Personal and household PM2.5 and black carbon exposure measures and respiratory symptoms in 8 low- and middle-income countries.

BACKGROUND: Household air pollution (HAP) from cooking with solid fuels has been associated with adverse respiratory effects, but most studies use surveys of fuel use to define HAP exposure, rather than on actual air pollution exposure measurements. OBJECTIVE: To examine associations between household and personal fine particulate matter (PM2.5) and black carbon (BC) measures and respiratory symptoms. METHODS: As part of the Prospective Urban and Rural Epidemiology Air Pollution study, we analyzed 48-h household and personal PM2.5 and BC measurements for 870 individuals using different cooking fuels from 62 communities in 8 countries (Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe). Self-reported respiratory symptoms were collected after monitoring. Associations between PM2.5 and BC exposures and respiratory symptoms were examined using logistic regression models, controlling for individual, household, and community covariates. RESULTS: The median (interquartile range) of household and personal PM2.5 was 73.5 (119.1) and 65.3 (91.5) µg/m3, and for household and personal BC was 3.4 (8.3) and 2.5 (4.9) x10-5 m-1, respectively. We observed associations between household PM2.5 and wheeze (OR: 1.25; 95%CI: 1.07, 1.46), cough (OR: 1.22; 95%CI: 1.06, 1.39), and sputum (OR: 1.26; 95%CI: 1.10, 1.44), as well as exposure to household BC and wheeze (OR: 1.20; 95%CI: 1.03, 1.39) and sputum (OR: 1.20; 95%CI: 1.05, 1.36), per IQR increase. We observed associations between personal PM2.5 and wheeze (OR: 1.23; 95%CI: 1.00, 1.50) and sputum (OR: 1.19; 95%CI: 1.00, 1.41). For household PM2.5 and BC, associations were generally stronger for females compared to males. Models using an indicator variable of solid versus clean fuels resulted in larger OR estimates with less precision. CONCLUSIONS: We used measurements of household and personal air pollution for individuals using different cooking fuels and documented strong associations with respiratory symptoms.

Only half of the authors of overviews of exercise-related interventions use some strategy to manage overlapping primary studies-a metaresearch study.

OBJECTIVES: The conduct of systematic reviews (SRs) and overviews share several similarities. However, because the unit of analysis for overviews is the SRs, there are some unique challenges. One of the most critical issues to manage when conducting an overview is the overlap of data across the primary studies included in the SRs. This metaresearch study aimed to describe the frequency of strategies to manage the overlap in overviews of exercise-related interventions. STUDY DESIGN AND SETTING: A systematic search in MEDLINE (Ovid), Embase (Ovid), Cochrane Library, Epistemonikos, and other sources was conducted from inception to June 2022. We included overviews of SRs that considered primary studies and evaluated the effectiveness of exercise-related interventions for any health condition. The overviews were screened by two authors independently, and the extraction was performed by one author and checked by a second. We found 353 overviews published between 2005 and 2022 that met the inclusion criteria. RESULTS: One hundred and sixty-four overviews (46%) used at least one strategy to visualize, quantify, or resolve overlap, with a matrix (32/164; 20%), absolute frequency (34/164; 21%), and authors' algorithms (24/164; 15%) being the most used methods, respectively. From 2016 onwards, there has been a trend toward increasing the use of some strategies to manage overlap. Of the 108 overviews that used some strategy to resolve the overlap, ie, avoiding double or multiple counting of primary study data, 79 (73%) succeeded. In overviews where no strategies to manage overlap were reported (n = 189/353; 54%), 16 overview authors (8%) recognized this as a study limitation. CONCLUSION: Although there is a trend toward increasing its use, only half of the authors of the overviews of exercise-related interventions used a strategy to visualize, quantify, or resolve overlap in the primary studies' data. In the future, authors should report such strategies to communicate more valid results.

Hybrid Cardiac Rehabilitation Program in a Low-Resource Setting: A Randomized Clinical Trial.

Importance: While effective, cardiovascular rehabilitation (CR) as traditionally delivered is not well implemented in lower-resource settings. Objective: To test the noninferiority of hybrid CR compared with traditional CR in terms of cardiovascular events. Design, Setting, and Participants: This pragmatic, multicenter, parallel arm, open-label randomized clinical trial (the Hybrid Cardiac Rehabilitation Trial [HYCARET]) with blinded outcome assessment was conducted at 6 referral centers in Chile. Adults aged 18 years or older who had a cardiovascular event or procedure, no contraindications to exercise, and access to a mobile telephone were eligible and recruited between April 1, 2019, and March 15, 2020, with follow-up until July 29, 2021. Interventions: Participants were randomized 1:1 in permuted blocks to the experimental arm, which received 10 center-based supervised exercise sessions plus counseling in 4 to 6 weeks and then were supported at home via telephone calls and text messages through weeks 8 to 12, or the control arm, which received the standard CR of 18 to 22 sessions with exercises and education in 8 to 12 weeks. Main Outcomes and Measures: The primary outcome was cardiovascular events or mortality. Secondary outcomes were quality of life, return to work, and lifestyle behaviors measured with validated questionnaires; muscle strength and functional capacity, measured through physical tests; and program adherence and exercise-related adverse events, assessed using checklists. Results: A total of 191 participants were included (mean [SD] age, 58.74 [9.80] years; 145 [75.92%] male); 93 were assigned to hybrid CR and 98 to standard CR. At 1 year, events had occurred in 5 unique participants in the hybrid CR group (5.38%) and 9 in the standard CR group (9.18%). In the intention-to-treat analysis, the hybrid CR group had 3.80% (95% CI, -11.13% to 3.52%) fewer cardiovascular events than the standard CR group, and relative risk was 0.59 (95% CI, 0.20-1.68) for the primary outcome. In the per-protocol analysis at different levels of adherence to the intervention, all 95% CIs crossed the noninferiority boundary (eg, 20% adherence: absolute risk difference, -0.35% [95% CI, -7.56% to 6.85%]; 80% adherence: absolute risk difference, 3.30% [95% CI, -3.70% to 10.31%]). No between-group differences were found for secondary outcomes except adherence to supervised CR sessions (79.14% [736 of 930 supervised sessions] in the hybrid CR group vs 61.46% [1201 of 1954 sessions] in the standard CR group). Conclusions and Relevance: The results suggest that a hybrid CR program is noninferior to standard center-based CR in a low-resource setting, primarily in terms of recurrent cardiovascular events and potentially in terms of intermediate outcomes. Hybrid CR may induce superior adherence to supervised exercise. Clinical factors and patient preferences should inform CR model allocation. Trial Registration: ClinicalTrials.gov Identifier: NCT03881150.

CROSS-CULTURAL ADAPTATION AND VALIDATION TO SPANISH OF THE PANELVIEW INSTRUMENT TO EVALUATE THE HEALTH GUIDELINES DEVELOPMENT PROCESS.

OBJECTIVE: The PANELVIEW questionnaire identifies the strengths and weaknesses of the process and methods used for developing health guidelines from the guideline development group's perspective. To expand its use, PANELVIEW ideally should be available in different languages. We aimed to cross-culturally adapt PANELVIEW into Spanish and assess its acceptability, validity, and reliability. STUDY DESIGN AND SETTING: To translate and culturally adapt PANELVIEW to Spanish, we followed ISPOR's Translation and Cultural Adaptation Good Practice Principles guidelines. The process consisted of 1) forward and back translation, 2) input from an expert panel, and 3) cognitive debriefing interviews. We assessed the content validity with experts in guideline development who rated instrument items for relevance to determine the item and scale content validity index (I-CVI; S-CVI). We tested the reliability with health guidelines panels from Spanish-speaking countries and measured internal consistency (Cronbach's alpha). We examined acceptability through the number of missing responses for each item. RESULTS: The content comparison between the back-translation and the original version showed that most items (24/34) were conceptually equivalent but with grammatical differences. Through the cognitive interviews, we identified six items with wording issues, ten with clarity issues, and two with applicability issues. I-CVI ranged from 0.77 to 1.00, with two items needing revision. S-CVI was 0.92, showing excellent content validity. The PANELVIEW Spanish version demonstrated very good reliability (Cronbach's alpha coefficient of 0.96). Panel members responded to all items, showing good acceptability. CONCLUSION: The PANELVIEW Spanish version was conceptually equivalent to the original version and provided satisfactory evidence of acceptability, validity and reliability.

Effectiveness of physical rehabilitation interventions in critically ill patients-A protocol for an overview of systematic reviews.

INTRODUCTION: Adult and pediatric patients admitted to intensive care units (ICUs) requiring invasive ventilatory support, sedation, and muscle blockade may present neuromusculoskeletal deterioration. Different physical rehabilitation interventions have been studied to evaluate their effectiveness in improving critically ill patients' outcomes. Given that many published systematic reviews (SRs) aims to determine the effectiveness of different types of physical rehabilitation interventions, it is necessary to group them systematically and assess the methodological quality of SRs to help clinicians make better evidence-based decisions. This overview of SRs (OoSRs) aims to map the existing evidence and to determine the effectiveness of physical rehabilitation interventions to improve neuromusculoskeletal function and other clinical outcomes in adult and pediatric critically ill patients. METHODS: An OoSRs of randomized and non-randomized clinical trials involving critically ill adult and pediatric patients receiving physical rehabilitation intervention will be conducted. A sensitive search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Cochrane Library, Epistemonikos, and other search resources will be conducted. Two independent reviewers will conduct study selection, data extraction, and methodological quality assessment. Discrepancies will be resolved by consensus or a third reviewer. The degree of overlap of studies will be calculated using the corrected covered area. The methodological quality of the SRs will be measured using the AMSTAR-2 tool. The GRADE framework will report the certainty of evidence by selecting the "best" SR for each physical rehabilitation intervention and outcome. DISCUSSION: The findings of this overview are expected to determine the effectiveness and safety of physical rehabilitation interventions to improve neuromusculoskeletal function in adult and pediatric critically ill patients based on a wide selection of the best available evidence and to determine the knowledge gaps in this topic by mapping and assessing the methodological quality of published SRs. REGISTRATION NUMBER: CRD42023389672.

Evaluation of counselling materials for hybrid cardiac rehabilitation in a low-resource setting: Perceptions of patients and providers.

OBJECTIVE: This study evaluated the usefulness of a booklet as support material for counseling focused on self-efficacy and therapist interaction in the course of counseling in a hybrid CR program (i.e., supervised and unsupervised sessions) developed for low-resource settings. METHODS: Counseling material was developed by a multidisciplinary team, with patient input. Using multi-methods, first input from patients from six centers in Chile was sought through a telephone survey (cross-sectional). Second, input from physiotherapists delivering the intervention at all centres was solicited qualitatively through a focus group on Zoom. Content analysis was performed using a deductive-thematic approach. RESULTS: Seventy-one patients were included. All (100 %) participants responded that the materials were easy to understand, contained suggestions applicable to daily life, captured their attention and was useful for future questions. The booklet overall was rated 6.7 ± 0.6/7 %, and 98.2 % were satisfied with the counselling. Overall themes from the six deliverers related to the CR intervention (e.g., well manualized protocols for counselling), the deliverer (e.g., expertise to deliver) and patients (e.g., found information useful). CONCLUSION: The usefulness of the counseling together with the supporting booklet was established by patients and delivering professionals. PRACTICE IMPLICATIONS: Thus, with some final refinement, this resource can be disseminated for use by other Spanish CR programs.

Assessment of redundancy, methodological and reporting quality, and potential discrepancies of results of systematic reviews of early mobilisation of critically ill adults: a meta-research protocol.

INTRODUCTION: Several systematic reviews (SRs) have been conducted to determine the effectiveness of early mobilisation in critically ill adults with heterogeneous methodology and results. Redundancy in conducting SRs, unclear justification when leading new SRs or updating, and discordant results of SRs on the same research question may generate research waste that makes it difficult for clinicians to keep up to date with the best available evidence. This meta-research aims to assess the redundancy, methodological and reporting quality, and potential reasons for discordance in the results reported by SRs conducted to determine the effectiveness of early mobilisation in critically ill adult patients. METHODS AND ANALYSIS: A meta-research of early mobilisation SRs in critically ill adult patients will be conducted. A search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Cochrane Library, Epistemonikos and other search resources will be conducted. Two independent reviewers will perform study selection, data extraction and quality appraisal. Discrepancies will be resolved by consensus or a third reviewer. The redundancy of SRs will be assessed by the degree of overlap of primary studies. In addition, the justification for conducting new SRs will be evaluated with the 'Evidence-Based Research' framework. The methodological quality of the SRs will be assessed with the A MeaSurement Tool to Assess systematic Reviews 2 tool, and the quality of the reports through compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. To assess the potential reasons for discordance in the results of the SRs considering divergence in results and their interpretation. ETHICS AND DISSEMINATION: As meta-research, this study does not involve the participation of people whose rights may be violated. However, this overview will be developed rigorously and systematically to achieve valid and reliable results. The findings of this meta-research study will be presented at conferences and published in a peer-reviewed journal related to rehabilitation, critical care or research methodology. TRIAL REGISTRATION NUMBER: osf.io/kxwq9.

Assessment of activities and participation of people by rehabilitation-focused clinical registries: a systematic scoping review.

INTRODUCTION: Rehabilitation is considered a key intervention in health care. Clinical registries, defined as an organized system that uses observational methods to collect information to assess specific outcomes in a defined population, can contribute to assessing the impact of the rehabilitation intervention. This review aims to identify and describe rehabilitation-specific registry systems with an emphasis on identifying outcomes that enable the assessment of vital areas and activities of daily living. EVIDENCE ACQUISITION: A systematic scoping review was conducted. A systematic search was conducted up to August 2022 in MEDLINE/PubMed, Embase, Cochrane Library, Epistemonikos, and other search resources. Studies related to rehabilitation registries presented data on people with health problems that could limit their functioning were selected. The inclusion of studies/clinical registries was not limited by methodological design, year of publication, country, or language. The unit of analysis was rehabilitation registries. The measurement instruments used to assess the outcomes were explored to estimate the domain assessed from the vital areas related to functioning and disability as described by the International Classification of Functioning, Disability and Health (ICF). The vital areas were classified according to activities of daily living (ADLs). EVIDENCE SYNTHESIS: Seventy-one registries in rehabilitation were identified. The registries included a median of 3 (IQR 2-5) assessment instruments designed to assess the impact of different rehabilitation programs. In total, 137 different assessment scales or instruments were identified. Each rehabilitation registry assessed 6 (IQR 2-8) domains of the ICF, and 15.4% of registries assessed all domains. The most assessed domain was "Mobility" (89.7%), and the least assessed was "General Tasks and Demands" (25.6%). In addition, 92.3% of rehabilitation registries assessed basic ADLs, 76.9% advanced ADLs, and 71.8% instrumental ADLs. CONCLUSIONS: Although clinical registries do not claim to directly assess the impact of rehabilitation programs on people's functioning according to the ICF framework, it was identified that a low percentage of them assessed the nine vital areas through different outcome assessment instruments. However, most rehabilitation registries directly or indirectly assess some basic, instrumental, and advanced ADLs. The findings of this review highlight the need to improve the design of clinical registries focused on assessing the impact of rehabilitation programs to assess people in all areas of their lives.

A hybrid exercise-based cardiac rehabilitation program is an effective strategy to improve muscle strength and functional exercise capacity in adults and older people with coronary artery disease.

Coronary heart disease is the most common cause of death worldwide. Standard cardiac rehabilitation (face-to-face sessions) has shown benefits in increasing muscle strength and functional exercise capacity in adults and older people. However, it is unknown whether hybrid cardiac rehabilitation (a first face-to-face phase + a second remote monitoring phase) will have similar benefits in adults versus older subjects. The aim of this study was to compare the effects of a hybrid exercise-based cardiac rehabilitation program on muscle strength and functional exercise capacity in "adult" versus "older" people with coronary artery disease. We hypothesized that a hybrid exercise-based cardiac rehabilitation program would improve muscle strength and functional exercise capacity, but the impact would be smaller in the older group than the adult individuals. This study is part of a larger project (The Hybrid Cardiac Rehabilitation Trial-HYCARET). We subjected 22 adult (<60 y) females and males (ADULT; n = 5/17 (f/m); 52 ± 5 y; 28.9 ± 3.4 kg·m-2) and 20 older (≥60 y) females and males (OLDER; n = 6/14 (f/m); 66 ± 4 y; 27.4 ± 3.9 kg·m-2) with coronary artery disease to 12 weeks of hybrid exercise-based cardiac rehabilitation program. Prior to and after 12 weeks of a hybrid exercise-based cardiac rehabilitation program, grip strength (handgrip), leg strength (chair stand test), and functional exercise capacity (6-minute walk test, 6MWT) were assessed. The hybrid exercise-based cardiac rehabilitation program resulted in a 9.4 ± 14.6% and a 6.2 ± 12.1% grip strength increase, a 14.4 ± 39.4% and a 28.9 ± 48.1% legs strength increase, and a 14.6 ± 26.4% and a 6.8 ± 14.0% functional exercise capacity improvement in ADULT and OLDER, respectively (p < 0.05) with no differences between groups. In conclusion, a hybrid exercise-based cardiac rehabilitation program could increase muscle strength and improve functional exercise capacity in adults and older people with coronary artery disease. More future studies comparing effectiveness among these age groups are needed to strengthen this conclusion.

Two-Minute Step Test as a Complement to Six-Minute Walk Test in Subjects With Treated Coronary Artery Disease.

The 2-Minute Step Test (2MST) has been presented as an alternative to the 6-Minute Walk Test (6MWT) based on the association between the two tests in older adults; however, some authors propose that it should not be a substitute but rather a complement to the latter in the fitness evaluation. Specifically, in coronary disease, despite the potential and clinical utility of 2MST, the relationship of both tests in this population is unknown. This study aimed to determine the relationship between 6MWT and 2MST and to explore the relationship of biodemographic factors for both tests in subjects with treated coronary artery disease. For this, the 6MWT and the 2MST were applied to patients with coronary artery disease treated in 6 hospitals in Chile between May 2019 and February 2020. Additionally, lower limb strength was assessed by a chair-stand test, grip strength was assessed by a dynamometer, and physical measurements were applied. In total, 163 participants underwent both tests (average age = 58.7 ± 9.8 years; 73.6% men; 64.4% revascularized by angioplasty; 28.2% revascularized by surgery, and 7.4% treated by drugs or thrombolysis). Heart rate was higher at the end of the 6MWT, while the perception of effort was greater at the end of the 2MST. There was a weak positive correlation between the 6MWT and the 2MST in subjects with treated coronary disease (r = 0.28, p = 0.0003). While age (r = -0.27), weight (r = 0.25), height (r = 0.49), and strength of both lower limbs (r = 0.41) and grip strength (r = 0.53) correlated weakly or moderately to the covered distance in 6MWT, the number of steps by the 2MST correlated only weakly to height (r = 0.23), lower limb strength (r = 0.34), and grip strength (r = 0.34). Age, weight, height, lower limb strength, and grip strength would explain better the meters walked in the 6MWT than the steps achieved in the 2MST. With these findings, we can conclude that, in patients with treated coronary artery disease, it does not seem advisable to replace 6MWT with 2MST when it is possible to do so. Additionally, the 2MST may provide additional information in the fitness evaluation. However, the usefulness of 2MST in this population needs to be further studied.

Measuring and predicting personal and household Black Carbon levels from 88 communities in eight countries.

Black Carbon (BC) is an important component of household air pollution (HAP) in low- and middle- income countries (LMICs), but levels and drivers of exposure are poorly understood. As part of the Prospective Urban and Rural Epidemiological (PURE) study, we analyzed 48-hour BC measurements for 1187 individual and 2242 household samples from 88 communities in 8 LMICs (Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe). Light absorbance (10-5 m-1) of collected PM2.5 filters, a proxy for BC concentrations, was calculated via an image-based reflectance method. Surveys of household/personal characteristics and behaviors were collected after monitoring. The geometric mean (GM) of personal and household BC measures was 2.4 (3.3) and 3.5 (3.9)·10-5 m-1, respectively. The correlation between BC and PM2.5 was r = 0.76 for personal and r = 0.82 for household measures. A gradient of increasing BC concentrations was observed for cooking fuels: BC increased 53% (95%CI: 30, 79) for coal, 142% (95%CI: 117, 169) for wood, and 190% (95%CI: 149, 238) for other biomass, compared to gas. Each hour of cooking was associated with an increase in household (5%, 95%CI: 3, 7) and personal (5%, 95%CI: 2, 8) BC; having a window in the kitchen was associated with a decrease in household (-38%, 95%CI: -45, -30) and personal (-31%, 95%CI: -44, -15) BC; and cooking on a mud stove, compared to a clean stove, was associated with an increase in household (125%, 95%CI: 96, 160) and personal (117%, 95%CI: 71, 117) BC. Male participants only had slightly lower personal BC (-0.6%, 95%CI: -1, 0.0) compared to females. In multivariate models, we were able to explain 46-60% of household BC variation and 33-54% of personal BC variation. These data and models provide new information on exposure to BC in LMICs, which can be incorporated into future exposure assessments, health research, and policy surrounding HAP and BC.

Characteristics of the coronavirus disease 2019: A review of emerging literature. / Características de la enfermedad por coronavirus 2019: una revisión de literatura emergente.

BACKGROUND: The 2019 coronavirus disease outbreak (COVID-19) spread rapidly around the world. The extent and ultimate effect are still unclear, as it is an ongoing and constantly evolving pandemic. AIMS: To compile the literature and synthesize in Spanish-Latin American language the available international information describing the etiological, pathophysiological, epidemiological and management aspects of COVID-19. METHODS: Narrative review, using specific sections created in the databases. The criteria for selecting studies depended on the specific area addressed: etiological, pathophysiological, epidemiological aspects, treatment alternatives, etc. References in Spanish and English were included. RESULTS: The World Health Organization reports that COVID-19 is a disease of zoonotic origin that was transmitted to a human host. The first cases were identified in late 2019 and January 2020, in Wuhan city, China. It was categorized as highly contagious and transmissible between humans, which is attributed to the structural features of this novel coronavirus. The clinical presentation is variable and nonspecific, as well as its severity. With a clear tropism for the respiratory system, the most severe cases may develop pneumonia, respiratory failure, multiorgan failure and thus death. It occurs in all age groups, with a lower percentage in children under 19 years of age (2.4%). Mortality varies between countries and regions (between 1.5 to 9.3% over the total of reported cases). Associated risk factors are the presence of comorbidities, advanced age, and immunosuppression. CONCLUSIONS: To date there have been thousands of scientific articles that attempt to explain the onset, progression, possible treatment options and global impact of the disease. There is still no certainty about the level or quality of this evidence. It is essential to generate documents synthesized and translated into Spanish or other languages that can bring this information to all the places and countries that are being impacted by this disease.

ANTECEDENTES: El brote de la enfermedad por coronavirus 2019 o COVID-19 se expandió rápidamente por todo el mundo. El alcance y efecto final aún no es claro, ya que es una pandemia en curso y constante evolución. OBJETIVOS: Recopilar la literatura y sintetizar en idioma español-latinoamericano la información internacional disponible que describa los aspectos etiológicos, fisiopatológicos, epidemiológicos y manejo de COVID-19. MÉTODO: Revisión narrativa. Se utilizaron apartados específicos creados en las bases de datos. Los criterios para seleccionar estudios dependieron del ámbito específico tratado: aspectos etiológicos, fisiopatológicos, epidemiológicos, alternativas de tratamiento, entre otras. Se incluyeron trabajos en idioma inglés y español. RESULTADOS: La Organización Mundial de la Salud informó que COVID-19 es una enfermedad de origen zoonótico que se transmitió a un huésped humano. Se identificaron los primeros casos a fines de 2019 y enero de 2020, en la ciudad de Wuhan, China. Esta enfermedad se catalogó como altamente contagiosa y transmisible entre los humanos, características estructurales particulares que se atribuyen a este nuevo coronavirus. La presentación clínica es variable e inespecífica, al igual que su gravedad. Los casos más severos pueden desarrollar neumonía, insuficiencia respiratoria, falla multiorgánica y, con esto, la muerte, presentando un claro tropismo por el sistema respiratorio. Se presenta en todas las edades, con un menor porcentaje en menores de 19 años (2,4%). La mortalidad varía entre países y regiones (entre 1,5 y 9,3% del total casos reportados). Los factores de riesgo asociados son la presencia de comorbilidades, edad avanzada e inmunodepresión. CONCLUSIONES: A la fecha de redacción de este trabajo, han surgido miles de artículos científicos que intentan explicar el inicio, progresión, posibles tratamientos e impacto mundial de la enfermedad. Aún no hay certeza del nivel o calidad de esta evidencia. Es imprescindible generar documentos sintetizados y traducidos al español, u otros idiomas, que puedan llevar esta información a todos los lugares y países que están siendo impactados producto de esta enfermedad.

Effectiveness of Telerehabilitation in Physical Therapy: A Rapid Overview.

OBJECTIVE: The purpose of this article was to summarize the available evidence from systematic reviews on telerehabilitation in physical therapy. METHODS: We searched Medline/PubMed, EMBASE, and Cochrane Library databases. In addition, the records in PROSPERO and Epistemonikos and PEDro were consulted. Systematic reviews of different conditions, populations, and contexts-where the intervention to be evaluated is telerehabilitation by physical therapy-were included. The outcomes were clinical effectiveness depending on specific condition, functionality, quality of life, satisfaction, adherence, and safety. Data extraction and risk of bias assessment were carried out by a reviewer with non-independent verification by a second reviewer. The findings are reported qualitatively in the tables and figures. RESULTS: Fifty-three systematic reviews were included, of which 17 were assessed as having low risk of bias. Fifteen reviews were on cardiorespiratory rehabilitation, 14 on musculoskeletal conditions, and 13 on neurorehabilitation. The other 11 reviews addressed other types of conditions and rehabilitation. Thirteen reviews evaluated with low risk of bias showed results in favor of telerehabilitation versus in-person rehabilitation or no rehabilitation, while 17 reported no differences between the groups. Thirty-five reviews with unclear or high risk of bias showed mixed results. CONCLUSIONS: Despite the contradictory results, telerehabilitation in physical therapy could be comparable with in-person rehabilitation or better than no rehabilitation for conditions such as osteoarthritis, low-back pain, hip and knee replacement, and multiple sclerosis and also in the context of cardiac and pulmonary rehabilitation. It is imperative to conduct better quality clinical trials and systematic reviews. IMPACT: Providing the best available evidence on the effectiveness of telerehabilitation to professionals, mainly physical therapists, will impact the decision-making process and therefore yield better clinical outcomes for patients, both in these times of the COVID-19 pandemic and in the future. The identification of research gaps will also contribute to the generation of relevant and novel research questions.

Effectiveness of telerehabilitation in physical therapy: A protocol for an overview in a time when rapid responses are needed. / Efectividad de la telerehabilitación en terapia física: protocolo de una revisión global en tiempos que exigen respuestas rápidas.

INTRODUCTION: Rehabilitation and physical therapy have been adapting to the telehealth era, increasing accessibility and improving the continuity of attention in geographically remote populations with disabilities. Due to the spread of infection by SARS-CoV-2, many professionals have had to adapt their work to telerehabilitation practices, which require the best evidence at short notice and in summarized form. In this context, this protocol has been developed to evaluate the effectiveness of telerehabilitation as a care strategy in physical therapy for different conditions, populations, and contexts. METHOD AND ANALYSIS: An overview will be carried out in the format of a rapid review. It will include systematic reviews of different conditions, populations, and contexts, where the intervention to be evaluated is telerehabilitation by physical therapy. The outcomes considered will be clinical effectiveness depending on the specific condition, functionality, quality of life, satisfaction, adherence, and safety. A search will be carried out of the MEDLINE/PubMed, EMBASE, and Cochrane Library databases. Studies will be selected in duplicate with any discrepancies resolved by a third reviewer. Data extraction and risk of bias assessment will be carried out by a reviewer with non-independent verification by a second reviewer. The findings will be reported qualitatively by tables and figures. ETHICS AND DISSEMINATION: The principles of the value of the research question, the methodological rigor, scientifically qualified investigators, an independent evaluation of the protocol, and timely and accurate publication of the results will be complied with. The complete review will lead to the publication of at least one article, and the results will be widely disseminated at various levels of decision-making. REGISTER: This protocol has been registered in PROSPERO with the number CRD42020185640.

INTRODUCCIÓN: La rehabilitación y las acciones de terapia física se han ido adaptando a la era de la telesalud, permitiendo aumentar la accesibilidad y mejorar la continuidad de la atención en poblaciones con discapacidades y alejadas geográficamente. En la actualidad, y debido a expansión de la infección por SARS-CoV-2, muchos profesionales han debido adaptar su trabajo a una modalidad de telerehabilitación, por lo que es necesario acceder a la mejor evidencia disponible de manera resumida y oportuna. Es en este contexto que se ha desarrollado el presente protocolo, con el objetivo de evaluar la efectividad de la telerehabilitación como estrategia de atención en terapia física para diferentes condiciones, poblaciones y contextos. MÉTODO Y ANÁLISIS: Se conducirá una revisión global o revisión de revisiones, en un formato de revisión rápida siguiendo las recomendaciones PRISMA-P. Se incluirán revisiones sistemáticas de diferentes condiciones, poblaciones y contextos, donde la intervención a evaluar es la telerehabilitación en terapia física. Los desenlaces de interés a considerar son la efectividad clínica dependiendo de la condición específica, la funcionalidad, calidad de vida, satisfacción, adherencia y seguridad. Se realizará una búsqueda en las bases de datos MEDLINE/PubMed, EMBASE y Cochrane Library. La selección de los estudios será realizada en duplicado con resolución de discrepancias por un tercer revisor. La extracción de datos y la evaluación del riesgo de sesgos serán realizadas por un revisor con verificación no independiente de un segundo revisor. Los hallazgos serán reportados cualitativamente a través de tablas y figuras. ÉTICA Y DISEMINACIÓN: Se considera el cumplimiento de los principios éticos del valor de la pregunta de investigación, rigor metodológico, investigadores científicamente cualificados, evaluación independiente del protocolo y publicación puntual y precisa de los resultados. Se espera publicar la revisión completa en al menos un artículo y los resultados se difundirán ampliamente en diversos niveles de decisión. REGISTRO: El protocolo está registrado en PROSPERO con el número CRD42020185640.

Knowledge translation strategies for dissemination with a focus on healthcare recipients: an overview of systematic reviews.

BACKGROUND: While there is an ample literature on the evaluation of knowledge translation interventions aimed at healthcare providers, managers, and policy-makers, there has been less focus on patients and their informal caregivers. Further, no overview of the literature on dissemination strategies aimed at healthcare users and their caregivers has been conducted. The overview has two specific research questions: (1) to determine the most effective strategies that have been used to disseminate knowledge to healthcare recipients, and (2) to determine the barriers (and facilitators) to dissemination of knowledge to this group. METHODS: This overview used systematic review methods and was conducted according to a pre-defined protocol. A comprehensive search of ten databases and five websites was conducted. Both published and unpublished reviews in English, Spanish, or Portuguese were included. A methodological quality assessment was conducted; low-quality reviews were excluded. A narrative synthesis was undertaken, informed by a matrix of strategy by outcome measure. The Health System Evidence taxonomy for "consumer targeted strategies" was used to separate strategies into one of six categories. RESULTS: We identified 44 systematic reviews that describe the effective strategies to disseminate health knowledge to the public, patients, and caregivers. Some of these reviews also describe the most important barriers to the uptake of these effective strategies. When analyzing those strategies with the greatest potential to achieve behavioral changes, the majority of strategies with sufficient evidence of effectiveness were combined, frequent, and/or intense over time. Further, strategies focused on the patient, with tailored interventions, and those that seek to acquire skills and competencies were more effective in achieving these changes. In relation to barriers and facilitators, while the lack of health literacy or e-literacy could increase inequities, the benefits of social media were also emphasized, for example by widening access to health information for ethnic minorities and lower socioeconomic groups. CONCLUSIONS: Those interventions that have been shown to be effective in improving knowledge uptake or health behaviors should be implemented in practice, programs, and policies-if not already implemented. When implementing strategies, decision-makers should consider the barriers and facilitators identified by this overview to ensure maximum effectiveness. PROTOCOL REGISTRATION: PROSPERO: CRD42018093245.

¿Cómo y Cuánto se Mueven los Adultos que sufrieron un Evento Coronario un Año después de haber entrado a un Programa de Rehabilitación Cardiaca? / How and How Much Do Adults Who Suffered a Coronary Event Move One Year After Entering a Cardiac Rehabilitation Program?

Introducción. Establecer un estilo de vida activo y saludable es uno de los objetivos más importantes y desafiantes de la rehabilitación cardíaca. Comprender el comportamiento de los patrones de actividad física (AF) en adultos que han sufrido un evento coronario y que han participado en un programa de Rehabilitación Cardíaca (RC) es necesario para evaluar su impacto y proponer estrategias oportunas en esta área. Objetivo. Evaluar el cumplimiento de la recomendación global de AF 1 año después de ingresar a un programa de RC para enfermedad arterial coronaria. Métodos. Se aplicó el Cuestionario Internacional de Actividad Física a adultos con enfermedad coronaria tratada a los 6 y 12 meses de su ingreso a un programa de Rehabilitación Cardíaca en 6 hospitales de Chile, entre mayo de 2019 y febrero de 2020 en el contexto del estudio aleatorizado. Se realizó un ensayo clínico multicéntrico de no inferioridad (Hybrid Cardiac Rehabilitation Trial, HYCARET). Resultados. 117 participantes (74 hombres, edad 59,34 ±9,52 años, 83,4±27,2% de adherencia a la RC) físicamente activos al final de un programa de RC fueron evaluados a los 6 y 12 meses desde el ingreso para determinar su adherencia a la AF. La tasa de seguimiento fue del 94,01% a los 6 meses (6m) y del 78,63% a los 12 meses (12m). El 90% de los participantes seguían físicamente activos a los 6 meses y el 92,39% seguían activos a los 12 meses después del evento coronario. Un 5,98% fueron clasificados como inactivos a los 6 m pero estaban físicamente activos al año. En contraste, sólo el 0,85% se volvió inactivo a los 6 meses y permaneció inactivo hasta 1 año, mientras que el 4,27% se reportó como activo a los 6 meses, pero terminó estando inactivo al año. La AF relacionada con las tareas del hogar es responsable del 40% y más del gasto calórico total de los adultos después de un evento coronario en todo momento. El gasto calórico relacionado con actividades recreativas y transporte disminuyó a los 6 y 12 meses, mientras que el gasto calórico asociado con el trabajo y las actividades domésticas aumentó a los 6 y 12 meses después de completar un programa de RC. Conclusión. Los adultos que completan un programa de RC continúan activos 6 y 12 meses después de un evento coronario. Sin embargo, las actividades que generan mayor gasto calórico varían con el tiempo. Este hallazgo resalta la importancia de fomentar la actividad física como parte del tiempo de ocio y recreación en los adultos, ya que se sabe que su beneficio es mayor.

Background. Establishing a healthy, active lifestyle is one of the most important and challenging goals of cardiac rehabilitation. Understanding the behavior of physical activity (PA) patterns in adults who have suffered a coronary event and who have participated in a Cardiac Rehabilitation (CR) program is necessary to evaluate its impact and propose timely strategies in this area. Objetive. To evaluate compliance with the global PA recommendation 1 year after entering a CR program for coronary artery disease. Methods. The International Physical Activity Questionnaire was applied to adults with coronary heart disease treated 6 and 12 months after admission to a Cardiac Rehabilitation program in 6 hospitals in Chile, between May 2019 and February 2020 in the context of the randomized study. A multicenter non-inferiority clinical trial (Hybrid Cardiac Rehabilitation Trial, HYCARET) was conducted. Results. 117 participants (74 men, age 59.34 ± 9.52 years, 83.4 ± 27.2% adherence to CR) physically active at the end of a CR program were evaluated at 6 and 12 months from entry. to determine their adherence to PA. The follow-up rate was 94.01% at 6 months (6m) and 78.63% at 12 months (12m). 90% of participants were still physically active at 6 months and 92.39% were still active at 12 months after the coronary event. 5.98% were classified as inactive at 6 m but were physically active at one year. In contrast, only 0.85% became inactive at 6 months and remained inactive for up to 1 year, while 4.27% reported themselves as active at 6 months but ended up being inactive at one year. Housework-related PA is responsible for 40% and more of adults' total caloric expenditure after a coronary event at all times. Caloric expenditure related to recreational activities and transportation decreased at 6 and 12 months, while caloric expenditure associated with work and home activities increased at 6 and 12 months after completing a CR program. Conclusion. Adults who complete a CR program remain active 6 and 12 months after a coronary event. However, the activities that generate the greatest caloric expenditure vary over time. This finding highlights the importance of promoting physical activity as part of leisure and recreation time in adults, since it is known that its benefit is greater.

Cost-Effectiveness of Exercise-Based Cardiac Rehabilitation in Chilean Patients Surviving Acute Coronary Syndrome.

PURPOSE: To assess the cost-effectiveness of 3 models of exercise-based cardiac rehabilitation (CR) compared with standard care in survivors of acute coronary syndrome (ACS) within the public health system in Chile. METHODS: A Markov model was designed using 5 health states: ACS survivor, second ACS, complications, general mortality, and cardiovascular mortality. The transition probabilities between health states for standard care and corresponding relative risk for CR were calculated from a systematic review. Health benefits were measured with the EuroQol 5-dimensional 3-level (EQ-5D-3L) survey. Costs for each health state were quantified using the national cost verification study. The CR cost was estimated with a microcosting methodology. The time horizon was a lifetime and the discount rate was 3% per year for costs and benefits. Deterministic and probabilistic analyses were performed. Structural uncertainty was managed by designing 3 scenarios: CR as currently delivered in a specific Chilean public health center, CR as recommended by South American guidelines, and CR as proposed for low-resource settings. RESULTS: Cardiac rehabilitation versus standard care showed an incremental cost-effectiveness ratio for the standard model of $722, for the South American model of $1247, and for the low-resource model of $666. The tornado diagram showed higher uncertainty in relative risk for the complications state and for the second ACS state. CONCLUSION: Considering a cost-effectiveness threshold of 1 unit of gross domestic product per capita (∼$19 000), CR is highly cost-effective for the public health system in Chile.

Efectividad de la telerehabilitación en terapia física: protocolo de una revisión global en tiempos que exigen respuestas rápidas / Effectiveness of telerehabilitation in physical therapy: a protocol for an overview in a time when rapid responses are needed

INTRODUCCIÓN: La rehabilitación y las acciones de terapia física se han ido adaptando a la era de la telesalud, permitiendo aumentar la accesibilidad y mejorar la continuidad de la atención en poblaciones con discapacidades y alejadas geográficamente. En la actualidad, y debido a expansión de la infección por SARS-CoV-2, muchos profesionales han debido adaptar su trabajo a una modalidad de telerehabilitación, por lo que es necesario acceder a la mejor evidencia disponible de manera resumida y oportuna. Es en este contexto que se ha desarrollado el presente protocolo, con el objetivo de evaluar la efectividad de la telerehabilitación como estrategia de atención en terapia física para diferentes condiciones, poblaciones y contextos. MÉTODO Y ANÁLISIS: Se conducirá una revisión global o revisión de revisiones, en un formato de revisión rápida siguiendo las recomendaciones PRISMA-P. Se incluirán revisiones sistemáticas de diferentes condiciones, poblaciones y contextos, donde la intervención a evaluar es la telerehabilitación en terapia física. Los desenlaces de interés a considerar son la efectividad clínica dependiendo de la condición específica, la funcionalidad, calidad de vida, satisfacción, adherencia y seguridad. Se realizará una búsqueda en las bases de datos MEDLINE/PubMed, EMBASE y Cochrane Library. La selección de los estudios será realizada en duplicado con resolución de discrepancias por un tercer revisor. La extracción de datos y la evaluación del riesgo de sesgos serán realizadas por un revisor con verificación no independiente de un segundo revisor. Los hallazgos serán reportados cualitativamente a través de tablas y figuras. ÉTICA Y DISEMINACIÓN: Se considera el cumplimiento de los principios éticos del valor de la pregunta de investigación, rigor metodológico, investigadores científicamente cualificados, evaluación independiente del protocolo y publicación puntual y precisa de los resultados. Se espera publicar la revisión completa en al menos un artículo y los resultados se difundirán ampliamente en diversos niveles de decisión.

INTRODUCTION: Rehabilitation and physical therapy have been adapting to the telehealth era, increasing accessibility and improving the continuity of attention in geographically remote populations with disabilities. Due to the spread of infection by SARS-CoV-2, many professionals have had to adapt their work to telerehabilitation practices, which require the best evidence at short notice and in summarized form. In this context, this protocol has been developed to evaluate the effectiveness of telerehabilitation as a care strategy in physical therapy for different conditions, populations, and contexts. METHOD AND ANALYSIS: An overview will be carried out in the format of a rapid review. It will include systematic reviews of different conditions, populations, and contexts, where the intervention to be evaluated is telerehabilitation by physical therapy. The outcomes considered will be clinical effectiveness depending on the specific condition, functionality, quality of life, satisfaction, adherence, and safety. A search will be carried out of the MEDLINE/PubMed, EMBASE, and Cochrane Library databases. Studies will be selected in duplicate with any discrepancies resolved by a third reviewer. Data extraction and risk of bias assessment will be carried out by a reviewer with non-independent verification by a second reviewer. The findings will be reported qualitatively by tables and figures. ETHICS AND DISSEMINATION: The principles of the value of the research question, the methodological rigor, scientifically qualified investigators, an independent evaluation of the protocol, and timely and accurate publication of the results will be complied with. The complete review will lead to the publication of at least one article, and the results will be widely disseminated at various levels of decision-making.