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Effects of an exercise and relaxation aquatic program in patients with spondyloarthritis: A randomized trial
Efectos de un programa de ejercicio físico y relajación en el medio acuático en pacientes con espondiloartritis: ensayo clínico aleatorizado
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"documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2015;145:385-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "PAPRICA-2 study: Role of precipitating factor of an acute heart failure episode on intermediate term prognosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "385" "paginaFinal" => "389" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio PAPRICA-2: papel del factor precipitante del episodio de insuficiencia cardiaca aguda en el pronóstico a medio plazo" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2297 "Ancho" => 3557 "Tamanyo" => 590757 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Left: cumulative survival curves within 90 days for revisits to the emergency department (above) and mortality (below) depending on the presence of precipitating factors of acute episode of heart failure. Right: crude and adjusted hazard ratios for survival curves of revisits to the emergency room (above) and mortality (below) within 90 days for those precipitating factors of acute episode of heart failure statistically significant in the univariate analysis. Model A: epidemiological factors are included in adjustment (age and sex). Model B: epidemiological (age and sex) and baseline patient condition (NYHA functional class and Barthel index) factors are included in the adjustment. Model C: epidemiological (age and sex), baseline patient condition (functional NYHA class and Barthel index) and the current episode of acute heart failure (systolic blood pressure, blood saturation basal oxygen, creatinine and sodium) factors are included in the adjustment. Model D: epidemiological (age and sex), baseline patient condition (functional NYHA class and Barthel index), the current episode of acute heart failure (systolic blood pressure, baseline arterial oxygen saturation, creatinine and sodium) and final destination of the patient (hospital admission or discharge directly from the emergency department) factors are included in the adjustment.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Òscar Miró, Alfons Aguirre, Pablo Herrero, Javier Jacob, Francisco Javier Martín-Sánchez, Pere Llorens" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Òscar" "apellidos" => "Miró" ] 1 => array:2 [ "nombre" => "Alfons" "apellidos" => "Aguirre" ] 2 => array:2 [ "nombre" => "Pablo" "apellidos" => "Herrero" ] 3 => array:2 [ "nombre" => "Javier" "apellidos" => "Jacob" ] 4 => array:2 [ "nombre" => "Francisco Javier" "apellidos" => "Martín-Sánchez" ] 5 => array:2 [ "nombre" => "Pere" "apellidos" => "Llorens" ] 6 => array:1 [ "colaborador" => "on behalf of the ICA-SEMES group" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775315000731" "doi" => "10.1016/j.medcli.2015.01.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775315000731?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616001789?idApp=UINPBA00004N" "url" => "/23870206/0000014500000009/v2_201605020201/S2387020616001789/v2_201605020201/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020616001765" "issn" => "23870206" "doi" => "10.1016/j.medcle.2014.07.010" "estado" => "S300" "fechaPublicacion" => "2015-11-06" "aid" => "3118" "copyright" => "Elsevier España, S.L.U." 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NSAIDs: nonsteroidal antiinflammatory drugs; ESSG: <span class="elsevierStyleItalic">European Spondylarthropathy Study Group</span>.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Spondyloarthropathies or spondyloarthritis (SpA) are a set of chronic rheumatic diseases that share many clinical, genetic, pathogenic, radiological and epidemiological features.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">1,2</span></a> With regard to its prevalence, if we consider the National Validation Study in Spondylarthropathies, this disease affects 1.9% of the general population and accounts for about 13% of patients attending rheumatology services in Spain.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Although the cause of SpA cannot be fully determined, it is true that they share a strong bond with one allele of the major histocompatibility complex, the HLA-B27.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">4</span></a> The clinical presentation of SpA is characterized by involvement of the axial and peripheral articular skeleton, enthesopathies and extra-articular manifestations.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> Indeed, chronic diseases, as in this case, represent a clear risk factor for the quality of life related to health.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Currently, diagnostic criteria are available for some of the diseases that are part of the SpA diseases; in the case of ankylosing spondylitis (AS) modified New York criteria are being primarily used.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">7</span></a> Sometimes ultrasound and MRI can also be used in the diagnosis and evolution of SpA. The latter is very sensitive to assess the initial stages of the disease and is very efficient in displaying inflammation in soft tissues.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">8,9</span></a> Regarding medical treatment, NSAIDs have been used to alleviate the symptoms as well as drugs inhibiting tumor necrosis factor, showing long term (6 months) effectiveness in improving functionality and pain.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">10</span></a> A number of other non-medical treatments<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">11</span></a> have been proven to have a positive effect on patients with SpA, such as hydrotherapy or physical exercise.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">12,13</span></a> Given the small number of scientific studies on the significant effects of exercise in a swimming-pool, this research has been aimed at determining the potential effects of an aquatic training program on functional capacity, degree of disease severity and quality of life of patients with SpA.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methodology</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0020" class="elsevierStylePara elsevierViewall">The sample consisted of 30 participants with a diagnosis of axial SpA (16 men and 14 women). The inclusion criteria were as follows: (I) to be diagnosed with SpA by a rheumatologist according to the criteria of the European Spondylarthropathy Study Group<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">14</span></a>; (II) to not present any severe cardiovascular disease; (III) to take only NSAIDs a month before and during the study period. The only exclusion criterion was to present some form of cardiovascular disease. Participants were members of the association of arthritis and spondylitis in Almería, referred voluntarily to therapy to the sports facilities of the University of Almería. In the initial interview, the sample gave informed consent to participate in the study and data of individuals such as age, sex, weight, height and the average time since diagnosis were collected. For a population of 90 participants (taking a sample error of 0.15), the final number of subjects was 30 (equivalent to a third of the total population). The study was conducted in accordance with the Declaration of Helsinki.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The experimental group visited 24 times the sports facilities of the University of Almería to carry out the aquatic exercise program. All sessions took place in a heated pool at 27–30<span class="elsevierStyleHsp" style=""></span>°C, en 3 sessions of 50<span class="elsevierStyleHsp" style=""></span>min a week for 8 weeks. The control group did not perform any physical or psychological therapy and continued with normal activities of daily living.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study variables</span><p id="par0030" class="elsevierStylePara elsevierViewall">The Bath Ankylosing Spondylitis Functional Index (BASFI)<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">15</span></a> was used to measure the functional capacity of the participants. BASFI includes 10 items regarding the capacity of SpA patients to perform activities of daily living. The degree of severity of the disease was measured by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI).<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a> The BASDAI collects 5 items regarding the status of SpA patients during the last week (fatigue, level of back and joint pain, swelling and morning stiffness). SF-12 Health Survey was used to assess the quality of life of patients.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">17</span></a> A Sigma PC3<span class="elsevierStyleSup">®</span> heart rate monitor (Sigma-Elektro GmbH, Neustadt, Germany) was also used to measure the beats per minute of the participants.</p><p id="par0035" class="elsevierStylePara elsevierViewall">All data were collected in both groups at the beginning of the study, immediately before the first intervention and 8 weeks after finishing the 24-session exercise program, right after the last intervention. The surveys were conducted with the help of an assistant, who did not know the group of each participant. After baseline assessment, individuals were randomized using random numbers to receive an aquatic exercise program (experimental group) or no intervention (control group).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Description of the intervention</span><p id="par0040" class="elsevierStylePara elsevierViewall">Within the field of body regulation therapy, exercise and health programs are particularly important. This time the program used consisted, in this order, of: relaxation technique based on the ability to be aware of when a muscle is tense and when relaxed<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">18</span></a> (10<span class="elsevierStyleHsp" style=""></span>min); breathing technique, where participants are asked to be aware of the sensations experienced when air enters and leaves their nose<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">19</span></a> (10<span class="elsevierStyleHsp" style=""></span>min); active joint exercises,<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">20</span></a> where patients are specifically asked to exercise joints at full articular range in all directions (5<span class="elsevierStyleHsp" style=""></span>s duration for each of the movements), starting with the neck and then followed by upper parts (shoulder, elbow and wrist) and then lower parts (hips, knees and ankles), and after each movement patients always came back to the starting or resting position (5<span class="elsevierStyleHsp" style=""></span>min); strength-resistence exercise with the muscles of the hip, training 3 times a week, during the 8 weeks of intervention, where loads were increased from 50 to 70% of maximum strength (15<span class="elsevierStyleHsp" style=""></span>min); and ending with aerobic exercise<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">21</span></a> by ipsilateral hip and shoulder flexion, maintaining in both cases the elbow and knee bent (first with one part of the body and then the other, with 60–65% of maximum heart rate controlled by a heart rate monitor) (20<span class="elsevierStyleHsp" style=""></span>min).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Design</span><p id="par0045" class="elsevierStylePara elsevierViewall">Pilot clinical trial following the CONSORT standards, with a control group (received no treatment) and an experimental group (the subjects in this group received 24 sessions in 2 months of an aquatic physical exercise program). The trial was not controlled mainly due to the low number of visits of the groups; therefore, it has been discussed that it might have been necessary to perform a larger number of measurements over time.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">For data analysis, 18.0 version of the SPSS statistical package was used, demographic data were treated by descriptive analysis, comparing scores between groups. Nonparametric Mann–Whitney <span class="elsevierStyleItalic">U</span> test was used to examine the effects of treatment, both within each study group (experimental or control) and between groups, taking into account the variable and time (baseline status and immediately after treatment). The level of statistical significance was set at 0.05.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">Initially, 90 people with SpA were recruited and 30 of them signed the informed consent after meeting the inclusion criteria (53.33% male). They agreed to participate and were randomly assigned to the control group (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15) or to the experimental group with an exercise program (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span> 15). <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows a flowchart of participant recruitment. The groups did not differ significantly in baseline demographic characteristics or the results of the initial tests (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Before the program no significant differences were observed statistically intragroup or between groups. The results of the Mann–Whitney <span class="elsevierStyleItalic">U</span> test were significant for the quality of life (physical function [<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.05]), BASFI (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.015), BASDAI (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.048; fatigue [<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.032], neck, back and hip pain [<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.045], pain or inflammation in other joints [<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.032] and morning stiffness upon waking [<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.019]). Compared to baseline values, the group receiving supervised aquatic exercise program showed post-intervention improvement in quality of life (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.011; physical function [<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.016]), BASFI (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.017) and BASDAI (pain in neck, back and hips [<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.05], pain or inflammation in other joints [<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.031] and morning stiffness upon waking [<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.018]), while the group that received no intervention showed no significant differences in any variable (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">The main results of the study show that the program used was effective in improving functional capacity, severity and quality of life. Regarding functional capacity, we understand that the procedure fitted the expected results, since it could improve activities of daily living, i.e., it included joint mobility exercises, connective tissue stretching, aerobic exercise and strength-resistance exercises. All of these techniques have been sufficient to achieve our purpose, because we must not forget their overall effects at intra-articular level, anti-inflammatory effect, temperature rise and improved cellular oxygenation, analgesic effect, venous return improvement and muscle flexibility, etc.<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">22,23</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Regarding the severity of the disease we found statistically significant differences. The procedure developed was intended to reduce the symptoms shown in this survey. In order to ensure the expected results, proper techniques to promote lower fatigue, stiffness, inflammation and back and joint pain were included.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">24</span></a> We understand then that the results of this variable in the experimental group were due to the intervention. Authors like Verhagen et al. have also demonstrated the effectiveness of aquatic exercise programs.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">11</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Finally it should be noted that statistically significant differences were hardly obtained related to the quality of life variable. These results might be due to the fact that the SF-12 Health survey is not specific to measure the quality of life in SpA patients,<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">25,26</span></a> even though some authors have used it in patients with this disease.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">12</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">On the other hand, if we consider the initial number of patients (i.e., 90), of whom 90% were diagnosed with AS, we can see that the ratio is consistent with the cited by Saraux et al., who found a higher prevalence of AS patients in males. However, other authors have found similar figures in both sexes.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a> Regarding age, in no case a figure lower than that suggested by Trontzas et al. was recorded, who set the beginning of AS at 26<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6 years.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">28</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">We should consider the various limitations of the study. First, it would have been convenient to have a larger sample, as only 30 of the initial 90 people participated in the end. Nevertheless we can confirm that the number of participants was sufficient to allow parametric tests. Second, it would be interesting, in future research, to use a placebo group. However, taking into account the characteristics of the procedure, in this case it would be difficult. The sample could also be extended to people with other chronic diseases, such as fibromyalgia, osteoarthritis, or sclerosis, in order to verify the effect of this exercise program in patients with these characteristics. Certainly a different procedure of aquatic exercise might be considered to see if better results would be obtained compared to the present study. Finally, we should not forget that more measurements over time are required to obtain more control over the results</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflict of interests</span><p id="par0090" class="elsevierStylePara elsevierViewall">The authors report no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres633039" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec645687" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres633040" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Fundamento y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec645686" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methodology" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Study variables" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Description of the intervention" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Design" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-04-24" "fechaAceptado" => "2014-10-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec645687" "palabras" => array:6 [ 0 => "Spondyloarthropathies" 1 => "Physical exercise" 2 => "Hydrotherapy" 3 => "Therapy organic regulation" 4 => "Chronic disease" 5 => "Randomized controlled trial" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec645686" "palabras" => array:6 [ 0 => "Espondiloartropatías" 1 => "Ejercicio físico" 2 => "Hidroterapia" 3 => "Terapia de regulación orgánica" 4 => "Enfermedad crónica" 5 => "Ensayo clínico controlado aleatorizado" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Spondyloarthritis is a general term referring to a group of chronic rheumatic illnesses that share clinical, genetic, radiological and epidemiological features. The clinical presentation of spondyloarthritis is characterized by the compromise of both the axial and peripheral articular skeleton. We aimed to evaluate the efficacy of an aquatic exercise plus relaxation program in patients with spondyloarthritis.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a randomized single blind study including 30 patients with spondylitis who were randomly assigned to an experimental or control group. For 2 months, the experimental group underwent an aquatic fitness plus relaxation program (3 sessions per week). Evaluations were also performed in the control group the same days as the experimental group but they did not participate in any supervised exercise program. The following data were obtained at baseline and immediately after application of the last session: Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Disease Activity Index, Health Questionnaire SF-12 and Sigma PC3<span class="elsevierStyleSup">®</span> (Sigma-Elektro GmbH, Neustadt, Germany) Heart Rate Monitor.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The Mann–Whitney test showed statistically significant differences in the quality of life (physical function [<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.05]), Bath Ankylosing Spondylitis Functional Index (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.015), Bath Ankylosing Spondylitis Disease Activity Index (fatigue [<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.032], neck pain, back and hips [<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.045], pain or swelling in other joints [<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.032] and in waking morning stiffness [<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.019]).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The results of the present study suggest that therapy with physical exercise plus relaxation provides benefits to spondyloarthritis patients and these are advised as a part of their usual treatment.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Fundamento y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La espondiloartritis hace referencia a un conjunto de enfermedades reumáticas crónicas que comparten diversas características clínicas, genéticas, radiológicas y epidemiológicas. La presentación clínica de las espondiloartritis se caracteriza por compromiso del esqueleto axial y articular periférico. El objetivo de este estudio fue evaluar la eficacia de un programa de entrenamiento físico más relajación en el medio acuático en personas con espondiloartritis.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio clínico aleatorizado de simple ciego en el que 30 personas con espondiloartritis fueron asignadas al azar a un grupo experimental o control. Durante 2 meses al grupo experimental se le aplicó un programa de entrenamiento físico en el medio acuático más relajación (3 sesiones por semana), y al grupo control se le realizaron las evaluaciones los mismos días que al experimental sin que participaran en ningún programa de ejercicio físico supervisado. Los datos obtenidos al inicio del estudio e inmediatamente después de la aplicación de la última sesión fueron: <span class="elsevierStyleItalic">Bath Ankylosing Spondylitis Functional Index</span> («Índice de funcionalidad para las espondiloartritis»), <span class="elsevierStyleItalic">Bath Ankylosing Spondylitis Disease Activity Index</span> («Índice de actividad de la enfermedad del grupo de Bath»), Cuestionario de Salud SF-12 y pulsómetro Sigma PC3<span class="elsevierStyleSup">®</span> (Sigma-Elektro GmbH, Neustadt, Aemania).</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La prueba U de Mann-Whitney mostró diferencias estadísticamente significativas para la calidad de vida (función física [p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,05]), <span class="elsevierStyleItalic">Bath Ankylosing Spondylitis Functional Index</span> (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,015), <span class="elsevierStyleItalic">Bath Ankylosing Spondylitis Disease Activity Index</span> (fatiga [p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,032], dolor de cuello, espalda y caderas [p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,045], dolor o inflamación en otras articulaciones [p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,032] y rigidez matutina la despertar [p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,019]).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los resultados del presente estudio muestran que los tratamientos de ejercicio físico unidos a la relajación aportan beneficios a los pacientes con espondiloartritis y son recomendables como parte del tratamiento de la enfermedad.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Fundamento y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fernández García R, Sánchez Sánchez LC, López Rodríguez MM, Sánchez Granados G. Efectos de un programa de ejercicio físico y relajación en el medio acuático en pacientes con espondiloartritis: ensayo clínico aleatorizado. Med Clin (Barc). 2015;145:380–384.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2145 "Ancho" => 2480 "Tamanyo" => 275159 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Design and flow of patients in the clinical trial. NSAIDs: nonsteroidal antiinflammatory drugs; ESSG: <span class="elsevierStyleItalic">European Spondylarthropathy Study Group</span>.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Values expressed as mean (SD).</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameters \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Experimental group (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Control group (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43.8 (9.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 (13) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean time since diagnosis (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.7 (3.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.8 (4.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight (kg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.8 (15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.1 (9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Height (cm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">168.7 (9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">164 (7.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1038322.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Demographic details of patients before the study.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">BASDAI: Bath Ankylosing Spondylitis Disease Activity Index; BASFI: Bath Ankylosing Spondylitis Functional Index.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables/group \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Baseline \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Post-treatment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Quality of life (max 56)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.27 (5.81) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.73 (4.14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.108 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Experimental \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34.80 (3.25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.60 (2.27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.011 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Physical function</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.91 (1.70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.18 (1.47) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.518 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Experimental \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.80 (1.75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.57 (1.28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.016 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">BASDAI</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.45 (1.98) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.03 (1.29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.593 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Experimental \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.88 (2.36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.81 (1.15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.008 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Fatigue</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.91 (2.58) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.45 (1.86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.394 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Experimental \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.20 (3.29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.20 (1.87) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.414 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Pain in neck, back and hips</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.09 (2.25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.01 (1.78) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.864 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Experimental \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.40 (2.87) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.10 (1.66) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.050 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Pain or inflammation in other joints</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.45 (2.20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.91 (1.18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.406 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Experimental \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.80 (3.55) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.80 (2.20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.031 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Morning stiffness</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.27 (2.01) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.01 (1.54) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.719 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Experimental \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.40 (2.36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.10 (1.72) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.018 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="char" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">BASFI</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.33 (1.69) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.77 (1.96) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.154 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Experimental \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.68 (2.04) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.81 (1.84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.017 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1038321.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Mean and standard deviation values for baseline and post-treatment status, and the average (95% confidence interval) for changes in intra and inter-group score.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib0145" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estrategias diagnósticas en las espondiloartropatías" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E. 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