Descripción de los resultados y costes de una intervención preventiva a nivel respiratorio en el anciano institucionalizado: estudio controlado aleatorizado

Introducción. En el anciano institucionalizado con limitación funcional se evidencia una mayor reducción de la funcionalidad de la musculatura respiratoria (MR). Los objetivos de este estudio son evaluar los resultados y costes de una intervención de entrenamiento de la MR mediante Pranayama en población anciana institucionalizada con limitación funcional. Material y métodos. Ensayo controlado aleatorizado desarrollado en ancianos institucionalizados con limitación para la deambulación (n=54). La intervención consistió en el entrenamiento de la MR mediante Pranayama, durante 6 semanas (5 sesiones/semana). Los resultados se midieron en relación a la función de la MR mediante las presiones respiratorias máximas (PImáx y PEmáx) y la ventilación máxima voluntaria (MVV), en 4 tiempos. También se valoró la satisfacción percibida por el grupo experimental (GE) a través de un cuestionario ad hoc. Se estimaron los costes directos e indirectos de la intervención desde la perspectiva social. Resultados. El GE reveló una mejora significativa de la fuerza (PImáx y PEmáx) y de la resistencia (MVV) de la MR. Además, un 92% del GE refirió una satisfacción alta. Los costes sociales totales, directos e indirectos, ascendieron a 21678¿. Conclusiones. Esta evaluación revela que los resultados en términos de la función de la MR son significativos, que la intervención es bien tolerada y valorada por el residente, y los costes de la intervención son moderados

In-home versus hospital preoperative balance and proprioceptive training in patients undergoing TKR; rationale, design, and method of a randomized controlled trial

Abstract Background Severe knee osteoarthritis, as well as the surgical procedure of total knee replacement that aims to reduce its symptoms, cause great deterioration on the proprioceptive system. Taking this fact into account, and considering that balance abilities positively influence the capacity to perform basic functional tasks, this trial aims to find the short and mid-term effects of a preoperative balance and proprioceptive training when conducted by patients undergoing total knee replacement. Along with the effects, it is intended to determine whether in-home based training can be as effective as hospital training. The results will help to conclude whether the possible benefits may outweigh the health costs. Methods Seventy-five participants will take part. The trial will include in-home and supervised hospital experimental training compared to a non-active control group in order to estimate the actual effect of the proposal against the benefits due exclusively to the surgical procedure. Interventions last 4 weeks prior to surgery, and the follow-up will be at 2w, 6w, and 1y following the operation. The primary outcomes are in agreement with the goals: self-reported functionality in terms of KOOS and overall balance in terms of the Berg Balance Scale. The secondary outcomes will include the measurements of static and dynamic balance abilities, pain, function, and quality of life. Discussion It is expected for the results of this trial to provide relevant information in order to decide if a specific intervention is cost-effective to be implemented in clinical practice. Trial registration Clinicaltrials.gov identifier NCT03100890 . Registered in April 4, 2017

Utilización de las TIC en el aprendizaje autónomo del estudiante: aplicación en la asignatura Fisioterapia Cardiocirculatoria

El Espacio Europeo de Educación Superior (EEES) promueve un cambio metodológico en los estudios universitarios, al que sin duda contribuye el uso de las tecnologías de la información y la comunicación (TIC). En este artículo presentamos un material multimedia desarrollado en el contexto de la titulación de Fisioterapia, cuya finalidad es guiar y reforzar el aprendizaje del estudiante, tanto dentro como fuera del aula. La valoración del material por parte de los estudiantes en el aula mediante un estudio piloto puso de manifiesto tanto ventajas como inconvenientes en relación a las metodologías planteadas y el formato utilizado

Efectos de un programa de ejercicio combinado de impacto, fuerza y resistencia en la prevención de osteoporosis de mujeres posmenopáusicas

Background and objective Post-menopausal women are a population susceptible to osteoporosis. The objective of this study was to determine the effects of a combined physical exercise program including impact, strength and progressive resistance exercises in post-menopausal women. Materials and methods Prospective quasi-experimental study, with an intervention group that included post-menopausal women with no prescribed pharmacological treatment for the prevention of osteoporosis. A 2-year intervention program was implemented, with 2 training sessions per week, based on impact, strength and progressive resistance exercises. The T-score index in the femur and lumbar spine was estimated in order to determine possible changes in bone mineral density after the intervention. Results A total of 16 women, with a mean age of 49.4 (SD: 5.2) participated. After the intervention, no significant differences were found with respect to baseline T-score of femur and spine (P>.05), suggesting that bone density levels were maintained after 2 years. Conclusions Two years of osteoporosis prevention training based on a combined resistance, strength and impact program is effective in maintaining bone mineral density levels in post-menopausal women. The results suggest that physical exercise without pharmacological treatment is effective for the prevention of osteoporosis in this population

Utilización de las TIC en el aprendizaje autónomo del estudiante: aplicación en la asignatura Fisioterapia Cardiocirculatoria

El Espacio Europeo de Educación Superior (EEES) promueve un cambio metodológico en los estudios universitarios, al que sin duda contribuye el uso de las tecnologías de la información y la comunicación (TIC). En este artículo presentamos un material multimedia desarrollado en el contexto de la titulación de Fisioterapia, cuya finalidad es guiar y reforzar el aprendizaje del estudiante, tanto dentro como fuera del aula. La valoración del material por parte de los estudiantes en el aula mediante un estudio piloto puso de manifiesto tanto ventajas como inconvenientes en relación a las metodologías planteadas y el formato utilizado

Effects of Inspiratory Muscle Training and Yoga Breathing Exercises on Respiratory Muscle Function in Institutionalized Frail Older Adults: A Randomized Controlled Trial

Background: In older adults, respiratory function may be seriously compromised when a marked decrease of respiratory muscle (RM) strength coexists with comorbidity and activity limitation. Respiratory muscle training has been widely studied and recommended as a treatment option for people who are unable to participate in whole-body exercise training (WBET); however, the effects of inspiratory muscle training and yoga breathing exercises on RM function remain unknown, specifi cally in impaired older adults. Purpose: To evaluate the effects of inspiratory threshold training (ITT) and yoga respiratory training (YRT) on RM function in institutionalized frail older adults. Methods: Eighty-one residents (90% women; mean age, 85 years), who were unable to perform WBET (inability to independently walk more than 10 m), were randomly assigned to a control group or one of the 2 experimental groups (ITT or YRT). Experimental groups performed a supervised intervalbased training protocol, either through threshold inspiratory muscle training device or yoga breathing exercises, which lasted 6 weeks (5 days per week). Outcome measures were collected at 4 time points (pretraining, intermediate, posttraining, and follow-up) and included the maximum respiratory pressures (maximum inspiratory pressure [MIP] and maximum expiratory pressure [MEP]) and the maximum voluntary ventilation (MVV). Results: Seventy-one residents completed the study: control (n = 24); ITT (n = 23); YRT (n = 24). The treatment on had a signifi cant effect on MIP YRT (F 6,204 = 6.755, P \u3c.001, η 2 = 0.166), MEP (F 6,204 = 4.257, P \u3c.001, η 2 = 0.111), and MVV (F 6,204 = 5.322, P \u3c.001, η 2 = 0.135). Analyses showed that the YRT group had a greater increase of RM strength (MIP and MEP) and endurance (MVV) than control and/or ITT groups. Conclusion: Yoga respiratory training appears to be an effective and well-tolerated exercise regimen in frail older adults and may therefore be a useful alternative to ITT or no training, to improve RM function in older population, when WBET is not possible

Effects of Three Interventions Combining Impact or Walking at Intense Pace Training, with or without Calcium and Vitamin Supplements, to Manage Postmenopausal Women with Osteopenia and Osteoporosis

The purpose was to assess the effects of three interventions on bone mineral density (BMD) to prevent the onset or progression of osteoporosis in postmenopausal women. Specifically, thirty-nine postmenopausal women, diagnosed with osteopenia or osteoporosis, implemented either high-impact training (G1), the same training + calcium and vitamin D intake (G2), or walked at an intense pace + calcium and vitamin D (G3). Baseline change (BC) in BMD was estimated using the femoral neck and lumbar spine T-scores. Participants were classified as having suffered fractures and/or falls before (24-month) and during the 2-year intervention. The participants—aged 61.8 years—were allocated into G1 (n = 9), G2 (n = 16), and G3 (n = 14). The groups evolved similarly over time; however, participants in G2 exhibited the largest T-score improvements with BC over 20%. G1 and G3 maintained BMD levels (BC = −7 to 13.3%; p > 0.05). Falls occurred similarly across the interventions, while the participants in G2 had the lowest percentage of fracture events (p = 0.037). Overall, the findings suggest that regular physical exercise may be effective in maintaining or improving BMD in postmenopausal women presenting with osteopenia or osteoporosis. Due to the limited sample size, the results are preliminary and warrant future randomized trials to validate the findings

Physiotherapy Intervention for Preventing the Respiratory Muscle Deterioration in Institutionalized Older Women with Functional Impairment

Introduction: In elderly seniors (\u3e80 years), respiratory function may be compromised when, in addition to the presence of comorbidity and loss of mobility, there is also reduced respiratory muscle (RM) strength. The literature has shown that RM training could be an effective method to improve RM function and prevent clinical deterioration, particularly in population with RM weakness.The main purpose of this paper was to assess the effectiveness of RM training on the respiratory muscle strength and endurance of institutionalized elderly women with functional impairment. Method: Fifty-four residents (mean=85 years, SD=6.7) were randomly assigned to either a control (n=27) or training (n=27) group. A supervised training program was developed with Threshold®IMT, five times per week for 6-weeks. The main variables of the intervention were: maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) and maximal voluntary ventilation (MVV), all of which were measured at weeks 0, 4, 7 and 10. Results: Statistical analysis revealed no significant differences in PImax (F3,114=1.04, p=0.368, R2=0.027), PEmax (F3,114=1.86, p=0.14, R2=0.047) and MVV (F3,114=1.74, p=0.162, R2=0.044) between the two groups after the intervention. However, the workload significantly improved with the training sessions (F5,100=72.031, p\u3c0.001, R2=0.791). Conclusion: In a 6-week interval-based training program, the threshold loading device does not significantly improve parameters related to RM strength and endurance of the study population

Playing-related musculoskeletal disorders in woodwind, brass and percussion players: a review

Performing Arts Medicine is a broad field that includes the study of medical conditions and injuries incurred by dancers, instrument musicians and vocalists. Musicians' playing-related health problems have focused more and more the interest of scientists, researchers, physicians, physiotherapists and, in generally, of health care professionals during the last decades. The most relevant Performing Arts Medicine's literature of approximately the past twenty years has been summarized. Special attention has been given to studies concerning playing-related musculoskeletal conditions of musicians. Overuse syndrome is the most reported diagnosis among instrumental musicians suffering from playing-related musculoskeletal disorders (PRMDs), despite the fact that epidemiologic rates of PRMDs among woodwind, brass and percussion musicians seem to variate widely. An unambiguous definition of specific PRMDs seems to be more and more necessary, and would permit subsequent studies not to be excluded in the data collection of further systematic reviews. In conclusion, in order to change musicians at- risk behaviours a significant mind-changing is necessary and prevention should be considered as a living matter. Health care professional should also represent an important stream to make aware musicians about PRMDs and pain management