Effects of a supervised exercise program in addition to electrical stimulation or kinesio taping in low back pain: a randomized controlled trial

Chronic low back pain it is one of the most common health problems worldwide. Usually is accompanied by a complex set of symptoms and generates significant direct and indirect socioeconomic and health costs. From a therapeutic point of view, there are a wide variety of methods to address the treatment of this pathology, however, these therapies have not been shown definitive efficacy. To investigate the effect of a mixed treatment with exercise and electrical stimulation versus exercise and kinesio taping in patients with non-specific chronic low back pain. A total of 58 patients participated in this single-blinded randomised clinical trial. Participants were assigned to the exercises- kinesio taping group, or exercises- analgesic current group, both received 12 treatment sessions. Disability, fear of movement, anxiety, depression, sleeps quality, pain, lower limb mechanosensitivity and pressure-pain thresholds were recorded at baseline and after 4 weeks of treatment. The 2 × 2 mixed analysis of covariance test showed statistically significant differences between groups for pain (P = 0.046). Pair-wise comparisons with baseline demonstrated significant differences for both groups in pain (P ≤ 0.001), disability (P ≤ 0.001), pressure-pain thresholds (P ≤ 0.044), lower limb mechanosensitivity, (P ≤ 0.047), anxiety (P ≤ 0.001), depression (P ≤ 0.001) and sleep quality (P ≤ 0.010). Patients with chronic low back pain who received a combined treatment of exercises and kinesio taping or analgesic current showed an improvement in pain, disability, anxiety, depression and sleep pattern. Moreover, exercises combined with electrotherapy produces greater improvements over these variables.FEDER-European Regional Development Fund/European Social Fund "A way to make Europe"/"Investing in your future"Proyecto E-CEPEDOL from the Carlos III Health Institute PI18/00562 PC-0185-2017 PC-0253-2017 PC-0536-201

Comparison of the effectiveness of an e-health program versus a home rehabilitation program in patients with chronic low back pain: A double blind randomized controlled trial

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Andalusian Health Service, Junta de Andalucia (grant number PC-0185-2017, PC-0253-2017 and PC-0536-2017, PI18/00562 Proyecto E-CEPEDOL). This study was funded by a research grant (PI18/00562 Proyecto E-CEPEDOL co-funded by FEDER -European Regional Development Fund/European Social Fund "A way to make Europe"/"Investing in your future") from the Carlos III Health Institute and 3 grants from the Andalusian Health Service, Junta de Andalucia (PC-0185-2017, PC-0253-2017 and PC-0536-2017). The funders did not take part in the design of the study, its implementation, analysis, data interpretation an/or the presentation of results.Objetive: We conducted a randomized double blind clinical trial, to compare the effectiveness of McKenzie exercises and electroanalgesia via an e-Health program versus a home rehabilitation program on functionality, pain, fear of movement and quality of life in patients with non-specific chronic low back pain. Methods: Seventy-four participants with non-specific chronic low back pain were randomized to either the e- Health program group (n=39) or the home rehabilitation program group (n=35). The interventions consisted of the e-Health program group performing McKenzie exercises and received transcutaneous electrical nerve stimulation, while the home rehabilitation group attended an information session to explain the exercises, which they then performed at home with printed instructions. Both groups performed 3 weekly sessions for 8 weeks. The following were analyzed main measures: pain, disability, fear of movement, quality of life, trunk muscle endurance and trunk anteflexion motion were assessed at baseline and at 2 months. Results: Independent samples Student’s t-tests showed that although the patients who followed the e-Health program showed significantly greater improvement than those who followed the home disability rehabilitation program in terms of intensity of pain, lumbar flexion mobility (P < 0.001), and the following dimensions of quality of life (P < 0.005), both groups improved significantly in the immediate post-treatment follow up compared with baseline scores. Conclusions: Patients with chronic low back pain who followed an unsupervised home intervention supported by an individualized video exercise program showed greater post-treatment improvement than those who followed the same program with printed instructions.Junta de Andalucia PC-0185-2017 PC-0253-2017 PC-0536-2017 PI18/00562 Proyecto E-CEPEDOLInstituto de Salud Carlos III PI18/00562 Proyecto E-CEPEDOLFEDER -European Regional Development Fund/European Social Fun

Effects of Olive Oil Consumption on Cardiovascular Risk Factors in Patients with Fibromyalgia

We wish to thank AFIXA (Association of Fibromyalgia of Jaén, Spain) for collaborating in this study.We have recently reported that patients with fibromyalgia (FM) may be at increased risk for cardiovascular disease. Olive oil reportedly has cardioprotective effects. We examined the influence of olive oil consumption on cardiovascular risk factors in FM. This preliminary study was performed on blood samples of women with FM who consumed 50 mL of organic olive oil daily for 3 weeks. Patients were randomized into two groups: 15 women ingested extra virgin olive oil (EVOO) and 15 refined olive oil (ROO). Cardiovascular risk markers were measured at baseline (pre measure) and after consumption of olive oil (post measure). Red blood cell count and erythrocyte sedimentation rate (ESR; both p < 0.05) declined significantly post-treatment in the EVOO group. Consumption of ROO increased mean platelet volume and reduced platelet distribution width (PDW), neutrophil-to-lymphocyte ratio, ESR and fibrinogen (all p < 0.05). Significant differences were found in pre–post change between the EVOO and ROO groups for cortisol and PDW (both p < 0.05). Our results have shown that consumption of olive oil may have antithrombotic and antiinflammatory properties in patients with FM, thereby improving a number of cardiovascular risk markers. Both EVOO and ROO may be useful as adjuvants for the prevention and/or treatment of cardiovascular disorders in these patients.This research was funded by Consejería de Economía, Innovación, Ciencia y Empleo (Junta de Andalucía, Spain), grant number AGR-6235

The Association of Body Mass Index and Body Composition with Pain, Disease Activity, Fatigue, Sleep and Anxiety in Women with Fibromyalgia

The link between fibromyalgia syndrome (FMS) and obesity has not been thoroughly investigated. The purpose of this study was to examine the relationships among body mass index (BMI) and body composition parameters, including fat mass, fat mass percentage, and visceral fat, as well as FMS features, such as tender point count (TPC), pain, disease activity, fatigue, sleep quality, and anxiety, in a population of FMS women and healthy controls. A total of seventy-three women with FMS and seventy-three healthy controls, matched on weight, were included in this cross-sectional study. We used a body composition analyzer to measure fat mass, fat mass percentage, and visceral fat. Tender point count (TPC) was measured by algometry pressure. The disease severity was measured with the Fibromyalgia Impact Questionnaire (FIQ-R) and self-reported global pain was evaluated with the visual analog scale (VAS). To measure the quality of sleep, fatigue, and anxiety we used the Pittsburgh Sleep Quality Questionnaire (PSQI), the Spanish version of the multidimensional fatigue inventory (MFI), and the Beck Anxiety Inventory (BAI), respectively. Of the women in this study, 38.4% and 31.5% were overweight and obese, respectively. Significant differences in FIQ-R.1 (16.82 +/- 6.86 vs. 20.66 +/- 4.71, p = 0.030), FIQ-R.3 (35.20 +/- 89.02 vs. 40.33 +/- 5.60, p = 0.033), and FIQ-R total score (63.87 +/- 19.12 vs. 75.94 +/- 12.25, p = 0.017) among normal-weight and overweight FMS were observed. Linear analysis regression revealed significant associations between FIQ-R.2 ( (95% CI) = 0.336, (0.027, 0.645), p = 0.034), FIQ-R.3 ( (95% CI) = 0.235, (0.017, 0.453), p = 0.035), and FIQ-R total score ( (95% CI) = 0.110, (0.010, 0.209), p = 0.032) and BMI in FMS women after adjusting for age and menopause status. Associations between sleep latency and fat mass percentage in FMS women ( (95% CI) = 1.910, (0.078, 3.742), p = 0.041) and sleep quality and visceral fat in healthy women ( (95% CI) = 2.614, (2.192, 3.036), p = 0.008) adjusted for covariates were also reported. The higher BMI values are associated with poor FIQ-R scores and overweight and obese women with FMS have higher symptom severity. The promotion of an optimal BMI might contribute to ameliorate some of the FMS symptoms

Analysis of Hand Function, Upper Limb Disability, and Its Relationship with Peripheral Vascular Alterations in Raynaud’s Phenomenon

This study aimed to compare vascular involvement, hand functionality, and upper limb disability between Raynaud’s phenomenon participants and controls. Also, we analyzed the relationships between vascular impairment, mobility, and strength with disability in this Raynaud population. We conducted a case–control study with fifty-seven participants. We registered sociodemographic and clinical data; vascular variables (temperature, cold test, blood flow, and oxygen saturation); functional variables (pinch strength, range of motion), and disability (Shortened Disabilities of the Arm, Shoulder and Hand Questionnaire) (Q-DASH). Raynaud participants present more disability in all Q-DASH subscales, lower hands’ temperature pre and post cold test, decreased blood flow on radial artery, decreased ranges of motions at passive extension of index finger, and active flexion and extension of thumb than the healthy controls. The multivariate regression analysis showed that extension of the index finger, lateral pinch strength, and oxygen saturation were significantly associated with disability in RP, almost the 55% of the total variance on the upper limb, 27% at sports/arts, and 42% at work. Our findings suggest that RP has a disabling effect on the upper extremities and a practice of activities in people who suffer it. Also, disability in Raynaud seems to be more related with hand mobility and strength impairment than vascular injury

Effectiveness of health education in patients with fibromyalgia: a systematic review

INTRODUCTIONː Fibromyalgia (FM) is a chronic illness characterized by the presence of generalised musculoskeletal pain among other symptoms, which reduce the quality of life of the patient. Clinical interventions such as patient education on central pain management could lead to promising results. The aim of this study is to evaluate the effectiveness of education techniques on the main symptoms such as pain, quality of life, anxiety, functionality or catastrophization in the treatment of FM. EVIDENCE ACQUISITIONː The bibliographic search was carried out on PubMed, Web of Science, Scopus, CINAHL, EMBASE, Medline, ProQuest, Cochrane Plus and PEDro databases. The quality assessment of the selected studies was carried out by means of the PEDro scale, obtaining external and internal validity scores to evaluate the generalizability and the appropriateness of design, conduction, and reporting. EVIDENCE SYNTHESISː The electronic search produced 2,050 articles up to February 2018. After applying the inclusion criteria, 12 articles were identified, without the presence of any RCT of high methodological quality (PEDro≤8; Internal Validity Score [PVI] ≤4). Despite the heterogeneity of the interventions, a significant reduction in the perception of the disease, the catastrophization, pain intensity and anxiety was observed. CONCLUSIONSː Patient education is considered to be the first step in self-management for a patient with FM, but the scientific evidence that supports the effectiveness of education in the reduction of the main symptoms is limited. Future research designed on more solid and homogeneous interventions is required

Mediterranean Diet, Body Composition, and Activity Associated with Bone Health in Women with Fibromyalgia Syndrome

Background: There is very little scientific literature on the potential relationships between modifiable factors, including body composition, dietary pattern and physical activity (PA), and bone status in patients with fibromyalgia—a musculoskeletal condition characterized by chronic, widespread pain that is often accompanied by a broad spectrum of symptoms. Objectives: The aim of the study was to investigate the impact of body composition parameters, adherence to the Mediterranean diet (Med Diet), and PA on bone health in a population of premenopausal and postmenopausal women with fibromyalgia syndrome (FMS). Methods: Ninety-five women diagnosed with FMS were included in this cross-sectional study. Body composition, including fat mass, percentage of fat mass, and lean mass (LM), were calculated using a body composition analyzer. Adherence to the Med Diet was measured through a validated 14-item questionnaire. The International Physical Activity Questionnaire was used to assess PA. Bone mass at the calcaneus was estimated through quantitative ultrasound. Results: Linear regression analysis revealed that LM had a significant association with broadband ultrasound attenuation (β = 0.211, 95% CI [0.046, 1.259], p = .035) and stiffness index parameters (β = 0.201, 95% CI [0.019, 1.654], p = .045) after adjusting for age and menopausal status. The Med Diet was also significantly associated with broadband ultrasound attenuation (β = 1.693, 95% CI [0.508, 2.879], p = .006). Discussion: LM and the Med Diet were consistently associated with calcaneal quantitative ultrasound parameters, supporting the hypothesis that LM and adherence to the Med Diet play determinant roles in bone health in FMS women. Training programs to maximize LM and strategies for promoting good adherence to the Med Diet should be considered in order to prevent the development of osteoporosis in FMS women. Because nurses are involved in implementing preventive programs, their roles in promoting this adherence to the Med Diet and maximizing LM in patients with FMS should help reduce the impact of osteoporosis

Effectiveness of a Functional Rehabilitation Program for Upper Limb Apraxia in Poststroke Patients: A Randomized Controlled Trial.

This research was partially supported by grants CTS-526 from Fondo Social Europeo (European union)-Junta de Andalucía (Regional Government of Andalusia, Spain) youth employment initiative 2018-2019 and Plan Propio of University of Granada 2019-2020. S. Toledano-Moreno was supported by Programa operativo de Garantía Juvenil and a research initiation fellowship in the Department of Physical Therapy at the University of Granada (Spain). Research initiation grants for student of official masters degrees funded by "the Own Research Plan 2019" of the University of Granada [Beca de inicio a la investigación para estudiantes de másteres oficiales del plan propio 2019 de la Universidad de Granada.]Objective: To analyze the effectiveness of a home-based restorative and compensatory upper limb apraxia (ULA) rehabilitation program. Design: Randomized controlled trial. Setting: Neurology Unit of San Cecilio Hospital and 2 private and specialized health care centers. Participants: Community dwelling participants (NZ38) between the ages of 25 and 95 years old (sex ratio, 1:1) with unilateral mild-to-moderate poststroke lesions (time of evolution since stroke, 12.03 8.98mo) and secondary ULA. Interventions: Participants were randomly assigned to an 8-week combined ULA functional rehabilitation group (nZ19) 3 days per week for 30 minutes or to a traditional health care education protocol group (nZ19) once a month for 8 weeks. Both interventions were conducted at home. Main Outcome Measures: Sociodemographic and clinical data, Barthel Index (primary outcome), Lawton and Brody Scale, observation and scoring activities of daily living, the De Renzi tests for ideational and ideomotor apraxia and imitating gestures test, recognition of gestures, test for upper limb apraxia , and stroke-specific quality of life scale were assessed at 3 time points: baseline, posttreatment (8wk), and follow-up (8wk). Results: There were statistically significant differences among the groups regarding ideomotor apraxia, imitating gestures, global recognition of gestures, intransitive gestures, and comprehension of gesture production (P<.05) in favor of the experimental group. However, no statistically significant differences were found between the groups regarding functionality or quality of life (P>.05). Regarding the within-group effect, statistically significant differences were found in all neuropsychological outcomes at posttreatment and follow-up (P<.05). Conclusion: A functional rehabilitation program was found to be superior to a traditional health care education program and resulted in improvements in neuropsychological functioning in ULA poststroke. Conventional education showed an insufficient effect on apraxia recovery. Further studies with larger sample sizes are needed to determine the effect of rehabilitation strategies on functionality and quality of life of poststroke ULA patients.Fondo Social Europeo CTS-526Junta de AndalucíaUniversity of Granad

Effectiveness of video-assisted debriefing versus oral debriefing in simulation-based interdisciplinary health professions education: A randomized trial

* Corresponding author at: Department of Nursing, Faculty of Health Sciences, University of Granada, Granada 18016, Spain. E-mail address: [email protected] (R. Gil-Gutiérrez).Aim We aimed to compare the debriefing experience, simulation assessment, reflection, anxiety and simulation satisfaction of using oral debriefing versus video-assisted debriefing after a simulated clinical session in an interdisciplinary cohort of health sciences students. Background Debriefing is a reflective process that takes place after a clinical simulation and that can be performed either in a traditional way (oral) or using video-assisted debriefing. Design A randomized controlled trial was conducted in 143 health sciences students (35.7% male, 61.5% female). Methods The simulation scenario was designed to evaluate the procedure for donning and doffing personal protective equipment. Differences in debriefing experience, simulation assessment, reflection, anxiety and satisfaction were assessed. Results Regarding debriefing experience, significant differences were observed for the category “learning” (34.9 (6.13) vs. 36.7 (3.89); p = 0.039). For simulation assessment, significantly higher scores for all categories were identified in video-assisted debriefing compared with oral debriefing (p<0.001). There were also significant differences between the oral debriefing versus video-assisted debriefing for the overall score of reflection ability (86.97 (10.55) vs. 90.74 (9.67); p=0.028) as well as for the category “reflective communication” (24.72 (3.77) vs 26.04 (4.07); p=0.047). Perceived satisfaction was significantly higher in the video-assisted debriefing group compared with oral debriefing group (p <0.001). For anxiety, no significant differences were observed between debriefing groups. Conclusion Video-assisted debriefing after a simulated clinical session improves debriefing experience, simulation assessment, reflection and simulation satisfaction, but does not increase anxiety compared with oral debriefing among health sciences students.*Funding for open access charge: Univeresidad de Granada/CBUA