Impacto de la COVID-19 en la salud del paciente poscrítico / Impact of the COVID-19 on health of critical patient

Introducción: Muchos pacientes perciben síntomas persistentes y deterioro en su calidad de vida tras la COVID-19. El paciente crítico es vulnerable a presentar alteraciones físicas y emocionales. El objetivo de este estudio fue valorar la situación funcional y la calidad de vida del paciente poscrítico por la COVID-19. Métodos: Se ha realizado un estudio multicéntrico longitudinal prospectivo en pacientes hospitalizados críticos por la COVID-19 con un seguimiento a 6 meses. Se han recogido variables sociodemográficas, comorbilidad, síntomas persistentes, escala SPPB; repercusión respiratoria y TAC pulmonar, índice de Barthel; variables neuropsicológicas, actividad física (escala IPAQ); calidad de vida (EuroQoL), y satisfacción. Resultados: Se han incluido 115 pacientes. El 75% son varones y el 86% obesos o con sobrepeso. El tiempo medio de hospitalización fue de 38,1±18,4 días, precisando ventilación mecánica el 80,9%. El 25% necesitaba ayuda de otra persona para su autocuidado al alta. El 29,2% presentaba normalidad en la TAC pulmonar a los 134,1+70,9 días. A los 6 meses la recuperación funcional fue favorable, aunque el 36,5% percibía debilidad muscular y el 22% presentaba fragilidad. Un 36,5% de los pacientes refirieron falta de concentración. La dimensión más afectada en la calidad de vida fue la referida al dolor (53%), seguida de la ansiedad o depresión. La mayoría realizaba actividad física baja. La satisfacción por el seguimiento clínico fue elevada. Conclusiones: En los pacientes poscríticos por la COVID-19, a los 6 meses del alta hospitalaria prevalecen alteraciones físicas, funcionales y en la calidad de vida.(AU)

Introduction: Many patients perceive persistent symptoms and impairment in their quality of life after COVID-19. The critical patient is vulnerable to presenting physical and emotional alterations. The objective of this study is to assess the functional evolution and quality of life of the critical patient due to COVID-19. Methods: A prospective longitudinal multicenter study was carried out in critically ill hospitalized patients due to COVID-19 with a 6 month follow-up. Sociodemographic variables, comorbidity, the persistence of symptoms, SPPB scale, pulmonary and respiratory impact, CT scan, Barthel index, neuropsychological variables, physical activity (IPAQ scale), quality of life (Euroqol), and satisfaction were collected. Results: 115 patients were included. 75% are male and 86% are obese or overweight. The average time of hospitalization was 38.1±18.4 days, with 80.9% requiring mechanical ventilation. 25% need help from another person for self-care at discharge. 29.2% had a normal CT lung screening at 134.1+70.9 days. At 6 months, functional recovery is favorable, although 36.5% perceive muscle weakness and 22% present fragility. 36.5% of patients report a lack of concentration. The most affected dimension in quality of life is that referred to pain (53%), followed by anxiety or depression. Most perform low physical activity. Satisfaction with clinical follow-up is high. Conclusions: In post-critical patients due to COVID-19, physical, functional, and quality of life alterations prevail at 6 months after hospital discharge.(AU)

[Impact of the COVID-19 on health of critical patient]. / Impacto de la COVID-19 en la salud del paciente poscrítico.

INTRODUCTION: Many patients perceive persistent symptoms and impairment in their quality of life after COVID-19. The critical patient is vulnerable to presenting physical and emotional alterations. The objective of this study is to assess the functional evolution and quality of life of the critical patient due to COVID-19. METHODS: A prospective longitudinal multicenter study was carried out in critically ill hospitalized patients due to COVID-19 with a 6 month follow-up. Sociodemographic variables, comorbidity, the persistence of symptoms, SPPB scale, pulmonary and respiratory impact, CT scan, Barthel index, neuropsychological variables, physical activity (IPAQ scale), quality of life (Euroqol), and satisfaction were collected. RESULTS: 115 patients were included. 75% are male and 86% are obese or overweight. The average time of hospitalization was 38.1±18.4 days, with 80.9% requiring mechanical ventilation. 25% need help from another person for self-care at discharge. 29.2% had a normal CT lung screening at 134.1+70.9 days. At 6 months, functional recovery is favorable, although 36.5% perceive muscle weakness and 22% present fragility. 36.5% of patients report a lack of concentration. The most affected dimension in quality of life is that referred to pain (53%), followed by anxiety or depression. Most perform low physical activity. Satisfaction with clinical follow-up is high. CONCLUSIONS: In post-critical patients due to COVID-19, physical, functional, and quality of life alterations prevail at 6 months after hospital discharge.

Versión española del Swallowing Quality of Life Questionnaire: fase inicial de adaptación transcultural / Spanish version of the Swallowing Quality of Life Questionnaire (SWAL-QoL): Initial phase of cross-cultural adaptation

Introducción. El objetivo de este trabajo es realizar una versión en español del Swallowing Quality of Life Questionnaire (SWAL-QoL), desde su versión original en inglés, como fase inicial del proceso de adaptación transcultural a la población española. Material y métodos. El SWAL-QoL es un cuestionario autoadministrado diseñado para evaluar la calidad de vida en los pacientes afectos de disfagia orofaríngea. Consta de 44 ítems divididos en 11 dominios diferentes. Para la adaptación del cuestionario al castellano se ha utilizado el proceso de traducción-retrotraducción, valoración de la equivalencia semántica y conceptual por un comité multidisciplinar y estudio piloto en 5 pacientes afectos de disfagia orofaríngea. Resultados. Veintiocho ítems (63%) se consideraron literales, 15 ítems (34%) se describieron como semejantes y un ítem (2%) se consideró diferente. Tras realizar el estudio piloto no fue necesario modificar ningún ítem del cuestionario. La comprensión de los ítems adaptados al español fue correcta y los pacientes emplearon un tiempo medio de 21 ± 5 min en completar el cuestionario. Conclusiones. Hemos obtenido una versión en castellano del SWAL-QoL conceptualmente equivalente a la versión original, de uso relativamente sencillo y buena aceptación en la práctica clínica diaria, completando la primera fase de adaptación transcultural a la población española, quedando pendiente su validación para comprobar su validez y fiabilidad(AU)

Introduction. This project has aimed to obtain a Spanish version of the Swallowing Quality of Life Questionnaire (SWAL-QoL). We used the original English version as a starting point in order to begin with the first phase of a cross-cultural adaptation process to be used among Spanish patients. Material and methods. The SWAL-QoL is a self-administered questionnaire designed to evaluate the quality of life among the patients affected by oropharyngeal dysphagia. It is made up of 44 items divided into 11 specific domains. The adaptation of the questionnaire was performed by using a translation and back-translation process, assessment of semantic and conceptual equivalence by a multi-disciplinary committee and a pilot study evaluating 5 patients affected by oropharyngeal dysphagia. Results. Of the items considered, 28 (63%) were considered as having a literal translation, 15 (34%) as being similarly translated and 1 (2%) was considered to be different due to its translation. It was not necessary to change or modify any item of the questionnaire after the pilot study. The comprehension of the items translated into Spanish was correct and the patients took an average time of 21±5 minutes to complete the questionnaire. Conclusions. We have obtained a Spanish version of the SWAL-QoL questionnaire conceptually equivalent to the original English version. Its use is relatively simple with good acceptance in the daily clinical practice. The first step of its cross-cultural adaptation to Spanish patients has been completed, pending its validation in order to prove its validity and reliability(AU)

Valor de la clasificación MSHen el paciente hemipléjico tras un ictus / Value of MSH classification in hemiplegias after stroke

Introducción. Para planificar el tratamiento rehabilitador de los pacientes es necesario conocer su pronóstico de funcionalidad. Objetivo. Comprobar el valor pronóstico de la clasificación MSH para pacientes hemipléjicos, que se basa en los déficit clínicos presentados tras el ictus, y distingue entre un grupo M (déficit motor), un grupo MS (déficit motor y sensitivo) y un grupo MSH (déficit motor, sensitivo y hemianopsia homónima). Pacientes y métodos. Se trata de un estudio analítico prospectivo de los pacientes hemipléjicos ingresados consecutivamente en un Servicio de Rehabilitación, tras un ictus. La exploración inicial se realizó a los 17 días (IC: 15 a 19) del ictus. Se ha considerado como resultado funcional satisfactorio la obtención de un índice de Barthel (IB) >90, así como el logro de una capacidad de marcha independiente por terreno regular al sexto mes de evolución. Resultados. De los 55 pacientes incluidos finalmente en nuestro estudio, 23 de ellos pertenecen al grupo M (41,8 por ciento), 21 pacientes al grupo MS (38,1 por ciento) y 11 pacientes al MSH (20,1 por ciento). La capacidad de deambulación conseguida y la funcionalidad en las distintas cohortes muestran una diferencia estadísticamente significativa. Mientras el 96 por ciento de los pacientes con hemiparesia pura (grupo M) logran un buen nivel de independencia en la deambulación, sólo el 54 por ciento de los pacientes con los tres déficit asociados (grupo MSH) lo consiguen. Mayor diferencia aún se encuentra en la independencia funcional adquirida, ya que, mientras un 82 por ciento del grupo M consiguen un buen grado de autonomía en la realización de las distintas actividades de la vida diaria, en el grupo MSH sólo lo consigue el 18 por ciento. El resto de los pacientes (grupo MS) alcanzan unos resultados intermedios. Conclusión. La clasificación MSH es, en una fase temprana tras el ictus, un medio útil de aproximación al pronóstico de funcionalidad del paciente hemipléjico (AU)

[The evolution and prognosis of disability in patients with hemiplegia]. / Evolución y pronóstico de la discapacidad en pacientes con hemiplejía.

BACKGROUND: In order to plan the objectives of the rehabilitation treatment after a stroke, it is necessary to know the functional prognosis of the patient. The main prognostic factors of disability in the hemiplegic patient, by means of an analysis of his neurological deficits (aphasia, disorientation, urinary incontinence, hemianopsia, sensitive disorders, anosognosia, muscular paresis, and control of trunk) are investigated. PATIENTS AND METHOD: 73 inpatients who were admitted to a Rehabilitation department after suffering a stroke were included. The inpatients clinical and functional evaluation was carried out just when they were admitted to Rehabilitation, in the third month, sixth month, and one year after stroke. The Barthel Index, modified by Shah in 1989, was used to evaluated the degree of disability. RESULTS: Most of the neurological deficits (strength deficit, sensitive deficit, trunk balance, aphasia) show a similar recuperation pattern, with the main recuperation in the third month, and stabilization at about the sixth month after stroke. Fifty-seven percent of the patients reach an elemental level of independence (Barthel Index > 90) in the achievement of the activities of daily living. A severe deficit of strength in the upper extremities or a deterioration of the deep sensitivity mean 9 and 13 times more risk of obtaining a bad functional result, respectively, than the patients who don't have this conditions, independently of other associated clinical deficits. The clinical variables with more prognostic value are the level of paresis (p < 0.001; Rho = 0.66), the sensitive disorders (p < 0.001; Rho = 0.57) and the instability of trunk control (p < 0.001; Rho = 0.53). CONCLUSION: There is not only one clinical variable, but a group of physical deficits which have an influence in the functional prognosis of the hemiplegic patient after stroke. The most relevant variables are the level of paresis, the deficit in deep sensitivity and the deficit in trunk control.

[Value of the MSH classification in the hemiplegic stroke patient]. / Valor de la clasificación MSH en el paciente hemipléjico tras un ictus.

INTRODUCTION: The functional prognosis of patients should be known when planning their rehabilitation treatment. OBJECTIVE: To find the prognostic value of the MSH classification for hemiplegic patients, which is based on the clinical deficits seen after the stroke, and to distinguish between the M group (motor deficit), MS group (motor and sensory deficits) and the MSH group (motor, sensory and homonymous deficits). PATIENTS AND METHODS: A prospective analytical study was made of the hemiplegic patients admitted consecutively to the Rehabilitation Department after strokes. The initial examination was made 17 days (CI: 15-19) after the stroke. Satisfactory functional results were considered to be obtaining a Barthel index of > 90 together with the ability to walk unaided on level ground six months after the stroke. RESULTS: Of the 55 patients finally included in the study, 23 were in group M (41.8%) 21 in group MS (38.1%) and 11 patients in group MSH (20.1%). Walking ability and function in the different cohorts showed a statistically significant difference. Whilst 96% of the patients with pure hemiparesia (group M) attained a satisfactory degree of independence in walking, only 54% of the patients with three associated deficits (MSH) achieved this. Even more difference was found with acquired functional independence, since whilst 82% of group M attained a good degree of autonomy in carrying out everyday activities, only 18% of the MSH group achieved this. The remaining patients (MS group) had intermediate results. CONCLUSION: The MSH classification is, soon after having a stroke, a useful means of determining the functional prognosis of hemiplegic patients.