Efficacy of Posterior Tibial Nerve Stimulation in the Treatment of Fecal Incontinence: A Systematic Review

Fecal incontinence is a condition that carries high social stigmatization and a determining factor in the quality of life of the person who suffers from it. Its etiology is multifactorial and treatment includes surgical and conservative measures, including stimulation of the posterior tibial nerve. The aim of this review is to determine whether posterior tibial nerve stimulation (PTNS) is more effective than other treatments in reducing episodes of fecal incontinence in adults. A systematic review of randomized clinical trials that analyzed different approaches and comparisons with other treatments in adults without neurological or metabolic diseases was carried out, analyzing, fundamentally, the reduction of episodes of fecal incontinence. In general, a reduction in fecal incontinence episodes is observed in the experimental groups compared with the control groups, although these differences are not significant in most studies. The results regarding the effectiveness of PTNS in reducing episodes of fecal incontinence compared to other treatments are not entirely conclusive, although benefits are observed regarding the stimulation of sacral roots. More well-designed studies with a long-term follow-up of the results are needed so that the recommendation of this treatment can be generalized.Ibáñez-Vera AJ, Mondéjar-Ros RM, Franco-Bernal V, Molina-Torres G, Diaz-Mohedo E. Efficacy of Posterior Tibial Nerve Stimulation in the Treatment of Fecal Incontinence: A Systematic Review. Journal of Clinical Medicine. 2022; 11(17):5191. https://doi.org/10.3390/jcm1117519

Efecto de la terapia con ondas electromagnéticas capacitadas monopolares en el tratamiento del dolor en fibromialgia

La fibromialgia es uno de los mayores problemas sanitarios de nuestro país y del mundo desarrollado con una prevalencia del 2,1%. El American College of Reumathology la define como estado doloroso generalizado en mínimo 11 de 18 puntos preestablecidos, sensibles a una presión de 4 kg/cm2 y con al menos 3 meses de evolución. La definición actual de la Organización Mundial de la Salud incluye presencia de otros síntomas como cefalea, colon irritable, menstruación dolorosa, irritabilidad, sensibilidad térmica, fatigabilidad, rigidez articular y alteraciones del sueño. A pesar de que se han desarrollado numerosos estudios para clarificar su etiología, sigue sin conocerse de manera exacta. Varios estudios apuntan a una alteración a nivel del Sistema Neuro Endocrino, donde se produce una hiporreactividad por agotamiento del eje Adreno-Hipotálamo-Pituitarial, que interviene en el metabolismo, el estrés y el Sistema Inmune. Una exposición prolongada al estrés agotaría la capacidad de ciertas glándulas de producir hormonas suficientes para mantener el estado de alerta, lo que el sujeto percibiría como cansancio y dolor muscular. En otra línea, un reciente estudio muestra que el dolor de los pacientes con fibromialgia podría estar originado por la vasoconstricción de pequeñas arteriolas controladas por el hipotálamo, que producen disrregulación de la temperatura corporal de los pacientes y mayor acumulación de ácido láctico en tejidos blandos. Otras hipótesis apuntan a alteraciones locales, como la mayor presencia de puntos gatillo miofasciales en pacientes con fibromialgia que en sujetos sanos. Actualmente, la fibromialgia carece de un tratamiento efectivo, consistiendo éste principalmente en tratamiento sintomático del dolor y del resto de síntomas que presente cada paciente, principalmente mediante fármacos. Sin embargo, la poca eficacia del tratamiento farmacológico para conseguir un alivio duradero del dolor, unido a los múltiples efectos secundarios y riesgo de dependencia y tolerancia que ocasiona un tratamiento prolongado con analgésicos y opiáceos, pone de manifiesto la necesidad de encontrar nuevas opciones terapéuticas que garanticen una analgesia de calidad que disminuya lo suficiente el dolor durante el máximo tiempo posible, minimizando los efectos secundarios. El gasto sanitario para el tratamiento de la fibromialgia se incrementa año tras año, por lo que es conveniente explorar nuevas opciones terapéuticas que puedan presentar mayor efectividad y bajo coste. La terapia por Ondas Electromagnéticas Capacitivas Monopolares (OEDCM) consiste en la aplicación transcutánea de señales electromagnéticas del espectro de la radiofrecuencia pulsadas y en rangos de frecuencia constantemente variables para evitar acomodación de los receptores tisulares, permitiendo así por diversos mecanismos la inducción de analgesia. Este tratamiento ha mostrado eficacia en el tratamiento de dolor neuropático y otros tipos de dolor por mecanismo de sensibilización central. La ausencia de efectos secundarios de este tratamiento lo sitúa como una interesante alternativa para el tratamiento sintomático de la fibromialgia. OBJETIVO: valorar la eficacia del tratamiento por OEDCM en el tratamiento del dolor, la calidad de vida, el estado de ánimo, la depresión y la calidad del sueño en sujetos con fibromialgia. MÉTODOS: se aleatorizó una muestra de 57 pacientes en cuatro grupos de tratamiento: un grupo de tratamiento días continuos, otro grupo de tratamiento días alternos, un grupo placebo con tratamiento sin emisión y un grupo control que mantuvo sus cuidados habituales. Se citó a los pacientes previamente al comienzo del estudio para informarles acerca del procedimiento y entrenarles en la cumplimentación de los cuestionarios. Se utilizó la escala EVA para valorar el dolor, el cuestionario ICAF para valorar el impacto en la calidad de vida de los sujetos, el cuestionario HADS para evaluar la depresión y la ansiedad de los sujetos y de nuevo la escala EVA para valorar la calidad del sueño. En el caso de las variables impacto en la calidad de vida, depresión, ansiedad y calidad del sueño se realizó una medición previa al tratamiento justo antes de comenzar la intervención y otra al finalizar la octava sesión de tratamiento. En cuanto a la variable dolor, se realizaron mediciones antes y después de la sesión de tratamiento en la primera y última sesión de cada una de las dos semanas del estudio, resultando un total de cuatro mediciones. Respecto a la intervención, se llevó a cabo con un equipo de OEDCM modelo Physicalm® de Biotronic® en una sala climatizada con una camilla plegable de madera. Los pacientes fueron tratados ocho sesiones de 20 minutos de duración a lo largo de dos semanas, en las cuales un terapeuta adiestrado para el uso de la técnica llevaba a cabo el tratamiento. En todo momento los pacientes fueron ajenos a la existencia de diferentes tratamientos, para garantizar el cegado en este aspecto. Para evaluar los datos obtenidos, se realizó un análisis estadístico con el programa estadístico MedCalc para Windows, versión 16.4.3, considerando para todos los análisis estadísticos un valor significativo de α= 0,05. El análisis de homogeneidad fue realizado mediante el test de Shapiro-Wilk. Para realizar la comparación entre las distintas mediciones de dolor local y dolor general, se realizó un test ANOVA de medidas repetidas, donde el factor intra-sujetos fue el tiempo y el factor inter-sujetos, el tratamiento recibido por el paciente. Posteriormente se calculó la d de Cohen para conocer el tamaño del efecto de cada uno de los tratamientos, tanto antes como después de la intervención e igualmente para determinar los cambios que el tratamiento produjo en las variables de impacto en la calidad de vida, calidad del sueño, depresión y estado de ánimo, se realizó una prueba T. Posteriormente se calculó la d de Cohen para conocer el tamaño del efecto de cada uno de los tratamientos en la variable impacto en la calidad de vida. RESULTADOS: el tratamiento por OEDCM produce mejoras significativas en el dolor local y general de sujetos con fibromialgia respecto a grupo control y placebo. En el dolor local, se producen diferencias significativas desde después de la primera sesión de tratamiento entre el grupo de tratamiento días contínuos y los grupos Placebo (P< 0,01) y Control (P<0,01) y entre el grupo de tratamiento días alternos y el grupo Control (p< 0,01). En la medición final del dolor local posterior al tratamiento se observan diferencias estadísticamente significativas entre el grupo de tratamiento A respecto a los grupos Placebo (P<0,01) y Control (P<0,01), del grupo de tratamiento días alternos respecto al grupo Control (P<0,01), y del grupo Placebo respecto al grupo Control (P<0,01). En cuanto al dolor general, se observan diferencias significativas desde la medición posterior al primer día de tratamiento entre grupo de días continuos con los grupos Placebo (P=0,01) y Control (P<0,01). En la última medición del dolor general tras el último tratamiento, se observan diferencias estadísticamente significativas entre el grupo de tratamiento días continuos respecto al grupo Placebo (P<0,05) y al grupo Control (P<0,01), entre el grupo de tratamiento días alternos respecto a grupo Control (P<0,01), y entre el grupo Placebo respecto al grupo Control (P<0,05). En el impacto de la calidad de vida medido al final del proceso, se hallaron diferencias estadísticamente significativas en los grupos de tratamiento días continuos (P<0,01), tratamiento días alternos (P<0,01) y grupo Placebo (P<0,05) respecto a la puntuación previa al inicio de la intervención. No se observaron mejoras en el estado de ánimo de los sujetos del estudio, obteniéndose incluso empeoramiento significativo en los grupos de tratamiento días continuos (P<0,05), tratamiento días alternos (P<0,05) y grupo Control (P<0,01). En cuanto a calidad del sueño, se observan diferencias estadísticamente significativas en el grupo de tratamiento días continuos entre la medición previa al tratamiento y la medición final (P<0,01). DISCUSIÓN: la incapacidad del tratamiento farmacológico actual para conseguir la curación de los síntomas de la fibromialgia hace necesaria la investigación de nuevos abordajes terapéuticos. El ejercicio físico terapéutico se ha mostrado eficaz en reducir el dolor, el impacto en la calidad de vida y la depresión de los sujetos con fibromialgia a largo plazo. La fisioterapia por su parte se muestra también efectiva en sus distintos ámbitos, siendo la electroterapia el más estudiado. Técnicas como el TENS, la estimulación eléctrica transcraneal (EET) y la terapia combinada muestran mejoras en dolor local, calidad de vida y calidad del sueño con aplicaciones cercanas a la hora diaria durante varias semanas. Técnicas de terapia manual como la liberación miofascial y el tratamiento craneo-sacral también consiguen mejoras en el dolor y la calidad de vida de los pacientes con protocolos de una hora de aplicación durante varias semanas. La terapia por OEDCM en tiempos de aplicación de 20 minutos parece obtener resultados equiparables a otras técnicas de electroterapia en dolor local y general, calidad de vida y calidad del sueño, no así en depresión y ansiedad. Serán necesarios más estudios para determinar la utilidad de combinar la mejora a corto plazo que muestra el tratamiento por OEDCM junto al ejercicio terapéutico y otras técnicas que permiten mantenimiento de la mejora a largo plazo. CONCLUSIÓN: la terapia por OEDCM es efectiva en el tratamiento del dolor local, el dolor general, la calidad de vida y la calidad del sueño de los pacientes con fibromialgia

Effectiveness of Virtual Reality Therapy on Balance and Gait in the Elderly: A Systematic Review

Virtual reality (VR) therapies are presently utilized to treat physical and cognitive impairments among elderly people. This systematic review aims to collect the most recent evidence on the effectiveness of VR in improving balance and gait among healthy elderly individuals, in comparison with other therapies. A literature search was conducted using the PubMed, SCOPUS, PEDro, and WoS databases, by selecting randomized clinical trials that evaluated balance, both static and dynamic, as well as gait in a population of healthy older adults who underwent virtual reality therapy. The methodological quality of the studies was assessed using the PEDro scale. After eligibility criteria were applied and duplicates were removed, 20 studies were selected out of 1705 initially identified. The present systematic review concludes that virtual reality therapy is more effective than minimal intervention or usual care in enhancing static balance, dynamic balance, and gait in healthy elderly individuals. Moreover, virtual reality therapy yields better outcomes compared to traditional balance training and physical exercise in improving balance and gait in this demographic. However, both methods have shown effectiveness

Analysis of the structural characteristics and psychometric properties of the Pelvic Floor Bother Questionnaire (PFBQ): a systematic review.

Background: The Pelvic Floor Bother Questionnaire is a validated and reliable questionnaire that studies the presence and degree of pelvic floor discomfort, providing a global vision of pelvic floor dysfunction. This questionnaire assesses urinary stress incontinence, urinary urgency, urinary frequency, urge urinary incontinence, pelvic organ prolapses, dysuria, dyspareunia, defecatory dysfunction, fecal incontinence, and the disability it causes to the respondent. Aim: The aim of the present study was to analyze the structural characteristics and psychometric properties of the different versions of the pelvic floor bother questionnaire, as well as the methodological quality, the quality of evidence, and the criteria used for good measurement properties. Methods: A systematic review was carried out in different databases, such as PubMed, SCOPUS, Web of Science, Dialnet, ScienceDirect, and CINAHL, on studies adapting and validating the pelvic floor bother questionnaire in other languages. The data were analyzed taking into account the guidelines of the preferred reporting item statement for systematic reviews and meta-analyses (PRISMA) and following the COSMIN guidelines, considering articles published up to February 28, 2022, and registered in the PROSPERO database. Results: Initially, a total of 443 studies were found, from which a total of four studies were analyzed with regard to structural characteristics and psychometric properties, such as reliability, internal consistency, construct validity, and criterion validity. Conclusions: The different versions of the questionnaires show basic structural characteristics and psychometric properties for the evaluation of patients with pelvic floor dysfunctions. Most of the analyzed versions present criteria for good measurement properties qualified as sufficient, inadequate–adequate methodological quality, and low–moderate quality of evidence

Percutaneous Electrolysis in the Treatment of Lateral Epicondylalgia: A Single-Blind Randomized Controlled Trial

Few studies have considered the effects of percutaneous electrolysis (PE) in the treatment of lateral epicondylalgia (LE). For this reason, the objective of this study was to compare the effects of PE with an evidence-based approach-trigger point dry needling (TDN)-in patients with LE. A randomized controlled trial was conducted in which 32 participants with LE were randomly assigned to two treatment groups, the PE group (n= 16) and the TDN group (n= 16). Both groups received four therapy sessions and an eccentric exercise program to be performed daily. The numerical pain rating scale (NPRS), pressure pain thresholds (PPT), quality of life, and range of motion were measured before treatment, at the end of treatment, and at one- and three-month follow-ups. Significant between-group mean differences were found after treatment for NPRS (p< 0.001) and flexion movement (p= 0.006). At one-month follow-up, significant mean differences between groups were found for NPRS (p< 0.001), PPT (p= 0.021), and flexion (p= 0.036). At three-months follow-up, significant mean differences between groups were found for NPRS (p< 0.001), PPT (p= 0.004), and flexion (p= 0.003). This study provides evidence that PE could be more effective than TDN for short- and medium-term improvement of pain and PPTs in LE when added to an eccentric exercise program

Effects of global postural reeducation on postural control, dynamic balance, and ankle range of motion in patients with hallux abducto valgus. A randomized controlled trial.

AbstractHallux abducto valgus (HAV) is a common musculoskeletal disorder that has been addressed surgically. Nevertheless, the manual therapy approach may play an important role in the management of this condition. The present study aimed to determine the effectiveness of global postural reeducation (GPR) in subjects with symptomatic mild to moderate HAV in static postural control, dynamic stability, and ankle dorsiflexion range of motion (DFROM). A total of 80 patients with mild to moderate symptomatic HAV were allocated to the intervention group (GPR) or control group (CG) (no treatment) for 8 weeks. Outcome measures were assessed at baseline at 4 and 8 weeks including static postural control (Romberg test), dynamic balance (Star Excursion Balance Test [SEBT]), and ankle DFROM (Weight‐Bearing Lunge Test [WBLT]). No improvements were observed at 4 weeks, but there were improvements at 8 weeks in: static postural control mediolateral displacement (X) of center of pressure (CoP) in both eyes open (EO) and eyes closed (EC): XEO (t(36) = 2.892, p = .006, d = 0.67); XEC (t(68) = 2.280, p = .026, d = 054); and velocity (V) of CoP displacement: VEO (t(68) = 2.380, p = .020, d = 0.57); VEC (t(36) = 2.057, p = .047, d = 0.37). It were also improvements in: WBLT (t(36) = −2.869, p = .007, d = 0.54) and SEBT at three directions (anterior, ANT; posteromedial, PM; and posterolateral, PL): SEBT.ANT (t(36) = −2.292, p = .028, d = 0.23); SEBT.PM (t(36) = −4.075, p < .001, d = 0.43); SEBT.PL (t(62) = −3.506, p = .001, d = 0.34). The present study showed that GPR compared to the CG might be effective in enhancing ankle function including postural control, dynamic balance, and DFROM

Relationship between stomatognathic alterations and idiopathic scoliosis: a systematic review with meta-analysis of observational studies

Purpose: The objective of this systematic review was to assess a possible relationship between stomatognathic alterations and idiopathic scoliosis (IS). Design: This study is a systematic review with meta-analysis of observational studies. Methods: The protocol of this systematic review with meta-analysis was registered in PROSPERO (CRD42022370593). A bibliographic search was carried out in the Pubmed (MEDLINE), Scopus, Web of Science and CINAHL databases using the MeSH terms ‘Scoliosis’ and ‘Stomatognathic Disease’. The odds ratio (OR) of prevalence and standardized mean difference (SMD) were used to synthesize the results. Results: Of 1592 studies located, 14 studies were selected with 3018 subjects (age: 13.9 years). IS was related to Angle’s class II (OR = 2.052, 95% CI = 1.236–3.406) and crossbite (OR = 2.234, 95% CI = 1.639–3.045). Patients with malocclusion showed a higher prevalence of IS than controls (OR = 4.633, 95% CI = 1.467–14.628), and subjects with IS showed high overjet (SMD = 0.405, 95% CI = 0.149–0.661) and greater dysfunction due to temporomandibular disorders (SMD = 1.153, 95% CI = 0.780–1.527). Conclusion: Compared with healthy controls, subjects with IS have twice the risk of suffering from occlusion disorders, present greater temporomandibular dysfunction and have a greater overjet in the incisors. Moreover, subjects with malocclusion have an IS prevalence up to four times higher. The systematic orofacial examination of patients with IS should be recommended

The Short Form of the Fonseca Anamnestic Index for the Screening of Temporomandibular Disorders: Validity and Reliability in a Spanish-Speaking Population

The Short Form of the Fonseca Anamnestic Index (SFAI) is a simple and quick questionnaire used for screening temporomandibular disorders (TMDs). The present study aimed to validate the Spanish version of the SFAI in patients with TMDs. The study sample comprised 112 subjects (50 TMDs and 52 controls). Test–retest reliability, factorial validity, internal consistency, concurrent validity, and the SFAI’s ability to discriminate between TMDs subjects and healthy controls were analyzed using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD protocol) as the reference. Factor analysis showed a single factor that explained 63% of the total variance. Cronbach’s alpha was 0.849. The reliability of the items measured with the Kappa index showed values from 0.767 to 0.888. Test–retest reliability was substantial (intraclass correlation coefficient = 0.837). The total SFAI score showed a significant correlation with orofacial pain, vertigo, and neck disability measurements. For a cut-off point of >10 points, the SFAI showed a sensitivity of 78% and specificity of 78.85% at differentiating between TMDs patients and healthy subjects, with an area under the curve (AUC) of 0.852. The Spanish version of the SFAI is a valid and reliable instrument for diagnosing people with TMDs and shows generally good psychometric properties

Effects of Pelvic-Floor Muscle Training in Patients with Pelvic Organ Prolapse Approached with Surgery vs. Conservative Treatment: A Systematic Review

The aim of this systematic review was to explore the effectiveness of pelvic-floor muscle training (PFMT) in the treatment of women with pelvic organ prolapse (POP) who had undergone either surgery or only conservative treatment, based on a selection of randomized clinical trials (RCT). The search was carried out in PubMed, Cochrane, Scopus, CINAHL, and PEDro databases between April 2021 and October 2021 using the following MeSH terms or keywords: &ldquo;pelvic organ prolapse&rdquo;, &ldquo;POP&rdquo;, &ldquo;pelvic floor muscle training&rdquo;, &ldquo;pelvic floor muscle exercise&rdquo;, &ldquo;kegel exercise&rdquo;, and &ldquo;surgery&rdquo;. The methodological quality of the studies was assessed using the PEDro scale. Eighteen RCTs were included in this review. The findings showed improvements in symptoms associated with POP, in pelvic-floor function, and in quality of life in women who performed a PFMT protocol. However, PFMT did not produce significant changes in sexual function, and the results of the change in POP stage were inconclusive. When viewing PFMT as a complementary treatment to surgery, no significant improvements were observed in any of the analyzed variables. In conclusion, a PFMT program is an effective way to improve the pelvic, urinary, and intestinal symptoms associated with POP; function of the pelvic floor; and quality of life. PFMT as an adjunct to surgery does not seem to provide a greater benefit than surgical treatment alone. RCTs of higher methodological quality, with a larger sample size and a longer follow-up, are needed to confirm the results

Effects of Monopolar Dielectric Radiofrequency Signals on the Symptoms of Fibromyalgia: A Single-Blind Randomized Controlled Trial.

Monopolar dielectric radiofrequency (MDR) is a non-invasive treatment for pain based on the local application of electromagnetic signals. The study's goal was to analyze the effects of MDR on the symptoms of fibromyalgia. For this aim, a randomized controlled trial was conducted on 66 female participants (aged 47 17.7) diagnosed with fibromyalgia. Participants were randomly allocated to either an experimental group (n = 23), which received eight 20-minute sessions of MDR; a sham group, which received the same number of sessions of a sham MDR therapy (n = 22); or a control group (n = 21), which received usual care. The outcome variables included pain measured by the visual analogue scale (VAS), score on the hospital anxiety and depression scale (HADS) and quality of life measured by the combined index of fibromyalgia severity (ICAF). A large effect size was observed for the local pain (R2 = 0.46), total ICAF (R2 = 0.42) and ICAF physical factor scores (R2 = 0.38). Significant mean differences were found for the local pain (p = 0.025) and ICAF physical factor (p = 0.031) scores of the experimental group in comparison with the sham group. No statistically significant differences between groups were found in HADS. In conclusion, MDR is more effective than either sham treatment or usual care in the short-term improvement of pain and the physical wellbeing of participants with fibromyalgia