Comorbidity and physical activity in people with paraplegia: a descriptive cross-sectional study.

STUDY DESIGN: Descriptive cross-sectional study. SETTING: The study was conducted in the Spinal Cord Injury Unit of the University Vall d'Hebron Hospital and in the Physical Education and Sports Department of the University of Valencia. OBJECTIVES: The aim of this study was to quantify the presence of comorbidities in spinal cord injury (SCI) subjects who did or did not perform regular physical activity (PA) and to identify the relationship between PA and the level of comorbidity. METHODS: The sample consisted of patients with complete motor SCI (T2-T12), who were fitted with an accelerometer attached to the non-dominant wrist for a period of 1 week. The clinical and blood analytic variables were selected by an expert panel. RESULTS: In the exploratory analysis, we have found differences in the total number of pathologies between active and inactive patients, with fewer total pathologies in the active patient group. An association was found between the PA level and diabetes mellitus (; P=0.047; φ=0.25). We also observed an association between the cardioprotector level of high-density lipoprotein (HDL)-cholesterol and PA level (; P=0.057; Φ0.24). CONCLUSIONS: Our results suggest that patients considered active showed lower total comorbidity than inactive patients and higher protection levels against developing cardiovascular comorbidity.

The influence of regular physical activity on lung function in paraplegic people.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: The main goal of this study was to examine the influence of regular physical activity (PA) on lung volumes and flows. SETTING: The study was conducted in the Vall d'Hebrón Hospital, Barcelona (Spain), and La Fe Hospital, Valencia (Spain). METHODS: Spirometric tests were performed to 67 paraplegics, and differences were established between the active group (AG) (n=37) that performed >60 min per week of moderate-to-vigorous PA (MVPA) and 30 non-AG (NAG). Further, we established the relationship between the spirometric and PA variables and between being active and reaching the lower limit of normal (LLN) of the spirometric variables. RESULTS: AG had greater values than the NAG: FVC (P<0.01), FEV1 (P<0.01) and PEF (P<0.01). Moderate correlations between the MVPA and FVC (r=0.41, P<0.01) and the MVPA and FEV1 (r=0.39, P<0.01) were obtained. The relationship between being physically active and reaching the LLN was statistically significant for FEV1 (χ2=6.184, P<0.05) but not for FVC (P>0.05). CONCLUSIONS: The performance of MVPA for a minimum of 60 min per week can have a beneficial effect, both on lung volumes and on expiratory flow, and led to an achievement of the LLN in FEV1.

Descenso de la estancia media en la Unidad de Lesionados Medulares. Implicaciones éticas sobre la asistencia / Decrease in the mean stay in the spinal cord injury unit. Ethical implications on the care

La estancia media (EM) es un factor importante para determinar la actividad asistencial y un indicador para el pago en determinados sistemas de salud. Se ha demostrado que ha descendido drásticamente, durante los últimos años, en los pacientes ingresados en los Servicios de Rehabilitación. Hemos analizado la evolución de la EM y el grado de complejidad del proceso asistencial, en el período comprendido entre los años 1997 y 2009, determinando la tendencia que sigue y como se ha visto influida por los cambios en el modelo asistencial, para conocer las modificaciones que se han producido en la gestión del proceso lesión medular y las implicaciones éticas que puede tener sobre el modelo asistencial. El número de pacientes en el período 1997-2009, ha sido de 907 con una media anual de 69,7 pacientes/año. La edad media es de 44,8 años (DE: 18,2), con un rango que varía entre 15 y 84 años y una mediana de 41 años. La edad media se ha incrementado de forma significativa (p<0,001) cuando se comparan los períodos 1997-2002 y 2003-2009. La EM en la unidad de cuidados intensivos, en los pacientes que lo precisaron, antes del ingreso en la Unidad de Lesionados Medulares (ULM), ha sido de 12,3 días (DE: 18,2) para las tetraplejías y de 15 días (DE: 19,6) para los paraplejías. El promedio de EM en la ULM ha sido de 66,4 días, con un rango que varía de 85,2 en 1997 a 55,4 en 2003. Se observa una reducción significativa de la EM, ostensible a partir de 2001, con descensos progresivos hasta 2003, estabilizándose a partir de ese año, existiendo diferencias significativas (p<0,0001) entre el período 1997-2002 y el 2003-2009. El grado de complejidad del proceso leucemia mieloide agudase ha incrementado de forma notable a partir de 2004, teniendo una media los grupos relacionados por el diagnóstico (GRD)en el período estudiado, de 5,37, con un rango que varía entre 3,79 en 1997 y 9,4 en 2009. Más de un 40% de los pacientes tienen GRD elevados, superiores a 5 puntos y un 10% tienen valores excesivos, superiores a 20 puntos. Se ha objetivado correlación entre EM más altas y mayor número de lesiones asociadas y mayor gravedad de la lesión, con una correlación significativa (p<0,01; r=78) entre EM más alta y GRD más alto. En conclusión, los cambios detectados a través de este estudio en cuanto a la incidencia EM y morbilidad añadida a la lesión medular aguda, evaluada a través de los GRD, indica que es necesario trabajar con el gobierno y los compradores de la salud en las CC.AA., para demostrar que la reducción de la EM, tienen un límite situado en el equilibrio entre la atención eficiente y la tolerable éticamente y que no siempre representan una gestión más rentable, por lo que será preciso tener en cuenta el grado de discapacidad de los pacientes y el análisis continuo de los procesos (AU)

Mean stay (MS) is an important factor to determine the care activity and is an indicator for payment in some health care systems. It has been shown that it has dramatically decreased in patients admitted in rehabilitation services during the last years. We have analyzed the evolution of EM and the degree of complexity of the health care process from 1997 to 2009. We have determined the tendency it has been following and how it has been influenced by the changes in the care model in order to discover the modifications that have been made in the management of the spinal cord injury process and the ethical implications it may have on the care model. The number of patients in the period 1997-2009 was 907 with an annual average of 69.7 patients/year. Average age was 44.8 years (SD: 18.2), with a range that varied from 15 to 84 years and a median of 41 years. Mean age increased significantly (P<0.001) when the periods 1997-2002 and 2003-2009 are compared. Mean stay (MS) in the ICU was 12.3 days (SD: 18.2) for tetraplegia and 15 days (SD: 19.6) for paraplegia. Mean stay in the spinal cord injured unit (SCI) was 66.4 days, with a range varying from 85.2 in 1997 to 55.4 in 2003. We observed a significant reduction of MS, ostensibly from 2001, with a steady decline until 2003, it stabilizing after this year, and with significant differences (P<0.0001) between the period 1997-2002 and 2003-2009. The complexity degree of SCI has increased significantly since 2004, with an average 5.37 diagnostic related groups (DRG), during the period study, and a range that varied from 3.79 in 1997 to 9.4 in 2009. More than 40 percent of the patients have elevated GRDs, greater than 5 points, and 10 per cent of patients have excessive values, which are considered to be more than 20 points. Correlations have been observed between higher MS and increased number of associated lesions, and greater severity of the injury, with a significant correlation (P<0.01; r=78) between higher MS and higher DRG. In conclusion, the changes detected by this study in regards to incidence, MS and morbidity added to the acute spinal cord injury, evaluated through the GRD, indicate the need to work with the Government and health care purchasers in the Autonomous Communities to demonstrate that the reduction of MS has a limit. This limit is found within the balance between efficient and ethically tolerable care, which does not always mean a more profitable process. Thus, it will be necessary to take into account the degree of disability of patients and the continuous analysis of processes (AU)

Mapa de conflictos éticos intrahospitalarios en rehabilitación / Map of ethical conflicts at health care hospital in the medical rehabilitation

Objetivo: Analizar los principales problemas que la ciencia, la tecnología y los cambios organizativos han causado en la actividad profesional, social, asistencial, organizativa y legal de los profesionales de rehabilitación. Material y método: El estudio comprendió a 83 profesionales sanitarios que atienden a pacientes que precisan tratamiento de rehabilitación: 35 médicos de rehabilitación (24 médicos especialistas con régimen estatutario y 11 MIR [médicos internos residentes] de rehabilitación), 48 diplomadas en enfermería (DUE): 16 de la Unidad de Lesionados Medulares, 16 de la Unidad de Cuidados Intensivos y 16 de las plantas de hospitalización general, no de urgencias. Se diseñaron 2 cuestionarios de valoración, uno basado en los 10 dilemas o conflictos éticos acreditados como más habituales en el desarrollo de la actividad asistencial y otro segundo basado en los conflictos expresados en diferentes áreas: profesional, social, asistencial, organizativa y legal. Resultados: No existen diferencias significativas entre los 2 grupos (DUE versus médicos) en relación con las variables de las áreas profesional, social y legal, pero sí en la asistencial y organizativa donde se mostraron diferencias significativas entre los 2 grupos (p<0,05): los médicos presentaron más conflictos que las DUE. No existen diferencias significativas entre los 2 grupos estudiados, médicos y DUE, para la puntuación global de los 10 dilemas. Conclusiones: Antes, la solución de los problemas éticos era competencia sólo del médico, hoy lo es también del resto de los profesionales de la salud, porque todos interaccionan con el paciente, por eso la ética es una construcción social y cultural que debe revisarse constantemente en las organizaciones asistenciales, para que sus procesos conlleven a mejorar la calidad de vida de la persona con discapacidad y promover su independencia, que ha sido el objeto del presente estudio (AU)

Objective: To analyze the ethical problems in the health care of the medical and nursing rehabilitation. Materials and methods: The sample were 83 health workers, 35 doctors and 48 nurse specialists. Materials and methods: Using two assessment scales, one of the 10 ethical dilemmas and conflicts the most important during health care and a second questionnaire where was studied professionals problems, social, medical care, organizational and legal. Results: There are not significant differences between the two groups (Physician and nurse) in the variables of the areas professional, social and legal, but there were differences in the care and organizational (p<0.05), presenting doctors more conflicts than nurses. There are not significant differences between the two groups for the 10 ethical dilemmas. Conclusion: The resolution of ethical problems was only the responsibility of the physician before, but now it is also other health professional, because all of us interact with the patient. For this reason the ethics is social and cultural construction which has to constantly revise with organizations aid. For their processes improve the quality of life of people with disabilities and promote their independence, which has been the goal of this study (AU)