Neurorehabilitación en pacientes mayores con ictus subagudo : factores predictores, niveles de recuperación y relación entre distintas escalas de valoración

INTRODUCCIÓN Se han detectado ciertas regularidades en el patrón de recuperación de los pacientes con secuelas de ictus. Se han identificado también múltiples factores predictores de su recuperación. Además del uso de las escalas de valoración como herramientas predictivas, la literatura insiste en la definición de niveles de recuperación a través de dichas escalas. OBJETIVOS -Comprobar la evolución temporal de la mejora en pacientes mayores con ictus sometidos a un programa interdisciplinar de neurorehabilitación. -Identificar factores relacionados con el estado de salud al ingreso así como aquellos influyentes sobre el grado y ritmo de la recuperación. -Determinar puntos de corte de interés clínico para la definición de niveles de recuperación en escalas de funcionalidad. -Identificar las tareas motoras con más importancia predictiva en la recuperación. MATERIAL Y MÉTODOS Se ha llevado a cabo un estudio retrospectivo de 106 pacientes con ictus subagudo mayores de 65 años, tratados en una unidad de neurorehabilitación. Se han establecido 3 evaluaciones: 1ª evaluación, al ingreso; 2ª evaluación, a los 6 meses; 3ª evaluación, al cabo de un año. En la 1ª evaluación, se han registrado características demográficas y clínicas. En las 3 evaluaciones se han recogido las puntuaciones relativas a 10 escalas de valoración. RESULTADOS Y DISCUSIÓN A través de un análisis de componentes principales, se ha obtenido una primera componente que se interpreta como un índice conjunto de las 10 escalas, que expresa el estado de salud global (ESG). Tras un ANOVA se observa una clara tendencia a la mejora, siendo esta más importante durante los 6 primeros meses (72,7%) que en los 6 últimos (27,3%). A diferencia de otras investigaciones, en nuestro trabajo no se ha observado una etapa de estabilización en la evolución. Tras realizar correlaciones, test T de Student y ANOVA, las características relacionadas (positivamente) con el ESG al ingreso son: estado motor, estado neurológico y nivel comunicativo. Sexo, edad, cronicidad, estado emocional-conductual y estado de salud inicial influyen sobre el grado de recuperación. Estado de salud y estado emocional-conductual iniciales también influyen sobre el ritmo de la recuperación. Los puntos de corte que expresan la separación entre recuperación mala y moderada en escalas de funcionalidad, extraídos a partir de los definidos para DOS y Rankin a través de modelos de regresión logística binaria son, respectivamente: 62,9 y 21,30 para Barthel; 70,62 y 38,29 para FIM; 116,07 y 66,02 para FAM. Las tareas motoras que presentan mayor relación con las valoraciones de escalas de funcionalidad y discapacidad, tras la realización de los correspondientes modelos de regresión, son: equilibrio en sedestación, movilidad en silla de ruedas y transferencias verticales en cama y suelo. CONCLUSIONES Los pacientes mayores con ictus experimentan una recuperación más rápida durante los 6 primeros meses. Los factores relacionados con el estado de salud al ingreso no coinciden con aquellos influyentes sobre la recuperación. Se han determinado los puntos de corte que separan los niveles de recuperación mala y moderada en escalas de funcionalidad. Las tareas motoras con mayor relevancia predictiva son las no bilaterales

An Instrument-Assisted coracoid pain test : an exploratory diagnostic accuracy study

The coracoid pain test (CPT) could contribute to the diagnosis of frozen shoulder (FS) with palpation. However, due to assessor performance these values might be unreliable. Therefore, the aim was to explore the diagnostic accuracy of an instrument-assisted CPT and two alternative approaches (pain severity and side comparison) for assistance in the diagnosis of FS. Patients with FS and healthy age-matched controls were recruited. All participants underwent the instrument-assisted CPT on both shoulders with a pressure algometer. Sensitivity, specificity, and likelihood ratios were determined for the three approaches. In total, 35 patients with FS and 35 healthy participants were included. The original approach was positive in eight participants (11.4%), with only sufficient specificity to draw a conclusion. The pain severity approach was positive in 31 participants (44.3%) with sufficient sensitivity, specificity and likelihood ratios. The side comparison approach was positive in 10 participants (14.3%) with excellent specificity and positive likelihood ratio. The specificity of the instrument-assisted CPT can be used to increase the probability of FS with both the original and alternative approaches. Only the pain severity approach can draw a conclusion with a negative test result. This study should be repeated with a cross-sectional design to strengthen and confirm the conclusions

Functional and Clinical Characteristics for Predicting Sarcopenia in Institutionalised Older Adults: Identifying Tools for Clinical Screening

Background: Recently, the European Working Group on Sarcopenia in Older People (EWGSOP2) has updated the sarcopenia definition based on objective evaluation of muscle strength, mass and physical performance. The aim of this study was to analyse the relationship between sarcopenia and clinical aspects such as functionality, comorbidity, polypharmacy, hospitalisations and falls in order to support sarcopenia screening in institutionalised older adults, as well as to estimate the prevalence of sarcopenia in this population using the EWGSOP2 new algorithm. Methods: A multicentre cross-sectional study was conducted on institutionalised older adults (n = 132, 77.7% female, mean age 82 years). Application of the EWGSOP2 algorithm consisted of the SARC-F questionnaire, handgrip strength (HG), appendicular skeletal muscle mass index (ASMI) and Short Physical Performance Battery (SPPB). Clinical study variables were: Barthel Index (BI), Abbreviated Charlson's Comorbidity Index (ACCI), number of medications, hospital stays and falls. Results: Age, BI and ACCI were shown to be predictors of the EWGSOP2 sarcopenia definition (Nagelkerke's R-square = 0.34), highlighting the ACCI. Sarcopenia was more prevalent in older adults aged over 85 (p = 0.005), but no differences were found according to gender (p = 0.512). Conclusion: BI and the ACCI can be considered predictors that guide healthcare professionals in early sarcopenia identification and therapeutic approach

Using the Updated EWGSOP2 Definition in Diagnosing Sarcopenia in Spanish Older Adults : Clinical Approach

Recently the European Working Group on Sarcopenia in Older People (EWGSOP2) has updated diagnostic criteria for sarcopenia, which consist of one or more measures of muscle strength, muscle mass, and physical performance, plus an initial screening test called SARC-F. The main objective was to compare the number of cases of sarcopenia, using the different measurements and screening options. A cross-sectional study was conducted on Spanish older adults (n = 272, 72% women). Combining the different measures proposed by the steps described in the EWGSOP2 algorithm, 12 options were obtained (A-L). These options were studied in each of the three models: (1) using SARC-F as initial screening; (2) not using SARC-F; and (3) using SARC-CalF instead of SARC-F. A χ2 independence test was statistically significant (χ2(6) = 88.41, p < 0.001), and the association between the algorithm used and the classification of sarcopenia was moderate (Cramer's V = 0.226). We conclude that the different EWGSOP2 measurement options imply case-finding differences in the studied population. Moreover, when applying the SARC-F, the number of people classified as sarcopenic decreases. Finally, when SARC-CalF is used as screening, case finding of sarcopenic people decreases. Thus, clinical settings should consider these outcomes, since these steps can make preventive and therapeutic interventions on sarcopenia vary widely

Determining cut-off points in functional assessment scales in stroke

[EN] BACKGROUND: A wide variety of well-validated assessment scales of functioning and disability have been developed for stroke population. However, these instruments have limitations in their interpretation. Therefore, determining cut-off points for their categorization becomes necessary. OBJECTIVES: To determine cut-off points for the BI, FIM and FAM scales to differentiate clinical disability categories and to establish the relationship between mRS and DOS scales. METHODS: One hundred and six adults with ischemic or haemorrhagic stroke were mainly recruited from a rehabilitation facility (Hospitales Nisa, Valencia, Spain). RESULTS: A high correlation was observed between the DOS and mRS scales (Kendall's tau-b = 0.475; p = 0.000) although a certain amount of disagreement between the two scales was detected. The cut-off points were 62.90 (95% CI, 57.26-69.29) and 21.30 (95% CI, 16.34-26.03) for the BI; 70.62 (95% CI, 66.65-75.22) and 38.29 (95% CI, 34.07-42.25) for the FIM; and 116.07 (95% CI, 110.30-122.68) and 66.02 (95% CI, 59.20-72.35) for the FAM. CONCLUSION(S): DOS was observed to be more demanding than the mRS, in terms of patient independence. Additionally, the lower cut-off points separating the levels of severe and moderate disability in the BI, FIM and FAM were determined. These findings would facilitate practitioners clinical interpretation of disability levels in post-stroke patients.Balasch I Bernat, M.; Balasch Parisi, S.; Noe Sebastian, E.; Dueñas Moscardo, L.; Ferri Campos, J.; Lopez Bueno, L. (2015). Determining cut-off points in functional assessment scales in stroke. NeuroRehabilitation. 37(2):165-172. doi:10.3233/NRE-151249S16517237

Material docent de l'assignatura Fisioteràpia en Especialitats Clíniques III

Es trata d'una compilació de diapositives utilitzades com a material docent de l'assignatura Fisioteràpia en Especialitats Clíniques III de 3er curs del Grau en Fisioteràpia. El temari comprèn aspectes tant teòrics com pràctics relacionats amb la fisioteràpia aplicada a l'àmbit de la promoció de la salut i la prevenció de les patologies més prevalents tant en la població adulta com d'adults majors. Al llarg del temari es presenten diverses estratègies basades principalment en l'aplicació d'exercici com a ferramenta per a la promoció de la salut així com modalitats específiques d'exercici terapéutic per a l'abordatge de les disfuncions més freqüents entre els adults i els adults majors.This is a compilation of slides used as teaching material for the subject Physiotherapy in Clinical Specialties III of the 3rd year of the Degree in Physiotherapy. The contents include both theoretical and practical aspects related to physiotherapy applied to the field of health promotion and the prevention of the most prevalent pathologies in both the adult population and older adults. Throughout the lides, various strategies are presented, mainly based on the application of exercise as a tool for health promotion as well as specific modalities of therapeutic exercise to address the most common dysfunctions between adults and older adults

Material Docent per a l'assignatura Fisioteràpia en Especialitats Clíniques III: actualitzacions 2021-22

El document forma part dels materials docents programats mitjançant l'ajut del Servei de Política Lingüística de la Universitat de València.Es trata d'una compilació de diapositives utilitzades com a material docent de l'assignatura Fisioteràpia en Especialitats Clíniques III de 3er curs del Grau en Fisioteràpia. El temari comprèn aspectes tant teòrics com pràctics relacionats amb la fisioteràpia aplicada a l'àmbit de la promoció de la salut i la prevenció de les patologies més prevalents tant en la població adulta com d'adults majors. Al llarg del temari es presenten diverses estratègies basades principalment en l'aplicació d'exercici com a ferramenta per a la promoció de la salut així com modalitats específiques d'exercici terapéutic per a l'abordatge de les disfuncions més freqüents entre els adults i els adults majors. Es presenten les diapositives actualitzades respecte al temari que varem penjar el curs acadèmic passat, que porta el mateix títol (exceptuant que en el títol d'aquest any s'especifíca que són actualitzacions)This is a compilation of slides used as teaching material for the subject Physiotherapy in Clinical Specialties III of the 3rd year of the Degree in Physiotherapy. The contents include both theoretical and practical aspects related to physiotherapy applied to the field of health promotion and the prevention of the most prevalent pathologies in both the adult population and older adults. Throughout the lides, various strategies are presented, mainly based on the application of exercise as a tool for health promotion as well as specific modalities of therapeutic exercise to address the most common dysfunctions between adults and older adults. The updated slides are presented with respect to those that we posted last academic year, which has the same title (except that in the title of this year it is specified that they are updates

Should Exercises be Painful or not? Effects on Clinical and Experimental Pain in Individuals with Shoulder Pain

Exercise can reduce pain, however the effect of painful versus non-painful exercises is uncertain. The primary aim of this randomized crossover study was to compare the effect of painful versus nonpainful isometric shoulder exercises on pain intensity after exercise in individuals with rotator cuff-related shoulder pain. Secondary exploratory aims were to describe the effects on pressure pain thresholds (PPTs), conditioned pain modulation (CPM) and muscle strength. On separate days, 35 individuals performed painful isometric shoulder exercises (external rotation; 20% above pain threshold), nonpainful isometric shoulder exercises (external rotation; 20% below pain threshold), and a rest condition, in randomised order. Shoulder pain intensity, PPTs, CPM, and external rotation strength were assessed before, immediately after and 45 minutes after conditions. No significant differences were observed between painful and nonpainful exercises. Visual analogue scale scores increased immediately after both painful and non-painful exercises compared with rest (P = .047, partial ƞ2 = .07), but were similar to preexercise levels after 45 minutes. No changes in PPTs, CPM, or muscle strength after exercises compared with rest were observed. Painful and non-painful isometric exercises caused a moderate but short-lasting increase in shoulder pain in individuals with RCRSP. Isometric exercises had no effect on pain sensitivity and shoulder muscle strength or CPM. Perspective: This study evaluated for the first time in individuals with rotator cuff-related shoulder pain the effects of painful versus non-painful isometric exercises on different pain-related outcome measures. Both painful and non-painful isometric exercises caused a moderate but relatively short-lasting increase in shoulder pain in individuals with rotator cuff-related shoulder pain

Study of the recovery patterns of elderly subacute stroke patients in an interdisciplinary neurorehabilitation unit

Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.[EN] Background: This study seeks to establish the facts of the improvement over time in elderly poststroke patients. Methods: A retrospective study was performed with regard to 106 subacute stroke patients aged older than 65 years, who were treated in an interdisciplinary neurorehabilitation unit. Three assessment points were established (on admission, 6 months post-onset, and 12 months post-onset), with the scores relative to 10 assessment scales having been collected at each point. Results: By means of a principal component analysis, a first component was obtained, which is taken to represent a combined index of the 10 scales and to express the overall health status of the patient. An analysis of variance of this first component enabled a clear improvement trend to be identified, with this being more marked during the first 6-month period (72.7%) than the second 6-month period (27.3%). Conclusions: The elderly stroke patients underwent an interdisciplinary rehabilitation program lasting 1 year, experimented an initial period of rapid recovery during the first 6 months followed by a less marked period of improvement. However, no stabilization period in the patients' progress was found.Balasch I Bernat, M.; Balasch Parisi, S.; Noé Sebastián, E.; Dueñas Moscardo, L.; Ferri Campos, J.; Lopez Bueno, L. (2015). Study of the recovery patterns of elderly subacute stroke patients in an interdisciplinary neurorehabilitation unit. Journal of Stroke and Cerebrovascular Diseases. 24(10):2213-2218. doi:10.1016/j.jstrokecerebrovasdis.2015.05.014S22132218241

A Manual Therapy and Home Stretching Program in Patients With Primary Frozen Shoulder Contracture Syndrome: A Case Series

STUDY DESIGN: Case series. BACKGROUND: Manual therapy has been demonstrated to reduce pain and improve function in patients with frozen shoulder contracture syndrome (FSCS), but no evidence exists to support one form of manual therapy over another. The purpose of this case series was to describe both short and long-term outcomes after a manual therapy program and home stretching exercises based on specific impairments in shoulder mobility and level of tissue irritability in patients with FSCS. CASE DESCRIPTION: Eleven patients with primary FSCS were treated with an individually tailored multimodal manual therapy approach once weekly for 12 visits coupled with home stretching exercises once a day, five days per week. Pain, disability, range of motion (ROM) and muscle strength of the affected shoulder were assessed at baseline, post-treatment, 6-months and 9-months. OUTCOMES: Significant improvements in self-reported pain, disability, shoulder ROM (active abduction and active abduction with overpressure, active external rotation and active external rotation with overpressure and isolated glenohumeral active abduction) and strength (shoulder flexion and internal rotation) were reported following treatment with impairment- and tissue irritability- based manual physical therapy and stretching exercises. Additionally, 4 of 11 of the patients showed pain improvements exceeding the minimal clinically important difference (MCID) on visual analogue scale (VAS) post-intervention and 8 of 11 on VAS at 6 and 9-months. Moreover, 7 of 11 of the patients showed improvements in Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores exceeding the MCID post-intervention and at 6-months, and 8 of 11 exceeded the MCID at 9-months. DISCUSSION: Clinically meaningful changes in shoulder pain and disability, ROM, or muscle strength were observed in eleven patients with primary FSCS treated with an individually tailored approach of both manual therapy techniques and stretching exercises, while accounting for tissue irritability. Randomized controlled trials are required to determine the effectiveness of this multimodal approach for the management of individuals with FSCS