Evaluación funcional avanzada y efectividad de una intervención educativa domiciliaria en personas con ictus desde terapia ocupacional

El marco empírico tiene como factor común el ictus, aunque esta patología ha sido estudiada desde la investigación preclínica, con un muestreo por intención de 30 casos repartidos entre los cinco estudios llevados a cabo para la evaluación avanzada de la funcionalidad, y la investigación clínica, en la que se realizó un muestreo estratificado de 27 casos para el desarrollo de una intervención educativa domiciliaria. Ambas ramas de esta tesis encuentran su nexo de unión en la investigación translacional, la cual hace referencia al uso de la investigación con una gran e inmediata aplicabilidad al ámbito clínico, lo que conocemos como índices ambulatorios. Por un lado, la objetivación de los test funcionales permite globalizar las mediciones realizadas en una población para así poder clasificar las limitaciones que padecen en los diferentes componentes de la funcionalidad y facilitar, de esta forma, la evaluación del paciente en el ámbito clínico. Y por otro lado, una intervención de baja intensidad con probada factibilidad y demostrados cambios en los pacientes con ictus que la reciben tras el alta a sus domicilios, lo que podría favorecer la aplicabilidad al ámbito clínico en un corto periodo de tiempo tras analizar su efectividad y realizar un estudio exhaustivo de coste-efectividad.La incidencia del ictus en España es de 186,9 casos por cada 100.000 habitantes al año, de forma que se produce un nuevo caso de ictus cada seis minutos. La mayoría de las personas que sufren un ictus sobreviven al mismo pero padecen déficits cognitivos y neurológicos, déficits de comunicación y déficits motores. Estos últimos, provocados principalmente por la hemiparesia, causan una serie de secuelas que repercuten en la funcionalidad del paciente, ya que afectan directamente al control postural, el equilibrio, la movilidad y la marcha Debido a la gran relación existente entre la funcionalidad y el desempeño de las actividades de la vida diaria, se entiende fundamental la valoración de dichas capacidades mediante test funcionales con contrastada fiabilidad, validez y sensibilidad. El desempeño de las ocupaciones de la vida diaria es fundamental para dar sentido y orden a la vida de las personas. Cuando una persona sufre un ictus, este afecta directamente al desempeño de las ocupaciones, provocando, por tanto, disfunciones severas en sus roles y rutinas. Por ello, es necesaria la perspectiva de la terapia ocupacional en el proceso rehabilitador, la cual debe ser componente esencial en la rehcuperación de estos pacientes. Los objetivos generales de esta tesis son: evaluar el equilibrio estático, semiestático y dinámico, y la funcionalidad de los miembros inferiores de las personas que han sufrido un ictus, a través de la parametrización de test funcionales mediante el uso de sensores inerciales y smartphones. Así como, evaluar la efectividad de una intervención educativa llevada a cabo en el domicilio de personas en fase aguda de ictus desde el enfoque de la terapia ocupacional

Parameterisation and reliability of the functional reach test in people who suffer stroke

AIM: The aim of this study is to analyse the reliability, sensitivity and specificity of the parameterisation of FRT using inertial sensors to record kinematic variables in subjects who have had a stroke. Our hypothesis is that the IS will be reliable instruments for kinematic study of the FRT. METHODS: This is a cross-sectional study of 5 subjects over 65 years who suffer of stroke. During the execution of Funtional Reach Test the subjects carried two inertial sensors, one was placed in the lumbar and the other in the trunk. After analysing the data obtained in the kinematic registration by inertial sensors a number of direct and indirect variables were obtained. The variables extracted directly from FRT through the IS were distance, maximun angular lumbosacral/thoracic displacement, time maximun angular lumbosacral/thoracic displacement, time return starting position and total time. Using this data the speed and the acceleration of each one of them were calculated. A descriptive analysis of all kinematic outcomes recorded by the two inertial sensors was developed (trunk and lumbar) and the average range achieved in the FRT. Reliability measures were calculated by analysing the internal consistency the measures with 95% confidence interval of each outcome variable. The reliability was calculated in the functional reach and the outcomes measured by the IS. RESULTS: The values in the the Functional Reach Test obtained in the present study (2.06 ± 12.75cm) are similar to those obtained in other studies with this population and in the same age range. Intrasubject reliability values observed in the use of inertial sensors are all located above 0.820, ranging from 0.829 (time B_C lumbar area) and 0.891 (A_B displacement of the trunk). Likewise, the observed intersubject values range from 0.821 (Time B_C lumbar area) and 0.883 (B_C trunk displacement). On the other hand, the reliability of the FRT was 0.987 (0.983-0.992) and 0.983 (0.979-0.989) intersubject and intrasubject respectively. CONCLUSION: The main conclusion that can be reached is that the inertial sensors are a tool with excellent reliability, validity, sensitivity and specificity in the parameterisation of the Functional Reach Test in people who have had a stroke.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Improving adherence physical activity, quality of life and social support for activities in people with intellectual disabilities, through multimodal intervention (education + activity)

Background People with intellectual disabilities (ID) have a poor level of physical activity as they experience many barriers towards doing it (Bodde & Seo, 2009). Physical activity provides many benefits so there are studies to improve adherence to physical activity (Stanish & Frey, 2008). In our study we carried out a multimodal intervention (educational advice + physical activity) to improve adherence to physical activity in people with ID. Method. The sample consisted of 40 people with ID. They all received a multimodal intervention in ASPROMANIS INDUSTRIAL (Malaga, Spain), 2 hours per week for 8 weeks. The outcome measures were: IPAQ (International Physical Activity Questionnaire, WhoQoL Scale to find out about quality of life and SE/SS-AID to know self-efficacy and social support for activity. We measured fitness condition (strength, flexibility, balance and aerobic condition) through a physical fitness test (Functional reach test, single-leg stance with eyes open, single-leg stance with eyes closed, passive knee extension, calf muscle flexibility, anterior hip flexibility, functional shoulder rotation, time-stands test, partial sit-up test, handgrip test, two-minute step test). Results and discussion The results show that with the multimodal intervention, we did not find significant changes in physical activity by measuring with IPAQ (Mets/total) in people with ID. However, we detected an increasing trend [F=0.04(0,84). On the other hand we found significant changes in quality of life [F=4.18(0,04)], professional support[F=40,31(0)] and support for friends [10,09(0)]. Finally, in those with the fitness condition, we found an increasing trend towards flexibility, strength, balance and aerobic condition, and a significant increase in abdominal muscle strength [4.22(0,04)]. Conclussion The conclusion of our study is that a multimodal intervention over 8 weeks in people with ID can improve their quality of life and provide social support for activity, but without significant improvement in physical condition and physical activity. Randomized clinical trials and a higher sample will be needed to confirm this tendency towards improvement.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tec

Correlation between self-efficacy and social support for activity scale and fitness condition

Background: Several factors influence the levels of fitness in people with intellectual disabilities (King et al., 2003) including self-efficacy and social support (Jamieson, Parker, Roberts-Thomson, Lawrence, & Broughton, 2014). The objective of our study is to examine the relationship between fitness and self-efficacy and social support for activity in people with intellectual disabilities. Our hypothesis is that self-efficacy and social support will have a mild relationship to fitness. Methods: An observational cross-sectional study was conducted. We used the self efficacy and social support for activity scale for people with intellectual disabilities (SE/SS-AID). To measure the correlations we used physical fitness tests (Functional reach test, Single-leg stance with eyes open-, Single-leg stance with eyes closed, passive knee extension, calf muscle flexibility, anterior hip flexibility, functional shoulder rotation, Time-stands test, Partial sit-up test, Handgrip test, two-minute step test). The physical fitness tests was separated into four categories to provide greater specificity (strength, balance, flexibility and aerobic condition). Data from the SE/SS-AID and physical fitness tests were measured in 131 adults with ID. Results and discussion. We found important correlations between the physical fitness tests and the SE/SS-AID (Calf Muscle Flexibility = 0.26 Anterior Hip Flexibility = 0.23 Abdominal Strength= 0, 21). To our knowledge, this is the first study to examine the correlations between fitness, self-efficacy and social support for activities. Other studies have measured fitness condition and social support and self efficacy for activity with regard to the SE/SS-AID scale for people with intellectual disabilities (Skowronski, Horvat, Nocera, Roswal, & Croce, 2009) but we can not know the correlations between these Conclusion: The main conclusion of our studywas that we found a low correlation between some physical fitness tests and the Self Efficacy and Social Support scales for activities. References Jamieson, L. M., Parker, E. J., Roberts-Thomson, K. F., Lawrence, H. P., & Broughton, J. (2014). Self-efficacy and self-rated oral health among pregnant aboriginal Australian women. BMC Oral Health, 14(1), 29. doi:10.1186/1472-6831-14-29 King, G., Law, M., King, S., Rosenbaum, P., Kertoy, M. K., & Young, N. L. (2003). A conceptual model of the factors affecting the recreation and leisure participation of children with disabilities. Physical & Occupational Therapy in Pediatrics, 23(1), 63-90. Skowronski, W., Horvat, M., Nocera, J., Roswal, G., & Croce, R. (2009). Eurofit special: European fitness battery score variation among individuals with intellectual disabilities. Adapted Physical Activity Quarterly: APAQ, 26(1), 54-67.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tec

Effect of obesity in Independence and balance in people with intelectual disability

Background People with obesity often have problems with postural control. Some studies show that people with intellectual disabilities (ID) have a higher likelihood of having falls than the general population, with a prevalence in adults of between 29% and 70% (Cox et al., 2010). Currently, there are no studies that show the effects of obesity on independence and balance in people with ID. The objective of our study is analyse, in people with ID, the degree of influence that obesity has on independence with regard to activities of daily living, static and semi-static balance. Therefore, we can compare two groups: obese people and non-obese people. Our hypothesis is that obesity will exercise a negative influence on static and semi-static balance as well as on independence and the development of the activities of daily living. Method In a cross-sectional study, we compared static and semi-static balance in two groups of people with ID: the obese and the non-obese. All those in the sample had a low ID (IQ: 70-50) to mild ID (IQ 50-35). To measure balance we used a single leg balance test (SLBT) with opened eyes and closed eyes, and a functional reach test (FRT). In order to measure levels of dependence we used a Barthel index. The outcome variables were: time in balance in SLBT open eyes/closed eyes), maximum range of FRT and Barthel index. Results and Discussion We found significant differences in all outcome variables between two groups. To our knowledge, this is the first study to analyze how obesity affects independence, static balance and semi-static balance in people with ID. However, other studies have analyzed the effects of obesity on the general population (Singh et al., 2009). In both studies (General population: Singh et al. 2009 and people with ID in this study) we observed that obesity can be a determinant of negatively static balance and semi-static balance. Conclussion The main conclusion of this study is that obesity has a negative effect on independence, static balance and semi-static balance in people with ID. These results would have been carried out when we carry out an intervention on people with ID to prevent falls. References - Cox CR, Clemson L, Stancliffe RJ, Durvasula S, Sherrington C. Incidence of and risk factors for falls among adults with an intellectual disability. J Intellect Disabil Res. 2010 Dec;54(12):1045-57. doi: 10.1111/j.1365-2788.2010.01333.x. - Enkelaar L, Smulders E, van Schrojenstein Lantman-de Valk H, Weerdesteyn V, Geurts AC. Clinical measures are feasible and sensitive to assess balance and gait capacities in older persons with mild to moderate Intellectual Disabilities. Res Dev Disabil. 2013 Jan;34(1):276-85. doi: 10.1016/j.ridd.2012.08.014. - Singh D, Park W, Levy MS, Jung ES. The effects of obesity and standing time on postural sway during prolonged quiet standing. Ergonomics. 2009 Aug;52(8):977-86.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Reliability in the parameterization of the functional reach test in elderly stroke patients: A pilot study

BACKGROUND: Postural instability is one of the major complications found in stroke survivors. Parameterising the functional reach test (FRT) could be useful in clinical practice and basic research. OBJECTIVES: To analyse the reliability, sensitivity, and specificity in the FRT parameterisation using inertial sensors for recording kinematic variables in patients who have suffered a stroke. DESIGN: Cross-sectional study. While performing FRT, two inertial sensors were placed on the patient's back (lumbar and trunk). PARTICIPANTS: Five subjects over 65 who suffer from a stroke. MEASUREMENTS: FRT measures, lumbosacral/thoracic maximum angular displacement, maximum time of lumbosacral/thoracic angular displacement, time return initial position, and total time. Speed and acceleration of the movements were calculated indirectly. RESULTS: FRT measure is  12.75±2.06 cm. Intrasubject reliability values range from 0.829 (time to return initial position (lumbar sensor)) to 0.891 (lumbosacral maximum angular displacement). Intersubject reliability values range from 0.821 (time to return initial position (lumbar sensor)) to 0.883 (lumbosacral maximum angular displacement). FRT's reliability was 0.987 (0.983-0.992) and 0.983 (0.979-0.989) intersubject and intrasubject, respectively. CONCLUSION: The main conclusion could be that the inertial sensors are a tool with excellent reliability and validity in the parameterization of the FRT in people who have had a stroke

Systematic review of mirror therapy compared with conventional rehabilitation in upper extremity function in stroke survivors

Free to read Background/aim Stroke is a leading cause of disability in developed countries. One of the most widespread techniques in clinical practice is mirror therapy (MT). To determine the effectiveness of MT over other methods of intervention in the recovery of upper limb function in people who have had a stroke. Methods A systematic review was conducted. The search string was established based on the last systematic review about MT that dated from 2009: “upper extremity” OR “upper limb “AND “mirror therapy” AND stroke. For this search Pubmed, Scopus and SciELO databases were used. Results Fifteen studies were included in the systematic review. Recovery of the upper limb, upper limb function and gross manual dexterity were frequently measured in these studies. Conclusions In the primary variables in promoting recovery, MT alone showed better results in acute and chronic stroke patients in upper limb functioning than either conventional rehabilitation (CR) or CR plus MT

Identification of Tools for the Functional and Subjective Assessment of Patients in an Aquatic Environment: A Systematic Review

Aquatic therapy is one of the most common treatments for alleviating musculoskeletal pathologies. Its effectiveness has been evaluated with functional tests and questionnaires. Functional tests are used in aquatic therapy; however, in most cases, they are carried out in a non-aquatic environment and, as such, their results may differ from those of tests performed in an aquatic environment. A systematic review was performed to assess the accuracy of functional tests and patient-reported outcomes to assess aquatic therapy interventions. The authors conducted a literature search in July 2019. In total, 70,863 records were identified after duplicates removed. Of these, 14 records were included about functional tests assessment in aquatic environment and 725 records for questionnaires. The majority of the tests had also been assessed in a dry environment, allowing differences and similarities between the tests in the two environments to be observed. Different variables have been assessed in tests included in the present systematic review (cardiorespiratory, neuromuscular, kinematic, physiological, kinetic responses and rating of perceived exertion) which are included in the manuscript. Visual Analogue Scale, Western Ontario and McMaster Universities Osteoarthritis Index and the 12-item Short Form Health Survey were the assessments most commonly used by the different authors.Ye

Psychometric analysis of the questionnaires for the assessment of upper limbs available in their Italian version: a systematic review of the structural and psychometric characteristics

Introduction: There is no systematic review that analyzes the psychometric properties of questionnaires in Italian. Previous studies have analyzed the psychometric characteristics of instruments for the measurement of pathologies of upper limbs and their joints in different languages. The aim of the present study was to analyze the psychometric properties of the questionnaires published in Italian for the evaluation of the entire upper limb or some of its specific regions and related dysfunctions. Evidence acquisition: For the development of this systematic review, the following databases were used: PubMed, Scopus, Cochrane, Dialnet, Cinahl, Embase and PEDro. The selection criteria used in this study were: studies of transcultural adaptation to Italian of questionnaires oriented to the evaluation of upper limbs or any of their structures (specifically shoulder, elbow and wrist/hand), and contribution of psychometric variables of the questionnaire in its Italian version. Evidence synthesis: After reading the titles and applying the inclusion and exclusion criteria to the complete documents, 16 documents were selected: 3 for the upper limb, 8 for the shoulder, 1 for the elbow and 4 for the wrist and hand. The cross-sectional psychometric variables show levels between good and excellent in all the questionnaires. Longitudinal psychometric variables had not been calculated in the vast majority of the analyzed questionnaires. Conclusions: Italian versions of the questionnaires show good basic structural and psychometric characteristics for the evaluation of patients with musculoskeletal disorders of the upper limb and its joints (shoulder, elbow and wrist/hand).</p