Reliability and Validity of the Spanish Version of the Brief-BESTest in Stroke Patients

Background: Balance disorders and postural control treatments play an important role in fall prevention. The Brief-BESTest is a short-scale employed to evaluate balance and fall risk in different populations. Balance assessment is a fundamental element in patients with Acquired Brain Injury rehabilitation since postural alteration is one of the most frequent sequelae. The objective was to validate the Spanish version of the Brief-BESTest questionnaire in the stroke population. Methods: Subjects of both sexes aged over 18 years with a diagnosis of acute/chronic stroke were included. The BESTest, Mini-BESTest, Brief-BESTest, Berg Balance Scale, and Timed Up & Go Test were used to assess balance. The scales were implemented once. Cronbach's alpha coefficient was used to assess the internal consistency and confirmatory factorial analysis was employed to assess validity. Results: A total of 44 patients with a mean age of 65.35 years (SD = 10.665) participated. Cronbach's alpha coefficient showed a high internal consistency with a value of 0.839. In the criterion validity, there was a high positive correlation between the Brief-BESTest and BESTest (r = 0.879), Mini-BESTest (r = 0.808), and Berg Balance Scale (r = 0.711). Conclusion: The Spanish version of the Brief-BESTest scale is valid and reliable, showing adequate psychometric properties for balance assessment in patients with acute or chronic stroke.

Synergy of Muscle and Cortical Activation through Vojta Reflex Locomotion Therapy in Young Healthy Adults: A Pilot Randomized Controlled Trial

BACKGROUND

Vojta Therapy is a neurorehabilitation therapy that allows to activate reflex movement patterns. The scientific literature has shown its ability to generate muscle contractions. The activation of brain neural networks has also been proven. However, the relationship between these processes has not yet been demonstrated. For this reason, the aim of this study is to verify brain activation produced by recording with near-infrared spectroscopy and its relationship with muscle activation produced in the abdominal muscles recorded with surface electromyography.

METHODS

A total sample of 27 healthy subjects over 18 years of age was recruited. An experimental study on a cohort was conducted. Two experimental conditions were considered: stimuli according to the Vojta protocol, and a control non-stimuli condition. Abdominal muscle activation was measured using surface electromyography, and the activation of the motor cortex was assessed with near-infrared spectroscopy.

RESULTS

In relation to the oxygenated hemoglobin concentration (HbO), an interaction between the stimulation phase and group was observed. Specifically, the Vojta stimulation group exhibited an increase in concentration from the baseline phase to the first resting period in the right hemisphere, contralateral to the stimulation area. This rise coincided with an enhanced wavelet coherence between the HbO concentration and the electromyography (EMG) signal within a gamma frequency band (very low frequency) during the first resting period.

CONCLUSIONS

The results underscore the neurophysiological effects on the brain following tactile stimulation via Vojta Therapy, highlighting increased activity in pivotal areas essential for sensory processing, motor planning, and control. This activation, particularly evident in the Vojta stimulation group, aligns with previous findings, suggesting that tactile stimuli can not only evoke the intention to move but can also initiate actual muscle contractions, emphasizing the therapy's potential in enhancing innate locomotion and rolling movements in patients with neurological disorders.

A web-based educational therapy intervention associated with physical exercise to promote health in fibromyalgia in Brazil: the Amigos De Fibro (Fibro Friends) study protocol

BACKGROUND

Health education is one of the main items to enable health promotion to patients with fibromyalgia. The objective of the study "Amigos de Fibro (Fibro Friends)" is to evaluate the impact of an educational intervention associated with physical exercise based on the web in promoting health and quality of life of patients with fibromyalgia in Brazil.

METHODS

A study with a randomized controlled trial approach will be carried out. The sample will consist of 24 participants, divided into two groups, with 12 individuals each. The experimental group will participate in meetings with lectures, debates, conversation rounds and exercises by a multidisciplinary team. Physical exercises will also be performed in an online environment. On the other hand, the control group will receive an e-book of education and self-care. Primary outcomes will be quality of life. The secondary outcomes will be sociodemographic and health profile, pain intensity, sleep quality, self-care agency, usage and costs of health and social care services, viability of the program and program participation. In addition, a qualitative evaluation process will be carried out with the participants. After the intervention, the data of both groups will be collected again, as well as after 3, 6, and 12 months to verify the effect and the maintenance of the intervention.

DISCUSSION

The results will provide data for studies to consider the use of this tool in the future by professionals working in the field of rheumatology.

TRIAL REGISTRATION

The protocol was registered in the Brazilian Registry of Clinical Trials RBR-3rh759 ( https://trialsearch.who.int/Trial2.aspx?TrialID=RBR-3rh759 ). Date of registration: 07/02/2020].

Validity of the telematic Fugl Meyer assessment scale - upper extremity (TFMA-UE) Spanish version

Background

Telematic assistance has become indispensable in recent years. The increased prevalence of Acquired brain injury and the sequels it causes, requires long-lasting multidisciplinary treatments. Validated tools to assess the evolution of the disabilities and limitations of this pathology are essential to individualize and prescribe adapted treatments. The aim has been to create the telematic version of the Fugl Meyer Assessment-Upper Extremity Motor Function (TFMA-UE) Spanish scale and its adaptation to the remote assessment of neurologic patients.

Methods

An adapted scale was designed based on the Fugl Meyer Assessment scale-telematic version (FMA-TV): TFMA-UE. This scale is composed by 21 items which evaluate the upper extremity motor function. Physiotherapists trained in this tool, evaluate the results obtained from applying the two versions (on-site and telematic) to compare the results.

Results

TFMA-UE was administered to 30 patients with acquired brain injury. It was applied on site and through the web platform selected by the patients in two different days. Patients completed all the scale in an easily way without help. The exploratory and confirmatory factor analysis confirmed a factorial structure with a factor (76.08% of the variance). The Cronbach's internal consistency index obtained was 0.98 and the weight kappa index used to measure agreement between the two versions was 0.78 which represents substantial agreement.

Conclusion

The Telematic Fugl Meyer Assessment-Upper Extremity Motor Function (TFMA-UE) scale is a viable, useful and easy to apply tool that allows the upper extremity motor function assessment of Acquired Brain Injury patients.

Optokinetic stimulation effects in the management of unilateral spatial neglect in patients with chronic stroke: study protocol for a randomised controlled trial

INTRODUCTION

Unilateral spatial neglect (USN) is a stroke complication of stroke. Optokinetic stimulation (OKS) is one of the treatments, but its effects on motor symptoms, such as poverty or alterations in movements on the affected side, are not clear yet. The aim of this study will be to evaluate the OKS effects on the perceptual and postural complications of patients with USN.

METHODS AND ANALYSIS

Randomised double-blinded clinical trial, with an intervention group that will undergo OKS and a control placebo group. The research will take place at the Faculty of Nursing and Physiotherapy, University of Salamanca, 102 patients older than 18 years with diagnosed USN will participate. The intervention group will receive 2 weekly OKS session for 10 weeks. Virtual reality glasses will be used for the application of a video. The video will project OKS at a preset speed and will request the participant's attention throughout the session. The control group will receive a placebo treatment, through a virtual reality video. The measurement variables will be posturography, Fluff test, line bisection, Fullerton Advance Balance Scale and Diller's cancellation test.

ETHICS AND DISSEMINATION

This study has been approved by the Ethics Committee University of Salamanca on February 2020 (registration number: 584). All patients in the study will be informed about the objective of the study and will give their written informed consent to participate in the study. The anonymised database will be available from the publication of the results for 10 years in the repository of the University of Salamanca GREDOS (https://gredos.usal.es/). The trial results will be shared with the scientific community at international conferences and by publication in a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

NCT04663646.

Long-Term Effects of Inspiratory Muscle Training in Institutionalized Elderly Women: A Double-Blind Randomized Controlled Trial

BACKGROUND

Inspiratory muscle training (IMT) has been applied to different populations, but evidence in elderly women and maintenance of improvements achieved during training is scarce. The objective of the study was to evaluate the effectiveness of IMT 6 months after finishing the training period in elderly women.

METHODS

A controlled, randomized, double-blind trial was conducted, with allocation concealment performed on 26 institutionalized elderly women distributed into 2 groups: high loads and low loads. Over an 8-week period, an IMT protocol was followed; later, elderly women continued for 6 months with their daily normal activities. Inspiratory strength, expiratory strength, and functional capacity were measured pre-IMT, post-IMT, and 6 months after intervention.

RESULTS

After an 8-week training, respiratory strength and functional capacity increased in both groups. Six months after finishing the intervention, these benefits were lost. Inspiratory strength decreased in the high-loads group but was 32% higher than initial values (p = 0.007); in the low-loads group, patients lost 41% (p = 0.015). Improvements were higher in the high-loads group after training (p = 0.000) and follow-up (p = 0.002). Functional capacity was similar to initial values in both groups.

CONCLUSION

The improvements achieved with IMT in elderly women disappeared 6 months after the end of training. High loads were more effective to keep inspiratory strength than low loads.

Electromyographic Response of the Abdominal Muscles and Stabilizers of the Trunk to Reflex Locomotion Therapy (RLT). A Preliminary Study

Reflex locomotion therapy (RLT) was developed by Vaclav Vojta in 1954 as a diagnostic and treatment tool. This therapy is mainly used to rehabilitate children with motor disorders and risk of cerebral palsy. It is also used for adults with neurological and motor impairment. RLT is based on specific postures and regular stimulation points through which a series of reflex responses are triggered. The neurophysiological mechanisms of this therapy have recently been discovered. This study aims to objectively evaluate muscular responses at the abdominal level after stimulation in the first phase of reflex rolling by showing, with surface electromyography analysis (sEMG), the muscular activity in trunk stabilizing muscles (rectus abdominis, external oblique, internal oblique, and serratus anterior) before, during, and after the application of RLT. A total sample of 27 healthy subjects over 18 years of age was recruited. An experimental study on a cohort was conducted. Two experimental conditions were considered: stimuli according to the Vojta protocol, and a control non-STI condition. Regarding muscular electrical activity, statistically significant differences were determined in all muscles during right-sided stimulation in the VSTI condition (p < 0.001), but not in the non-STI condition. The mean increase in muscle activity in the VSTI condition during the first stimulation ranged from 7% to 20% in the different abdominal muscles. In conclusion, an sEMG response was observed in the abdominal muscles during stimulation of the pectoral area as described in RLT, compared to stimulation of non-described areas.

[Adaptation and feasibility of the online version of the Fugl Meyer scale for the assessment of patients following cerebrovascular accidents]

INTRODUCTION

Patients who have suffered a chronic cerebrovascular accident or a stroke need long-term physiotherapy treatments. However, they have had to be stopped due to the COVID-19 pandemic. To be able to offer these patients an online functional assessment, a proposal was put forward to design an adaptation of the Spanish version of the Fugl Meyer assessment scale and to test its viability.

PATIENTS AND METHODS

The adapted online scale, based on the Fugl Meyer assessment scale. The motor function, balance and pain domains were kept, and items requiring assistance for the patient were removed. This scale was administered to 13 patients with a chronic cerebrovascular accident from the Salamanca Acquired Brain Injury Association (Asociacion de Dano Cerebral Adquirido) via different web platforms. The procedure followed was the same as for the original scale and lasted from 30 to 45 minutes.

RESULTS

All the patients completed the Fugl Meyer assessment scale, online version. The greatest difficulty was encountered in the assessment of the lower limbs. Patients and physiotherapists highlighted how easy it was to complete the items in the scale. On comparing the versions, statistically significant positive correlations were found with the original version (p < 0.001) and the correlation coefficients indicated a strong association. The difference between the equivalent sections of the scale in each instrument was no greater than 5%, except for balance.

CONCLUSION

The Fugl Meyer assessment scale, online version, is a feasible, useful and easy to apply scale that allows assessment of the functional status of stroke patients and can help meet the current needs during the COVID-19 pandemic.

Construct Validity of the Spanish Versions of the Memorial Symptom Assessment Scale Short Form and Condensed Form: Rasch Analysis of Responses in Oncology Outpatients

CONTEXT

The Memorial Symptom Assessment Scale (MSAS) is a self-rating instrument for the assessment of symptom distress in cancer patients. The Spanish version of the MSAS has recently been validated. However, we lack evidence of the internal construct validity of the shorter versions (short form [MSAS-SF] and condensed form [CMSAS]). In addition, rigorous testing of these scales with modern psychometric methods is needed.

OBJECTIVES

The aim of this study was to evaluate the internal construct validity and reliability of the Spanish versions of the MSAS-SF and CMSAS in oncology outpatients using Rasch analysis.

METHODS

Data from a convenience sample of oncology outpatients receiving chemotherapy (n = 306; mean age 60 years; 63% women) at a university hospital were analyzed. The Rasch unidimensional measurement model was used to examine response category functioning, item hierarchy, targeting, unidimensionality, reliability, and differential item functioning by age, gender, and marital status.

RESULTS

The response category structure of the symptom distress items was improved by collapsing two categories. The scales were adequately targeted to the study patients, showed overall Rasch model fit (mean Infit MnSq ranged from 0.98 to 1.05), met criteria for unidimensionality, and the reliability of scores was good (person reliability > 0.80), except for the CMSAS prevalence scale. Only four items showed differential item functioning.

CONCLUSION

The present study demonstrated that the Spanish versions of the MSAS-SF and CMSAS have adequate psychometric properties to evaluate symptom distress in oncology outpatients. Additional studies of the CMSAS are recommended.

Chronic obstructive pulmonary disease patients' experience with pulmonary rehabilitation: a systematic review of qualitative research

The aim of this study was to give an in-depth consideration of the chronic obstructive pulmonary disease (COPD) patients' subjective view of the impact of pulmonary rehabilitation (PR) on their lives. A systematic review in PubMed, Embase, CINAHL and PsychInfo databases yielded 3306 articles, of which 387 were duplicates, 263 remained after screening abstract and title; of them, 4 were excluded (editorial or due to lacking of full text) remaining a total of 259 for full text reading. Among these, eight studies met the inclusion criteria and were finally included. The meta-ethnography approach synthesized an understanding of the studies, which focused on constructing interpretations and developed a 'line-of-argument' synthesis. The psychosocial support of PR contributes to the patients' strength and desire for participation and the health education leads to illness-perception learning. Both psychosocial support and health education develop patients' empowerment, while PR promotes opportunities to health transitions. The empowerment experienced by the patients in taking advantage of these opportunities leads to positive impacts over time. If they do not exploit these occasions, negative impacts arise in their life, which make the treatment assistance or follow-up more difficult. The COPD patients' feedback revealed that PR promotes a better 'way of life', well-being and important behavioural changes towards health promotion.