Artículos Seleccionados 1997 - CLINICA KINESICA

TITULO ORIGINAL: Fysioterapi i behandling av urininkontinens hos eldre kvinner.

AUTOR/ES: Bo-K

DIRECCIÓN: Kompetansesenteret i fysioterapi, Oslo.

FUENTE: Tidsskr-Nor-Laegeforen. 1997 Aug 10; 117(18): 2623-6

PAÍS: NORWAY

RESUMEN: Urinary incontinence is defined as involuntary loss of urine that is demonstrable objectively and constitutes a social/hygienic problem. Urinary incontinence can affect both men and women at different ages. It is more prevalent, however, in women, and may be considered a greater problem in the elderly, who may also have other problems, such as difficulty in walking, and generally impaired capacity for the activities of daily living. In a Norwegian study, 27% of the women aged 74-75 years who lived at home, were found to have urinary incontinence. Studies from other countries have shown a prevalence of 30% in patients in hospitals and 50-70% in nursing homes. Randomized controlled trials have shown a positive effect of pelvic floor muscle exercise in women with stress incontinence. Some researchers have found a negative association between age and response to treatment, but this is contradicted by results from other studies. Few randomized controlled studies have evaluated the effect of pelvic floor muscle exercise alone or in combination with bladder training in elderly women. However, the results from two controlled studies and other uncontrolled trials show a potentially high effect of physiotherapy to treat urinary incontinence in elderly women. More controlled randomized studies are needed using reliable and valid outcome measures to evaluate each method of physiotherapy separately. Both bladder training and pelvic floor muscle exercises have no known side effects and can be recommended for today's elderly population.

AUTOR/ES: Feine-JS; Lund-JP

DIRECCIÓN: Faculty of Dentistry, McGill University, Montreal, Quebec, Canada. feine@medcor.mcgill.ca

FUENTE: Pain. 1997 May; 71(1): 5-23

PAÍS: NETHERLANDS

RESUMEN: An analysis of review articles and controlled clinical trials for temporomandibular disorders and similar chronic musculoskeletal pain disorders was carried out. Although little evidence was found that any specific therapy had long-term efficacy greater than placebo, we did find strong evidence that symptoms improve during treatment with most forms of physical therapy, including placebo. When the frequency of significant between-group differences in trials that used placebo and waiting list control (i.e., no treatment) groups were compared, it was found that treatment was better than placebo in only 7/22 trials, whereas treatment was almost always better than no treatment (15/16). This difference was highly significant (P = 0.001). A similar analysis of trials that included more than one treatment group showed that while equal amounts of treatment were usually associated with equal outcome (9/10), unequal treatment regimes led to unequal outcome (10/15; P = 0.012). The group that received the most therapy appeared to do best. In conclusion, it seems that patients are helped during the period that they are being treated with most forms of physical therapy. However, most of these therapies have not been shown to be more efficacious than placebo.

AUTOR/ES: Ginn-KA; Herbert-RD; Khouw-W; Lee-R

DIRECCIÓN: Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia. k.ginn@cchs.usyd.edu.au

FUENTE: Phys-Ther. 1997 Aug; 77(8): 802-9; discussion 810-1

IDIOMA: ENGLISH

PAÍS: UNITED-STATES

RESUMEN: BACKGROUND AND PURPOSE: The aim of this study was to evaluate the efficacy of a physical therapy approach to the treatment of shoulder pain. Subjects. Sixty-six volunteers with shoulder pain believed to be of local mechanical origin were randomly allocated to either a treatment group or a control group. METHODS: Subjects in the treatment group received 1 month of physical therapy aimed at restoring function of their shoulder muscles. Subjects in the control group received no treatment. Outcome measurements of pain intensity, range of motion (ROM), isometric muscle force, functional impairment, and self-perception of improvement were obtained by blinded assessment. RESULTS: Subjects in the treatment group showed improvement in pain-free abduction and flexion ROM, functional impairment, and self-perception of improvement. The control group deteriorated slightly over the experimental period in ROM and functional impairment measures. CONCLUSION AND DISCUSSION: These results suggest that the physical therapy approach used in this study is effective in improving shoulder function in subjects experiencing pain of mechanical origin. The results also provide little evidence of spontaneous recovery over a 1-month period.

AUTOR/ES: van-der-Heijden-GJ; van-der-Windt-DA; de-Winter-AF

DIRECCIÓN: Institute for Rehabilitation Research, Hoensbroek, Netherlands.

FUENTE: BMJ. 1997 Jul 5; 315(7099): 25-30

IDIOMA: ENGLISH

PAÍS: ENGLAND

RESUMEN: OBJECTIVE: To assess the effectiveness of physiotherapy for patients with soft tissue shoulder disorders. DESIGN: A systematic computerised literature search of Medline and Embase, supplemented with citation tracking, for relevant trials with random allocation published before 1996. SUBJECTS: Patients treated with physiotherapy for disorders of soft tissue of the shoulder. MAIN OUTCOME MEASURES: Success rates, mobility, pain, functional status. RESULTS: Six of the 20 assessed trials satisfied at least five of eight validity criteria. Assessment of methods was often hampered by insufficient information on various validity criteria, and trials were often flawed by lack of blinding, high proportions of withdrawals from treatment, and high proportions of missing values. Trial sizes were small: only six trials included intervention groups of more than 25 patients. Ultrasound therapy, evaluated in six trials, was not shown to be effective. Four other trials favoured physiotherapy (laser therapy or manipulation), but the validity of their methods was unsatisfactory. CONCLUSIONS: There is evidence that ultrasound therapy is ineffective in the treatment of soft tissue shoulder disorders. Due to small trial sizes and unsatisfactory methods, evidence for the effectiveness of other methods of physiotherapy is inconclusive. For all methods of treatment, trials were too heterogeneous with respect to included patients, index and reference treatments, and follow up to merit valid statistical pooling. Future studies should show whether physiotherapy is superior to treatment with drugs, steroid injections, or a wait and see policy.

AUTOR/ES: Ferrell-BA; Josephson-KR; Pollan-AM; Loy-S; Ferrell-BR

DIRECCIÓN: UCLA School of Medicine, USA.

FUENTE: Aging-Milano. 1997 Feb-Apr; 9(1-2): 99-105

IDIOMA: ENGLISH

PAÍS: ITALY

RESUMEN: We conducted a pilot study to evaluate a practical exercise program for elderly people with chronic musculo-skeletal pain. Thirty-three subjects (mean age, 73 years; 69% back pain; 24% knee pain; 9% hip pain) were randomly assigned to one of three groups. Group 1 received 6-week supervised program of walking. Group 2 received a pain education program that included instruction and demonstration of use of heat, cold, massage, relaxation and distraction. Group 3 received usual care. Outcomes including pain, self-reported health and functional status, and performance-based measures of functional status were evaluated at baseline, at two weeks and at eight weeks (end of study). Attendance was 100% for the education sessions and 93% for walking sessions. No injuries were sustained. Both intervention groups demonstrated significant improvements in pain (p < 0.05) and performance-based measures of functional status (p < 0.05), while the control group had no changes. These data suggest that patient education and fitness walking can improve overall pain management and related functional limitations among elderly people with chronic musculo-skeletal pain.

AUTOR/ES: Hemmila-HM; Keinanen-Kiukaanniemi-SM; Levoska-S; Puska-P

DIRECCIÓN: Folk Medicine Centre, Kaustines, Finland.

FUENTE: Arch-Phys-Med-Rehabil. 1997 Jun; 78(6): 571-7

IDIOMA: ENGLISH

PAÍS: UNITED-STATES

RESUMEN: OBJECTIVE: To determine whether traditional bone-setting or continuous light exercise therapy could case back pain and improve function better than ordinary physiotherapy. DESIGN: Observer-blinded, randomized clinical trial with a 6-month follow-up. SETTING: An outpatient institution for folk medicine research. PATIENTS: Of 147 back pain patients recruited from local health centers and by newspaper announcements, 132 were found eligible (non-retired-no contraindications to manipulation) and entered. A final 114 (one dropout) with back pain for longer than 7 weeks were included in this intent to treat analysis. INTERVENTIONS: Bone-setting, guidance for continuous light back movements or physiotherapy for up to ten 1-hour sessions during 6 weeks. MAIN OUTCOME MEASURES: Spinal mobility and muscular performance. Back pain assessed by visual analog scales (VAS). RESULTS: The physical measures changed only modestly, from one tenth to half of standard deviation, while the VAS was halved. The thoracolumbar side-bending, the modified Schober, and the VAS were significantly better improved by bone-setting than by exercise but not better than by physiotherapy. CONCLUSION: Neither bone-setting nor exercise differed significantly from physiotherapy, but bone-setting improved lateral and forward bending of the spine and back pain more than did exercise.

AUTOR/ES: Stenstrom-CH; Arge-B; Sundbom-A

DIRECCIÓN: Department of Rheumatology, Malarsjukhuset, Eskilstuna, Sweden.

FUENTE: J-Rheumatol. 1997 Mar; 24(3): 470-6

IDIOMA: ENGLISH

PAÍS: CANADA

RESUMEN: OBJECTIVE: To survey and to compare the one year effects of dynamic muscle training and progressive muscle relaxation as home exercise for patients with inflammatory rheumatic diseases; and to identify predictors for compliance with a longterm home exercise regimen. METHODS: Fifty-four patients (mean age 54 yrs, mean symptom duration 14 yrs) were assessed for health related quality of life, exercise motivation, joint tenderness, and physical capacities. After randomization into 2 groups, every patient was instructed on one occasion in a 30 min program of either dynamic training or muscle relaxation to carry out at home, 5 times a week during 3 months, and then 2-3 times a week for another 9 months. RESULTS: Seventeen patients in each group completed the one year exercise protocol, while 10 from each group did not. Compliance with the one year exercise regimen seemed to be predicted by high self-efficacy for exercise, regular range-of-motion exercises before the intervention, and being unmarried. After one year, minor improvements in physical effect (p < or = 0.05) and work effect (p < or = 0.05) were found in the dynamic training group, while minor improvements in pain effect (p < or = 0.05), emotional reactions (p < or = 0.05), and arm endurance (p < or = 0.01) were found in the muscle relaxation group. No differences between the groups regarding changes in health status, joint tenderness, or physical capacities during the intervention period were found. CONCLUSION: These results may improve the selection of patients for home exercise, and form a basis for improved administration of home exercise programs.