Daily compliance of the ABCDEF liberation bundle for patients in the intensive care unit: A retrospective descriptive study / Cumplimiento diario del bundle ABCDEF de liberación de los pacientes de cuidados intensivos: estudio descriptivo retrospectivo.

Introduction: Implementing the ABCDEF bundle has demonstrated improved outcomes in patients with critical illness. This study aims to describe the daily compliance of the ABCDEF bundle in a Chilean intensive care unit. Methods: Retrospective observational study of electronic clinical records of nursing, physiotherapy, and medical professionals who cared for patients over 18 years of age, admitted to an intensive care unit for at least 24 hours, with or without mechanical ventilation. Daily bundle compliance was determined by considering the daily records for each element: Assess pain (element A), both spontaneous awakening trials (element B1) and spontaneous breathing trials (element B2), choice of sedation (element C), delirium assessment (element D), early mobilization (element E), and family engagement (element F). Results: 4165 registered bundle elements were obtained from nursing (47%), physiotherapy (44%), and physicians (7%), including 1134 patient/days (from 133 patients). Elements E and C showed 67 and 40% compliance, while D, A, and B2 showed 24, 14 and 11%, respectively. For B1 and F, 0% compliance was achieved. Compliance was higher in patients without mechanical ventilation for A and E, while it was similar for D. Conclusions: Early mobilization had the highest compliance, while spontaneous awakening trials and family engagement had absolute non-compliance. Future studies should explore the reasons for the different degrees of compliance per bundle element in clinical practice.

Introducción: La implementación del ABCDEF ha demostrado mejores resultados en los pacientes críticos. El objetivo de este trabajo es identificar el cumplimiento del registro diario del ABCDEF en una unidad de cuidados intensivos chilena. Métodos: Estudio observacional retrospectivo de los registros clínicos electrónicos de profesionales de enfermería, kinesiología y medicina que trataron a pacientes mayores de 18 años, hospitalizados en una unidad de cuidados intensivos durante al menos 24 horas, con o sin requerimiento de ventilación mecánica. Se determinó el cumplimiento diario del considerando la presencia del registro en la ficha clínica de cada elemento: evaluación del dolor (elemento A), prueba de interrupción de la sedación (elemento B1) y ventilación espontánea (elemento B2), elección de la sedación (elemento C), evaluación del (elemento D), movilización temprana (elemento E) y empoderamiento de la familia (elemento F). Resultados: Se obtuvieron 4165 elementos del registrados provenientes de enfermería (47%), kinesiología (44%) y medicina (7%), incluyendo 1134 días/paciente (133 pacientes). Los elementos E y C mostraron un cumplimiento del 67 y 40%, mientras que D, A, y B2 mostraron 24, 14 y 11%, respectivamente. Para B1 y F se obtuvo 0% de cumplimiento. El cumplimiento fue mayor en los pacientes sin ventilación mecánica para A y E, mientras que para D fue similar. Conclusiones: La movilización temprana fue el elemento con mayor cumplimiento, mientras que las pruebas de interrupción de sedación y el empoderamiento de la familia tuvieron incumplimiento absoluto. Futuros estudios deberían explorar las razones que expliquen los diferentes grados de cumplimiento por elemento del en la práctica clínica.

Cumplimiento diario del bundle ABCDEF de liberación de los pacientes de cuidados intensivos: estudio descriptivo retrospectivo / Daily compliance of the ABCDEF liberation bundle for patients in the intensive care unit: A retrospective descriptive study

Introducción La implementación del ABCDEF ha demostrado mejores resultados en los pacientes críticos. El objetivo de este trabajo es identificar el cumplimiento del registro diario del ABCDEF en una unidad de cuidados intensivos chilena. Métodos Estudio observacional retrospectivo de los registros clínicos electrónicos de profesionales de enfermería, kinesiología y medicina que trataron a pacientes mayores de 18 años, hospitalizados en una unidad de cuidados intensivos durante al menos 24 horas, con o sin requerimiento de ventilación mecánica. Se determinó el cumplimiento diario del considerando la presencia del registro en la ficha clínica de cada elemento: evaluación del dolor (elemento A), prueba de interrupción de la sedación (elemento B1) y ventilación espontánea (elemento B2), elección de la sedación (elemento C), evaluación del (elemento D), movilización temprana (elemento E) y empoderamiento de la familia (elemento F). Resultados Se obtuvieron 4165 elementos del registrados provenientes de enfermería (47%), kinesiología (44%) y medicina (7%), incluyendo 1134 días/paciente (133 pacientes). Los elementos E y C mostraron un cumplimiento del 67 y 40%, mientras que D, A, y B2 mostraron 24, 14 y 11%, respectivamente. Para B1 y F se obtuvo 0% de cumplimiento. El cumplimiento fue mayor en los pacientes sin ventilación mecánica para A y E, mientras que para D fue similar. Conclusiones La movilización temprana fue el elemento con mayor cumplimiento, mientras que las pruebas de interrupción de sedación y el empoderamiento de la familia tuvieron incumplimiento absoluto. Futuros estudios deberían explorar las razones que expliquen los diferentes grados de cumplimiento por elemento del en la práctica clínica.

Introduction Implementing the ABCDEF bundle has demonstrated improved outcomes in patients with critical illness. This study aims to describe the daily compliance of the ABCDEF bundle in a Chilean intensive care unit. Methods Retrospective observational study of electronic clinical records of nursing, physiotherapy, and medical professionals who cared for patients over 18 years of age, admitted to an intensive care unit for at least 24 hours, with or without mechanical ventilation. Daily bundle compliance was determined by considering the daily records for each element: Assess pain (element A), both spontaneous awakening trials (element B1) and spontaneous breathing trials (element B2), choice of sedation (element C), delirium assessment (element D), early mobilization (element E), and family engagement (element F). Results 4165 registered bundle elements were obtained from nursing (47%), physiotherapy (44%), and physicians (7%), including 1134 patient/days (from 133 patients). Elements E and C showed 67 and 40% compliance, while D, A, and B2 showed 24, 14 and 11%, respectively. For B1 and F, 0% compliance was achieved. Compliance was higher in patients without mechanical ventilation for A and E, while it was similar for D. Conclusions Early mobilization had the highest compliance, while spontaneous awakening trials and family engagement had absolute non-compliance. Future studies should explore the reasons for the different degrees of compliance per bundle element in clinical practice.

Study protocol and rationale of "the UP project": evaluating the effectiveness of active breaks on health indicators in desk-based workers.

Background: Excessive sedentary time has been negatively associated with several health outcomes, and physical activity alone does not seem to fully counteract these consequences. This panorama emphasizes the essential of sedentary time interruption programs. "The Up Project" seeks to assess the effectiveness of two interventions, one incorporating active breaks led by a professional and the other utilizing a computer application (self-led), of both equivalent duration and intensity. These interventions will be compared with a control group to evaluate their impact on physical activity levels, sedentary time, stress perception, occupational pain, and cardiometabolic risk factors among office workers. Methods: This quasi-experimental study includes 60 desk-based workers from universities and educational institutes in Valparaiso, Chile, assigned to three groups: (a) booster breaks led by professionals, (b) computer prompts that are unled, and (c) a control group. The intervention protocol for both experimental groups will last 12 weeks (only weekdays). The following measurements will be performed at baseline and post-intervention: cardiometabolic risk based on body composition (fat mass, fat-free mass, and bone mass evaluated by DXA), waist circumference, blood pressure, resting heart rate, and handgrip strength. Physical activity and sedentary time will be self-reported and device-based assessed using accelerometry. Questionnaires will be used to determine the perception of stress and occupational pain. Discussion: Governments worldwide are addressing health issues associated with sedentary behavior, particularly concerning individuals highly exposed to it, such as desk-based workers. Despite implementing certain strategies, there remains a noticeable gap in comprehensive research comparing diverse protocols. For instance, studies that contrast the outcomes of interventions led by professionals with those prompted by computers are scarce. This ongoing project is expected to contribute to evidence-based interventions targeting reduced perceived stress levels and enhancing desk-based employees' mental and physical well-being. The implications of these findings could have the capacity to lay the groundwork for future public health initiatives and government-funded programs.

Seguimiento Funcional hasta Seis Meses después de Sobrevivir a Cuidados Intensivos: Lecciones aprendidas de un Estudio Chileno Multicéntrico / Functional follow-up six months after surviving intensive care: lessons learned from a Chilean multicenter study

Introducción. Las tasas de retención en los estudios de seguimiento oscilan entre el 32 y 100%, demostrando el desafío que implica realizar estudios longitudinales de sobrevivientes de la unidad de cuidados intensivos (UCI). Objetivo. Identificar las estrategias implementadas y lecciones aprendidas en un estudio prospectivo multicéntrico de seguimiento de sobrevivientes de la UCI durante la pandemia. Métodos. Estudio post-hoc de las lecciones aprendidas mediante encuestas y entrevistas dirigidas a explorar la experiencia de los investigadores y coordinadores del estudio IMPACCT COVID-19, realizado en siete centros chilenos entre octubre 2020 y abril 2021 evaluando el síndrome post-cuidados intensivos de sobrevivientes hasta seis meses después. Resultados. Identificamos ocho lecciones: 1) selección de instrumentos de medición, 2) identificación de centros participantes, 3) aprobación del estudio, 4) financiamiento, 5) capacitación de evaluadores, 6) coordinación/aseguramiento de calidad, 7) reclutamiento y 8) seguimiento de pacientes. Incluso durante el primer año de pandemia, reclutamos 252 pacientes a una tasa de 1,4 pacientes/día con una retención del 48% a los 6 meses de seguimiento. El uso de redes académicas existentes y las estrategias de comunicación entre investigadores, coordinadores y evaluadores fueron aspectos positivos; mientras que la fidelización con evaluadores al egreso de la UCI y con pacientes durante el seguimiento son aspectos que deberían considerarse en futuros estudios. Conclusiones. Se evaluaron más de 250 pacientes en seis meses durante la pandemia, con tasas de retención post UCI acorde a la literatura. Futuros estudios debiesen optimizar los procesos de medición y de seguimiento para minimizar la pérdida de pacientes.

Background. Retention rates of follow-up studies range from 32 to 100%, demonstrating the challenge to conduct longitudinal studies of intensive care unit (ICU) survivors. Objective. To identify the strategies implemented and lessons learned in a multicenter prospective follow-up study of ICU survivors during pandemic times. Methods. Post-hoc study of lessons learned through surveys and interviews aimed at exploring the experience of the researchers and coordinators of the IMPACCT COVID-19 study. The original study was performed in seven Chilean sites between October 2020 and April 2021 evaluating the post-intensive care syndrome of survivors up to six-month follow-up. Results. We identified eight lessons: 1) selection of measurement instruments, 2) identification of participating sites, 3) Study approval, 4) funding, 5) evaluators training, 6) coordination/quality assurance, 7) recruitment, and 8) patient follow-up. Even during the first year of the pandemic, we recruited 252 patients at a rate of 1.4 patients/day with a retention rate of 48% at 6 months of follow-up. The use of existing academic networks and communication strategies between researchers, coordinators and evaluators were positive aspects; while evaluators fidelity at ICU discharge and patient engagement during follow-up are aspects should be considered. Conclusions. More than 250 patients were evaluated in six months during the pandemic, with post-ICU retention rates consistent with the literature. Future studies should optimize measurement and monitoring processes to minimize patient atrition.

Six-month post-intensive care outcomes during high and low bed occupancy due to the COVID-19 pandemic: A multicenter prospective cohort study.

INTRODUCTION: The COVID-19 pandemic can be seen as a natural experiment to test how bed occupancy affects post-intensive care unit (ICU) patient's functional outcomes. To compare by bed occupancy the frequency of mental, physical, and cognitive impairments in patients admitted to ICU during the COVID-19 pandemic. METHODS: Prospective cohort of adults mechanically ventilated >48 hours in 19 ICUs from seven Chilean public and private hospitals. Ninety percent of nationwide beds occupied was the cut-off for low versus high bed occupancy. At ICU discharge, 3- and 6-month follow-up, we assessed disability using the World Health Organization Disability Assessment Schedule 2.0. Quality of life, mental, physical, and cognitive outcomes were also evaluated following the core outcome set for acute respiratory failure. RESULTS: We enrolled 252 participants, 103 (41%) during low and 149 (59%) during high bed occupancy. Patients treated during high occupancy were younger (P50 [P25-P75]: 55 [44-63] vs 61 [51-71]; p<0.001), more likely to be admitted due to COVID-19 (126 [85%] vs 65 [63%]; p<0.001), and have higher education qualification (94 [63%] vs 48 [47%]; p = 0.03). No differences were found in the frequency of at least one mental, physical or cognitive impairment by bed occupancy at ICU discharge (low vs high: 93% vs 91%; p = 0.6), 3-month (74% vs 63%; p = 0.2) and 6-month (57% vs 57%; p = 0.9) follow-up. CONCLUSIONS: There were no differences in post-ICU outcomes between high and low bed occupancy. Most patients (>90%) had at least one mental, physical or cognitive impairment at ICU discharge, which remained high at 6-month follow-up (57%). CLINICAL TRIAL REGISTRATION: NCT04979897 (clinicaltrials.gov).

Hypoglycemia and glycemic variability of people with type 1 diabetes with lower and higher physical activity loads in free-living conditions using continuous subcutaneous insulin infusion with predictive low-glucose suspend system.

INTRODUCTION: Maintaining glycemic control during and after physical activity (PA) is a major challenge in type 1 diabetes (T1D). This study compared the glycemic variability and exercise-related diabetic management strategies of adults with T1D achieving higher and lower PA loads in nighttime-daytime and active- sedentary behavior hours in free-living conditions. RESEARCH DESIGN AND METHODS: Active adults (n=28) with T1D (ages: 35±10 years; diabetes duration: 21±11 years; body mass index: 24.8±3.4 kg/m2; glycated hemoglobin A1c: 6.9±0.6%) on continuous subcutaneous insulin delivery system with predictive low glucose suspend system and glucose monitoring, performed different types, duration and intensity of PA under free-living conditions, tracked by accelerometer over 14 days. Participants were equally divided into lower load (LL) and higher load (HL) by median of daily counts per minute (61122). Glycemic variability was studied monitoring predefined time in glycemic ranges (time in range (TIR), time above range (TAR) and time below range (TBR)), coefficient of variation (CV) and mean amplitude of glycemic excursions (MAGE). Parameters were studied in defined hours timeframes (nighttime-daytime and active-sedentary behavior). Self-reported diabetes management strategies were analysed during and post-PA. RESULTS: Higher glycemic variability (CV) was observed in sedentary hours compared with active hours in the LL group (p≤0.05). HL group showed an increment in glycemic variability (MAGE) during nighttime versus daytime (p≤0.05). There were no differences in TIR and TAR across all timeframes between HL and LL groups. The HL group had significantly more TBR during night hours than the LL group (p≤0.05). Both groups showed TBR above recommended values. All participants used fewer post-PA management strategies than during PA (p≤0.05). CONCLUSION: Active people with T1D are able to maintain glycemic variability, TIR and TAR within recommended values regardless of PA loads. However, the high prevalence of TBR and the less use of post-PA management strategies highlights the potential need to increase awareness on actions to avoid glycemic excursions and hypoglycemia after exercise completion.

Cross-cultural adaptation and evaluation of the psychometric properties of the University of Wisconsin Running Injury and Recovery Index questionnaire in Spanish (UWRI-S).

OBJECTIVE: To cross-culturally adapt and evaluate the psychometric properties of the University of Wisconsin Running Injury and Recovery Index questionnaire in Spanish (UWRI-S) in Chilean runners with a running-related injury. DESIGN: Cross-cultural adaptation and validation study, following the Consensus-based Standards for selecting health Measurement Instruments (COSMIN) recommendations. SETTING: Outpatient sports medicine clinic and running clubs. PARTICIPANTS: UWRI was forward and backward translated, and culturally adapted. Thirty-one runners participated in the content validity of the UWRI-S; and fifty-seven in the assessment of psychometric properties. MAIN OUTCOME MEASURES: Runners seeking care from a physiotherapist completed the UWRI-S (baseline and after 48-72 h for reliability), Lower Extremity Functional Scale (LEFS), Patient Specific Functional Scale (PSFS), Global Rating of Change scale (GROC), and Numeric Pain Rating Scale (NPRS). RESULTS: Suggestions about accuracy of wording and understanding of items were incorporated. UWRI-S showed a positive moderate correlation with LEFS (r = 0.6; p < 0.05), positive fair with GROC (r = 0.5, p < 0.05), negative fair with NPRS (r = -0.4; p < 0.05) and no correlation with PSFS (r = 0.3; p = 0.1). UWRI-S demonstrated acceptable internal consistency (α = 0.87) and test-retest reliability (ICC = 0.87). CONCLUSION: UWRI-S is a valid and reliable measure to evaluate running ability of Chilean runners during recovery from a running-related injury.

Inter-observer reliability of trained physiotherapists on the Functional Status Score for the Intensive Care Unit Chilean-Spanish version.

Purpose: Evaluate inter-observer reliability of trained physiotherapists administering the Chilean-Spanish version of the Functional Status Score for the Intensive Care Unit (FSS-ICU).Methods: Six adult patients in a medical-surgical ICU were assessed and video-recorded by 1 of 2 expert physiotherapists. Twelve physiotherapists were then trained using recommended Spanish-language FSS-ICU materials. The 12 physiotherapists independently scored the FSS-ICU for the 6 video-recorded patients. Intraclass Correlation Coefficient (ICC) was used to evaluate the inter-observer reliability, and modified Bland-Altman plots evaluated agreement between the physiotherapists and experts.Results: This study was performed between May and August 2018. The FSS-ICU total score had a median score of 18 (range: 6 to 34) for the 6 patients. The ICC of the total score was 0.96 (95% CI, 0.92 to 1.00), and for each of the 5 individual FSS-ICU tasks, the ICC ranged between 0.87 and 0.92. The modified Bland-Altman plot revealed a mean difference of 0.6 (95% limits of agreement: -3.3 to 4.5).Conclusions: Twelve trained physiotherapists had excellent inter-observer reliability when administering the Chilean-Spanish FSS-ICU using videos of six critically ill patients, and had excellent agreement with an expert, revealing differences within the established minimal important difference. These findings provide new data supporting clinimetric properties of the Chilean-Spanish FSS-ICU.

Impact on Mental, Physical and Cognitive functioning of a Critical care sTay during the COVID-19 pandemic (IMPACCT COVID-19): protocol for a prospective, multicentre, mixed-methods cohort study.

INTRODUCTION: The ongoing pandemic could affect the duration, variety and severity of the mental, physical, and cognitive impairments intensive care unit (ICU) survivors and their families frequently present. We aim to determine the impact of the COVID-19 pandemic on the mental, physical, and cognitive health of survivors, the experience of their families and their treating healthcare professionals. METHODS AND ANALYSIS: Prospective, multicentre, mixed-methods cohort study in seven Chilean ICUs. SAMPLE: 450 adults, able to walk independently prior to admission, in ICU and mechanical ventilation >48 hours with and without COVID-19. Clinical Frailty Scale, Charlson comorbidity index, mobility (Functional Status Score for the Status Score for the Intensive Care Unit) and muscle strength (Medical Research Council Sum Score) will be assessed at ICU discharge. Cognitive functioning (Montreal Cognitive Assessment-blind), anxiety and depression (Hospital Anxiety and Depression Scale), post-traumatic stress (Impact of Event Scale-Revised) symptoms, disability (WHO Disability Assessment Schedule 2.0), quality of life (European Quality of Life Health Questionnaire), employment and survival will be assessed at ICU discharge, 3 months and 6 months. A sample will be assessed using actigraphy and the Global Physical Activity Questionnaire at 6 months after ICU discharge. Trajectories of mental, physical, and cognitive impairments will be estimated using multilevel longitudinal modelling. A sensitivity analysis using multiple imputations will be performed to account for missing data and loss-to-follow-up. Survival will be analysed using Kaplan-Meier curves. The perceptions of family members regarding the ICU stay and the later recovery will be explored 3 months after discharge. Healthcare professionals will be invited to discuss the challenges faced during the pandemic using semistructured interviews. Interviews will be thematically analysed by two independent coders to identify the main themes of the experience of family members and healthcare professionals. ETHICS AND DISSEMINATION: The study was approved by the Clinica Alemana Universidad del Desarrollo Ethics Committee (2020-78) and each participating site. Study findings will be published in peer-reviewed journals and disseminated through social media and conference meetings. TRIAL REGISTRATION NUMBER: NCT04979897.

Adverse Events of Prone Positioning in Mechanically Ventilated Adults With ARDS.

BACKGROUND: Prone positioning is a therapy utilized globally to improve gas exchange, minimize ventilator-induced lung injury, and reduce mortality in ARDS, particularly during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Whereas the respiratory benefits of prone positioning in ARDS have been accepted, the concurrent complications could be undervalued. Therefore, this study aimed to identify the adverse events (AEs) related to prone positioning in ARDS and, secondarily, to collect strategies and recommendations to mitigate these AEs. METHODS: In this scoping review, we searched recommendation documents and original studies published between June 2013 and November 2020 from 6 relevant electronic databases and the websites of intensive care societies. RESULTS: We selected 41 documents from 121 eligible documents, comprising 13 recommendation documents and 28 original studies (involving 1,578 subjects and 994 prone maneuvers). We identified > 40 individual AEs, and the highest-pooled occurrence rates were those of severe desaturation (37.9%), barotrauma (30.5%), pressure sores (29.7%), ventilation-associated pneumonia (28.2%), facial edema (16.7%), arrhythmia (15.4%), hypotension (10.2%), and peripheral nerve injuries (8.1%). The reported mitigation strategies during prone positioning included alternate face rotation (18 [43.9%]), repositioning every 2 h (17 [41.5%]), and the use of pillows under the chest and pelvis (14 [34.1%]). The reported mitigation strategies for performing the prone maneuver comprised one person being at the headboard (23 [56.1%]), the use of a pre-maneuver safety checklist (18 [43.9%]), vital sign monitoring (15 [36.6%]), and ensuring appropriate ventilator settings (12 [29.3%]). CONCLUSIONS: We identified > 40 AEs reported in prone positioning ARDS studies, including additional AEs not yet reported by previous systematic reviews. The pooled AE proportions collected in this review could guide research and clinical practice decisions, and the strategies to mitigate AEs could promote future consensus-based recommendations.

Construct Validity of the Chilean-Spanish Version of the Functional Status Score for the Intensive Care Unit: A Prospective Observational Study Using Actigraphy in Mechanically Ventilated Patients.

OBJECTIVE: To evaluate the construct validity (hypotheses testing) of the Chilean-Spanish version of the Functional Status Score for the Intensive Care Unit (FSS-ICU) using continuous actigraphy from intensive care unit (ICU) admission to ICU discharge. DESIGN: The Chilean-Spanish version of the FSS-ICU was used in a prospective observational study to mainly evaluate its correlation with actigraphy variables. The FSS-ICU was assessed on awakening and at ICU discharge, while actigraphy variables were recorded from ICU admission to ICU discharge. SETTING: A 12-bed academic medical-surgical ICU. PARTICIPANTS: Mechanically ventilated patients (N=30), of 92 patients screened. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Construct validity of the FSS-ICU Chilean-Spanish version was assessed by testing 12 hypotheses, including the correlation with activity counts, activity time (>99 counts/min), inactivity time (0-99 counts/min), muscle strength, ICU length of stay, and duration of mechanical ventilation. RESULTS: The median FSS-ICU was 19 points (interquartile range [IQR], 10-26 points) on awakening and 28.5 points (IQR, 22-32 points) at ICU discharge. There was no floor/ceiling effect of the FSS-ICU at awakening (0%/0%) and only a ceiling effect at ICU discharge that was acceptable (0%/10%). Less activity time was associated with better mobility on the FSS-ICU at both awakening (ρ=-0.62, P<.001) and ICU discharge (ρ=-0.79, P<.001). Activity counts and activity time were not correlated as expected with the FSS-ICU. CONCLUSIONS: The Chilean-Spanish FSS-ICU had a strong correlation with inactivity time during the ICU stay. These findings enhance the available clinimetric properties of the FSS-ICU.

Quality of life in chronic musculoskeletal symptomatic Chilean population: secondary analysis of National Health Survey 2009-2010.

BACKGROUND: Health-related quality of life (HRQoL) is defined as the patient's perception of their health status. HRQoL can be modified by illnesses, treatments or social and health policies. Chronic musculoskeletal pain is a modifying factor of HRQoL that leads to lower quality of life, elevated suffering and disability. Knowing HRQoL in subjects reporting chronic musculoskeletal symptoms (cMSS), like pain, discomfort or swollenness lasting more than 3 months, will provide information to health teams and organizations engaged in the Chilean health system. This study aim was to determine the relationship between HRQoL and musculoskeletal symptoms measured in three different Chilean groups: [1] without symptoms; [2] with acute symptoms; and [3] with cMSS. METHODS: A secondary analysis of the 2009-10 Chilean National Health Survey (NHS) was executed to determine the relationship between HRQoL (measured with SF-12) in three MSS groups. The Chilean NHS considered a national, probabilistic, stratified and multistage sample of 5293 participants aged 15 and older; it was representative at the national, urban-rural and regional levels. A multivariate logistic regression model studied the relationship between cMSS and HRQoL, adjusted for age, sex, educational level and residence area as control variables (p < 0.05). RESULTS: Out of 5293 participants in the NHS 2009-10, 5276 subjects were included for analysis. The median age was 46 years (IQR 31-60), 59.4% women, a median of 10 years formal education (IQR 7-12) and an urban residence in 85.2% of the population of the NHS 2009-10. The observed population prevalence of people with cMSS was 42.6% (95% CI 40.4-44.9). Presence of cMSS is a risk factor for low HRQoL, exhibited both in the physical (OR 3.1 95% CI 2.7-3.5) and mental (OR 1.9 95% CI 1.6-2,) HRQoL dimensions, independent of control variables. CONCLUSIONS: Physical and mental HRQoL are affected in people with cMSS, low educational level and advanced age. This is especially seen in women. This information will facilitate assessment and treatment of cMSS as a prevalent and multidimensional health problem.

Assistive Devices for Older Adults: A Longitudinal Study of Policy Effectiveness, Santiago, Chile, 2014-2016.

INTRODUCTION Population aging is a worldwide phenomenon. It is estimated that by 2050, one of five persons will be aged ≥60 years. In Chile, 15.8% of the population is now aged ≥60 years, and this figure will reach 30.7% by 2050. In 2006, a national program was implemented to provide assistive devices to older adults aged ≥65 years with limited mobility or difficulty performing activities of daily living. To date, there have been no assessments of the program's effectiveness. OBJECTIVE Assess the effectiveness of an assistive devices policy in Chile on improving functional capacity of older adults aged ≥65 years, and beneficiaries' perceptions of the services received, including changes in their quality of life. METHODS This was a before-after longitudinal study. A cohort of 309 persons was recruited, consisting of patients who received care at a public hospital in Santiago, Chile during 2014-2015. They were assessed before delivery of assistive devices, then followed for seven months, with repeated evaluations made in their homes. The following indicators were measured: functional capacity (Tinetti scale and Barthel Index); changes in perceived quality of life related to use of assistive devices; and other sociodemographic, clinical and protocol-compliance variables. A longitudinal analysis of before-after progress was carried out, as well as a description of service delivery and medical followup. RESULTS Sixty-eight percent of those surveyed were women; median age was 74 years, average schooling was 6 years, and 93% had low income (monthly income

Characteristics of physiotherapy staffing levels and caseload: a cross-sectional survey of Chilean adult Intensive Care Units.

INTRODUCTION: The European Society of Intensive Care Medicine recommends the presence of a specialist physiotherapist, available every five beds, seven days a week in the high complexity Intensive Care Unit. However, in Chile the adherence of adult Intensive Care Units to this recommendation is unknown. OBJECTIVE: To describe the organizational characteristics and the physiotherapist availability in adult Intensive Care Units in Chile, and according to the adherence to international recommendations, inform health decision-makers. METHODS: Observational study based on a telephone survey. All adult Intensive Care Units institutions of high complexity, private hospitals and teaching health centers in Chile were eligible (n = 74). The primary outcome measures were the proportion of institutions with physiotherapist availability 24 hours a day and seven days a week (24/7 physiotherapist), a maximum caseload per physiotherapist of five patients and the presence of a specialist physiotherapist. RESULTS: Response rate was 86.5%, with 59% of responding units being public and 83% offering level III care. 70% of the adult Intensive Care Units in Chile have 24/7 physiotherapist (87% of the public and 46% of the private sector). 41% of the centers had a maximum caseload per physiotherapist of five patients during the day on weekdays. This number decreased on weekends and during night shifts. 23% of the Intensive Care Units had a specialist physiotherapist, being more common in the private sector (31%). CONCLUSIONS: In Chilean adult ICU, 24/7 physiotherapist availability is high, the prevalence of physiotherapists with specialist training is low. Future efforts should focus on promoting the uptake of specialist training.

INTRODUCCIÓN: La Sociedad Europea de Medicina de Cuidados Intensivos recomienda la presencia de un Kinesiólogo con formación especializada, disponible cada cinco camas de alta complejidad, los 7 días de la semana en la Unidad de Cuidados Intensivos (UCI). En Chile se desconoce la adherencia de las UCI adulto a esta recomendación. OBJETIVO: Describir las características administrativas y de cobertura kinésica en las UCI adulto chilenas, y de acuerdo con la adherencia a las recomendaciones internacionales, informar a los tomadores de decisión en salud. MÉTODOS: Estudio observacional transversal, basado en encuesta telefónica. Se incluyeron las UCI adultos de establecimientos de mayor complejidad, clínicas privadas y centros asociados a universidades (n = 74). La proporción de instituciones con disponibilidad de kinesiólogos las 24 horas del día, los siete días de la semana (kinesiólogo 24/7), con un número máximo de cinco pacientes por kinesiólogo y presencia de un kinesiólogo especialista fueron reportados. RESULTADOS: La tasa de respuesta fue del 86,5% (n = 64), principalmente públicas (59%) y de nivel III (83%). El 70% (n = 45) de las UCI adulto chilenas cuentan con kinesiólogo 24/7; correspondiendo el 87% al sector público y el 46% al privado. El 41% de los centros posee un máximo de 5 pacientes por kinesiólogo en día hábil diurno, disminuyendo en fines de semana y horarios nocturnos. Un 23% de las UCIs cuenta con kinesiólogo especialista en intensivo, siendo mayor en el sector privado (31%). CONCLUSIONES: En UCI adulto chilenas, la disponibilidad de kinesiólogos 24/7 es alta, y la prevalencia de especialistas es baja. Estrategias de creación de programas de formación de especialidad podrían contribuir a disminuir la brecha de especialistas.

Chilean version of the Functional Status Score for the Intensive Care Unit: a translation and cross-cultural adaptation. / Versión chilena de la Functional Status Score for the Intensive Care Unit: traducción y adaptación transcultural.

BACKGROUND: The Functional Status Score for the Intensive Care Unit (FSS-ICU) is a valid and reliable instrument to measure physical functioning in the intensive care unit setting. Translation and cross-cultural adaptation in Chile has not been published for the FSS-ICU. AIM: To translate and cross-culturally adapt all associated documents of the original FSS-ICU for Chile. METHOD: The Spanish version of FSS-ICU, available at www.ImproveLTO.com, was used as the starting point. This version was previously translated, with the original FSS-ICU developers, following established guidelines for this process. The Chilean pocket card version was newly developed based on the English version at www.ImproveLTO.com. Cognitive interviews were conducted for the adaptation of the FSS-ICU and pocket card version to assess understanding of relevant stakeholders (i.e., Chilean intensive care unit physiotherapists). Adaptations to the translation were made when agreement among the physiotherapists was less than 80%. RESULTS: Cognitive interviews of the Chilean FSS-ICU (85 items) and pocket card version (18 items) were performed with 30 Chilean physiotherapists from 18 hospitals (14 public and 4 private). During the interviews, modest adaptations mainly made in the general guidelines and specific instructions for three items of the FSS-ICU and two items of the pocket card. Finally, the frequently asked questions, pocket card and full version of the FSS-ICU were developed. The original developers accepted all adaptations. CONCLUSIONS: The Chilean version of the FSS-ICU was easy to understand by the physiotherapists. The FSS-ICU is freely available for non-commercial clinical and research use by Chilean Spanish-speakers.

INTRODUCCIÓN: La Functional Status Score for the Intensive Care Unit (FSS-ICU) es un instrumento válido y confiable para medir funcionamiento físico en unidades de cuidados intensivos. Sin embargo, la traducción y adaptación trans-cultural de la FSS-ICU en Chile no ha sido publicada. OBJETIVO: Traducir y adaptar transculturalmente todos los documentos asociados de la FSS-ICU original para Chile. MÉTODO: Se utilizó como punto de partida la versión en español de la FSS-ICU, disponible en www.ImproveLTO.com. Esta versión se tradujo previamente junto a los desarrolladores originales de la FSS-ICU, siguiendo las recomendaciones establecidas para este proceso. La versión de bolsillo chilena se desarrolló recientemente en base a la versión original en inglés. Se realizaron entrevistas cognitivas a kinesiólogos de la unidad de cuidados intensivos para evaluar la comprensión de la FSS-ICU y versión de bolsillo. Las adaptaciones se realizaron cuando el acuerdo entre los kinesiólogos fue inferior al 80%. RESULTADOS: Se realizaron las entrevistas cognitivas de la FSS-ICU en español (85 ítems) y versión de bolsillo (18 ítems) en 30 kinesiólogos chilenos provenientes de 18 diferentes hospitales (14 públicos y 4 privados). Durante las entrevistas se realizaron adaptaciones principalmente en las guías generales e instrucciones específicas para tres ítems de la FSS-ICU y dos ítems de la versión de bolsillo. Finalmente, se desarrollaron las preguntas frecuentes, la versión de bolsillo y la versión completa de la FSS-ICU. Todas las adaptaciones fueron aceptadas por los desarrolladores originales. CONCLUSIONES: La versión chilena de la FSS-ICU fue fácil de entender por los kinesiólogos. La FSS-ICU está disponible gratis para uso clínico e investigación no comercial en Chile.

Recent Versus Old Previous Injury and Its Association with Running-Related Injuries During Competition by SeRUN® Running Profiles: a Cross-sectional Study.

BACKGROUND: Previous injury in the last 12 months is the main risk factor for future running-related injuries (RRI) during training and competition environments. However, the relationship between a recent versus old previous injury and a new RRI has not been established yet, nor a separate analysis by different types of runners. METHODS: An online questionnaire was sent to 6000 participants of a running event (10 km, 21 km and 42 km), 10 days following the event. The questionnaire included the following information: the presence and topography of new RRIs during the race, old previous injury (from 12-4 months before the race), recent previous injury (from 3-0 months before the race), running experience, training factors and socio-demographic characteristics. Univariate binomial regression analysis was applied to assess different associated factors, and multivariable binomial backward regression (p < 0.05) was used to analyse the relationship between the new and previous injury. RESULTS: A total of 868 surveys were analysed (10 km, 32.6%; 21 km, 52%; 42 km, 15.4%). The median age was 38 years (IQR 31-46), and 63.5% were males. Previous injury was reported by 30.3% and 27.6% for old and recent, respectively. The majority of runners were categorised into the advanced group (42.9%), having more than 5 years of running experience. During the race, 7.0% reported a RRI, with 36.1% located at the knee. The multivariable analysis showed an association only between new injury and recent injury. CONCLUSION: The delineation of recent and old previous injuries should be considered in running epidemiological research.

SeRUN® study: Development of running profiles using a mixed methods analysis.

OBJECTIVE: To determine profiles of urban runners based on socio-demographic, health, motivational, training characteristics and running-related beliefs and behaviours. METHODS: Mixed, exploratory, sequential study with two stages: 1) quantitative, using an online survey; and 2) qualitative, using semi-structured interviews with runners from the previous stage. Participants were recruited via: running routes commonly attended by runners, eight races, previous databases and social media networks. The survey collected information on six dimensions: (1) socio-demographic; (2) health; (3) motivations; (4) training characteristics; (5) running-related behaviour; and (6) beliefs and perceptions about health. Profiles were identified using a two-step hierarchical clustering analysis. Subsequently, 15 interviews were conducted with participating runners across each of the identified profiles. Qualitative analysis complemented the profiles characterization, explaining motivations to start and continue running, beliefs about risk factors and injury prevention, and the physical therapist's role in rehabilitation. Statistical analysis from stage one was conducted using SPSS 22 with a confidence level of 5%. Qualitative data were analysed using thematic and content analyses. RESULTS: A total of 821 surveys were analysed (46% female), mean aged 36.6±10.0 years. Cluster analysis delineated four profiles (n = 752) according to years of running experience, weekly running volume and hours of weekly training. Profiles were named "Beginner" (n = 163); "Basic" (n = 164); "Middle" (n = 160) and "Advanced" (n = 265). Profiles were statistically different according to sex, age, years of running experience, training characteristics, previous injuries and use of technological devices (p<0.05). There were identified motivations to start and continue running. Beliefs about risk factors vary among stretching, footwear, training surface and overload. Runners identified the physical therapist as a specialist, involved in the rehabilitation process and showing empathy towards the patient. The identification of these profiles allows the generation of future prospective studies and clinical trials to evaluate risk and prognostic factors targeting specific populations of runners, with the ultimate aim of reducing running-related injury.

The boundaries of mild chronic obstructive pulmonary disease (COPD): design of the searching clinical COPD onset (SOON) study.

INTRODUCTION: Clinical onset of chronic obstructive pulmonary disease (COPD) is the point at which the disease is first identifiable by physicians. It is a poorly defined stage which seems to include both mild spirometric and non-spirometric disease, and could be described as early grade COPD, for practical purposes. While dyspnoea; chronic bronchitis and CT imaging evidence of emphysema and airway disease may be present very early, the lone significance of dyspnoea, the most relevant symptom in COPD in identifying these individuals, has been scarcely assessed.The Searching Clinical COPD Onset (SOON) Study was designed primarily to detect clinical, physiological and structural differences between dyspnoeic and non-dyspnoeic individuals with early grade COPD. It is hypothesised that presence of dyspnoea in early disease may identify a subtype of individuals with reduced exercise capacity, notwithstanding of their spirometry results. In addition, dyspnoeic individuals will share worse quality of life, lower physical activity, greater lung hyperinflation greater emphysema and airway thickness and reduced peripheral muscle mass than their non-dyspnoeic counterpart. METHODS AND ANALYSIS: SOON is a monocentric study, with a cross sectional design aimed at obtaining representative samples of current or ex-smoker-adults aged ≥45 and ≤80 years. Two hundred and forty participants will be enrolled into four strata, according to normal spirometry or mild spirometric obstruction and presence or not of dyspnoea modified Medical Research Council score ≥1. The primary outcome will be the difference between dyspnoeic and non-dyspnoeic individuals on the 6-min walk test performance, regardless of their spirometry results. To account for the confounding effect of heart failure on dyspnoea, stress echocardiography will be also performed. Secondary outcomes will include clinical (quality of life, physical activity), physiological (exercise testing) and structural characteristics (emphysema, airway disease and peripheral muscle mass by CT imaging). ETHICS AND DISSEMINATION: The Institutional Ethics Committee from Pontificia Universidad Católica de Chile has approved the study protocol and signed informed consent will be obtained from all participants. The findings of the trial will be disseminated through relevant peer-reviewed journals and international conference presentations. TRIAL REGISTRATION NUMBER: NCT03026439.

Autopercepción de aumento de volumen de extremidades superiores y cuatro criterios diagnósticos para linfedema en mujeres tratadas por cáncer de mama / Self-perception of upper limbs swelling and four diagnostic criteria for lymphedema in women treated for breast cancer

La autopercepción de aumento de volumen de extremidad superior, puede ser una herramienta eficaz en la pesquisa e intervención temprana del linfedema. El objetivo del estudio fueverificar la asociación entre autopercepción de aumento de volumen de extremidad superior y criterios objetivos de uso común para linfedema en mujeres tratadas por cáncer de mama. Se evaluaron 112 mujeres con cáncer de mama, quienes tenían entre 6 y 18 meses post cirugía. Se realizó el cálculo de volumetría indirecta de extremidades superiores, a través de cuatro criterios diagnósticos basados en diferencia de volumen de extremidades (≥2 cm, ≥ 200 mL, ≥10% ≥20%). La autopercepción de volumen fue evaluada con una pregunta. Para el análisis de datos, se utilizó la prueba de chi cuadrado. La media de edad fue 56,3 años (DE=13,1). La prevalencia observada para el criterio de diferencia de volumen ≥ 200 mL fue de 13,4%, 17% para criterio ≥10%, 6,25% para criterio ≥ 20% y 33% para criterio ≥2 cm. Stemmer fue positivo en 51,8% y fóvea positiva en 17,9% de las mujeres. La autopercepción de aumento de volumen se asoció con los criterios ≥ 200 mL y ≥10% y con la presencia de Stemmer y fóvea (p<0,05). En conclusión, la información entregada por las pacientes respecto de la autopercepción del volumen de su extremidad, se asoció con los criterios diagnósticos de linfedema más conservadores, así como para la presencia de signos de Stemmer y fóvea positiva. Estos se debiera considerar dentro de la evaluación clínica.

Self-perception of upper limbs swelling can be an effective tool in diagnostic and early intervention of lymphedema. The aim of the present paper was to verify the association between self-perception of swelling of upper extremities and objective criteria commonly used for lymphedema diagnostic in women treated for breast cancer. We evaluated 112 women with breast cancer between 6- and 18-months post-surgery. Indirect calculation of the volume of upper extremities through four criteria commonly used was employed (≥2 cm, ≥ 200 mL, ≥10%, ≥20%). The self-perception of swelling was evaluated with a question. The chi square test was used for data analysis. The mean age was 56.3 years (DE=13.1). The prevalence of lymphedema according to limb volume difference ≥ 200 ml criterion was 13.4%; 17% for criterion ≥10 %; 6.25% for criterion ≥ 20%; and 33% for criterion ≥2 cm. Stemmer was positive in 51.8% and 17.9% women presented positive fovea. Self-perception of swelling was associated with the criteria ≥ 200 mL and ≥10 % and the presence of positive Stemmer and fovea (p <0.05). In conclusion, the information provided by the patient about her perception of swelling, is associated with objective diagnostic criteria and the Stemmer and fovea positive signs. Self-perception should be considered in the clinical evaluation.

Results From Chile's 2016 Report Card on Physical Activity for Children and Youth.

BACKGROUND: The 2016 Chilean Report Card on Physical Activity for Children and Youth is a review of the evidence across indicators of behaviors, settings, and sources of influence associated with physical activity (PA) of Chilean children and youth. METHODS: A Research Work Group reviewed available evidence from publications, surveys, government documents and datasets to assign a grade for 11 indicators for PA behavior based on the percentage of compliance for defined benchmarks. Grades were defined as follows: A, 81% to 100% of children accomplishing a given benchmark; B, 61% to 80%; C, 41% to 60%; D, 21% to 40%; F, 0% to 20%; INC, incomplete data available to assign score. RESULTS: Grades assigned were for i) 'Behaviors that contribute to overall PA levels': Overall PA, F; Organized Sport Participation, D; Active Play, INC; and Active Transportation, C-; ii) 'Factors associated with cardiometabolic risk': Sedentary Behavior, D; Overweight and Obesity, F; Fitness, F; and iii) 'Factors that influence PA': Family and Peers, D; School, D; Community and Built Environment, C; Government Strategies and Investments, C. CONCLUSIONS: Chile faces a major challenge as most PA indicators scored low. There were clear research and information gaps that need to be filled with the implementation of consistent and regular data collection methods.