Programa de intervención fisioterapéutica para la mejora del estrés y la calidad de vida en cuidadores de personas con discapacidad

[Resumen] La atención continuada a una persona dependiente, especialmente si esta tiene demencia, es una situación generadora de estrés para los cuidadores informales, que puede provocar la aparición de consecuencias negativas en su calidad de vida y/o en su funcionamiento. Estas dos conceptualizaciones han sido integradas dentro de un constructo denominado calidad de vida relacionada con la función (CVRF) , el cual pretende ser, a partir de los diferentes dominios que lo conforman (contexto, calidad de vida y función según los niveles de detalle de la CIF), un elemento facilitador de actuaciones relevantes dentro de la disciplina de la Fisioterapia como es el plan de intervención (diagnóstico, objetivos, etc.). Desde postulados que derivan de la gestión frente a desastres, este deterioro de la CVRF puede ser entendido como el resultado del afrontamiento de los cuidadores informales frente al “estresor” (el cuidado del familiar), desde sus “vulnerabilidades” (percepción de sobrecarga) y desde los “recursos” disponibles (dedicación al autocuidado). Con el fin de favorecer en los cuidadores informales la mejora de su CVRF, se llevaron a cabo, sobre un total de 36 participantes, dos modalidades de intervención fisioterapéutica (grupo control y experimental). Los sujetos del grupo de control (n=14) participaron en un abordaje basado en la comunicación de información (consecuencias de las tareas de apoyo informal en su salud, consejos sobre actividades terapéuticas adecuadas como parte de un plan de acción general de autocuidado, etc.). Por su parte, el grupo experimental (n=22) recibió, además de esta información, un entrenamiento progresivo y supervisado en una serie de ejercicios de autocuidado específicos (relajación, automasaje y autoposturas de estiramiento). En relación a los resultados, cabe destacar los efectos beneficiosos alcanzados por el grupo experimental tanto a corto como a largo plazo. A corto plazo (18 semanas), se obtuvieron mejoras significativas sobre los dos factores contextuales objeto de estudio (percepción de sobrecarga-factor asociado al riesgo y dedicación al autocuidado-factor protector ) y sobre algunas de las variables relativas al funcionamiento, tanto psicológico (mayor autonomía, aceptación hacia sí mismos, propósito en la vida y crecimiento personal, personalidad menos ansiosa y menos sentimientos de melancolía, desesperanza o incapacidad), como físico (flexibilidad y alineación). Las mejoras alcanzadas sobre las dos escalas del bienestar psicológico más genuinas, el crecimiento personal y el propósito en la vida, y sobre los dos indicadores de flexibilidad/movilidad (tren superior e inferior/ tronco), resultaron estar relacionadas con los efectos beneficiosos conseguidos en el factor asociado al riesgo (puntuación global de sobrecarga, dimensión impacto e incompetencia), es decir, con la menor “vulnerabilidad” de los participantes. Para ese mismo grupo experimental también se observaron mejorías a largo plazo (36 semanas) respecto a los valores iniciales de algunas de las dimensiones de la CVRF objeto de estudio (mayor aceptación, propósito en la vida, activación positiva, animación, bienestar, satisfacción y confianza en sí mismos, menor estado de ansiedad), manteniéndose algunos de los efectos positivos alcanzados a corto plazo (percepción de sobrecarga, implicación en autocuidado,) y mitigándose otros (alineación postural). También se presentan resultados estadísticos que demuestran, siguiendo la visión que deriva de la gestión de riesgos frente a desastres, que una parte de las mejoras alcanzadas en esta fase, estaban relacionadas con el aumento de los “recursos”, expresado desde la mayor dedicación al autocuidado por los cuidadores. Partiendo de los resultados empíricos observados, se espera que lo presentado en este trabajo constituya un marco conceptual que resulte útil para los fisioterapeutas en su práctica clínica habitual.[Resumo] A atención continuada a unha persoa dependente, especialmente si esta ten demencia, é unha situación xeradora de estrés para os cuidadores informais, que pode provocar a aparición de consecuencias negativas na súa calidade de vida e/ou no seu funcionamento. Estas dous conceptualizacións intégranse dentro dun constructo chamado calidade de vida relacionada coa función (CVRF), o cal pretende ser, a partir dos diferentes dominios que o conforman (contexto, calidade de vida e función segundo os niveis de detalle da CIF), un elemento facilitador de actuacións relevantes dentro da disciplina da Fisioterapia como é o plan de intervención (diagnose, obxectivos, etc.). Dende postulados que derivan da xestión frente a desastres, este deterioro da CVRF pode entenderse como o resultado do afrontamento dos cuidadores informais fronte ao “estresor” (o cuidado do familiar), dende as súas “vulnerabilidades” (percepción de sobrecarga) e dende os “recursos” disponibels (dedicación ao autocuidado). Co fin de favorecer nos cuidadores informais a mellora do seu CVRF, leváronse a cabo, sobre un total de 36 participantes, duas modalidades de intervención fisioterapéutica (grupo control e experimental). Os suxeitos do grupo control (n=14) participaron nun abordaxe baseado na comunicación de información (consecuencias das tarefas de apoio informal na súa saude, consellos sobre actividades terapéuticas axeitadas como parte dun plan de acción xeral de autocuidado, etc.). Pola sua parte, o grupo experimental (n=22) recibió, ademáis desta información, un entrenamento progresivo e supervisado nunha serie de exercicios de autocuidado específicos (relaxación, automasaxe e autoposturas de estiramento). En relación aos resultados, cabe destacar os efectos beneficiosos obtidos polo grupo experimental tanto a curto como a largo plazo. A curto plazo (18 semans), obtivéronse melloras significativas sobre os dous factores contextuais obxecto de estud (percepción de sobrecarga-factor asociado ao riesgo e adicación ao autocuidado-factor protector) e sobre algunhas das variabels relativas ao funcionamento, tanto psicolóxico (maior autonomía, aceptación hacia sí mesmos, propósito na vida e crecemento personal, personalidade menos ansiosa e menos sentimentos de melancolía, desesperanza o incapacidade), como físico (flexibilidade e alineación). A mellora obtida nas dúas escalas do benestar psicoxógico máis genuinas, el crecemento personal e o propósito na vida , e en flexibilidade, resultó estar relacionada cos efectos beneficiosos obtidos no factor asociado ao riesgo (puntuación global de sobrecarga, dimensión impacto e interpersonal, a saber, coa menor “vulnerabilidade” de los participantes. Para ese mesmo grupo experimental tamén obtivéronse mellorías a largo plazo (36 semans) respeito aos valores iniciais de moitas dimensións da CVRF obxecto de estudo (maior aceptación, propósito na vida, activación positiva, animación, benestar, satisfacción e confianza en sí mesmos, menor estado de ansiedade e maior implicación no seu autocuidado), manténdose alguns dos efectos positivos obtidos a curto plazo (percepción de sobrecarga) e mitigándose outros (alineación postural). Tamén presentou resultados mostrando, seguindo a visión que deriva da xestión de riesgos fronte a desastres, que unha parte de as melloras obtidas nesta fase estaban relacionadas co incremento dos seus “recursos”, expresado dende a maior adicación ao autocuidado. Pariendo dos resultados empíricos obtidos, espérase que o presentado neste traballo constitua un marco conceptual que resulte útil para os fisioterapeutas na súa práctica clínica cotiá.[Abstract] Providing continuous care assistance to a dependent person, especially if this person suffers from dementia, is a situation that generates a lot of stress for informal caregivers and it can cause a negative impact on their quality of life and/or on their performance. These two conceptualisations have been integrated into a construct called function-related quality of life (FRQL), which intends to be, considering the different domains that constitute it (context, quality of life and function according to the levels of detail of the ICF), a facilitator element of important actions within the discipline of Physiotherapy such as the intervention plan (diagnosis, objectives, etc.). Considering some postulates derived from disaster management, this deterioration of the FRQL can be understood as a result of informal caregivers coping with the “stressor” element (taking care of their relative) in view of their "vulnerabilities" (perception of overload) and of the "resources" available (dedication to self-care). In order to improve the FRQL of informal caregivers, two methods of physiotherapy intervention (control group and experimental group) were implemented on 36 participants in total. On the one hand, the subjects in the control group (n = 14) participated in an approach based on communication of information (consequences of tasks of informal care, tips on suitable therapeutic activities as part of a self-care general plan of action, etc.). On the other hand, the experimental group (n = 22) received a progressive and supervised training with a series of specific self-care exercises (relaxation, self-massage and self-stretching) in addition to the previous information. Regarding the results, the beneficial effects obtained by the experimental group, both in the short term and in the long term, should be highlighted. In the short term (18 weeks), significant improvements were obtained on the two contextual factors under study (perception of overload – factor associated with risk and self-care – factor of protection ) and on some of the variables related to the function, both at the psychological level (greater autonomy, acceptance for the self, purpose in life and personal growth, less anxious personality and fewer feelings of melancholia, hopelessness or incompetence) and at the physical level (flexibility and alignment). The improvement achieved on two of the most genuine scales of psychological well-being, personal growth and purpose in life, and on flexibility (upper and inferior limbs), was found to be related to the benefits achieved on the factor associated with risk (global score of overload, dimension of impact and incompetence), that is to say, with less "vulnerability" perceived by the participants Regarding the same experimental group in the long-term (36 weeks), improvements were also observed in comparison to the initial value of the many dimensions of the FRQL under study (greater acceptance, purpose in life, positive activation, liveliness, wellness, satisfaction and self-confidence, a reduced state of anxiety), preserving some of the positive effects achieved in the short term (perception of overload, implication towards self-care) and mitigating some others (postural alignment). This document also presents results, from the point of view of risk management in case of disaster, about the relationship between some of the improvements achieved at this stage and to the increase of the "resources", this expressed as a greater dedication to self-care by the participants. Based on the empirical results observed, it is expected that the content of this paper establishes a conceptual framework to help physiotherapists in their everyday clinical practice

Physiotherapeutic intervention to promote self-care: exploratory study on Spanish caregivers of patients with dementia

[EN] The caregivers of dependent persons should benefit from social–health interventions that empower them. Physiotherapists can play an important role as facilitators of self-care learning by boosting the mind–body interaction. The aim of this study was to analyse the efficacy of a physiotherapeutic intervention centered on the promotion of self-care within a sample of caregivers, members of four Spanish Associations of Relative of Alzheimer's and other dementias. To fulfill the study goal, a pre-experimental study was developed with two different groups. Group 1 participated in four training sessions based exclusively on the communication of information and which addressed, among other aspects, the most frequent health problems in caregivers and the powerful role of self-care to face such problems. Group 2 received the same theoretical information as group 1, followed by 10 sessions of practical training in several concrete strategies of body–mind self-care. The results obtained support the usefulness of combining theoretical and practical training in mind–body strategies (relaxation, self-massage and stretching), as such combination managed to favor their implication to self-care and certain dimensions of psychological well-being, while attenuating the burden. Conversely, training based solely on theoretical approaches was not beneficial. Besides evidencing the usefulness of combining passive and active methodologies to favor self-care, the data provided calls for greater consideration of aspects close to philosophical perspectives like personal growth.S

Involvement in self‐care and psychological well‐being of Spanish family caregivers of relatives with dementia

[EN] The provision of continuous care to a dependent person can lead to a lack of self-care by the caregiver themselves with corresponding low levels of well-being. This well-being has been analysed mostly from within the perspective of the hedonic tradition, with the development of personal growth often being overlooked. This study aims to increase the understanding of the connection between this type of psychological well-being and involvement in self-care activities, and to be a starting point for the determination of categories that may serve in the screening of potential participants in social-health interventions where it is being promoted. Taking the hypothesis of a probable positive connection between psychological well-being and involvement in self-care, an observational study was carried out on 45 caregivers of relatives with dementia. In those caregivers showing greater dedication to self-care, a higher score was obtained on the well-being scales connected to personal significance and positive emotions and experiences. These findings were further reinforced by the identification of other positive connections, the involvement in self-care and the six dimensions of wellness contemplated by Ryff. It is possible to envisage the existence of a virtuous circle in respect of the caregiver, whereby a greater involvement in self-care is related to a higher psychological well-being, which in turn is related to greater self-care, and so on.S

3D Visualization Techniques in Health Science Learning. Application case of Thermographic Images to Blood Flow Monitoring

The present work proposes a new learning methodology based on the combination of geotechnologies for the acquisition of competence in the studies of physiotherapy and nursery. The approach is based on three-dimensional visualization techniques over thermographic images to improve the comprehension and interpretation of blood flow. The proposal is aimed to be applied in practical sessions of subjects of the area of knowledge of the Physiology, to demonstrate through the geotechnologies, the effect of the application of the changes of the flow blood. The present approach is related to the virtual laboratories field, since the generated virtual material can be used for acquisition of practical skills and competences, as well as evaluation of competencies in e-learning courses. The learning material is structured to be easily deployed in a learning management system, allowing the students to work with the models by means of open-source solutions without an additional effor

Analysis of Postural Control in Sitting by Pressure Mapping in Patients with Multiple Sclerosis, Spinal Cord Injury and Friedreich’s Ataxia: A Case Series Study

[EN], The postural control assessments in patients with neurological diseases lack reliability and sensitivity to small changes in patient functionality. The appearance of pressure mapping has allowed quantitative evaluation of postural control in sitting. This study was carried out to determine the evaluations in pressure mapping and verifying whether they are different between the three sample groups (multiple sclerosis, spinal cord injury and Friedreich’s ataxia), and to determine whether the variables extracted from the pressure mapping analysis are more sensitive than functional tests to evaluate the postural trunk control. A case series study was carried out in a sample of 10 adult patients with multiple sclerosis (n = 2), spinal cord injury (n = 4) and Friedreich’s ataxia (n = 4). The tests applied were: pressure mapping, seated Lateral Reach Test, seated Functional Reach Test, Berg Balance Scale, Posture and Postural Ability Scale, Function in Sitting Test, and Trunk Control Test. The participants with Friedreich’s ataxia showed a tendency to present a higher mean pressure on the seat of subject’s wheelchair compared to other groups. In parallel, users with spinal cord injury showed a tendency to present the highest values of maximum pressure and area of contact. People with different neurological pathologies and similar results in functional tests have very different results in the pressure mapping. Although it is not possible to establish a strong statistical correlation, the relationships between the pressure mapping variables and the functional tests seem to be numerous, especially in the multiple sclerosis group.S

Comparison of the Agonist/Antagonist Tensional Balance of the Knee between Two Isokinetic Positions: A Pilot Study on a Sample of High-Level Competitive Soccer Players

[EN] Isokinetic knee dynamometry evolves towards more precise techniques, such as the cal-culation of the functional ratio. This study evaluated the influence of an intermediate hip position called the unified reclined position (URP) compared to the classic sitting position, (CSP) on hamstring eccentric PT values (Hexc30) and conventional (Hcon60/Qcon60) and functional (Hexc30/Qcon60) ratios.Twenty Spanish high-level competitive soccer players (20.4 ± 4.44 years) were evaluated in CSP and in URP. The hip angle in URP (44◦) was determined with a passive extensibility test (quadriceps and hamstrings), looking for an agonist/antagonist tension balance. The following were performed: three repetitions (60◦/s) and five repetitions (240◦/s) in concentric quadriceps and hamstrings mode; and three repetitions (30◦/s) in concentric and eccentric for the hamstrings. At 30◦/s, the CSP presents higher values of maximal eccentric hamstring strength than URP, (Dom + N-Dom leg (Nm): CSP = 148.3 ± 19.5 vs. URP 143.5 ± 23.2); p = 0.086 (n.s.). The conventional relationship did not show data justifying the preference for URP over CSP (p = 0.86 (n.s.)). However, although the functional index did not show significant values (p = 0.97 (n.s.), it did show a greater number of subjects with imbalances measured in URP (five in URP vs. two in CSP). An assessment angle of the hip closer to sports reality seems to favor the use of the URP as a complementary method to the CSP. These data stimulate new studies using URP together with the classic protocol.SIColegio Profesional de Fisioterapeutas from Castilla y León (Spain)This research was partially funded by the Colegio Profesional de Fisioterapeutas from Castilla y León (Spain) through the II Call for Scholarships for Research (INV2015-3)

Effects of 2 Physiotherapy Programs on Pain Perception, Muscular Flexibility, and Illness Impact in Women With Fibromyalgia: A Pilot Study

[EN] Objective This study assessed the effect of 2 physiotherapy programs designed to improve flexibility and to reduce the impact of the illness and pain perception in women with the fibromyalgia syndrome (FMS), and compared the effects of the 2 programs in the short and intermediate term. Methods Twenty FMS patients were randomly assigned to 2 training groups, one following a program of kinesiotherapy and active muscular stretching and one using techniques of Global Myofascial Physiotherapy, according to the Mézières method. Both groups met twice a week for 12 weeks, for a total of 150 minutes each week. Flexibility and illness impact were measured by means of a standard test, whereas pain was assessed by means of thumb palpation. Measurements were taken at the beginning and end of the program and 24 weeks after its end. Results Patients had achieved a statistically significant reduction in the severity of the disease and improved their flexibility level by the end of the program, but had returned to initial values after follow-up. Significant differences were not observed between the 2 treatment groups in the initial values or in the results at the end of the program or after the follow-up, so neither program proved better than the other. Conclusion The FMS patients in this study improved their flexibility level and general well-being using both kinesiotherapy and stretching exercises techniques.S

Relationship between aerobic fitness and quality of life in female fibromyalgia patients

[EN] Objective: To determine whether there is a direct link between quality of life and aerobic capacity among female fibromyalgia patients. Design: Cross-section study. Setting: University of Leo´ n. Subjects: Twenty-nine women belonging to the Leo´ n Fibromyalgia and Chronic Fatigue Association. Main measurements: Aerobic capacity and quality of life were measured by means of the Six-Minute Walk Test and the Fibromyalgia Impact Questionnaire. Outcome measures included heart rate and rate of perceived fatigue and dypsnoea. Results: The average distance walked was 432.8 (61.2) m and the total average Fibromyalgia Impact Questionnaire score was 47.5 (18.9). Only item 1 of the Fibromyalgia Impact Questionnaire, physical function, showed any statistically significant link with the distance walked, which had no statistically significant rela- tionship with any of the variables studied. Conclusion: The physical fitness of women with fibromyalgia, as determined by the Six-Minute Walk Test and the Fibromyalgia Impact Questionnaire, has no direct relation with quality of life as the patients perceive it.S

Socioeconomic Status in Adolescents: A Study of Its Relationship with Overweight and Obesity and Influence on Social Network Configuration

[EN],Socioeconomic status (SES) influences all the determinants of health, conditioning health throughout life. The aim of the present study was to explore the relationship between socioeconomic status and obesity in adolescence through an analysis of the patterns of contact between peers as a function of this parameter. A cross-sectional study was performed, analyzing a sample of 235 students aged 14 to 18 and 11 class networks. Social network analysis was used to analyze structural variables of centrality from a sociocentric perspective. We found that adolescents with a medium-low SES presented a two-fold higher probability of being overweight, but we did not detect any differences in the configuration of their social networks when compared with those of normal-weight adolescents. However, we did find significant differences in the formation of networks according to SES in the overall sample and disaggregated by gender, whereby adolescents with a high SES in general presented a higher capacity to form wider social networks. Elucidating the relationship between SES and overweight and its influence on social network formation can contribute to the design of preventative strategies against overweight and obesity in adolescents, since their social environment can provide them with several resources to combat excess weight.S

Local and Contralateral Effects after the Application of Neuromuscular Electrostimulation in Lower Limbs

[EN], Neuromuscular electrostimulation (NMES) has been used mainly as a method to promote muscle strength, but its effects on improving blood flow are less well known. The aim of this study is to deepen the knowledge about the local and contralateral effects of the application of symmetric biphasic square currents on skin temperature (Tsk). An experimental pilot study was developed with a single study group consisting of 45 healthy subjects. Thermographic evaluations were recorded following the application of NMES to the anterior region of the thigh. The results showed an increase in the maximal Tsk of 0.67% in the anterior region of the thigh where the NMES was applied (p < 0.001) and an increase of 0.54% (p < 0.01) due to cross-education effects, which was higher when the NMES was applied on the dominant side (0.79%; p < 0.01). The duration of the effect was 20 min in the dominant leg and 10 min in the nondominant one. The application of a symmetrical biphasic current (8 Hz and 400 μs) creates an increase in the maximal Tsk at the local level. A temperature cross-education effect is produced, which is greater when the NMES is applied on the dominant side.This could be a useful noninvasive measurement tool in NMES treatments.S