Impacto de la pandemia por COVID-19 en los Servicios de Rehabilitación de España / Pandemic COVID-19 impact in Rehabilitation Services in Spain

Introducción: El presente estudio tiene como objetivo describir la adaptación de los servicios de Rehabilitación al rápido y significativo incremento de pacientes con COVID-19 con necesidad de valoración y tratamiento rehabilitador. Material y métodos: Estudio transversal. Se realizó una encuesta online entre los principales servicios de Rehabilitación de España entre el 22-12-2020 y el 27-02-2021. Un comité de expertos de SORECAR desarrolló la encuesta. El análisis se realizó utilizando SPSS v22.0. Objetivo: Definir las necesidades y los cambios surgidos a raíz de la pandemia SARS-CoV-2 en los servicios de Medicina Física y Rehabilitación (SMFyR). Resultados: Participaron 38 servicios de Rehabilitación de 18 ciudades (se enviaron encuestas a 49 centros hospitalarios). La demanda asistencial media en Unidad de Cuidados Intensivos fue de 7,84 ± 6,8 hojas de interconsulta (HIC)/semana, planta de hospitalización: 9,63 ± 6,21 HIC/semana de media. En horas de trabajo por semana, el tiempo médico dedicado fue 6,59 h/semana y el tiempo de fisioterapeutas fue de 16,43 h/semana. Ahora el tiempo medio de dedicación en médicos es 10,38 h/semana y en fisioterapeutas es de 25,95 h/semana. Solo 7 hospitales de la muestra (16,7%) cuentan con terapeutas ocupacionales con dedicación media de 5 h/semana.El 59,1% (n = 23) de los casos hay una consulta específica de Rehabilitación post-COVID. El 64,3% (n = 24) de los hospitales afirmaban haber desarrollado un protocolo específico asistencial en el servicio para pacientes COVID-19. Un 48,5% (n = 18) de centros no dispone de rotación específica en Rehabilitación en cuidados intensivos ni en rehabilitación respiratoria para los médicos internos residentes. Solo en rehabilitación respiratoria (15,7%, n = 6), en ambas disciplinas en un 38,4% (n = 14).(AU)

Introduction: The COVID-19 pandemic situation has brought a considerable growth on the amount of patients requiring ICU admissions and long-term hospitalization. The present study is aimed at determining whether Rehabilitation Services has been able to reach a sufficient adaptation level, regarding the exponential increase on the demand of Rehab-related services from intensive care patients and inpatients. Material and methods: Through this cross-sectional research, an online survey was implemented in various Rehabilitation Departments across Spain from December the 22nd, 2020 to February the 12th, 2021. SORECAR (The Spanish Cardiopulmonary Rehabilitation Society) was the responsible entity for the design of the survey (ICU Rehabilitation Services Identification). Descriptive statistical analysis was conducted using SPSS. Objective: To address the specific needs and changes arising from the new COVID-19 pandemic situation within Spanish Rehabilitation Departments. Results: 38 hospitals from 18 cities (From a total of 49) participated in the study. The ICUs weekly demand scored 7.84 ± 6,8 Medical Consultation (MC) on average (range: 2-45). The hospitalization average was displayed as 9, 63 ± 6,2 MC/week (range: 2-55). The total worktime dedicated by physicians was 10.38 h/week, from which physiotherapists stood with 25.95 h/week. Only 7 hospitals (16.7%) counted with occupational therapists (OT) (average dedication of 5 h/week). Each Rehab-session lasted 30 min on average.(AU)

[Pandemic COVID-19 impact in Rehabilitation Services in Spain]. / Impacto de la pandemia por COVID-19 en los Servicios de Rehabilitación de España.

INTRODUCTION: The COVID-19 pandemic situation has brought a considerable growth on the amount of patients requiring ICU admissions and long-term hospitalization. The present study is aimed at determining whether Rehabilitation Services has been able to reach a sufficient adaptation level, regarding the exponential increase on the demand of Rehab-related services from intensive care patients and inpatients. MATERIAL AND METHODS: Through this cross-sectional research, an online survey was implemented in various Rehabilitation Departments across Spain from December the 22nd, 2020 to February the 12th, 2021. SORECAR (The Spanish Cardiopulmonary Rehabilitation Society) was the responsible entity for the design of the survey (ICU Rehabilitation Services Identification). Descriptive statistical analysis was conducted using SPSS. OBJECTIVE: To address the specific needs and changes arising from the new COVID-19 pandemic situation within Spanish Rehabilitation Departments. RESULTS: 38 hospitals from 18 cities (From a total of 49) participated in the study. The ICUs weekly demand scored 7.84 ± 6,8 Medical Consultation (MC) on average (range: 2-45). The hospitalization average was displayed as 9, 63 ± 6,2 MC/week (range: 2-55). The total worktime dedicated by physicians was 10.38 h/week, from which physiotherapists stood with 25.95 h/week. Only 7 hospitals (16.7%) counted with occupational therapists (OT) (average dedication of 5 h/week). Each Rehab-session lasted 30 min on average. 59.1% (n = 23) of the included hospitals had already implemented a specific post-covid follow-up rehab-consultation, whereas 9.1% (n = 4) of them were planning on implementing it. 64.3% (n = 24) of the surveyed centers implemented specific protocols for COVID-19 patients, while another 7.1% (n = 3) were in development progress. 48.5% (n = 18) of the surveyed centers did not owe its own specific training program within its ICUs and respiratory rehab-areas for the internal medical residents. CONCLUSIONS: The pandemic situation has resulted in a substantial increase on the workload in the Spanish Rehabilitation Services. Most of the hospitals included in the present study had already implemented outpatient follow-up consultations. Rehabilitation in critical patients is an exponentially recurrent topic for this medical specialty that needs to be furtherly addressed in the nearby future.

Ruptura bilateral y espontánea de tendones aquíleos. Efectos del tratamiento corticoideo en el sistema musculoesquelético / Bilateral and spontaneous rupture of achilles tendon. Effects of corticosteroid treatment in the musculoskeletal system

El 0,5 % de la población precisa tratamiento con glucocorticoides. A pesar de su indiscutible utilidad, pueden originar múltiples efectos secundarios, entre ellos los musculoesqueléticos como la osteoporosis, la ruptura tendinosa, que es excepcional, la osteonecrosis y la miopatía. Presentamos el caso de una paciente de 72 años con antecedente de asma bronquial que, tras una reagudización de la misma que requirió tratamiento con 5 mg/día de prednisona, presentó dolor y dificultad para la marcha. La exploración hizo sospechar una ruptura bilateral de tendones aquíleos, que se confirmó mediante ecografía y resonancia magnética nuclear (RMN). La incapacidad era grave. Realizando marcha en el domicilio con andador, la puntuación según la escala FIM pasó desde 112 a 120 tras tratamiento quirúrgico y rehabilitador. Ante un paciente en tratamiento crónico con corticoides y patología musculoesquelética es preciso descartar que dicha patología sea consecuencia del consumo de estos fármacos. La ruptura tendinosa espontánea y bilateral es excepcional y muy incapacitante, su tratamiento es quirúrgico y/o rehabilitador

A total of 0.5 % of the population requires treatment with glucocosteroids. In spite of their unquestionable utility, they can cause multiple side effects, among the musculoskeletal ones such as osteoporosis, tendinous rupture which is rare, osteonecrosis and myopathy. 72 year old patient with bronchial asthma background who after its deterioration that required treatment with 5 mg/day of prednisone, subsequently had pain and walking difficulty. The examination led to the suspicion of bilateral rupture of Achilles tendons, that was confirmed by ultrasonography and MRI. The incapacity was serious, having to use a walker at home to walk, the score according to the FIM scale went from 112 to 120 after surgical and rehabilitation treatment. Faced with a patient under chronic treatment with corticosteroids and musculoskeletal disease, it must be ruled out that this disease is due to the consumption of these drugs. Spontaneous and bilateral tendinous rupture is rare and very incapacitating and its treatment is surgical and/or rehabilitation