Impact of Kinesiotherapy Rehabilitation on Quadriceps Femoris Muscle Strength and Functionality in Total Hip Arthroplasty Patients / Impacto de la Rehabilitación con Kinesioterapia en la Fuerza y Funcionalidad del Músculo Cuádriceps Femoral en Pacientes con Artroplastía Total de Cadera

SUMMARY: The objective was measure quadricep strength after Total Hip Arthroplasty (THA) and kinetic treatment and then determine its impact on the functional recovery of patients with hip osteoarthritis. A total of 79 (25 were male and 54 were female) patients with THA. Exclusion criteria were previous extra-system kinetic treatment, operated on for hip fracture, not completing the treatment. Maximum Isometric Strength (MIS), Time Up and Go (TUG), Modified Harris Hip Score. There was a significant increase in the MIS of the post-treatment operated knee extension in both men and women (p < 0.0001 SE = 0.43; p < 0.0001 SE = 1.22, respectively). In the TUG, the execution time was significantly lower post-treatment in both men and women (p < 0.0001 SE = 0.77; p < 0.0001 SE = 0.94, respectively). The final Harris score increased significantly post-treatment in male and female (p < 0.0001 SE = 2.90; p < 0.0001 SE = 1.96, respectively). the association between MIS and the Harris score, it was noted that, for a 1 kg increase in this measure compared to the initial assessment, the Harris score, after 12 weeks of treatment, increased by 0.179 points (β = 0.179; p = 0.050). The conclusions were Indicate an increase in knee extension MIS of the operated hip after treatment in both sexes. At the same time, functionality increased post-treatment in both male and female.

El objetivo del estudio fue medir la fuerza del músculo cuádriceps femoral después de la artroplastia total de cadera (THA, por sus siglas en inglés) y el tratamiento kinésico, para determinar su impacto en la recuperación funcional de pacientes con osteoartritis de cadera. En el estudio participaron 79 pacientes con THA (25 hombres y 54 mujeres). Se excluyeron quienes tuvieron tratamiento Kinésico previo fuera del hospital, operación por fractura de cadera y no completar el tratamiento. Las principales medidas tomadas fueron: Fuerza Máxima Isométrica (MIS), Time UP and GO (TUG), Puntuación Modificada de Harris de Cadera. Hubo un aumento significativo en la MIS de la extensión de rodilla del lado operado después del tratamiento tanto en hombres (p<0,0001, EE=0,43) como en mujeres (p<0,0001, EE=1,22). En el TUG, el tiempo de ejecución fue significativamente menor después del tratamiento en hombres (p<0,0001, EE=0,77) y mujeres (p<0,0001, EE=0,94). La puntuación final de Harris aumentó significativamente después del tratamiento en hombres (p<0,0001, EE=2,90) y mujeres (p<0,0001, EE=1,96). En cuanto a la asociación entre MIS y la puntuación de Harris, se observó que por cada aumento de 1 kg en esta medida en comparación con la evaluación inicial, la puntuación de Harris aumentó en 0,179 puntos después de 12 semanas de tratamiento (β=0,179; p=0,050). En conclusión se observó un aumento en la MIS de la extensión de rodilla del lado operado después del tratamiento en ambos sexos. Al mismo tiempo, la funcionalidad aumentó después del tratamiento tanto en hombres como en mujeres.

Interacción de Tratamiento Ortodóncico, Fonoaudiológico y Kinesiológico. Reporte de caso / Interaction of Orthodontics, Speech and Physical Therapy. Case report

Se describe el caso clínico de una paciente de 8 años de edad, sexo femenino que presenta respiración oral, anomalía dentomaxilar, interposición lingual en deglución, fonación, lengua descendida en reposo y adaptaciones musculoesqueléticas por lo que requiere tratamiento de Ortodoncia, Fonoaudiología y Kinesiología. El presente reporte de caso describe la interacción de las especialidades requeridas para el manejo adecuado de la paciente y expone un flujograma sugerido para abordar casos similares.

The following is a clinical case of an eight-year-old female patient who presents oral respiration, dentomaxilar anomaly, tongue interposition during swallowing and phonation, lowered tongue at rest and musculoskeletal adaptations, hence requires orthodontics, speech and physical therapy. This case report describes the interaction of the specialties necessary for the proper management of the patient and presents a suggested flow chart to address similar cases.

Eficacia de los factores de crecimiento derivados de plaquetas en el tratamiento de las lesiones condrales y osteocondrales / Effectiveness of platelet-derived growth factors in the treatment of chondral and osteochondral injuries

Las lesiones condrales y osteondrales afectan a sectores del cartílago articular. Producen dolor, inflamación e impotencia funcional que evolucionan a osteoartritis. Los factores de crecimiento presentes en el plasma rico en plaquetas (PRP) son señales bioquímicas capaces de modificar las respuestas de las células al crecimiento y la diferenciación celular, lo que interviene en la curación de los tejidos. Material y métodos. Estudio experimental, aleatorizado, abierto, de 1 año de duración. Objetivo. Evaluar la eficacia clínica del PRP. Incluimos a 324 pacientes con lesiones grado I, II y III, divididos en 2 grupos mediante aleatorización simple. El grupo Tratamiento fue tratado con PRP (3 ml intraarticular) cuya aplicación fue repetida a los 90 días, fisiokinesioterapia y glucosamina. El grupo Control fue tratado con fisiokinesioterapia y glucosamina, durante 90 días. Los resultados fueron evaluados mediante el cuestionario WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index). Resultados. 81% (n = 262) de los pacientes fue del sexo femenino; 19% (n = 62), masculino. La edad promedio fue 59 años (rango de 41 a 86). Todos los casos correspondieron a rodilla: 73% (n = 237) bilateral, 27% (n = 87) unilateral, 14% (n = 45) derecha, 13% (n = 42) izquierda. No se obtuvieron diferencias significativas entre ambos grupos en el primer control postratamiento. La mejoría clínica del grupo Control disminuyó luego del día 90, y se mantuvo en el grupo Tratamiento, lo que representa un resultado significativo desde el punto de vista estadístico (p < 0,05). Conclusiones. El tratamiento con PRP mostró mejor resultado clínico en el tiempo. No hubo efectos adversos. Nivel de evidencia: 1. (AU)

Chondral and ostechondral injuries affect sectors of articular cartilage. They cause pain, inflammation and functional impairment that can lead to osteoarthritis. The growth factors present in platelet-rich plasma (PRP) are biochemical signals capable of modifying cell responses to growth and differentiation, which play a role in tissue healing. Material and methods. Experimental, randomized, open-label study. Objective. To evaluate the clinical efficacy of PRP. We included 324 patients with grade I, II and III injuries, divided into 2 groups through simple randomization: Treatment group was treated with PRP (3 ml intraarticular) repeated at 90 days, physio-kinesiotherapy and glucosamine. Control group was treated with physio-kinesiotherapy and glucosamine for 90 days. Results were evaluated using WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index). Results. 81% (n = 262) were female, 19% (n = 62) were male. The mean age was 59 years (range 41 to 86). All cases involved the knee: 73% (n = 237) bilateral, 27% (n = 87) unilateral, 14% (n = 45) right, 13% (n = 42) left. No significant differences were found between both groups in the first post-treatment assessment. Clinical improvement of the Control group decreased after day 90, while it was maintained in the Treatment group, representing a statistically significant result (p < 0.05). Conclusions. Treatment with PRP showed better clinical results over time. There were no adverse effects observed. Evidence level: 1. (AU)

Comparison of Muscle Energy Technique, Myofascial Release, and Combined Techniques for Glenohumeral Internal-Rotation Deficit. An Interventional Study / Comparación de Técnica de Energía Muscular, Liberación Miofascial y Técnicas Combinadas para el Déficit de Rotación Interna Glenohumeral. Un Estudio Intervencionista

SUMMARY: This study aimed to determine the benefits of a combined technique of muscle energy with and myofascial release more effective than using each in isolation in glenohumeral internal rotator deficits. An interventional study was designed for this study. Thirty-eight patients were diagnosed with painful shoulder syndrome. Patients were randomly allocated into 4 groups where Group A was treated with combined muscle energy and myofascial release; Group B with muscle energy technique; Group C with myofascial release and Group D used as control. The evaluation of the passive joint range of the glenohumeral internal rotation and sociodemographic data for each of the groups were measured, before and after interventions. Despite the use of myofascial release and muscle energy techniques being significantly beneficial in their respective groups, when both were combined; it outcomes were highly successful. A combination therapy treatment applied with the Muscle Energy and Myofascial Release Techniques in patients with painful shoulder syndrome will be more effective in increasing the range of motion of the glenohumeral internal rotation joint than any of the techniques applied individually.

Este estudio tuvo como objetivo determinar los beneficios de una técnica combinada de energía muscular con liberación miofascial más efectiva que usar cada una de manera aislada en los déficits de los músculos rotadores internos glenohumerales. Para este estudio se diseñó un protocolo de intervención. En 38 pacientes se diagnosticó síndrome de hombro doloroso. Los pacientes fueron asignados aleatoriamente a 4 grupos; el grupo A fue tratado con energía muscular combinada y liberación miofascial; Grupo B con técnica de energía muscular; Grupo C con liberación miofascial y Grupo D utilizado como control. Se midió la evaluación del rango articular pasivo de la rotación interna de la articulación glenohumeral y datos sociodemográficos de cada uno de los grupos, antes y después de las intervenciones. A pesar de que el uso de técnicas de liberación miofascial y energía muscular resultó significativamente beneficioso en sus respectivos grupos, cuando ambas se combinaron; Sus resultados fueron muy exitosos. Un tratamiento de terapia combinada aplicado con las Técnicas de Energía Muscular y Liberación Miofascial en pacientes con síndrome de hombro doloroso será más efectivo para aumentar el rango de movimiento de la articulación de rotación interna glenohumeral que cualquiera de las técnicas aplicadas individualmente.

Resultado da mobilização precoce sobre as repercussões clínicas e funcionais de cirurgias torácicas: revisão integrativa / Resultados de la temprana movilización sobre las repercusiones clínicas y funcionales de cirugíatorácica: revisión integrativa / Results of early mobilization on the clinical and functional repercussions of patients submitted to thoracic surgery: integrative review

Introdução: O período de internação os pacientes passam por um longo período de imobilização no leito, acompanhada de complicações e comorbidades que podem ocorrer no período pós-operatório. A fisioterapia aturará prevenindo os efeitos da imobilidade no leito, além de melhorar a independência funcional do paciente. Objetivo: Diante o exposto, o objetivo desse estudo é analisar as repercussões clínicas e funcionais da reabilitação precoce em pacientes submetidos à cirurgia torácica. Metodologia: Trata-se de uma revisão integrativa. Critérios de inclusão: ensaios clínicos randomizados, artigos completos, dos idiomas português, inglês e espanhol, publicados entre 2012 e 2022. Critérios de exclusão: protocolos de ensaios, ensaios não finalizados, estudos inferiores ao ano de 2012 e outras línguas. Descritores: Cirurgia torácica; Deambulação precoce; Modalidades de Fisioterapia. Com seus respectivos termos na língua inglesa. Resultados: Foram encontrados 51 artigos. Com os critérios estabelecidos foram selecionados 06 artigos. Os estudos dos autores avaliados se mostraram benéficos para a terapia de deambulação precoce combinada e exercícios. Conclusões: Os achados resultam na minimização das alterações de fluxo e volume pulmonar, otimização da mecânica do movimento tóraco-abdominal e aumento da amplitude do movimento dos músculos respiratórios, facilitando a reexpansão pulmonar e melhorando osparâmetros de função pulmonar (AU)>

Introduction: During hospitalization, patients go through a long period of immobilization in bed, accompanied by complications and comorbidities that may occur in the postoperative period. Physical therapy will help prevent the effects of immobility in bed, in addition to improving the patient's functional independence. Objective:Given the above, the objective of this study is to analyze the clinical and functional repercussions of early rehabilitation in patients undergoing thoracic surgery. Methodology:It is a systematic review. Inclusion criteria: randomized clinical trials, complete articles, in Portuguese, English and Spanish, published between 2012 and 2022. Exclusion criteria: trial protocols, unfinished trials, studies smaller than 2012 in other languages. Descriptors: Thoracic surgery; Early ambulation; Physiotherapy modalities. Results:51 articles were found. With the established criteria, 06 articles were selected. The evaluated authors' studies have shown benefit for combined early ambulation therapy and exercise. Conclusions:The findings result in the minimization of changes in lung flow and volume, optimization of the mechanics of thoracoabdominal movement and increased range of motion of the respiratory muscles, facilitating lung re-expansion and improving lung function parameters (AU).

Introducción: A lo largo de la hospitalización, los pacientes pasan por un largo período de inmovilización en cama, acompañado de complicacionesy comorbilidades que pueden presentarse en el postoperatorio. La fisioterapia ayudará a prevenir los efectos de la inmovilidad en cama, además de mejorar la independencia funcional del paciente. Objetivo:Teniendo en cuenta lo anterior, el objetivo de este estudio es analizar las repercusiones clínicas y funcionales de la rehabilitación temprana en pacientes sometidos a cirugía torácica.Metodología: Esta es una revisión sistemática. Criterios de inclusión: ensayos clínicos aleatorizados, artículos completos, en portugués, inglés y español, publicados entre 2012 y 2022. Criterios de exclusión: protocolos de ensayos, ensayos inconclusos, estudios menores a 2012 y otros idiomas. Descriptores: Cirugía torácica; Deambulación temprana; Modalidades de fisioterapia. Con sus respectivos términosen inglés.Resultados: Se encontraron 51 artículos. Fueron seleccionados 06 artículos, con los criterios establecidos. Los estudios de los autores evaluados han demostrado beneficios para la combinación de terapia de deambulación temprana y ejercicio.Conclusiones: Los hallazgos resultan en la minimización de alteraciones en el flujo y volumen pulmonar, optimización de la mecánica del movimiento toracoabdominal y aumento en el rango de movimiento de los músculos respiratorios, facilitando la reexpansión pulmonar y mejorando los parámetrosde la función pulmonar (AU).

Pausas inspiratórias de 0.5 e 2.0 segundos durante avaliação de mecânica respiratória não produzem alterações hemodinâmicas em pacientes sob ventilação mecânica: estudo transversal / Inspiratory pauses of 0.5 and 2.0 seconds during respiratory mechanics assessment do not produce hemodynamic changes in mechanically ventilated patients: cross-sectional study

INTRODUÇÃO: A interação coração-pulmão influenciada pela Ventilação Mecânica (VM), que impacta diretamente no retorno venoso e débito cardíaco através, e não somente, de ajustes da Pressão Positiva Expiratória Final (PEEP) e Pressão média nas vias aéreas (Pmed). Além disso, as pausas inspiratórias para avaliação da mecânica pulmonar interrompem o movimento torácico, pode impactar mais nesta interação. OBJETIVO: Comparar as alterações hemodinâmicas durante os tempos de 0,5 e 2,0 segundos de pausa inspiratória durante as mensurações de mecânica respiratória. MÉTODOS: Trata-se de um estudo transversal, realizado nas unidades de terapia intensivas de um hospital público de Salvador/BA. Foram incluídos pacientes em uso de VM e acima de 18 anos. Os excluídos foram aqueles que apresentassem instabilidade hemodinâmica e hipoxemia sustentada durante a avaliação. Para caracterização amostral, os pacientes foram divididos em grupos daqueles com e sem afecções pulmonares. Os principais dados coletados e analisados foram PEEP, Pmed, Pressão Arterial Sistólica (PAS), Pressão Arterial Diastólica (PAD), Pressão Arterial Média (PAM), Frequência Cardíaca (FC). Para comparação de dados foram utilizados os testes Wilcoxon-Rank e Mann-Whitney para dados pareados e não pareados, respectivamente. RESULTADOS: Foram incluídos 37 pacientes, mediana de idade 63 anos, 19 (51,4%) do sexo masculino, 30 (81,1%) com diagnóstico admissional de natureza clínica. Não foram identificadas alterações hemodinâmicas estatisticamente significantes entre os tempos de pausa inspiratória de 0,5 e 2,0 segundos nas variáveis PAS (p=0,99), PAD (p=0,11), PAM (p=0,29) e FC (p=0,25). CONCLUSÃO: Não foram identificadas variações hemodinâmicas durante as mensurações da mecânica respiratória nas pausas de 0,5 e 2,0 segundos.

INTRODUCTION: The heart-lung interaction is influenced by Mechanical Ventilation (MV), which directly impacts venous return and cardiac output through, but not limited to, adjustments in Positive End-Expiratory Pressure (PEEP) and mean airway pressure (Pmean). Additionally, inspiratory pauses for the assessment of pulmonary mechanics interrupt thoracic movement, potentially further impacting this interaction. OBJECTIVE: To compare hemodynamic changes during 0.5 and 2.0-second inspiratory pauses during respiratory mechanics measurements. METHODS: This is a cross-sectional study conducted in the intensive care units of a hospital in Salvador/BA. Patients on MV and over 18 years old were included. Exclusions were made for those with hemodynamic instability and sustained hypoxemia during the evaluation. For sample characterization, patients were divided into groups with and without pulmonary conditions. The main data collected and analyzed were PEEP, Pmean, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), and Heart Rate (HR). For data comparison, Wilcoxon-Rank and Mann-Whitney tests were used for paired and unpaired data, respectively. RESULTS: Thirty-seven patients were included, with a median age of 63 years, 19 (51.4%) males, and 30 (81.1%) with an admission diagnosis of a clinical nature. No statistically significant hemodynamic changes were identified between the 0.5 and 2.0-second inspiratory pause times in the variables SBP (p=0.99), DBP (p=0.11), MAP (p=0.29), and HR (p=0.25). CONCLUSION: No hemodynamic variations were identified during respiratory mechanics measurements at 0.5 and 2.0-second inspiratory pauses.

Valores de referencia para el 1-minute sit-to-stand test en pacientes pediátricos con artritis idiopática juvenil / Reference values for the 1-minute sit-to-stand test in pediatric patients with juvenile idiopathic arthritis

Introducción: los niños con artritis idiopática juvenil (AIJ) experimentan períodos de dolor e inmovilidad que afectan sus capacidades condicionales. Objetivos: describir los valores de referencia para el 1-minute Sit-to-Stand Test(1-STS; test de 1 minuto de sentarse y pararse) en niños con AIJ como evaluación de la capacidad aeróbico-funcional y de la fuerza muscular de los miembros inferiores (MMII).Materiales y métodos: se realizó un estudio observacional que incluyó a 15 niños con AIJ de entre 5 y 16 años. Se evaluó su rendimiento en el 1-STS. Resultados: se encontró una correlación positiva significativa entre el 1-STS y el test de la marcha de 6 minutos (r=0,56; p=0,03), como con el índice de capacidad funcional (CAPFUN) (r=0,54; p=0,03). No se observaron correlaciones significati-vas entre el Childhood Health Assessment Questionnaire (CHAQ) y el 1-STS (r=-0,21; p=0,44), tampoco con el Juvenile Arthritis Disease Activity Score (JADAS-10) (p=0,83). Conclusiones: el 1-STS parece prometedor para medir la capacidad aeróbi-co-funcional y la fuerza muscular de los miembros inferiores en niños con AIJ oligoarticular.

Introduction: children with juvenile idiopathic arthritis (JIA) experience periods of pain and immobility that affect their physical capacities. Objectives: to describe reference values for the 1-minute sit to stand test (1-STS) in children with JIA as an assessment of aerobic-functional capacity and lower limb muscle strength.Materials and methods: an observational study was conducted, including 15 children with JIA aged between 5 and 16 years. Their performance in the 1-STS was assessed. Results: a significant positive correlation was found between the 1-STS and the 6-Minute Walk Test (r=0,56; p=0,03), as well as with the Functional Capacity Index (CAPFUN) (r=0,54; p=0,03). No significant correlations were observed between the Childhood Health Assessment Questionnaire (CHAQ) and the 1-STS (r=-0,21; p=0,44), nor with the Juvenile Arthritis Disease Activity Score (JADAS-10) (p=0,83). Conclusions: the 1-STS appears promising for assessing aerobic-functional capacity and lower limb muscle strength in children with oligoarticular JIA.

Construction of a Guide for Assessment and Physiotherapeutic Management of Pain in Cancer Patients / Construction of a Guide for Assessment and Physiotherapeutic Management of Pain in Cancer Patients / Construção de um Guia para Avaliação e Manejo Fisioterapêutico da Dor em Pacientes com Câncer

Physiotherapy can contribute to control pain in cancer patients and educational strategies should be developed to increase physiotherapeutic actions in this context. Objective: To develop a guide for the assessment and physiotherapeutic management of cancer pain. Method: Study developed in three stages: 1. Descriptive analysis of sociodemographic, clinical, functional data, pain characteristics and physiotherapeutic treatments performed on cancer patients receiving palliative care; 2. Development of the preliminary version of the guide based on the results of the first stage and theoretical content; 3. Focus group formed by physiotherapists that resulted in the final version of the guide. Results: 62 patients were included, mainly females (69.3%). The most common tumor site was gynecological (25.8%) and half presented bone metastasis. Neuropathic pain (51.6%), located in the spine (29.0%) was the most prevalent type of pain. The physiotherapeutic treatments most used were: positioning (98.0%), kinesiotherapy (68.0%), walking (39.0%), orthoses (32.0%) and transcutaneous electrical nerve stimulation (21.0%). The focus group suggested changes and positively evaluated the preliminary version of the guide, highlighting that, in addition to an easy-to-understand language, it provided a comprehensive view of the methods for evaluating and physiotherapy treatment of pain.

A fisioterapia pode contribuir para o controle da dor em pacientes com câncer e estratégias educativas devem ser desenvolvidas para aumentar as ações fisioterapêuticas nesse contexto. Objetivo: Elaborar um guia para avaliação e manejo fisioterapêutico da dor no câncer. Método:Estudo desenvolvido em três etapas: 1. Análise descritiva de dados sociodemográficos, clínicos, funcionais, características da dor e tratamentos fisioterapêuticos realizados em pacientes com câncer em cuidados paliativos; 2. Desenvolvimento da versão preliminar do guia a partir dos resultados da primeira etapa e de conteúdo teórico na temática; 3. Realização de grupo focal composto por fisioterapeutas que originou a versão final do guia. Resultados: Foram incluídos 62 pacientes, principalmente do sexo feminino (69,3%). O sítio tumoral mais frequente foi o ginecológico (25,8%) e metade apresentou metástase óssea. O tipo de dor mais prevalente foi a neuropática (51,6%), localizada na coluna (29,0%). Os tratamentos fisioterapêuticos mais utilizados foram: posicionamento (98,0%), cinesioterapia (68,0%), deambulação (39,0%), uso de órteses (32,0%) e transcutaneous electrical nerve stimulation (21,0%). O grupo focal sugeriu alterações e avaliou positivamente a versão preliminar do guia, ressaltando que, além de ser elaborado com linguagem de fácil compreensão, possibilitou a visão integral sobre os métodos para avaliação e tratamento fisioterapêutico da dor.

La fisioterapia puede contribuir al control del dolor en pacientes con cáncer y se deben desarrollar estrategias educativas para incrementar las acciones fisioterapéuticas en este contexto. Objetivo:Desarrollar una guía para la evaluación y manejo fisioterapéutico del dolor oncológico. Método: Estudio desarrollado en tres etapas: 1. Análisis descriptivo de datos sociodemográficos, clínicos, funcionales, características del dolor y tratamientos fisioterapéuticos realizados a pacientes con cáncer que reciben cuidados paliativos; 2. Elaboración de la versión preliminar de la guía con base en los resultados de la primera etapa y contenidos teóricos sobre el tema; 3. Realización de un grupo focal compuesto por fisioterapeutas que dio como resultado la versión final de la guía. Resultados: Se incluyeron 62 pacientes, principalmente mujeres (69,3%). La localización tumoral más frecuente fue ginecológica (25,8%) y la mitad presentó metástasis óseas. El tipo de dolor más prevalente fue el neuropático (51,6%), localizado en la columna (29,0%). Los tratamientos fisioterapéuticos más utilizados fueron: posicionamiento (98,0%), kinesioterapia (68,0%), marcha (39,0%), uso de órtesis (32,0%) y estimulación nerviosa eléctrica transcutánea (21,0%). El grupo focal sugirió cambios y evaluó positivamente la versión preliminar de la guía, destacando que, además de estar elaborada en un lenguaje fácil de entender, proporcionó una visión integral de los métodos de evaluación y tratamiento fisioterapéutico del dolor.

Efeitos de um programa de reabilitação sobre capacidade física de pacientes pós-infecção por SARS-CoV-2: um estudo retrospectivo / Effects of a rehabilitation program on the physical capacity of patients after SARS-Cov-2 infection: a retrospective study

Objetivo: avaliar o efeito de um programa de reabilitação sobre a capacidade física de pacientes integrantes de um programa de reabilitação pós-infecção por SARS-CoV-2. Métodos: estudo observacional de incidência retrospectiva, com amostra de prontuários de pacientes >18 anos, participantes do programa de reabilitação pós-COVID-19 no Centro de Reabilitação da PUCRS. Foram extraídos dados demográficos, antropométricos e de testes funcionais, incluindo o teste da caminhada dos seis minutos (TC6) e o teste de sentar e levantar (TSL), antes e depois do programa. O programa foi composto por treinamento aeróbico e re-sistido, duas vezes por semana, totalizando 16 sessões. O treinamento aeróbico foi conduzido na esteira com duração de 30 minutos, sendo avaliada frequência cardíaca, saturação, pressão arterial e escala de Borg (dispneia e cansaço em membros inferiores). O treino resistido foi realizado após o teste de repetição máxima (1RM) com a carga variando entre 50-80% de 1RM, durante 30 minutos. Resultados: foram incluídos 13 pacientes, com média de idade de 51,0±16,4 anos. Ao comparar os resultados pré e pós-reabilitação, encontramos diferenças significativas na distância percorrida no TC6, sendo de 480,5±91,3 metros pré e 722,1±235,9 metros após a intervenção (p<0,001), bem como no percentual do previsto, sendo 87,5±18,8 pré e 130,7±43,5 após (p=0,001). Além disso, ao analisar o TSL, verificou-se uma redução significativa no tempo, de 12,3±4,7 segundos pré-programa para 8,8±2,2 após (p=0,005). Conclusão: o programa de reabilitação apresentou impacto positivo na capaci-dade física de pacientes que integraram o programa de reabilitação pós-infecção por SARS-CoV-2

Objective: to evaluate the effect of a rehabilitation program on the physical capacity of patients participating in a rehabilitation program after SARS-CoV-2 infection. Methods: retrospective incidence observational study, with a sample of medical records of patients >18 years old, participants in the post-covid-19 rehabilitation program at the PUCRS Rehabilitation Center. Demographic, anthropometric and functional test data: six-minute walk test (TC6) and sit-to-stand teste (TSL) were extracted pre and post program. The program consisted of aerobic and resistance training, twice a week, totaling 16 sessions. Aerobic training was performed on a treadmill lasting 30 minutes, with heart rate, saturation, blood pressure and Borg (dyspnea and fatigue in the lower limbs) being evaluated. Resistance training was performed after the maximum repetition test (1RM) with a load ranging from 50-80% of 1RM, for 30 minutes. Results: 13 patients were included, with a mean age of 51.0±16.4 years. When comparing the pre and post rehabilitation results, we found significant differences in the distance covered in the TC6, being 480.5±91.3 meters before and 722.1±235.9 meters after the inter-vention (p<0.001) and in the percentage of predicted, being 87.5±18.8 pre and 130.7±43.5 post (p=0.001). Fur-themore, when analyzing the TSL, we found a significant reduction in time of 12.3±4.7 seconds pre-program and 8.8±2.2 post (p=0.005). Conclusion: the rehabilitation program had a positive impact on the physical capacity of patients who parti-cipated in the rehabilitation program after SARS-CoV-2 infection

Modalidades Fisioterapêuticas no Manejo da Dor Neuropática Induzida pelo Tratamento do Câncer de Mama: Revisãoda Literatura / Physiotherapeutic Modalities in the Management of Neuropathic Pain Induced by Breast Cancer Treatment: Literature Review / Modalidades Fisioterapéuticas en el Manejo Del Dolor Neuropático Inducido por el Tratamiento del Cáncer de Mama: Revisión de la Literatura

A sobrevida de mulheres após o tratamento do câncer de mama tem aumentado em virtude de avanços na detecção precoce e terapias disponíveis. Porém, as sobreviventes comumente enfrentam efeitos adversos após o tratamento que representam grande carga física e psicológica. Além da fadiga, a dor é o sintoma persistente mais frequente após o tratamento. Objetivo: Sistematizar os resultados de ensaios clínicos randomizados sobre a intervenção fisioterapêutica na dor neuropática periférica induzida pelos tratamentos para o câncer de mama. Método: Busca realizada nas bases de dados MEDLINE via portal PubMed e Cochrane. Foram selecionados ensaios clínicos randomizados publicados a partir de 2017, em língua inglesa, que abordassem as modalidades fisioterapêuticas como intervenção, a dor neuropática periférica induzida por tratamentos oncológicos como desfecho, e mulheres sobreviventes ao câncer de mama como população de interesse. A qualidade metodológica dos estudos foi avaliada pela ferramenta Cochrane para o risco de viés. Resultados: Quatro estudos foram revisados na íntegra. Majoritariamente, os efeitos adversos do tratamento oncológico se devem a regimes quimioterápicos à base de taxanos. Os desfechos avaliados incluem, além da dor, demais sinais neuropáticos e influência nas atividades de vida diária. Os estudos variaram quanto à intervenção e fase de tratamento. Apenas um dos estudos demonstrou resultado significativamente positivo a favor do grupo intervenção. Conclusão: Estudos clínicos randomizados disponibilizam evidências escassas quanto aos efeitos positivos da intervenção fisioterapêutica na dor neuropática periférica induzida pelos tratamentos para o câncer de mama.

Women's survival after breast cancer treatment has increased due to advances in early detection and available therapies. However, great physical and psychological burden are the result of adverse effects that survivors commonly face. In addition to fatigue, pain is the most common persistent symptom after cancer treatment. Objective: Systematize the results of randomized clinical trials on physiotherapeutic intervention in peripheral neuropathic pain induced by breast cancer treatments . Method:The search was carried out on the MEDLINE databases via PubMed and Cochrane portals. Randomized clinical trials published since 2017 in English, that addressed physiotherapeutic modalities as intervention, peripheral neuropathic pain induced by oncological treatments as outcome were selected, and the population of interest were women surviving breast cancer. The Cochrane-risk-of-bias tool was applied to evaluate the methodological quality of the studies. Results: Four studies were fully reviewed. Most of the adverse effects of cancer treatment are due to taxane-based chemotherapy regimens. The outcomes assessed include, in addition to pain, other neuropathic signs and influence on activities of daily living. The studies varied in terms of intervention and treatment phase. Only one of the studies demonstrated a significantly positive result in favor of the intervention group. Conclusion: Randomized clinical studies provide scant evidence regarding the positive effects of physiotherapeutic intervention on peripheral neuropathic pain induced by breast cancer treatments.

La supervivencia de las mujeres después del tratamiento del cáncer de mama ha aumentado debido a los avances en la detección temprana y las terapias disponibles. Sin embargo, los supervivientes suelen enfrentarse a efectos adversos después del tratamiento que representan una gran carga física y psicológica. Además de la fatiga, el dolor es el síntoma persistente más común después del tratamiento del cáncer. Objetivo: Sistematizar los resultados de ensayos clínicos aleatorizados sobre intervención fisioterapéutica en el dolor neuropático periférico inducido por tratamientos para el cáncer de mama. Método: La búsqueda se realizó en las bases de datos MEDLINE a través de los portales PubMed y Cochrane. Se seleccionaron ensayos clínicos aleatorizados publicados desde 2017, en inglés, que abordaron modalidades fisioterapéuticas como intervención, dolor neuropático periférico inducido por tratamientos oncológicos como resultado y mujeres sobrevivientes de cáncer de mama como población de interés. La calidad metodológica de los estudios se evaluó mediante la herramienta Cochrane de Riesgo de Sesgo. Resultados: Se revisaron en su totalidad cuatro estudios. La mayoría de los efectos adversos del tratamiento del cáncer se deben a los regímenes de quimioterapia basados en taxanos. Los resultados evaluados incluyen, además del dolor, otros signos neuropáticos y su influencia en las actividades de la vida diaria. Los estudios variaron en términos de intervención y fase de tratamiento. Sólo uno de los estudios demostró un resultado significativamente positivo a favor del grupo de intervención. Conclusión: Los estudios clínicos aleatorizados aportan escasa evidencia sobre los efectos positivos de la intervención fisioterapéutica sobre el dolor neuropático periférico inducido por los tratamientos del cáncer de mama

Desenvolvimento e implementação de um protocolo de mobilização precoce neurofuncional para pacientes após acidente vascular cerebral hospitalizados / Development and implementation of an early neurofunctional mobilization protocol for hospitalized post-stroke patients

Introdução: A Mobilização Precoce voltada para o Acidente Vascular Cerebral (AVC) é um tema amplamente discutido no meio científico em vista de seus benefícios, recomendações por diretrizes clínicas e questionamentos sobre o formato em que é implementada. O Protocolo de Mobilização Precoce Neurofuncional (PMPneuro) propõe estratégias diferenciadas para implementação da MP voltada à reabilitação do AVC agudo, porém precisa de investigações acerca de sua segurança e eficácia. Objetivo: Avaliar a segurança e eficácia do PMPneuro em relação ao atendimento com a Fisioterapia Convencional para pacientes após o AVC durante a internação hospitalar. Métodos: Este é um estudo do tipo caso-controle voltado para a população internada por AVC (entre 24h e 1 mês). O grupo controle (GC) foi estabelecido a partir da análise retrospectiva de prontuários, considerando os desfechos diante dos atendimentos ocorridos com a Fisioterapia Convencional do hospital. O Grupo de Intervenção (GI) foi constituído a partir da implementação do PMPneuro na mesma instituição em um período subsequente. A análise da segurança do PMPneuro transcorreu conforme a comparação da ocorrência de efeitos adversos durante os dois tipos de intervenções, assim como o comparativo entre as pontuações obtidas nas altas dos dois grupos pela escala de Morse. O critério de eficácia foi identificado confrontando as altas dos dois grupos pelas escalas Functional Status Scale (FSS ­ ICU), Escala de Coma de Glasgow (E. Glasgow), Medical Research Council - Sum-Score (MRC- SS) e tempo de internação hospitalar. Os critérios de segurança e eficácia foram analisados pelo Teste de Mann Whitney. Isolando cada uma das amostras, foram analisadas progressões entre admissão e alta do PMPneuro (através da FSS ­ ICU, Morse, MRC, escala Modificada de Rankin, Índice de Barthel modificado, E. Glasgow e Nível de Atividade - NA) e do GC (E. Glasgow, FSS ­ ICU, Nível de Atividade Funcional - NAF, MRC e Morse). Estas comparações ocorreram através do teste Wilcoxon Signed Rankin Test. O PMPneuro foi implementado após o treinamento de fisioterapeutas do hospital participante através de um Curso de treinamento e uso de aplicativo de celular especifico, sendo a compreensão e adesão ao PMPneuro investigada a partir do questionário Análise da Compreensão e Adesão ao PMPneuro e a ferramenta do app "atendimentos realizados". Resultados: Ao todo constaram no estudo 108 pacientes, 61 constituindo o GC e 47 o GI (64% de ambas as amostras eram identificadas como do sexo feminino). As amostras apresentaram medianas de idade parecidas tendo 76 ± 14 e 74 ± 15 anos, com 88% e 79% de AVCs isquêmicos no GC e GI, respectivamente. O GC apresentou mais efeitos adversos a nível percentual, porém sem diferença estatística. Não houve diferença significativa entre as amostras pela escala de Morse. Quanto ao critério de eficácia, houve significância para a variável internação hospitalar (p = 0,006). A amostra do GC evoluiu quanto a E. Glasgow (p = 0,01), NAF (p= 0,001) e MRC ­ SS (p < 0,01) e o GI quanto a E. Glasgow, MRC - SS, FSS, Rankin e IBM (todos com p < 0,001). O questionário e o app identificaram boa compreensão e adesão do PMPneuro pelos fisioterapeutas. Conclusão: O PMPneuro foi uma estratégia realizada pela equipe de fisioterapeutas, sendo eficaz em reduzir o tempo de internação hospitalar de pacientes com AVC. Sua eficácia ocorreu somente durante a diferenciação entre admissão e alta através das escalas E. Glasgow, MRC - SS, FSS, Rankin e IBM.(AU)

Introduction: Early Mobilization (EM) for patients with Stroke is a widely topic discussed in literature. The Neurofunctional Early Mobilization Protocol (NEMP) proposes different strategies for implementing EM aimed at acute stroke rehabilitation but requires investigations into its safety and effectiveness. Aim: To evaluate the safety and effectiveness of NEMP when implemented to patients with stroke during hospital stay. Methods: This is a case-control study that includes patients with stroke (between 24 hours and 6 months). The control group (CG) was established based on a retrospective analysis of medical records, considering the outcomes of care provided to the hospital's Conventional Physiotherapy. The Intervention Group (IG) was formed based on the NEMP' implementation in the same institution. NEMP safety analysis was carried out by comparing the occurrence of adverse events during these two interventions, as well as comparing the scores obtained at discharge time point using the Morse scale. The effectiveness criteria was identified by comparing the discharges of the two groups using the Functional Status Scale (FSS ­ ICU), Glasgow Coma Scale (GCS), Medical Research Council - Sum-Score (MRC-SS) and length of hospital stay. Safety and efficacy criteria were analyzed using the Mann Whitney Test. Progressions between admission and discharge through FSS ­ ICU, Morse, MRC - SS, Modified Rankin Scale, Modified Barthel Index (MBI), GCS and Activity Level (AL) in GC and GCS, FSS ­ ICU, Functional Activity Level - FAL, MRC - SS and Morse in IG were analyzed through Wilcoxon Signed Rank Test. NEMP was implemented after training physiotherapists through a training course and use of a specific cell phone application, with the adherence to protocol being investigated using the questionnaire "Analysis of Comprehension and Adherence to NEMP". Results: Were included in the study 108 patients, 61 constituting the CG and 47 the IG (64% of both samples were identified as female). The samples had similar median ages of 76 ± 14 and 74 ± 15 years, with 88% and 79% of ischemic strokes in the CG and IG, respectively. The CG showed more adverse effects in percentage terms, but without statistical difference. There was no significant difference between the samples using the Morse scale. Regarding the effectiveness criteria, there was significance for length of stay variable (p = 0.006). The CG progressed through GCS (p = 0.01), FAL (p= 0.001) and MRC - SS (p < 0.01) and the IG in terms of GCS, MRC - SS, FSS, Rankin and MBI (all with p < 0.001). The questionnaire and the app identified good understanding and adherence to NEMP by physiotherapists. Conclusion: NEMP was a strategy carried out by physiotherapists, being effective in reducing the length of hospital stay for stroke patients. Its effectiveness occurred only during the differentiation between admission and discharge using the GCS, MRC - SS, FSS, Rankin and MBI scales.(AU)

Neuromuscular bandage for the prevention of post-mastectomy seroma: a clinical trial protocol

Introduction: Seroma is the most common early complication after breast cancer surgery and is associated with other complications and adjuvant therapy delays. A potential hypothesis for its prevention is the obliteration of dead space between tissues, which can be achieved by external compression. To assess whether the use of a neuromuscular bandage employing the compressive technique during the first postoperative week is effective in preventing seroma. Methods: This study comprises a two-arm randomized superiority clinical trial to evaluate the following as primary outcomes: seroma incidence, volume and duration using a suction drain and bandage safety and satisfaction as secondary outcomes. Women aged ≥18 years submitted to a mastectomy as breast cancer treatment will be included, while women submitted to bilateral mastectomies, immediate breast reconstruction or surgical flap rotation closure, who present hematomas or surgical wound infections at the time of recruitment or autoimmune diseases that lead to skin lesions and/ or allergy to tape, as well as those exhibit difficulties in understanding the study will be excluded. Randomization will be performed by lots at study enrollment. Coded envelopes will be available for intervention or control group allocations. Patients allocated in the intervention group will be submitted to the bandage application for seven days. All patients will use a suction drain according to the institution's routine. Ethics and disclosure: This study was approved by the Brazilian National Cancer Institute, Research Ethics Committee under no. 2,774,824 and it is registered in the ClinicalTrials.gov (NCT04471142). (AU)

A web-based survey on the telerehabilitation knowledge, attitude, and practice of physical therapists in a developing country during the COVID-19 pandemic: An analytical cross-sectional study

Background and Objective@#Pre-pandemic, various healthcare settings were not used to seeing patients virtually. The unprecedented need to adopt virtual care during the COVID-19 pandemic may have caught physical therapists (PTs) unready for it. This study aimed to determine the telerehabilitation knowledge, attitude, and practice of PTs in the Philippines during the COVID-19 pandemic and determine the association between demographic and study outcome variables.@*Methods@#This is an analytical cross-sectional study among members of the Philippine Physical Therapy Association, Inc. (PPTA) practicing in the Philippines. Purposive sampling (total enumeration) was employed. All PPTA members were invited to the study through e-mail and official social media group chats. A self-administered questionnaire was used to obtain data on telerehabilitation knowledge (through test questions on various theoretical aspects), attitude, and practice.@*Results@#The questionnaire items had a content validity index of >0.80. The study yielded a 40% response rate. Most respondents were practicing clinicians in urban-based, private rehabilitation centers. Approximately half had average telerehabilitation knowledge, while the majority had agreeable telerehabilitation attitudes across different constructs. Among the respondents, 15.9% used telerehabilitation pre-pandemic, while 64.8% used it during the pandemic. Hybrid (synchronous and asynchronous) telerehabilitation sessions usually lasted one hour per patient, mostly using Facebook Messenger. @*Conclusion@#Telerehabilitation was not widely practiced locally pre-pandemic, which may explain their average telerehabilitation knowledge. The positive telerehabilitation attitudes may represent a small group of PTs favoring telerehabilitation, while information from the larger population remains unknown. Early adopters of telerehabilitation may help introduce virtual care to colleagues and guide them in developing relevant knowledge and skills amid and beyond the enduring COVID-19 crisis.

Intervención con terapia manual: rehabilitación sobre la regulación del tono muscular en parálisis cerebral / Intervention with manual therapy: rehabilitation on the regulation of muscle tone in cerebral palsy

Cerebral palsy is a disorder of posture, tone and movement, resulting from damage to an immature central nervous system. The tension of the connective tissue with vascular and nervous entrapment is a frequent alteration that affects the entire locomotor system in children with cerebral palsy, especially in those who present quadriparesis. These increase responses to reactions considered pathological such as tonic postural reflexes, of exaggerated Moro or opisthotonus. The objective of the present study is to analyze the effects obtained on the regulation of muscle tone, after the application of a pediatric manual therapy program in a case with spastic cerebral palsy during 9 months of outpatient treatment in a private office. Acting on the tension of the fascial tissue that surrounds the nervous and muscular system, present in the subject and thus allowing oral nutritional activity. The case patient in this study is a 3-year-old female, with a diagnosis of cerebral palsy and severe quadriparesis. In the initial motor evaluation, fixation of the head and neck and elevated muscle tone in the trunk and limbs were observed. A manual therapy intervention of 45 minutes per session is performed once a week for 9 months. At the end of treatment, oral feeding, free flexion of the head and a decrease in general muscle tone are achieved.

La parálisis cerebral es un trastorno de la postura, el tono y el movimiento, producto de un daño en un sistema nervioso central inmaduro. La tensión del tejido conectivo con atrapamiento vascular y nervioso es una alteración frecuente que afecta a todo el aparato locomotor en los niños con parálisis cerebral, sobre todo en aquellos que presentan cuadriparesia; este trastorno aumenta las respuestas a reacciones consideradas patológicas, como los reflejos tónicos posturales, el reflejo de Moro exagerado u el opistotono. El objetivo del presente estudio es analizar los efectos obtenidos sobre la regulación del tono muscular, tras la aplicación de un programa de terapia manual pediátrica en un caso con parálisis cerebral espástica, durante 9 meses de tratamiento ambulatorio en consultorio privado. Se actúa sobre la tensión del tejido fascial que envuelve los sistemas nervioso y muscular presente en el sujeto, de manera de permitir la actividad nutricional por vía oral. La paciente caso de este estudio es de sexo femenino, de 3 años de edad, con diagnóstico de parálisis cerebral y cuadriparesia grave. En la evaluación motora inicial se observa fijación de la cabeza y el cuello, y tono muscular elevado en tronco y miembros. Se realiza una intervención de terapia manual de 45 minutos por sesión, una vez por semana durante 9 meses. Al final del tratamiento se logra la alimentación por vía oral, flexión libre de la cabeza y disminución del tono muscular general.

Características epidemiológicas, clínicas y funcionales de niños quemados atendidos en un hospital de alta complejidad de Medellín, Colombia / Epidemiological, clinical and functional characteristics in burned children treated in a high complexity hospital

Introducción. Las estadísticas mundiales demuestran que las quemaduras ocurren principalmente en mujeres y niños, siendo estos últimos más propensos por su curiosidad ya que esta favorece la exposición a diversos riesgos de quemadura. Objetivo. Identificar las características epidemiológicas, clínicas y de manejo de rehabilitación en niños quemados atendidos en una unidad de quemados de un hospital de alta complejidad de Medellín, Colombia. Métodos. Estudio descriptivo retrospectivo realizado en 710 pacientes quemados menores de 14 años que recibieron manejo hospitalario en el Hospital Infantil de San Vicente Fundación Medellín entre 2018 y 2020. Se registraron datos sobre: edad, sexo, causa de la quemadura, extensión de la quemadura, tiempo de estancia hospitalaria, cirugías, ortesis, presoterapia, funcionalidad, entre otras. Resultados. El 58,6% de los participantes eran de sexo masculino y las medianas de edad, superficie corporal compro-metida y estancia hospitalaria fueron de 24 meses, 6% y 12 días, respectivamente. La principal causa de quemadura fue por líquidos calientes (73,2%). 70,7% de los participantes presentaron quemaduras de segundo grado profundo. En 89,4% las quemaduras se presentaron en áreas especiales: en 32,8%, en la cara, y en 7,3%, en los genitales. Asimismo, 2% requirieron manejo en la unidad de cuidados intensivos, 23,1% necesitaron cirugía, 95,4% fueron tratados por fisioterapia y 93,4% recibieron atención por medicina física y rehabilitación. Además, 86,9% requirieron presoterapia y 11,5%, ortesis. 95,3% mejoraron en el posicionamiento, 95,6% mostraron mejoría en los conocimientos de los pacientes y cuidadores, en 94,9% mejoro la funcionalidad y en 18% mejoró la independencia. Conclusiones. Las quemaduras en población pediátrica requieren un manejo integral y multidisciplinario que incluya la rehabilitación como parte de la primera línea de atención y otras especialidades que permitan la atención integral del paciente para prevenir compromisos funcionales y favorecer el reintegro social.

Introduction. World statistics demonstrate that burns occur mainly in women and children, the latter being more prone due to their curiosity, since it favors exposure to various burn risks. Objective. To identify the epidemiological, clinical and rehabilitation management characteristics of burned children treated in a burn unit of a high complexity hospital in Medellín, Colombia. Methods. Retrospective descriptive study conducted in 710 burn patients under 14 years of age who received hospital management in the Children's Hospital of San Vicente Fundación Medellín between the years 2018 and 2020. Data were recorded on: age, sex, cause of the burn, extent of the burn, length of hospital stay, surgeries, orthoses, pressure therapy, and functionality, among others. Results. 58.6% of the participants were male and the median age, body surface area involved and hospital stay were 24 months, 6% and 12 days, respectively. The main cause of burns was due to hot liquids (73.2%). 70.7% of the participants had deep second-degree burns. In 89.4% of cases, burns occurred in special areas: in 32.8%, on the face, and in 7.3%, on the genitals. Likewise, 2% required management in the intensive care unit, 23.1% needed surgery, 95.4% were treated by physiotherapy and 93.4% received care by physical medicine and rehabilitation. In addition, 86.9% required pressure therapy and 11.5% required orthoses. 95.3% improved their positioning, 95.6% showed improvement in patient and caregiver knowledge, functionality improved in 94.9% and independence improved in18%. Conclusions. Burns in the pediatric population require comprehensive and multidisciplinary management that includes rehabilitation as part of the first line of care and other specialties that allow comprehensive care of the patient to prevent functional compromises and promote social reintegration.

Evaluation of User Experience and Functional Adequacy in Mobile Applications for Rehabilitation: Systematic Review / Evaluación de la experiencia de usuario y la adecuación funcional en aplicaciones móviles de rehabilitación. Revisión sistemática

Introduction. Mobile rehabilitation applications offer benefits such as accessibility, cost reduction, and increased pa-tient engagement, but they face quality challenges, including unfriendly interfaces and deficient functionalities. This systematic review examines the quality of these applications in terms of Functional Suitability and User Experience.Objective. To evaluate the compliance of mobile rehabilitation applications with the ISO/IEC 25010 standard, focusing on User Experience and Functional Suitability in areas such as physiotherapy, speech therapy, and occupational therapy.Method. A systematic literature review following the PRISMA framework. Relevant studies from 2019 to 2023 were identified and evaluated for methodological quality using CASP and MMAT. Approved studies were analyzed to verify the compliance of the applications with the ISO 25010 standard, using a mixed-method approach combining qualitative and quantitative assessments of User Experience and Functional Suitability, supported by collaborative tools such as Rayyan, Google Sheets, and researcher consensus.Results. The study shows that mobile rehabilitation applications do not report a high level of quality according to the criteria of the ISO/IEC 25010 standard. Slightly more than half declare compliance with functional suitability (56.9%), and only 38.2% report compliance with User Experience.Conclusions. To improve User Experience, it is recommended to simplify interfaces, include educational content, and provide customization options. Regarding Functional Suitability, there is a need to enhance communication between patients and professionals, expand the needs covered, and update algorithms for more personalized treatments

Introducción. Las aplicaciones móviles de rehabilitación ofrecen beneficios como accesibilidad, reducción de costos y mayor participación del paciente; sin embargo, enfrentan desafíos de calidad como interfaces poco amigables y funcionalidades deficientes. Esta revisión sistemática examina la calidad de estas aplicaciones en términos de adecuación funcional y experiencia de usuario. Objetivo. Evaluar la conformidad de las aplicaciones móviles de rehabilitación con el estándar ISO/IEC 25010, centrándose en la experiencia de usuario y la adecuación funcional en áreas como fisioterapia, fonoaudiología y terapia ocupacional. Métodos. Se realizó una revisión sistemática de la literatura siguiendo el protocolo de la declaración PRISMA. Se identificaron y evaluaron estudios relevantes con calidad metodológica (2019-2023) mediante CASP y MMAT. Los estudios aprobados fueron analizados para verificar la conformidad de las aplicaciones con la norma ISO 25010 utilizando un enfoque mixto de evaluación cualitativa y cuantitativa de la experiencia de usuario y la adecuación funcional, apoyados por herramientas colaborativas de Rayyan, una hoja de cálculo y el consenso de los investigadores. Resultados. El estudio muestra que las aplicaciones móviles de rehabilitación no reportan buen nivel de calidad de acuerdo con los criterios del estándar ISO/IEC 25010. Un poco más de la mitad declara cumplimiento de adecuación funcional (56.9%) y solo 38.2% reporta cumplimiento en la experiencia de usuario. Conclusiones. Para mejorar la experiencia de usuario se recomienda simplificar las interfaces e incluir contenido educativo y opciones de personalización. En cuanto a la adecuación funcional, es necesario mejorar la comunicación entre pacientes y profesionales, ampliar las necesidades cubiertas y actualizar algoritmos para tratamientos más personalizados.

Anatomical and Clinical Education in Physical and Occupational Therapy: Influence of Integration and Soft Preservation / Educación Anatómica y Clínica en Terapia Física y Ocupacional: Influencia de la Integración y la Preservación Blanda

SUMMARY: Anatomy and clinical skills are taught separately to physical and occupational therapy students. Formaldehyde is the primary chemical used to embalm donors which creates a challenge in integrating clinical skills into the anatomy curriculum. This study aimed to evaluate the integration of clinical skills into anatomical education using Imperial College London- Soft Preservation (ICL-SP) and formaldehyde embalming through the evaluation of student perceived learning and confidence. Students were invited to complete a survey after dissecting an ICL-SP and formaldehyde embalmed donors and perform clinical tests. It was easier to dissect and identify neurovascular structures on ICL-SP donors compared to formaldehyde. Clinical tests, like measuring range of motion and ligament tests were also more realistic on ICL-SP donors. The integration of clinical skills in the anatomical curriculum increased student perceived understanding of associated anatomy (p < 0.001), gave better understanding of how anatomy is important to their professions (p < 0.001) and increased motivation to learn anatomy (p < 0.001). The integration of clinical skills into anatomical education can facilitate student learning with higher confidence performing clinical skills and is complemented by the utilization of the new ICL-SP methodology instead of the traditional formaldehyde preservation.

Las habilidades anatómicas y clínicas se enseñan por separado a los estudiantes de terapia física y ocupacional. El formaldehído es el químico principal que se usa para embalsamar a los donantes, lo que crea un desafío para integrar las habilidades clínicas en el plan de estudios de anatomía. Este estudio tuvo como objetivo evaluar la integración de habilidades clínicas en la educación anatómica utilizando Imperial College London-Soft Preservation (ICL-SP) y embalsamamiento de formaldehído a través de la evaluación del aprendizaje y la confianza percibidos por los estudiantes. Se invitó a los estudiantes a completar una encuesta después de diseccionar un ICL-SP y donantes embalsamados formolizados y realizar pruebas clínicas. Fue más fácil diseccionar e identificar estructuras neurovasculares en donantes ICL-SP en comparación con los fijados en formaldehído. Las pruebas clínicas, como la medición del rango de movimiento y las pruebas de ligamentos, también fueron más realistas en los donantes de ICL-SP. La integración de habilidades clínicas en el plan de estudios anatómico aumentó la comprensión percibida por los estudiantes de anatomía asociada (p < 0,001), dio una mejor comprensión de cómo la anatomía es importante para sus profesiones (p < 0,001) y aumentó la motivación para aprender anatomía (p < 0,001). La integración de las habilidades clínicas en la educación anatómica puede facilitar el aprendizaje de los estudiantes con mayor confianza en el desempeño de las habilidades clínicas y se complementa con la utilización de la nueva metodología ICL-SP en lugar de la conservación tradicional con formaldehído.

Educación sobre las disciplinas del dolor en las carreras de kinesiología en Chile: necesidad de un cambio / Education on pain disciplines in physical therapy in Chile: in need of change

El dolor es un importante problema de salud pública, asociado con trastornos emocionales y discapacidad física, generando un aumento en licencias laborales y gastos en el sistema de salud. Sin embargo, a pesar del impacto social y los altos costos relacionados con el dolor, hay una capacitación insuficiente en la formación de los profesionales de la salud, como kinesiólogos y fisioterapeutas sobre el manejo del dolor, lo que lleva a un abordaje terapéutico inadecuado. El objetivo de este estudio fue determinar la existencia de un programa específico en dolor dentro de las mallas curriculares de las carreras de kinesiología en universidades acreditadas en Chile. De 40 carreras de kinesiología, analizamos 38 mallas curriculares. Ninguna de ellas presentaba una disciplina específica sobre dolor en su plan de estudios. Si bien no hay una definición concreta sobre la mejor modalidad para la educación en dolor en alumnos de pregrado, se ha demostrado que seguir los planes de estudios de la impacta significativamente en el conocimiento y las creencias del dolor de los estudiantes.

Pain is a major public health concern associated with emotional disorders and physical disability and generates increased sick leave and healthcare expenditures. However, despite its social impact and the high pain-related costs, the training of healthcare professionals, such as physical therapists, in pain management is insufficient, leading to an inadequate therapeutic approach. This study aimed to determine the existence of a specific program on pain within the curricula of physical therapy careers in accredited universities in Chile. Out of 40 physical therapy careers, we analyzed 38 curricula. None of them had a specific discipline on pain management in their curricula. Although there is no concrete definition of the best modality for pain education in undergraduate students, it has been shown that following the International Association for The Study of Pain curricula improves students' knowledge and awareness of pain management.

Fisioterapia respiratoria en sujetos adultos cursando internación por neumonía adquirida en la comunidad. Revisión bibliográfica / Respiratory physiotherapy in adult subjects hospitalized for community-acquired pneumonia. Literature review

Introducción: La neumonía adquirida en la comunidad (NAC) es una infección respiratoria en la cual es frecuente observar la indicación de fisioterapia respiratoria (FR). Sin embargo, en la actualidad las recomendaciones respecto a su uso en NAC son controvertidas, no existiendo evidencia que respalde su uso y permita conocer su real alcance. Objetivos: Revisar la evidencia respecto al impacto de la FR en pacientes adultos que cursan internación por NAC. Resultados: 5 estudios cumplieron los criterios de inclusión de esta revisión. Las maniobras de FR incluyeron ejercicios respiratorios, drenaje postural, percusión, vibración, espirometría incentivada, resistencia espiratoria, asistencia torácica durante movimientos respiratorios, tos dirigida y presión positiva intermitente. En los estudios incluidos la FR no disminuyó la mortalidad ni mejoró los valores espirométricos en los pacientes con NAC, así como tampoco los días hasta la curación ni la estadía hospitalaria. Respecto a los costos, el uso de FR en pacientes con NAC presentó un incremento significativo de los mismos. Conclusión: No hay evidencia que respalde el uso de manera rutinaria de FR en los pacientes adultos con NAC. Consideramos que se requieren de futuras investigaciones que permitan conocer el impacto de la FR en pacientes adultos con NAC, así como establecer consensos respecto a su indicación, selección de maniobras, estandarización de técnicas, tiempos y dosificación.

Introduction: Community-acquired pneumonia (CAP) is a respiratory infection in which the indication for respiratory physiotherapy (RF) is frequently observed. However, currently the recommendations regarding its use in CAP are controversial, and there is no evidence to support its use and allow us to know its real scope. Objectives: To review the evidence regarding the impact of RF in adult patients who are hospitalized for CAP. Results: 5 studies met the inclusion criteria of this review. RF maneuvers included breathing exercises, postural drainage, percussion, vibration, incentive spirometry, expiratory resistance, chest support during respiratory movements, directed cough, and intermittent positive pressure. In the included studies, RF did not reduce mortality or improve spirometric values in patients with CAP, nor did it improve days to cure or hospital stay. Regarding costs, the use of RF in patients with CAP presented a significant increase in costs. Conclusion: There is no evidence to support the routine use of RF in adult patients with CAP. We believe that future research is required to determine the impact of RF in adult patients with CAP, as well as to establish consensus regarding its indication, selection of maneuvers, standardization of techniques, times, and dosage.