Tratamientos mínimamente invasivos en fisioterapia para el tratamiento de la tendinopatía rotuliana.

Las tendinopatías son un tipo de trastorno musculoesquelético muy común en la población, producidas habitualmente por un sobreuso o sobrecarga del tendón afectado. Una de las más habituales es la tendinopatía rotuliana, en la cual se ve afectado el tendón rotuliano encontrando dolor y pérdida de la funcionalidad, asociado a una degeneración y desorganización del colágeno presente en el tendón en diversas ocaciones. La encontramos especialmente en los sujetos que realizan deportes con saltos, y por ello ha recibido también el nombre de “rodilla del saltador”. El tratamiento habitual para conseguir una mejora de esta sintomatología es la aplicación de carga por medio del ejercicio terapéutico, el cual, provoca un estímulo al tendón para que sea capaz de adaptarse a las nuevas condiciones. Sin embargo, en fisioterapia están empezando a usarse nuevas técnicas de regeneración mínimamente invasivas (punción seca, electrolisis, etc.) que buscan la regeneración de ese tejido lesionado, sin todavía una evidencia científica concluyente. Además, no existen estudios que hayan comparado la efectividad de las técnicas anteriormente mencionadas cuando son aplicadas para el tratamiento de lesiones tendinosas, lo que constituye la principal novedad de esta tesis.Por ello, el principal objetivo de la presente Tesis Doctoral es analizar el papel de dos técnicas mínimamente invasivas en la mejora de las tendinopatías rotulianas, así como profundizar en los cambios que se producen en el tendón tanto estructural como funcionalmente. Esta Tesis incluye varios estudios. Por un lado, realizamos un ensayo en jugadores de baloncesto sanos para detectar los cambios que se producen en las propiedades físicas del tendón tras un protocolo de ejercicio excéntrico. Tras el análisis de los resultados junto con la consecuente capacidad de conseguir cambios en el tendón por medio del ejercicio terapéutico realizamos una revisión bibliográfica y metaanálisis de técnicas mínimamente invasivas que se utilizan en el tratamiento de las lesiones del tendón, más específicamente de la tendinopatía rotuliana. Por último, realizamos un estudio donde comparamos 3 intervenciones diferentes para el tratamiento de la patología. En dos de los grupos aplicamos diferentes técnicas mínimamente invasivas, las cuales carecían de ensayos clínicos aleatorizados hasta la fecha, junto con un programa de ejercicio terapéutico, y un tercer grupo que únicamente recibió el ejercicio terapéutico. En él, analizamos funcionalidad, dolor, calidad de vida y cambios estructurales del tendón en sujetos diagnosticados con tendinopatía rotuliana. Los principales resultados son los siguientes: - Los protocolos de ejercicio excéntrico parecen ser una técnica efectiva para conseguir cambios en la rigidez del tendón rotuliano sano, según el estudio realizado en jugadores de baloncesto. - Los estudios incluidos en la revisión que investigaron la efectividad de técnicas mínimamente invasivas demostraron que las técnicas mínimamente invasivas son efectivas a corto y largo plazo para el tratamiento de tendinopatía rotuliana cuando se realizaron junto con ejercicio físico. - No existe evidencia científica de calidad que respalde el uso de punción seca ni de electrolisis en el tratamiento de la tendinopatía rotuliana. - La punción seca, la electrolisis percutánea intratisular o la punción placebo combinado con un protocolo de ejercicio excéntrico han demostrado ser eficaces para mejorar la funcionalidad y el dolor en pacientes con tendinopatía rotuliana a corto y medio plazo.- La electrolisis percutánea intratisular fue capaz de conseguir una mayor mejoría en la calidad de vida a largo plazo de los pacientes con tendinopatía rotuliana analizados en este estudio. - Las mejoras clínicas de estos pacientes con tendinopatía rotuliana no se asociaron con cambios estructurales en dicho tendón.<br /

A comparative study of treatment interventions for patellar tendinopathy: a secondary cost-effectiveness analysis

Objective: To compare the cost-effectiveness of three patellar tendinopathy treatments. Design: Secondary (cost-effectiveness) analysis of a blinded, randomised controlled trial, with follow-up at 10 and 22 weeks. Settings: Recruitment was performed in sport clubs. The diagnosis and the intervention were carried out at San Jorge University. Participants: The participants were adults between 18 and 45 years (n = 48) with patellar tendinopathy. Interventions: Participants received percutaneous needle electrolysis, dry needling or sham needling, all of which were combined with eccentric exercise. Main outcome measures: Costs, quality-adjusted life years and incremental cost-effectiveness ratio were calculated for each group. Results: The total cost per session was similar in the three groups: €9.46 for the percutaneous needle electrolysis group; €9.44 for the dry needling group; and €8.96 for the sham group. The percutaneous needle electrolysis group presented better cost-effectiveness in terms of quality-adjusted life years and 96% and 93% probability of being cost-effective compared to the sham and dry needling groups, respectively. Conclusion: Our study shows that percutaneous needle electrolysis has a greater probability of being cost-effective than sham or dry needling treatment

La empresa con propósito

El presente trabajo trata de definir el concepto de “empresa con propósito” a la par que contextualizar losmovimientos filosóficos promotores e influyentes que caracterizan este tipo de empresas desde el puntode vista de diferentes autores. Para conocer mejor como es una “empresa con propósito”, se realizó unaentrevista a dos empresas aragonesas con el objetivo de conocer las ventajas e inconvenientes queencuentran a la hora de apostar por este modelo de liderazgo empresarial. En ocasiones, la misión seconfunde con el propósito, por ello, se trata de definir los objetivos que persiguen cada uno. Por otro lado,las empresas socialmente comprometidas pueden optar por el Certificado B Corp si cumplen con una seriede requisitos sostenibles. Hasta el momento no existía una legislación concreta para la “empresa conpropósito”, aunque en la actualidad, España ya cuenta con leyes que regulan lo que llaman ”Sociedades deBeneficio e Interés Común”. <br /

Placebo and nocebo effects of percutaneous needle electrolysis and dry-needling: an intra and inter-treatment sessions analysis of a three-arm randomized double-blinded controlled trial in patients with patellar tendinopathy

ObjectiveThis study aimed to investigate the influence of potential placebo and nocebo effects on pain perception of percutaneous needle electrolysis (PNE) in individuals with patellar tendinopathy.MethodsIn this secondary analysis of a three-arm randomized double-blinded controlled trial, intra and inter-session pain perception data from 48 sporting participants with patellar tendinopathy between 18 and 45 years were investigated. Participants were divided into 3 parallel groups: “no-sham group” [PNE intervention], “single-sham group” [sham PNE by using dry needling], and “double-sham group” [sham PNE by using sham needles]. Every group received 4 sessions of the needling therapies targeting the patellar tendon over 8 weeks and was instructed to perform a unilateral eccentric exercise program of the quadriceps muscle on the affected side. Clinical and needle-related pain was assessed before, during, and after each treatment session using a visual analog scale.ResultsNo differences were found between groups intra- or inter-session in terms of pain reduction (P = 0.424) despite clinical pain decreased in all groups since the first treatment session (P &lt; 0.001). Furthermore, although the double-sham group showed a lower percentage of participants reporting needle-related pain during needle intervention (P = 0.005), the needle-related pain intensity after needle intervention was similar between groups (P = 0.682). Moreover, there were no group differences for the duration of pain sensation after any needle intervention (P = 0.184), extending in many cases beyond 24 h.ConclusionNeedling therapies for individuals with patellar tendinopathy are prone to elicit placebo effects regarding clinical pain and nocebo effects regarding needling-related pain. Clinicians and physical therapists treating musculoskeletal pain conditions should consider the added value and potential mechanisms of action before routinely using needle techniques

Comparative study of treatment interventions for patellar tendinopathy: A protocol for a randomised controlled trial

Introduction Patellar tendinopathy is a degenerative disease of the patellar tendon, which affects athletes from a variety of sports, and is especially predominant in sports involving high-impact jumping. The aim of this study is to determine the additional effect of two interventions combined with eccentric exercise and compare which one is the most effective at short-term and long-term follow-up for patients with patellar tendinopathy. Methods and analysis This study is a randomised controlled trial with blinded participants. Measurements will be carried out by a specially trained blinded assessor. A sample of 57 patients with a medical diagnosis of patellar tendinopathy will participate in this study and will be divided into three treatment groups. Eligible participants will be randomly allocated to receive either: (a) treatment group with percutaneous needle electrolysis, (b) treatment group with dry needling or (c) treatment group with placebo needling. In addition, all groups will perform eccentric exercise. Functionality and muscle strength parameters, pain, ultrasound appearances and patient perceived quality of life shall be evaluated using the Victorian Institute of Sports Assessment for patellar (VISA-P), jump tests, Visual Analogue Scale, ultrasound images and Short Form-36 (SF-36), respectively. Participants will be assessed at baseline, at 10 weeks and at 22 weeks after baseline. The expected findings will allow us to advance in the treatment of this injury, as they will help determine whether a needling intervention has additional effects on an eccentric exercise programme and whether any of the needling modalities is more effective than the other

Asistir, consultar, involucrar: ¿es necesario redefinir el concepto de participación comunitaria?

Objetivo Describir qué entienden por participación comunitaria las personas que trabajan en 10 proyectos de promoción de la salud y cómo se implementa. Método Estudio mixto cuali-cuantitativo. Se recopilaron datos mediante entrevistas semiestructuradas a 10 personas representantes de los proyectos, y se realizaron talleres presenciales en los que participaron 53 personas que contestaron a un cuestionario elaborado ad hoc para identificar los niveles de participación comunitaria. Análisis estadístico descriptivo de los cuestionarios y análisis de matriz de las entrevistas, observaciones y grabaciones de los talleres. Resultados Aunque los proyectos se definen como muy participativos, la participación se manifiesta principalmente como asistencia, con escasos ejemplos de consulta o implicación real de la comunidad. Conclusiones La discrepancia observada puede deberse a una falta de cultura de participación de individuos e instituciones, y a falta de formación. Se propone dejar de hablar de participación-asistencia y hacerlo de consultar o involucrar a las personas

Psychoeducational preventive treatment for women at risk of postpartum depression: study protocol for a randomized controlled trial, PROGEA

Background: Postpartum depression is a disease with a prevalence of 20% that has deleterious consequences not only for the mother but also for the baby and can cause delays in physical, social and cognitive development. In this context, the European Union Committee on Public Health has declared it essential that preventative measures are taken by centres providing care for women with a multidisciplinary approach. PROGEA is a multicentre, single-blind randomized, 3-year, longitudinal clinical trial aiming to evaluate the efficacy of a psychoeducational programme in preventing postpartum depression in at-risk women, based on a range of clinical variables, and explore prognostic factors. This paper describes the methods and rationale behind the study. Methods: We will study women receiving treatment as usual plus a psychoeducation cognitive behavioural therapy (CBT)-based intervention and a control group receiving only treatment as usual. The sample will be recruited from an incidental sampling of pregnant women in two health regions. We will recruit 600 women in the third trimester of pregnancy who consent to take part in the study. Almost half of the women, about 280, would be expected to have some risk factors for postpartum depression. All those found to have risk factors will be evaluated, and we estimate that a quarter will be classified as at-risk of developing postpartum depression as measured with the Edinburgh Postnatal Depression Scale. This subset will be randomly allocated to receive treatment as usual with or without the CBT intervention. Six sessions of CBT (1 individual and 5 group) will be offered by a psychologist. Discussion: Findings from this study will be used to design a definitive study that will examine the clinical and cost-effectiveness of the CBT-based intervention in improving the mood of women in the postpartum period.This work was supported by local grants from the Department of Education, Linguistic Policy and Culture of the Basque Country Government (2011111110)

Analytical tools for the multiplex rapid detection of SARS-CoV-2

There is a high demand for analytical tools that can readily be applied to effectively diagnose the Covid-19 but also to carry out screening and surveillance detection with enough frequency to get the transmission rates under control and thus help to timely tackling the disease. On the one hand, high throughput analytical benchtop approaches are still highly demanding for accelerating diagnostics. Such platforms are required to show multiplexed capabilities while in turn reducing the turnaround times of currently applied techniques such as the RT-PCR gold standard. On the other hand, massive screening and surveillance protocols still require for effective tools at the point of need that could reliably detect the virus in individuals after being exposed or the likelihood of being immunized after suffering from the disease. The rapid detection of coronavirus biomarkers, including RNA as well as spike and nucleocapsid proteins in nasopharyngeal and oropharyngeal samples, together with host biomarkers such as immunoglobulins and cytokines in serum has been addressed in this work. We aim to produce tools that provided with a global response to the diagnosis, prognosis and follow-up of the disease (Figure 1). All the biocomponents and corresponding bioassay protocols required for measuring these biomarkers have been tailored made and implemented in three different platforms. A calorimetric device based on a lateral flow assay format [1, 2] and a multiplex electrochemical platform comprising an electrochemical transducer array and a paper microfluidic component [3] have been adapted to produce tools to be used at the point of care. Likewise, a fluorescence microarray platform has been set up with the potential for high-throughput screening by recording molecular signatures thanks to the its multiplexing and miniaturization capabilities. REFERENCES [1] E. Polo et al. PCT, ES2013/070549 [2] E. Polo et al. Chem. Commun., 49 (2013) 3676 [3] C. Fernández-Sánchez et al. Application no. EP20382721.

Safety and preliminary efficacy on cognitive performance and adaptive functionality of epigallocatechin gallate (EGCG) in children with Down syndrome. A randomized phase Ib clinical trial (PERSEUS study)

Purpose: Although some caregivers are using epigallocatechin gallate (EGCG) off label in hopes of improving cognition in young adults with Down syndrome (DS), nothing is known about its safety, tolerability, and efficacy in the DS pediatric population. We aimed to evaluate safety and tolerability of a dietary supplement containing EGCG and if EGCG improves cognitive and functional performance. Methods: A total of 73 children with DS (aged 6-12 years) were randomized. Participants received 0.5% EGCG (10 mg/kg daily dose) or placebo for 6 months with 3 months follow up after treatment discontinuation. Results: In total, 72 children were treated and 66 completed the study. A total of 38 participants were included in the EGCG group and 35 in the placebo group. Of 72 treated participants, 62 (86%) had 229 treatment-emergent adverse events (AEs). Of 37 participants in the EGCG group, 13 (35%) had 18 drug-related treatment-emergent AEs and 12 of 35 (34%) from the placebo group had 22 events. In the EGCG group, neither severe AEs nor increase in the incidence of AEs related to safety biomarkers were observed. Cognition and functionality were not improved compared with placebo. Secondary efficacy outcomes in girls point to a need for future work. Conclusion: The use of EGCG is safe and well-tolerated in children with DS, but efficacy results do not support its use in this population. (C) 2022 The Authors. Published by Elsevier Inc. on behalf of American College of Medical Genetics and Genomics

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe