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Puentes Gutiérrez AB, García Bascones M, Jiménez Díaz F, Cuena Boy R, Puentes Gutiérrez R. [Validity and reliability of DASH questionnaire in women who suffer from lymphedema as a side effect of a breast cancer treatment]. Rehabilitacion (Madr) 2023; 57:100780. [PMID: 36739630 DOI: 10.1016/j.rh.2022.100780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 10/01/2022] [Accepted: 11/06/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION DASH questionnaire was designed to assess upper limb function in musculoskeletal pathologies. The aim of this manuscript is to study the reliability and validity of this questionnaire, to determine if is adequate to use in women with lymphedema due to breast cancer treatment. METHODS Prospective study in 65 women with lymphedema due to breast cancer treatment was done, in which the reliability of DASH score with internal consistency (Cronbach's alpha) and test-retest reproducibility 15 days' interval (interclass correlation coefficient) and validity by correlation with SF-36v2 and FACT-B+4 (r or Kendall's τ b) scores was investigated. RESULTS The internal consistency and the test-retest were Cronbach's alpha 0.969 and interclass correlation coefficient 0.861, respectively. There was correlation between the DASH score with the SF-36v2 score, mainly in the areas of physical function, body pain and physical role (r 0.800, 0.738, and 0.682, respectively; p<0.001), and lowest with the emotional and social wellbeing. The DASH score had correlation with FACT-B+4 (0.836; p<0.001) and the subscales the upper limb score (r=0.816; p<0.001), and there was no correlation with the social/familiar subscale (r=0.193; p=0.216). CONCLUSION The DASH questionnaire is a reliable and valid tool to assess upper limb functionality in Spanish women with breast cancer related lymphedema.
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Affiliation(s)
- A B Puentes Gutiérrez
- Servicio de Rehabilitación, Complejo Hospitalario Universitario de Toledo, Toledo, España.
| | - M García Bascones
- Servicio de Rehabilitación, Complejo Hospitalario Universitario de Toledo, Toledo, España
| | - F Jiménez Díaz
- Facultad de Ciencias del Deporte, Universidad de Castilla-La Mancha, Toledo, España
| | - R Cuena Boy
- Servicio de Farmacología Clínica, Complejo Hospitalario Universitario de Toledo, Toledo, España
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Hernández López M, Puentes Gutiérrez AB, García Bascones M, Fernández García L, Pérez Novales D, Marquina Valero MA. [Strength training education for physicians increases its prescription]. Rehabilitacion (Madr) 2022; 56:274-278. [PMID: 35469644 DOI: 10.1016/j.rh.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 08/16/2021] [Accepted: 10/23/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Medical prescriptions have traditionally been focused on aerobic exercise. However, an increasing number of authors are pointing towards strength training as the healthiest exercise modality. The purpose of this study is to assess whether physicians increase their knowledge as well as their confidence to prescribe strength training after attending a physical training course. MATERIALS AND METHODS A prospective cohort study of 160 physicians was conducted, 80 physicians out of the 160 attended a physical training course, whereas the remaining 80 physicians did not. Personal and professional data was collected, as well as data regarding the type of exercise they were practising or prescribing and the confidence and knowledge for their prescription. Finally, differences between the two groups and the impact of attending the course where analysed. RESULTS Both groups were homogeneous in gender, age, medical speciality and practice of physical exercise, with very low rates of strength training and prescription for both groups. It was established that the group attending the course acquired knowledge and confidence for prescribing strength training. Moreover, this group considered that strength training was the exercise modality which should be encouraged (P<.001). CONCLUSIONS Education in strength training for physicians by means of a theoretical-practical course increases knowledge and confidence for its prescription.
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Affiliation(s)
- M Hernández López
- Servicio de Medicina Física y Rehabilitación, Complejo Hospitalario Universitario de Toledo, Toledo, España.
| | - A B Puentes Gutiérrez
- Servicio de Medicina Física y Rehabilitación, Complejo Hospitalario Universitario de Toledo, Toledo, España
| | - M García Bascones
- Servicio de Medicina Física y Rehabilitación, Complejo Hospitalario Universitario de Toledo, Toledo, España
| | - L Fernández García
- Servicio de Medicina Física y Rehabilitación, Complejo Hospitalario Universitario de Toledo, Toledo, España
| | - D Pérez Novales
- Servicio de Medicina Física y Rehabilitación, Complejo Hospitalario Universitario de Toledo, Toledo, España
| | - M A Marquina Valero
- Servicio de Medicina Física y Rehabilitación, Complejo Hospitalario Universitario de Toledo, Toledo, España
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Hernández López M, Puentes Gutiérrez AB, López Zarzuela MC, García Bascones M. [Involuntary movements of the stump after transtibial amputation: Jumping stump syndrome]. Rehabilitacion (Madr) 2022; 57:100745. [PMID: 35738919 DOI: 10.1016/j.rh.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
Abstract
45-year-old woman with history of hallux valgus surgery and torpid evolution, which led to transtibial amputation. Six months after surgery, she began to experience involuntary movements of the stump such as myoclonus, that were triggered by touch or hip extension, associating worsening of the previous stump and phantom limb pain. During the following year, concurring with change of prosthesis, symptoms progressively worsened, which limited walking. The therapeutic approach to pain and myoclonus was initially pharmacological, without response. Given the clinical and ultrasound suspicion of neuroma in the external popliteal sciatic nerve, it was infiltrated with corticosteroid and anesthetic, and the gastrocnemius with botulinum toxin type A, without success. Finally, the myoclonus disappeared, and the pain decreased after surgical remodeling of the stump and resection of the neuroma. This clinical picture is known as jumping stump syndrome and is a rare complication that must be considered after amputation.
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Affiliation(s)
- M Hernández López
- Servicio de Medicina Física y Rehabilitación, Complejo Hospitalario Universitario de Toledo, Toledo, España.
| | - A B Puentes Gutiérrez
- Servicio de Medicina Física y Rehabilitación, Complejo Hospitalario Universitario de Toledo, Toledo, España
| | - M C López Zarzuela
- Servicio de Medicina Física y Rehabilitación, Complejo Hospitalario Universitario de Toledo, Toledo, España
| | - M García Bascones
- Servicio de Medicina Física y Rehabilitación, Complejo Hospitalario Universitario de Toledo, Toledo, España
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Puentes Gutiérrez AB, García Bascones M, Puentes Gutiérrez R, Rubio Mellado M, Esteban Esteban C, García Ávila M. [Axillary web syndrome following breast cancer surgery. Rare variant with subcutaneous nodules]. Rehabilitacion (Madr) 2020; 55:320-324. [PMID: 33168182 DOI: 10.1016/j.rh.2020.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/10/2020] [Accepted: 09/03/2020] [Indexed: 11/28/2022]
Abstract
We describe the case of a 49-year-old woman who, after surgical treatment of breast cancer, developed axillary web syndrome (AWS) followed, 3 weeks later, by the appearance of soft and painless subcutaneous nodules along the cords and close to the flexure of the elbow. After tests (soft tissue and Doppler ultrasound), a dermal/subcutaneous or neoplastic cause was ruled out, although a cephalic and ulnar venous thrombosis was revealed. Anticoagulant medication was prescribed, with disappearance of the nodules 3-4 weeks later and improvement of AWS. The symptoms, clinical course, diagnostic tests, as well as the published evidence, helped to establish a diagnosis of AWS with subcutaneous nodules. AWS is an early complication after axillary surgery, which is well known among breast cancer professionals and whose diagnosis is based on clinical presentation. Its association with subcutaneous nodules is one of its rare variants and requires compulsory complementary studies to exclude other causes. Like AWS, nodules are believed to be due to lymphatic vessel thrombosis.
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Affiliation(s)
| | - M García Bascones
- Servicio de Rehabilitación, Complejo Hospitalario de Toledo, Toledo, España
| | | | - M Rubio Mellado
- Servicio de Rehabilitación, Complejo Hospitalario de Toledo, Toledo, España
| | - C Esteban Esteban
- Servicio de Oncología, Complejo Hospitalario de Toledo, Toledo, España
| | - M García Ávila
- Servicio de Cirugía General, Complejo Hospitalario de Toledo, Toledo, España
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García Bascones M, Puentes Gutiérrez AB, Fernández García L, Rubio Mellado M, Madrid Sánchez J, Hernández López M. [Fighting against COVID-19: clinical activities of spanish rehabilitation physicians: A cross-sectional study]. Rehabilitacion (Madr) 2020; 54:260-268. [PMID: 32977993 PMCID: PMC7414309 DOI: 10.1016/j.rh.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/11/2020] [Accepted: 07/16/2020] [Indexed: 11/16/2022]
Abstract
Objetivo El objetivo de este estudio es analizar el impacto y la organización tanto asistencial como docente en los Servicios de Medicina Física y Rehabilitación de España ante el nuevo y cambiante escenario debido a la pandemia por la COVID-19. Métodos Se realiza una encuesta dirigida a los tutores de los Servicios de Rehabilitación. Un total de 31 preguntas divididas en 6 apartados: información general de los Servicios, adaptación del Servicio durante el periodo COVID, labor asistencial de los médicos rehabilitadores, abordaje rehabilitador de pacientes COVID, consecuencia de la pandemia sobre la salud de los rehabilitadores y labores de tutoría durante ese periodo. Resultados Se recibieron un total de 54 encuestas. Casi la mitad de los Servicios cancelaron todas las consultas presenciales (40%) y las salas de terapias se destinaron a camas de pacientes COVID (48%). En 30 hospitales (55,6%) los facultativos han trabajado en plantas COVID. La gran mayoría de los Servicios han elaborado material gráfico y audiovisual con ejercicios, así como protocolos de derivación y tratamiento rehabilitador de pacientes COVID ingresados. Casi la mitad de los Servicios encuestados han tenido algún caso de ansiedad en el personal médico. Las labores de tutoría se han anulado (40,7%) o disminuido (35,2%). Conclusiones La organización de los Servicios de Rehabilitación para hacer frente a la pandemia ha sido similar en todo el territorio español. La respuesta de los Servicios a la crisis sanitaria ha visualizado la versatilidad de trabajo de los médicos rehabilitadores.
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Puentes Gutiérrez AB, García Bascones M, Puentes Gutiérrez R, Díaz Jiménez M. [Idiopathic axillary web syndrome]. Rehabilitacion (Madr) 2019; 54:68-72. [PMID: 32007185 DOI: 10.1016/j.rh.2019.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/28/2019] [Accepted: 10/16/2019] [Indexed: 11/16/2022]
Abstract
We report the case of a 67-year-old woman who developed a cord of subcutaneous tissue extending from the axilla into the medial arm, accompanied by axillary neuropathic pain, with no history of surgery or infection. The patient was instructed in home exercises, and the condition progressively improved. Four months later, a small cord was visible on abduction with mild axillary dysesthesia, which was less severe than at onset. Diagnosis of exclusion was idiopathic axillary web syndrome (AWS). This syndrome is widely recognized after surgical axillary lymph node removal to treat breast cancer, but the etiopathogenesis is still unknown. Published reports of AWS with no history of surgery are rare, but a few reports have described this entity after infection or intense exercise. There are currently no previous reports of idiopathic AWS. The anatomical and clinical presentation, and clinical course of AWS without prior surgery, are similar to those of postoperative AWS.
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Affiliation(s)
| | - M García Bascones
- Servicio de Rehabilitación, Hospital Virgen de la Salud, Toledo, España
| | | | - M Díaz Jiménez
- Servicio de Rehabilitación, Hospital Virgen de la Salud, Toledo, España
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Puentes Gutiérrez AB, García Bascones M, Puentes Gutiérrez R, Díaz Jiménez M. [Subcutaneous botulinum toxin in the treatment of peripheral neuropathic pain]. Rehabilitacion (Madr) 2019; 53:131-135. [PMID: 31186096 DOI: 10.1016/j.rh.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 09/24/2018] [Accepted: 12/27/2018] [Indexed: 06/09/2023]
Abstract
Neuropathic pain impairs quality of life in affected individuals and poses a challenge to clinicians due to the complexity of its treatment and frequent therapeutic failures. We present 4clinical cases of chronic neuropathic pain (LANSS ≥ 19), refractory to conservative treatment (meralgia paraesthetica, post-surgical pain and 2surgical scars). Subcutaneous botulinum toxin type A was infiltrated periodically over the painful area. All patients experienced subjective improvement in pain and improvement measured by the visual analogic scale. Pain relief started at 5-21 days and continued up to 1.5-3 months, and up to 9 months in one patient. Pain that reappeared was of lower intensity in 3patients and was reduced in area in 2patients.
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Affiliation(s)
| | - M García Bascones
- Servicio de Rehabilitación, Hospital Virgen de la Salud, Toledo, España
| | | | - M Díaz Jiménez
- Servicio de Rehabilitación, Hospital Virgen de la Salud, Toledo, España
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