RCAAP Repository

Objectives: Assessment of self-perceived health status and quality of life in a sample of patients with failed back surgery syndrome (FBSS) and analysis of correlations between the bodily pain dimension of the SF-36, the remaining dimensions of the same instrument and patients clinical data. Methods: Cross-sectional study with convenience sampling that included 40 patients with FBSS observed in PMR consultation between January and October 2010. Clinical data were recorded and the Portuguese version of SF-36 was self-administered. SPSS 17.0 was used for statistical analysis. Results: The mean score in all subscales of the SF-36 was less than 50 points except in social function. There was a significant correlation coefficient between the bodily pain domain and physical functioning, mental health, social functioning and role emotional domains. There was a stronger statistical correlation in the last two cases. There was also a statistically significant correlation between bodily pain and number of surgeries that patients underwent. Conclusion: This sample of patients with FBSS presented SF-36 results that reflect a self-perception of decreased quality of life. Bodily pain, being related to other dimensions, has obvious implications in the quality of life of these patients, which suggests and reinforces the importance of describing the experience of pain as a multifactorial process. Keywords: Failed Back Surgery Syndrome; Pain; Quality of life.

Objectives: To evaluate clinical and functional responses to botulinum toxin type A (BoNT-A) administration in the treatment of upper limb (UL) focal spasticity.Methods: Descriptive, inferential, retrospective study of all patients followed in tonus disorders consultation due to spasticity sequelar to brain injury, treated with BoNT-A, in the last 3 years. Clinical data were collected prior to BoNT-A treatment and on the last observation (≥ 4 weeks after treatment). Goal Attainment Scaling (GAS) was used primarily on the results evaluation and were used secondarily: Visual Analog Scale for pain (VAS), Modified Ashworth Scale (MAS), Goniometry and Likert scale about subjective benefit impression (patient and doctor). Statistical data analysis was performed using Epi Info ™ and IBM SPSS Statistics for Wilcoxon and student’s t tests application.Results: A sample of 28 patients was studied (19 men, 9 women; mean age 55,5 years). We found higher frequencies of: in pathology, ischemic stroke (60,7%); in disability, left hemiplegia (67,9%); and on spasticity patterns, clenched fist and elbow flexion (57,1%). GAS mean was 37,7 (sd=1,1) pre-treatment and 48,5 (sd=3,8) after treatment, with mean increase of 10,8 points (p <0,001). In tonus assessment there was a 0,6 degrees reduction in MAS (0-4) in the elbow (p <0,001), 0,8 in the wrist (p <0,001) and 0,6 in the fingers (p = 0,001). In terms of joint range of motion a gain was found in active and passive movement: +26,4° (p=0,004) and +19,3° (p=0,005) in shoulder abduction, +10,0° and +2,0° in elbow flexion; +3,9º and +4,5º in elbow extension and +3,6° (p=0,006) and 22,5° (p=0,001) in wrist extension, respectively.Conclusions: Results suggest that BoNT-A treatment is effective in reducing upper limb spasticity and range of motion. GAS proved to be a useful and sensitive tool, with the majority of patients achieving the minimum goals initially outlined. Most of the patients had an impression of benefit from BoNT-A application.

Introduction: The pain associated with spasticity after stroke is common and interfere with the functionality and quality of life, and their treatment is not easy in some cases. Currently botulinum toxin type A (BoNTA) has an alternative to established treatments, so the authors aims to evaluate the success of their treatment in pain in patients with stroke sequelae, measured by goal attainment scaling.Material and Methods: Prospective, non-interventional study. Cohort of 82 cases treated between 01/03/09 and 31/10/12. Included patients aged 18 to 85 years with a diagnosis of stroke, in which pain was a target for treatment. The scales used were the numerical pain scale and Likert scale. The measuring success was made with goal attainment scaling. The treatment met the characteristics and expectations of each case. The results were analyzed with parametric tests and non-parametric tests.Results and Discussion: Sample of 37 men and 39 women with a mean age of 59 years. The pain affected more the upper limb (77.6%), and was most frequent in shoulder (49%). The numerical pain scale was used in 53 cases and the mean value before and after treatment was 7/10 and 3/10 respectively. In 49 (92%) patients, the decreased amount of one or more degrees in numerical pain scale. The difference was significant (p < 0.001). The Likert scale was used in 23 cases. After treatment 20 (87%) were “better” or “much better”. This result was significant (p < 0.001). The end goal attainment scaling score was 52 and its variation was 12 on average. In 61 (80%) cases this was clinically significant (≥ 10). The difference between initial and final scores was statistically significant (p < 0.001).Conclusion: The goal attainment scaling was a valid instrument, which resulted in the successful delivery of objectives centered on the patient and their quality of life, and had good correlation with the results of standardized scales, used to measure the clinical results in the treatment of pain.

Introduction: Chronic knee pain is multifactorial and its management is multimodal, with peripheral nerve blocks being a therapeutic alternative after failure of conservative first-line treatment. our objective was to evaluate the immediate and short-term symptomatic improvement of patients with gonarthrosis submitted to genicular nerve block.Material and Methods: Twenty blockades of the genicular nerves (ropivacaine and methylprednisolone) were performed, after which questionnaires were carried out to characterize the knee pain in several time frames. The data obtained were processed using IBM-SPSS Software version 24.0.Results: The 20 patients included in the study (3 men and 17 women) had a median age of 74.5 years, the median pain before the procedure was 9, after was 2 and a month later was 6 (according to numeric rating scale). A percentage of 30% of patients had side effects, particularly paresthesia. There was a positive correlation that tended to be significant (p <0.10) between pain before the procedure and pain 1 month after the procedure and a statistically significant positive correlation (p <0.05) between pain with the procedure and pain 1 month after. Conclusion: Genicular nerve block has contributed to the symptomatic relief of chronic knee pain in the short term and it seems that the intensity of pre-procedure pain and procedural pain are factors that influence the analgesic response to this intervention.

Botulinum toxin type A (BTA) has been used in our institution since 2001 in a growing number of patients, which lead to the creation of a specific spasticity treatment clinic. We have 370 patients up to October 2007, which account for a total of 731 treatment sessions. We aimed to evaluate the impact of this treatment on the perspective of the patients treated during 2006, and to make a comparative analysis of the results obtained with those of a previous study that we published in 2004. We selected the patients treated in 2006, who had started treatment with BTA for more than 1 year and had had since more than 1 treatment session (n=62). We made a telephone enquiry, consisting of 7 multiple choice questions, and we obtained 54 answers to the hole enquiry. The results were statistically analysed. We found that spasticity was of cerebral aetiology in 100% of cases , and hemiparesis was the most frequent clinical situation (81,5%). The patients’/carers’ aims were: to reduce spasticity (70,4%), to be able to walk better (50%), and to reduce pain (35,2%). The result was satisfying in 90,8% of cases, the local and regional effects predominated (87%) and side effects were very scarse (5,7%). This treatment was considered very relevant for the rehabilitation process (98,1%), which translated in clear motivation for continuing with the treatment in 96,3% of cases. In comparison with the previous study from 2003, there is a statistically significant difference concerning the aims for starting the treatment, which used to focus more on improving posture and facilitate activities of daily living, apart from controlling spasticity. BTA continues to be recognized by patients/carers as an effective, safe and very relevant treatment within the rehabilitation process.

Introduction: This study aims to determine the level of knowledge of autonomic dysreflexia, its causes and symptoms, treatment and complications, in health care professionals in the hospital setting, namely doctors and nurses of the Intensive Care Unit.Material and Methods: The study design involved the creation of a questionnaire, adapted from two other questionnaires previously published. It was distributed and available both in paper and digital formats and was applied to the doctors and nurses of the Intensive Care Unit.Results: A total of 52 health care professionals completed the questionnaire (7 doctors and 45 nurses). About 43% (n = 3) of doctors and 60% (n = 27) of nurses had never heard the term autonomic dysreflexia. Only 3 nurses and 1 doctor had pre-graduate education on autonomic dysreflexia. All nurses with Rehabilitation specialty (n = 4) have heard the term autonomic dysreflexia and had higher scores than the other nurses. All the inquired would like to have more information about autonomic dysreflexia.Conclusion: Autonomic dysreflexia is considered a medical emergency and should be immediately recognized and treated, in order to prevent serious complications. It is still under-recognized by health care professionals outside of the rehabilitation field and there is generally little, if any, undergraduate or postgraduate training on spinal cord injury. Even though autonomic dysreflexia usually occurs in the chronic phase of the lesion, it can be present in the first days or weeks, and it is believed that it is still under-recognized in this phase. All health care professionals who deal with spinal cord injury patients should be alert to this condition, since it is a potential medical emergency, beyond rehabilitation care.

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Introdução: Apesar de a sarcopenia ser considerada uma doença do idoso sabe-se que a perda muscular começa no adulto jovem. A sarcopenia, é responsável por uma menor qualidade de vida e perda de independência, pelo que o desenvolvimento e validação de biomarcadores de sarcopenia poderá ser uma estratégia custo efetiva no diagnóstico e monotorização deste problema nos cuidados de saúde primários. Pretende-se rever os principais biomarcadores estudados em indivíduos jovens que nos permitam implementar medidas preventivas em fases iniciais de doença.Métodos: Revisão sistemática da literatura com os termos MeSH “sarcopenia” e “biomarkers”, entre 2011 e 2021 em bases de dados científicas. Foram incluídos estudos em adultos com menos de 65 anos, nas línguas portuguesa, inglesa e espanhola. Toda a revisão seguiu a metodologia PRISMA. Foi utilizada a Strenght of Recommendation Taxonomy (SORT) da American Academy of Family Physicians para estratificar o nível de evidência e a ferramenta AMSTAR2 (A MeaSurement Tool to Assess systematic Reviews) para avaliação da qualidade da revisão sistemática.Resultados: Foram incluídos oito estudos (seis observacionais transversais e dois caso controlo). Os biomarcadores fator de diferenciação de crescimento 5, a isoleucina, a leucina, o triptofano, a insulina em jejum, o índice HOMA, os triglicerídeos e o C1q associaram-se a piores resultados de avaliação muscular enquanto que a irisina sérica, o rácio putrescina/ornitina, o rácio quinurenina/triptofano, a lipoprotéina de alta densidade, o fator de crescimento semelhante à insulina e a isoforma solúvel do recetor dos produtos finais de glicação avançada mostraram uma relação positiva com os parâmetros musculares avaliados.Conclusão: Não parece existir evidência robusta para definir um único biomarcador precoce isolado de sarcopenia, no entanto, alterações em biomarcadores serológicos juntamente com a avaliação física podem ser úteis na prática clínica. Com base na ferramenta SORT foi atribuída uma força de recomendação B e com base na ferramenta AMSTAR2 foi considerada uma revisão de moderada qualidade.

Objective: Characterize children with limb deficiency observed at Hospital Pediátrico de Coimbra betweenJanuary 2005 and July 2009.Compare prosthetic prescription and functioning in children with congenital and acquired limb deficiency.Methods: Retrospective study based on informatic reports of the 36 patients as well as complete clinical processesof the 12 children with upper limb deficiency.Results: Thirty six patients, 21 with congenital and 15 with acquired limb deficiency. Transtibial amputation wasthe most frequent acquired amputation and upper limb longitidinal deficiency was the congenital deficiencymost representative. Acquired amputations were most frequently caused by trauma. Twelve patients had upper limb deficiency. The most frequent was transverse below the elbow reductiondeficiency. The rejection to use a prosthetic device is higher on the congenital group. The children who still areprosthetic users, mainly use active devices. Children with upper limb reduction deficiency perform well on dailyactivities, even the prosthetic non-users.Conclusions: Congenital limb deficiencies outnumber acquired amputations, being unknown its precise cause.The cause and level of acquired amputations in our population are similar to those described in other studies.Nevertheless, upper limb congenital defect was not the most frequent.Even though the prescription of active devices in children with upper limb defect is related with the currentprosthetic use, the prostheses are useful for specific activities, rather than for daily activities in general.Keywords: Amputation; Congenital deficiency; Rehabilitation; Prostheses.

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The sacroiliac joints (SI) dysfunction is a condition when the normal joint biomechanics is affected, thereby leading to a restricted or excessive motion. Although it is a relatively common pathology, it is often underdiagnosed. This study aims to characterize this entity, particularly regarding the anatomy, biomechanics and physiopathology, as well as to describe the most relevant clinical features and treatment. For this purpose, we performed a narrative review of the literature published until May 2016 in medical databases. SI is the strongest and most stable diarthroses that support body weight. The torsional forces exerted on the SI are significant and are controlled by ligaments around them, particularly the sacrospinous and sacrotuberous ligaments. Both the ischiotibial and abdominal muscles appear to have a considerable lever effect, forcing the iliac to a posterior rotation. Clinical history and objective evaluation (eg, trunk flexion pattern and specific maneuvers) are fundamental for diagnosis and to exclude other potential differential diagnoses, such as discopathy and lumbar facet dysfunction. Treatment involves a multimodal approach that should include patient education, pharmacological treatment, physical agents, manual, muscle energy and stabilization techniques, and prolotherapy.

Introduction: Prolonged orotracheal intubation may induce dysphagia and lead to dehydration, malnutrition, aspiration pneumonia and death. A case study was developed to evaluate the presence of post-prolonged orotracheal intubation dysphagia and the  importance of early diagnosis to avoid complications.Material and Methods: For 12 months, between September 2016 and August 2017, patients submitted to prolonged orotracheal intubation were evaluated, with “STOP Dysphagia” protocol, between 24-72 hours and 6-8 weeks post-extubation,. The gender, age, comorbidities, admission diagnosis, severity indices at 24 hours APACHE II and SAPS II, time of prolonged orotracheal intubation, degree of dysphagia and complications were recorded. Patients with pathology involving swallowing physiology, unable to use the oral cavity for feeding or non-colaborative, were excludedResults: Fifty patients were evaluated, aged 20-83 years. The mean time of prolonged orotracheal intubation was 173 hours and 43 hours till evaluation. Twenty one (42%) patients had no dysphagia, 15 (30%) needed nectar, 5 (10%) honey, 7 (14%) pudding and 2 (4%) nasogastric intubation. A statistically significant difference was found between the presence of dysphagia and age (p=0.006) and severity indexes (APACHE II p=0.016, SAPS II p=0.014) and a moderate correlation between dysphagia severity and age (p=0.427 p=0.002)), APACHE-II (p=0.458 (p=0.001)) and SAPS II (p=0.428 (p=0.002)). No significant statistic correlation was found between prolonged orotracheal intubation and time of orotracheal intubation (p=0.385). Forty-one patients were reassessed 6-8 weeks after the first evaluation and only one still had dysphagia.Discussion: Post-prolonged orotracheal intubation dysphagia is a frequent complication and the early diagnosis allow to take adequate care and prevent complications. It has a good short-term prognosis with tendency to full resolution.Conclusion: Post-prolonged orotracheal intubation dysphagia must be excluded before oral feeding, to allow preventive measures and to avoid complications.

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Introduction: Our objective was the identification and characterization of the bacterial spectrum and of its susceptibility to antibiotics in patients treated in a Spinal Cord Injury Unit. The determination of the role played in the infections by the vesical emptying method and the medullar injury, as classified by the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI).Material and Methods: We retrospectively analyzed 79 patients who had been hospitalized in a Spinal Cord Injury Unit between 1/09/2014 and 1/09/2015. One hundred and fifty-eight urine samples were collected and sent for bacteriological examination. The urine samples were collected only in cases where there was clinical suspicion of a UTI. The variables taken into account were: gender, age, ISCNCSCI classification, antibiotic therapy applied, microorganisms isolated in the urine cultures, the method employed to bladder emptying at the time of the infection, and the profile of resistance to antibiotics.Results: We found that 75.9% of patients contracted at least one UTI in our Spinal Cord Injury Unit, with a higher frequency detected among those subjected to a urinary catheterization technique. Patients undergoing continuous catheterization presented a higher number of UTIs than those on intermittent catheterization. The most common bacteria isolated were Klebsiella pneumoniae (43%) and Escherichia coli (22.8%). We determined that 71.5% of the isolated bacteria were multidrug-resistant. The highest rates of resistance (82%) were found among patients undergoing continuous catheterization (p < 0.05).Conclusion: Klebsiella pneumoniae was the most frequent bacterial cause of UTIs in our unit. Our results are consistent with scientific reports describing increasingly higher levels of bacterial resistance to drugs, as well as a higher rate of multi-resistant infections within the population with SCI. Intermittent catheterization is preferable, since most UTIs were reported among patients undergoing continuous catheterization. AIS D patients, and those with spontaneous urination, exhibited a lower rate of infection. These results are food for thought on the antimicrobial resistance of bacteria and on the need for the development of alternative strategies to prevent UTIs.

Background: Surf has been growing exponentially in Portugal. However, in Portugal, there are no publishedstudies about this issue. The few published researches (international) show that the most common acute injuriesare lacerations and contusions to the head, neck and lower extremity. Most of them result from direct collisionwith their own board.Objectives: The purpose of the study was to know the Portuguese reality about Surfing-related Acute Injuries,understand their pattern and risk factors and define injury prevention strategies.Methods: Cross-sectional study that included 151 surfers (convenience sample) of both genders, aged 18 years ormore, and that have been active surfers at 2009. The questionnaire was developed by the author. It was used SPSSprogram.Results: 246 acute injuries were reported: lacerations (46.4%), contusions (10.1%), sprains/strains (8.2%) andfractures (8.2%). They were to the head (31.3%) and lower limb (31.3%). 53.3% resulted from the collision withtheir own board, 20.2% occurred during the entering/exiting water, 65.9% in sand bottom, with small waves(427%) and with shortboards (81%). Surfers that practice in large waves have a higher risk for significant injuries.The calculated risk injury was 2.4 per 1000 surfing episodes.Conclusions: It is quite possible that most of the injuries can be prevented using protective equipment, changesin the equipment and self-protection strategies. It is important that these data are published and known and topromote a culture (and even a “fashion “) of prevention. More studies are needed for a better evaluation of Surfing Injuries.Keywords: Sports; Athletic injuries.

A actividade física na população idosa é uma realidade crescente. A consolidação desta realidade torna imperativa a opção por tratamentos cirúrgicos da anca que permitam a manutenção da maior funcionalidade. Estes doentes devem efectuar um período de reabilitação gradual, após a cirurgia, que lhes permitam realizar as actividades que eram comuns antes desta, nomeadamente a condução automóvel, actividades desportivas e relações sexuais. O médico assistente deve aconselhar sobre as actividades permitidas na fase pós-operatória para prevenir uma possível luxação da prótese. O sucesso da reabilitação na artroplastia da anca depende principalmente do próprio doente, sendo o papel da equipa multidisciplinar fundamental para o orientar em todo este processo.

A dor lombar crónica determina um elevado nível de incapacidade sendo atualmente um problema de Saúde Pública que afeta uma grande percentagem da população ativa na Europa. A fadiga, embora subjetiva e complexa, parece ser um dos principais sintomas dos doentes com dor lombar crónica. A prevalência e a patogenia da fadiga não estão completamente esclarecidas, porém sabe-se que a fadiga interfere de forma decisiva na percepção de bem-estar e na qualidade de vida. Este estudo pretende avaliar a prevalência da fadiga em doentes com dor lombar crónica não específica e o seu impacto na funcionalidade.Estudo clínico, transversal não-randomizado, em 30 adultos portugueses com dor lombar crónica que incluiu a aplicação dos seguintes instrumentos: Questionário de Caracterização Individual, Escala Visual Analógica para Dor, Escala de Impacto da Fadiga e Questionário de Roland e Morris.Verificou-se uma duração longa da dor (média de 10.6 anos) e valor moderado a alto de incapacidade na população estudada. Constatou-se uma relação estatisticamente significativa entre intensidade da dor e fadiga (p≤0.05) e entre fadiga e incapacidade (p≤0.001).A fadiga é um sintoma prevalente nos doentes com dor lombar crónica e está associada à intensidade da dor e à incapacidade. Este facto realça a necessidade de uma abordagem clínica do elemento nociceptivo, entendido como gerador de limitação à atividade e à participação. Sublinha também a necessidade de um programa de reabilitação funcional que identifique e aborde de forma objectiva as variáveis dor, fadiga e função.

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Objectives: In patients with Traumatic Brain Injury (TBI), the increase of the pre-admission inpatient Length Of Stay (LOS) (hospital acute care inpatient LOS in other specialties, before the admission in Physiatry) and the Physiatry ward inpatient LOS can not justify its inclusion or maintenance in inpatient rehabilitation. Therefore, it may not be cost-effective comparatively to ambulatory models. The main objective of this study was to evaluate the impact of the pre-admission and the Physiatry ward inpatient LOS in functionality gains obtained by patients with TBI. Material and Methods: Population: Patients admitted for TBI in the Physical Medicine and Rehabilitation (PMR) ward between 1/1/1996 and 31/12/2010 (n = 79). Inclusion criteria: TBI; pre-admission inpatient LOS < 6 months; PMR ward inpatient LOS >7 days. Exclusion criteria: neurologic and musculoskeletal impairments before the TBI; complications that would affect the rehabilitation program. Study sample n=64. The variation of several functionality parameters (dependent variables) were analysed based on the PMR ward admission and discharge records. The analyses used generalized linear statistical models: logistic regression, multiple linear regression and logistic ordinal regression, in the variables with binary, interval or ordinal scales, respectively. The independent variables of the model were gender, age and the pre-admission and PMR ward inpatient LOS. To test if there was improvement after inpatient rehabilitation in the PMR ward, the t parametric test for paired samples was applied. Results: Gender (female: 32.81%, male: 67.19%); mean age (34.73±14.64 years); mean LOS (pre-admission: 68.03±36.71 days, PMR ward: 46.55±29.23 days). The PMR ward inpatient LOS led to statistically significant gains (p < 6.54x10-2) in all the dependent variables. The Pre-Admission Inpatient LOS (PAILOS) had a nonlinear statistically significant influence in the PMR ward inpatient LOS (estimate PAILOS: 1.18, estimate PAILOS2: -5.92x10-3, p PAILOS: 9.17x10-3, p PAILOS2: 1.52x10-2). The reduction of the pre-admission inpatient LOS was associated with a more favourable evolution in 20 functionality variables, 10 of which with statistically significant influence (p < 0.12). The increase of the PMR ward inpatient LOS was significantly associated with greater gains in the FIM and Barthel scales (p < 4.31x10-3). Conclusions: The pre-admission inpatient LOS has a nonlinear influence on the PMR ward LOS and constitutes a parameter of functional outcome in rehabilitation. Its reduction is cost-effective in the TBI rehabilitation. Therefore, it is recommend to be taken into consideration when selecting patients to inpatient rehabilitation. The inpatient rehabilitation program leads to significant functionality gains and a higher duration is associated with greater gains. Keywords: Traumatic Brain Injury; Length of Stay; Physiatry; Cost-Benefit Analysis Rehabilitation.