[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

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)

Gestión por competencias: acreditación y carrera profesional / Management by competences, professional accreditation and professional career

El II Plan de Calidad de la Consejería de Salud de la Junta de Andalucía recoge, entre sus líneas estratégicas, el desarrollo de los programas de acreditación como el de competencias profesionales, basado en la mejora continua de la calidad y en el progreso y desarrollo profesionales. Esta línea de política sanitaria resulta prioritaria en nuestro ámbito, y ha servido para que en el contrato programa 2009 que va a servir de referente para los objetivos de las unidades de gestión clínica, entre las que se incluye la nuestra, se recoja la necesidad de aumentar en un 25 % el número de profesionales acreditados. Acreditarse significa obtener un reconocimiento, expreso y público, al cumplimiento de estos requisitos necesarios para prestar una atención sanitaria de calidad. La acreditación es un proceso mediante el cual se observa y reconoce en qué forma la atención sanitaria que prestan los profesionales responde al modelo de calidad previa. En este artículo tratamos de reflejar cómo es para un médico rehabilitador andaluz este proceso de acreditación, y cuál es la situación actual de nuestra especialidad con respecto al resto de los profesionales (AU)

The II Quality Plan of the Health Care Council of the Board of Andalusía includes, among its strategic lines, the development of the Accreditation Program and of Professional Competences based on the continuous improvement of quality and on professional progress and development. This line of health care policy is of priority in our setting. Due to it, the contract program 2009 that is going to serve as a reference for the objectives of the clinical management units, among which ours is included, includes the need to increase the number of accredited professionals by 25 %. Accrediting means obtaining express and public recognition on the fulfillment of these requirements that are necessary to provide quality health care. Accreditation is a process that observes how the health care provided by professionals responds to the previous quality model after which recognition is given. In this article, we attempt to reflect how this accreditation process is for an Andalusian rehabilitation doctor and what is the current situation of our specialty in regards to the emaining professionals (AU)