Effectiveness of an interprofessional assessment and management approach for people with chronic low back disorders delivered via virtual care: A randomized controlled trial pilot intervention.

Objective: Virtual care for chronic conditions has seen uptake due to COVID-19. Evaluation of virtual models is important to ensure evidence-based practice. There is a paucity of research in the use of virtual care for management of chronic back disorders. The objective of this study was to evaluate effectiveness of a team-based virtual care model for back disorder assessment where a physical therapist uses virtual care to join a nurse practitioner and patient in a rural Saskatchewan, Canada community. Methods: Sixty-four rural adults with chronic back disorders were randomly allocated to receive either: (1) team-based virtual care (n = 24); (2) care from an urban physical therapist travelling to community (n = 20); or (3) care from a rural nurse practitioner (n = 20). The team-based care group involved a nurse practitioner located with a rural patient, and a physical therapist joining using virtual care. The physical therapist alone and the nurse practitioner alone groups received in-person assessments. Groups with a physical therapist involved had follow-up treatments by in-person physical therapy. Outcomes over six months included pain, disability, back beliefs, satisfaction, quality-adjusted health status and management-related costs. Results: There were no significant differences for pain, disability, back beliefs and satisfaction between groups. The average cost per patient for implementing in-person physical therapist assessment ($135) was higher compared with the team over virtual care ($118) and NP care ($59). Conclusion: Primary outcomes were not different by group. Physical therapist alone was more costly than other groups. Future research should include more participants, longer follow-up time and refined cost parameters. Trial Registration: ClinicalTrials.gov NCT02225535; https://clinicaltrials.gov/ct2/show/NCT02225535 (Archived by WebCite at http://www.webcitation.org/6lqLTCNF7).

Gender-Related Factors Associated With Outcomes of Acute Coronary Syndrome in Young Female Patients.

Acute coronary syndrome (ACS) remains a significant global health concern, with a growing recognition of its impact on young adults, particularly young female adults. Although gender-related factors, defined as a social construct that encompasses 4 distinct dimensions (gender roles, gender identity, gender relations, and institutionalized gender) are undoubtedly relevant across age groups, young female patients with ACS face specific challenges and disparities in outcomes, compared to other populations. This narrative review examines the role of gender-related factors-specifically, gender roles, gender identity, gender relations, and institutionalized gender-in influencing objective and subjective ACS outcomes in young female patients. In the 5 articles identified, the objective outcomes included hospital readmission, "door-to-electrocardiography" time, and coronary atherosclerosis progression. Subjective outcomes, such as physical and mental functional status, quality of life, physical limitations, and vital exhaustion, were also examined. Being employed, which is a gender role, emerged as a protective factor against hospital readmission. Gender identity factors such as depression and stress were correlated with negative outcomes, and anxiety influenced "door-to-electrocardiography" times. Institutional factors, including income disparities, affected readmission likelihood. Strong social support decreased physical limitations post-ACS, whereas financial challenges and lower education negatively impacted quality of life and vital exhaustion. These findings underscore the intricate interplay of gender dimensions in shaping ACS outcomes among young female patients. Integrating these insights into clinical practice and research can enhance care, mitigate disparities, and foster improved cardiovascular health in this vulnerable population.

Le syndrome coronarien aigu (SCA) demeure un problème de santé préoccupant à l'échelle mondiale, avec une reconnaissance croissante de ses conséquences chez les jeunes adultes, plus particulièrement les jeunes femmes adultes. Les facteurs liés au genre, définis comme un construit social à quatre dimensions distinctes (les rôles liés au genre, l'identité de genre, les relations de genre et le genre institutionnalisé) sont indéniablement d'une grande importance dans tous les groupes d'âge, mais les jeunes patientes atteintes d'un SCA font face à des disparités et des défis particuliers à l'égard des résultats de santé par rapport à d'autres populations. La présente synthèse narrative propose un examen de l'influence des facteurs liés au genre (plus particulièrement les rôles liés au genre, l'identité de genre, les relations de genre et le genre institutionnalisé) sur les issues objectives et subjectives du SCA chez les jeunes patientes. Dans les 5 articles retenus, les issues objectives incluaient la réadmission à l'hôpital, le temps écoulé entre l'arrivée à l'hôpital et la réalisation de l'électrocardiographie et l'évolution de l'athérosclérose coronarienne. Les issues subjectives, comme le statut fonctionnel physique et mental, la qualité de vie, les limitations physiques et le syndrome d'épuisement, ont également été examinées. Être employé, qui est un rôle de genre, est apparu comme facteur de protection contre la réadmission à l'hôpital. Des facteurs liés à l'identité de genre, comme la dépression et le stress, étaient corrélés à des issues négatives et l'anxiété était liée au temps écoulé entre l'arrivée à l'hôpital et la réalisation de l'électrocardiographie. Les facteurs liés aux institutions, y compris les disparités de revenus, influençaient la probabilité de réadmission à l'hôpital. La présence d'un bon réseau social était associée à de plus faibles limitations physiques après le SCA, alors que les problèmes financiers et un faible niveau d'éducation avaient une influence néfaste sur la qualité de vie et le syndrome d'épuisement. Ces résultats font ressortir les interactions complexes entre les différentes dimensions du genre qui façonnent les issues du SCA chez les jeunes patientes. L'intégration de ces renseignements dans la pratique clinique et dans la recherche scientifique pourrait permettre d'améliorer les soins, de limiter les disparités auxquelles font face ces patientes et de favoriser une meilleure santé cardiovasculaire au sein de cette population vulnérable.

Prevalence of cannabis use for pain management in Quebec: A post-legalization estimate among generations living with chronic pain.

Background: Medical cannabis has been legal in Canada since 2001, and recreational cannabis was legalized in October 2018, which has led to a widespread increase in the accessibility of cannabis products. Aims: This study aimed to estimate the prevalence of cannabis use among adults living with chronic pain (CP) and investigate the relationship between age and cannabis use for CP management. Methods: A cross-sectional analysis of the COPE Cohort data set, a large Quebec sample of 1935 adults living with CP, was conducted. Participants completed a web-based questionnaire in 2019 that contained three yes/no questions about past-year use of cannabis (i.e., for pain management, management of other health-related conditions, recreational purposes). Results: Among the 1344 participants who completed the cannabis use section of the questionnaire, the overall prevalence of cannabis use for pain management was 30.1% (95% confidence interval 27.7-32.7). Differences were found between age groups, with the highest prevalence among participants aged ≤26 years (36.5%) and lowest for those aged ≥74 years (8.8%). A multivariable logistic model revealed that age, region of residence, generalized pain, use of medications or nonpharmacological approaches for pain management, alcohol/drug consumption, and smoking were associated with the likelihood of using cannabis for pain management. Conclusions: Cannabis is a common treatment for the management of CP, especially in younger generations. The high prevalence of use emphasizes the importance of better knowledge translation for people living with CP, rapidly generating evidence regarding the safety and efficacy of cannabis, and clinicians' involvement in supporting people who use cannabis for pain management.

Contexte: Le cannabis médical est légal au Canada depuis 2001 et le cannabis récréatif a été légalisé en octobre 2018, ce qui a conduit à une augmentation généralisée de l'accessibilité des produits du cannabis. Objectifs: Cette étude visait à estimer la prévalence de la consommation de cannabis chez les adultes vivant avec la douleur chronique et à étudier l'association entre l'âge et la consommation de cannabis pour la prise en charge de la douleur chronique. Méthodes: Une analyse transversale de l'ensemble de données de la cohorte COPE, un grand échantillon québécois de 1 935 adultes vivant avec la douleur chronique, a été menée. En 2019, les participants ont rempli un questionnaire en ligne qui contenait trois questions oui/non sur la consommation de cannabis au cours de l'année écoulée (c.-à-d., pour la prise en charge de la douleur, la prise en charge d'autres affections liées à la santé, à des fins récréatives). Résultats: Parmi les 1 344 participants qui ont rempli la section du questionnaire portant sur la consommation de cannabis, la prévalence globale de la consommation de cannabis pour la prise en charge de la douleur était de 30,1 % (intervalle de confiance à 95 %, 27,7-32,7). Des différences ont été constatées entre les groupes d'âge, avec la prévalence la plus élevée chez les participants âgés de ≤ 26 ans (36,5 %) et la plus basse chez les participants âgés de ≥ 74 ans (8,8 %). Un modéle logistique multivariable a révélé que l'âge, la région de résidence, la douleur généralisée, l'utilisation de médicaments ou approches non pharmacologiques pour la prise en charge de la douleur, la consommation d'alcool/de drogue et le tabagisme étaient associés à la probabilité d'utiliser le cannabis pour la prise en charge de la douleur. Conclusions: Le cannabis est un traitement courant pour la prise en charge de la douleur chronique, en particulier chez les jeunes générations. La prévalence élevée de l'utilisation souligne l'importance d'un meilleur transfert des connaissances pour les personnes vivant avec la douleur chronique, en générant rapidement des donnant probantes concernant l'innocuité et l'efficacité du cannabis, ainsi que l'implication des cliniciens dans le soutien aux personnes qui consomment du cannabis pour la prise en charge de la douleur.

The Effects of Maintenance Cardiac Rehabilitation: A SYSTEMATIC REVIEW.

PURPOSE: Maintenance cardiac rehabilitation (M-CR) programs aim to preserve the health benefits achieved during phase II cardiac rehabilitation (CR). The aim of this study was to establish the effects of M-CR on functional capacity, quality of life, risk factors, costs, mortality, and morbidity, among other outcomes. METHODS: Scopus, ISI Web of Science, PubMed, Embase & Embase classic OVID, and Lilacs were searched. Randomized controlled trials, published between 2000 and 2016, on the effects of M-CR in patients with cardiovascular disease, who had graduated from CR, having a control or comparison arm were included. Citations were processed by two authors, independently. Methodological quality was assessed using PEDro, and level of evidence graded with the Scottish scale. Outcomes were qualitatively synthesized. RESULTS: The searches retrieved 1901 studies with 26 articles meeting inclusion criteria (3752 participants). Some trials tested M-CR in nonclinical settings, and others used resistance or high-intensity interval training. The methodological quality of 11 articles was good, with a level of evidence (1+) and a grade B recommendation. Results showed M-CR resulted in increased or maintained functional capacity, quality of life, and physical activity levels, when compared with the control. No adverse events were reported. Few studies assessed rehospitalizations and mortality. CONCLUSION: Quality of included trials was low because it is not possible to double-blind in M-CR trials and also due to the heterogeneity of M-CR interventions. Understanding, availability, and use of M-CR programs should be increased.

Cumplimiento de la capacidad tecnológica-científica en los servicios de Fisioterapia de Bucaramanga y Floridablanca / Achievement of technological and scientific capacity in Physical Therapy services of Bucaramanga and Floridablanca

Objetivo Determinar el cumplimiento de la condición de capacidad tecnológica y científica de una muestra de servicios de terapia física y respiratoria del área urbana de Floridablanca y Bucaramanga. Metodología Se realizó un estudio descriptivo, con un muestreo no probabilístico por conveniencia. La muestra la conforman cuatro instituciones prestadoras de servicios de salud del municipio de Floridablanca y tres instituciones del área urbana de Bucaramanga, a las que durante el año 2011 se les aplicaron dos encuestas para verificar el cumplimiento de los estándares de habilitación y conocer las razones por las cuales incumplen con alguno de los requisitos. Resultados En Floridablanca, tres instituciones corresponden al primer nivel de atención y una al segundo nivel de atención; los estándares con menor cumplimiento son: Seguimiento a riesgos con una mediana del puntaje de cumplimiento de 0 (Rango: 0-12); Historia Clínica asistencial con una mediana de 9,5 (Rango: 0-100) y el estándar de procesos prioritarios con una mediana de 18 (Rango: 9-27). En Bucaramanga, dos correspondían al segundo nivel de atención y una a un tercer nivel de atención. Los estándares de menor cumplimiento fueron: Medicamentos y dispositivos con 0 para una institución, Procesos prioritarios con una mediana de 60 (Rango: 0-89) e instalaciones físicas con una mediana de 73 (Rango: 64-84). Conclusiones Los resultados muestran un incumplimiento de los requisitos esenciales de habilitación, pese a que éstos son exigidos por los entes territoriales departamentales, distritales y municipales de salud.(AU)

Objective To identify the achievement of the condition of technological and scientific capacity of a sample of physical therapy and respiratory services from the urban area of Floridablanca and Bucaramanga. Methodology A descriptive study was performed with a set of samples not based on probabilities out of convenience. The sample consisted of four health service provider institutions in the town of Floridablanca and three institutions from the urban area of Bucaramanga. During the year 2011, two check lists were applied in order to verify the fulfillment of standards of habilitation and to find the reasons for their non-compliance in some of their requisites. Results Three institutions in Floridablanca belong to the first level of care and one to the second level of care; the standards with the lowest fulfillments are: Risk follow-up with a median fulfillment score of 0 (Range: 0-12); Medical Records of care with a median of 9.5 (Range: 0-100) and the standard of priority procedures with a median of 18 (Range: 9-27). In Bucaramanga, two institutions belong to the second level of care and one to the third level of care. The lowest standards in fulfillment were: Medications and devices with zero for one institution, Priority procedures with a median of 60 (Range: 0-89) and physical installations with a median of 73 (Range: 64-84). Conclusions The results show a non-compliance with the essential requisites of habilitation even though these are demanded by the territorial organizations in each health department, district, and municipality.(AU)

Prevalencia y caracterización de la población en condición de discapacidad del municipio de Los Santos (Santander, Colombia), 2011 / Prevalence and characterization of the population in condition of disability in Los Santos (Santander, Colombia), 2011

Objetivo: Determinar la prevalencia y caracterizar la población en condición de discapacidad del municipio de Los Santos (Santander, Colombia), durante 2010 y 2011. Materiales y métodos: Se realizó un estudio descriptivo aplicando el instrumento de registro "Encuesta a Personas con Discapacidad y su cuidador". Estudiantes de último año de fisioterapia y bacteriología de la Universidad de Santander (UDES), previamente entrenados, recogieron la información mediante entrevista. Se realizó un análisis estadístico descriptivo aplicando medidas de tendencia central y frecuencias absolutas y relativas. Resultados: Se encontraron 108 PCD, la prevalencia de discapacidad de esta población fue de 1,3% (IC 95% 1,1-1,6), la vereda con mayor prevalencia fue Los Teres (9,4%; IC95% 5,1-15,5). De las 108 PCD, el 48% corresponde a género femenino y el 47,2°% se encuentra entre 15 y 44 años. La estructura corporal con mayor deficiencia fue el sistema nervioso, con un 64,8%, y las actividades de demanda general fueron las más afectadas (57,4%). Los problemas con servicios, sistemas y políticas de transporte, seguro social, salud y educación constituyen el principal facilitador (57, 4%). Conclusión: La discapacidad como problema de salud pública afecta las actividades, participación y desempeño de las PCD, lo cual disminuye su desarrollo individual y sus oportunidades de integración a la sociedad.

Objective: To determine the prevalence and characterize the condition of disabled people in the municipality Los Santos, Santander in 2010 and 2011. Materials and methods: A descriptive study was conducted using the tool of record "Survey of Persons with Disabilities and its attendant". Physiotherapy and bacteriology students from University of Santander (UDES), previously trained, collected the information by interview. We use descriptive statistics applying central tendency measures and absolute and relative frequencies. Results: We found 108 people with disabilities; the prevalence of disability in this popu-lation was 1.3% (95% CI 1.1 -1.6), the place with the highest prevalence was Los Teres (9.4%; 95% CI 5.1-15.5). Of the 108 disabled people, 48% were female and 47.2% were between 15 and 44 years old. The body structure more impairment was nervous system with a 64.8% and general tasks and demands were the most affected (57.4%). Problems with services, transport systems and policies, social security, health, and education were the main facilitator (57.4%). Conclusion: Disability as a public health problem affecting the activities, participation and performance of the people with disabilities decreasing their individual development and opportunities for integration into society.

Reproducibilidad de las pruebas Arm Curly Chair Stand para evaluar resistencia muscular en población adulta mayor / Reliability of Arm Curl and Chair Stand tests for assessing muscular endurance in older people / Reprodutibilidade dos testes de Arm Curl e Chair Stand para avaliar resistência muscular em idosos

Objetivo: evaluar la reproducibilidad prueba-reprueba y el nivel de acuerdo entre mediciones de las pruebas 30 seg (30-s) Arm Curl y 30-s Chair Stand en una muestra de adultos mayores de Bucaramanga. Materiales y métodos: se realizó un estudio de evaluación de tecnologías diagnósticas. Ambas pruebas fueron administradas en dos oportunidades por el mismo evaluador a 111 adultos mayores de 59 años (70,4 ± 7,3), con un intervalo de 4 a 8 días. En el análisis se determinó la reproducibilidad prueba-reprueba mediante el coeficiente de correlación intraclase, CCI= 2,1 con sus respectivos intervalos de confianza de 95% (IC 95%). El nivel de acuerdo se estableció mediante el método de Bland y Altman. Resultados: la reproducibilidad prueba-reprueba para el 30-s Arm Curl test fue muy buena, con un CCI= 0,88 y para el 30-s Chair Stand test fue buena, con un CCI= 0,78. Así, el acuerdo fue muy bueno para las dos pruebas de resistencia muscular. Los IC 95% estuvieron entre -3,8 y 3,2 repeticiones para la prueba 30-s Chair Stand y entre -3,1 y 2,8 repeticiones para la prueba 30-s Arm Curl. Conclusión: las pruebas 30-s Arm Curl y 30-s Chair Stand tienen buena reproducibilidad y nivel de acuerdo para evaluar resistencia muscular en adultos mayores funcionalmente independientes.

Objective: to assess the test-retest reliability and level of agreement between measures of the 30 second (30-s) Arm Curl and 30-s Chair Stand test in a sample of older adults from Bucaramanga. Materials and methods: a study of evaluation of diagnostic technology was done. Both tests were administered by the same evaluator to 111 adults older than 59 year-old (70,4 ± 7,3), on two occasions, with an interval of time between measures of 4 to 8 days. In the analysis, test-retest reliability was determined using the Intraclass Correlation Coefficient ICC= 2,1 with their confidence interval 95% (CI 95%) respective. The agreement level was established by the Bland and Altman method. Results: the test-retest reproducibility of the 30-s Arm Curl test was very good ICC= 0,88 and to the Chair Stand test was good ICC= 0,78. The agreement was very good for both tests of muscle endurance. The CI 95% were between -3,8 and 3,2 stands to 30-s Chair Stand test and between -3,1 and 2,8 curls to 30-s Arm Curl test. Conclusion: the 30-s Arm Curl and 30-s Chair Stand test have good reliability and agreement to assess muscle endurance in older adults functionally independent.

Objetivo: avaliar a reprodutibilidade teste-reteste e nível de concordância entre as medidas de testes 30 second (30-s) Arm Curl e 30-s Chair Stand em uma amostra de idosos de Bucaramanga. Materiais e métodos: se realizou um estudo de avaliação da tecnologia de diagnóstico. Ambos os testes foram administrados pelo mesmo avaliador a 111 adultos com mais de 59 anos de idade (70,4 ± 7,3), em duas ocasiões, com um intervalo de tempo entre as medidas de 4 a 8 dias. Na análise, se determinou a reprodutibilidade teste-reteste usando o Coeficiente de Correlação Intraclasse ICC= 2,1 com seus respectivos intervalos de confiança de 95% (IC 95%). O nível de concordância foi estabelecido pelo método de Bland e Altman. Resultados: a reprodutibilidade teste-reteste do 30-s Arm Curl teste era muito bom ICC= 0,88 e do 30-s Chair Stand teste foi boa ICC= 0,78. O acordo foi muito bom para ambos os testes de resistência muscular. Os IC 95% foram de -3,8 e 3,2 repetições para o 30-s Chair Stand teste e de -3,1 e 2,8 repetições para o 30-s Arm Curl teste. Conclusão: testes 30-s Arm Curl e 30-s Chair Stand possui boa reprodutibilidade e concordância para avaliar a resistência muscular em idosos funcionalmente independentes.

Reproducibilidad del tiempo en posición sedente evaluado con el International Physical Activity Questionnaire (IPAQ) y el Global Physical Activity Questionnaire (GPAQ) / Time reproducibility assessed in a seated position with the International Physical Activity Questionnaire (IPAQ) and the Global Physical Activity Questionnaire (GPAQ)

Objetivo: Evaluar la reproducibilidad y el nivel de acuerdo del tiempo en posición sedente evaluado con el IPAQ y el GPAQ. Métodos: Se realizó un estudio de evaluación de tecnologías diagnósticas. Los cuestionarios IPAQ y GPAQ fueron administrados por dos encuestadores a 92 adultos (42.2 ± 13.9 años), en dos oportunidades con un intervalo de tiempo entre 3 y 6 días, en el mismo orden de aplicación establecido aleatoriamente en la primera prueba. En el análisis, se evaluó la reproducibilidad prueba-reprueba de los ítems que miden el tiempo en posición sedente del IPAQ y del GPAQ y la reproducibilidad entre ítems, aplicando el Coeficiente de Correlación Intraclase (CCI (2.1)) y sus intervalos de confianza del 95% (IC95%). El nivel de acuerdo se estableció mediante el método Bland y Altman. Resultados: La reproducibilidad prueba-reprueba para el tiempo en posición sedente fue buena para el IPAQ (CCI: 0.77 IC95% 0.67; 0.84) y muy buena para el GPAQ (CCI: 0.83 IC95% 0.76; 0.89). El acuerdo fue pobre con un promedio de las diferencias de -0.04 h/d (límites de acuerdo: -4.95; 4.9 h/d) para el IPAQ y 0.15 h/d (límites de acuerdo: -4.2; 4.5 h/d) para el GPAQ. La reproducibilidad entre ítems fue muy buena en la primera CCI: 0.81, (IC95% 0.73; 0.87) y segunda prueba CCI: 0.82 (IC95% 0.74; 0.88); el nivel de acuerdo entre ítems fue pobre para la primera -0.54 h/d (límites de acuerdo: -4.7; 3.6 h/d) y segunda prueba -0.6 h/d (límites de acuerdo: -4.9; 4.2 h/d). Conclusiones: La medición del comportamiento sedentario o hipoactividad física mediante los ítems del IPAQ y GPAQ presenta buena reproducibilidad pero pobre acuerdo, lo cual sugiere mejorar la medición de este comportamiento. Adicionalmente, los resultados mostraron que los ítems del IPAQ y el GPAQ proveen información similar. [Angarita A, Camargo DM, Oróstegui I. Reproducibilidad del tiempo en posición sedente evaluado con el International Physical Activity Questionnaire (IPAQ) y el Global Physical Activity Questionnaire (GPAQ). MedUNAB 2010; 13:5-12].

Purpose: To evaluate the reliability and agreement of the time sitting items form the IPAQ and GPAQ. Methods: An evaluation of diagnostic technologies was done. The IPAQ and GPAQ were administered by two interviewers to a sample of 92 adults (42.4 ± 13.9 years), twice with an interval of time between 3 to 6 days, in the same order of application established randomly in the first test. In the analysis, we assessed test-retest reliability of the sitting items from the IPAQ and GPAQ and between items reliability by Intraclass Correlation Coefficient (CCI 2.1) and their confidence intervals at 95% (IC95%). The level of agreement was established by Bland-Altman method. Results: Test-retest reliability to time sitting items of the IPAQ was good (ICC: 0.77 (CI95%: 0.67-0.84) and very good to GPAQ (ICC: 0.83 CI95% 0.76-0.89). Agreement was poor with a mean difference of -0.04 (limits of agreement: -4.95, 4.9 h/d) to the IPAQ and 0.15 h/d (limits of agreement -4.2, 4.5 h/d) to the GPAQ. Between items reliability was very good in the first test (CCI: 0.81 CI95% 0.73-0.87) and in the second test (CCI:0.82 CI95% 0.74-0.88); Agreement was poor in the first test with a mean difference of -0.54 (limits of agreement: -4.7; 3.6 h/d) and in the second test -0.36 (limits of agreement: -4.9; 4.2 h/d). Conclusions: The measurement of sedentary behavior or physical hypoactivity through the items of the IPAQ and GPAQ showed good reliability but poor agreement, it is suggested to improve the measurement of this behavior. Additionally, the results showed that the sitting item of the IPAQ and GPAQ provide similar information. [Angarita A, Camargo DM, Oróstegui I. Reliability of time sitting items from the International Physical Activity Questionnaire (IPAQ) and Global Physical Activity Questionnaire (GPAQ). MedUNAB 2010; 13:5-12].