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

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

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

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

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

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

Assessment by proxy of the SF-36 and WHO-DAS 2.0. A systematic review.

BACKGROUND AND OBJECTIVE: In some cases, for the evaluation of the health status of patients it is not possible to obtain data directly from the patient. The objective of this study was to determine if the instruments that cannot be applied to the patient can be completed by a proxy. METHODS: A systematic review of the literature was carried out and 20 studies were included. The instruments reviewed in this synthesis were: Short Form-36 (SF-36), Montreal Cognitive Assessment (MoCA), WHODAS 2.0, Patient Health Questionnaire 9 (PHQ-9), State-Trait Anxiety Inventory (STAI), Disability Rating Scale (DRS). RESULTS: The levels of agreement between the responses of the patients and the proxies were good, mainly when evaluating HRQoL and functioning with the SF-36 and WHODAS 2.0 instruments, respectively, with a higher level of agreement in the more objective and observable domains such as physical functioning and lower level of agreement in less objective domains, such as emotional or affective status, and self-perception. CONCLUSION: In patients who cannot complete the different instruments, the use of a proxy can help avoid the omission of responses.

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

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

The role of backstop shape during inversion tectonics physical models

The style of deformation of rocks from basin-infilling sequences in positively inverted natural basins was discussed upon the results of laboratory experiments carried out in sandboxes with sand packs laid down in the space between two wooden blocks. The space simulated stages of crustal extension leading to (1) a half graben due to extension above a listric extensional detachment, with the blocks simulating the footwall and hanging wall, or (2) a graben, with the blocks simulating the external margins that drifted apart above a horizontal detachment. Combinations of two different angles were used to simulate the dip of curved normal faults along the internal face of the wooden blocks. Backstops in the half graben had a convex up internal face. Backstops in the graben had a concave up internal face. Shortening as partitioned in forward and backward movements within the sand packs, and the kinematics of contraction was largely influenced by the convex or concave internal faces. A buttress effect characterized by rotation of the sand pack close to the footwall was stronger for footwall with steeper-dipping internal faces. The results were compared to other physical experiments and applied to an inverted basin found in nature.

O estilo da deformação de sequências sedimentares de bacias submetidas a uma inversão tectônica positiva foi discutido a partir da análise de modelos laboratoriais, desenvolvidos em caixas de experimentos, com camadas de areia depositadas no espaço entre dois blocos de madeira. O espaço simulava estágios de extensão crustal que conduziram à formação de (1) um hemi-graben, gerado sobre um descolamento basal lístrico, com os blocos simulando o teto e o muro; e (2) um graben, com os blocos representando as margens externas que se distanciaram ao longo de um descolamento horizontal. Combinações de dois ângulos diferentes foram usadas para simular o mergulho das falhas normais curvas ao longo da face interna dos blocos de madeira. Nos hemi-grabens, os anteparos possuíam geometria convexa, e, nos grabens, geometria côncava. No pacote de areia, o encurtamento foi particionado em movimentos dirigidos a pós e antepaís, e a cinemática da contração foi fortemente influenciada pela geometria convexa ou côncava das faces internas dos anteparos. Um efeito obstáculo, caracterizado por rotação do pacote de areia, próximo ao bloco do muro, foi mais elevado junto às faces internas dos blocos de mais alto ângulo de mergulho. Os resultados foram comparados a outros experimentos físicos e aplicados a uma bacia invertida encontrada na natureza.

Anovulatorios en LES / Contraceptives in SLE

Los estrógenos juegan un papel importante en el LES y la utilización de anovulatorios, en pacientes lúpicas, no ha sido sistemáticamente estudiada. Basados en ciertos reportes de casos y pequeñas series, probablemente los anovulatorios se deben evitar en pacientes con enfermedad renal activa, por el riesgo de recaída, y en mujeres con títulos altos de anticuerpos antifosfolípido por el riesgo de trombosis. Sus beneficios incluyen la anticoncepción, preservación de la masa ósea, y protección de la fertilidad en pacientes que requieren de ciclofosfamida. Estudios clínicos controlados como el SELENA nos darán algunas respuestas sobre su seguridad y beneficio. Mientras tanto los anovulatorios se pueden considerar en pacientes lúpicas seleccionadas, con enfermedad estable, sin compromiso renal y en ausencia de anticuerpos antifosfolípido en títulos elevados