Análisis de la actividad en las unidades móviles de rehabilitación-fisioterapia en atención primaria / Analysis of the activity of mobile rehabilitation-physiotherapy units in primary care

ObjetivoDescribir la atención domiciliaria que ofrecen los equipos móviles de rehabilitación-fisioterapia (EMRF) como respuesta a las necesidades de la población dependiente, las características que tiene su aplicación y las consecuencias que produce sobre el paciente y su independencia funcional.DiseñoEstudio descriptivo transversal desde 2004 hasta junio de 2007.EmplazamientoMedio comunitario. Los EMRF de atención primaria en Almería.ParticipantesEn total 1.093 pacientes incluidos en el programa.Mediciones principalesSe recogió sistemáticamente el estado de salud de los pacientes (proceso discapacitante principal, motivos de inclusión en el tratamiento, valoración funcional inicial y final e índice de Barthel), los datos sobre la atención fisioterapéutica y el n.o de sesiones.ResultadosUn 64,2% de la muestra fueron mujeres; la edad media fue de 78 años. El tiempo medio de espera para su valoración fue de 4 días y hubo una gran diversidad de procesos discapacitantes principales que han quedado descritos. Existió un elevado porcentaje de síntomas de grave deterioro motor, dolor y debilidad muscular. El 88,6% de los pacientes realizó tratamiento fisioterapéutico; el 11,1% de los pacientes fisioterapia y tratamiento ocupacional y el 0,3% de los pacientes tratamiento ortésico. El número medio de sesiones fue de 12,85. Se describe la variación en el índice de Barthel final tras la intervención realizada (cinesiterapia [61,9%]; combinada con electroterapia [10,2%]; cinesiterapia y educación al cuidador [14,5%], etc.).ConclusionesSe aporta información valiosa respecto a las características de la población geriátrica y dependiente así como la ayuda fisioterapéutica que viene recibiendo y cómo se lleva a cabo el proceso(AU)

ObjectiveTo describe the home care provided by mobile rehabilitation-physiotherapy teams as a response to the needs of the dependent population, the characteristics of their application, and the results they have on patients and their functional independence.DesignA descriptive, cross-sectional study from 2004 to June 2007.SettingCommunity setting. Mobile rehabilitation-physiotherapy teams from Primary Care in Almeria.ParticipantsA total of 1093 patients were included in the programme.Main measurementsData were collected on, the state of the patients’ health (primary disabling process, reasons for inclusion in the treatment, initial and final functional assessment and Barthel Index); details of physiotherapy treatment, and number of sessions.ResultsOf the total sample, the mean age was 78 years and 64.2% were female. The mean waiting time for their assessment was 4 days and there was a wide variety of primary disabling processes described. There was a high percentage of symptoms of severe motor deterioration, pain and muscle weakness. Physiotherapy treatment was given in 88.6%, physiotherapy and occupational therapy in 11.1%, and orthopaedic treatment in 0.3%, of the patients. The mean number of sessions was 12.85. The variation in the Barthel Index after the final therapy was given was, 61.9% for kinesiotherapy, 10.2% combined with electrotherapy, and 14.5% for kinesiotherapy and carer education.ConclusionsValuable information is provided as regards the characteristics of the geriatric and dependent population, as well as the physiotherapy help they are receiving, and also how the procedure is carried out(AU)

Atualizações no tratamento não-farmacológico da doença de Alzheimer / Actualizations in non-pharmacologic treatment of Alzheimer disease

A doença de Alzheimer representa o tipo mais freqüente de demência senil. Uma vez que os medicamentos não se mostram totalmente eficazes no tratamento dos sintomas comportamentais, abordagens não-farmacológicas vêm ganhando cada vez mais a atenção de pesquisadores e clínicos da área geriátrica. A proposta deste artigo é difundir métodos de tratamento não-farmacológico que visam abordar o paciente em seus aspectos globais. O presente trabalho consiste em revisão de literatura atual através de busca à base de dados Medline, entre os anos 1998 a 2008. Foram selecionadas alternativas de tratamento a fim de diminuir o declínio cognitivo e funcional dos pacientes e o estresse dos cuidadores. São citados o uso da estimulação elétrica nervosa transcutânea (TENS), estimulação multi-sensorial, toque terapêutico, musicoterapia, terapia assistida por animais domésticos e atividades cinesioterapêuticas e cognitivas. Todas as intervenções têm como objetivo comum melhorar a qualidade de vida dos pacientes. Porém, há escassez de pesquisas científicas documentadas, o que sugere a realização de mais estudos em torno do assunto.

Alzheimer disease is the most common cause of senile dementia. Since new drugs are not really effective for treating behavioral symptoms, non pharmacologic approaches have been considered by researchers and geriatric clinicians. The objective of this study was to spread information on non pharmacologic treatment methods which treat patients as a whole. The present paper consists on a systematic literature review that uses Medline database from 1998 to 2008. Alternative treatments where selected in order to reduce cognitive and function impairment and caregiver stress. The use of transcutaneous electrical nerve stimulation (TENS), multi-sensory stimulation, therapeutic touch, music therapy, animal-assisted therapy, kinesiotherapy and cognitive interventions are described. The interventions aim to improve patient quality of life. However, the lack of documented studies suggests that further research is needed.

Organización de la actividad asistencial del fisioterapeuta en salas de Atención Primaria / Organization of care activity of the physiotherapist in primary care sites

Objetivo: conocer el tiempo dedicado a la actividad asistencial en salas de fisioterapia del Área de Gestión Sanitaria Norte de Almería. Métodos: estudio observacional descriptivo de la actividad asistencial realizada en tres salas de fisioterapia de las Zonas Básicas de Salud de Serón, Albox y Los Vélez durante el mes de febrero de 2006. Se cuantificó el tiempo dedicado a las distintas actividades asistenciales en dichas salas. Se diferenció por actividad asistencial efectiva (tratamiento individual, grupal y tratamiento domiciliario), actividades de formación y tareas de organización, según indica la Guía de Procedimientos de Fisioterapia en Atención Primaria. Se cuantificaron también otras actividades no incluidas en la cartera de servicios del fisioterapeuta. Resultados: del total del tiempo trabajado durante el mes de febrero en las tres Zonas Básicas de Salud (18 días), el mayor porcentaje correspondió a la actividad asistencial efectiva con un 86,37% de la jornada laboral (aproximadamente 6 horas diarias). Para actividades organizativas el porcentaje de tiempo dedicado diariamente fue del 6,89%. El tiempo dedicado a las actividades no incluidas en la cartera de servicios fue de 6,74%. Conclusiones: se ha encontrado que tanto las actividades realizadas por el fisioterapeuta como los tiempos empleados para las mismas no se corresponden en general con lo recomendado, siendo el tratamiento individual el que mayoritariamente ocupa la jornada laboral. Se dedica tiempo a actividades que no son propias del fisioterapeuta de Atención Primaria y que sería más conveniente utilizar en actividades formativas, de prevención y promoción de la salud(AU)

Objective: Know the time dedicated to care activity in the physiotherapy rooms of the North Health Care Management Area of Almeria.Methods: Observational, descriptive study of the care activity performed in threephysiotherapy sites of the Basic Health Zones of Seron, Albox and los Velez during themonth of February 2006. Time dedicated to the different care activities in said sites wasquantified. It was differentiated by real care activity (individual and group treatment andhome treatment), training activities and organization tasks as indicated by thePhysiotherapy Procedures Guidelines in Primary Care. Other activities not included inthe list of physiotherapeutic services were also quantified.Results: The greatest percentage of time worked during the month of February in thethree Basic Health Zones (18 days) corresponded to real care activity, this accounting for86.37% of the work day (approximately 6 hours daily). The percentage of time dedicated toorganizational activities daily was 6.89%. Time dedicated to activities not included in thelist of services was 6.74%.Conclusions: It was found that both the activities performed by the physiotherapist andthe times used for them do not correspond in general with that recommended, individualtreatment being that which mostly occupies the work day. Time is dedicated to activitiesthat are not characteristic of the primary care physiotherapist and that could be betterused in training activities, prevention activities and health promotion activities(AU)