[Purpose] The aim of this study was to determine changes in pressure sensitivity and pinch strength in patients with thumb carpometacarpal (CMC) osteoarthritis (OA) in the contralateral hand after unilateral Kaltenborn mobilization on the symptomatic hand. [Subjects and Methods] Twenty-nine females with dominant hand thumb CMC osteoarthritis participated (age 70–90), and were randomized into 2 groups. The experimental group received a Kaltenborn mobilization, and the placebo group received a nontherapeutic dose of intermittent ultrasound. Pressure pain thresholds (PPT) at the thumb CMC joint, scaphoid bone and hamate bone and tip and tripod pinch strength were assessed before and after the intervention and 1 week (1st follow-up) and 2 weeks (2nd follow-up) after the intervention. [Results] Significant increases in PPT in the experimental group at all follow-up periods as compared with baseline data were found. The post-intervention between-group mean differences for PPT were 1.1 (95%CI 0.4–1.8) for the CMC joint, 1.1 (95%CI 0.2–2.1) for the scaphoid, and 1.5 (95%CI 0.5–2.8) for the hamate. The post-intervention between-group mean differences were 0.5 (95%CI 0.2–0.9) for the tip pinch and 0.3 (95%CI 0.1–0.6) for the tripod pinch. [Conclusion] The current secondary analysis found that Kaltenborn mobilization for the symptomatic hand reduces pressure pain sensitivity (PPT increases) and also produces motor changes in the contralateral non-treated hand compared with a placebo group.
Fundamento. Evaluar el efecto de un ciclo de mejora en la atención a pacientes con cefalea en dos centros de Fisioterapia sobre la calidad asistencial y su asociación con la satisfacción percibida y su mejora clínica.Métodos. Para medir la calidad asistencial se observó el cumplimiento de quince criterios de calidad en las historias clínicas de todos los pacientes con diagnós-tico de cefalea tensional, cervicogénica o migraña en dos centros de Fisioterapia entre 2010 y 2014. En 2015, tras introducir en uno de los centros (C1) medidas correctivas, se reevaluó la calidad asistencial en ambos centros, usando el otro como control (C2).resultados. En la primera evaluación, en ambos centros se observó un número muy elevado de incumplimientos en todos los criterios. Tras el ciclo de mejora, en el C1 hubo un aumento significativo en el cumplimiento de los criterios de calidad, como la entrega de un calendario de cefalea, que pasó del 0% a un 100% de cumplimiento, o el uso de la escala HIT-6, que pasó del 30 a un 100%, Asimismo, hubo una mejor valoración en la calidad percibida por el paciente en el C1 respecto al C2, incluyendo una mejora en el estado de salud.conclusiones. El uso de la metodología de mejora de la calidad, con iniciativa interna, obtuvo mejoras significativas tanto en la calidad de la atención prestada como en la percepción que tienen los usuarios de los servicios de fisioterapia, así como en la salud de los pacientes.Palabras clave. Calidad asistencial. Cefalea tensional. Migraña. Cefalea cervicogénica. Fisioterapia. aBstractBackground. To evaluate the effects on healthcare quality following implementation of a program to improve care for individuals with headache in two physical therapy clinics and its association with outcomes and self-perceived improvement. Methods.We assessed healthcare quality by creating a questionnaire on fulfilment of fifteen quality criteria included in the clinical history of individuals suffering from tension-type, cervicogenic or migraine headaches seeking physical therapy between 2010 and 2014. In 2015, after applying a program to improve care in one center (C1), we reassessed the same fulfilment questionnaire in both centers, using the other center (C2) as control.results. In the first evaluation there was a huge number of cases of non-compliance of all the criteria in both centers. After implementation of the care improvement program in C1 a significant improvement was observed in some items, as use of a headache diary, which rose from 0 to 100%, or use of the HIT-6 disability questionnaire, which rose from 30 to 100%. In addition, there was a significant improvement in self-perceived health status after implementation of the care program in C1.conclusions. The implementation of a care improvement program was effective in improving healthcare quality for individuals with headache attending physical therapy services.
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