RCAAP Repository

Introduction: Fragility fractures of the proximal femur (FFPF) are associated with increased mortality and functional impairment. The main aim of this work was the determination of factors associated with walking ability impairment six months post-fracture and one-year mortality.Methods: Retrospective cohort study comprising all patients admitted to a hospital center. Data were collected from electronic medical records. A comparative analysis was performed for several factors regarding walking ability impairment by six month post-fracture and one-year mortality post-fracture.Results: Five hundred twenty two patients were admitted with FFPF. Around 49% had walking ability impairment by six month post-fracture compared to pre-fracture status. Analyzing the subgroup of patients that had been integrated in rehabilitation programs on National Network of Integrated Continued Care (RNCCI), only 11% of patients recover the pre-fracture level of walking capacity during Orthopedics inpatient stay with additional recover in 28% of patients through rehabilitation intervention in RNCCI. No significative associations were found between walking ability impairment by six month and the analyzed variables. Died within oneyear post-fracture, 18% of the patients. Previous inability to walk (p=0.094), inability to walk by six month postfracture (p=0.024), femoral neck fractures (p=0.006) and surgery with arthroplasty and hemiarthroplasty (p=0.047 and p=0.033 respectively) had significant inferior survival curves. The calculated logistic regression model showed that male gender (OR 2.95; p=0.033) and walking ability impairment by six month post-fracture (OR 7.43; p=0.024) were predictors of one-year mortality.Conclusion: One-year mortality and walking ability impairment are considerable in patients with FFPF. Early comprehensive rehabilitation should be prioritized on those patients as it can impact their vital and functional prognosis.

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Introdução: A incontinência urinária (IU) é um problema frequente, particularmente nas mulheres. A abordagem de primeira linha para a IU é conservadora e inclui alterações do estilo de vida, treino vesical e reeducação muscular do pavimento pélvico (RMPP). A RMPP pode ser realizada em diferentes formatos: sessões individuais supervisionadas, aulas de grupo ou exercícios no domicílio, de acordo com um plano individualizado.A pandemia SARS-CoV-2 levou ao atraso ou cancelamento de tratamentos de reabilitação em muitos doentes, tendo a telereabilitação ganho importância. O objetivo da presente revisão é a análise da evidência relativa a diferentes métodos de telereabilitação utilizado no tratamento da IU.Métodos: Foi realizada uma pesquisa na base de dados PubMed com os termos “telerehabilitation”, “telemedicine”, “app”, “smartphone”, “mobile health” ou “videoconfe- rence”, em combinação com “pelvic floor” ou “urinary incontinence”.Resultados: Nove artigos foram analisados. Os métodos utilizados foram aplicações móveis (6 estudos), com ou sem aparelho de biofeedback; aulas de grupo por videoconferência (1 estudo); programa de RMPP via website (1 estudo); sistema de lembrete via smartphone (1 estudo). Aulas de grupo por videoconferência mostraram resultados similares aos obtidos em sessões individuais supervisionadas de RMPP. Os programas baseados em aplicações móveis mostraram superioridade relativamente à ausência de tratamento (tratamento adiado). Os programas de RMPP via website ou aplicação móvel parecem obter resultados semelhantes a instruções por escrito para exercícios no domicílio. Não parece existir benefício adicional em associar aparelho de biofeedback a um programa por aplicação móvel. Em homens após prostatectomia, um programa de RMPP baseado em aplicação móvel acelerou a melhoria da IU. A utilização de tecnologias parece fomentar a adesão e satisfação com os programas.Conclusão: A telereabilitação na IU apresenta-se como uma alternativa útil na ausência de programas presenciais supervisionados, apresentando resultados comparáveis aos de exercícios realizados no domicílio e contribuindo para a adesão e satisfação com os tratamentos. Estudos adicionais são necessários relativamente à sua aplicabilidade em populações idosas e aos resultados a longo prazo.

Background: Cerebral palsy, an umbrella designation of a group of permanent and non progressive disorders ofmovement and posture, caused by a cerebral lesion occurred until 5 years-old, is the commonest cause of disabilityin pediatric age. Its repercussions are varied, potentially causing cognitive, motor, postural, sensorial andcommunication changes, and therefore compromise the complete development of the child.Objective: Characterize the children with cerebral palsy followed in the Pediatric Rehabilitation Consultationregarding epidemiologic, demographic, social and function aspects and describe the most frequent neuroorthopaedicalcomplications in that population.Methods and Subjects: Retrospective longitudinal study of the children with cerebral palsy followed in PediatricRehabilitation Consultation of the Centro de Medicina de Reabilitação de Alcoitão (CMRA), born between 2001-2005. Data on socio-demographic and clinical aspects were collected from clinical files, and also the scores of theclassification systems used.Results: Of the 75 children followed, 40% had severe motor and bimanual manipulative ability limitations. 21children (28%) had severe or very severe oromotor changes. One third had severe or very severe changes in thecommunication ability and the majority (67%) had some degree of cognitive affection. 41% of the children hada sensorial deficit (vision and/or hearing).Lower limbs deformities were the most common orthopedic alterations, followed by upper limb deformities andcifoscoliosis. Bilateral spastic patients had the greater number of complications and therefore had more benefitof botulinum toxin administration.40% of these children inward admissions in CMRA were for rehabilitation after orthopedic surgery such asAchilles lengthening (50 %), hip varus derotation (34 %) and adductors tenotomy (16%).Conclusions: Stablishing the functional profile of children and teenagers with cerebral palsy is determinant toidentify and characterize the population followed in a Consultation, in a easy and rapid way. In order to achieveit, there are several standardized classification systems. The acknowledgement of the most frequent clinical casesallows the definition of therapeutic strategies, resource necessities in short and long-term periods, social andschool supports, besides preventing/delaying the onset of possible complications.Keywords: Cerebral Palsy; Child; Motor Skills.

The purpose of this case report is to highlight the role of acetic acid iontophoresis in the treatment of calcifying tendinitis of the shoulder. Calcifying tendinitis is a common disorder and it is most common around the shoulder joint, despite most cases being asymptomatic.The clinical use of acetic acid iontophoresis in the treatment of patients with calcium deposits was first described in 1955. It is thought that the acetic ion replaces the carbonate ion in the insoluble calcium carbonate deposit, forming a more soluble compound. Therefore, it is reasonable to expect a regression of the calcification.The use of therapeutic acid acetic iontophoresis is predominantly empirical, probably because it is relatively inexpensive and safe. Despite all doubts regarding the effectiveness of acetic acid iontophoresis on the treatment of calcifying tendinitis of the shoulder, this case report appears to be another example of therapeutic success.

Introduction: Chronic pain is a very debilitating and underestimated condition, affecting patients’ quality of life. Its prevalence is around 20% in adult European population and about 36.7% in Portugal adult population. Neuropathic pain represents about 7% - 8% of all chronic pain conditions in Europe and accounts for more depression, anxiety and sleep disorders than any other type of pain. For this reason, chronic neuropathic pain is now considered as a common public health problem with a major impact on health related costs.Objectives: To understand patients’ satisfaction regarding topical treatment with lidocaine patches in some clinical conditions of neuropathic localized chronic pain.Methods: A telephone survey of 6 questions specifically designed for this study was applied to all the patients followed in consultation for chronic neuropathic pain to whom lidocaine patches were recommended. This retrospective study took place in Hospital de Braga, at the Physical and Rehabilitation Medicine Service, between December 2015 and December 2016.Results: Fifty two patients in such conditions were identified, but only 31 were included (27 women and 4 men). Four groups were then formed, according to diagnosis or consultation purpose: Pain after surgical intervention (n=21), peripheral canal syndromes (n=3), post-herpetic neuralgia (n=1) and Morton neuroma (n=6). Twenty four patients (77%) were satisfied with the recommended treatment with lidocaine patches, with post-herpetic neuralgia attending for the biggest score for pain relief (50%), followed by pain after surgical intervention group (47% in pain relief). Eighteen out of 31 patients also tried other therapeutic options, including pharmacological or physiotherapy.Conclusion: Despite some limitations of this study, such as small simple size and heterogeneity between the groups, most of the patients felt satisfied with lidocaine patches treatment. This study enhances the potential of using lidocaine patches in different contexts of localized neuropathic pain other than Post-herpetic Neuralgia. The authors suggest, however, the need for more clinical studies to sustainably propose treatment with lidocaine patches in localized neuropathic pain.

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Traumatic brain injury (TBI), traumatic injuries to the brain, also called intracranial injury, or simply head injury, occurs when a sudden trauma causes brain damage. TBI can result from a closed head injury or a penetrating head injury and is one of two subsets of acquired brain injury (ABI). TBI is a major public health problem, especially among males ages 15 to 24, and among elderly people of both sexes 75 years and older. Children aged 5 and younger are also at high risk for TBI.Males account for two thirds of childhood and adolescent head trauma patients. Half of all TBIs are due to transportation accidents involving automobiles, motorcycles, bicycles, and pedestrians. Approximately 20% of TBIs are due to violence, such as firearm assaults and child abuse, and about 3% are due to sports injuries. Material and methods: The authors describe a case of a young boy of 17 years old that by the age of 8 was hit by a football beacon that caused a severe brain injury. He is regularly followed in consultations in the Pediatric and Development Rehabilitation Service – Centro de Medicina de Reablitação Alcoitão. The authors will describe the effects of TBI in this particular case, either cognitive problems, sensory, emotional as physical problems. Conclusions: Rehabilitation is an important and critical part of the recovery process for a TBI patient. The overall goal of rehabilitation after a TBI is to improve the patient’s ability to function at home and in society in the face of the residual effects of the injury, which may be complex and multifaceted. Patients will often have problems in the areas of general cognition, social cognition/awareness, behavior and emotional regulation that present significant challenges, in terms of being able to resume expected social roles. This case is an example of how the neuro-phsychological sequelae were disabling in the child’s life, specially in cognition areas. Póster Científico apresentado no VII World Congress on Brain Injury – Lisboa, 9 a 12 de Maio 2008

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Introduction: Handshake is a form of interaction with those around us and it may be limited by palmar hyperhidrosis, a disease that has substantial impact upon affective, workplace and social relationships. This study aims to review the existing evidences about the effectiveness of botulinum toxin in the off-label treatment of palmar hyperhidrosis and consequent impact on quality of life, and also the role of iontophoresis as a drug delivery method.Material and Methods: The expression “”botulinum toxin” AND “palmar hyperhidrosis” AND (“quality of life” OR “iontophoresis”)” was searched on PubMed, Cochrane and PEDro databases.Results: Botulinum toxin type A, despite its cost and the transient therapeutic effect, is a valid treatment option in patients with severe sweating who have not responded to topical treatments. The benefits of using botulinum toxin type A to reduce palmar hyperhidrosis were documented in several studies and it was reported a significant improvement on quality of life after treatment. Palmar injection of botulinum toxin is however very painful. Previous studies demonstrated that botulinum toxin type A can be effectively delivered to the palms by iontophoresis with a favorable impact on quality of life.Conclusions: Palmar hyperhidrosis can lead to embarrassing social and occupational situations as well as have a psychological impact on the patients affected. Botulinum toxin type A injection grants the reduction of sweat production on hands, but this procedure has limitations. Botulinum toxin type A iontophoresis combines a noninvasive and inexpensive delivery method with a safe and effective treatment option for palmar hyperhidrosis.Botulinum toxin type A, even when delivered by iontophoresis, is an effective treatment option for palmar hyperhidrosis and that fact reflects positively on patients’ quality of life. Considering the established evidences, it is important to revise this unlabeled use.

Os autores apresentam um caso de síndrome do desfiladeiro torácico neurogénica associada a síndrome postural, numa jovem que apresentava queixas de dor no ombro direito e cãibras nos dedos da mão ipsilateral, associadas a limitação funcional progressiva de movimentos de abdução do ombro superior a 90º e pinças manuais. No exame objetivo eram evidentes alterações da estática do ráquis e atrofias tenar e hipotenar relevantes. Foi efetuado diagnóstico diferencial com radiculopatia cervical, plexite braquial, síndrome do túnel cárpico/ síndrome de Guyon, distonia do escrivão, doença de Hirayama. Apenas a eletromiografia e o estudo de condução nervosa foram sugestivos do diagnóstico, dado o radiograma simples de tórax/ cervical, ressonância magnética nuclear cervical e de plexo braquial não terem revelado alterações de relevo. Foi realizado tratamento conservador por Medicina Física e de Reabilitação, com melhoria da sintomatologia álgica e ganhos funcionais significativos. É feita uma breve e contextualizada revisão da literatura., enquadrando a síndrome no âmbito da Saúde Ocupacional.

A 21 years old female patient was referred due to pain and slight functional limitation of the left shoulder. There was fibrous band swelling of the left sternocleidomastoid muscle’s clavicular head. The imaging study revealed enlargement of the inner half of the left clavicle and diffuse thickening of the clavicular head of the left sternocleidomastoid muscle, suggesting fibrosis. After surgery, another rehabilitation program was initiated and the patient had a good recovery.

ISPRM and SPMFR - a commitment for a closer relation

Introduction: Functional capacity is a major determinant of morbidity, mortality and quality of life in most cardiovascular diseases. Understanding and identifying functional capacity predictors will allow fine-tuning of strategies and components of cardiac rehabilitation programs (CRP) in order to minimize disability and enhance patients social and vocational status. We aim to identify predictors of functional capacity at the end of phase II CRP in coronary heart disease patients, irrespective of initial functional status. The purpose of this study was to determine the functional capacity predictors in acute coronary syndrome (ACS) patients undergoing a phase II cardiac rehabilitation program (CRP). Methods: Prospective study enrolling consecutive patients admitted to an outpatient CRP after an acute coronary event between September 2008 and November 2011. Only patients who completed a formal phase II CRP were considered in this analysis. Sociodemographic, clinical, antropometric, laboratorial, echocardiographic and functional data were abstracted from medical records. Psychosocial profile and quality of life were assessed using Hospital Anxiety and Depression Scale (clinical depression/anxiety if subscores≥ 8) and short-form 36v2 (SF-36), respectively. A multivariable linear regression analyses was performed using end of PRC exercise testing duration in minutes as the dependent variable, adjusting for the duration of the baseline exercise stress test, and building a model by hierarchical inclusion of predictors identified in the univariate analysis. Results: From a total of 276 patients that completed CRP, 97(35,1%) were excluded due to incomplete data. Of the 179(54,2%) patients evaluated, 160(89,4%) were male, mean age of [mean(SD):53,5(9,8)] years and level of education of [P50(P25-75):6(4-12)] years. Among these, 30(16,8%) were diabetic; 32(17,9%) had previous history of coronary artery disease; 45(30%) were depressed, and the mean reported physical capacity perception, using the summary physical component of SF-36, was 46,6(7,7). Multivariate analysis identified male gender (p=0,008; β=0,12), level of education (p=0,007; β=0,144) and physical capacity perception (p=0,024; β=0,127) as positive predictor of functional capacity; whereas diabetes (p=0,005; β= -0,147), previous history of coronary artery disease (p= 0,019; β= -0,123) and depression (p=0,05; β= -0,102) had an inverse effect on functional status. Conclusion: Functional capacity in coronary heart disease patients is multifactorial and relies on a combination of clinical, psychosocial and socio-demographic characteristics. Specific strategies are needed to ensure adequate multidimensional/multiprofessional interventions in CRP instead of simple exercise based programs. Keywords: Coronary Disease/rehabilitation; Exercise Test; Exercise Tolerance. 

In clinical practice, it is usual for clinicians to recommend rest for several days up to weeks following a sports injury. The athlete is frequently advised to remain inactive beyond the acute inflammatory period, often starting rehabilitation several weeks after the injury. Prolonged inactivity is not usually the adequate treatment for muscle, tendon, ligament and cartilage injuries, whether chronic or acute. An extended period of total suspension of the normal mechanical load decreases the structural tissue resistance and may induce acute or chronic lesions when resuming normal sports activity.In musculoskeletal system pathological conditions, it is important to introduce at an early stage the exact benefic load since excessive or scarce loads may be injurious. In acute lesions, mechanical stress should take place soon after bleeding control and the initial inflammatory stage. The mechanical stimulus’ role on the regulation of cellular and matrix components proliferation and maintenance is important not solely in the bone (as described more than a century ago in Wolff’s law), but in all living tissue, including skin, neural tissue, hematopoietic and musculoskeletal systems. The anabolic and catabolic cellular activity is also regulated by mechanical stress on the cell surface. The conversion process of a mechanical signal in a chemical or biological response is called mechanotransduction.In this narrative review, the authors address several typical sports injuries affecting different tissues in the musculoskeletal system, for which prolonged rest, although often recommended, has been shown not to be the most appropriate treatment. Finally, they put forward treatment proposals in which the initial rest is replaced by the exact beneficial load, in light of mechanotransduction’s principles.

Introduction: Our objective was to characterize patients under 18 years old with cerebral palsy (CP), followed in our center, regarding their clinical and functional characterization and the presence of hip deformities, as well as surgical orientations.Material and Methods: Retrospective cross-sectional study based on the files of patients with CP, clinical registers, and serial radiological evaluation of hips according to the Australian Hip Surveillance Program (HSP). Analysis of the group with functional classifications IV and V and characterization of hip deformities: radiological evaluation of the femoral migration index (MI). Subanalysis of patients submitted to orthopedic surgery and patients not submitted to any surgery. The presentation of the results was divided into age groups (1-5 years; 6 – 11 years; 12-18years), according to the coverage of the HSP implemented, in 2012, at our center.Results: Of the total of 285 children with PC, the group with functional levels IV and V had 88 patients. From these group, more than half had subluxation of the hip. Were excluded 30 children. The total non-operated children was 35, the mean MI was 31.6%. The age group of 1-5 years had 3 patients, with a MI of 33.5% and the mean of the last hip radiograph was 7.1 months. The group of 6-11 years had 13 patients, with MI of 32.2%, and the mean of the last radiograph was 11.6 months. The 12-18 years group had 19 patients with a MI of 30.9% and the mean of the last radiograph was 24.5 months. The total operated patients was 23. From these group, 4 were operated before the implementation of the hip surveillance program. After 2012, 19 patients were operated. From these group, 6 were operated with preventive tenotomies and mean of 5 years.Conclusion: About half of the patients with IV and V functional levels had subluxation of the hip. About 38% of these patients have already submitted to surgery. From these group, 1/3 were tenotomies with early ages. Patients who are not surgically treated are under hip surveillance. In this population there is a high prevalence of this hip deformity. However, articulation with orthopedics has allowed early surgical interventions.