RESUMEN
BACKGROUND: Muscle mechanical properties (MMPs) are relevant in the pathophysiology of lumbopelvic disorders. However, they have not been described in the pelvic floor muscles (PFM) and lumbar paravertebral muscles (LPM) of women with urge urinary incontinence (UUI). OBJECTIVE: To identify differences between MMPs of PFM and LPM in patients with UUI and healthy controls. Secondarily also aimed to observe the relationship between sociodemographic and clinical variables with the PFM and LPM MMPs. METHODS: The participants of this case-control study comprised 34 women with UUI (UUI group) and 34 continent women (control group). Sociodemographic variables were obtained together with data on the clinical status of the pelvic floor. The MMPs, i.e., frequency (tone), stiffness, decrement (inverse of elasticity), and viscoelastic properties (VP), such as relaxation time and creep, of PFM and LPM were assessed with a hand-held tonometer. Between-group differences and intra-group correlations were identified. RESULTS: The UUI group presented higher frequency and stiffness, as well as lower relaxation time in PFM, whereas the LPM had lower tone and stiffness, and higher VP, compared to the control group (p < 0.05). The UUI group showed a pattern of moderate correlations (|0.403|
RESUMEN
OBJECTIVE: To identify differences in the muscle mechanical properties of the pelvic floor (PF) and lumbar paravertebral (LP) muscles between young nulliparous and uni/multiparous women. Secondarily, specific behaviors, depending on the presence or absence or urinary incontinence (UI), were also researched. DESIGN: Case-control study. SETTING: Higher education institution. PARTICIPANTS: One hundred young women participated, divided into two groups depending on whether they had vaginal birth (nulliparous or uni/multiparous). Each group included women with and without UI. MAIN MEASURES: A muscle mechanical properties (tone, stiffness, decrement-inverse of elasticity-, and viscoelastic properties: relaxation and creep) assessment of the PF and LP muscles were performed with a hand-held tonometer. RESULTS: Tone and stiffness of both sides of the PF presented group by UI interaction (p < 0.05), with uni/multiparous women with UI showing higher tone and stiffness compared to multiparous women without UI. In LP muscles, uni/multiparous women showed greater tone and stiffness on the right and left sides [-2.57â Hz (95% confidence interval -4.42,-0.72) and -79.74â N/m (-143.52,-15.97); -2.20â Hz (-3.82,-0.58) and -81.30â N/m (-140.66-,21.95), respectively], as well as a decrease in viscoelastic properties compared to nulliparous women [relaxation: 2.88â ms (0.31,5.44); creep: 0.15 (0.01,0.30); relaxation: 2.69â ms (0.13,5.25); creep: 0.14 (0,0.28), respectively]. CONCLUSIONS: Vaginal birth and UI have a differential influence on the muscle mechanical properties of the PF and LP muscles. The determination of muscle mechanical properties by externally applied hand-held tonometry improves the knowledge of the lumbopelvic status, with applicability in clinical and research fields.
Asunto(s)
Incontinencia Urinaria , Femenino , Humanos , Estudios de Casos y Controles , Incontinencia Urinaria/etiología , Fuerza Muscular/fisiología , MúsculosRESUMEN
The lumbopelvic muscle mechanical properties (MMPs) are clinically relevant, but their dependence on sex remains unknown. Therefore, this study aimed to identify if lumbopelvic MMPs depend on the sex in a young adult population. Thirty-five healthy nulliparous women and 35 healthy men were analyzed (age range: 18-50). Lumbopelvic MMPs, that is, tone, stiffness, elasticity, relaxation and creep, assessed with MyotonPRO®, and pelvic floor (PF) health questionnaires were compared between-sexes. Intra-group correlations between sociodemographic and clinical data, and MMPs were also determined. The MMPs of PF were different between healthy non-climacteric adults of both sexes, with women showing higher values of tone and stiffness and lower values of elasticity and viscoelastic properties than men (in all cases, p < 0.03). At lumbar level, tone and stiffness were higher for men at both sides (in all cases, p < 0.04), and relaxation was lower at left side (p = 0.02). The MMPs showed few correlations with sociodemographic data within women. However, within males, there were positive correlations for PF stiffness and viscoelastic parameters with age, BMI and function (0.334 < r < 0.591) and, at lumbar level, negative correlations for tone and stiffness ( - 0.385 < r < -0.590) and positive correlations for viscoelastic properties (0.564 < r < 0.719), with BMI. This indicated that between-sexes differences of lumbopelvic MMPs depend on the specific location of assessment in healthy non-obese young individuals. Women show higher tone and stiffness and lower elasticity and viscoelasticity than men, at PF level.
Asunto(s)
Fenómenos Fisiológicos Musculoesqueléticos , Masculino , Adulto Joven , Humanos , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Estudios Transversales , Región Lumbosacra , Tono Muscular/fisiología , MúsculosRESUMEN
This research aimed to identify changes in muscle mechanical properties (MMPs) when a standardized sequence of movements is performed and to determine the influence of acute low back pain (LBP) and age on the MMPs. Socio-demographic, clinical variables and MMPs were collected in 33 patients with LBP and 33 healthy controls. A 2 × 2 × 2 (group × age × time) analysis of variance (ANOVA) mixed model was used to determine the effect of the study factors on the different MMPs. There were no significant triple interactions. After the movements, tone and stiffness increased 0.37 Hz and 22.75 N/m, respectively, in subjects <35 years, independent of their clinical status. Relaxation showed differences by age in healthy subjects and creep in LBP subjects. Furthermore, elasticity was higher in <35 years (p < 0.001) without the influence of any other factor. In conclusion, sequenced movements can modify tone and stiffness as a function of age, while age-associated changes in viscoelastic characteristics depends on pain but not on movements. The MMPs should be assessed, not only at the beginning of the physical examination at rest, but also along the patient's follow-up, depending on their pain and age, in a clinical setting.
RESUMEN
An analysis of the muscle mechanical properties (MMPs) of the pelvic floor muscles (PFMs) is relevant for understanding the physiopathology of urinary incontinence (UI). However, there is no objective and reliable methodology currently available for quantifying the MMPs of PFMs. Thus, the objective was to determine the intra-rater and inter-rater reliability of the MMPs of PFM assessment with a hand-held tonometer device, called the MyotonPRO, in young women with and without UI. Sociodemographic and pelvic floor questionnaires, plus MMPs of PFMs were assessed in 38 nulliparous women with UI and 40 matched healthy women by two trained physiotherapists on two different occasions, 48-72 h apart. Good to excellent absolute reliability was found for tone, stiffness, and decrement of both intra- and inter-rater analyses in both study groups (Intraclass Correlation Coefficient ranged from 0.75 to 0.92), with a trend of lower values for relaxation and creep. The standard error of measurement (SEM) did not achieve 10% of the mean values for any MMPs. The minimum detectable change (MDC) values were also provided for clinical applications. In conclusion, the relative reliability of tone, stiffness, and the assessment of the decrement of PFMs with MyotonPRO is good to excellent for UI and healthy women. The SEM and MDC values were acceptable for their application in clinical settings.
RESUMEN
Different musculoskeletal disorders are a source of pain in the spinal region; most of them can be divided into mechanical, such as low back pain (LBP), or inflammatory origins, as is the case of axial spondyloarthritis (axSpA). Nevertheless, insufficient information is available about the muscle negative consequences of these conditions. Thus, the objective of this study was to identify whether mechanical muscle properties (MMPs) of cervical and lumbar muscles are different between patients with axSpA, subacute LBP (sLBP), and healthy controls. Furthermore, we aimed identify whether MMPs were related to sociodemographic and clinical variables in various study groups. The MMPs, sociodemographic, and clinical variables were obtained in 43 patients with axSpA, 43 subjects with sLBP, and 43 healthy controls. One-way ANOVAs and ROC curves were applied to identify whether the MMPs could differentiate between the study groups. Intra-group Pearson r coefficients to test the associations between MMPs and the rest of the variables were calculated. The results showed that axSpA subjects have a higher tone and stiffness and a lower relaxation and creep than sLBP and healthy ones (p < 0.05). All lumbar and cervical MMPs, except for decrement, could correctly classify axSpA and healthy subjects and axSpA and sLBP patients (in both cases, Area Under the Curve > 0.8). However, no MMP could differentiate between sLBP and healthy subjects. Each group had a different pattern of bivariate correlations between MMPs and sociodemographic and clinical data, with a worse state and progression of the axSpA group associated with a higher tone and stiffness in both spinal regions. This study supports that MMPs are different and show different patterns of correlations depending on the type of spinal pain.
RESUMEN
BACKGROUND: Axial spondyloarthritis (axSpA) affects spinal muscles, due to inflammation and structural damage. The mechanical properties of the muscles, such as tone or stiffness, could be altered in axSpA. The aim of this work is to analyze the mechanical properties of cervical and lumbar spine muscles in axSpA patients and their relationship with metrology measures, function, disease activity, structural damage and quality of life. METHODS: axSpA patients and age/gender/BMI matched healthy controls were recruited. The muscle mechanical properties (MMPs), such as tone or frequency, stiffness, decrement (linear elastic properties), relaxation and creep (viscoelastic properties), of cervical (semispinalis capitis) and lumbar (erector spinae) muscles were bilaterally measured at rest using myotonometry. Additionally, conventional metrology, BASMI (metrology index), BASDAI (disease activity index), mSASSS (radiological structural damage index) and SF-12 (health-related quality of life questionnaire) were used in the axSpA group. Between-groups comparison, intra-group correlations and multivariable regression analyses were performed to achieve the study aims. RESULTS: Thirty-four axSpA patients (mean age: 46.21 ± 8.53 y) and 34 healthy volunteers (mean age: 43.97 ± 8.49 y) were recruited. Both in cervical and lumbar spine, linear elastic parameters were significantly higher in axSpA patients in comparison with controls, while viscoelastic parameters were significantly lower. Lumbar muscle frequency, stiffness, relaxation, creep and cervical muscle elasticity were fair to strongly correlated (|0.346| < r < |0.774|) with age, functional status, activity of disease, structural damage and quality of life in axSpA patients. Furthermore, moderate to good fitted multivariate models (0.328 < R2 < 0.697) were obtained combining age, conventional metrology, activity of the disease and function for the estimation of cervical and lumbar MMPs. CONCLUSION: Mechanical properties of spinal muscles of axSpA patients differ from controls. Lumbar and cervical muscles exhibit greater linear elastic properties and lower viscoelastic properties, which are related with age, clinical and psychophysiological features of axSpA.
RESUMEN
Our aims were to identify potential differences in muscle mechanical properties (MMPs) of cervical and lumbar tissues and in spinal range of motion (ROM) between patients with acute low back pain (LBP) or acute neck pain (NP) and healthy controls, and to identify if ROMs and MMPs are able to identify subjects among the three groups. Clinical variables (pain, disability, fear of movement, kinesiophobia, quality of life), MMPs and ROMs were obtained in 33 subjects with acute LBP, 33 with acute NP, and 33 healthy control subjects. Between-groups differences and explanatory models to discriminate groups depending on MMPs and ROMs were calculated. The results showed that cervical tone was higher in patients with acute NP than in controls, while cervical decrement was higher in both spinal pain groups. Patients with acute NP showed reduced cervical flexion when compared to acute LBP and control groups, and also cervical rotation, but just against controls. Furthermore, lumbar flexion was reduced in patients with acute LBP when compared to those with acute NP. Cervical decrement was able to discriminate spinal pain individuals from controls in a multinominal regression (R2: Cox-Snell estimation = 0.533; Nagelkerke estimation = 0.600). Lumbar flexion differentiated patients with acute LBP and controls, whereas cervical flexion differentiated patients with acute NP and controls. This study supports a tendency of the affectation of other spinal regions when only one is affected.
RESUMEN
OBJECTIVE: The aim of this study was to design and propose a new test based on inertial measurement unit (IMU) technology, for measuring cervical posture and motor control in children with cerebral palsy (CP) and to evaluate its validity and reliability. METHODS: Twenty-four individuals with CP (4-14 years) and 24 gender- and age-matched controls were evaluated with a new test based on IMU technology to identify and measure any movement in the three spatial planes while the individual is seated watching a two-minute video. An ellipse was obtained encompassing 95% of the flexion/extension and rotation movements in the sagittal and transversal planes. The protocol was repeated on two occasions separated by 3 to 5 days. Construct and concurrent validity were assessed by determining the discriminant capacity of the new test and by identifying associations between functional measures and the new test outcomes. Relative reliability was determined using the intraclass correlation coefficient (ICC) for test-retest data. Absolute reliability was obtained by the standard error of measurement (SEM) and the Minimum Detectable Change at a 90% confidence level (MDC90). RESULTS: The discriminant capacity of the area and both dimensions of the new test was high (Area Under the Curve ≈ 0.8), and consistent multiple regression models were identified to explain functional measures with new test results and sociodemographic data. A consistent trend of ICCs higher than 0.8 was identified for CP individuals. Finally, the SEM can be considered low in both groups, although the high variability among individuals determined some high MDC90 values, mainly in the CP group. CONCLUSIONS: The new test, based on IMU data, is valid and reliable for evaluating posture and motor control in children with CP.
RESUMEN
OBJECTIVE: This study aimed to determine the validity and reliability of Inertial Measurement Units (IMUs) for the assessment of craniocervical range of motion (ROM) in patients with cerebral palsy (CP). METHODS: twenty-three subjects with CP and 23 controls, aged between 4 and 14 years, were evaluated on two occasions, separated by 3 to 5 days. An IMU and a Cervical Range of Motion device (CROM) were used to assess craniocervical ROM in the three spatial planes. Validity was assessed by comparing IMU and CROM data using the Pearson correlation coefficient, the paired t-test and Bland-Altman plots. Intra-day and inter-day relative reliability were determined using the Intraclass Correlation Coefficient (ICC). The Standard Error of Measurement (SEM) and the Minimum Detectable Change at a 90% confidence level (MDC90) were obtained for absolute reliability. RESULTS: High correlations were detected between methods in both groups on the sagittal and frontal planes (r > 0.9), although this was reduced in the case of the transverse plane. Bland-Altman plots indicated bias below 5º, although for the range of cervical rotation in the CP group, this was 8.2º. The distance between the limits of agreement was over 23.5º in both groups, except for the range of flexion-extension in the control group. ICCs were higher than 0.8 for both comparisons and groups, except for inter-day comparisons of rotational range in the CP group. Absolute reliability showed high variability, with most SEM below 8.5º, although with worse inter-day results, mainly in CP subjects, with the MDC90 of rotational range achieving more than 20º. CONCLUSIONS: IMU application is highly correlated with CROM for the assessment of craniocervical movement in CP and healthy subjects; however, both methods are not interchangeable. The IMU error of measurement can be considered clinically acceptable; however, caution should be taken when this is used as a reference measure for interventions.
RESUMEN
Tanto la obesidad como la diabetes mellitus tipo 2 (DM2) son 2 problemas sanitarios fuera de control y con un coste sanitario muy significativo. El principal factor de riesgo para el desarrollo de DM2 es padecer obesidad, y cerca del 90% de los pacientes con DM2 tienen sobrepeso u obesidad. La cirugía bariátrica (CB) induce una resolución a largo plazo de la DM2 en más de la mitad de las personas con obesidad y diabetes que se operan. La CB pone en evidencia las limitaciones del tratamiento médico de la obesidad en la actualidad y nos hace plantear importantes cuestiones, tales como: ¿debemos ofrecer tratamiento quirúrgico a los pacientes con diabetes y obesidad cuando fracasa el tratamiento médico? ¿Qué lugar debe ocupar la CB en el algoritmo de tratamiento de la DM2? ¿Qué técnica quirúrgica sería más indicada y a qué índice de masa corporal debe recomendarse? Profundizar en un mejor entendimiento de los mecanismos fisiopatológicos responsables de resolución de la DM2 tras la CB ayudará sin duda a contestar de forma apropiada las preguntas arriba formuladas y potencialmente contribuirá al desarrollo de tratamientos médicos eficaces y alternativos a la CB
Both obesity and type 2 diabetes mellitus (T2DM) are two major health problems out of control and with a significant health cost. The main risk factor for the development of T2DM is suffering from obesity, and nearly 90% of patients with T2DM are overweight or obese. Bariatric Surgery can lead to a long-term resolution T2DM in more than half of people with obesity and diabetes who undergo this surgery. Bariatric surgery highlights the current limitations of medical treatment of obesity, and brings up important issues, such as: should we offer surgical treatment to patients with diabetes and obesity when medical therapy fails?, where in the T2DM therapy algorithm, should bariatric surgery be placed?, what surgical technique would be more indicated, and at what body mass index should it be recommended? A better understanding of the pathophysiological mechanisms responsible for the resolution of T2DM after the bariatric surgery will help to properly answer the questions above raised above, and potentially contribute to the development of effective medical treatments, alternatives to bariatric surgery
Asunto(s)
Humanos , Masculino , Femenino , Cirugía Bariátrica/métodos , Cirugía Bariátrica/tendencias , Cirugía Bariátrica , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/cirugía , Obesidad/complicaciones , Obesidad/cirugía , Factores de Riesgo , Derivación Gástrica/métodos , Derivación Gástrica/tendencias , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/fisiopatología , Derivación GástricaRESUMEN
La práctica clínica basada en la evidencia requiere la integración de la experiencia profesional individual con los mejores datos objetivos para tomar la mejor decisión terapéutica. Los datos científicos de mejor grado de evidencia derivan de ensayos clínicos controlados y aleatorizados e investigaciones de vigilancia farmacológica poscomercialización y metaanálisis. En muchas ocasiones durante nuestras actividades clínicas buscamos sin éxito el ensayo clínico que conteste a nuestras preguntas científicas. Es en estos momentos cuando en ocasiones nos planteamos la puesta en marcha de un ensayo clínico. Si usted como investigador clínico tiene una pregunta científica (relevante), que potencialmente requeriría la realización de un Ensayo Clínico para alcanzar una respuesta y carece del respaldo de una Compañía Farmacéutica para llevarlo a cabo, quizá encuentre de utilidad la lectura de este artículo, en el que intentamos presentar de forma breve y clarificadora la normativa regulatoria para planificar un Ensayo Clínico, con la humilde intención de que se convierta en una herramienta útil para cualquier investigador independiente (AU)
Evidence-based clinical practice requires integration of individual professional experience with the best objective data to make the best therapeutic decision. The best degree of scientific evidence derives from controlled, randomized clinical trials and post-marketing drug surveillance studies and meta-analyses. During our clinical activities, we often search unsuccessfully for a clinical trial which answers our scientific questions. It is at those times that we may sometimes consider the conduct of a clinical trial. If you, as a clinical investigator, have a (relevant) scientific question that could potentially require the conduct of a clinical trial to achieve a response and have no support from a pharmaceutical company to perform it, you may find it useful to read this article, in which an attempt has been made to briefly and clearly explain the applicable regulations for planning a clinical trial. Our humble intention is that this publication becomes a useful tool for any independent researche (AU)
Asunto(s)
Humanos , Ensayos Clínicos como Asunto/métodos , Recolección de Datos , Documentación , Agencias Gubernamentales , Evaluación de Resultado en la Atención de Salud , Investigadores , Informe de Investigación , Apoyo a la Investigación como Asunto , Sociedades Médicas , EspañaRESUMEN
Comunicamos la puesta en marcha de un programa intensivo y multidisciplinar de pérdida de peso en pacientes con obesidad mórbida (OM). Este ensayo clínico se basa en la educación para la salud, el apoyo en el proceso de cambio, los medicamentos y las sesiones de terapia de grupo. Nuestra intención es demostrar que los resultados obtenidos con este programa de pérdida de peso a 2 años son, cuando menos, comparables a los resultados que se obtienen con la cirugía bariátrica en estos pacientes con OM. Es nuestra intención igualmente (..) (AU)
Implementation of an intensive, multidisciplinary weight loss program in patients with morbid obesity is reported. This program is based on behavioral changes, lifestyle intervention, medication, and group therapy sessions. Our objective is to show that the results achieved with this two-year weight loss program will be at least similar to those achieved with bariatric surgery in patients with morbid obesity. We also intend to show that this multidisciplinary treatment induces an improvement in the comorbidity rate associated to smaller costs for our national health system (AU)
Asunto(s)
Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Obesidad Mórbida/terapiaRESUMEN
Implementation of an intensive, multidisciplinary weight loss program in patients with morbid obesity is reported. This program is based on behavioral changes, lifestyle intervention, medication, and group therapy sessions. Our objective is to show that the results achieved with this two-year weight loss program will be at least similar to those achieved with bariatric surgery in patients with morbid obesity. We also intend to show that this multidisciplinary treatment induces an improvement in the comorbidity rate associated to smaller costs for our national health system.
Asunto(s)
Obesidad Mórbida/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Adolescente , Adulto , Anciano , Cirugía Bariátrica/economía , Terapia Conductista/economía , Terapia Combinada/economía , Comorbilidad , Dieta Reductora/economía , Terapia por Ejercicio/economía , Femenino , Costos de la Atención en Salud , Humanos , Masculino , Medicina , Persona de Mediana Edad , Apoyo Nutricional/economía , Obesidad Mórbida/sangre , Obesidad Mórbida/economía , Obesidad Mórbida/epidemiología , Obesidad Mórbida/cirugía , Grupo de Atención al Paciente , Selección de Paciente , Proyectos de Investigación , España/epidemiología , Resultado del Tratamiento , Adulto JovenRESUMEN
Evidence-based clinical practice requires integration of individual professional experience with the best objective data to make the best therapeutic decision. The best degree of scientific evidence derives from controlled, randomized clinical trials and post-marketing drug surveillance studies and meta-analyses. During our clinical activities, we often search unsuccessfully for a clinical trial which answers our scientific questions. It is at those times that we may sometimes consider the conduct of a clinical trial. If you, as a clinical investigator, have a (relevant) scientific question that could potentially require the conduct of a clinical trial to achieve a response and have no support from a pharmaceutical company to perform it, you may find it useful to read this article, in which an attempt has been made to briefly and clearly explain the applicable regulations for planning a clinical trial. Our humble intention is that this publication becomes a useful tool for any independent researcher.