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"titulo" => "Implementation of neuroreflexotherapy in the treatment of back pain. Results of a pilot trial"
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"resumen" => "<span class="elsevierStyleSectionTitle">Fundamento</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ensayos clínicos previos han demostrado la eficacia, seguridad, efectividad y eficiencia de la intervención neurorreflejoterápica (NRT) para el tratamiento de las enfermedades mecánicas del raquis subagudas y crónicas. El objetivo de este estudio es describir la sistemática con la que se implantó su uso sistemático en el Sistema Nacional de Salud, evaluar la operatividad del protocolo de derivación establecido y recabar datos necesarios para planificar la extensión del uso de esta tecnología.</p> <span class="elsevierStyleSectionTitle">Método</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se estableció un protocolo de derivación que se explicó en una sola sesión clínica en 18 centros de salud de Mallorca, en la que también se repartieron recordatorios escritos del protocolo y se facilitó un número de teléfono de consulta. Tras la sesión, los médicos de los centros fueron autorizados a derivar a sus pacientes a una unidad acreditada en la realización de NRT. Durante 4 meses se cuantificó la demanda asistencial generada, la operatividad del protocolo de derivación, la adecuación de la remisión y la satisfacción de pacientes y médicos. También se recogieron la evolución clínica de los pacientes y los efectos secundarios detectados.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">De los 208 médicos, 43 derivaron a 97 pacientes. La tasa media de derivación por 10.000 personas adscritas a cada centro de salud fue de 1,07 pacientes al mes. La tasa de remisión adecuada fue del 91,8%, sin que ningún médico tuviera que usar el teléfono de consulta. La mayoría de los casos derivados eran crónicos, de mal pronóstico, con dolor intenso y alto grado de incapacidad. No hubo ningún caso de rechazo a la NRT, reclamación ni efectos adversos relevantes. El grado de satisfacción fue alto, y el 98% de los pacientes y el 87% de los médicos recomendarían la derivación a un familiar suyo. Además, el 89% de los médicos opinaba que debería seguírseles permitiendo derivar a sus pacientes. La evolución clínica de los pacientes fue favorable y consistente con la observada en los ensayos clínicos previos.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La sistemática de implantación aplicada permite incorporar la intervención NRT a la práctica clínica sistemática del Sistema Nacional de Salud en las condiciones de aplicación en las que ha sido evaluada en estudios previos. El protocolo de derivación definido genera una alta tasa de remisión adecuada, un elevado grado de satisfacción entre pacientes y médicos, y unos resultados clínicos consistentes con la efectividad y seguridad previamente demostrada por esta tecnología.</p>"
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"titulo" => "Abstract"
"resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Previous clinical trials have demonstrated the efficacy, safety, effectiveness and efficiency of neuroreflexotherapy (NRT) in the treatment of subacute and chronic nonspecific low back pain. The goal of this study was to describe the implementation of this method into the Spanish National Health System, to assess the viability of the referral protocol, and to obtain the data required for planning the widespread use of this technology.</p> <span class="elsevierStyleSectionTitle">Method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A referral protocol was established and explained in a single clinical session in 18 health centers in Majorca (Spain). During this session, handouts of the referral protocol and a telephone number for questions were also given. After the session, the centers' physicians were authorized to refer their patients to a unit certified for NRT. Demand for this therapy, the applicability of the referral protocol, the appropriateness of referrals, and patient and physician satisfaction were quantified over a four-month period. Data were also collected on patients' clinical outcomes and on adverse effects of the treatment.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Of the 208 physicians, 43 referred 97 patients. The mean rate of referral per 10,000 persons affiliated with each health center was 1.07 patients per month. The rate of appropriate referral was 91.8%, with no physician having to call for assistance. Most of the referred patients had chronic, intense pain, with a poor prognosis and considerable disability. None of the patients refused NRT. There were no complaints, or serious adverse effects. The degree of satisfaction was high, and 98% of patients and 87% of physicians would recommend a relative referral to. In addition, 89% of physicians believed they should be allowed to continue referring their patients. The patients' clinical outcomes were favorable and consistent with those observed in previous clinical trials.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The method described allows NRT to be included in routine clinical practice within the Spanish National Health System under the conditions in which it was evaluated in previous randomized controlled trials. The referral protocol that was used generates a high rate of appropriate re-ferrals, a high degree of satisfaction among patients and physicians, and clinical results that are consistent with the effectiveness and safety previously demonstrated for this technology.</p>"
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"nota" => "<p class="elsevierStyleNotepara">Al final del artículo se relacionan los centros y los miembros del gupo PINS. (Pilotaje de la Intervención Neurorreflejoterápica en el Sistema Nacional de Salud).</p>"
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