RCAAP Repository

Introduction: Dupuytren’s disease is a benign proliferative connective tissue disorder that involves the hand’s palmar fascia. The first clinical signs reported by the patients are thickening near the MCP. The small finger is the most affected. Dupuytren’s disease is more common in men over 40 years old. Diabetes mellitus, alcohol use, smoking and HIV have all been associated with a higher risk of Dupuytren’s disease. Surgical intervention is the gold standard on Dupuytren’s treatment and is indicated in cases of advanced disease. Postoperative rehabilitation should start between 3 and 5 days with early range of motion and palmar shift.Purpose: Characterize the post-operative population with Dupuytren’s disease and evaluate gains with the intervention of rehabilitation.Method: Retrospective and descriptive longitudinal study using the clinical data of surgically treated patients with Dupuytren’s disease evaluated and treated according with a protocol of occupational therapy at our department. Results: From a total of 50 surgically treated patients, between January 2014 and August 2015, 92% were men. The average age was 64.22 years. Risk factors association was predominantly diabetes mellitus (22%), smoking (8%) and moderate to severe alcoholic habits (6%). A percentage of 54% were intervened in the right hand, and the majority of the patients were intervened in the 5th finger (38%). Forty two patients (84%) attended the sessions twice a week. Thirteen patients abandoned the treatment before the end. The treatment had an average length of 70.14 days (SD 42.5). In comparison between the beginning and the end of the rehabilitation program there were a significantly difference in the range of motion of the extension and flexion of the MCP (p = 0.00, p = 0.03) and PIP (p = 0.00, p = 0.01). Other statistical significant relations were not foundDiscussion and Conclusion: Surgery followed by a structured rehabilitation program in Dupuytren’s disease allows an improvement in range of motion.

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Introduction: After an ischemic cardiac event patients often face the increased risk of developing ObstructivePeripheral Arterial Disease (OPAD) symptoms as a manifestation of vascular disease, with additional impact overfunctional capacity and quality of life. Frequently, intermittent claudication (IC) symptoms appear for the firsttime during supervised exercise sessions in the context of a cardiac rehabilitation program (CRP) addressed tocoronary disease (CD), influencing the rehabilitative process. It’s therefore important to implement specific strategies to diagnose and treat OPAD on Cardiovascular Prevention and Rehabilitation Units (CVPRU),incorporated on the established CRP.Methods: Prospective study aiming to determine the real prevalence of OPAD and its association with modifiable Cardiovascular Risk Factors in patients with CD referred to the Cardiovascular Prevention and Rehabilitation Unitin Centro Hospitalar do Porto/Hospital de Santo António during the year 2009.Results: Doppler ultrasound with Ankle-Brachial Index (ABI) was performed on 141 patients with CD admitted toa CRP in the CVPRU: 115(81,5%) male and 26 (18,5%) female. OPAD diagnosis (ABI <0,9) was confirmed in 21patients (17 male and 4 women), corresponding to a 14,8% prevalence. In 11 patients (7,8%; 52,3% of thepatients with OPAD) IC appeared for the first time during the CRP. There was a significant correlation between OPAD and smoking habits (p<0,002), present in 17 of the 21 patients); sedentary habits (p<0,002), also present in17 patients and Hypertension (p<0,01) diagnosed in 15 patients.Conclusion: OPAD elevated prevalence and its clinical variability indicates the need to include the ABI in theevaluation of patients with CD. It’s important to implement on CVPRU measures to prevent and treat the severalmanifestations of atherosclerotic disease.Keywords: Coronary Disease, Peripheral Vascular Disease, Ankle Brachial Index, Rehabilitation.

Introduction: This study aims to calculate the percentage of young adults among patients admitted with stroke diagnosis in one Rehabilitation Centre service and study the effect of some parameters on the efficiency of their rehabilitation program in the post-acute phase.Material and Methods: Retrospective, analytical study, drawn up from information contained in the patients admitted in one Rehabilitation Centre service database. Inclusion criteria: hospitalization by cerebrovascular disease diagnosis, namely ischemic or hemorrhagic stroke; first stroke episode and end of hospitalization between January 1, 2007 and December 31, 2012. Exclusion criteria: absence of the event date and readmission. Young adult category was defined for age between 18 and 45 years. It was analyzed the impact of time between event and admission to the rehabilitation centre, type of stroke and laterality on injury inpatient rehabilitation program efficiency in young adults. Z test and t test were used for comparison of proportions and means, respectively.Results: Among patients admitted to the rehabilitation centre because stroke, the annual percentage of young adults ranged from 5% (2010) and 23.3% (2011). The average efficiency of the inpatient rehabilitation program for young adults decreased with increasing number of days that mediated the event and the admission date to the Rehabilitation Centre. The effectiveness of rehabilitation programs in young adults who have suffered an ischemic stroke (versus hemorrhagic) was slightly better, but without statistical significance. Conclusions: The results, while not necessarily representative of the national reality, reveal the relevance of addressing the issue of stroke in young adults with the greatest attention. In young adults, the rehabilitation program efficiency in an inpatient rehabilitation centre decreases with the delay between the stroke event and the Rehabilitation Centre admission.

Introdução:O síndrome isquémico agudo da medula espinhal (SIAME), ou enfarte medular, é uma entidade rara, com uma prevalência de 1-2% de todas as patologias isquémicas agudas do sistema nervoso central. Existem vários fatores que podem condicionar a perfusão sanguínea medular e em alguns casos a etiologia permanece desconhecida.Apresentamos dois casos clínicos, admitidos num internamento de Reabilitação, e comparamos o seu padrão e evolução clínica com os estudos mais recentes da literatura.Caso clínico:Uma melhor, de 55 anos, admitida por uma tetraplegia incompleta nível neurológico C8, por enfarte medular de etiologia desconhecida. O segundo caso aborda um homem, de 58 anos, que desenvolveu subitamente um quadro de tetraplegia incompleta nível neurológico C6, após um enfarte cardíaco. Em ambos os casos, a ressonância magnética identificou lesões compatíveis com isquémia medular. Após reabilitação, ambos apresentaram uma boa evolução clínica e funcional. À alta encontravam-se independentes nas atividades de vida diária e faziam marcha de forma autónoma com auxiliares.Discussão:O SIAME apresenta-se com variados padrões clínicos, dependendo do nível de lesão e do território vascular afetado. Os dois casos apresentam clínica sugestiva de enfarte da artéria espinhal anterior, e encontram-se em concordância com os achados mais recentes da literatura. Estes demonstram que o melhor fator de prognóstico é o grau de incapacidade à admissão, determinado pela classificação da American Spinal Injury Association. Em termos de recuperação, as análises de casos confirmam que doentes submetidos a um programa de reabilitação holístico e individual apresentam uma boa evolução funcional.

Introduction: Peripheral mononeuropathies are one of the leading causes of access to health care.Case Report: A 70-year-old woman felt non-specific pain in the popliteal region. After the exams, it was thought to be a radiculopathy. Therefore, the patient was medicated with muscle relaxants and anti-inflammatories without improvement of complaints, though. On examination, she had apparent pain during palpation of the semitendinosus and semimembranosus tendons. This way, it was decided to make an ultrasound scan of the popliteal region, being verified that the tibial nerve had an increased dimension in comparison to the contralateral one. The patient reported that, for the past two months, she had been using elastic stockings up to the knee region. A nerve block was performed with lidocaine, which led to a successful regression of the symptomatology.Discussion: Tibial nerve lesions tend to be uncommon as opposed to peroneal nerve lesions, since it is found in a relatively deep region.Conclusion: This case report highlights the importance of having a good clinical history combined with a detailed physical examination and the valuable details given by the ultrasound analysis at the time of the evaluation, in order to complement the data collected. Keywords: Peripheral Nerve Injuries/diagnostic imaging; Peripheral Nerve Injuries/therapy; Stockings, Compression; Tibial Nerve/injuries.

In cyclists, overuse injuries are quite common; the knee is one of the most frequently affected anatomical sites. Knee overuse injuries can be caused by several factors and are sometimes associated with changes in mode, intensity or duration of training. Knee pain is the main clinical manifestation. In decreasing order of frequency and according to its location, knee pain can be classified as anterior, lateral, medial and posterior knee pain. An adequate approach to these injuries includes the establishment of a correct anatomical and pathological diagnosis as well as the identification and correction of intrinsic or extrinsic predisposing factors. As these injuries have a significant functional impact, their prevention seems more relevant than their treatment. Keywords: Bicycling, Cumulative trauma; Athletic Injuries; Knee injuries.

The patellofemoral instability is pathology of the adolescent and young adult. An important contributory factor is trochlear dysplasia, which may cause patellar recurrent dislocation. Trochleoplasty pretends to recreate the patellofemoral biomechanical stability. The authors present a case report of a young woman, combat sports practitioner, with trochlear dysplasia and patellar recurrent dislocation. The patient did a trochleoplasty and was submitted to a rehabilitation programme, with good outcome. In this case report diagnosis, treatment and follow-up results are discussed. Keywords: Patellar Instability; Patellar Dislocation; Rehabilitation. 

Introduction: Presentation of a prospective study of a 14 patients series with adhesive capsulitis of the shoulder, undergoing an ultrasound guided capsular hydrodistension, as part of a multimodal physiatric therapeutic approach.Material and Methods: This article presents a nine months prospective study. All patients were diagnosed with stage II adhesive capsulitis, and were submitted to an ultrasound guided capsular distension of the shoulder. Subsequently, they underwent a specific adhesive capsulitis conventional rehabilitation protocol. The outcome measures analyzed were pain through the visual numeric scale of pain (VNS), passive range of motion (ROM), and function using the UCLA (University of California and Los Angeles) Shoulder scale. These parameters were evaluated before capsular distension, immediately after the distension, at six months and at nine months of follow-up.Results: In all 14 patients there was demonstrated pain reduction, with a mean pre-distension VNS of 6.4/10, a six months post-distension VNS of 4.5/10 and a nine months post-distension VNS of 4.3/10. The mean pre-distension lateral elevation was 117.9º, immediately passing to 151.4º right after the intervention, maintaining the articular amplitude of 163.6º at the ninth month of evaluation. The mean pre-distension external rotation was 30.4º, immediately passing to 54.6º after distension, maintaining 54.3º at the end of the follow up period. The adduction/ internal rotation was evaluated in terms of vertebral level gain. Before the intervention, the articular amplitudes in adduction/internal rotation variated between the gluteal region and T12. We observed an immediate gain of 4.1 vertebral levels right after the distension, which increased to 5.6 levels at the end of the nine months follow-up. Concerning the functional scale, the mean score before the distension was 13.8/35 in the UCLA shoulder scale. At the sixth month of follow up it was 25.6/35 and at the ninth month of evaluation it was 25.5/35.Conclusion: In this study, ultrasound guided capsular hydrodistension associated to a specific rehabilitation program demonstrated clinical and statistical benefit in the treatment of adhesive capsulitis, regarding pain, ROM and function, at a short, medium and long term follow-up. More studies are necessary to evaluate the real valor of the ultrasound guided capsular distension in the therapeutic approach of this pathology.

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Background: Overweight and its consequences are associated with increased cardiovascular morbidity andmortality. Weight loss significantly contributes to improvement in overall cardiac risk factor profile both inprimary and secondary prevention of coronary heart disease.Objective: To identify predictors of weight change during a hospital-based phase II cardiac rehabilitation programin coronary patients.Methods: Prospective cohort study of 118 patients who completed a phase II cardiac rehabilitation program (CRP)within 3 months after acute coronary syndrome (ACS) recruited between September 2008 and December 2009.Data regarding anthropometric, clinical, laboratorial and functional response was collected at baseline andprogram completion. Psychosocial profile and quality of life were assessed using Patient Health Questionnaire(PHQ-9) and Short-Form 36 (SF-36), respectively. Univariate linear regression was used to identify predictors ofweight change during CRP.Results: We analyzed 118 patients who completed a mean of 14,92(4,32) exercise sessions. They were mostly men108(91,5%) and had low-levels of education. Mean weight loss and mean Body Mass Index (BMI) reduction was0,73(2,56)Kg and 0,27(0,93)Kg/m2 respectively. Body composition showed 1,13(2,91) percent reduction in fat massand 0,45(1,16) percent increase in lean body mass. Independent predictors of weight loss were level of education(b=0,25; p<0,001), smoking status at program entrance (quitters: b=-0,35; p<0,001; persistent smokers b=-0,27;p<0,05), depressive symptoms (b=-0,10; p=0,001; major depression: b=-1,55; p<0,001) and total energyexpenditure during training session (b=0,20; p<0,05).Conclusion: Weight reduction is a reflection of compliance to both dietary and physical activity recommendationsin secondary prevention programs, hence its dependency on level of education, smoking status and estimatedenergy expenditure during physical activity. Weight change is also negatively influenced by psychological factors,mainly depression. Identifying factors associated with poorer weight response might allow earlier, individuallytailored interventions such as more aggressive low-calorie high-expenditure combinations and psychobehaviouralinterventions. Further studies are needed to evaluate the impact of such interventions.Keywords: predictors, weight change, cardiac rehabilitation.

The goals of total knee arthroplasty are to minimize knee pain, promote articular stability during gait and maximize the range of motion. The prevalence of knee stiffness after arthroplasty can reach 25%. The scientific community points out, as main risk factors for its appearance, a smaller preoperative range of motion, the lack of collaboration of the patient in a rehabilitation program, patella ínfera and the use of coumarinic anticoagulation. The improvement of knee range of motion rarely occurs after six months of arthroplasty, even under an appropriate rehabilitation program. In case of postoperative stiffness, the most effective option for current gain of range includes joint manipulation under anesthesia. Arthroscopic or open arthrolysis has modest results in the gain of range of motion as well as revision arthroplasty. However, the latter proves to be effective in individual cases of stiffness with flexion contracture.

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Introduction: This article aims to expose the current scientific evidence concerning adjuvant therapeutic options of botulinum toxin in the control of spasticity.Methods: A narrative review of the literature published in the Medscape, Cochrane Library and PubMed databases until December 2020 was performed. The terms used in the research were: “botulinum toxin”, “spasticity” and “adjunct therapy”. A total of 137 articles emerged from the research. Case reports, articles of dubious methodological rigor and articles not specifically referring to the objective of the study were excluded. Meta-analysis studies, systematic and narrative reviews as well as controlled and randomized clinical trials were included. After applying the mentioned criteria, 23 articles were selected.Results: The scientific evidence of the different therapeutic options identified was divided into the following categories: physiotherapy/kinesitherapy (stretching, functional training and other interventions), orthoses, plastered immobilizations, functional bands, modified constraint-induced movement therapy and physical agents (electrostimulation, ultrasound, extracorporeal shock waves and vibration). Comparative studies between therapeutic modalities after the application of BoNT-A were also identified.In general, a shortage of evidence for the effectiveness of the various modalities mentioned and, in some cases, evidence of lack of benefit from certain associations was found. Even so, clinical trials with promising interventions were identified, namely the ones that targeted physiotherapy with an association of techniques, electrostimulation, and shock waves therapy. The authors also identified comparative studies that seem to indicate the superiority of electrostimulation and functional bands in relation to stretches, the superiority of shock waves therapy in relation to electrostimulation and the superiority of plastered immobilizations compared to stretches.Conclusion: Prescribing physical therapy with functional training, electrostimulation, shock waves therapy and occasionally using orthoses for intermittent use, may be the most advantageous strategies after the application of BoNT- A. Ultrasound, body vibration and stretching (mainly if applied alone) seem to be less useful. The choice of the specific adjuvant therapy is limited by the available scientific evidence, and the must meet the patient’s, caregivers’ and rehabilitation resources’ particularities.

Background: Borg’s Rating of Perceived Exertion (RPE) is a simple and convenient method for monitoring exercise intensity. However, it’s based on subjective feeling of exertion and fatigue during exercise, and possible factors that influence perception are highly variable inter and intra-individually. Objective: To evaluate the predictors of a higher RPE at the beginning of a cardiac rehabilitation program (CRP). Methods: Patients enrolled in a cardiac rehabilitation program after an acute coronary event between September 2008 and October 2010. Psychosocial profile at admission was characterized using Hospital Anxiety and Depression Scale (HADS) and the Medical Outcomes Study Short Form – 36 (SF-36). Functional status was estimated using both physical components of the SF-36 and exercise intensity in metabolic equivalents (MET) achieved at baseline exercise stress testing (EST). We used peak exercise perception score (PEPS=RPE/MET) to determine level of fatigue indexed to exercise intensity level during the first exercise training session. Results: One-hundred seventy five patients were analysed, 160(91,4%) were male, mean age [mean(SD): 53(9)] years and had low level of education [P50(P25-P75):6(4.-11)]. Treatment after the acute coronary event consisted of percutaneous coronary revascularization in 144 (82,3%), coronary artery bypass graft surgery in 19 (10,9%) and 12 (6,9%) patients received only medical treatment. Mean exercise capacity was 10 (2,0) MET at baseline EST and the perception of overall physical ability in daily activities scored 46,2 (8,1) in summary physical component of SF36. During initial exercise training sessions, we found a 2,27(0,6) increase in RPE per 1 MET increase in exercise intensity. Univariate determinants of exercise perception were gender (b=-0.23; p=0.003), years of education (b=- 0.32; p<0.001), maximum volume ventilation (MVV) (b=-0.29 per 10% of MVV increase; p<0.001), functional status at admission [SF-36v2 physical domains (b=-0.34; p<0.001); peak MET level at EST (b=-0.32; p<0.001)] and psychosocial profile at admission [HADS≥8 (b=0.18; p=0.02); SF-36 summary mental component (b=- 0.20;p=0.009)]. Age and sex-adjusted multivariate analysis identified level of education (b=-0.24; p=0.001), MVV (b=-0.19 per 10% of MVV increase; p=0.008), SF-36v2 physical domains (b=-0.19; p=0.011), MET level at EST (b=- 0.20; p=0.009), as predictor variables. Conclusions: Effort perception is multifactorial depending upon a complex interplay between psychosocial and physical capacities. Indentifying their main determinants may allow for more individualized interventions in CRP resulting in a better functional recovery, social participation and quality of life. Keywords: Coronary Heart Disease; Cardiac Rehabilitation; Physical Exertion.

In literature it is largely established the role of physical inactivity as a major risk factor to coronary heart disease. A Cardiac Rehabilitation Program improves functional capacity of the patient with cardiac disease as well as educates for the control of their cardiovascular risk factors. Aim: To evaluate the functional capacity of patients with coronary heart disease who underwent a Cardiac Rehabilitation Program over a 12-month follow-up and its relationship with changes in physical activity habits. Methods: We conducted a prospective cohort study that included patients with coronary heart disease consecutively referred for Cardiac Rehabilitation Program exercise based between January 2008 and December 2009. We evaluated the patients at three moments: baseline (first visit of Phase II), 3 and 12 months. We analyzed physical activity performed at home through the International Physical Activity Questionnaire and assessed time and Metabolic Equivalents (MET) achieved during exercise tests performed. Results: From a total of 329 patients 73 were excluded for not completing the phase II of the PRC due to loss of data during follow-up period. We studied 256 patients (76.2% male, mean age: 61,1 (10,6) years). At the end of phase II, there was a statistically significant improvement in the studied parameters, namely the average amount of physical activity performed in IPAQ scores (70.5%; p <0.0001), time (18,9%; p <0,0001 / 23,7; p =0,002) and MET (20,4%; p <0,0001) on exercise testing. This difference remained statistically significant after 12 months of follow- up. Conclusion: This study emphasizes the importance of Cardiac Rehabilitation programs in secondary prevention of cardiovascular disease and the need to implement strategies in order to maximize the long term effects. Keywords: Heart Diseases/rehabilitation; Recovery of Function. 

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Purpose: Given the global scope of disability, it is important that tools used to measure disability are not biasedby the language or literacy of the respondents. Yet it is impossible to accurately translate tools into the world’s7000 languages. The Language Independent Functional Evaluation (L.I.F.E.) is a video animated functionalassessment that bypasses language and literacy. This study assesses the face validity and content validity of theL.I.F.E.Methods: Rehabilitation professionals and non-rehabilitation students wrote descriptions of the 30 graphicanimations representing functional stages for 11 activities portrayed in the L.I.F.E. The relationship betweendescriptions and the principle L.I.F.E. designer’s description was rated by consensus of three reviewers on a 4-pointagreement scale.Results: Exact agreement was obtained for 82% of 600 responses provided by 12 rehabilitation professionals and8 students. Complete misunderstanding of the concept occurred in only 6% of cases. Most of these were in therealms of bowel, bladder, and mobility. There was no difference in understanding between the professionals(content validity) and students (face validity).Conclusions: The face and content validity of the L.I.F.E. are good enough for users to trust that the test portraysintended functions. This paves the way for easier measurement of functional ability regardless of language orliteracy.Keywords: Disability Evaluation, Language Tests, Physical Therapy Modalities.

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