Antonio Cuesta-Vargas

Exercise, Manual Therapy, and Education with or Without High-Intensity Deep-Water Running for Nonspecific Chronic Low Back Pain A Pragmatic Randomized Controlled Trial

Objectives: The aim of this study on persons with nonspecific chronic low back pain was to evaluate the effect of a multimodal physical therapy program with or without the addition of deep-water running on pain, physical disability, and general health. Design: A randomized controlled trial involving 46 subjects with nonspecific chronic low back pain were treated three times a week for 15 wks. Each group received 60 mins of multimodal physical therapy program (an individualized exercise program; manual therapy; and back care, pain education, and information on an active lifestyle), whereas one group performed additional 20-min sessions of deep-water running at an individual workload of the aerobic threshold. Results: Both interventions resulted in significant improvements in pain, disability, and physical health. The mean change in pain, disability, and physical health state were −36.1 ± 25.1 mm on the visual analog scale, −3.0 ± 4.8 points for the Roland Morris Questionnaire, and 10.6 ± 12.9 points for the Short Form-12 for the physical therapy plus deep-water running group and −34.1 ± 26.0 mm on the visual analog scale, −1.6 ± 1.5 points for the Roland Morris Questionnaire, and 8.9 ± 13.0 points for the Short Form-12 for the physical therapy alone group. Conclusions: Pain, disability, health status, muscle strength and endurance, and lumbar range of motion significantly improved in both groups. The addition of a deep-water running program at an individual workload of the aerobic threshold to the multimodal physical therapy program produced a significant improvement in pain in patients with nonspecific chronic low back pain, but this was not significantly different when compared with multimodal physical therapy program alone. Disability, health status, muscle strength and endurance, and lumbar range of motion significantly improved to a similar level in both intervention groups.

The Effectiveness of a Deep Water Aquatic Exercise Program in Cancer-Related Fatigue in Breast Cancer Survivors: A Randomized Controlled Trial

OBJECTIVE To investigate the effectiveness of an 8-week aquatic program on cancer-related fatigue, as well as physical and psychological outcomes in breast cancer survivors. DESIGN A randomized controlled trial. SETTING Outpatient clinic, urban, academic medical center, and a sport university swimming pool. PARTICIPANTS Breast cancer survivors (N=68) were randomly assigned to either an experimental (aquatic exercise group in deep water pool) group or a control (usual care) group. INTERVENTIONS The intervention group attended aquatic exercise sessions 3 times per week for 8 weeks in a heated deep swimming pool. Sessions lasted 60 minutes in duration: 10 minutes of warm-up, 40 minutes of aerobic and endurance exercises, and 10 minutes of cool-down exercises. Patients allocated to the usual care group followed the oncologists recommendations in relation to a healthy lifestyle. MAIN OUTCOME MEASURES Values for fatigue (Piper Fatigue Scale), mood state (Profile of Mood States), and abdominal (trunk curl static endurance test) and leg (multiple sit-to-stand test) strength were collected at baseline, after the last treatment session, and at a 6-month follow-up. RESULTS Immediately after discharge, the aquatic exercise group showed a large effect size in total fatigue score (d=.87; 95% confidence interval, .48-1.26), trunk curl endurance (d=.92; 95% confidence interval, 1.97-3.83), and leg strength (d=1.10; .55-2.76), but negligible effects in vigor, confusion, and disturbance of mood (d<.25). At the 6-month follow-up period, the aquatic exercise group maintained large to small effect sizes in fatigue scores, multiple sit-to-stand test, and trunk curl static endurance (.25>d>.90) and negligible effects for the fatigue-severity dimension and different scales of the Profile of Mood States (d<.25). CONCLUSION An aquatic exercise program conducted in deep water was effective for improving cancer-related fatigue and strength in breast cancer survivors.

Attitudes towards massage modify effects of manual therapy in breast cancer survivors: a randomised clinical trial with crossover design.

Our aims were to investigate the immediate effect of myofascial release on heart rate variability and mood state, and the influence of attitude towards massage in breast cancer survivors with cancer-related fatigue. Twenty breast cancer survivors reporting moderate to high cancer-related fatigue participated in this crossover study. All patients presented to the laboratory at the same time of the day on two occasions separated by a 2-week interval. At each session, they received either a massage intervention or control intervention. Holter electrocardiogram recordings and Profile of Mood States questionnaire (six domains: tension-anxiety, depression-dejection, anger-hostility, vigour, fatigue, confusion) were obtained before and immediately after each intervention. The attitude towards massage scale was collected before the first session in all breast cancer survivors. The results showed a significant session × time interaction for standard deviation of the normal-to-normal interval (SDNN) (F= 5.063, P= 0.039), square root of mean squared differences of successive normal-to-normal intervals (RMSSD) (F= 8.273, P= 0.010), high-frequency component (HF) (F= 7.571, P= 0.013), but not for index heart rate variability (F= 3.451, P= 0.080), low-frequency component (LF) (F= 0.014, P= 0.997) and ratio LF/HF (F= 3.680, P= 0.072): significant increases in SDNN, RMSSD and HF domain (P < 0.05) were observed after the manual therapy intervention, with no changes after placebo (P > 0.6). No influence of the attitude scale on heart rate variability results was found. A significant session × time interaction was also found for fatigue (F= 5.101, P= 0.036) and disturbance of mood (F= 6.690, P= 0.018) scales of the Profile of Mood States: patients showed a significant decrease in fatigue and disturbance of mood (P < 0.001) after manual therapy, with no changes after placebo (P > 0.50). A significant influence of the attitude scale was observed in tension-anxiety, depression-dejection and anger-hostility scales. This controlled trial suggests that massage leads to an immediate increase of heart rate variability and an improvement in mood in breast cancer survivors with cancer-related fatigue. Further, the positive impact of massage on cancer-related fatigue is modulated by the attitude of the patient towards massage.

Physical fitness profile in adults with intellectual disabilities: Differences between levels of sport practice

Neuromuscular and aerobic capacity can be reduced in people with intellectual disabilities (ID). Previous studies suggest these individuals might be particularly susceptible to losing basic functions because of poor physical fitness. The aim of this study is to describe the physical fitness profile of adult athletes with ID and identify whether there are differences in the physical performance between the most physically active individuals and less active individuals. A cross-sectional observational study was developed involving 266 athletes with mild ID (187 males and 79 females), recruited from the Spanish Special Olympics Games. A questionnaire was used to evaluate the health status of participants and their frequency of physical activity practice. A battery of 13 fitness tests was applied to assess flexibility, strength/endurance, balance and cardiovascular capabilities. Of the total participants, 44.3% were classified as sportspersons and the remainder as non sportspersons, taking in consideration the frequency of physical activity. Regarding the scores, a significant difference was found in degrees of flexibility between genders, higher for females for one test but higher for males in the other three. A significant difference was not encountered between other variables of physical fitness, although the mens scores were higher in strength/endurance and balance. When the scores of the sportspersons and non sportspersons groups were compared, no significant difference was found between the two, with the exception of one test for flexibility. Differences among groups and gender were not statistically significant in most of the tests. The findings in this study illustrate an unclear and inconclusive relation between the scores and the declared level of physical activity, maybe due to the context in which participants for the study were selected.

Differences in Trunk Accelerometry Between Frail and Nonfrail Elderly Persons in Sit-to-Stand and Stand-to-Sit Transitions Based on a Mobile Inertial Sensor

Background Clinical frailty syndrome is a common geriatric syndrome, which is characterized by physiological reserve decreases and increased vulnerability. The changes associated to ageing and frailties are associated to changes in gait characteristics and the basic functional capacities. Traditional clinical evaluation of Sit-to-Stand (Si-St) and Stand-to-Sit (St-Si) transition is based on visual observation of joint angle motion to describe alterations in coordination and movement pattern. The latest generation smartphones often include inertial sensors with subunits such as accelerometers and gyroscopes, which can detect acceleration. Objective Firstly, to describe the variability of the accelerations, angular velocity, and displacement of the trunk during the Sit-to-Stand and Stand-to-Sit transitions in two groups of frail and physically active elderly persons, through instrumentation with the iPhone 4 smartphone. Secondly, we want to analyze the differences between the two study groups. Methods A cross-sectional study that involved 30 subjects over 65 years, 14 frail and 16 fit subjects. The participants were classified with frail syndrome by the Fried criteria. Linear acceleration was measured along three orthogonal axes using the iPhone 4 accelerometer. Each subject performed up to three successive Si-St and St-Si postural transitions using a standard chair with armrest. Results Significant differences were found between the two groups of frail and fit elderly persons in the accelerometry and angular displacement variables obtained in the kinematic readings of the trunk during both transitions. Conclusions The inertial sensor fitted in the iPhone 4 is able to study and analyze the kinematics of the Si-St and St-Si transitions in frail and physically active elderly persons. The accelerometry values for the frail elderly are lower than for the physically active elderly, while variability in the readings for the frail elderly is also lower than for the control group.

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

IntroductionCognitive 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.MethodsThe 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).ResultsOn 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.ConclusionsBecause 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 registrationCurrent Controlled Trials ISRCTN10804772. Registered 29 September 2008.

The Contribution of Previous Episodes of Pain, Pain Intensity, Physical Impairment, and Pain-Related Fear to Disability in Patients with Chronic Mechanical Neck Pain

Objective The influence of physical and psychosocial variables on self-rated disability in patients with chronic mechanical neck pain has not been fully determined. This study examined the relationship of pain, physical impairment, and pain-related fear to disability in individuals with chronic mechanical neck pain. Design A cross-sectional study was conducted. Ninety-seven (n = 97) subjects (28 men, 69 women; mean age, 39.3 yrs) with chronic mechanical neck pain were prospectively recruited. Demographic information, duration of pain symptoms, pain intensity, pain-related fear, and cervical range of motion were collected on all subjects. Self-reported disability was measured with the Neck Disability Index. Correlation and regression analyses were performed to determine the association among the variables and to determine the proportions of explained variance in disability. Results Significant positive correlations existed between disability and previous history of neck pain (r = 0.45; P < 0.001), disability and pain intensity (r = 0.32, P = 0.01), and disability and kinesiophobia (r = 0.23, P = 0.02). In addition, a significant negative correlation existed between disability and cervical extension range of motion (r = −0.18, P = 0.04). Stepwise regression analyses revealed that previous neck pain episodes, intensity of neck pain, kinesiophobia, and cervical extension range of motion were significant predictors of disability (r 2 = 0.400; r 2 adjusted = 0.372; F = 14.64; P < 0.001). Conclusions This study found that previous episodes of neck pain, pain intensity, pain-related fear, and cervical extension range of motion explained 37.2% of the variability of self-report disability. Future longitudinal studies will help to determine the clinical implications of these findings.

Cross-cultural adaptation and validation of the Foot Function Index to Spanish

BACKGROUND The purpose of this study was to adapt and validate the Foot Function Index to the Spanish (FFI-Sp) following the guidelines of the American Academy of Orthopaedic Surgeons. METHODS A cross-sectional study 80 participants with some foot pathology. A statistical analysis was made, including a correlation study with other questionnaires (the Foot Health Status Questionnaire, EuroQol 5-D, Visual Analogue Pain Scale, and the Short Form SF-12 Health Survey). Data analysis included reliability, construct and criterion-related validity and factor analyses. RESULTS The principal components analysis with varimax rotation produced 3 principal factors that explained 80% of the variance. The confirmatory factor analysis showed an acceptable fit with a comparative fit index of 0.78. The FFI-Sp demonstrated excellent internal consistency on the three subscales: pain 0.95; disability 0.96; and activity limitation 0.69, the subscale that scored lowest. The correlation between the FFI-Sp and the other questionnaires was high to moderate. CONCLUSIONS The Spanish version of the Foot Function Index (FFI-Sp) is a tool that is a valid and reliable tool with a very good internal consistency for use in the assessment of pain, disability and limitation of the function of the foot, for use both in clinic and research.

A multimodal physiotherapy programme plus deep water running for improving cancer-related fatigue and quality of life in breast cancer survivors.

The aim of the study was to assess the feasibility and effectiveness of aquatic-based exercise in the form of deep water running (DWR) as part of a multimodal physiotherapy programme (MMPP) for breast cancer survivors. A controlled clinical trial was conducted in 42 primary breast cancer survivors recruited from community-based Primary Care Centres. Patients in the experimental group received a MMPP incorporating DWR, 3 times a week, for an 8-week period. The control group received a leaflet containing instructions to continue with normal activities. Statistically significant improvements and intergroup effect size were found for the experimental group for Piper Fatigue Scale-Revised total score (d = 0.7, P = 0.001), as well as behavioural/severity (d = 0.6, P = 0.05), affective/meaning (d = 1.0, P = 0.001) and sensory (d = 0.3, P = 0.03) domains. Statistically significant differences between the experimental and control groups were also found for general health (d = 0.5, P < 0.05) and quality of life (d = 1.3, P < 0.05). All participants attended over 80% of sessions, with no major adverse events reported. The results of this study suggest MMPP incorporating DWR decreases cancer-related fatigue and improves general health and quality of life in breast cancer survivors. Further, the high level of adherence and lack of adverse events indicate such a programme is safe and feasible.

An Investigation Into the Kinematics of 2 Cervical Manipulation Techniques

OBJECTIVE The purpose of this study was to quantify the kinematics of the premanipulative position, the angular displacement, and velocity of thrust of 2 commonly used cervical spine manipulative procedures using inertial sensor technology. METHODS Thirteen asymptomatic subjects (7 females; mean age, 25.3 years; mean height, 170.9 cm; mean weight, 65.3 kg) received a right-handed and left-handed downslope and upslope manipulation, aimed at C4/5 while cervical kinematics were measured using an inertial sensor mounted on the forehead of the subject. One therapist used the upslope, and another therapist, the downslope, as was their preferred method. t tests were used to compare techniques and handiness. RESULTS The results demonstrated differences in the kinematics between the 2 techniques. The downslope manipulation was associated with a mean premanipulative position of 24.8° side bending and 2.7° rotation, thrust displacement magnitude comprising of 4.5° side bending and 5.4° rotation with thrust velocity comprising, on average, of 57.5°/s side bending and 74.8°/s rotation. Upslope premanipulation was on average comprised of 30.1° side bending and 8.4° rotation, thrust displacement comprised of 4.5° side bending and 12.7° rotation with thrust velocity comprising of 75.9°/s side bending and 194.7°/s rotation. CONCLUSION The results of this study demonstrate that there are different kinematic patterns for these 2 manipulative techniques.