Tratamiento con miniplatos inestables del síndrome de desequilibrio posterior en pacientes ancianos institucionalizados

INTRODUCCIÓN: Los problemas de equilibrio son comunes entre los adultos mayores y específicamente el denominado Síndrome de Desequilibrio Posterior predisponiendo a los sujetos a sufrir caídas. El tratamiento fisioterápico habitual se basa principalmente en una mejora de la propiocepción y del equilibrio, permitiendo al individuo una mejor toma de conciencia de su posición corporal. OBJETIVO: Comprobar si el protocolo de tratamiento con miniplatos inestables propuesto mejora el equilibrio en pacientes geriátricos institucionalizados y diagnosticados de Síndrome de Desequilibrio Posterior. METODOLOGÍA: Ensayo clínico controlado aleatorizado, con ciego simple y dos grupos. Los participantes fueron ancianos de 65 años o más, sin discriminación por género, raza o nivel cultural y/o socioeconómico diagnosticados d e Síndrome de Desequilibrio Posterior e institucionalizados. La intervención consistió en un protocolo de ejercicios de propiocepción y equilibrio bajo la supervisión de un fisioterapeuta durante 12 semanas. El grupo control recibió el tratamiento convencional y habitual que venía recibiendo hasta el momento. La medición de resultados se basó en las escalas del test “Timed Up and Go” (TUG) y “Tinetti” cuyos resultados se registraron al inicio, 6 semanas, 8 semanas y 12 semanas de la intervención. RESULTADOS/DISCUSIÓN: La muestra se constituyó de 77 pacientes. En los resultados obtenidos se observó una mejora en el uso de miniplatos 1,77 (0,70-3,54) respecto al Tinetti Total y la relación existente entre cada punto más de Tinetti estático (-0,50) y con cada año más de edad (-0,08). Igualmente, se observó una reducción media en el TUG de 2,80 segundos (1,70-6,40), así como su relación con la edad del paciente, mostrando como por cada año adicional del paciente, empeoró el resultado obtenido en -0,05 (-0,08-0,03). CONCLUSIONES: Los miniplatos se han mostrado como un método más eficaz que el tratamiento convencional siendo mayor la mejora del equilibrio dinámico. El resultado del TUG se ha producido en menor grado y ha presentado menor relación que el Tinetti en comparación a la edad.INTRODUCTION Balance issues, and most specifically Backward Disequilibrium Syndrome (BDS), are common amongst the elderly population. BDS is a postural disorder which implies a posterior shift of a person’s center of gravity, relative to their base of support, increasing their risk of falls. Falls are a main cause of morbidity and mortality, and a burden for the health system and its workers. Treatment for BDS is mainly based on improving proprioception and balance, in order to improve body awareness. This study aims to determine whether a specific protocol using unstable mini-boards can improve balance in institutionalized older people. PURPOSE To evaluate whether the proposed treatment protocol using unstable mi- ni-boards improves balance in institutio- nalized elderly patients, diagnosed with Backward Disequilibrium Syndrome. METHODS Single-blinded, 2-group, randomized controlled clinical trial. Patients were institutionalized adults, age 65 or older, of any gender, ethnic, cultural or socioeconomic status, diagnosed with Backward Disequilibrium Syndrome. The intervention group underwent a supervised, 12-week proprioception and balance exercise program. The control group continued receiving the conventional treatment they had been receiving so far. Outcomes were assessed using the Tinetti and Timed Up and Go (TUG) scales, at baseline, weeks 6, 8 and 12. RESULTS/DISCUSSION Sample consisted of 77 patients from 11 different residential homes in the Catalunya and Castilla Leon regions of Spain. Size was n=48 for the interven- tion group; n=29 for the control group, which was considered as well-balanced, for all analysis factors. Results showed a 1,77 improvement (= 0,70-3,54), relative to the Total Tinetti score and the existing relationship between each additional point for the Static Tine- tti (-0,50) with every additional age increase in years (-0,08). A mean reduc- tion of 2,80 seconds was observed for the TUG (1,70-6,40), as well as a corre- lation with the patient’s age, showing that for every additional life year, re- sults dropped by -0,05 (-0,08-0,03). For all subjects who enrolled and dropped out, an intention-to-treat analysis was undertaken, which showed no signifi- cant differences in final results. CONCLUSIONS The use of mini-boards has proven to be a more effective way of treatment than conventional therapy, achieving greater improvements in dynamic balance. Results for TUG were smaller, and have shown a lesser correlation to age than Tinetti scores.INTRODUCCIÓ Els problemes d'equilibri són comuns entre els adults majors i específicament la denominada Síndrome del Desequilibri Posterior. Aquest desordre postural es caracteritza per una posició posterioritzada del centre de gravetat respecte a la base de suport, predisposant als individus a patir caigudes. Aquesta, és una causa important de mobilitat i mortalitat, a més a més d'una càrrega per al sistema de salut i els seus treballadors. El tractament fisioterapèutic habitual es basa principalment en una millora de la propiocepció i de l'equilibri, permetent a l'individu una millor presa de consciència de la seva posició corporal.OBJECTIU Comprovar si el protocol de tractament amb miniplats inestables proposat millora l'equilibri en pacients geriàtrics institucionalitzats i diagnosticats de Síndrome de Desequilibri Posterior.METODOLOGIA Assaig clínic controlat aleatoritzat, amb simple cec i dos grups. Els participants van ser ancians de 65 anys o més, sense discriminació per gènere, raça o nivell cultural i/o socioeconòmic. Havien d'estar diagnosticats de Síndrome de Desequilibri Posterior i trobar-se institucionalitzats. La intervenció va consistir en un protocol d'exercicis de propiocepció i equilibri sota la supervisió d'un fisioterapeuta durant 12 setmanes. El control va rebre el tractament convencional i habitual que venia rebent fins al moment. El mesurament dels resultats es va basar en les escales del test «Timed Up and Go» (TUG) i «Tinetti». Els resultats es van enregistrar a l'inici, 6 setmanes, 8 setmanes i 12 setmanes de la intervenció. RESULTATS/DISCUSSIÓ La mostra es va constituir de 77 pacients provinents d'11 centres assistencials de Catalunya i Castella i Lleó. Els grups es van trobar ben balancejats respecte a tots els factors d'anàlisis, tenint una mostra de n=48 per al grup miniplats i n=29 en el grup control. En els resultats obtinguts es va observar una millora en l'ús de miniplats 1,77 (0,70-3,54) respecte al Tinetti Total i la relació existent entre cada punt més de Tinetti estàtic (-0,50) i amb cada any més d'edat (-0,08). Igualment, es va observar una reducció mitjana en el TUG de 2,80 segons (1,70-6,40), així com la seva relació amb l'edat del pacient, mostrant com per cada any addicional del pacient, empitjorava el resultat obtingut -0,50 (-0,08-0,03). Cal destacar que es va realitzar una anàlisi amb intenció de tractar d'aquells subjectes que van iniciar l'estudi però no el van acabar, no mostrant diferències significatives en relació a la seva inclusió. CONCLUSIONS Els miniplats s'han mostrat com un mètode més eficaç que el tractament convencional essent major la millora de l'equilibri dinàmic. El resultat del TUG s'ha produït en menor grau i ha presentat menor relació que el Tinetti en comparació a l'edat

Effect of a brief progressive resistance training program in hospital porters on pain, work ability, and physical function

Background Hospital porters are possibly exposed to the greatest mechanical loads within the hospital environment. However, the evidence about preventive strategies in this population is scarce. Objective To investigate the effect of a workplace-based progressive resistance-training program on musculoskeletal pain among hospital porters. Method A total of 37 hospital porters (27 women, 10 men) participated. Participants allocated to the intervention group performed five brief resistance training sessions/week, for 9 weeks during working hours at the hospital. Intensity was progressively increased. Participants allocated to the control group maintained their usual physical activity. The primary outcome was pain assessed with the patient global impression of pain change scale. Secondary outcome measures were average pain intensity, work ability, use of analgesics, and physical function. Additionally, perceived general changes were evaluated at follow-up: wellness, satisfaction at work, desire to exercise, motivation to eat healthy, energy to be with family and friends, and socialization with colleagues. Results For the primary outcome, the intervention group showed lower general pain (p < 0.0001) and greater wellbeing (p < 0.0001), work satisfaction (p = 0.0048), desire for practicing exercise (p = 0.0007), and energy (p = 0.0474) compared with the control group. Significant between-group interactions were found for work impairment due to diseases (d = -1.2), hips/thighs pain (d = 0.7), ankles/feet pain (d = 0.4), the Biering-Sorensen test (d = -0.6) and the push-ups test (d = -2.3) favoring the intervention group. All between-group differences were clinically important. Conclusion A progressive resistance training program performed at the workplace is feasible and effective in reducing musculoskeletal pain and improving work ability and physical function among hospital porters.This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Escriche-Escuder is supported by a predoctoral grant of the University Teaching Training Programme (FPU) of the Ministry of Science, Innovation and Universities of Spain. Grant number: FPU17/00161

Fear Avoidance Beliefs and Risk of Long-Term Sickness Absence: Prospective Cohort Study among Workers with Musculoskeletal Pain

Background and Objective. Musculoskeletal pain is common in the population. Negative beliefs about musculoskeletal pain and physical activity may lead to avoidance behavior resulting in absence from work. The present study investigates the influence of fear avoidance beliefs on long-term sickness absence. Methods. Workers of the general working population with musculoskeletal pain (low back, neck/shoulder, and/or arm/hand pain; n = 8319) from the Danish Work Environment Cohort Study were included. Long-term sickness absence data were obtained from the Danish Register for Evaluation and Marginalization (DREAM). Time-to-event analyses (cox regression) controlled for various confounders estimated the association between fear avoidance beliefs (very low, low, moderate [reference category], high, and very high) at baseline and long-term sickness absence (LTSA; ≥6 consecutive weeks) during a 2-year follow-up. Results. During the 2-year follow-up, 10.2% of the workers experienced long-term sickness absence. In the fully adjusted model, very high-level fear avoidance increased the risk of LTSA with hazard ratio (HR) of 1.48 (95% CI 1.15-1.90). Similar results were seen analyses stratified for occupational physical activity, i.e., sedentary workers (HR 1.72 (95% CI 1.04-2.83)) and physically active workers (HR 1.48 (95% CI 1.10-2.01)). Conclusion. A very high level of fear avoidance is a risk factor for long-term sickness absence among workers with musculoskeletal pain regardless of the level of occupational physical activity. Future interventions should target fear avoidance beliefs through information and campaigns about the benefits of staying active when having musculoskeletal pain

Tolerability and Muscle Activity of Core Muscle Exercises in Chronic Low-back Pain

Most of the studies evaluating core muscle activity during exercises have been conducted with healthy participants. The objective of this study was to compare core muscle activity and tolerability of a variety of dynamic and isometric exercises in patients with nonspecific low back pain (NSLBP). 13 outpatients (average age 52 years; all with standing or walking work in their current or latest job) performed 3 consecutive repetitions at 15-repetition maximum during different exercises in random order. Surface electromyography was recorded for the rectus abdominis; external oblique and lumbar erector spinae. Patients rated tolerability of each exercise on a 5-point scale. The front plank with brace; front plank and modified curl-up can be considered the most effective exercises in activating the rectus abdominis; with a median normalized EMG (nEMG) value of 48% (34-61%), 46% (26-61%) and 50% (28-65%), respectively. The front plank with brace can be considered the most effective exercise in activating the external oblique; with a nEMG of 77% (60-97%). The squat and bird-dog exercises are especially effective in activing the lumbar erector spinae; with nEMG of 40% (24-87%) and 29% (27-46%), respectively. All the exercises were well tolerated; except for the lateral plank that was mostly non-tolerated. In conclusion; the present study provides a variety of dynamic and isometric exercises; where muscle activity values and tolerability can be used as guide to design evidence-based exercise programs for outpatients with NSCLBP

José Cervaens y Rodríguez, hispanista portugués, comentarista del poeta catalán Jacinto Verdaguer

José Cervaens y Rodríguez dedicó a la literatura catalana un estudio en el libro Litteraturas mortas (Breves estudos sobre as litteraturas gallega, euskara, italiana e catalã, 1911). Centrado especialmente en la literatura ochocentista, presenta al público portugués la figura del escritor Jacint Verdaguer y su obra, ilustrada además con una generosa selección de textos. Jacint Verdaguer fue la personalidad más relevante del romanticismo catalán y de la “Renaixença”. Fue el escritor catalán que logró una mayor proyección internacional, también en Portugal a través de las traducciones de dos de sus obras: O sonho de Sam João (1907), traducida por João Serafim Gomes, y A Atlantida (1909), traducida por José M. Gomes Ribeiro. El presente articulo analiza el conocimiento que Cervaens tuvo de Verdaguer, las fuentes bibliográficas que utilizó y los contactos que estableció para elaborar dicho estudio, especialmente con don Marcelino Menéndez y Pelayo.José Cervaens y Rodríguez devoted a study to the Catalan literature in the book Litteraturas mortas (Breves estudos sobre as litteraturas gallega, euskara, italiana e catalã, 1911). Essentailly focused in the XIXth century literature, Cervaens introduces the character of the writer Jacint Verdaguer to the portuguese public, as well as his works together with a wide selection of texts. Jacint Verdaguer was the most prominent figure in the Catalan Romanticism and “Reinaxença”. He was the Catalan writer that achieved more international renown. Known in Portugal as well through two of his pieces: O sonho de Sam João (1907), translated by João Serafim Gomes, and A Atlantida (1909), translated by José M. Gomes Ribeiro. This article analyzes Cervaens knowledge about Verdaguer, the bibliographic sources used by him and the contacts he established to prepare this study, especially with don Marcelino Menéndez y Pelayo

High-Intensity Interval Training (HIIT) on Biological and Body Composition Variables in Patients with Musculoskeletal Disorders: A Systematic Review and Meta-Analysis

In order to assess the impact of high-intensity interval training (HIIT) on biological and body composition variables in patients with musculoskeletal disorders (MSKD), a systematic search on PubMed (Medline), CENTRAL, CINAHL, Web of Science, SPORTDiscus, and Scopus was conducted. Standardized mean differences (SMD) and 95% confidence intervals were calculated and pooled in a meta-analysis using the random-effects model. The effectiveness of HIIT on waist circumference, muscle mass, resting heart rate, resting systolic and diastolic blood pressure, C-reactive protein, body weight, and body fat were determined. GRADE, risk of bias 2, and PEDro scales were employed. HIIT compared to no intervention, minimal intervention, or usual care did not show significant results in its favor on any of the variables studied, except for the resting heart rate when compared with no intervention (SMD = −0.33; 95% CI: −0.63, −0.04; heterogeneity Q value: 0.14; p = 0.93; I2 = 0%). In addition, HIIT also does not seem to be more effective than moderate-intensity continuous training. Based on the results, it seems that HIIT has almost no significant effects on biological and body composition variables, except for resting heart rate, in patients with MSKD

Effectiveness of a Multicomponent Training Program on Physical Performance and Muscle Quality in Older Adults: A Quasi-Experimental Study.

Aging is associated with a decrease in functional capacity, manifested by a loss of strength, physical performance and muscle quality. Multicomponent training (MCT), characterized by the combination of at least three types of training, could be a good strategy to counteract these changes. To date there are no studies evaluating the effectiveness of MCT in improving both physical performance and muscle quality simultaneously. The aim of this study is to evaluate the changes produced by an MCT program on both physical performance and muscle quality in a population of healthy older adults. Sixteen healthy older adults were recruited to perform a 15-session multicomponent training intervention. Physical performance was assessed by different functional tests, and muscle quality was assessed by tensiomyography and myotonometry. The main results of this study show some improvement in functional tests, but not in muscle quality parameters, except for vastus lateralis stiffness. MCT is able to generate improvements in the physical performance of older adults, but these improvements are not reflected in muscle quality parameters measured by tensiomyography and myotonometry