Evaluación de un programa de fisioterapia respiratoria en pacientes sometidos a resección pulmonar

169 p.+ anexosLas intervenciones de fisioterapia durante el perioperatorio inmediato en los pacientes intervenidos de resección pulmonar están implementadas de forma rutinaria en la mayoría de unidades de cirugía torácica por la capacidad que se les atribuye para prevenir o reducir las complicaciones postoperatorias. Sin embargo, la evidencia en la que basar sus beneficios es escasa. El objetivo de este estudio es el de evaluar los efectos de un programa de fisioterapia postoperatoria basado en ejercicios respiratorios que ha sido añadido a los cuidados estándares en pacientes operados de resección pulmonar. Métodos. Se ha diseñado un estudio comparativo retrospectivo de doble cohorte en el que se han incluido un total de 237 pacientes. El grupo control (n=114) incluyó los datos de las altas de hospitalización registradas en el Hospital de Navarra durante 2006-07, y el grupo experimental (n=123) aquellas durante el 2009-10, tras implementarse un programa de fisioterapia postoperatoria. Ambas series fueron operadas por el mismo equipo, sin modificar los criterios de operabilidad, abordaje quirúrgico, manejo anestésico o cuidados perioperatorios. El programa consistió en sesiones diarias de ejercicios respiratorios dirigidos a la reexpansión pulmonar y toilet bronquial hasta el alta hospitalaria. Las variables de resultado principales fueron las tasas de complicaciones postoperatorias y la duración de la estancia hospitalaria.Resultados. Ambos grupos resultaron comparables respecto a las características preoperatorias y quirúrgicas. La tasa de complicaciones postoperatorias fue de 30.70% en el grupo control y 17.89% en el experimental (p=0.021). Los días de hospitalización se redujeron significativamente (p=0.001) tras la implementación del programa de fisioterapia (mediana 14 días, rango (min-max) 62 (2-64) en el grupo control; mediana 12 días, rango (min-max) 100 (1-101) en el experimental). El modelo de regresión logística identificó al programa de fisioterapia evaluado como factor protector de desarrollar complicaciones postoperatorias (O.R. 0.482, IC 95% 0.255-0.913; p=0.025). Las limitaciones derivan fundamentalmente del diseño, pero el hecho de que todas las intervenciones perioperatorias se mantuviesen inalteradas durante el periodo de estudio, puede minimizar ciertas deficiencias de diseño. En cualquier caso, las conclusiones deben ser interpretadas con cierta cautela. Conclusiones. El programa de fisioterapia evaluado ha reducido el riesgo de desarrollar complicaciones postoperatorias y la duración de la estancia hospitalaria en los pacientes intervenidos de resección pulmonar

Effect of the COVID-19 pandemic on the physical and psychoaffective health of older adults in a physical exercise program

[EN]COVID-19 lockdowns restricted physical activity levels for individuals in many countries. In particular, older adults experienced limited access to their usual activities, including physical exercise programs. How such restrictions and interruptions in physical exercise programs might impact the physical and mental health of older adults has not yet been studied. We sought to analyse changes in the physical and mental health of older adults enrolled in a group-based multicomponent physical exercise (MPE) program that was interrupted due to the COVID-19 pandemic. We followed 17 participants of this program from October 2018 to October 2020, including the interruption of the program during the pandemic. The MPE program included strength, balance, and stretching exercises. We compared anthropometric and cardiovascular parameters, physical fitness, frailty, quality of life, and psychoaffective status of participants before and during the COVID-19 pandemic. Most parameters followed the same pattern, improving after 8 months of the first MPE season (Oct. 2018-Jun. 2019), worsening after 4 months of summer rest, improving from October 2019 to January 2020 in the second MPE season (Oct. 2019-Jan. 2020), and severely worsening after 7 months of program interruption. We show that an MPE program has clear benefits to the physical and psychoaffective health of older adults, and interruption of these programs could adversely impact participants. These results highlight the need to maintain physical exercise programs or facilitate engagement in physical activity and reduce sedentary behaviour in older adults, particularly in situations such as the COVID-19 pandemic.This work was supported by Siel Bleu and Basque Government (SAN 20/12)

Sensorized Tip for Monitoring People with Multiple Sclerosis that Require Assistive Devices for Walking

Multiple Sclerosis (MS) is a neurological degenerative disease with high impact on our society. In order to mitigate its effects, proper rehabilitation therapy is mandatory, in which individualisation is a key factor. Technological solutions can provide the information required for this purpose, by monitoring patients and extracting relevant indicators. In this work, a novel Sensorized Tip is proposed for monitoring People with Multiple Sclerosis (PwMS) that require Assistive Devices for Walking (ADW) such as canes or crutches. The developed Sensorized Tip can be adapted to the personal ADW of each patient to reduce its impact, and provides sensor data while naturally walking in the everyday activities. This data that can be processed to obtain relevant indicators that helps assessing the status of the patient. Different from other approaches, a full validation of the proposed processing algorithms is carried out in this work, and a preliminary study-case is carried out with PwMS considering a set of indicators obtained from the Sensorized Tip’s processed data. Results of the preliminary study-case demonstrate the potential of the device to monitor and characterise patient status

Jarduera fisikoa, guztion osasuna eta ongizatea hobetzeko tresna

Nazio Batuen Garapen Jasangarrirako 2030 Agendaren hirugarren helburua guztiontzat eta adin guztie- tan bizimodu osasungarria bermatzea eta ongizatea sustatzea da. Osasunaren Mundu Erakundearen arabera, jarduera fisikoa munduko hilkortasun-arriskua murrizten duen faktore garrantzitsuetako bat da. Lan honen helburua honako hau da: jarduera fisikoak eta haren modu egituratuak -hots, ariketa fisikoak- pertsona ororentzat dituen onurak laburbiltzea eta pertsona nagusietan eta populazio zaurgarrienetan dituen eraginetan sakontzea. Gaur egun, jakina da jarduera fisikoa eta ariketa fi- sikoa eraginkorrak direla gaixotasun kroniko nagusien prebentzioan eta tratamenduan. Aldi berean, pertsonen ongizatea eta bizi-kalitatea hobetzen laguntzen dute. Oro har, ikertzaileak bat datoz jarduera fisikoak eta ariketa fisikoak onura nabariak sortzen dituztela adin eta egoera fisiko ia guztietako pertsonetan, baita hauskor eta zaurgarrienetan ere. Azken urteetan, au- rrerapen handiak egin dira talde horiei buruzko ikerketan. Orain dela gutxi arte, oso intentsitate baxuko mugikortasun-pro- gramak proposatzen zitzaizkien, eta gaur egun frogatu da indarra eta erresistentzia aerobikoa intentsitate handiagoan lan- tzeak onura gehiago dakarzkiela. Jarduera fisikoaren eta ariketa fisikoaren eragina ez da arlo fisikora mugatzen, zeren behatu baita eragin positiboa duela kognizioan, ongizate emozionalean eta gizarte-sareen eraketan ere. Hala ere, jarduera fisikoa onuragarria izateko, banakoari egokitua, progresiboa eta egingarria izan behar du. Etorkizunerako erronka zera da: pertsona guztiek beren neurriko jarduera fisikoa egiteko aukera izatea, guztien osasuna eta ongizatea hobetzeko. Horrek Nazio Batuen 2030 Agendaren hirugarren helburua betetzen lagunduko digu.; The third goal of the United Nations 2030 Agenda for Sustainable Development is to ensure healthy lives and promote wellbeing at all ages. According to the World Health Organization, physical activity is an important factor that reduces the risk of global mortality.The aim of this revision is to summarize the benefits of physical activity and exercise and to delve deeper on their benefits on elder and vulnerable population. Nowdays, it is widely accepted that hysical activity and exercise have proved their effectiveness in the prevention and treatment of the main chronic diseases. At the same time, they contribute to improving well-being and quality of life. In general, researchers agree, physical activity and exercise have benefits for people of all ages and almost all physical conditions, even the most frail and vulnerable. In these groups, there have been important advances in research in the last few years. Until recently, very low intensity mobility programs were proposed to them and today it has been shown that working out on strength and aerobic endurance at higher intensities gives them greater benefits. The impact of physical activity and exercise is not limited to physical parameters, as it has been observed that it also has positive effects on cognition, emotional well-being and the formation of social networks. However, to be beneficial physical activity must be individually adappted, progressive and feasible. The challenge for the future is that each individual has the opportunity to perform tailored physical activity to improve health and well-being of everybody. This will bring us closer to achieve the third goal of the United Nations 2030 Agenda

Health-related quality of life, handgrip strength and falls during detraining in elderly habitual exercisers

Background: The effects of regular exercise on physical functioning and health-related quality of life (HRQOL) have been thoroughly studied. In contrast, little is known about the changes which occur following cessation of activity (detraining). Here, we have investigated the effect of a 3 month detraining period on HRQOL and on handgrip strength in elderly people who had regularly exercised, and examined the association of these variables with falls. Methods: Thirty-eight women and 11 men (mean age, 75.5 +/- 5.7 years) took part in a supervised physical exercise program for 9 months, followed by a 3 month detraining period. Participants completed the SF-36 HRQOL questionnaire at the beginning of detraining (baseline) and 3 months later. Handgrip strength and number of falls were also recorded. Results: Participants had been exercising for 12.1 +/- 8.7 years. After the detraining period, we found a significant (p < 0.001--0.05) decline in all SF-36 dimensions, with the exception of handgrip strength. Women presented a larger decline (p < 0.05) in more items than men. During the detraining period, 18.4% participants had a fall incident. HRQOL declined in both fallers and non-fallers during detraining. Interestingly, fallers already had at baseline significantly lower values in physical functioning (p < 0.05), emotional role (p < 0.05) and mental health (p < 0.01), than non-fallers. Conclusions: An important decline was found in most items of the SF-36 following a 3 month detraining period, particularly in women. In contrast, strength of the upper limb was not affected by the detraining. The prior lower HRQOL values of those who will subsequently fall suggest that this criterion should be studied as a candidate risk factor for falls. Efforts should be made to encourage the elderly to continue with exercise activities and/or to shorten holiday break periods, in order to maintain their quality of life.Esain I was supported by a grant from the Basque Government (Pre_2014_1_137). This work was supported by the Basque Government (IT922-16)

PETRHA (Physioterapy E-Training Re-habilitación)

PETRHA (Physiotherapy E-Training Re-HAbilitation), is an European project that is being developed since 2015 to 2017. His main goal is to develop a serious game for students in Physiotherapy. This simulation game will enhance the learning process of the "clinical approach in physiotheray" and will allow more intensive training opportunities for students in association with the use of simulation.info:eu-repo/semantics/publishedVersio

Robot de rehabilitación configurable para terapias del miembro superior

La rehabilitación basada en dispositivos robóticos precisa de un robot capaz de adaptarse al estado de recuperación motora del paciente. En este trabajo se presenta un robot de rehabilitación reconfigurable denominado Universal Haptic Pantograph (UHP). Este dispositivo robótico, gracias a su estructura multiconfigurable, permite la rehabilitación del miembro superior (hombro, codo y muñeca) con un único dispositivo. Además, ha sido diseñado para trabajar con diferentes modalidades de interacción como son las asistidas, correctoras y opositoras, pudiendo así adaptarse al estado funcional progresivo del paciente durante el proceso de rehabilitación. Con el objetivo de garantizar el correcto funcionamiento de este sistema robótico se han realizado diferentes ensayos experimentales. Los resultados demuestran que el robot de rehabilitación UHP funciona correctamente con diferentes tareas de rehabilitación, realizando movimientos suaves que garantizan la seguridad del usuario en todo momento.Este trabajo ha sido parcialmente financiado por el Ministerio de Economía y Competitividad MINECO & FEDER en el marco del proyecto DPI-2012-32882, así como por la beca PRE-2014-1-152 y el proyecto IT914-16 del Gobierno Vasco, el proyecto PPG17/56 de la UPV/EHU y por Euskampus Fundazioa. Además, los autores desean expresar su agradecimiento al centro de investigación Tecnalia por su colaboración y por prestar su robot de rehabilitación UHP

Effects of COVID-19 Lockdown on Physical Activity and Health-Related Quality of Life in Older Adults Who Regularly Exercise

The aim of the study was to analyze the effect of social distancing on physical activity (PA) and Health-Related Quality of Life (HRQoL) in active Spanish older adults according to their physical functionality. The study included 58 older adults aged 76.24 ± 6.00 years who were enrolled in a supervised physical exercise program before the COVID-19 outbreak. Anthropometric, physical function, physical activity and HRQoL were measured at baseline (October 2019). After the two-month lockdown due to the COVID-19, questionnaires were collected again during de-escalation (May 2020). Participants were divided into high- (n = 29) and low-functionality (n = 29) groups. Total PA, walking and cleaning significantly decreased (p < 0.001) whilst exercising or dancing increased (p < 0.001). General health, social and emotional role functioning dimensions and overall mental component scores worsened (p < 0.01–p < 0.05). Low-functionality participants had significantly lower physical functioning scores at baseline (p < 0.01) and lower bodily pain scores at de-escalation (p < 0.01). Emotional role functioning dimension and overall mental component significantly decreased only in low-functionality participants (p < 0.05). Although PA levels decreased significantly, older adults continued being active regardless of their functionality. While mental HRQoL in participants with higher physical functionality remained unchanged, participants with lower functional capacity had a higher risk of mental health concerns. Therefore, attention should focus on strategies to mitigate the negative effects of distancing measures on older people’s mental health, especially in those with lower functionality.This work was supported by the Basque Government (IT1288-19)

Pre-clinical validation of the UHP multifunctional upper-limb rehabilitation robot based platform

Interest in robotic devices for rehabilitation has increased in the last years, due to the increasing number of patients that require rehabilitation therapies, and the need to optimize existing resources. The UHP rehabilitation robot is a multifunctional device that allows to execute robotized therapies for the upper-limb using a simple pantograph based reconfigurable structure and the implementation of advanced position/force control approaches. However, in applications such as rehabilitation, where the robotic device interacts directly with the user, complying with the demands of the users is as important as complying with the functional requirements. Otherwise, the patient will reject the robotic device. Therefore, in this work the pre-clinical validation of the UHP upper-limb rehabilitation robotic platform is presented. 25 subjects of different physical characteristics have participated in the evaluation of the device, evaluating not only the correct behaviour of the device, but also its safety and adaptativity. Results show the correct behaviour of the platform, and a good acceptance rate of the device.This work was supported in part by the Basque Country Governments (GV/EJ) under grant PRE-2014-1-152, UPV/EHU’s PPG17/56 project, Basque Country Governments IT914-16 project, Spanish Ministry of Economy and Competitiveness’ MINECO & FEDER inside DPI2017-82694-R project, Euskampus, FIK and Spanish Ministry of Science and Innovation PDI-020100-2009-21 project

Effects of a videoconference-based therapeutic exercise intervention on the musculoskeletal pain of eldercare workers: protocol for the ReViEEW randomized controlled trial

Background Prevalence of musculoskeletal pain is high among eldercare workers, and therapeutic exercise has shown to be effective for its management. Although telerehabilitation is an increasingly used alternative for delivering therapeutic exercise, no studies have assessed synchronous group telerehabilitation interventions for the manage‑ ment of musculoskeletal disorders. Thus, the aim of this article is to describe the protocol of a randomized controlled trial that will assess the effects of a videoconference‑based group therapeutic exercise intervention on the musculo‑ skeletal pain of eldercare workers. Methods This multicenter trial will randomly assign 130 eldercare workers to either a control or experimental group. Participants in the control group will not receive any intervention, and participants in the experimental group will take part in a 12‑week remote supervised videoconference‑based intervention, consisting of 2 weekly 45‑min group ses‑ sions. Each session will include 4 sets of 6 progressive resistance exercises for the lower limbs, upper limbs and trunk, performed with bodyweight and elastic bands at moderate‑high intensity. Following the 12 weeks, participants in the experimental group will be provided with material for autonomously carry on the therapeutic exercises and advised to continue performing 2 weekly sessions on their own until a 48‑week follow‑up. Assessments will be performed at baseline, 12 and 48 weeks. Primary outcome will be average pain intensity in the low back during the last 7 days, measured by the 0–10 Numerical Rating Scale. Secondary outcomes will include additional measures of musculoskel‑ etal pain, psycho‑affective state, work‑related variables, and physical fitness. Discussion This will be the first trial, to our knowledge, assessing whether a remote delivery of a group therapeutic exercise intervention via videoconference is effective for reducing the musculoskeletal pain, improving the psycho‑ affective state and physical fitness, and enhancing the work‑related parameters in eldercare workers. If successful, this study will provide innovative tools for implementing effective, scalable and affordable interventions to tackle mus‑ culoskeletal disorders in the workplace. It will also highlight the utility of telehealth, and address the importance of therapeutic exercise to manage musculoskeletal pain in a critical population for the future of the aging societies as it is the eldercare workers.This work is funded by the Basque Government (IT1538‑22 and PRE_2021_2_0056) and the University of the Basque Country (GIU20/06). The funders played no role in the design, conduct, or reporting of this stud