Telemedicina en rehabilitación: necesidad y oportunidad post-COVID / Telemedicine in rehabilitation: post-COVID need and opportunity

No disponible

Rehabilitación domiciliaria postartroplastia total de rodilla: estudio coste-efectividad / Home-based rehabilitation after total knee arthroplasty: A cost-effectiveness study

Introducción: La rehabilitación domiciliaria permite a los pacientes intervenidos de artroplastia total de rodilla (ATR) volver antes a su domicilio y acelerar su reinserción comunitaria. Material y métodos: Estudio observacional simple, con incorporación consecutiva de pacientes desde noviembre del 2005 hasta mayo del 2008. Población de estudio: Pacientes remitidos al servicio domiciliario desde el Hospital Clínico de Barcelona post-ATR por gonartrosis. Intervención: Se realizó un programa de rehabilitación domiciliaria con evaluaciones antes del tratamiento y al alta, y seguimiento a los 6 meses. Se consideraron como variables de eficacia la variación en las puntuaciones del Western Ontario and McMaster Osteoarthritis (cuestionario WOMAC), el índice de Barthel (IB) y el balance articular. Se realizó una comparativa de costes según parámetros del Servei Català de la Salut. Se utilizó el test no paramétrico de Wilcoxon para comparar las puntuaciones del cuestionario WOMAC. Los datos cuantitativos fueron analizados por la t de Student. Resultados: Se reclutó a un total de 530 pacientes. El 78% de estos alcanzaron un grado de independencia con puntuación 100 según el IB, el arco de movimiento de flexión de rodilla fue superior a 100° en el 96,4% y la puntación media en todos los pacientes del cuestionario WOMAC fue de 13,48 (intervalo de confianza, 12,27-14,68). Se redujo la estancia media hospitalaria a 5,1 días, siendo el coste en el ámbito domiciliario la mitad que en el ambulatorio. Conclusión: La rehabilitación domiciliaria consigue disminuir la estancia hospitalaria con resultados funcionales óptimos y minimización de costes (AU)

Introduction: Home rehabilitation allows an earlier return to home in patients undergoing total knee arthroplasty. Material and methods: We performed a simple observational study with consecutive enrolment of patients from November 2005 to May 2008. Study population: Adult patients referred to the home-based rehabilitation service of Hospital Clinic in Barcelona after total knee arthroplasty for gonarthrosis. Intervention: We conducted a multidisciplinary home-based rehabilitation program with assessments before treatment, at discharge from rehabilitation and at 6 months follow-up. The outcomes measured were the Western Ontario and McMaster Universities Index (WOMAC), the Barthel Index (BI), and range of motion (ROM) scores. Costs were compared using parameters of the Catalan Health Service. Wilcoxon’s non-parametric test was used to analyze WOMAC outcomes. Quantitative data were analyzed using Student’s t test. Results: A total of 530 patients were recruited. Of these, 78% achieved a degree of independence, with a BI score of 100. The ROM for knee flexion was greater than 100◦ in 96.4% and the average rating of all the patients in the questionnaire WOMAC was 13.48 (CI: 12.27-14.68). The average length of hospital stay was reduced to 5.1 days, and the cost of home rehabilitation was half that in the outpatient setting. Conclusion: The home rehabilitation model reduces length of hospital stay and cost and has optimal functional results (AU)

Intraspinal baclofen in the treatment of severe spasticity and spasms.

Ten patients with severe spasticity were evaluated according to a standardized protocol in order to be treated by intraspinal baclofen. Entry criteria in the protocol were the following: 1) Stable central nervous system lesion, 2) Severe spasticity and/or flexo-extensor spasms not controllable by oral treatment, 3) Normal CSF circulation and 4) Informed consent. All patients received a test dose of twenty-five micrograms of baclofen injected intrathecally. At intervals of at least one day, doses were increased in 10-25 microgram steps until total abolition of spontaneous spasms was achieved in complete spinal cord lesions. In patients with residual motor function, doses were titrated until the optimal dose was found that reduced spasms and enabled performance of maximum daily life activities according to the patient's neurological level. In nine patients a multidose reservoir was implanted to deliver intrathecal baclofen. Effective dosage was 60 +/- 31 micrograms in the entire group. Ashworth score was reduced from 4.6 +/- 0.7 to 1.2 +/- 0.4 (mean +/- SD) (p less than 0.0001) and spasms from 3.2 +/- 0.8 to 0.2 +/- 0.4 (p less than 0.0001). Follow-up of the nine patients in whom a reservoir was implanted has been 18 +/- 9 months. Initial dosage requirements and tolerance were significantly different in complete (Frankel's A grade) or incomplete lesions (Frankel's B, C and D grades). Complete spinal cord lesions required a greater initial dose (156 +/- 43) than incomplete lesions (44 +/- 24), these differences being statistically significant (Student's t-test, p less than 0.05). Tolerance was observed only in patients with complete motor and complete sensory lesions. In incomplete lesions, dose increase was insignificant.