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Letter to the Editor
Intervention by physical medicine and rehabilitation management units in cases of cerebrovascular disease
Intervención de las unidades de gestión clínica de medicina física y rehabilitación en la enfermedad cerebrovascular
R. López-Liriaa,
Corresponding author
rll040@ual.es

Corresponding author.
, E. Fernández Mirandab, M.L. Marina Zufiab, S. Ortega Vinuesab, D. Padilla-Góngoraa, representing the group of researchers
a Facultad de Ciencias de la Educación, Enfermería y Fisioterapia, Universidad de Almería, Almería, Spain
b Unidad de Gestión Clínica de Medicina Física y Rehabilitación, Complejo Hospitalario Torrecárdenas, Servicio Andaluz de Salud, Almería, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">It was with great interest that we read the original article by Pardo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> on implementing clinical practice guidelines &#40;CPG&#41; for acute ischaemic stroke&#46; These results are extremely useful in that they describe prevalence of vascular risk factors in patients receiving specialist care&#44; adherence to CPGs focusing on prevention&#44; and treatments prescribed according to stroke aetiology&#46; We wish to provide additional data to corroborate and expand on these results&#46; Since 2008&#44; we have been conducting a study on the effectiveness of physiotherapy<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> in patients with acute cerebrovascular disease &#40;CVD&#41; in the Clinical Management Unit &#40;CMU&#41; for physical therapy and rehabilitation at Complejo Hospitalario Torrec&#225;rdenas &#40;Almer&#237;a province&#41;&#46; These data may be useful for determining a patient&#39;s prognosis&#44; and they also illustrate the characteristics of the programmes and treatments employed to promote the patient&#39;s functional recovery&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">One of our study&#39;s objectives is to describe the patient&#39;s sociodemographic characteristics&#44; and clinical and functional characteristics until discharge from our unit&#44; in a sample recruited between 2008 and 2012&#46; The 173 patients diagnosed with CVD were treated with physiotherapy by one of the teams in our UGC &#40;the hospital&#39;s rehabilitation team or the circulating rehabilitation and physiotherapy team&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The mean patient age was 70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12 years and 57&#46;8&#37; of the group were men&#46; The most prevalent risk factors were arterial hypertension &#40;60&#37;&#41;&#44; diabetes &#40;26&#46;5&#37;&#41;&#44; prior stroke &#40;25&#37;&#41;&#44; former smoking habit &#40;23&#46;2&#37;&#41;&#44; atrial fibrillation &#40;18&#46;3&#37;&#41;&#44; dyslipidaemia &#40;14&#46;9&#37;&#41;&#44; active smoking habit &#40;12&#46;2&#37;&#41;&#44; and alcohol habit &#40;10&#46;4&#37;&#41;&#46; CVD was diagnosed as ischaemic in origin in 80&#46;1&#37; of the cases and haemorrhagic in 19&#46;9&#37;&#46; Regarding the techniques applied&#44; 78&#46;8&#37; of the patients underwent physiotherapy &#40;facilitation on the affected side of the body and techniques for normalising muscle tone&#44; posture&#44; and gait<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a>&#41;&#59; this was accompanied by electrotherapy in 35&#46;2&#37;&#46; Carer training &#40;in transfers&#44; mobility assistance&#44; and postural care&#41; was provided in 70&#46;8&#37; of the cases&#59; 19&#46;2&#37; of the patients were prescribed orthotics&#46; Functional status was measured with the Barthel index &#40;initial&#44; x&#175;&#61;33&#46;11&#59; final&#44; x&#175;&#61;58&#46;02&#41;&#46; The <span class="elsevierStyleItalic">t</span> test indicated that the differences observed after the treatment&#44; and which indicated improvement&#44; were statistically significant &#40;<span class="elsevierStyleItalic">t</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;15&#46;234&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Using the modified Rankin scale&#44; we found that 40&#46;8&#37; of the sample initially displayed severe disability &#40;patients who were bedridden&#44; incontinent&#44; and required constant supervision and nursing care&#41;&#59; this percentage had decreased to 22&#46;5&#37; by the final evaluation&#46; The mean number of physiotherapy sessions was 23<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17 &#40;mode&#44; 16&#41;&#46; Patients were treated on alternate days&#44; with 50&#37; undergoing treatment on Tuesdays and Thursdays&#44; and the remainder attending 3 times weekly&#46; At the end of the recovery process&#44; 59&#46;6&#37; of the patients were discharged due to improvement&#46; Ten percent of the patients continued in-hospital treatments after a period of at-home rehabilitation &#40;according to the EMRF protocol&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Impairment worsened in 12&#46;2&#37; of the patients&#59; 5&#46;8&#37; required hospitalisation at some point and 9&#46;4&#37; were discharged when they were stabilised&#46; Other outcomes included death&#44; institutionalisation &#40;3&#46;5&#37;&#41;&#44; and self-discharge &#40;4&#46;7&#37;&#41;&#46; In conclusion&#44; these treatments effectively minimise the sequelae of cerebrovascular events and their impact on activities of daily living&#46; We believe that functional status may be an indicator of&#44; or a variable affecting&#44; patient prognosis&#46; An interesting addition to the CPGs for cerebrovascular disease in Spain<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> is the level of evidence for the effectiveness of the units providing rehabilitation therapy for this disease with its high monetary and social impact&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> A large portion of the problem arises from the consequences of the years of disability that patients face&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">Funded as research project <span class="elsevierStyleGrantNumber" refid="gs1">PI 0449&#47;2008</span> by the <span class="elsevierStyleGrantSponsor" id="gs1">Andalusian Regional Department of Health</span> through its General Secretariat for Quality and Modernisation&#46; Project pertains to the financing programme for biomedical and health science research in Andalusia &#40;Resolution of 26 December 2008&#41;&#46;</p></span></span>"
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Article information
ISSN: 21735808
Original language: English
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