Estudio epidemiológico sobre la demanda de rehabilitación en pacientes hospitalizados / Epidemiological study on the demand for rehabilitation in hospitalized patients

Introducción. Los especialistas en Medicina Física y Rehabilitación (MFyR) damos asistencia a pacientes que han perdido su autonomía. Hay un porcentaje considerable de pacientes hospitalizados que adquieren una discapacidad y precisan ser asistidos por terapeutas de Rehabilitación. Hemos desarrollado el presente estudio descriptivo para analizar la demanda de rehabilitación en pacientes ingresados en nuestro hospital. Material y métodos. Se realizó un estudio observacional prospectivo, que incluyó a todos los pacientes ingresados y que fueron valorados por nuestro servicio durante los meses de febrero, marzo y abril de 2008. Resultados. El número de interconsultas realizadas por el Servicio de MFyR durante los meses de febrero-abril de 2008 (60 días laborales) ha sido de 464 para atender a 345 pacientes. La media de interconsultas diaria a nuestro servicio ha sido de 7,73 y el número medio de interconsultas por paciente ha sido de 1,36 (desviación estándar [DE] 0,70; rango 1-7). De los 354 pacientes valorados durante el estudio, 55 no fueron incluidos en terapia por no cumplir los criterios, lo que significa que un 84 % de los pacientes hospitalizados ha precisado tratamiento rehabilitador. Conclusión. El presente estudio nos ha permitido conocer que un porcentaje considerable de pacientes hospitalizados necesita valoración y tratamiento por parte de los servicios de MFyR. Los servicios de Traumatología y Medicina Interna son los que demandan más nuestra asistencia. Solo un grupo minoritario de pacientes precisa continuar tratamiento de forma ambulatoria (AU)

Introduction. Specialists in Physical Medicine and Rehabilitation (FM&R) attend to patients who have lost their autonomy. A large number of hospitalized patients who had acquired a disability need to be attended by rehabilitation therapists. We have developed this descriptive study to analyze demand for rehabilitation in patients admitted to our hospital. Materials and methods. A prospective observational study was performed for all the patients admitted during the months of February, March and April 2008 who were evaluated by our department. Results. In our FM&R Department from February to April 2008 (60 days), there were 464 consultations made by 345 patients. Average daily consultations to our department was 7.73 and average number of consultations per patient was 1.36 (SD 0.70, range 1-7). Of the 354 patients evaluated during the study, 55 were not included in therapy as they did not meet the criteria. Thus 84 % of the hospitalized patients has required rehabilitation. Conclusion. This study has revealed that a considerable number of inpatients need assessment and treatment from FM&R Department. Traumatology and Internal Medicine Departments are those who demand our care the most. Only a minority of patients required outpatient physical therapy treatment (AU)

Spanish adaptation of the Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39).

AIM: The stroke and aphasia quality of life scale-39 is an interviewer administered questionnaire that has been developed and validated in the United Kingdom to be applied to patients with chronic aphasia as a consequence of a stroke. The objective of this article was to translate the Stroke and Aphasia Quality of Life-39 Scale (SAQOL-39) into Spanish language, and evaluate its acceptability and reliability. METHODS: The cross-cultural adaptation of the SAQOL-39 into Spanish was carried out by following the translation and back-translation method. Twenty three patients with long-term aphasia due to stroke were tested. The patients were interviewed twice in a period from 2 to 12 days. The acceptability of the Spanish SAQOL-39 was evaluated by examining the floor/ceiling effects and the missing data. The reliability was assessed by Cronbach's alpha (internal consistence) and intraclass correlation coefficients (test-retest reliability) for the overall scale and its subdomains. RESULTS: There were no difficulties to translate the original version into Spanish. There was good acceptability demonstrated by minimal missing data and floor/ceiling effects. Test-retest reliability for the overall score, and the subscales scores was 0.949 (0.854-0.944). Internal consistency analysis by Cronbach's a was 0.950 (0.851-0.900). CONCLUSIONS: This small scale study provided preliminary evidence for the acceptability and reliability of the Spanish version of the SAQOL-39. Further testing in larger samples is needed to evaluate the validity of the scale, its sensitivity to change and to confirm its reliability.

Estudio de los niños con deformidades vertebrales remitidos desde Primaria a una unidad especializada / No disponible

Las deformidades vertebrales son un motivo frecuente de consulta en la edad infantil. Suponen el 1% de las remisiones del pediatra al especialista y el 6,2% de las consultas a Cirugía Ortopédica Infantil. Su diagnóstico precoz es clave para un tratamiento eficaz. Existe controversia sobre el método que debe emplearse para la detección de las alteraciones raquídeas. El objetivo de este estudio es evaluar el funcionamiento de esta Unidad Específica de Deformidades Vertebrales, conocer las características de los pacientes que nos son remitidos, exponer nuestro método de trabajo y extraer las conclusiones oportunas. Resultados: se incluyen 174 pacientes, con edad media 12 ± 2,9 años (rango 1-18). Sexo: 61,5% niñas, 38,5% niños. El 71,8% fueron descubiertos por el pediatra y el 13,2% por los padres. Del total de escoliosis diagnosticadas, el 83,3% fueron niñas. El 32,7% de las niñas remitidas presentaron escoliosis frente al 10,4% de los niños (p = 0,002). El 61% de las curvas escolióticas eran menores de 20º al diagnóstico. El valor angular de las cifosis fue de 49,4º. El 30,5% referían dolor. Conclusiones: debe establecerse un sistema de detección precoz de las alteraciones del raquis en crecimiento. La exploración de la espalda en los chequeos de salud pediátricos es un sistema más eficaz que los cribados escolares. El pediatra es el profesional más capacitado para realizar esta labor. Es necesaria la existencia de unidades específicas donde puedan remitirse estos niños para su estudio y seguimiento

Vertebral deformities are a frequent reason of examination in children and adolescents. They count for 1% of the paediatrician referrals to the specialist, and 6.2% of the examinations in a Child Orthopaedic Surgery. An early diagnosis is the key for an effective treatment. There is controversy about the method which must be used in the detection of raquis deviations. The objective of this study is to evaluate the running of this specific unit of Vertebral Deformities, to know the features of the patients who are referred to it, to expose our working methods and to draw some appropriate conclusions. Results: 174 patients, who are 12 ± 2.9 years old (range 1-18), are included. Sex: 61.5% girls, 38.5% boys. The 71.8% were detected by the paediatrician, and the 13.2% by their parents. The 83.3% of the diagnosis of scoliosis were made in girls. The 32% of the referred girls showed scoliosis, opposite to the 10.4 of the boys (p = 0.002). The 61% of the scoliotic curves were less than 20º at the time of diagnosis. The angular value of the kyphosis was 49.4º. The 30.5% of all referred patients had backpain. Conclusions: there must be established an early detection system for the raquis deviations during the growth period. The exploration of the back in the paediatric health check-ups is a more efficacious system than the school screening. The paediatrician is the most qualified professional to carry out this job. It is necessary the existence of specific units where these children can be referred for study and monitoring

Artroplastia de rodilla / Knee arthroplasty

La artroplastia de rodilla es hoy en día una de las intervenciones más eficientes y consolidadas en el campo de la cirugía ortopédica. En la mayor parte de los pacientes que son sometidos a este tipo de cirugía se obtienen unos buenos resultados funcionales e importante mejoría del dolor. El avance tecnológico ha conseguido una cada vez mayor longevidad de la prótesis, lo que junto con el progresivo asentamiento de las prótesis unicompartimentales en artrosis no demasiado evolucionada han hecho de esta intervención una opción terapéutica cada vez menos limitada por razones de edad. En este trabajo realizamos una puesta al día de este tema comentando los aspectos de mayor interés para el médico rehabilitador, tanto en lo referente a la fase quirúrgica como a la de los cuidados posteriores

Knee arthroplasty is currently one of the most efficient and supported surgical intervention in orthopedic surgery. Most of the patients who undergo this kind of surgery obtain good functional outcomes and important pain relief. Technological advance has achieved longer longevity of the prosthesis, which, together with the progressive establishment of unicompartimental prosthesis in not too developed arthrosis, has changed this surgery into a therapeutic option less and less restricted according to people¿s age. An update to discuss the most interesting topics for the rehabilitation physician, referring either to the surgical phase and later care, is made in this article

Artropatía vertebral de Charcot en lesionados medulares: problema diagnóstico / Vertebral osteoarthropathy or Charcot’s disease of the spine in spinal cord lesions: a diagnostic challenge

La artropatía neuropática de Charcot fue descrita en 1868 en pacientes afectos de tabes dorsal, y unos años después se describió su localización en articulaciones intervertebrales. Actualmente es una entidad reconocida entre las secuelas de lesiones medulares crónicas. Sin embargo, su diagnóstico y tratamiento siguen sujetos a discusión, y diversas publicaciones hacen referencia al problema del diagnóstico diferencial con artropatías de origen infeccioso afectando a la columna. Se exponen dos casos de pacientes afectos de lesiones medulares de larga evolución y que presentaron hallazgos compatibles con articulaciones neuropáticas de columna, pero que dieron lugar a un problema de diagnóstico diferencial con artritis infecciosa. El diagnóstico es complejo en pacientes lesionados medulares que presentan clínica de infección, pudiendo incluso superponerse ambos procesos

Neuropathic osteoarthropathy, or Charcot joint disease, was first described in 1868 in patients affected by tabes dorsalis, and it is currently a recognized entity among the sequelae of chronic spinal cord lesions. However, its diagnosis and treatment are still under discussion, and various publications make reference to the difficulties of differential diagnosis in cases of osteoarthropathies of infectious origin affecting the spine. The diagnosis is complex in patients with spinal cord lesions that have symptoms and signs of infection, and the two processes can even overlap. We describe two cases of patients with long-standing spinal cord lesions that presented findings compatible with neuropathic spinal articulations but that gave rise to a problem in the differential diagnosis with infectious arthritis. A surgical approach enabled histological and microbiological studies, confirming Charcot's disease and ruling out infection of the intervertebral space in the second case. Conclusion. In patients presenting febrile syndromes of unknown origin and a generally declining state of health whose laboratory findings indicate infection, the differential diagnosis can be hindered when it is difficult to differentiate Charcot's disease from pyogenic discitis or Pott's disease on imaging studies. The possibility of superinfection of a Charcot joint must be taken into account, and the surgical approach is usually necessary

Artroplastia de rodilla / Knee arthroplasty

La artroplastia de rodilla es hoy en día una de las intervenciones más eficientes y consolidadas en el campo de la cirugía ortopédica. En la mayor parte de los pacientes que son sometidos a este tipo de cirugía se obtienen unos buenos resultados funcionales e importante mejoría del dolor. El avance tecnológico ha conseguido una cada vez mayor longevidad de la prótesis, lo que junto con el progresivo asentamiento de las prótesis unicompartimentales en artrosis no demasiado evolucionada han hecho de esta intervención una opción terapéutica cada vez menos limitada por razones de edad. En este trabajo realizamos una puesta al día de este tema comentando los aspectos de mayor interés para el médico rehabilitador, tanto en lo referente a la fase quirúrgica como a la de los cuidados posteriores (AU)

Knee arthroplasty is currently one of the most efficient and supported surgical intervention in orthopedic surgery. Most of the patients who undergo this kind of surgery obtain good functional outcomes and important pain relief. Technological advance has achieved longer longevity of the prosthesis, which, together with the progressive establishment of unicompartimental prosthesis in not too developed arthrosis, has changed this surgery into a therapeutic option less and less restricted according to people’s age. An update to discuss the most interesting topics for the rehabilitation physician, referring either to the surgical phase and later care, is made in this article (AU)