94
Informaciones
Psiquiátricas
2016 - n.º 224
Palabras clave:
Entrevista motivacional,
rehabilitación, convalecencia, fractura de
fémur, ictus, geriatría.
Abstract
Feasibility study of motivational inter-
viewing to improve rehabilitation in an
Intermediate Care Hospital.
Objective:
Our main objective was to test
the feasibility of adding a patient cente-
red motivational intervention to the usual
rehabilitation in an Intermediate Care (IC)
Hospital for patients admitted after a hip
fracture or stroke.
Methods:
20 patients>65 years (10 hip
fracture;10 stroke) participated in the stu-
dy, receiving two motivational interviewing
sessions by a trained geriatrician, the first
within the 72 hours after admission, the se-
cond one week later. All patients were given
leaflets informing about different rehabili-
tation exercises to perform besides formal
physical therapy provided in the hospital,
among which they could choose those they
felt more suitable. Data collected included
socio-demographics, comorbidity, and clini-
cal, cognitive and functional status.
Results:
The motivational intervention
was accepted by all patients and all felt it
to be appropriate. Opportunities for this in-
tervention were high,4-5 patients per week,
best time for the interventions was in the af-
ternoons, which avoided interferences with
hospital activities. In patients with mild
cognitive impairment the intervention was
harder, and in 3 occasions the primary care-
giver was invited to participate, with high
acceptance and enthusiasm. Patients at ba-
seline were already highly motivated to do
rehabilitation, and ambivalence was not big.
Therefore most of the interviews focussed
on empowering patients and helping them
to identify and set their own goals during
rehabilitation.
Conclusions:
Adding specific motivatio-
nal interventions to usual rehabilitation
treatment in older patients admitted after
a hip fracture or stroke, is feasible and ac-
ceptable in our IC Hospital. Since patients
are quite prone to rehabilitation, interviews
tend to focus on empowerment. Further, ri-
gorous research is needed.
Key words:
Motivational interview, rehabilita-
tion, recovery, hip fracture, stroke, geriatrics.
Introducción
En la práctica de la geriatría, la capacidad
física o funcionalidad de los pacientes es bá-
sica, i está estrechamente relacionada con su
calidad de vida y supervivencia
1-4
. La capaci-
dad funcional (como por ejemplo la velocidad
de la marcha) es uno de los mejores pronós-
ticos de mortalidad, dependencia, fragilidad,
deterioro cognitivo e institucionalización
5
.
Es por ello que mantener una buena funcio-
nalidad y autonomía el máximo de tiempo
posible se convierte una de las prioridades.
En este sentido, varios estudios publicados
en los últimos años demuestran programas de
ejercicio físico regular aumentan la capaci-
dad funcional de los pacientes y disminuyen
el riesgo de caídas
6,7
, la dependencia o dis-
capacidad
8
, la mortalidad y al mismo tiempo
pueden revertir estados de fragilidad
9
. Tam-
bién se ha objetivado en estos estudios que
una vez terminado el ejercicio físico, la ca-
pacidad de los pacientes disminuye de forma
progresiva con el tiempo, lo que sugiere que
con el tiempo, el cumplimiento de los pro-
gramas resulta más irregular. Esta limitación
abre la puerta a la búsqueda de nuevas es-
Neus Gual / Alicia Calle / Míriam Colomina / Nuria Maestro /
Eva Ruzafa / Pilar Lusilla / Antoni Gual / Marco Inzitari
