Vendaje en ocho como recurso fisioterápico para rehabilitación del desempeño funcional tras accidente cerebrovascular

A stroke may leave neurological, motor and sensory sequelae, interfering with the function of movements and culminating in gait and balance changes. Therefore, it is necessary to demonstrate the efficacy of eight-point binding, a low-cost technique that functions to provide proprioceptive information and promote the biomechanical alignment of the ankle, acting against mechanisms that lead to equinovarus foot. This study aims to determine the immediate effect of eight-point binding as a physical therapy resource for the rehabilitation of function performance after a stroke. To this end, 22 patients who were able to walk alone without an orthosis were evaluated, and performed the Timed Up and Go (TUG) functional mobility test, a gait speed assessment and the Berg Balance Scale, with and without the eight-point binding in the paretic lower limb. When comparing the results after the eight-point binding, it was possible to observe a statistically significant difference (pEl accidente cerebrovascular (ACV) puede dejar secuelas neurológicas, motoras y sensoriales, interfiriendo en la función de los movimientos y culminando en cambios en la marcha y el equilibrio. Por ende, hay la necesidad de comprobarse científicamente la eficacia de vendaje en ocho, una técnica de bajo costo que tiene la función de proporcionar informaciones propioceptivas y promover la alineación biomecánica del tobillo, actuando en contra de los mecanismos que conducen al pie equinovaro. El objetivo de este estudio fue determinar el efecto inmediato de los vendajes en ocho como recurso fisioterápico para la rehabilitación del desempeño funcional tras accidente cerebrovascular. Para ello, participaron de este estudio 22 pacientes los cuales fueron capaces de caminar solos, sin la ayuda de aparatos ortopédicos, y que realizaron el test de la movilidad funcional Timed Up and Go (TUG), la evaluación de la velocidad de la marcha y de la escala de Equilibrio de Berg, con y sin el vendaje en ocho del tobillo de la extremidad inferior parética. Al comparar los resultados antes y después de los vendajes, fue evidenciada diferencia estadísticamente significativa (pO Acidente Vascular Encefálico (AVE) pode deixar sequelas neurológicas, motoras e sensitivas, interferindo na função dos movimentos e culminando em alterações na marcha e no equilíbrio. Sendo assim, há a necessidade de se comprovar cientificamente a eficácia do enfaixamento em oito, uma técnica de baixo custo que tem como função fornecer informações proprioceptivas e promover o alinhamento biomecânico do tornozelo, agindo contra os mecanismos que levam ao pé equinovaro. O objetivo deste estudo foi determinar o efeito imediato do enfaixamento em oito como recurso fisioterapêutico para a reabilitação do desempenho funcional após AVE. Para tanto, participaram deste estudo 22 pacientes que foram capazes de deambular sozinhos, sem auxílio de órteses, que realizaram o teste de mobilidade funcional Timed Up and Go (TUG), a avaliação da velocidade da marcha e da escala de Equilíbrio de Berg, com e sem o enfaixamento em oito no tornozelo do membro inferior parético. Quando comparados os resultados antes e após o enfaixamento em oito, foi evidenciada diferença estatisticamente significante (

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used