Rehabilitación funcional y adherencia terapéutica tras medidas farmacológicas y no farmacológicas en pacientes con diferentes trastornos del movimiento involuntario anormal
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2021
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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Introducción: El manejo de los trastornos del movimiento involuntario (TMI) incluye medidas farmacológicas y no farmacológicas. La rehabilitación funcional (RF) constituye la principal medida no farmacológica. En el Ecuador aún no se ha estimado apropiadamente el desenlace clínico tras RF en pacientes con distintos TMI anormal, más aún la adherencia terapéutica. Objetivo: estimar la frecuencia de casos con distintos TMI anormal en quienes se logró adecuada RF tras medidas farmacológicas y no farmacológicas. Metodología: estudio observacional, analítico, longitudinal prospectivo, del tipo cohorte. Entre el 2018– 2020 se selecionó pacientes con diagnóstico naïve de Parkinson, Parkinsonismo vascular, parálisis supranuclear progresiva. Resultados: Se incluyó 109 casos con enfermedad de Parkinson (mediana edad 69 años, 48% mujeres). Se indicó adyuvancia farmacológica en el 35.8% de los casos. En 29/109 (26.6%) casos se realizó solo una sesión de RF. Se realizó un subanálisis entre aquellos pacientes quienes habían asistido a cuando menos cuatro sesiones de RF (n=57). La mediana de severidad estimada mediante UPDRS descendió de 34 (25 – 53) a 28 (14 – 53) puntos (P=0.0478). Evaluado por cada dimensión de la UPDRS se verificó que dicho descenso es a expensas de la mejoría en los síntomas asociados al estado mental (P<0.001) principalmente. Conclusión: La implementación de medidas farmacológicas y no farmacológicas (RF) permite disminuir la severidad sintomatológica de la enfermedad de Parkinson principalmente aquellos síntomas relacionados con el estado mental. Considerando el acudir a cuando menos una segunda sesión de rehabilitación funcional, esta presenta buena adherencia terapéutica en la mayoría de los casos.
Introduction: The management of involuntary movement disorders includes both pharmacological and non-pharmacological measures. FR constitutes the main non- pharmacological measure in the context of multimodal management. In Ecuador, the clinical outcome after FR has not yet been properly estimated in patients with different abnormal involuntary movement disorders, even more so, therapeutic adherence. Aim: to estimate the frequency of cases with different abnormal involuntary movement disorders in whom adequate FR was achieved after the implementation of pharmacological and non- pharmacological measures. Methods: observational, analytical, prospective longitudinal study, of the cohort type. Between 2018-2020, patients with a naive diagnosis of Parkinson's, vascular Parkinsonism, and progressive supranuclear palsy were selected. Results: 109 cases with Parkinson's disease were included (median age 69 years, 48% women). Some pharmacological adjuvant was indicated in 35.8% of the cases. In 29/109 (26.6%) cases, only one physical rehabilitation session was performed. A sub-analysis was performed among those patients who attended at least four functional rehabilitation sessions (n = 57). The median severity estimated by UPDRS decreased from 34 (25 - 53) to 28 (14 - 53) points (P = 0.0478). Evaluated by each dimension of the UPDRS, it was verified that said decrease is mainly due to the improvement in the symptoms associated with the mental state (P <0.001). Conclusion: The implementation of pharmacological and non-pharmacological measures (FR) allows reducing the symptomatic severity of Parkinson's disease, mainly those symptoms related to the mental state. Considering attending at least a second functional rehabilitation session, this presents good therapeutic adherence in most cases
Introduction: The management of involuntary movement disorders includes both pharmacological and non-pharmacological measures. FR constitutes the main non- pharmacological measure in the context of multimodal management. In Ecuador, the clinical outcome after FR has not yet been properly estimated in patients with different abnormal involuntary movement disorders, even more so, therapeutic adherence. Aim: to estimate the frequency of cases with different abnormal involuntary movement disorders in whom adequate FR was achieved after the implementation of pharmacological and non- pharmacological measures. Methods: observational, analytical, prospective longitudinal study, of the cohort type. Between 2018-2020, patients with a naive diagnosis of Parkinson's, vascular Parkinsonism, and progressive supranuclear palsy were selected. Results: 109 cases with Parkinson's disease were included (median age 69 years, 48% women). Some pharmacological adjuvant was indicated in 35.8% of the cases. In 29/109 (26.6%) cases, only one physical rehabilitation session was performed. A sub-analysis was performed among those patients who attended at least four functional rehabilitation sessions (n = 57). The median severity estimated by UPDRS decreased from 34 (25 - 53) to 28 (14 - 53) points (P = 0.0478). Evaluated by each dimension of the UPDRS, it was verified that said decrease is mainly due to the improvement in the symptoms associated with the mental state (P <0.001). Conclusion: The implementation of pharmacological and non-pharmacological measures (FR) allows reducing the symptomatic severity of Parkinson's disease, mainly those symptoms related to the mental state. Considering attending at least a second functional rehabilitation session, this presents good therapeutic adherence in most cases
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CUMPLIMIENTO Y ADHERENCIA AL TRATAMIENTO, ENFERMEDAD DE PARKINSON, TRASTORNOS DEL MOVIMIENTO, REHABILITACION FUNCIONAL, ESTUDIO OBSERVACIONAL, ESTUDIOS PROSPECTIVOS, HOSPITAL REGIONAL DR. VERDI CEVALLOS BALDA, CANTON PORTOVIEJO, ECUADOR