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

Influence of Emotional Intelligence, Motivation and Resilience on Academic Performance and the Adoption of Healthy Lifestyle Habits among Adolescents

Included among the basic objectives of Physical Education (PE) classes is the consolidation of habits of a healthy lifestyle among adolescents. However, the main studies in this field have focused on cognitive aspects related to students during these classes, yet they ignore the role that emotions can play in the adoption of future habits. Objectives: To analyze how emotions (emotional intelligence and emotional state) can influence the resilience and motivation of adolescents, as well as academic performance and adoption of healthy lifestyle habits. Methodology: 615 secondary school students between the ages of 14 and 19 participated (M = 16.02; SD = 1.57) in the study. A structural equations model was developed using the main variables and by applying some of the principles of Self-Determination Theory. The results show that emotional intelligence is positively related to positive emotions and negatively related to negative emotions. Positive emotions positively predict both self-motivation towards physical education classes and resilience. Resilience positively predicts self-motivation. Finally, self-motivation acts as a predictor of both academic performance and regular participation in physical activity. Conclusions: This study successfully shows the importance of focusing on emotions in PE classes inasmuch as emotion increases the tendency to get good grades and maintain active lifestyle habits. In this sense, focusing on the emotions of students in PE could prove quite beneficial

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

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

Interventions for hyperhidrosis in secondary care : a systematic review and value-of-information analysis

Background: Hyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable. Objective: To establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care. Methods: A systematic review and economic model, including a value-of-information (VOI) analysis. Treatments to be prescribed by dermatologists and minor surgical treatments for hyperhidrosis of the hands, feet and axillae were reviewed; as endoscopic thoracic sympathectomy (ETS) is incontestably an end-of-line treatment, it was not reviewed further. Fifteen databases (e.g. CENTRAL, PubMed and PsycINFO), conference proceedings and trial registers were searched from inception to July 2016. Systematic review methods were followed. Pairwise meta-analyses were conducted for comparisons between botulinum toxin (BTX) injections and placebo for axillary hyperhidrosis, but otherwise, owing to evidence limitations, data were synthesised narratively. A decision-analytic model assessed the cost-effectiveness and VOI of five treatments (iontophoresis, medication, BTX, curettage, ETS) in 64 different sequences for axillary hyperhidrosis only. Results and conclusions: Fifty studies were included in the effectiveness review: 32 randomised controlled trials (RCTs), 17 non-RCTs and one large prospective case series. Most studies were small, rated as having a high risk of bias and poorly reported. The interventions assessed in the review were iontophoresis, BTX, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland (e.g. laser, microwave). There is moderate-quality evidence of a large statistically significant effect of BTX on axillary hyperhidrosis symptoms, compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was of low or very low quality. For axillary hyperhidrosis cost-effectiveness results indicated that iontophoresis, BTX, medication, curettage and ETS was the most cost-effective sequence (probability 0.8), with an incremental cost-effectiveness ratio of £9304 per quality-adjusted life-year. Uncertainty associated with study bias was not reflected in the economic results. Patients and clinicians attending an end-of-project workshop were satisfied with the sequence of treatments for axillary hyperhidrosis identified as being cost-effective. All patient advisors considered that the Hyperhidrosis Quality of Life Index was superior to other tools commonly used in hyperhidrosis research for assessing quality of life. Limitations: The evidence for the clinical effectiveness and safety of second-line treatments for primary hyperhidrosis is limited. This meant that there was insufficient evidence to draw conclusions for most interventions assessed and the cost-effectiveness analysis was restricted to hyperhidrosis of the axilla. Future work: Based on anecdotal evidence and inference from evidence for the axillae, participants agreed that a trial of BTX (with anaesthesia) compared with iontophoresis for palmar hyperhidrosis would be most useful. The VOI analysis indicates that further research into the effectiveness of existing medications might be worthwhile, but it is unclear that such trials are of clinical importance. Research that established a robust estimate of the annual incidence of axillary hyperhidrosis in the UK population would reduce the uncertainty in future VOI analyses

Short-term effects of two Kinesio taping applications in patients with risk of severe chr venous insufficiency

Chronic venous insufficiency (CVI) is a prevalent pathology, with some typical signs and symptoms that cause significant socio-economic cost and impact on quality of life. Pain, despite being a recurrent symptom in this pathology, has scarcely been studied. Compression therapy is the standard method for non-invasive CVI treatment; however, it has been indicated that the patient seldom follows this type of treatment. Kinesio Taping is a new technique of neuromuscular bandaging that can affect muscular and joint function, decrease pain and influence lymph and venous circulation. No previous studies have been found on the application of this bandaging on patients with CVI. The main objectives of this doctoral thesis are to describe the characteristics of pain in postmenopausal women with CVI and its relationship with risk factors; and assessing the efficacy of two application of neuromuscular bandaging (Kinesio Taping [KT]) on musculoskeletal alterations, specific venous symptomatology, pain, severity and quality of life in postmenopausal women at short-term risk of severe CVI (CEAP C1-C3). A total of 259 patients with initial CVI and 40 healthy women that fulfilled the criteria for inclusion participated in the studies for this thesis. The main findings and conclusions are: a) postmenopausal women with CVI present intense pathological pain and lowered nociceptive thresholds, suggesting that there is central sensitization; the pain is principally related with peripheral venous reflux and with the pain and functional limitation induced by knee or hip osteoarthritis; b) the use of the Pain Matcher device seems to be a valid technique for assessing chronic venous pain; c) applying standardised bandaging with KT in postmenopausal women at short-term risk of severe CVI can reduce the specific venous symptomatology, pain and clinical severity and increase the bioelectric activity of the gastrocnemius muscle; d) the method of mixed KT-peripheral compression seems to improve ankle dorsiflexion during walking, gait parameters, peripheral venous flow, specific venous symptomatology, foot and malleolar oedema, pain, clinical severity and quality of life,while it increases the general state of health slightly, in postmenopausal women at risk of short-term severe CVI; and e) KT can have a placebo effect on venous pain. Our findings help to clarify the mechanisms involved in pain from CVI and support the use of KT as an alternative bandaging technique for managing the symptoms associated with venous pathology in initial stages.Tesis Univ. Granada. Departamento de Medicina Legal, Toxicología y Antropología Física