Development of a self-assessment tool to address the functioning of community-dwelling older adults in general practice: a validation study of the EFA23 questionnaire.

BACKGROUND: Multimorbidity is increasingly prevalent among ageing patients, leading to reduced daily functioning. To address the challenges posed by multimorbidity in older adults, a person- and context-centred approach is needed. This study aimed to develop a questionnaire as a self-assessment tool for older adults focusing on functioning in general practice based on the International Classification of Functioning, Disability and Health (ICF). METHODS: A mixed-methods approach was employed in the development and validation of the German EFA23 (Erfassung Funktionaler Gesundheit im Alter - 23 Fragen; Assessing Functional Health in Old Age - 23 questions) questionnaire. Based on an ICF subset developed in a preparatory phase and consensus study, questionnaire items were formulated and tested in a qualitative pretest, followed by a validation study. A workshop with general practitioners (GPs) was held to develop a supplementary manual for GPs on how to interpret the questionnaire results and discuss them with the patients. RESULTS: A total of 69 items were developed and tested in the qualitative pretest with 15 respondents, resulting in 37 items for the validation study. The validation study, involving 237 older adults, showed the presence of one significant principal component. It demonstrated good internal consistency (Cronbach's alpha = 0.967) and construct validity, showing positive correlations with established assessment tools. Descriptive statistics showed differences between the means of self-assessment by patients and an external GP assessment. The final EFA23 questionnaire consists of 23 items assessing limitations in functioning. CONCLUSIONS: The EFA23 questionnaire can be used as a valid self-assessment instrument to measure functioning in older adults, supporting a person- and context-centred approach in general practice.

Disseminating the F-Words for Child Development to Parents of Children With Developmental Disabilities in Iran: A Qualitative Pilot Feasibility Study.

BACKGROUND: Attitudes toward childhood disability have historically focused on biomedical efforts on 'fixing'. The introduction of WHO's ICF framework for health and Canadian researchers' 'F-words' (functioning, fitness, fun, friends, family and future) have significantly changed the field. To explore whether the F-words ideas influenced parents' perspectives on their child's abilities and rehabilitation goals, this qualitative pilot study introduced the F-words to Iranian parents with a child with a developmental disability. METHODS: This study was conducted in Tabriz, Iran, in 2023, using Iranian educational F-words materials built on ideas available on the CanChild F-words Knowledge Hub. Data were collected through semistructured interviews with five mothers of children <5 years old with a developmental disability before and after attending an 'F-words Awareness Session' and analysed using thematic analysis. RESULTS: In the preinterviews, six themes (and 20 subthemes) were identified: (i) routines (5); (ii) challenges (4); (iii) parental concerns (3); (iv) child's needs and priorities (3); (v) the role of parents in satisfying needs and challenges (2); and (vi) expectations of rehabilitation (3). In the postinterview, the same six themes and four additional subthemes emerged. CONCLUSION: Findings from the pilot study showed that the intervention had an impact on the attitudes and behaviours of participants. Specifically, teaching about the F-words reduced parents' emphasis on the concept of 'normality'. Families' positive response to the 'F-words Awareness Session' indicates their openness to incorporating this approach into their daily lives. These findings highlight the potential benefits of utilizing the F-words in rehabilitation in Iran. Studies like these can serve as a foundation for developing effective strategies for integrating the F-words into existing rehabilitation practices in Iran.

Application of the international classification of functioning, disability, and health in autism and attention-deficit hyperactivity disorder: A scoping review.

LAY ABSTRACT: The International Classification of Functioning, Disability, and Health (ICF) is a framework designed by the World Health Organization (WHO) to help different sectors, such as healthcare, social services, education, and policy, understand how people with health-related issues function (do the things they want to and need to do) in their daily lives. This framework has also been used to guide clinical practice and research in autism and attention-deficit hyperactivity disorder (ADHD). To make it more practical, shorter versions of the ICF called Core Sets have been developed. We wanted to explore how the ICF and the ICF Core Sets have been used in research relating to autism and ADHD. We looked at the research that had been previously published on this topic by conducting a systematic search and review. Seventy-eight studies meeting our criteria were included in our review. Results show that the ICF has been applied in many ways across various contexts. However, most of the research has focused on autism, mainly involving children. The review highlights that although the ICF was used in some studies, the underlying philosophies of the framework were not always followed. The medical perspective still influenced the way research was done and interpreted. Nevertheless, using the ICF in the right way can help shift research on neurodevelopmental conditions like autism and ADHD toward a more holistic approach, moving away from solely focusing on medical aspects.

Resilience in the face of neurodivergence: A scoping review of resilience and factors promoting positive outcomes.

Neurodivergent individuals, including a range of conditions impacting neurological function, are at an increased likelihood of poor life outcomes, such as in functional adaptation, mental health, and well-being. Yet, many live meaningful and fulfilling lives. Resilience may provide some explanation for the heterogeneity in outcomes observed in neurodivergent populations. We conducted a scoping review embedded in a neurodiversity-affirmative approach to provide an understanding of resilience in neurodivergent populations. A total of 176 articles were included in this review and were synthesized using a two-phased process. First, findings were synthesized narratively to examine how resilience has been conceptualized and explored in neurodivergent populations. Second, to identify the bio-psycho-social factors important for resilience in neurodivergent individuals, we converted concepts identified in articles to the nomenclature of the World Health Organizations' International Classification of Functioning, Disability and Health (ICF) using a standardized linking process. We find considerable variability in how resilience is conceptualized and measured in neurodivergent populations. We identified 83 unique ICF categories representing resilience factors, of which only 20 appeared in more than 5% of the articles. Identified ICF categories highlight the importance of support systems such as families and friends, community participation and acceptance, and individual capabilities for resilience.

Two decades of the International Classification of Functioning, Disability and Health (ICF) in health research: a bibliometric analysis.

Introduction: We conducted a twenty-year bibliometric analysis of scientific literature, focusing on the trends of The International Classification of Functioning, Disability and Health (ICF) use in health research.Methods: We retrieved 3'467 documents published between 2002 and 2022, sourced from the Web of Science Core Collection database. We used the Bibliometrix and VoSviewer tools for descriptive analyses and data visualization.Results: Our findings indicate a significant increase in ICF application since 2011, with an average annual growth rate of 13.19%. Prominent contributions were observed globally, with notable outputs from the U.S., Canada, Germany, the Netherlands, and Switzerland. The Ludwig Maximilian University Munich, Swiss Paraplegic Research, and McMaster University authored a quarter of the documents (24.6%). Collaboration networks of countries and institutions revealed robust partnerships, particularly between Germany and Switzerland. "Rehabilitation" was the most frequently occurring keyword, although a thematic shift towards epidemiology, aging, and health-related quality of life was observed post-2020. While rehabilitation remained the primary thematic focus, literature post-2020 highlighted epidemiology as a growing area of interest.Conclusions: A steady increase in ICF-based research mirrors the rising interest in a biopsychosocial and person-centered approach to healthcare. However, the literature is primarily produced by high-resource countries, with underrepresentation from low and middle-resource countries, suggesting an area of future research to address this discrepancy.

The International Classification of Functioning, Disability and Health (ICF) serves as a universal framework for describing functioning and disability.The increasing application of the ICF in rehabilitation research underscores its value in developing comprehensive, person-centered care plans.By integrating the ICF, rehabilitation programs can better address the multifaceted needs of patients, facilitating improved outcomes in participation and quality of life.The observed thematic shift towards aging and health-related quality of life post-2020 indicates the growing relevance of the ICF in managing the complex health challenges of an aging population.The study also suggests that expanding the ICF implementation in low- and middle-income countries could bridge existing disparities in rehabilitation services, promoting global health equity.

The impact of increased computer screen time during the COVID-19 pandemic on the occurrence of upper part of musculoskeletal diseases among health personnel.

Health personnel who played a key role in the fight against the pandemic stayed during it burdened with increased working time using a computer. We analyzed the impact of increased computer working time during the COVID-19 pandemic on the occurrence of the upper part of musculoskeletal diseases among health personnel. The study group consisted of 418 health personnel, divided according to the time they worked at the computer during the pandemic: up to 2 h a day, from 3 to 5 h a day, and more than 6 h a day. The ICF profile analyzed symptoms of dysfunction of structures of the upper part of the musculoskeletal system (head and cervical spine, shoulder girdle, elbow joint, wrist joint). Employees working more than 6 h daily had a higher risk of developing restrictions in tone of isolated muscles and muscle groups p < 0.001), range of motion of the shoulder girdle (p < 0.001), increased tension of paraspinal muscles (p < 0.001), weakened shoulder girdle muscle strength (p < 0.001), elbow joint pain (p = 0.016), wrist joint pain (p < 0.001), coordination disorders (p = 0.004), difficulties in arm and hand use (p < 0.001), lifting and carrying objects (p = 0.008) and paraesthesia (p < 0.001) compared to those working less than 2 h daily. Additionally, working for 3-5 h and above 6 h compared to health personnel working up to 2 h was associated with a greater risk of headaches and cervical spine pain (p < 0.001), shoulder girdle pain (p < 0.001), limited mobility in the wrist joint (p = 0.003), and tremors (p < 0.001), that working below 2 h. Prolonged computer working time among health personnel during the COVID-19 pandemic is significantly associated with an increased risk of dysfunction and pain in structures of the upper part of the musculoskeletal system. Effective preventive measures are necessary to improve the functioning of the musculoskeletal system during extended periods of computer use.

Examining the content validity of the Comprehensive Assessment of Functioning for Mental Illness-Subjective Version (CAMI-S) with reference to the framework of the International Classification of Functioning, Disability, and Health (ICF).

Aim: To support the achievement of life goals and social participation of persons with mental illness, based on the World Health Organization's International Classification of Functioning, Disability, and Health (ICF), we generated items, identified domains, and examined the content validity of the Comprehensive Assessment of Functioning for Mental Illness-Subjective Version (CAMI-S). The purpose was to assess patients' strengths and weaknesses by incorporating the patient and public involvement perspective. Methods: Focus group interviews on the items to be included were conducted with Group A. A draft scale was constructed by extracting articles mentioning factors for social participation and recovery for each ICF component from PubMed. Group B participants rated themselves using the draft and highlighted items they considered inappropriate. Experts then rated the importance of the items through the Delphi method. Lastly, Group C participants evaluated whether the draft scale would help in understanding their strengths and weaknesses. Results: The interviews revealed subjective experience items. The draft scale had 81 items (physical and mental functions, 10; activities, 23; participation, 24; environment, 12; individuals, six; and subjective experience, six). Through the Delphi method, the number of items was reduced to 34 in six domains. Most participants (N = 50) indicated that it helped them ascertain patients' strengths and weaknesses (mean = 2.11 ± .714). Completion time for the scale was 56 min, including the 60-item face sheet (20-110 min). Conclusion: The CAMI-S helped participants ascertain patients' strengths and weaknesses. Its reliability and validity will be verified through a large-scale survey in the future.

Living with adult-onset myotonic dystrophy type 1: a scoping review.

PURPOSE: To identify the existing literature on experiences of living with adult-onset myotonic dystrophy type 1 (DM1) from people with adult-onset DM1, their caregivers and health care professionals. MATERIALS AND METHODS: Following the framework of Arksey and O'Malley, a literature search was performed in five databases in October-November 2022. An updated search was conducted in December 2023. Studies were eligible if they reported on experiences related to living with DM1 from people with adult-onset DM1, caregivers or healthcare professionals. Qualitative, quantitative, and mixed method studies were included. Key findings were categorized using the International Classification of Functioning, Disability and Health (ICF) components. RESULTS: 11 out of 1842 studies were included, of which five had a quantitative design, five had a qualitative design and one study had a mixed methods design. The studies reported on multiple experiences of living with adult-onset DM1 from the perspectives of people with the disease and their caregivers. All components of the ICF were reported in the studies; activity and participation and personal factors were the most reported. CONCLUSION: Adult-onset DM1 is a complex disease with great biopsychosocial impact making it challenging to live with for those diagnosed with DM1 as well as their caregivers.

Issues with hands or arms, myotonia, fatigue, impaired sleep or daytime sleepiness, and symptoms of depression in everyday life should be addressed in the follow-up of people with adult-onset myotonic dystrophy type 1 (DM1) to facilitate increased participation in daily life.Challenges related to activity and participation should be addressed in the follow-up of people with adult-onset DM1 to help facilitate increased activity and participation in everyday life.Interventions targeting caregiver needs are necessary to help them cope with living with a person with adult-onset DM1 and to minimize the negative impact DM1 has on their lives.

Investigating cognitive impairment, biopsychosocial barriers, and predictors of return to daily life among older stroke survivors.

Purpose: The aim was to investigate the associations between cognitive impairment and biopsychosocial factors among older stroke survivors and predictors of poststroke return to daily life. Materials and methods: This cross-sectional study involved 117 stroke survivors (61% men) with an average age of 77 years (range 65-91). The participants completed two questionnaires (Riksstroke and Short Form 36 questionnaires). The Montreal Cognitive Assessment (MoCA) was used to assess cognitive abilities. The International Classification of Functioning, Disability, and Health (ICF) framework guided the selection of biopsychosocial variables. We used Spearman's correlation coefficient and multiple logistic regression in the analyses. Results: The average MoCA score was 21.7 points (range: 4-30, SD 5.6). The need for assistance from relatives and professionals, need for help with dressing and household chores, reliance on others for mobility, and reading and balance problems were correlated with more severe cognitive impairment (r = 0.20-0.33). Cognitive impairment, fatigue, and balance issues predicted an unfavorable return to daily life (odds ratio: 6.2-6.8). Conclusion: The study indicated that cognitive impairment is associated with difficulties in all ICF domains. Cognitive impairment, fatigue, and balance issues are associated with an unsuccessful return to daily life. Prioritizing these factors and screening for cognitive impairment with objective assessment tools may improve rehabilitation outcomes and enhance overall quality of life poststroke.

Measurement properties of utility-based health-related quality of life measures in cardiac rehabilitation and secondary prevention programs: a systematic review.

PURPOSE: To identify utility-based patient-reported outcome measures (PROMs) for assessing health-related quality of life (HRQoL) in cardiac rehabilitation and secondary prevention programs (CR) and appraise existing evidence on their measurement properties. Secondly, to link their items to the International Classification of Functioning Disability and Health (ICF) and the International Consortium of Health Outcome Measures (ICHOM) domains for cardiovascular disease (CVD). METHODS: Eight databases were searched. The review followed the COSMIN and JBI guidelines for measurement properties systematic reviews and PRISMA 2020 reporting guidelines. Non-experimental and observational empirical studies of patients ≥ 18 years of age with CVD undergoing CR and assessed quality of life (QoL) or HRQoL using utility-based PROMs or one accompanied by health state utilities were included. RESULTS: Nine PROMs were identified with evidence on measurement properties for three measures: the German translations of SF-12, EQ-5D-5L, and MacNew heart disease HRQoL questionnaire. There was moderate quality evidence for responsiveness and hypothesis testing of the SF-12 and EQ-5D-5L, and high-quality evidence for responsiveness and hypothesis testing for the MacNew. All items of SF-12 and EQ-5D were linked to ICF categories, but four items of the MacNew were not classified or defined. All the PROM domains were mapped onto similar constructs from the ICHOM global sets. CONCLUSION: Three utility-based PROMs validated in CR were identified: the German versions of the EQ-5D and SF-12 and the MacNew questionnaire. These PROMs are linked to a breadth of ICF categories and all ICHOM global sets. Additional validation studies of PROMs in CR are required.

Giving insights into an ICF training: evaluation of an in-person interactive ICF training in Germany.

Introduction: The World Health Organization (WHO) adopted the International Classification of Functioning, Disability and Health (ICF) in 2001. The classification provides a framework for the standardised description of functioning and disability using health and health-related domains. The implementation of the ICF is diverse and has a wide range of applications. A thorough understanding of the ICF classification is essential for successful implementation. We developed and delivered an in-person interactive ICF training to facilitate the implementation of the ICF in Germany. The aim of this paper is to present the evaluation of this in-person interactive ICF training. Methods: The evaluation was conducted with questionnaires assessing the organisation of the workshops and the knowledge gained during the training using Likert scaled questions. Open-ended questions were used to gather feedback on the further development of the ICF training. Data were analysed descriptively using absolute and relative frequencies. Open-ended questions were analysed qualitatively. Results: Between 2017 and mid-2020, a team of trainers at the Chair of Public Health and Health Services Research (IBE) at LMU Munich organised 12 in-person interactive ICF trainings with a total of 191 participants. In total 151 participants filled in the questionnaires (response rate: 79.1%). The participants` professional backgrounds were primarily in the social sector (n = 76; 50.3%), clinical sector (n = 36; 23.8%), and administrative sector (n = 31; 20.5%). 42.4% of the participants strongly agreed that the content was relevant to their work, while an additional 51.0% almost agreed. According to this evaluation, 82.1% of the participants would recommend the training to others. Discussion: A number of constructive suggestions and proposals were made for the further development of the training programme. These mainly related to the content of the training, such as the themes of children and youth and integration assistance.

The 22q11.2 Deletion Syndrome from A Biopsychosocial Perspective: A Series of Cases with an ICF-Based Approach.

The 22q11.2 deletion syndrome (DS) can have a significant impact on functionality. The purpose was to describe 22q11.2DS children with functioning from a biopsychosocial perspective, focusing on the impact of children's health condition from domains of the International Classification of Functioning, Disability, and Health (ICF). METHODS: A descriptive, cross-sectional case series study with seven 22q11.2DS children. A questionnaire with an ICF checklist for 22q11.2DS was completed using a structured interview. The Wechsler Abbreviated Scale of Intelligence (WASI) was used to determine the Intelligence Quotient (IQ). RESULTS: Seven participants from 7 to 12 years old, presented some level of IQ impairment. It was observed that 22q11.2DS children experience significant intellectual, cognitive, and speech impairments across ICF Body Function domains. Impairments related to nose and pharynx were found in only one patient. The most relevant categories considered limitations in the Activity and Participation components pertained to producing nonverbal messages, communication, handling stress, and social interaction. Family, health professionals, and acquaintances were perceived as facilitators in the component Environmental Factors. CONCLUSION: The sample has its functioning affected by aspects that go beyond impairments in body structure and function. The organization of information from the perspective of the ICF is a different approach that helps clinical reasoning.

Can International Classification of Functioning, Disability and Health (ICF) Be Used for Prediction of Work Capacity and Employment Status in Multiple Sclerosis?

Background: Multiple sclerosis (MS) affects many body functions and activities, including work capacity and ability to work. An evaluation of work-related parameters is important to understand the barriers to maintaining the job. The aim of this study was to evaluate if a Comprehensive International Classification of Functioning, Disability and Health (ICF) core set for MS can be used to predict work capacity and employment status. Methods: The cohort included 151 participants with MS (99 female/52 male, mean age 49 years) referred for a work capacity evaluation. Results: 71 (47.0%) were employed and a major part (131, 86.7%) had a work capacity between 20 and 40% with no difference between those who were employed and those who were unemployed. The analysis revealed that age and the following categories explained 68.8% of the work capacity: b770 Gait pattern functions; b730 Muscle power functions; b134 Sleep functions; d845 Acquiring, keeping and terminating a job; and b620 Urination functions. The following categories in 79.5% predicted ability to work: b164 Higher-level cognitive functions; d510 Washing oneself; d630; Preparing meals; and d870 Economic self-sufficiency. Conclusions: Here, we show that different functions/activities predicted work capacity in comparison with employment status in MS. Therefore, ICF should be implemented when assessing work ability.

Activity limitations related to cold hypersensitivity in patients with hand injuries.

BACKGROUND: Knowledge of specific activity limitations due to cold hypersensitivity is sparse. PURPOSE: To explore activity limitations caused by cold hypersensitivity and the associated environmental factors in patients with hand injuries. STUDY DESIGN: Descriptive study. METHODS: Seventy-seven patients with multiple tissue hand injuries described activity limitations related to cold hypersensitivity in questionnaires six and/or 12 months after surgery. To characterize the activity limitations, we performed a quantitative content analysis applying the International classification of functioning and health (ICF). RESULTS: The respondents described on average 3.6 cold related activity limitations in leisure and/or work. The activities were most frequently (n) assigned to the ICF domains d920 Recreation and leisure (95), d440 Fine hand use (77), and d850 Remunerative employment (39). The most common related environmental factors were Products and technology for e140 Culture, recreation and sport (79) and for e135 Employment (71), respectively, and e225 Climate (71). Gloves were both a facilitator and a barrier for activity performance. CONCLUSION: The impact of cold hypersensitivity on activity was related to both the activity and the environment. The results call for clinical interventions and product development, for example of gloves, to help patients solve their cold related activity limitations.

Validity, reliability, and responsiveness of the Brazilian version of the instrument World Health Organization Disability Assessment Schedule (WHODAS 2.0) for individuals with obstructive sleep apnoea.

BACKGROUND: Obstructive sleep apnoea (OSA) is a disabling health condition, and there is no disease-specific patient-reported outcome instrument to assess individuals with OSA. OBJECTIVES: To evaluate the psychometric properties of the Brazilian version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) in individuals with OSA. METHODS: One hundred individuals with OSA responded to the WHODAS 2.0 version of 36 items, the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), and the 12-item health survey (SF-12). Internal consistency, convergent and discriminative validity, and responsiveness to continuous positive airway pressure (CPAP) were the psychometric properties tested. RESULTS: Cronbach's α values indicate good internal consistency (0.91 - 0.73), except for the self-care domain (α = 0.52). Convergent validity indicated an excellent correlation (r = -0.80) between the domains of functioning and quality of life. Discriminative validity showed no association between OSA severity and functioning (p = 0.90). The responsiveness to CPAP treatment showed a large effect size (r = 0.82; p < 0.05) CONCLUSIONS: The WHODAS 2.0 instrument is valid, reliable, and responsive for assessing individuals with OSA.

Standardization use of the international classification of functioning, disability and health in the determination of health status in patients with post-acute COVID-19 syndrome.

PURPOSE: To propose a standardized method for the use of the International Classification of Functioning, Disability and Health (ICF) to describe the health status in Post-Acute COVID-19 Syndrome (PACS) and investigate interrater agreement in the linking process in instruments and clinical exams using the ICF categories. MATERIALS AND METHODS: Cross-sectional and interrater agreement study that followed the Guidelines for Reporting Reliability and Agreement Studies. Two raters performed the linking coding process in instruments of quality of life, anxiety and depression, fatigue and pulmonary function, inspiratory muscle strength and cardiopulmonary exercise testing. The codes were qualified by standards defined to each instrument and exams. RESULTS: The instrument with the lowest Cohen's Kappa coefficient was anxiety and depression (k = 0.57). Forty ICF codes were linked to clinical instruments and exams. The fatigue instrument presented a higher degree of disability by the qualification process, from severe to complete, in the linked codes. CONCLUSION: The study presents a standardized method for the assessment of the health status of patients with PACS through ICF. Restriction in work performance, socialization and family relationships as well as disabilities in physical endurance, fatigue and exercise tolerance were found in the sample. The agreement between the raters was moderate to perfect, demonstrating that the method can be reproducible.

The body structures and functions, environmental factors, activities and participation in a person's environment are determinant aspects of his health.Ways to measure these aspects are key to assessing health not only as absence of disease, so the International Classification of Disability and Functional Health demonstrates the ability to fully describe health.This study proposes a standardization in the use of the tool to facilitate usability in clinical practice.

Children with developmental coordination disorders: a review of approaches to assessment and intervention.

Developmental Coordination Disorder (DCD) is a neurodevelopmental disorder characterized by deficits in motor skills, with gross and fine motor dysfunction being the main symptom. This condition greatly impairs children's daily life, learning, and social interaction. Symptoms typically appear during preschool or school age, and if left untreated, they can persist into adulthood. Thus, early assessment and intervention are crucial to improve the prognosis. This study aims to review the existing literature on DCD, providing a comprehensive overview of the assessment for children with DCD in terms of body functions and structures, activities and participation, and environmental factors within the framework of the International Classification of Functioning, Disability, and Health - Children and Youth (ICF-CY). Additionally, specific rehabilitation interventions will be described, offering valuable insights for the clinical assessment and intervention of children with DCD.

Funcionalidade familiar por meiodo instrumento APGAR: avaliaçãodas produções / Family functionality through the APGAR instrument: evaluation of productions

Objetivo: Sintetizar e descrever o que há produzido referente a funcionalidade familiar por meio do uso do instrumento APGAR familiar. Método: O estudo se sustenta na revisão do tipo integrativa de literatura de cunho narrativo, possibilitando a análise do conhecimento científico já produzido sobre o tema investigado. Resultados: A partir dos resultados da revisão integrativa, foi possível a formação de 02 (duas) categorias, como: Categoria 1-APGAR familiar na avaliação das relações cuidadores/familiares do idoso (60 a 100 anos). Categoria 2-Função familiar no cuidado a portadores de situações crônicas, como patologias oncológicas e patologias psiquiátricas. Conclusão: O estudo conseguiu concluir seus objetivos uma vez que os achados sugerem questões significativa concernente à família, pois, detém notoriedade, propiciando a conservação da integridade do ser humano em seus profusos aspectos.(AU)

Objective: To synthesize and describe what has been produced regarding family functionality through the use of the family APGAR instrument. Method: The study is based on an integrative review of narrative literature, enabling the analysis of scientific knowledge already produced on the topic investigated. Results: Based on the results of the integrative review, it was possible to form 02 (two) categories, such as: Category 1-Family APGAR in the assessment of caregiver/family relationships of the elderly (60 to 100 years old). Category2-Family role in caring for people with chronic conditions, such as oncological pathologies and psychiatric pathologies. Conclusion: The study managed to complete its objectives since the findings suggest significant issues concerning the family, as it holds notoriety, enabling the conservation of the integrity of the human being in its profuse aspects.(AU)

Objetivo: Sintetizar y describir lo producido sobre la funcionalidad familiar mediante el uso del instrumento APGAR familiar. Método: El estudio se basa en una revisión integradora de la literatura narrativa, posibilitando el análisis del conocimiento científico ya producido sobre el tema investigado. Resultados: Con base en los resultados de la revisión integradora, fue posible formar 02 (dos) categorías, tales como: Categoría 1-APGAR Familiar en la evaluación de las relaciones cuidador/familiar del anciano (60 a 100 años). Categoría2-Papel familiar en el cuidado de personas con enfermedades crónicas, como patologías oncológicas y patologías psiquiátricas. Conclusión: El estudio logró cumplir sus objetivos ya que los hallazgos sugieren cuestiones significativas relativas a la familia, ya que ésta goza de notoriedad, permitiendo la conservación de la integridad del ser humano en sus aspectos profusos.(AU)

Correlation between postoperative cardiac risks factors, functionality and hospital length of stay / Correlação entre os fatores de risco cardíaco pós-operatórios, funcionalidade e tempo de internação

INTRODUÇÃO: Cardiac surgery (CS) may be associated with several organic repercussions responsible for the appearance of cardiac risk factors during the postoperative period. These, associated with prolonged hospital length of stay (LoS), may trigger critical manifestations in individuals undergoing this surgical procedure. OBJECTIVE: To investigate the relationships between postoperative cardiac risk factors, LoS, and changes in functioning state. METHODS: Patients undergoing reconstructive, substitutive, or corrective cardiac surgeries were evaluated. The presence of postoperative cardiovascular risks was assessed using the InsCor score, while LoS and functionality were collected from medical records. RESULTS: One-hundred patients with a mean age of 59.2±12.3 years were included. Significant correlations between functionality and both the hospital and Intensive Care Unit (ICU) LoS (p<0.0001, ρ=0.56; p=0.002, ρ=0.29, respectively), as well as between hospital LoS and the number of comorbidities (p=0.003, ρ=0.28) were found. No significant relationships were observed between the number of postoperative risk factors and LoS. CONCLUSION: Functionality and comorbidities are associated with increased hospital and ICU LoS in patients undergoing cardiac surgery.

INTRODUÇÃO: A cirurgia cardíaca (CC) pode estar associada a diversas repercussões orgânicas responsáveis pelo surgimento de fatores de risco cardíaco no pós-operatório. Estas, associadas ao tempo de internação hospitalar (TIH) prolongado, podem desencadear manifestações críticas em indivíduos submetidos a esse procedimento cirúrgico. OBJETIVO: Investigar a correlação entre os fatores de risco cardíaco pós-operatórios em CC, funcionalidade e o (TIH). MÉTODOS: Foram avaliados pacientes submetidos a CC reconstrutivas, substitutivas ou corretivas. A presença de riscos cardiovasculares pós-operatórios foi avaliada pelo escore da InsCor, enquanto o TIH e a funcionalidade foram coletados em prontuários médicos. RESULTADOS: Cem pacientes com idade média de 59,2±12,3 anos foram incluídos. Correlações significativas entre funcionalidade e TIH total e na Unidade de Terapia Intensiva (UTI) (p<0.0001, ρ=0.56; p=0.002, ρ=0.29, respectivamente), bem como entre o TIH e o número de comorbidades (p=0.003, ρ=0.28) foram encontradas. Não foram observadas correlações significativas entre o número de fatores de risco pós-operatórios e o TIH. CONCLUSÃO: O número de alterações funcionais e o número de comorbidades estão associados ao aumento do TIH total e na UTI em pacientes submetidos à CC.

Advancing women's pelvic floor muscle function diagnosis: the EFSMAP examination and its reliability evaluation.

BACKGROUND: The accurate diagnosis of pelvic floor muscle impairments is essential. The plethora of terms and the lack of evidence to support widely used pelvic floor muscle function (PFMF) measurements hinder diagnostic labels. OBJECTIVE: To structure an examination of PFMF using visual observation and digital palpation and terms consistent with the ICF terminology, and to test its intra and interrater reliability/agreement. METHODS: A panel of 9 physical therapists applied Delphi method to structure the PFMF exam under ICF terminology and to verify its measurements reproducibility. For reliability and agreement, a convenience sample of women aged 51.2 ± 14.7 years had the sensitivity to pressure, pain, muscle tone, involuntary movement reaction, control of voluntary movement (contraction/relaxation), coordination, strength, and endurance examined by two raters, in the same day for interrater (n = 40), and one week apart, for intrarater reliability (n = 25). Percent agreement, linear weighted kappa, intraclass correlation coefficient, and Bland-Altman's limits of agreement were calculated (alpha = 0.05). RESULTS: Four round Delphi discussion structured the PFMF exam, named EFSMAP (Exame das Funções Sensoriais e Motoras do Assoalho Pélvico/Examination of Pelvic Floor Sensory and Motor Functions), set a list of concepts and instructions targeted at reproducibility and established PFMF diagnostic labels. Reliability, except for pain and tone, were moderate to excellent (Kw= 0.67-1.0 and ICC=0.48-0.82). Agreement was substantial for most PFMF features (0.64-1.00), except pain. CONCLUSIONS: The EFSMAP was successfully developed as a valid and reliable exam to be used in research and clinical practice; it provides labels for the diagnosis of pelvic floor muscle impairments. It might be easily adopted worldwide as it uses ICF terminology.