Evaluación funcional tras SARS-CoV-2 crítico. Estudio de cohortes de la unidad de rehabilitación en un hospital de tercer nivel / Functional evaluation in patient with critical SARS-CoV-2 disease: Cohort study in a third level hospital rehabilitation unit

Introducción: La neumonía por SARS-CoV-2 es una enfermedad infecciosa respiratoria altamente contagiosa que causa disfunción respiratoria, física y psicológica. Presentamos resultados de los pacientes valorados por el Servicio de Rehabilitación al alta de UCI por SARS-CoV-2. Material y método: Estudio de cohortes de pacientes ingresados en UCI por neumonía por SARS-CoV-2 desde el 01/10/2020 al 31/07/2021. Recogemos datos sociodemográficos, antecedentes personales, estancia media en UCI y hospital, Barthel, marcha (FAC) y mMRC (preingreso/valoración inicial/alta), desarrollo de patología osteomuscular y/o neurológica y necesidad de tratamiento rehabilitador. Resultados: Muestra de 341 pacientes de los cuales 224 cumplen criterios. Edad media: 63 años (68,75% hombres). Estancia media UCI/hospital: 27/44 días. Valorados por médicos rehabilitadores, facilitamos a los pacientes una guía elaborada por el equipo médico resolviendo dudas del proceso y pautando ejercicios de intensidad y dificultad progresiva, a realizar durante el ingreso y en el domicilio. El 42,86% desarrolló patología neurológica (83,33% del sistema nervioso periférico). El 100% ha realizado fisioterapia respiratoria y el 72,32% ha precisado fisioterapia motora. Conclusiones: En nuestro estudio, un elevado número de pacientes han precisado tratamiento rehabilitador para su recuperación funcional, destacando el desarrollo de patología neurológica post-COVID. El SARS-CoV-2 genera otras complicaciones, no solo respiratorias, subsidiarias de valorarse y tratarse por los Servicios de Rehabilitación para una recuperación integral que minimice las secuelas.(AU)

Introduction: SARS-COV-2 pneumonia is a highly contagious respiratory disease that causes respiratory, physical and psychological dysfunctions. We present the results of patient assessment when they were discharged from the ICU. Material and method: Cohort study of patients affected by SARS-COV-2 pneumonia admitted to the intensive care unit from 01/10/2020 to 31/07/2021. We collect sociodemographic data, personal history, ICU and hospital stay, Barthel, FAC and mMRC (pre-admission/initial assessment/discharge), development of osteomuscular and/or neurological pathology and need for rehabilitation treatment. Results: A total of 341 patients were evaluated, of which 224 met criteria. The average age was 63 years (68.75% men). Mean ICU/hospital stay were 27/44 days. They were assessed by physiatry, after that, we provide a guide developed by physiatry, solving doubts about the disease and setting exercises of intensity and progressive difficulty, to be carried out during the admission and at home. Neurological pathology was present at 42.86% patients, of whom a 83.33% were peripheral nervous system disease. The total of the sample needed respiratory physiotherapy and a 72.32% motor physiotherapy. Conclusions: In our study, a high number of patients have needed rehabilitation treatment in order to get functional recovery, highlighting the development of post-COVID neurological pathology. SARS-COV-2 generates other complications, not only respiratory, subsidiary to be assessed and treated by rehabilitation services for a comprehensive recovery that minimizes sequelae.(AU)

[Functional evaluation in patient with critical SARS-CoV-2 disease: Cohort study in a third level hospital rehabilitation unit]. / Evaluación funcional tras SARS-CoV-2 crítico. Estudio de cohortes de la unidad de rehabilitación en un hospital de tercer nivel.

INTRODUCTION: SARS-COV-2 pneumonia is a highly contagious respiratory disease that causes respiratory, physical and psychological dysfunctions. We present the results of patient assessment when they were discharged from the ICU. MATERIAL AND METHOD: Cohort study of patients affected by SARS-COV-2 pneumonia admitted to the intensive care unit from 01/10/2020 to 31/07/2021. We collect sociodemographic data, personal history, ICU and hospital stay, Barthel, FAC and mMRC (pre-admission/initial assessment/discharge), development of osteomuscular and/or neurological pathology and need for rehabilitation treatment. RESULTS: A total of 341 patients were evaluated, of which 224 met criteria. The average age was 63 years (68.75% men). Mean ICU/hospital stay were 27/44 days. They were assessed by physiatry, after that, we provide a guide developed by physiatry, solving doubts about the disease and setting exercises of intensity and progressive difficulty, to be carried out during the admission and at home. Neurological pathology was present at 42.86% patients, of whom a 83.33% were peripheral nervous system disease. The total of the sample needed respiratory physiotherapy and a 72.32% motor physiotherapy. CONCLUSIONS: In our study, a high number of patients have needed rehabilitation treatment in order to get functional recovery, highlighting the development of post-COVID neurological pathology. SARS-COV-2 generates other complications, not only respiratory, subsidiary to be assessed and treated by rehabilitation services for a comprehensive recovery that minimizes sequelae.

[Capsular hydrodilatation versus kinesitherapy as initial treatment of finger capsulitis]. / Hidrodilatación capsular versus cinesiterapia como tratamiento inicial en las capsulitis de dedos.

INTRODUCTION: To evaluate the effectiveness of early capsular ultrasound-guided hydrodilatation (HD) of the proximal interphalangeal or metacarpophalangeal joints in reducing joint stiffness and shortening kinesitherapy, as well as in improving hand functionality. MATERIAL AND METHODS: We performed a one-year quasi-experimental pretest-posttest study with a control group in patients with proximal interphalangeal or metacarpophalangeal capsulitis in complex regional pain syndrome stages 2 or 3. Inclusion criteria consisted of age over 18 years, visual analogue scale<4 points and the absence of prior treatment. The control group received only kinesitherapy and the experimental group received capsular HD before kinesitherapy. There were 10 patients per group. The main measures were range of motion, active grip, Spanish validated Michigan Hand Outcomes Questionnaire and the number of kinesitherapy sessions required. RESULTS: At baseline, the range of motion of the proximal proximal interphalangeal joint was 20° worse in the experimental group (P=.01). There were no statistically significant differences in the other baseline characteristics. Immediate gain in range of motion after HD was 61.71% (P=.024). No significant improvements were observed in functionality except in active grip after 2 weeks of HD (P=.02) and one month later compared with the control group (P=.014). The number of kinesitherapy sessions required was 19.6±10.42 (95% CI) in the HD group and 29.4±8.11 (95% CI) in the control group (P>.05). CONCLUSIONS: Capsular HD could be considered as an initial treatment in finger joint stiffness because of the significant immediate improvement in range of motion. It is also an innovative technique in these joints with a short learning curve. The technique can be safely and effectively performed in a physiatry consulting room.

Hidrodilatación capsular versus cinesiterapia como tratamiento inicial en las capsulitis de dedos / Capsular hydrodilatation versus kinesitherapy as initial treatment of finger capsulitis

Introducción: Valorar la efectividad de la hidrodilatación capsular en las articulaciones interfalángicas proximales o en las metacarpofalángicas precozmente para mejorar la rigidez articular y acortar el tratamiento cinesiterápico. Secundariamente, mejorar la funcionalidad. Material y método: Estudio cuasiexperimental antes-después con grupo control de un año de duración de pacientes con capsulitis en las metacarpofalángicas o interfalángicas proximales en fase 2 o 3 del síndrome de dolor regional complejo. Se incluyen pacientes mayores de 18 años con capsulitis, sin cinesiterapia previa y con escala visual analógica<4 puntos. Realizamos hidrodilatación ecoguiada (HD) más cinesiterapia o solo cinesiterapia. Había 10 pacientes por grupo. Las principales variables son rango articular, empuñadura, escala Michigan Hand Outcomes Questionnaire y número de sesiones de cinesiterapia. Resultados: Basalmente, el rango articular de las articulaciones interfalángicas proximales fue 20° peor en el grupo experimental (p=0,01); el resto de las características basales no mostraron diferencias significativas. La ganancia inmediata con la HD es del 61,71% respecto al rango articular previo (p=0,024). No hubo mejoras significativas en la funcionalidad, excepto en la empuñadura activa, tras la HD (p=0,02) y al mes respecto al grupo control (p=0,014). En el grupo HD la duración media de la cinesiterapia es de 19,6±10,42 (IC 95%) y de 29,4±8,11 (IC 95%) sesiones en el grupo control (p>0,05). Conclusiones: La HD capsular podría considerarse como la opción inicial de tratamiento en la rigidez articular, ya que supone una mejora significativa del rango articular de forma inmediata. Es una técnica innovadora en estas articulaciones y con una rápida curva de aprendizaje, que ha demostrado ser segura y efectiva para realizar en una consulta de Rehabilitación

Introduction: To evaluate the effectiveness of early capsular ultrasound-guided hydrodilatation (HD) of the proximal interphalangeal or metacarpophalangeal joints in reducing joint stiffness and shortening kinesitherapy, as well as in improving hand functionality. Material and methods: We performed a one-year quasi-experimental pretest-posttest study with a control group in patients with proximal interphalangeal or metacarpophalangeal capsulitis in complex regional pain syndrome stages 2 or 3. Inclusion criteria consisted of age over 18 years, visual analogue scale<4 points and the absence of prior treatment. The control group received only kinesitherapy and the experimental group received capsular HD before kinesitherapy. There were 10 patients per group. The main measures were range of motion, active grip, Spanish validated Michigan Hand Outcomes Questionnaire and the number of kinesitherapy sessions required. Results: At baseline, the range of motion of the proximal proximal interphalangeal joint was 20° worse in the experimental group (P=.01). There were no statistically significant differences in the other baseline characteristics. Immediate gain in range of motion after HD was 61.71% (P=.024). No significant improvements were observed in functionality except in active grip after 2 weeks of HD (P=.02) and one month later compared with the control group (P=.014). The number of kinesitherapy sessions required was 19.6±10.42 (95% CI) in the HD group and 29.4±8.11 (95% CI) in the control group (P>.05). Conclusions: Capsular HD could be considered as an initial treatment in finger joint stiffness because of the significant immediate improvement in range of motion. It is also an innovative technique in these joints with a short learning curve. The technique can be safely and effectively performed in a physiatry consulting room

Escuela de escoliosis como herramienta de información en escoliosis idiopática del adolescente. Resultados iniciales / Scoliosis school as an information tool in teenagers with adolescent idiopathic scoliosis. Initial results

Introducción. La escoliosis idiopática del adolescente (EIA) es un problema de salud crónico en el que las deformidades y el tratamiento ortésico que precisan en algunos casos pueden afectar negativamente a la calidad de vida de estos pacientes, más aun teniendo en consideración la difícil etapa en la que se encuentran. Objetivo. Creación de una escuela de escoliosis (EE) para intentar mejorar la información que reciben los pacientes con EIA y sus familiares sobre la deformidad, la evolución y los posibles tratamientos, intentando favorecer una mayor adherencia a las terapias y una mejora en su calidad de vida. Material y método. Creación de una EE para pacientes y sus familiares. Estudio cuasi-experimental antes-después de pacientes con EIA que inician tratamiento ortésico durante el año 2015. Evaluamos la escala de conocimientos acerca de la deformidad, la calidad de vida percibida mediante el perfil CAVIDRA y la satisfacción global. Resultados. Un total de 29 pacientes han asistido a la EE; de ellos, 22 eran niñas con una edad media de 12,82±3,72 años. El corsé más utilizado ha sido el Chêneau. Tanto el cuestionario sobre conocimientos como el perfil CAVIDRA mejoraron tras la EE. La satisfacción con el proceso global de información ha sido mayor de 8 en todos los ítems. Conclusiones. La EE puede ser una importante herramienta informativa en pacientes con escoliosis idiopática del adolescente, dada la edad vulnerable que presentan y la complejidad del tratamiento ortésico. Esta herramienta parece mejorar el nivel de conocimientos de la deformidad, la adherencia al corsé y la calidad de vida percibida (AU)

Introduction. Adolescent idiopathic scoliosis (AIS) is a chronic health problem in which trunk deformities and the necessary brace treatment can sometimes negatively affect adolescents’ quality of life, especially given the difficulties of this stage of life. Objective. To create a scoliosis school (SS) in order to improve the information received by AIS patients and their familiars about the deformity, its natural history and possible treatments, as well as to encourage treatment adherence and improve quality of life. Material and method. Creation of an SS for patients and their families. This was a before-after quasi-experimental study of patients with AIS who began brace treatment during 2015. We evaluated knowledge about the deformity, self-perceived quality of life assessed by the CAVIDRA profile and global satisfaction. Results. A total of 29 patients have attended the SS; of these, 22 were girls with a mean age of 12.82±3.72 years. The most commonly used brace was the Chêneau brace. Both the knowledge questionnaire and CAVIDRA scale scores improved after attendance at the SS. Satisfaction with the global information process was above 8 in all items. Conclusions. The SS could be an important information tool in AIS patients due to their vulnerable age and the complexity of brace treatment, improving their knowledge about the deformity, as well as their quality of life and treatment adherence (AU)

Bloqueo ecoguiado del nervio supraescapular en la capsulitis adhesiva de hombro / Ultrasound-guided suprascapular nerve block in adhesive capsulitis of the shoulder

Introducción. Lo prioritario en la capsulitis adhesiva es controlar el dolor para mejorar la evolución y secuelas. Nuestro objetivo es valorar la efectividad del bloqueo ecoguiado en fases 1 y 2 y como tratamiento precoz. Material y métodos. Estudio cuasiexperimental de 41 pacientes con capsulitis y bloqueo ecoguiado del nervio supraescapular entre septiembre de 2012 y diciembre de 2013. Evaluamos Escala Visual Analógica, balance articular y QuickDash inicial, 1, 2 y 3 meses. Resultados. Trece hombres y 28 mujeres, edad media de 56,6 años, con capsulitis unilateral en el 85,4%. Los antecedentes más frecuentes son diabetes mellitus (43,9%) con una evolución más lenta estadísticamente significativa e hipertensión arterial (36,6%). Los tratamientos previos fueron analgesia oral (90,2%), cinesiterapia (78%) e infiltraciones (36,5%). Tras bloqueo el 41,5% fue alta, el 17,1% derivado a traumatología y un 31, 7% continúan en tratamiento con cinesiterapia (60,9%) e infiltración (14,63%). Solo un 9,7% fue derivado a la clínica del dolor por mala evolución. Encontramos una relación significativa entre el bloqueo precoz y evolución más rápida (r = 0,588). Existe mejoría estadísticamente significativa respecto a la Escala Visual Analógica inicial (P50 9) tanto en primer bloqueo (7,5) como en segundo (5); en QuickDASH con 73,3 inicial, 65,9 en primero y 63,6 en segundo; y balance articular en los cuatro rangos de movimiento. Conclusiones. Tanto dolor, funcionalidad como balance articular mejoran tras el bloqueo. Por lo que podemos plantearlo como opción inicial en el tratamiento de capsulitis. No obstante, aconsejamos la realización de nuevos estudios de mayor calidad con guía ecográfica para corroborar nuestros resultados (AU)

Introduction. The main goal in adhesive capsulitis is to control pain in order to iad recovery and minimize sequels. Our aim was to assess the effectiveness of ultrasound-guided nerve block in phases 1 and 2 and as early treatment of this condition. Material and methods. A non-randomized clinical trial was conducted in 41 patients with adhesive capsulitis and ultrasound-guided suprascapular nerve block between September 2012 and December 2013. We analyzed our results according to the visual analogue scale, articular range of motion, and QuickDASH at baseline and at 1, 2, and 3 months. Results. The study group comprised 13 men and 28 women, with a mean age of 56.6 years; 85.4% of them had unilateral capsulitis. The most common antecedents were diabetes mellitus (43.9%), which was statistically significantly associated with slower recovery, and hypertension (36.6%). Previous treatments were oral analgesia (90.2%), kinesitherapy (78%) and infiltration (36.5%). After the blockade, 41.5% recovered, 17.1% underwent surgery, and 31.7% continued kinesitherapy (60.9%) or infiltration (14.63%). Only 9.7% were referred to the pain clinic due to poor recovery. We found statistically significant differences between early nerve block and faster recovery (r = 0.588), and between the initial visual analogue scale (P509) and after the second nerve block (visual analogue scale = 5). The QuickDASH decreased from 73.3 at baseline, to 65.9 at the first block and 63.6 at the second. The four ranges of motion also showed significant differences. Conclusions. Pain, functionality and articular range of motion improved after nerve block, which could therefore be a suitable treatment for adhesive capsulitis. However, further and better-quality ultrasound-guided studies are needed to confirm our results (AU)