Identification of the needs of informal caregivers: an exploratory study

[ES] Introducción: El envejecimiento de la población es uno de los principales retos de la salud pública en los países desarrollados. Los cuidadores informales emergen como uno de los principales actores en este escenario, y esto puede afectarlos de forma negativa. Objetivo: El presente estudio tiene como objetivo identificar las necesidades de los cuidadores informales relacionadas con el cuidado de una persona dependiente de una zona básica de salud. Método: Estudio cualitativo y fenomenológico. Participaron en él cuatro cuidadores informales de pacientes no institucionalizados, a quienes se le realizó una entrevista semiestructurada. Posteriormente se realizó un análisis deductivo del discurso. Resultados: El análisis mostró tres temas clave: efecto del cuidar (cuidar tiene efectos negativos en la salud global de los cuidadores), dificultades relacionadas con el cuidado (relacionadas con las adaptaciones en el domicilio, la prevención de heridas, accidentes y movilizaciones) y estrategias de aprendizaje del cuidar (por lógica, observación y formación). Conclusiones: Cuidar tiene un efecto negativo sobre la salud global de los cuidadores. Estos presentan dificultades a la hora de cuidar, y manifiestan utilizar diferentes metodologías para el aprendizaje de los cuidados. Las intervenciones dirigidas a los cuidadores informales deberían incluir aspectos relacionados con la mejoría de su salud y su formación en cuidados. [EN] Introduction: Population aging is one of the main issues in public health within developed countries. Informal caregivers play a central role in this scenario, which can affect them negatively. Objective: The aim of this study is to identify the needs of informal caregivers related to the care of dependent persons of a Basic Health Area. Method: Qualitative and phenomenological study. Four informal caregivers in charge of non-institutionalized patients took part. These patients expressed their opinions in a semi-structured interview, that was deductively analyzed afterwards. Results: The analysis showed three key subjects: the effects of caregiving (how this task negatively affects the global health of the caregivers); difficulties related to care (related to the process of adaptation once at home, prevention of wounds, accidents and mobility issues), and caregiving learning strategies (by deductive reasoning, observation and formation). Conclusions: Caregiving has a negative effect on the caregivers' global health. They show some difficulties in the execution of their tasks, and they declare that they are using various caregiving learning methods. Interventions directed at informal caregivers should include aspects related to health improvement and caregiving training.S

Is Cycling Practice Related to Men’s Pelvic Floor Dysfunctions? A Hypothesis-Generating Observational Study

Background: There is a lack of consensus with regards to the consequences of cycling practice on urogenital and sexual problems in men. The aim of the study was to analyse the relationship between intensity of cycling practice and urinary tract symptoms, erectile dysfunction, and urinary incontinence. Methods: Observational hypothesis-generating design. Cyclists, men, between 25 and 70 years who had been cycling for more than one year were included. During the statistical analysis, a multiple linear regression model, partial correlation and Spearman’s correlation were carried out. Results: Fifty-eight men participated in the study. Results showed that there is a correlation between years of cycling and prostate symptoms (p = 0.041), and between age and erectile dysfunction (p = 0.001). The multiple linear regression model and the partial correlation analysis showed a correlation between the years of cycling and prostate symptoms (p = 0.007 and p = 0.018). Conclusions: The results have shown that there is a slight correlation between the years of cycling and the presence of lower urinary tract symptoms, independently of the man’s age. Therefore, the results display that high-intensity cycling practice might impact negatively in some men’s pelvic floor functions. Further research is needed to analyse the impact of cycling on urogenital problems in this population group

Postoperative Psychological Predictors for Chronic Postsurgical Pain After a Knee Arthroplasty: A Prospective Observational Study

Objective Chronic postsurgical pain is a significant adverse effect shown in around 20% of people who had undergone a knee arthroplasty. Psychological risk factors emerged as significant and potentially modifiable risk factors for its development. However, there is still little evidence when assessing these factors during the acute postoperative period. This study aimed to assess the predictive value of postoperative pain catastrophizing, pain-related fear of movement, anxiety, depression, and pain attitudes in developing chronic postsurgical pain after knee arthroplasty. Methods A 6-month follow-up prospective observational study design was used. The study sample comprised 115 people who underwent a knee arthroplasty due to painful primary osteoarthritis. Measures of pain catastrophizing, pain-related fear of movement, anxiety, depression, and pain attitudes were obtained 1 week after surgery. Chronic postsurgical pain was set at an intensity of ≥30 using a 100-mm visual analog scale 3 and 6 months after surgery. Results Analysis revealed that baseline pain intensity, pain catastrophizing, pain-related fear of movement, anxiety, depression, and maladaptive pain attitudes were significant predictors of chronic pain at 3 and 6 months after surgery in a univariate analysis. However, at 3 months after surgery, only pain intensity and pain catastrophizing were predictors in the final multivariate model forecasting disturbing pain. Moreover, 6 months after surgery, pain intensity and distrust in medical procedures remained independent predictors. Most of the psychological factors can be grouped into a single dimension defined as pain-related psychological distress. Conclusion The results suggest that postoperative pain intensity, pain catastrophizing, and pain attitudes are independent predictors for chronic postsurgical pain after knee arthroplasty. Impact Postoperative cognitive and emotional factors should be considered alongside pain intensity during postoperative rehabilitation after knee arthroplasty since they could influence the development of chronic postsurgical pain

Assessment of postoperative health functioning after knee arthroplasty in relation to pain catastrophizing: a 6-month follow-up cohort study

Knee arthroplasty (KA) is a typically successful surgical procedure commonly performed to alleviate pain in participants with end-stage knee osteoarthritis. Despite its beneficial effects, a significant proportion of individuals with KA continue experiencing persistent pain and functional limitations. The purpose of this study was to assess the postoperative outcomes after KA in relation to postoperative pain catastrophizing. Methods. Participants were recruited at a domiciliary physiotherapy service, using a prospective, observational, hypothesis-generating cohort design. Participants were divided into two groups based on their Pain Catastrophizing Scale (PCS) total score (50th percentile), which resulted in high and low PCS groups. The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). In addition, quality of life, walking speed, physical performance, range of motion, and pain were measured. Outcome measures were collected at baseline (1 week postoperatively) and at follow-up (1, 3, and 6 months postoperatively). Results. A total of 60 participants (21 total KA and 39 unicompartmental KA) were recruited. Individuals with a higher degree of pain catastrophizing showed significantly higher WOMAC total scores at every follow-up, indicating poorer health functioning (p 0.05). Conclusion. The results of the present study suggest that participants with high postoperative pain catastrophizing might have poorer outcomes during the rehabilitation process after KA. Future work should seek to clarify if this relationship is causal

Identification of the needs of informal caregivers: an exploratory study

Introducción: El envejecimiento de la población es uno de los principales retos de la salud pública en los países desarrollados. Los cuidadores informales emergen como uno de los principales actores en este escenario, y esto puede afectarlos de forma negativa. Objetivo: El presente estudio tiene como objetivo identificar las necesidades de los cuidadores informales relacionadas con el cuidado de una persona dependiente de una zona básica de salud. Método: Estudio cualitativo y fenomenológico. Participaron en él cuatro cuidadores informales de pacientes no institucionalizados, a quienes se le realizó una entrevista semiestructurada. Posteriormente se realizó un análisis deductivo del discurso. Resultados: El análisis mostró tres temas clave: efecto del cuidar (cuidar tiene efectos negativos en la salud global de los cuidadores), dificultades relacionadas con el cuidado (relacionadas con las adaptaciones en el domicilio, la prevención de heridas, accidentes y movilizaciones) y estrategias de aprendizaje del cuidar (por lógica, observación y formación) Conclusiones: Cuidar tiene un efecto negativo sobre la salud global de los cuidadores. Estos presentan dificultades a la hora de cuidar, y manifiestan utilizar diferentes metodologías para el aprendizaje de los cuidados. Las intervenciones dirigidas a los cuidadores informales deberían incluir aspectos relacionados con la mejoría de su salud y su formación en cuidados.Introduction: Population aging is one of the main issues in public health within developed countries. Informal caregivers play a central role in this scenario, which can affect them negatively. Objective: The aim of this study is to identify the needs of informal caregivers related to the care of dependent persons of a Basic Health Area. Method: Qualitative and phenomenological study. Four informal caregivers in charge of non-institutionalized patients took part. These patients expressed their opinions in a semi-structured interview, that was deductively analyzed afterwards. Results: The analysis showed three key subjects: the effects of caregiving (how this task negatively affects the global health of the caregivers); difficulties related to care (related to the process of adaptation once at home, prevention of wounds, accidents and mobility issues), and caregiving learning strategies (by deductive reasoning, observation and formation). Conclusions: Caregiving has a negative effect on the caregivers’ global health. They show some difficulties in the execution of their tasks, and they declare that they are using various caregiving learning methods. Interventions directed at informal caregivers should include aspects related to health improvement and caregiving trainin

Effectiveness of virtual reality on functional mobility during treadmill training in children with cerebral palsy: a single-blind, two-arm parallel group randomised clinical trial (VirtWalkCP Project)

IntroductionTreadmill training and virtual reality have been investigated in children with cerebral palsy. However, few studies have assessed the effectiveness of the combination of both treatments on children's functional and balance activities. The project aims to compare the effects of treadmill training with and without virtual reality on walking endurance and speed, static and dynamic balance, gross motor function, functional independence, quality of life and occupational participation in children with spastic cerebral palsy between the ages of 4 and 12 years classified at levels I, II and III of the Gross Motor Function Classification System. Methods and analysisThis study is a single-blind, two-arm parallel group, randomised, controlled clinical trial. Participants will be recruited at the Pediatric Department of the Vic Hospital Consortium, and the research will be conducted at the University of Vic - Central University of Catalonia. The participants will be randomly allocated into two groups: (1) the experimental group, which will receive the treadmill training at the same time as the virtual reality; and (2) the control group, which will undertake treadmill gait training alone. The training will be provided in 10 sessions over 2 weeks with 30min for each session. Assessments will be performed on three occasions: 1week before the intervention, 1week following the intervention and 1month after the end of the intervention. The evaluations will involve the 6min walk test, stabilometry, the Berg Balance Scale, the 10 m walk test, the Gross Motor Function Measure, the Functional Independence Measure, the paediatric quality of life inventory and the Children Participation Questionnaire. For between-within group comparison, a mixed-effect linear model will be used. Ethics and disseminationThe study has been approved by the Clinical Research Ethics Committee of the Osona Foundation for Health Research and Education (2021061). Results will be published in peer-reviewed journals and presented at international conferences. Trial registration numberNCT05131724

A feasibility study of home-based preoperative multimodal physiotherapy for patients scheduled for a total knee arthroplasty who catastrophize about their pain

Background Preoperative pain catastrophizing (PC) and pain are both risk factors for poor outcomes after a total knee arthroplasty (TKA). Despite that, there is limited evidence about physiotherapy interventions' effectiveness on addressing such factors. Purpose To evaluate the feasibility and clinical impact of a home-based multimodal physiotherapy intervention in reducing pain and PC, in patients scheduled for a TKA who present preoperative moderate-to-severe pain and PC. Methods Three-armed parallel-group randomized controlled feasibility study. Subjects with symptomatic osteoarthritis and a score of >= 20 on the Pain Catastrophizing Scale (PCS) were recruited. The control group received usual care. Both experimental groups received pain neuroscience education, coping skills training and therapeutic exercise, but differ in the number of sessions, dosage, hands-on approach, and grade of supervision. All outcomes were measured before and after the intervention. Results A total of 33,7% were eligible for inclusion, and 97,1% agreed to participate. Every participant completed the treatment. Treatment compliance was higher in the group with additional supervision. Both groups showed significant effects in PC and pain reduction. A total of 33 patients would be required for a full trial. Conclusion Preoperative physiotherapy is a feasible and effective treatment in reducing pain intensity and PC in high PCS osteoarthritis subjects scheduled for a TKA.Part of Hector Beltran-Alacreu'ssalary is financed by the European Regional Development Fund (2020/5154)

A Sytematic review

ReviewTo perform a systematic review of the literature to investigate the influence of psychosocial factors on pain and functional outcomes after knee arthroplasty from 6 months after surgery. Methods: Studies were included if they were prospective cohort observational studies. The subjects had to be middle aged or aged (mean age: 45 years) and have undergone total or unilateral knee arthroplasty. Studies should have recorded the influence of different psychosocial factors and the surgery outcomes had to be evaluated according to pain and/or function variables regardless of the tools used to measure them. In addition, outcome measures had to be recorded in the medium term (6 months) or the long term (12 months). Two reviewers assessed independently the MEDLINE, PsycINFO, and CINAHL databases to select observational studies. Results: Twenty-two studies with a total of 7156 patients (5349 females) were included in this review and the mean age was 67.92 years. Twenty-two studies included in this review showed a good average methodological quality (mean +/- SD: 7.22 +/- 0.92) on the Newcastle-Ottawa Scale for cohort studies. Conclusion: The evidence suggests that catastrophizing, kinesiophobia, anxiety, self-efficacy, and mental health are predictors of postoperative functional outcomes at 6 and 12 months after surgery. There is conflicting evidence on whether or not catastrophizing, anxiety, and depression are predictors of postoperative pain at 6 and 12 months after surgery

Postoperative psychosocial factors in health functioning and health-related quality of life after knee arthroplasty: A 6- month follow up prospective observational study

Knee arthroplasty (KA) is an effective and cost-effective treatment for end-stage knee osteoarthritis. Despite high surgical success rates, as many as 25% of patients report compromised postoperative functioning, persistent pain, and reduced quality of life. The purpose of this study was to assess the predictive value of psychological factors in health functioning and quality of life, during a 6-month period after KA. Design. A prospective observational study. Setting. Surgery at two hospitals and follow-up was carried out through the domiciliary rehabilitation service. Subjects. In total, 89 patients (age 70.2767.99 years) met the inclusion criteria. Method. A test battery composed of Health functioning associated with osteoarthritis (WOMAC), Health-related quality of life (EQ-5D-5L), Anxiety and Depression (HADS), Pain attitudes (SOPA-B), Pain catastrophizing (PCS), and Fear of Movement (TSK11) was assessed at 1 week, and 1, 3, and 6 months after surgery. A mixed effects linear model was used to estimate the effect of time and covariates. An exploratory factor analysis was used to identify the number of dimensions underlying the group of psychological measurements. Results. In WOMAC model, anxiety level (F - 120.8), PCS (F - 103.9), depression level (F - 93.6) and pain score (F - 72.8) were the most influential variables. Regarding EQ5D-5L model, anxiety level (F = 98.5), PCS (F - 79.8), depression level (F - 78.3) and pain score (F - 45) were the most influential variables. Pain score and the psychosocial variables of PCS, TSK, HADS-A, HADS-D, SOPA-B Emotion, SOPA-B Harm and SOPA-B Disability loaded in one single dimension. Conclusions. Postoperative acute pain and psychosocial factors of pain catastrophizing, anxiety, depression, and pain attitudes might influence health functioning and quality of life during KA rehabilitation. Such factors could be gathered into one single dimension defined as pain-related psychologic distress

Experiences and coping strategies of preterm infants' parents and parental competences after early physiotherapy intervention: qualitative study

Background Birth before term is a stressful experience for parents because of the unexpected delivery or admission to the neonatal intensive care unit. Objective This research aimed to evaluate the impact of the early PT intervention on preterm infants' parents' experiences, and also to obtain knowledge about parents' experiences and perceived difficulties during preterm infants' care. Methods This qualitative study is based on the methods of phenomenology. In the first phase, open interviews were developed to allow researchers to immerse themselves in the context of the study and refine the questions for the semi-structured interviews. Data collected from the semi-structured interviews were analyzed through content analysis. Results The results were summarized around three themes: 1) parental competence; 2) difficulties during preterm infants' care; and 3) coping strategies. Each theme was divided into two sub-themes. Conclusion Mothers and fathers of preterm infants experienced difficulties when caring for their babies. Parents that received the early physiotherapy intervention felt empowered to take care of their babies and to enhance infants' development. These parents were more capable of developing coping strategies after the intervention. Parents that did not receive the early physiotherapy intervention expressed difficulties when caring for their preterm babies.This work was supported by the The Catalan Board of Physical Therapists [59255]