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

The Efficacy of Therapeutic Respiratory Muscle Training Interventions in People with Bronchiectasis: A Systematic Review and Meta-Analysis

Background: Respiratory muscle dysfunction is an important health problem with high morbidity and mortality and associated costs in patients with bronchiectasis (BC). The aim of this study was to analyse the effects of therapeutic respiratory muscle training (RMT) interventions on improving sputum clearance, ventilator function, muscle strength and functional capacity in BC. Methods: Systematic review and meta-analysis were conducted following PRISMA guidelines. Two independent investigators searched using several electronic databases. The methodological quality of nine studies was assessed using the PEDro scale. Study selection/eligibility criteria: The following were included: randomised controlled trials, randomised crossover trials and pilot studies of patients with BC that used the intervention as RMT (inspiratory/expiratory) and evaluations of respiratory muscle strength (maximal expiratory pressure/maximal inspiratory pressure). This systematic review was registered in PROSPERO (CRD42017075101). Nine studies were included, five of which obtained an A recommendation grade, three with B, and one with C. Study quality was poor to good (mean PEDro Score of 6.375 out of 10). Studies had small sample sizes (8-98). Results show improvements on PImax in favour of therapeutic respiratory muscle training intervention (MD = 6.08; 95% CI = 1.38, 10.77; p < 0.01; I-2 = 92%). However, high heterogeneity was identified on meta-analysis

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

Aprendizaje colaborativo y evaluación por pares a través de rúbricas en las asignaturas de “Métodos específicos de intervención en Fisioterapia I y II”

Artículo dentro de la convocatoria de Innovación Docente 18-19La docencia siempre es un reto para cualquier profesor y es necesario poseer herramientas que motiven al alumnado para participar en el proceso de aprendizaje. El objetivo principal de este proyecto de innovación docente es integrar el uso de recursos audiovisuales para mejorar el aprendizaje mediante el trabajo en grupo, así como involucrar al alumnado en el proceso de evaluación mediante la utilización de rúbricas. Metodología: Este proyecto se llevó a cabo en dos asignaturas del tercer curso del Grado de Fisioterapia con la colaboración del Centro de Recursos Digitales de la UCA. Se basó en la organización de los alumnos por equipos, y cada grupo debía realizar un power point y un vídeo sobre una determinada técnica de Fisioterapia. Fueron 12 trabajos en total por cada asignatura involucrada. Posteriormente a su visualización por el profesorado y el alumnado, se debían valorar mediante una rúbrica consensuada Finalmente se elaboraron dos encuestas (una de expectativas y otra de satisfacción) que los alumnos debían realizar al inicio y al final del proyecto. Resultados y Conclusiones: Ante los resultados obtenidos podemos concluir que el trabajo colaborativo ha sido beneficioso, aunque les suponga una inversión de tiempo extra. No se han encontrado diferencias relevantes en las encuestas las encuestas al comparar ambas asignaturas. En cuanto a la evaluación por rúbricas, las notas realizadas por el docente y los compañeros han variado, siendo inferiores las calificaciones de los profesores.6 página

Spilled ink blots the mind: A reply to Merrit et al. (2018) on subjectivity and bone surface modifications

Categorical variables identifying microscopic features of cut marks produce high accuracy in discrimination of bone surface modifications, but are vulnerable to variable degrees of inter-analyst subjectivity. Metric analyses of cut mark width and depth are presented by Merritt et al. (2018) as a more objective method of identifying cut marks. However, this uni(bi)variate method has shown very high rates of mark classification error when structurally similar marks are compared. Furthermore, within-sample comparison carried out via subsampling shows that different datasets of metric values, obtained with the same type of tool and raw material, are subject to such a high degree of variability that significant differences of homogeneous subsamples are repeatedly obtained, thus preventing any useful analogs to be made. Additionally, this much higher stochastic variability depends on limited knowledge of the contextual processes that intervene in cut mark metric properties, as well as on a mismatch between theoretical premises on the immanent-configurational process-trace dynamics and their confusion during experimental praxis. The selection of specific contextual variables and disregard of others, in addition to the combination of different tool types and raw materials, distorts the resulting cut mark properties. This indicates that even when attempting to use exclusively metric numeric variables, subjectivity is a conditioning factor in analyzing and interpreting cut marks

Respiratory Physiotherapy Intervention Strategies in the Sequelae of Breast Cancer Treatment: A Systematic Review

Breast cancer treatments can trigger respiratory sequelae. Respiratory physiotherapy helps to eliminate or mitigate the sequelae by optimizing respiratory function. This systematic review aims to synthesize the scientific evidence and assess its quality regarding the use of respiratory physiotherapy in the sequelae of breast cancer. The Cochrane Library, Physiotherapy Evidence Database, PubMed, Web of Science, Scientific Electronic Library Online, Cumulative Index of Nursing and Allied Literature Complete, and Scopus were searched. Study quality was determined using the PEDro scale, STROBE Statement, and Single-Case Experimental Design Scale. Ten studies, six clinical trials, one case study, and three observational studies were selected. The mean methodological quality of the clinical trials was 5.6, that of the case study was 7, and that of the observational studies was 56%. Respiratory physiotherapy has been observed to improve respiratory capacity, lung function, respiratory muscle strength, effort tolerance, dyspnea, fatigue, thoracic mobility, upper limb volume, sleep quality and quality of life, as well as sensitivity to adverse physiological reactions, nausea, vomiting, and anxiety. However, it is not effective for vasomotor symptoms. More clinical trials are needed. These studies should homogenize the techniques used, as well as improve their methodological qualityThis research was funded by the Department of Nursing and Physiotherapy (University of Cadiz). Partial funding for open access charge: Universidad de Málaga

Effects of Training on Cardiorespiratory Fitness in Triathletes: A Systematic Review and Meta-Analysis

Triathlon is an aerobic sport, which is commonly measured by maximal aerobic consumption (VO2max). Objective: to analyze the changes produced in cardiorespiratory and physiological measurements during practice, which determine triathletes’ performance level. A systematic review and a meta-analysis based on PRISMA protocol and registered in PROSPERO (CRD42020189076) was conducted. The research was performed using PubMed, SPORTDiscus, Embase, Dialnet, Web of Science (WOS) and MEDLINE databases during February and March 2020. Studies that measured cardiorespiratory variables in triathletes published in the last 10 years were included. Results: 713 articles were identified, with 25 studies selected for the systematic review and five articles for the meta-analysis. These articles concluded that the main cardiorespiratory variables that determine triathletes’ performance were modified depending on the triathlon segment performed and the athletes’ sex and age. The meta-analysis showed no conclusive results related to the effects of changes in VO2max in triathletes’ performance [SMD = −0.21; 95%CI: (−0.84 to 0.43)]. Conclusions: cardiorespiratory fitness, in terms of VO2max and ventilatory thresholds, is the strongest predictor of performance in triathlon. This response may be affected depending on the triathlon segment performed and the athlete’s age or sex, leading to both physiological and biomechanical alterations that affect competition performance.This research received partial funding by the University of Malaga and the Department of Nursing and Physiotherapy (University of Cadiz). Partial funding for open access charge: Universidad de Málaga

Effectiveness and Safety of the Sequential Use of a Second and Third Anti-TNF Agent in Patients With Inflammatory Bowel Disease: Results From the Eneida Registry

Background: The effectiveness of the switch to another anti-tumor necrosis factor (anti-TNF) agent is not known. The aim of this study was to analyze the effectiveness and safety of treatment with a second and third anti-TNF drug after intolerance to or failure of a previous anti-TNF agent in inflammatory bowel disease (IBD) patients. Methods: We included patients diagnosed with IBD from the ENEIDA registry who received another anti-TNF after intolerance to or failure of a prior anti-TNF agent. Results: A total of 1122 patients were included. In the short term, remission was achieved in 55% of the patients with the second anti-TNF. The incidence of loss of response was 19% per patient-year with the second anti-TNF. Combination therapy (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.8-3; P < 0.0001) and ulcerative colitis vs Crohn's disease (HR, 1.6; 95% CI, 1.1-2.1; P = 0.005) were associated with a higher probability of loss of response. Fifteen percent of the patients had adverse events, and 10% had to discontinue the second anti-TNF. Of the 71 patients who received a third anti-TNF, 55% achieved remission. The incidence of loss of response was 22% per patient-year with a third anti-TNF. Adverse events occurred in 7 patients (11%), but only 1 stopped the drug. Conclusions: Approximately half of the patients who received a second anti-TNF achieved remission; nevertheless, a significant proportion of them subsequently lost response. Combination therapy and type of IBD were associated with loss of response. Remission was achieved in almost 50% of patients who received a third anti-TNF; nevertheless, a significant proportion of them subsequently lost response

European Registry on Helicobacter pylori Management: Effectiveness of First and Second-Line Treatment in Spain

The management of Helicobacter pylori infection has to rely on previous local effectiveness due to the geographical variability of antibiotic resistance. The aim of this study was to evaluate the effectiveness of first and second-line H. pylori treatment in Spain, where the empirical prescription is recommended. A multicentre prospective non-interventional registry of the clinical practice of European gastroenterologists concerning H. pylori infection (Hp-EuReg) was developed, including patients from 2013 until June 2019. Effectiveness was evaluated descriptively and through a multivariate analysis concerning age, gender, presence of ulcer, proton-pump inhibitor (PPI) dose, therapy duration and compliance. Overall, 53 Spanish hospitals were included, and 10,267 patients received a first-line therapy. The best results were obtained with the 10-day bismuth single-capsule therapy (95% cure rate by intention-to-treat) and with both the 14-day bismuth-clarithromycin quadruple (PPI-bismuth-clarithromycin-amoxicillin, 91%) and the 14-day non-bismuth quadruple concomitant (PPI-clarithromycin-amoxicillin-metronidazole, 92%) therapies. Second-line therapies were prescribed to 2448 patients, with most-effective therapies being the triple quinolone (PPI-amoxicillin-levofloxacin/moxifloxacin) and the bismuth-levofloxacin quadruple schemes (PPI-bismuth-levofloxacin-amoxicillin) prescribed for 14 days (92%, 89% and 90% effectiveness, respectively), and the bismuth single-capsule (10 days, 88.5%). Compliance, longer duration and higher acid inhibition were associated with higher effectiveness. "Optimized" H. pylori therapies achieve over 90% success in Spain