The aim of this study was to assess the effectiveness of microcurrent therapy for healing pressure ulcers in aged people. A multicentric, randomized clinical trial was designed with a sham ...stimulation control. The experimental group received an intervention following a standardized protocol for curing ulcers combined with 10 h of microcurrent therapy daily for 25 days. The sham group received the same curing protocol plus a sham microcurrent stimulation. The studied healing-related variables were the Pressure Ulcer Scale for Healing (PUSH) and the surface, depth, grade, and number of ulcers that healed completely. Three evaluations were conducted: pre-intervention (T1), 14 days following the start of the intervention (T2), and 1 day after the intervention was completed (T3). In total, 30 participants met the inclusion criteria (n = 15 in each group). The improvement in the PUSH at T2 and T3 was 16.8% (CI95% 0.5–33.1) and 25.3% (CI95% 7.6–43.0) greater in the experimental group versus the sham control, respectively. The reduction in the wound area at T2 and T3 was 20.1% (CI95% 5.2–35.0) and 28.6% (CI95% 11.9–45.3) greater in the experimental group versus the control, respectively. Microcurrent therapy improves the healing of pressure ulcers in older adults, both quantitatively and qualitatively.
Correct blinding is essential for preventing potential biases. The aim of this study was to assess the blinding of participants and a therapist following treatment with transcranial direct current ...stimulation in subjects with fibromyalgia using James’ and Bang’s blinding indexes. Eighty subjects were randomly allocated either active or sham stimulation groups in an intervention of five sessions lasting 20 min each. A questionnaire was delivered to both the therapist and patients after the last session to record their guess of which treatment had been applied. No differences between the groups were noted at baseline in terms of demographic or clinical data. James’ BI was 0.83 (CI 95%: 0.76–0.90) for the patients and 0.55 (CI 95%: 0.45–0.64) for the therapist. Bang’s BI for subjects was −0.08 (CI 95%: −0.24–0.09) and −0.8 (CI 95%: −0.26–0.1) for the active and sham transcranial direct current stimulation groups, respectively. Bang’s BI for the therapist was 0.21 (CI 95%: −0.02–0.43) and 0.13 (CI 95%: −0.09–0.35) for the active and sham transcranial direct current stimulation groups, respectively. Protocols of active and sham transcranial direct current stimulation applied in this study have shown satisfactory blinding of the therapist and subjects with fibromyalgia.
The main aim of this work was to investigate the difference in the excitability of the soleus H-reflex in healthy volunteers following spinal transcutaneous electrical nerve stimulation (TENS) and ...high-frequency alternating current (HFAC) at a frequency of 10 kHz applied at the lower thoracic spinal level (T10–T12). A double-blind, randomized, crossover, controlled clinical trial was designed. Participants received three randomized interventions (TENS, 10 kHz, and sham stimulation) during 40 min. The amplitude and latency of the soleus H-reflex were registered prior to, during, and 10 min following stimulation. Twenty-four participants completed the study. A significant inhibition of H-reflex amplitude was observed following transcutaneous spinal TENS (12.7%; 95% CI 1.5–22.2%) when compared with sham stimulation (5.5%; 95% CI 3.6–14.5%; p = 0.03). An increase in H-reflex latency was also observed following transcutaneous spinal stimulation at 10 kHz (2%; 95% CI 1.4–2.5%) as compared with sham stimulation (0.7%; 95% CI 0.07–1.3%; p < 0.01). No differences were found between TENS and 10 kHz for H-reflex modulation. Transcutaneous spinal TENS and HFAC at a frequency of 10 kHz had a modulatory effect on the soleus H-reflex when compared to sham stimulation; however, no differences were found between these two interventions.
Transcranial direct current stimulation (tDCS) is a non-invasive, easy to administer, well-tolerated, and safe technique capable of affecting brain excitability, both at the cortical and cerebellum ...levels. However, its effectiveness has not been sufficiently assessed in all population segments or clinical applications. This systematic review aimed at compiling and summarizing the currently available scientific evidence about the effect of tDCS on functionality in older adults over 60 years of age. A search of databases was conducted to find randomized clinical trials that applied tDCS versus sham stimulation in the above-mentioned population. No limits were established in terms of date of publication. A total of 237 trials were found, of which 24 met the inclusion criteria. Finally, nine studies were analyzed, including 260 healthy subjects with average age between 61.0 and 85.8 years. Seven of the nine included studies reported superior improvements in functionality variables following the application of tDCS compared to sham stimulation. Anodal tDCS applied over the motor cortex may be an effective technique for improving balance and posture control in healthy older adults. However, further high-quality randomized controlled trials are required to determine the most effective protocols and to clarify potential benefits for older adults.
Approximately 65%-78% of patients with a spinal cord injury (SCI) develop any symptom of spasticity. The aim of this study was to investigate the tolerability and short-term effects of radial ...extracorporeal shock wave therapy (rESWT) on plantar flexor spasticity in a patient with incomplete SCI.
An 18-year-old man with an incomplete SCI completed five sessions of rESWT. The primary outcomes were the changes in ankle-passive range of motion (A-PROM) and passive resistive force to ankle dorsiflexion. The outcomes were assessed at baseline (T0), immediately after treatment (T1) and 1 wk after the end of treatment (T2). The A-PROM increased by 15 degrees at T1 and 25 degrees at T2 compared with T0. The passive resistive force to ankle dorsiflexion at low velocity decreased by 33% at T1 and 55% at T2 in the gastrocnemius muscle and by 41% at T1 and 39% at T2 in the soleus muscle compared with T0. At high velocity, it also decreased by 44% at T1 and 30% at T2 in the gastrocnemius muscle compared with T0. However, in the soleus muscle, the change was minor, with a decrease of 12% at T1 and increased by 39% at T2 compared with T0.
In this patient, the findings showed that rESWT combined with conventional therapy was well-tolerated and could be effective in improving A-PROM and passive resistive force to ankle dorsiflexion in the short-term. Further randomized controlled clinical trials with longer period of follow-up are necessary to confirm the results obtained in patients with SCI.
Abstract
Background
Devices for applying transcutaneous electrical nerve stimulation (TENS) use numerous frequency modulation patterns for decreasing habituation to currents. However, there is no ...evidence supporting the use of an optimal pattern instead of the others, or even modulated frequencies instead of a fixed frequency.
Objective
The objectives of this study were to determine the effects of 3 TENS patterns (fixed frequency, random modulation, and 6-second–6-second 6s-6s modulation) on habituation, to examine the subjective perception of habituation and comfort, and to determine their effects on the mechanical pain threshold (MPT).
Design
This study was a randomized, double-blind, sham-controlled crossover trial.
Setting
The study took place in a university research laboratory under attenuated noise conditions at a regulated temperature of 22°C to 26°C.
Participants
Thirty-nine volunteers who were healthy participated in this trial.
Intervention
The participants received 4 different TENS interventions (fixed frequency, random modulation, 6s-6s modulation, and sham) in random order, with a 24-hour washout period, on the radial nerve.
Measurements
The main outcome—habituation—was quantified by the increase in current density and the number of times the intensity had to be increased during the session. Secondary outcome variables were subjective perception of habituation and comfort and MPT.
Results
Random modulation reduced the number of times the intensity had to be increased because of habituation compared with no modulation (1.6 times; 95% confidence interval CI = 0.7–2.6) and 6s-6s modulation (0.8 times; 95% CI = 0.01–1.6). No differences were observed between interventions in terms of an increase in current density, self-perceived habituation, or self-perceived comfort. MPT increased during the intervention in the random-modulation group (4.4 N; 95% CI = 1.8–7.0) and the no-modulation group (5.9 N; 95% CI = 1.9–10.0); there were no significant changes in the other 2 groups.
Limitations
The success of masking or blinding procedures of the participants was not assessed.
Conclusions
Randomly modulated frequencies caused less habituation than nonmodulated frequencies or 6s-6s modulation. Further research on more prolonged (hours-long) interventions in participants with pain is required.
There is a need for an appropriate instrument to measure the satisfaction of patients about therapeutic textile devices used for breast cancer-related lymphedema (BCRL).
A new satisfaction ...questionnaire about therapeutic textile devices used for BCRL was developed and psychometrically tested. An approach to criterion validity by contrast of hypothesis was made. Different average scores were expected depending on the type of therapeutic textile device: Kinesio taping, compression garment, and multilayer low-stretch bandage. Items were analyzed in nine phases: apparent validity, missing responses, internal consistency, factor analysis, reproducibility, confirmation of factor analysis, contrast of hypothesis, variability, and time for completion. One hundred fifty women were sampled in a consecutive order. A final questionnaire was drafted that fulfilled the validation hypothesis, including 20 items that explored 4 dimensions: mood, patient comfort, patient compliance, and perceived benefits. The total Cronbach's α was 0.87. The intraclass correlation coefficient was 0.93 for test-retest and 0.91 for inter-rater. Neither ceiling nor floor effects were observed. The average burden for the respondent and interviewer was 5.6 (standard deviation SD = 3.8) and 2.2 (SD = 1.3) minutes, respectively.
This preliminary analysis supports the content validity, reliability, and validity of construct of the questionnaire.
To determine whether transcutaneous electrical nerve stimulation (TENS) has an analgesic effect greater than placebo or other treatments in patients with fibromyalgia. Furthermore, it was intended to ...analyze the optimal application parameters to achieve a greater reduction of pain.
A systematic review.
Randomized clinical trials on the effect of TENS on fibromyalgia in the databases Pubmed, Cochrane and PEDro until November 2016.
8 studies out of a total of 62 were selected. Controlled clinical trials in which TENS was applied in patients with fibromyalgia were included.
Pain was analyzed as the main variable, although other variables such as fatigue, quality of life and impact, range of motion and depression were also included.
6 out of 8 studies obtained a significant decrease of pain. In 2 studies, TENS was applied as complementary treatment to therapeutic exercise with results evidencing a decrease in pain. The rest of the variables studied presented a great variability and conclusive results could not be established.
Treatment with TENS is effective for reducing pain in people with fibromyalgia. In addition, the inclusion of TENS in therapeutic exercise programs seems to have a greater effect than practicing therapeutic exercise in isolation. However, no efficacy has been demonstrated in other variables different to pain. Further studies are needed to investigate the optimization of the parameters of the TENS and a greater consensus among the variables used.
Fecal incontinence severely impacts on quality of life, causing stigmatization and social exclusion. Posterior tibial nerve stimulation (PTNS) is one technique used for treatment. This systematic ...review aims to assess the effectiveness of PTNS for the treatment of fecal incontinence. A literature review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration. Pubmed, Scopus, Web of Knowledge and PEDro databases were searched for both randomized clinical trials and cases series. The outcome variables were treatment effectiveness, severity of incontinence and quality of life; all were measured in the short, mid and long-term after performing both percutaneous and transcutaneous PTNS. Twenty-three studies met the selection criteria. Two clinical trials found significant differences in treatment effectiveness compared to the placebo response. Fifteen cases series observed significant differences in terms of effectiveness, severity and quality of life. All clinical trials achieved a reduction in the number of incontinence episodes and an increase in the deferral time for defecation. Optimal results were achieved by interventions consisting of one or two weekly sessions of a 30-60 minutes duration and the use of pulse widths of 200 µs and frequencies of 10-20 Hz. Percutaneous stimulation did not demonstrate better results compared to transcutaneous application. PTNS is an effective technique for the treatment of fecal incontinence, although long-term interventions are required in order to prolong its effects in the long-term.
Background: There is a high prevalence of subacromial
syndrome among patients with shoulder pathology,
where the pain and tendency to chronification are
some of its most important characteristics. ...This is why
it is necessary to objectively interact with the quality of
life of the subject. The main goal was to determine if
there are differences between subacromial patients and
asymptomatic patients regarding quality of life.
Methods: Transversal study carried out in
the Talavera Integrated Area during the months of
November 2016 to March 2017. Participated a total
of 92 subjects, 46 were symptomatic mating by age
and sex with an asymptomatic sample and without
joint pathology of the same size and health area. In
both cases, the EQ-5D questionnaire was administered.
The prevalence was calculated from the waiting
list of traumatology physiotherapy in the year 2015.
The SPSS statistical program was used, applying the
T-test and the chi-square.
Results: The EQ-5D questionnaire obtained a
standardized mean of 0.70 in the subacromial syndrome
and 0.85 in the asymptomatic population
(P=0,0001). The prevalence of impingement subacromial
within shoulder pathology was 39.19%.
Conclusions: Subacromial syndrome has a
high prevalence within the shoulder pathology in the
Rehabilitation Service and significantly interferes in
the quality of life related to the health of the subject.
Fundamentos: Existe una alta prevalencia del
síndrome subacromial dentro de los pacientes con
patología de hombro, en el cual el dolor y la tendencia
a la cronificación son alguna de sus características
más importantes. Por ello es necesario objetivar
su interacción con la calidad de vida del sujeto.
El objetivo principal del estudio fue determinar si
existían diferencias en la calidad de vida entre sujetos
con síndrome subacromial y asintomáticos.
Sujetos y métodos: Se realizó un estudio
transversal en el Área Integrada de Talavera de la
Reina (Toledo), durante los meses de noviembre de
2016 a marzo de 2017. Participaron un total de 92
sujetos, de los que 46 eran sintomáticos, apareándose
por edad y sexo con una muestra asintomática y
sin patología articular del mismo tamaño y área de
salud. En ambos casos se les administró el cuestionario
EQ-5D. La prevalencia se calculó a partir de
la lista de espera de fisioterapia traumatológica del
año 2015. Se utilizó el programa estadístico SPSS,
empleándose la prueba T y la chi-cuadrado.
Resultados: El cuestionario EQ-5D obtuvo
una media estandarizada de 0,70 en el síndrome
subacromial y de 0,85 en la población asintomática
(p=0,0001). La prevalencia del impingement
subacromial dentro de la patología de hombro fue
del 39,19%.
Conclusiones: El síndrome subacromial tiene
una alta prevalencia dentro de la patología de
hombro en el Servicio de Rehabilitación e interfiere
significativamente en la calidad de vida relacionada
con la salud del sujeto.
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