Private practice model of physiotherapy: professional challenges identified through an exploratory qualitative study.

Introduction Community-based primary care physiotherapy has developed through private practice, fee-for-service model in Aotearoa New Zealand where independent businesses operate in competition. Aim We aimed to explore how the private practice model of physiotherapy impacts patient care, physiotherapists, and professional behaviour. Methods Six physiotherapists managing musculoskeletal conditions in a primary care private practice in Aotearoa New Zealand were recruited using maximum variation purposive sampling. In-depth individual face-to-face semi-structured interviews were audio-recorded, transcribed verbatim, and analysed using Interpretive Description. Inductive data analysis synthesised and contextualised data, creating a thematic framework that developed across interviews. Results All physiotherapy participants discussed concerns about culture and professionalism in private practice physiotherapy despite not being asked about these. Three themes were identified. 'Competitive business model and lack of collaboration' - participants thought that competition between practices resulted in a lack of trust, collegiality, and collaboration, and pressure on clinicians to maintain income. '(Un)professional behaviour' - participants thought that physiotherapists were defensive and averse to scrutiny, resulting in reluctance to admit when they needed help, or to undertake peer review or seek second opinions. 'Lack of support and mentoring' - the professional culture in private practice was perceived to reduce support and mentoring, with negative impacts that affected physiotherapists at all stages of career. Conclusion This exploratory qualitative study suggests that competition dominates communication and collaboration in private practice physiotherapy and may have wider implications for professionalism and the quality of patient care. Competitive business models and an aversion to scrutiny may reduce collegial interaction and professional behaviour.

Impacto de la pandemia de COVID-19 en los síntomas de salud mental y actuaciones de fisioterapia / Impact of the COVID-19 pandemic on mental health symptoms and physiotherapy actions

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La fisioterapia en la crisis sanitaria COVID-19: ¿y si no soy enfermo COVID-19? / Physiotherapy in the COVID-19 health crisis: What if I am not sick with COVID-19?

No disponible

WebPalestra: atuação fisioterapêutica no pré operatório de cirurgia bariátrica

Fisiologia do sistema respiratório. Volumes e capacidades pulmonares. Obesidade como fator de risco. Terapia incentivadora da inspiração.

Recomendaciones para la atención kinésica respiratoria en el contexto de paciente sospechoso y confirmado para Covid-19 en las unidades de Hospitalización Domiciliaria / Recommendations for respiratory physiotherapy in the context of suspicious and confirmed patient for Covid-19 in hospital at home

PROPÓSITO: Ante la crisis sanitaria que vive el país y el mundo actualmente, se confeccionó este documento por la iniciativa autónoma de kinesiólogos de doce unidades de Hospitalización Domiciliaria (HD) de hospitales públicos de Chile, con el fin de unificar criterios en base a sus experiencias y la evidencia científica disponible para poder realizar una atención kinésica respiratoria segura en pacientes con sospecha o confirmados para COVID-19. Además, este documento tiene el objetivo de ser una guía para quienes tengan la necesidad de protocolizar y/o estandarizar su atención en HD, pudiendo ser adaptado según la necesidad y disponibilidad de recursos e infraestructura de cada unidad. Es importante señalar, que este documento puede variar según la evolución de esta pandemia y la actualización de la evidencia científica. CAMPO DE APLICACIÓN: Este documento está diseñado para ser aplicado en el domicilio de los pacientes adultos y pediátricos ingresados a las Unidades de Hospitalización Domiciliaria (UHD) con sospecha de infección por SARS-CoV-2 o con resultado positivo para COVID-19

PURPUSE: Given the health crisis that the country and the world are currently experiencing, this document was prepared by the autonomous initiative of kinesiologists from twelve Hospital at Home units of public hospitals in Chile, in order to unify criteria based on their experiences and the available scientific evidence in order to carry out safe respiratory physiotherapy care in patients with suspected or confirmed COVID-19. In addition, this document is intended to be a guide for those who need to protocolize and / or standardize their care at Hospital at home, and can be adapted according to the need and availability of resources and infrastructure of each unit. It is important to note that this document may vary depending on the evolution of this pandemic and the updating of scientific evidence. SCOPE: This document is designed to be applied in the home of adult and pediatric patients admitted to Hospital at Home Units (UHD) with suspected SARS-CoV-2 infection or with a positive result for COVID-19

Modificaciones en las prácticas de los kinesiólogos de cuidados Críticos durante y después de la Pandemia COVID-19 en Chile: protocolo de una Encuesta Nacional / Modifications in Critical Care Physiotherapists Practices during and after COVID-19 Pandemic in Chile: Study Protocol of a National Survey

ANTECEDENTES: El 11 de marzo de 2020, la Organización Mundial de la Salud declaró la enfermedad por coronavirus (COVID-19) como pandemia, cuyos casos y gravedad en Chile han sido elevados. Internacionalmente, los profesionales de la salud han debido adaptar sus actividades laborales hacia pacientes mecánicamente ventilados por agravamiento de los síntomas respiratorios. La terapia respiratoria y terapia física que realizan los kinesiólogos en la unidad de cuidados intensivos (UCI) es fundamental, y existe la urgencia por agrupar datos nacionales que permitan describir la situación y así prepararse para futuros aumentos de la carga asistencial en UCI. OBJETIVO: Describir las modificaciones institucionales, laborales y asistenciales, experimentadas por kinesiólogos que se desempeñan en UCI durante y después de la pandemia COVID-19 en Chile. MÉTODOS: Este es el protocolo de un estudio observacional analítico transversal, el cual recopilará información desde el inicio hasta un año iniciada la pandemia. Se incluirán todas las UCI adulto existentes y las creadas por contingencia COVID-19. Se excluirán aquellas que no hayan recibido pacientes en UCI con COVID-19 confirmado. Se aplicará una encuesta online (REDCap®) al kinesiólogo representante de cada centro, la cual recopilará la información anonimizada principalmente a través de selección múltiple y escala Likert. RESULTADOS ESPERADOS: Se espera identificar un alto porcentaje de modificaciones institucionales en las UCI de Chile, y kinesiólogos que se vieron en la necesidad decambiar sus condiciones laborales y asistenciales durante la pandemia, en comparación al período pre-pandemia;cambios que en un menor porcentaje se mantuvieron en el tiempo.

BACKGROUND: On March 11, 2020, the World Health Organization declared coronavirus disease (COVID-19) as a pandemic, whose cases and severity in Chile have been high. Worldwide, health staffs have adapted their working activities focusing mainly on mechanically ventilated patients due to respiratory decline. Respiratory therapy and physical therapy by physiotherapists in the intensive care unit (ICU) are essential, and national data needs to be collected to describe the pandemic-related context to prepare for future increases in the ICU demand. OBJECTIVE: To describe the institutional, workforce and healthcare modifications experienced by the ICU physiotherapists during and after the COVID-19 pandemic in Chile. METHODS: This is the protocol of a cross-sectional study, which will collect information from the beginning to 1 year after the pandemic begins. All existing adult ICUs and those ICUs created during the pandemic will be included. Those who have not received ICU patients with confirmed COVID-19 will be excluded. An online survey will be applied to the physiotherapists representing each ICU, which will collect the anonymous information mainly through multiple selection-choice and Likert scale.EXPECTED RESULTS: We will be expected to identify a high percentage of institutional modifications in the ICUs in Chile, and that the physiotherapists would need of changing their working and healthcare conditions during the pandemic, compared to the pre-pandemic period; changes that in a smaller percentage would be maintained over time.

Physiotherapy services in the face of a pandemic

SUMMARY BACKGROUND Physiotherapy services are necessary for hospitalized patients of COVID-19 as well as chronic patients. Thus, physiotherapists present an increased risk of exposure to coronavirus. This study aimed to determine the number of physiotherapists who interrupted their services because of the COVID-19 pandemic and to verify the procedures adopted by the ones who are still working. METHODS The sample comprised 619 physiotherapists who worked in Portugal, 154 (24.9%) male and 465 (75.1%) female, aged between 22 and 67 years (34.47±8.70). The measurement instrument was an on-line questionnaire applied in late March 2020 through contacts and social networks. RESULTS 453 (73.2%) physiotherapists interrupted their work activities in person because of the pandemic and 166 (26.8%) continue to work in person. The main measures adopted by physical therapists who continue to work in person included: hand washing (21.5%), mask use (20.3%), material disinfection (19.3%) and, glove use (19.3%). Of the physiotherapists who are not working in person (n = 453), 267 (58.9%) continue to monitor their patients at a distance, and 186 (41.1%) are not monitoring the patients. The main measures used by physiotherapists to monitor their patients at a distance included: written treatment prescription (38%), making explanatory videos (26.7%), and synchronous video conference treatment (23.5%). CONCLUSIONS Our data revealed that most of the physiotherapists interrupted their face-to-face practices because of the COVID-19 pandemic, however, once they do not follow up their patients' treatment in person, most of them adapted to monitor their patients from a distance.

SUMMARY INTRODUÇÃO Os serviços de fisioterapia são necessários para o tratamento de pacientes hospitalizados com COVID-19 e também para pacientes crônicos. Assim, os fisioterapeutas apresentam um maior risco de exposição ao coronavírus. O objetivo deste estudo foi determinar o número de fisioterapeutas que interromperam seus serviços devido à pandemia do COVID-19 e verificar os procedimentos adotados pelos fisioterapeutas que continuam trabalhando. METODOLOGIA A amostra foi constituída por 619 fisioterapeutas, que trabalhavam em Portugal, sendo 154 (24,9%) do sexo masculino e 465 (75,1%) do sexo feminino, com idades compreendidas entre os 22 e 67 anos (34,47 ± 8,70 anos). O instrumento de medida utilizado consistiu num questionário online, tendo sido aplicado em finais de março de 2020, através de contatos e redes sociais. RESULTADOS 453 (73.2%) fisioterapeutas interromperam as suas atividades laborais de forma presencial por causa da pandemia e 166 (26.8%) continuam a trabalhar presencialmente. As principais medidas adotadas pelos fisioterapeutas que continuam a trabalhar presencialmente incluíram: lavagem das mãos (21.5%), uso de máscaras (20.3%), desinfecção do material (19.3%) e uso de luvas (19.3%). Dos fisioterapeutas que não estão a trabalhar presencialmente (n=453), 267 (58.9%) continuam a acompanhar os seus pacientes à distância e 186 (41.1%) não estão a acompanhar os pacientes. As principais medidas utilizadas pelos fisioterapeutas para acompanhar os seus pacientes à distância incluíram: prescrição do tratamento por escrito (38%), realização de vídeos explicativos (26.7%) e tratamento por videoconferência de forma síncrona (23.5%). CONCLUSÕES Os dados do presente estudo revelaram que a maioria dos fisioterapeutas interromperam as suas práticas presenciais em virtude da pandemia COVID-19, no entanto, apesar de não estarem a acompanhar os seus pacientes pessoalmente, a maioria deles elaborou ferramentas para monitorar seus pacientes à distância.

Características de los profesionales kinesiólogos y carga laboral: encuesta transversal de las Unidades de Cuidados Intensivos adulto en Chile / Characteristics of physiotherapy staffing levels and caseload: a cross-sectional survey of Chilean adult Intensive Care Units

INTRODUCCIÓN: La Sociedad Europea de Medicina de Cuidados Intensivos recomienda la presencia de un Kinesiólogo con formación especializada, disponible cada cinco camas de alta complejidad, los 7 días de la semana en la Unidad de Cuidados Intensivos (UCI). En Chile se desconoce la adherencia de las UCI adulto a esta recomendación. OBJETIVO: Describir las características administrativas y de cobertura kinésica en las UCI adulto chilenas, y de acuerdo con la adherencia a las recomendaciones internacionales, informar a los tomadores de decisión en salud. MÉTODOS: Estudio observacional transversal, basado en encuesta telefónica. Se incluyeron las UCI adultos de establecimientos de mayor complejidad, clínicas privadas y centros asociados a universidades (n = 74). La proporción de instituciones con disponibilidad de kinesiólogos las 24 horas del día, los siete días de la semana (kinesiólogo 24/7), con un número máximo de cinco pacientes por kinesiólogo y presencia de un kinesiólogo especialista fueron reportados. RESULTADOS: La tasa de respuesta fue del 86,5% (n = 64), principalmente públicas (59%) y de nivel III (83%). El 70% (n = 45) de las UCI adulto chilenas cuentan con kinesiólogo 24/7; correspondiendo el 87% al sector público y el 46% al privado. El 41% de los centros posee un máximo de 5 pacientes por kinesiólogo en día hábil diurno, disminuyendo en fines de semana y horarios nocturnos. Un 23% de las UCIs cuenta con kinesiólogo especialista en intensivo, siendo mayor en el sector privado (31%). CONCLUSIONES: En UCI adulto chilenas, la disponibilidad de kinesiólogos 24/7 es alta, y la prevalencia de especialistas es baja. Estrategias de creación de programas de formación de especialidad podrían contribuir a disminuir la brecha de especialistas.

INTRODUCTION: The European Society of Intensive Care Medicine recommends the presence of a specialist physiotherapist, available every five beds, seven days a week in the high complexity Intensive Care Unit. However, in Chile the adherence of adult Intensive Care Units to this recommendation is unknown. OBJECTIVE: To describe the organizational characteristics and the physiotherapist availability in adult Intensive Care Units in Chile, and according to the adherence to international recommendations, inform health decision-makers. METHODS: Observational study based on a telephone survey. All adult Intensive Care Units institutions of high complexity, private hospitals and teaching health centers in Chile were eligible (n = 74). The primary outcome measures were the proportion of institutions with physiotherapist availability 24 hours a day and seven days a week (24/7 physiotherapist), a maximum caseload per physiotherapist of five patients and the presence of a specialist physiotherapist. RESULTS: Response rate was 86.5%, with 59% of responding units being public and 83% offering level III care. 70% of the adult Intensive Care Units in Chile have 24/7 physiotherapist (87% of the public and 46% of the private sector). 41% of the centers had a maximum caseload per physiotherapist of five patients during the day on weekdays. This number decreased on weekends and during night shifts. 23% of the Intensive Care Units had a specialist physiotherapist, being more common in the private sector (31%). CONCLUSIONS: In Chilean adult ICU, 24/7 physiotherapist availability is high, the prevalence of physiotherapists with specialist training is low. Future efforts should focus on promoting the uptake of specialist training.

Medición del gasto energético en pruebas submáximas de valoración funcional mediante acelerometría / Measurement of energy expenditure in submaximal functional assessment tests through accelerometry

Introducción: La valoración funcional del paciente es un elemento relevante en la práctica clínica prestando atención a la desadaptación al ejercicio como consecuencia del proceso patológico. El grado de desadaptación podemos valorarlo mediante pruebas de campo, como las pruebas ISWT y 6MWT. La acelerometría puede ser una herramienta de utilidad para valorar la actividad física y el consumo energético. El objetivo de este estudio es determinar el gasto energético entre las pruebas de valoración funcional ISWT y 6MWT; analizar las diferencias y el grado de correlación existente entre ellas, teniendo en cuenta el nivel de actividad física de los sujetos. Métodos: Veintiséis sujetos jóvenes sanos realizaron las pruebas ISWT y 6MWT con la colocación de un acelerómetro triaxial en la muñeca que registraba el movimiento. Resultados: Las pruebas ISWT y 6MWT mostraron un consumo distinto para todos los sujetos (p<0,001) y un alto grado de correlación entre ellas (p<0,001) basado en el coeficiente tanto de Pearson como de Spearman. Conclusión: La acelerometría es útil para la medición del gasto energético en pruebas submáximas de valoración funcional, permitiéndonos así relacionar el consumo energético con el nivel de actividad física

Introduction: Functional assessment of patients is a key element of clinical practice because it focuses on impaired adjustment to exercise as a consequence of the pathological process. The degree of impairment can be assessed by field tests such as the incremental shuttle walk test (ISWT) and the 6minute walk test (6MWT). Accelerometry might be a useful tool to evaluate physical activity and energy expenditure. The aim of this study was to determine energy expenditure through the use of ISWT and 6MWT and to analyse the differences and correlation between them, bearing in mind the participants' level of physical activity. Methods: A total of 26 healthy young participants performed the ISWT and 6MWT functional assessment tests while wearing a triaxial accelerometer on their wrists that recorded their movements. Results: The ISWT and 6MWT showed different expenditure levels for each participant (P<.001) and a high correlation between them (P<.001) based on both Pearson and Spearman coefficients. Conclusion: Accelerometry is useful for measuring energy expenditure in submaximal functional assessment tests, allowing us to relate energy consumption to physical activity

La implantación de unidades de rehabilitación cardiaca mejora y prolonga la reinserción sociolaboral / The introduction of cardiac rehabilitation units improves and prolongs social and occupational reintegration

No disponible

Methodological quality of randomized clinical trials of respiratory physiotherapy in coronary artery bypass grafting patients in the intensive care unit: a systematic review

Abstract Objective: To assess methodological quality of the randomized controlled trials of physiotherapy in patients undergoing coronary artery bypass grafting in the intensive care unit. Methods: The studies published until May 2015, in MEDLINE, Cochrane and PEDro were included. The primary outcome extracted was proper filling of the Cochrane Collaboration's tool's items and the secondary was suitability to the requirements of the CONSORT Statement and its extension. Results: From 807 studies identified, 39 were included. Most at CONSORT items showed a better adequacy after the statement's publication. Studies with positive outcomes presented better methodological quality. Conclusion: The methodological quality of the studies has been improving over the years. However, many aspects can still be better designed.

Prescription medication by physiotherapists: a Brazilian view of the United Kingdom, Canada, Australia and New Zealand / Prescrição de medicamentos por fisioterapeutas: um olhar brasileiro sobre o Reino Unido, Canadá, Austrália e Nova Zelândia

Abstract Many health systems (HS) have adopted novel models of care which have included non-medical prescription (NMP) by physiotherapists. The aim of this study was to verify in the literature the existence of this practice and its possible benefits. A literature review was carried out through search on Science Direct, PubMed, SciELO, Lilacs and Google Scholar, and in the World Confederation for Physical Therapy and Chartered Society of Physiotherapy websites. In recent decades the United Kingdom adopted the NMP for health professionals, followed by Canada. In Australia and New Zealand physiotherapists have acted in the prescription and administration of medications under medical orders, which is the first step into independent prescription. Brazilian physiotherapists cannot prescribe any medication, despite of high demands from patients in the Brazilian HS, shortage of physicians in many regions and bureaucracy in accessing health services. The adoption of NMP by physiotherapists may play an important role in the HS, and it seems to be an inevitable achievement in the next years in Australia and New Zealand. The main benefits include decreasing bureaucracy for assistance, population demands for medication as well as major professional refinement.

Resumo Alguns sistemas de saúde (SS) têm adotado modelos inovadores de assistência que incluem a prescrição não médica (PNM) por fisioterapeutas. Este estudo objetivou verificar na literatura a existência dessa prática e seus possíveis benefícios. Foi realizada revisão da literatura, com buscas na Science Direct, PubMed, SciELO, Lilacs e Google Scholar, e nos sites da World Confederation for Physical Therapy e da Charthered Society of Physiotherapy, entre 2014 e 2015. O Reino Unido adotou a PNM por fisioterapeutas em décadas recentes, exemplo seguido pelo Canadá. Na Austrália e Nova Zelândia, fisioterapeutas têm atuado na prescrição e administração de medicamentos, sob ordens médicas, sendo este o primeiro passo para a prescrição independente. Fisioterapeutas brasileiros não podem prescrever medicamentos, apesar das altas demandas de pacientes, carência de médicos em muitas regiões e burocracia no acesso aos serviços de saúde. A prática da PNM por fisioterapeutas pode preencher um importante papel nos SS, e parece ser uma inevitável realização na Austrália e Nova Zelândia nos próximos anos. Os principais benefícios são a diminuição da burocracia no acesso a medicamentos e demandas populacionais, bem como maior refinamento profissional.

Vértigo posicional paroxístico benigno y su tratamiento con maniobras de reposicionamiento: revisión sistemática / Benign paroxysmal positional vertigo and its treatment with repositioning manoeuvres: a systematic review

Con el objetivo de revisar los resultados recientes obtenidos tras la aplicación de maniobras de reposicionamiento en el tratamiento del vértigo posicional paroxístico benigno (VPPB), se realizó una búsqueda de enero de 2010 a mayo de 2016 en Medline, Scopus, Web of Science, CINAHL y PubMed. Los criterios de inclusión fueron: estudios con pacientes afectados por VPPB, a los que se les realizase una maniobra de reposicionamiento, y con resultados pre- y postintervención. Se obtuvieron 17 estudios. Estos resaltan que el canal semicircular posterior es el más afectado habitualmente, que el VPPB afecta más a mujeres y durante la sexta y séptima décadas de la vida, que el principal test de valoración empleado es el de Dix-Hallpike y que la maniobra de Epley es la más usada y parece que más efectiva. Sin embargo, se precisa protocolizar las pautas diagnósticas y de tratamiento del VPPB, teniendo en cuenta que hay resoluciones espontáneas, afectación de otros canales semicirculares distintos al posterior o pueden existir contraindicaciones a determinados movimientos en algunos pacientes. Además, son necesarios estudios de mayor calidad metodológica (AU)

This study aimed to review current evidence on the results obtained after implementation of repositioning manoeuvres in the treatment of benign paroxysmal positional vertigo (BPPV). To do this, a search was made of Medline, Scopus, Web of Science, CINAHL and PubMed databases for articles published from January 2010 to May 2016. Inclusion criteria consisted of studies in patients with BPPV treated with a repositioning manoeuvre, and with pre- and postintervention results. Seventeen studies were obtained. The main results indicate that the posterior semicircular canal is usually the most affected site and that BPPV is more common in men than in women and during the sixth and seventh decades of life; the main test used is the Dix-Hallpike test and the most widely used manoeuver is the Epley manoeuvre, which seems to be the most effective. However, guidelines on the diagnosis and treatment of BPPV should be protocol-based, considering that the condition sometimes resolves spontaneously, there may be involvement of other semicircular canals, and certain movements may be contraindicated in some patients. There is a need for studies with higher methodological quality (AU)

Eficacia del uso del calzado inestable en la calidad de vida de pacientes con linfedema de miembro inferior. Estudio piloto / Effectiveness of the use of unstable shoes in improving quality of life in lower limb lymphedema. A pilot study

Introducción. El linfedema se produce por una alteración en la circulación linfática. La bomba muscular y articular juegan un papel importante en dicha circulación, constituyendo mecanismos extrínsecos para favorecer el retorno, tanto venoso como linfático. El uso del calzado con suela inestable puede activar y fortalecer la musculatura de los miembros inferiores potenciando ambos mecanismos. El objetivo es evaluar la eficacia del uso del calzado con suela inestable en la calidad de vida en pacientes con linfedema de miembro inferior. Material y métodos. Se diseñó un ensayo clínico, controlado y aleatorizado, a doble ciego. Al tratamiento habitual del linfedema se añadió el uso de los zapatos con suela inestable (MBT®) al grupo experimental, para realizar las actividades diarias. Al grupo control se añadió el uso de zapatillas deportivas normales. Se reclutaron 21 sujetos. Se utilizó la encuesta EQ-5D de calidad de vida. Para el análisis comparativo se utilizó la t de Student. Resultados. Diecisiete sujetos completaron el estudio, de los cuales 10 usaron MBT® y 7 calzado deportivo convencional. Después de la intervención, ambos grupos mostraron un aumento de la puntuación media del cuestionario. Sin embargo, en el grupo que utilizó el calzado con suela inestable, el incremento fue de 18 puntos (p=0,003), frente a 11,4 (p=0,18) del grupo control. Conclusiones. Se puede considerar que el uso del calzado con suela inestable puede contribuir a mejorar la calidad de vida del paciente con linfedema del miembro inferior (AU)

Introduction. Lymphoedema is due to a lymph circulation disorder. Muscle and joint pumps are important extrinsic mechanisms of both lymphatic and venous return. The use of unstable shoes can activate and strengthen the muscles in the lower limbs, thus activating both mechanisms. The aim of this study was to evaluate the effectiveness of unstable shoes in improving quality of life in patients with lower limb lymphoedema. Material and methods. A double blind, randomised controlled trial was designed. In addition to their usual lymphoedema treatment, persons in the experimental group wore unstable shoes (MBT®) during their activities of daily living. The control group was given regular trainers. A total of 21 participants were recruited. Quality of life was measured using the EQ-5D questionnaire. Student's t- test was used for comparisons between groups. Results. Seventeen participants completed the study, of whom 10 used unstable shoes and 7 used another type of trainers. After the intervention, both groups showed an increase in mean quality of life scores. However, the mean score increased by 18 points in the group wearing MBT shoes (p=.003) and by 11.4 points in the control group (p=.18). Conclusions. The results of this study show that this kind of footwear may help to enhance quality of life in people with lower limb lymphoedema (AU)

Análisis descriptivo de la fisioterapia respiratoria en España / Descriptive analysis of respiratory physiotherapy in Spain

Introducción. La fisioterapia respiratoria (FR) consiste en un conjunto de estrategias destinadas a la prevención, el tratamiento y la estabilización de las alteraciones cardiorrespiratorias en pacientes adultos y pediátricos. El objetivo del presente estudio fue describir la situación de la FR en España en el ámbito asistencial, docente, y de investigación. Métodos. Se diseñó un cuestionario on-line para obtener información sobre la implementación de la FR en España en los ámbitos asistencial, docente, y de investigación. El cuestionario quedó disponible on-line entre octubre de 2010 y enero de 2011 para todos aquellos profesionales interesados en contestarlo. Solo se aceptaron respuestas de fisioterapeutas titulados que vivían y trabajaban en España, a razón de una respuesta por persona. Resultados. Se obtuvieron 793 respuestas válidas a partir de las cuales se determinó que un 67,8% del total de participantes estaban vinculados asistencialmente a la FR. De estos, un 79,3% lo hacían de manera esporádica y solo un 50,4% tenían formación específica. Los tratamientos de FR se realizaban básicamente en hospitales (35,5%), centros privados (31%) o en el domicilio del paciente (16,9%). Un 16,4% de los participantes estaban vinculados a docencia en FR y tenían amplia formación específica. Solo un 11,7% de los encuestados estaban involucrados en proyectos de investigación relacionados con FR, pero generalmente lo hacían de manera esporádica y en combinación con tareas asistenciales o docentes. Conclusiones. La FR en España tiene una baja implementación y dedicación laboral. El nivel de formación específica de los fisioterapeutas que realizan intervenciones de FR es aceptable aunque limitado (AU)

Introduction. Respiratory physiotherapy (RP) consists of a combination of strategies aiming to prevent, treat and stabilize cardiorespiratory disorders in adult and pediatric patients. The aim of this study was to describe RP in Spain in the settings of clinical practice, teaching and research. Methods. An on-line questionnaire was designed to obtain information about the implementation of RP in Spain in settings such clinical practice, teaching and research. The questionnaire was available on-line between October 2010-January 2011 to all professionals interested in completing it. Only responses from graduate physiotherapists living and working in Spain were accepted, at a rate of one answer per person. Results. A total of 793 valid answers were obtained, revealing that 67.8% of the respondents were involved in RP in clinical practice, but that 79.3% of respondents practicing RP did so occasionally and only 50.4% had specific RP training. RP treatments were mostly implemented in hospitals (35.5%), private centers (31%) or at patients’ homes (16.9%). Overall, 16.4% of the participants were involved in RP teaching, and most of them had specific training in RP. Only 11.7% of the respondents were involved in research projects related to RP, and most of this participation was sporadic or combined with clinical or teaching tasks. Conclusions. Respiratory physiotherapy is not widely implemented or practiced in Spain. Professionals providing RP interventions have an acceptable level of training but training is scarce (AU)

Manejo fisioterapéutico del dolor en personas quemadas en sus tres fases de recuperación. Revisión sistemática / Physical therapy pain management in burned in three stages of recovery. Systematic review

Introducción: Los equipos interprofesionales especialistas en el abordaje de personas con quemaduras deben tener presente la fisioterapia como una de las primeras opciones terapéuticas en el tratamiento del dolor, ya que es clave importante en el manejo del dolor, puesto que contribuye a disminuir la tasa de complicaciones, atenuar la respuesta al estrés por quemadura y por la estancia hospitalaria, y su manejo facilita la ejecución de otras técnicas terapéuticas que permitan el abordaje sin generar el trauma que implica la coexistencia del dolor y favorecer la calidad de vida de las personas afectadas. Objetivo: Realizar una revisión sistemática para el manejo fisioterapéutico del dolor de la persona quemada en sus tres fases de recuperación. Metodología: Revisión sistemática de la literatura para la identificación de la mejor evidencia disponible en torno a los estudios realizados hasta la fecha, que demuestren evidencia científica sobre la efectividad del manejo fisioterapéutico del dolor en personas quemadas para reducir el impacto que genera en el proceso de recuperación funcional. Resultados: Se encontró disminución del dolor con el uso de realidad virtual para variables, como cambios en la percepción del dolor durante el cambio de vendajes de -1,81 %, cambios en el tiempo invertido en pensar en el dolor durante el cambio de vendajes -19,47 % y cambios en el rango de movimiento de 1 %. Conclusiones: La escasa evidencia existente sugiere que los procedimientos para la disminución del dolor en personas quemadas, en especial las terapias de distracción, el uso de la realidad virtual, el masaje y la terapia de distracción mandibular, son las más utilizadas, las cuales generan disminución en la percepción y calificación del dolor y disminución del tiempo invertido en pensar en éste; sin embargo, los resultados deben observarse con precaución debido al alto riesgo de sesgos de selección y detección y al tamaño de la muestra pequeña en casi todos los estudios (AU)

Introduction: Interprofessional teams specialists in dealing with people with burns must be present as one of the first therapeutic options pain management therefore; Physiotherapy is important in pain management key, since it helps to reduce the rate of complications, reduce the stress response and burn hospital stance and management facilitates the implementation of other therapeutic techniques that allow the approach without generating the trauma of the coexistence of pain and enhance the quality of life of those affected. Aim: To conduct a systematic review for the physiotherapy management of pain of the person burned in three stages of recovery. Methodology: systematic review of literatura to identify the best available evidence regarding the studies to date that demonstrate scientific evidence on the effectiveness of physiotherapy management of pain in people burned to reduce the impact generated in the process functional recovery. Outcome: pain reduction was found with the use of virtual reality as cambios variables in the perception of pain during dressing changes of -1.81 %, changes in invested in thinking about the pain during dressing changes while -19.47 % and changes in the movement range of 1 %. Conclusions: The limited evidence suggests that procedures for reducing pain in people burned in special therapies distraction, the use of virtual reality, massage therapy and mandibular distraction are the most used which generate decreased perception and pain rating and reduced invested in thinking about this time, however, the results should be viewed with caution because of the high risk of selection bias and detection and the small sample size in most studies (AU)

Efectividad de programas educativo-terapéuticos en Fisioterapia / Effectiveness of educational and therapeutic programs in Physiotherapy

El fisioterapeuta aborda la atención terapéutica desde un punto de vista global, teniendo en cuenta todos sus aspectos. Uno de los objetivos principales del tratamiento en fisioterapia pretende disminuir el dolor; así el fisioterapeuta, desde una perspectiva eduativo-terapéutica, participa en actividades físicas para rehabilitar y mejorar la función de diversos sistemas a través de ejercicios específicos, que serán pautados acorde a las necesidades de cada usuario, organizando las sesiones formativas y terapéuticas en función de su evolución. El objetivo fundamental de esta revisión es dar a conocer el beneficio de los programas educativo-terapéuticos en fisioterapia como herramientas frente al dolor. En esta revisión se han incluido todos los artículos encontrados en las bases de PubMed, ENFISPO y PEDro que cumplieran los parámetros de búsqueda. Las consideraciones finales permiten mostrar que la educación para la salud que aporta el fisioterapeuta tiende a mejorar la salud y la calidad de vida de los usuarios (AU)

The physiotherapist addresses the therapeutic care from a global perspective by taking into account all its aspects. One of the main objectives of physical therapy is to reduce pain. Therefore the physiotherapist develops physical activities from an educational-therapeutic perspective in order to rehabilitate and to improve physical functions in various systems with specific exercises. These exercises will be prescribed according to each patient needs by organizing educational and therapeutic sessions based on their progress. The main objective of this review is to present the benefits of educational and therapeutic programs in physiotherapy as tools against pain. In this review we have included all the papers found in PubMed, ENFISPO and PEDro that meet the search parameters. The final considerations show that the health education given by the physiotherapist tends to improve the health and the patients quality of life (AU)

Análisis de la marcha y fisioterapia Bobath en adultos con síndrome de Down / Gait analysis and Bobath physiotherapy in adults with Down syndrome

Introducción. El síndrome de Down (SD) es un trastorno cromosómico de expresión fenotípica variable, aunque con rasgos comunes en los distintos pacientes. Entre ellos, destaca la hipotonía, hiperlaxitud ligamentosa y el retraso en el desarrollo psicomotor. Estos rasgos mejoran con la terapia temprana, pero persisten en forma de inestabilidad de la marcha y compensaciones patológicas en el adulto. La marcha patológica en estos pacientes ha sido objeto de estudios previos, pero el tratamiento de los problemas motores no ha sido abordado desde un enfoque neurorrehabilitador, dirigido a la calidad del funcionamiento. Objetivos. El propósito del presente estudio es describir las alteraciones de la marcha en una muestra de pacientes con SD y evaluar los cambios después del tratamiento con fisioterapia Bobath. Material y métodos. Estudio prospectivo experimental de tipo ensayo no controlado. Diez personas adultas con SD (edad media: 28 años) fueron evaluadas en situación basal y después de 10 sesiones de fisioterapia Bobath. Se recogieron variables cuantitativas (como longitud del paso, velocidad de la marcha) y variables cualitativas (como calidad del braceo o inestabilidad) a través de un evaluador ciego al tratamiento fisioterápico. Resultados. Se encontraron claras desviaciones respecto a la marcha adulta normal y una tendencia a la mejoría después del tratamiento fisioterápico. Esta mejoría fue significativa en la corrección del ángulo y en la simetría del paso. Se pone de manifiesto el potencial beneficio de la fisioterapia en adultos con SD y alteraciones de la marcha, así como la necesidad de realizar más estudios en este sentido (AU)

Introduction. Down syndrome (DS) is a chromosomal disorder with variable phenotypic expression, although different patients share some common features. Among them, hypotonia, ligament laxity and delayed psychomotor development stand out. These traits can improve with early therapy, but remain as gait instability and pathologic compensatory strategies in adult patients. Pathological gait in DS patients has been studied previously, but the treatment of motor problems has not been approached from a neurological rehabilitation viewpoint, focused on quality of function. Objectives. The aim of this study was to describe the gait alterations in a sample of patients with DS and to assess changes after Bobath physiotherapy. Material and methods. An experimental prospective uncontrolled study was performed. Ten adults with DS (mean age: 28 years) were assessed at baseline and after 10 sessions of Bobath physiotherapy treatment. Quantitative data (such as step length or walking speed) and qualitative data (such as characteristics of arm movements and instability) were recorded by an evaluator blinded to the treatment received. Results. Clear deviations with respect to normal adult gait were found, and a trend towards improvement after physiotherapy treatment. The results were significant in the correction of pitch angle and its symmetry. The study has revealed the potential benefits of physiotherapy in adults with DS and the need to complete more studies in this sense (AU)

Baropodometria dinâmica de atletas remadores, com sinais e sintomas de disfunção temporomandibular, pré e pós tratamento, com placa oclusal estabilizadora e exercício terapêutico de movimento mandibular: estudo piloto / Dynamic baropodometry in rowing athletes refering signs and symptoms of temporomandibular joint dysfunction before and after using an occlusal splint associated to therapeutic mandibular exercise: pilot study

A desordem temporomadibular em atletas da modalidade do remo é uma temática ainda pouco abordada na literatura, muito embora se tenha conhecimento que a biomecânica do gesto esportivo possa provocar dores lombares, fratura de costela devido ao estresse, além de dores cervicais provenientes do desprendimento de força, para atingir grande velocidade e manutendo o equilíbrio por um longo tempo. O presente estudo tem como objetivo analisar, por meio da baropodometria dinâmica, a ação da placa oclusal estabilizadora associada ao exercício terapêutico de movimento mandibular em atletas remadores diagnosticados como portadores de desordem temporomandibular (DTM). Estudos prévios demonstram que um dispositivo intraoclusal (placa oclusal estabilizadora) tem ação significante sobre o sistema de manutenção do equilíbrio corporal na postura estática. Trinta indivíduos remadores apresentaram-se como voluntários com queixa de dor, sendo 10 deles (40% homens e 60% mulheres), com idade entre 24 e 35 anos foram diagnosticados com DTM por meio do preenchimento do questionário RDC/TMD e de exame clínico. O presente estudo piloto foi caracterizado por ser um ensaio clínico, randomizado, controlado, prospectivo e de intervenção. Imediatamente após aplicação do questionário e do exame clínico, todos os indivíduos realizaram testes de

baropodometria estática e dinâmica. Após esta etapa, realizou-se a randomização dos grupos por meio de software online gratuito (www.random.org) que determinou os integrantes do grupo controle, denomindado de Grupo Exercício (GE) e grupo teste denominado de Grupo Placa (GP). Ambos os grupos receberam orientação para a realização do exercício terapeutico de movimento mandibular. Definidos os integrantes do GP, foram realizados agendamento para a realização da etapa de confecção da placa oclusal. Os grupos foram monitorados por 12 semanas e após este período foram reavaliados segundo os mesmos parâmetros da etapa inicial. A análise estatísitca foi realizada utilizando o modelo ANOVA (normalidade e homoscedasticiodade),teste T-Student e teste não paramétrico de Wilcoxon. Os resultados apresentaram significância estatística na redução da dor e aumento da amplitude articular da articulação temporomandibular (ATM) no GP (p<0,05). Não foi observada significância estatísitica na análise da pressão plantar dinâmica, justificado pelo fato da insuficiência do número de invidíduos da amostra. Concluiu-se que o uso da placa oclusal foi eficaz no tratamento da DTM pela redução do quadro doloroso, entretanto, uma amostragem maior se faz necessária pra a verificação da integração entre sistema estomatognático e postural na dinâmica da marcha.

Temporomadibular joint disorder (TMJD) in rower athletes has still few studies over this theme, where the biomechanics of athletic gesture points can produce low back pain, rib stress fractures and cervical pain as resulting from power requirement to obtain high speed and body balance for repeatedly long period exercises. The aim of this study was to analyze through dynamic plantar pressure the effects of occlusal splint and therapeutic exercise of mandibular movement in rowers diagnosed as suffering from TMJD. Previous studies have shown that the occlusal splint has significant action to keep the system of body balance in standing position. 30 rower athletes came as volunteers with pain symptoms, and 10 individuals, 40% men ande 60% women, aged between 24 and 35 years, were diagnosed with TMJD through completion of the RDC/TMD questionnaire and clinical examination. The research was performed by a randomized controlled prospective clinical study besides intervention. Immediately after the questionnaire application and clinical examination, all individuals performed tests of static and dynamic baropodometry. After this procedure, the groups were randomized by using a free online software (www.random.org) which determined the

members of control group, named Exercise Group (EG) and test group called Oclusal Splint Group (OSG). Both groups received guidance for performing only therapeutic exercise of mandibular movement. The OSG were scheduled for the completion of preparation stage for occlusal splint. All groups were monitored for 12 weeks and after this period were evaluated according to the same parameters of the initial step. Statistic analysis was performed by using ANOVA model (normal and homoscedasticity), t-Student test and Wilcoxon nonparametric test. The results showed statistical significance to pain relief and increase of amplitude range of jaw joint in OSG (p < 0.05). No statistical significance was observed in the analysis of dynamic plantar pressure, justified by insufficient statistic population. In conclusion the use of occlusal splint was effective in the treatment of TMJD to pain relief, however, a larger sampling is necessary to verify the integration among stomatognatic system, posture and and gait dynamics analyzes.

Actualización sobre los efectos de los estiramientos en la lumbalgia: una revisión sistemática / Update on the effects of stretching in low back pain: a systematic review

Objetivo: Analizar la literatura científica actual para conocer los efectos de los estiramientos en pacientes con lumbalgia. Estrategia de búsqueda: La búsqueda se llevó a cabo en enero de 2014 en Medline, CINAHL, Scopus, WOS, LILACS y PubMed. Selección de los estudios: Se obtuvieron un total de 350 artículos publicados entre 2009 y 2014, y aplicando los criterios de inclusión y exclusión, 12 fueron válidos para la revisión. Resultados: En muchos de los artículos seleccionados se realizaron estiramientos de la musculatura de la cadena posterior, en uno de ellos se hizo estiramiento del tejido nervioso, y otro comparó estiramientos musculares con movilización neural. Conclusiones: Los estiramientos, en general, obtienen resultados positivos. La calidad metodológica de los artículos analizados fue baja, por lo que serían necesarios más estudios de mejor calidad y con tamaños de muestra más amplios que verificasen los buenos resultados

Objective: To analyze the current scientific evidence to know the effects of stretching in patients with low back pain. Research strategy. The research was carried out in January 2014 using Medline, CINAHL, Scopus, WOS, LILACS and PubMed. Study selection: A total of 350 papers, published between 2009 and 2014, were review. Of these, 12 were finally selected for review after applying the inclusion and exclusion criteria. Results: Stretching of posterior muscle chain was done in many of the articles. In one article, the nervous tissue was stretched, and in another, muscle stretching was compared with neural mobilization. Conclusions: In general, stretching resulted in positives results. The methodological quality of the papers analyzed was low. Therefore, more studies with better quality and larger samples sizes are needed to verify the good results