, no existe consenso en el manejo del dolor lumbar crónico, lo que generó la inquietud de esta revisión sistemática. Objetivo: Identificar la efectividad de los protocolos de fisioterapia en el manejo del dolor lumbar crónico. Metodología: Se realizó una búsqueda sistemática en las bases de datos Pubmed, ScienceDirect, Scopus, Oxford, Wiley, Cochrane Library Plus, PEDro, Epistemonikos, Hinari y LILACS, Google Scholar, Teseo y PROSPERO, desde el inicio de las bases hasta agosto de 2021. Los criterios de selección se definieron según la intervención y el tema del artículo. Resultados: Se incluyeron 26 estudios en la síntesis cualitativa, se excluyeron artículos que no cumplieran con los criterios de inclusión. Se encontró efecto en el control del dolor y la disminución de la discapacidad y las principales intervenciones son: fortalecimiento muscular del Core y miembros inferiores, estiramiento de miembros inferiores, movilidad lumbopélvica y educación o escuela de espalda. La frecuencia en el tratamiento osciló entre 2 y 3 veces por semana durante 5 semanas. Conclusiones: Se encontró mayor efectividad en el tiempo de control del dolor y la disminución de la discapacidad, relacionados principalmente con el fortalecimiento muscular del Core y las estrategias educativas.(AU)

Introduction: Chronic low back pain is one of the main causes of incapacity for work in the world. It requires an interdisciplinary approach for the evolution of the patient. Until now, there is no consensus on the management of chronic low back pain, which generated the concern of this systematic review. Aim: To identify the effectiveness of physiotherapy protocols in the management of chronic low back pain. Methodology: A systematic search was carried out in the Pubmed, ScienceDirect, Scopus, Oxford, Wiley, Cochrane Library Plus, PEDro, Epistemonikos, Hinari and LILACS, Google Scholar, Teseo and PROSPERO databases, from the beginning of the databases until August, 2021. The selection criteria were defined according to the intervention and topic of the article. Results: Twenty-six studies were included in the qualitative synthesis, articles that did not meet the inclusion criteria were excluded. An effect was found in the control of pain and the reduction of disability and the main interventions are: muscular strengthening of the core and lower limbs, stretching of the lower limbs, lumbopelvic mobility and education or back school. The treatment frequency ranged from 2 to 3 times per week for 5 weeks. Conclusions: Greater effectiveness was found in pain control time and disability reduction, mainly related to core muscle strengthening and educational strategies.(AU)

Dislodgment of continuous suprascapular nerve block catheters after physiotherapy: A cadaver study.

BACKGROUND: Continuous peripheral nerve blocks are commonly used for pain management. However, the incidence of catheter dislodgement or migration is unclear, and may be underestimated and underreported. Our objective was to assess suprascapular catheter tip positioning before and after routine simulated shoulder physiotherapy manipulation in an anatomical cadaver model. METHOD: Eight ultrasound-guided continuous suprascapular nerve block catheters were placed in cryopreserved fresh cadavers. Computed tomography (CT) confirmed the location of the catheter tip after injection of 1 ml of contrast medium. We performed a series of standardized shoulder movements during a simulated shoulder physiotherapy session in cadavers. Following this, we administered 1 ml of methylene blue through the catheters, and then performed anatomical dissections to accurately identify the location of the catheter tips and compare them to their placement prior to the 'physiotherapy'. RESULT: CT imaging confirmed the location of the catheter tips at the suprascapular notch in all cases. However, following physiotherapy, 2 catheters (25%) were found to have migrated - specifically, 1 was located in the supraspinatus muscle, and the other was located in the trapezius muscle. CONCLUSION: Our findings suggest that catheter dislodgement may occur in approximately 25% of cases following simulated physiotherapy manipulation. However, further research is needed to determine the read incidence of catheter dislodgement in clinical practice.

Electrical impedance tomography: Usefulness for respiratory physiotherapy in critical illnesses.

Respiratory physiotherapy, including the management of invasive mechanical ventilation (MV) and noninvasive mechanical ventilation (NIV), is a key supportive intervention for critically ill patients. MV has potential for inducing ventilator-induced lung injury (VILI) as well as long-term complications related to prolonged bed rest, such as post-intensive care syndrome and intensive care unit acquired weakness. Physical and respiratory therapy, developed by the critical care team, in a timely manner, has been shown to prevent these complications. In this pathway, real-time bedside monitoring of changes in pulmonary aeration and alveolar gas distribution associated with postural positioning, respiratory physiotherapy techniques and changes in MV strategies can be crucial in guiding these procedures, providing safe therapy and prevention of potential harm to the patient. Along this path, electrical impedance tomography (EIT) has emerged as a new key non-invasive bedside strategy free of radiation, to allow visualization of lung recruitment. This review article presents the main and potential applications of EIT in relation to physiotherapy techniques in the ICU setting.

Eficacia del ejercicio de alta intensidad en personas con dolor lumbar crónico: una revisión sistemática / Efficacy of high-intensity exercise in people with chronic low back pain: A systematic review

El dolor lumbar crónico causa discapacidad e impacto socioeconómico. El ejercicio de alta intensidad muestra resultados positivos en otras enfermedades, pero no existe evidencia sobre esta patología. Se pretende determinar su eficacia en la calidad de vida relacionada con la salud, la discapacidad, la intensidad del dolor y la adherencia al tratamiento en personas con dolor lumbar crónico. Se realiza una revisión bibliográfica en Pubmed, PEDro y Scopus, incluyendo ensayos clínicos aleatorizados, guías de práctica clínica y revisiones sistemáticas en español, inglés o portugués (2012-2022). Además, se hace una búsqueda en bola de nieve. Se incorporan ocho ensayos clínicos aleatorizados (n=379). Se analizan diferentes modalidades de ejercicio de alta intensidad, que parecen mejorar la calidad de vida relacionada con la salud y reducir la discapacidad y la intensidad del dolor. Estos datos se deben tomar con cautela dada la poca cantidad de estudios y el riesgo de sesgo que presentan.(AU)

Chronic low back pain causes disability and socioeconomic impact. High-intensity exercise shows positive results in other diseases, but there is no evidence on this pathology. The aim is to determine its efficacy on health-related quality of life, disability, pain intensity and adherence to treatment in people with chronic low back pain. A literature review is conducted in Pubmed, PEDro and Scopus, including randomized clinical trials, clinical practice guidelines and systematic reviews in Spanish, English or Portuguese (2012-2022). In addition, a snowball search is performed. Eight randomized clinical trials (n=379) are incorporated. Different high-intensity exercise modalities are analyzed, which seem to improve health-related quality of life and reduce disability and pain intensity. These data should be taken with caution given the small number of studies and the risk of bias presented.(AU)

Actualización del tratamiento de fisioterapia en el abordaje de la endometriosis. Una revisión sistemática / Update on physiotherapy treatment in endometriosis: A systematic review

La endometriosis es una patología ginecológica crónica e inflamatoria caracterizada por la presencia de tejido endometrial fuera del útero. Entre las manifestaciones clínicas están el dolor pélvico crónico, la fatiga, la dismenorrea, la dispareunia, la infertilidad, la disuria y la disquecia. La fisioterapia puede formar parte del tratamiento sintomático de la endometriosis, es por ello, que con esta revisión se pretende analizar la bibliografía científica para evaluar el efecto de la fisioterapia en este padecimiento. Se realizó una búsqueda bibliográfica durante las dos primeras semanas del mes de diciembre de 2022 en las bases de datos PubMed, Medline, Scopus, Web of Science, Physiotherapy Evidence Database (PEDro), Cumulative Index to Nursing and Allied Health Literature (CINAHL) y Enfermería-Fisioterapia-Podología (ENFISPO). Se emplearon los descriptores «Endometriosis» «Physical Therapy Modalities», «Physiotherapy», «Physiotherapist», «Physical therapy» y «Physical rehabilitation». Los resultados se limitaron a estudios clínicos aleatorizados publicados en inglés o español. Se obtuvieron un total de 943 artículos, de los cuales seis fueron seleccionados tras aplicar los criterios de elegibilidad. Las investigaciones seleccionadas desarrollaron diferentes intervenciones de fisioterapia con técnicas tales como la electroterapia con estimulación nerviosa transcutánea (TENS) y láser pulsado de alta intensidad (HILT), el entrenamiento de relajación muscular progresiva, la actividad física aeróbica, la terapia manual y el ejercicio terapéutico a través del yoga. La fisioterapia parece aportar beneficios en cuanto a la reducción del dolor pélvico y mejora de la calidad de vida en mujeres con endometriosis.(AU)

Endometriosis is a chronic, inflammatory gynecological pathology characterized by the presence of endometrial tissue outside the uterus. Clinical manifestations include chronic pelvic pain, fatigue, dysmenorrhea, dyspareunia, infertility, dysuria and dyschezia. Physical therapy can be part of the symptomatic treatment of endometriosis; therefore, this review aims to analyze the scientific literature to evaluate the effect of physical therapy in endometriosis. A bibliographic search was carried out during the first two weeks of December 2022 in the databases PubMed, Medline, Scopus, Web of Science, PEDro, CINAHL and ENFISPO. The descriptors “Endometriosis” “Physical Therapy Modalities”, “Physiotherapy”, “Physiotherapist”, “Physical therapy” and “Physical rehabilitation” were used. Results were limited to randomized clinical studies published in English or Spanish. A total of 943 results were obtained, of which 6 were selected after applying the eligibility criteria. The selected studies develop different physiotherapy interventions with techniques such as electrotherapy with TENS and high intensity pulsed laser, progressive muscle relaxation training, aerobic training, manual therapy, and therapeutic exercise through yoga. Physiotherapy appears to provide benefits in terms of reducing pelvic pain and improving quality of life in women with endometriosis.(AU)

Improving health-related quality of life in middle-age children with cerebral palsy following selective percutaneous myofascial lengthening and functional physiotherapy / Mejora de la calidad de vida relacionada con la salud en niños de mediana edad con parálisis cerebral después de un alargamiento miofascial percutáneo selectivo y fisioterapia funcional

Introduction and objectives: Children with cerebral palsy (CP) experience decreased health-related quality of life (HRQOL). This study aimed to assess the HRQOL of children with CP before versus after a combined program of minimally invasive selective percutaneous myofascial lengthening (SPML) and functional physiotherapy. Material and methods: A single-group pre–posttest design was used. Twenty-six middle childhood children with spastic CP, aged 5–7 years, with Gross Motor Function Classification System levels II–IV underwent SPML surgery and 9 months of postoperative functional strength training therapy. The proxy version of the DISABKIDS-Smiley questionnaire was completed by one parent of each child. Dependent t-tests were used to compare mean pre- and post-measurement scores. Results: After the 9-month intervention, the children with CP had significantly higher quality of life scores (mean difference, 11.06±9.05; 95% confidence interval [CI], 7.40–14.71; p<0.001). Conclusions: This study demonstrated that children with CP had better HRQOL after a combined program of minimally invasive SPML surgery and functional physiotherapy (ACTRN12618001535268).(AU)

Introducción y objetivos: Los niños con parálisis cerebral (PC) experimentan una disminución de la calidad de vida relacionada con la salud (CVRS). El objetivo de este estudio fue evaluar la CVRS de niños con PC antes y después de un programa combinado de alargamiento miofascial percutáneo selectivo (SPML) y fisioterapia funcional. Material y métodos: Se utilizó un diseño de un solo grupo con pretest y postest. Veintiséis niños de mediana edad (5 a 7 años) con PC espástica, niveles II-IV del sistema de la clasificación de la función motora gruesa se sometieron a cirugía SPML y fisioterapia de funcional posquirúrgica durante 9 meses. La versión proxy del cuestionario DISABKIDS-Smiley fue completada por uno de los padres de cada niño. Se realizaron pruebas t dependientes para comparar las puntuaciones medias previas y posteriores a la medición. Resultados: Después de 9 meses de intervención, los niños con PC tenían puntuaciones de calidad de vida significativamente más altas desde el punto de vista estadístico (diferencia de medias: 11,06±9,05; intervalo de confianza del 95%: 7,40-14,71; p <0,001). Conclusión: Este estudio demostró que los niños con PC presentaron una mejor CVRS después de un programa combinado de cirugía SPML y fisioterapia funcional.(AU)

[Artículo traducido] Mejora de la calidad de vida relacionada con la salud en niños de mediana edad con parálisis cerebral después de un alargamiento miofascial percutáneo selectivo y fisioterapia funcional / Improving health-related quality of life in middle-age children with cerebral palsy following selective percutaneous myofascial lengthening and functional physiotherapy

Introduction and objectives: Children with cerebral palsy (CP) experience decreased health-related quality of life (HRQOL). This study aimed to assess the HRQOL of children with CP before versus after a combined program of minimally invasive selective percutaneous myofascial lengthening (SPML) and functional physiotherapy. Material and methods: A single-group pre–posttest design was used. Twenty-six middle childhood children with spastic CP, aged 5–7 years, with Gross Motor Function Classification System levels II–IV underwent SPML surgery and 9 months of postoperative functional strength training therapy. The proxy version of the DISABKIDS-Smiley questionnaire was completed by one parent of each child. Dependent t-tests were used to compare mean pre- and post-measurement scores. Results: After the 9-month intervention, the children with CP had significantly higher quality of life scores (mean difference, 11.06±9.05; 95% confidence interval [CI], 7.40–14.71; p<0.001). Conclusions: This study demonstrated that children with CP had better HRQOL after a combined program of minimally invasive SPML surgery and functional physiotherapy (ACTRN12618001535268).(AU)

Introducción y objetivos: Los niños con parálisis cerebral (PC) experimentan una disminución de la calidad de vida relacionada con la salud (CVRS). El objetivo de este estudio fue evaluar la CVRS de niños con PC antes y después de un programa combinado de alargamiento miofascial percutáneo selectivo (SPML) y fisioterapia funcional. Material y métodos: Se utilizó un diseño de un solo grupo con pretest y postest. Veintiséis niños de mediana edad (5 a 7 años) con PC espástica, niveles II-IV del sistema de la clasificación de la función motora gruesa se sometieron a cirugía SPML y fisioterapia de funcional posquirúrgica durante 9 meses. La versión proxy del cuestionario DISABKIDS-Smiley fue completada por uno de los padres de cada niño. Se realizaron pruebas t dependientes para comparar las puntuaciones medias previas y posteriores a la medición. Resultados: Después de 9 meses de intervención, los niños con PC tenían puntuaciones de calidad de vida significativamente más altas desde el punto de vista estadístico (diferencia de medias: 11,06±9,05; intervalo de confianza del 95%: 7,40-14,71; p <0,001). Conclusión: Este estudio demostró que los niños con PC presentaron una mejor CVRS después de un programa combinado de cirugía SPML y fisioterapia funcional.(AU)

Efectos de la mastectomía en los parámetros baropodométricos de pacientes con cáncer de seno / The effect of mastectomy on baropodometric parameters for breast cancer patients / Efeitos da mastectomia nos parâmetros baropodometricos de pacientes com câncer de mama

Objetivo: la mastectomía posterior al cáncer de seno produce diversas alteraciones posturales y biomecánicas en el plano frontal y sagital. Dichos cambios conducen a una cinemática alterada de la columna vertebral, desequilibrio muscular y alteración del soporte del peso del pie. Este estudio pretende describir las alteraciones de la baropodometría después de la mastectomía, con base en análisis baropodométricos de la presión media y la carga estática. Metodología: se realizó un estudio descriptivo correlacional. Las propiedades de carga del pie se identificaron en 17 mujeres mastectomizadas. Se utilizó una placa de presión Ecosanit Foot para medir la carga del pie en posición anatómica y con los pies juntos. Resultados: en el estudio participaron 17 mujeres mastectomizadas con una edad media de 54.16 años. Las pacientes reportaron una presión media significativamente mayor en la posición anatómica del lado dominante mastectomizado en comparación con el lado no dominante mastectomizado (227.2 ± 22.16 vs. 175.6 ± 14.95, p =0.05). No hubo diferencia significativa para la carga estática entre el lado dominante mastectomizado y el lado no dominante mastectomizado en la posición anatómica (52.43±4.069 vs. 49.69 ± 4.094, de forma respectiva). Conclusión: los resultados actuales de nuestro estudio evidenciaron la distribución desequilibrada del peso (vector carga en el pie) en pacientes después de la mastectomía. Por tanto, en este texto se describen las alteraciones posturales, musculares, y el desequilibrio estático y dinámico en pacientes con cáncer de seno.

Objective: mastectomy after breast cancer produces several postural and biomechanical alterations in the frontal and sagittal plane. Such changes lead to disturbed kinematics of the spine, muscle imbalance and altered foot weight bearing. This study aims to describe body balance alterations after mastectomy based on the baropodometric analysis of their mean pressure and static load. Methodology: a descriptive correlational research was carried out. Foot weight-bearing properties were identified in 17 patients who have undergone a mastectomy. An Ecosanit Foot pressure plate was used to measure foot load at anatomical position and keeping the feet together. Results: 17 female patients who had undergo mastectomy with a mean age of 54.16 years took part on the research. Patients who have had a dominant-side mastectomy demonstrated significant greater mean pressure at anatomical position when compared to those patients who have had a non-dominant side mastectomy (227.2 ± 22.16 versus 175.6 ± 14.95, p =0.05). There was no significant difference for static load between the patients who have had a dominant side mastectomy and patients who have had a non dominant side mastectomy at anatomical position (52.43 ± 4.069 versus 49.69 ± 4.094, respectively). Conclusion: the current results of our research showed the unbalanced weight distribution in patients after mastectomy. Consequently, it describes the postural and muscular alterations, and the static and dynamic imbalance in breast cancer patients.

Objetivo: A mastectomia após câncer de mama produz diversas alterações posturais e biomecânicas nos planos frontal e sagital. Tais mudanças levam a alteração da cinemática da coluna, desequilíbrio muscular e alteração do suporte de peso do pé. Este estudo tem como objetivo descrever as alterações baropodométricas após mastectomia, com base em análises baropodométricas de pressão média e carga estática. Metodologia: foi realizado estudo correlacional descritivo. Propriedades de carga nos pés foram identificadas em 17 mulheres mastectomizadas. Uma placa de pressão Ecosanit Foot foi usada para medir a carga do pé em posição anatômica e com os pés juntos. Resultados: participaram do estudo 17 mulheres mastectomizadas com idade média de 54,16 anos. Os pacientes relataram uma pressão média significativamente maior na posição anatômica do lado mastectomizado dominante em comparação ao lado mastectomizado não dominante (227,2 ± 22,16 vs. 175,6 ± 14,95, p =0,05). Não houve diferença significativa para a carga estática entre o lado mastectomizado dominante e o lado mastectomizado não dominante na posição anatômica (52,43 ± 4,069 vs. 49,69 ± 4,094, respectivamente). Conclusão: Os resultados atuais do nosso estudo mostraram distribuição de peso desequilibrada (carga vetorial no pé) em pacientes após mastectomia. Portanto, este texto descreve alterações posturais, musculares e desequilíbrio estático e dinâmico em pacientes com câncer de mama.

[Efficacy of high-intensity exercise in people with chronic low back pain: A systematic review]. / Eficacia del ejercicio de alta intensidad en personas con dolor lumbar crónico: una revisión sistemática.

Chronic low back pain causes disability and socioeconomic impact. High-intensity exercise shows positive results in other diseases, but there is no evidence on this pathology. The aim is to determine its efficacy on health-related quality of life, disability, pain intensity and adherence to treatment in people with chronic low back pain. A literature review is conducted in Pubmed, PEDro and Scopus, including randomized clinical trials, clinical practice guidelines and systematic reviews in Spanish, English or Portuguese (2012-2022). In addition, a snowball search is performed. Eight randomized clinical trials (n=379) are incorporated. Different high-intensity exercise modalities are analyzed, which seem to improve health-related quality of life and reduce disability and pain intensity. These data should be taken with caution given the small number of studies and the risk of bias presented.

Improving health-related quality of life in middle-age children with cerebral palsy following selective percutaneous myofascial lengthening and functional physiotherapy. / [Artículo traducido] Mejora de la calidad de vida relacionada con la salud en niños de mediana edad con parálisis cerebral después de un alargamiento miofascial percutáneo selectivo y fisioterapia funcional.

INTRODUCTION AND OBJECTIVES: Children with cerebral palsy (CP) experience decreased health-related quality of life (HRQOL). This study aimed to assess the HRQOL of children with CP before versus after a combined program of minimally invasive selective percutaneous myofascial lengthening (SPML) and functional physiotherapy. MATERIAL AND METHODS: A single-group pre-posttest design was used. Twenty-six middle childhood children with spastic CP, aged 5-7 years, with Gross Motor Function Classification System levels II-IV underwent SPML surgery and 9 months of postoperative functional strength training therapy. The proxy version of the DISABKIDS-Smiley questionnaire was completed by one parent of each child. Dependent t-tests were used to compare mean pre- and post-measurement scores. RESULTS: After the 9-month intervention, the children with CP had significantly higher quality of life scores (mean difference, 11.06 ± 9.05; 95% confidence interval [CI], 7.40-14.71; p < 0.001). CONCLUSIONS: This study demonstrated that children with CP had better HRQOL after a combined program of minimally invasive SPML surgery and functional physiotherapy (ACTRN12618001535268).

Improving health-related quality of life in middle-age children with cerebral palsy following selective percutaneous myofascial lengthening and functional physiotherapy.

INTRODUCTION AND OBJECTIVES: Children with cerebral palsy (CP) experience decreased health-related quality of life (HRQOL). This study aimed to assess the HRQOL of children with CP before versus after a combined program of minimally invasive selective percutaneous myofascial lengthening (SPML) and functional physiotherapy. MATERIAL AND METHODS: A single-group pre-posttest design was used. Twenty-six middle childhood children with spastic CP, aged 5-7 years, with Gross Motor Function Classification System levels II-IV underwent SPML surgery and 9 months of postoperative functional strength training therapy. The proxy version of the DISABKIDS-Smiley questionnaire was completed by one parent of each child. Dependent t-tests were used to compare mean pre- and post-measurement scores. RESULTS: After the 9-month intervention, the children with CP had significantly higher quality of life scores (mean difference, 11.06±9.05; 95% confidence interval [CI], 7.40-14.71; p<0.001). CONCLUSIONS: This study demonstrated that children with CP had better HRQOL after a combined program of minimally invasive SPML surgery and functional physiotherapy (ACTRN12618001535268).

[Effectiveness of early motor interventions in children with cerebral palsy between 3 to 5years of age: Systematic review]. / Efectividad de la intervención motora temprana en el desarrollo motor de los niños con parálisis cerebral entre 3 y 5años de edad. Revisión sistemática.

Early motor intervention is essential in children with cerebral palsy; however, it is unknown its effectiveness between 3 to 5years. The objective was to determinate the effectiveness of early motor intervention in the motor development of this population. A systematic literature search was performed in Pubmed/Medline, PEDro, OTSeeker, Embase, and LILACS. Finally, 18 articles were selected, of which 4 showed favorable changes in the experimental group in the outcomes of overall motor development and manual motor function, with sensory integration therapy and movement-induced restriction therapy, respectively; however, the results were not statistically significant, and the level of evidence was low. Early motor intervention could be cautiously considered for improving overall motor development and manual function. Higher-quality methodological studies are necessary.

Reproducibility of an instrument for motor assessment of youth with autism / Reprodutibilidade de instrumento para avaliação motora de jovens com autismo

Abstract Introduction Individuals with autistic spectrum disorder (ASD) have motor impairments that precede communi-cation and socialization disorders. Evaluative instruments compatible with the real possibilities and specificities of patients with ASD, and who quantitatively and qualitatively translate the data in which is wished to intervene with therapeutic actions, are important both in the scope of research and in the clinical evaluation of physiotherapists. Objective To test the interobserver and intraobserver reproducibility of the instrument "Gross Motor Assessment of Children and Adolescents with Autism Spectrum Disorder" (GMA-AUT checklist). Methods The sample consisted of 34 individuals with ASD, aged between 6 and 18 years. The interobserver reproducibility was performed in a blinded manner by two physiotherapists experts in the ASD area of treatment. Intraobserver reproducibility was performed by one of the evaluators on two different days, with a gap of seven days and without access to data from the first evaluation. To verify the reproducibility, percentage of agreement and kappa statistics (k) were used, with the weighted kappa and, for the instrument scores, the intraclass correlation coefficient (ICC). Results The GMA-AUT checklist showed excellent intraobserver agreement, with k ≥ 0.75 and ICC > 0.75. Interobserver reproducibility ranged from good to sufficient agreement with k between 0.40 and 0.75 and ICC > 0.75 for the most part. Conclusion The GMA-AUT checklist had excellent intraobserver reproducibility and, therefore, can be reliably used for assessments of individuals aged between 6 and 18 years with ASD.

Resumo Introdução Indivíduos com transtorno do espectro autista (TEA) apresentam comprometimentos motores que precedem os distúrbios de comunicação e socialização. Instrumentos avaliativos compatíveis com as reais possibilidades e especi-ficidades dos pacientes com TEA, e que traduzam quantitativa e qualitativamente os dados nos quais se deseja intervir com ações terapêuticas, são importantes tanto no âmbito da pesquisa quanto na avaliação clínica do fisioterapeuta. Objetivo Testar a reprodutibilidade interobservador e intraobservador do instrumento "Avaliação Motora Grossa de Crianças e Adolescentes com Transtorno do Espectro Autista" (checklist GMA-AUT). Métodos A amostra foi composta por 34 indivíduos com TEA, com idade entre 6 e 18 anos. A repro-dutibilidade interobservador foi realizada de forma cega por dois fisioterapeutas especialistas na área de tratamento do TEA. A reprodutibilidade intraobservador foi realizada por um dos avaliadores em dois dias distintos, com intervalo de sete dias e sem acesso aos dados da primeira avaliação. Para verificar a reprodutibilidade foram utilizadas a porcentagem de concordância e a estatística kappa (k), com kappa ponderado e, para os escores do instrumento, coeficiente de correlação intraclasse (CCI). Resultados O checklist GMA-AUT apresentou excelente concordância intraobservador, com k ≥ 0,75 e ICC > 0,75. A reprodutibilidade interobservador variou de boa a suficiente concordância, com k entre 0,40 e 0,75 e ICC > 0,75 na maior parte. Conclusão O checklist GMA-AUT apresentou excelente reprodutibilidade intraobservador e, portanto, pode ser utilizado de forma confiável para avaliações de indivíduos com idade entre 6 e 18 anos com TEA.

Step tests are feasible, safe, and can be used to evaluate exercise capacity at home after hospitalization for COVID-19 / Os testes do degrau são viáveis, seguros e podem ser utilizados para avaliar a capacidade de exercício no domicílio após hospitalização por COVID-19

Abstract Introduction: Step-based tests are commonly utilized to assess the exercise capacity of individuals with respiratory diseases. However, the feasibility and safety of the step tests have not yet been studied in individuals after COVID-19. Objective: To investigate the feasibility and safety of the six-minute step test (6MST) and the modified incremental step test (MIST) in assessing exercise capacity at home in individuals after hospitalization for COVID-19, and to identify factors associated with performance in these tests. Methods: Cross-sectional multicenter study with individuals hospitalized for COVID-19 fifteen days after hospital discharge. Participants performed spirometry, 6MST, and MIST during a single home visit. Adverse events were registered during and immediately after the tests. Results: Sixty-five participants were studied (50 ± 10 years old, 55% male). The feasibility was 96.9% and the incidence of adverse events was 13.8% in 6MST and 6.2% in MIST. The individuals performed 76.9% of the predicted on the 6MST, with 40% of the participants reaching 80% of the maximum HR and 31% presenting exercise-induced oxygen desaturation. In the MIST, the individuals performed 20% of the predicted, 23% of the participants reached 80% of the maximum heart rate, and 17% presented exercise-induced oxy-gen desaturation. Length of hospital stay and the use of mechanical ventilation were associated with test performance. Conclusion: 6MST and MIST are feasible, safe, and can be used to assess exercise capacity in a home environment in individuals after hospitalization for COVID-19. The performance in these tests was associated with a prolonged hospital stay and the use of mechanical ventilation.

Resumo Introdução: Testes baseados em degraus são comumente utilizados para avaliar a capacidade de exercício de indivíduos com doenças respiratórias. No entanto, a viabilidade e segu-rança dos testes de degrau ainda não foram estudadas em indivíduos após hospitalização por COVID-19. Objetivo: In-vestigar a viabilidade e segurança do teste do degrau de seis minutos (TD6) e do teste do degrau incremental modificado (TDIM) na avaliação da capacidade de exercício no domicílio em indivíduos após hospitalização por COVID-19, e identificar fatores associados ao desempenho nesses testes. Métodos: Estudo transversal multicêntrico com indivíduos internados por COVID-19 quinze dias após a alta hospitalar. Os participantes realizaram espirometria, TD6 e TDIM durante uma única visita domiciliar. Eventos adversos foram registrados durante e ime-diatamente após os testes. Resultados: Foram estudados 65 participantes (50 ± 10 anos, 55% do sexo masculino). A via-bilidade foi de 96,9% e a incidência de eventos adversos foi de 13,8% no 6MST e 6,2% no TDIM. Os indivíduos realizaram 76,9% do previsto no TD6, sendo que 40% dos participantes atingiram 80% da frequência cardíaca máxima e 31% apresen-taram dessaturação de oxigênio induzida pelo exercício. No TDIM, os indivíduos realizaram 20% do previsto, 23% dos participantes atingiram 80% da frequência cardíaca máxima e 17% apresentaram dessaturação de oxigênio induzida pelo exercício. O tempo de internação e o uso de ventilação mecâni-ca estiveram associados ao desempenho do teste. Conclusão: O TD6 e o TDIM são viáveis, seguros e podem ser usados para avaliar a capacidade de exercício em ambiente domiciliar em indivíduos após hospitalização por COVID-19. O desempenho nesses testes esteve associado ao tempo prolongado de internação e ao uso de ventilação mecânica.

Profile of cardiovascular diseases and physiotherapeutic intervention in a hospital emergency service / Perfil das doenças cardiovasculares e atuação fisioterapeutica em um serviço de emergência hospitalar

Abstract Introduction Cardiovascular disease (CVD) is the lead-ing cause of death globally, with a high proportion of hospitalizations and costs. In view of this, it is essential to understand the main CVDs in patients admitted to hospital emergency services and the role of physiotherapists, in order to plan and direct health services, and to denote participation and encourage specific physiotherapy training in the context of tertiary care. Objective To outline the profile of cardiovascular emergencies and to evaluate physiotherapy in adult patients in the emergency department of a hospital in the interior of the state of São Paulo. Methods This was an observational study which analyzed 1,256 on-call records over a period of eight months. The data collected included age, gender, cardiovascular diagnostic hypothesis and physiotherapy treatment carried out. Results A total of 75 patients with cardiovascular emergencies were included, the most prevalent of which were: heart failure (n = 21), acute coronary syndrome (n = 14), acute myocardial infarction (n = 13), bradyarrhythmia (n = 6) and hypertensive crisis (n = 5). Regarding physiotherapeutic actions and their applications, the most frequent were invasive mechanical ventilation management (n = 34), lung re-expansion maneuvers (n = 17), orotracheal intubation assistance (n = 17), non-invasive mechanical ventilation (n = 14), bronchial hygiene maneuvers (n = 12), kinesiotherapy (n = 10) and sedation (n = 10). Conclusion Heart failure and acute coronary syndrome were the cardiovascular diseases that caused the most admissions to the hospital emergency department and that the procedures with an emphasis on the respiratory system were the most applied.

Resumo Introdução As doenças cardiovasculares (DCV) repre-sentam a principal causa de morte global, destacando-se em internações e gastos. Diante disso, é essencial compreender as principais DCV em pacientes admitidos em serviços de emergência hospitalar e a atuação do fisioterapeuta para planejamento e direcionamento dos serviços de saúde e para denotar a participação e incentivar formações fisioterapêuticas específicas no contexto da atenção terciária. Objetivo Traçar o perfil de emergências cardiovasculares e avaliar a atuação fisioterapêutica em pacientes adultos de serviço de emergência de um hospital no interior do estado de São Paulo. Métodos Trata-se de um estudo observacional, em que foram analisadas 1.256 fichas de passagem de plantão, no período de oito meses. Os dados coletados foram idade, sexo, hipótese diagnóstica cardiovascular e tratamento fisioterapêutico realizado. Resultados Foram incluídos 75 pacientes que apresentavam o perfil de emergências cardiovasculares, sendo as mais prevalentes: insuficiência cardíaca (n = 21), síndrome corona-riana aguda (n = 14), infarto agudo do miocárdio (n = 13), bradarritmia (n = 6) e crise hipertensiva (n = 5). Em relação à atuação fisioterapêutica e suas aplicações, as mais frequentes foram manejo da ventilação mecânica invasiva (n = 34), manobras de reexpansão pulmonar (n = 17), auxílio a intubação orotraqueal (n = 17), ventila-ção mecânica não invasiva (n = 14), manobras de higiene brônquica (n = 12), cinesioterapia (n = 10) e sedestação (n = 10). Conclusão A insuficiência cardíaca e a síndrome coronária aguda foram as doenças cardiovasculares que mais ocasionaram internação no serviço de emergência hospitalar e as condutas com ênfase no aparelho respiratório foram as mais aplicadas.

Diaphragmatic and excursion thickness in newborns using diaphragmatic kinesiology ultrasound: an observational study / Espessura e excursão diafragmática em recém-nascidos usando ultrassonografia cinesiológica do diafragma: um estudo observacional

Abstract Introduction The study of the diaphragm muscle has aroused the interest of physiotherapists who work with kinesiological ultrasonography, but still little explored; however, its findings can contribute to the clinical practice of hospitalized patients in neonatal intensive care units. Objective To measure the excursion and thickening of the diaphragm and describe measurements among neonates, preterm, and full-term. Methods Diaphragmatic kinesiological ultrasonography was performed on hospitalized newborns, in Neonatal Unit Care Unit, placed in supine position in their own bed, on the sixth day of life. Three repeated measurements of the same respiratory cycle were made, both for excursion and for diaphragmatic thickening. Results 37 newborns participated in the study and 25 were premature. The mean weight at the time of collection was 2,307.0 ± 672.76 grams and the gestational age was 35.7 ± 3.3 weeks. Diaphragmatic excursion increased with increasing gestational age (p = 0.01, df = 0.21) in term infants (p = 0.17, df = 0.35). Conclusion There was a positive correlation between diaphragmatic excursion and gestational age. There was no statistically significant difference in the measurements of excursion and inspiratory diaphragm thickening between preterm and term newborns, although pointing to higher measurements in the latter group.

Resumo Introdução O estudo do músculo diafragma tem des-pertado o interesse dos fisioterapeutas que trabalham com ultrassonografia cinesiológica. Ainda pouco explo-rado, contudo, seus achados podem contribuir para a prática clínica dos pacientes internados em unidades de terapia intensiva neonatal (UTIN). Objetivo Mensurar a excursão e o espessamento diafragmático e descrever as medidas entre recém-nascidos prematuros e a termo. Métodos Realizou-se ultrassonografia cinesiológica diafragmática em recém-nascidos internados em UTIN, posicionados em supino em seu próprio leito, no sexto dia de vida. Foram realizadas três medidas repetidas do mesmo ciclo respiratório, tanto da excursão quanto do espessamento diafragmático. Resultados Participaram do estudo 37 recém-nascidos, dos quais 25 eram pre-maturos. O peso no momento da coleta foi de 2.307,0 ± 672,76 gramas e a idade gestacional foi de 35,7 ± 3,3 semanas. A excursão diafragmática aumentou de acordo com o aumento da idade gestacional (p = 0,01; df = 0,21). A espessura variou entre 0,10 e 0,16 cm durante a inspiração nos prematuros e entre 0,11 e 0,19 cm nos nascidos a termo (p = 0,17; df = 0,35). Conclusão Houve correlação positiva entre a excursão diafragmá-tica e a idade gestacional. Não observou-se diferença estatisticamente significativa das medidas de excursão e de espessamento diafragmático inspiratório entre recém-nascidos prematuros e recém-nascidos a termo, embora apontando para maiores medidas neste último grupo.

Modelo para avaliação da efetividade da atuação fisioterapêutica na atenção básica / Model for evaluating the effectiveness of physiotherapeutic activities in primary care

RESUMO A pesquisa objetivou elaborar um modelo para avaliação da efetividade da atuação fisioterapêutica na atenção básica. O modelo foi elaborado com base na literatura, em entrevistas com experts envolvidos na atuação fisioterapêutica na Atenção Básica à Saúde e conferência de consenso para validação com especialistas. A matriz avaliativa proposta é composta por três dimensões - ações assistenciais, de gestão e de promoção de saúde - e nove indicadores. Esse modelo proposto será posteriormente aplicado para verificar sua aplicabilidade, necessidade de ajustes e possibilidade de replicação em diferentes contextos.

ABSTRACT The research aimed to develop a model to evaluate the effectiveness of physiotherapeutic activities in primary care. The model was elaborated based on the literature, through interviews with experts involved in physiotherapeutic activities in Primary Health Care and a consensus conference for validation with specialists. The proposed evaluation matrix is composed of three dimensions - care, management and health promotion actions - and nine indicators. This proposed model will be later applied to verify its applicability, the need for adjustments and the possibility of replication in different contexts.