Rehabilitation in primary care for an ageing population: a secondary analysis from a scoping review of rehabilitation delivery models.

BACKGROUND: The world population is ageing rapidly. Rehabilitation is one of the most effective health strategies for improving the health and functioning of older persons. An understanding of the current provision of rehabilitation services in primary care (PC) is needed to optimise access to rehabilitation for an ageing population. The objectives of this scoping review are a) to describe how rehabilitation services are currently offered in PC to older persons, and b) to explore age-related differences in the type of rehabilitation services provided. METHODS: We conducted a secondary analysis of a scoping review examining rehabilitation models for older persons, with a focus on PC. Medline and Embase (2015-2022) were searched to identify studies published in English on rehabilitation services for people aged 50 + . Two authors independently screened records and extracted data using the World Health Organization (WHO)'s operational framework, the Primary Health Care Systems (PRIMASYS) approach and the WHO paper on rehabilitation in PC. Data synthesis included quantitative and qualitative analysis. RESULTS: We synthesised data from 96 studies, 88.6% conducted in high-income countries (HICs), with 31,956 participants and identified five models for delivering rehabilitation to older persons in PC: community, home, telerehabilitation, outpatient and eldercare. Nurses, physiotherapists, and occupational therapists were the most common providers, with task-shifting reported in 15.6% of studies. The most common interventions were assessment of functioning, rehabilitation coordination, therapeutic exercise, psychological interventions, and self-management education. Environmental adaptations and assistive technology were rarely reported. CONCLUSIONS: We described how rehabilitation services are currently provided in PC and explored age-related differences in the type of rehabilitation services received. PC can play a key role in assessing functioning and coordinating the rehabilitation process and is also well-placed to deliver rehabilitation interventions. By understanding models of rehabilitation service delivery in PC, stakeholders can work towards developing more comprehensive and accessible services that meet the diverse needs of an ageing population. Our findings, which highlight the role of rehabilitation in healthy ageing, are a valuable resource for informing policy, practice and future research in the context of the United Nations Decade of Healthy Ageing, the Rehab2030 initiative and the recently adopted WHA resolution on strengthening rehabilitation in health systems, but the conclusions can only be applied to HICs and more studies are needed that reflect the reality in low- and middle-income countries.

Discapacidad y calidad de vida después de un accidente de tránsito en Medellín y su área metropolitana. Estudio de cohorte

Objetivo: Comparar al año, el funcionamiento, calidad de vida (cv), dolor y depresión entre adultos menores y mayores de 60 años que tuvieron lesiones moderadas y graves en accidentes de tránsito ocurridos en Medellín y su área metropolitana. Metodología: Análisis secundario de dos cohortes de pacientes con lesiones moderadas y graves ocurridas en Medellín y su área metropolitana en 2009-2010 y 2015-2016. Se hizo evaluación para el funcionamiento, la cv, depresión y el dolor, con instrumentos validados para ello. Las diferencias entre las cohortes 12 meses después del accidente se compararon con t-Student. Se hizo un análisis de regresión lineal múltiple para determinar los factores explicativos de discapacidad y cv. Resultados: Se incluyeron 837 pacientes, de los cuales el 84,8 % completó el seguimiento. La motocicleta fue el principal vehículo involucrado (86,1 y 60,7 %). Se observó mejor funcionamiento en mayores de 60 años en cuidado personal, y mayor compromiso en las actividades de la vida diaria, laborales y funcionamiento global. La cv fue significativamente mejor en menores, en desempeño emocional, desempeño físico y función física. En el análisis multivariado, el mayor compromiso en el funcionamiento fue explicado por ser mujer, tener más edad, lesión más grave, mayor dolor y depresión. La mejor cv fue explicada por ser hombre, menos edad, menor gravedad de la lesión, dolor y síntomas depresivos. Conclusiones: La edad, el sexo, la gravedad de la lesión, el dolor y la depresión explican la discapacidad y las dimensiones de la cv 12 meses después del accidente de tránsito.

Objective: To compare functioning, quality of life (QoL), pain, and depression at one year between adults under and over 60 years of age who had moderate and severe injuries in traffic accidents in Medellin and its metropolitan area. Methodology: Secondary analysis of two cohorts of patients with moderate and severe injuries that occurred in Medellín and its metropolitan area in 2009-2010 and 2015-2016. They were evaluated at baseline and 12 months with functioning (who-das ii), QoL (sf-36), pain (vas), and depression (phq-9). The differences between cohorts 12 months after the accident were compared with t-Student test. A multiple linear regression analysis was done to determine factors related to disability and QoL. Results: 837 patients were included, 84,8% completed the follow-up. The motorcycle was the main vehicle involved (86,1% vs. 60,7). Better functioning was observed in people over 60 years of age in personal care, and greater commitment in activities of daily living, work and global functioning. QoL was significantly better in minors, in emotional performance, physical performance and physical function. In the multivariate analysis, the greater compromise in functioning was explained by being female, older, more severe injury, greater pain, and depression. The best QoL was explained by being male, younger, less severe injury, pain, and depressive symptoms. Conclusions: Age, sex, injury severity, pain, and depression explain disability and QoL dimensions 12 months after the traffic accident.

Objetivo: Comparar a funcionalidade, qualidade de vida (QV), dor e depressão entre adultos com menos e mais de 60 anos de idade que sofreram lesões moderadas e graves em acidentes de trânsito ocorridos em Medellín e sua região metropolitana. Metodologia: Análise secundária de duas coortes de pacientes com lesões moderadas e graves que ocorreram em Medellín e sua área metropolitana em 2009-2010 e 2015-2016. Foi feita avaliação funcional, cv, depressão e dor, com instrumentos validados para isso. As diferenças entre as coortes 12 meses após o acidente foram comparadas com o teste t de Student. Uma análise de regressão linear múltipla foi realizada para determinar os fatores explicativos para deficiência e cv. Resultados: foram incluídos 837 pacientes, dos quais 84,8% completaram o seguimento. A motocicleta foi o principal veículo envolvido (86,1 e 60,7%). Melhor funcionamento foi observado em pessoas com mais de 60 anos nos cuidados pessoais e maior comprometimento nas atividades de vida diária, trabalho e funcionamento global. A QV foi significativamente melhor nos menores, no desempenho emocional, no desempenho físico e na função física. Na análise multivariada, o maior comprometimento funcional foi explicado por ser mulher, ser mais velho, lesão mais grave, maior dor e depressão. A melhor QV foi explicada por ser homem, menor idade, menor gravidade da lesão, dor e sintomas depressivos. Conclusões: Idade, sexo, gravidade da lesão, dor e depressão explicam as dimensões de incapacidade e QV 12 meses após o acidente de trânsito.

Participación de pacientes en la guía de práctica clínica de baja visión / Involvement of patients in the clinical practice guideline for low vision / Participação de pacientes na diretriz de prática clínica de visão subnormal

Objetivo: como parte de la elaboración de una guía de práctica clínica (GPC) para el cuidado de personas con baja visión en Colombia, se recomienda incluir la participación de pacientes. El objetivo fue identificar los aspectos de la vida cotidiana que se ven más afectados por la baja visión, los cuales se deben trabajar en un proceso de rehabilitación de la visión y así reconocer las barreras para acceder a ese proceso. Además, se pretende calificar la importancia de los desenlaces para los pacientes y sus cuidadores. Metodología: pacientes con baja visión y sus familiares fueron invitados a participar en un grupo focal que indagó por sus percepciones sobre los aspectos más afectados por la baja visión, los elementos más importantes de los procesos de rehabilitación de la visión y sus barreras más frecuentes. Resultados: se reportaron dificultades en la realización de las actividades instrumentales, como el uso del computador o celular, el uso del transporte público, el manejo del dinero, ir de compras, la movilidad y la orientación. La rehabilitación de la visión exitosa fue definida como aquella que les permite recuperar la independencia y ganar confianza en sí mismos. Las intervenciones de rehabilitación que mejoren las capacidades de orientación y movilidad, que incluyan acompañamiento psicológico para el paciente y la familia y que cuenten con enfoques grupales fueron altamente apreciadas. Las barreras administrativas fueron las más mencionadas. Conclusión: estos resultados apoyaron la toma de decisiones en el desarrollo de las recomendaciones de la GPC para personas con baja visión en Colombia.

Objective: As part of the development of a clinical practice guideline (CPG) for the care of individuals with low vision in Colombia, it is recommended to include patient involvement. The objective was to identify aspects of daily life most affected by low vision, which should be addressed in a vision rehabilitation process, and to recognize barriers to accessing that process. Additionally, the aim was to assess the importance of outcomes for patients and their caregivers. Methodology: Patients with low vision and their family members were invited to participate in a focus group that explored their perceptions regarding the most affected aspects of low vision, the key elements of vision rehabilitation processes, and the most common barriers they face. Results: Difficulties were reported in performing instrumental activities such as computer or cellphone use, using public transportation, handling money, shopping, mobility, and orientation. Successful vision rehabilitation was defined as the ability to recover independence and gain self-confidence. Rehabilitation interventions that improve orientation and mobility skills, include psychological support for patients and their families, and incorporate group approaches were highly valued. Administrative barriers were the most frequently mentioned.

Objetivo: Como parte do desenvolvimento de uma diretriz de prática clínica (CPG) para o atendimento de pessoas com baixa visão na Colômbia, recomenda-se incluir a parti-cipação dos pacientes. O objetivo foi identificar os aspectos do cotidiano mais afetados pela baixa visão, que devem ser trabalhados em um processo de reabilitação da visão e assim reconhecer as barreiras para acessar esse processo. Além disso, pretende-se qualificar a importância dos desfechos para os pacientes e seus cuidadores. Metodologia: os pacientes com baixa visão e seus familiares foram convidados a par-ticipar de um grupo focal que indagou sobre suas percepções sobre os aspectos mais afetados pela baixa visão, os elementos mais importantes dos processos de reabilitação da visão e suas barreiras mais frequentes. Resultados: foram relatadas dificuldades na realização de atividades instrumentais, como uso do computador ou celular, uso de transporte público, administração do dinheiro, compras, locomoção e orientação. A reabilitação visual bem-sucedida foi definida como aquela que lhes permite recuperar a independência e ganhar autoconfiança. Intervenções de reabilitação que melhoram as habilidades de orientação e mobilidade, que incluem apoio psicológico para o paciente e a família e que têm abordagens em grupo foram muito apreciadas. As barreiras administrativas foram as mais mencionadas. Conclusão: estes resultados apoiaram a tomada de decisões no desenvolvimento das recomendações CPG para pessoas com baixa visão na Colômbia.

Factors that influence the provision of home-based rehabilitation services for people needing rehabilitation: a qualitative evidence synthesis.

BACKGROUND: To increase people's access to rehabilitation services, particularly in the context of the COVID-19 pandemic, we need to explore how the delivery of these services can be adapted. This includes the use of home-based rehabilitation and telerehabilitation. Home-based rehabilitation services may become frequently used options in the recovery process of patients, not only as a solution to accessibility barriers, but as a complement to the usual in-person inpatient rehabilitation provision. Telerehabilitation is also becoming more viable as the usability and availability of communication technologies improve. OBJECTIVES: To identify factors that influence the organisation and delivery of in-person home-based rehabilitation and home-based telerehabilitation for people needing rehabilitation. SEARCH METHODS: We searched PubMed, Global Health, the VHL Regional Portal, Epistemonikos, Health Systems Evidence, and EBM Reviews as well as preprints, regional repositories, and rehabilitation organisations websites for eligible studies, from database inception to search date in June 2022.  SELECTION CRITERIA: We included studies that used qualitative methods for data collection and analysis; and that explored patients, caregivers, healthcare providers and other stakeholders' experiences, perceptions and behaviours about the provision of in-person home-based rehabilitation and home-based telerehabilitation services responding to patients' needs in different phases of their health conditions.   DATA COLLECTION AND ANALYSIS: We used a purposive sampling approach and applied maximum variation sampling in a four-step sampling frame. We conducted a framework thematic analysis using the CFIR (Consolidated Framework for Implementation Research) framework as our starting point. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach.  MAIN RESULTS: We included 223 studies in the review and sampled 53 of these for our analysis. Forty-five studies were conducted in high-income countries, and eight in low-and middle-income countries. Twenty studies addressed in-person home-based rehabilitation, 28 studies addressed home-based telerehabilitation services, and five studies addressed both modes of delivery. The studies mainly explored the perspectives of healthcare providers, patients with a range of different health conditions, and their informal caregivers and family members.  Based on our GRADE-CERQual assessments, we had high confidence in eight of the findings, and moderate confidence in five, indicating that it is highly likely or likely respectively that these findings are a reasonable representation of the phenomenon of interest. There were two findings with low confidence. High and moderate confidence findings Home-based rehabilitation services delivered in-person or through telerehabilitation  Patients experience home-based services as convenient and less disruptive of their everyday activities. Patients and providers also suggest that these services can encourage patients' self-management and can make them feel empowered about the rehabilitation process. But patients, family members, and providers describe privacy and confidentiality issues when services are provided at home. These include the increased privacy of being able to exercise at home but also the loss of privacy when one's home life is visible to others.  Patients and providers also describe other factors that can affect the success of home-based rehabilitation services. These include support from providers and family members, good communication with providers, the requirements made of patients and their surroundings, and the transition from hospital to home-based services. Telerehabilitation specifically Patients, family members and providers see telerehabilitation as an opportunity to make services more available. But providers point to practical problems when assessing whether patients are performing their exercises correctly. Providers and patients also describe interruptions from family members.  In addition, providers complain of a lack of equipment, infrastructure and maintenance and patients refer to usability issues and frustration with digital technology. Providers have different opinions about whether telerehabilitation is cost-efficient for them. But many patients see telerehabilitation as affordable and cost-saving if the equipment and infrastructure have been provided. Patients and providers suggest that telerehabilitation can change the nature of their relationship. For instance, some patients describe how telerehabilitation leads to easier and more relaxed communication. Other patients describe feeling abandoned when receiving telerehabilitation services.  Patients, family members and providers call for easy-to-use technologies and more training and support. They also suggest that at least some in-person sessions with the provider are necessary. They feel that telerehabilitation services alone can make it difficult to make meaningful connections. They also explain that some services need the provider's hands. Providers highlight the importance of personalising the services to each person's needs and circumstances. AUTHORS' CONCLUSIONS: This synthesis identified several factors that can influence the successful implementation of in-person home-based rehabilitation and telerehabilitation services. These included factors that facilitate implementation, but also factors that can challenge this process. Healthcare providers, program planners and policymakers might benefit from considering these factors when designing and implementing programmes.

Psychometric Properties of Scales for Assessing the Vision-related Quality of Life of People with Low Vision: A Systematic Review.

OBJECTIVE: To synthesize information on the psychometric properties of scales used to assess vision-related quality of life in people with low vision. METHODS: A systematic review was conducted. The Cochrane Library, Embase, PubMed, Bireme and Epistemonikos databases were consulted in July 2020. Eligibility assessment of abstracts and full texts was performed independently by two investigators.A standardized template was used for data extraction regarding study design, scale and version, clinical condition of participants, and psychometric properties measured, using database-specific controlled vocabulary terms for low vision and keywords for vision-related quality of life and validity. Data was synthesized considering two approaches for scales validations, Classical Test Theory and Rasch Analysis. RESULTS: A total of 53 articles were included in our analysis. In total, 40 studies evaluated the NEI VFQ scale, four evaluated the IVI scale, two evaluated the VA LV VFQ instrument and seven validated the LVQOL scale. This review found that the VRQoL NEI VFQ, IVI, LVQOL and VA LV VFQ-48 scales have adequate psychometric properties, with good internal consistency, when assessed using the CTT approach. The NEI VFQ scale also showed adequate test-retest reliability and adequate construct and content validity. The NEI VFQ and LVQOL scales showed inadequate items and multidimensionality when Rasch analysis was used. The IVI scale showed potential for assessing change in HRQoL after providing interventions to patients with low vision. CONCLUSIONS: Many questionnaires exist to measure vision-related quality of life in people with low vision, but the psychometric properties of the questionnaires are variable.

Situación de la medicina física y rehabilitación en Colombia: descripción desde la perspectiva de los profesionales / The situation of Physical Medicine and Rehabilitation in Colombia: Description from the perspective of professionals

En 2019, 2.410 millones de personas alrededor del mundo tenían condiciones que podrían beneficiarse de servicios de rehabilitación en algún momento durante el curso de su enfermedad, lo que contribuyó a 310 millones de años de vida vividos con discapacidad. Se estima que para finales del siglo XXI la rehabilitación será la estrategia sanitaria que optimice el funcionamiento de las personas con condiciones agudas, crónicas y causadas por el envejecimiento, por lo que el presente articulo aborda la situación actual de la especialidad en medicina física y rehabilitación en Colombia desde una visión del Grupo de Rehabilitación en Salud de la Universidad de Antioquia. De este modo, se hace una aproximación sobre la prestación de servicios en rehabilitación, los programas de formación en pregrado y postgrado, los recursos humanos disponibles en el área y la investigación en esta especialidad.

In 2019, 2.41 billion people around the world had conditions that could benefit from rehabilitation services at some point during the course of their disease, which contributed to 310 million years lived with disability. It is estimated that by the end of the 21st Century, rehabilitation will be the health strategy that optimizes the functioning of people with acute, chronic and agingrelated conditions, which is why this article addresses the current situation of the specialty of physical medicine and rehabilitation in Colombia from the view of the Health Rehabilitation Group of the University of Antioquia. In this way, an approach is made about the provision of rehabilitation services, the undergraduate and postgraduate training programs, the human resources available in the area and the research in this specialty

Development of a Clinical Practice Guideline for Lower Limb Amputees. A Knowledge Translation Process in a Middle Income Country.

Background and Aim: Knowledge translation processes are necessary for improving patients' and communities' health outcomes. The aim of this study was to systematically develop evidence-based recommendations for people over 16 years of age who are in risk for or have suffered a lower limb amputation for medical reasons (vascular, diabetes mellitus) or trauma (civilian or military trauma) in order to improve function, quality of life, decrease complications and morbidity. Methods: Following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach we developed a Clinical Practice Guideline (CPG) for lower limb amputees with funding from the Ministry of Health in Colombia and participation of a multidisciplinary group. We included patients' preferences. Based on the scope, purposes and objectives the questions were elaborated with the PECOT strategy. The evidence search was performed for each question in the main databases: Cochrane Library, Embase and PubMed, without time limit or language restriction. Teams were formed with thematic experts and clinical epidemiologists to review the clinical studies, describe the evidence, and evaluate the quality of the body of evidence with the GRADE methodology. The recommendations were made according to the judgments proposed by the GRADE working group. We conducted a stakeholder's dialogue as a mechanism for the external validation of the guideline implementation. Results: The CPG included 43 recommendations related to the diagnosis, surgical treatment, rehabilitation, prescription and adaptation of the prosthesis. They were strong in favor 37.2, weak in favor 53.5, strong against 2.3, Weak against 7.0%. Quality of evidence was high in 0, moderate in 11.6, low in 58.1, and very low 30.2%. Discussion: In 93% of the recommendations, the quality of the evidence was between low and very low. This is why it was so important to validate and discuss each recommendation with an expanded multidisciplinary group. The research group identified 25 interventions and five milestones to be prioritized in the implementation and in the stakeholder's dialogue participants identified opportunities and barriers for implementation of recommendations. Conclusion: It is necessary to develop a national policy for implementation strategies of CPG recommendations that promotes the necessary arrangements for the provision of services for diagnosis, treatment, and rehabilitation of individuals with amputations.

Ruta integral de atención en salud para personas con amputaciones de miembro inferior, para mejorar el funcionamiento y la calidad de vida / Integral pathway of health care for people with lower limb amputations, to improve the functioning and quality of life / Rota abrangente de cuidados de saúde de pessoas com amputações de membros inferiores, para melhorar o funcionamento e qualidade de vida

Resumen Objetivo: Presentar el estudio mediante el cual se construyó una ruta integral de atención en salud (RIAS) para la atención del paciente amputado de miembro inferior por causas traumática, vascular o diabetes mellitus, cuyo fin es implementar las recomendaciones de la Guía de práctica clínica del paciente amputado y garantizar la atención integral en salud de esta población en Colombia. Con la ruta se pretende orientar a los actores involucrados en la ejecución de intervenciones individuales para el diagnóstico, el tratamiento y la rehabilitación, e impactar en los desenlaces en salud y equidad de esta población. Metodología: Este estudio responde a una estrategia de mejoramiento de la atención en salud. Para esto, se revisó el Manual metodológico para la elaboración e implementación de las RIAS; se creó el grupo desarrollador de la ruta; se priorizaron y describieron las intervenciones en función del proceso continuo de atención en salud; se evaluó la práctica asistencial actual con grupos focales de pacientes y profesionales; se formularon los resultados esperados en el proceso de gestión y atención en salud (hitos), y se elaboró el diagrama de la ruta. Resultados: A partir de la Guía de práctica clínica se elaboraron 25 intervenciones individuales priorizadas y caracterizadas según el actor responsable, la población objetivo y el entorno. Para cada una de las intervenciones se presentan resultados esperados en salud, calidad de prestación de servicios, aspectos relacionados con la equidad, y la perspectiva de pacientes y actores involucrados con la atención. Se construyeron los indicadores para el seguimiento e implementación de la ruta. Conclusión: Se construyó la primera ruta integral de atención en salud del paciente con amputación de miembro inferior, de acuerdo con los lineamientos del manual del Ministerio de Salud y de la Protección Social.

Abstract Objective: Build an Integral Health Care Pathway for the care of patients with lower limb amputation due to traumatic, vascular or diabetes mellitus causes, in order to implement the recommendations of the cpg for amputee patients and guarantee comprehensive health care for this population in Colombia. Methodology: This study is a strategy to improve health care. Carried out by a review of the Methodological Manual for the Development and Implementation of Comprehensive Health Care Pathway, then the development group was created. A process of prioritization and description of required individual interventions was developed based on health care. Evaluation of current care practice with focus groups, formulation of milestones and development of the intervention diagram. Results: 25 individual interventions were prioritized and characterized according to the responsible actor, target population and environment. Expected results in health, quality of service delivery, issues related to equity, as well as the perspective of patients and actors involved with care are shown. Indicators were built for monitoring and implementation of the pathway. Conclusion: With the previous results, the first Integral Health Care Pathway for the Lower Limb Amputee Patient was developed. It intends to guide the actors involved, when executing individual interventions for the diagnosis, treatment and rehabilitation, to impact outcomes in health and equity of this group .

Resumo Objetivo: Construir uma Rota de Atenção Integral à Saúde do Paciente Amputado do Membro Inferior por causas traumáticas, vasculares ou diabetes mellitus, com a finalização de implementar as recomendações do gpc do paciente amputado e garantir a atenção integral na saúde desta población em Colômbia. Metodologia: Este estudo responde a uma estratégia para melhorar os cuidados de saúde. Foi realizada uma revisão do Manual Metodológico para o Desenvolvimento e Implementação de Rotas Integrais de Atenção à Saúde, criação do grupo de desenvolvimento da rota. Um processo de priorização e descrição das intervenções individuais necessárias foi desenvolvido com base na continuidade dos cuidados de saúde. Avaliação da prática assistencial atual com grupos focais, formulação de marcos e desenvolvimento do diagrama de intervenção. Resultados: 25 intervenções individuais foram priorizadas e caracterizadas de acordo com o ator responsável, população-alvo e ambiente. Determinação dos resultados esperados em saúde, qualidade da prestação de serviços, questões relacionadas a equidade, bem como a perspectiva de pacientes e atores envolvidos no atendimento. Foram construídos indicadores para o monitoramento e implementação da rota. Conclusão: Com os resultados anteriores, foi construída a primeira Rota de Atenção Integral à Saúde do paciente com amputação de membros inferiores por causas traumáticas e neurovasculares, com sua implementação, visando orientar os atores envolvidos na execução de intervenções individuais para a diagnóstico, tratamento e reabilitação, impactar os resultados em saúde e eqüidade dessa população.

Validación del Minnesota Living with Heart Failure questionnaire (MLFHQ) en pacientes con falla cardíaca en Colombia / Validation of the Minnesota Living with Heart Failure questionnaire in patients with heart failure in Colombia

Resumen Objetivo: Validar el cuestionario de calidad de vida `` Minnesota Living with Heart Failure'' en pacientes con falla cardíaca para su uso en población colombiana. Materiales y métodos: Estudio observacional de validación de una escala, prospectivo en tres momentos: en el primero se hizo la traducción, la retrotraducción y la adaptación cultural; en el segundo se hizo la evaluación de la validez de contenido, constructo, criterio convergente y divergente con el SF36, WHODASII y DASI, y se evaluó la consistencia interna y la fiabilidad intra e interobservador, y en el tercero, longitudinal, se evaluó la sensibilidad al cambio. Resultados: Se incluyeron 134 pacientes, con clase funcional I-IV de la NYHA, fracción de eyección ≤ 50%. El análisis confirmatorio se ajustó a las tres dimensiones de la escala original. Hubo mejor calidad de vida en quienes tuvieron mejor capacidad física de acuerdo con los MET alcanzados. La validez de criterio convergente fue superior a 0,6 y la divergente menor a 0,4 con el SF36, WHODAS II y DASI. Se encontraron diferencias estadísticamente significativas entre el inicio, el primero, el tercero y el sexto mes. El mínimo cambio detectable (MCD) fue para la dimensión física de 6,0, para la dimensión emocional de 4,8 y para el total de 12,6. Conclusiones: La escala de "Minnesota Living with Heart Failure" (MLHFQ) es válida, confiable y tiene una buena sensibilidad al cambio para ser utilizada en las personas con falla cardiaca en Colombia.

Abstract Objective: To validate the "Minnesota Living with Heart Failure" quality of life questionnaire in patients with heart failure, for its use in a Colombian population. Materials and methods: An observational, prospective study with validation of a scale at three points was conducted. First of all, a translation, back-translation, and cultural adaptation were performed. This was followed by the evaluation of the content validity, construct, convergent and divergent criteria with the SF36, WHODAS II and DAS I questionnaires, as well as the assessment of internal consistency and the within- and between-observer reliability. Finally, a longitudinal study was carried out to evaluate the sensitivity to change. Results: The study included a total of 134 patients, with NYHA functional class I-IV, and an ejection fraction ≤ 50%. The confirmatory analysis was adjusted to the three dimensions of the original scale. There was a better quality of life in those that had a better physical capacity according to the MET achieved. The validity of the convergent criteria was greater than 0.6, with the divergent being less than 0.4 with the SF36, WHODAS II and DASI. Statistically significant differences were found between the beginning and the first, third, and sixth month. The minimum detectable change was for the physical dimension, 0.6, for the emotional dimension, 4.8, and for the total, 12.6. Conclusions: The "Minnesota Living with Heart Failure" scale is valid and reliable, and has a good sensitivity to change, in order to be used in the populations with heart failure in Colombia.

Individual, health system, and contextual barriers and facilitators for the implementation of clinical practice guidelines: a systematic metareview.

INTRODUCTION: Clinical practice guidelines (CPGs) are designed to improve the quality of care and reduce unjustified individual variation in clinical practice. Knowledge of the barriers and facilitators that influence the implementation of the CPG recommendations is the first step in creating strategies to improve health outcomes. The present systematic meta-review sought to explore the barriers and facilitators for the implementation of CPGs. METHODS: A search was conducted in the PubMed, Embase, Cochrane, Health System Evidence and International Guideline Library (G-I-N) databases. Systematic reviews of qualitative, quantitative or mixed-methods studies that identified barriers or facilitators for the implementation of CPGs were included. The selection of the title and abstract, the evaluation of the full text, extraction of the data and the quality assessment were carried out by two independent reviewers. To summarise the evidence, we grouped the barriers and facilitators according to the following contexts: political and social, health organisational system, guidelines, health professionals and patients. RESULTS: Overall, 25 systematic reviews were selected. The relevant barriers in the social-political context were the absence of a leader, difficulties with teamwork and a lack of agreement with colleagues. Relevant barriers in the health system were a lack of time, financial problems and a lack of specialised personnel. Barriers of the CPGs included a lack of clarity and a lack of credibility in the evidence. Regarding the health professional, a lack of knowledge about the CPG and confidence in oneself were relevant. Regarding patients, a negative attitude towards implementation, a lack of knowledge about the CPG and sociocultural beliefs played a role. Some of the most frequent facilitators were consistent leadership, commitment of the members of the team, administrative support of the institution, existence of multidisciplinary teams, application of technology to improve the practice and education regarding the guidelines. CONCLUSIONS: The barriers and facilitators described in this review are factors that influence the implementation of evidence in clinical practice. Knowledge of these factors should contribute to the development of a theoretical basis for the creation of CPG implementation strategies to improve professional practice and health outcomes for patients.

Implementation of the clinical practice guideline for individuals with amputations in Colombia: a qualitative study on perceived barriers and facilitators.

BACKGROUND: The issue of lower extremity amputation has been in the Colombian political agenda for its relationship with the armed conflict and antipersonnel mines. In 2015 the Colombian Ministry of Health published a national clinical practice guideline (CPG) for amputee patients. However, there is a need to design implementation strategies that target end-users and the context in which the CPG will be used. This study aims to identify users' perceptions about the barriers and facilitators for implementing the guideline for the care of amputee patients in a middle-income country such as Colombia. METHODS: Semi-structured interviews were conducted with 38 users, including patients, health workers, and administrative staff of institutions of the health system in Colombia. Individuals were purposively selected to ensure different perspectives, allowing a balance of individual positions. RESULTS: According to participants' perceptions, barriers to implementation are classified as individual barriers (characteristics of the amputee patient and professionals), health system barriers (resource availability, timely care, information systems, service costs, and regulatory changes), and barriers related to clinical practice guidelines (utility, methodological rigour, implementation flexibility, and characteristics of the group developing the guidelines). CONCLUSIONS: Our study advances knowledge on the perceived individual and health system barriers and facilitators for the implementation of the CPG for amputee patients in Colombia. Importantly, the governance, financial, and service delivery arrangements of the Colombian health system are determining factors in implementing CPGs. For example, the financial arrangements between the insurance companies and the health care provider institutions were identified as barriers for the implementation of recommendations related to the continuity and opportunity of care of patients with amputations. The design of implementation strategies that successfully address the individual behaviours and the contextual health systems arrangements may significantly impact the health care process for amputee patients in Colombia.

Derechos de las personas con discapacidad en la pandemia por Covid-19. Síntesis rápida / The rights of people with disabilities in the Covid-19 pandemic Rapidreview

La pandemia por Coronavirus 2019 (Covid-19) ha profundizado las desigualdades preexistentes de las personas con discapacidad. Los afectados por Covid-19 se encuentran entre los grupos más vulnerables al ser uno de los grupos más excluidos de la sociedad. El objetivo del presente estudio esidentificarlas declaraciones y recomendaciones que las organizaciones supranacionales han emitido para garantizar los derechos de las personas con discapacidad en la actual pandemia. Se realizó una búsqueda amplia y sistemática; fueron consultadas 20 organizaciones y analizados 58 documentos en esta síntesis rápida. Los documentos encontrados fueron asignados en cuatro categorías dependiendo de su enfoque principal: principio de igualdad y no discriminación (25,8%), derecho al respeto de la dignidad inherente (10,3%), derecho a la accesibilidad (36,2%) y derecho a la salud (27,6%). Las organizaciones supranacionales hacen un llamado a los gobiernos a garantizar la protección y promoción de los derechos de las personas con discapacidad y a implementar medidas y estrategias razonables que aborden las necesidades especiales de esta población en la actual pandemia.

The Coronavirus 2019 (Covid-19) pandemic has deepened pre-existing inequalities for people with disabilities. Those affected by Covid-19 are among the most vulnerable groups as one of the most excluded groups in society. The objective of this study is to identify the declarations and recommendations that supranational organizations have issued to guarantee the rights of persons with disabilities in the current pandemic. A broad and systematic search was carried out; 20 organizations were consulted and 58 documents were analyzed in this rapid synthesis. The documents found were assigned into four categories depending on their main focus: principle of equality and non-discrimination (25.8%), right to respect for inherent dignity (10.3%), right to accessibility (36.2%) and right to health (27.6%). The supranational organizations call on governments to ensure the protection and promotion of the rights of persons with disabilities and to implement reasonable measures and strategies to address the special needs of this population in the current pandemic.

Guía de práctica clínica para la prevención, el diagnóstico, el tratamiento y la rehabilitación de la falla cardiaca en población mayor de 18 años, clasificación B, C y D. Componente de rehabilitación cardiaca / Practice Guidelines for the prevention, diagnosis, treatment, and rehabilitation of heart failure in a population greater than 18 years-old: B, C and D Classification. Cardiac rehabilitation component

Resumen Introducción: Los programas de rehabilitación cardiaca integran la realización de ejercicio supervisado con prevención secundaria y soporte sicosocial que permite mejorar la adherencia a medidas con impacto claro sobre la morbilidad y mortalidad en pacientes con falla cardiaca. Metodología: Para el desarrollo de la guía de práctica clínica basada en la evidencia se siguieron los pasos definidos en la Guía Metodológica para la Elaboración de Guías de Práctica Clínica con Evaluación Económica en el Sistema General de Seguridad Social en Salud Colombiano del Ministerio de Salud y Protección Social de Colombia. Resultados: Se establecen las recomendaciones para el desarrollo adecuado de un programa de rehabilitación cardiaca integral en pacientes con falla cardiaca, abordando aspectos de evaluación de capacidad funcional, efectividad y seguridad del ejercicio, dosificación, modalidad y rehabilitación en pacientes con dispositivos. Conclusión: La práctica de ejercicio en pacientes con falla cardíaca estable ha demostrado disminuir las hospitalizaciones, mejorar la calidad de vida y la capacidad funcional y ser seguro en aquellos a quienes se les ha implantado un dispositivo.

Abstract Introduction: Cardiac rehabilitation programs combine the performing of supervised exercise with secondary prevention and psycho-social support that helps to improve adherence to measures, with a clear impact on the morbidity and mortality in patients with heart failure. Methodology: For the development of the evidence-based clinical practice guidelines, the steps followed were those defined in the Methodological Guidelines for the Preparation of Clinical Practice Guidelines with an Economic Assessment in the General Social Security System in Colombian Health by the Ministry of Health and Social Protection of Colombia. Results: Recommendations were established for the adequate development of an integrated cardiac rehabilitation program for patients with heart failure. The aspects approached included the assessment of functional capacity, effectivity and safety of the exercise, dosification, methodology, and rehabilitation in patients with devices. Conclusion: The practice of exercise in patients with stable heart has shown to reduce the number of hospital admissions, improve the quality of life and functional capacity. It has also shown to be safe in those that have a device implanted.

Lesiones graves y moderadas por accidentes de tránsito en mayores de 60 años. Medellín, Colombia / Severe and moderate injuries in people over 60 years of age caused by road traffic accidents in Medellín, Colombia

Resumen Introducción. Cada día, 3 400 personas mueren en el mundo por un accidente de tránsito (AT); miles sufren lesiones o adquieren una discapacidad cada año por la misma causa. En Colombia, en 2016 se registró una tasa de 92.8 heridos y 14.9 muertes por cada 100 000 habitantes. Objetivo. Describir las características de los AT y el entorno de su atención en mayores de 60 años con lesiones moderadas o graves en Medellín, Colombia, durante el periodo 2015-2016. Materiales y métodos. Estudio descriptivo de las características de personas mayores de 60 años con lesiones moderadas y graves después de un AT. Resultados. Se evaluaron247 personas, 93.1% con lesiones moderadas; el 94.1% de las lesiones graves ocurrieron cuando se atropelló un peatón. En 60.7% de los AT una moto estuvo involucrada. El puntaje global del WHODAS-II fue de 40.6 y los dominios de funcionamiento más afectados fueron actividades domésticas, actividades fuera de la casa y movilidad; en cuanto a la calidad de vida, se afectó la función física, el desempeño físico y el cambio en salud. Conclusión. Los mayores de 60 años con lesiones por AT fueron, en su mayoría, peatones atropellados por motocicletas. El AT afectó la calidad de vida y el funcionamiento de los pacientes.

Abstract Introduction: Every day, 3 400 people are killed in road traffic accidents (RTA) in the world; thousands are injured or disabled each year from the same cause. In Colombia, a rate of 92.8 injured and 14.9 deaths per 100 000 inhabitants was reported in 2016. Objective: To describe the characteristics of RTA, clinical care and quality of life of people over 60 years of age with moderate or severe injuries in Medellín, Colombia, during the period 2015-2016. Materials and methods: Descriptive study of the characteristics of people over 60 years of age with moderate and severe injuries after a a RTA. Results: 247 people were included in the study, of which 93.1% had moderate injuries; 94.1% of the severe injuries occurred when a pedestrian was hit. In 60.7% of the RTA, a motorcycle was involved. The overall WHODAS-II Score was 40.6 and the most affected operational domains were domestic activities, activities outside the home and mobility. In terms of quality of life, physical function, physical performance and change in health were affected. Conclusion: People over 60 years of age with RTA injuries were mostly pedestrians and motorcycles were the most frequent vehicle involved. RTA affected patients' quality of life and functioning.

Validación para Colombia del cuestionario para la "Medición de la capacidad funcional en pacientes con falla cardíaca" / Validation of a questionnaire for Measuring functional capacity in patients with heart failure in Colombia

Resumen Objetivos: Hacer la validación para Colombia del cuestionario "Índice de estado actividad de Duke en pacientes con falla cardíaca". Métodos: Se hizo la traducción y adaptación cultural del Índice de estado actividad de Duke (DASI) al español. Se incluyeron 135 pacientes, con quienes se hizo la validación de contenido con un análisis factorial confirmatorio. Se evaluó la validez de constructo convergente y divergente y la validez de criterio comparando grupos de la New York Heart Asociation (NYHA) y con las correlaciones con el cuestionario de calidad de vida "Minnesota Living with Heart Failure Questionnaire", la escala genérica de calidad de vida SF-36 y un cuestionario de evaluación de la discapacidad de la Organización Mundial de la Salud (WHO-DAS II). Se evaluó la consistencia interna y la fiabilidad interobservador e intraobservador, así como la sensibilidad al cambio al mes, tres y seis meses. Resultados: En la validez de contenido la escala se ajusta a dos dominios; en la validez convergente y divergente se verificó con correlaciones significativas del DASI con las escalas con las que se comparó. La validez de criterio del DASI con la clasificación NYHA mostró relación adecuada, aunque no es estadísticamente significativa. En la consistencia interna el coeficiente de alfa de Cronbach fue de 0,69 y los coeficientes de correlación intraclase para la fiabilidad interevaluador e intraevaluador fueron 0,81 y 0,90 respectivamente. Conclusiones: Esta versión en Español del Índice de estado actividad de Duke es válida y confiable para pacientes con falla cardíaca en Colombia.

Abstract Objectives: To validate the Duke Activity Status Index questionnaire in patients with heart failure in Colombia. Methods: A translation to Spanish and a cultural adaptation was performed on the Duke Activity Status Index (DASI) questionnaire. A total 135 patients were included to carry out the content validity, with a confirmatory factor analysis. The convergent and divergent construct validity, and the criteria validity was evaluated, comparing New York Heart Association (NYHA) classification groups, and the correlations with the "Minnesota Living with Heart Failure Questionnaire" quality of life questionnaire, the SF-36 quality of life generic scale, and a questionnaire on the evaluation of disability by the World Health Organisation (WHO-DAS II). Internal consistency and inter-observer reliability was evaluated, as well as the sensitivity to change at one, three, and six months. Results: The scale is adjusted to two domains in the content validity. The convergent and divergent validity was verified, with significant correlations of the DASI with the scales that it was compared against. The criteria validity of the DASI with the NYHA classification showed some relationship, but it was not statistically significant. The Cronbach alpha was 0.69 in the internal consistency, and the inter-class correlation coefficients for inter-observer and within-observer reliability were 0.81 and 0.90, respectively. Conclusions: This version of the Duke Activity Status Index (DASI) in Spanish is valid and reliable for patients with heart failure in Colombia.

Determinantes de los costos de la atención y la rehabilitación de personas lesionadas en accidentes de tránsito en Medellín, Colombia / Determinants of the Cost of Care and Rehabilitation of People Injured in Traffic Accidents in Medellin, Colombia / Determinantes dos custos de atendimento e reabilitação de pessoal lesado em acidentes de trânsito em Medellín, Colômbia

Resumen Objetivo: estimar los determinantes de los costos de atención y rehabilitación de personas lesionadas en accidentes de tránsito en Medellín, Colombia. Materiales y métodos: estudio de seguimiento a un año de 483 pacientes atendidos por lesiones moderadas y graves. Se incluyeron costos médicos, calculados a partir de los sistemas de facturación de los hospitales, y costos indirectos, asociados a la incapacidad para pacientes y cuidadores. Los determinantes del costo total se estimaron mediante un modelo lineal generalizado. Resultados: los costos de los pacientes graves fueron en promedio USD $2152 mayores que los de pacientes con lesiones moderadas. Quienes ingresaron a unidades de cuidados intensivos y especiales generaron costos adicionales de USD $29 362 y USD $5746 con respecto a quienes no lo hicieron. Los costos indirectos ascendieron al 3 % del costo total. Conclusiones: la gravedad de la lesión y el tipo de atención fueron los que más afectaron los costos de atención y rehabilitación.

Abstract Objective: estimating the determinants of the costs of care and rehabilitation of people injured in traffic accidents in Medellin, Colombia. Materials and Methods: follow-up study for a year on 483 patients treated due to moderate and severe injuries. We included medical costs calculated based on the hospital billing systems and indirect costs associated to the incapacity for patients and caregivers. The determinants of the total cost were estimated by means of a generalized linear model. Results: the costs for severely injured patients were, on average, higher by US $2,152 than those of patients with moderate injuries. Those who were interned in the intensive and special care units generated additional costs amounting to US $29,362 and US $5,746 in comparison to those who were not interned there. Indirect costs amounted to 3% of the total cost. Conclusions: the severity of the injuries and the type of care were the factors that influenced the most the cost of care and rehabilitation.

Resumo Objetivo: estimar as determinantes de custos de atendimento e reabilitação de pessoal leso em acidentes de trânsito em Medellín, Colômbia. Materiais e métodos: estudo de acompanhamento durante um ano de 483 pacientes atendidos por lesões moderadas e críticas. Incluíram-se custos médicos, calculados a partir dos sistemas de faturação dos hospitais e custos indiretos, associados à incapacidade para pacientes e cuidadores. As determinantes do custo total foram estimadas mediante modelo lineal generalizado. Resultados: os custos dos pacientes críticos foram USD $2152 em media, superiores aos de pacientes com lesões moderadas. Aqueles que ingressaram a unidades de tratamento intensivo e especial geraram custos adicionais de USD $29 362 e USD $5746 no que diz respeito de aqueles que não. Os custos indiretos ascenderam a 3% do custo total. Conclusões: a gravidade da lesão e o tipo de atendimento foram os que mais afetaram os custos de atendimento e reabilitação.

Colombian Rasch validation of KIDSCREEN-27 quality of life questionnaire.

BACKGROUND: The family of KIDSCREEN instruments is the only one with trans-cultural adaptation and validation in Colombia. These validations have been performed from the classical test theory approach, which has evidenced satisfactory psychometric properties. The aim of this study was to evaluate psychometric properties of KIDSCREEN-27 children and parent-proxy versions, through Rasch analysis. METHODS: The participants in the present study were two different sets of populations, 321 kids with a mean age of 12.3 (SD 2.6), 41 % 8 to 11 years old and 59 % 12 to 18 years old; and 1150 parent-proxy with an average age of 45.5 (SD 18.9). Psychometric properties were assessed using the partial credits model in the Rasch approach. Unidimensionality, fitting of person and item, response form, and differential item functioning (DIF) were measured. RESULTS: The Infit MNSQ in child self-reported version that ranges between 0.71-1.76, and 0.69-1.31 in the parent-proxy version. Scores gathered on Likert forms of 5-response options, person separation was 2.08 for child self-reported version and 2.40 for parent-proxy; reliability was 0.81 and 0.85, respectively. Items reliability was 0.99 on both versions, with separations of 11.92 for child self-reported and 10.83 for parent-proxy. There was not DIF according to the variables sex and age but was present according to socioeconomic status. CONCLUSION: There was a good fit for items and individuals to the Rasch model. Item separation was adecuate, and person separation improved when the response form was re-codified to four options. The presence of DIF according to socioeconomic status implies a scale's bias in the measure of HRQoL of Colombian children.

Calidad de vida y reinserción al trabajo en pacientes con trauma moderado y grave por accidentes de tránsito en Medellín (Colombia) / Quality of Life and Reintegration to Work in Patients with Moderate and Severe Trauma due to Traffic Accidents in Medellin (Colombia) / Qualidade de vida e reinserção no trabalho em pacientes com trauma moderado e grave por acidentes de trânsito em Medellín (Colombia)

Objetivo: evaluar la calidad de vida (CV) y su relación con la reinserción al trabajo, depresión y dolor, en personas lesionadas en accidentes de tránsito. Métodos: pacientes con trauma moderado o grave, se evaluó reinserción al trabajo, CV (SF-36), depresión (PHQ-9) y dolor (escala análoga visual). Resultados: doce meses después del trauma se reintegraron 367 de 451 pacientes (81,4%). Los pacientes no reintegrados tuvieron menores puntaciones en las subescalas de CV, comparados con las de referencia, y en los que sí se reintegraron fueron superiores. No se observó depresión y el PHQ-9 tuvo mayor correlación con la subescala desempeño emocional del SF-36 en los reintegrados y con la de desempeño físico en los que no se reintegraron. La gravedad de la lesión y el dolor afectaron la CV. Conclusión: la CV en pacientes que no se reintegran laboralmente fue inferior y estuvo afectada por la gravedad de la lesión y la depresión.

Objective: Assessing the quality of life (CV) and its relationship with reintegration to work, depression and pain in people injured in traFFic accidents. Methods: we evaluated reintegration to work, CV (SF-36); depression (PHQ-9); and pain (visual analog scale), in patients with moderate or severe trauma. Results: twelve months after the trauma 367 out of 461 patients reintegrated to work (81.4%). The patients that did not reintegrate had lower scores in the CV subscales, compared to the reference scores; those who did reintegrate to work had higher scores. We did not observe depression and PHQ-9 had a greater correlation with the emotional performance subscale of SF-36 in reintegrated people and with physical performance in those who did not reintegrate. CV was aFFected by the severity of the injuries and pain. Conclusion: CV is lower and was aFFected by the severity of the injuries and depression in patients who did not reintegrate to work.

Objetivo: avaliar a qualidade de vida (CV) e sua relacào com a reinsercào ao trabalho, depressào e dor, em pessoas lesas em acidentes de trànsito. Métodos: pacientes com trauma moderado ou grave, avaliou-se reinsercào ao trabalho, CV (SF-36), depressào (PHQ-9) e dor (escala analógica visual). Resultados: doze meses depois do trauma reintegraram-se 367 de 451 pacientes (81,4%). Os pacientes nào reinseridos tiveram menores pontuações nas subescalas de CV se comparados com as de referencia, e nos que se reintegraram foram superiores. Nào se observou depressào e o PHQ-9 apresentou maior correlacào com a subescala desempenho emocional do SF-36 nos reinseridos e com a de desempenho físico nos que nào se reinseriram. A gravidade da lesào e a dor afetaram a CV. Conclusào: a CV em pacientes que nào foram reinseridos laboralmente foi inferior e esteve afetada pela gravidade da lesào e a depressào.

Guía de práctica clínica para la detección temprana, atención integral, seguimiento y rehabilitación de pacientes con diagnóstico de distrofia muscular. Guía para padres y cuidadores / Clinical practice guide for early detection, comprehensive care, monitoring and rehabilitation of patients diagnosed with muscular dystrophy. Guide for parents and caregivers

La Guía desarrollará recomendaciones para la atención integral de pacientes con sospecha o diagnóstico de distrofia muscular de Duchenne, Becker, miotónica, facioescapulohumeral y de cinturas. No están incluidos los pacientes con distrofias musculares congénitas (enfermedad de Ullrich, síndrome de espina rígida, enfermedad multinúcleo, distrofia muscular congénita por déficit de Merosina), ni con la distrofia muscular Emery Dreifuss.