Eficacia del tratamiento de la cefalea tensional mediante técnicas neurodinámicas y de tejido blando

Contexto. La cefalea tensional (CT) es una patología muy frecuente, cuya sintomatología causa un gran impacto social y económico. Sin embargo, la escasez de estudios de alta calidad hace que el desarrollo y eficacia de tratamientos no sean claros. Objetivos. Analizar la eficacia de un protocolo de tratamiento mediante técnicas de tejido blando y/o de técnicas neurodinámicas en pacientes con cefalea tensional. Material y métodos. Noventa y siete participantes de entre 19 y 60 años, con CT episódica y/o crónica fueron reclutados del hospital Son Llàtzer y otros centros sanitarios de la región y clasificados aleatoriamente en: grupo A (n = 24; masaje superficial placebo); grupo B (n =23; recibió técnicas de tejido blando); grupo C (n = 25; recibió técnicas neurodinámicas); grupo D (n = 25; recibió un protocolo que combinaba las dos anteriores). Todos los protocolos tuvieron un total de 6 sesiones, distribuidas en 4 semanas. Antes, después, a los 15 días y a los 30 días, se midió el umbral doloroso a la presión (UDP) (2 en músculo temporal y 1 en masetero), frecuencia de las crisis de dolor, la intensidad máxima de la cefalea y el impacto de la CT en las actividades de la vida diaria (Cuestionario HIT-6). Resultados. El análisis de los datos mostró que en el UDP, los grupos B, C y D aumentaron los valores en los tres puntos con respecto a la medida basal (p 0,8), el cual además D mostró valores significativamente más elevados que el resto de grupos en dos de los puntos (p 0,8), donde además, el grupo D tenía valores significativamente menores que el grupo B (p 0,8). El grupo control tuvo valores significativamente menores en UDP y mayores en frecuencia, intensidad y cuestionario Hit-6 que el resto de grupos en todas las mediciones posteriores al tratamiento (p 0,05). Conclusiones. El protocolo de tratamiento que combina técnicas neurodinámicas y de tejido blando es más efectivo en el abordaje de la sintomatología de la CT que estos tratamientos empleados de forma aislada, aunque por separado, estas técnicas también ayudan a mejorar la sintomatología de los pacientes con CT. Los profesionales de la salud deben considerar la inclusión de las técnicas neurodinámicas en el manejo de los pacientes con cefalea tensional, tanto episódica frecuente como crónica, y su combinación con otras técnicas de fisioterapia manual, con el fin de desensibilizar el mayor número de estructuras neuro-musculo-esqueléticas posible y disminuir así los estímulos nociceptivos generados por la mecanosensibilidad de estructuras nerviosas periféricas

Validity and Reliability of Methods for Sonography Education in Physiotherapy: Onsite vs. Online.

Background: in physiotherapy, the interest in sonography education has been increasing in recent decades, giving rise to opportunities in education in an attempt to meet the elevated demand. In other health professions, online education has demonstrated to be of interest, and another possibility by which to obtain knowledge. Methods: this exploratory observational prospective study compared the outcomes between onsite versus online education, and was approved by the ethics committee of the Francisco de Vitoria University. Two groups (onsite and online) with 136 attendants and two levels for each (basic and advanced) received the same content but through different presentations. Theoretical exams were conducted via “Kahoot” and practical exams using phantoms, and the results were subject to statistical analyses. Results: the average age of onsite participants was 29.5 (25–35.25) years and 34 (28.5–40.5) for the online participants, with a higher percentage of women. The average score ranks in the Kahoot_basic test were higher for both online groups corresponding to basic (group 1) and advanced (group 2) levels: 7 (6.5, 7.5) for group 1 and 7 (6.5, 8.5) for group 2 vs. the onsite groups: 6 (5.5, 7) for group 1 and 6 (5, 6.5) for group 2. In the practical exam, the model detected that a small negative difference between the Onsite 2 group and the total effect was significant with a low effect size (R2adjusted = 0.025) for the measurements of the hollow structure; the difference between the Online 2 and Onsite 1 group was positive (1.5026, SE = 0.5822) and significant (t = 2.5809, p = 0.0113), with a low effect size (R2adjusted = 0.016) for the solid structure depth measurement. Conclusions: the results showed that there could be an opportunity to access sonography knowledge through online education in physical therapy compared to the traditional onsite model. These conclusions support the use of a low-cost and accessible method for ultrasound educationpost-print1219 K

Visceral origin: an underestimated source of neck pain

The diagnosis of neck pain is challenging. Many visceral disorders are known tocause it, and clinical practice guidelines recommend to rule them out during neck pain diagnosis.However, the absence of suspicion of any cause impedes one from establishing that specific aetiology asthe final diagnosis. To investigate the degree of consideration given to visceral aetiology, a systematicsearch of trials about neck pain was carried out to evaluate their selection criteria. The search yielded309 eligible articles, which were screened by two independent reviewers. The PEDro scale score wasused to assess the methodological quality of the studies. The following information was retrieved:number of authors affiliated to a clinical or non-clinical institution, number of citations in the Webof Science, study aims, characteristics of participants, and eligibility criteria. The top 15 most citedtrials, and the 15 most recent studies about treatment efficacy in neck pain, published in first quartilejournals of the Journal Citation Reports, were selected. Females represented 67.5% of participants.A single study was of poor methodological quality (4/10). Based on the eligibility criteria of thearticles that were systematically reviewed, it would appear that visceral aetiology was not consideredin eighty percent of the trials on neck pain, showing a low level of suspicion both in research andclinical settings

Homogeneización del proceso de tutorización del trabajo final de grado en estudiantes de Fisioterapia

La asignatura de trabajo final de grado (TFG) es una incorporación del espacio europeo con la que el alumno integra los contenidos adquiridos durante su formación. A pesar de intentar homogeneizar la formación, la inexistencia de instrucciones específicas produce diferencias en el desarrollo de los trabajos, incluso en una misma facultad debido a las diferencias metodológicas de los docentes, frustrando al alumnado. Este trabajo evaluó la influencia del uso de rúbricas y tutoriales como herramientas para homogeneizar el proceso de tutorización del TFG en el grado de satisfacción del alumnado con la asignatura. Durante dos años académicos, 9 profesores recibieron rúbricas y tutoriales para guiar la tutorización. El resto de profesores no recibieron ningún material adicional. Después de la presentación del trabajo, el alumnado contestó un cuestionario para evaluar el grado de satisfacción con el TFG. Los resultados mostraron que el uso de rúbricas no mejora la percepción de la organización de la asignatura ni del aprendizaje adquirido, así como tampoco aumenta el grado de satisfacción con el tutor y la asignatura. Sin embargo, esta metodología puede ser útil para minimizar la creencia de la exigencia de las tareas vinculadas al tutor, y con ello, la posible frustración del alumnado

Immediate and Short-Term Effects of Kinesio Taping Tightness in Mechanical Low Back Pain: A Randomized Controlled Trial

Background: There is controversy regarding the best technique for applying Kinesio Taping (KT), and the theory supporting that skin convolutions may explain its efficacy has recently been challenged. Objective: To compare the immediate and short-term effectiveness of KT tightness on mechanosensitivity and spinal mobility in nonspecific low back pain (LBP), and to observe the influence of gender in the outcome measures. Design: Double-blind, randomized, controlled trial. Setting: University-based clinical research center. Participants: A total of 75 individuals with a mean age of 33 years (±7.4 years), 60% female and 40% male, with nonspecific LBP were recruited and randomly assigned to 1 of the following study groups: standard KT tension (n = 26), increased KT tension (n = 25), and no KT tension (n = 24). Interventions: All participants received a two I-strip taping over the paravertebral muscles for 24 hours. Paper-off tension (15%-25% of the available stretch) was used in the standard KT group, which was increased to 40% in the increased KT tension group. The rest of participants received a taping procedure with no KT tension. Measurements were taken at baseline, immediately after the taping, 24 hours after the taping, and after KT removal. Main outcome measures: The primary outcome included pressure pain thresholds over the erector spinae and gluteus medius muscles. The secondary outcome was lumbar mobility (assessed with a digital inclinometer, and back-saver sit-and-reach, finger-to-floor, and sit-and-reach tests). Results: In the between-groups analysis of the mean score changes after baseline assessment, no significant differences were found for any of the outcome measures (P > .05) except the left back-saver sit-and-reach test (P = .03). A statistically significant interaction group × gender × time was observed only for mechanosensitivity values (P = .02 for the gluteus and P = .01 for the erector spinae). Conclusion: KT tightness does not seem to influence pain sensitivity and lumbar mobility in chronic LBP in either the immediate or short term

Role of Upper Cervical Spine in Temporomandibular Disorders

[eng] BACKGROUND: Temporomandibular disorders (TMDs) are prevalent multifactorial pathologies in which the actual role of the cervical region position is controversial. OBJECTIVE: To analyze the relationship between the position of the upper cervical rachis and the symptoms of TMD. METHODS: Sixty women were recruited to this study. All of them completed a questionnaire and were subjected to a temporomadibular exploration to create two different groups: a TMD Group (n = 30) - women who suffered TMD symptoms according to the evaluation; and a control group (n = 30) - women who were free from TMD symptoms. Two X-ray examinations were performed in all the women: a lateral one and a frontal one with mouth open to assess the C1-C0 distance and the craniocervical angle. RESULTS: ANOVA showed that the TMD and control women had similar C1-C0 distances and craniocervical angles (p > 0.05). Pearson correlation did not indicate any relationship between the craniocervical position and the symptomatology of TMD (r = - 0.070). CONCLUSIONS: TMD symptomatology is unrelated to alterations in craniocervical position (C0-C1 distance and craniocervical angle). Women with and without TMD showed a similar prevalence of alteration in the craniocervical position

A Decade of Progress Using Virtual Reality for Poststroke Lower Extremity Rehabilitation: Systematic Review of the Intervention Methods

Objective. To develop a systematic review of the literature, to describe the different virtual reality (VR) interventions and interactive videogames applied to the lower extremity (LE) of stroke patients, and to analyse the results according to the most frequently used outcome measures. Material and Methods. An electronic search of randomized trials between January 2004 and January 2014 in different databases (Medline, Cinahl, Web of Science, PEDro, and Cochrane) was carried out. Several terms (virtual reality, feedback, stroke, hemiplegia, brain injury, cerebrovascular accident, lower limb, leg, and gait) were combined, and finally 11 articles were included according to the established inclusion and exclusion criteria. Results. The reviewed trials showed a high heterogeneity in terms of study design and assessment tools, which makes it difficult to compare and analyze the different types of interventions. However, most of them found a significant improvement on gait speed, balance and motor function, due to VR intervention. Conclusions. Although evidence is limited, it suggests that VR intervention (more than 10 sessions) in stroke patients may have a positive impact on balance, and gait recovery. Better results were obtained when a multimodal approach, combining VR and conventional physiotherapy, was used. Flexible software seems to adapt better to patients’ requirements, allowing more specific and individual treatments

Manual therapy in joint and nerve structures combined with exercises in the treatment of recurrent ankle sprains: A randomized, controlled trial

Background: Recurrent ankle sprains often involve residual symptoms for which subjects often perform proprioceptive or/and strengthening exercises. However, the effectiveness of mobilization to influence important nerve structures due to its anatomical distribution like tibial and peroneal nerves is unclear. Objetives: To analyze the effects of proprioceptive/strengthening exercises versus the same exercises and manual therapy including mobilizations to influence joint and nerve structures in the management of recurrent ankle sprains. Study design: A randomized single-blind controlled clinical trial. Method: Fifty-six patients with recurrent ankle sprains and regular sports practice were randomly assigned to experimental or control group. The control group performed 4 weeks of proprioceptive/strengthening exercises; the experimental group performed 4 weeks of the same exercises combined with manual therapy (mobilizations to influence joint and nerve structures). Pain, self-reported functional ankle instability, pressure pain threshold (PPT), ankle muscle strength, and active range of motion (ROM) were evaluated in the ankle joint before, just after and one month after the interventions. Results: The within-group differences revealed improvements in all of the variables in both groups throughout the time. Between-group differences revealed that the experimental group exhibited lower pain levels and self-reported functional ankle instability and higher PPT, ankle muscle strength and ROM values compared to the control group immediately after the interventions and one month later. Conclusions: A protocol involving proprioceptive and strengthening exercises and manual therapy (mobilizations to influence joint and nerve structures) resulted in greater improvements in pain, self-reported functional joint stability, strength and ROM compared to exercises alone.Sección Deptal. de Radiología, Rehabilitación y Fisioterapia (Enfermería)Fac. de Enfermería, Fisioterapia y PodologíaTRUEpu