Browsing articles by "Ángel León Valenzuela"
jul
31
2013

Evidencias en la Rehabilitación del EPOC

Os dejo un resumen de las evidencias actuales en la Rehabilitación del paciente con EPOC, basado en la actualización de la Guía GOLD 2013.

  • Mejora la capacidad de ejercicio (Evidencia A).
  • Reduce la intensidad de la percepción de la disnea (Evidencia A).
  • Mejora la calidad de vida relacionada con la salud (Evidencia A).
  • Reduce el número de hospitalizaciones y días en el hospital(Evidencia A).
  • Reduce la ansiedad y la depresión asociada con la EPOC (evidencia A).
  • El entrenamiento de fuerza y resistencia mejora la función de las extremidades superiores (Evidencia B).
  • Los beneficios se extienden mucho más allá del período inmediato de la formación (Evidencia B).
  • Mejora la supervivencia (Evidencia B).
  • El entrenamiento de los músculos respiratorios puede ser beneficioso, especialmente cuando es combinado con el entrenamiento físico general (evidencia C).
  • Mejora la recuperación después de la hospitalización por una exacerbación (Evidencia A).
  • Aumenta el efecto de los broncodilatadores de acción prolongada (Evidencia B).
  • Los beneficios se han observado en pacientes con una amplia gama de discapacidades, aunque los usuarios de silla de ruedas parecen menos propensos a responder incluso a los programas domiciliarios (Evidencia B).
  • La estratificación por intensidad de la disnea mediante el cuestionario mMRC puede ser útil en la selección de pacientes con más probabilidades de beneficiarse de la rehabilitación. Aquellos con mMRC grado 4 disnea pueden no beneficiarse (Evidencia B).
  • No hay evidencia de que los fumadores se benefician menos que los no fumadores, aunque algunos sugieren que los fumadores continuos son menos propensos a completar los programas de rehabilitación (Evidencia B).

Podéis bajar la guía  en: GOLD 2013 EPOC

jul
29
2013

Entrenamiento de fuerza y ejercicio aeróbico en enfermedades musculares.

DM2 Histopathology

Distrofia miotónica- histopatología

Se ha publicado una actualización de la Cochrane sobre el entrenamiento de fuerza y ejercicio aeróbico en enfermedades musculares.
Se incluyen dos ensayos sobre el entrenamiento de fuerza en personas con distrofia muscular facioescapulohumeral y distrofia miotónica (101 participantes), dos ensayos de entrenamiento de fuerza combinado con ejercicios aeróbicos en personas con miopatía mitocondrial (18 participantes) y distrofia miotónica tipo I (35 participantes) y una prueba de ejercicio aeróbico en pacientes con polimiositis y dermatomiositis (14 participantes).
Estos ensayos mostraron que el entrenamiento de fuerza de intensidad moderada en personas con distrofia miotónica o con distrofia muscular facioescapulohumeral, y con ejercicios aeróbicos en pacientes con dermatomiositis o polimiositis parece no provocar daño muscular.
El entrenamiento de fuerza combinado con ejercicio aeróbico parece ser seguro en la distrofia miotónica tipo I y puede ser eficaz en el aumento de la resistencia en las personas con miopatía mitocondrial.
La evidencia sugiere que el entrenamiento de fuerza no es perjudicial en personas con distrofia facioescapulohumeral, distrofia miotónica, trastornos mitocondriales y dermatomiositis y polimiositis, pero más investigación es necesaria para determinar el beneficio potencial.

Podéis leer el artículo en: Strength training and aerobic exercise training for muscle disease

 

Mostrar resumen »

Background:
Strength training or aerobic exercise programmes might optimise muscle and cardiorespiratory function and prevent additional disuse atrophy and deconditioning in people with a muscle disease. This is an update of a review first published in 2004.Objectives:
To examine the safety and efficacy of strength training and aerobic exercise training in people with a muscle disease.Search strategy:
We searched the Cochrane Neuromuscular Disease Group Specialized Register (July 2012), CENTRAL (2012 Issue 3 of 4), MEDLINE (January 1946 to July 2012), EMBASE (January 1974 to July 2012), EMBASE Classic (1947 to 1973) and CINAHL (January 1982 to July 2012).Selection criteria:
Randomised or quasi-randomised controlled trials comparing strength training or aerobic exercise programmes, or both, to no training, and lasting at least six weeks, in people with a well-described diagnosis of a muscle disease.We did not use the reporting of specific outcomes as a study selection criterion.

Data collection and analysis:
Two authors independently assessed trial quality and extracted the data obtained from the full text-articles and from the original investigators. We collected adverse event data from included studies.

Main results:
We included five trials (170 participants). The first trial compared the effect of strength training versus no training in 36 people with myotonic dystrophy. The second trial compared aerobic exercise training versus no training in 14 people with polymyositis and dermatomyositis. The third trial compared strength training versus no training in a factorial trial that also compared albuterol with placebo, in 65 people with facioscapulohumeral muscular dystrophy (FSHD). The fourth trial compared combined strength training and aerobic exercise versus no training in 18 people with mitochondrial myopathy. The fifth trial compared combined strength training and aerobic exercise versus no training in 35 people with myotonic dystrophy type 1.

In both myotonic dystrophy trials and the dermatomyositis and polymyositis trial there were no significant differences between training and non-training groups for primary and secondary outcome measures. The risk of bias of the strength training trial in myotonic dystrophy and the aerobic exercise trial in polymyositis and dermatomyositis was judged as uncertain, and for the combined strength training and aerobic exercise trial, the risk of bias was judged as adequate. In the FSHD trial, for which the risk of bias was judged as adequate, a +1.17 kg difference (95% confidence interval (CI) 0.18 to 2.16) in dynamic strength of elbow flexors in favour of the training group reached statistical significance. In the mitochondrial myopathy trial, there were no significant differences in dynamic strength measures between training and non-training groups. Exercise duration and distance cycled in a submaximal endurance test increased significantly in the training group compared to the control group. The differences in mean time and mean distance cycled till exhaustion between groups were 23.70 min (95% CI 2.63 to 44.77) and 9.70 km (95% CI 1.51 to 17.89), respectively. The risk of bias was judged as uncertain. In all trials, no adverse events were reported.

Authors’ conclusions:
Moderate-intensity strength training in myotonic dystrophy and FSHD and aerobic exercise training in dermatomyositis and polymyositis and myotonic dystrophy type I appear to do no harm, but there is insufficient evidence to conclude that they offer benefit. In mitochondrial myopathy, aerobic exercise combined with strength training appears to be safe and may be effective in increasing submaximal endurance capacity. Limitations in the design of studies in other muscle diseases prevent more general conclusions in these disorders.

This record should be cited as: Voet NBM, van der Kooi EL, Riphagen II, Lindeman E, van Engelen BGM, Geurts ACH. Strength training and aerobic exercise training for muscle disease. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD003907. DOI: 10.1002/14651858.CD003907.pub4
Assessed as up to date: July 2, 2012
- See more at: http://summaries.cochrane.org/CD003907/strength-training-or-comprehensive-aerobic-exercise-training-for-muscle-disease#sthash.mQgvfS1G.dpuf

jul
1
2013

Estimulación magnética transcraneal y Rehabilitación Cognitiva sobre deficits de atención en el Ictus

Recientemente se han publicado varias revisiones de la Cochrane sobre el ictus, os las dejo a continuación:

Estimulación magnética transcraneal Ictus

1) En la primera de ellas se concluye que la evidencia actual no soporta el uso rutinario de la estimulación magnética transcraneal en el ictus.

Mostrar resumen »

Cochrane Database Syst Rev. 2013 May 31;5:CD008862. doi: 10.1002/14651858.CD008862.pub2.
Repetitive transcranial magnetic stimulation for improving function after stroke.
Hao Z, Wang D, Zeng Y, Liu M.
Source
Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan, China, 610041.
Abstract
BACKGROUND:
It had been assumed that suppressing the undamaged contralesional motor cortex by repetitive low-frequency transcranial magnetic stimulation (rTMS) or increasing the excitability of the damaged hemisphere cortex by high-frequency rTMS will promote function recovery after stroke.
OBJECTIVES:
To assess the efficacy and safety of rTMS for improving function in people with stroke.
SEARCH METHODS:
We searched the Cochrane Stroke Group Trials Register (April 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 4), the Chinese Stroke Trials Register (April 2012), MEDLINE (1950 to May 2012), EMBASE (1980 to May 2012), Science Citation Index (1981 to April 2012), Conference Proceedings Citation Index-Science (1990 to April 2012), CINAHL (1982 to May 2012), AMED (1985 to May 2012), PEDro (April 2012), REHABDATA (April 2012) and CIRRIE Database of International Rehabilitation Research (April 2012). In addition, we searched five Chinese databases, ongoing trials registers and relevant reference lists.
SELECTION CRITERIA:
We included randomised controlled trials comparing rTMS therapy with sham therapy or no therapy. We excluded trials that reported only laboratory parameters.
DATA COLLECTION AND ANALYSIS:
Two review authors independently selected trials, assessed trial quality and extracted the data. We resolved disagreements by discussion.
MAIN RESULTS:
We included 19 trials involving a total of 588 participants in this review. Two heterogenous trials with a total of 183 participants showed that rTMS treatment was not associated with a significant increase in the Barthel Index score (mean difference (MD) 15.92, 95% CI -2.11 to 33.95). Four trials with a total of 73 participants were not found to have a statistically significant effect on motor function (standardised mean difference (SMD) 0.51, 95% CI -0.99 to 2.01). Subgroup analyses of different stimulation frequencies or duration of illness also showed no significant difference. Few mild adverse events were observed in the rTMS groups, with the most common events being transient or mild headaches (2.4%, 8/327) and local discomfort at the site of the stimulation.
AUTHORS’ CONCLUSIONS:
Current evidence does not support the routine use of rTMS for the treatment of stroke. Further trials with larger sample sizes are needed to determine a suitable rTMS protocol and the long-term functional outcome.

 

 

2) En la siguiente revisión sobre Rehabilitación Cognitiva sobre déficits de atención en el ictus, los resultados sugieren que puede haber un efecto a corto plazo sobre la capacidad de atención, pero no hay estudios de calidad sobre la persistencia de los efectos y sobre la relación con las AVDs.

Mostrar resumen »

Cochrane Database Syst Rev. 2013 May 31;5:CD002842. doi: 10.1002/14651858.CD002842.pub2.
Cognitive rehabilitation for attention deficits following stroke.
Loetscher T, Lincoln NB.
Source
School of Psychology, Flinders University, Adelaide, Australia.
Abstract
BACKGROUND:
Many survivors of stroke complain about attentional impairments, such as diminished concentration and mental slowness. However, the effectiveness of cognitive rehabilitation for improving these impairments is uncertain.
OBJECTIVES:
To determine whether (1) people receiving attentional treatment show better outcomes in their attentional functions than those given no treatment or treatment as usual, and (2) people receiving attentional treatment techniques have a better functional recovery, in terms of independence in activities of daily living, mood and quality of life, than those given no treatment or treatment as usual.
SEARCH METHODS:
We searched the Cochrane Stroke Group Trials Register (October 2012), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library October 2012), MEDLINE (1948 to October 2012), EMBASE (1947 to October 2012), CINAHL (1981 to October 2012), PsycINFO (1806 to October 2012), PsycBITE and REHABDATA (searched October 2012) and ongoing trials registers. We screened reference lists and tracked citations using Scopus.
SELECTION CRITERIA:
We included randomised controlled trials (RCTs) of cognitive rehabilitation for impairments of attention for people with stroke. The primary outcome was measures of global attentional functions, and secondary outcomes were measures of attention domains, functional abilities, mood and quality of life.
DATA COLLECTION AND ANALYSIS:
Two review authors independently selected trials, extracted data and assessed trial quality.
MAIN RESULTS:
We included six RCTs with 223 participants. All six RCTs compared cognitive rehabilitation with a usual care control. Meta-analyses demonstrated no statistically significant effect of cognitive rehabilitation for persisting effects on global measures of attention (two studies, 99 participants; standardised mean difference (SMD) 0.16, 95% confidence interval (CI) -0.23 to 0.56; P value = 0.41), standardised attention assessments (two studies, 99 participants; P value ≥ 0.08) or functional outcomes (two studies, 99 participants; P value ≥ 0.15). In contrast, a statistically significant effect was found in favour of cognitive rehabilitation when compared with control for immediate effects on measures of divided attention (four studies, 165 participants; SMD 0.67, 95% CI 0.35 to 0.98; P value < 0.0001) but no significant effects on global attention (two studies, 53 participants; P value = 0.06), other attentional domains (six studies, 223 participants; P value ≥ 0.16) or functional outcomes (three studies, 109 participants; P value ≥ 0.21).Thus there was limited evidence that cognitive rehabilitation may improve some aspects of attention in the short term, but there was insufficient evidence to support or refute the persisting effects of cognitive rehabilitation on attention, or on functional outcomes in either the short or long term.
AUTHORS’ CONCLUSIONS:
The effectiveness of cognitive rehabilitation remains unconfirmed. The results suggest there may be a short-term effect on attentional abilities, but future studies need to assess the persisting effects and measure attentional skills in daily life. Trials also need to have higher methodological quality and better reporting.

Páginas:1234567...50»
UA-37655059-1