Instrumentos predictores del éxito en la protetización de pacientes con amputaciones unilaterales mayores de miembro inferior / Objective measurement tools that predict success in the fitting of major unilateral lower limb amputations patients

El perfil del paciente que más frecuentemente sufre amputaciones de miembro inferior suele ser uno de edad avanzada y alta comorbilidad. Los médicos rehabilitadores precisamos en la valoración de estos pacientes de herramientas objetivas que predigan los resultados de los programas de protetización para aumentar la seguridad del paciente y eficiencia de los programas de rehabilitación protésica. Dada la necesidad de actualizar el conocimiento científico en este campo hemos realizado una revisión de la literatura con el objetivo de definir una propuesta de herramientas que faciliten la toma de decisiones en la indicación de rehabilitación protésica en estos pacientes. Para la realización de este trabajo se ha realizado una estrategia de búsqueda bibliográfica utilizando las bases de datos científicas PubMed, Web of Science, Scopus y Cochrane Library. La calidad de los artículos seleccionados se ha valorado según las herramientas propuestas por CASPe.(AU)

The profile of the patient who most frequently suffers lower limb amputations is usually an elderly patient with high comorbidity. Physiatrists need objective tools in the assessment of these patients that predict the results of prosthetic programs to increase patient safety and efficiency of prosthetic rehabilitation programs. Given the need to update scientific knowledge in this field, we have carried out a review of the literature with the aim of defining a proposal for tools that facilitate decision-making in the indication of prosthetic rehabilitation in these patients. A bibliographic search strategy has been carried out using the scientific databases PubMed, Web of Science, Scopus and Cochrane Library. The quality of the selected articles has been assessed according to the tools proposed by CASPe.(AU)

Valoración multidisciplinar de las secuelas al mes del alta hospitalaria por neumonía grave COVID-19, ¿existen diferencias en función de la terapia respiratoria empleada durante su ingreso en Cuidados Intensivos? / Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care?

Objetivo Describir las secuelas al mes del alta hospitalaria en pacientes que precisaron ingreso en Cuidados Intensivos por neumonía grave COVID-19 y analizar las diferencias entre los que recibieron terapia exclusivamente con oxigenoterapia con alto flujo con respecto a los que precisaron ventilación mecánica invasiva (VMI). Diseño Estudio de cohorte, prospectivo y observacional. Ámbito Consulta multidisciplinar pos Cuidados Intensivos. Pacientes o participantes Pacientes que superaron el ingreso en la Unidad de Cuidados Intensivos (UCI) por neumonía grave COVID-19 desde abril 2020 hasta octubre 2021. Intervenciones Inclusión en el programa multidisciplinar pos UCI. Variables de interés principales Secuelas motoras, sensitivas, psicológicas/psiquiátricas, respiratorias y nutricionales tras el ingreso hospitalario. Resultados Se incluyeron 104 pacientes. 48 pacientes recibieron oxigenoterapia nasal de alto flujo (ONAF) y 56 VMI. Las principales secuelas encontradas fueron la neuropatía distal (33,9% VMI vs. 10,4% ONAF); plexopatía braquial (10,7% VMI vs. 0% ONAF); disminución de fuerza de agarre: mano derecha 20,67 kg (± 8,27) en VMI vs. 31,8 kg (± 11,59) en ONAF y mano izquierda 19,39 kg (± 8,45) en VMI vs. 30,26 kg (± 12,74) en ONAF; y balance muscular limitado en miembros inferiores (28,6% VMI vs. 8,6% ONAF). Las diferencias observadas entre ambos grupos no alcanzaron significación estadística en el estudio multivariable. Conclusiones Los resultados obtenidos tras el estudio multivariable sugieren no existir diferencias en cuanto a las secuelas físicas percibidas al mes del alta hospitalaria en función de la terapia respiratoria empleada, ya fuera ONAF o ventilación mecánica prolongada, si bien son precisos más estudios para poder obtener conclusiones al respecto (AU)

Objective To describe the sequelae one month after hospital discharge in patients who required admission to intensive care for severe COVID-19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. Design Cohort, prospective and observational study. Setting Post-intensive care multidisciplinary program. Patients or participants Patients who survived admission to the intensive care unit (ICU) for severe COVID-19 pneumonia from April 2020 to October 2021. Interventions Inclusion in the post-ICU multidisciplinary program. Main variables of interest Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. Results One hundred and four patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs. 10.4% ONAF); brachial plexopathy (10.7% IMV vs. 0% ONAF); decrease in grip strength: right hand 20.67 kg (± 8.27) in VMI vs. 31.8 kg (± 11.59) in ONAF and left hand 19.39 kg (± 8.45) in VMI vs. 30.26 kg (± 12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs. 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. Conclusions The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions (AU)

[Objective measurement tools that predict success in the fitting of major unilateral lower limb amputations patients]. / Instrumentos predictores del éxito en la protetización de pacientes con amputaciones unilaterales mayores de miembro inferior.

The profile of the patient who most frequently suffers lower limb amputations is usually an elderly patient with high comorbidity. Physiatrists need objective tools in the assessment of these patients that predict the results of prosthetic programs to increase patient safety and efficiency of prosthetic rehabilitation programs. Given the need to update scientific knowledge in this field, we have carried out a review of the literature with the aim of defining a proposal for tools that facilitate decision-making in the indication of prosthetic rehabilitation in these patients. A bibliographic search strategy has been carried out using the scientific databases PubMed, Web of Science, Scopus and Cochrane Library. The quality of the selected articles has been assessed according to the tools proposed by CASPe.

Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care?

OBJECTIVE: To describe the sequelae one month after hospital discharge in patients who required admission to Intensive Care for severe COVID 19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. DESIGN: Cohort, prospective and observational study. SETTING: Post-intensive care multidisciplinary program. PATIENTS OR PARTICIPANTS: Patients who survived admission to the intensive care unit (ICU) for severe COVID 19 pneumonia from April 2020 to October 2021. INTERVENTIONS: Inclusion in the post-ICU multidisciplinary program. MAIN VARIABLES OF INTEREST: Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. RESULTS: 104 patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs 10.4% ONAF); brachial plexopathy (10.7% IMV vs 0% ONAF); decrease in grip strength: right hand 20.67kg (±8.27) in VMI vs 31.8kg (±11.59) in ONAF and left hand 19.39kg (±8.45) in VMI vs 30.26kg (±12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. CONCLUSIONS: The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions.

[Multidisciplinary approach of the sequelae one month after hospital discharge in patients with severe bilateral COVID-19 pneumonia, are there differences depending on the respiratory therapy used during admission to intensive care?] / Valoración multidisciplinar de las secuelas al mes del alta hospitalaria por neumonía grave COVID-19, ¿existen diferencias en función de la terapia respiratoria empleada durante su ingreso en Cuidados Intensivos?

Objective: To describe the sequelae one month after hospital discharge in patients who required admission to intensive care for severe COVID-19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. Design: Cohort, prospective and observational study. Setting: Post-intensive care multidisciplinary program. Patients or participants: Patients who survived admission to the intensive care unit (ICU) for severe COVID-19 pneumonia from April 2020 to October 2021. Interventions: Inclusion in the post-ICU multidisciplinary program. Main variables of interest: Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. Results: One hundred and four patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs. 10.4% ONAF); brachial plexopathy (10.7% IMV vs. 0% ONAF); decrease in grip strength: right hand 20.67 kg (± 8.27) in VMI vs. 31.8 kg (± 11.59) in ONAF and left hand 19.39 kg (± 8.45) in VMI vs. 30.26 kg (± 12.74) in ONAF; and limited muscle balance in the lower limbs (28.6% VMI vs. 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. Conclusions: The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions.

Infarto-reinfarto: estudio comparativo clínico-funcional en un programa de rehabilitación cardiaca / Infarction-reinfarction: A clinical-functional comparative study within a cardiac rehabilitation program

Introducción: Los pacientes con reinfarto de miocardio pertenecen al grupo de alto riesgo en los programas de rehabilitación cardiaca (PRC). Objetivos: Evaluar si existen diferencias basales entre pacientes infartados y reinfartados que acuden a un PRC. Analizar su respuesta tras el programa. Métodos: Estudio longitudinal retrospectivo tipo casos controles en pacientes con reinfarto de miocardio frente a pacientes con un único infarto. Muestra: 152 pacientes (76 casos y 76 controles). Periodo de estudio: del 1 de enero del 2005 al 31 de octubre del 2012. Intervención PRC en Hospital Virgen de la Victoria, Málaga. Variables: factores de riesgo cardiovascular, nivel de estrés, situación emocional, profesión, hábito de ejercicio, tipo de personalidad, percepción de salud, ergometría y ecocardiografía. Análisis estadístico: programa SPSS-15.0. Resultados: Basalmente, se observan diferencias estadísticamente significativas en casos frente a controles en: hábito de ejercicio (OR = 1,31 [1,01-1,69]), percepción de salud buena (15,2%/64%), ansiedad (66,7%/38%) depresión (46%/25%) y perímetro abdominal > 102 cm (OR = 1,8 [1,16-2,78]). Tras el programa, los pacientes re-IAM mejoran de forma significativa en el hábito de ejercicio (p = 0,00), percepción de salud buena (p = 0,00), estrés laboral (p = 0,00), ansiedad (p = 0,00), depresión (p = 0,00) y perímetro abdominal (p = 0,00). En cuanto a la cardiopatía, mejoran la función ventricular (p = 0,00) y la ergometría (0,9 METS p = 0,00; tiempo: 32,79 s, p = 0,00). Conclusiones: Los pacientes con reinfarto parten de peor hábito de ejercicio, peor percepción de salud, mayor ansiedad-depresión y obesidad central. La respuesta al programa de rehabilitación es positiva en ambos grupos, con cambios más favorables en pacientes reinfartados en cuanto a aspectos funcionales y psicológicos (AU)

Introduction: Patients with myocardial infarction recurrence belong to the group of patients at high risk in cardiac rehabilitation programs (CRP). Objectives: To assess whether there are baseline differences between single myocardial infarction patients and recurrent infarction patients. To analyze changes after a CRP. Methods: A longitudinal, retrospective, case-control study was conducted in patients with a single event of myocardial infarction compared to patients with recurrent infarction. Sample: The sample was made up of 76 cases and 76 controls. Study period: 1 January 2005 to 31 October 2012. Intervention: CRP at Virgen de la Victoria Hospital from Malaga. Study variables were cardiovascular risk factors, stress level, emotional status, profession, exercise habit, personality type, perceived health, exercise test, echocardiography. Statistical analysis was done using the SPSS-15.0. Results: At baseline statistically significant differences were observed in cases versus controls: exercise habit [OR 1.31 (1.01-1.69)], good health perception (15.2%/64%), anxiety (66,7%/38%) depression (46%/25%), abdominal circumference > 102 cm (OR: 1.8 [1.16-2.78]). After CRP, patients with infarction recurrence improved significantly in exercise habit (P=.00), health perception (P=0.00) work stress perception (P=0.00), anxiety (P=00), depression (P=00) and abdominal circumference (P=0.00), systolic function improves (P=.00) and ergometry (0.9 METS P=0.00 and 32.79 seconds P=0.00). Conclusions: Patients with recurrent myocardial infarction started the program with worse exercise habit, worse perceived health, central obesity, increased anxiety and depression. Changes after rehabilitation program were positive in both groups, with more favorable changes in recurrent infarction patients regarding functional and psychological aspects (AU)