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Nan Fang Yi Ke Da Xue Xue Bao ; 39(11): 1298-1304, 2019 Nov 30.
Artigo em Chinês | MEDLINE | ID: mdl-31852650


OBJECTIVE: To investigate the therapeutic effect and safety of early physical therapy for acute gastrointestinal injury (AGI) in septic patients receiving mechanical ventilation. METHODS: A randomized controlled trial was conducted in the ICU of a tertiary teaching hospital from May, 2017 to March, 2018. The patients diagnosed with sepsis complicated by AGI during mechanical ventilation were recruited and block-randomized into intervention group and control group. Both groups received standard therapy of sepsis, and the patients in the intervention group also received physical therapy as soon as they were hemodynamically stable. The outcome measures included the recovery of AGI, ICU mortality, duration and outcomes of mechanical ventilation and the length of ICU stay. RESULTS: A total of 60 patients were initially included, and 34 of them completed the study, including 16 in the intervention group and 18 in the control group. After physical rehabilitation, the number of patients with a cure of AGI did not significantly differ between the two group (P > 0.05). Nonetheless, the reduction of AGI scores after the treatments differed significantly between the intervention group and the control group (-1.9±2.1 vs 0.9± 1.6, P < 0.05). No significant differences were found between the two groups in ICU mortality, duration and outcomes of mechanical ventilation, or the length of ICU stay (P > 0.05). In the intervention group, the incidence of exercise-related adverse events was 3.33%, and severe organ injury or death occurred in none of patients. CONCLUSIONS: Early rehabilitation therapy does not reduce the incidence of AGI but can lower AGI scores and alleviate gastrointestinal symptoms in patients with sepsis during mechanical ventilation. The results still await further verification by welldesigned multicenter clinical trials with large sample sizes.

Respiração Artificial , Sepse , Humanos , Incidência , Unidades de Terapia Intensiva , Tempo de Internação , Modalidades de Fisioterapia , Projetos Piloto
Artigo em Russo | MEDLINE | ID: mdl-31880761


BACKGROUND: In recent decades, the volume of high-tech medical care in the field of orthopedics and traumatology, including endoprosthetic replacement of major joints (MJs) (the hip joint and/or the knee joint) in the lower extremities (LE) (LEMJ), has substantially increased. In this connection, there are an increasing number of patients in need of medical rehabilitation, to solve the problems of which needs the effective physical and rehabilitation medicine (PRM) techniques proven during researches to be introduced into practice. OBJECTIVE: To analyze evidence-based studies containing sound data on the use of PRM technologies in the rehabilitation of patients after endoprosthetic replacement of LEMJs, to identify the most effective PRM technologies and to formulate recommendations for their use for practitioners, which are based on the evidence obtained during the analysis. MATERIAL AND METHODS: The paper is based on the scientometric analysis of 241 studies conducted in 2000 to 2018, which were devoted to the use of physical exercises and PRM technologies in the rehabilitation of patients after endoprosthetic replacement of LEMJs. RESULTS: Over the past decade, there has been a tangible rise in the number of studies on endoprosthetic replacement of LEMJs. Some of the most studied PRM technologies having the proven effect are physical exercises in combination with neuromuscular electrical stimulation, kinesiotherapy, cryotherapy, and pressure therapy that is effective in preventing thromboembolism after surgery. CONCLUSION: The use of PRM technologies in the rehabilitation of patients after endoprosthetic replacement of LEMJs should be based on the results of high-quality randomized controlled clinical trials, which serve as the basis for the development of clinical recommendations. The process of analyzing the data of studies should be regular.

Artroplastia de Quadril/reabilitação , Artroplastia do Joelho/reabilitação , Modalidades de Fisioterapia , Humanos , Resultado do Tratamento
Odontoestomatol ; 21(34): 46-55, Jul-Dic. 2019.
Artigo em Espanhol | LILACS, InstitutionalDB | ID: biblio-1024979


El Síndrome de Down (SD) o trisomía 21, es la anomalía congénita autosómica más frecuente cuya prevalencia mundial es de 10/10.000, en Chile de 2,5/1.000 nacidos vivos. Por trastornos de crecimiento, desarrollo e hipotonía muscular, las personas con SD presentan boca abierta con gran salivación, labio inferior evertido, elevación del labio superior en inactividad y descenso del ángulo de la boca. Objetivo: Evaluar la literatura sobre el tratamiento temprano de alteraciones orofaciales en niños con SD para prevenirlas o minimizarlas. Método: Búsqueda en base de datos PubMed y Scielo, sin discriminar año de publicación, idioma: inglés-español, seleccionando 26 artículos. Resultados: Existen cambios positivos en la función motora orofacial, observando mayores cambios en los casos más severos. Conclusiones: Un niño con SD se beneficia del tratamiento temprano, pero faltan estudios comparables en cuanto a duración, edad y tipo de terapia.

Down syndrome (DS) or trisomy 21 is the most frequent autosomal congenital anomaly, with a worldwide prevalence of 10/10,000; in Chile, the prevalence is 2.5/1,000 live births. People with DS present an open mouth with increased salivation, an everted lower lip, elevated and inactive upper lip, and lowering of the angle of the mouth on account of growth and development disorders, and muscular hypotonia. Objective: To evaluate the literature on the early treatment of orofacial alterations in children with DS to prevent or minimize them. Method: Search in PubMed and Scielo databases, regardless of the year of publication or language; 26 articles were selected. Results: There are positive effects on the orofacial motor function, observing significant changes in the most severe cases. Conclusions: A child with DS can benefit from early treatment, but there are insufficient comparable studies in terms of duration, age and type of therapy

A síndrome de Down (SD) ou a trissomia do cromossomo 21, é a anomalia congênita autossômica mais frequente, com prevalência global de 1 / 1.000, no Chile de 2.5 / 1.000 nascidos vivos. Devido aos distúrbios de crescimento, desenvolvimento e hipotonia muscular, as pessoas com SD apresentam boca aberta com grande salivação, lábio inferior evertido, elevação do lábio superior inativo e ângulo da boca mais baixo. Objetivo: Avaliar a literatura sobre o tratamento precoce dos distúrbios orofaciais em crianças com SD para prevenilas ou minimizá-las. Método: Pesquisa na base de dados PubMed e Scielo, sem discriminar ano de publicação, idioma: inglês-espanhol, selecionando 26 artigos. Resultados: Existem mudanças positivas na função motora orofacial, observando-se grandes alterações nos casos mais graves. Conclusões: Uma criança com SD se beneficia do tratamento precoce, mas faltam estudos comparáveis em termos de duração, idade e tipo de terapia.

Humanos , Criança , Síndrome de Down , Modalidades de Fisioterapia
BMJ ; 367: l5922, 2019 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690561


OBJECTIVE: To investigate the clinical effectiveness and safety of stand alone and blended internet based vestibular rehabilitation (VR) in the management of chronic vestibular syndromes in general practice. DESIGN: Pragmatic, three armed, parallel group, individually randomised controlled trial. SETTING: 59 general practices in the Netherlands. PARTICIPANTS: 322 adults aged 50 and older with a chronic vestibular syndrome. INTERVENTIONS: Stand alone VR comprising a six week, internet based intervention with weekly online sessions and daily exercises (10-20 minutes a day). In the blended VR group, the same internet based intervention was supplemented by face-to-face physiotherapy support (home visits in weeks 1 and 3). Participants in the usual care group received standard care from a general practitioner, without any restrictions. MAIN OUTCOME MEASURES: The primary outcome was vestibular symptoms after six months as measured by the vertigo symptom scale-short form (VSS-SF range 0-60, clinically relevant difference ≥3 points). Secondary outcomes were dizziness related impairment, anxiety, depressive symptoms, subjective improvement of vestibular symptoms after three and six months, and adverse events. RESULTS: In the intention-to-treat analysis, participants in the stand alone and blended VR groups had lower VSS-SF scores at six months than participants in the usual care group (adjusted mean difference -4.1 points, 95% confidence interval -5.8 to -2.5; and -3.5 points, -5.1 to -1.9, respectively). Similar differences in VSS-SF scores were seen at three months follow-up. Participants in the stand alone and blended VR groups also experienced less dizziness related impairment, less anxiety, and more subjective improvement of vestibular symptoms at three and six months. No serious adverse events related to online VR occurred during the trial. CONCLUSION: Stand alone and blended internet based VR are clinically effective and safe interventions to treat adults aged 50 and older with a chronic vestibular syndrome. Online VR is an easily accessible form of treatment, with the potential to improve care for an undertreated group of patients in general practice. TRIAL REGISTRATION: Netherlands Trial Register NTR5712.

Medicina Geral/métodos , Modalidades de Fisioterapia , Qualidade de Vida , Telemedicina/métodos , Doenças Vestibulares/reabilitação , Idoso , Doença Crônica/psicologia , Doença Crônica/reabilitação , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Países Baixos , Síndrome , Resultado do Tratamento , Doenças Vestibulares/diagnóstico , Doenças Vestibulares/psicologia
Medicine (Baltimore) ; 98(45): e17874, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702655


BACKGROUND: Stepping in place (SIP) is a useful locomotor training intervention. The purpose of this study was to investigate the effects of single auditory-cued SIP training on cortical excitability, rhythmic movements and walking ability in patients with Parkinson's disease(PD). METHODS: Cross-over randomized control trial. Each participant completed two interventions with at least one-week washout period in between: (1) SIP with concurrent auditory cues (AC condition) and (2) SIP without auditory cues (NC condition). RESULTS: In the primary outcome, the cortical silent period (CSP) duration increased (P = .005), whereas short intracortical inhibition (SICI) decreased after training (P = .001). Freezers demonstrated enhanced inhibition in the resting motor threshold and CSP duration. SICI and intracortical facilitation were modulated in both groups under the AC condition. In the secondary outcomes, the stepping variability decreased significantly (AC: P = .033; NC: P = .009), whereas walking cadence increased after training (AC: P = .019; NC: P = .0023). CONCLUSIONS: Auditory-cued SIP training improved the lower-limb movement variability and modulated the cortical excitability in patients with PD. Freezers may benefit more from this training than nonfreezers.

Estimulação Acústica/métodos , Sinais (Psicologia) , Transtornos Neurológicos da Marcha/terapia , Estimulação Magnética Transcraniana/métodos , Idoso , Estudos Cross-Over , Potenciais Evocados Auditivos/fisiologia , Transtornos Neurológicos da Marcha/etiologia , Humanos , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Desempenho Físico Funcional , Modalidades de Fisioterapia , Caminhada/fisiologia
Klin Padiatr ; 231(6): 304-312, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31724139


BACKGROUND: Physiotherapy, including vibration-assisted therapy, has been proven to be effective for patients with ataxic cerebral palsy. Herewith, we studied the effect of a functional, goal-oriented interval rehabilitation program, including vibration-assisted home-training on the motor function of children with congenital ataxias. PATIENTS: 45 children (mean age 7.7 years, SD 4.70) with ataxia, having received a 6-month home-based side-alternating vibration-assisted therapy combined with intensive, goal-oriented, functional rehabilitation intervals, were included in the study, classified according to the progressive or non-progressive ataxia character. METHOD: Retrospective analysis of the prospectively collected data of the registry of the Cologne rehabilitation program "Auf die Beine". Motor abilities have been assessed prior to the intervention (M0), after 6 months of home-training (M6) as well as in a follow-up 6 months later (M12). We performed a gait analysis, a 1-minute walking test (1-MWT), and the Gross Motor Function Measure (GMFM-66). RESULTS: The GMFM-66 improvement (M6-M0 vs. M12-M6) was statistically significant with median improvement of 2.4 points (non-progressive) and 2.9 points (progressive) respectively, and clinically relevant. The 1-MWT improvement was statistically significant and clinically relevant for non-progressive ataxia. CONCLUSION: The intensive training, including vibration-assisted therapy significantly improved the motor function of children with ataxia. Six months later the skills were preserved in children with progressive ataxia and could be further developed in non-progressive forms.

Ataxia/reabilitação , Paralisia Cerebral/reabilitação , Modalidades de Fisioterapia , Vibração/uso terapêutico , Criança , Feminino , Humanos , Masculino , Destreza Motora , Estudos Retrospectivos , Resultado do Tratamento
Medicine (Baltimore) ; 98(46): e17582, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725606


RATIONALE: Myotonic dystrophy type 1 (DM1) is a slowly progressive multisystem neuromuscular disease characterized by myotonia and muscle weakness and wasting of distal and axial muscles. People with DM1, due to the disease progression, are often concerned about their ability to carry out and participate in the activities of daily living. Rehabilitation approaches in DM1, including moderate-to-intense strength training, have shown not univocal efficacy to face such difficulties. Aim of this case-study was to demonstrate the effects of a combined approach by using conventional plus robotic training in rare neuromuscular diseases, such as DM1. PATIENT CONCERNS: A 46-year-old woman came to our observation complaining of difficulty in opening fist after strong voluntary muscle contraction for about 20 years. Over the years, she referred swallowing difficulties for solid foods, balance impairment complicated by tendency to stumble and falls, fatigability, hand muscle weakness with difficulty to open bottles and lifting weights, and daytime sleepiness DIAGNOSIS:: Paraparesis in DM1. INTERVENTIONS: The patient underwent 2 different trainings. The first period of treatment was carried out by using conventional physiotherapy, 6 times a week (twice a day) for 4 weeks. Then, she underwent a two-month specific task-oriented robotic rehabilitation training for the gait impairment using an overground exoskeleton, namely Ekso-GT, combined to the conventional therapy. OUTCOMES: The patient, after the EKSO training, gained a significant improvement in walking, balance and lower limbs muscle strength, as per 10-meter walking test and Left Lower Limb Motricity Index. Neurophysiological data (electroencephalography and surface electromyography) were also collected to more objectively assess the functional outcomes. LESSONS: Rehabilitation approaches in DM1, including moderate-to-intense strength training, have shown not univocal efficacy. Emerging and advancing robotic technologies can enhance clinical therapeutic outcomes by allowing therapists to activate and/or modulate neural networks to maximize motor and functional recovery.

Exoesqueleto Energizado , Distrofia Miotônica/reabilitação , Plasticidade Neuronal , Modalidades de Fisioterapia , Treinamento de Resistência/métodos , Atividades Cotidianas , Terapia Combinada , Eletromiografia , Feminino , Humanos , Pessoa de Meia-Idade , Distrofia Miotônica/fisiopatologia , Resultado do Tratamento
Wiad Lek ; 72(9 cz 1): 1667-1670, 2019.
Artigo em Polonês | MEDLINE | ID: mdl-31586980


As UN research indicates, populations in approx. 40% of the world's countries presently meet the criteria of demographic old age. It is estimated that by 2050, those criteria will have applied to 84% of them, out of which 65% will have entered an advanced stage. Data current for 2017 put the estimated number of seniors around the world at approx. 962 million, i.e. 13% of the world's population. Population ageing process has already reached its top dynamics in Poland. Both international studies, and our own research experience imply that only an interdisciplinary and holistic approach to the seniors may help fully appreciate overall complexity of this challenge, and consequently offer an adequate platform for mapping out effective therapeutic management. Provision of a scope of wide-ranging, physiotherapeutic regimens for the seniors requires of any attending therapeutic team a specialist body of knowledge, pertinent expertise in geriatrics and physiotherapy, and plenty of hands-on skills. Physiotherapy in geriatrics is a complex, teamwork-based approach targeted at the seniors of appreciably reduced functional capabilities, and/or burdened with concomitant risk factors for a number of diseases, and/or prone to sustaining other adverse incidents (e.g. falls) typical for older age. In physiotherapeutic management offered to the seniors, as opposed to other age groups, by far the most essential issue consists in multiple concomitant diseases and polypragmacy. After a patient has been diagnosed by an attending physician, and his functional capabilities have been assessed by a physiotherapist, the therapeutic team should primarily focus upon securing for him the most essential goals, as identified at the time. Increased life expectancy raises a number of questions and challenges, to be urgently addressed by the medical sciences; the most basic and pragmatic question being - how are physicians, physiotherapists, and other health care professionals presently prepared to deal effectively with the seniors in terms of the actual treatment management, and a scope of physiotherapeutic interventions urgently required?

Geriatria , Modalidades de Fisioterapia , Idoso , Humanos , Expectativa de Vida , Polônia
MMW Fortschr Med ; 161(Suppl 6): 15-23, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31587168


BACKGROUND: Non-vitamin K-dependent oral anticoagulants (NOAC) have changed the management of patients with oral anticoagulation. This raises the question of which patients should preferably be anticoagulated with NOAC and which preferably with vitamin K antagonists (VKA). This discussion has so far been insufficiently conducted and often decided on a flat-rate basis in favor of the NOAC. METHOD: To clarify the question owhich form of anticoagulation - NOAC or VKA - is the best choice for patients with atrial fibrillation, an interdisciplinary team of experts met. RESULTS AND CONCLUSIONS: The experts discussed essential practical aspects of NOAC and VKA therapy. Based on typical clinical scenarios, they developed assistance, comments and tips on the differentiated use of oral anticoagulants in patients with atrial fibrillation. A criteria served amongst others practicability in daily medical practice, contraindications, side effects and interactions, but also the patient's desire. The advantages and disadvantages of therapy with VKA and NOAC were summarized in a table.

Anticoagulantes/uso terapêutico , Fibrilação Atrial , Vitamina K/antagonistas & inibidores , Administração Oral , Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Fibrinolíticos , Humanos , Modalidades de Fisioterapia
Handchir Mikrochir Plast Chir ; 51(5): 356-361, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31574548


A consistently high proportion of thermal injuries in children are to the hand, and scalds and contact burns are the main causes. While most thermal Injuries to the hand in children can be treated conservatively, deep burns can result in scary contractures and syndactylies that cause functional impairments to the hand. Therefore, thermal injuries to the hand in children should be treated in a specialised centre, thus ensuring a differentiated approach with respect to the localisation and extent of the thermal injury.Besides acute therapy, regular follow-up consultations - including splint and compression treatments -, physiotherapy, ergotherapy and, if necessary, corrective surgical measures are of immense importance. Only adherence to this treatment regime can guarantee optimal functional and aesthetic results and minimise daily restrictions for the young patients. The purpose of this article is to illustrate/outline the essential aspects of this treatment of thermal injuries to the infantile hand.

Queimaduras , Traumatismos da Mão , Traumatismos do Punho , Queimaduras/cirurgia , Pré-Escolar , Contratura/cirurgia , Feminino , Traumatismos da Mão/cirurgia , Humanos , Lactente , Masculino , Modalidades de Fisioterapia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Contenções , Retalhos Cirúrgicos , Cicatrização
Medicine (Baltimore) ; 98(38): e17241, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567989


BACKGROUND: Previous studies have reported that physical therapy (PT) can be used for the treatment of chronic obstructive pulmonary disease (COPD). However, its effectiveness is still inconclusive. This systematic review will aim to assess its effectiveness and safety for the treatment of patients with COPD. METHODS: All randomized controlled trials (RCTs) literatures of PT for COPD will be searched from the databases of Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, MEDILINE, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Information, and Wanfang Data from inception to the present without any language restrictions. Two reviewers will independently perform the study selection, data extraction, and methodological quality assessment. A third reviewer will be invited to resolve any disagreements occurred between 2 reviewers. RESULTS: The primary outcome is lung function. The secondary outcomes include symptoms, health-related quality of life, mortality, and adverse events. The outcome data will be pooled by using the models of random-effects or fixed-effects according to the detected heterogeneity. CONCLUSION: The findings of this study will provide up-todated summary evidence for assessing the effectiveness and safety of PT for COPD.

Modalidades de Fisioterapia , Doença Pulmonar Obstrutiva Crônica/terapia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
Z Orthop Unfall ; 157(5): 574-596, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31594004


The basis for assessing thoracolumbar vertebral body fractures are two established classification systems. Important, especially in terms of further treatment, is the distinction between osteoporotic and healthy bones. The AO Spine classification offers a comprehensive tool for healthy bones to reliably specify the morphological criterias (alignment, integrity of the intervertebral disc, fragment separation, stenosis of the spinal canal). In addition to the fracture morphology, the OF classification for osteoporotic fractures includes patient-specific characteristics to initiate adequate therapy. In general an adequate pain therapy is required for early rehabilitation. While in the bone healthy population, physiotherapy reduces the risk of muscle deconditioning, in the osteoporotic population it additionally serves to prevent subsequent fractures. Unlike osteoporotic patients, bone healthy patients with vertebral fractures should not undergo a corset/orthosis treatment.

Tratamento Conservador/métodos , Vértebras Lombares/lesões , Fraturas da Coluna Vertebral/terapia , Vértebras Torácicas/lesões , Educação Médica Continuada , Fraturas por Compressão/terapia , Humanos , Fraturas por Osteoporose/classificação , Fraturas por Osteoporose/terapia , Modalidades de Fisioterapia , Fraturas da Coluna Vertebral/classificação , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico , Traumatismos do Sistema Nervoso/classificação , Traumatismos do Sistema Nervoso/diagnóstico , Traumatismos do Sistema Nervoso/etiologia , Traumatismos do Sistema Nervoso/terapia , Resultado do Tratamento
Fisioterapia (Madr., Ed. impr.) ; 41(5): 258-265, sept.-oct. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183935


Antecedentes y objetivo: Los fisioterapeutas son un grupo de profesionales con importancia creciente dentro de las unidades de cuidados intensivos (UCI). Sin embargo, tanto sus prácticas terapéuticas como su disponibilidad en estas unidades son muy heterogéneas. El objetivo de este trabajo fue evaluar la variabilidad en cuanto a disponibilidad, actividades terapéuticas, formación y entorno de trabajo de los fisioterapeutas de las UCI de adultos en Barcelona. Materiales y métodos: Se realizó un estudio transversal y descriptivo a través de dos cuestionarios que se diseñaron para ser contestados por los jefes de servicio y por los fisioterapeutas de las UCI de adultos del área metropolitana de Barcelona durante marzo y abril de 2018. Resultados: Se contestaron 19/21 cuestionarios de jefes de servicio y 23/29 de fisioterapeutas. Todas las UCI disponían de servicio de fisioterapia en días laborables, con una ratio -mediana (rango intercuartílico, p25-p75)- de 13 (11,5, 5,5-17) camas UCI por fisioterapeuta, dedicando la mayoría (65%) un promedio de 16-30min por paciente. La disponibilidad en festivos era del 47% de los casos, y no se ofrecía fisioterapia en horario nocturno. El trabajo de los fisioterapeutas fue considerado satisfactorio por la mayoría de los jefes de servicio, si bien se consideraban insuficientes en número y en tiempo de dedicación para cubrir las necesidades. Las actividades terapéuticas fueron variables entre los participantes. Conclusiones: La disponibilidad de los fisioterapeutas en las UCI de adultos de Barcelona es variable, siendo significativamente inferior a las recomendaciones europeas y nacionales vigentes. Existen también diferencias entre las actividades terapéuticas realizadas entre ellos

Background and objective: Physiotherapists are a group of professionals with increasing importance within the intensive care units (ICU). However, both their therapeutic practices and their availability for these units are very heterogeneous. The aim of this study was to evaluate the variability in terms of availability, therapeutic activities, training and work environment of the physiotherapists of adult ICU in Barcelona. Materials and methods: A cross-sectional and descriptive study was carried out through two questionnaires that were designed to be answered by department heads and physiotherapists of adult ICU in the metropolitan area of Barcelona, from March to April 2018. Results: Nineteen of 21 questionnaires for head physicians and 23/29 for physiotherapists were answered. All ICU had a physiotherapy service on weekdays, with a median (IQR, p25-p75) ratio of 1 physiotherapist for every 13 (11.5, 5.5-17) ICU beds. Most of the physiotherapists (65%) spent 16-30minutes per patient. Availability on holidays was 47%, and there were no physiotherapists during the night-shifts. Physiotherapist assistance was considered satisfactory by most head physicians, although it was also considered insufficient both in number and time to meet patients' needs. Therapeutic activities were different among participants. Conclusions: Physiotherapist availability in adult ICU in Barcelona was variable and significantly below current European and national recommendations. There were also differences in therapeutic activities among them

Humanos , Cuidados Críticos , Unidades de Terapia Intensiva , Modalidades de Fisioterapia/instrumentação , Terapia Respiratória/métodos , Estudos Transversais , Inquéritos e Questionários , Modalidades de Fisioterapia/tendências
Fisioterapia (Madr., Ed. impr.) ; 41(5): 275-284, sept.-oct. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183937


Introducción: La actividad física (AF) es fundamental para la salud. Las secuelas producidas tras un ictus y otras barreras pueden interferir en la realización de ejercicio físico (EF). Consecuentemente, podría variar la percepción de sus beneficios. El objetivo de este estudio fue determinar el nivel de AF en función de la capacidad de deambulación, y el grado de incapacidad que presentan los individuos con dichos caracteres, así como las barreras y los beneficios en la práctica de EF percibidos por estos. Material y métodos: Se realizó un estudio transversal de encuesta en una muestra de personas con secuelas crónicas tras ictus. Se elaboró una encuesta que contó con un diario de actividad, la escala SIS-16, el cuestionario IPAQ-E, y las escalas FAC y EBBS. Resultados: Participaron 74 personas (edad media de 59,19±15,4 años). El 51,4% mostraron una AF baja; particularmente las mujeres (56,7%), los mayores de 65 años (76,9%), los que vivían institucionalizados (100%) y los residentes en el ámbito rural (69,2%). Aquellos individuos con un bajo grado de incapacidad destacaron dentro de los niveles de AF moderada (Mdn=76) y alta (Mdn=87,5), mientras que las personas con un mayor grado de incapacidad despuntaron dentro del nivel de AF bajo (Mdn=51). Hubo diferencias significativas entre el grupo de marcha totalmente dependiente (Mdn=0) y el grupo de marcha independiente (Mdn=1110,500)U=108,500; p<0,001), siendo el primero de los grupos el que obtuvo un nivel bajo de AF. Las barreras más comunes fueron las relacionadas con la fatiga y el cansancio que provoca el EF. Los participantes reconocieron los beneficios del EF para el incremento de la fuerza y el tono muscular; la mejora de la flexibilidad; el funcionamiento del corazón y la condición física. No se encontraron diferencias significativas en cuanto a la percepción de barreras y beneficios. Conclusión: La mayoría de los participantes presenta una AF baja, predominando esta en aquellos con un mayor grado de incapacidad y con una marcha dependiente. Se reconocen los beneficios del EF para la mejora de su sistema cardiovascular, su fuerza muscular y su condición física. Justifican la falta de EF por la fatiga y el cansancio que provoca

Introduction: Physical activity (PA) is fundamental for health. The sequelae produced after a stroke and other barriers can interfere in the performance of physical exercise (PE). Consequently, the perception of its benefits may vary. The aim of this study was to determine the level of PA according to the ability to walk, and the degree of disability that individuals with these characteristics present, as well as the barriers and benefits to PE practice perceived by them. Material and methods: A cross-sectional survey study was conducted in a sample of people with chronic squeal after stroke. The survey included a daily activity diary, the SIS-16 scale, the IPAQ-E questionnaire, and the FAC and EBBS scales. Results: 74 people participated (mean age 59.19 ±15.4). Of these, 51.4% showed a low PA; particularly the women (56.7%), those over 65 years (76.9%), those who were institutionalized (100%), and residents in rural areas (69.2%). The individuals with a low degree of disability stood out within the levels of moderate PA (Mdn=76) and high PA (Mdn=87.5), while those with a higher degree of disability stood out within the level of low PA (Mdn=51). There were significant differences between the totally dependent walking group (Mdn=0) and the independent walking group (Mdn=1110.500) (U=108.500, p<.001), the first of the groups obtained a low level of PA. The most common barriers were those related to fatigue caused by PE. Participants recognized the benefits of PA for increasing strength and muscle tone; the improvement of flexibility; the functioning of the heart and physical condition. No significant differences were found regarding the perception of barriers and benefits. Conclusion: The majority of participants present a low PA, predominantly those with a higher degree of disability and with dependent walking. The benefits of PE are recognized for improving cardiovascular health, muscle strength and physical condition. They justify their lack of PE by the fatigue it causes

Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Atividade Motora/fisiologia , Acidente Vascular Cerebral/epidemiologia , Comportamento Sedentário , Modalidades de Fisioterapia , Acidente Vascular Cerebral/terapia , Estudos Transversais , Inquéritos e Questionários
JAMA ; 322(10): 946-956, 2019 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-31503309


Importance: Disability persists after hip fracture in older persons. Current rehabilitation may not be sufficient to restore ability to walk in the community. Objective: To compare a multicomponent home-based physical therapy intervention (training) with an active control on ability to walk in the community. Design, Setting, and Participants: Parallel, 2-group randomized clinical trial conducted at 3 US clinical centers (Arcadia University, University of Connecticut Health Center, and University of Maryland, Baltimore). Randomization began on September 16, 2013, and ended on June 20, 2017; follow-up ended on October 17, 2017. Patients aged 60 years and older were enrolled after nonpathologic, minimal trauma hip fracture, if they were living in the community and walking without human assistance before the fracture, were assessed within 26 weeks of hospitalization, and were not able to walk during daily activities at the time of enrollment. A total of 210 participants were randomized and reassessed 16 and 40 weeks later. Interventions: The training intervention (active treatment) (n = 105) included aerobic, strength, balance, and functional training. The active control group (n = 105) received transcutaneous electrical nerve stimulation and active range-of-motion exercises. Both groups received 2 to 3 home visits from a physical therapist weekly for 16 weeks; nutritional counseling; and daily vitamin D (2000 IU), calcium (600 mg), and multivitamins. Main Outcomes and Measures: The primary outcome (community ambulation) was defined as walking 300 m or more in 6 minutes at 16 weeks after randomization. The study was designed to test a 1-sided hypothesis of superiority of training compared with active control. Results: Among 210 randomized participants (mean age, 80.8 years; 161 women [76.7%]), 197 (93.8%) completed the trial (187 [89.0%] by completing the 6-minute walk test at 16 weeks and 10 [4.8%] by adjudication of the primary outcome). Among these, 22 of 96 training participants (22.9%) and 18 of 101 active control participants (17.8%) (difference, 5.1% [1-sided 97.5% CI, -∞ to 16.3%]; 1-sided P = .19) became community ambulators. Seventeen training participants (16.2%) and 15 control participants (14.3%) had 1 or more reportable adverse events during the intervention period. The most common reportable adverse events reported were falls (training: 6 [5.7%], control: 4 [3.8%]), femur/hip fracture (2 in each group), pneumonia (training: 2, control: 0), urinary tract infection (training: 2, control: 0), dehydration (training: 0, control: 2), and dyspnea (training: 0, control: 2). Conclusions and Relevance: Among older adults with a hip fracture, a multicomponent home-based physical therapy intervention compared with an active control that included transcutaneous electrical nerve stimulation and active range-of-motion exercises did not result in a statistically significant improvement in the ability to walk 300 m or more in 6 minutes after 16 weeks. Trial Registration: Identifier: NCT01783704.

Fraturas do Quadril/reabilitação , Modalidades de Fisioterapia , Idoso , Idoso de 80 Anos ou mais , Terapia por Exercício/métodos , Feminino , Serviços de Assistência Domiciliar , Humanos , Masculino , Amplitude de Movimento Articular , Estimulação Elétrica Nervosa Transcutânea , Teste de Caminhada