Desafío de la rehabilitación en Colombia en la pandemia de COVID-19

The COVID-19 pandemic has left nearly 70.000 deaths in Colombia and presents great challenges to the health care system. Rehabilitation professionals play a fundamental role in the recovery of many people who have suffered COVID-19 and have had to adapt to the consequences caused by the pandemic, reorganizing the care protocol to be able to meet the rehabilitation needs during the acute, subacute, and long-term phases. In this context, it seeks to identify and reflect on the challenges of rehabilitation implicit in the management of people with COVID-19.La pandemia por COVID-19 ha dejado cerca de 70 mil muertes en Colombia y presenta grandes desafíos al sistema de atención en salud. Los profesionales de la rehabilitación tienen un rol fundamental en la recuperación de muchas personas que han padecido COVID-19 y han debido adaptarse a las consecuencias provocadas por la pandemia, reorganizando el protocolo de atención para poder atender las necesidades de rehabilitación durante las fases aguda, subaguda, y a largo plazo. En este contexto, se busca identificar y reflexionar acerca de los desafíos de la rehabilitación implícitos en el manejo de personas con COVID-19

Fisioterapia en casa para paciente post COVID-19 con Síndrome Post Cuidado Intensivo: Reporte de caso

We describe a case of home-physiotherapy intervention supported by telemedicine for a post-COVID-19 patient with impairments associated with PICS. A 42-year-old male patient that was diagnosed with COVID-19 and stayed for 22 days in an Intensive Care Unit, developed impairments associated with PICS and was assigned home-physiotherapy sessions supported by telemedicine. A physiotherapist performed the intervention on the patient at home, following the instructions of another physiotherapist more experienced in post-COVID-19 patients and that was in another city. The physiotherapists were connected through a video call. The muscle strength in the four limbs increased from 3- to 4+, the dyspnea improved from 8 to 0, the functionality from 50 to 95/100, the anxiety from 9 to 6 and the depression from 9 to 1; SF36V2 domains improved 60%, except for limitations due to physical problems. Four weeks of home physiotherapy helped to reduce symptoms, and to improve exercise tolerance as well as daily living activities and quality of life. The home physiotherapy intervention used in this case, helped the post-COVID-19 patient to improve impairments associated with PICS, nevertheless, further studies with a longer follow-up period are needed to validate our results.Describimos un caso de intervención de fisioterapia domiciliaria apoyada por telemedicina para un paciente post-COVID-19 con deficiencias asociadas a Síndrome Post Cuidado Intensivo (SPCI). Paciente varón de 42 años, diagnosticado de COVID-19 e internado durante 22 días en una Unidad de Cuidados Intensivos, desarrolló alteraciones asociadas a PICS y se le asignaron sesiones de fisioterapia domiciliaria apoyadas por telemedicina. Un fisioterapeuta realizó la intervención al paciente en su domicilio, siguiendo las indicaciones de otro fisioterapeuta con más experiencia en pacientes post-COVID-19 y que se encontraba en otra ciudad. Los fisioterapeutas se conectaron a través de una videollamada. La fuerza muscular en las cuatro extremidades aumentó de 3- a 4+, la disnea mejoró de 8 a 0, la funcionalidad de 50 a 95/100, la ansiedad de 9 a 6 y la depresión de 9 a 1; Los dominios de SF36V2 mejoraron un 60%, salvo limitaciones por problemas físicos. Cuatro semanas de fisioterapia domiciliaria ayudaron a reducir los síntomas y a mejorar la tolerancia al ejercicio, así como las actividades de la vida diaria y la calidad de vida. La intervención de fisioterapia domiciliaria utilizada en este caso ayudó al paciente post-COVID-19 a mejorar las deficiencias asociadas con el SPCI, sin embargo, se necesitan más estudios con un período de seguimiento más prolongado para validar nuestros resultados

Perfiles de riesgo cardiovascular y condición física en docentes y empleados no docentes de una facultad de salud

Objetivo Establecer el perfil de riesgo cardiovascular y la condición física de docentes y empleados no docentes en una facultad de salud de una universidad pública.Materiales y Métodos Estudio observacional transversal con 40 docentes y 13 empleados, se realizó: test de caminata, Cuestionario Internacional de Actividad Física (IPAQ), Auto informe de Barreras para la Práctica de Ejercicio Físico, antropometría, perfil lipídico, hemoglobina glicosilada y se identificó el riesgo cardiovascular con la Escala Framingham Clásica.Resultados El 51,4 % de los docentes y 41,7 % de los no docentes presentaron bajo riesgo cardiovascular. Para ambos el valor promedio del IMC fue 25,56 Kg/cm2 ±3,9 Kg/cm2 y 23,18 Kg/cm2 ± 3,7 Kg/cm2 respectivamente. El promedio del peso graso de los docentes fue del 32 % y en no docentes 27 %. La distancia promedio recorrida por los docentes fue 553 ± 226 metros y para los no docentes de 590 ± 187 metros. Ambos grupos presentaron buena flexibilidad. El 49 % de docentes y el 77 % de los no docentes presentaron nivel de actividad física alto según el IPAQ. Las principales barreras para la práctica del ejercicio físico fueron la falta de tiempo y el exceso de obligaciones.Conclusiones Los empleados docentes y no docentes de la facultad de salud presentaron bajo riesgo cardiovascular con alto nivel de actividad física, esto debe ser considerado en la implementación de programas de promoción de estilos de vida saludable y prevención de enfermedad cardiovascular

Translation, reliability and validation of the Spanish version of the Perme Intensive Care Unit Mobility score (PERME SCORE) and ICU mobility scale (UTI mobility scale, IMS)

Introdução: Escalas para avaliação do estado funcional de pacientes críticos foram desenvolvidas e validadas na língua inglesa sendo necessária a tradução e validação em outros idiomas. Objetivo: realizar validação e estabelecer a confiabilidade interavaliador da versão em espanhol do Perme Intensive Care Unit Mobility Escore e ICU Mobility Scale e a sensibilidade à mudança e capacidade de reposta do Perme Escore. Materiais e métodos: Estudo longitudinal e prospectivo de tradução e validação, realizado entre novembro de 2016 e julho de 2017, seguindo as recomendações da lista de verifição COSMIN (Consensus-based Standards for the Selection of Health Measurement Instrument. Duas duplas de fisioterapeutas (observador/avaliador) aplicaram ambas as escalas em 150 pacientes na admissão e alta de uma UTI médico-cirúrgica de um hospital privado na Colômbia. Resultados: A tradução e adaptação cultural foram realizadas e a versão final de ambas as escalas em língua espanhola foi aprovada pelos autores. 52% eram homens, a média de idade foi de 58 ± 17 anos e a ventilação mecânica invasiva esteve presente em 42% dos casos. A confiabilidade interavaliadores da ICU Mobility Scale foi de 0,97 e 1, e para o Perme Escore de 0,99 e 1 nos dois momentos das medições. A diferença mínima detectável para o Perme Escore foi de 1,36, e 80% apresentaram valores maiores ou iguais, observando diferença significativa no tipo de desmame e no tempo de permanencia na Unidade de Intensiva (p <0,005). Conclusões: Ambas as escalas foram traduzidas e adaptadas culturalmente e apresentaram excelente confiabilidade inter avaliador e o Perme Escore mostrou-se sensível à mudança.Introduction: The scales to measure the functional mobility in the critical patient have been developed and validated in the English language, there is a need to have these scales in Spanish-speaking countries. Objective: To perform translation, cultural adaptation and to determine inter-evaluator reliability of the Spanish version of the Perme Intensive Care Unit Mobility Escore and the ICU Mobility Scale and the sensitivity to change and responsiveness of Perme Escore. Materials and methods: Longitudinal and prospective study of translation and validation, carried out between November 2016 and July 2017, following the recommendations of the COSMIN checklist Two pairs of physiotherapists (observer / evaluator) applied both scales to 150 patients on admission and discharge from a medical-surgical ICU of a private hospital in Colombia. Results: The translation and cultural adaptation were performed, the final version of both scales in the Spanish language was approved by the authors. The sample was 150 patients, 52% were men, the average age was 58 ± 17 years, invasive mechanical ventilation was present in 42.0% of the cases. Inter-evaluator reliability of the Mobility Scale ICU was found between 0.97 and 1.00, and for Perme Intensive Care Unit Mobility Escore it was between 0.99 and 1.00 at the two measurement moments. The minimum detectable change for Perme Escore was 1.36, and 80% had greater or equal values, observing a significant difference in the type of weaning and the length of stay in the ICU (p <0.005). Conclusions: Both scales were translated and culturally adapted and presented excellent inter-rater reliability and the Perme Escore showed evidence of being sensitive to change

Relação entre independência funcional e força de preensão manual em pacientes adultos atendidos em cuidados intermediários

Patients that leave intensive care for intermediate care present compromised muscle strength and functionality. In this context, our main objective was to describe the correlation between functional independence and handgrip strength in adult patients at intermediate care unit (IMCU). This was an analytical, correlational, and prospective study that compared patients admitted to IMCU after a stay of more than 24 hours in intensive care, with invasive or non-invasive ventilatory support. We used Barthel index (BI) and hand dynamometry at admission/discharge from IMCU. In total, 69 patients were included, 62.3% were men, with an average age of 63 years and a stay in intermediate care of five days. On admission to IMCU, 31.9% had complete dependence and 66.7% severe dependence. The most compromised categories were "bathroom use" and "stairs". On the other hand, "dressing" was the one with the greatest improvement (admission 24.6%, discharge 82.5%). A positive correlation [(r=0.4) and (p=0.000)] was identified between functionality and grip strength at admission and was maintained at discharge [(r=0.6) and (p=0.000)]. We identified a positive correlation between BI scores and handgrip strength, remaining stronger at IMCU discharge.Los pacientes dados de alta de la Unidad de Cuidados Intensivos (UCI) y trasladados a la Unidad de Cuidados Intermedios (UCIM) presentan deterioro de la funcionalidad y la fuerza muscular. En este contexto, el objetivo de este estudio fue describir la relación entre independencia funcional y fuerza de agarre en pacientes adultos en UCIM. Este es un estudio analítico, correlacional y prospectivo, que compara pacientes ingresados en cuidados intermedios tras más de 24 horas en cuidados intensivos, con soporte ventilatorio invasivo o no invasivo. El índice de Barthel y la dinamometría manual se utilizaron en el ingreso y en el dado de alta de cuidados intermedios de 69 pacientes, el 62,3% varones (con promedio de edad de 63 años y el tiempo de estancia en cuidados intermedios de 5 días). Al ingreso en cuidados intermedios, el 31,9% estaban completamente dependientes, y el 66,7% severamente dependientes. Las categorías más comprometidas fueron el uso del baño y las escaleras. La actividad que mostró una mayor mejora fue vestirse (un 24,6% al ingresar, y un 82,5% al dar de alta). Al ingreso, las mujeres tenían una fuerza de agarre de 6,7±1,8kg; y los varones, 10,2±2,5kg (p=0,000). Al darles de alta, las mujeres tenían un promedio de fuerza de 12,3±4,4kg; y los varones, 19,3±6,6kg (p=0,000). Se identificó una relación positiva entre funcionalidad y fuerza de agarre al ingreso (r=0,4) y (p=0,000), mantenida al alta (r=0,6) y (p=0,000). La relación positiva entre la funcionalidad y la fuerza de agarre señala la importancia de esas medidas para continuar la rehabilitación pos-UCI.Pacientes que recebem alta da Unidade de Terapia Intensiva (UTI) e passam para a Unidade de Cuidados Intermediários (UCI) mostram comprometimento de funcionalidade e de força muscular. Nesse contexto, o objetivo foi descrever a relação entre independência funcional e a força de preensão manual em pacientes adultos na UCI. Este é um estudo analítico, correlacional e prospectivo em que são comparados pacientes admitidos em cuidados intermediários após permanência de mais de 24 horas em terapia intensiva, com suporte ventilatório invasivo ou não invasivo. O Índice de Barthel e a dinamometria manual foram utilizados na admissão e na alta do cuidado intermediario de 69 pacientes, 62,3% homens (com idade média de 63 anos e permanência em cuidados intermediários por 5 dias). Na admissão ao cuidado intermediário, 31,9% tinham dependência completa e 66,7% dependência grave. As categorias mais comprometidas foram o uso do banheiro e das escadas. Vestir-se foi a atividade que apresentou maior melhora (admissão 24,6%, alta 82,5%). Na admissão, as mulheres apresentaram força de preensão manual de 6,7±1,8kg; os homens, de 10,2±2,5kg (p=0,000). Na alta, as mulheres apresentaram média de 12,3±4,4kg; os homens, 19,3±6,6kg (p=0,000). Foi identificada uma relação positiva entre a funcionalidade e a força de preensão na admissão - (r=0,4) e (p=0,000) -, mantida na alta - (r=0,6) e (p=0,000). A relação positiva entre funcionalidade e força de preensão destaca a importância dessas medidas para continuar a reabilitação pós-UTI

Descripción y análisis del estado actual de los programas asistenciales de rehabilitación pulmonar en cuatro ciudades de Colombia

Purpose: there are many studies reporting the benefits of pulmonary rehabilitation, but few of them exhibit the behavior and activitiesof these services. This article presents the characteristics of services, parts management and training level of team members, inaddition to the variables or instruments used to measure the effectiveness and impact in these programs. Methodology: it was madea cross sectional convenience sample which included seven pulmonaryrehabilitation services in four Colombian cities (Bogotá, Medellín, Manizales and Cali), selected by the coverage, for having at leastone year of experience and for being formally established and recognized nationwide. The interdisciplinary team of each serviceanswered a survey that was validated through a pilot test and expert consensus. Participation was voluntary.Results: labor onset pulmonary rehabilitation services correspond toan average of a decade, with COPD and asthma pathologies of attention. The programs are characterized by an outpatient treatmentwith an average duration of eight to twelve weeks, with a frequency of an hour three times a week. Also, the director of the service is regularly a pulmonologist and the coordinator a physiotherapist (57.14%). The posgradual training of these professionals is notable, and they report to have procedural, administrative and communicative skills, but qualify regular there research skills. The physical and technological resources are well tested. 71.42% have done impact studies, but only 28.57% have been published. All have in commontraining in upper limbs, lower limbs, respiratory muscles,counseling, functional assessment and quality of life. Conclusions:The effectiveness and impact of programs is measured by the walkingtest, quality of life questionnaires and activities of daily living

Análisis de las maniobras de reclutamiento alveolar aplicadas en siete Unidades de Cuidado Intensivo

Introduction: For the past years, alveolar recruitment maneuvers (RM) have originated a growing interest due to their beneficial potential in pulmonary protection, and have been introduced in clinical practice. Objective: Describe and analyze the knowledge of the MR andits application in seven intensive care units in the city of Cali,Colombia. Method and materials: Descriptive Cross-Sectional Studywith an intentional sample of 64 professionals working inseven intensive care units and apply MR. The self-completed survey was made up of thirteen questions, and the application period was two months. Results: To perform RM, of 64 professionals survey, 77.8% of the healthcare providers that were polled follow a protocol guide, inwhich 54.7% answered that during RM the ideal Positive end-expiratorypressure (PEEP) is the one which maintains a saturation > 90% and a PaO2 > 60 mmHg; 42.1% tolerates airway pressures between 35 and 50cmH2O; 48.4% perform RM with a progressive increase of the PEEPand a low tidal volume. Conclusions: Regarding the knowledge relatedto RM, heterogeneity was found in the answers. There is currently noconsensus about which is the most effective and secure way to implement an MR. This study can be the starting point to create awareness towards the revision of knowledge, capacities and abilitiesthat are required to perform RM

Análise das manobras de recrutamento alveolar aplicadas em sete unidades de cuidado intensivo

Introduction: During the past years, alveolar recruitment maneuvers (RM) have produced growing interest due to their beneficial potential in pulmonary protection, and have been introduced in clinical practice. Objective: To describe and analyze the knowledge of MR and its application at seven intensive care units in the city of Cali, Colombia. Methods and materials: Descriptive Cross-Sectional Study with an intentional sample of 64 professionals working in seven intensive care units and who apply MR. The self-completed survey was made up of thirteen questions, and the application period was two months. Results: Out of 64 professionals surveyed, 77.8% of them follow a protocol guide; 54.7% employes during RM the ideal Positive end-expiratory pressure (PEEP), which maintains a saturation > 90% and a PaO2 > 60 mmHg; 42.1% tolerates airway pressures between 35 and 50 cmH2O; 48.4% perform RM with a progressive increase of the PEEP and a low tidal volume. Conclusions: Regarding the knowledge related to RM, heterogeneity was found in the answers. There is currently no consensus about which is the most effective and secure way to implement an MR. This study can be the starting point to create awareness towards the revision of knowledge, capacities and abilities that are required to perform RM.Introducción: En los últimos años las maniobras de reclutamiento alveolar (MR) han despertado un interés creciente por su potencial beneficio en la protección pulmonar y se han ido introduciendo en la práctica clínica. Objetivo: Describir y analizar los conocimientos sobre las MR y su aplicación en siete Unidades de Cuidado Intensivo de la ciudad de Cali - Colombia. Materiales y métodos: Estudio descriptivo de corte transversal, con una muestra intencional de 64 profesionales que laboran en siete Unidades de Cuidado Intensivo de Cali y aplican las MR. La encuesta auto-administrada constaba de trece preguntas y el periodo de aplicación fue de dos meses. Resultados: De los 64 encuestados el 77,8% sigue una guía o protocolo para realizar las MR; el 54,7% utiliza durante la MR un nivel de Presión Positiva al Final de la Espiración (PEEP) ideal que asegure una saturación > de 90% y PaO2 > de 60 mmHg; el 42,1% acepta presiones en la vía aérea entre 35 y 50 cmH2O; el 48,4% realiza las MR con aumento progresivo de la PEEP y bajo volumen corriente. Conclusiones: Se encontró heterogeneidad en las respuestas relacionadas con el conocimiento de las MR. No existe en la actualidad un consenso acerca de cuál es la forma más eficaz y segura de aplicar una MR. Este estudio puede ser el punto de partida para un llamado de atención a la revisión de los conocimientos, competencias y habilidades que se requieren para realizar las MR.Introdução: Nos últimos anos as manobras de recrutamento alveolar (MR) têm despertado um interesse crescente por seu potencial benéfico na proteção pulmonar e têm-se ido introduzindo na prática clínica. Objetivo: Descrever e analisar os conhecimentos sobre as MR e sua aplicação em sete Unidades de Cuidado Intensivo da cidade de Cali - Colômbia. Materiais e métodos: Estudo descritivo de corte transversal, com uma amostra intencional de 64 profissionais que trabalham em sete Unidades de Cuidado Intensivo de Cali e aplicam as MR. A enquête auto-administrada constava de treze perguntas e o período de aplicação foi de sois meses. Resultados: Dos 64 pesquisados o 77,8% segue uma guia ou protocolo para realizar as MR; o 54,7% utiliza durante a MR um nível de Pressão Expiratória Positiva Final (PEEP) ideal que segure uma saturação > de 90% e PaO2 > de 60 mmHg; o 42,1% aceita pressões na via aérea entre 35 e 50 cmH2O; o 48,4% realiza as MR com aumento progressivo da PEEP e sob o volume corrente. Conclusões: Se encontrou heterogeneidade nas respostas relacionadas com o conhecimento das MR. Não existe na atualidade um consenso acerca de qual é a forma mais eficaz e segura de aplicar uma MR. Este estudo pode ser o ponto de partida para um chamado de atenção à revisão dos conhecimentos, competências e habilidades que se requerem para realizar as MR

Characterization and Perceived Impact on Graduates of a Specialization in Cardiopulmonary Physiotherapy at a Public University in the South West of Colombia. Period 2009 - 2013

Objectives: To characterize the graduates of a specialization in cardiopulmonary physiotherapy in a public university located in the south west of Colombia in the period 2009-2013 and iden­tify the impact perceived by graduates at work level. Materials and methods: Descriptive study based on the application of a survey sent via email. The survey consisted of 33 questions assessing sociodemographic characteristics, performance areas, frequent wage income, perceived impact at workplace, and the organizational structure of the specialization. Results: The rate of graduates with work-related activity training area was 98 %. The distribution of the employing institu­tions by level of complexity was level iii (25 %) and iv (75 %). The predominant work activity was patient care (59 %), and the greatest performance area was the adult intensive care service (65 %). The teaching resource was identified as the main strength of the specialization program (77 %). The greatest positive impact perceived by the graduates was the improvement in patient care (91 %) and the least impact on salary improvement. Conclusions: The specialization degree in cardiopulmonary physiotherapy is a program that improves graduates’ performance and con­tributes to apply newly learned competencies at workplace. The results will be used to develop an action plan based on the negative impacts perceived by the graduates