Fibromialgia y síndrome de dolor miofascial abordadas desde la liberación miofascial y la punción seca

Contenido principal del artículo

Autores

Liseth Yurany Betancur Rojas
Lisethbetancur18@gmail.com
Maria Paula Ovalle Vivas
paw_2711@hotmail.com

Resumen

La terapia manual es un área de la fisioterapia que utiliza técnicas con finalidades terapéuticas sobre tejidos musculares, óseos, conjuntivos y nerviosos, para favorecer reacciones fisiológicas que promueven la disminución del dolor. Objetivo: Describir, mediante revisión los efectos reportados en la literatura científica, las técnicas de liberación miofascial y punción seca en pacientes con Fibromialgia y Síndrome de Dolor Miofascial. Método: Se realizó una revisión a de Ensayos Clínicos Controlados en materia de intervención con técnicas de liberación miofascial y punción seca en pacientes con diagnóstico de fibromialgia y síndrome de dolor miofascial. Se excluyeron estudios en participantes con trastornos psiquiátricos y neurológicos, o con  participación en otro tipo de tratamiento. La consulta se realizó en diferentes bases de datos: Pubmed, Elsevier, Ebscohost, Proquest, Pedro mediante términos DeCS. Resultados: El análisis de resultados se realizó a partir de la clasificación de los documentos según las técnicas de liberación miofascial (masaje, inducción miofascial, presión manual o isquémica) y la punción seca. Las medidas efecto varían de acuerdo a los diferentes protocolos de intervención, con un valor p< 0.001 y 0.005.  Discusión: Se demuestra que tanto las técnicas de liberación miofascial como la punción seca, logran disminuir el dolor, mejorar rangos de movimiento y la funcionalidad principalmente en pacientes con Fibromialgia y Síndrome de Dolor Miofascial

Palabras clave:

Detalles del artículo

Licencia

Derechos de autor 2019 Revista Colombiana de Rehabilitación

Aquellos autores/as que tengan publicaciones con esta revista, aceptan los términos siguientes:

  1. Los autores/as conservarán sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de reconocimiento de Creative Commons que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación esta revista.
  2. Los autores/as podrán adoptar otros acuerdos de licencia no exclusiva de distribución de la versión de la obra publicada (p. ej.: depositarla en un archivo telemático institucional o publicarla en un volumen monográfico) siempre que se indique la publicación inicial en esta revista.
  3. Se permite y recomienda a los autores/as difundir su obra a través de Internet (p. ej.: en archivos telemáticos institucionales o en su página web) antes y durante el proceso de envío, lo cual puede producir intercambios interesantes y aumentar las citas de la obra publicada. (Véase El efecto del acceso abierto). 

 

Los autores que publican en la revista se acogen al código de licencia de Creative Commons Atribución 4.0 Internacional (CC BY 4.0)

Logotipo de Creative Commons Colombia Botón de Creative Commons Atribución Logotipo de iThenticate Logotipo de CrossRef

Referencias

Aridici, R., Yetisgin, A., Boyaci, A., Tutoglu, A., Bozdogan, E., Sen Dokumaci, D., ... Boyaci, N. (2016). Comparison of the Efficacy of Dry Needling and High-Power Pain Threshold Ultrasound Therapy with Clinical Status and Sonoe-lastography in Myofascial Pain Syndrome: American Journal of Physical Medicine & Rehabilitation, 95(10), e149-e158. https://doi.org/10.1097/PHM.0000000000000600

Arumugam, N., & Kaur, H. (2014). Efficacy of Cognitive Behaviour Therapy in Fibromyalgia as compared with Myofascial Release Technique. International Journal of Therapies and Rehabilitation Research, 3(3), 33. Recuperado de https://www.scopemed.org/?mno=163796

Ay, S., Evcik, D., & Tur, B. S. (2010). Comparison of injection methods in myofascial pain syndrome: a randomized con trolled trial. Clinical Rheumatology, 29(1), 19-23. https://doi.org/10.1007/s10067-009-1307-8

Bakar, Y., Sertel, M., Öztürk, A., Yümin, E. T., Tatarli, N., & Ankarali, H. (2014). Short Term Effects of Classic Massage Compared to Connective Tissue Massage on Pressure Pain Threshold and Muscle Relaxation Response in Women With Chronic Neck Pain: A Preliminary Study. Journal of Manipulative and Physiological Therapeutics, 37(6), 415-421. https://doi.org/10.1016/j.jmpt.2014.05.004

Bidonde, J., Busch, A. J., Schachter, C. L., Overend, T. J., Kim, S. Y., Góes, S. M., ... Foulds, H. J. (2017). Aerobic exercise training for adults with fibromyalgia. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858. CD012700

Bidonde, J., Busch, A. J., van der Spuy, I., Tupper, S., Kim, S. Y., & Boden, C. (2017). Whole body vibration exercise training for fibromyalgia. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD011755.pub2

Boluk, H. (2016). Comparision of two different dry-needling techniques in the treatment of myofascial pain syndrome. Ağrı - The Journal of The Turkish Society of Algology. https://doi.org/10.5505/agri.2016.38991

Bron, C., de Gast, A., Dommerholt, J., Stegenga, B., Wensing, M., & Oostendorp, R. A. (2011). Treatment of myofascial trigger points in patients with chronic shoulder pain: a randomized, controlled trial. BMC Medicine, 9(1). https://doi. org/10.1186/1741-7015-9-8

Bron, C., Wensing, M., Franssen, J. L., & Oostendorp, R. A. (2007). Treatment of myofascial trigger points in commonshoulder disorders by physical therapy: A randomized controlled trial [ISRCTN75722066]. BMC Musculoskeletal Disorders, 8(1). https://doi.org/10.1186/1471-2474-8-107

Buttagat, V., Narktro, T., Onsrira, K., & Pobsamai, C. (2016). Short-term effects of traditional Thai massage on electromyogram, muscle tension and pain among patients with upper back pain associated with myofascial trigger points. Complementary Therapies in Medicine, 28, 8-12. https://doi.org/10.1016/j.ctim.2016.07.004

Cadenas-Sánchez, C., & Ruiz-Ruiz, J. (2014). Efecto de un programa de actividad física en pacientes con fibromialgia: revisión sistemática. Medicina Clínica, 143(12), 548-553. https://doi.org/10.1016/j.medcli.2013.12.010

Calvo-Lobo, C., Pacheco-da-Costa, S., & Hita-Herranz, E. (2017). Efficacy of Deep Dry Needling on Latent Myofascial Trigger Points in Older Adults With Nonspecific Shoulder Pain: A Randomized, Controlled Clinical Trial Pilot Study. Journal of Geriatric Physical Therapy, 40(2), 63-73. https://doi.org/10.1519/JPT.0000000000000048

Campa-Moran, I., Rey-Gudin, E., Fernández-Carnero, J., Paris-Alemany, A., Gil-Martinez, A., Lerma Lara, S., ... La Touche, R. (2015). Comparison of Dry Needling versus Orthopedic Manual Therapy in Patients with Myofascial Chronic Neck Pain: A Single-Blind, Randomized Pilot Study. Pain Research and Treatment, 2015, 1-15. https://doi.org/10.1155/2015/327307

Casanueva, B., Rivas, P., Rodero, B., Quintial, C., Llorca, J., & González-Gay, M. A. (2014). Short-term improvement following dry needle stimulation of tender points in fibromyalgia. Rheumatology International, 34(6), 861-866. https://doi.org/10.1007/s00296-013-2759-3

Castro-Sánchez, A. M., Aguilar-Ferrándiz, M. E., Matarán-Peñarrocha, G. A., Sánchez-Joya, M. del M., Arroyo-Morales, M., & Fernández-de-las-Peñas, C. (2013). Short-Term Effects of a Manual Therapy Protocol on Pain, Physical Function, Quality of Sleep, Depressive symptoms and Pressure Sensitivity in Women and Men with Fibromyalgia Syndrome: A Randomized Controlled Trial. The Clinical Journal of Pain, 1.https://doi.org/10.1097/AJP.0000000000000008

Castro-Sanchez, A. M., Garcia-Lopez, H., Mataran-Penarrocha, G. A., Fernandez-Sanchez, M., Fernandez-Sola, C.,Granero-Molina, J., & Aguilar-Ferrandiz, M. E. (2017). Effects of Dry Needling on Spinal Mobility and Trigger Points in Patients with Fibromyalgia Syndrome. Pain Physician, 20(2), 37-52.

Castro-Sánchez, A. M., Matarán-Peñarrocha, G. A., Arroyo-Morales, M., Saavedra-Hernández, M., Fernández-Sola, C., & Moreno-Lorenzo, C. (2011). Effects of myofascial release techniques on pain, physical function, and postural stability in patients with fibromyalgia: a randomized controlled trial. Clinical Rehabilitation, 25(9), 800-813. https:// doi.org/10.1177/0269215511399476

Castro-Sánchez, A. M., Matarán-Peñarrocha, G. A., Granero-Molina, J., Aguilera-Manrique, G., Quesada-Rubio, J. M., & Moreno-Lorenzo, C. (2011). Benefits of Massage-Myofascial Release Therapy on Pain, Anxiety, Quality of Sleep, Depression, and Quality of Life in Patients with Fibromyalgia. Evidence-Based Complementary and Alternative Medicine, 2011, 1-9. https://doi.org/10.1155/2011/561753

Ceca, D., Elvira, L., Guzmán, J. F., & Pablos, A. (2017). Benefits of a self-myofascial release program on health-related quality of life in people with fibromyalgia: a randomized controlled trial. The Journal of Sports Medicine and Physical Fitness, (7-8). https://doi.org/10.23736/S0022-4707.17.07025-6

Chatchawan, U., Thinkhamrop, B., Kharmwan, S., Knowles, J., & Eungpinichpong, W. (2005). Effectiveness of traditional Thai massage versus Swedish massage among patients with back pain associated with myofascial trigger points. Journal of Bodywork and Movement Therapies, 9(4), 298-309. https://doi.org/10.1016/j.jbmt.2005.02.001

Clay, J., Pounds, D., & Nuñez, O. (2004). Masoterapia Clinica Basica: Integracion Terapeutics Anatomica. McGraw-Hill.

Cook, A. J., Wellman, R. D., Cherkin, D. C., Kahn, J. R., & Sherman, K. J. (2015). Randomized clinical trial assessing whether additional massage treatments for chronic neck pain improve 12- and 26-week outcomes. The Spine Journal, 15(10), 2206-2215. https://doi.org/10.1016/j.spinee.2015.06.049

Cotchett, M. P., Munteanu, S. E., & Landorf, K. B. (2014). Effectiveness of Trigger Point Dry Needling for Plantar Heel Pain: A Randomized Controlled Trial. Physical Therapy, 94(8), 1083-1094. https://doi.org/10.2522/ptj.20130255

Couto, C., de Souza, I. C. C., Torres, I. L. S., Fregni, F., & Caumo, W. (2014). Paraspinal Stimulation Combined WithTrigger Point Needling and Needle Rotation for the Treatment of Myofascial Pain: A Randomized Sham-controlled Clinical Trial. The Clinical Journal of Pain, 30(3), 214-223. https://doi.org/10.1097/AJP.0b013e3182934b8d

De Meulemeester, K. E., Castelein, B., Coppieters, I., Barbe, T., Cools, A., & Cagnie, B. (2017). Comparing Trigger Point Dry Needling and Manual Pressure Technique for the Management of Myofascial Neck/Shoulder Pain: A Randomized Clinical Trial. Journal of Manipulative and Physiological Therapeutics, 40(1), 11-20. https://doi.org/10.1016/j.jmpt.2016.10.008

Dıraçoğlu, D., Vural, M., Karan, A., & Aksoy, C. (2012). Effectiveness of dry needling for the treatment of temporoman dibular myofascial pain: A double-blind, randomized, placebo controlled study. Journal of Back and Musculoskeletal Rehabilitation, 25(4), 285-290. https://doi.org/10.3233/BMR-2012-0338 Edwards, J., & Knowles, N. (2003). Superficial dry needling and active stretching in the treatment of myofascial pain—a randomised controlled trial. Acupuncture in Medicine: Journal of the British Medical Acupuncture Society, 21(3), 80-86.

Ekici, G., Bakar, Y., Akbayrak, T., & Yuksel, I. (2009). Comparison of Manual Lymph Drainage Therapy and Connective Tissue Massage in Women With Fibromyalgia: A Randomized Controlled Trial. Journal of Manipulative and Physiological Therapeutics, 32(2), 127-133. https://doi.org/10.1016/j.jmpt.2008.12.001

Espí-López, G. V., Serra-Añó, P., Vicent-Ferrando, J., Sánchez-Moreno-Giner, M., Arias-Buría, J. L., Cleland, J., & Fernández-de-las-Peñas, C. (2017). Effectiveness of Inclusion of Dry Needling in a Multimodal Therapy Program for Patellofemoral Pain: A Randomized Parallel-Group Trial. Journal of Orthopaedic & Sports Physical Therapy, 47(6), 392 401. https://doi.org/10.2519/jospt.2017.7389

Fernández-Carnero, J., Gilarranz-de-Frutos, L., León-Hernández, J. V., Pecos-Martin, D., Alguacil-Diego, I., Gallego-Izquierdo, T., & Martín-Pintado-Zugasti, A. (2017). Effectiveness of Different Deep Dry Needling Dosages in the Treatment of Patients With Cervical Myofascial Pain: A Pilot RCT. American Journal of Physical Medicine & Rehabilitation, 96(10), 726-733. https://doi.org/10.1097/PHM.0000000000000733

Ga, H., Choi, J.-H., Park, C.-H., & Yoon, H.-J. (2007). Dry Needling of Trigger Points with and Without Paraspinal Needling in Myofascial Pain Syndromes in Elderly Patients. The Journal of Alternative and Complementary Medicine, 13(6), 617-624. https://doi.org/10.1089/acm.2006.6371

Gazi, M. C. B., Issy, A. M., Ávila, I. P., & Sakata, R. K. (2011). Comparison of Acupuncture to Injection for Myofascial Trigger Point Pain: Acupuncture vs. Trigger Point Injection. Pain Practice, 11(2), 132-138.https://doi.org/10.1111/j.1533-2500.2010.00396.x

Gonzalez-Perez, L., Infante-Cossio, P., Granados-Nunez, M., Urresti-Lopez, F., Lopez-Martos, R., & Ruiz-Canela-Mendez, P. (2015). Deep dry needling of trigger points located in the lateral pterygoid muscle: Efficacy and safety of treatment for management of myofascial pain and temporomandibular dysfunction. Medicina Oral Patología Oral y Cirugia Bucal, e326-e333. https://doi.org/10.4317/medoral.20384

Haran, R. H., & Singh, A. K. (2013). Effect of High Power Pain Threshold Static Ultrasound Combined with Transverse Friction Massage and Stretching on Upper Trapezius Myofascial Trigger Point. Indian Journal of Physiotherapy and Occupational Therapy - An International Journal, 7(3), 113. https://doi.org/10.5958/j.0973-5674.7.3.076

Hsieh, Y.-L., Kao, M.-J., Kuan, T.-S., Chen, S.-M., Chen, J.-T., & Hong, C.-Z. (2007). Dry Needling to a Key Myofascial Trigger Point May Reduce the Irritability of Satellite MTrPs: American Journal of Physical Medicine & Rehabilitation, 86(5), 397-403. https://doi.org/10.1097/PHM.0b013e31804a554d

Liptan, G., Mist, S., Wright, C., Arzt, A., & Jones, K. D. (2013). A pilot study of myofascial release therapy compared to Swedish massage in Fibromyalgia. Journal of Bodywork and Movement Therapies, 17(3), 365-370. https://doi.org/10.1016/j.jbmt.2012.11.010

Llamas Ramos, R. (2014). Efectividad del Tratamiento con Punción Seca Profunda frente a un protocolo de Fisioterapia Manual en el Musculo Trapecio Superior. Universidad de Alcala, Madrid. Recuperado de https://dspace.uah.es/dspace/bitstream/ handle/10017/22730/TESIS%20ROCIO%20LLAMAS%20RAMOS.pdf?sequence=1&isAllowed=y

Martín-Pintado-Zugasti, A., Pecos-Martin, D., Rodríguez-Fernández, Á. L., Alguacil-Diego, I. M., Portillo-Aceituno, A., Gallego-Izquierdo, T., & Fernandez-Carnero, J. (2015). Ischemic Compression After Dry Needling of a Latent Myofascial Trigger Point Reduces Postneedling Soreness Intensity and Duration. PM&R, 7(10), 1026-1034. https://doi.org/10.1016/j.pmrj.2015.03.021

Moraska, A. F., Schmiege, S. J., Mann, J. D., Butryn, N., & Krutsch, J. P. (2017). Responsiveness of Myofascial Trigger Points to Single and Multiple Trigger Point Release Massages: A Randomized, Placebo Controlled Trial. American Journal of Physical Medicine & Rehabilitation, 96(9), 639-645. https://doi.org/10.1097/PHM.0000000000000728

Moustafa, I. M., & Diab, A. A. (2015). The addition of upper cervical manipulative therapy in the treatment of patients with fibromyalgia: a randomized controlled trial. Rheumatology International, 35(7), 1163-1174. https://doi.org/10.1007/ s00296-015-3248-7

Oliveira-Campelo, N. M., de Melo, C. A., Alburquerque-Sendín, F., & Machado, J. P. (2013). Short- and Medium-Term Effects of Manual Therapy on Cervical Active Range of Motion and Pressure Pain Sensitivity in Latent Myofascial Pain of the Upper Trapezius Muscle: A Randomized Controlled Trial. Journal of Manipulative and Physiological Therapeutics, 36(5), 300-309. https://doi.org/10.1016/j.jmpt.2013.04.008

Osuna Crespo, E. (2015). La puncion seca como tratatamiento para los puntos gatillo en el sindrome del dolor miofascial (Tesis).Universidad de Jaen. Recuperado de http://tauja.ujaen.es/bitstream/10953.1/1529/1/TFG%20Osuna%20Crespo,%20 Enrique.pdf

Pecos-Martín, D., Montañez-Aguilera, F. J., Gallego-Izquierdo, T., Urraca-Gesto, A., Gómez-Conesa, A., Romero-Franco, N., & Plaza-Manzano, G. (2015). Effectiveness of Dry Needling on the Lower Trapezius in Patients With Mechanical Neck Pain: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 96(5), 775-781. https://doi.org/10.1016/j.apmr.2014.12.016

Pérez-Palomares, S., Oliván-Blázquez, B., Pérez-Palomares, A., Gaspar-Calvo, E., Pérez-Benito, M., López-Lapeña, E., ... Magallón-Botaya, R. (2017). Contribution of Dry Needling to Individualized Physical Therapy Treatment of Shoulder Pain: A Randomized Clinical Trial. Journal of Orthopaedic & Sports Physical Therapy, 47(1), 11-20. https://doi.org/10.2519/jospt.2017.6698

Pinzón Ríos, I. (2014). Actualización en fibromialgia: Implicaciones neurofisiológicas y biomecánicas útiles para el abordaje fisioterapéutico. Revista Colombiana de Rehabilitación, 13 (1), 14-25.

https://doi.org/10.30788/RevColReh.v13.n1.2014.26 Rayegani, S. M., Bayat, M., Bahrami, M. H., Raeissadat, S. A., & Kargozar, E. (2014). Comparison of dry needling and physiotherapy in treatment of myofascial pain syndrome. Clinical Rheumatology, 33(6), 859-864. https://doi.org/10.1007/s10067-013-2448-3

Rodríguez-Fuentes, I., De Toro, F. J., Rodríguez-Fuentes, G., de Oliveira, I. M., Meijide-Faílde, R., & Fuentes-Boquete, I. M. (2016). Myofascial Release Therapy in the Treatment of Occupational Mechanical Neck Pain: A Randomized Parallel Group Study. American Journal of Physical Medicine & Rehabilitation, 95(7), 507-515. https://doi.org/10.1097/PHM.0000000000000425

Salinas Bueno, I., Moreno Gómez, C., Velasco Roldán, O., & Aguiló Pons, A. (2009). Terapia manual y terapia combinada en el abordaje de puntos gatillo: revisión bibliográfica. Fisioterapia, 31(1), 17-23. https://doi.org/10.1016/j.ft.2008.01.003

Santos, R. B. da C., Carneiro, M. I. S., Oliveira, D. M. de, Maciel, A. B. do R., Monte-Silva, K. K. do, & Araújo, M. das G. R. (2014). Impact of dry needling and ischemic pressure in the myofascial syndrome: controlled clinical trial. Fisioterapia em Movimento, 27(4), 515-522. https://doi.org/10.1590/0103-5150.027.004.AO03

Segura-Ortí, E., Prades-Vergara, S., Manzaneda-Piña, L., Valero-Martínez, R., & Polo-Traverso, J. (2016). Trigger point dry needling versus strain–counterstrain technique for upper trapezius myofascial trigger points: a randomised controlled trial. Acupuncture in Medicine, 34(3), 171-177. https://doi.org/10.1136/acupmed-2015-010868

Srbely, J., Dickey, J., Lee, D., & Lowerison, M. (2010). Dry needle stimulation of myofascial trigger points evokes segmental anti-nociceptive effects. Journal of Rehabilitation Medicine, 42(5), 463-468. https://doi.org/10.2340/16501977-0535

Tekin, L., Akarsu, S., Durmuş, O., Çakar, E., Dinçer, Ü., & Kıralp, M. Z. (2013). The effect of dry needling in the treatment of myofascial pain syndrome: a randomized double-blinded placebo-controlled trial. Clinical Rheumatology, 32(3), 309-315. https://doi.org/10.1007/s10067-012-2112-3

Trampas, A., Kitsios, A., Sykaras, E., Symeonidis, S., & Lazarou, L. (2010). Clinical massage and modified Proprioceptive Neuromuscular Facilitation stretching in males with latent myofascial trigger points. Physical Therapy in Sport, 11(3), 91-98. https://doi.org/10.1016/j.ptsp.2010.02.003

Turo, D., Otto, P., Hossain, M., Gebreab, T., Armstrong, K., Rosenberger, W. F., ... Sikdar, S. (2015). Novel Use of Ultrasound Elastography to Quantify Muscle Tissue Changes After Dry Needling of Myofascial Trigger Points in Patients With Chronic Myofascial Pain. Journal of Ultrasound in Medicine, 34(12), 2149-2161. https://doi.org/10.7863/ultra.14.08033

Vasquez Gallego, J. (2009). Manual Profesional del Masaje (Primera Edicion). Barcelona: Editoria Paidotribo. Wamontree, P., Kanchanakhan, N., Eungpinichpong, W., & Jeensawek, A. (2015). Effects of traditional Thai self-massage using a Wilai massage stickTM versus ibuprofen in patients with upper back pain associated with myofascial trigger points: a randomized controlled trial. Journal of Physical Therapy Science, 27(11), 3493-3497. https://doi.org/10.1589/jpts.27.3493

Wang, G., Gao, Q., Hou, J., & Li, J. (2014). Effects of Temperature on Chronic Trapezius Myofascial Pain Syndrome during Dry Needling Therapy. Evidence-Based Complementary and Alternative Medicine, 2014, 1-9. https://doi.org/10.1155/2014/638268

Wang, G., Gao, Q., Li, J., Tian, Y., & Hou, J. (2016). Impact of Needle Diameter on Long-Term Dry Needling Treatment of Chronic Lumbar Myofascial Pain Syndrome: American Journal of Physical Medicine & Rehabilitation, 95(7), 483-494. https://doi.org/10.1097/PHM.0000000000000401

Yuan, S. L. K., Berssaneti, A. A., & Marques, A. P. (2013). Effects of Shiatsu in the Management of Fibromyalgia Symptoms: A Controlled Pilot Study. Journal of Manipulative and Physiological Therapeutics, 36(7), 436-443. https://doi.org/10.1016/j.jmpt.2013.05.019

Ziaeifar, M., Arab, A. M., Karimi, N., & Nourbakhsh, M. R. (2014). The effect of dry needling on pain, pressure pain threshold and disability in patients with a myofascial trigger point in the upper trapezius muscle. Journal of Bodywork and Movement Therapies, 18(2), 298-305. https://doi.org/10.1016/j.jbmt.2013.11.004

Ziani, M. M., Bueno, E. A., Kipper, L. R., Vendrusculo, F. M., Winck, A. D., & Heinzmann-Filho, J. P. (2017). Efeitos da terapia manual sobre a dor em mulheres com fibromialgia: uma revisão de literatura. Ciência & Saúde, 10(1), 48. https://doi.org/10.15448/1983-652X.2017.1.23875

Descargas

La descarga de datos todavía no está disponible.