Aportación del Sistema Vestibular a la percepción de la verticalidad en estudiantes universitarios con dolor de cabeza

Los trastornos del dolor de cabeza son una problemática muy frecuente, siendo la población universitaria una de las más afectadas. Se ha observado cierta relación entre los procesos cefalálgicos y otras patologías como el dolor de cuello o las alteraciones inespecíficas del equilibrio, así como posibles alteraciones de la percepción de la verticalidad en estos pacientes. En la presente tesis doctoral, debido a la ausencia de una herramienta para evaluar la discapacidad asociada al dolor de cabeza, se ha llevado a cabo la validación transcultural de cuestionario Migraine Disabiliy Assessment (MIDAS) en población universitaria. Esto ha posibilitado explorar qué actividades generadoras de dolor de cuello e inestabilidad corporal se relacionan con la presencia, frecuencia e intensidad del dolor de cabeza, así como con la discapacidad relacionada con la cefalea en población universitaria, además de indagar en las posibles alteraciones en la percepción de la verticalidad en estos pacientes.Headache disorders are very frecuent diseases, being the university population mainly affected. It has been possible to observe a relationship between headache and other disorders such as neck pain or non-specific balance disorders. In addition, possible disturbances in verticality perception have been observed in patients with headache. In the present doctoral thesis, due to the absence of a tool to evaluate headache-related disability, the cross-cultural validation of the Migraine Disability Assessment Questionnaire (MIDAS) has been carried out in the university population, allowing us to explore which neck pain and body instability-generating activities are related to the presence, frequency, intensity and headache-related disability, as well as to explore the possible disturbances in verticality perception in this patients.Tesis Univ. Jaén. Departamento de Ciencias de la Salu

Structural and Functional Changes in Supraspinatus Tendinopathy through Percutaneous Electrolysis, Percutaneous Peripheral Nerve Stimulation and Eccentric Exercise Combined Therapy: A Single-Blinded Randomized Clinical Trial

Abstract Shoulder tendinopathies produce pain and reduce functionality. The aim of this randomized clinical trial was to analyze the effects of Percutaneous electrolysis (PE), Percutaneous peripheral Nerve Stimulation (PNS) and eccentric exercise (EE) on pain (NPRS), strength, electromyographic activity, ultrasound characteristics of the tendon (echogenicity, thickness and hypervascularization) and functionality (DASH and SPADI) in individuals with supraspinatus tendinopathy. Participants (n = 50) were divided into two groups; they received 4 treatment sessions, 1 per week, of PE and PNS (n = 25) or 10 treatment sessions of TENS and US (n = 25). Both groups performed the EE program consisting of 3 sets of 10 repetitions of each of the 3 exercises, twice a day, during the 4 weeks. Follow-up was carried out at 4, 12 and 24 weeks after the start of the intervention. There are statistically significant differences in the analysis between groups (p < 0.001) in the post-treatment and follow-up measurements favorable to the PE+PNS+EE treatment on pain (NPRS), strength, supraspinatus electromyographic amplitude, ultrasound characteristics of the tendon (echogenicity, thickness and hypervascularization) and DASH and SPADI questionnaires. The combined treatment with PE, PNS and EE is an effective option in the clinical management of tendinopathies, with positive results in the short and long term on the variables studied

Effectiveness of Virtual Reality Therapy on Balance and Gait in the Elderly: A Systematic Review

Virtual reality (VR) therapies are presently utilized to treat physical and cognitive impairments among elderly people. This systematic review aims to collect the most recent evidence on the effectiveness of VR in improving balance and gait among healthy elderly individuals, in comparison with other therapies. A literature search was conducted using the PubMed, SCOPUS, PEDro, and WoS databases, by selecting randomized clinical trials that evaluated balance, both static and dynamic, as well as gait in a population of healthy older adults who underwent virtual reality therapy. The methodological quality of the studies was assessed using the PEDro scale. After eligibility criteria were applied and duplicates were removed, 20 studies were selected out of 1705 initially identified. The present systematic review concludes that virtual reality therapy is more effective than minimal intervention or usual care in enhancing static balance, dynamic balance, and gait in healthy elderly individuals. Moreover, virtual reality therapy yields better outcomes compared to traditional balance training and physical exercise in improving balance and gait in this demographic. However, both methods have shown effectiveness

Effectiveness of the Treatment of Physiotherapy in the Congenital Muscular Torticollis: A Systematic Review

A single congenital muscular torticollis (CMT) is a postural musculoskeletal deformity and is characterized by the shortening or stiffness of the sternocleidomastoid muscle. The reported incidence of CMT ranges from 0.2% to 2%. The objective is to evaluate the effect of physical therapy programs on CMT. For the search, PubMed, Scopus, Web of Science, PEDro and Cochrane databases were used. Randomized controlled trials published between 2018 and 2023 have been included. This study follows the PRISMA 2020 statement and has been registered in the PROSPERO database. Finally, six studies were included. The cervical range of motion (ROM) in rotation was the most analyzed variable, followed by the ultrasound evaluation; one of the studies included the analysis of children’s motor development with the Alberta scale. All research found benefits associated with soft tissue mobilization, passive stretching techniques and manual therapy of the cervical spine. In conclusion, it is possible to recommend manual therapy and passive stretching techniques for the treatment of CMT, with significant results on the cervical ROM

Pulsed negative pressure myofascial vacuum therapy and percutaneous electrolysis in the treatment of lateral epicondylalgia: A single-blind randomized controlled trial

Background Lateral Epicondylalgia (LE) represents one of the most common injuries of the upper limb. It is necessary to find effective treatments that reduce pain and increase functionality. Purpose To determine the effects of an integrated intervention of Pulsed Negative Pressure Myofascial Vacuum Therapy (VT), Percutaneous Electrolysis (PE) and eccentric exercise (EE) in the treatment of LE compared versus Manual Therapy soft tissue mobilization (MT) and Ultrasound therapy (US) and EE. Study design Single-blind randomized controlled trial. Methods Forty participants, with unilateral LE, were randomly divided into two groups: VT + PE + EE group (n = 20) and MT + US + EE group (n = 20). The VT + PE + EE group received one weekly session for four weeks and a regimen of EE daily at-home, and the MT + US + EE group received 10 sessions over a period of two weeks and a regimen of EE daily at-home. Numerical pain rating scale (NPRS), range of motion (ROM) pressure pain threshold (PPT) and function (PRTEE questionnaire) were measured before treatment, at the end of treatment, and at one- and three-month follow-ups. Results The statistically significant improvements were found post-treatment, favoring the VT + PE group in pain intensity (p < 0.001; ES = 0.408), PRTEE-S Pain (p = 0.001; ES = 0.377), PRTEE-S Specific function (p = 0.004; ES = 0.306) and PRTEE-S Total (p = 0.001; ES = 0.355). The VT + PE + EE treatment showed greater effectiveness than the MT + US + EE treatment at immediate post-treatment, as well as at the one-month and three-months follow-up. Conclusions VT and PE added to an EE program could be an effective treatment for pain, ROM, PPT, and function in patients with LE. List of abbreviations ICCIntraclass Correlation CoefficientLELateral EpicondylalgiaPEPercutaneous ElectrolysisMDCMinimum Detectable ChangeMTManual Therapy soft tissue mobilizationNPRSNumerical pain rating scalePPTpressure pain thresholdPRTEE questionnairePatient-Rated Tennis Elbow Evaluation QuestionnaireROMrange of motionSEMStandard Error of MeasurementVTPulsed Negative Pressure Myofascial Vacuum TherapyUSUltrasound therap

Effectiveness of Percutaneous Electrolysis in Supraspinatus Tendinopathy: A Single-Blinded Randomized Controlled Trial

Supraspinatus tendinopathy is one of the most common causes of shoulder pain. Many studies support conservative treatments such as exercise, trigger point dry needling or corticosteroid injections. Otherwise, a minimally invasive approach with percutaneous electrolysis (PE) has also been used successfully in shoulder pain, although evidence about its long-term effects is scarce. The aim of this trial was to determine the effects of PE on supraspinatus tendinopathy compared with trigger point dry needling (TDN). Thirty-six patients with supraspinatus tendinopathy were randomly assigned to either a PE group (n=18) or a TDN group (n=18). Both groups also performed eccentric exercises. The main outcome to be measured was the Numerical Pain Rating Scale (NPRS), but the shoulder range of motion (ROM) and trigger point pressure pain threshold (PPT) were also considered. A one-year follow-up was conducted. Significant differences favoring the PE group were found regarding pain at one-year follow-up (p=0.002). The improvement achieved in the PE group was greater in the NPRS (p<0.001), proximal PPT, middle PPT, distal PPT (all p<0.001) and ranges of movement. PE seems to be more effective than TDN in relieving pain and improving ROM and PPT supraspinatus values in patients with supraspinatus tendinopathy, both right after treatment and at one-year follow-up

Validation of the Spanish version of the migraine disability assessment questionnaire (MIDAS) in university students with migraine

Background: The Migraine Disability Assessment (MIDAS) questionnaire is widely used to determine the degree of migraine-related disability of subjects. So far, and to the best of our knowledge, no Spanish version of this tool has been validated. The questionnaire comprises seven items, with the first five constituting the main scale while the sixth and seventh items referring, respectively, to the frequency and intensity of headache. The present study aims to analyze the clinimetric properties of the Spanish version of the MIDAS questionnaire in a population of university students. Methods: We performed a cross-sectional study of validation for this measuring instrument. A total of 153 subjects participated in the study. We analyzed construct validity using factor analysis, test-retest reliability by the Intraclass Correlation Coeficient (ICC), internal consistency, and concurrent validity with respect to the 12-Item Short Form Health Survey (SF-12). Results: Factor analysis revealed a two-factor structure. The questionnaire has good reliability for the MIDAS main scale score ([ICC = 0.81; 95% CI: 0.63–0.90]), excellent reliability for headache frequency (ICC = 0.90; 95%; CI: [0.79– 0.95]), and moderately good reliability for headache intensity (ICC = 0.63; 95% CI: [0.34–0.80]). The analysis also yielded good internal consistency results (α Cronbach = 0.797) and a moderate correlation between MIDAS-main scale and the physical component summary of SF-12 (Rho = − 0.326; p < 0.001). Conclusions: The Spanish version of the MIDAS questionnaire is a valid and reliable tool to measure migraine related disability in university subjects. The two additional items provide information that could help clinicians in making decisions

Effectiveness of Active Therapy-Based Training to Improve the Balance in Patients with Fibromyalgia: A Systematic Review with Meta-Analysis

Balance impairment is a frequent disorder in patients with fibromyalgia (FMS), increasing the risk of falls and decreasing physical function and quality of life. In recent years, the use of active therapy-based training (ATBT) has increased, with the aim of improving balance in women with FMS. Our study aimed to assess the effect of ATBT to improve different balance outcomes in subjects with FMS. A systematic review with meta-analysis was carried out. We searched PubMed Medline, SCOPUS, Web of Science, CINAHL, and PEDro (Physiotherapy Evidence Database) databases up to September 2020. We included randomized controlled trials (RCT) that assessed the balance in patients with FMS after ATBT and compared to other treatments or no intervention. In a random-effects model, the standardized mean difference (SMD) was used to calculate the effect size. Ten studies were included in the review providing data from 546 FMS patients with a mean age of 52.41 +/- 2.90 years old (98% females). Our results showed a medium effect favors ATBT with respect to other therapies for monopedal static balance (SMD = 0.571; 95% CI = 0.305, 0.836; p < 0.001), dynamic balance (SMD = 0.618; 95% CI = 0.348, 0.888; p < 0.001), and functional balance (SMD = 0.409; 95% CI = 0.044, 0.774; p = 0.028). No statistically significant differences were found for balance on unstable support. The present meta-analysis showed moderate-quality evidence of a medium effect of ATBT to improve dynamic and functional balance and low-quality evidence of a medium effect to improve monopedal static balance with respect to other therapies or no intervention

Percutaneous Electrolysis in the Treatment of Lateral Epicondylalgia: A Single-Blind Randomized Controlled Trial

Few studies have considered the effects of percutaneous electrolysis (PE) in the treatment of lateral epicondylalgia (LE). For this reason, the objective of this study was to compare the effects of PE with an evidence-based approach-trigger point dry needling (TDN)-in patients with LE. A randomized controlled trial was conducted in which 32 participants with LE were randomly assigned to two treatment groups, the PE group (n= 16) and the TDN group (n= 16). Both groups received four therapy sessions and an eccentric exercise program to be performed daily. The numerical pain rating scale (NPRS), pressure pain thresholds (PPT), quality of life, and range of motion were measured before treatment, at the end of treatment, and at one- and three-month follow-ups. Significant between-group mean differences were found after treatment for NPRS (p< 0.001) and flexion movement (p= 0.006). At one-month follow-up, significant mean differences between groups were found for NPRS (p< 0.001), PPT (p= 0.021), and flexion (p= 0.036). At three-months follow-up, significant mean differences between groups were found for NPRS (p< 0.001), PPT (p= 0.004), and flexion (p= 0.003). This study provides evidence that PE could be more effective than TDN for short- and medium-term improvement of pain and PPTs in LE when added to an eccentric exercise program

Falls and sleep disorders in Spanish Alzheimer’s disease in nursing homes: An observational study

Producción CientíficaObjective: The main objective of this study was to establish a relationship between the number of falls and sleep problems experienced by patients with Alzheimer’s disease. Materials and Methods: This was a cross-sectional study. A total of 114 Spanish aged people with Alzheimer’s disease institutionalized in nursing homes and 80 independent Spanish aged people without neurodegenerative diseases living at home were enrolled in this study and completed in-person interviews and digital questionnaires. Results: The mean age was 78.98 ± 8.59 years. Sleep disorders were related to continuous stress (p = 0.001; OR = 4.729) and a high frequency of falls (p = 0.001; OR = 2.145), while predictor variables associated with falls in patients with Alzheimer’s disease were continuous medical visits (β = 0.319, p < 0.001), family history of dementia (β = 0.212; p = 0.014), and sleep disorders (β = 0.235; p = 0.007). Second, the analysis showed that moderate physical activity (p = 0.001; OR = 0.147), continuous medical visits (p < 0.001; OR = 0.621), and high level of study (p = 0.011; OR = 0.334) were protective factors against Alzheimer’s, while older age (p = 0.035; OR = 1.087), type II Diabetes Mellitus (p = 0.042; OR = 3.973), number of falls (p = 0.021; OR = 1.409), and daily drug intake (p = 0.001; OR = 1.437) were risk factors for Alzheimer’s. Conclusions: Sleep disturbances are related to stress and falls in a sample of 114 Spanish AD aged people institutionalized in nursing homes, and the falls they experience are related to ongoing medical visits, a history of dementia, and sleep disturbances. Therefore, a bidirectional relationship was established between falls and sleep disorders in these patients. Moreover, this study showed that a greater frequency of falls and high daily drug intake could constitute novel risk factors for Alzheimer’s disease, in addition to already known factors, such as age and type II Diabetes Mellitus, while being physically active and a high level of studies are protective factors against Alzheimer’s disease