Residencia de Medicina Física y Rehabilitación en el Perú: número de vacantes y análisis de los planes de estudios

Introducción. En el Perú existe un déficit de médicos fisiatras y los estándares para la formación de especialistas en Medicina Física y Rehabilitación (MFyR) no han sido actualizados desde el 2002. No existen estudios que aborden esta problemática. Objetivos. Describir el número de vacantes y analizar los planes de estudios de los programas de residencia de MFyR. Métodos. Estudio observacional descriptivo. Revisamos el número de vacantes para MFyR ofertadas en el período 2017-2022. Asimismo, recolectamos las variables de interés de los planes de estudios de los programas de residencia, incluyendo el abordaje de 30 competencias básicas recomendadas por la Sociedad Internacional de MFyR (ISPRM). Resultados. Durante el periodo 2017-2022, 11 universidades ofertaron 283 vacantes para MFyR, de las cuales 89,4% correspondieron a la ciudad de Lima. El número de vacantes mostró una tendencia a la baja desde el 2018 hasta el 2021. 7 de 11 planes de estudios abordaron por lo menos el 75% de las competencias básicas recomendadas por la ISPRM, y ninguno abordó el 100% de estas competencias. Además, encontramos heterogeneidad respecto a los cursos teóricos, el número de créditos académicos y las rotaciones externas permitidas. Conclusiones. En el Perú, el número de vacantes para MFyR disminuyó durante la pandemia por COVID-19, a pesar de su rol fundamental en la atención de la población afectada por la enfermedad y del déficit de médicos fisiatras. Ningún plan de estudios incluye todas las competencias básicas recomendadas por la ISPRM, lo cual alerta sobre la necesidad de actualizarlos y reestructurarlos.

Introduction. In Peru there is a shortage of physiatrists, and the standards for the training of specialists in Physical Medicine and Rehabilitation (PM&R) have not been updated since 2002. There are no studies that have focused on this problem. Objectives. To describe the number of PM&R positions and analyze the PM&R residency programs' curriculums. Methods. Descriptive observational study. We reviewed the number of PM&R positions offered in the 2017-2022 period. Likewise, we collected the variables of interest from the curriculums that offer this residency program, including the approach of 30 basic competencies recommended by the International Society of PM&R (ISPRM). Results. During the 2017-2022 period, 11 universities offered 283 PM&R positions, of which 89.4% corresponded to the city of Lima. The number of positions showed a downward trend from 2018 to 2021. 7/11 curriculums addressed at least 75% of the basic competencies recommended by the ISPRM, and none of them addressed 100% of these competencies. In addition, we found heterogeneity between universities respect to the theoretical courses taught, the number of academic credits and the external rotations allowed. Conclusions. In Peru, the number of PM&R positions decreased during the COVID-19 pandemic, despite its crucial role in caring for the affected population and the shortage of physiatrists. No curriculum includes all the basic competencies recommended by ISPRM, highlighting the need to update and restructure them.

Satisfacción del usuario en consulta externa de Medicina Física y Rehabilitación del Hospital Nacional Edgardo Rebagliati Martins, 2022

Introducción : La satisfacción del paciente es un indicador fundamental de la calidad en los servicios de salud. Sin embargo, encontramos escasos estudios previos en Medicina Física y Rehabilitación (MFyR), especialidad que atiende a pacientes con discapacidad quienes tienen derecho a recibir servicios de salud de la más alta calidad. El objetivo del estudio fue evaluar la satisfacción del usuario en consulta externa de MFyR del Hospital Nacional Edgardo Rebagliati Martins (HNERM) de julio a septiembre del 2022. Métodos : Se realizó un estudio observacional transversal de tipo descriptivo. Se evaluó la satisfacción del usuario de consulta externa con la encuesta SERVQUAL. Asimismo, se incluyeron variables sociodemográficas, relacionadas a la atención brindada, y el tipo de terapia de rehabilitación que recibió. Se realizó el análisis de datos utilizando el paquete estadístico Stata/SE ®. Se realizó el análisis bivariado entre las covariables de interés y la satisfacción. Resultados : Se incluyó a 93 participantes, con una mediana de edad de 43 años, el 49.5 % tuvo un tiempo menor a 6 meses desde la primera atención en consulta externa y el 59.1 % recibía solo terapia física. La satisfacción global fue de 72.4 %. La satisfacción por dimensión fue de 79,6 % para seguridad, 78,5 % para aspectos tangibles, 76,9 % para empatía, 68,8 % para fiabilidad y 58,1 % para capacidad de respuesta. Conclusiones : Hallamos que aproximadamente siete de cada diez participantes presentaron satisfacción global en consulta externa de MFyR del HNERM. Las dimensiones con mayor satisfacción fueron seguridad, aspectos tangibles, y empatía.

Introduction : Patient satisfaction is an important indicator for quality in healthcare services. However, we found scant previous studies on this respect carried out in the Physical and Rehabilitation Medicine (PRM) service, a specialty that takes care of disabled patients entitled to receive best quality medical services. The objective of this study was to evaluate users' satisfaction in the outpatient clinic of the PRM service at Edgardo Rebagliati-Martins National Hospital (ERMNH), from July to September, 2022. Methods : A descriptive cross-sectional observational study was carried out. Outpatient's satisfaction was assessed using the SERVQUAL survey. Also, sociodemographic variables related to healthcare services and the type of rehabilitation therapy these patients received were assessed. Data analysis was performed using the Stata/SE® statistical software. Bivariate analysis for interest covariates and satisfaction was also performed. Results : Ninety-tree participants were included, their mean age was 43 years, nearly half (49.5%) had a less than 6-month time since they were seen for the first time in the outpatient clinic, and 59.1% only received physical therapy. Overall satisfaction was 72.4%. Satisfaction according to different dimensions was as follows> 79.6% for safety, 78.5% for tangible issues, 76.9% for empathy, 68.8% for reliability, and 58.1% for response capacity. Conclusions : We found that approximately seven out of ten patients had overall satisfaction in the PRM outpatient clinic at ERMNH. The dimensions with great satisfaction were safety, tangible issues, and empathy.

Aproximación a la práctica clínica del médico fisiatra y su desarrollo en Chile / Approach to clinical practice for Physiatrists or PM&R physicians and its development in Chile

Introducción: la actividad médica no acaba cuando la enfermedad remite. Así lo han demostrado las personas con COVID-19 grave, que no hablan de recuperación hasta meses después del egreso hospitalario. Bajo esta premisa amerita profundizar en el rol de la Medicina física y Rehabilitación. Materiales y Métodos: se realizó una revisión de la literatura en revistas de habla hispana e inglesa indexadas en bases de datos científicas. Los criterios de búsqueda fueron dirigidos a los objetivos: definir fisiatría y su posición dentro del modelo sanitario, conocer sus áreas de desempeño y la realidad nacional. Resultados: la fisiatría es la especialidad médica que se encarga de optimizar el funcionamiento de las personas mediante técnicas y estrategias de rehabilitación. Una vez establecido el diagnóstico trimodal, el fisiatra propone objetivos que involucren a todo el equipo rehabilitador, previo acuerdo con el paciente y su familia. Se encuadra bajo el modelo biopsicosocial y su espectro de acción comprende toda condición de salud o patología -congénita o adquirida- que genere una disfunción física, cognitiva o emocional, una limitación en la actividad o algún grado de restricción en la participación. A pesar del desarrollo de casi 60 años de la especialidad en Chile, existe desconocimiento en torno a ella y su alcance clínico. Discusión: parece importante contar en Chile con canales y agentes de difusión sobre el papel que juega la fisiatría como un recurso que eficientiza la restitución de las personas; deben promoverse líneas de investigación, desarrollo de subespecialidades y la descentralización de sus atenciones.

Introduction: Medical activity does not end when the disease remits. This has been demonstrated by patients with severe COVID-19, who do not speak of recovery until months after hospital discharge. Under this premise, the role of Physical medicine and rehabilitation deserves to be studied in depth. Materials and Methods: A literature review was conducted in Spanish and English language journals indexed in scientific databases. Search criteria were refined with the following objectives: to define Physiatry and its position within the health model, recognize its areas of performance, and describe the national context. Results: Physiatry is the medical specialty responsible for optimizing the functionality of people through rehabilitation techniques and strategies. Once the trimodal diagnosis is established, the physiatrist proposes objectives that involve the entire rehabilitation team and prior agreement with the patient and family. It is framed under the biopsychosocial model. Its range of action includes any health condition or pathology -congenital or acquired- that generates a physical, cognitive or emotional dysfunction, a limitation in activities, or any degree of restriction in participation. Despite 60 years of development in Chile, there is a lack of knowledge about this specialty and its potential clinical applicability. Discussion: It seems essential to create channels for dissemination of the role played by Physiatry in Chile as a resource that makes people's restitution more efficient, as well as promoting lines of research, development of subspecialties, and decentralization of care

PAIN MANAGEMENT OF COVID–19 INFECTED PATIENTS AFTER THE VACCINATION: A PROSPECTIVE STUDY

Background: COVID-19 is a severe infectious disease (SID) claimed that >180,000 lives are infected millions in the elderly population globally. Emerging evidences we observed that virus to cause hemorrhagic and immunologic responses impact in all the organs, including lungs, kidneys, eye , the brain, and extremities as well as. We had Material and Methods: performed with prospectively of >1,500 articles and included 525 references from our online databases, including with the Scopus, PubMed, Medline, Google Scholar, and the wave of Sciences. COVID-19 patients are also going through the acute respiratory distress syndrome (ARDS), cytokine storm (CS), acute hypercoagulable state (AHCS), and the autonomic dysfunction (ADF) managed by the multidisciplinary team approach. This is including with Physical medicine rehabilitation, medicine, nursing, nutrition, and rehabilitation and the other important radiological ?ndings. A total no of 30 vaccines under the developmental process (DP), Results: and now newly developed with their guidelines for the better treatment strategies and newly developed protocols are being well implemented. The majority of 80-95% of elderly population those are suffering from neurological diseases (ND-90-95%), Alzheimer's disease (AD-85%, Parkinsonism Diseases (PD-95%) and dementia (D-80%) related illnesses noticed that they are at higher risk during COVID-19 pandemic. The future management for COVID-19 should include B-cell and T-cell immunotherapy in combination with all the emerging prophylaxis is also more helpful. The pain CONCLUSION: management in the neurological disorders (ND) including with all the mental health with several illness aspects of the COVID-19 is the most important side effects of during the pandemic. Hence the national level and International level plan for prevention, diagnosis and treatment for SARS-CoV-2 also affects patients', families', society's neurological disorders (ND), Alzheimer's disease (AD), Parkinsonism Diseases (PD), Dementia Diseases (DD), and the other mental health patients at larger in population. Now growing evidence of re-infection in some neurological disorders (ND) patients is to provide a comprehensive knowledge of SARS-CoV-2-induced with neurological diseases (NDs) and their mechanism of infection (MOI), diagnostics, therapeutics, and their new treatment strategies, focusing with less attended aspects including with the nutritional support, psychological, and physical medicine and rehabilitation and its management are essential for elders, youth, and children.

Índice de independência funcional de pacientes pós-acidente vascular cerebral submetidos a um programa de reabilitação multiprofissional / Functional independence index of patients submitted to multiprofessional rehabilitation program after cerebrovascular accident

Acidente Vascular Cerebral (AVC) pode causar óbito ou sequelas motoras e funcionais de intensidade variável. O objetivo do estudo foi avaliar o índice de independência funcional de pacientes pós-Acidente Vascular Cerebral submetidos a um programa de reabilitação multiprofissional. Trata-se de estudo retrospectivo por meio de revisão dos prontuários de sobreviventes de lesão vascular na artéria cerebral média, admitidos entre 2014 e 2019 em hospital público de Curitiba - Paraná, e que foram analisados na admissão e na alta por meio da Escala de Rankin modificada (mRS). Foram aplicados teste Qui-Quadrado, Mann-Whitney e Wilcoxon, considerando p < 0,05 %. A amostra, composta por 64 pacientes, teve predomínio masculino (56 %), faixa etária média de 59 anos, eapresentou como sequelas principais déficit motor (98 %), disartria (51 %), afasia (46 %), dor (45 %) e incontinência urinária (42 %). Houve diferença significativa entre os escores aferidos por meio da mRS na admissão e na alta, com maior independência funcional após realização do programa de reabilitação proposto (p < 0,001). Conclui-se que a participação no programa refletiu em ganho de autonomia no autocuidado e na realização de atividades diárias pelos pacientes. [au]

A cerebrovascular accident (CVA) can cause death or motor and functional consequences of variable intensity. This study analyzed the rate of functional independence of patients after a cerebrovascular accident and a multi professional rehabilitation program. This was a retrospective research analyzing the medical charts of middle cerebral artery stroke survivors, admitted to a public hospital at Curitiba-Paraná between 2014 and 2019. The participants were analyzed at admission and discharge using the Modified Rankin Scale (mRS). The Chi-Squared test, Mann-Whitney test and Wilcoxon tests were applied, considering p<0.05%. The sample was composed of 64 patients, mainly men (56%), with a mean age of 59 years old. The main stroke sequelae were motor deficit (98%), dysarthria (51%), aphasia (46%), pain (45%) and urinary incontinence (42%). There was a significant difference between the mRS scores at admission and discharge, with greater functional independence after the proposed rehabilitation program (p <0.001). It is concluded that participation in the program led to increased autonomy in self-care and daily activities for the patients.[au]

Effects of a multimodal rehabilitation program in COVID-19 patients admitted to the Intensive Care Unit: A quasi-experimental study / Efectos de un programa de rehabilitación multimodal en pacientes con COVID-19 ingresados en la Unidad de Cuidados Intensivos: Un estudio cuasi-experimental

Background: Patients with severe COVID-19 evolve to acute respiratory distress syndrome (ARDS) and require management in Intensive Care Units (ICU) where they are exposed to immobilization, immunosuppression, malnutrition, nosocomial infections; may develop ICU Acquired Weakness (ICUAW), which increases with the stay and use of mechanical ventilation (MV).There is evidence of the use of different modalities in rehabilitation to mitigate these effects. Goal: To determine the efficacy of a Multimodal Rehabilitation Program (MRP) in reducing the number of days of mechanical ventilation and stay in patients hospitalized for COVID-19 in ICU, as well as to describe its clinical and hospital characteristics. Material and Methods: An quasi-experimental study was designed, with sequential sampling and without blinding. Acontrol and intervention group was formed, with 32 participants each. AMultimodal Rehabilitation Program (MRP) based on four therapeutic modalities was applied and the intervention was quantified through the use of proposed indicators. Results: The variation in days of ICU stay and days of MV were similar in both groups. The Multimodal Rehabilitation Index (iMR) ranged from 0.1 to 2.7 (mean = 1.2, SD = 0.7) and had significance for cut-off points ≤ 0.81 and ≤ 0.94 in mortality (p = 0.02) and Ventilator-free days at 28 days (VFDs-28) (p = 0.01). Conclusions: No statistically significant difference was found in favor of the intervention in terms of days of stay in the ICU and days of MV. Explanatorily, it was reported that iMR was related to (VFDs-28) and mortality in patients with severe COVID-19.

Introducción: Los pacientes con COVID-19 severo, evolucionan a síndrome de distrés respiratorio agudo (SDRA)y requieren manejo en Unidades de Cuidados Intensivos (UCI) donde están expuestos a inmovilización, inmunosupresión, desnutrición, infecciones nosocomiales; pueden desarrollar Debilidad Adquirida (DAUCI o ICUAW), que se incrementa con la estancia y uso de ventilación mecánica (VM). También se incrementa la mortalidad. Objetivo: Determinar la eficacia de un Programa de Rehabilitación Multimodal (PRM) en la disminución de días de ventilación mecánica y estancia en los pacientes hospitalizados por COVID-19 en UCI, así como describir sus características clínicas y hospitalarias. Material y Métodos: Se diseñó un estudio experimental, de muestreo secuencial y sin cegamiento. Se conformó un grupo control e intervención, con 32 participantes cada uno. Se aplicó un Programa de Rehabilitación Multimodal (PRM) basado en cuatro modalidadesterapéuticas y se cuantificó la intervención a través del uso de indicadores propuestos. Resultados: La variación en días de estancia UCI y días de VM fueron similar en ambos grupos. El Índice de Rehabilitación Multimodal (iRM) varió desde 0.11 a 2.71 (media= 1.23, DS=0.7) y tuvo significancia para los puntos de corte ≤ 0.81 y ≤ 0.94 en mortalidad (p=0.02) y días libres de ventilación mecánica al día 28 (DLVM-28) (p=0.01). Conclusiones: No se halló diferencia estadísticamente significativa a favor de la intervención en cuando a días de estancia en UCI y días de VM. Exploratoriamente se reportó que el iRM tuvo relación con los DLVM-28 y de la mortalidad en pacientes con COVID-19 severo.

Effect of Curricular Reforms of Physical Medicine and Rehabilitation in Medical Engineering Interdisciplinary Crossing on Eight-year Medical Students / 中国康复理论与实践

Objective:To observe the effect of curricular reforms of physical medicine and rehabilitation in medical engineering interdisciplinary on learning of eight-year medical students. Methods:The eight-year medical students studying Physical Medicine and Rehabilitation in Tsinghua University in 2018 and 2019 were enrolled into control group (n = 20) and observation group (n = 18), respectively. The control group used routine courses and studied with teachers of rehabilitation medicine; while the observation group added neuroscience theory and new advances, the development of functional magnetic resonance and application in rehabilitation medicine, new technology and progress in medical engineering in the course, and studied with teachers of electronic engineering, mechanical engineering and medicine. Their performances were compared. The observation group was surveyed with self-designed questionaire. Results:The performance of paper test, general test and total test were higher in the observation group than in the control group (t > 2.694, P < 0.01). The questionnaire showed that the observation group could better understand the course of Physical Medicine and Rehabilitation and the development of medical engineering interdisciplinary crossing and translational research within physical medicine and rehabilitation, and they thought it was more necessary to study the new course after the curriculum finished (|Z| > 2.304, P < 0.05). The proportion of students who were interested and very interested in medical engineering interdisciplinary crossing and translational research within physical medicine and rehabilitation increased from 77.78% to 94.44% (P = 0.222), and the the proportion of students who were probably and very probably engaged in physical medicine and rehabilitation increased from 61.11% to 83.33% (P =0.043). Conclusion:The curricular reforms in medical engineering interdisciplinary crossing could raise the interest and improve the test performance of eight-year students with physical medicine and rehabilitation.

Efeitos combinados da fisioterapia e terapia robótica no equilíbrio e velocidade da marcha em pacientes com lesão medular incompleta / Combined effects of physiotherapy and robotic therapy on gait balance and speed in patients with incomplete spinal cord injury

Restaurar a capacidade de andar é um dos objetivos da reabilitação na lesão medular incompleta (LMI). O treino orientado a tarefa abrange os princípios do aprendizado motor, envolvendo mecanismos de neuroplasticidade central e, consequentemente, reorganização cortical. O treinamento da marcha robótica G-EO System (GS) atua como um reforço da prática repetitiva e específica das fases da marcha. Objetivo: Investigar os efeitos combinados da fisioterapia e da terapia robótica na funcionalidade da marcha em relação ao equilíbrio e velocidade da marcha em pacientes com LMI. Métodos: Estudo de coorte retrospectivo com 14 pacientes na fase crônica da doença, que realizaram 20 sessões de GS associado à fisioterapia convencional (FC). Utilizamos o Teste de Caminhada de 10 Metros (TC10) e a Escala de Equilíbrio de Berg (EEB). Valores de p <0,05 foram considerados estatisticamente significativos pelo teste de Wilcoxon ao início da fisioterapia convencional e pré e pós intervenção. Resultados: Observou-se que no TC10, a velocidade inicial média variou de 2,60 m/s ± 1,72 no início da FC a 1,57 m/s ± 0,80 no final das 20 sessões de GS com p = 0,0424. Para a EEB no início da FC, a média foi de 31,85 pontos ± 12,50 e 42,35 ± 14,25 ao final da intervenção, com p = 0,0096. Conclusão: A terapia robótica da marcha associada à FC mostrou-se eficaz na promoção do equilíbrio e da melhora da velocidade da marcha em indivíduos na fase crônica da LMI.

Restoring the ability to walk, especially independently, is one of the goals in the rehabilitation of patients with incomplete spinal cord injury (ISCI). The G-EO System (GS) robotic gait training acts as a reinforcer of the repetitive and specific practice of the gait phases. Objective: Investigate the combined effects of physiotherapy and robotic therapy on gait functionality in relation to balance and gait speed in patients with ISCI. Methods: Retrospective cohort study with 14 patients in the chronic phase of the disease, using the GS as a robotic intervention for gait and stairs, consisting of a 20-session protocol associated with conventional physical therapy. We used the 10-meter Walk Test (10WT) and the Berg Balance Scale (BBS). P values <0.05 were considered statistically significant using the Wilcoxon test at the beginning of conventional physical therapy and before and after intervention. Results: At the 10WT, the mean initial velocity ranged from 2.60 m/s ± 1.72 at the beginning of conventional physical therapy to 1.57 m/s ± 0.80 at the end of the 20 GS sessions with p = 0.0424. For BBS at the beginning of conventional physical therapy, the average was 31.85 points ± 12.50, and 42.35 ± 14.25 at the end of the 20 GS sessions, with p = 0.0096. Conclusions: Robotic gait therapy associated with conventional physiotherapy has been shown to be effective in promoting balance and gait speed improvement in individuals in the chronic phase after involvement of incomplete spinal cord injury.

Características de patentes de dispositivos para rehabilitación física registradas en los Estados Unidos / Characteristics of patents of physical rehabilitation devices registered in the United States

Introducción: La rehabilitación física puede verse beneficiada con el uso de dispositivos, los cuales en su mayoría suelen ser patentados. La oficina de patentes y marcas de los Estados Unidos (USPTO) es una de las oficinas de patentes y marcas más grandes y reconocidas. Resulta de interés evaluar las características y la evolución de las patentes para la rehabilitación física; sin embargo, existen pocos estudios al respecto. Objetivo: Identificar las características de las patentes de dispositivos de rehabilitación física de extremidades, registradas en la oficina de patentes y marcas de los Estados Unidos. Material y métodos: Estudio descriptivo transversal. Se realizó una búsqueda en UPSTO usando una lista de palabras clave relacionadas con la rehabilitación. Se eligieron 10 grupos de patentes relacionados con la rehabilitación. Las variables estudiadas fueron: número de la patente, fecha de publicación, país, titular, área de la patente, extremidades para las cuales es útil la patente y portabilidad. Se realizó un análisis descriptivo usando STATA v.14. Resultados: Se analizaron 1971 patentes, de las cuales 16,2 por ciento fueron incluidas en los grupos de rehabilitación y 83,8 por ciento en ejercicio físico. El 36,6 por ciento de todas las patentes fueron patentadas por un titular corporativo, el 29,9 por ciento fueron portables, y el 46,3 por ciento tenían utilidad para ambas extremidades. Conclusiones: De las patentes encontradas las enfocadas para ejercicio físico fueron las predominantes. Existe una mayor cantidad de patentes útiles para ambas extremidades. Además, existe una tendencia ascendente en el tiempo, en el número de patentes del área de rehabilitación y de las invenciones portables(AU)

ABSTRACT Introduction: Physical rehabilitation can be benefitted from the use of devices, which are usually patented. The United States Patent and Trademark Office (USPTO) is one of the largest and most recognized patent and trademark offices. The characteristics and evolution of patents for physical rehabilitation is of great interest; however, there are few studies in this respect. Objective: To identify the characteristics of patents of physical rehabilitation devices for the physical rehabilitation of damaged limbs registered the United States Patent and Trademark Office. Material and methods: A cross-sectional descriptive study was conducted. A search was made at UPSTO using a list of keywords related to rehabilitation. Ten groups of patents related to rehabilitation were chosen. The variables studied were: patent number, publication date, country, holder, patent area, limbs for which the patent is useful, and portability. A descriptive analysis was performed by using STATA v.14. Results: A total of 1971 patents were analyzed, of which 16.2 percent were included in the rehabilitation groups and 83.8 percent in the physical exercise groups. The 36.6 percent of them were corporate-owned patents, 29.9 percent were portable, and 46.3 percent had usability which demonstrated to be useful for both extremities. Conclusions: Of the patents found, those focused on physical exercise were predominant. There is a greater number of useful patents for both extremities. In addition, there is an upward trend over time, the number of patents in the area of ​​rehabilitation, and portable inventions(AU)

Exercício físico e redução da lipemia pós-prandial: a influência do gasto calórico / Physical exercise and reduction of postprandial lipemia: the influence of caloric expenditure

INTRODUÇÃO: Embora o efeito redutor de uma única sessão de exercício físico (EF) sobre a lipemia pós-prandial (LPP) seja controverso, estudos apontam que o gasto calórico é o principal determinante de redução da LPP. OBJETIVO: Testar a hipótese de que uma sessão de EF, baseado no gasto calórico modifica a LPP. MÉTODOS: Estudo de intervenção prospectivo controlado, tendo como população 18 homens com idade média de 22±1,3 anos e IMC de 21±4,2kg/m². Todos eram estudantes irregularmente ativos, com valores de triglicerídeos (TG) de jejum menor ou igual a 150mg/dl. Foram submetidos a dois testes de LPP: Basal (LPPB) e Exercício (LPPE). Amostras sanguíneas foram coletadas nos tempos 0(jejum) e após a ingestão de um composto lipídico (25g) em 180 e 240 minutos para a dosagem dos TG. No teste da LPPE foi aplicado logo após a coleta de 120 minutos, uma sessão de EF em esteira ergométrica alcançando um gasto energético de 500kcal. ESTATÍSTICA: Foram comparadas as medianas da variação (delta) entre os valores dos TG dosados entre o jejum e 120min (∆1), jejum e 240min (∆2) e entre 120 e 240min (∆3). Utilizou-se o teste de Wilcoxon bidirecional para comparação dos deltas. RESULTADOS: As medianas dos TG do ∆1 respectivamente para LPPB e LPPE foram de 63 Vs 60 (p=0,95); ∆2 102 Vs 25 (p=0,02) e ∆3 32 Vs -10 (p˂0,01). CONCLUSÃO: Neste estudo, uma sessão de exercício físico baseado no gasto calórico de 500kcal, após a ingestão lipídica, reduziu o pico da LPP em jovens sadios. [AU]

INTRODUCTION: Although the reductive effect of a single physical exercise (PE) session on postprandial lipemia (PPL) is controversial, studies indicate that caloric expenditure is the main determinant of PPL reduction. OBJECTIVE: Test the hypothesis that a PE session based on caloric expenditure modifies PPL. METHODS: This is a prospective controlled intervention study, including a cohort of 18 men with average age of 22 ± 1.3 years and BMI of 21 ± 4.2 kg/m². All were irregularly active students, with fasting triglyceride (TG) values of less than or equal to 150mg/dL. They were submitted to two PPL tests: Basal (PPLB) and Exercise (PPLE). Blood samples were collected at time 0 (fasting) and after ingestion of a lipid compound (25g) at 180 and 240 minutes for TG dosing. In the PPLE test, a PE session on treadmill was applied shortly after the collection at 120 minutes, achieving an energy expenditure of 500kcal. STATISTICS: The medians of the variation (delta) between the TG values between fasting and 120min (Δ1), fasting and 240min (Δ2) and between 120 and 240min (Δ3) were compared. The bi-directional Wilcoxon test was used to compare deltas. RESULTS: The TG medians of Δ1 respectively for PPLB and PPLE were 63 Vs.60 (p=0.95); Δ2 102 Vs. 25 (p=0.02) and Δ3 32 Vs. -10 (p<0.01). CONCLUSION: In this study, a physical exercise session based on caloric expenditure of 500kcal, after lipid intake, reduced the PPL peak in healthy youngsters. [AU]

Puesta en marcha del área de terapia ocupacional en servicio de rehabilitación, en el Hospital El Carmen / Starting the area of occupational therapy in rehabilitation services Hospital El Carmen

Los cambios demográficos y epidemiológicos asociados con el envejecimiento poblacional e incremento de enfermedades crónicas producen un aumento de las demandas en salud. Por este motivo, en los próximos años el Estado contempla la apertura de servicios de medicina física y rehabilitación que incorporen el área de terapia ocupacional en la red pública asistencial. El objetivo del presente documento es transmitir la experiencia de la puesta en marcha del área de terapia ocupacional en un hospital público. Se identifican 10 etapas a lo largo del proceso de implementación y puesta en marcha, cada una de ellas con sus respectivos facilitadores y obstaculizadores. Los principales resultados son la confección de protocolos de atención, de documentos técnicos asociados a la intervención, el fortalecimiento de la coordinación con la red de discapacidad, la terapia ocupacional como disciplina necesaria en estas unidades, el aumento de la demanda de atención, la buena recepción de los usuarios y la importancia de los equipos de trabajo. Como conclusiones destacan las habilidades particulares del equipo de trabajo para el desarrollo de procesos, la coordinación con la red para clarificar la pertinencia de ingreso de usuarios y los procesos de referencia y contra referencia. Y por último, la importancia de sistematizar la experiencia que facilite el traspaso de información a equipos que puedan ejecutarlo posteriormente.

Demographic and epidemiological changes associated with aging population and increasing chronic diseases result in increased health demands. For this reason the State plans to open services physical medicine and rehabilitation incorporating the area of occupational therapy in the coming years. The objective of this document is to convey the experience of the implementation of the area of occupational therapy in a public hospital. Ten stages are identified throughout the implementation process and implementation, each with their facilitators and obstructionist. The main results are translated into the making of care protocols, technical documents associated with the intervention, strengthening coordination with the network of disability, occupational therapy as necessary discipline in these units, increased demand for care, the good reception of users, the importance of the work teams, and systematization document. As findings highlight the particular skills of the work team development process, coordination with network to clarify the relevance of user input, reference and counter processes. And finally, the importance of systematizing the experience that facilitates the transfer of information to teams that can run later.

Conocimiento sobre medicina física y rehabilitación de los médicos del sistema público de salud de la Región Metropolitana de Chile / Physician knowledge of physical medicine and rehabilitation in the public health system, Metropolitan Region, Chile

Más de mil millones de personas viven en el mundo en situación de discapacidad. La Medicina Física y Rehabilitación (MFR) o Fisiatría es la especialidad médica que con un enfoque transdisciplinario es responsable de la prevención, diagnóstico y tratamiento rehabilitador de las personas en situación de discapacidad (PSD). La literatura internacional reporta que un importante número de personas en situación de discapacidad no han recibido el manejo y soporte adecuados, pudiendo ello deberse en parte a la falta de conocimientos de los médicos sobre los alcances de la MFR. OBJETIVO: Explorar el conocimiento existente respecto a la especialidad MFR entre los médicos que trabajan en el sistema público de salud (SPS) de la Región Metropolitana (RM) de Chile. MÉTODO: Estudio descriptivo de corte transversal. Se aplicó una encuesta confeccionada y validada para explorar el conocimiento de los médicos sobre la MFR en 27 centros de salud de la RM. RESULTADOS: 131 médicos de diferentes especialidades contestaron la encuesta. El 24,07% de los pacientes por ellos atendidos correspondía a PSD. El 39,7% de los encuestados respondió "nunca" derivar pacientes al médico fisiatra y el 74,8% reconoció no estar completamente interiorizado sobre las áreas que involucra la MFR. CONCLUSIÓN: El conocimiento sobre la MFR entre los encuestados es parcial. Áreas específicas del quehacer del fisiatra y algunas instituciones en las cuales trabajan son desconocidas. Un importante número de pacientes podría no estar recibiendo oportunamente evaluación fisiátrica y tratamiento rehabilitador, perpetuando o incluso agravando la condición inicial. Se deben crear mecanismos de difusión de esta rama médica en los equipos de salud para un mejor conocimiento e integración de la rehabilitación en Chile.

More than one billion people in the world live with a disability. Physical Medicine and Rehabilitation (PMR), or Physiatry, is a medical specialty with a transdisciplinary approach that is responsible for the prevention, diagnosis, treatment and rehabilitation of people with disabilities (PD). The international literature reports that a significant number of people with disabilities have not received proper handling and support; this may be partly due to lack of knowledge concerning PMR. OBJECTIVE: To explore the existing knowledge of PMR among physicians working in the public health system (PHS) of the metropolitan region (MR), Chile. METHOD: Descriptive cross-sectional study. A validated survey was applied to physicians in 27health centers in the MR. RESULTS: 131 physicians from different specialties responded to the survey: 24.07% of their patients corresponded to PD. 39.7% of respondents answered they "never" refer patients to the physiatrist and 74.8% admitted not being completely familiar with the areas involved in PMR. CONCLUSION: Knowledge about PMR among respondents is partial. Specific areas of the physiatrist's role and institutions in which they work at are unknown. A significant number of patients might not be receiving opportune physiatric evaluation and rehabilitation, possibly perpetuating or even exacerbating their initial condition. Mechanisms for disseminating this medical branch among health teams should be created for a better understanding and integration of rehabilitation in Chile.

Fluoroscopy-guided intra-articular sacroiliac joint steroid injection for sacroiliitis in ankylosing spondylitis: a Case Report / Infiltración intraarticular de esteroides en la articulación sacro-ilíaca guiada por fluoroscopia para la sacroiliitis en la espondilitis anquilosante: Reporte de Caso

Sacroiliitis, a condition commonly seen in ankylosing spondylitis, is well known to be one of the main pain generators of low back pain, which may result in difficulty with walking. A 20-year old male with history of ankylosing spondylitis presented to the University Hospital of the West Indies, Physical Medicine and Rehabilitation Clinic, with a two-year history of right buttock, low back and groin pain. Radiographic evaluation revealed increased sclerosis and erosive changes in bilateral sacroiliac joints, right greater than left. Right intra-articular sacroiliac joint steroid injection was administered under fluoroscopy guidance. Post-injection visual analogue pain scale (VAS) score with activity improved from 8 to 1 and Oswestry Disability Index improved from 40% moderate disability to 16% minimal disability. The patient's overall assessment was 95% perceived improvement in pain. This case report illustrates the effectiveness of intra-articular sacroiliac joint steroid injection in treating sacroiliitis in ankylosing spondylitis.

La sacroilitis, una condición comúnmente vista en la espondilitis anquilosante, es bien conocida por ser uno de los principales generadores de dolor lumbar, que puede ocasionar dificultad para caminar. Un paciente de 20 años de edad con una historia de espondilitis anquilosante, acompañada de dos años de dolor en la nalga derecha, la región lumbar, y en la ingle, acudió a la Clínica de Rehabilitación y Medicina Física del Hospital Universitario de West Indies. La evaluación radiográfica reveló esclerosis aumentada y cambios erosivos en la articulación sacroilíaca bilateral, mayor en el lado derecho que en el izquierdo. Con la ayuda de la fluoroscopia para guiar el procedimiento, se le administró al paciente una inyección intraarticular de esteroide en la articulación sacro-ilíaca, al lado derecho. La puntuación de la escala analógica visual del dolor (VAS) tras la inyección mejoró de 8 a 1, y el Índice de Discapacidad de Oswestry mejoró de una discapacidad moderada del 40% a una mínima discapacidad del 16%. La evaluación general del paciente fue de un 95% en cuanto a la percepción de la mejoría del dolor. Este reporte de caso ilustra la eficacia de la inyección intraarticular de esteroides de la articulación sacroilíaca para el tratamiento de la sacroiliitis en la espondilitis anquilosante.

Secondary Prevention as Integral Part of Stroke Rehabilitation

Stroke is the second leading cause of death, and the leading cause of acquired disability in adults. Survivors of stroke are at risk of a recurrent event, which is often more disabling than first-ever stroke. Recurrent strokes continue to account for 25~30% of all strokes. That represents the needs of successful secondary prevention. Appropriate secondary prevention of recurrent stroke needs rapid diagnosis and treatment and prompt identification of the underlying cardiovascular cause. Some epidemiological data suggest that a substantial proportion of strokes can be attributed to unhealthy lifestyle behaviors. This review summarizes the evidence for optimum secondary prevention of recurrent ischemic stroke as integral part of physical medicine and rehabilitation.

Satisfacción y retención de los contenidos del Curso Agentes Físicos del Diplomado en Rehabilitación / Satisfaction and retention of the contents of the course on Physical Agents given in the Diploma Course on Rehabilitation

Se realizó una investigación educacional para identificar la satisfacción de residentes y profesores de la especialidad en Medicina Física y Rehabilitación con el Curso Agentes Físicos (AF) impartido en el Diplomado de Rehabilitación en la Atención Primaria de Salud y evaluar la retención de los contenidos recibidos, así como la necesidad de abordarlos nuevamente en el programa de la especialidad, por su importancia. Para medir la satisfacción se aplicaron encuestas a los 23 residentes de segundo año de la especialidad y a 16 profesores, que impartieron clases en el curso. Se aplicó un examen teórico a todos los residentes, para evaluar la retención de dichos contenidos. Para el análisis de la información se procesaron los datos mediante frecuencias y porcentajes y se presentaron en tablas, para darles significación se realizó una triangulación de los datos con elementos teóricos. Los resultados mostraron satisfacción baja respecto a los contenidos de agentes físicos del diplomado, los que son insuficientes, no están actualizados y presentan dificultades con su profundización y aplicación, por lo que deben ser abordados nuevamente y con mayor profundidad en el programa de la especialidad. Los residentes demostraron no tener suficiente dominio de los contenidos recibidos

An education research was conducted to identify the satisfaction of residents and professors of the specialty of Physical Medicine and Rehabilitation with the course on Physical Agents given in the Diploma Course on Rehabilitation in Primary Health Attention and evaluate retention of the contents studied as well as the need to deal with these contents again, because of their importance, in the course design of the specialty. To measure the level of satisfaction, inquiries were applied to the 23 second year residents of the specialty and 16 professors who gave lessons in the course. A theory exam was applied to all residents to evaluate retention of the above contents. For information analysis, all data were processed by means of frequencies and percentages, they were shown in tables and, to emphasize their importance, a triangulation of data with theoretical elements was presented. The results showed low satisfaction with the contents on physical agents given in the Diploma Course which are not sufficient; they are not updated and present difficulties in their depth and application what means that they should be undertaken again in depth in the course design of the specialty. Residents showed not to have enough knowledge of the contents received

A citation analysis of Chinese Journal of Physical Medicine and Rehabilitation / 中华物理医学与康复杂志

Objective To evaluate the academic level and the popularity of Chinese Journal of Physical Medicine and Rehabilitation (CJPMR). Methods According to the information of Chinese Medical citation Index (CMCI), the amount and distribution of the CJPMR originals cited by the journals included by CMCI was statistically analyzed. Results The percent of cited papers in all published articles was 39.24%, and the average times of each original article cited by other researchers is 2.13. The most frequently cited authors are from 28 provinces, especially from Beijing, Hubei and Guangdong. There are 313 citing journals, and self-citing rate is 0.26. Conclusion CJPMR has published high quality articles, and has the own edition characteristics to keep its steady level of research. It is one of the most important information resources for the physical medicine and rehabilitation researchers and the core journal in the rehabilitation medical research field.