HB - Medicina Física e Reabilitação
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- Benchmarking na gestão de unidades de saúde: Relevância, aplicabilidade e construção de um modelo de Benchmarking para o serviço de Fisioterapia de Medicina Física e Reabilitação do Hospital de BragaPublication . Silva e Couto, HMO trabalho realizado aborda a temática do Benchmarking em Gestão de Unidades de Saúde, a criação de um modelo de Benchmarking e indicadores não clínicos para a Fisioterapia do serviço de Medicina Física e Reabilitação do Hospital de Braga. Um modelo de Benchmarking adota várias fases que integram passos específicos que estruturam o processo, tornando-o uma ferramenta poderosa na análise comparativa e de melhoria continua. De acordo com a proposta apresentada, foi construído um modelo de Benchmarking específico para o serviço, focando os esforços na análise de indicadores e medidas para possibilitar a medição do sucesso dos processos determinados pela gestão inerentes ao funcionamento do serviço. Esta abordagem premiou a análise do impacto dos processos determinados pela gestão do serviço no Acesso e Equidade do utente do SNS no serviço de Fisioterapia de Medicina Física e Reabilitação do Hospital de Braga. Os indicadores foram submetidos a aprovação por parte dos Fisiatras e Fisioterapeutas do serviço de Medicina Física e Reabilitação, sendo validados e apresentados para futuras considerações Realizou-se uma análise do investimento na implementação do modelo construído. Como conclusão a ferramenta do Benchmarking na saúde poderá abordar indicadores de processo não clínicos. Existe potencial para a recolha de dados e utilidade dos indicadores, como a criação de outros adaptados à realidade dos parceiros no Benchmarking. A ferramenta do Benchmarking nos moldes em que foi proposta é útil e poderá ser potenciadora de melhoria de performance, criação e reforço de laços.
- Development, Test and Validation of a Mechatronic Device for Spasticity QuantificationPublication . Ferreira, JF; Moreira, V; Lima, CS; Soares, F; Machado, J; Leão, CP
- Dor após AVCPublication . Antunes, F
- Dor após cirurgia lombar: imagens e reflexosPublication . Gaspar, AT; Morgado, S; Antunes, FAim: To characterize one population with persistent or recurrent pain after lumbar spinal surgery and evaluate the functional impact of this pathological condition. Methods: The sample consisted of patients with a history of back surgery that kept the pain level and whom had performed imaging examination of the lumbar spine after surgery. The authors made the demographic characterization of the population and the characterization of pain using the DN-4 survey. It was considered the findings in neurological examination and the results of imaging studies. The assessment of quality of life was objectified using the SF-36 survey. Results: The study included 28 patients, mostly female and working age. Most patients had neuropathic pain, changes in neurological examination and for 27 of the 28 patients were found in imaging compression of neurvous structures, mainly by recurrence of initial pathology and scarring. The results obtained in the survey SF- 36 clearly showed the negative impact on patients quality of life. Conclusion: In this sample, most patients presents with documented anatomical lesion that may justify pain complaints. The negative impact on quality of life makes this clinical picture a true challenge for Physical Medicine and Rehabilitation.
- Entorses do tornozelo: do diagnóstico ao tratamento perspectiva fisiátricaPublication . Moreira, V; Antunes, FAnkle injuries are the most frequently encountered injuries in clinical practice. They are often managed by general practicians, and not only by orthopaedic or physiatric physicians. This injury is usually non-complicated, but some care should be taken to assure an adequate management and to exclude severe lesions. The stability of the ankle is necessary for functional activity of lower extremity, allowing walking and participation in other high demanding activities like running or jumping. There is a constant concern in adopting the best diagnostic and treatment procedures to enhance the recovery and to prevent the chronic joint instability. According to this, there should be proposed comprehensive strategies focusing the rehabilitation view. The ankle is a complex articular structure with contributions from the talocrural, subtalar, and inferior tibiofibular joints. The full understanding of the functional anatomy and biomechanics is the first step for the evaluation of the etiologic factors. The recognition of the mechanism of injury, and the risk factors, should be carefully addressed to make an accurate diagnosis, proper management and to implement prophylactic measures, knowing that the lateral ligamentous complex is the most commonly injured. As always, diagnosis can be made taking an adequate history, performing a thorough physical examination, and when necessary, requesting complementary studies. The priority in initial assessment it's to clear out some severe complications, like fractures, that can mimic or that can be associated with ankle sprains. Although the conventional radiology is suitable for most cases, that has been greatly improved through the institution of the Ottawa Rules, in selected patients the severity of the damage is best evaluated with other imaging resources. Treatment of acute ankle sprains depends on the severity of the injury. Most acute lateral ligament injuries are best treated nonsurgically and will regain satisfactory ankle stability after functional treatment. The conservative approach has been found to be equally effective in treating grade I and II ankle sprains. Some controversy still exists regarding the appropriate treatment of grade III injuries. General belief is that the majority of these patients may also be treated well with conservative management. Surgical reconstruction may be necessary, in cases that develop chronic functional instability, and especially in athletes with high demands on ankle joint stability. The purpose of this article is to review the biomechanics, clinical examination, diagnosis, management and secondary prevention of ankle sprains. We discuss the use and benefit of different modalities and outline a three-phase intervention program of rehabilitation based on recent guidelines.
- Fraqueza Muscular Adquirida nos Cuidados Intensivos: Sub ou Sobrediagnosticada?Publication . Morgado, S; Moura, SIntensive care unit-acquired weakness (ICU-AW) is recognized as an important and common clinical problem, associated with an increased morbidity in critical ill patients. This muscle weakness has been described in a wide range of clinical settings and therefore, has many different terminologies such as “critical illness myopathy – CIM”, “critical illness polyneuropathy - CIP”, “acute quadriplegic myopathy”, among others. Nowadays, these designations are considered somewhat restrictive, therefore most authors adopt the more wide range designation of “ICU-Acquired Weakness”.Generally, these patients have a flacid tetraparesis without cranial nerve palsy, normal or diminished osteotendinous reflexes and no sensitive alterations unless on the cases traditionally classified as polyneuropathy. The diagnosis of ICU-AW is often difficult, and should be suspected whenever a critical ill patient has unexplained weakness. Traditionally, the diagnosis of neuromuscular diseases is based in nerve conduction studies and electromyography. Muscle biopsy can be used to confirm or exclude myopathy, but is not a routine exam. Since there is a significant percentage of critical patients that develop muscle weakness it is important to screen all patients in the ICU, avoid potential toxic re-exposures on the identified patients and begin early rehabilitation. However, two questions arise from this screening: if the screening is only clinical are we underestimating these patients? If electrophysiological are we overestimating ICU-AW? There are no specific therapies for ICU-AW. The criterious use of some drugs is one of the possible measures to be taken. On the other hand, the early inclusion of these patients in a rehabilitation program seems to be helpful for a speedy functional recovery. There are few studies regarding ICU-AW, and systematic studies with longer follow-ups and bigger samples are necessary to determine the most effective rehabilitation approach for these patients.
- Qualidade de vida na síndrome de 'cirurgia lombar falhada'Publication . Matias, AC; Antunes, FObjectives: 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.
- “Quando o Lateral se Torna Central” – Caso ClínicoPublication . Roriz, N; Antunes, FPain control in rheumatological disorders is a true clinical challenge because of its multiple presentations. Unsuccessful pain control attempts, add extra difficulty to its management. Osteoarticular chronic symptoms, especially in an advanced phase, are strongly incapacitating but often undervalued despite its functional impact in patient’s life quality. Treatment options are frequently limited by its side effects, being these one of the major problems when handling different pharmacological groups. We report the case of a patient with an enteropathic arthropathy presenting with difficult persisting pain control. It reflects the importance of a correct and rigorous clinical evaluation leading to therapeutic success.
- Síndrome de Escápula CrepitantePublication . Morgado, S; Antunes, FSnapping Scapula Syndrome is a rare disorder that consists mainly in an audible and/or palpable crepitus of the scapula with movements on the scapulo-thoracic plane. This crepitus is often associated with shoulder or cervicodorsal pain. Patients generally seek medical help for pain relief. This syndrome can have many causes, originating from the various anatomical structures involved in the scapulothoracic movement (bone, muscle, bursa…). The diagnosis is clinical, although imaging studies can be helpful in the identification of the underlying cause. Most patients with Snapping Scapula Syndrome are treated conservatively, with a rehabilitation program and analgesic medication. Surgical approach can be beneficial in patients that do not respond to the nonoperative treatment, although its execution is still not consensual. The authors present the case of a patient with Snapping Scapula Syndrome, its diagnostic and therapeutic approach and a revision of the literature on this pathological entity.
- Síndrome doloroso regional complexo tipo IPublication . Gaspar, AT; Antunes, FType I complex regional pain syndrome is a neurophatic pain syndrome whose physiopathology is not yet fully understood. It mainly affects limb extremities and often occurs after local trauma. There is no consensus on the treatment, but early intervention seems important, particularly in the context of Physical Medicine and Rehabilitation. The authors review physiopathologic mechanisms and point to importance of an early diagnosis, since failure to recognize this clinical picture and the consequent delay in treatment may cause serious functional impairments.