Eulogio Pleguezuelos

Effectiveness of using blended learning strategies for teaching and learning human anatomy

Objectives  This study aimed to implement innovative teaching methods − blended learning strategies − that include the use of new information technologies in the teaching of human anatomy and to analyse both the impact of these strategies on academic performance, and the degree of user satisfaction.

Effects of whole body vibration training in patients with severe chronic obstructive pulmonary disease

To determine if whole body vibration training (WBVT) improves muscular force and modifies functional capacity parameters in patients with severe chronic obstructive pulmonary disease (COPD).

Improving physical activity in patients with COPD with urban walking circuits

BACKGROUND Even after a rehabilitation program, levels of physical activity in COPD progressively decrease unless strategies to encourage activity are implemented. We analyzed the effects of the implementation of urban walking circuits on levels of physical activity and exercise capacity of patients with severe and very severe COPD after a rehabilitation program. METHOD A total of 83 patients were randomized to either urban circuits group (UCG) or usual care in the non-circuit group (NCG), after completing a 2-week rehabilitation program. Results were evaluated 9 months after completion of the rehabilitation program and were compared with a control group of 54 patients not enrolled in the rehabilitation program. RESULTS At the end of follow-up, UCG patients increased their physical activity by a mean of 32.4 (SE = 5.9) min per day and 1.09 (SE = 0.22) days walked per week; 33.9 (SE = 5.6) min per day and 1.12 (SE = 0.24) days per week more compared to the NCG (p < 0.001). There was a significant positive correlation between the results of the 6-min walking test and minutes walked per day in the UCG (r(2) = 0.52, p < 0.05) but not in the NCG (r(2) = 0.094, p > 0.05). Controls showed a significant decrease in exercise capacity and physical activity over the follow-up. CONCLUSIONS Urban circuits are an easy, inexpensive strategy, which demonstrated to be useful to stimulate physical activity in our population of severe and very severe COPD patients and resulted in increased exercise capacity even 9 months after completion of a rehabilitation program.

The benefits of using a vacuum-assisted socket system to improve balance and gait in elderly transtibial amputees

Background: Lower limb amputation leads to impaired balance, ambulation, and transfers. Proper fit of the prosthesis is a determining factor for successful ambulation. Vacuum-assisted socket systems extract air from the socket, which decreases pistoning and probability of soft-tissue injuries and increases proprioception and socket comfort. Objectives: To investigate the effect of vacuum-assisted socket system on transtibial amputees’ performance-based and perceived balance, transfers, and gait. Study design: Quasi-experimental before-and-after study. Methods: Subjects were initially assessed using their prosthesis with the regular socket and re-evaluated 4 weeks after fitting including the vacuum-assisted socket system. We evaluated the mobility grade using Medicare Functional Classification Level, Berg Balance Scale, Four Square Step Test, Timed Up and Go Test, the 6-Min Walk Test, the Locomotor Capabilities Index, Satisfaction with Prosthesis (SAT-PRO questionnaire), and Houghton Scale. Results: A total of 16 unilateral transtibial dysvascular amputees, mean age 65.12 (standard deviation = 10.15) years. Using the vacuum-assisted socket system, the patients significantly improved in balance, gait, and transfers: scores of the Berg Balance Scale increased from 45.75 (standard deviation = 6.91) to 49.06 (standard deviation = 5.62) (p < 0.01), Four Square Step Test decreased from 18.18 (standard deviation = 3.84) s to 14.97 (3.9) s (p < 0.01), Timed Up and Go Test decreased from 14.3 (standard deviation = 3.29) s to 11.56 (2.46) s (p < 0.01). The distance walked in the 6-Min Walk Test increased from 288.53 (standard deviation = 59.57) m to 321.38 (standard deviation = 72.81) m (p < 0.01). Conclusion: Vacuum-assisted socket systems are useful for improving balance, gait, and transfers in over-50-year-old dysvascular transtibial amputees. Clinical relevance This study gives more insight into the use of vacuum-assisted socket systems to improve elderly transtibial dysvascular amputees’ functionality and decrease their risk of falls. The use of an additional distal valve in the socket should be considered in patients with a lower activity level.

Oral Drugs Related with Muscle Wasting and Sarcopenia. A Review.

Sarcopenia is a geriatric syndrome characterized by progressive and generalized loss of skeletal muscle mass and function. Reported prevalence of this geriatric syndrome, differs depending on the definition, the population and the method used to identify sarcopenia. The causes of sarcopenia are multifactorial, and can include genetic influence, immobility or disuse, endocrine factors, inflammation and nutritional deficiencies. These disorders involve an imbalance between anabolic and catabolic pathways that rules muscle mass. Many drugs taken regularly for common conditions may interact with some mechanisms that can alter the balance between protein synthesis and degradation. This may lead to a harmful or a beneficial effect on muscle mass and strength. Widely prescribed drugs could play an important role during the time of onset and development of sarcopenia. In this paper, we reviewed the current understanding of how can drugs contribute positively or negatively on sarcopenia and muscle wasting. We decided to focus this review on oral common drugs, which are usually prescribed in older adults, leaving aside other drugs as hormone therapy.

Factores relacionados con la evolución clínica del síndrome del latigazo cervical

Fundamento y objetivo LOS factores de mala evolucion clinica en el sindrome del latigazo cervical (SLC) no son concluyentes. El objetivo de este estudio longitudinal y prospectivo ha sido identificar aquellos que permitan seleccionar a pacientes con riesgo de desarrollar sintomas cronicos y discapacidad en la fase aguda del SLC. Pacientes y metodo Se incluyo a 226 pacientes con SLC secundario a accidente de trafico, que habian sido remitidos al Servicio de Medicina Fisica y Rehabilitacion para tratamiento medico rehabilitador. Ademas de recoger las variables del protocolo disenado para el estudio, se cumplimentaron la escala visual analogica (EVA) para valorar la intensidad del dolor, la Escala de Depresion y Ansiedad de Goldberg y el Northwick Park Hospital Neck Pain Questionnaire (NPH) para valorar la funcionalidad de la columna cervical en la valoracion inicial y al alta del tratamiento fisioterapico. Resultados LOS factores relacionados con una mala recuperacion del NPH en el momento del alta eran el numero de dias de inmovilizacion cervical con ortesis cervical, presencia inicial de cefalea, vertigo y/o dolor dorsal, valor inicial de la EVA y la Escala de Depresion y Ansiedad de Goldberg. En el analisis multivariado, las variables con influencia estadisticamente significativa sobre el NPH al alta eran la EVA, la subescala de depresion de Goldberg y el NPH de la valoracion inicial. Conclusiones LOS factores que influyen en la evolucion clinica tras un SLC son la valoracion inicial de la intensidad del dolor cervical mediante la EVA, la funcionalidad de la columna cervical mediante el NPH y la subescala de depresion de Goldberg.

Self-reported daily walking time in COPD: relationship with relevant clinical and functional characteristics

Background Quantifying physical activity in chronic obstructive pulmonary disease (COPD) is important as physical inactivity is related to poor health outcomes. This study analyzed the relationship between patients’ self-reported daily walking time and relevant characteristics related to COPD severity. Methods Pooled analysis was performed on data from four observational studies on which daily walking time was gathered from a personal interview. Patients were classified as physically inactive if walking time was <30 min/day. Walking times were described and compared according to several markers of disease severity. Results The mean daily walking time of 5,969 patients was 66 (standard deviation [SD] 47) min/day; 893 (15%) patients were inactive. A linear dose–response relationship was observed between walking time and the modified Medical Research Council (mMRC) dyspnea score, admissions, COPD assessment test (CAT), body mass index, airway obstruction, dyspnea, exacerbation (BODEx) index, and Charlson index (P<0.001). Daily walking times were lower in patients classified as Global Initiative for Chronic Obstructive Lung Disease (GOLD) B and D (P<0.001). Often, inactive patients had mMRC or Charlson index >3, post-bronchodilator forced expiratory volume in the first second <30% predicted, at least one hospitalization for COPD, classified as GOLD B or D, BODEx >4, and CAT score >30. Conclusion Lower self-reported walking times are related to worse markers of disease severity in COPD.

Improvement in walking abilities in transfemoral amputees with a distal weight bearing implant

Background: The ability to walk with a prosthesis is the main objective of rehabilitation following amputation, and distance and speed of walking achieved are considered determining factors in amputees’ perception of quality-of-life. Objectives: To assess walking abilities and improvement in gait distance and speed parameters in patients undergoing transfemoral amputation with a femoral implant that allows distal support of the residuum. Study design: Experimental before-and-after study. Methods: Ten transfemoral amputation patients received a titanium implant that allowed distal weight bearing of the residuum within the socket. The post-intervention follow-up period was 14 months. We evaluated the functionality using a 2-min walk test and the physiological cost index. Results: The etiology of amputation was traumatic in six patients (60%). The mean 2-min walk test score was 98.4 ± 19.5 m prior to the femoral implant and 122.5 ± 26.1 m at 14 months (p < 0.008), representing an improvement of 24.5%. The mean gait speed prior to the femoral implant was 0.82 ± 0.16 and 1.02 ± 0.21 m/s at 14 months (p < 0.008). The physiological cost index showed no differences (p < 0.55). Conclusion: The results of this study show an improvement in the distance walked and gait speed in amputees 14 months after having received a femoral implant. Clinical relevance This article provides additional insight into the use of a femoral implant that allows distal support of the residuum to improve walking abilities and gait distance and speed parameters in patients undergoing transfemoral amputation, mainly those of vascular origin.

Safety of Rehabilitation Program for COPD Patients

Comorbidities n (%) Arterial hypertension 183 (62.8) Dyslipidemia 132 (45.3) SAHS 43 (14.7) Insulin-dependent diabetes mellitus 18 (6.1) Non insulin-dependent diabetes mellitus 45 (15.4) Acute coronary syndrome 58 (19.3) Heart failure 12 (4.1) Atrial fibrillation 35 (12.) Atrial Flutter 9 (3) Pacemaker 8 (2.7) Automatic implantable cardioverter defibrillator 2 (0.8) Stroke transient ischemic attack 3 (1.2) Peripheral Arterial Disease 32 (10.9) Abdominal aortic aneurysm 1 (0.4)

Caminar al menos 30 minutos al día 5 días por semana. ¿Por qué y cómo prescribir ejercicio físico en la enfermedad pulmonar obstructiva crónica?

Eulogio Pleguezuelos , Maria A. Ramon , Eva Moreno e y Marc Miravitlles * a Servicio de Medicina Fı́sica y Rehabilitación, Hospital de Mataró, Mataró, Barcelona, España b Facultat de Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, España c Servicio de Neumologı́a, Hospital Universitari Vall d’Hebron, Barcelona, España d Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, España e Servicio de Medicina Fı́sica y Rehabilitación, Hospital General de L’Hospitalet, L’Hospitalet de Llobregat, Barcelona, España