RCAAP Repository

Introduction: Chronic low back pain causes a high level of disability and is a public health problem that currently affects a large percentage of the working population in Europe. Fatigue, although subjective and complex, seems to be one of the main symptoms of patients with chronic low back pain. The prevalence and pathogenesis of fatigue are not completely understood, but it is well known that fatigue interferes decisively in the perception of wellness and quality of life. This study aims to assess the prevalence of fatigue in patients with nonspecific chronic low back pain and its impact on functionality.Material and Methods: This was a transversal, non-randomized clinical study, with 30 Portuguese adults suffering from chronic low back pain, and included the following instruments: an individual characterization questionnaire, visual analogue scale for pain, fatigue impact scale and Roland Morris questionnaire.Results: The study showed a long duration of pain (mean 10.6 years) and moderate to high value of disability in this population. We found a significant relationship between pain intensity and fatigue (p ≤ 0.05) and between fatigue and disability (p ≤ 0.001).Discussion: Fatigue is a prevalent symptom in patients with chronic low back pain and increases with the intensity of pain. In these patients more fatigue means greater functional disability. This underlines the need for comprehensive clinical management of the nociceptive environment, understood as a potential generator of limitation on activity and participation. It emphasizes also the need for a functional rehabilitation program to identify the variables of pain, fatigue and function objectively.

Objetivos: Avaliar o impacto da inclusão de um médico fisiatra na coordenação da Equipa de Gestão de Altas e da referenciação direta pela Medicina Física e de Reabilitação para a Rede Nacional de Cuidados Continuados.Materiais e métodos: Análise estatística de base de dados disponibilizados pela Equipa de Gestão de Altas de um hospital relativamente a 2017. Comparação dos resultados com 2016 e entre os processos referenciados pela Medicina Física e de Reabilitação e os por outras especialidades.Resultados: Em 2017 foram referenciados pela Equipa de Gestão de Altas 678 doentes, menos 103 doentes que em 2016, com menos 5,8% de processos cancelados e mais 4,4% de óbitos prévios à sua inclusão. Os tempos médios de espera para cada unidade foram sobreponíveis nos dois anos. A partir de abril de 2017, os fisiatras referenciaram 219 doentes, dos quais 50,2% foram para Unidade de Média Duração e Reabilitação, 41,6% para Unidade de Convalescença e 8,2% para Equipa de Cuidados Continuados Integrados. Os tempos médios de espera globais foram inferiores para os casos referenciados por fisiatra face aos das outras especialidades, no entanto analisando cada unidade em particular os mesmos foram sobreponíveis. Dos doentes referenciados pelo fisiatra apenas 14,2% foram cancelados, 7,3% faleceram e 75,8% dos doentes foram colocados, enquanto pelas outras especialidades: 29,3% foram cancelados, 27,1% faleceram e 39,3% foram colocados.Conclusões: O papel do fisiatra é essencial na avaliação clínica e determinação do potencial de reabilitação e terapêuticas de reabilitação, favorecendo a celeridade do processo e otimização dos recursos existentes.

Shoulder injury related to vaccine administration (SIRVA) are rare events that can lead to multiple diagnosis, such as bursitis, muscle rupture, adhesive capsulitis, chondral injury and infection.The authors describe the case of a 39-year-old nurse, who developed severe left omalgia shortly after receiving the second dose of COVID-19 vaccine. She attended an Occupation Health consultation, after four weeks of clinical worsening and was referred for a Physical Medicine and Rehabilitation consultation. On objective examination she presented pain during the mobilization of her left shoulder and loss of mobility, and it was made the diagnosis of adhesive capsulitis. Ultrasound guided suprascapular nerve block and hydrodistension of the joint capsule were performed with immediate symptomatic relief. She started later physiotherapy sessions that are still being performed.The correct anatomical positioning of the needle as well as the choice of its length are essential to prevent this type of injury, since deeper inoculations can contribute to the immune response to the injected material. It is also essential to alert and train health professionals responsible for administering vaccines, in order to carry out rapid diagnosis and appropriate treatment.

Background: Peripheral arterial disease (PAD) is strongly associated with increased cardiovascular risk and limitswalking ability, further contributing to physical inactivity, cardiopulmonary and peripheral muscledeconditioning, worsened cardiovascular risk factor profile further compromising prognosis of ischemiccardiomiopathy.Objective: Establish prevalence of vascular claudication in a hospital-based cardiac rehabilitation (CR) setting, andassess its influence on cardiac rehabilitation outcomes, including functional, psychosocial and quality of lifeaspects.Methods and Subjects: Longitudinal interventional study of patients who completed a two-month phase II CRprogram, recruited between October 2008 and March 2010. Data on sociodemographic, clinical, laboratorial,echocardiographic and functional capacity was collected from clinical files. Quality of life and walking limitationwere assessed by Short-Form 36 (SF-36) version 2 and the Walking Impairment Questionnaire (WIQ), respectively.The authors summarized walking ability using a mean value of the three components of the WIQ, and furthercategorized patients in two groups: claudicating (<80%) and non-claudicating (≥80%).Results: A total of 126 patients were analyzed, including 47 (40,8%) with clinical claudication. Except for gender,with higher proportion of claudication in males (p<0,05), there were no difference between groups in age, levelof education or professional status. Prevalence of hypertension, diabetes, tobacco consumption, overweight andabdominal obesity was higher in the claudicating group. Walking impairment was associated with higher levelsof anxiety, depressive symptoms, lower functional capacity and functional impairment in both physical andmental dimensions of health-related quality of life, both at program entry and completion. Both groups showedsimilar improvements in anthropometric, functional and quality of life measures.Conclusions: An individually tailored CRP allows for significant gains in functional capacity and health-relatedquality of life, even in those severely impaired by their peripheral arteriopathy. Adjustments in both intensity andvolume of exercise training sessions will allow for significant improvements and compliance withrecommendations for secondary prevention in coronary heart disease in this subset of the coronary heart diseasepatients.Keywords: Peripheral Arterial Disease; Cardiac Rehabilitation.

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Introduction: The goal of this study was to find the existing evidence about the suprascapular nerve block in chronic shoulder pain. Methods: The term “suprascapular nerve block” was searched at PubMed, in October 2015, with 156 analyzed articles. The inclusion criteria were experimental studies with non-continuous suprascapular nerve blocks in patients with chronic shoulder pain not surgery-related.Results: After the application of the inclusion/exclusion criteria, 8 studies were selected: 7 randomized controlled trials and 1 case series. Of these trials, only 2 were placebo controlled with saline injection. The most frequent pathologies were adhesive capsulitis, hemiplegic shoulder pain and glenohumeral osteoarthritis. The procedures were guided by ultrasound, electromyography or anatomy landmarks and the most frequent drugs used were a mixture of bupivacaine and metilprednisolone. All the studies reported significant improvements in pain and range of motion scores (p < 0.05), which are analyzed.Discussion: There are multiple variations among the studies, from the number of injections (1-3), the drugs used (with or without corticosteroid), the studied pathologies and the control groups. However, across all the studies there is a longitudinal improvement in patient’s pain and range of motion scores.Conclusion: Suprascapular nerve block may be an effective treatment in chronic shoulder pain. Additional quality studies are needed to find in which pathologies it may be useful and which are the most efficient injected drugs and treatment regime.

Introduction: Informal caregivers are the people who take care of other persons in a chronic, deficiency or dependent situation, partially or totally, temporarily or forever, besides their regular work. There are several functions related to informal caregivers and the act of caring is related to several positive and negative aspects that are important to identify in order to plan and discuss a correct health plan. It is essential that health care professionals know the impact of the act of caring in the caregivers.Methods: The used databases were “Medline”, “PEDro” and “Scielo and the keywords used were “Informal”, “Caregiver”, “Palliative” to conduct a narrative review that obtained 173 articles that were later reduced to 12 articles by analysis and filter utilization. The goal of this work was to make a literature review of consequences of the act of caring in the informal caregivers.Results: From the 12 articles there was not any positive aspect of the act of caring. On the contrary, there were innumerable negative aspects associated with caring. Female caregivers were more affected by the negative effects of caring.Discussion: The act of caring is associated with positives and negatives aspects that are diffused in the literature. However, only the negative aspects were focused on the analysed articles. The bigger impact of the negative aspects and the highest prevalence of female caregivers were also accord to the literature.Conclusion: The increased aging of population is related with a more dependent status and will demand an increase number of caregivers. The act of caring is associated with several positive and negative aspects that should be remembered in order to make the best decisions in health planning. Health professionals should be sensitized to these aspects so they can be able to decrease them and potentiate the support by the caregivers.

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Introduction: Patients discharged from the Intensive Care Units (ICU) with tracheostomy tubes in situ are increasing; optimal care of patients with tracheostomy is provided by inter/multidisciplinary care teams. This article makes a literature review and presents a study conducted at an Acute Patient Care Unit (APCU), cocoordinated by a Physiatrist.Material and Methods: Data were collected retrospectively, for the 40 patients with tracheostomy admitted to the APCU from May 2011 to 2013. Reference department, mean age, main diagnosis, medical/ surgical pathology, time to decannulation, hospital length of stay, percentage of decannulations and discharge destination were recorded. Statistical analysis was performed for functional improvement in all patients and by subgroups (decannulated versus non decannulated). For literature review we searched MEDLINE database. A comparative analysis was performed between APCU outcomes and literature data.Results: Forty patients with tracheostomy were admitted to the APCU. The average age was 59.6 years. 77.5% of patients were decannulated, 100% successfully. The mean time to decannulation was 35 days and the mean hospital length of stay was 60.9 days. Functional scores at admission date were statistically different from functional scores at discharge (p < 0.001), and decannulated patients have higher functional improvement than those who remained with a tracheostomy tube in situ (p = 0.023). Mean age, time to decannulation and hospital length of stay were at the upper limit of that described in the literature.Conclusion: Inter and multidisciplinary care model for patients with tracheostomy has a favourable impact. The APCU described represents a growing experience providing care for patients with tracheostomy. Decannulated APCU’s patients verified greater functional improvement than those who remained with a tracheostomy tube in situ. The mean age, time to decannulation and hospital length of stay were at the upper limit of that described in the literature, probably due to higher severity-of-disease scores, more comorbidities and provide rehabilitation regardless predetermined hospital length of stay. APCU may be demonstrative of an innovative healthcare Physical Medicine and Rehabilitation (PRM) clinical area.

Adolescent idiopathic scoliosis (AIS) is defined as three- dimensional deformation of the spine with a lateral curvature on the frontal plane greater than 10° and age of onset greater than 10 years, with no underlying etiology. The clinical assessment requires the exclusion of other etiologies. Management of AIS is determined according to the magnitude of the curve and remaining growth potential. The main goals of the conservative management are the control of curve progression, prevention of future complications, improve aesthetic appearance and quality of life. Orthotic management (bracing) of scoliosis, particularly rigid braces, has greater scientific evidence in AIS compared to other conservative strategies. There is a dose-response effect in bracing and non-adherence to the treatment is the main cause for loss of effectiveness which demands an appropriate monitoring. Electronic monitoring with compliance sensors applied on braces is an effective strategy for AIS monitoring. Scoliosis-specific exercises have some evidence in AIS, but in lesser degree compared to bracing, and can be used as an individual strategy or as a complement of bracing. The Schroth method and the Scientific Exercise Approach to Scoliosis accounts more evidence supporting better control of AIS. Management of AIS is complex and therefore it requires an individualized and integrative approach with multidisciplinary teams based on the current recommendations and scientific evidence which are highlighted throughout this work as well as some innovations in study.

Snapping Scapula Syndrome is a rare disorder that consists mainly in an audible and/or palpable crepitus of thescapula with movements on the scapulo-thoracic plane. This crepitus is often associated with shoulder or cervicodorsalpain. Patients generally seek medical help for pain relief.This syndrome can have many causes, originating from the various anatomical structures involved in the scapulothoracicmovement (bone, muscle, bursa…). The diagnosis is clinical, although imaging studies can be helpful inthe identification of the underlying cause.Most patients with Snapping Scapula Syndrome are treated conservatively, with a rehabilitation program andanalgesic medication. Surgical approach can be beneficial in patients that do not respond to the nonoperativetreatment, although its execution is still not consensual.The authors present the case of a patient with Snapping Scapula Syndrome, its diagnostic and therapeuticapproach and a revision of the literature on this pathological entity.Keywords: Scapula, Shoulder pain, Case Report.

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Objetivos Cada vez mais doentes com traqueostomia (DTQ) têm alta de Unidades de Cuidados Intensivos antes da descanulação; o melhor modelo de prestação destes cuidados são as equipas inter/multidisciplinares. O presente trabalho faz uma revisão da literatura acerca deste tema e apresenta um estudo numa Unidade de Doentes Agudos (UDA) hospitalar, co-coordenada por Fisiatra.Materiais e Métodos Estudo observacional retrospetivo da análise da atividade assistencial no internamento em UDA (maio/2011-2013). Recolhida informação dos processos clínicos de 40 DTQ, relativa às variáveis: proveniência, idade, diagnóstico de entrada, patologia médica/cirúrgica, duração de TQ e de internamento hospitalar, percentagem de descanulações, destino após alta. Análise da significância estatística da evolução funcional de toda a amostra e comparativa dos doentes descanulados vs não descanulados. Na revisão da literatura usou-se a base de dados eletrónica MEDLINE. Efetuou-se paralelismo entre os dados da UDA e os da literatura.Resultados 40 DTQ foram internados na UDA. A idade média dos doentes foi 59.6 anos. Descanularam-se 77.5% dos doentes, 100% com sucesso. O tempo médio de descanulação foi 35 dias e o total de internamento foi 60.9 dias. A diferença de medianas de evolução funcional à data de entrada e alta foi significativa (p<0.001), tendo os doentes descanulados tido uma evolução funcional superior à dos não descanulados (p=0.023). A idade média, os tempos de descanulação e de internamento dos doentes da UDA estão no limite superior do descrito nos artigos, o que se poderá dever a elevados índices de gravidade e mais comorbilidades dos doentes da UDA, assim como prestação de reabilitação intensiva enquanto necessária.Conclusões A criação de equipas inter/multidisciplinares que prestem cuidados a DTQ é o melhor modelo de prestação destes cuidados. A UDA apresentada representa uma experiência crescente na prestação deste tipo de cuidados. Os doentes descanulados na UDA registaram evolução funcional mais favorável do que os não descanulados. A idade média e tempos de descanulação e de internamento estão no limite superior do descrito nos artigos encontrados, provavelmente por mais comorbilidades, índices de gravidade superiores e prestação de reabilitação intensiva independentemente do tempo de internamento previsto. A UDA poderá ser inovadora evidenciando nova área de atuação da MFR. Palavras-chave:Traqueostomia, Traqueotomia, Equipa interdisciplinar / multidisciplinar.

Introduction: Stroke is one of the main causes of morbidity and mortality, representing the neurological pathology most frequently admitted to Internal Medicine (IM) departments. Rehabilitation is essential in optimizing the functionality of these patients.Material and Methods: Retrospective study of patients admitted to an IM department from January to December 2017 with a clinical diagnosis of stroke. The sample was characterized for sociodemographic and clinical variables. Functional variation during hospitalization was evaluated using the Barthel index. Statistical analysis was performed using the SPSS® software, version 23.0, considering a pvalue !0.05 as significant.Results: A total of 189 patients were included, which presented a median age of 78 years, a slightly female predominance (51.3%) and multiple comorbidities, such as hypertension (68.8%), dyslipidemia (47.6%) and diabetes mellitus (35.5%). The majority (77.8%) had imagiological translation, with 82.5% being of ischemic aetiology. The mortality rate was 10.1%. In 70.9% of cases, a Physical Medicine and Rehabilitation (PMR) assessment was requested. A statistically significant association was identified between the performance of rehabilitation and the in-hospital functionality variation (p=0.000).Conclusion: In this study, stroke occurred predominantly in a geriatric population, it was mostly due to ischemic aetiology and was associated with multiple comorbidities. The vast majority of patients were referred to PMR, with most of them presenting gain or maintenance of in-hospital functionality with rehabilitation performance. Thus, this study demonstrates the important role of PMR in minimizing functional deficits after stroke, allowing functionality improvement and facilitating socio-familiar integration.

Introduction: Chemical synoviorthesis (CS) is a procedure frequently utilized/used in the management of patients with active arthritis in a limited number of joints. This technique involves the intraarticular administration of a therapeutic agent, such as long-acting corticosteroid. Its use in children is described since 1979. Currently, it is recommended in the oligoarticular form of juvenile idiopathic arthritis (JIA) and also used in the other forms of JIA when refractory arthritis to conservative treatment is present.Purpose: To assess the efficacy and safety of chemical synoviorthesis in patients with JIA, which had not responded to systemic therapy. Material: Twenty-six patients (6 males, mean age 13.4 years) who met the ILAR criteria for JIA (2 systemic JIA, 20 oligoarthritis, 1 RF-positive polyarticular JIA, 2 RF-negative polyarticular JIA and 1 psoriatic arthritis) were included in the study. Thirty-seven synoviorthesis were performed from January 2006 to December 2009, using triamcinolone acetonide (35) or hexacetonide(2). Methods: A retrospective review of patient’s data was performed using a protocol which included demographic information, disease characteristics, evolution and follow-up after synoviorthesis. Microsoft Excel 2003 and SPSS Statistics 17.0 for Windows were used for data organization and analysis. Results: Mean disease evolution was 27.4 months and mean follow up time was 6.3 years. Relapse occurred in 6 cases. In the oligoarthritis subgroup, 92,9% of the treated joints showed no inflammatory activity in 24 months versus 62,5% in the other subgroups of JIA. Fifteen patients were considered to be in clinical remission, with a tendency for the oligoarthritis subgroup (X2(1) =5.38, p=0,020). Complications of the procedure occurred in 2 cases (subcutaneous atrophy). Conclusion: We found a positive association between the oligoarthritis subgroup of JIA and clinical remission, despite small sample size. Chemical synoviorthesis is a safe and effective procedure for treatment of arthritis in pediatric patients with JIA, especially in oligoarticular form, strongly suggesting its application as first line therapy in oligoarthritis JIA. Keywords: Arthritis, Juvenile Rheumatoid; Injections, Intra-Articular; Triamcinolone Acetonide.

Introdução: A paralisia cerebral é uma patologia que surge na idade pediátrica e implica necessidades de reabilitação ao longo da vida. O exercício físico, nomeadamente o aquático, ganhou importância no processo de reabilitação das crianças e adolescentes com paralisia cerebral. Contudo, os seus verdadeiros efeitos não foram ainda definidos. Métodos: Pesquisou-se a expressão (“cerebral palsy” AND “aquatic”) OR (“children” AND “aquatic exercise”) nas bases de dados PubMed, PEDro e Cochrane e analisaram-se os dados relativos à população, intervenção terapêutica, controlo e resultados em 13 artigos. Resultados: 102 crianças/adolescentes com paralisia cerebral foram submetidos a um programa de exercício aquático. As amostras variaram entre um e 46 elementos com 5 a 21 anos de idade; todos eles apresentavam um padrão espástico de paralisia cerebral, sendo a forma de apresentação variável. Todos os artigos incluíram no programa de exercício aquático atividades para desenvolver a resistência aeróbia; alguns deles incluíram ainda atividades de fortalecimento muscular e/ou de outras variantes da aptidão física. As intervenções duraram 30 a 60 minutos (1-3 vezes/semana) num período de 6 semanas a 8 meses. Nenhum dos artigos procedeu à randomização da amostra e apenas quatro compararam grupos com intervenções distintas. A metodologia de avaliação dos resultados foi diversa, abrangendo as repercussões do programa de exercício aquático na funcionalidade. Discussão: As particularidades do meio aquático conferem uma vantagem para a reabilitação de crianças e adolescentes com paralisia cerebral tendo em conta o espectro de apresentação da doença. Apesar das evidências de eficácia e segurança do exercício aquático na reabilitação de crianças e adolescentes com paralisia cerebral serem ainda limitadas, este tipo de exercício enquadra-se como uma boa alternativa para melhorar os níveis de aptidão física, parâmetro fundamental no processo de reabilitação desta população. A diversidade das arquiteturas dos estudos já realizados não permite aglutinar evidências quanto à eficácia do exercício aquático na reabilitação de crianças e adolescentes com paralisia cerebral mas permite avançar com sugestões para tentar ultrapassar esta limitação. Conclusões: O exercício aquático revela-se uma opção válida para as crianças e adolescentes com paralisia cerebral alcançarem alguns dos benefícios de uma vida ativa, otimizarem a sua funcionalidade e melhorarem a sua qualidade de vida. Os próximos estudos sobre programas de exercício aquático na reabilitação da paralisia cerebral deverão, entre outros aspetos, recrutar indivíduos pela classificação no Sistema de Classificação da Função Motora Global, utilizar escalas de avaliação consensuais e tecer considerações sobre barreiras à participação, adequação do programa de reabilitação e segurança do ambiente aquático. Palavras-chave: Exercício; Reabilitação; Criança; Adolescente; Paralisia Cerebral. 

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Introduction: Osteoarthritis is a common and debilitating disease, associated with loss of quality of life and important healthcare costs. It usually presents with pain, stiffness, diminished range of motion and loss of functional capacity. The treatment is multimodal, envolving oral/topic medication, patient education, physiotherapy; in refractory cases with moderate to severe pain the interventional procedures are a valid option. Intrarticular injection is a procedure for decades, and nowadays the componentes usually injected are: corticosteroids, hyaluronates and platelet rich plasma. The objective of this paper is to find the evidence available to date related to the interventional treatment of the osteoarthritis of the knee, comparing the three options available and mentioned previously.Methods: Narrative revision of the literature published on the following medical databases: Medscape, Cochrane Library and PubMed.Results: There is evidence of positive results with the three options in analysis; the safety profile is favorable. Corticosteroids are a safe and eficient option, mainly on inflamatory periods/flare, providing good short term pain relief. Hyaluronates also show efficacy, with possible benefit up to 24 weeks, with a potentially unfavorable profile of cost/effectiveness. Platelet rich plasma, more recent, presents a promising profile of efficacy on pain and quality of life, with potential benefit up to 12 months.Discussion: The interventional treatment of the osteoarthritis of the knee is widely used, in the meanwhile, there are no formal guidelines to date. Other issue is the fact that the concept of osteoarthritis deserves, probably, a revision, since it is an extremely heterogeneous and hard to define disease. In this sense, a detailed semiology and objective examination are of utmost importance, since the focus of the clinician should be the identification of the source of pain, leading to a correct line of thought that allows a selection of the best approach possible that guarantees a good symptomatic control The majority of the studies analysed present a suboptimal methodological quality, which compromises the result analysis and eventual conclusions.Conclusion: Osteoarthritis of the knee is a worldwide health issue, that tends to increase accordingly to the evolution of the demographic pyramid. Intrarticular injections are a safe and valid option, that must be considered following a detailed clinical examinations and, given the objective, staging and functional prognosis the most valid option should be selected. More investigation is necessary, studies with better methodological profiles and longer follow-up times, so that more robust conclusions can be achieved.

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