Study Design Survey study. Objectives People living with spinal cord injury (SCI) are major healthcare and rehabilitation services consumers and have unmet healthcare needs. This study aimed to describe the socioeconomic characteristics of people living with SCI in Spain and to determine the level of use and satisfaction with the public healthcare system. Methods We conducted a survey (the Spanish version of the International Spinal Cord Injury Community Survey) consisting of 134 questions. We analyzed the age, sex, neurological classification of the injury on the American Spinal Injury Association Impairment Scale, time of injury, socio-occupational and socioeconomic status, and level of use and satisfaction with the public health system. Results 472 people responded to the survey [68.9% male; mean age 51.2 years (standard deviation: 13.9 years); 61.7% with paraplegia and 38.3% with tetraplegia]. 89.2% of those surveyed were unemployed and 77.1% received a disability pension. The number of medical visits was 2.3/year, and 19.8% of the patients required at least 1 hospital admission during the previous year. 94.7% of the people with SCI considered the health care received as good or very good. Conclusions Respondents with SCI in Spain considered they had good access to primary and specialized care and were satisfied with the healthcare system. Notably, we observed a high average of annual visits to medical professionals but a low rate of hospitalizations. Technical aids and state services related to disability should be the most important elements to be improved.

Kuroda R. The influence of adipose-derived stromal vascular fraction cells on the treatment of knee osteoarthritis. BMC Musculoskelet Disord. 2020;21(1):207. 10. Zaffagnini S, Andriolo L, Boffa A, et al. Microfragmented adipose tissue versus platelet-rich plasma for the treatment of knee osteoarthritis: a prospective randomized controlled trial at 2-year follow-up. Am J Sports Med. 2022;50(11):2881-2892.

Comentario al original ‘Adaptación y viabilidad de la versión telemática de la escala Fugl Meyer para la evaluación de pacientes tras accidentes cerebrovasculares.

Background:Regenerative cell therapies, such as adipose-derived stromal vascular fraction (SVF), have been postulated as potential treatments for knee osteoarthritis (KOA).Objectives:To assess the efficacy and safety of SVF treatment against placebo and other standard therapies for treating KOA in adult patients.Design:A systematic review.Data sources and methods:We searched the following databases: MEDLINE via PubMed, Epistemonikos, PEDro, DynaMed, TripDatabase, Elsevier via Clinicalkey and Cochrane Controlled Trials Register. We included prospective interventional studies where treatment with SVF in adults with KOA was compared against placebo or other standard therapies, and results were objectively measured with at least one widely recognised osteoarthritis scale.Results:Among 266 studies published until May 2021, nine met our inclusion criteria. A total of 239 patients (274 knees) were included in our study. The follow-up ranged from 6 to 24 months. Six studies had a control group (only one being placebo). All studies showed that SVF improved pain and functionality measured, in most cases, with the visual analogue scale and the Western Ontario and McMaster Universities Osteoarthritis Index. In addition, five studies reported an improvement in anatomical structures, as detected in MR images. However, the number of cells contained in SVF varied substantially between different studies, which could induce a comparison bias.Conclusion:Although based on a small number of dissimilar studies, SVF was considered a safe treatment for KOA and could be promising in terms of pain, functionality and anatomical structure improvement. However, SVF products need to be standardised, the number of cells homogenised and the use of concomitant treatments reduced to establish proper comparisons.Registration:PROSPERO registration number: CRD42021284187.

Erosive arthritis is an unusual pathology. Despite using magnetotherapy as a treatment, there is no evidence supporting its use. The aim of the study is to evaluate magnetotherapy efficacy in patients suffering from hand erosive arthritis, compared to placebo, in terms of pain. Treatment safety will be also evaluated.Prospective experimental double-blind randomized study consisting of an intervention group (IG: treatment with magnetotherapy: 15 20-minute-sesions 5 consecutive days per week) and a control group (CG: placebo). Treatment efficacy was evaluated at the end and 3 months after. We used Visual Analog Scale (VAS) for assess pain. Secondarily, functionality (The Disabilities of the Arm, Shoulder and Hand (DASH) score), rigidity (Modified Kapandji Index), grip strength (dynamometry) and quality of life (SF-36 questionnaire) were assessed.29 patients were evaluated. Due to exclusion criteria, there were 19 patients left, all women with an average age of 59. After randomization, 10 were awarded to IG and 9 to CG, being both comparable groups. A higher percentage of patients with pain controlled (VAS<6) was found in IG post treatment and after 3-months (77.8% vs 33.3%, p=0.1 y 83.3% vs 33.3%, p=0.2; respectively). A tendency to decrease VAS for IG at 3-months (regression coefficient: -2.1 (95% CI: -5.7-1.5; p=0.2) was showed. There were no other statistically significant differences, except a higher dynamometry results in IG, in both hands (p<0.01 and p<0.04 respectively). There were neither adverse effects nor secondary effects.Magnetotherapy treatment for hand erosive arthritis patients is safe and probably leads to clinical improvement.

Our randomized cross-over study compared exercise against a postural garment (Posture Plus Force) in the management of cervical pain in female health professionals. The garment showed a similar effect to exercise in pain reduction, a decrease in the use of pain relievers and fostered compliance. Study Design. Randomized cross-over study. Objective. The aim of this study was to compare exercise, the criterion standard, to the postural garment PosturePlusForce in the management of nonspecific cervical pain in women. We also analyzed both interventions with regards to baseline posture, use of pharmacological pain relievers, compliance, and comfort. Summary of Background Data. The prevalence of neck pain has increased during the last decade, preferentially affecting women. Those suffering from this condition may manifest a decrease in quality of life and inability to work. Consistent recommendations highlight the importance of exercise and posture for neck pain improvement. Methods. A total of 32 female health care professionals with cervical pain (≥3 on the visual analogue scale) entered the trial. Participants were allocated to either performing exercises or wearing the postural garment. The cross-over between interventions was separated by a 3-month washout period. Primary outcomes included pain intensity and posture. Secondary outcomes comprised cervical pain-related disability, psychological factors, physical activity, global perceived effect of treatment, and garment comfort. Treatment compliance, medication use, and adverse events were also recorded. Results. Both interventions showed a significant improvement in pain in subjects with an adherence >60%. However, in participants with dorsal hyperkyphosis (>45°), the garment demonstrated a greater reduction in pain than exercise (P = 0.019). Additionally, those wearing the garment needed fewer pain relievers than those performing exercises (P = 0.007). Compliance was >50% for both interventions and comfort was contingent on season. Conclusion. In our study, PosturePlusForce showed, at least, a similar effect on pain to exercise, although those with dorsal hyperkyphosis exhibited a greater reduction in pain and related variables with the garment. Pain relievers were less required by those wearing PosturePlusForce than by those performing the exercises. Level of Evidence: 1

The health system is facing a global pandemic due to coronavirus disease 2019. Emergency plans often fail to consider specific rehabilitation issues, whether inpatient or outpatient, although the World Health Organization advises the inclusion of rehabilitation professionals as soon as possible. The contingency plans of rehabilitation services must be carried out in coordination with the other healthcare areas. This review was prepared with the current available evidence on coronavirus disease 2019 and was based on the experience of a specific environment, to plan the continuity of rehabilitation care for all patients and to help rehabilitation teams in this period of lockdown and uncertain lifting of restrictions.

BACKGROUND:There is a high prevalence of work-related musculoskeletal disorders among health care professionals. Posture is an essential point to be addressed for health care professionals with musculoskeletal disorders. Cervical pain can result from several conditions. Treatment should include posture modification and home exercise.OBJECTIVE:This study aims to compare a new postural garment (Posture Plus Force; Medi, Bayreuth, Germany) with exercises for women with nonspecific cervical pain. The investigators focus on nurses and allied health professionals due to the importance of posture in work-related musculoskeletal disorders.METHODS:This randomized crossover clinical trial has a 3-month treatment sequence and a 3-month washout period. Participants will include nurses and allied health professionals 21 to 55 years of age with cervical pain. Participants are allocated at random to two intervention groups: a postural garment (Posture Plus Force) to be worn for 2 to 4 hours per day for 90 days (P+ group) and five physiotherapy sessions (20 minutes each) to learn stretching and strengthening exercises with instructions to continue at home on a daily basis for 90 days (Ex group). The participants in each group will crossover interventions after a 3-month washout period. The primary outcomes are postural control and pain intensity. A static posturography will be performed with a scan (SpinalMouse; Idiag AG, Fehraltorf, Switzerland). The visual analogue scale is a psychometric measuring instrument designed to document cervical pain severity in individual participants. The secondary outcomes are cervical pain-related disability, catastrophizing, the global perceived effect of treatment, and the evaluation of garment comfort. Physical activity is assessed with the International Physical Activity Questionnaire. Assessment of primary and secondary outcomes is performed at T0 (pre-intervention), T1 (immediately after garment fitting for P+ group), T30, T60, and T90. The same measurements are recorded after the washout period and during the second intervention following the same sequence. All patients are provided with a logbook for compliance recording, over the counter drug use, pain evaluation, and sick leave. Statistical analysis is conducted following intention-to-treat principles and the treatment effects calculated using linear mixed models.RESULTS:The study design has been approved by the Ethics Commission of Hospital N Sra de Meritxell, Andorra in March 2017. A total of 32 participants are already enrolled in the study. An extension of the study is planned in a Spanish university hospital to achieve a larger sample. Study results are expected to be published during 2020.CONCLUSIONS:The Postural garment is expected to improve cervical pain by enhancing posture.TRIAL REGISTRATION:ClinicalTrials.gov NCT03560492; https://clinicaltrials.gov/ct2/show/NCT03560492.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):DERR1-10.2196/14807.

El sistema sanitario se encuentra ante una pandemia mundial en relación con la enfermedad por coronavirus 2019. Los planes de preparación para emergencias a menudo no consideran cuestiones específicas de rehabilitación para pacientes hospitalizados ni para ambulatorios, aunque la Organización Mundial de la Salud aconseja incluir a profesionales de rehabilitación lo antes posible. Los planes de contingencia de los servicios de rehabilitación deben realizarse en coordinación con las otras áreas asistenciales. En esta revisión se ha resumido y analizado la información disponible sobre la enfermedad por coronavirus 2019 basada en una búsqueda cuidadosa de la literatura científica y en la experiencia de un entorno concreto, para planificar la continuidad asistencial de rehabilitación para todos los pacientes y para ayudar a los equipos de rehabilitación en este periodo de confinamiento/desconfinamiento incierto.

INTRODUCTION:Erosive arthritis is an unusual pathology. Despite using magnetotherapy as a treatment, there is no evidence supporting its use. The aim of the study is to evaluate magnetotherapy efficacy in patients suffering from hand erosive arthritis, compared to placebo, in terms of pain. Treatment safety will be also evaluated.METHOD:Prospective experimental double-blind randomized study consisting of an intervention group (IG: treatment with magnetotherapy: 15 20-minute-sesions 5 consecutive days per week) and a control group (CG: placebo). Treatment efficacy was evaluated at the end and 3 months after. We used Visual Analog Scale (VAS) for assess pain. Secondarily, functionality (The Disabilities of the Arm, Shoulder and Hand (DASH) score), rigidity (Modified Kapandji Index), grip strength (dynamometry) and quality of life (SF-36 questionnaire) were assessed.RESULTS:29 patients were evaluated. Due to exclusion criteria, there were 19 patients left, all women with an average age of 59. After randomization, 10 were awarded to IG and 9 to CG, being both comparable groups. A higher percentage of patients with pain controlled (VAS<6) was found in IG post treatment and after 3-months (77.8% vs 33.3%, p=0.1 y 83.3% vs 33.3%, p=0.2; respectively). A tendency to decrease VAS for IG at 3-months (regression coefficient: -2.1 (95% CI: -5.7-1.5; p=0.2) was showed. There were no other statistically significant differences, except a higher dynamometry results in IG, in both hands (p<0.01 and p<0.04 respectively). There were neither adverse effects nor secondary effects.CONCLUSION:Magnetotherapy treatment for hand erosive arthritis patients is safe and probably leads to clinical improvement.

The health system is facing a global pandemic due to coronavirus disease 2019. Emergency plans often fail to consider specific rehabilitation issues, whether inpatient or outpatient, although the World Health Organization advises the inclusion of rehabilitation professionals as soon as possible. The contingency plans of rehabilitation services must be carried out in coordination with the other healthcare areas. This review was prepared with the current available evidence on coronavirus disease 2019 and was based on the experience of a specific environment, to plan the continuity of rehabilitation care for all patients and to help rehabilitation teams in this period of lockdown and uncertain lifting of restrictions.

Disability becomes increasingly common with advancing age. Physical Medicine and Rehabilitation (PMR) aims to enhance functional ability and decrease dependency and disabilities. In Andorra, there is a genuine dependence classification called Grau de Dependència Andorra (GDA), which rates 0 (no dependence) to 5 (total dependence). It is used to allocate therapeutic and economic resources at the national public skilled nursing facility (El Cedre). In order to improve patient experience and achieve greater efficiency from health system (Integrated care), this paper aims to reevaluate the actual level of dependence of people staying in El Cedre with several validated scales. Moreover, this study aims to measure patient’s dependency against GDA levels and to provide the rehabilitation resources needed for an improved health care. Method: We conducted a cross-sectional descriptive study in which a PMR physician evaluated all residents using a functional dependence scale (Barthel Index), a cognitive impairment scale (Pfeiffer test), assessment of independent living skills (Lawton Instrumental Activities of Daily Living Scale) and assessment of gait dependence (Rankin Modified Scale Score and Functional Ambulation Classification). Additionally, patients underwent a physical musculoskeletal examination. The residents, their relatives and the staff, including the rehabilitation team, were part of the assessment. Results: We evaluated 143 patients (120 in patient and 23 in day hospital) of which 48 were men and 95 women. Considering previous GDA classification, almost 70% of patients had at least high dependence. However, there is no data specified on which kind of disability patients were suffering from. Comparing PMR evaluation to GDA results, we found no correlation between GDA level and rehabilitation requirements. As a result we adapted groups to differentiate those subjects with predominantly cognitive impairment from those with mostly physical impairment. We identified more than a half of subjects (52.4%) suffering from cognitive impairment in comparison with the 19.5%, whose main disability came from physical impairment. The vast majority (72.02%) had moderate to high disability. Furthermore, up to 61.55% needed one or more people to walk. Results were reported to Hospital Executive Department, assisting with El Cedre’s management. Physical Medicine & Rehabilitation Journal How to Assess the Level of Dependency in an Integrated Care Health System. Phys Med Rehabil J. 2018; 2(1):112. Conclusion: PMR evaluation in a skilled nursing facility resulted in a change in allocating therapeutic resources, establishing properly the rehabilitation goals. To entirely evaluate disability, it is necessary to use both instruments of cognitive and physical assessment.

Background: Disability becomes increasingly common with advancing age. Physical medicine and rehabilitation (PMR) aim to enhance the functional ability and decrease dependency and disabilities. In Andorra, there is a genuine dependence classification called Grau de Dependencia Andorra (GDA), which rates 0 (no dependence) to 5 (total dependence). It is used to allocate therapeutic and economic resources at the national public skilled nursing facility (El Cedre). To improve patient experience and achieve greater efficiency from health system (integrated care), this paper aims to reevaluate the actual level of dependence of people staying in El Cedre with several validated scales. Moreover, this study aims to measure patient's dependency against GDA levels and to provide the rehabilitation resources needed for improved healthcare. Methods: We conducted a cross-sectional descriptive study in which a PMR physician evaluated all residents using a functional dependence scale (Barthel Index), a cognitive impairment scale (Pfeiffer test), assessment of independent living skills (Lawton instrumental activities of daily living scale), and assessment of gait dependence (Rankin modified scale score and functional ambulation classification). In addition, patients underwent a physical musculoskeletal examination. The residents, their relatives, and the staff, including the rehabilitation team, were part of the assessment. Results: We evaluated 143 patients (120 inpatient and 23 in day hospitals) of which 48 were men and 95 were women. Considering previous GDA classification, almost 70% of patients had at least high dependence. However, there are no data specified on which kind of disability patients were suffering from. Comparing PMR evaluation to GDA results, we found no correlation between GDA level and rehabilitation requirements. As a result, we adapted groups to differentiate those participants with predominantly cognitive impairment from those with mostly physical impairment. We identified more than a half of participants (52.4%) suffering from cognitive impairment in comparison with the 19.5%, whose main disability came from physical impairment. The vast majority (72.02%) had moderate-to-high disability. Furthermore, up to 61.55% needed one or more people to walk. Results were reported to hospital executive department, assisting with El Cedre's management. Conclusions: PMR evaluation in a skilled nursing facility resulted in a change in allocating therapeutic resources, establishing properly the rehabilitation goals. To entirely evaluate disability, it is necessary to use both instruments of cognitive and physical assessment.