Irene Cabrera-Martos

Cognitive impairment in COPD: a systematic review

The objectives of this study were to characterize and clarify the relationships between the various cognitive domains affected in COPD patients and the disease itself, as well as to determine the prevalence of impairment in the various cognitive domains in such patients. To that end, we performed a systematic review using the following databases: PubMed, Scopus, and ScienceDirect. We included articles that provided information on cognitive impairment in COPD patients. The review of the findings of the articles showed a significant relationship between COPD and cognitive impairment. The most widely studied cognitive domains are memory and attention. Verbal memory and learning constitute the second most commonly impaired cognitive domain in patients with COPD. The prevalence of impairment in visuospatial memory and intermediate visual memory is 26.9% and 19.2%, respectively. We found that cognitive impairment is associated with the profile of COPD severity and its comorbidities. The articles reviewed demonstrated that there is considerable impairment of the cognitive domains memory and attention in patients with COPD. Future studies should address impairments in different cognitive domains according to the disease stage in patients with COPD.

Clinical profile and evolution of infants with deformational plagiocephaly included in a conservative treatment program

PurposeThe aim of this study was to evaluate the results of a conservative intervention in infants with plagiocephaly according to their specific clinical profile.MethodsProspective clinical trial in which 104 infants with plagiocephaly accompanied or not by congenital or positional torticollis were referred to Early Care and Monitoring Unit (USAT) of San Cecilio Hospital in Granada, between 2009 and 2012. All the infants, grouped into three categories of severity, were included in the physiotherapy protocol until adequate craniofacial morphology and motor development were achieved. The study included an assessment of parents and infants. Parents were assessed with a questionnaire about the mother’s medical history and birth-related issues. The assessment of infants included anthropometric measures, a positional assessment, the observation of the head, the assessment of severity, and motor development.ResultsBirth characteristics were similar in the total sample but showed different clinical profiles according to treatment aspects. More specifically, infants with severe plagiocephaly were referred to treatment later and spent more time in treatment; use of an orthotic helmet was also more prevalent in this category. There were also significant differences (P < 0.05) in the acquisition of specific gross motor skills depending on the severity of plagiocephaly.ConclusionThe findings suggest that the physiotherapy protocol presented is effective to correct plagiocephaly. Severity of plagiocephaly is a marker that should be taken into account when designing actions aimed at improving gross motor skill development.

Physical Activity as a Predictor of Absence of Frailty in Subjects With Stable COPD and COPD Exacerbation

BACKGROUND: Frailty is a key issue in the care of elderly patients. Patients with COPD are more likely to be frail, with a prevalence of 57.8%. Frailty is associated with a low level of physical activity. The aim of this study was to analyze the predictive power and identify the cutoffs of physical activity in their different domains (household, leisure time, and sport) for the absence of frailty in subjects with COPD exacerbation and stable COPD. METHODS: A cross-sectional study was conducted. The participants underwent an individual interview, including sociodemographic and clinical aspects. The total physical activity and its domains were assessed by the modified Baecke questionnaire, and frailty was measured according to the modified version of Fried. A total of 212 subjects with COPD (104 stable and 108 with COPD exacerbation) were enrolled, along with 100 healthy subjects. RESULTS: The prevalence of frailty was higher in subjects with COPD compared with the control group. An activity level of 3.54 for COPD exacerbation, 3.88 for stable COPD, and 3.50 for healthy subjects assessed using the Baecke questionnaire were recommended as the cutoff points for frailty. Sensitivity and specificity values were 0.95 and 0.807; 0.95 and 0.815; and 0.95 and 0.947, respectively. CONCLUSIONS: Physical activity level can predict the absence or presence of frailty in subjects with stable and exacerbated COPD.

Effects of a Single Hand–Exercise Session on Manual Dexterity and Strength in Persons with Parkinson Disease: A Randomized Controlled Trial

To evaluate the effects on manual dexterity, hand grip, and pinch strength of a single intervention focused on hand exercises.

Results of a Multimodal Program During Hospitalization in Obese COPD Exacerbated Patients

The objective of this study was to analyze the results of a multimodal therapeutic program during hospitalization in obese AECOPD patients. This was a randomized, single-blind clinical trial conducted at two university hospitals in Granada, Spain. Forty-nine patients hospitalized due to AECOPD were randomly allocated to a control group (CG), in which patients received standard care, or to an intervention group (IG), in which patients were included in a multimodal therapeutic program, added to the standard care. The main outcome measures were pulmonary, physical (strength and exercise capacity) and perceived (dyspnea, quality of life and psychological distress) variables. Within-group significant improvements (p < 0.05) were found in physical and perceived variables in the IG after the treatment. In the CG, a significant decrease was found in lower limb strength and a significant improvement in dyspnea and in three subscales of the EuroQol-5D questionnaire. The between-groups analysis showed significant differences after the treatment on lower limb strength and exercise capacity values (p < 0.05), in three of the EuroQol-5D subscales, and in the total score and the depression subscale of the Hospital Anxiety and Depression Scale. A multimodal therapeutic program has a beneficial effect on physical functioning and perceived variables in hospitalized obese patients with AECOPD.

The effects of a physiotherapy programme on patients with a pleural effusion: a randomized controlled trial:

Objective: To investigate the effects of a physiotherapy protocol on patients with pleural effusion. Design: Randomized controlled trial. Setting: University hospital. Participants: A total of 104 consecutive inpatients with a medical diagnosis of pleural effusion. Intervention: Patients were randomly allocated to a control group receiving standard treatment (medical treatment and drainage) or an intervention group treated with physiotherapy added to standard treatment. The physiotherapy programme included deep breathing exercises, mobilizations and incentive spirometry. Main outcome measures: Spirometric predicted values and chest radiographs were measured before treatment and at discharge and the length of hospital stay was recorded. Assessors were blinded to the intervention. Results: A comparative analysis showed a significant improvement of spirometric parameters in the intervention group; pre-to-post hospitalization predicted values showed significant changes in vital capacity (73.1 ± 12.6% to 72.13 ± 13.7 %, P<0.001 ), forced expiratory volume in first second (72.13 ± 13.7% to 78.98 ± 16.9%, P<0.001) and forced expiratory flow at 25-75 % (64.8 ± 35.1% to 76.78 ± 35.3%, P=0.198) compared to the control group that showed no significant changes across treatment. The radiographic findings showed better scores on the affected side of the thorax at discharge in the physiotherapy group. Length of hospital stay was also significantly (P=0.014) shorter in the intervention group (26.7 ± 8.8 days) compared to the control group (38.6 ± 10.7 days). Conclusions: A physiotherapy programme added to standard treatment improves the spirometric parameters and the radiological findings and reduces the hospital stay in patients with a pleural effusion.

Impact of torticollis associated with plagiocephaly on infants' motor development.

ObjectiveThis study investigated whether torticollis (congenital or acquired) in infants with plagiocephaly affects the achievement of specific gross motor milestones. MethodsA total of 175 infants affected by plagiocephaly with or without torticollis were recruited and included in this prospective trial. Anthropometric and clinical variables were recorded at baseline. The infants were included in a physiotherapy treatment program, and they were monthly assessed until hospital discharge. ResultsSignificant differences (P < 0.05) were observed in the achievement of rolling over, crawling, and standing skills depending on the specific profile (plagiocephaly and plagiocephaly with congenital or acquired torticollis). After adjusting for the severity of the plagiocephaly and the age at referral, the torticollis was significantly (P < 0.05) associated with crawling and standing skills. ConclusionsThe findings suggest that the presence or absence of congenital or acquired torticollis is an important factor that affects gross motor development in infants with plagiocephaly.

Acute Effects of Contract-Relax Stretching vs. TENS in Young Subjects With Anterior Knee Pain: A Randomized Controlled Trial

Abstract Valenza, MC, Torres-Sánchez, I, Cabrera-Martos, I, Valenza-Demet, G, and Cano-Cappellacci, M. Acute effects of contract-relax stretching vs. TENS in young subjects with anterior knee pain: A randomized controlled trial. J Strength Cond Res 30(8): 2271–2278, 2016—The aim of this study was to examine the immediate effects on pressure point tenderness, range of motion (ROM), and vertical jump (VJ) of contract-relax stretching vs. transcutaneous electrical nerve stimulation (TENS) therapy in individuals with anterior knee pain (AKP). Eighty-four subjects with AKP were randomly assigned to 1 of 3 different intervention groups: a contract-relax stretching group (n = 28), a TENS intervention group (n = 28), and a control group (n = 28). The participants included in the sample were both sex (37.5% men vs. 62.5% women) at a mean age of 21 years, with mean values of height and weight of 169 cm and 64 kg, respectively. The main outcome measures were knee ROM, pressure pain threshold (PPT), and VJ. The participants were assessed at baseline and immediately after treatment. In the case of VJ, at baseline, immediately after the intervention, at 3 and at 6 minutes posttreatment. The data analysis showed that PPT scores of participants in the stretching and TENS group significantly increased from pretest to posttest (p ⩽ 0.05). A significant increase pre- to posttreatment in ROM (p < 0.001) was also observed in both treatment groups. In VJ measures, TENS and stretching groups showed significant differences between preintervention and all postintervention values (p ⩽ 0.05), whereas no significant differences were found in the control group. In conclusion, the results show significant pre-to-post-treatment effects in PPT, ROM, and VJ from both contract-relax stretching and TENS in young subjects with AKP.

Effect of occupational therapy on functional and emotional outcomes after hip fracture treatment: a randomized controlled trial:

Objective: To explore whether an occupational therapy intervention combined with physiotherapy rehabilitation improved hip fracture patient outcomes regarding emotional distress, fatigue, independence and function. Design: Randomized controlled trial. Setting: Inpatient trauma ward in a rehabilitation and trauma hospital. Participants: One hundred and twenty-two patients admitted into hospital for hip fracture. Intervention: Patients were randomly assigned to a standard care group (SC, n = 61) or a combined treatment group (CT, n = 61). The SC group received conventional hospital care for hip fracture patients and the CT group underwent occupational therapy as well. Main measures: Patients’ emotional distress (GHQ-28), perceived fatigue (the first item of the BASDAI using a 0–100 visual analogue scale scale), level of independence (Modified Barthel Index) and function (Harris Hip Score) were measured at baseline and one, three and six months after the intervention. Results: Patients in the CT group experienced a considerable decrease of emotional distress at three and six months (p = 0.005 and p < 0.001, respectively). A between-group analysis showed significant differences in emotional distress at one, three and six months (p < 0.001). Although fatigue levels decreased in the SC group, the most significant decline was reported by the CT group at six months (p < 0.001, mean difference = 14 points). Regarding independence level, significant differences were found within groups at each stage, but also between groups at one month in favor of the CT group. Function improved in both groups compared with baseline (p < 0.001), but no significant differences were found in functionality between groups. Conclusion: Although both groups reported significant improvements, patients in the CT group had better scores in emotional distress and dependence throughout follow-up and better scores in all measures at six months.

Physical and Functional Impairment During and After Hospitalization in Subjects With Severe COPD Exacerbation.

BACKGROUND: COPD exacerbations are frequent events that have a negative impact on the lives of patients. The aims of this study were to analyze physical and functional impairment during hospital stay in subjects hospitalized due to COPD exacerbation and to assess the physical and functional impact of hospitalization at a 1-month follow-up in patients with severe COPD. METHODS: This was a prospective observational study on a sample of 52 subjects hospitalized due to COPD exacerbation. The assessments were performed at baseline, discharge, and 1-month follow-up. The outcome measures were dyspnea, muscle strength, functional capacity, and postural steadiness. RESULTS: Quadriceps strength [1.036 (P = .043) kg mean difference] and the one-leg stance test [1.04 (P = .02) and 0.73 (P = .032) s mean difference right and left leg] showed significant impairment during hospitalization. Dyspnea perception improved significantly (P = .004) during hospitalization. Additionally, strength in the upper and lower limbs [4.04 (P = .002) and 1.23 (P = .038) kg mean difference], functional capacity [3.0 number of steps mean difference (P = .032)], and the one-leg stance test [2.12 (P = .006) and 0.53 (P = .047) s mean difference right and left leg] showed significant impairment 1-month follow-up. CONCLUSIONS: Hospitalization due to COPD exacerbation leads to physical and functional impairment in patients; impairment is greater at 1-month follow-up. It would be interesting to conduct physical therapy interventions to prevent the impairment.