A lifestyle adjustments program in long COVID-19 improves symptomatic severity and quality of life. A randomized control trial

OBJECTIVE

To evaluate the efficacy of a therapeutic intervention based on self-adjustment strategies for improving of symptomatic severity and quality of life.

METHODS

The study was a randomised single-blind clinical trial. Quality of life, disability, and functional impairment were collected. The control group received a leaflet with information on the main symptoms of Long-COVID-19 syndrome, in addition to standard medical treatment. The intervention group received treatment following a dual approach; on the one hand, monitoring and recognition of symptomatology and on the other hand, adaptation and functional improvement.

RESULTS

A total of 54 participants were included, 27 were included in the intervention group and 27 in the control group. At the beginning of the study, no significant differences were found between groups. After intervention, the quality of life variable showed significant differences between groups in the self-care and anxiety/depression dimensions. Significant between-groups differences were also found for the self-care subscale of the disability variable. The intervention group showed significant differences from baseline on some subscales of the quality of life, disability, and functional impairment variables.

CONCLUSION

Strategies based on lifestyle adjustments are adequate for the improvement of quality of life and symptom severity in the long COVID-19 population.

PRACTICE IMPLICATION

The findings suggest that applying an intervention focused in self-adjustment for long COVID patients can have positive effects.

Effects of Tai-Chi on Quality of Life in People With Neurodegenerative Diseases. A systematic Review of Randomised Clinical Trials

OBJECTIVE

This systematic review aimed to evaluate the effects of Tai Chi on the health-related quality of life (HRQoL) of people with neurodegenerative diseases.

DATA SOURCE

This review followed the guidelines of the updated PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020. A systematic search in five electronic databases (Medline via PubMed, Web of Science, Scopus, PEDro, and OTseeker) was performed.

STUDY INCLUSION AND EXCLUSION CRITERIA

Randomized control trials (RCTs) examining Tai Chi interventions to improve HRQoL in patients with neurodegenerative diseases published through March 2023 were included.

DATA EXTRACTION

Data were extracted from each study by two independent researchers into a data extraction form based on the Cochrane recommendations. Methodological quality and risk of bias were assessed.

DATA SYNTHESIS

A meta-analysis was performed using Review Manager 5.3 software.

RESULTS

Of the 439 records that were screened, eight RCTs met the eligibility criteria. They assessed cognitive decline (n = 2) or Parkinson's disease (n = 6). RCT comparison groups included active interventions or usual care. The duration of Tai Chi therapy ranged from 8 to 24 weeks. A sensitivity analysis using a fixed effect model indicated that Tai Chi therapy significantly increased HRQoL [P < 001, SMD (95% CI) = .41 [.21, .60], I2 = 4%].

CONCLUSION

Tai Chi can effectively improve the HRQoL of people with neurodegenerative diseases, but the heterogeneity across intervention was relatively high. Further studies are needed as research into the benefits of Tai Chi in neurodegenerative disease rehabilitation is still limited.

The Effectiveness of Combined Exercise and Self-Determination Theory Programmes on Chronic Low Back Pain: A Systematic Review and Metanalysis

Low back pain is a pervasive issue worldwide, having considerable prevalence and a significant impact on disability. As low back pain is a complicated condition with many potential contributors, the use of therapeutic exercise, combined with other techniques such as self-determination theory programmes, has the potential to improve several outcomes. The aim of this systematic review was to explore the effectiveness of combined exercise and self-determination theory programmes on chronic low back pain. This study was designed according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A systematic search in three databases (PubMed/MEDLINE, Web of Science, and Scopus) was conducted from September to November 2023. After screening, a total of five random control trials with patients with chronic low back pain were included in this systematic review and meta-analysis. The results showed significant differences in disability (SMD = -0.98; 95% CI = -1.86, -0.09; p = 0.03) and in quality of life (SMD = 0.23; 95% CI = 0.02, 0.44; p = 0.03) in favour of the intervention group versus the control group.

Relationship between engagement in meaningful activities, self-efficacy, and quality of life in healthy young adults: An exploratory study

BACKGROUND

The use of meaningful activities promotes health and well-being. There is no study with a healthy adult Spanish population that tries to determine how people engage in meaningful activities and the relationship between self-efficacy and quality of life.

AIMS

This study aimed to 1) confirm the construct validity of the Engagement in Meaningful Activities Survey (EMAS) with a healthy population; 2) evaluate the internal consistency of the EMAS for a non-clinical population, and 3) examine convergent validity with self-efficacy (General Self-Efficacy) and health-related quality of life.

MATERIAL AND METHODS

The methodology for construct validation and reliability of health questionnaires was conducted. A total of 177 non-clinical adults participated, between 18 and 60 years old. Confirmatory factor analysis was performed, and Cronbach's alpha was obtained to measure internal consistency for EMAS. A correlation analysis was performed with the other variables of interest: self-efficacy and quality of life.

RESULTS

The two-dimensional structure of the EMAS for the non-clinical adult population is confirmed: personal emotional competence versus the social experiential component. In addition, the results indicate a moderate association between engagement in meaningful activities and self-efficacy.

CONCLUSION

The EMAS is a valid questionnaire to be used in the Spanish adult population.

Differences of Disabling Symptoms between Previously Hospitalized or Non-Hospitalized Currently Working Long-COVID Survivors One Year after Infection: A Descriptive Study

This study aimed to describe the presence of disabling symptoms in currently working Long-COVID survivors by comparing the hospitalized and non-hospitalized one year after infection. Patients with Long-COVID syndrome (LCS) that have been infected by COVID-19 a year ago and were actually working were included. Participants that had been hospitalized due to COVID-19 were included in the LCS hospitalized group, and participants that had not been hospitalized were included in the LCS non-hospitalized group. The eligible patients were prompted to complete the latest self-report version of the COVID-19 Yorkshire Rehabilitation Screening Tool (C19-YRS). A total of 465 subjects were included in the study. Participants in the LCS hospitalized group were significantly older, had a significantly higher BMI, and had a significantly higher prevalence of women compared to the LCS non-hospitalized group. Additionally, participants in the LCS hospitalized group had obtained significantly worse results in symptom severity, functional disability, and global health perceived subscales of C19-YRS compared to the participants included in the LCS non-hospitalized group. We concluded that disabling symptoms are presented in patients with LCS at working age one year after infection and are higher in LCS hospitalized patients compared to LCS non-hospitalized patients.

Agreement between telerehabilitation and face-to-face orofacial myofunctional assessment in persons with acquired brain injury

BACKGROUND AND OBJECTIVE

Orofacial myofunctional disorders are common in persons with acquired brain injury. A new way for early detection of orofacial myofunctional disorders via information and communication technologies may improve accessibility. The purpose of this study was to evaluate the level of agreement between face-to-face and tele-assessment of an orofacial myofunctional protocol in a sample of persons with acquired brain injury.

METHODS

A masked comparative evaluation was conducted in a local association of patients with acquired brain injury. Twenty-three participants (39.1% female, mean age of 54 years) with a diagnosis of acquired brain injury were included in the study. The patients followed a face-to-face and a real-time online assessment using the Orofacial Myofunctional Evaluation with Scores protocol. This is a protocol for evaluation with numerical scales that assess the physical characteristics and the main orofacial functions of patients including appearance, posture, and mobility of lips, tongue, cheeks, and jaws, respiration, mastication, and deglutition.

RESULTS

The analysis showed excellent interrater reliability (ρ ≥ 0.85) for all the categories. In addition, most confidence intervals were narrow.

CONCLUSIONS

This study reveals excellent interrater reliability of an orofacial myofunctional tele-assessment in patients with acquired brain injury in comparison with a traditional face-to-face evaluation.

Characteristics of Frailty in Perimenopausal Women with Long COVID-19

The aim of this study was to compare the prevalence of risk factors for frailty between perimenopausal women with long COVID-19 syndrome, women having successfully recovered from COVID-19, and controls from the community. Women with a diagnosis of long COVID-19 and at least one symptom related to the perimenopausal period, women who had successfully recovered from COVID-19, and healthy women of comparable age were included in this study. Symptom severity and functional disability were assessed with the COVID-19 Yorkshire Rehabilitation Scale, and the presence of frailty was evaluated considering the Fried criteria. A total of 195 women were included in the study, distributed over the three groups. The long COVID-19 group showed a higher prevalence of perimenopausal symptoms and impact of COVID-19. Statistically significant differences were found between the long COVID-19 group and the other two groups for the frailty variables. When studying the associations between frailty variables and COVID-19 symptom impact, significant positive correlations were found. Perimenopausal women with long COVID-19 syndrome present more frailty-related factors and experience a higher range of debilitating ongoing symptoms. A significant relationship is shown to exist between long COVID-19 syndrome-related disability and symptoms and frailty variables, resulting in an increased chance of presenting disability.

Effects of non-pharmacological therapies on hand function and the ability to perform daily activities in people with systemic sclerosis: A systematic review and meta-analysis of randomized control trials

BACKGROUND

Systemic sclerosis (SSc) is an autoimmune rheumatic disease. Individuals with a diagnosis of SSc describe repercussions on their activities of daily living and instrumental activities of daily living that affect their everyday functional capacity. The objective of this systematic review was to explore the effectiveness of non-pharmacological interventions to improve hand function and the ability to perform activities of daily living.

METHODS

A systematic review was conducted on the Cochrane Library, Medline/PubMed, OTseeker, PEDro, Scopus, Web of Science up to September 10, 2022. Inclusion criteria were defined following PICOS recommendations (Populations, Intervention, Comparison and Outcome measures). Methodological quality was assessed with the Downs and Black Scale and risk of bias was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). A meta-analysis of each outcome was performed.

RESULTS

A total of 8 studies met the inclusion criteria, providing data on 487 individuals with SSc. The non-pharmacological intervention applied the most was exercise. The effects of non-pharmacological interventions were better than those of the waiting list or no treatment control conditions in both outcomes - hand function (mean difference [MD] = -6.98; 95% CI [-11.45, - 2.50], P = 0.002, I²  = 0%) and performance of daily activities (MD = -0.19; 95% CI [-0.33, - 0.04], P = 0.01, I²  = 0%). Moderate risk of bias was found in the majority of the studies included.

CONCLUSION

There is emerging evidence that non-pharmacological interventions can improve hand function and performance of daily activities in individuals with a diagnosis of SSc. Given the moderate risk of bias found in the studies included, the results should be considered with caution.

Pain and Clinical Presentation: A Cross-Sectional Study of Patients with New-Onset Chronic Pain in Long-COVID-19 Syndrome

The aim of this study was to evaluate the characteristics of pain (i.e., pain intensity, pain interference, clinical presentation) in Long-COVID-19 patients and compare the location of pain between successfully recovered COVID-19 patients and healthy matched controls. A cross-sectional case-control study was carried out. Long-COVID-19 patients, age- and sex-matched patients with a history of COVID-19 who had successfully recovered, and healthy controls were included. Outcomes included were pain characteristics (Brief Pain Inventory and Short-Form McGill Pain Questionnaire) and clinical presentation (Widespread Pain Index and Euroqol-5 Dimensions 5 Levels Visual Analogue Scale). Sixty-nine patients with Long-COVID-19 syndrome, sixty-six successfully recovered COVID-19 patients, and sixty-seven healthy controls were evaluated. Patients with Long-COVID-19 syndrome showed greater pain intensity and interference. In addition, they showed worse quality of life and greater widespread pain, with the most frequent locations of pain being the neck, legs, and head. In conclusion, patients with Long-COVID-19 syndrome show a high prevalence of pain, characterized by widespread pain of moderate intensity and interference, with the most frequent locations being the neck, legs, and head, significantly affecting the quality of life of these patients.

Systematic review of self-management programs for prostate cancer patients, a quality of life and self-efficacy meta-analysis

OBJECTIVE

To investigate the efficacy of self-management interventions on quality of life and/or self-efficacy in patients diagnosed with prostate cancer through a systematic review with meta-analysis.

METHODS

A search was conducted from database inception to March 2022 across three databases. Randomized controlled trials were included. Two reviewers performed independent data extraction and methodologic quality assessment of the studies.

RESULTS

A total of fifteen studies were included in the study. Self-management interventions were identified by the Practical Reviews in Self-Management Support. The meta-analysis showed that self-management interventions have a significant effect on self-efficacy CONCLUSION: Self-management programs could have positive effects on quality of life and improve self-efficacy in prostate cancer patients.

PRACTICE IMPLICATIONS

Self-management components may be heterogeneous but show positive results in improving self-efficacy in prostate cancer survivors. Including self-management components in the rehabilitation of prostate survivors can improve their quality of life.

Clinical Characteristics and Rehabilitation Strategies for the Stomatognathic System Disturbances in Patients with Stroke: A Systematic Review

Background: Understanding the stomatognathic system disturbances is key to diagnosing them early and implementing rehabilitation approaches to promote functional recovery. The objective of this study was to systematically review all published data that examined the assessment and rehabilitation strategies for the stomatognathic system disturbances in patients with stroke. Methods: Five databases (i.e., PubMed/MEDLINE, Scopus, Science Direct, Web of Science, and PEDro), were screened for manuscripts that included the assessment and rehabilitation strategies for stomatognathic system disturbances. The methodological quality was evaluated using the Mixed Methods Appraisal Tool. Results: Sixteen articles were included in this systematic review. The most frequently reported symptoms in patients with stroke included stiffness and thickness of the masseter muscle on the affected side and suprahyoid muscles; facial muscles' asymmetry and weakness; temporomandibular disorders; and a reduced maximum lip force, tongue pressure, and saliva flow rate. The rehabilitation strategies more frequently reported included exercises directed to the jaw, temporomandibular joint, tongue, and neck. The mean score for methodological quality was 85%. Conclusion: The stomatognathic system disturbances are frequently reported among patients with stroke, leading to dysfunction in masticatory performance or swallowing. More studies on interventions for stomatognathic system disturbances are required before conclusions may be drawn. Key Practitioner Message: This systematic review has clinical implications for rehabilitation practices, given that the results may help to develop early assessment and rehabilitation strategies for stomatognathic disturbances in patients with stroke.

Cross-sectional study of pain-related variables before and during the COVID-19 pandemic in patients with COPD

BACKGROUND

The impact of the COVID-19 pandemic influences of COPD patients. The worsening of their health status may contribute to a higher pain prevalence.

AIM

The aim of this study was to analyze the pain-related variables before and during the COVID-19 pandemic in patients with chronic obstructive pulmonary disease.

METHODS

In this cross-sectional case-control study, stable patients with chronic obstructive pulmonary disease without a COVID-19 diagnosis were evaluated before and during the pandemic. The main outcomes were the pronociceptive pain profile (general pain sensitivity, pain intensity, pain interference, and pressure pain sensitivity) and the psychological vulnerability (perceived health status, anxiety, and depression).

RESULTS

Our results showed that patients with chronic obstructive pulmonary disease during COVID-19 pandemic experienced higher general pain sensitivity and intensity with statistical differences in pain interference (p < .001), being the overall perceived health status lower than before the pandemic (p < .05).

CONCLUSIONS

We concluded that patients with chronic obstructive pulmonary disease during the COVID-19 pandemic showed a rise the pronociceptive pain profile accompanied by increased psychological vulnerability.

The use of eHealth to promote physical activity in thoracic malignancies survivors: A systematic review and meta-analysis

BACKGROUND

Survival rates for many forms of thoracic malignancies have improved over the past few decades, however, many survivors are coping with the side effects of cancer treatment for longer. Physical activity (PA) has been proposed as a therapeutic strategy to combat the effects of treatment in cancer survivors and eHealth could be a good way to encourage patients to practice it.

OBJECTIVE

To explore the effects of eHealth in the promotion of PA among thoracic malignancies.

METHODS

Suitable articles were searched using PubMed, Web of Science and Scopus databases using a combination of medical subject headings.

RESULTS

In total, 4781 articles were identified, of which ten met eligibility criteria. Different eHealth interventions were described in these studies: mobile application (app) (n = 3), website (n = 2), email (n = 2), web and mobile application (n = 1), telephone counseling (n = 1) and online sheet (n = 1). All studies reported improvements in PA, with 8/10 studies reporting statistically significant changes.

CONCLUSION

Our results show that eHealth programs are useful to promote PA in malignancy thoracic survivors, compared to no intervention, conventional treatment or a dietary approach. Moreover, the meta-analysis also revealed eHealth is a good way to improve the level of PA in thoracic malignancies survivors.

Adaptation, validity, and reliability of the Interaction with Disabled Persons Scale in Spanish population

PURPOSE

To adapt the Interaction with Disabled Persons Scale (IDP) into Spanish and examine its factor structure.

METHODS

A forward and back translation of the IPD was performed by professional translators of scholarly articles. Spanish-speaking professional translators provided modifications in order to develop the final version of the scale. Participants filled in the Spanish version of the IDP, Positive and Negative Affect Schedule (PANAS), Multidimensional Attitudes Scale toward persons with disabilities (MAS), and Semantic Differential Technique (SDT).

RESULTS

A total of 523 persons (62.6% women), with a mean age of 29.22 (SD = 14.03) ranking from 18 to 81. The confirmatory factor analysis showed a reliable brief version of the IDP with adequate psychometric properties and two factors: (χ₍₁₉₎²=28.98, p < 0.001, CFI = 0.94, TLI = 0.91, RMSEA (90% IC)=0.05 (0.01, 0.08), SRMR = 0.06). The first factor solution was Coping/Succumbing Framework and the second factor was Discomfort in Social Interaction. The internal consistency reliability for the first factor was 0.63 and for the second 0.66.

CONCLUSIONS

Our findings provide evidence of the psychometric properties of the IDP as a brief measure of attitude toward individual with special needs in Spanish population.Implications for rehabilitationThe Interaction with Disabled Persons Scale (IDP) was successfully translated into Spanish language.The Spanish version of IDP Scale has a good acceptability, acceptable internal consistency, and high test-retest reliability.The Spanish version of IDP can been used to assist the clinicians, educators, and researchers in identifying the attitudes of the Spanish population toward persons with functional diversity in Spanish.Identifying the attitudes will permit to improve the inclusion polity and to design social programs toward greater inclusion.

Efficacy of Web-Based Supportive Interventions in Quality of Life in COPD Patients, a Systematic Review and Meta-Analysis

Background: Adults living with Chronic Obstructive Pulmonary Disease (COPD) often have difficulties when trying to access health care services. Interactive communication technologies are a valuable tool to enable patients to access supportive interventions to cope with their disease. The aim of this revision and meta-analysis is to analyze the content and efficacy of web-based supportive interventions in quality of life in COPD. Methods: Medline (via PubMed), Web of Science, and Scopus were the databases used to select the studies for this systematic review. A screening, analysis, and assessment of the methodological quality was carried out by two independent researchers. A meta-analysis of the extracted data was performed. Results: A total of 9 of the 3089 studies reviewed met the inclusion criteria. Most repeated web content elements were educational and involved communication with healthcare professional content. Finally, seven of the nine studies were included in a quantitative analysis. Web-based supportive interventions significantly improved quality of life when added to usual care (SMD = −1.26, 95% CI = −1.65, −0.86; p < 0.001) but no significant differences were found when compared with an autonomous pedometer walking intervention (p = 0.64) or a face-to-face treatment (p = 0.82). Conclusion: This systematic review and meta-analysis suggests that web-based supportive interventions may complement or accompany treatments in COPD patients due to the advantages of online interventions. The results obtained should be treated with caution due to the limited number of studies in this area and methodological weaknesses.

Virtual Reality in the Treatment of Adults with Chronic Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Virtual reality (VR) can present advantages in the treatment of chronic low back pain. The objective of this systematic review and meta-analysis was to analyze the effectiveness of VR in chronic low back pain. This review was designed according to PRISMA and registered in PROSPERO (CRD42020222129). Four databases (PubMed, Cinahl, Scopus, Web of Science) were searched up to August 2021. Inclusion criteria were defined following PICOS recommendations. Methodological quality was assessed with the Downs and Black scale and the risk of bias with the Cochrane Risk of Bias Assessment Tool. Fourteen studies were included in the systematic review and eleven in the meta-analysis. Significant differences were found in favor of VR compared to no VR in pain intensity postintervention (11 trials; n = 569; SMD = −1.92; 95% CI = −2.73, −1.11; p < 0.00001) and followup (4 trials; n = 240; SDM = −6.34; 95% CI = −9.12, −3.56; p < 0.00001); and kinesiophobia postintervention (3 trials; n = 192; MD = −8.96; 95% CI = −17.52, −0.40; p = 0.04) and followup (2 trials; n = 149; MD = −12.04; 95% CI = −20.58, −3.49; p = 0.006). No significant differences were found in disability. In conclusion, VR can significantly reduce pain intensity and kinesiophobia in patients with chronic low back pain after the intervention and at followup. However, high heterogeneity exists and can influence the consistency of the results.

The Caregiver Burden Inventory as a Sleep Disturbance Screening Tool for Parents of Children with Autism Spectrum Disorder

PURPOSE

The study was conducted to explore the degree to which caregiver burden is associated with sleep quality in parents of children with autism spectrum disorder, and to determine a statistically valid cutoff score for the Caregiver Burden Inventory (CBI) in order to identify parents of risk of poor sleep quality.

DESIGN AND METHODS

We conducted a cross-sectional analysis. We assessed caregiver burden with the CBI, sleep quality with the Pittsburgh Sleep Quality Index, emotional status with the Hospital Anxiety and Depression Scale, and impact on family with the Impact on Family Scale. Caregiver burden was evaluated with a logistic regression analysis. The best fit model was used in a receiver operating characteristic analysis. Likelihood ratios and post-test probabilities were calculated.

RESULTS

A total of 116 parents were included in this study. Higher caregiver burden was associated with a reduction in sleep quality in the logistic regression analysis (p < 0.001). The area under the curve for the univariate burden test model (best fit) was 76.70 (p < 0.001). The cutoff score for poor sleep quality was caregiver burden ≥26.50. The post-test probability of poor sleep quality increased to 82.02% from a pre-test probability of 76.72%.

CONCLUSIONS

Our findings suggest that caregiver burden is associated with sleep quality among parents of children with autism spectrum disorder. The findings suggest that a CBI cutoff score of 26.50 may help to detect risk of poor sleep quality in parents of children with autism spectrum disorder.

A New Tool for Assessment of Professional Skills of Occupational Therapy Students

The assessment of the acquisition of professional skills is an essential process in occupational therapy students. Until now, there has been no standardized and validated instrument for evaluating these skills in Spanish occupational therapy students. This study reports the development and testing of the psychometric properties of the professional skills in students of occupational therapy during their practical training. Methods: A new instrument was developed to assess the professional skills of occupational therapy students, called CPTO. A total of 69 occupational therapists participated in evaluating 295 occupational therapy students from the University of Granada, between the 2018 and 2021 academic years. Results: Of a total of 79 items, the factor analysis yielded a final solution of 33 items, which explains 70.22% of the variance with the following three dimensions: (1) self-appraisal and professional responsibility (α = 0.951); (2) communication skills and delivering intervention (α = 0.944); and (3) clinical reasoning for assessing and planning the intervention (α = 0.947). The instrument allows students with low, medium, high and excellent clinical skills to be differentiated according to the cutting points established by the quartiles. Conclusion: the instrument has good psychometric properties, and is a useful tool to assess professional competencies in occupational therapy students during their practice placement education.

[Prevalence and repercussions of the locomotor syndrome in patients with chronic obstructive pulmonary disease]

BACKGROUND

Patients with Chronic Obstructive Pulmonary Disease (COPD) suffer a progressive deterioration of functional status and a decrease in independence in activities of daily living. Locomotor Syndrome (SL) is the involvement of the musculoskeletal system due to the deterioration caused by age.

AIM

In patients with COPD, to evaluate the prevalence in LS and assess its impact on functional status and quality of life.

MATERIAL AND METHODS

Cross sectional assessment of 259 patients with COPD. LS was evaluated with the Geriatric Locomotive Function Scale (GFLS-25). Those with a score < 16 were classified as having LS. Functional status was evaluated with dynamometry, Five Times Sit-to-Stand test, and the Modified Baecke Physical Activity Questionnaire. Functional impairment was measured with the London Chest Activity of Daily Living, and the quality of life was evaluated with EuroQol-5D.

RESULTS

LS was found in 139 patients (53%). Activity levels and muscle strength were lower in these patients. Also, they had a higher frequency of functional impairment and a lower quality of life perception.

CONCLUSIONS

LS in patients with COPD impacts their functional status and quality of life.

A Feasibility and Efficacy Randomized Controlled Trial of Two Exercise Programs in Severe AECOPD Patients with Resting Hypoxemia

Resting hypoxemia is the most severe stage of Chronic Obstructive Pulmonary Disease (COPD). Due to their impairments during the exacerbation, these patients are limited to traditional exercise rehabilitation and are excluded from the majority of the studies. The aim of this study was to assess the feasibility and the efficacy of two exercise programs in Acute Exacerbation of COPD (AECOPD) patients with resting hypoxemia. In this randomized clinical trial, patients hospitalized due to an acute exacerbation of COPD with hypoxemia at rest were included. Patients were randomly assigned into three groups. A Control Group (pharmacological treatment), a Global Exercise Group (GEG), and a Functional Electrostimulation Group (FEG). Patients were treated during the hospitalization period. The main outcomes were lower limb strength (assessed by a dynamometer), balance (assessed by the one leg standing balance test), health related quality of life (assessed by the EQ-5D), adverse events and adherence. At the end of the intervention, there were significant differences in all the variables in favour of the experimental groups (p < 0.05). We concluded that conducting an exercise program is feasible and improves lower limb strength, balance, and health related quality of life in AECOPD patients with resting hypoxemia.

Physical Therapist Interventions for Infants With Nonsynostotic Positional Head Deformities: A Systematic Review

OBJECTIVE

This study sought to examine the methodological quality and summarize the evidence from clinical trials that examined the effectiveness of physical therapist interventions in the management of nonsynostotic positional head deformities in infants.

METHODS

The following electronic databases were searched: PubMed/MEDLINE, ScienceDirect, CINAHL, Scopus, PEDro, and Web of Science. Two different authors conducted the searches and completed the data extraction. Randomized and non-randomized clinical trials were included. The risk of bias was assessed using the Downs and Black Scale and the Cochrane Collaboration's tool.

RESULTS

Six articles were finally included. The main features of interventions included education to parents about positioning, manual therapy, and motor stimulation. The small sample sizes were not adequately powered and methodological quality showed a high risk of bias, mainly from a lack of blinding and limited external validity.

CONCLUSION

There are indicators that suggest that physical therapist interventions may be useful for infants with nonsynostotic head deformities at improving cranial asymmetries and motor development. However, the validity of such conclusion is limited because most trials included had a high risk of bias. More rigorous research on physical therapy, including randomized controlled trials with larger sample sizes, is required in this area.

IMPACT

The high prevalence and incidence of nonsynostotic positional head deformities in infants calls for the development of effective interventions. Physical therapists have a promising role in the improvement of cranial asymmetry and motor development. The most reported interventions involved educating parents about positioning and manual therapy. Some studies show that changes obtained after physical therapist intervention were comparable with those obtained after helmet therapy.

LAY SUMMARY

Early referral to physical therapy may help to prevent or reduce the severity of nonsynostotic positional head deformities. Education about positioning is important to prevent and improve the asymmetry of the baby's head when there is nonsynostotic positional head deformity. Physical therapist interventions can improve motor development in infants with nonsynostotic positional head deformity who have motor delays.

Respiratory disturbances in fibromyalgia: A systematic review and meta-analysis of case control studies

Background: Fibromyalgia is a debilitating syndrome characterized by diffuse and chronic musculoskeletal pain.Objective: To perform a systematic review and meta-analysis of case-control studies to explore the respiratory disturbances among persons with fibromyalgia.Study appraisal and synthesis method: This review was performed in accordance with PRISMA guidelines (PROSPERO; identification number CRD: 42,020,196,835). We systematically searched seven electronic databases for articles published before December 2020.Eligibility criteria: Case-control studies comparing adults with fibromyalgia syndrome and healthy individuals with regard to the respiratory disturbances.Results: A total of six studies were included in the quantitative analysis. Pooled analysis showed that persons with fibromyalgia reported reduced chest expansion (MD -0.72, 95% CI, -1.70 to 0.27, I² = 95%, p = 0.016), maximum expiratory pressure (MD -10.67, 95% CI, -18.62 to -2.72, I² = 77%, p = 0.009), maximum inspiratory pressure (MD 11.04, 95% CI, -14.45 to -7.62, I² = 0%, p < 0.001) and maximal voluntary ventilation (MD 11.79, 95% CI, -16.80 to -7.78, I² = 0%, p < 0.001).Conclusion: Persons with fibromyalgia experience respiratory disturbances, such as reduced chest expansion, maximum expiratory pressure, maximum inspiratory pressure, and maximal voluntary ventilation.

Exploring perceived occupational balance in women with fibromyalgia. A descriptive study

BACKGROUND

People with chronic pain conditions such as fibromyalgia may experience occupational limitations and imbalances in their basic and instrumental occupations of daily living, leisure, work, and social participation.

OBJECTIVE

To describe occupational balance in persons with fibromyalgia and to analyze whether it is associated with self-reported disability and self-efficacy to manage symptoms.

METHODS

A cross-sectional study was carried out. Individuals with fibromyalgia were invited to participate. Occupational balance was assessed with the Occupational Balance Questionnaire; self-reported disability was assessed with the World Health Organization Disability Assessment Schedule, WHODAS 2.0-12; and self-efficacy was evaluated with the 8-item version of the Arthritis Self-Efficacy Scale. Data were analyzed using multiple linear regression with a forward stepwise procedure.

RESULTS

One hundred women with fibromyalgia were included. Occupational balance was 26.96 ± 12.09; however, scores differed between the mild disability group and the moderate disability group (33.11 ± 9.99 vs. 20.29 ± 10.61, p < 0.001). Multiple linear regression analyses revealed that self-reported disability and self-reported pain management explained 58.1% of the variance in occupational balance.

CONCLUSION

Women with fibromyalgia showed low occupational balance. Self-reported disability and self-reported pain management were associated with occupational balance.

SIGNIFICANCE

Occupational therapy practitioners can design intervention programs focussing on occupational balance and self-efficacy to manage symptoms.

Deficits underlying handgrip performance in mildly affected chronic stroke persons

BACKGROUND

Knowledge of the deficits underlying handgrip performance is fundamental for the development of targeted interventions.

OBJECTIVES

The purpose of this study was to evaluate maximal handgrip strength, fatigue resistance, grip work, and muscle fatigue in mildly affected stroke persons.

METHODS

We conducted a prospective observational study. A total of 20 individuals after a first unilateral ischemic/hemorrhagic chronic stroke (months poststroke: mean 33.64 ± 19.60), mildly affected according to functional score (FIM: 112.71 ± 16.14) and with arm motor impairment (upper-extremity Fugl-Meyer score: mean 57.07 ± 7.82 on the contralesional side); and 20 sex and age-matched controls were included. The outcomes assessed were maximal handgrip strength evaluated through maximal voluntary contraction, fatigue resistance defined as the seconds during which grip strength dropped to 50% of its maximum and gripwork, which was calculated using the equation grip work = maximal grip strength * 0.75 * fatigue resistance. Muscle fatigue was assessed using surface electromyography during a sustained contraction over 50% of maximal voluntary contraction.

RESULTS

Persons with stroke demonstrated significantly reduced handgrip performance regarding maximal handgrip strength, resistance to fatigue, grip work, and muscle fatigue for the contralesional hand. In addition, a reduced grip resistance and muscle fatigue was shown for the ipsilesional hand compared with controls. We found no effect of the hemispheric side of the lesion on the grip performance measures assessed.

CONCLUSIONS

Our findings provide evidence that handgrip performance remain impaired after 6 months after stroke, and may serve as a target for interventions to improve these abilities after stroke.

Effects of a core stabilization training program on balance ability in persons with Parkinson's disease: a randomized controlled trial

OBJECTIVE

To explore the effects of an eight-week core stability program on balance ability in persons with Parkinson's disease.

DESIGN

Randomized controlled trial.

SETTING

A local Parkinson's association.

SUBJECTS

A total of 44 participants with a clinical diagnosis of Parkinson's disease were randomly assigned to an experimental (n = 22) or control group (n = 22).

INTERVENTION

The experimental group received 24 sessions of core training, while the control group received an intervention including active joint mobilization, muscle stretching, and motor coordination exercises.

MAIN MEASURES

The primary outcome measure was dynamic balance evaluated using the Mini-Balance Evaluation Systems Test. Secondary outcomes included the balance confidence assessed with the Activities-specific Balance Confidence Scale and standing balance assessed by the maximal excursion of center of pressure during the Modified Clinical Test of Sensory Interaction on Balance and the Limits of Stability test.

RESULTS

After treatment, a significant between-group improvement in dynamic balance was observed in the experimental group compared to the control group (change, 2.75 ± 1.80 vs 0.38 ± 2.15, P = 0.002). The experimental group also showed a significant improvement in confidence (change, 16.48 ± 16.21 vs 3.05 ± 13.53, P = 0.047) and maximal excursion of center of pressure in forward (change, 0.86 ± 1.89 cm vs 0.17 ± 0.26 cm, P = 0.048), left (change, 0.88 ± 2.63 cm vs 0.07 ± 0.48 cm, P = 0.010), and right (change, 1.63 ± 2.82 cm vs 0.05 ± 0.17 cm, P = 0.046) directions of limits of stability compared to the control group.

CONCLUSION

A program based on core stability in comparison with non-specific exercise benefits dynamic balance and confidence and increases center of mass excursion in patients with Parkinson's disease.

Does adding an integrated physical therapy and neuromuscular electrical stimulation therapy to standard rehabilitation improve functional outcome in elderly patients with pneumonia? A randomised controlled trial

OBJECTIVE

To compare the effects of an integrated programme of physical and electrical therapy to standard rehabilitation to improve physical and functional performance in elderly patients with pneumonia.

DESIGN

Randomized clinical trial. The study was registered in the ClinicalTrial.gov website (identifier: NCT02515565).

SETTING

University Hospital.

SUBJECTS

In total, 185 elderly patients with pneumonia were eligible for the study, of which 95 were finally randomized.

INTERVENTIONS

Patients were randomized to a control group which received the standard treatment or to an intervention group which received additionally an integrated programme of physical and electrical therapy.

MAIN MEASURES

Demographic and clinical information was acquired. Pulmonary function, length of hospital stay, handgrip strength, independence levels and comorbidities were assessed as descriptive outcomes. The main outcome measure was functional and physical performance, evaluated with the short physical performance battery. Secondary outcome measures were respiratory symptoms including dyspnoea, fatigue and cough.

RESULTS

Mean age of patients was 74.92 (11.03) years in the intervention group and 72.53 (9.24) years in the control group. Significant between groups differences (P < 0.05) were found in short physical performance battery chair stand test (2.17 (0.97) vs. 0.58 (0.61)) and total score (5.91 (3.61) vs. 4.15 (3.15)). The intervention group showed better performance than the control group in both cases. Fatigue (32.04 (18.58) vs. 46.22 (8.90)) and cough (18.84 (2.47) vs. 17.40 (3.67)) showed higher improvement in the intervention group, and significant differences were observed between the groups.

CONCLUSION

An integrated programme of physical and electrical therapy during hospitalization improves physical and functional performance in patients with pneumonia.

Agreement Between Face-to-Face and Tele-assessment of Upper Limb Functioning in Patients with Parkinson Disease

BACKGROUND

Upper limb disturbances are prevalent in patients with Parkinson disease (PD) and can limit their participation in activities of daily living. Tele-assessment of upper limb motor symptoms using an Internet application may be an alternative for addressing the growing demand for monitoring of disease progression.

OBJECTIVE

To evaluate the level of agreement between face-to-face and tele-assessment of patients with PD.

DESIGN

Reliability study.

SETTING

Parkinson's Disease Association.

PARTICIPANTS

Twenty-one patients with PD from a local association participated in the study.

METHODS

Patients attended a session for clinical face-to-face and real-time online tele-assessment.

MAIN OUTCOME MEASUREMENTS

Upper limb measures of function (assessed with the Manual Ability Measure 16), dexterity (evaluated using the coin rotation task), motor speed (assessed by the finger tapping test), tremor (evaluated with the Fahn-Tolosa-Marin Tremor Rating Scale), and range of motion (using the Kinovea software) were recorded by two independent researchers.

RESULTS

All the outcome measures evaluated showed a good interrater, intraclass correlation coefficient (ρ > 0.75). In addition, most confidence intervals were narrow and excluded 0.8. The lowest reliability was obtained for elbow flexion of the most affected upper limb (ρ = 0.75; confidence interval 0.49-0.89) and the highest reliability for finger tapping tests (ρ = 1; 1, 1).

CONCLUSIONS

This study demonstrates high interrater reliability of upper limb tele-assessment in patients with PD compared to a face-to-face assessment.

LEVEL OF EVIDENCE

III.

[Association between the functional impact of osteoarthritis and body mass index in women]

BACKGROUND

Obesity is associated with pain, reduction of function and quality of life in patients with osteoarthritis (OA).

AIM

To describe the clinical profile of women with knee OA according to their body mass index (BMI).

MATERIAL AND METHODS

Observational study in 308 women with knee OA. According to their BMI, they were classified as normal-weight, overweight and obese. The primary outcome measure was functionality evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes were sleep quality evaluated using the Pittsburgh Sleep Quality Index (PSQI) and quality of life assessed with the European Quality of Life Five Dimension (EuroQol-5D).

RESULTS

WOMAC, PSQI and EuroQol-5D scores were significantly higher in obese women.

CONCLUSIONS

Overweight and obese women with OA have more sleep disorders, reduction on functionality and quality of life compared to their normal weight counterparts.

Actitudes de estudiantes españoles de terapia ocupacional hacia las personas mayores

Introducción. La población mundial está creciendo y envejeciendo. Debido al cambio demográfico en la población, gran parte de los profesionales de ciencias de la salud trabajarán con personas mayores, aunque la mayoría de los estudiantes de estas áreas tienen poco conocimiento e interés para ocuparse de esta población.Objetivo. Analizar las actitudes hacia las personas mayores en los estudiantes del programa de Terapia Ocupacional de la Universidad de Granada en España.Materiales y métodos. Estudio descriptivo. Se utilizó la escala de actitudes hacia el adulto mayor de Kogan (KAOP), validada al español, en 109 estudiantes de Terapia Ocupacional de la Universidad de Granada.Resultados. Los estudiantes participantes manifestaron tener, de media, una actitud neutral hacia el adulto mayor (valor KAOP 143.60±11.70). No se encontraron diferencias estadísticamente significativas por género ni por año académico (p=0.804) en los datos observados.Conclusiones. La actitud observada hacia el adulto mayor entre los estudiantes de Terapia Ocupacional de la Universidad de Granada es neutral, sin diferencias por género ni por año académico. Son necesarios estudios futuros sobre la temática para esclarecer las posibles causas de esta actitud.

A randomized controlled study of whether setting specific goals improves the effectiveness of therapy in people with Parkinson's disease

OBJECTIVE:

To evaluate the effects of an intervention based on a specific set of goals on goal attainment, manual dexterity, hand grip strength and finger prehension force compared to a standardized approach in patients with Parkinson's disease.

DESIGN:

Randomized controlled trial.

SETTING:

Home-based.

PARTICIPANTS:

Fifty patients with a clinical diagnosis of Parkinson's disease acknowledging impaired manual ability were randomized into two groups.

INTERVENTIONS:

Patients in the experimental group ( n = 25) were included in an intervention focused on task components that involved goals proposed by participants. Patients in the control group ( n = 25) received a standard intervention focused on impairments in range of motion, grasp and manipulation. Home condition and duration (four weeks, twice a week) were similar in both groups.

MAIN OUTCOME MEASURES:

The primary outcome measure was goal achievement assessed with the Goal Attainment Scaling. Secondary outcomes were manual dexterity evaluated with the Purdue Pegboard Test and hand grip strength and finger prehension force assessed using a dynamometer.

RESULTS:

After four weeks, significant between-group improvement in goal attainment was observed in the experimental group (change 17.36 ± 7.48 vs. 4.03 ± 6.43, P < 0.001). Compared to the control group, the experimental group also showed a significant improvement ( P < 0.05) in manual dexterity (postintervention values in the most affected arm 10.55 ± 1.95 vs. 7.33 ± 3.63 pins, P < 0.001) and finger prehension force (postintervention values in the most affected arm 8.03 ± 1.93 vs. 6.31 ± 1.85 kg, P = 0.010).

CONCLUSIONS:

Targeting therapy toward specific goals leads to greater changes in arm function than a standardized approach in people with Parkinson's disease.

Effects of a Patient-Centered Graded Exposure Intervention Added to Manual Therapy for Women With Chronic Pelvic Pain: A Randomized Controlled Trial

OBJECTIVE

To explore the effects of a 6-week patient-centered graded exposure intervention added to manual therapy in women with chronic pelvic pain (CPP) and fear of movement/(re)injury.

DESIGN

Prospective 3-armed randomized controlled trial.

SETTING

Faculty of Health Sciences.

PARTICIPANTS

A total of 49 women with CPP and substantial fear of movement were randomly allocated to 1 of 3 groups: (1) patient-centered graded exposure intervention added to manual therapy; (2) manual therapy; (3) control group.

INTERVENTIONS

The 6-week intervention consisted of 12 sessions in the group receiving manual therapy and 6 additional sessions of graded exposure therapy in the group receiving both interventions.

MAIN OUTCOME MEASURES

Primary outcomes were fear-avoidance behavior assessed using the Fear-Avoidance Beliefs Questionnaire and pain interference and severity evaluated with the Brief Pain Inventory. The secondary outcome was disability evaluated with the Oswestry Disability Index. All the variables were assessed in a blinded manner at baseline, after the treatment, and at 3-month follow-up.

RESULTS

Our results show interaction effects (P<.05) for all the outcomes. Graded exposure added to manual therapy is distinctly superior to manual therapy alone in maintaining improvements for long-term fear-avoidance behavior and physical functioning.

CONCLUSIONS

Graded exposure added to manual therapy is a promising approach with long-term effects for women with CPP and fear of movement/(re)injury.

Uso de test dual en ancianos institucionalizados con diferentes niveles de deterioro cognitivo. Estudio transversal

Introducción. El envejecimiento se ha relacionado con una mayor prevalencia de deterioro cognitivo. Las personas mayores con pérdida de funciones cognitivas presentan elevadas tasas de caídas. El desarrollo de las actividades de la vida diaria engloba dos o más tareas, siendo necesarios componentes cognitivos y motores.Objetivo. Analizar el rendimiento en pruebas sencillas y duales de sujetos en entorno residencial con diferentes grados de deterioro cognitivo.Materiales y métodos. Se realizó un estudio observacional de corte transversal en ancianos institucionalizados >65 años (n=80). Se evaluó el deterioro cognitivo con el Mini-Mental State Examination y se solicitó a los participantes realizar una tarea simple y dual en las pruebas Six-Minute Walk Test (6MWT) y Timed Up and Go (TUG).Resultados. Se distribuyeron los participantes en tres grupos. Se encontraron diferencias significativas entre los grupos con deterioro cognitivo y el grupo sin deterioro cognitivo para las pruebas 6MWT (p<0.05) y TUG (p<0.05), tanto en la tarea simple como en la tarea dual. Un peor rendimiento se asoció con una menor capacidad cognitiva.Conclusión. La severidad del deterioro cognitivo se encuentra relacionada con el desempeño en las tareas duales.

Effects of home-based neuromuscular electrical stimulation in severe chronic obstructive pulmonary disease patients: a randomized controlled clinical trial

BACKGROUND

Chronic obstructive pulmonary disease (COPD) patients experience a sustained deterioration of several capacities. Those with severe COPD undergo a considerable decline in their physical and functional capacities, but pulmonary rehabilitation (PR) is used to reduce the weakness of such patients. To date, neuromuscular electrical stimulation (NMES) has been used in acute COPD patients but NMES superimposed onto voluntary muscular contraction has not been tested in COPD patients.

AIM

The aim of this study was to evaluate the effects of superimposed NMES on the cardiorespiratory performance and functionality of severe COPD patients undergoing a home-based rehabilitation program.

DESIGN

This was a randomized controlled clinical trial.

POPULATION

A total of 36 stable severe COPD patients were included in this study and were randomly divided into two groups: an intervention group and a control group.

SETTING

The study was conducted as a home-based program.

METHODS

The control group received standard medical treatment. The intervention group additionally underwent an individualized physical therapy program. The intervention consisted of a pulmonary rehabilitation (PR) protocol for 8 weeks (2 h/week). The protocol was carried out as follows: 10 minutes of controlled breathing training; 30 minutes of NMES superimposed onto voluntary muscular contraction; and 5 minutes of relaxation/cool-down. The outcome measures were cardiorespiratory performance measured using the 6-Minute Walk Test in the treadmill and functionality assessed with the functional independence measure.

RESULTS

In the intervention group, significant improvements were observed after the treatment in cardiorespiratory performance and functionality (P<0.05), while the control group did not show any significant changes (P>0.05). The between-group analysis showed significant differences in cardiorespiratory performance and functionality (P<0.05).

CONCLUSIONS

An 8-week individualized home-based PR program including controlled breathing training, aerobic exercise with elastic bands, and NMES superimposed onto voluntary muscle contraction significantly improves cardiorespiratory performance and functionality in stable COPD patients.

CLINICAL REHABILITATION IMPACT

A home-based pulmonary rehabilitation program including controlled breathing training, and NMES superimposed onto voluntary muscle contraction significantly improves cardiorespiratory performance and functionality in stable COPD patients.