Adecuación de la terapia hidrocinética en el paciente ortopédico-traumatológico: un estudio transversal / Appropriateness of hydrokinesitherapy in the orthopedic-traumatological patient: a cross sectional surve

ABSTRACT Introduction: Hydrokinesitherapy is a rehabilitation method used for the treatment of different types of orthopedic, neurological, respiratory problems, etc. However, the existing literature presents not so much evidence regarding the greater efficacy of water treatment compared to dry treatment in patients with post-traumatic outcomes. Objective: Through the administration of a questionnaire, we tried to investigate the rehabilitation experience of hydrokinetic therapists (trained with the so-called Sequential and Preparatory Approach) in order to understand hydrokinesitherapy areas and methods of proper application based on experts' opinion. Methods: A cross-sectional study was carried out in 2020 by administering a questionnaire to physiotherapists trained in hydrokinesitherapy according to the Sequential and Preparatory Approach method, with the aim to investigate their opinion on the use of hydrokinesitherapy in patients with various orthopedic-traumatological problems. Microsoft FORMS® platform was used for the administration of the questionnaire. Results: Sixty-two users participated in the study. From their answers emerged that the use of hydrokinesitherapy is not recommended for the treatment of post-traumatic hypersensitization of peri-lesional tissues (hypersensitive scars; general hypersensitization) and neuropathic syndromes (of the upper and lower limbs). Conclusions: The data obtained from administering the questionnaire were not sufficient to create a specific path to define the appropriateness of hydrokinesitherapy for some orthopedic-traumatological problems but could be considered a good starting point on which to build future developments through further studies.

RESUMEN Introducción: La terapia hidrocinética es un método rehabilitador utilizado para el tratamiento de diferentes tipos de problemas ortopédicos, neurológicos, respiratorios, entre otros. Sin embargo, en la literatura existente no abundan evidencias en cuanto a la mayor eficacia del tratamiento con agua en comparación con el tratamiento seco en pacientes con resultados traumáticos. Objetivo: A través de un cuestionario, se intentó investigar la experiencia de rehabilitación de los terapeutas hidrocinéticos (entrenados con el llamado Enfoque Secuencial y Preparatorio) para comprender las áreas de la terapia hidrocinética y los métodos de aplicación adecuados con base en la opinión de expertos. Métodos: Se realizó un estudio transversal en el año 2020 mediante la administración de un cuestionario a fisioterapeutas formados en la terapia hidrocinética según el método de Abordaje Secuencial y Preparatorio, con el objetivo de averiguar su opinión sobre el uso de la terapia hidrocinética en pacientes con diversos problemas ortopédico-traumatológicos. Se utilizó la plataforma Microsoft FORMS® para la administración del cuestionario. Resultados: Sesenta y dos usuarios participaron en el estudio. De sus respuestas surgió que no se recomienda el uso de la terapia hidrocinética para el tratamiento de la hipersensibilización postraumática de los tejidos perilesionales (cicatrices hipersensibles; hipersensibilización general) y síndromes neuropáticos (de miembros superiores e inferiores). Conclusiones: Los datos obtenidos del cuestionario no fueron suficientes para crear una ruta específica que defina la idoneidad de la terapia hidrocinética para algunos problemas ortopédicos-traumatológicos, pero podría considerarse un buen punto de partida para construir futuros desarrollos a través de estudios adicionales.

Hosting the Unwanted: Stethoscope Contamination Threat.

Aims: Stethoscopes represent a vehicle of bacteria and other microorganisms and may play a role in the spread of health-care associated infections (HAIs). We aimed to evaluate the contamination levels of stethoscopes before and after use of a disinfecting technique (DT). Study Design: Matched cross-over study. Place and Duration of Study: The study was conducted in July 2012 and involved three hospitals in Siena Province (Italy). Two were public hospitals with about 750 and 140 beds, and the other was private with 40 beds. Methodology: We evaluated: i) contamination on 74 shared and non shared stethoscopes; ii) bacterial load before and after use of a DT. Total bacterial count (TBC) at 36ºC and 22ºC, Staphylococcus spp., molds, Enterococcus spp., Pseudomonas spp., Escherichia coli and total coliforms bacteria were evaluated. Mann Whitney and Wilcoxon tests were used for comparisons (p<0.05). Results: Before DT, 49 stethoscopes were positive for TBC at 36ºC, 48 for TBC at 22ºC, 40 for Staphylococcus spp., 18 for methicillin-resistant Staphylococcus aureus, 33 for coliforms (9 for Escherichia coli), 5 for Enterococcus spp. and 2 for molds. After cleaning, the percentage reduction in CFUs was close at 100% in most comparisons. Shared stethoscopes proved to be less contaminated than non shared ones (p<0.05). Conclusion: Our results suggest that stethoscopes may be potential vehicles of HAIs. The DT was effective in reducing bacterial contamination.