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Estimulación eléctrica neuromuscular en el paciente crítico. Una revisión narrativa
(Sociedad de Anestesiologia de Chile, 2022) Gutiérrez-Arias, Ruvistay; Contreras, Yorschua Jalil
Advances in the treatment of critically ill patients have led to increased survival rates. However, survivors often experience significant consequences associated with the conventional model of care, in which patients tend to remain inactive, particularly during treatment with mechanical ventilation (MV) and prolonged use of sedation. This can result in mental, psychological, speech and swallowing disorders, and/or physical sequelae, including muscle weakness and consequent physical disability, which in many cases persist after discharge. Current evidence suggests that neuromuscular electrical stimulation has a positive effect on the mass and strength of the stimulated muscles, and may also induce systemic pro-myogenic, anti-inflammatory and regenerative effects, which could influence a decrease in MV time among other benefits. These effects could impact outcomes relevant to decision-makers, such as reduced intensive care unit length of stay and total hospitalization time. © 2022 Sociedad de Anestesiologia de Chile. All rights reserved.
Effect of Strength Training Programs in Middle- and Long-Distance Runners’ Economy at Different Running Speeds: A Systematic Review with Meta-analysis
(Springer Science and Business Media Deutschland GmbH, 2024-04) Llanos-Lagos, Cristian; Ramirez-Campillo, Rodrigo; Moran, Jason; Sáez de Villarreal, Eduardo
Background Running economy is defned as the energy demand at submaximal running speed, a key determinant of overall running performance. Strength training can improve running economy, although the magnitude of its efect may depend on factors such as the strength training method and the speed at which running economy is assessed. Aim To compare the efect of diferent strength training methods (e.g., high loads, plyometric, combined methods) on the running economy in middle- and long-distance runners, over diferent running speeds, through a systematic review with meta-analysis. Methods A systematic search was conducted across several electronic databases including Web of Science, PubMed, SPORTDiscus, and SCOPUS. Using diferent keywords and Boolean operators for the search, all articles indexed up to November 2022 were considered for inclusion. In addition, the PICOS criteria were applied: Population: middle- and long-distance runners, without restriction on sex or training/competitive level; Intervention: application of a strength training method for≥3 weeks (i.e., high loads (≥80% of one repetition maximum); submaximal loads [40–79% of one repetition maximum); plyometric; isometric; combined methods (i.e., two or more methods); Comparator: control group that performed endurance running training but did not receive strength training or received it with low loads (<40% of one repetition maximum); Outcome: running economy, measured before and after a strength training intervention programme; Study design: randomized and non-randomized controlled studies. Certainty of evidence was assessed with the GRADE approach. A three-level random-efects meta-analysis and moderator analysis were performed using R software (version 4.2.1). Results The certainty of the evidence was found to be moderate for high load training, submaximal load training, plyometric training and isometric training methods and low for combined methods. The studies included 195 moderately trained, 272 well trained, and 185 highly trained athletes. The strength training programmes were between 6 and 24 weeks’ duration, with one to four sessions executed per week. The high load and combined methods induced small (ES=−0.266, p=0.039) and moderate (ES=−0.426, p=0.018) improvements in running economy at speeds from 8.64 to 17.85 km/h and 10.00 to 14.45 km/h, respectively. Plyometric training improved running economy at speeds≤12.00 km/h (small efect, ES=−0.307, p=0.028, β1=0.470, p=0.017). Compared to control groups, no improvement in running economy (assessed speed: 10.00 to 15.28 and 9.75 to 16.00 km/h, respectively) was noted after either submaximal or isometric strength training (all, p>0.131). The moderator analyses showed that running speed (β1=−0.117, p=0.027) and VO2max (β1=−0.040, p=0.020) modulated the efect of high load strength training on running economy (i.e., greater improvements at higher speeds and higher VO2max). Conclusions Compared to a control condition, strength training with high loads, plyometric training, and a combination of strength training methods may improve running economy in middle- and long-distance runners. Other methods such as submaximal load training and isometric strength training seem less efective to improve running economy in this population. Of note, the data derived from this systematic review suggest that although both high load training and plyometric training may improve running economy, plyometric training might be efective at lower speeds (i.e., ≤12.00 km/h) and high load strength training might be particularly efective in improving running economy (i) in athletes with a high VO2max, and (ii) at high running speeds
Aortic pulse wave analysis and functional capacity of heart transplantation candidates: a pilot study
(Scientific Reports, Volume 14, Issue 1December 2024 Article number 10504, 2024-12) Alcici-Moreira, Adriana Marques; Vitarelli, Marcela Oliveira; Velloso, Tiago Abreu; Carvalho-Ribeiro, Igor Antônio; Dario, Daniella Moura; Polese, Janaine Cunha; Guimarães, Hélio Penna; Pena, José Luiz Barros; Tuesta, Marcelo; de Rezende, Bruno Almeida; Rodrigues-Machado, Maria da Glória
We compared cardiovascular parameters obtained with the Mobil-O-Graph and functional capacity assessed by the Duke Activity Status Index (DASI) before and after Heart Transplantation (HT) and also compared the cardiovascular parameters and the functional capacity of candidates for HT with a control group. Peripheral and central vascular pressures increased after surgery. Similar results were observed in cardiac output and pulse wave velocity. The significant increase in left ventricular ejection fraction (LVEF) postoperatively was not followed by an increase in the functional capacity. 24 candidates for HT and 24 controls were also compared. Functional capacity was significantly lower in the HT candidates compared to controls. Stroke volume, systolic, diastolic, and pulse pressure measured peripherally and centrally were lower in the HT candidates when compared to controls. Despite the significant increase in peripheral and central blood pressures after surgery, the patients were normotensive. The 143.85% increase in LVEF in the postoperative period was not able to positively affect functional capacity. Furthermore, the lower values of LVEF, systolic volume, central and peripheral arterial pressures in the candidates for HT are consistent with the characteristics signs of advanced heart failure, negatively impacting functional capacity, as observed by the lower DASI score. © The Author(s) 2024.
Neuropsychological profiles and neural correlates in typical and atypical variants of Alzheimer disease: A systematic qualitative review
(Spanish Society of Neurology, 2023-07) Fredes-Roa C.; Gutiérrez-Barría F.; Ramírez-Bruna C.; Cigarroa I.; Martella D.; Julio-Ramos T.; Méndez-Orellana C.; Toloza-Ramírez D.
Introduction: Neuropsychological symptoms and cortical atrophy patterns show similarities between typical Alzheimer's Disease (AD) and its variants. Thus, correct diagnosis is difficult, leading to errors in the therapeutic process. Indeed, the challenge in cognitive neuroscience focuses on identifying key features of cognitive-linguistic profiles and improving the knowledge of neural correlates for accurate differential diagnosis between the heterogeneous profiles of typical and atypical AD. Aim: This systematic review aims to describe different AD profiles, considering their neuropsychological symptoms and neural correlates. Methods: The present study followed the PRISMA guidelines and included studies from the PubMed, ScienceDirect, Scopus, and Web of Science databases, published between 2011 and 2021. Results: Thirty-one articles were included in this systematic review for critical analysis. Results suggest significant declines in episodic and working memory and executive function. Likewise, in all groups, verbal fluency and visuospatial/visuoconstructive skills declined. However, these symptoms overlap between typical AD, logopenic variant primary progressive aphasia, posterior cortical atrophy, behavioural/dysexecutive or frontal variant AD, and corticobasal syndrome. On the other hand, the neural correlate showed a pattern of atrophy in frontal, temporal, parietal, and occipital areas, even compromising the cuneus and precuneus. Conclusion: Spontaneous language and semantic and phonological verbal fluency could be an important biomarker for differential diagnosis between typical AD and its atypical variants. Likewise, clinical assessment should consider using advanced neuroimaging techniques to establish early associations between brain dysfunction and neuropsychological performance, with particular attention to brain areas such as the cuneus and precuneus. © 2022 Sociedad Española de Neurología
Influence of the body positions adopted for resistance training on intraocular pressure: a comparison between the supine and seated positions
(Springer Science and Business Media Deutschland GmbH, 2023-07) Lara, Paula M.; Redondo, Beatriz; Jerez-Mayorga, Daniel; Martínez-García, Dario; García-Ramos, Amador; Vera, Jesús
Objectives: A variety of factors are known to mediate on the intraocular pressure (IOP) response to resistance training. However, the influence of the body position adopted during resistance training on IOP remain unknown. The objective of this study was to determine the IOP response to the bench press exercise at three levels of intensity when performed in supine and seated positions. Methods: Twenty-three physically active healthy young adults (10 men and 13 women) performed 6 sets of 10 repetitions against the 10-RM (repetition maximum) load during the bench press exercise against three levels of intensity (high intensity: 10-RM load; medium intensity: 50% of the 10-RM load; and control: no external load) and while adopting two different body positions (supine and seated). A rebound tonometer was employed to measure IOP in baseline conditions (after 60 s in the corresponding body position), after each of the 10 repetitions, and after 10 s of recovery. Results: The body position adopted during the execution of the bench press exercise significantly affected the changes in IOP (p < 0.001, η p2 = 0.83), with the seated position providing lower increases in IOP levels compared to the supine position. There was an association between IOP and exercise intensity, with greater IOP values in the more physically demanding conditions (p < 0.001, η p2 = 0.80). Conclusions: The use of seated positions, instead of supine positions, for the execution of resistance training should be prioritized for maintaining more stable IOP levels. This set of findings incorporates novel insights into the mediating factors on the IOP response to resistance training. In future studies, the inclusion of glaucoma patients would allow to assess the generalizability of these findings. [Figure not available: see fulltext.] © 2023, The Author(s).
Anatomical Repair With Achilles Tendon Allograft Augmentation for Distal Medial Collateral Ligament Ruptures
(Elsevier B.V., 2024-07) Yáñez, Roberto; Saravia, Anthony; Zamorano, Hector; Caracciolo, Gaston; Neira, Alejandro; De la Fuente, Carlos
Several conditions may require medial collateral ligament (MCL) surgery, especially when high physical demands are required. Thus, we described a technique for anatomical repair of distal MCL rupture using a distal anchor and MCL augmentation through Achilles tendon allograft with proximal bone block and interference screw. This procedure fixes an anchor distally at the tibia. Then, the ligament endings are sutured using a continuous simple-type technique. Subsequently, a low-radiated Achilles tendon allograft is attached proximally and fixed through an interference screw. Finally, the allograft is sutured using a continuous simple-type technique. Our anatomical MCL repair and augmentation allows a reinforced anatomical technique to control the valgus instability caused by MCL distal ruptures, considering the MCL axial traction and posterior oblique ligament fiber orientations.
Effects of combined plyometric, speed and change of direction training on female soccer players on physical performance
(Federacion Espanola de Docentes de Educacion Fisica, 2024-07) Muñoz, Carlos León; Campillo, Rodrigo Ramírez; Gil, Pablo Traver; de Villarreal Sáez, Eduardo Sáez
The objective of this study is todetermine the influence of short-term combined plyometrics(PL), speed and change of direction (COD) training(6 weeks) within regular soccer practice on the jumping, speedand COD of femalesoccer players during the season. Twenty-threesubjects were randomly assigned to PL+ speed + COD (COMB), orcontrol group(CG). Subjects performed 2 sessions per week for 6 weeks. Beforeandafter trainingcontramovement jump (CMJ), contramovement jump with arms (CMJA), 10metres (m) -20msprintand L-RUN tests were analysed.Within-group analysis showed substantial improvements in CMJ (effect size [ES] = 0.92),20msprint (ES: <0.001), L-run (ES: <0.001). Between-group analysis showed significant improvements in 20msprint (p ≤ 0.001). No significant improvements in CMJ(p ≤ 0.95); CMJA (p ≤ 0.61); 10msprint (p ≤ 0.23); L-Run (p ≤ 0.24) in experimental groups in comparison to CG. The replacement of some low-intensity football drills with PLexercises combined withsprints and COD,during warm-up may be a possible option to optimise sprint performance
Velocity of the Five Sit-to-Stand Test in Older Adults: A Systematic Review
(Federacion Espanola de Docentes de Educacion Fisica, 2022) Jerez-Mayorga, Daniel; Miranda-Fuentes, Claudia; Pérez-Doncel, Julieta; Rool-Maureira, Bárbara; Saavedra-Rincón, Francisca; Zambra-Álvarez, Rocío; Intelangelo, Leonardo; Guede-Rojas, Francisco
The purpose of this study was to determine the reference values of the velocity of execution of the five Sit-to-Stand in older adults through a systematic review of the literature.Three databases were reviewed: Medline (PubMed), Scopus and Web of Science, with the deadline of March 2021.The search terms were: «sit to stand» OR «stand to sit» OR «chair rise» OR «chair rising» AND «kinematic» OR «velocity». The experimental studies were evaluated using the Quality Assessment of Diagnostic Accuracy Assessment (QUADAS) scale by independent reviewers. A total of seven studies were included. The velocity of execution in older adults (n=85) that presented neurological health conditions was between 0.33 m/s and 0.38 m/s. In the healthy (n=246) ones it was between 0.27 m/s and 0.94 m/s. Between 60 to 70 years (n=157) it was from 0.31 m/s and 1.59 m/s, and from 70 to 80 years (n=225) it was from 0.27 m/s and 1.04 m/s.The execution velocity of five Sit-to-Stand in older adults ranges from a minimum of 0.27 m/s to a maximum of 1.59 m/s ffor the complete cycle of standing up and sitting down.These antecedents may be useful to predict or detect functional alterations and disability. © Federación Española de Asociaciones de Docentes de Educación Física (FEADEF).
Finite element graft stress for anteromedial portal, transtibial, and hybrid transtibial femoral drillings under anterior translation and medial rotation: an exploratory study
(Scientific Reports, Volume 14, Issue 1 December 2024 Article number 11922, 2024-12) Yañez, Roberto; Silvestre, Rony; Roby, Matias; Neira, Alejandro; Azar, Camilo; Madera, Samuel; Ortiz-Bernardin, Alejandro; Carpes, Felipe P.; De la Fuente, Carlos
Stress concentration on the Anterior Cruciate Ligament Reconstruction (ACLr) for femoral drillings is crucial to understanding failures. Therefore, we described the graft stress for transtibial (TT), the anteromedial portal (AM), and hybrid transtibial (HTT) techniques during the anterior tibial translation and medial knee rotation in a finite element model. A healthy participant with a non-medical record of Anterior Cruciate Ligament rupture with regular sports practice underwent finite element analysis. We modeled TT, HTT, AM drillings, and the ACLr as hyperelastic isotropic material. The maximum Von Mises principal stresses and distributions were obtained from anterior tibial translation and medial rotation. During the anterior tibia translation, the HTT, TT, and AM drilling were 31.5 MPa, 34.6 Mpa, and 35.0 MPa, respectively. During the medial knee rotation, the AM, TT, and HTT drilling were 17.3 MPa, 20.3 Mpa, and 21.6 MPa, respectively. The stress was concentrated at the lateral aspect of ACLr,near the femoral tunnel for all techniques independent of the knee movement. Meanwhile, the AM tunnel concentrates the stress at the medial aspect of the ACLr body under medial rotation. The HTT better constrains the anterior tibia translation than AM and TT drillings, while AM does for medial knee rotation. © The Author(s) 2024.
Acute Fatigue Impairs Heart Rate Variability and Resting Muscle Oxygen Consumption Kinetics
(Multidisciplinary Digital Publishing Institute (MDPI), 2024-10) Vasquez-Bonilla, Aldo A.; Yáñez-Sepúlveda, Rodrigo; Tuesta, Marcelo; Martin, Eduardo Báez-San; Monsalves-Álvarez, Matías; Olivares-Arancibia, Jorge; Duclos-Bastías, Daniel; Recabarren-Dueñas, Catalina; Alacid, Fernando
Featured Application: Importantly, measurements obtained through VOT-NIRS can vary significantly post-exercise, which should be considered by researchers before application. This study evaluated the influence of acute fatigue on heart rate variability (HRV) and muscle oxygen saturation (SmO2) at rest, as well as the reliability of SmO2 data measured using near-infrared spectroscopy (NIRS) during a vascular occlusion test (VOT). Twelve physically active subjects participated. Measurements included perceived muscle soreness using the visual analog scale (VAS pain), HRV parameters, variables of resting SmO2 (desaturation and resaturation), and reoxygenation kinetics (mean response time, MRT) through a VOT-NIRS located in the vastus lateralis (VL). Measurements were taken at three points: 24 h before, before exhaustive exercise, and 30 min after exhaustive exercise. The results indicated that acute fatigue increased resting muscle oxygen consumption in desaturation (+22 SmO2) and resaturation (+18 SmO2), improved MRT (−15 s), and elevated sympathetic nervous system (SNS) activity, as observed in the R-R interval (−262 ms) and SNS index (+0.5). HRV significantly influenced desaturation (r2 = 0.69), resaturation (r2 = 0.60), and MRT (r2 = 0.54). Reliability was established with an ICC of 0.49 and 0.63 for desaturation and resaturation, respectively. Real changes in desaturation and resaturation should be considered ≥ 7% SmO2 at rest and ≥ 11% SmO2 to avoid daily fatigue interference. In conclusion, acute fatigue increases resting SmO2 consumption and is associated with higher SNS activity and increased VAS pain.
Impacto de ejercicios bilaterales y unilaterales en la potenciación aguda del salto horizontal en futbolistas profesionales
(Universidad Nacional, 2024-06) Sanchez-Sanchez, Javier; Sanchez, Mario; Pérez, Luis; Ramirez-Campillo, Rodrigo
Objetivo: Analizar el efecto de una activación realizada a través de ejercicios de fuerza y pliometría ejecutados de forma bilateral o unilateral sobre el rendimiento en salto horizontal. Metodología: En el estudio participaron 15 futbolistas masculinos, altamente entrenados (edad, 24.7 ± 3.1 años; altura, 181.2 ± 4.7 cm; peso, 79.7 ± 3.4 kg) pertenecientes al mismo equipo, que competía en liga nacional. Su rutina de entrenamiento regular constaba de 4 sesiones y 1 partido competitivo por semana. Los participantes llevaron a cabo 1 protocolo control (CON) y 3 protocolos de activación, siguiendo un diseño contrabalanceado, basados en ejercicios específicos de fútbol (SIN), ejercicios de fuerza y pliometría ejecutados de forma bilateral (BIL) y unilateral (UNI). Después de cada protocolo los jugadores realizaron la prueba de salto horizontal (HZB). Resultados: Los resultados de la prueba ANOVA de medidas repetidas mostraron efectos positivos significativos sobre el HZB de los protocolos SIN (p<0.01; dif = 2.95(2.00)%), BIL (p<0.01; dif = 3.22(2.61) %); y UNI (p<0.01; dif = 6.80(3.40) %) con respecto a CON. Además, HZB fue, significativamente, mayor después del protocolo UNI que del SIN (p<0.01; dif = 3.74(2.62) %) y BIL (p<0.01; dif = 3.47(1.94) %). El análisis de la respuesta individual reflejó efectos positivos en HZB de los protocolos SIN, BIL y UNI respecto al CON, mientras que el 89 % de los jugadores tuvieron mejor rendimiento en HZB después de UNI que de BIL. Conclusiones: Una activación que incorpora estímulos de fuerza y pliometría ejecutados, de forma unilateral, tiene un efecto positivo mayor sobre la capacidad de salto horizontal, que una activación que involucra ejercicios generales, específicos de fútbol y de ejecución bilateral.
Exploring the mediating role of promoting school physical activity on the relationship between low socioeconomic status and academic achievement and school climate: evidence from 4,990 Chilean schools
(Frontiers Media SA, 2024-06) Delgado-Floody, Pedro; Cristi-Montero, Carlos; Jerez-Mayorga, Daniel; Ruiz-Ariza, Alberto; Guzmán-Guzmán, Iris Paola; Álvarez, Cristian; Gómez-López, Manuel; Carter-Thuillier, Bastian; Caamaño-Navarrete, Felipe
There is evidence that promoting school physical activity (PSPA) benefits children and adolescents, but little is understood about how this promotion may relate to academic achievement and school climate across varying levels of socioeconomic status (SES). Hence, the study aimed to address this knowledge gap by examining two main objectives: (1) determining the association between PSPA and academic achievement and school climate according to schools’ SES and (2) exploring the potential mediating role of PSPA in the relationship between schools’ SES and academic achievement and school climate. This cross-sectional study at the school level focused on 4,990 schools (including public, subsidized, and private schools) that participated in the National Educational Study 2018 (Chile), which was applied to primary schoolchildren (4th grade, aged 8–10 years). Schools were divided into non-PSPA (n = 4,280) and PSPA (n = 710) during the year 2018. Changes in academic achievement from 2017 to 2018 and school climate were considered. PSPA was associated with improvements in maths (low-SES OR: 1.80, p < 0.001) and reading (middle-SES OR: 1.45, p = 0.029; low-SES OR: 1.47, p < 0.001). The indirect effect (IE) showed that PSPA partially mediated the relationship between SES and academic achievement in reading (IE = 1.017; SE = 0.12; 95%CI, −1.27, −0.77), maths (IE = –1.019; SE = 0.12; 95%CI, −1.25, −0.78), and school climate (IE = –0.46; SE = 0.52; 95%CI, −0.56, −0.35). In conclusion, PSPA was linked to positive changes in academic achievement, especially among low SES, and PSPA presented a potential mediating role in the relationship between SES of schools and academic achievement and school climate.
Association between the home-to-healthcare center distance and hearing aid abandonment among older adults
(Frontiers Media SA, 2024-03) Fuentes-López, Eduardo; Galaz-Mella, Javier; Ayala, Salvador; De la Fuente, Carlos; Luna-Monsalve, Manuel; Nieman, Carrie; Marcotti, Anthony
Background: Access to audiology services for older adults residing in sparsely populated regions is often limited compared to those in central urban areas. The geographic accessibility to follow-up care, particularly the influence of distance, may contribute to an increased risk of hearing aid abandonment. Objective: To assess the association between the home-to-healthcare-calibration-center distance and hearing aid abandonment among older adults fitted in the Chilean public health system. Methods: 455 patients who received hearing aids from two public hospitals in two regions were considered. Univariate and multivariate Poisson regression models with robust variance estimation were used to analyze the association between the geographical distance and hearing aid abandonment, accounting for confounding effects. Results: Approximately 18% of the sample abandoned the hearing aid, and around 50% reported using the hearing aid every day. A twofold increase in distance between home and the hearing center yielded a 35% (RR = 1.35; 95% CI: 1.04–1.74; p = 0.022) increased risk of hearing aid abandonment. Also, those in the second quintile had a 2.17 times the risk of abandoning the hearing aid compared to the first quintile (up to 2.3 km). Under the assumption that patients reside within the first quintile of distance, a potential reduction of 45% in the incidence of hearing aid abandonment would be observed. The observed risk remained consistent across different statistical models to assess sensitivity. Conclusion: A higher distance between the residence and the healthcare center increases hearing aid abandonment risk. The association may be explained by barriers in purchasing supplies required to maintain the device (batteries, cleaning elements, potential repairs, or maintenance).
Intra- and Inter-Day Reliability of Inertial Loads with Cluster Sets When Performed during a Quarter Squat on a Flywheel Device
(MDPI, 2023-06) Ryan, Shane; Ramirez-Campillo, Rodrigo; Browne, Declan; Moody, Jeremy A.; Byrne, Paul J.
The aims of this study were to (i) estimate the intra- and inter-day reliability of mean concentric (CON) and eccentric (ECC) power at different inertial loads during a flywheel quarter-squat using a cluster set approach and (ii) to determine the acute effect of internal and external attentional focus on mean power when performing the flywheel quarter squat. Twelve collegiate field sport male athletes (age 22.4 ± 3.2 years, weight 81.4 ± 10.3 kg, height 1.81 ± 0.06 m) attended four cluster set testing sessions separated by 7 days. Sessions consisted of 4 sets of 15 repetitions using 4 inertial loads (0.025, 0.050, 0.075, and 0.100 kg·m2). A cluster block consisted of 5 repetitions, including “momentum repetitions” (4 × 5 + 5 + 5). Mean power (MP), CON power, ECC power, and ECC overload were recorded for both internal and external attentional focus groups. The external instructional group attained familiarization after two flywheel sessions (ES = 0.03–0.15) with little volatility between performance measures (CV% = 3.39–9.22). The internal instructional group showed large differences in MP output from session 2 to session 3 for all loads (ES = 0.59–1.25). In conclusion, the flywheel cluster set approach is a reliable training modality for maintaining MP output during all repetitions. © 2023 by the authors.
Dolor musculoesquelético y discapacidad del cuadrante superior en estudiantes de instrumentos de cuerda: Un estudio piloto transversal
(Federacion Espanola de Docentes de Educacion Fisica, 2024-06) Jara, Ornella Cheuquel; Alegría, Jetzabel Rodríguez; Carvajal-Parodi, Claudio; Arias-Álvarez, Gonzalo; Mendoza, Cristhian; Soto-Martínez, Adolfo; Guede-Rojas, Francisco
Antecedentes: El dolor musculoesquelético (DME) es prevalente en los músicos y se localiza principalmente en el cuadrante superior, afectando la funcionalidad. Los movimientos repetitivos, el tipo de instrumento, la edad y el sexo condicionan este comportamiento, entre otros factores. Si bien la evidencia es limitada, pareciera ser que los músicos de cuerdas se encuentran dentro de quienes más frecuentemente reportan dolor y discapacidad de origen musculoesquelético. Objetivo: Caracterizar el DME y el nivel de discapacidad en el cuadrante superior asociado a la práctica de instrumentos de cuerda en estudiantes de conservatorio. Método: En este estudio piloto observacional de corte transversal, se aplicaron seis instrumentos de evaluación autoreportados a 14 estudiantes de cuerdas (8 hombres y 6 mujeres) de diferentes instrumentos (violín, viola, guitarra clásica, violoncello y contrabajo): Quick Dash Global (QDG) y de Alto Rendimiento/Músicos (QDL), Índice de Discapacidad Cervical (NDI), Escala de Graduación de Dolor Crónico (EGDC), el Cuestionario de Dolor Neuropático (DN4 abreviado) y el Mapa Corporal de Dolor (body chart). Resultados: El 100% de la muestra presentaba DME al momento de la evaluación, mayoritariamente de baja intensidad, siendo en el 21.42% de los casos de carácter crónico y diseminado. El 64.28% presentaba dolor neuropático. La funcionalidad general medida con EGDC se encontraba afectada en el 71.42% de los individuos. La funcionalidad del miembro superior presentó un QDG medio de 16.4 ±15.63 y un QDL medio de 32.11 ±16.78, mientras que a nivel cervical el 64.28% presentó discapacidad de leve a moderada medida con NDI. Conclusión: El DME y la discapacidad en el cuadrante superior son condiciones frecuentes en estudiantes músicos cordófonos. Futuros estudios deberán profundizar en las causas e indagar en estrategias eficientes para prevenir estas afecciones a lo largo de su proceso de formación.
Validating an objective structured clinical examination to enhance assessment of clinical skills in physical therapy students
(SPER Publications, 2024) Gomez Miranda, LA; Amigo Reyes, T.; de la Barra Ortiz, HA
The validation of evaluation instruments such as the Objective Structured Clinical Examination (OSCE) in healthcare education is crucial for precise clinical skills assessments, which are requisites for professional practice. This study aims to validate an OSCE designed specifically for physical therapy students enrolled in the electrophysical agents course. A non-experimental cross-sectional study included 167 fourth-year students (86 men,79 women, average age 21 years ±1.3) at Andres Bello University. The OSCE, comprising five stations (S1-S5) assessing electrophysical agent applications, constituted 30% of the course grade. Stations evaluated generic skills, clinical reasoning, and practical abilities with checklists. Statistical Analysis KR-20 for internal consistency and exploratory factor analysis for construct validity, with the removal of criteria with low correlations and high eigenvalues to refine the instrument. Descriptive statistics indicated a non-normal score distribution (p<0.01) across stations. Notably, stations S1 (connective tissue flexibility) and S5 (equipment installation) exhibited notable performance. The KR-20 statistic showed that most stations had high (S2-S4) or very high (S1, S2) reliability. Analysis by domain revealed low internal consistency (<0.4) for generic and practical skills, specifically for S3 (drainage), S4 (strengthening), and S5 (equipment installation). Factor analysis identified underlying latent variables, particularly in S2, S3, and S4. Refinement led to the removal of 6,7, and 3 criteria from S1, S2-S4, and S5, respectively, resulting in improved reliability and construct validity in the instrument. The enhancements in validity and internal consistency, justifying the removal of the generic domain‎.
Effectiveness of combined therapy in physical therapy for the management of musculoskeletal pain: a systematic review and meta-analysis
(Wroclaw University of Health and Sport Sciences, 2024) de la Barra Ortiz, Hernán Andrés; Leiva, Cristóbal Alfaro; Lillo, Camilo Alfaro; Álvarez, Diego Carvajal; Pizarro, Bastián Cuéllar
Introduction. Therapeutic ultrasound and electrotherapy are commonly used in physical therapy for musculoskeletal pain (MSP) management. Combined therapy (CT) is a resource that merges both techniques, enhancing the analgesic effects of both treatments, although studies are limited. Objective: To determine the effectiveness of CT in physical therapy for the management of MSP. Methods. The PubMed, Web of Science, Scopus, Cinahl, Science Direct, and PEDro databases were searched for randomised clinical trials (RCTs) (updated June 5, 2024). RCTs comparing CT with other physical therapy treatments for MSP were included. Thirteen studies met the eligibility criteria, including those of the qualitative synthesis and meta-analysis types. The Cochrane Rob2 tool was used to assess the articles’ quality. Results. RCTs were assessed as having a low risk of bias for all RoB2 domains. Although the qualitative synthesis reports a reduction in pain, an increase in ROM, and less disability in favour of CT, the quantitative analysis only shows large, statistically significant effect sizes (Cohen’s d) (p < 0.05) for the standardised mean differences (SMD) in pain (SMD = 0.9; CI = 0.8, 1.1) and ROM (SMD = –0.93; CI = –1.1, –0.8). These analgesic and ROM benefits improve when CT is applied with interferential currents (Pain: SMD = –1.54; IC = –1.8, –1.3) (ROM: SMD = 2.28; CI = 1.8, 2.7). Although the analgesic evidence was qualified as important, the heterogeneity obtained in the studies (I2 > 75%) moderates its degree of recommendation. Conclusions. This SR shows that CT has better analgesic effects than TENS, interferential currents, or therapeutic ultrasound alone, which supports the idea of a combined analgesic effect. The researchers propose dosage recommendations for clinical practice and future research
Effects of prone position in acute respiratory distress syndrome secondary to COVID-19: experience in a high complexity hospital
(Elsevier Espana S.L.U, 2023-05) Vivanco-Aravena, Paulina; Hernández, Iván; Troncozo, Cristián; Gómez, Francisco; Pino, Rita
Introduction: The use of protective mechanical ventilation and prone position was recommended for the management of moderate to severe acute respiratory distress syndrome (ARDS) due to COVID-19, as a result of its reported utility on oxygenation and mortality. Our objective is to describe gasometric and mechanical behavior in subjects with ARDS due to COVID-19 managed with protective mechanical ventilation and prone position in a high complexity hospital. Method: Observational study. Subjects ≥18 years of age with ARDS due to COVID-19 were included. Protective mechanical ventilation was started from the first connection to invasive ventilation, while the prone position started with PaO2/FIO2 150. Follow-up was performed during and after the prone position. A descriptive analysis of baseline characteristics and comparison of means between groups was performed using the Dunn and Friedman test. Statistical significance corresponds to p 0.05 in all analyses. Results: 74 subjects were studied, 58% correspond to men with a mean age of 60 years. There is evidence of a significant increase in arterial oxygenation assessed by PaO2 (76 to 98 mmHg, p 0.05) and PaO2/FIO2 (100 to 161, p 0.05) during the first hour of treatment, with stability of values beyond 48 hours after supination. Pulmonary mechanics values remain constant within the established protection range (p = 0,18). Conclusion: The strategy of protective mechanical ventilation and prone position for 48 or more hours, in subjects with moderate to severe ARDS due to COVID-19, improves and maintains arterial oxygenation up to 48 hours after supination. © 2023
Percutaneous electrolysis and microelectrolysis for musculoskeletal pain management: milliamps or microamps? An evidence-based comparison through systematic review and meta-analysis
(Termedia Publishing House Ltd., 2024-02) de la Barra Ortiz, Hernán Andrés; Chamorro, Claudio; Ronzio, Óscar
Invasive techniques like percutaneous electrolysis have recently surged in popularity for treating musculoskeletal disorders. However, emerging techniques have sparked debates on the current needed to achieve optimal results. The aim of this review was to compare the effects of electrolysis and microelectrolysis on pain intensity in individuals with musculoskeletal pain. This quantitative systematic review has an observational, retrospective, and secondary design. The search included databases such as PubMed, Scopus, Web of Science, EMBSCOhost, Embase, Cochrane Library, PEDro, and Google Scholar (updated on July 1, 2024). Independent reviewers selected eligible studies and assessed their quality using the Cochrane risk of bias 2 tool. The primary outcome was pain intensity, while secondary outcomes included pain pressure threshold and disability. The meta-analysis calculated pooled effects using mean differences or standardized mean differences for these outcomes. Twenty-eight studies were included with an overall low risk of bias (21.4%). Randomization and outcome measurement (21.4%), intervention deviations (28.6%), and outcome measurement (53.6%) were all sources of bias. Statistically-significant reductions in pain intensity and disability (p < 0.01) were observed post-treatment for both microelectrolysis (pain: SMD = -0.92; 95% CI: -1.3, -0.5 and disability: SMD = -0.92; 95% CI: -1.3, -0.5) and electrolysis (pain: SMD = -0.3; 95% CI: -0.6, -0.01 and disability: SMD = -1.8; 95% CI: -3.1, -0.6). For the pain pressure threshold, neither modality outperformed the controls. This review highlights the effectiveness of electrolysis modalities in the treatment of musculoskeletal pain and disability, especially microelectrolysis, which shows a larger effect in terms of pain reduction. Further research is needed to understand their analgesic mechanisms, and US-guided decisions should be based on comprehensive risk-benefit assessments
Effects of strength and flexibility training on knee valgus and pain in adult women physically active adult women
(Federacion Espanola de Docentes de Educacion Fisica, 2024-12) Verdugo, Sebastián Astorga a; Silva, Soledad González; Araya, Aldo Martínez; Concha-Cisternas, Yeny; Luna-Villouta, Pablo; Alarcón-Rivera, Miguel; Fuentes-Barría, Héctor
Introduction: Knee valgus is a medial alignment of the joint that primarily affects women. The objective of this study was to evaluate the effects of a strength and flexibility training protocol on passive knee valgus (PKV), dynamic knee valgus (DKV), and the presence of pain in physically active young women. Thirty-four college women, aged 18-30 years, participated in a four-week training program, which included exercises with TheraBand®. The measurements included the Q-angle for PKV, the Landing Escape Test (LESS) for DKV, and the Analog Numerical Scale (ENA) for the presence of pain. The results indicated a significant decrease in PKV (p=0.0028), effect size (d=0.20), with a change of -2.21%. About DKV, significant reductions were observed at both the initial and second landings. The first landing exhibited a p-value of less than 0.0001, with a d-value of 0.34, resulting in a 10.06% change. The second landing demonstrated a p-value of 0.0226, with a d-value of 0.13, resulting in a 4.37% change. Furthermore, the presence of pain was found to decrease significantly (p=0.0019, d=0.89, -38.64% change). It can be concluded that a four-week combined strength and flexibility training protocol may be effective in reducing PKV, DKV, and pain in physically active women. © 2024 Federacion Espanola de Docentes de Educacion Fisica. All rights reserved

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