Modelling and in vivo evaluation of tendon forces and strain in dynamic rehabilitation exercises: a scoping review

Objectives Although exercise is considered the preferred approach for tendinopathies, the actual load that acts on the tendon in loading programmes is usually unknown. The objective of this study was to review the techniques that have been applied in vivo to estimate the forces and strain that act on the human tendon in dynamic exercises used during rehabilitation. Design Scoping review. Data sources Embase, PubMed, Web of Science and Google Scholar were searched from database inception to February 2021. Eligibility criteria Cross-sectional studies available in English or Spanish language were included if they focused on evaluating the forces or strain of human tendons in vivo during dynamic exercises. Studies were excluded if they did not evaluate tendon forces or strain; if they evaluated running, walking, jumping, landing or no dynamic exercise at all; and if they were conference proceedings or book chapters. Data extraction and synthesis Data extracted included year of publication, study setting, study population characteristics, technique used and exercises evaluated. The studies were grouped by the types of techniques and the tendon location. Results Twenty-one studies were included. Fourteen studies used an indirect methodology based on inverse dynamics, nine of them in the Achilles and five in the patellar tendon. Six studies implemented force transducers for measuring tendon forces in open carpal tunnel release surgery patients. One study applied an optic fibre technique to detect forces in the patellar tendon. Four studies measured strain using ultrasound-based techniques. Conclusions There is a predominant use of inverse dynamics, but force transducers, optic fibre and estimations from strain data are also used. Although these tools may be used to make general estimates of tendon forces and strains, the invasiveness of some methods and the loss of immediacy of others make it difficult to provide immediate feedback to the individuals.This work is part of a government-funded project supported by the University Teaching Training Programme (FPU) of the Ministry of Science, Innovation and Universities of Spain. Grant number: FPU17/00161. The University of Malaga has supported this study with the contribution of funds to support its publication in open access

Three-Dimensional Kinematics during Shoulder Scaption in Asymptomatic and Symptomatic Subjects by Inertial Sensors: A Cross-Sectional Study

Shoulder kinematics is a measure of interest in the clinical setting for diagnosis, evaluating treatment, and quantifying possible changes. The aim was to compare shoulder scaption kinematics between symptomatic and asymptomatic subjects by inertial sensors. Methods: Scaption kinematics of 27 subjects with shoulder symptomatology and 16 asymptomatic subjects were evaluated using four inertial sensors placed on the humerus, scapula, forearm, and sternum. Mobility, velocity, and acceleration were obtained from each sensor and the vector norm was calculated from the three spatial axis (x,y,Z). Shoulder function was measured by Upper Limb Functional Index and Disabilities of the Arm, Shoulder, and Hand questionnaires. One way ANOVA was calculated to test differences between the two groups. Effect size was calculated by Cohen’s d with 95% coefficient Intervals. Pearson’s correlation analysis was performed between the vector norms humerus and scapula kinematics against DASH and ULFI results in symptomatic subjects. Results: The asymptomatic group showed higher kinematic values, especially in the humerus and forearm. Symptomatic subjects showed significantly lower values of mobility for scapular protraction-retraction (Cohen’s d 2.654 (1.819–3.489) and anteriorisation-posteriorisation (Cohen’s d 1.195 (0.527–1.863). Values were also lower in symptomatic subjects for velocity in all scapular planes of motion. Negative correlation showed that subjects with higher scores in ULFI or DASH had lower kinematics values. Conclusion: Asymptomatic subjects tend to present greater kinematics in terms of mobility, velocity, and linear acceleration of the upper limb, and lower humerus and scapula kinematics in symptomatic subjects is associated with lower levels of functionThis research received no external funding. Partial funding for open access charge: Universidad de Málag

Calidad de la muerte percibida por los cuidadores de pacientes en cuidados paliativos

Objective: To determine the quality of dying and death in an advanced oncology population, and to analyze the association with the suffering and the quality of attention at the end of life.Methods: A cross-sectional, descriptive, correlational design was used. For the evaluation of the quality of dying and death, the Spanish version of the Quality of Dying and Death Questionnaire was used. Suffering was assessed with the Mini-Suffering State Examination and the quality of end-of-life care was evaluated with the Palliative care Outcome Scale.Results: 74 relatives of deceased patients were included in this study. The mean total score of the Spanish version of the Quality of Dying and Death Questionnaire was 64.58 (± 20.98). A negative correlation between the quality of dying and death and the suffering was found (r = -0.63), and a positive correlation between the quality of dying and death and the quality of the attention at the end of life was found (r = 0.62).Conclusion: Quality of dying and death in advanced cancer population is positively related to the quality of of the attention at the end of life and negatively related to suffering. Palliative care can contribute to achieving a satisfactory quality of dying and death of advanced cancer patients.Objetivo: Determinar la calidad de la muerte y del proceso del morir en población oncológica avanzada, y analizar su asociación con el sufrimiento y la calidad de la atención al final de la vida.Método: Estudio descriptivo, correlacional, de corte transversal en el que participaron los cuidadores principales de los pacientes oncológicos fallecidos en cuidados paliativos. Para la evaluación de la calidad de la muerte y del proceso del morir se utilizó la versión española del Quality of Dying and Death Questionnaire. El sufrimiento fue evaluado con el Mini-Suffering State Examination y la calidad de la atención al final de la vida con la Palliative care Outcome Scale. Resultados: 74 cuidadores familiares de pacientes paliativos fallecidos participaron en este estudio. La puntuación media de la versión española del Quality of Dying and Death Questionnaire fue de 65,58 (± 20,98). Se encontró una correlación negativa entre la calidad de la muerte y el sufrimiento (r=-0,63) y positiva entre la calidad de la muerte y la calidad de la atención al final de la vida (r=0,62).Conclusión: La calidad de la muerte de los enfermos oncológicos avanzados en cuidados paliativos se relaciona positivamente con la calidad de la atención al final de la vida y negativamente con el sufrimiento. La atención paliativa contribuye a alcanzar niveles satisfactorios en la calidad de la muerte y del proceso del morir de los pacientes oncológicos avanzados

Cross-cultural adaptation and validation of the Spanish version of the American Academy of Orthopaedic Surgeons-Foot and Ankle Module (AAOS-FAMsp)

Background The current study performed a cross-cultural adaptation to Spanish and examined the internal and external validation of the AAOS-FAM questionnaire. Methods A direct translation (English to Spanish) and a reverse translation (Spanish to English) were performed by two independent professional native translators. Cronbach’s α coefficients were calculated to analyse the internal consistency of the measure. The factor structure and construct validity were analysed after extraction by maximum likelihood (EML); extraction was necessary if the following three requirements were met: accounting for ≥10 % of variance, Eigenvalue >1.0 and a scree plot inflexion point. The standard error of measurement and minimal detectable change 90 (MDC90) were calculated. Criterion validity was calculated by analysing the correlation between the American Academy of Orthopaedic Surgeons-Foot and Ankle Module (Spanish version) (AAOS-FAMsp) and Spanish versions of the questionnaires FFI and FHSQ. Results Regarding internal consistency, Cronbach’s α was 0.877, and in the test-retest analysis, the ICC ranged between 0.899 and 0.942. Error measures were calculated by MDC90 and SEM, which showed values of 3.444 and 1.476 %, respectively. The analysis demonstrated a goodness of fit chi-squared value of 803.166 (p p r = 0.206 (p r = 0.665 (p Conclusions The results indicate that AAOS-FAMsp has satisfactory psychometric properties, facilitating the inclusion of Spanish-speaking individuals into both research and clinical practice

Inter-rater and intra-rater reliability of the extended TUG test in elderly participants

Background: To analyse the reliability, variance and execution time of the Extended Timed Up and Go (Extended TUG) test in three age groups of elderly participants (G1: 55–64 years; G2: 65–74 years; G3: 75–85 years). Methods: An analytical cross-sectional study of 114 recruited participants (63 women) of average age 70.17 (± 7.3) years was undertaken. Each participant performed the Extended TUG three consecutive times, with a rest break between tests of 120 s. Both the intragroup and intergroup reliability of the measurements in the Extended TUG were analysed. Results: The reliability of the Extended TUG test is excellent for the first and second decades but drops down to good for the third decade. Specifically, intragroup reliability ranged from 0.784 for G3 to 0.977 for G1 (G2 = 0.858). Intergroup reliability, compared with intragroup reliability, was slightly lower, ranging between 0.779 for G3 and 0.972 for G1 (G2 = 0.853). Conclusion: The reliability of the Extended TUG test progressively decreases with increasing age, being excellent for the younger age groups and good for the oldest age group

Validation of the upper limb functional index on breast cancer survivor

Breast cancer survivors (BCS) may face functional alterations after surgical intervention. Upper Limb Disorders (ULDs) are highly prevalent even years after a diagnosis. Clinicians may assess the upper limbs after breast cancer. The Upper Limb Functional Index (ULFI) has been validated across different populations and languages. This study aimed to assess the psychometric properties of the Upper Limb Functional Index Spanish version (ULFI-Sp) in the BCS. Methods: A psychometric validation study of the ULFI-Sp was conducted on 216 voluntary breast cancer survivors. The psychometric properties were as follows: analysis of the factor structure by maximum likelihood extraction (MLE), internal consistency, and construct validity by confirmatory factor analysis (CFA). Results: The factor structure was one-dimensional. ULFI-Sp showed a high internal consistency for the total score (α = 0.916) and the regression score obtained from MLE (α = 0.996). CFA revealed a poor fit, and a new 14-item model (short version) was further tested. The developed short version of the ULFI-SP is preferable to assess upper limb function in Spanish BCS. Conclusions: Given the high prevalence of ULD in this population and the broader versions of ULFI across different languages, this study’s results may be transferred to clinical practice and integrated as part of upper limb assessment after breast cancer.Partial funding for open access charge: Universidad de Málag

Forearm Muscle Activity During the Handgrip Test in Breast Cancer Survivors: A Cross-Sectional Study

We recruited 102 breast cancer survivors at a secondary care in Malaga. Included breast cancer survivors showed a good upper limb functionality but a reduced forearm muscle activity. Forearm muscle activity showed a poor significant correlation with the cancer-related fatigue . Handgrip strength also showed a poor correlation with the upper limb functionality. Both outcomes tended to lower values with higher levels of cancer-related fatigue. Introduction/Background: Breast cancer survivors (BCS) frequently show upper limb dysfunctions. The forearm muscle activity measured by surface electromyography (sEMG) in this population has not been studied. This study aimed to describe forearm muscle activity in BCS, as well as to assess its possible relationship with other variables related to upper limb functionality and cancer-related fatigue (CRF). Materials and Methods: A cross-sectional study was carried out including 102 BCS as volunteers at a secondary care in Malaga, Spain. BCS were included if they were aged between 32 and 70 years old, without evidence of cancer recurrence at the time of recruitment. The forearm muscle activity (microvolts, μV) was assessed by sEMG during the handgrip test. The handgrip strength was assessed by dynamometry (kg), the upper limb functionality (%) was measured by the upper limb functional index (ULFI) question- naire and the CRF was also assessed by revised Piper Fatigue Scale (0-10 points). Results: BCS reported reduced forearm muscle activity (287.88 μV) and reduced handgrip strength (21.31 Kg), a good upper limb functionality (68.85%), and a moderate cancer-related fatigue (4.74). Forearm muscle activity showed a poor significant correlation (r = –0.223, P = .038) with the CRF. Handgrip strength showed a poor correlation with the upper limb functionality (r = 0.387, P < .001) and age (r=-0.200, P = .047)...Funding for open access charge: Universidad de Málaga /CBU

Thematic Trends in Complementary and Alternative Medicine Applied in Cancer-Related Symptoms

Purpose: The main goal of this study is to discover the scientific evolution of Cancer-Related Symptoms in Complementary and Alternative Medicine research area, analyzing the articles indexed in the Web of Science database from 1980 to 2013. Design/Methodology/Approach: A co-word science mapping analysis is performed under a longitudinal framework (1980 to 2013). The documental corpus is divided into two subperiods, 1980–2008 and 2009–2013. Thus, the performance and impact rates, and conceptual evolution of the research field are shown. Findings: According to the results, the co-word analysis allows us to identify 12 main thematic areas in this emerging research field: anxiety, survivors and palliative care, meditation, treatment, symptoms and cancer types, postmenopause, cancer pain, low back pain, herbal medicine, children, depression and insomnia, inflammation mediators, and lymphedema. The different research lines are identified according to the main thematic areas, centered fundamentally on anxiety and suffering prevention. The scientific community can use this information to identify where the interest is focused and make decisions in different ways. Research limitation: Several limitations can be addressed: 1) some of the Complementary and Alternative Medicine therapies may not have been included; 2) only the documents indexed in Web of Science are analyzed; and 3) the thematic areas detected could change if another dataset was considered. Practical implications: The results obtained in the present study could be considered as an evidence-based framework in which future studies could be built. Originality/value: Currently, there are no studies that show the thematic evolution of this research area

Cost-utility of cognitive behavioral therapy versus U.S. Food and Drug Administration recommended drugs and usual care in the treatment of patients with fibromyalgia: an economic evaluation alongside a 6-month randomized controlled trial

Introduction:- Cognitive behavioral therapy (CBT) and U.S. Food and Drug Administration (FDA)-recommended pharmacologic treatments (RPTs; pregabalin, duloxetine, and milnacipran) are effective treatment options for fibromyalgia (FM) syndrome and are currently recommended by clinical guidelines. We compared the cost-utility from the healthcare and societal perspectives of CBT versus RPT (combination of pregabalin + duloxetine) and usual care (TAU) groups in the treatment of FM. Methods:- The economic evaluation was conducted alongside a 6-month, multicenter, randomized, blinded, parallel group, controlled trial. In total, 168 FM patients from 41 general practices in Zaragoza (Spain) were randomized to CBT (n = 57), RPT (n = 56), or TAU (n = 55). The main outcome measures were Quality-Adjusted Life Years (QALYs, assessed by using the EuroQoL-5D questionnaire) and improvements in health-related quality of life (HRQoL, assessed by using EuroQoL-5D visual analogue scale, EQ-VAS). The costs of healthcare use were estimated from patient self-reports (Client Service Receipt Inventory). Cost-utility was assessed by using the net-benefit approach and cost-effectiveness acceptability curves (CEACs). Results:- On average, the total costs per patient in the CBT group (1,847€) were significantly lower than those in patients receiving RPT (3,664€) or TAU (3,124€). Patients receiving CBT reported a higher quality of life (QALYs and EQ-VAS scores); the differences between groups were significant only for EQ-VAS. From a complete case-analysis approach (base case), the point estimates of the cost-effectiveness ratios resulted in dominance for the CBT group in all of the comparisons performed, by using both QALYs and EQ-VAS as outcomes. These findings were confirmed by bootstrap analyses, net-benefit curves, and CEACs. Two additional sensitivity analyses (intention-to-treat analysis and per-protocol analysis) indicated that the results were robust. The comparison of RPT with TAU yielded no clear preference for either treatment when using QALYs, although RPT was determined to be more cost-effective than TAU when evaluating EQ-VAS. Conclusions:- Because of lower costs, CBT is the most cost-effective treatment for adult FM patients. Implementation in routine medical care would require policymakers to develop more-widespread public access to trained and experienced therapists in group-based forms of CBT. Trial registration:- Current Controlled Trials ISRCTN10804772. Registered 29 September 2008