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.

Gestión del conocimiento I: formación universitaria, especializada y formación continuada / Management of knowledge I: university, specializaed training and continuing education

La actividad desarrollada por profesionales y docentes universitarios es primordial para establecer los cauces que coordinen el sistema sanitario y universitario. Las unidades de gestión clínica (UGC) deben promover la participación del profesional en el ámbito asistencial, de gestión, docente e investigador. En la Universidad de Sevilla, la asignatura de principios de medicina física y rehabilitación (MEFYR), vinculada al área de conocimiento de radiología y medicina física, es impartida por 8 profesores especialistas en MEFYR. Una de las máximas preocupaciones de los facultativos dedicados a la MEFYR es la formación de nuevos especialistas. La UGC de Rehabilitación lleva a cabo su actividad docente mediante el desarrollo de un programa tutelado para los residentes, con unos contenidos específicos de formación teóricos (sesión clínica tipo Critical Apraisal Topics [CAT], sesiones clásicas y bibliográficas) y prácticos (manipulaciones). La formación continuada es un proceso de enseñanza y aprendizaje activo y permanente destinado a actualizar y mejorar los conocimientos, habilidades y actitudes de los profesionales sanitarios. La UGC de Rehabilitación, a través de la Comisión de Docencia, organiza e imparte cursos anuales de formación continuada de 30 horas lectivas, contribuyendo a la difusión y conocimiento de nuestra especialidad. Consideramos que las UGC, en el plano docente y formativo, nos proporcionan las herramientas necesarias para mejorar el conocimiento y la calidad de la formación. Desde estas unidades se incentiva: participar en la docencia universitaria, elaborar tesis doctorales y contribuir a la formación especializada y continuada. Se promueven las publicaciones en revistas de impacto y la investigación (AU)

The activity developed by professionals and university teachers is essential to establish the pathways that coordinate the health care and university system. The Clinical Management Units (CMU) should promote the participation of the professional in the areas of care, management, teaching and investigator. In the University of Seville, eight professors who are specialized in Physical and Rehabilitation Medicine Principles (PRMP) teach the subjects of (PRMP) link to the area of knowledge of Radiology and Physical Medicine is given by. One of the maximum concerns of the professionals dedicated to the PRMP is the training of new specialists. The CMU of rehabilitation performs its teaching activities through the development of a tutelary program for the residents, with some specific contents on theoretical training (clinical session type Critical Appraisal Topics (CAT), classical sessions and be a graphical ones) unpractical training (manipulations). The continuing education is an active and permanent teaching and learning process aimed at updating and improving knowledge, skills and attitudes of the health care professionals. The CMU of Rehabilitation, through the Teaching Committee, organizes and gives yearly courses on continuing education with 13 teaching hours contributing to the spreading and knowledge of our specialty (AU)