Artículos Seleccionados - CLINICA KINESICA - 1998.

Treatment of leg edema and wounds in a patient with severe musculoskeletal injuries.

Lymphedema of the limb. An overview of treatment options.

Total shoulder arthroplasty biomechanics: a study of the forces and strains at the glenoid component.

Reproducibility of manual pressure force on provocation of the sacroiliac joint.

Presentation and response of patients with upper extremity repetitive use syndrome to a multidisciplinary rehabilitation program: a retrospective review of 24 cases.

Positive effects of physiotherapy on chronic pain and performance in osteoporosis.

Classification and low back pain: a review of the literature and critical analysis of selected systems.

A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain.

A randomized study comparing manual lymph drainage with sequential pneumatic compression for treatment of postoperative arm lymphedema.

Pelvic floor dyssynergia and bimodal rehabilitation: results of combined pelviperineal kinesitherapy and biofeedback training.

Nonpharmacological treatment for migraine: incremental utility of physical therapy with relaxation and thermal biofeedback.

Update on lumbar spinal stenosis. Retrospective study of 62 patients and review of the literature.

Conservative inhospital management of low back pain patients. Factors predicting two-year outcomes.

Conservative treatment of stress urinary incontinence in women: a systematic review of randomized clinical trials.

Treatment of lymphedema and patient rehabilitation.

Curricular content on urinary incontinence in entry-level physical therapy programmes in three countries.

Trunk strength in combined motions of rotation and flexion/extension in normal young adults.

Clinical experience of rehabilitation therapists with chronic diseases: a quantitative approach.

The effect of pelvic floor exercise on stress urinary incontinence.

Physical therapy for patients with TMD: a descriptive study of treatment, disability, and health status.

Treatment-seeking patterns of facial pain patients: many possibilities, limited satisfaction.

Cognitive and physical capacity process variables predict long-term outcome after treatment of chronic pain.

Combined exercise and motivation program: effect on the compliance and level of disability of patients with chronic low back pain: a randomized controlled trial.

The effect of static stretch and dynamic range of motion training on the flexibility of the hamstring muscles.

Intensive training, physiotherapy, or manipulation for patients with chronic neck pain. A prospective, single-blinded, randomized clinical trial.

Título en Inglés: Treatment of leg edema and wounds in a patient with severe musculoskeletal injuries.

Autor/es: Weiss-JM

Lugar: Cox Regional Center for Sports Medicine and Rehabilitation, Springfield, MO 65807, USA.

Fuente: Phys-Ther. 1998 Oct; 78(10): 1104-13

ISSN: 0031-9023

Idioma: ENGLISH

Resumen: This case report describes the application of a technique for the treatment of leg edema and wounds resulting from a severe distal tibiofibular fracture. Following injury and numerous fracture- and wound-related surgeries in the first year postinjury, this patient developed leg edema, required daily treatment of 2 leg wounds, and was unable to wear a shoe due to foot swelling. He was referred to the physical therapy clinic 1 year postinjury for ankle rehabilitation and to diminish the leg edema. Therapy consisting of manual lymph drainage, compressive bandaging, exercise, and skin care was provided for 7 weeks. A compression stocking was issued near the end of treatment, which the patient continued to wear daily thereafter. At the time of discharge from therapy, the leg edema had decreased 74% and the wound area of both wounds had decreased 89%. Improvements continued following discharge. By 10 weeks after the start of treatment, edema had decreased 80.9%, one wound had healed, and the second wound was 93% improved. The patient was able to wear a shoe and resume recreational activities. This case report provides insight into a treatment that may shorten rehabilitation and control the cost of caring for injuries complicated by prolonged edema.[volver]

Título en Inglés: Lymphedema of the limb. An overview of treatment options.

Autor/es: Tunkel-RS; Lachmann-E

Lugar: Memorial Sloan-Kettering Cancer Center, New York, USA.

Fuente: Postgrad-Med. 1998 Oct; 104(4): 131-4, 137-8, 141 passim

ISSN: 0032-5481

Idioma: ENGLISH

Resumen: In developed countries, prevalence is increasing of malignancy-related secondary lymphedema, usually resulting from lymph node resection or irradiation. Untreated lymphedema usually increases over time, and the physical and psychological sequelae in even mild cases demand appropriate diagnosis and treatment. Patients should be referred to a clinic familiar with the treatment of lymphedema, and therapy should be customized to optimize patient compliance. Treatment programs do exist, but clinicians who are unfamiliar with them may find it difficult to determine the best program for individual patients. Currently, most lymphedema clinics favor the use of MLT-CPT for significant lymphedema.[volver]

Título en Inglés: Total shoulder arthroplasty biomechanics: a study of the forces and strains at the glenoid component.

Autor/es: Karduna-AR; Williams-GR; Iannotti-JP; Williams-JL

Lugar: Department of Physical Therapy, Allegheny University of the Health Sciences, Philadelphia, PA 19102, USA.

Fuente: J-Biomech-Eng. 1998 Feb; 120(1): 92-9

ISSN: 0148-0731

Año de Publicación: 1998

Idioma: ENGLISH

Resumen: The objective of this study was to examine how changes in glenohumeral joint conformity and loading patterns affected the forces and strains developed at the glenoid. After removal of soft tissue (muscles, ligaments, and labrum), force-displacement data were collected for both natural and prosthetically reconstructed joints. Joints were shown to develop higher forces for a given translation as joint conformity increased. A rigid body model of joint contact forces was used to determined the so-called effective radial mismatch of each joint. For the purposes of this study, the effective radial mismatch is defined as the mismatch required for a rigid body joint to have the same force-displacement relationship as the joint in question. This parameter is an indication of the deformation at the articular surface. The effective radial mismatch dramatically increased with increasing medial loads, indicating that under physiological loads, the effective radial mismatch of a joint is much greater than its measured mismatch at no load. This increase in effective mismatch as medial loads were increased was found to be threefold greater in cartilaginous joints than in reconstructed joints. Rosette strain gages positioned at the midlevel of the glenoid keel in the reconstructed joints revealed that anterior/posterior component loading leads to fully reversible cyclic keel strains. The highest compressive strains occurred with the head centered in the glenoid, and were larger for nonconforming joints (epsilon = 0.23 percent). These strains became tensile just before rim loading and were greater for conforming joints (epsilon = 0.15 percent). Although recorded peak strains are below the yield point for polyethylene, the fully reversed cyclic loading of the component in this fashion may ultimately lead to component toggling and implant failure.[volver]

Título en Inglés: Reproducibility of manual pressure force on provocation of the sacroiliac joint.

Autor/es: Levin-U; Nilsson-Wikmar-L; Stenstrom-CH; Lundeberg-T

Lugar: Department of Physical Therapy, Karolinska Institutet, Stockholm, Sweden.

Fuente: Physiother-Res-Int. 1998; 3(1): 1-14

ISSN: 1358-2267

Idioma: ENGLISH

Resumen: BACKGROUND AND PURPOSE: Previous studies of pain-provocation sacroiliac (SI) joint tests have revealed conflicting results. The aim of the present study was to evaluate the intra- and inter-test reliability of pressure force applied during distraction test, compression test and pressure on the apex sacralis. METHODS: Seventeen physiotherapists (PTs), median age 43 years and median clinical experience 11 years, all experienced in musculoskeletal evaluation and therapy, participated in the study. Each PT performed each test on the same healthy volunteer for 20 s, on three separate occasions, at intervals of one week using a specially constructed examination table which registered pressure force. RESULTS: The PTs were capable of maintaining a relatively constant pressure force for 20 s. The intra-test reliability was acceptable even though there were individual differences on different occasions between those PTs who used the SI joint tests often and those who seldom or never used them. The inter-test reliability was insufficient. CONCLUSIONS: The findings indicate the advantage of registering pressure force as a complement for standardized methods for pain-provoking tests and when learning provocation tests, since individual variability was considerable.[volver]

Título en Inglés: Presentation and response of patients with upper extremity repetitive use syndrome to a multidisciplinary rehabilitation program: a retrospective review of 24 cases.

Autor/es: Barthel-HR; Miller-LS; Deardorff-WW; Portenier-R

Lugar: Cedars-Sinai Medical Center, Los Angeles, California, USA. hrbarthel@earthlink.net

Fuente: J-Hand-Ther. 1998 Jul-Sep; 11(3): 191-9

ISSN: 0894-1130

Idioma: ENGLISH

Resumen: OBJECTIVE: To analyze retrospectively a group of patients presenting to an outpatient hand rehabilitation clinic with complaints related to repetitive tasks of the upper extremity. DESIGN: Retrospective case study reviewing 24 consecutive cases for presenting symptoms and response of patients to a multidisciplinary rehabilitation approach. SETTING: An outpatient hand rehabilitation clinic in a tertiary referral center offering simultaneous medical, psychological, and occupational evaluations. PATIENTS: Twenty-four patients with upper extremity symptoms related to repetitive use, who had all failed various prior therapeutic interventions. Fifty percent of the patients were receiving medical disability compensation because of their symptoms. Sixty-two percent had filed a worker's compensation claim. INTERVENTIONS: Treatment consisted of medical management with pharmacologic interventions, occupational therapy with workplace simulation and job-site evaluations, and psychological treatment with pain management and biofeedback training. Treatments were individualized to meet each patient's needs. OUTCOME MEASURES: Reduction in symptom intensity or frequency, increase in work and performance of activities of daily living, and termination of medical disability with return to work. RESULTS: Most cases (83%) were found to be related to occupational computer keyboard use. Bilateral hand and forearm pain were the major symptoms. A unique physical finding was diffuse tendon tenderness and tightness of the long flexor and extensor muscles of the forearm. Carpal tunnel syndrome was found in only one patient. Twenty-five percent of patients achieved resolution of most symptoms, although on a modified and often reduced activity level; 54% had moderate improvement; and 13% had only minimal or no improvement. Of the patients receiving medical disability compensation, 58% returned to their previous jobs. CONCLUSIONS: Patients with upper extremity symptoms related to repetitive use often have unique physical findings, distinct from those of carpal tunnel syndrome. Resulting work disability is high. Patients who have not responded to conventional interventions within a reasonable time may benefit from a multidisciplinary treatment approach. Most patients improve with this treatment but do not fully recover.[volver]

Título en Inglés: Positive effects of physiotherapy on chronic pain and performance in osteoporosis.

Autor/es: Malmros-B; Mortensen-L; Jensen-MB; Charles-P

Lugar: Department of Physiotherapy, Aarhus Amtssygehus, Denmark.

Fuente: Osteoporos-Int. 1998; 8(3): 215-21

ISSN: 0937-941X

Idioma: ENGLISH

Resumen: The aim of this placebo-controlled, randomized, single-masked study was to establish the effects of a 10-week ambulatory exercise programme for osteoporotic patients on pain, use of analgesics, functional status, quality of life, balance and muscle strength. Fifty-three ambulatory postmenopausal women with at least one spinal crush fracture and pains within the last 3 years were randomized for physiotherapeutic training twice a week for 10 weeks or no training. The training included general training of balance and muscle strength, with stabilization of the lumbar spine. The participants were tested at baseline, week 5 and week 10 with a balance test, muscle strength test and questionnaires on pain, use of analgesics, functional status and quality of life. Twelve weeks after the supervised training had finished (week 22) they answered the same questionnaires. The study groups were comparable at baseline. The training group had a significant reduction in use of analgesics (p = 0.02) and pain level (p = 0.01) during the training period. Distribution of functional score improved; the improvement was reduced at week 22. Quality of life score improved significantly throughout the study (p = 0.0008), even after week 22. Balance improved non-significantly (p = 0.08). Quadriceps muscle strength improved significantly after 5 weeks (p = 0.04). Back extensor muscle strength improved almost significantly (p = 0.09). In conclusion, this training programme for osteoporotic patients improved balance and level of daily function and decreased experience of pain and use of analgesics. Quality of life was improved even beyond the active training period.[volver]

Título en Inglés: Classification and low back pain: a review of the literature and critical analysis of selected systems.

Autor/es: Riddle-DL

Lugar: Department of Physical Therapy, Virginia Commonwealth University, Richmond 23298-0224, USA. driddle@hsc.vcu.edu

Fuente: Phys-Ther. 1998 Jul; 78(7): 708-37

ISSN: 0031-9023

Idioma: ENGLISH

Resumen: Classification systems for patients with low back pain have become more abundant in the literature since the mid-1980s. Some classification systems are designed to determine the most appropriate treatment, some are designed to aid in prognosis, and others are designed to identify pathology. Still other classification systems categorize patients into homogeneous groups based on selected variables. The purpose of this review is to describe and critically evaluate low back pain classification systems. Several classification systems were summarized and examined. Four classification systems that were judged to be the most commonly cited and most relevant to physical therapists were critiqued using a more thorough systematic approach. The analysis suggests that future research should address the usefulness of existing classification systems as well as the development of new classification systems designed using commonly accepted measurement principles.[volver]

Título en Inglés: A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain [see comments]

CM: Comment in: N Engl J Med 1998 Oct 8;339(15):1074-5

Autor/es: Cherkin-DC; Deyo-RA; Battie-M; Street-J; Barlow-W

Lugar: Department of Health Services, University of Washington, Seattle 98101, USA.

Fuente: N-Engl-J-Med. 1998 Oct 8; 339(15): 1021-9

ISSN: 0028-4793

Idioma: ENGLISH

Resumen: BACKGROUND AND METHODS: There are few data on the relative effectiveness and costs of treatments for low back pain. We randomly assigned 321 adults with low back pain that persisted for seven days after a primary care visit to the McKenzie method of physical therapy, chiropractic manipulation, or a minimal intervention (provision of an educational booklet). Patients with sciatica were excluded. Physical therapy or chiropractic manipulation was provided for one month (the number of visits was determined by the practitioner but was limited to a maximum of nine); patients were followed for a total of two years. The bothersomeness of symptoms was measured on an 11-point scale, and the level of dysfunction was measured on the 24-point Roland Disability Scale. RESULTS: After adjustment for base-line differences, the chiropractic group had less severe symptoms than the booklet group at four weeks (P=0.02), and there was a trend toward less severe symptoms in the physical therapy group (P=0.06). However, these differences were small and not significant after transformations of the data to adjust for their non-normal distribution. Differences in the extent of dysfunction among the groups were small and approached significance only at one year, with greater dysfunction in the booklet group than in the other two groups (P=0.05). For all outcomes, there were no significant differences between the physical-therapy and chiropractic groups and no significant differences among the groups in the numbers of days of reduced activity or missed work or in recurrences of back pain. About 75 percent of the subjects in the therapy groups rated their care as very good or excellent, as compared with about 30 percent of the subjects in the booklet group (P<0.001). Over a two-year period, the mean costs of care were $437 for the physical-therapy group, $429 for the chiropractic group, and $153 for the booklet group. CONCLUSIONS: For patients with low back pain, the McKenzie method of physical therapy and chiropractic manipulation had similar effects and costs, and patients receiving these treatments had only marginally better outcomes than those receiving the minimal intervention of an educational booklet. Whether the limited benefits of these treatments are worth the additional costs is open to question.[volver]

Título en Inglés: A randomized study comparing manual lymph drainage with sequential pneumatic compression for treatment of postoperative arm lymphedema.

Autor/es: Johansson-K; Lie-E; Ekdahl-C; Lindfeldt-J

Lugar: Department of Physical Therapy, University Hospital, Lund, Sweden.

Fuente: Lymphology. 1998 Jun; 31(2): 56-64

ISSN: 0024-7766

Idioma: ENGLISH

Resumen: We compared manual lymph drainage (MLD) with sequential pneumatic compression (SPC) for treatment of unilateral arm lymphedema in 28 women previously treated for breast cancer. After 2 weeks of therapy with a standard compression sleeve (Part I) with maintenance of a steady arm volume, each patient was randomly assigned to either one of two treatment regimens (Part II). MLD was performed according to the Vodder technique for 45 min/day and SPC was performed with a pressure of 40-60 mmHg for 2 hours/day. Both treatments were carried out for 2 weeks. Arm volume was measured by water displacement. Arm mobility, strength, and subjective assessments were also determined. Lymphedema was reduced by 49 ml (7% reduction) (p = 0.01) in the total group during Part I. During Part II, the MLD group decreased by 75 ml (15% reduction) (p < 0.001) and the SPC group by 28 ml (7% reduction) (p = 0.03). The total group reported a decrease of tension (p = 0.004) and heaviness (p = 0.01) during Part I. During Part II, only the MLD group reported a further decrease of tension (p = 0.01) and heaviness (p = 0.008). MLD and SPC each significantly decreased arm volume but no significant difference was detected between the two treatment methods.[volver]

Título en Inglés: Pelvic floor dyssynergia and bimodal rehabilitation: results of combined pelviperineal kinesitherapy and biofeedback training.

Autor/es: Pucciani-F; Rottoli-ML; Bologna-A; Cianchi-F; Forconi-S; Cutelle-M; Cortesini-C

Lugar: Istituto di Clinica Chirurgica Generale e Discipline Chirurgiche, Universita degli Studi di Firenze, Italy.

Fuente: Int-J-Colorectal-Dis. 1998; 13(3): 124-30

ISSN: 0179-1958

Idioma: ENGLISH

Resumen: Dyschezia may be caused by pelvic floor dyssynergia, which takes place when a paradoxical contraction or a failure to relax the pelvic floor muscles occurs during attempts to defecate. The aim of our study was to set up a new bimodal rehabilitation programme for pelvic floor dyssynergia, which combined pelviperineal kinesitherapy and biofeedback, and to evaluate the results of this treatment. Thirty-five patients (age range: 28-64 years; mean age: 42.5 years) from the outpatient unit of the Clinica Chirurgica of the University of Florence, Italy, and an age-matched group of 10 healthy control subjects (age range: 31-59 years; mean age 45.7 years) with normal bowel habits and without any defecatory disorders, were studied. The 35 patients were symptomatic for dyschezia without slow colonic transit and had been diagnosed as being affected by pelvic floor dyssynergia. No evidence of any organic aetiology was present but all demonstrated both manometric and radiological evidence of inappropriate function of the pelvic floor. All of the patients underwent bimodal rehabilitation, using the combined training programme Clinical evaluation, computerized anorectal manometry and defecography were carried out 1 week before and 1 week after a completed course in bimodal rehabilitation. The control group underwent manometric and defecographic examination. Their results were compared with those of the 35 patients before and after training. After the programme, all 35 patients had a very significant increase in stool frequency (P < 0.001), while laxative and enema-induced bowel movements had become significantly less frequent (P < 0.001). After bimodal rehabilitation, computerized anorectal manometry showed some peculiar results. Resting anal canal pressure had increased but not significantly. Pre-programme values that indicated a shorter duration ("exhaustio") of maximal voluntary contraction than found in the controls had returned to normal values. The rectoanal inhibitory reflex (RAIR), with incomplete relaxation, which had been shorter than that of controls, became normal by the end of the rehabilitation. All RAIR parameters were significantly different especially when pre- and post-treatment values were compared (P < 0.001). No differences were found as regards rectal sensation parameters and rectal compliance between those before or after bimodal rehabilitation. Defecographic pretreatment X-ray films showed indentation of the puborectalis and poor anorectal angle (ARA) opening, at evacuation, with trapping barium of at 50%. After pelviperineal kinesitherapy and biofeedback training, the indentation had disappeared and the ARA had become significantly larger (P < 0.001) during evacuation. No differences were found after rehabilitation, when both were compared with those of controls. The pelvic floor descent was also significantly deeper (P < 0.001) than before the start of the programme. The bimodal rehabilitation technique can be considered a useful therapeutic option for functional dyschezia as shown by our clinical evaluations, manometric data and defecographic reports.[volver]

Título en Inglés: Effect of electrical stimulation on stress and urge urinary incontinence. Clinical outcome and practical recommendations based on randomized controlled trials.

Autor/es: Bo-K

Lugar: Norwegian Center for Physiotherapy Research, Oslo.

Fuente: Acta-Obstet-Gynecol-Scand-Suppl. 1998; 168: 3-11

Consulte #1

ISSN: 0300-8835

Idioma: ENGLISH

Resumen: BACKGROUND: The aim of the present study was to review the literature on randomized controlled trials of electrical stimulation to treat urge and stress urinary incontinence. METHODS: Studies were compiled from Medline from 1980 till 1996 and manual searches of relevant journals. Randomized controlled studies full length published in English, German and Scandinavian languages were included. RESULTS: Nine studies evaluating the effect of electrical stimulation on stress urinary incontinence and one study evaluating the effect of urge incontinence were found. Only three studies had a sufficient sample size to enable conclusion on stress urinary incontinence. Two demonstrated negative, and one positive effect (20%) cure and 46% improved measured by pad test). The study on urge incontinence demonstrated that there was no difference in effect after electrical stimulation or anticholinergic drugs. CONCLUSION: The results of randomized controlled trials evaluating the effect of electrical stimulation to treat stress and urge urinary incontinence are conflicting. There is a need for more randomized controlled trials with sufficient sample sizes, use of sensitive, reproducible and valid outcome measures, and optimal stimulation parameters. Based on the present knowledge pelvic floor muscle exercise should be the first choice of treatment for stress urinary incontinence.[volver]

Título en Inglés: Nonpharmacological treatment for migraine: incremental utility of physical therapy with relaxation and thermal biofeedback.

Autor/es: Marcus-DA; Scharff-L; Mercer-S; Turk-DC

Lugar: University of Pittsburgh Medical Center, PA, USA.

Fuente: Cephalalgia. 1998 Jun; 18(5): 266-72; discussion 242

ISSN: 0333-1024

Idioma: ENGLISH

Resumen: The identification of musculoskeletal abnormalities in headache patients has led to the incorporation of physical therapy (PT) into treatment programs for chronic headache. The current studies: (i) investigated the efficacy of PT as a treatment for migraine, and (ii) investigated the utility of PT as an adjunct treatment in patients who fail to improve with relaxation training/thermal biofeedback (RTB). PT alone is not effective in reducing headache, with only 14% of subjects reporting significant headache reduction (mean reduction of 15.6% in comparison with 41.3% in RTB). However, PT may have been a useful adjunct, with 47% of a group of 11 subjects who had failed to improve with RTB reporting improvement with the addition of PT. It is recommended that RTB remain the nonmedical treatment of choice for migraine, and that PT may be a useful adjunct for patients who fail to improve after such treatment.[volver]

Título en Inglés: Update on lumbar spinal stenosis. Retrospective study of 62 patients and review of the literature.

Autor/es: Radu-AS; Menkes-CJ

Lugar: Department of Rheumatology, School of Medicine of the Sao Paulo University, Brazil.

Fuente: Rev-Rhum-Engl-Ed. 1998 May; 65(5): 337-45

ISSN: 1169-8446

Idioma: ENGLISH

Resumen: PURPOSE AND METHODS: Although lumbar spinal stenosis syndrome is extremely common, considerable controversy continues to surround its classification, diagnosis, and treatment. We retrospectively reviewed the medical charts of 62 patients admitted for lumbar spinal stenosis syndrome, and we compared our findings to those in the literature. There were 31 women and 31 men. Mean age was 71.8 years. The most common symptoms were positional radiculopathy (92%) and low back pain (95%). The more suggestive sign of pseudoclaudication was observed in only 75% of cases, in keeping with earlier studies. Neurologic symptoms consisting primarily in mild motor loss were present in 15 patients. RESULTS: The most common physical finding was pain during spinal extension (70%). Adopting a bent forward position during walking, a very suggestive manifestation, was seen in 15 patients. Imaging study findings included extensive changes in the discs and facet joints, disc protrusion, scoliosis, and degenerative spondylolisthesis. Myelography was rarely needed. There are no criteria sets for lumbar spinal stenosis syndrome. The diagnosis rests on clinical grounds, and extensive imaging studies are usually unnecessary. Our patients were treated with repeated corticosteroid injections into the thecal sac or epidural space and/or into the facet joints. Only eight patients required surgery. CONCLUSION: Our study supports the view that most cases of lumbar spinal stenosis can be managed conservatively.[volver]

Título en Inglés: Conservative inhospital management of low back pain patients. Factors predicting two-year outcomes.

Autor/es: Zufferey-P; Cedraschi-C; Vischer-TL

Lugar: Department of Rheumatology, Geneva University Hospital, Switzerland.

Fuente: Rev-Rhum-Engl-Ed. 1998 May; 65(5): 320-7

ISSN: 1169-8446

Idioma: ENGLISH

Resumen: OBJECTIVE: To evaluate the course of symptoms and occupational outcomes in low back pain patients two years after conservative inhospital therapy. METHODS: Retrospective medical chart study of all patients admitted to a rheumatology department in Geneva in 1993, and telephone interview two years after the admission. RESULTS: Eighty of the 99 patients (81%) identified by the chart review were interviewed by telephone. The course of symptoms (evaluated based on subjective assessments and on the number of subsequent admissions) was similar in the patients who had acute (n = 33) and chronic (n = 47) low back pain at the index admission. Patients who had not returned to work were significantly more likely to report persistent pain (P < 0.001). As many as 61% of patients had not resumed work. Sick leave duration and symptom duration at admission were the factors that had the largest effects on prognosis. Over 90% of patients who were put on sick leave for more than four weeks did not return to work. Permanent cessation of work was recorded in 82% of manual laborers versus 27% of patients in sedentary jobs (P < 0.001). CONCLUSION: Our results are ascribable, at least in part, to the fact that our population included large numbers of patients with persistent pain and of blue collar workers with physically-challenging jobs. Sick leave duration and occupation were the best predictors of the course of symptoms and work status.[volver]

Título en Inglés: Conservative treatment of stress urinary incontinence in women: a systematic review of randomized clinical trials.

Autor/es: Berghmans-LC; Hendriks-HJ; Bo-K; Hay-Smith-EJ; de-Bie-RA; van-Waalwijk-van-Doorn-ES

Lugar: Department of Urology, University Hospital Maastricht, The Netherlands.

Fuente: Br-J-Urol. 1998 Aug; 82(2): 181-91

ISSN: 0007-1331

Idioma: ENGLISH

Resumen: OBJECTIVE: To assess the efficacy of physical therapies for first-line use in the treatment and prevention of stress urinary incontinence (SUI) in women, using a systematic review of randomized clinical trials (RCTs). MATERIALS AND METHODS: A computer-aided and manual search for published RCTs investigating treatment and prevention of SUI using physical therapies, e.g. pelvic floor muscle (PFM) exercises, with or without other treatment modalities, were carried out. The methodological quality of the included trials was assessed using criteria based on generally accepted principles of interventional research. RESULTS: Twenty-four RCTs (22 treatment and two prevention) were identified; the methodological quality of the studies included was moderate and 11 RCTs were of sufficient quality to be included in further analysis. Based on levels-of-evidence criteria, there is strong evidence to suggest that PFM exercises are effective in reducing the symptoms of SUI. There is limited evidence for the efficacy of high-intensity vs a low-intensity regimen of PFM exercises. Despite significant effects of biofeedback after testing as an adjunct to PFM exercises, there is no evidence that PFM exercises with biofeedback are more effective than PFM exercises alone. There is little consistency (of stimulation types and parameters) in the studies of electrical stimulation, but when the results are combined there is strong evidence to suggest that electrostimulation is superior to sham electrostimulation, and limited evidence that there is no difference between electrostimulation and other physical therapies. In the prevention of SUI the efficacy of PFM exercises, with or without other adjuncts, is uncertain.[volver]

Título en Inglés: Treatment of lymphedema and patient rehabilitation.

Autor/es: Foldi-E

Lugar: Foldiclinic, Hinterzarten, Germany.

Fuente: Anticancer-Res. 1998 May-Jun; 18(3C): 2211-2

ISSN: 0250-7005

Idioma: ENGLISH

Resumen: Even without clinically manifest lymphedema, in the overwhelming majority of patients after breast cancer treatment the function of the lymphatics is impaired. As a consequence, appropriate preventive measures have to be carried out. The method of choice of the treatment of lymphedema is combined physiotherapy.[volver]

Título en Inglés: Curricular content on urinary incontinence in entry-level physical therapy programmes in three countries.

Autor/es: Walker-JM

Lugar: Dalhousie University, Canada.

Fuente: Physiother-Res-Int. 1998; 3(2): 123-34

ISSN: 1358-2267

Idioma: ENGLISH

Resumen: BACKGROUND AND PURPOSE: Urinary incontinence (UI) is a significant psychological, social and healthcare problem across the lifespan. Although there is evidence of physical therapy (PT) efficacy, no literature was located pertaining to UI in PT curricula. The aim was to compare curricular content on UI (of non-neuropathic origin) in PT programmes in Canada, the UK and the USA. The study subjects were PT educators in entry-level programmes. METHODS: All Canadian PT programmes (13) were surveyed. Stratification was used to make random samples of PT programmes: 50% of UK (13/26) and 50% of USA (69/136). A questionnaire was used to obtain information on: degree level, programme length, specific courses, time allotted, UI topics, teaching method(s), the professional teaching patients with UI and reasons for non-inclusion in the study. One follow-up letter was sent. Results are presented as frequencies and percentages. RESULTS: Overall, the response rate was 62.8%; country response rates were: Canada 92.3%; UK 76.9% and USA 53.6%. UI was taught in 80% of Canadian, 90% of UK (which gave the most time to teaching on UI: 70% > 60 minutes) and 78.4% of USA PT programmes. Kegel exercises were taught in all three countries (> 81.1%) and electrical stimulation in > 65%. Theory only was the primary method of teaching in all countries (> 64.9%). Physical therapists were reported to have a major role in treating patients with UI (Canada > 75%; UK 100%; USA 70.3%). CONCLUSIONS: With Kegel exercises and electrical stimulation taught in two-thirds of all programmes physical therapy graduates may have some knowledge of UI management. However, for the UK and USA programmes data are from only 38.5% and 27% respectively. As the common method of teaching on UI was by theory only, graduating physical therapists may lack the clinical skills to apply assessment and treatment techniques.[volver]

Título en Inglés: Trunk strength in combined motions of rotation and flexion/extension in normal young adults.

Autor/es: Kumar-S; Narayan-Y; Zedka-M

Lugar: Department of Physical Therapy, University of Alberta, Edmonton, Canada.

Fuente: Ergonomics. 1998 Jun; 41(6): 835-52

ISSN: 0014-0139

Idioma: ENGLISH

Resumen: Thirty-eight normal healthy young subjects (14 males, 24 females) with mean ages of 23 years (males) and 21 years (females), performed 36 functional rotational tasks of the trunk. The subject's lower extremities were stabilized in a stabilizing platform, allowing the entire motion of flexion-rotation and extension-rotation to take place in the trunk. Of these tasks, 18 were isometric and the other 18 were isokinetic. The isometric tasks consisted of flexion-rotation and extension-rotation from a 20 degrees, 40 degrees and 60 degrees flexed trunk in 20 degrees, 40 degrees and 60 degrees of axial rotation. The isokinetic activity consisted of flexion-rotation and extension-rotation from upright and flexed postures respectively in 20 degrees, 40 degrees and 60 degrees rotation planes at 15 degrees, 30 degrees and 60 degrees/s angular velocities. The results revealed that the males were significantly stronger than females (p < 0.01) and isometric activities produced significantly greater torque compared to isokinetic efforts (p < 0.01). The degree of trunk flexion was not significant; the angle of rotation, although significant, had only a small effect. The 60 degrees trunk rotation was significantly different from 20 degrees and 40 degrees of trunk rotation. The multiple regressions were all significant (p < 0.01); however, they predicted only 40 to 60% of the variations. Based on the results and analysis, it is suggested that the motion involved rather than the torque may have a consequential effect in the precipitation of back injuries.[volver]

Título en Inglés: Clinical experience of rehabilitation therapists with chronic diseases: a quantitative approach.

Autor/es: Rijken-PM; Dekker-J

Lugar: NIVEL/Netherlands Institute of Primary Health Care, Utrecht.

Fuente: Clin-Rehabil. 1998 Apr; 12(2): 143-50

ISSN: 0269-2155

Idioma: ENGLISH

Resumen: OBJECTIVES: To provide an overview of the numbers of patients with selected chronic diseases treated by rehabilitation therapists (physical therapists, occupational therapists, exercise therapists and podiatrists). The study was performed to get quantitative information on the degree to which rehabilitation therapists are experienced in the treatment of chronically ill patients. METHODS: Secondary analyses were performed on several databases containing representative data on patients treated by rehabilitation therapists. Rates per 1000 patients in the populations of these rehabilitation therapists and 90% confidence intervals were computed for patients with the following diagnoses: ischaemic heart diseases, stroke, rheumatoid arthritis, osteoarthritis, osteoporosis, multiple sclerosis, Parkinson's disease, epilepsy, headache syndromes, COPD/asthma, diabetes mellitus and chronic back pain (the size of the latter group could only be assessed in physical therapy in primary care). RESULTS: The largest group of chronically ill patients treated by physical therapists in primary care are patients with chronic back pain (82 per 1000). Stroke patients are the most common chronically ill patients treated by physical therapists in institutional care (157 per 1000) and by occupational therapists in institutional (358 per 1000) and noninstitutional care (246 per 1000). These therapists also see a variety of other chronically ill patients. Exercise therapists and podiatrists treat less patients with the selected chronic diseases.[volver]

Título en Inglés: [The effect of pelvic floor exercise on stress urinary incontinence]

Título Original: Effekt av bekkenbunnstrening pa stressinkontinens.

Autor/es: Finckenhagen-HB; Bo-K

Fuente: Tidsskr-Nor-Laegeforen. 1998 May 20; 118(13): 2015-7

ISSN: 0029-2001

Idioma: NORWEGIAN; NON-ENGLISH

Resumen: Several randomised controlled trials have shown that pelvic floor muscle exercise has resulted in a 60-70% improvement or cure rate from stress incontinence. The aim of the present study was to assess whether these methods could be put into general use in a physiotherapy clinic in primary health care. 36 women, all with a diagnoses of stress urinary incontinence, mean age 49 (range 25-67 years), participated in the study. Before treatment they underwent vaginal examination to ensure there was proper pelvic floor muscle contraction. Pelvic floor muscle strength was assessed by vaginal pressure measurement. Urinary leakage was registered on a 13-item "leakage index", using a 5-point graded scale (1 = never leakage to 5 = always leakage). The women attended a six-month pelvic floor muscle exercise programme, training in groups led by a physiotherapist, and exercising at home with three series of 8-12 contractions a day. 12 patients reported to be cured, and 12 reported a significant improvement (67% in all). Five patients achieved some improvement, whereas in another five there was no change. None became worse. It is concluded that pelvic floor muscle exercises, under the guidance of trained physiotherapists, may be just as effective in clinical practice as in randomised controlled trials.[volver]

Título en Inglés: Physical therapy for patients with TMD: a descriptive study of treatment, disability, and health status.

Autor/es: Di-Fabio-RP

Lugar: Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis 55455, USA. difab001@maroon.tc.umn.edu

Fuente: J-Orofac-Pain. 1998 Spring; 12(2): 124-35

ISSN: 1064-6655

Idioma: ENGLISH

Resumen: The purposes of this study were to compare disabilities and health status associated with temporomandibular disorders (TMD) to other musculoskeletal disorders, to describe the types of physical therapy administered to patients with TMD, and to evaluate health-related quality of life (HRQOL) as an index of clinical change following physical therapy treatment. Outcomes for 56 patients (mean age 40 years, SD 13 years; 89% female) were evaluated from a large database generated by the Focus on Therapeutic Outcomes network. A generic assessment of HRQOL--the Medical Outcomes Study (MOS) 17--was used to evaluate the physical and mental aspects of disability associated with TMD, and the results were compared descriptively to three groups of patients with different cervical pain syndromes. The results showed that patients with TMD had limitations in social function, emotional well-being, and energy level similar to patients with cervical disorders. Physical function (i.e., walking, carrying loads, or lifting), however, was much more limited in cervical disorder patients and bodily pain interfered more with daily work. Large positive effect sizes (> 0.80) in the areas of social function and bodily pain indicated clinical improvement for patients with TMD at the completion of physical therapy. The results suggest that the MOS-17 may be useful as one measure of clinical change for patients with TMD who receive physical therapy.[volver]

Título en Inglés: Treatment-seeking patterns of facial pain patients: many possibilities, limited satisfaction.

Autor/es: Turp-JC; Kowalski-CJ; Stohler-CS

Lugar: Department of Biologic and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor 48109-1078, USA.

Fuente: J-Orofac-Pain. 1998 Winter; 12(1): 61-6

ISSN: 1064-6655

Idioma: ENGLISH

Resumen: Knowledge about the different kinds of treatment provided to patients with nonmalignant musculoskeletal facial pain is limited. The present study was based on 206 consecutive patients who were referred to a university-based tertiary care clinic for the diagnosis and management of persistent facial pain. Its purpose was to get information about the number and specialty of providers consulted by patients prior to their referral, and to follow the underlying treatment-seeking patterns. The results showed that on average 4.88 providers from 44 different categories were consulted. A general dentist or a dental specialist was seen by about 70% of patients. For patients whose first provider was a dentist, the most likely subsequent provider was another dentist. Conversely, if the first provider was a physician, chances were greater that the subsequent provider was a physician rather than a dentist. Among the nondental therapies patients received, physical therapy was chosen most frequently (42.2%). More than 60% of patients had at least one nondental treatment; however, the majority of these patients experienced two or more different types of such therapy (e.g., chiropractic, osteopathic, relaxation training). Patients' satisfaction with care and treatment was moderate, since only 18.5% of the patients were very satisfied, while 27.7% were dissatisfied or very dissatisfied. The present findings, which corroborate a recent study from the Kansas City, Missouri, region, indicate that patients with persistent facial pain see a large number of different providers, and that nonmedical/nondental treatment approaches are common. The moderate satisfaction experienced with any of the therapies points out that much needs to be done before this patient population is served satisfactorily.[volver]

Título en Inglés: Cognitive and physical capacity process variables predict long-term outcome after treatment of chronic pain.

Autor/es: Burns-JW; Johnson-BJ; Mahoney-N; Devine-J; Pawl-R

Lugar: Department of Psychology, Finch University of Health Sciences, Chicago Medical School, Illinois 60064, USA.

Fuente: J-Consult-Clin-Psychol. 1998 Apr; 66(2): 434-9

ISSN: 0022-006X

Idioma: ENGLISH

Resumen: Cognitive-behavioral and physical therapies are incorporated into multidisciplinary chronic pain programs because changes in pain cognitions and physical capacity may represent therapeutic processes that facilitate favorable outcome. Decreases in depression, however, may explain treatment responses more parsimoniously. Measures of pain helplessness, lifting capacity, walking endurance, depression, pain severity, and activity level were collected from 94 chronic pain patients at pre- and posttreatment and at 3- to 6-month follow-up evaluations. Decreases in pain helplessness were linked to pain severity reduction, whereas walking endurance increases were related to improvements in activity levels and downtime even after controlling for effects of depression decreases. Thus, cognitive and physical capacity changes that occur through pain treatment may make unique contributions to long-term outcome.[volver]

Título en Inglés: Combined exercise and motivation program: effect on the compliance and level of disability of patients with chronic low back pain: a randomized controlled trial.

Autor/es: Friedrich-M; Gittler-G; Halberstadt-Y; Cermak-T; Heiller-I

Lugar: Department of Orthopedic Physiotherapy, Orthopedic Hospital Speising, Vienna, Austria.

Fuente: Arch-Phys-Med-Rehabil. 1998 May; 79(5): 475-87

ISSN: 0003-9993

Idioma: ENGLISH

Resumen: OBJECTIVE: To assess the effect of a combined exercise and motivation program on the compliance and level of disability of patients with chronic and recurrent low back pain. DESIGN: A double-blind prospective randomized controlled trial. SETTING: Physical therapy outpatient department, tertiary care. PATIENTS: Ninety-three low back pain patients were randomly assigned to either a standard exercise program (n = 49) or a combined exercise and motivation program (n = 44). INTERVENTIONS: Patients were prescribed 10 physical therapy sessions and were advised to continue exercising after treatment termination. The motivation program consisted of five compliance-enhancing interventions. Follow-up assessments were performed at 3 1/2 weeks, 4 months, and 12 months. MAIN OUTCOME MEASURES: Disability (low back outcome score), pain intensity, physical impairment (modified Waddell score, fingertip-to-floor distance, abdominal muscle strength), working ability, motivation, and compliance. RESULTS: The patients in the motivation group were significantly more likely to attend their exercise therapy appointments (p = .0005). Four and 12 months after study entry there was a significant difference in favor of the motivation group with regard to the disability score (p = .004) and pain intensity (p < or = .026). At 4 months, there was a significant advantage for the motivation group in the fingertip-to-floor distance (p = .01) and in abdominal muscle strength (p = .018). No significant differences were found in motivation scores, self-reported compliance with long-term exercise, and modified Waddell score. In terms of working ability, there was a trend favoring the combined exercise and motivation program. CONCLUSION: The combined exercise and motivation program increased the rate of attendance at scheduled physical therapy sessions, ie, short-term compliance, and reduced disability and pain levels by the 12-month follow-up. However, there was no difference between the motivation and control groups with regard to long-term exercise compliance.[volver]

Título en Inglés: The effect of static stretch and dynamic range of motion training on the flexibility of the hamstring muscles.

Autor/es: Bandy-WD; Irion-JM; Briggler-M

Lugar: Department of Physical Therapy, University of Central Arkansas, Physical Therapy Center, Conway 72035, USA.

Fuente: J-Orthop-Sports-Phys-Ther. 1998 Apr; 27(4): 295-300

ISSN: 0190-6011

Idioma: ENGLISH

Resumen: To date, limited information exists describing a relatively new stretching technique, dynamic range of motion (DROM). The purpose of this study was to compare the effects of DROM with static stretch on hamstring flexibility. Fifty-eight subjects, ranging in age from 21 to 41 years and with limited hamstring flexibility (defined as 30 degrees loss of knee extension measured with the femur held at 90 degrees of hip flexion), were randomly assigned to one of three groups. One group performed DROM 5 days a week by lying supine with the hip held in 90 degrees of flexion. The subject then actively moved the leg into knee extension (5 seconds), held the leg in end range knee extension for 5 seconds, and then slowly lowered the leg to the initial position (5 seconds). These movements were performed six times per session (30 seconds of total actual stretching time). The second group performed one 30-second static stretch, 5 days per week. The third group served as a control group and did not stretch. Before and after 6 weeks of training, flexibility of the hamstring muscles was determined in all three groups by measuring knee extension range of motion (ROM) with the femur maintained in 90 degrees of hip flexion. Data were analyzed with a 2 x 3 (test x group) two-way analysis of variance (ANOVA) with repeated measures on one variable (test) and appropriate post hoc analyses. The results of the two-way ANOVA revealed a significant interaction. Further statistical post hoc analysis of data to interpret the interaction revealed significant differences between the control group (gain = 0.70 degree) and both stretching groups, as well as a significant difference between the static stretch group (gain = 11.42 degrees) and the DROM group (gain = 4.26 degrees). The results of this study suggest that, although both static stretch and DROM will increase hamstring flexibility, a 30-second static stretch was more effective than the newer technique, DROM, for enhancing flexibility. Given the fact that a 30-second static stretch increased ROM more than two times that of DROM, the use of DROM to increase flexibility of muscle must be questioned.[volver]

Título en Inglés: Intensive training, physiotherapy, or manipulation for patients with chronic neck pain. A prospective, single-blinded, randomized clinical trial.

Autor/es: Jordan-A; Bendix-T; Nielsen-H; Hansen-FR; Host-D; Winkel-A

Lugar: Medical Orthopedic Department, RHIMA Center, Copenhagen, Denmark.

Fuente: Spine. 1998 Feb 1; 23(3): 311-8; discussion 319

ISSN: 0362-2436

Idioma: ENGLISH

Resumen: STUDY DESIGN: A randomized, prospective clinical study was conducted that included 119 patients with chronic neck pain of greater than 3 months' duration. OBJECTIVES: To compare the relative effectiveness of intensive training of the cervical musculature, a physiotherapy treatment regimen, and chiropractic treatment on this patient group. SUMMARY OF BACKGROUND DATA: There are only a few studies involving chronic neck pain patients representative of those seeking care in primary health care centers. Mobilization techniques and intensive training have been shown to be useful, but cervical manipulation has not been assessed. Clinical results involving these commonly used therapies have not been compared. METHODS: A total of 167 consecutive patients were screened. One hundred nineteen patients were admitted to the study and were randomized according to Taves' minimization principles. Primary outcome measures included self-reported pain, disability, medication use, patients' perceived effect, and physician's global assessment. Patients were assessed at enrollment and at completion of the study. Postal questionnaires were used to carry out 4- and 12-month follow-up assessments. Secondary outcome measures included active range of motion of the cervical spine as well as strength and endurance measurements of the cervical musculature. These measurements were carried out at enrollment and completion of the study. RESULTS: A total of 88% of the patients completed the study. Of these, 97% completed the 4-month questionnaire and 93% the 12-month questionnaire. Patients from all three groups demonstrated significant improvements regarding self-reported pain and disability on completion of the study. Improvements were maintained throughout the follow-up period. Medication use was also significantly reduced in all groups. There was, however, no significant difference between groups at any assessment period. Physician's and patients' assessments were also positive, and again group scores were essentially equal. Patients who underwent intensive training demonstrated significantly greater endurance levels at the completion of treatment. CONCLUSIONS: There was no clinical difference between the three treatments. All three treatment interventions demonstrated meaningful improvement in all primary effect parameters. Improvements were maintained at 4- and 12-month follow-up. However, whether this was a result of the treatments or simply a result of time is unknown. Future studies will be necessary to delineate ideal treatment strategies.[volver]