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Integrating Telerehabilitation into the Prehabilitation and Rehabilitation Pathway in Colorectal Cancer: A Case Series
Get PDFBackground and Clinical Significance: Colorectal cancer (CRC) remains a global health challenge with significant postoperative complications and functional declines. Telerehabilitation offers an accessible alternative to improve preoperative physical condition and postoperative recovery. Case Presentation: Five CRC patients scheduled for laparoscopic surgery participated in an asynchronous telerehabilitation multimodal program, including two weeks of prehabilitation and four weeks of postoperative rehabilitation. Delivered via a digital platform with remote physiotherapist support, the intervention improved functional capacity and muscle strength preoperatively, with partial recovery noted post-surgery. Conclusions: Integrating telerehabilitation into the CRC surgical pathway is feasible and may enhance functional outcomes and quality of life. Further studies are required to confirm these preliminary findings
Implementation of self management strategies in patients with musculoskeletal pain: Book of good practices for healthcare professionals:
No full textEl dolor musculoesquelético (MSK) representa una de las afecciones de salud más prevalentes e incapacitantes en todo el mundo. A menudo persiste más allá de la resolución de cualquier lesión tisular, convirtiéndose en una experiencia compleja y multifacética moldeada por factores biológicos, psicológicos y sociales. Para los profesionales sanitarios que trabajan con estos pacientes, la experiencia clínica por sí sola no es suficiente: el verdadero reto radica en ayudar a las personas a comprender su dolor, darle sentido y asumir un papel activo y seguro en su gestión. Este libro pretende servir de guía de referencia rápida para los profesionales sanitarios y los especialistas musculoesqueléticos que buscan herramientas prácticas y una base teórica sintética sobre temas clave relacionados con la aplicación de estrategias de autocontrol en el tratamiento del dolor musculoesquelético. El lenguaje utilizado en todo el libro es deliberadamente claro, respetuoso y centrado en la persona. Los pacientes son considerados socios activos, no receptores pasivos. El papel del médico es guiar, apoyar y orientar, ayudando a las personas a desarrollar habilidades, confianza y resiliencia en el manejo de su afección.
En concreto, la guía proporciona marcos concisos y clínicamente relevantes sobre:
Los principios generales del autocontrol del dolor musculoesquelético, haciendo hincapié en cómo capacitar a los pacientes para que adopten y mantengan comportamientos que mejoren su función y calidad de vida.
Cómo evaluar y mejorar la motivación del paciente para el autocontrol y el cambio de comportamiento, utilizando modelos de la psicología de la salud y la ciencia del dolor.
Cómo identificar y abordar la baja salud musculoesquelética y el desconocimiento del dolor, asegurándose de que la información no solo se proporcione, sino que se comprenda, se valore y se aplique en la vida diaria del paciente.
Para complementar estas secciones conceptuales, el libro también incluye 26 viñetas clínicas que ilustran los retos comunes que se encuentran en la práctica musculoesquelética. Estos casos breves y realistas muestran cómo manejar barreras como el miedo al movimiento, los comportamientos de evitación, las expectativas poco realistas, los malentendidos sobre los resultados de las pruebas de imagen, las dificultades para participar en el trabajo o las dificultades para establecer objetivos y cumplirlos. Cada viñeta integra técnicas de comunicación (por ejemplo, entrevistas motivacionales, retroalimentación, diálogo basado en la empatía) y razonamiento clínico para demostrar cómo la teoría se traduce en la práctica.Musculoskeletal (MSK) pain represents one of the most prevalent and disabling health conditions worldwide. It often persists beyond the resolution of any tissue injury, becoming a complex and multifaceted experience shaped by biological, psychological, and social factors. For healthcare professionals working with these patients, clinical expertise alone is not enough — the real challenge lies in helping people understand their pain, make sense of it, and take an active, confident role in managing it. This book aims to serve as a quick reference guide for healthcare professionals and musculoskeletal specialists seeking practical tools and synthetic theoretical grounding on key topics related to the implementation of self-management strategies in musculoskeletal pain care. The language throughout this book is deliberately clear, respectful, and person-centred. Patients are viewed as active partners, not passive recipients. The clinician’s role is to guide, support, and coach—helping people build skills, confidence, and resilience in managing their condition.
Specifically, the guide provides concise, clinically relevant frameworks on:
The general principles of self-management in musculoskeletal pain, emphasizing how to enable patients to adopt and sustain behaviours that improve function and quality of life.
How to assess and enhance patient motivation for self-management and behaviour change, using models from health psychology and pain science.
How to identify and address low musculoskeletal health and pain literacy, ensuring that information is not only provided but actually understood, appraised, and applied in the patient’s daily life.
To complement these conceptual sections, the book also includes 26 clinical vignettes that illustrate common challenges encountered in musculoskeletal practice. These short, realistic cases show how to handle barriers such as fear of movement, avoidance behaviours, unrealistic expectations, misunderstandings about imaging results, difficulties in work participation, or struggles with goal setting and adherence. Each vignette integrates communication techniques (e.g., motivational interviewing, teach-back, empathy-based dialogue) and clinical reasoning to demonstrate how theory translates into practice.Funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Education and Culture Executive Agency (EACEA). Neither the European Union nor EACEA can be held responsible for them. ERASMUS-EDU-2022-PI-ALL-INNO: Project n.10111170
Natural Compounds as Alternative Strategy Against Antimicrobial Resistance. Analysis of their Efficacy, Synergy, and Environmental Safety as Antibiotic Adjuvants.
No full textThe widespread use of conventional antibiotics has led to escalating antimicrobial resistance and growing concerns regarding their presence in the environment and their ecotoxicological impact on non-target ecosystems. This doctoral thesis addresses these challenges by proposing and evaluating natural antimicrobial alternatives within a "One Health" framework, which integrates human health, animal health, and environmental sustainability.
We first established an environmental baseline, confirming that eight common antibiotics produce significant ecotoxic effects on aquatic and soil bioindicators, validating the need for safer alternatives. The investigation then transitioned to natural products, first evaluating Satureja montana hydrolate, a distillation by-product. While it demonstrated antimicrobial activity and circular economy potential, its moderate potency, difficulty of standardization and impact on non-target microbial communities highlighted the need for more defined and potent compounds.
This led to a focus on the hydrolate's primary bioactive constituents, thymol (THY) and carvacrol (CARV). Although both display intrinsic antimicrobial activity, their minimum inhibitory concentration (MICs) are relatively high, for example 250 μg.mL⁻¹ against Staphylococcus aureus and 125–250 μg.mL⁻¹ against Acinetobacter baumannii, making them unsuitable as monotherapies; accordingly, we evaluated them as adjuvants to commercial antibiotics. Checkerboard assays revealed potent synergistic interactions between these monoterpenoids and conventional antibiotics (e.g., gentamicin, chloramphenicol), reducing antibiotic MICs by up to 16-fold against pathogens like S.
aureus and A. baumannii. Mechanistic studies elucidated that bioactivity and synergy arise from multi-target actions, including bacterial membrane disruption, efflux pump inhibition, modulation of antibiotic-induced oxidative stress and perturbation of ATP metabolism. Crucially, these combinations significantly suppressed the emergence of antibiotic resistance, with THY–aminoglycoside pairs reducing resistance emergence by up to 32-fold in A. baumannii and 16-fold in S. aureus, while THY or CARV alone did not select for resistance.
Having demonstrated that natural product - antibiotic combinations are efficacious, we next assessed the environmental safety of THY, CARV, and their synergistic antimicrobial combinations (SACs), using standard bioindicators and river/soil microbial communities.
Both monoterpenes were acutely toxic to individual non-target indicators at low concentrations, yet river and soil communities showed minimal growth inhibition up to 100 mg L⁻¹. Synergistic antimicrobial combinations were then tested at their synergistic doses (THY or CARV paired with chloramphenicol, gentamicin, or streptomycin). They were generally less toxic than the antibiotics alone when compared at efficacious concentrations. This indicates a reduced environmental impact for the same antimicrobial effect.
In summary, this thesis proposes a compelling strategy to address antimicrobial resistance: the use of well-characterized natural compounds such as THY and CARV as antibiotic adjuvants. This approach enhances therapeutic efficacy, limits the emergence of resistance, and reduces the ecological footprint of antimicrobial treatments. As a preliminary study, it offers a promising, sustainable, and clinically translatable alternative to be further explored within the framework of a unified One Health paradigm
XII Buenas Prácticas de Innovación Docente en el Espacio Europeo de Educación Superior
No full textLa llamada a promover la innovación educativa y la calidad en el proceso de enseñanza-aprendizaje adquiere una relevancia especial en la implantación del Espacio Europeo de Educación Superior. El reto reside, sin lugar a dudas, en clarificar qué significa innovar y dónde es necesario hacerlo. Promover la aplicación de herramientas, metodologías y experiencias que favorezcan aprendizajes más activos y significativos requiere igualmente una reflexión profunda de los docentes sobre los objetivos que se persiguen, así como sobre los métodos que utilizan para favorecer que dichas finalidades se consigan.
The call to promote educational innovation and to increase the quality in the teaching-learning process takes special relevance in the European Higher Education Area. The challenge lies in clarifying what innovation means and how to implement it. The application of new tools, methodologies, and practices to sustain more active and meaningful learning also requires a deep reflection on the goals pursued, as well as on the methods teachers use to help achieve these goals
Multimodal Telerehabilitation in Post COVID-19 Condition Recovery: A Series of 12 Cases
Get PDFBackground: Post COVID-19 Condition is a recently recognized syndrome characterized by the persistence of various symptoms, including dyspnea, physical and mental fatigue, and post-exertional malaise. Currently, there is no established treatment or clear consensus on the effectiveness of rehabilitation, and given that patients could benefit from home-based rehabilitation, telerehabilitation, defined as remote rehabilitation using telematic systems, may be an option to reach more of the population with persistent COVID-19 symptoms. Therefore, it is necessary to show the efficacy of this telematic approach and the benefits of a multimodal rehabilitation strategy in these patients. Methods: Patients underwent home rehabilitation using a 12-week synchronous telerehabilitation system. The intervention included therapeutic education and physical and respiratory rehabilitation. The following variables were analyzed: Fatigue, quality of life, dyspnea, respiratory strength, aerobic capacity, and upper and lower limb strength. Conclusions: After 12 weeks, significant improvements were found in fatigue, aerobic capacity, and limb and respiratory strength. However, no improvement was found in dyspnea scores, which did not correlate with respiratory strength. Interestingly, a post-intervention correlation emerged between the distance covered in aerobic capacity and perceived fatigue, suggesting that asynchronous telerehabilitation could be a viable treatment strategy for these patients
Real-Time Performance Prediction in Long-Distance Trail Running: A Practical Model Based on Terrain Difficulty and Pacing Variability
Get PDFTrail running is a demanding endurance sport where performance prediction modelscoften rely on laboratory testing or pre-race data, limiting their practical application. This study presents a real-time predictive model for marathon and ultra-trail races, based on variables recorded during the race, including uphill/downhill pace-times, terrain difficulty coefficients, and partial rankings. A total of 947 runners from the ‘Trail Valle de Tena’ event (Spain) were analyzed to develop equations that estimate total race time using only the first third of the race. The model incorporates weighted time (WTn), pacing variability (WTVn,n+2), and checkpoint percentile rank (CPRn), showing strong predictive power
(adjusted R2 > 0.95) across sexes and race modalities. These variables reflect the runner’s ability to both overcome elevation and maintain consistent pacing, offering insights into fatigue management and performance optimization. The model enables coaches and athletes to monitor race progression, adjust strategies in real time, and potentially reduce injury risk through better control of effort intensity. Unlike laboratory-based models, this approach is fully applicable in field conditions and does not require prior testing. Further validation in similar endurance events is recommended to confirm its utility as a practical tool for training and competition planning
Benefits of musculoskeletal health promotion in school communities through service-learning: a mixed-method approach
Get PDFBackground: Service-learning (S-L) is an educational method that enhances social and civic engagement among health science students, addressing unmet community needs. Musculoskeletal disorders (MSKD) represent a public health issue with increasing prevalence among school-aged population as reported by at least 1 on 5 children. Prevention programs for MSKD in schools are scarce, although evidence supports the efficacy of health education provided by physical therapists. This study aimed to evaluate the impact of a musculoskeletal health promotion program through S-L on school students, teachers, and physical therapy students.
Methods: A mixed-methods approach was used. A quasi-experimental design assessed the learning and satisfaction of school students and teachers using pre-and post-intervention questionnaires. Additionally, qualitative data from reflective diaries of fourth-year physical therapy students were analyzed to capture their experiences. The intervention was conducted in 10 schools in Spain over two academic years, targeting children aged 10–14 and their teachers.
Results: A total of 1,051 school students and 32 teachers participated. Pre-post evaluations revealed significant learnings on MSKD prevention and body awareness in both groups (p < 0.05), highlighting the increase in knowledge about MSKD prevention and self-treatment for school students and on MSKD derived from inadequate postures for schoolteachers. Satisfaction was high, with students and teachers rating the program 4.4/5. Teachers highlighted the value of training for their professional practice, while students appreciated learning about self-care. Physical therapy students were 4 and reflected on their motivation for the project, learning experiences, as well as positive and negative aspects of the service.
Discussion: The S-L community-based intervention effectively increased awareness of musculoskeletal health and self-management skills. The peer learning environment and participatory approach encouraged engagement and knowledge retention in both students and teachers.
Conclusion: S-L is a valuable strategy for promoting musculoskeletal health in schools while improving health education skills among the future physical therapists through experiential learning
Introducing Phylogenetics in Search-based SoftwareEngineering: Phylogenetics-aware SBSE
Get PDFPhylogenetics studies the relationships, in terms of biological history and kinship, of a set of taxa (e.g., species). We argue that in Search-based Software Engineering (SBSE), the individuals of an evolutionary computation-driven population could be considered as taxa for which the leverage of Phylogenetic Inference might be beneficial. In this work, we present our Phylogenetics-aware SBSE approach. Our approach introduces a novel Phylogenetic Operation to promote results which are sufficiently aligned (in terms of lineage) with a certain reference given by the domain expert. Our approach is evaluated in two heterogeneous industrial case studies: Procedural Content Generation from Game Software Engineering, and Feature Location from Software Maintenance. The results are analyzed using quality-of-the-solution and acceptance-by-developers measurements. We performed a statistical analysis to determine whether the impact on the results is significant compared to baselines that do not leverage Phylogenetics. The results show that our approach significantly outperforms two baselines in both case studies. Furthermore, two focus groups confirmed the acceptance of our approach and stressed that solution acceptance may make the difference in industrial environments. Our work has the potential to motivate a new breed of research work on Phylogenetics awareness to produce better results in Software Engineering
Physical Training Considerations for Futsal Players According to Strength and Conditioning Coaches: A Qualitative Study
Get PDFThe professionalization of futsal requires greater physical demands on players, requiring strength and conditioning coaches to manage loads, optimize performance, and prevent injuries. This study aimed to describe the current practices of high-level strength and conditioning coaches and determine the elements needed to optimize their performance. Two video-recorded focus groups consisting of eight strength and conditioning coaches from the Spanish futsal league’s first and second divisions were transcribed, translated, and analyzed using a content analysis approach with open-ended questions on physical preparation and current practices. Results showed that strength and conditioning coaches prioritized five main areas: (1) competitive demands, (2) training load control and monitoring, (3) injury risk mitigation strategies, (4) contextual factors and interpersonal relationships, and (5) training methodologies to optimize performance. However, they also claim to deal with several limitations such as lack of time, limited resources and access to facilities, insufficient staff, problems related to combining sport with other activities (e.g., work), or the difficulty to individualize, which limits the optimization of their practices. Based on these findings, practical applications include implementing neuromuscular and strength training sessions at least twice a week, using cost-effective load monitoring
tools (e.g., RPE and wellness questionnaires) to manage workloads, individualizing training programs to address the specific demands and characteristics of each player, and fostering close multidisciplinary collaboration to optimize performance and reduce injury risks. These insights can guide current and aspiring strength and conditioning coaches toward optimized practices. This study can assist novice strength and conditioning coaches in identifying the key focus areas of elite physical trainers and understanding their challenges and limitations, fostering collaboration among sports professionals to create a more optimized environment
Efectividad de la crioterapia combinada con la terapia descongestiva compleja en mujeres con linfedema secundario a cáncer de mama: protocolo de ensayo clínico aleatorizado
No full textIntroducción:
El linfedema secundario al cáncer de mama es una complicación crónica frecuente de los tratamientos oncológicos, en particular tras la cirugía de los ganglios linfáticos y/o la radioterapia. Se manifiesta como una acumulación de líquido intersticial en el miembro superior, lo que provoca hinchazón, dolor, deterioro funcional y una importante merma de la calidad de vida. Entre los tratamientos disponibles, la terapia descongestiva compleja cuyo pilar central es el drenaje linfático manual, en particular mediante el método Leduc es el enfoque de referencia. La crioterapia, como modalidad complementaria con efectos antiinflamatorios y vasoconstrictores, podría reforzar y optimizar los beneficios clínicos de la terapia descongestiva compleja por si sola.
Objetivo:
Evaluar si la utilización de la terapia descongestiva compleja combinada con la crioterapia induce cambios positivos en el volumen del linfedema en mujeres que sufren linfedema secundario al cáncer de mama.
Metodología:
Se realizará un ensayo clínico controlado aleatorizado en mujeres adultas con linfedema unilateral de la extremidad superior secundario a cáncer de mama. El estudio tendrá lugar en el Instituto Bergonié de Bordeaux. Las participantes se dividirán aleatoriamente en dos grupo: un grupo control que recibirá únicamente terapia descongestiva compleja mediante y un grupo experimental que recibirá la terapia descongestiva compleja combinada con crioterapia local aplicada en la extremidad afectada. La intervención durara cuatro semanas, con cuatro sesiones semanales. Se recogerán variables de evaluación antes y después del protocolo: se medirá el volumen de la extremidad superior mediante perimetría circunferencial, se evaluará el dolor mediante la escala visual analógica, la calidad de vida a través del cuestionario EORTC QLQ-BR23 y la funcionalidad de la extremidad superior por medio del cuestionario DASH.
Resultados esperados:
Se espera que el grupo combinado de terapia descongestiva compleja y crioterapia muestre una reducción más significativa del volumen linfático y una mayor mejoría del dolor, la funcionalidad de la extremidad superior y la calidad de vida que el grupo control.
Conclusión:
La combinación de la crioterapia con la terapia descongestiva compleja podría representar una estrategia terapéutica complementaria prometedora en el tratamiento del linfedema secundario al cáncer de mama.
Si los resultados confirman la hipótesis, este enfoque combinado podría constituir una opción eficaz y fácilmente aplicable en la práctica clínica para mejorar el manejo de estas pacientes