Search

Background: Many women with breast cancer experience a great number of side effects, such as cognitive impairment, during and after chemotherapy that reduces their quality of life. Currently, research focusing on the use of non-pharmacological, and specifically telehealth interventions to prevent or mitigate them has been insufficient. Methods: This protocol describes a randomized controlled trial aimed at studying the preventive effects of a videoconferenced cognitive-adaptive training (e-OTCAT) program (ClinicalTrials.gov NCT04783402). A number of 98 eligible participants will be randomized to one of the following groups: (a) the experimental group receiving the e-OTCAT program during 12 consecutive weeks since the beginning of chemotherapy; and (b) the control group receiving and educational handbook and usual care. The primary outcome will be the cognitive function. Secondary measures will be psychological distress, fatigue, sleep disturbance, quality of life and occupational performance. The time-points for these measures will be placed at baseline, after 12 weeks and six months of post-randomization. Conclusion: This trial may support the inclusion of multidimensional interventions through a telehealth approach in a worldwide growing population suffering from breast cancer, emphasizing the prevention of cognitive impairment as one of the side effects of cancer and its treatments., Spanish Government FPU17/00939 FPU18/03575, Instituto de Salud Carlos III FI19/00230

BACKGROUND Physical exercise is already known to be beneficial for women who have or had breast cancer. However, avoiding overreaching or insufficient recovery in this population is important, as they are in a situation of physiological vulnerability due to cancer and its treatments, a similar state to what appears during overtraining in athletes. These alterations could lead breast cancer survivors to decrease their exercise capacity or favour overreaching, which maintained over time, would alter their homeostasis, increasing their vulnerability to illness and death. OBJECTIVE The study aims to evaluate the validity and reliability of ATOPE+ mHealth system, developed for Android/iOS mobile operating systems, to estimate autonomic balance and other wellness parameters that influence internal load, with the idea to facilitate nonlinear prescription, assessing readiness in breast cancer survivors. METHODS Twenty-two breast cancer survivors were included in the validity and reliability analysis. The participants measured during four days their morning autonomic balance, perception of recovery, sleep satisfaction, emotional distress and fatigue; with ATOPE+ mHealth system and with reliable comparison tools. RESULTS The validity results showed no significant differences, except for fatigue. The reliability results indicated an intraclass correlation coefficient (ICC) showed an excellent correlation for recovery (0.93; 95% CI 0.85-0.96) and distress (0.94, 95% CI 0.89-0.97) and good for LnRMSSD (0.87; 95% CI 0.74-0.94) and fatigue (0.86, 95% CI 0.29-0.95). Sleep satisfaction also showed excellent correlation with a Weighted kappa=0.83. CONCLUSIONS ATOPE+ is valid and reliable to remotely assess autonomic balance, perception of recovery, sleep satisfaction and emotional distress in breast cancer survivors; however, it is not for fatigue. This highlights that ATOPE+ could potentially be an easy and fast system used to measure tailored readiness in breast cancer survivors. ATOPE+ will offer a tool to improve health in this population, by helping rehabilitation professionals to prescribe optimal and safe physical exercise. Moreover, ATOPE+ may provide reliable data-driven analysis with machine learning algorithms, as originally described in its architecture. CLINICALTRIAL NCT03787966 ClinicalTrials.gov, December 2019 [ATOPE project]

Ethics approval The study protocols were approved by the Research Ethics Committee of the University of Granada (0572-M1-16 and 1087-N-16), and the study was performed in accordance with Law 14/2007 on Biomedical Research and the guidelines of the WMA Declaration of Helsinki., Availability of data and material Data will be available upon request from the corresponding author., Background The current study sought to explore whether cancer pain (CP) already exists in patients at colorectal cancer (CRC) diagnosis before treatment compared with patients with colorectal cancer (CRC) after treatment and a healthy matched control group. The study also sought to examine whether factors related to physical health status could enhance pain processes. Methods An observational cross-sectional study was conducted following the STROBE checklist. Twenty-nine newly diagnosed and forty post-treatment patients with CRC and 40 healthy age/sex-matched controls were included for comparison. Pain, local muscle function, and body composition outcomes were assessed by a physiotherapist with > 3 years of experience. ANCOVA and Kruskal–Wallis tests were performed, with Bonferroni and Dunn-Bonferroni post hoc analyses and Cohen’s d and Hedge’s effect size, as appropriate. Results The analysis detected lower values of pressure pain threshold (PPT) points, the PPT index, and abdominal strength and higher values of self-reported abdominal pain in newly diagnosed patients, with even more marked results observed in the post-treatment patients, where lower lean mass and skeletal muscle index values were also found than those in the healthy matched controls (p, Universidad de Granada/CBUA, Spanish Ministry of Education Culture and Sport (MECD) (FPU17/00939, FPU18/03575), European Social Fund, the Carlos III Health Institute (FI19/00230), CEIBiotic Universidad de Granada (CEI13-MP18 and CEI14-MPBS40)

To examine the minimal clinically important difference (MCID) in the treadmill 6-minute walk test (6MWT) in women with breast cancer. A secondary analysis of cross-sectional data from 112 women who were undergoing chemotherapy or had undergone anticancer treatment was conducted. Participants completed the 6MWT on a treadmill and the European Organization for Research and Treatment of Cancer Questionnaire (EORTC-QLQ-C30) twice, eight weeks apart. Change in the physical function domain of the EORTC-QLQ-C30 was used to classify the “positive change” subgroup (≥5 points difference) and the “unchanged” subgroup (

Head and neck cancer (HNC) is the sixth most common cancer worldwide. Yet, less than 60% of HNC survivors receive adequate therapy for treatment-related sequelae. The objective of this study was to determine the efficacy of myofascial induction therapy (MIT) in improving cervical and shoulder pain and range of motion, maximal mouth opening, and cervical muscle function in HNC survivors. This crossover, blinded, placebo-controlled study involved 22 HNC survivors (average age 56.55 ± 12.71) of which 13 were males (59.1%) who received, in a crossover fashion, both a single 30-min session of MIT in the form of manual unwinding and simulated pulsed shortwave therapy (placebo), with a 4-week washout interval between the two. Cervical and shoulder pain (visual analogue scale) and range of motion (cervical range of motion device and goniometer), maximum mouth opening (digital caliper), and cervical muscle function (deep cervical flexor endurance test) were measured before and after the treatment and placebo sessions. A single session of MIT improved cervical and affected side shoulder pain, cervical range of motion, maximum mouth opening, and cervical muscle function. The associated effect sizes ranged from moderate to large. The present study suggests that MIT, in the form of manual unwinding, improves cervical (−3.91 ± 2.77) and affected-side shoulder (−3.64 ± 3.1) pain, cervical range of motion (flexion: 8.41 ± 8.26 deg, extension: 12.23 ± 6.55, affected-side rotation: 14.27 ± 11.05, unaffected-side rotation: 11.73 ± 8.65, affected-side lateroflexion: 7.95 ± 5.1, unaffected-side lateroflexion: 9.55 ± 6.6), maximum mouth opening (3.36 ± 3.4 mm), and cervical muscle function (8.09 ± 6.96 s) in HNC survivors.

Physical therapy is appropriate for patients with cancer. The literature supports treatment from diagnosis throughout the entire survival period. However, there is a lack of adherence to physical t...

BACKGROUND Heavy physical and mental loads are typical for professional soccer players during the competitive season. COVID-19 lockdowns had recently forced competitions to be interrupted and later disputed in a shrunken calendar. Wearable sensors and mobile phones could be potentially useful in monitoring players’ training load in such highly demanding environments. OBJECTIVE The aim of this study was to explore whether remote heart rate variability (HRV) monitoring and self-reported wellness of professional soccer players could be useful to monitor players’ internal training load and to estimate their performance during the continuation of the 2020 season after the COVID-19 lockdown in Spain. METHODS A total of 21 professional soccer players participated in a 6-week study. Participants used an Android or iOS-based smartphone and a Polar H10 wearable ECG monitor for the duration of the study. Every morning they recorded their HRV and answered a questionnaire about their perceived recovery, muscle soreness, stress and sleep satisfaction. Smallest worthwhile change (SWC) and coefficient of variation (CV) were calculated for the logarithm of the root mean square of the successives differences (LnRMSSD) of the HRV. Players’ in-game performance was evaluated subjectively by independent observers and classified as high, normal and low. In order to find which variables could be potentially linked to performance, we studied their correlation and tested for significant differences among distributions. We also trained random forest models with cross-validation and bootstrapping to find the wellness and HRV features with best predictive ability for performance. RESULTS We found the usability of Readiness Soccer in a real scenario to be very good, with 81.36 points in the System Usability Scale. A total of 241 measurements of HRV and self-reported wellness were recorded. For a entire training microcycle (ie, time in between matches), self-reported high recovery (Mann-Whitney U, P=.003), low muscle soreness (P=.002), high sleep satisfaction (P=.02), low stress (Anderson-Darling, P=.03), and not needing more than 30 minutes to sleep since going to bed (Chi-Squared, P=.02), were found significant to differentiate high from normal match performance. Performance estimation models achieved the highest accuracy (73.4%) when combining self-reported wellness and HRV features. CONCLUSIONS HRV and self-reported wellness data were useful to monitor the evolution of professional soccer players’ internal load and to predict match performance levels out of measures in a training microcycle. Despite the limitations, these findings highlight opportunities for long-term monitoring of soccer players during the competitive season as well as real-time interventions aimed at early management of overtraining and boosting individual performance.

This study was made possible thanks to funding from the University of Granada, Plan Propio de Investigacion 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES)., This work was part of a Ph.D. thesis conducted in the Clinical Medicine and Public Health Doctoral Studies of the University of Granada, Granada, Spain., There is no systematic review that has identified existing studies evaluating the pharmacological and non-pharmacological intervention for pain management in patients with bone metastasis. To fill this gap in the literature, this systematic review with meta-analysis aims to evaluate the effectiveness of different antalgic therapies (pharmacological and non-pharmacological) in the improvement of pain of these patients. To this end, this protocol has been written according to the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) and registered in PROSPERO (CRD42020135762). A systematic search will be carried out in four international databases: Medline (Via PubMed), Web of Science, Cochrane Library and SCOPUS, to select the randomized controlled clinical trials. The Risk of Bias Tool developed by Cochrane will be used to assess the risk of bias and the quality of the identified studies. A narrative synthesis will be used to describe and compare the studies, and after the data extraction, random effects model and a subgroup analyses will be performed according to the type of intervention, if possible. This protocol aims to generate a systematic review that compiles and synthesizes the best and most recent evidence on the treatment of pain derived from vertebral metastasis., University of Granada, Plan Propio de Investigacion 2016, Excellence action: Units of Excellence, University of Granada, Plan Propio de Investigacion 2016, Excellence action: Unit of Excellence on Exercise and Health (UCEES)

This research was funded by the Spanish Ministry of Education Culture and Sport (FPU17/00939), the University of Granada Excellence Actions (Unit of Excellence in Exercise and Health)., We would like to thank Adrian Burton for his language assistance., The long-term sequelae of coronavirus disease 2019 (COVID-19) are only now beginning to be defined, but it is already known that the disease can have direct and indirect impacts mainly on the cardiorespiratory and neuromuscular systems and may affect mental health. A role for rehabilitation professionals from all disciplines in addressing COVID-19 sequelae is recognised, but it is essential that patient assessment be systematic if health complications are to be identified and treated and, if possible, prevented. The aim is to present a COVID-19 prospective surveillance model based on sensitive and easily used assessment tools, which is urgently required. Following the Oxford Centre for Evidence-Based Medicine Level of Evidence Tool, an expert team in cardiorespiratory, neuromuscular and mental health worked via telemeetings to establish a model that provides guidelines to rehabilitation professionals working with patients who require rehabilitation after suffering from COVID-19. A COVID-19 prospective surveillance model is proposed for use by rehabilitation professionals and includes both face-to-face and telematic monitoring components. This model should facilitate the early identification and management of long-term COVID-19 sequelae, thus responding to an arising need., Spanish Ministry of Education Culture and Sport FPU17/00939, University of Granada Excellence Actions (Unit of Excellence in Exercise and Health)

Background: This systematic review and meta-analysis compared the isokinetic strength of the muscular knee joint between quadriceps tendon autografts (QTAs) and hamstring tendon autografts (HTAs) or patellar tendon autografts (PTAs) after anterior cruciate ligament (ACL) reconstruction by determining the isokinetic angular velocity and follow-up time points. The functional outcomes and knee stability at the same time points were also compared using isokinetic technology. Methods: Two independent reviewers searched the Medline (via PubMed search engine), Scopus, Web of Science and Cochrane Library databases to include full text comparative studies that assessed isokinetic strength test following ACL reconstruction. The DerSimonian and Laird method was used. Results: In total, ten studies were included; seven compared studies QTAs vs. HTAs, and three compared QTAs vs. PTAs. Five studies were included in the meta-analysis. Isokinetic strength data were reported 3, 6, 12 and 24 months after ACL reconstruction. Conclusions: The QTAs showed better and significant results with knee flexion compared with HTAs, similar results to PTAs at 6 and 12 months. While HTAs showed better and significant results with knee extension at 6 months and similar results at 12 months compared to QTAs. Furthermore, a standardized isokinetic strength test must be followed to achieve a more specific conclusion and better clinical comparison among participants.

Spanish Ministry of Education Culture and Sport, Grant/Award Number: FPU17/00939; Universidad de Granada/CBUA, Background: Aquatic therapeutic exercise can be equally effective or even superior to land-based exercise in improving several clinical variables. However, there is still a lack of knowledge on the effects compared to land-based interventions particularly in breast cancer (BC) patients. Objective: The objective of this study is to examine the effects of aquatic therapeutic exercise on pain, shoulder mobility, lymphedema, cardiorespiratory fitness, muscle strength, body composition, pulmonary function, cancer-related fatigue (CRF) and health-related quality of life (HRQoL) and which parameters are effective compared to similar land-based interventions. Methods: The databases used were PubMed, Scopus, Web of Science, Cochrane Library and CINAHL, retrieving 145 articles. Results: Eleven studies were included. Aquatic therapeutic exercise is feasible, safe, well tolerated and achieved high percentages of adherence. As for the assessed outcomes, moderate to large improvements were found compared to usual care or to land-based physical exercise interventions in pain, shoulder range of motion, pulmonary function, HRQoL, cardiorespiratory fitness and muscle strength. Inconclusive results were found for lymphedema, body composition and CRF. Conclusions: Aquatic therapeutic exercise interventions using a combination of endurance, strength, mobility, stretching and breathing exercises resulted in improvements in common side effects of BC and its treatments. More studies on CRF, body composition and lymphedema need to be done to further evaluate the impact of the intervention on these outcomes., Spanish Ministry of Education Culture and Sport FPU17/00939, Universidad de Granada/CBUA

The authors express their gratitude to the patients and experts for their participation in the evaluation of ATOPEC. They also express their gratitude to the anonymous reviewers for the instructive criticism of an earlier version of this article., The introduction of mobile technologies in therapeutic exercise interventions has permitted the collection of fine-grained objective quantified information about patients' health. However, exercise interventions generally fail to leverage these data when personalizing the exercise needs of patients individually. Interventions that include technology-driven personalization strategies typically rely on the use of expensive laboratory equipment with expert supervision, or in the self-management of patients to meet the prescribed exercise levels by an activity tracker. These methods often do not perform better than non technology-driven methods, therefore more sophisticated strategies are required to improve the personalization process. In this paper we present ATOPE+, an mHealth system to support personalized exercise interventions in patients with cancer based on workload-recovery ratio estimation. ATOPE+ enables the remote assessment of workload-recovery ratio to provide optimal exercise dosage by means of a knowledge-based system and by combining physiological data from heterogeneous data sources in a multilevel architecture. The results show that ATOPE+ is a system ready to be used in the context of a clinical trial after being tested with patients with breast cancer and conducting an usability evaluation by clinical experts., Spanish Ministry of Science, Innovation, and Universities (MICINN) PGC2018-098813-B-C31 RTI2018-101674-B-I00, Health Research Funds of the Carlos III Health Institute PI18/01840, German Research Foundation (DFG) FPU16/04201 FPU17/00939

[EN] The use of smartphones, despite being mainly social, has begun to be implemented in the university environment as a tool for working in class and for communication between students regarding teaching material. However, before creating teaching methodologies that use these devices, it is important to know the opinion that the students have of them. Our objective was to analyze the personal and academic use of Smartphones by Health Sciences students from different Universities. With this objective, a form was created consisting of sociodemographic questions and the Questionnaire on perceptions and attitudes towards learning through mobile devices (CPAAM). Subsequently, a descriptive analysis of the results was carried out. In total, 233 students participated. Our results showed that the personal is the largest use of Smartphones in these students, while the perception of their educational use is relatively low. Obtaining these data is a starting point for future analyzes that associate the use of these devices with the individual situation of the student, as well as for the effectiveness of the implementation of new learning methodologies., [ES] El uso de los dispositivos móviles, a pesar de ser principalmente social, se ha comenzado a implantar en el ámbito universitario como herramienta para trabajar en clase y para la comunicación entre estudiantes de cara al material docente. Sin embargo, antes de la creación de metodologías docentes que utilicen estos dispositivos, es importante conocer la opinión que el estudiantado tiene de los mismos. Nuestro objetivo fue analizar el uso personal y académico de los teléfonos móviles por el estudiantado de Ciencias de la Salud de diferentes Universidades. Para ello, se creó un formulario compuesto por preguntas de carácter sociodemográfico y por el Cuestionario sobre percepciones y actitudes hacia el aprendizaje por dispositivos móviles (CPAAM). Posteriormente, se realizó un análisis descriptivo de los resultados. En total, participaron 233 estudiantes. Nuestros resultados demuestran que el personal es el mayor de los usos de los dispositivos móviles en la población estudiada mientras que la percepción de su uso educativo es relativamente baja. La obtención de estos datos supone un punto de partida para futuros análisis que asocien el uso de estos dispositivos a la situación individual del estudiantado, así como para la efectividad de la implantación de nuevas metodologías docentes.

The authors thank the Asociación Española Contra el Cáncer (IDEAS19055CANT), the Spanish Ministry of Education Culture and Sport (MECD) (FPU17/00939, FPU18/03575), the Carlos III Health Institute (FI19/00230), and Carlos III Health Insitute and the European Regional Development Fund (FEDER) (PI18/01840), for funding this study and all participants of the study. IEC is supported by the Spanish Ministry of Economy and Competitiveness. This study was part of a Ph.D thesis conducted in the Clinical Medicine and Public Health Doctoral Studies of the University of Granada, Spain. Trial registration: ClinicalTrials. Gov identifier: NCT04583124., A current challenge in breast cancer (BC) patients is how to reduce the side effects of cancer and cancer treatments and prevent a decrease in quality of life (QoL). Neurotoxic side effects, especially from chemotherapy, are present in up to 75% of women with BC, which implies a large impact on QoL. There is a special interest in the preventive possibilities of therapeutic exercise (TE) for these neurological sequelae, and the benefits of TE could be improved when it is combined with vagal activation techniques (VATs). This superiority randomized controlled trial aims to examine the feasibility and efficacy of an 8-week multimodal intervention (ATENTO) based on moderate-vigorous intensity and individualized TE (aerobic and strength exercises) and VAT (myofascial and breathing exercises), on neurotoxicity prevention in women with BC before starting adjuvant chemotherapy (ATENTO-B) versus throughout adjuvant chemotherapy (ATENTO-T). A sample of 56 women newly diagnosed with BC, as calculated with a power of 85%, will be randomly allocated into these two groups. This study could provide an impetus for the introduction of early multimodal intervention methods to prevent neurotoxicity and consequently avoid the QoL deterioration that BC patients presently suffer throughout their treatments., Fundacion Cientifica Asociacion Espanola Contra el Cancer IDEAS19055CANT, Spanish Ministry of Education Culture and Sport FPU17/00939 FPU18/03575, Instituto de Salud Carlos III FI19/00230 PI18/01840, Fondos Estructurales de la Union Europea (FEDER) PI18/01840, Spanish Ministry of Economy and Competitiveness

Objective Therapeutic exercise is already used to ameliorate some of the side effects of cancer treatment. Recent studies examined its preventive potential regarding treatment-related toxicity, which can increase the risk of functional decline and lead to disease recurrence and death. This trial will examine whether the Tailored Therapeutic Exercise and Recovery Strategies (ATOPE) program, performed before treatment, can mitigate the onset and extent of cardiotoxicity beyond that achieved when the program is followed during treatment in recently diagnosed breast cancer patients. Methods The intervention has a preparatory phase plus 12 to 18 sessions of tailored, high-intensity exercise, and post-exercise recovery strategies. A total of 120 women recently diagnosed with breast cancer, at risk of cardiotoxicity due to anticancer treatment awaiting surgery followed by chemotherapy and/or radiotherapy, will be randomized to either group. In a feasibility study, measurements related to recruitment rate, satisfaction with the program, adherence to them, the retention of participants, safety, and adverse effects will be explored. In the main trial, the efficacy of these interventions will be examined. The major outcome will be cardiotoxicity, assessed echocardiographically via the left ventricular ejection fraction. Other clinical, physical, and anthropometric outcomes and biological and hormonal variables will also be assessed after diagnosis, after treatment, 1 year after treatment ends, and 3 years after treatment ends. Conclusion Given its potential effect on patient survival, the mitigation of cardiotoxicity is a priority, and physical therapists have an important role in this mitigation. If the ATOPE intervention performed before treatment returns better cardioprotection results, it may be recommendable that patients recently diagnosed follow this program. Impact The ATOPE program will highlight the need for a physical therapist intervention from the moment of diagnosis, in the prevention or mitigation of cardiotoxicity, in women with breast cancer. It could help physical therapists to establish an adequate therapeutic exercise dose adapted to breast cancer patients and to propose correct therapeutic exercise prescription according to the assimilation of the sessions.

BACKGROUND Therapeutic exercise is already much used as a means of ameliorating some of the side effects of cancer treatment. Recent studies have examined its preventive potential with respect to the appearance of treatment-related toxicity. Toxicity-induced cardiac damage - indeed, even temporary adverse effects on the heart - can increase the risk of functional decline, which can in turn lead to disease recurrence and death. OBJECTIVE The present trial will examine whether the ATOPE (Tailored Therapeutic Exercise and Recovery Strategies) program, performed before treatment starts for recently diagnosed breast cancer (ATOPE-B), can mitigate the onset and extent of cardiotoxicity beyond that achieved when the program is followed by similar patients who have already begun treatment (ATOPE-I), using a mobile app, ATOPE+, to determine women’s therapeutic exercise assimilation. METHODS The ATOPE intervention consists of 6 bouts of general preparatory exercise plus 12-18 bouts of tailored, high intensity exercise (whole-body and locoregional exercises), and the following of post-exercise recovery strategies (stretching and breathing exercises). A total of 120 female patients recently diagnosed with stage 1-IIIb breast cancer and awaiting surgery followed by chemotherapy and/or radiotherapy, and at risk of cardiotoxicity as described by the American Society of Clinical Oncology Guidelines, will be randomised 1:1 to either ATOPE-B or ATOPE-I. In a small feasibility study performed before the main trial, and lasting one full cycle of the ATOPE program, measurements related to recruitment rate, satisfaction with the application, satisfaction with the ATOPE-B and ATOPE-I programs, adherence to the program, the retention of subjects, safety, and adverse effects will be explored. In the main trial, which is designed to examine the efficacy of these interventions, the major outcome variable will be cardiotoxicity, assessed echocardiographically via the left ventricular ejection fraction. This, along with other clinical, physical, and anthropometric outcomes, and biological and hormonal variables, will be assessed after diagnosis, 3 days before the third chemotherapy session, 1 year after treatment ends, and 3 years after treatment ends. RESULTS Not aplicable CONCLUSIONS The left ventricular ejection fraction is modified by cancer treatment. Given its potential effect on patient survival, the mitigation of cardiotoxicity is a priority. If the ATOPE-B intervention returns better cardioprotection results than ATOPE-I, it may be recommendable that patients yet to begin treatment for breast cancer, follow this program. CLINICALTRIAL ClinicalTrials.gov, NCT03787966

Trial Registration: ClinicalTrials.gov NCT04138511; https://clinicaltrials.gov/ct2/show/NCT04138511, We are grateful to Ms Carmen Sainz-Quinn for her assistance with the English language. The authors are also grateful for the collaboration of the students who participated in the study. This study was funded by a grant from the Educational Innovation Unit of the University of Granada, Spain (PID 14-56). This study was conducted thanks to the additional funding from the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES)., Background: Generation Z is starting to reach college age. They have adopted technology from an early age and have a deep dependence on it; therefore, they have become more drawn to the virtual world. M-learning has experienced huge growth in recent years, both in the medical context and in medical and health sciences education. Ultrasound imaging is an important diagnosis technique in physiotherapy, especially in sports pathology. M-learning systems could be useful tools for improving the comprehension of ultrasound concepts and the acquisition of professional competencies. Objective: The purpose of this study was to evaluate the efficacy and use of an interactive platform accessible through mobile devices—Ecofisio—using ultrasound imaging for the development of professional competencies in the evaluation and diagnosis of sports pathologies. Methods: Participants included 110 undergraduate students who were placed into one of two groups of a randomized controlled multicenter study: control group (ie, traditional learning) and experimental group (ie, Ecofisio mobile app). Participants’ theoretical knowledge was assessed using a multiple-choice questionnaire (MCQ); students were also assessed by means of the Objective Structured Clinical Examination (OSCE). Moreover, a satisfaction survey was completed by the students. Results: The statistical analyses revealed that Ecofisio was effective in most of the processes evaluated when compared with the traditional learning method: all OSCE stations, P, This study was funded by a grant from the Educational Innovation Unit of the University of Granada, Spain (PID 14-56)

To evaluate the patterns of treatment among patients with fibromyalgia (FM) in Spain and to assess patient satisfaction and perceived tolerability of the treatment received.An observational, cross-sectional study was conducted in Spain via internet from September 2015 to March 2017. We recorded sociodemographic and clinical information, including treatment satisfaction evaluated using a 10-point numerical rating scale (NRS) and adverse events.Evaluable subjects (n=915) were predominantly middle-aged, married women who presented with moderate to severe pain, sleep disturbance and affected quality-of-life. The most frequent non-pharmacologic treatments were physical exercise (85%), diet (47%), supplements such as magnesium and vitamins (47%), and psychotherapy (31%). The most frequently prescribed drugs were tramadol (40%), benzodiazepines (30%), duloxetine (22%), pregabalin (19%), amitriptyline (17%) and nonsteroidal anti-inflammatory drugs (NSAIDs; 16%); 7.5% of patients received stronger opioids. After excluding benzodiazepines, NSAIDs, and paracetamol, 46% of patients received ≥2 drugs. Satisfaction with treatment (NRS mean score) was generally poor for pharmacologic treatment (4.1), exercise (4.7), psychotherapy (5.2), diet (5.0), physiotherapy (6.2) and acupuncture (6.3). The increase in the number of drugs prescribed was not associated with an increase in satisfaction, but rather with an increase in adverse events.Patients with FM in Spain are overtreated with a combination of non-pharmacologic and pharmacologic therapies. Several of these therapies lack adequate support from randomised clinical trials and/or clinical practice guidelines. This overtreatment is not associated with relevant clinical benefits or patient satisfaction and, in the case of pharmacologic treatments, poses tolerability and safety issues.

Background: Breast cancer patients have to face a high-risk state during chemotherapy, which involves deterioration of their health including extensive physical deterioration. Face-to-face physical exercise programs have presented low adherence rates during medical treatment, and telehealth systems could improve these adherence rates. Objective: This study aimed to evaluate the effectiveness of a Web-based exercise program (e-CuidateChemo) to mitigate the side effects of chemotherapy on the physical being, anthropometric aspects, and body composition. Results: Functional capacity improved significantly in the e-CuidateChemo group compared to the control group (6-minute walk test: 62.07 [SD 130.09] m versus –26.34 [SD 82.21] m; 6-minute walk test % distance predicted: 10.81% [SD 22.69%] m versus –4.60% [SD 14.58%]; between-group effect: P=.015 for both). The intervention group also showed significantly improved secondary outcomes such as between-group effects for abdominal (24.93 [SD 26.83] s vs –18.59 [SD 38.69] s), back (12.45 [SD 10.20] kg vs 1.39 [10.72] kg), and lower body (–2.82 [SD 3.75] s vs 1.26 [SD 2.84] s) strength; all P, The study was funded by a research project grant from the Andalusian Health Service, Junta de Andalucia, call for subsidies for the financing of biomedical research and health sciences in Andalusia (SAS-0457-2010) and by the Spanish Ministry of Education (FPU14/01069 and FPU17/00939).

Energy balance is defined as the difference between energy expenditure and energy intake. The current state of knowledge supports the need to better integrate mechanistic approaches through effective studies of energy balance in the cancer population because of an observed significant lack of adherence to healthy lifestyle recommendations. To stimulate changes in breast cancer survivors’ lifestyles based on energy balance, our group developed the BENECA (Energy Balance on Cancer) mHealth app. BENECA has been previously validated as a reliable energy balance monitoring system. Based on our previous results, the goal of this study was to investigate the feasibility of BENECA mHealth in an ecological clinical setting with breast cancer survivors, by studying (1) its feasibility and (2) pretest-posttest differences with regard to breast cancer survivor lifestyles, quality of life (QoL), and physical activity (PA) motivation. BENECA mHealth can be considered feasible in a real clinical context to promote behavioral changes in the lifestyles of breast cancer survivors, but it needs to be enhanced to improve user satisfaction with use and functionality. This study highlights the importance of the use of mobile apps based on energy balance and how the QoL of breast cancer survivors can be improved via monitoring., Spanish Ministry of Economy and Competitiveness (Plan Estatal de I+D+I 2013-2016), Fondo de Investigación Sanitaria del Instituto de Salud Carlos III (PI14/01627), Fondos Estructurales de la Unión Europea (FEDER), Spanish Ministry of Education (FPU14/01069 and FPU17/00939), Additional funding from the University of Granada, Plan Propio de Investigación 2016, Excellence Actions: Units of Excellence; Unit of Excellence on Exercise and Health (UCEES)

BACKGROUND Energy balance is defined as the difference between energy expenditure and energy intake. The current state of knowledge supports the need to better integrate mechanistic approaches through effective studies of energy balance in cancer population, due to it is observed a significant lack of adherence to healthy lifestyle recommendations. In an attempt to stimulate changes in breast cancer survivors (BCS) lifestyles based on energy balance, our group developed BENECA mHealth application, which has been previously validated as a reliable energy balance monitoring system. OBJECTIVE Based on our previous results, the goal of this study was to investigate the feasibility of BENECA mHealth in an ecological clinical setting with breast cancer survivors, studying (1) its feasibility; and (2) pretest-posttest differences with regard to BCS’ lifestyles, quality of life (QoL), and physical activity (PA) motivation. METHODS Eighty BCS were enrolled in this prospective test-retest quasi-experimental study diagnosed with stage I to IIIA and with a body mass index over 25 kg/m2. Patients had to use BENECA mHealth for 8 weeks and were assessed at baseline and post-intervention period. Feasibility main outcomes included percentage of adoption, usage and attrition, user app-quality perception measured with the Mobile App Rating Scale (MARS), satisfaction with Net Promoter Score (NPS), and barriers and facilitators of its use. Clinical main outcomes included quality of life measure with EORT QLQ-C30, PA assess with accelerometry, PA motivation measure with the self-efficacy scale for physical activity (EAF), and body composition with a Dual-energy X-ray absorptiometry. Statistical (paired-sample t-tests was used) and Kaplan-Meier survival curve were analyzed. RESULTS BENECA was considered feasible by the BCS, in terms of use (76.3%; 58/76 BCS) adoption (69%; 80/116), and satisfaction (positive NPS). App quality score did not make it one of the best rated apps (3.71 ± 0.47 points out of 5). BENECA mHealth seems to improve the QoL of BCSs (global health mean difference (MD) 12.83, 95% CI 8.95–16.71, p CONCLUSIONS BENECA mHealth can be considered feasible in a real clinical context for being able to promote behavioral changes in the lifestyles of BCSs, but it needs to be optimized to improve user satisfaction with use and functionality. This study highlights the importance of the use of mobile applications based on energy balance and how the QoL of BCSs can be improved via monitoring.