Journal Information
Vol. 56. Issue 11.
Pages 767-768 (November 2020)
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Vol. 56. Issue 11.
Pages 767-768 (November 2020)
Letter to the Editor
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When the Need is Greater Than Feasible
Cuando la necesidad es mayor de lo factible
Carlos Alfredo Fraile Oliveroa,
Corresponding author

Corresponding author.
, José Ramón Jarabo Sarcedab, Carlos Cerdán Santacruzc, Passio Santos Capad, Pedro Daniel Arribas Manzanale, Rafael Barriusof, Florentino Hernando Tranchob
a Thoracic Surgery Department, University Hospital Arnau de Vilanova, Lérida, Spain
b Thoracic Surgery Department, University Hospital Clínico San Carlos, Madrid, Spain
c General Surgery Department, University Hospital de la Princesa, Madrid, Spain
d Department of Physical Medicine and Rehabilitation, University Hospital Clínico San Carlos, Madrid, Spain
e Department of Physical Medicine and Rehabilitation, University Hospital Clínico San Carlos, Madrid, Spain
f Tribalyte Technologies, Spain
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Dear Editor:

An unexpected cruel pandemic has been able to paralyze not only our lives but also, somehow, our hopes. Digital transformation in healthcare has become essential to survive, subsist and resist. Huge efforts are made to generate impact and visibility, measured in “likes” or followers; however, we have not been able to work as a “global” system on tools generating value in terms of health among citizens. There are thousands of Smartphones applications available to download but in most cases it is difficult to validate their quality and regulate their content, both mandatory to properly manage patients’ data and achieve adequate dissemination of scientific information.1

Benefits of pulmonary rehabilitation are well known, not only within chronic processes but also after acute events, such as pneumonia or thoracic surgical procedures. Up to now, the only way to corner the virus is social distancing, and due to person-to-person spread of the virus occurs mainly via respiratory droplets, some respiratory exercises are discouraged without wearing appropriate personal protective equipment.2 Thus, some patients have limitations to get access to pulmonary rehabilitation, which could result in suboptimal recovery or even developing pulmonary complications once they are supposed to have overcome COVID-19. In this setting, chances for e-Health tools turn into imperatives, and health community is compelled to provide patients with global and affordable resources transcending social and geographical issues.

A group of Spanish thoracic surgeons and physiotherapists from Hospital Clínico San Carlos in Madrid created Fissios App3 (Fig. 1), a free Smartphone application that guides patients scheduled for a thoracic surgical procedure through a chest physical exercises program. A series of basic and simple exercises are displayed to teach, from the basic correct position to muscle strengthening techniques or secretion drainage. This method uses animations that show the ranges of movement complemented by a text panel explaining their execution in detail. All of this is meant to be done in a safe and self-sufficient manner. The initial experiences were very satisfactory and were positively evaluated by most of the users through feedback questionnaires.4 Several scientific societies have commented on the advantages of respiratory physiotherapy in patients affected by COVID-19, mainly at the time of discharge and those patients with mild symptoms.5 At Fissios App we continue with our commitment and responsibility by preparing a “COVID-19 section” of the App that allows us to specifically guide all the patients that happily overcome the disease, in a special and instructive way, under the hypothesis that the performance of respiratory physiotherapy exercises may improve their recovery.

Fig. 1.

Fissios App Logo.


Perhaps after all this, at last, the “mutualist” mentality will arrive and we will be able to learn that, if we do not protect the group, individual success will be of little use and that transcendence lies in surviving as a species. Perhaps after all this, it will happen that, for really important issues such as the health of individuals and that of the collective, feasible may exceed needs, and we will thus be permanently prepared to face new challenges.

Conflicts of interest


C.E. Joy, Edlin, P. Ranjit, Deshpande.
Caveats of smartphone applications for the cardiothoracic trainee,.
J Thorac Cardiovasc Surg, 146 (2013),
P. Thomas, C. Baldwin, B. Bissett, I. Boden, R. Gosselink, C.L. Granger, et al.
Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations.
Tribalyte technologies, Fraile, et al.
Fissios Web-App.
(2020, April 13),
C.A.F. Olivero, J.R. Jarabo Sarceda, E. Fernández Martín, X.W. Trelles, A.M. Gómez Martínez, J. Calatayud Gastardi, et al.
Implementation and initial evaluation of a smartphone application to improve perioperative pulmonary rehabilitation in elective thoracic surgical patients. Oral communication. Book of abstract O040. 26th Meeting of the European Society of Thoracic Surgeons. Ljubljana, Slovenia, May 27th–30th.
Department of Thoracic Surgery, Hospital Clinico San Carlos, (2018),
Zhonghua Jie He He Hu Xi Za Zhi.
Chinese Association of Rehabilitation Medicine; Respiratory Rehabilitation Committee of Chinese Association of Rehabilitation Medicine; Cardiopulmonary Rehabilitation Group of Chinese Society of Physical Medicine and Rehabilitation.
Copyright © 2020. SEPAR
Archivos de Bronconeumología

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