El benestar subjectiu i la participació en la neurorehabilitació de persones amb lesió medul·lar

Durant les últimes quatre dècades, la rehabilitació de la lesió medul·lar ha canviat el focus del tractament mèdic cap als problemes que afecten a la qualitat de vida i a la participació. Les persones amb lesió medul·lar tendeixen a presentar una percepció del benestar més baix, de mitjana, en comparació de la població que no té una discapacitat, i la puntuen més baix pel que fa a la salut física, mental i social i en altres àmbits de la vida que es consideren importants per a tenir una bona qualitat de vida. La participació pot ser considerada com un component clau o com un factor determinant de la qualitat de vida, depenent de com es conceptualitza el constructe qualitat de vida. En les persones amb lesió medul·lar, la participació està més fortament associada amb la qualitat de vida subjectiva que no pas amb les deficències o les limitacions de les activitats. Els objectius d’aquesta tesi doctoral són els següents: Identificar, avaluar i sintetitzar l'evidència sobre la participació com un resultat dels tractaments de rehabilitació funcional per a persones amb lesió medul·lar. Identificar, avaluar i sintetitzar l'evidència sobre el benestar subjectiu com a resultat dels tractaments de rehabilitació funcional per a persones amb lesió medul·lar. Descriure les associacions entre el nivell de funcionament, la percepció del benestar subjectiu i el nivell de participació en les persones amb lesió medul·lar durant el procés de neurorehabilitació hospitalària que practiquen activitat física. Per tal d’abordar aquesta situació, aquesta tesi doctoral ha estat estructurada en tres treballs: 1. La rehabilitació funcional després de la lesió medul·lar: una revisió sistemàtica dels tractament focalitzats en la participació. 2. El benestar subjectiu com a resultat de les intervencions en rehabilitació funcional després de la lesió medul·lar: una revisió sistemàtica. 3. L’activitat física en la neurorehabilitació de la lesió medul·lar: un estudi pilot, obert, transversal de la relació amb el funcionament, el benestar subjectiu i la participació.Durante las últimas cuatro décadas, la rehabilitación de la lesión medular ha cambiado el foco del tratamiento médico hacia los problemas que afectan a la calidad de vida y a la participación. Las personas con lesión medular tienden a presentar una percepción del bienestar más baja, en promedio, en comparación con la población que no tiene una discapacidad, y la puntúan más bajo en cuanto a la salud física, mental y social y en otros ámbitos de la vida que se consideran importantes para tener una buena calidad de vida. La participación puede ser considerada como un componente clave o como un factor determinante de la calidad de vida, dependiendo de cómo se conceptualiza el constructo calidad de vida. En las personas con lesión medular, la participación está más fuertemente asociada con la calidad de vida subjetiva que con las deficiencias o las limitaciones de las actividades. Los objetivos de esta tesis doctoral son los siguientes: 1. Identificar, evaluar y sintetizar la evidencia sobre la participación como un resultado de los tratamientos de rehabilitación funcional para personas con lesión medular. 2. Identificar, evaluar y sintetizar la evidencia sobre el bienestar subjetivo como resultado de los tratamientos de rehabilitación funcional para personas con lesión medular. 3. Describir las asociaciones entre el nivel de funcionamiento, la percepción del bienestar subjetivo y el nivel de participación en las personas con lesión medular durante el proceso de neurorrehabilitación hospitalaria que practican actividad física. Para abordar esta situación, esta tesis doctoral ha sido estructurada en tres trabajos: 1) La rehabilitación funcional tras la lesión medular: una revisión sistemática de los tratamientos focalizados en la participación. 2) El bienestar subjetivo como resultado de las intervenciones en rehabilitación funcional tras una lesión medular: una revisión sistemática. 3) La actividad física en la neurorrehabilitación de la lesión medular: un estudio piloto, abierto, transversal de la relación con el funcionamiento, el bienestar subjetivo y la participación.Over the past four decades, the rehabilitation of spinal cord injury has shifted the focus from medical treatment to the problems that affect the quality of life and participation. People with SCI tend to have a perception of quality of life lower on average compared to people without a disability, and scored lowest in terms of physical, mental and social health and other areas of life that are considered important to have a good quality of life. Participation can be seen as a key component or as a determinant of quality of life, depending on how the quality of life construct is conceptualized. In people with spinal cord injury, participation is more strongly associated with subjective quality of life than with deficiencies or limitations of activities. The objectives of this thesis are: 1. Identify, assess and synthesize the evidence on participation as an outcome of functional rehabilitation treatments for people with spinal cord injury. 2. Identify, assess and synthesize the evidence on subjective well-being as an outcome of functional rehabilitation treatments for people with spinal cord injury. 3. Describe the associations between the functioning, the perception of subjective well-being and participation in people with spinal cord injury during neurorehabilitation inpatient hospital. To address this situation, this dissertation has been structured in three works: 1) Functional rehabilitation after spinal cord injury: a systematic review of treatments focused on participation. 2) The subjective well-being as an outcome of interventions on functional rehabilitation after spinal cord injury: a systematic review. 3) The effect of physical activity on subjective well-being and participation in individuals with spinal cord injury during inpatient neurorehabilitation: A cross-sectional pilot study

Exercise-based interventions to enhance long-term sustainability of physical activity in older adults: a systematic review and meta-analysis of randomized clinical trials

Older adults; Physical activity; AdherenceAdultos mayores; Actividad física; AdherenciaAdults majors; Activitat física; AdherènciaExercise is a form of physical activity (PA). PA is an important marker of health and quality of life in older adults. The purpose of this study was to conduct a systematic review of the literature to assess the effect of exercise-based interventions on an at least six-month follow up PA measure, and to describe the specific strategies implemented during the intervention to strengthen the sustainability of PA in community-dwelling 65+ year-old adults. We registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42017070892) of randomized clinical trials (RCT). We searched three electronic databases during January 2018 to identify RCT assessing any type of exercise-based intervention. Studies had to report a pre-, post-, and at least 6-month post-intervention follow-up. To be included, at least one PA outcome had to be assessed. The effect of exercise-based interventions was assessed compared to active (e.g., a low-intensity type of exercise, such as stretching or toning activities) and non-active (e.g., usual care) control interventions at several time points. Secondary analyses were conducted, restricted to studies that reported specific strategies to enhance the sustainability of PA. The intervention effect was measured on self-reported and objective measures of time spent in PA, by means of standardized mean differences. Standardized mean differences of PA level were pooled. Pooled estimates of effect were computed with the DerSimonian–Laird method, applying a random effects model. The risk of bias was also assessed. We included 12 studies, comparing 18 exercise intervention groups to four active and nine non-active control groups. Nine studies reported specific strategies to enhance the long-term sustainability of PA. The strategies were mostly related to the self-efficacy, self-control, and behavior capability principles based on the social cognitive theory. Exercise interventions compared to active control showed inconclusive and heterogeneous results. When compared to non-active control, exercise interventions improved PA time at the six-months follow up (standardized mean difference (SMD) 0.30; 95%CI 0.15 to 0.44; four studies; 724 participants; I2 0%), but not at the one- or two-years follow-ups. No data were available on the mid- and long-term effect of adding strategies to enhance the sustainability of PA. Exercise interventions have small clinical benefits on PA levels in community-dwelling older adults, with a decline in the observed improvement after six months of the intervention cessation.The present study was funded by United States Department of Health & Human Services National Institutes of Health (NIH), USA, and NIH National Institute on Aging (NIA), USA, (K24 AG057728)

The Efficacy of the proprioceptive neuromuscular facilitation (PNF) approach in stroke rehabilitation to improve basic activities of daily living and quality of life : A systematic review and meta-analysis protocol

Proprioceptive neuromuscular facilitation (PNF) is a widely used rehabilitation concept, although its efficacy has not yet been demonstrated in stroke survivors. The aim of this systematic review is to identify, assess and synthesise the potential benefits of using PNF to improve the activities of daily living (ADL) and quality of life (QoL) of individuals with stroke. A systematic electronic search will be conducted in MEDLINE, Embase, CENTRAL and PEDro. We will include randomised or quasi-randomised controlled trials of PNF interventions conducted in stroke survivors up to April 2017. Two review authors will independently select relevant studies and will extract data using the Cochrane handbook for systematic reviews of interventions approach and the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The methodological quality will be assessed by using the PEDro scale. Finally, with the permitted numeric data, we will carry out a meta-analysis. Ethical considerations will not be required. will be disseminated in a peer-review journal. This systematic review aims to examine the effects of PNF (neurophysiological approach) in order to clarify its efficacy in improving ADL and QoL in the rehabilitation process of stroke survivors

The Efficacy of the proprioceptive neuromuscular facilitation (PNF) approach in stroke rehabilitation to improve basic activities of daily living and quality of life: a systematic review and meta-analysis protocol

Introduction Proprioceptive neuromuscular facilitation (PNF) is a widely used rehabilitation concept, although its efficacy has not yet been demonstrated in stroke survivors. The aim of this systematic review is to identify, assess and synthesise the potential benefits of using PNF to improve the activities of daily living (ADL) and quality of life (QoL) of individuals with stroke. Methods and analysis A systematic electronic search will be conducted in MEDLINE, Embase, CENTRAL and PEDro. We will include randomised or quasi-randomised controlled trials of PNF interventions conducted in stroke survivors up to April 2017. Two review authors will independently select relevant studies and will extract data using the Cochrane handbook for sstematic reviews of interventions approach and the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The methodological quality will be assessed by using the PEDro scale. Finally, with the permitted numeric data, we will carry out a meta-analysis. Ethics and dissemination Ethical considerations will not be required. Results will be disseminated in a peer-review journal. This systematic review aims to examine the effects of PNF (neurophysiological approach) in order to clarify its efficacy in improving ADL and QoL in the rehabilitation process of stroke survivor

Acupuncture techniques for COPD: a systematic review

Background This is the second part of a large spectrum systematic review which aims to identify and assess the evidence for the efficacy of non-pharmacological acupuncture techniques in the treatment of chronic obstructive pulmonary disease (COPD). The results of all techniques except for filiform needle are described in this publication. Methods Eleven different databases were screened for randomised controlled trials up to June 2019. Authors in pairs extracted the data and assessed the risk of bias independently. RevMan 5.3 software was used for the meta-analysis. Results Thirty-three trials met the inclusion criteria, which involved the follow techniques: AcuTENS (7 trials), moxibustion (11 trials), acupressure (7 trials), ear acupuncture (6 trials), acupressure and ear acupuncture combined (1 trial) and cupping (1 trial). Due to the great heterogeneity, only 7 meta-analysis could be performed (AcuTENS vs sham on quality of life and exercise capacity, acupressure vs no acupressure on quality of life and anxiety and ear acupuncture vs sham on FEV1 and FEV1/FVC) with only acupressure showing statistical differences for quality of life (SMD: -0.63 95%CI: − 0.88, − 0.39 I2 = 0%) and anxiety (HAM-A scale MD:-4.83 95%CI: − 5.71, − 3.94 I2 = 0%). Conclusions Overall, strong evidence in favour of any technique was not found. Acupressure could be beneficial for dyspnoea, quality of life and anxiety, but this is based on low quality trials. Further large well-designed randomised control trials are needed to elucidate the possible role of acupuncture techniques in the treatment of COPD

Exercise-based interventions to enhance long-term sustainability of physical activity in older adults: a systematic review and meta-analysis of randomized clinical trials

Exercise is a form of physical activity (PA). PA is an important marker of health and quality of life in older adults. The purpose of this study was to conduct a systematic review of the literature to assess the effect of exercise-based interventions on an at least six-month follow up PA measure, and to describe the specific strategies implemented during the intervention to strengthen the sustainability of PA in community-dwelling 65+ year-old adults. We registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42017070892) of randomized clinical trials (RCT). We searched three electronic databases during January 2018 to identify RCT assessing any type of exercise-based intervention. Studies had to report a pre-, post-, and at least 6-month post-intervention follow-up. To be included, at least one PA outcome had to be assessed. The effect of exercise-based interventions was assessed compared to active (e.g., a low-intensity type of exercise, such as stretching or toning activities) and non-active (e.g., usual care) control interventions at several time points. Secondary analyses were conducted, restricted to studies that reported specific strategies to enhance the sustainability of PA. The intervention effect was measured on self-reported and objective measures of time spent in PA, by means of standardized mean differences. Standardized mean differences of PA level were pooled. Pooled estimates of effect were computed with the DerSimonian–Laird method, applying a random effects model. The risk of bias was also assessed. We included 12 studies, comparing 18 exercise intervention groups to four active and nine non-active control groups. Nine studies reported specific strategies to enhance the long-term sustainability of PA. The strategies were mostly related to the self-efficacy, self-control, and behavior capability principles based on the social cognitive theory. Exercise interventions compared to active control showed inconclusive and heterogeneous results. When compared to non-active control, exercise interventions improved PA time at the six-months follow up (standardized mean difference (SMD) 0.30; 95%CI 0.15 to 0.44; four studies; 724 participants; I2 0%), but not at the one- or two-years follow-ups. No data were available on the mid- and long-term effect of adding strategies to enhance the sustainability of PA. Exercise interventions have small clinical benefits on PA levels in community-dwelling older adults, with a decline in the observed improvement after six months of the intervention cessation

Exercise-based interventions to enhance long-term sustainability of physical activity in older adults : A systematic review and meta-analysis of randomized clinical trials

Exercise is a form of physical activity (PA). PA is an important marker of health and quality of life in older adults. The purpose of this study was to conduct a systematic review of the literature to assess the effect of exercise-based interventions on an at least six-month follow up PA measure, and to describe the specific strategies implemented during the intervention to strengthen the sustainability of PA in community-dwelling 65+ year-old adults. We registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42017070892) of randomized clinical trials (RCT). We searched three electronic databases during January 2018 to identify RCT assessing any type of exercise-based intervention. Studies had to report a pre-, post-, and at least 6-month post-intervention follow-up. To be included, at least one PA outcome had to be assessed. The effect of exercise-based interventions was assessed compared to active (e.g., a low-intensity type of exercise, such as stretching or toning activities) and non-active (e.g., usual care) control interventions at several time points. Secondary analyses were conducted, restricted to studies that reported specific strategies to enhance the sustainability of PA. The intervention effect was measured on self-reported and objective measures of time spent in PA, by means of standardized mean differences. Standardized mean differences of PA level were pooled. Pooled estimates of effect were computed with the DerSimonian-Laird method, applying a random effects model. The risk of bias was also assessed. We included 12 studies, comparing 18 exercise intervention groups to four active and nine non-active control groups. Nine studies reported specific strategies to enhance the long-term sustainability of PA. The strategies were mostly related to the self-efficacy, self-control, and behavior capability principles based on the social cognitive theory. Exercise interventions compared to active control showed inconclusive and heterogeneous results. When compared to non-active control, exercise interventions improved PA time at the six-months follow up (standardized mean difference (SMD) 0.30; 95%CI 0.15 to 0.44; four studies; 724 participants; I2 0%), but not at the one- or two-years follow-ups. No data were available on the mid- and long-term effect of adding strategies to enhance the sustainability of PA. Exercise interventions have small clinical benefits on PA levels in community-dwelling older adults, with a decline in the observed improvement after six months of the intervention cessation