Resumo Introdução e objetivos: Durante a pandemia COVID-19 a utilização de máscaras faciais, incluindo durante o exercício terapêutico, faz parte das medidas de segurança adotadas. Este facto originou preocupação a nível das unidades de reabilitação cardíaca, uma vez que as máscaras faciais podem promover efeitos deletérios na capacidade de exercício. Este estudo avaliou o impacto da utilização das máscaras faciais durante o treino aeróbio em passadeira. Métodos: Doze profissionais de saúde saudáveis completaram três provas em passadeira de acordo com o protocolo de Bruce: sem máscara, com máscara cirúrgica e com um respirador. A perceção de esforço e dispneia foi avaliada com a Escala de Perceção de Esforço de Borg e com a Escala de Dispneia de Borg, respetivamente. A pressão arterial, frequência cardíaca e saturação arterial de oxigénio (SpO2) foram registadas em cada estadio do protocolo. Resultados: A utilização de máscara facial resultou numa menor duração da prova e, em determinados momentos, níveis de perceção de dispneia e de esforço mais elevados. Verificou-se uma descida significativa da SpO2 no final da prova com respirador. Não se verificaram diferenças na resposta cronotrópica ou da pressão arterial entre as diferentes condições de prova. Conclusões: Os profissionais envolvidos na reabilitação cardíaca devem reconhecer os impactos cardiorrespiratórios provocados pela utilização da máscara facial. São necessários mais estudos para determinar se a exposição a estas condições de treino pode ter impacto nos resultados dos programas de reabilitação cardíaca.
Introduction The Handheld Dynamometer (HHD) has the potential to overcome some of the logistic and economic limitations of isokinetic dynamometers for measuring knee extension muscle strength. However, its reliability has not been fully assessed. The purpose of this study is to measure intra and inter-rater reliability of HHD for knee extension strength in patients receiving rehabilitation treatment, as well as to understand in which conditions is the reliability higher. Methods Twenty-nine patients admitted in an inpatient Physical Medicine and Rehabilitation unit were consecutively included in this cross-sectional study. Two experienced and two inexperienced physicians made two assessments of knee extension strength with HHD, separated by three hours. Intraclass Correlation Coefficients (ICC), absolute differences between assessments, and correlations between strength and functional variables were calculated. Results Intra and inter-rater ICC were overall high (≥ 0.950 and 0.927, respectively). Higher values were found when average of two measurements were made for estimating intra-rater ICC (ICC = 0.978; 95%CI = 0.969–0.985) but not for inter-rater ICC. ICC were not statistically significantly different when calculated based on measurements performed by inexperienced physicians and experienced ones. There was a moderate correlation between strength and functional variables. Conclusion Handheld Dynamometer seems to be a reliable option to measure knee extension muscle strength, particularly when two measurements are performed and their average is reported.
This study aimed to review the recent literature about botulinum toxin type A treatment patterns, including muscle targets, doses, duration of effect, adverse effects, and clinical outcomes in patients with postparetic synkinesis. A bibliographic research of studies published in the last 10 yrs was carried out on PubMed database, using the medical subject heading terms: botulinum toxin and synkinesis. English-language cohort studies or randomized controlled trials about botulinum toxin type A treatment on patients with postparetic synkinesis were eligible for inclusion. Ten studies met the inclusion criteria, seven prospective studies, two retrospective studies, and one randomized controlled trial, involving 23-99 patients. The target facial muscles included frontalis, corrugator supercilli, orbicularis oculi, levator labii superioris, zygomaticus major, orbicularis oris, risorius, buccinator, depressor anguli oris, depressor labii inferioris, mentalis, and platysma. The dose of onabotulinumtoxinA administered per injection site ranged between 0.5 and 10 U. Adverse effects were rare and temporary. The mean duration of onabotulinumtoxinA effect ranges from 66 days to 4 mos. There was a statistically significant improvement in posttreatment evaluation, both in objective and subjective assessments. There is scientific evidence of the benefit of botulinum toxin type A treatment for postparetic synkinesis, but there is lack of standardized treatment protocols.
Objective: Ascertain healthcare-associated infection (HAI) prevalence and identify risk factors associated with a higher incidence of infection in a Rehabilitation Ward. Materials and Methods: Two-year retrospective cohort study conducted in a post-acute Rehabilitation Ward of a tertiary-care, public, university-affiliated hospital. Demographic and clinical data were collected from electronic medical record. The assessment of risk factors was done by comparison of patients with or without HAI. Univariate and multivariate logistic regression analysis was used to identify risk factors. Results: There were 262 admissions to the Rehabilitation Ward during the study period. One-hundred thirty-one HAIs were detected in 95 (36.3%) of the 262 patients. The most common infections were urinary tract infections (87.8% of all infections). An age-sex adjusted multivariate logistic regression model showed that urinary catheter, surgery in the last 30 days and length of stay ≥ 30 days were independent risk factors for HAI. Length of stay was associated with an increased odd of developing HAI (median length of 28 days for those without HAI, 35 days for those with only one HAI and 55 days for patients having ≥ 2 HAI). Only one patient died of infection. Conclusions: HAI is a frequent complication in a post-acute Rehabilitation Ward. The logistic regression model identified patients with urinary catheter, surgery in the last 30 days and length of stay ≥ 30 days as having an higher risk for HAI, thereby being the main targets of surveillance and adoption of preventive measures.
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