1. Investigación

BACKGROUND: There are still many barriers when implementing exercise routines within daily dialysis care, even though benefits are well-known. Developing cost-effective strategies is necessary to overcome these barriers and include exercise as a complementary therapy in dialysis. AIM: To compare several exercise programs on hemodialysis patient’s functional capacity and health-related quality of life. DESIGN: This study was a 16-week follow-up, two-parallel group trial with balanced randomization. SETTING: Participants in this study belonged to a private hospitalized care center. POPULATION: Referred sample of 71 patients that suffered end-stage chronic kidney disease who underwent hemodialysis for at least 3 months and had a medical stable condition. METHODS: Thirty-six participants performed for 16 weeks an intradialytic exercise program lead by the nursing staff of the hemodialysis unit and 35 a home-based program supervised by physical therapists of the hospital. RESULTS: The main researcher and the data analyst were both blinded to participant allocation. There was a significant effect in time for both groups. Participants improved significantly in the Short Performance Physical Battery (SPPB), One-Leg Heel-Rise (OLHR) and 6 Minute-Walk Test (6MWT), and in the Physical Activity Scale for the Elderly (PASE) and Short Survey Form 36 (SF-36) questionnaires. CONCLUSIONS: Nurse-led and home-based exercise interventions produce beneficial effects involving physical function, activity levels and health-related quality of life in patients undergoing hemodialysis. CLINICAL REHABILITATION IMPACT: The study emphasizes the importance of exercise rehabilitation routines in fragile populations such as dialysis patients, and the potential to overcome barriers for its daily implementation.

The aim of this study was to systematically review the scientific evidence related to the physiotherapy interventions in neurorehabilitation that utilize virtual reality (VR) for balance training and risk of falls in people with multiple sclerosis (MS). A search was conducted in Medline (PubMed), PEDro, and Google Scholar to identify all the relevant studies. Clinical trials assessing the effects of VR in people with MS were included. Risk of bias was evaluated using the Cochrane Risk of Bias Tool and PEDro scale. Qualitative analysis was performed according to the GRADE. In total, 16 studies (n = 663) were included. The meta-analysis showed statistically significant differences for the VR intervention in comparison with conventional treatment for balance, with a moderate clinical effect in eight studies (SMD: 0.63; 95% CI 0.34–0.92; p < 0.05). In addition, the meta-analysis showed statistically significant differences for the VR intervention in comparison with conventional treatment for risk of falls, with a small clinical effect in six studies (SMD: 􀀀0.55; 95% CI 􀀀1.07–0.04; p < 0.05). VR-based treatments are more effective than non-intervention in improving balance and fall risk in people with MS, with a very low certainty of evidence. In addition, they also show to be more effective than conventional rehabilitation, with a very low certainty of evidence.

The presence of myofascial trigger points (MTrPs) is one of the most common causes of musculoskeletal problems and may lead to limited professional activity. Among the various treatment methods proposed for MTrPs, Kinesio Taping (KT) is a non-invasive, painless, and less time-consuming method with fewer side efects that has become widely used as a therapeutic tool in a variety of prevention and rehabilitation protocols. The aim of the study was to evaluate the immediate and short-term efcacy of the space correction KT technique in patients with latent or active MTrPs in the upper trapezius muscle. Two parallel randomized sham-controlled trials were simultaneously executed: in trial A, ninety-seven participants with latent MTrPs were randomly assigned to either the KT (n=51) or sham (n=46) group; in trial B, thirty-seven participants with active MTrPs were assigned to the KT (n=20) or sham (n=17) group. The primary outcome was pressure pain threshold (PPT) in the upper trapezius muscle, measured with algometry. Secondary outcomes included the active range of motion (ROM) of the cervical spine (lateral fexion and rotation), measured with a cervical ROM goniometer. In each trial, two-way ANOVA tests were used to compare the study efects on the outcome measures between the groups, with time serving as the intra-group factor (baseline, immediately, and 72h after the application) and the intervention type (KT and sham) as the between-group factor. At 72h, participants receiving KT did not show signifcant diferences in PPT (trial A: mean diference −1.8N; 95% CI: [−8.1, 4.4], trial B: mean diference −1.2N; 95% CI: [−7.4, 5.1]), cervical lateral fexion (trial A: mean diference 0.2 degrees; 95% CI: [−2.7, 3.1], trial B: mean diference −2.4 degrees; 95% CI: [−8.4, 3.6]), and cervical rotation (trial A: mean diference 3.7 degrees; 95% CI: [−0.1, 7.5], trial B: mean diference 1.4 degrees; 95% CI: [−5.7, 8.4]), compared to the sham groups. Thus, the results of this study do not support the use of the space correction KT technique to treat patients with latent or active myofascial trigger points in the upper trapezius muscle.