Gestión de la fatiga en Esclerosis Múltiple y Terapia conductual en Afasia

1) Terapia de “gestión de la fatiga” en Esclerosis Múltiple: Revisión sistemática A corto plazo, la terapia de “gestión de la fatiga” puede ser más eficaz que la no intervención en la reducción del impacto de la fatiga y en la mejora de 3 escalas de calidad de vida (rol físico, función social y salud mental) en pacientes fatigados con EM. Se necesitan más ECA que también estudian los resultados a largo plazo.

Hecho en falta un seguimiento a largo plazo para ver las consecuencias de la terapia y comparación con otras medidas farmacológicas y no farmacológicas.

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Arch Phys Med Rehabil. 2013 Feb 8. pii: S0003-9993(13)00112-3. doi: 10.1016/j.apmr.2013.01.025. [Epub ahead of print]
Effectiveness of Energy Conservation Treatment in Reducing Fatigue in Multiple Sclerosis: A Systematic Review and Meta-Analysis.
Blikman LJ, Huisstede BM, Kooijmans H, Stam HJ, Bussmann JB, van Meeteren J.
Source
Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC University Medical Center, Rotterdam, The Netherlands. Electronic address: l.blikman@erasmusmc.nl.
Abstract
OBJECTIVES:
To systematically review the effects of energy conservation management (ECM) treatment for fatigue in multiple sclerosis (MS), and to study the effect of ECM treatment on restrictions in participation and quality of life (QoL).
DATA SOURCES:
PubMed, CINAHL, Embase, and Web of Knowledge were searched to identify relevant randomized controlled trials (RCTs) and controlled clinical trials.
STUDY SELECTION:
To select potential studies, 2 reviewers independently applied the inclusion criteria.
DATA EXTRACTION:
Two reviewers independently extracted data and assessed the methodologic quality of the studies included. If meta-analysis was not possible, qualitative best-evidence synthesis was used to summarize the results.
DATA SYNTHESIS:
The searches identified 532 studies, 6 of which were included. The studies compared the short-term effects of ECM treatment and control treatment on fatigue and QoL; 1 study reported short-term and midterm effects on participation, but found no evidence for effectiveness. Meta-analyses (2 RCTs, N=350) showed that ECM treatment was more effective than no treatment in improving subscale scores of the (1) Fatigue Impact Scale: cognitive (mean difference [MD]=-2.91; 95% confidence interval [CI], -4.32 to -1.50), physical (MD=-2.99; 95% CI, -4.47 to -1.52), and psychosocial (MD=-6.05; 95% CI, -8.72 to -3.37); and (2) QoL: role physical (MD=17.26; 95% CI, 9.69-24.84), social function (MD=6.91; 95% CI, 1.32-12.49), and mental health (MD=5.55; 95% CI, 2.27-8.83). Limited or no evidence was found for the effectiveness of ECM treatment on the other outcomes in the short-term or midterm. None of the studies reported long-term results.
CONCLUSIONS:
The systematic review results provide evidence that in the short-term, ECM treatment can be more effective than no treatment (waiting controls) in reducing the impact of fatigue and in improving 3 QoL scales-role physical, social function, and mental health-in fatigued patients with MS. More RCTs that also study long-term results are needed.

 

Afasia

2) Una de los problemas añadidos en el trabajo con pacientes con afasia tras un ictus es la alteración de la esfera emocional. La identificación y el tratamiento precoz de los trastornos depresivos es fundamental en el ictus, ahondando en el tema se ha publicado un ECA que concluye que la terapia conductual puede mejorar el estado de animo de los pacientes con afasia.

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Clin Rehabil. 2013 May;27(5):398-408. doi: 10.1177/0269215512462227. Epub 2012 Oct 11.
Communication and Low Mood (CALM): a randomized controlled trial of behavioural therapy for stroke patients with aphasia.
Thomas SA, Walker MF, Macniven JA, Haworth H, Lincoln NB.
Source
1University of Nottingham, Nottingham, UK.
Abstract
Objective: The aim was to evaluate behavioural therapy as a treatment for low mood in people with aphasia. Design: A randomized controlled trial comparing behavioural therapy plus usual care with a usual care control. Potential participants with aphasia after stroke were screened for the presence of low mood. Those who met the criteria and gave consent were randomly allocated. Setting: Participants were recruited from hospital wards, community rehabilitation, speech and language therapy services and stroke groups. Subjects: Of 511 people with aphasia identified, 105 had low mood and were recruited. Interventions: Behavioural therapy was offered for up to three months. Outcomes were assessed three and six months after random allocation. Main measures: Stroke Aphasic Depression Questionnaire, Visual Analog Mood Scales ‘sad’ item, and Visual Analogue Self-Esteem Scale. Results: Participants were aged 29 to 94 years (mean 67.0, SD 13.5) and 66 (63%) were men. Regression analysis showed that at three months, when baseline values and communication impairment were controlled for, group allocation was a significant predictor of the Stroke Aphasic Depression Questionnaire (P < 0.05), visual analogue ‘sad’ (P = 0.03), and Visual Analogue Self-Esteem Scale (P < 0.01). At six months, group alone was a significant predictor of the Stroke Aphasic Depression Questionnaire (P < 0.05), and remained significant when baseline values were controlled for (P = 0.02). Mean Stroke Aphasic Depression Questionnaire 10-item hospital version scores decreased from baseline to six months by six points in the intervention group as compared with an increase of 1.9 points in the control group. Conclusions: Behavioural therapy seemed to improve the mood of people with aphasia.

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