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.

Calidad de vida en personas con lesión medular de más de 10 años de evolución. La implicación de las complicaciones secundarias / Quality of life in patients with spinal cord injury for at least 10years: Importance of secondary health complications

Objetivo: Determinar la calidad de vida que presentan los lesionados medulares con más de 10 años de evolución. Valorar la prevalencia de complicaciones secundarias y su relación con la calidad de vida y el tiempo desde la lesión. Pacientes y método Diseño: Estudio epidemiológico transversal. Sujetos del estudio Pacientes: con lesión medular traumática, de más 10 años desde la lesión, y que cumplían los criterios de inclusión.Método: calidad de vida se valoró mediante el International spinal cord injury quality of life basic data set. Como variables se incluyeron: factores individuales, déficit neurológico, nivel de lesión y complicaciones secundarias. Resultados: Ciento treinta y un sujetos fueron incluidos en el estudio con edad media de 49 años y un tiempo desde la lesión de 21 años (11-53 años). La media de complicaciones secundarias fue de 2, siendo la más frecuente las urológicas, en 76 sujetos (58%). No existieron diferencias significativas entre el número de complicaciones y el tiempo transcurrido desde la lesión medular. La calidad de vida fue significativamente menor en aquellos que presentaban un mayor número de complicaciones (p = 0,003). Las complicaciones urológicas (p=0,04, IC del 95%, –1,02-2), el dolor musculoesquelético (p=0,01, IC del 95% IC, 1-6), las complicaciones respiratorias (p=0,05, IC del, –3-0,1) y el dolor neuropático que interfería con actividades básicas de la vida (p=0,01, IC del 95%, 1-5) se relacionaban significativamente con una menor calidad de vida. Conclusiones : Las complicaciones secundarias son frecuentes tras la lesión medular, aunque su número no aumenta con el tiempo desde la lesión. La calidad de vida sí está condicionada por la existencia de distintas complicaciones, como la existencia de dolor musculoesquelético.(AU)

Objective: To determine the quality of life of spinal cord injuries with more than 10 years of evolution. Assess the prevalence of secondary complications, and their relationship with quality of life and time since the injury. Patients and method Design: Cross-sectional epidemiological study. Study subjects: Patients with traumatic spinal cord injury, more than 10 years after the injury, and who met the inclusion criteria. Method: Quality of life was assessed using the International spinal cord injury quality of life basic data set. Variables included: individual factors, neurological deficit, level of injury and secondary complications. Results: 131 subjects were included in the study with a mean age of 49 years, and a time since the injury of 21 years (11–53 years). The mean number of secondary complications was 2, the most frequent being urological, in 76 subjects (58%). There were no significant differences between the number of complications and the time elapsed since the spinal cord injury. The quality of life was significantly lower in those with a higher number of complications (P=.003). Urological complications (P=.04, 95% CI: −1.02 to 2), musculoskeletal pain (P=.01, 95% CI: 1–6), respiratory complications (P=.05, 95% CI: −3 to 0.1) and neuropathic pain that interfered with basic life activities (P=.01, 95% CI: 1–5) were significantly related to a lower quality of life. Conclusions: Secondary complications are common after spinal cord injury, although their number does not increase over time after injury. Quality of life is conditioned by the existence of different complications such as the existence of musculoskeletal pain.(AU)

[Quality of life in patients with spinal cord injury for at least 10years: Importance of secondary health complications]. / Calidad de vida en personas con lesión medular de más de 10 años de evolución. La implicación de las complicaciones secundarias.

OBJECTIVE: To determine the quality of life of spinal cord injuries with more than 10 years of evolution. Assess the prevalence of secondary complications, and their relationship with quality of life and time since the injury. PATIENTS AND METHOD DESIGN: Cross-sectional epidemiological study. STUDY SUBJECTS: Patients with traumatic spinal cord injury, more than 10 years after the injury, and who met the inclusion criteria. METHOD: Quality of life was assessed using the International spinal cord injury quality of life basic data set. Variables included: individual factors, neurological deficit, level of injury and secondary complications. RESULTS: 131 subjects were included in the study with a mean age of 49 years, and a time since the injury of 21 years (11-53 years). The mean number of secondary complications was 2, the most frequent being urological, in 76 subjects (58%). There were no significant differences between the number of complications and the time elapsed since the spinal cord injury. The quality of life was significantly lower in those with a higher number of complications (P=.003). Urological complications (P=.04, 95% CI: -1.02 to 2), musculoskeletal pain (P=.01, 95% CI: 1-6), respiratory complications (P=.05, 95% CI: -3 to 0.1) and neuropathic pain that interfered with basic life activities (P=.01, 95% CI: 1-5) were significantly related to a lower quality of life. CONCLUSIONS: Secondary complications are common after spinal cord injury, although their number does not increase over time after injury. Quality of life is conditioned by the existence of different complications such as the existence of musculoskeletal pain.

Oxycodone improves pain control and quality of life in anticonvulsant-pretreated spinal cord-injured patients with neuropathic pain.

STUDY DESIGN: A 3-month follow-up, observational, prospective, multicenter, study in traumatic spinal cord-injured (SCI) patients with neuropathic pain (NP). OBJECTIVES: To assess the effectiveness and safety of oxycodone treatment in SCI patients with anticonvulsants-refractory NP. SETTING: 'Spinal injury follow-up units' throughout Spain. METHODS: Data regarding NP characteristics were collated from male and female adults with traumatic SCI and difficult-to-control central NP of moderate-to-severe intensity (visual analog scale (VAS) ≥4) persisting ≥1 month, who had been para- or tetraplegic for ≥2 months, had been previously treated with anticonvulsants and were now treated with oxycodone. RESULTS: In all, 54 out of the 57 patients recruited were assessable. A total of 81% were men and the mean age was 46.4. Patients were treated with oxycodone, 83% combined with anticonvulsant. Pain intensity (VAS: 7.1 ± 1.3-4.3 ± 1.7) and Lattinen total score (13.2 ± 3-7.7 ± 3.4) decreased significantly (P < 0.001) along the study. No patient got worse regarding pain impact on physical activity and on sleep (Lattinen scale). EQ-5D VAS showed a trend to increase (P = 0.061) and the index of preference values increased significantly from baseline to month 3 (0.26-0.62; P < 0.001). A total of 53.7% patients showed at least one treatment-related adverse event, with constipation being the most frequent one (33.3%). CONCLUSION: Oxycodone treatment, mostly in combination with anticonvulsants, in SCI patients with NP decreases pain intensity, improves health-related quality of life and diminishes the impact of pain on physical activity and sleep.

Traumatismos craneoencefálicos. Escalas de valoración para la medida de resultados en rehabilitación / Cranioencephalic traumatisms. Assessment scales for the measurement of outcome in rehabilitation

La evaluación de la severidad de un traumatismo craneoencefálico, puede contemplarse tanto desde una perspectiva de estudio de las lesiones que el traumatismo determina a nivel intracraneal, como desde la perspectiva de las repercusiones funcionales que dicho impacto mecánico tiene sobre el normal funcionalismo del sistema nervioso central. En este artículo se desarrollan las diferentes escalas que más se utilizan en la actualidad en este proceso. Sin duda, ninguna recoge todos los aspectos que serían deseables para el médico neurorrehabilitador, es por ello que se proponen varias escalas universales para medir aspectos diferentes. (AU)