Desarrollo, análisis y estudio de sonomiografía aplicada a Fisioterapia.

Tras este primer trabajo se desarrolló otro trabajo centrado en el estudio de los tejidos blandos, donde la técnica había demostrados ser eficaz para detectar cambios de rigidez en tejidos profundos. Con este objetivo se realizó un estudio donde, mediante el empleo de las mismas variables que en el estudio anterior, se intentó valorar de una forma más objetiva que mediante la algometría, la escala EVA del dolor, o la palpación, el efecto a corto plazo de una terapia manual en el tratamiento de los puntos gatillo miofasciales. Este estudio mostró cambios en la rigidez y en el flujo sanguíneo tras la aplicación del tratamiento manual. Posteriormente, en esa misma línea de trabajo, un tercer estudio abordó el estudio de la algometría como el método más empleado actualmente para la cuantificación de los puntos gatillo miofasciales. En este estudio se empleó la sonoelastografía, enfrentándola a la algometría, y valorando la primera como una técnica que pudiese obtener resultados más objetivos y con una mayor sensibilidad al cambio que la algometría, tras la realización de un tratamiento de terapia manual. Este último estudio no mostró correlación entre algometría y sonoelastografía, aunque sí cambios en la rigidez muscular tras la aplicación del tratamiento manual.El modo B del ecógrafo es muy útil para visualizar algunos tipos de lesiones, pero es incapaz de distinguir lesiones de carácter isoecoico con el tejido de alrededor, lesiones que en cambio poseen mayor rigidez como algunos tumores o la cirrosis hepática. La palpación puede ayudar a detectar esos cambios en la rigidez de los tejidos, pero sufre de limitaciones como la dificultad de acceso a tejidos profundos, un reducido tamaño de la lesión o la pericia del examinador. La elastografía es una nueva herramienta de estudio que usa técnicas de imagen como la sonografía (entre otras posibles técnicas como la resonancia magnética o la tomografía computarizada) como medio de apoyo para estudiar los cambios en la rigidez en tejidos profundos. La aparición de varios trabajos, en los que se desarrollaban una de estas técnicas para el estudio de los puntos gatillo miofasciales, junto a la similitud existente en dos patologías del sistema musculoesquelético tan comunes como el síndrome del dolor miofascial, con sus puntos gatillo miofasciales y la fibromialgia, con sus tender points, llevó a la elaboración de un primer trabajo donde se valoró la posible utilidad de diferentes variables ecográficas en la discriminación de los tender points en pacientes con fibromialgia. En este primer trabajo se emplearon diferentes indicadores ecográficos para el estudio de los tender points en el músculo trapecio superior, empleando en concreto: la valoración de la morfología mediante la imagen en escala de grises, el uso de técnicas Doppler color para el estudio de la resistencia de los tejidos al paso del flujo sanguíneo, y el estudio de la elasticidad relativa de la zona mediante sonoelastografía por vibración. En este trabajo no se encontraron diferencias significativas en la rigidez del trapecio superior en pacientes con fibromialgia en comparación con un grupo control

Assessment of the Quality of Mobile Applications (Apps) for Management of Low Back Pain Using the Mobile App Rating Scale (MARS).

Digital health interventions may improve different behaviours. However, the rapid proliferation of technological solutions often does not allow for a correct assessment of the quality of the tools. This study aims to review and assess the quality of the available mobile applications (apps) related to interventions for low back pain. Two reviewers search the official stores of Android (Play Store) and iOS (App Store) for localisation in Spain and the United Kingdom, in September 2019, searching for apps related to interventions for low back pain. Seventeen apps finally are included. The quality of the apps is measured using the Mobile App Rating Scale (MARS). The scores of each section and the final score of the apps are retrieved and the mean and standard deviation obtained. The average quality ranges between 2.83 and 4.57 (mean 3.82) on a scale from 1 (inadequate) to 5 (excellent). The best scores are found in functionality (4.7), followed by aesthetic content (mean 4.1). Information (2.93) and engagement (3.58) are the worst rated items. Apps generally have good overall quality, especially in terms of functionality and aesthetics. Engagement and information should be improved in most of the apps. Moreover, scientific evidence is necessary to support the use of applied health tools.This project has received funding from the European Union’s Horizon 2020 Research and Innovation programme under the Marie Sklodowska-Curie actions. Grant Agreement: 823871 (iGAME)

Evaluation of Android and Apple Store Depression Applications Based on Mobile Application Rating Scale.

There are a large number of mobile applications that allow the monitoring of health status. The quality of the applications is only evaluated by users and not by standard criteria. This study aimed to examine depression-related applications in major mobile application stores and to analyze them using the rating scale tool Mobile Application Rating Scale (MARS). A search of digital applications for the control of symptoms and behavioral changes in depression was carried out in the two reference mobile operating systems, Apple (App Store) and Android (Play Store), by means of two reviewers with a blind methodology between September and October 2019 in stores from Spain and the United Kingdom. Eighteen applications from the Android Play Store and twelve from the App Store were included in this study. The quality of the applications was evaluated using the MARS scale from 1 (inadequate) to 5 (excellent). The average score of the applications based on the MARS was 3.67 ± 0.53. The sections with the highest scores were "Functionality" (4.51) and "Esthetics" (3.98) and the lowest "Application Subjective quality" (2.86) and "Information" (3.08). Mobile Health applications for the treatment of depression have great potential to influence the health status of users; however, applications come to the digital market without health control.This project has received funding from the European Union’s Horizon 2020 Research and Innovation programme under the Marie Sklodowska-Curie actions. Grant Agreement: 823871 (iGAME)

Behavior Change Techniques and the Effects Associated With Digital Behavior Change Interventions in Sedentary Behavior in the Clinical Population: A Systematic Review.

This systematic review aimed to evaluate the most frequently used behavior change techniques (BCTs) in digital health interventions targeting sedentary behavior (SB) and to review their effects. Eighteen randomized clinical trials (RCTs) were included, involving both healthy adults and individuals with a disease. The most commonly employed digital behavior change interventions (DBCI) for SB included goal setting, problem solving, outcome/goal review, feedback on behavior and outcomes, behavioral self-monitoring, social support, information about health consequences, and behavioral practice/rehearsal. The effects of DBCIs showed improvements in physical activity (PA) and self-reported physiological and anthropometric outcomes. However, the study also highlighted that the effectiveness of DBCIs is influenced by various factors such as intervention type, patient preferences and values, and the number of BCTs employed. Further research is needed to determine the most effective DBCIs and BCTs for reducing SB in the clinical population.This project received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement, no.823871 (iGame)

Effectiveness of a gamified digital intervention based on lifestyle modification (iGAME) in secondary prevention: a protocol for a randomised controlled trial

Introduction Combating physical inactivity and reducing sitting time are one of the principal challenges proposed by public health systems. Gamification has been seen as an innovative, functional and motivating strategy to encourage patients to increase their physical activity (PA) and reduce sedentary lifestyles through behaviour change techniques (BCT). However, the effectiveness of these interventions is not usually studied before their use. The main objective of this study will be to analyse the effectiveness of a gamified mobile application (iGAME) developed in the context of promoting PA and reducing sitting time with the BCT approach, as an intervention of secondary prevention in sedentary patients. Methods and analysis A randomised clinical trial will be conducted among sedentary patients with one of these conditions: non-specific low back pain, cancer survivors and mild depression. The experimental group will receive a 12-week intervention based on a gamified mobile health application using BCT to promote PA and reduce sedentarism. Participants in the control group will be educated about the benefits of PA. The International Physical Activity Questionnaire will be considered the primary outcome. International Sedentary Assessment Tool, EuroQoL-5D, MEDRISK Instruments and consumption of Health System resources will be evaluated as secondary outcomes. Specific questionnaires will be administered depending on the clinical population. Outcomes will be assessed at baseline, at 6 weeks, at the end of the intervention (12 weeks), at 26 weeks and at 52 weeks. Ethics and dissemination The study has been approved by the Portal de Ética de la Investigación Biomédica de Andalucía Ethics Committee (RCT-iGAME 24092020). All participants will be informed about the purpose and content of the study and written informed consent will be completed. The results of this study will be published in a peer-reviewed journal and disseminated electronically and in print.This study is framed within the European Project 'Multi-dimensional Intervention Support Architecture for Gamified eHealth and mHealth Products (iGAME)' (ID 823871)