A COVID-19 Rehabilitation Prospective Surveillance Model for Use by Physiotherapists

This research was funded by the Spanish Ministry of Education Culture and Sport (FPU17/00939), the University of Granada Excellence Actions (Unit of Excellence in Exercise and Health).We would like to thank Adrian Burton for his language assistance.The long-term sequelae of coronavirus disease 2019 (COVID-19) are only now beginning to be defined, but it is already known that the disease can have direct and indirect impacts mainly on the cardiorespiratory and neuromuscular systems and may affect mental health. A role for rehabilitation professionals from all disciplines in addressing COVID-19 sequelae is recognised, but it is essential that patient assessment be systematic if health complications are to be identified and treated and, if possible, prevented. The aim is to present a COVID-19 prospective surveillance model based on sensitive and easily used assessment tools, which is urgently required. Following the Oxford Centre for Evidence-Based Medicine Level of Evidence Tool, an expert team in cardiorespiratory, neuromuscular and mental health worked via telemeetings to establish a model that provides guidelines to rehabilitation professionals working with patients who require rehabilitation after suffering from COVID-19. A COVID-19 prospective surveillance model is proposed for use by rehabilitation professionals and includes both face-to-face and telematic monitoring components. This model should facilitate the early identification and management of long-term COVID-19 sequelae, thus responding to an arising need.Spanish Ministry of Education Culture and Sport FPU17/00939University of Granada Excellence Actions (Unit of Excellence in Exercise and Health

A Web-Based Exercise System (e-CuidateChemo) to Counter the Side Effects of Chemotherapy in Patients With Breast Cancer: Randomized Controlled Trial

Background: Breast cancer patients have to face a high-risk state during chemotherapy, which involves deterioration of their health including extensive physical deterioration. Face-to-face physical exercise programs have presented low adherence rates during medical treatment, and telehealth systems could improve these adherence rates. Objective: This study aimed to evaluate the effectiveness of a Web-based exercise program (e-CuidateChemo) to mitigate the side effects of chemotherapy on the physical being, anthropometric aspects, and body composition. Results: Functional capacity improved significantly in the e-CuidateChemo group compared to the control group (6-minute walk test: 62.07 [SD 130.09] m versus –26.34 [SD 82.21] m; 6-minute walk test % distance predicted: 10.81% [SD 22.69%] m versus –4.60% [SD 14.58%]; between-group effect: P=.015 for both). The intervention group also showed significantly improved secondary outcomes such as between-group effects for abdominal (24.93 [SD 26.83] s vs –18.59 [SD 38.69] s), back (12.45 [SD 10.20] kg vs 1.39 [10.72] kg), and lower body (–2.82 [SD 3.75] s vs 1.26 [SD 2.84] s) strength; all P<.001 compared to the control group. Conclusions: This paper showed that a Web-based exercise program was effective in reversing the detriment in functional capacity and strength due to chemotherapy.The study was funded by a research project grant from the Andalusian Health Service, Junta de Andalucia, call for subsidies for the financing of biomedical research and health sciences in Andalusia (SAS-0457-2010) and by the Spanish Ministry of Education (FPU14/01069 and FPU17/00939)

The Ecofisio Mobile App for Assessment and Diagnosis Using Ultrasound Imaging for Undergraduate Health Science Students: Multicenter Randomized Controlled Trial

Trial Registration: ClinicalTrials.gov NCT04138511; https://clinicaltrials.gov/ct2/show/NCT04138511We are grateful to Ms Carmen Sainz-Quinn for her assistance with the English language. The authors are also grateful for the collaboration of the students who participated in the study. This study was funded by a grant from the Educational Innovation Unit of the University of Granada, Spain (PID 14-56). This study was conducted thanks to the additional funding from the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES).Background: Generation Z is starting to reach college age. They have adopted technology from an early age and have a deep dependence on it; therefore, they have become more drawn to the virtual world. M-learning has experienced huge growth in recent years, both in the medical context and in medical and health sciences education. Ultrasound imaging is an important diagnosis technique in physiotherapy, especially in sports pathology. M-learning systems could be useful tools for improving the comprehension of ultrasound concepts and the acquisition of professional competencies. Objective: The purpose of this study was to evaluate the efficacy and use of an interactive platform accessible through mobile devices—Ecofisio—using ultrasound imaging for the development of professional competencies in the evaluation and diagnosis of sports pathologies. Methods: Participants included 110 undergraduate students who were placed into one of two groups of a randomized controlled multicenter study: control group (ie, traditional learning) and experimental group (ie, Ecofisio mobile app). Participants’ theoretical knowledge was assessed using a multiple-choice questionnaire (MCQ); students were also assessed by means of the Objective Structured Clinical Examination (OSCE). Moreover, a satisfaction survey was completed by the students. Results: The statistical analyses revealed that Ecofisio was effective in most of the processes evaluated when compared with the traditional learning method: all OSCE stations, P<.001; MCQ, 43 versus 15 students passed in the Ecofisio and control groups, respectively, P<.001. Moreover, the results revealed that the students found the app to be attractive and useful. Conclusions: The Ecofisio mobile app may be an effective way for physiotherapy students to obtain adequate professional competencies regarding evaluation and diagnosis of sports pathologies.This study was funded by a grant from the Educational Innovation Unit of the University of Granada, Spain (PID 14-56

ATOPE+: An mHealth System to Support Personalized Therapeutic Exercise Interventions in Patients With Cancer

The authors express their gratitude to the patients and experts for their participation in the evaluation of ATOPEC. They also express their gratitude to the anonymous reviewers for the instructive criticism of an earlier version of this article.The introduction of mobile technologies in therapeutic exercise interventions has permitted the collection of fine-grained objective quantified information about patients' health. However, exercise interventions generally fail to leverage these data when personalizing the exercise needs of patients individually. Interventions that include technology-driven personalization strategies typically rely on the use of expensive laboratory equipment with expert supervision, or in the self-management of patients to meet the prescribed exercise levels by an activity tracker. These methods often do not perform better than non technology-driven methods, therefore more sophisticated strategies are required to improve the personalization process. In this paper we present ATOPE+, an mHealth system to support personalized exercise interventions in patients with cancer based on workload-recovery ratio estimation. ATOPE+ enables the remote assessment of workload-recovery ratio to provide optimal exercise dosage by means of a knowledge-based system and by combining physiological data from heterogeneous data sources in a multilevel architecture. The results show that ATOPE+ is a system ready to be used in the context of a clinical trial after being tested with patients with breast cancer and conducting an usability evaluation by clinical experts.Spanish Ministry of Science, Innovation, and Universities (MICINN) PGC2018-098813-B-C31 RTI2018-101674-B-I00Health Research Funds of the Carlos III Health Institute PI18/01840German Research Foundation (DFG) FPU16/04201 FPU17/0093

Colorectal cancer pain upon diagnosis and after treatment: a cross‑sectional comparison with healthy matched controls

Ethics approval The study protocols were approved by the Research Ethics Committee of the University of Granada (0572-M1-16 and 1087-N-16), and the study was performed in accordance with Law 14/2007 on Biomedical Research and the guidelines of the WMA Declaration of Helsinki.Availability of data and material Data will be available upon request from the corresponding author.Background The current study sought to explore whether cancer pain (CP) already exists in patients at colorectal cancer (CRC) diagnosis before treatment compared with patients with colorectal cancer (CRC) after treatment and a healthy matched control group. The study also sought to examine whether factors related to physical health status could enhance pain processes. Methods An observational cross-sectional study was conducted following the STROBE checklist. Twenty-nine newly diagnosed and forty post-treatment patients with CRC and 40 healthy age/sex-matched controls were included for comparison. Pain, local muscle function, and body composition outcomes were assessed by a physiotherapist with > 3 years of experience. ANCOVA and Kruskal–Wallis tests were performed, with Bonferroni and Dunn-Bonferroni post hoc analyses and Cohen’s d and Hedge’s effect size, as appropriate. Results The analysis detected lower values of pressure pain threshold (PPT) points, the PPT index, and abdominal strength and higher values of self-reported abdominal pain in newly diagnosed patients, with even more marked results observed in the post-treatment patients, where lower lean mass and skeletal muscle index values were also found than those in the healthy matched controls (p < 0.05). In the post-treatment and healthy matched control groups, positive associations were observed between the PPT lumbar dominant side points and abdominal isometric strength and lean mass, and negative associations were observed between the lumbar dominant side points and body fat (p < 0.05). Conclusion Upon diagnosis, patients with CRC already show signs of hyperalgesia and central sensitization and deteriorated physical conditions and body composition, and this state could be aggravated by subsequent treatmentsUniversidad de Granada/CBUASpanish Ministry of Education Culture and Sport (MECD) (FPU17/00939, FPU18/03575)European Social Fund, the Carlos III Health Institute (FI19/00230)CEIBiotic Universidad de Granada (CEI13-MP18 and CEI14-MPBS40

Nonlinear, Multicomponent Physical Exercise With Heart Rate Variability-Guided Prescription in Women With Breast Cancer During Treatment: Feasibility and Preliminary Results (ATOPE Study)

The study is funded by the Fondo de Investigación Sanitaria del Instituto de Salud Carlos III and the Fondos Estructurales de la Unión Europea (FEDER) (PI18/01840). Á.G.S. has received funding for its training with the grant FPU18/03575 by the Spanish Ministry of Education Cultura y Deporte. M.L.G. has received funding for its training with the grant FI19/00230 by the Fondo de Investigación Sanitaria del Instituto de Salud Carlos III. R.G.G. has received funding for its training with the grant FPU20/05674 by the Spanish Ministry of Education Cultura y Deporte. Additional funding is provided by the European Regional Development Fund (ERDF, SOMM17/6107/UGR), “Plan Propio de Investigación 2021” University of Granada (PPJIB2021–13) and the Spanish Ministry of Economy and Competitiveness (Plan Estatal de I + D + I 2013–2016).Objective. The purpose of this study was to examine the feasibility, safety, adherence, and preliminary efficacy of the ATOPE program during radiotherapy (RT) or chemotherapy (CT) for women with breast cancer. Methods. This single-blind, pretest–posttest feasibility study included 38 women with breast cancer at the beginning of their treatment. The ATOPE program consisted of 12 to 18 sessions of a multimodal physical exercise program, prescribed based on daily heart rate variability and clinimetric assessments using the ATOPE+ mHealth system. Overall health was assessed with quality of life, autonomous balance, and body composition, whereas health-related fitness was measured through functional capacity, physical activity levels, and upper and lower limb strength. Results. The rates of recruitment, retention, and adherence were 52.35, 73.68, and 84.37%, respectively, and the satisfaction rating was 9.2 out of a possible 10 points. The perceived health status change score was 3.83 points, scored on a −5 to 5 point scale. No adverse effects were found. Compliance results showed that the ATOPE+ mHealth system was used on 73.38% of the days, and the Fitbit bracelet (Google, Mountain View, CA, USA) was used on 84.91% of the days. Women stayed physically active 55% of days. Regarding preliminary results, for overall health, the percentage of body fat in the RT group decreased by 1.93%, whereas it increased by 5.03% in the CT group. Lower limb strength increased in the RT group, specifically knee extensor isometric strength (6.07%), isokinetic knee flexors 180 degree/second (1.53%), and isokinetic knee extensors 300 degree/second (4.53%), in contrast with the reductions found in the CT group (11.07, 18.67, and 14.89%, respectively). Conclusion. The ATOPE program, through nonlinear prescription based on daily monitoring with the ATOPE+ mHealth system, is feasible and safe for application during breast cancer treatment. The results suggest that the overall health can be maintained or even improved regarding most variables. Impact. This study focused on the feasibility, safety, and completion of a physical therapist-led program at early diagnosis for adults with breast cancer. The multimodal, supervised, tailored, nonlinear physical exercise program is feasible and safe, showed a good completion rate, and was able to prevent the quality-of-life deficits that are often triggered by systemic breast cancer treatment. This study highlights the importance of daily morning assessments using the ATOPE+ mHealth system in patients with breast cancer to prescribe nonlinear physical exercise.Fondos Estructurales de la Unión Europea (FEDER) (PI18/01840)Fondo de Investigación Sanitaria del Instituto de Salud Carlos III FI19/00230Spanish Ministry of Education Cultura y Deporte FPU18/03575, FPU20/05674European Regional Development Fund (ERDF, SOMM17/6107/UGR)University of Granada (PPJIB2021–13)Spanish Ministry of Economy and Competitivenes

mHealth system (ATOPE+) to support exercise prescription in breast cancer survivors: a reliability and validity, cross‑sectional observational study (ATOPE study)

Physical exercise is known to be beneficial for breast cancer survivors (BCS). However, avoiding nonfunctional overreaching is crucial in this population, as they are in physiological dysregulation. These factors could decrease their exercise capacity or facilitate nonfunctional overreaching, which can increase their risk of additional morbidities and even all-cause mortality. The focus of this study is to evaluate the reliability and validity of the ATOPE+ mHealth system to estimate autonomic balance and specific wellness parameters associated with BCS’ perceived load, thereby informing nonlinear prescriptions in individualized physical exercise programs for BCS.Twenty-two BCS were included in the reliability and validity analysis. Measures were taken for four days, including morning autonomic balance by heart rate variability, self-reported perception of recovery from exercise, sleep satisfaction, emotional distress and fatigue after exertion. Measures were taken utilizing the ATOPE+ mHealth system application. The results of these measures were compared with criterion instruments to assess validity.The reliability results indicated that the intraclass correlation coefficient (ICC) showed an excellent correlation for recovery (0.93; 95% CI 0.85–0.96) and distress (0.94, 95% CI 0.89–0.97) as well as good correlation for the natural logarithm of the mean square root differences of the standard deviation (LnRMSSD) (0.87; 95% CI 0.74–0.94). Sleep satisfaction also showed an excellent correlation with a weighted kappa of 0.83. The validity results showed no significant differences, except for fatigue. ATOPE+ is reliable and valid for remotely assessing autonomic balance, perception of recovery, sleep satisfaction and emotional distress in BCS; however, it is not for fatigue. This highlights that ATOPE+ could be an easy and efficient system used to assess readiness in BCS, and could help to improve their health by supporting the prescription of optimal and safe physical exercise. Trial registration NCT03787966 ClinicalTrials.gov, December 2019 [ATOPE project]. https:// clini caltr ials. gov/ ct2/ show/ NCT03 787966.Spanish Ministry of Economy and Competitiveness (Plan Estatal de I + D + I 2013– 2016)Fondo de Investigación Sanitaria del Instituto de Salud Carlos III (PI18/01840)Fondos Estructurales de la Unión Europea (FEDER)European Social fund the Carlos III Health Institute (FI19/00230)Spanish Ministry of Education Cultura y Deporte (FPU17/00939, FPU16/04201, FPU18/0357)ERDF, SOMM17/6107/UG

Persistent pain management in an oncology population through pain neuroscience education, a multimodal program: PaiNEd randomized clinical trial protocol

Pain is one of the most persistent symptoms after cancer treatment. The central nervous system can erroneously stay in its alarm phase, altering the pain experience of patients who have cancer. Pain neuroscience education (PNE) with multimodal approaches may benefit these patients.“Subvenciones para la Financiación de la Investigación, Desarrollo e Innovación (I+D+I) Biomédica y en Ciencias de la Salud, Consejería de Salud y Familias”, of the Andalusian Regional Government (PI-0171-2020

Neurotoxicity prevention with a multimodal program (ATENTO) prior to cancer treatment versus throughout cancer treatment in women newly diagnosed for breast cancer: Protocol for a randomized clinical trial

The authors thank the Asociación Española Contra el Cáncer (IDEAS19055CANT), the Spanish Ministry of Education Culture and Sport (MECD) (FPU17/00939, FPU18/03575), the Carlos III Health Institute (FI19/00230), and Carlos III Health Insitute and the European Regional Development Fund (FEDER) (PI18/01840), for funding this study and all participants of the study. IEC is supported by the Spanish Ministry of Economy and Competitiveness. This study was part of a Ph.D thesis conducted in the Clinical Medicine and Public Health Doctoral Studies of the University of Granada, Spain. Trial registration: ClinicalTrials. Gov identifier: NCT04583124.A current challenge in breast cancer (BC) patients is how to reduce the side effects of cancer and cancer treatments and prevent a decrease in quality of life (QoL). Neurotoxic side effects, especially from chemotherapy, are present in up to 75% of women with BC, which implies a large impact on QoL. There is a special interest in the preventive possibilities of therapeutic exercise (TE) for these neurological sequelae, and the benefits of TE could be improved when it is combined with vagal activation techniques (VATs). This superiority randomized controlled trial aims to examine the feasibility and efficacy of an 8-week multimodal intervention (ATENTO) based on moderate-vigorous intensity and individualized TE (aerobic and strength exercises) and VAT (myofascial and breathing exercises), on neurotoxicity prevention in women with BC before starting adjuvant chemotherapy (ATENTO-B) versus throughout adjuvant chemotherapy (ATENTO-T). A sample of 56 women newly diagnosed with BC, as calculated with a power of 85%, will be randomly allocated into these two groups. This study could provide an impetus for the introduction of early multimodal intervention methods to prevent neurotoxicity and consequently avoid the QoL deterioration that BC patients presently suffer throughout their treatments.Fundacion Cientifica Asociacion Espanola Contra el Cancer IDEAS19055CANTSpanish Ministry of Education Culture and Sport FPU17/00939 FPU18/03575Instituto de Salud Carlos III FI19/00230 PI18/01840Fondos Estructurales de la Union Europea (FEDER) PI18/01840Spanish Ministry of Economy and Competitivenes