Effects of a Home-Based Upper Limb Training Program in Patients With Multiple Sclerosis: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the effects of a home-based upper limb training program on arm function in patients with multiple sclerosis (MS). Additionally, the effects of this program on manual dexterity, handgrip strength, and finger prehension force were analyzed. DESIGN: Randomized, single-blind controlled trial. SETTING: Home based. PARTICIPANTS: Patients with a clinical diagnosis of MS acknowledging impaired manual ability (N=37) were randomized into 2 groups. INTERVENTIONS: Patients in the experimental group were included in a supervised home-based upper limb training program for 8 weeks twice a week. Patients in the control group received information in the form of a leaflet with a schedule of upper limb exercise training. MAIN OUTCOME MEASURES: The primary outcome measure was arm function (motor functioning assessed using the finger tapping test and a functional measure, the Action Research Arm Test). The secondary outcome measures were manual dexterity assessed with the Purdue Pegboard Test and handgrip strength and finger prehension force evaluated with a handgrip and a pinch dynamometer, respectively. RESULTS: After 8 weeks, a significant between-group improvement (P<.05) was found on the Action Research Arm Test bilaterally and the finger tapping test in the most affected upper limb. The secondary outcomes also improved in the most affected limb in the experimental group. CONCLUSIONS: An 8-week home-based intervention program focused on upper limbs twice a week improved arm function and physiologic variables with a primary focus on the more affected extremity in patients with MS compared with the control group.

Results of Physiotherapy Treatments in Exacerbations of Chronic Obstructive Pulmonary Disease: A Systematic Review.

Purpose: The objective of this study was to review clinical trials of the effectiveness of physiotherapy compared with standard care, focused mainly on the functional status of patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods: Search strategies were developed for each of the databases (PubMed, Scopus, and Web of Science). The study eligibility criteria were as follows: (1) The objective was to assess the effect and efficacy of physiotherapy compared with standard care (which included only medical and pharmacological treatment); (2) adults subjects had AECOPD; (3) one of the outcome measures was functional status, defined as an individual's ability to perform the normal daily activities required to meet basic needs, fulfill usual roles, and maintain health and well-being; (4) it was a clinical trial; (5) it was written in English; (6) it was published between January 2009 and February 2016; and (7) the full-text article was available. Results: The review revealed that for patients hospitalized for AECOPD, exercise, neuromuscular electrical stimulation, breathing exercises, and chest therapy significantly improved their functional status compared with standard care. Conclusions: A variety of physiotherapy modalities have been shown to improve functional status compared with standard care among patients hospitalized for AECOPD; other outcome measures also showed improvements.

Objectif : recenser les essais cliniques sur l'efficacité de la physiothérapie par rapport aux soins conventionnels pour évaluer l'état fonctionnel des patients hospitalisés pour exacerbations aiguës de la maladie pulmonaire obstructive chronique (EAMPOC). Méthodologie : des stratégies de recherche ont été mises au point pour chaque banque de données (PubMed, Scopus et Web of Science). Critères d'admissibilité des études : (1) l'étude vise à évaluer l'effet et l'efficacité de la physiothérapie par rapport aux soins conventionnels (traitement médical et médicamenteux seulement); (2) les sujets adultes souffrent d'EAMPOC; (3) un des résultats mesurés est l'état fonctionnel, défini comme la faculté d'une personne à accomplir les activités quotidiennes nécessaires pour répondre à ses besoins fondamentaux, assumer ses rôles habituels et maintenir sa santé et son bien-être; (4) il s'agit d'un essai clinique; (5) l'article est rédigé en anglais; (6) l'étude a été publiée entre janvier 2009 et février 2016; (7) le texte intégral de l'article est disponible. Résultats : le recensement révèle que l'exercice, la stimulation électrique neuromusculaire, les exercices de respiration et la physiothérapie respiratoire améliorent de façon significative l'état fonctionnel de patients hospitalisés pour EAMPOC par rapport aux soins conventionnels. Conclusions : divers soins de physiothérapie ont prouvé leur efficacité pour améliorer l'état fonctionnel de patients hospitalisés pour EAMPOC davantage que les seuls soins conventionnels. D'autres mesures de résultats ont également montré des améliorations.

Physical and Functional Impairment During and After Hospitalization in Subjects With Severe COPD Exacerbation.

BACKGROUND: COPD exacerbations are frequent events that have a negative impact on the lives of patients. The aims of this study were to analyze physical and functional impairment during hospital stay in subjects hospitalized due to COPD exacerbation and to assess the physical and functional impact of hospitalization at a 1-month follow-up in patients with severe COPD. METHODS: This was a prospective observational study on a sample of 52 subjects hospitalized due to COPD exacerbation. The assessments were performed at baseline, discharge, and 1-month follow-up. The outcome measures were dyspnea, muscle strength, functional capacity, and postural steadiness. RESULTS: Quadriceps strength [1.036 (P = .043) kg mean difference] and the one-leg stance test [1.04 (P = .02) and 0.73 (P = .032) s mean difference right and left leg] showed significant impairment during hospitalization. Dyspnea perception improved significantly (P = .004) during hospitalization. Additionally, strength in the upper and lower limbs [4.04 (P = .002) and 1.23 (P = .038) kg mean difference], functional capacity [3.0 number of steps mean difference (P = .032)], and the one-leg stance test [2.12 (P = .006) and 0.53 (P = .047) s mean difference right and left leg] showed significant impairment 1-month follow-up. CONCLUSIONS: Hospitalization due to COPD exacerbation leads to physical and functional impairment in patients; impairment is greater at 1-month follow-up. It would be interesting to conduct physical therapy interventions to prevent the impairment.

Effects of a dance-based aquatic exercise program in obese postmenopausal women with knee osteoarthritis: a randomized controlled trial.

OBJECTIVE: To evaluate the effects of a dance-based aquatic exercise program on functionality, cardiorespiratory capacity, postexercise heart rate, and fatigue in obese postmenopausal women with knee osteoarthritis. METHODS: A randomized controlled trial was performed. In all, 34 obese women diagnosed with knee osteoarthritis participated. Women were randomly allocated to an experimental group (n = 17) or a control group (n = 17). Participants in the experimental group were included in an 8-week dance-based aquatic exercise program conducted in community swimming pools. Those in the control group underwent a global aquatic exercise program. The primary outcome measure was functionality assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes were cardiorespiratory capacity evaluated with the 6-minute walk test, and postexercise heart rate and fatigue assessed using a visual analog scale. Variables were measured at baseline, after the intervention, and at 3-month follow-up. RESULTS: A between-group analysis showed significant postintervention differences in functionality (aggregate postintervention WOMAC score of 37.30 ±â€Š16.61 vs 41.83 ±â€Š13.69; P = 0.048) in favor of the experimental group. In addition, significant between-group differences were found after the 8 weeks in cardiorespiratory capacity, postexercise heart rate, and fatigue. Follow-up continued to show significant differences between groups in function (aggregate WOMAC score of 38.60 ±â€Š13.61 vs 42.60 ±â€Š9.05; P = 0.038), postexercise heart rate, and fatigue. CONCLUSIONS: An 8-week dance-based exercise program significantly improved function and cardiorespiratory capacity, and decreased postexercise heart rate and fatigue. Most of these improvements were maintained at 3-month follow-up in obese postmenopausal women.

[Effects of cognitive state on balance disturbances and gait disorders in institutionalised elderly]. / Efectos del estado cognitivo sobre las alteraciones del equilibrio y la marcha en ancianos institucionalizados.

BACKGROUND: Ageing has been linked to a high prevalence of cognitive impairment, which, in turn, has been related to balance disturbances and gait disorders. The aim of this study was to identify whether there are differences between subjects with and without cognitive impairment regarding the quality of gait and balance. MATERIAL AND METHODS: An observational study was conducted on institutionalised people older than 65 years (n=82). Gait and balance was evaluated after the assessment of cognitive impairment using the Mini-Mental State Examination (MMSE). Single and dual tests were used including, the 6-minute walking, stride length, and gait speed. Timed Up and Go tests were also used to evaluate balance. RESULTS: The participants were divided into three groups: 28 subjects in the group without cognitive impairment (MMSE≥27), 29 subjects with mild (27

[Not Available]. / Enfermedad pulmonar obstructiva crónica severa y malnutrición: efecto sobre la sintomatología y la función.

Introducción: las alteraciones en el estado nutricional en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) son frecuentes. La sintomatología y la funcionalidad de estos enfermos pueden estar relacionadas con la nutrición, incrementando su gravedad en los sujetos con malnutrición. Objetivos: el objetivo de esta investigación fue profundizar sobre el perfil clínico del paciente con EPOC malnutrido y relacionar el estado nutricional con la funcionalidad y con los síntomas de estos pacientes. Métodos: se desarrolló un estudio observacional en pacientes con EPOC severo. Se valoró el estado de dependencia, la calidad de vida, las comorbilidades y la ansiedad y depresión. La función respiratoria se valoró con el volumen espiratorio forzado en el primer segundo y la escala de Borg modificada y el estado nutricional, con el Mini Nutritional Assessment. La sintomatología fue evaluada mediante el Leicester Cough Questionnaire y el London Chest Activity of Daily Living Scale. Resultados: 154 sujetos fueron incluidos en este estudio, 98 de ellos fueron varones. Un grupo de 71 sujetos mostraron malnutrición y un grupo de 83 sujetos un estado nutricional normal. La comparación entre los grupos mostró características clínicas significativamente diferen- tes (p < 0,05). El análisis mostró diferencias significativas en la disnea (p = 0,043), así como en las subescalas de funcionalidad relacionadas con sintomatología respiratoria autocuidado (p = 0,040), actividades de ocio (p = 0,019) y la puntuación total (p = 0,031), siendo peores en los sujetos malnutridos. Conclusión: los pacientes con EPOC malnutridos presentan más síntomas y peores niveles de funcionalidad que los pacientes con EPOC con estado nutricional normal.