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Abstract Introduction Telehealth consists in the application of technology to provide remote health service. This resource is considered safe and effective and has attracted an exponential interest in the context of the COVID pandemic. Expanded to dizzy patients, it would be able to provide diagnosis and treatment, minimizing the risk of disease transmission. Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder. The diagnosis typically rests on the description of the symptoms along with the nystagmus observed at a well-established positional testing. Objectives The aim of the present study was to propose a teleconsultation and teletreatment protocol to manage patients with BPPV during the COVID-19 pandemic. Methods Specialists in the vestibular field met through remote access technologies to discuss the best strategy to manage BPPV patients by teleconsultation and teletreatment system. Additionally, several scientific sources were consulted. Technical issues, patient safety, and clinical assessment were independently analyzed. All relevant information was considered in order to design a clinical protocol to manage BPPV patients in the pandemic context. Results Teleconsultation for BPPV patients requires a double way (video and audio) digital system. An adapted informed consent to follow good clinical practice statements must be considered. The time, trigger and target eye bedside examination (TiTRaTe) protocol has proven to be a valuable first approach. The bow and lean test is the most rational screening maneuver for patients with suspected positional vertigo, followed by most specific maneuvers to diagnostic the sub-variants of BPPV. Conclusion Although with limited evidence, teleconsultation and teletreatment are both reasonable and feasible strategies for the management of patients with BPPV in adverse situations for face-to-face consultation.
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Introdução: O Programa Nacional de Reorientação da Formação Profissional em Saúde (PRO-SAUDE), do Ministério da Saúde, preconiza que a formação de novos profissionais de saúde deve ser feita em parceria com os serviços. Objetivo: Revisar a base legal para estágios em fisioterapia. Materiais e métodos: Foi realizada uma revisão da literatura sobre a legislação relativa a estágios em fisioterapia, buscando identificar a correlação entre a legislação federal sobre estágios, a Lei de Diretrizes e Bases da Educação Nacional (LDB), as Diretrizes Curriculares para Cursos de Graduação em Fisioterapia e as resoluções do Conselho Federal de Fisioterapia (COFFITO). Resultados: A LDB assegura a autonomia das instituições de ensino para a proposição de estágios. As Diretrizes Curriculares de Fisioterapia mencionam que estágios podem ser desenvolvidos desde o início do curso, porém sempre sob a responsabilidade de docente fisioterapeuta. As atividades complementares não obrigatoriamente dependem de supervisão docente direta. O COFITTO determina que estágios em serviços só podem ser realizados a partir do 6º período da graduação ou sob supervisão direta de docentes. Conclusão: As resoluções do COFFITO não estão em consonância com a LDB e com o PRO-SAUDE e podem constituir obstáculo ao estabelecimento das parcerias tão necessárias à formação de profissionais de saúde para o SUS.
Introduction: The Brazilian Health Ministrys National Program for the Professional Formation in Health (PRO-SAUDE) recommends that health professionals education should be made in association with the health services. Objective: Reviewing the legal basis concerning professional physiotherapeutic training. Material and methods: A literature review was accomplished about the relative legislation on physioterapeutic training, to identify the correlation between the federal legislation related to the interships in health fields, Guidelines and Basis to National Education (LDB), the Curricular Guideline to Physiotherapy Undergraduated Courses and the resolutions of the Federal Council of Physiotherapy (COFFITO). Results: The LDB guarantees the autonomy of the universities to define the intership. According to Curricular Guidelines of Physical therapy, the students can have periods of training in health services since the beginning the course with the supervision of a professor. Extracurricular activities do not depend on direct supervision of a professor. The COFFITO has decided that the direct supervision of a professor is mandatory up to the 6th semester of undergraduated studies. Conclusion: The COFFITO resolutions are not in agreement with the LDB and the PRO-SAUDE and can represent an obstacle to the partnerships between the schools of physical therapy and the health services.
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Universities , Internship and Residency , Physical Therapy Specialty , Staff DevelopmentABSTRACT
A Vertigem Posicional Paroxística Benigna (VPPB) é uma das mais freqüentes patologias do sistema vestibular e é caracterizada por episódios de vertigens recorrentes desencadeados por movimentos da cabeça ou mudanças posturais. Há várias opções para o seu tratamento, porém as efetividades terapêuticas das mesmas permanecem controversas. OBJETIVO: Avaliar a efetividade terapêutica das manobras específicas disponíveis para o tratamento da VPPB. METODOLOGIA: Realizou-se uma busca eletrônica nas principais bases de dados, selecionando-se estudos clínicos randomizados envolvendo adultos com diagnóstico de VPPB confirmado com o teste de Dix-Hallpike e tratamento com manobras específicas (Epley ou Semont, por exemplo). Considerou-se como desfecho clínico a negativação do teste de Dix-Hallpike e a melhora das queixas subjetivas. Agruparam-se em metanálise os estudos com Escala de Jadad igual ou superior a três. RESULTADOS: Cinco estudos clínicos preencheram os critérios de inclusão, ou seja, ensaios randomizados de fase I comparando a manobra de Epley com placebos e controles. A metanálise mostra evidência dos efeitos benéficos da manobra de Epley para o tratamento do canal semicircular posterior (magnitude do efeito de 0,11 [IC 95 por cento 0.05, 0.26] de melhora objetiva (Dix-Halpike) após uma semana, 0.24 [IC 95 por cento 0.13, 0.45] após um mês e 0.16 [IC 95 por cento 0.08, 0.33] de melhora referida pelos pacientes após a primeira semana). CONCLUSÃO: Evidencia-se boa eficácia clínica da manobra de Epley para o tratamento da VPPB do canal semicircular posterior. Contrariamente, trabalhos com a manobra de Semont e as propostas de manejo dos demais canais semicirculares não obtiveram qualidade metodológica satisfatória, não sendo possível demonstrar a efetividade dos mesmos
Benign Paroxysmal Positional Vertigo (BPPV) is one of the most frequent diseases of the vestibular system and it is characterized by episodes of recurrent vertigo triggered by head movements or position changes. There are several approaches for treatment, but efficacy is still being discussed. AIM: To asses the effectiveness of the specific maneuvers available to the treatment of BPPV. METHODOLOGY: An electronic search at the main databases, including MEDLINE, LILACS, PEDro, Cochrane Collaborations Database was performed, and we selected only randomized clinical trials studying adults with diagnosis of BPPV confirmed by the Dix-Hallpike test. The trials should have included physical maneuvers such as Epley and Semont. The main outcome was Dix-Hallpike negative test and the changes to subjective complaints. The trials were assessed using Jadad's scale and only studies with quality scores equal or above 3 were pooled on a meta-analyses to assess their effectiveness. RESULTS: We found five controlled clinical trials phase I comparing the Epley's maneuver with controls or placebo. The meta-analysis showed positive evidence of Epley's maneuver to the posterior semicircular canal (effect size = 0.11 [CI 95 percent 0.05, 0.26] of objective improvement [Dix-Halpike] within one week, 0.24 [CI 95 percent 0.13, 0.45] within one month and 0.16 [CI 95 percent 0.08, 0.33] of improvement reported by the patients within one week. There are no studies about the efficacy of Semont's maneuver. CONCLUSION: There is scientific evidence showing good efficacy of Epley's maneuver in the treatment.