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ABSTRACT Introduction: As the World Health Organization declared the novel coronavirus as a pandemic in March 2020, physical therapy is more difficult to execute, and social distancing is mandatory in the healthcare sector. Objective: In physical therapy, an online video analysis software that provides real-time graphic and numerical information about the patient's movement executions without direct personal contact would mean a significant improvement in eHealth treatment. Methods: We have developed a software layer on top of OpenPose human body position estimation software that can extract the time series of angles of arbitrary body parts using the output coordinates from OpenPose processing the data recorded by two cameras simultaneously. To validate the procedure of determining the joint angles using the Openpose software we have used the Kinovea software. Results: The comparison of the determined maximal knee angle in our and the Kinovea software, which is widely used in biomechanical measurements, was not significantly different (2.03±1.06°, p<0.05) Conclusion: This indicates, that the developed software can calculate the appropriate joint angles with the accuracy that physiotherapy treatments require. As, to our knowledge no such software yet exists, with the help of this software development, therapists could control and correct the exercises in real-time, and also from a distance, and physical therapy effectiveness could be increased. Level of Evidence II; Experimental, comparative.
RESUMEN Introducción: Como la Organización Mundial de la Salud declaró el nuevo coronavirus como una pandemia en marzo de 2020, la fisioterapia es más difícil de ejecutar, el distanciamiento social es obligatorio en el sector de la salud. Objetivo: En la práctica de fisioterapia un software de análisis de vídeo online que proporcione información gráfica y numérica en tiempo real sobre las ejecuciones de movimiento del paciente sin contacto personal directo supondría una mejora significativa en el tratamiento de la eSalud. Métodos: Fue desarrollado una capa de software sobre el software de estimación de posición del cuerpo humano OpenPose que puede extraer la serie temporal de ángulos de partes arbitrarias del cuerpo utilizando las coordenadas de salida de OpenPose procesando los datos registrados por dos cámaras simultáneamente. Para validar el procedimiento de determinación de los ángulos articulares mediante el software Openpose fue utilizado el software Kinovea. Resultados: La comparación del ángulo máximo de rodilla determinado en nuestro software y Kinovea, que es ampliamente utilizado en mediciones biomecánicas, no fue significativamente diferente (2,03±1,06°, p<0,05). Conclusión: Esto indica que el software desarrollado puede calcular los ángulos articulares adecuados con la precisión que requieren los tratamientos de fisioterapia. Dado que aún no existe dicho software, con la ayuda de este desarrollo de software, los terapeutas podrían controlar y corregir los ejercicios en tiempo real, y también a distancia, y se podría aumentar la eficacia de la fisioterapia. Nivel de Evidencia II; Experimental, comparativo.
RESUMO Introdução: Como a Organização Mundial da Saúde declarou o novo coronavírus como pandemia em março de 2020, a fisioterapia é mais difícil de executar, o distanciamento social é obrigatório no setor de saúde. Objetivo: Na prática da fisioterapia, um software de análise de vídeo online que fornece informações gráficas e numéricas em tempo real sobre as execuções de movimento do paciente sem contato pessoal direto significaria uma melhora significativa no tratamento eHealth. Métodos: Desenvolveu-se uma camada de software em cima do software de estimativa de posição do corpo humano OpenPose que pode extrair as séries temporais de ângulos de partes do corpo arbitrárias usando as coordenadas de saída do OpenPose processando os dados gravados por duas câmeras simultaneamente. Para validar o procedimento de determinação dos ângulos articulares utilizando o software Openpose utilizou-se o software Kinovea. Resultados: A comparação do ângulo máximo do joelho determinado em nosso e no software Kinovea, amplamente utilizado em medidas biomecânicas, não foi significativamente diferente (2,03±1,06°, p<0,05) Conclusão: Isso indica que o software desenvolvido pode calcular os ângulos articulares adequados com a precisão que os tratamentos de fisioterapia exigem. Como esse software ainda não existe, com a ajuda do desenvolvimento desse software, os terapeutas puderam controlar e corrigir os exercícios em tempo real, e também à distância, aumentando a eficácia da fisioterapia. Nível de Evidência II; Experimental, comparativo.
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ObjectiveTo analyze the medical services, quality and safety of rehabilitation medicine departments in general hospitals and rehabilitation hospitals in 2021 in perspectives of structure, segment and outcome quality. MethodsWe analyzed the data from National Clinical Improvement System of the National Health Commission, involving 9 328 hospitals, including all secondary and above general hospitals and rehabilitation hospitals, as well as traditional Chinese Medicine hospitals and integrated traditional Chinese and Western medicine hospitals in 2021. A total of 2 513 sampling hospitals that equipped with rehabilitation wards were included. ResultsAmong the 9 328 general hospitals surveyed this year, only 2 713 had rehabilitation wards. In general hospitals, the average number of physicians per bed in 56.77% hospitals, the average number of rehabilitation therapists per bed in 80.36% hospitals, and the average number of nurses per bed in 53.53% hospitals did not meet the national requirements, and the average number of rehabilitation medical personnel per bed in rehabilitation medicine departments in different regions was significantly different. The rates of early rehabilitation intervention were 13.45%, 20.67% and 29.74% respectively in department of orthopedics, department of neurology and intensive care units in general hospitals. The average improvement rate of activities of daily living of discharged patients was 77.87% in rehabilitation department of general hospitals, and 69.01% in rehabilitation hospitals. ConclusionIn 2021, professional medical services, quality and safety of rehabilitation medicine in China have improved steadily. However, most general hospitals in China still have not configured the rehabilitation wards, and there are problems such as the total number of rehabilitation medical personnel in the country does not meet the requirements, early rehabilitation intervention is significantly insufficient, and the implementation of important evaluation and therapies is deficient. The effect of rehabilitation still needs to improve. It is necessary to continuously promote capacity building of the medical rehabilitation to improve the quality of medical rehabilitation services.
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In order to explore the medical and social problems related to postoperative lymphedema in breast cancer patients, improve the compliance of rehabilitation treatment and help patients return to society. The self-designed questionnaire was used to investigate 76 patients who met the criteria of lymphedema after breast cancer and refused or failed to adhere to rehabilitation threapy. According to the relevant measurement scale theory and method, the computer-aided software was used to analyze the data to find out the problem and analyze the cause. The prominent problems of poor compliance in patients with breast cancer after operation were successively: subjective factors, objective factors, family social and ethical factors, multidisciplinary factors, hospital management and policy issues. For the above ethical problems, we should adopt positive coping strategies to increase the compliance of patients and improve their quality of life.
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Anti-signal recognition particle myositis (ASRPM) is a steroid-resistant disease that develops in approximately 5-8％ of patients with dermatomyositis, polymyositis, or other types of myositis. It restricts the patient's activities of daily life (ADLs), mainly owing to muscle weakness of the trunk and proximal lower extremities. We report a case of ASRPM treated at a Kaifukuki rehabilitation ward (KRW；a type of inpatient rehabilitation ward in Japan). A female ASRPM patient in her eighties underwent treatment at the KRW twice, with an interval of 18 months between treatments. During each hospital stay, concentrative and graded exercise therapy was performed under continuous administration of steroid and tacrolimus hydrate. The severity of ASRPM was evaluated using periodic measurement of creatinine kinase (CK) levels. After each KRW treatment, the patient gained the ability to walk and perform instrumental ADLs to live alone. The details of exercise therapy for ASRPM and the management of ASRPM and steroid-induced osteoporosis and its complications (for e.g., lumbar compression fracture) are also discussed.
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Objectives@#Perception about Physical and Rehabilitation Medicine provides information about awareness on identifying disabilities and managing their impact on activities of daily living; however, misconceptions about the field continue to exist among both students and physicians. This study aims to describe the perceptions of clinical clerks and interns towards the practice and role of Rehabilitation Medicine in management of patients. @*Methods@#This is a descriptive cross-sectional study. Students from the Learning Unit 6 and 7 of UP College of Medicine answered adapted online survey forms from a previous study and participated in online focus group discussions. Qualitative data were used to infer the perception of medical students towards the specialty. The effect of the respondent’s profile, background and affiliation on their knowledge, attitudes and perceptions were analyzed using One-Way ANOVA (α = 0.05). Qualitative data were analyzed using thematic analysis. @*Results@#Learning Unit 6 and 7 students were found to have a perceived broad level of knowledge with regards the specialty. The students associated the specialty with focus on holistic care, quality of life, interdisciplinary collaboration, and diversity of cases managed. No statistically significant differences were found between the perception among: 1) Learning Unit 6 and 7, 2) those with or without a previous encounter with the specialty, 3) allied medical and non-allied medical undergraduate courses in terms of: a) confidence in the knowledge (p = 0.489), b) familiarity with conditions managed (p = 0.93) and c) interest towards the specialty (p = 0.693). The Organ System Integrated (OSI) curriculum, which promotes horizontal and vertical integration of concepts, provided a wide understanding of the basic concepts related to physiatry. The students’ responses suggest a positive attitude towards Physical and Rehabilitation Medicine, as measured in their level of interest about knowing more regarding the specialty. Most common perceptions were that the specialty was multidisciplinary and holistic. However, the respondents’ perceptions regarding the roles of the Rehabilitation team were limited. @*Conclusion@#Learning unit level 6 and 7 students had a broad understanding of the practice and scope of the Physical and Rehabilitation Medicine specialty. Future researches can include other medical students in all year levels, including Learning Units 3, 4 and 5 of UPCM, to observe the development of their perceptions about the specialty throughout medical school.
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Percepción , Estudiantes de Medicina , CurriculumRESUMEN
ABSTRACT Introduction Traumatic injury to the knee joints and their adjacent muscles is common among athletes, and their organizational characteristics require thorough analysis. Objective Investigate the motor organization of muscles in the lower limbs of athletes with traumatic knee injuries. Methods A systematic survey of the peculiarities of motor organization in the muscles of physically healthy athletes was preceded by an analytical survey of the peculiarities of this organization among athletes with traumatic knee injuries interested in medical treatment to restore the functional condition of the knee joints and perform active sports activities. Results The characteristics of muscle motor organization in traumatic injuries and their recovery methods were determined, as well as the formation of a sequential understanding of the recovery process of knee joint injuries for athletes representing various sports. Conclusion The results of this scientific study and the conclusions formulated based on them are of great importance for athletes concerned with restoring functional status after knee joint injuries sustained during the competition and in the training process. Evidence level II; Therapeutic studies - outcomes research.
RESUMO Introdução A lesão traumática nas articulações do joelho e seus músculos adjacentes é comum entre atletas e suas características organizacionais exigem uma análise minuciosa. Objetivo Investigar a organização motora dos músculos nos membros inferiores de atletas com lesões traumáticas no joelho. Métodos Uma pesquisa sistemática sobre as peculiaridades da organização motora na musculatura de atletas fisicamente saudáveis foi precedida a uma pesquisa analítica das peculiaridades desta organização entre atletas com lesões traumáticas no joelho, interessados no tratamento médico a fim de restaurar a condição funcional das articulações do joelho e realizar atividades esportivas ativas. Resultados Foram determinadas as características de organização motora muscular nas lesões traumáticas e seus métodos de recuperação, bem como a formação de uma compreensão sequencial no processo de recuperação das lesões das articulações do joelho para os atletas que representam diversos esportes. Conclusão Os resultados deste estudo científico e as conclusões formuladas com base neles são de grande importância para atletas preocupados com o restauro do estado funcional após as lesões nas articulações do joelho sofridas durante o período de competição e no processo de treinamento. Evidência nível II; Estudos terapêuticos - pesquisa de resultados.
RESUMEN Introducción Las lesiones traumáticas de las articulaciones de la rodilla y sus músculos adyacentes son frecuentes entre los deportistas y sus características organizativas requieren un análisis exhaustivo. Objetivo Investigar la organización motora de los músculos de las extremidades inferiores de atletas con lesiones traumáticas de rodilla. Métodos Una investigación sistemática sobre las peculiaridades de la organización motora en los músculos de los atletas físicamente sanos fue precedida por una investigación analítica de las peculiaridades de esta organización entre los atletas con lesiones traumáticas de la rodilla, interesados en el tratamiento médico para restaurar la condición funcional de las articulaciones de la rodilla y realizar actividades deportivas activas. Resultados Se determinaron las características de la organización motora del músculo en las lesiones traumáticas y sus métodos de recuperación, así como la formación de una comprensión secuencial en el proceso de recuperación de las lesiones de la articulación de la rodilla para los atletas que representan varios deportes. Conclusión Los resultados de este estudio científico y las conclusiones formuladas a partir de ellos son de gran importancia para los deportistas preocupados por el restablecimiento del estado funcional tras las lesiones de la articulación de la rodilla sufridas durante el periodo de competición y en el proceso de entrenamiento. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados.
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ABSTRACT Introduction Knee joint injury is a common sports injury and how to speed up the recovery process is a concern for all athletes. Objective Determine whether aquatic sports rehabilitation nursing can accelerate the rehabilitation process of knee joint injuries. Methods Thirty patients with knee ligament or meniscal injury were divided into an aquatic sports group and a control group. The control group assumed general recovery measures, while the aquatic exercise group was added another 8 weeks of rehabilitation nursing with aquatic exercises. The evolution of the degree of knee joint pain, knee joint range of motion, knee joint muscle strength and other indicators before and after the experiment were compared. Results After 8 weeks of intervention, pain and activities of daily living in the aquatic exercise group improved significantly compared with those before the experiment; the degree of recovery from knee joint injury in the aquatic exercise group was significantly better than that in the control group, and knee joint flexion range of motion, flexor and extensor muscle strength, and other indicators in the aquatic exercise group were significantly better than those in the control group. Conclusion Aquatic rehabilitation exercise can accelerate the recovery process of patients with knee joint injuries. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.
RESUMO Introdução A lesão articular do joelho é uma lesão esportiva corriqueira e a maneira de acelerar o processo de recuperação é uma preocupação para todos os atletas. Objetivo Determinar se a enfermagem de reabilitação esportiva aquática pode acelerar o processo de reabilitação das lesões nas articulações do joelho. Métodos Trinta pacientes com lesão ligamentar ou meniscal do joelho foram divididos em grupo de esportes aquáticos e grupo de controle. O grupo de controle assumiu medidas gerais de recuperação, enquanto ao grupo de exercícios aquáticos acrescentou-se mais 8 semanas de enfermagem de reabilitação com exercícios aquáticos. Comparou-se a evolução do grau de dor na articulação do joelho, a amplitude de movimento da articulação do joelho, a força muscular da articulação do joelho e outros indicadores antes e depois da experiência. Resultados Após 8 semanas de intervenção, a dor e as atividades das atividades de vida diária no grupo de exercícios aquáticos melhoraram significativamente em comparação com aquelas antes do experimento; o grau de recuperação da lesão da articulação do joelho no grupo de exercícios aquáticos foi significativamente melhor do que o do grupo controle, e a amplitude de flexão da articulação do joelho, a força muscular flexora e extensora e outros indicadores no grupo de exercícios aquáticos foram significativamente melhores do que os do grupo controle. Conclusão O exercício de reabilitação aquática pode acelerar o processo de recuperação de pacientes com lesões articulares no joelho. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.
RESUMEN Introducción La lesión de la articulación de la rodilla es una lesión deportiva común y acelerar el proceso de recuperación es una preocupación para todos los atletas. Objetivo Determinar si la enfermería de rehabilitación deportiva acuática puede acelerar el proceso de rehabilitación de las lesiones articulares de rodilla. Métodos Treinta pacientes con lesiones de ligamentos o meniscos de rodilla se dividieron en un grupo de deportes acuáticos y un grupo de control. El grupo de control asumió medidas generales de recuperación, mientras que al grupo de ejercicios acuáticos se le añadieron 8 semanas adicionales de enfermería de rehabilitación con ejercicios acuáticos. Se comparó la evolución del grado de dolor de la articulación de la rodilla, la amplitud de movimiento de la articulación de la rodilla, la fuerza muscular de la articulación de la rodilla y otros indicadores antes y después del experimento. Resultados Tras 8 semanas de intervención, el dolor y las actividades de la vida diaria en el grupo de ejercicio acuático mejoraron significativamente en comparación con los anteriores al experimento; el grado de recuperación de la lesión de la articulación de la rodilla en el grupo de ejercicio acuático fue significativamente mejor que el del grupo de control, y la amplitud de la flexión de la articulación de la rodilla, la fuerza muscular flexora y extensora y otros indicadores en el grupo de ejercicio acuático fueron significativamente mejores que los del grupo de control. Conclusión El ejercicio de rehabilitación acuática puede acelerar el proceso de recuperación de los pacientes con lesiones articulares de rodilla. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.
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ObjectiveTo evaluate the Chinese guidelines and consensus of rehabilitation medicine published in the medical journals in 2022 using Scientific, Transparent and Applicable Rankings (STAR). MethodsGuidelines and consensus which were developed by Chinese institutions or led by Chinese scholars were retrieved in databases of CNKI, Wanfang Data, CBM, Chinese Medical Journal Network, PubMed and Web of Science, in 2022, followed by screening for rehabilitation medicine field. The literature were rated with STAR. ResultsSeven guidelines and eleven consensuses were included. The STAR scores ranged from 11.7 to 69.6, with a median score of 25.9 and mean score of 28.3. There was a significant difference in the total score between guidelines and consensus (U = 12.000, P = 0.014). The score ratio was high in the domains of recommendations (73.6%), evidence (39.5%) and others (33.3%), while it was low in the domains of protocol (1.4%), clinical questions (12.5%) and conflicts of interest (13.9%). The score ratio was high in the items of listing the institutional affiliations of all individuals involved in developing the guideline (94.4%), identifying the references for evidence supporting the main recommendations (94.4%), indicating the considerations (e.g., adverse effects) in clinical practice when implementing the recommendations (88.9%), and making the recommendations clearly identifiable, e.g., in a table, or using enlarged or bold fonts (75%); and it was low in the items of describing the role of funder(s) in the guideline development (0), indicating information about the evaluation and management of conflicts of interest (0), providing tailored editions of the guidelines for different groups of target users (0), presenting the guideline or recommendations visually, such as with figures or videos (0), providing details of the guideline protocol (2.8%), assessing the risk of bias or methodological quality of the included studies (2.8%), describing the responsibilities of all individuals or sub-groups involved in developing the guideline (5.6%), indicating how the clinical questions were selected and sorted (5.6%), formating clinical questions in PICO or other formats (5.6%), making the guideline accessible through multiple platforms (5.6%), and declaring that the funder(s) did not influence the guideline's recommendations (8.3%). ConclusionThe quality of current clinical practice guidelines and consensus of rehabilitation medicine is poor, which should be developed in accordance with the relevant standards.
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Objective@#This study aimed to determine the perceptions of rehabilitation medicine resident trainees on using modified Thiel soft-embalmed cadavers as a learning tool in acquiring knowledge on musculoskeletal ultrasound (MSK-UTZ) and anatomy. @*Methods@#This descriptive cross-sectional study used total enumeration to recruit residents in training under the rehabilitation medicine department of a tertiary referral hospital. An online survey tool was self-administered to determine their perceptions on the use of MSK-UTZ on Thiel-embalmed cadavers. Pre- and post-test scores were compared to determine if their knowledge has improved. @*Results@#Fifteen participants were recruited, who answered the pre- and post-test, and the online survey. The mean pre-test score of participants was 5.87 (±1.68), and the mean post-test score was 6.87 (±2.00). There was no statistically significant difference (P = 0.20) using a paired t-test. At an arbitrary passing rate of 70%, only 5/15 participants passed the pre-test while 10/15 passed the post-test. A chi-square test of independence showed that there was no significant association between the number of participants who passed or failed on the pre- and posttest, X2 (1, N = 15) = 3.3, p = .0.068. Most of the perceptions of the participants were positive in terms of the use of modified Thiel soft-embalmed cadavers as a learning tool, its relevance in the training of a rehabilitation medicine resident, and the overall experience on its use. @*Conclusion@#Thiel-embalmed cadavers as a learning tool was well-accepted, having generally positive perceptions from the participants mainly in terms of perceived enhancement of the understanding of the anatomical basis of musculoskeletal ultrasound, perceived improvement in skills in performing musculoskeletal ultrasound, and most even recommended that it be part of their training as rehabilitation medicine residents. In terms of acquiring knowledge on musculoskeletal ultrasound (MSK-UTZ) and anatomy, no significant improvement in knowledge was noted. Further studies with larger sample sizes are recommended to yield more statistically significant improvement in knowledge and to observe trends in the perceptions of participants.
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Educación Médica , AnatomíaRESUMEN
Noticiamos com muita alegria o cinquentenário da Academia de Medicina de Reabilitação - ABMR, ocasião que todos os médicos Fisiatras prestam uma homenagem ao fundador reproduzindo a historia desta Academia.
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Foram comparadas características clínicas e epidemiológicas de pacientes com tetraplegia traumática e Malformação de Chiari tipo I, atendidos em centro de neurorreabilitação através de estudo observacional analítico e retrospectivo, realizado por meio de análise de prontuário eletrônico. No grupo de pacientes com Malformação de Chiari tipo I predominaram mulheres, com marcha e que apresentavam transtornos de ansiedade e a presença de siringomielia. No grupo com tetraplegia traumática predominaram os homens, com locomoção em cadeira de rodas e maior presença de espasticidade e disfunções neurogênicas do intestino e do trato urinário inferior. Os pacientes com Malformação de Chiari tipo I representam um grupo com diferentes características clínicas e epidemiológicas em relação aos pacientes com sequelas de traumatismo raquimedular, tradicionalmente o principal grupo atendido dentro dos programas de neurorreabilitação. Desta forma, os pacientes com Malformação de Chiari tipo I necessitam de uma abordagem diferenciada que contemplem suas necessidades nos programas de neurorreabilitação.
Clinical and epidemiological characteristics of patients with traumatic tetraplegia and Chiari malformation type I treated at a neurorehabilitation center were compared through an analytical and retrospective observational study, carried out through electronic medical record analysis. In the group of patients with Chiari malformation type I predominated female gender, with gait, the presence of syringomyelia and anxiety disorders. In the group with traumatic tetraplegia predominated male gender, use of wheelchair and presence of spasticity and neurogenic dysfunctions of the bowel and lower urinary tract. Patients with Chiari malformation type I represent a group with different clinical and epidemiological characteristics in relation to patients with sequelae of spinal cord injury, traditionally the main group treated within neurorehabilitation. Thus, patients with Chiari malformation type I need a differentiated approach that addresses their needs in neurorehabilitation.
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Introducción: A diario, los profesionales de la salud se enfrentan a importantes retos diagnósticos cuando atienden a sus pacientes, por lo que se apoyan en exámenes paraclínicos que complementan su ejercicio semiológico, porque les permiten confirmar o descartar una enfermedad. Objetivo: Explicar a los especialistas en rehabilitación cardiopulmonar los conceptos requeridos para interpretar de forma crítica los resultados de las pruebas diagnósticas. Materiales y métodos: Revisión narrativa de la literatura, que expone conceptos actualizados, ejemplos y gráficas con enfoque académico y didáctico. Resultado: Se realizó la actualización y explicación de los conceptos de sensibilidad, especificidad, valores predictivos positivo y negativo y los likelihood ratio positivo y negativo y su interpretación en el normograma de Fagan, a través de ejemplos del día a día del especialista. Conclusión: Comprender los conceptos que acompañan la evaluación de pruebas diagnósticas ayuda a que los especialistas en rehabilitación cardiopulmonar analicen críticamente los resultados de las ayudas paraclínicas funcionales y estructurales que acompañan a sus pacientes y, de esta manera, puedan caracterizar bien el diagnóstico y seguimiento de las personas
Introduction: Health professionals face important diagnostic challenges daily when they care for their patients, which is why they rely on paraclinical tests that complement their semiological exercise by confirming or ruling out a disease. Objective: Explain to cardiopulmonary rehabilitation specialists, the concepts necessary to critically interpret the results of diagnostic tests. Materials and methods: narrative review of the literature was carried out, which exposes updated concepts, examples, and graphs with an academic and didactic approach.Result: The concepts of sensitivity, specificity, positive and negative predictive values and the positive and negative Likelihood Ratio and their interpretation in the Fagan normogram were updated and explained, through examples of the specialists day-to-day. Conclusion: understanding the concepts that accompany the evaluation of diagnostic tests help car-diopulmonary rehabilitation specialists to critically analyze the results of the functional and structural paraclinical aids that accompany their patients, and thus be able to properly characterize the diagno-sis and follow-up. of people
Introdução: Diariamente, os profissionais da saúde enfrentam desafios diagnósticos, recorrendo a exames que complementem a sua prática semiológica, permitindo-lhes confirmar ou excluir uma doença. Objetivo: Explicar aos especialistas em reabilitação cardiopulmonar os conceitos necessários para interpretar criticamente os resultados dos testes de diagnóstico. Materiais e métodos: Revisão narrativa da literatura, fornecendo conceitos atualizados, exemplos e gráficas com uma abordagem académica e didática. Resultado: Os conceitos de sensibilidade, especificidade, valores preditivos positivos e negativos e razões de verossimilhança positivas e negativas e a sua interpretação no normograma de Fagan foram atualizados e explicados com exemplos do trabalho diário do especialista. Conclusão: A compreensão dos conceitos que acompanham a avaliação dos testes de diagnóstico ajuda aos especialistas em reabilitação cardiopulmonar na analise critica dos resultados das ajudas clínicas funcionais e estruturais dos pacientes e, desta forma, caracterizar bem o diagnóstico e o acompanhamento dos indivíduos
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Rehabilitación Cardiaca , Medicina Física y Rehabilitación , Epidemiología , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Pruebas Diagnósticas de RutinaRESUMEN
Rehabilitation therapy is important for patients with cancer, especially for those with terminal stage cancer who have physical malfunction and psychological distress. By setting goals according to patients' wishes, rehabilitation therapy may positively affect physical activity. In this study, we reported the implementation of rehabilitation training outside the hospital as a rehabilitation treatment. A 64-year-old man was diagnosed as having multiple brain metastases from lung cancer. The patient was admitted to the palliative care ward without active treatment according to his wish and was referred to the rehabilitation department. The patient had mild right hemiplegia at the time of initial examination and therefore required assistance for walking and eating. On the 51st day of the intervention, he requested to visit the ramen restaurant of his friend, which recently opened. Going out independently to the restaurant served as his practical training for improving his quality of life (QOL). This outing further expanded his activities of daily living, which made him motivated to treat his cancer. On the 71st day of intervention, he was discharged from the hospital and underwent outpatient examination. Therefore, the role of treatment in palliative care is to achieve the highest possible QOL. In this case, providing options according to the patients' wishes, such as outing, is believed to be effective in cancer treatment
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A novel and portable device is proposed to monitor motor rehabilitation equipment, which can be mounted on most equipment with rotor shaft. The software of the device, whose main functions include equipment configuration, monitoring and statistical computation, is developed based on available sensor. The data collected by the device serve both department managers to learn the efficiency of the equipment, and physicians and therapists to understand the physical conditions of the patients who perform training exercises with the monitored rehabilitation equipment. About 2000 hours' monitoring has been carried out, and the experimental result indicates that the monitoring device is applicable to many types of motor rehabilitation equipment and achieves good monitoring accuracy. The data aggregated by the device can be used to evaluate the motor functions of the patients and make rehabilitation training plan. Besides, it is agreed by physicians and therapists that the device is easy-to-use, robust and has good real-time performance. The monitoring device thus holds the promise of boosting the development of digitalized rehabilitation medicine.
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Humanos , Diseño de Equipo , Terapia por Ejercicio , Monitoreo FisiológicoRESUMEN
@#Objective To investigate the development of rehabilitation medical resources in Jiangsu during Thirteenth Five-year Plan.Methods The electronic questionnaire was issued uniformly to the medical and health institutions in 13 prefecture-level cities in Jiangsu Province through the Health Commission system, to survey the rehabilitation medical resources data from 2015 to 2019.Results Compared with those in 2015, the secondary and above general hospitals with rehabilitation medicine departments increased 3.42 percentage points and community-level medical and healthcare institutions providing rehabilitation medical services increased 5.67 percentage points at the end of 2019; while, the authorized beds increased 127 and actual beds increased 142 in the rehabilitation department per million population; the early rehabilitation intervention increased 4 326 person-times per million population; there were 91 more rehabilitation professionals per million population, including 25 rehabilitation physicians, 31 rehabilitation therapists, 29 rehabilitation nurses and six other rehabilitation practitioners; the practitioners with associate senior titles and above increased 1.65 percentage points, and those with master-degree or above increased 1.27 percentage points.Conclusion The allocation of various rehabilitation resources has been improved in Jiangsu province during Thirteenth Five-year Plan.
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@#In April 2020, the Department of Rehabilitation Medicine (DRM) of the University of the Philippines - Philippine General Hospital (UP-PGH) transitioned to a telerehabilitation program called ITAWAG, an acronym for Introducing Telerehab As a Way to Access General rehabilitation medicine services. This was in response to the designation of UP-PGH as a COVID-19 referral center and the abrupt closure of all its in-patient and out-patient rehabilitation services. Eleven previous in-patients and out-patients with musculoskeletal and neurologic impairments continued their rehabilitation programs remotely, either through a phone call or video call. Their clinical outcomes and the implementation of the ITAWAG program were monitored to determine the effectiveness of an offsite continuing care program. Using the Clinical Global Impressions-Severity (CGI-S) scale, eight patients had a reduction in the severity of their illness, while the remaining three clients had no change. Feedback surveys showed that most clients and caregivers (68%) and health providers (77%) were satisfied with the program's implementation and its outcome. A frequent complaint was the poor phone reception and internet connection. As threats of a COVID-19 outbreak continue, telerehabilitation gives patients a safe, affordable, and convenient alternative for follow-up and continuity of care in medical rehabilitation. Integrating the ITAWAG program into the initial facility-based rehabilitation management can enhance its value in optimizing functional gains and resolving its shortcomings.
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Telerrehabilitación , COVID-19 , Continuidad de la Atención al PacienteRESUMEN
@#Musculoskeletal conditions are among the leading causes of consultations in Rehabilitation Medicine. A fellowship program in Musculoskeletal Rehabilitation Medicine was proposed to enrich physiatrists’ knowledge and skills in evaluating and managing musculoskeletal conditions. In this paper, we shared the process of developing the curriculum of the fellowship program, which was proposed to and eventually approved by the Postgraduate Institute of Medicine, College of Medicine, University of the Philippines Manila. A core group of consultants, considered as experienced clinicians and educators in Musculoskeletal Rehabilitation Medicine in the study institution, designed the program from the scope of training to learning competencies, outcomes, and assessment methods. To our knowledge, developing the fellowship program in this constantly evolving area in Rehabilitation Medicine is the first of its kind in the Philippines and a milestone in the history of postgraduate education in the longest-running training program for aspiring physiatrists.
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Medicina Física y RehabilitaciónRESUMEN
Objectives@#The objective of this study was to determine the coping strategies and job satisfaction among rehabilitation medical and paramedical staff deployed to different areas at the University of the Philippines Manila Philippine General Hospital, a designated COVID-19 referral center. @*Method@#This was a cross-sectional study that utilized total population sampling of the medical and paramedical staff of the Department of Rehabilitation Medicine deployed to other areas in PGH and who carried out non-rehabilitation-related clinical work responsibilities during the COVID-19 pandemic. Electronic informed consent was obtained from each participant. Two sets of validated and reliable self-administered online questionnaires, namely, the Brief Coping Orientation to Problems Experienced (COPE) Inventory Tool and Satisfaction of Employee in Health Care (SEHC) Survey, were used to determine coping strategies and work satisfaction, respectively. Descriptive statistics (such as frequencies, percentages, ranges, means) were used to present the data. @*Results@#A total of 50 medical and paramedical staff participated in the study. The participants’ age ranged from 22 to 60 years (mean: 30.2 ± 8.7). The majority were single (84%), women (64%), and with a Bachelor of Science degree. Most of the participants were assigned in the orange zone, which included the COVID ward nurses’ station and donning/doffing areas; with 30% who rotated in the COVID wards. There were three types of coping strategies utilized by the department staff: (1) emotion-focused coping, (2) problem-focused coping, and (3) dysfunctional coping. Problem-focused coping was the most common general strategy (mean COPE score for all problem-focused strategies, 3.1 ± 0.9). Acceptance was the most common specific coping strategy, followed by active coping and a tie among positive reframing, planning, and self-distraction. The work satisfaction rate was at 76.9% ± 13.2. Three out of 4 participants would recommend their workplace to other healthcare workers. @*Conclusion@#The medical and paramedical staff of the Department of Rehabilitation Medicine in a COVID referral center had relatively high job satisfaction despite their health risks and changes in responsibilities among others. The majority utilized functional coping strategies to help them adapt to the work demands. The sources of motivation and values of the staff are areas for future research to help explain their positive outlook about their jobs and generally high recommendation about their workplace in the middle of the COVID-19 crisis.
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Satisfacción en el Trabajo , Personal de SaludRESUMEN
Objective@#This study described levels of fear, anxiety, depression, and contributing factors among health providers and administrative staff of the Department of Rehabilitation Medicine, Philippine General Hospital (PGH-DRM) during the COVID-19 pandemic. @*Methods@#The cross-sectional study was conducted from August to November 2020. We recruited 71 participants who were working in the premises of the hospital and those who were working from home by purposive sampling. The fear numerical rating scale and Hospital Anxiety and Depression Scale were used to determine the presence of fear, anxiety, and depression. The 36-Item Short Form Survey (SF-36) was used to determine the baseline level of physical and mental wellness among participants. @*Results@#Seventy-three percent of the full-time, permanent employees of the PGH-DRM unit joined the study. Majority of the respondents were health providers (86%) but only one hospital staff had high-risk contact with patients with COVID-19. Most participants (63%) did a combination of on-site work and home-based work and three (4%) worked entirely from home. Moderate to severe levels of fear was reported by 54% of the participants. Fear levels were highest among those who worked on-site. Anxiety was borderline in 32%, and abnormal in 30%, while depression was borderline in 21%, and abnormally high in 34% of the participating employees. Feelings of anxiety were higher among those who worked on-site and who worked both on-site and from home, while depression was highest among those who worked from home. The SF-36 Physical Health Summary score (x̄ = 72.49) was higher than the Mental Health Summary score (x̄ = 55.45). Employees who worked from home had the highest SF-36 summary scores for both mental and physical health. @*Conclusion@#The employees of the DRM had low-risk contact work assignments when the PGH transitioned to a tertiary level COVID-19 referral hospital. Half of the employees experienced fear, anxiety, and depression and had low SF-36 summary scores in mental health. Further studies are needed to determine the key factors that affect their mental health and well-being during the pandemic. A relevant mental health and wellness program is strongly recommended.
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Depresión , Ansiedad , Miedo , COVID-19 , Salud MentalRESUMEN
Introduction@#Musculoskeletal complaints have been observed in the recovery phase of patients with moderate-to-severe coronavirus disease 2019 (COVID-19). We noted several referrals for physical rehabilitation at the University of the Philippines-Philippine General Hospital (UP-PGH), a designated COVID-19 referral center. These observations resembled the musculoskeletal manifestations associated with poorer outcomes reported in other coronavirus studies. @*Objectives@#The study determined the musculoskeletal signs and symptoms of adults in the recovery phase of moderate to severe COVID-19 using the COVID Musculoskeletal Assessment Tool (CMAT). @*Methods@#This was a three-phased, prospective, descriptive study of adults admitted for COVID-19 at the UP-PGH. Phase 1 was the development of the CMAT based on a review of related literature and patient charts, and patient interviews. The tool was pretested and validated in Phase 2 before it was used in the evaluation of study participants in Phase 3 of the research. Data was encoded using Microsoft® Excel 2007 and analyzed using STATA, Version 12.0 (Texas, USA). Descriptive statistics were used to summarize the variables collected for the study. @*Results@#A cohort of 40 patients admitted at the UP-PGH for moderate-to-severe COVID-19 infection was evaluated using the CMAT. Most of the patients had an average age of 55 years and were males. Majority resided in an urban area, reached high school education, and were ambulatory before their illness. The most common comorbidities were hypertension and diabetes. All patients required oxygen support. Based on the CMAT, majority of the participants complained of muscle pain, generalized weakness, and easy fatigability. Other common findings were neck-shoulder and lower limb pain, dyspnea on exertion, limited mobility in the trunk, hips, and knees, joint pains, and decreased muscle strength. Half of the participants needed a wheelchair or walker to ambulate. These findings may be due to the COVID-19 disease and to prolonged confinement in bed. Only one patient underwent physical therapy through bedside instructions. @*Conclusion@#Musculoskeletal signs and symptoms were common in the patients recovering from COVID-19 disease. The COVID-19 Musculoskeletal Assessment Tool facilitated the evaluation of patients and the recording of results. Early referral for medical rehabilitation and timely intervention are strongly recommended.