Avaliação da dependência no autocuidado: estudo exploratório do fenómeno em contexto comunitário / Self-care dependency assessment: an exploratory study of the phenomenon in community

The assessment of the dependent person's self-care ability, through measure-ment instruments, and the assessment of the level and kind of dependency, may provide nurses a more assertive method for understand the nature of the problems that affect dependency and for establish an action plan tailored to the development of new practices centered on the dependent person, looking forward to promote autonomy. Within this context, and in order to develop nursing practice in self-care dependency context, this paper serves the goal of the characterization of dependent people in self-care in a community context and the analysis of the different domains of self-care according to sociodemographic and clinical variables. It was used the non-probabilistic sampling method, of the accidental type and for data collection was used the reduced version of the Self-Care Dependency Assessment Form. The results found show that women and the elderly are more dependent, and that the dependence settles mainly gradually. Regarding the level of dependence by self-care domain, the one that registered the highest level of dependence was self-care "taking medication", followed by "dressing and undressing" and self-care "taking a bath". The "global level of dependence" has an average of 2.64 and a standard deviation of 0.83, which reveals high degrees of dependence on self-care. With current demographic changes and consequent health needs and their implications for health policy preparation and planning, the measurement and evaluation of the dependent person and their caregiver is becoming increasingly essential, enabling a holistic and adjusted approach

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Riesgo de dependencia y autoestima en personas mayores de 60 años según la actividad física y el consumo farmacológico / Risk of dependence and self-esteem in elderly people according to physical activity and drug consumption

OBJETIVO: A pesar de saberse que la práctica de actividad física puede influir positivamente sobre la salud de las personas mayores, existen variables como el riesgo de dependencia y el nivel de autoestima que pueden mediar en la calidad de vida de las personas. El objetivo del presente estudio fue conocer la relación existente entre el riesgo de dependencia y el nivel de autoestima en las personas mayores. MÉTODOS: Se entrevistaron 515 personas mayores, de entre 60 y 90 años de edad. Se realizó una única medición, utilizando diferentes escalas y cuestionarios validados (Escala de autoestima personal de Rosenberg, test de Barber y cuestionario Modificado Baecke PAQ). Se realizaron análisis estadísticos (con el programa SPSS V. 23.0) descriptivos, ANOVA, análisis de regresión lineal y correlaciones. RESULTADOS: El 89,1% presentó riesgo de dependencia, el 32,6% eran activos físicamente y el 43,3% tenían autoestima baja. El nivel de práctica de actividad física evidenció diferencias significativas (p < 0,001) favorables para las personas activas, las cuales presentaban menor riesgo de dependencia, mejor autoestima y menor consumo de medicamentos que las sedentarias. CONCLUSIONES: La práctica de actividad física ayuda a la reducción del consumo farmacológico, lo cual mejora la autoestima de las personas mayores y disminuye el riesgo de dependencia

OBJECTIVE: Despite knowing that the practice of physical activity can positively influence the health of older people, there are variables such as the risk of dependency and the level of self-esteem that can mediate people's quality of life. The objective of this study was to know the relationship between the risk of dependence and level of self-esteem in older people. METHODS: 515 seniors between 60 and 90 years old were interviewed. A single measurement was made, using different scales and validated questionnaires (Rosenberg personal self-esteem scale, Barber test and Modified Baecke PAQ questionnaire). Statistical analyzes (with the SPSS V. 23.0 program) descriptive, ANOVA, linear regression analysis and correlations were performed. RESULTS: 89.1% had dependency risk, 32.6% were physically active and 43.3% had low self-esteem. The level of physical activity practice showed significant differences (p < 0.001) favorable to active people, who had a lower risk of dependence, better self-esteem and lower consumption of medications than sedentary ones. CONCLUSIONS: The practice of physical activity helps reduce drug consumption, which improves the self-esteem of the elderly and decreases the risk of dependence

The impact of Dependency Act benefits on employment / La creación de empleo derivada de las prestaciones de la Ley de Dependencia

Objective: To assess the amount of employment generated from the effective development of the Dependency Act in 2012, by evaluating the number of jobs depending on whether in-kind services or cash benefits were applied. Methods: The level and total costs of dependency were obtained by using the Survey on Disability, Personal Autonomy and Dependency Situations of 2008. The consumption of dependent households was collected from the Household Budget Survey of 2012 carried out by the Spanish Statistics Institute. The impact on employment was estimated using an extended Input-Output model based on Symmetric Input-Output Tables and labour data from the Spanish National Accounts Base. Results: The total estimated costs of dependency in 2012 were 4,545 million Euros for in-kind services and 2,662 for cash benefits. One hundred and ninety-five thousand, six hundred and sixty-eight jobs were generated in 2012 from dependency costs, and132,997 were linked to in-kind services and 62,671 to cash benefits. Every million Euros allocated for dependency by the Government returned 53.33 jobs linked to in-kind services and 46.21 to cash benefits. Furthermore, 341,505 jobs would have been created if dependency benefits had been exclusively offered via in-kind services. Conclusions: Dependency benefits were equally distributed between in-kind services and cash benefits in 2012. Given that two out of three job positions generated from dependency benefits are linked to in-kind services, while the remaining third is generated by cash benefits, we conclude that around 146 thousand more jobs would have been generated if benefits had been offered as in-kind services instead of overusing cash benefits

Objetivo: Estimar la creación de empleo generada por la implantación de la Ley de Dependencia en 2012, evaluando el número de puestos de trabajo vinculados a servicios y a prestaciones económicas. Métodos: Los grados y los costes totales de la dependencia se han obtenido de la Encuesta sobre Discapacidades, Autonomía Personal y Situaciones de Dependencia de 2008. El consumo de los hogares dependientes proviene de la Encuesta de Presupuestos Familiares realizada por el Instituto Nacional de Estadística en 2012. La creación de empleo se ha estimado con un modelo ampliado input-output basado en las tablas simétricas input-output y en datos de empleo de la Contabilidad Nacional de España. Resultados: Los costes totales de dependencia estimados en 2012 fueron de 4545 millones de euros en servicios y 2662 millones de euros en prestaciones económicas. Se generaron 195.668 empleos vinculados a prestaciones de dependencia en 2012, 132.997 asociados a servicios y 62.671 a prestaciones económicas. Cada millón de euros asignados a prestaciones de dependencia por la Administración generó 53,33 empleos vinculados a servicios y 46,21 a prestaciones económicas. Además, se habrían creado 341.505 empleos si las prestaciones de dependencia hubieran sido asignadas únicamente como servicios. Conclusiones: Los costes de dependencia se distribuyeron por igual entre servicios y prestaciones económicas en 2012. Dado que dos de cada tres empleos generados por las prestaciones de dependencia están vinculados a servicios, mientras que el tercio restante a prestaciones económicas, se habrían generado 146.000 empleos más si todas las prestaciones hubieran sido asignadas como servicios en lugar de la masiva utilización de prestaciones económicas

Elderly people with limited mobility: their families and the implications of their dependency

Introduction and objectives: The family has suffered several changes throughout the times, leading to many elderly people living alone or with other elderly. In a family the situation of the elderly that depended on others can compromise the family's relationships, which leads to little availability to motivate them to mobilization. The objective of the study was to understand the way the family functions in view of to the dependence of the elderly with limited mobility in a community context. Methodology: Descriptive study, exploratory of a quantitive character. The data was gathered through a questionnaire, including the Lawton & Brody (1969) scales, the lifestyle profile (Nahas, 2013) and the familiar APGAR (Smilkstein, 1978). Non-probabilistic sample, composed by 1298 elderly with limited mobility, from 26 civil parishes from the municipality of Vila Nova de Famalicão. Results and discussion: Most of the people polled considered that his own family was a functional one (64.8%) and 49.6% were moderately dependent. By analysing the physical activity lifestyle profile and the familiar functionality one could con-clude that 65.2% had a positive profile, presenting typical behaviours of an active lifestyle. We think that the fact that 73.1% are inserted in functional families had something to do with it. We have verified a perfect association (p = 0.000) between dependency, lifestyle physical activity and familiar functionality - APGAR. Conclusions: The results show that the family determines the lifestyle physical acti-vity and the elderly's dependency. A functional family influences a positive physical activity profile, even in the elderly with limited mobility

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A nationwide Danish survey on the use of green spaces by people with mobility disabilities.

BACKGROUND: There is increasing awareness of the importance and health benefits of living near green spaces. Research usually focuses on the general population's use of green spaces and there has been little focus on the use of green spaces by specific groups, such as people with mobility disabilities. This represents a significant knowledge gap with regard to facilitating access to healthy green environments by all population groups. This study aims to provide knowledge of the use of green spaces by people with mobility disabilities. METHODS: The study was based on data from the Danish Health and Morbidity Survey in 2005. The study participants consisted of 11,238 adult Danes, 383 of whom reported mobility disabilities, meaning that they were dependent on assistive devices for walking or moving around. Multiple logistic regression analysis was used to investigate the association between mobility disability and use of green spaces. RESULTS: The results show that respondents who reported mobility disabilities visited green spaces less often than respondents without mobility disabilities. The severity of the mobility disability was associated with the frequency of visits. Frequency of visits was also related to the respondents' health-related quality of life status. CONCLUSIONS: These results highlight the need for further research into the constraints faced by people with mobility disabilities with regard to visiting green spaces.

Aplicación de la Escala de fragilidad de Edmonton en población colombiana. Comparación con los criterios de Fried / Edmonton Frail Scale in Colombian older people. Comparison with the Fried criteria

Introducción. La Escala de fragilidad de Edmonton fue desarrollada en Alberta, Canadá. Ha sido aplicada en diferentes escenarios como unidad de agudos, hospital día y atención ambulatoria. En Colombia no han sido publicados estudios que describan la utilidad esta escala. Materiales y métodos. Se diseñó un estudio de corte transversal y análisis secundario de prueba diagnóstica con el objetivo de estudiar la validez de criterio de la escala de Edmonton tomando como estándar los criterios de fragilidad de Fried. Se incluyeron pacientes mayores de 60 años de la comunidad. Se excluyeron pacientes con demencia severa, limitación para la movilidad y el desarrollo de las pruebas. Resultados. Se incluyeron 101 pacientes de la comunidad en Floridablanca, Colombia. La edad promedio fue de 68,9años, 74% mujeres. La velocidad de la marcha promedio fue de 1,1m/seg. Según la escala de Linda Fried, el 46% eran ancianos vigorosos, y la prevalencia de fragilidad fue del 7,9%. Respecto a la escala de Edmonton el 78% eran ancianos vigorosos, con una prevalencia de fragilidad de 8,9%. Tomando como punto de corte de 6 o más puntos la sensibilidad de esta escala fue de 75% y una especificidad del 88%. Conclusiones. Se encontró una frecuencia similar de fragilidad con la aplicación de los 2 instrumentos. Es de resaltar la visión multidimensional de Edmonton, complementando los datos del fenotipo más físico y centrado en sarcopenia de los criterios de Fried (AU)

Introduction. The Edmonton Frailty Scale was developed in Alberta (Canada). It has been applied in different scenarios, such as acute units, day hospitals, and outpatient care. There are no studies published describing the usefulness of this scale in Colombia. Materials and methods. A cross-sectional study and secondary diagnostic test analysis was designed with the objective of studying the criterion validity of the Edmonton Frail Scale using Fried's frailty criteria as standard. Patients 60 years old and over from the community were included. Patients with severe dementia, limited mobility, and unable to perform the tests were excluded. Results. The study included 101 patients from the community in Floridablanca, Colombia. The mean age was 68.9 years, and 74% were women. The median walking speed was 1.1m/sec. According to the Fried's criteria, 46% were vigorous elderly, and the prevalence of frailty was 7.9%. Using the EFS, 78% were vigorous elderly, with a prevalence of frailty of 8.9%. Taking 6 or more points as a cut-off, the sensitivity of this scale was 75% and had a specificity of 88%. Conclusions. A similar frequency of frailty was found on applying the two measurement scales. It is important to highlight the multidimensional view of the Edmonton scale, complementing the data of the most physical and sarcopenia-centred phenotype of Fried's criteria (AU)

Predicción de dependencia en ancianos atendidos en atención primaria / Prediction of dependency in the elderly attended in primary health care

Objetivo principal: Identificar a la población anciana atendida en atención primaria con más riesgo de ser dependiente para las actividades de la vida diaria. Metodología: estudio longitudinal, basado en datos registrados en la historia clínica informatizada de personas a partir de 75 años. Se construyó un modelo de Cox para determinar el riesgo de devenir dependiente en el seguimiento y se estimó su capacidad de discriminación. Resultados principales: el modelo mostró como variables predictoras de dependencia el deterioro mental severo (HR: 3,02; 95% IC 2,03-4,49) o moderado (HR: 1,35; 95% IC 1,08-1,68) según el test de Pfeiffer, tener la condición de atención domiciliaria (HR: 1,82; 95% IC 1,44-2,31) y tener historia de caídas registradas (HR: 1,51; 95% IC 1,20-1,90). El índice C del modelo fue de 0,72 (95% IC 0,68-0,76). Conclusión principal: El modelo predice de forma precisa aquellos pacientes con más probabilidad de ser dependientes

Objective: To identify the elderly population attended in primary health care with more risk of becoming dependent for activities of daily living. Methods: A longitudinal study, based on data recorded in the medical record of people from 75 years old. We constructed a Cox models to determine the risk of becoming dependent on the follow up. The discrimination capacity of the model was estimated with the concordance index. Results: The model showed as predictors of dependency: the mental impairment, according to the Pfeiffer test, severe (HR: 3,02; 95% CI 2,03-4,49) or moderate (HR: 1,35; 95% CI 1,08 to 1,68), homecare situation (HR: 1,82; 95% CI 1,44 to 2,31) and to have recorded history of falls (HR: 1,51; 95% CI 1,20 to 1,90). The C index of the derivation model was 0,72 (95% CI 0,68 to 0,76). Conclusions: The model accurately predicts patients most likely to be dependent

[Needs, uses, cons-pros, good practices and opportunities about walker in elderly with loss of autonomy]. / Besoins, usages, bénéfices-inconvénients, bonnes pratiques et perspectives en matière de déambulateurs chez les sujets âgés dépendants.

Non-use of the walker may be secondary to an initial inappropriate prescribing, a lack of adequate training, a lack of monitoring and side effects of using. Improving both stability and mobility in users is due to several biomechanical mechanisms. The benefits of walker are: general physiological effects, more confidence, better social life and decrease in the burden of care. The disadvantages of walker are: technical or practical aspects criticized by users, musculoskeletal disorders, delayed reaction time, fall risk and stigma. Few scientific data evaluating the interest of the walker concerning mobility exist, thus recommendations are low grade and are often taken from professional clinical experiences. The choice of technical walking assistance depends on the pathology and biomechanical mechanism. The walker robots are few distributed.

Low manipulation prevalence following fast-track total knee arthroplasty.

BACKGROUND AND PURPOSE: Postoperative joint stiffness following total knee arthroplasty (TKA) may compromise the outcome and necessitate manipulation. Previous studies have not been in a fast-track setting with optimized pain treatment, early mobilization, and short length of stay (LOS), which may have influenced the prevalence of joint stiffness and subsequent manipulation. We investigated the prevalence of manipulation following fast-track TKA and identified patients at risk of needing manipulation. PATIENTS AND METHODS: 3,145 consecutive unselected elective primary unilateral TKA patients operated in 6 departments with well-defined fast-track settings were included in the study. Demographic data, prevalence, type and timing of manipulation, and preoperative and postoperative ROM were recorded prospectively, ensuring complete 1-year follow-up. RESULTS: 70 manipulations were performed within 1 year (2.2%) at a mean of 4 months after index surgery. Younger age and not using walking aids preoperatively were associated with a higher risk of manipulation. LOS ≤ 4 days (as opposed to a longer LOS) was not associated with an increased risk of manipulation. INTERPRETATION: The prevalence of manipulation was lower or comparable to that in most published studies following more conventional pathways. Inherent patient demographics were identified as risk factors for manipulation whereas LOS ≤ 4 days was not. Thus, fast-track TKA does not result in increased risk of manipulation-despite a shorter LOS. Optimized pain treatment and early mobilization may contribute to these favorable results that support the use of fast-track.

Revisión sobre el deterioro funcional en el anciano asociado al ingreso por enfermedad aguda / Review of functional impairment associated with acute illness in the elderly

El ingreso hospitalario supone un riesgo para el paciente mayor, con alta probabilidad de sufrir eventos adversos, entre los que destaca el deterioro funcional asociado, por su alta frecuencia y el grave impacto sobre la calidad de vida que produce. Los principales factores de riesgo del deterioro funcional asociado al ingreso hospitalario son la edad avanzada, la inmovilidad, las alteraciones cognitivas y la situación funcional previa al ingreso. Es preciso detectar a tiempo al paciente de riesgo para poner en marcha las medidas necesarias para evitar este deterioro, entre las que destacan el ejercicio físico y la atención geriátrica multidisciplinar (AU)

Hospitalization is a risk for elderly population, with a high probability of having adverse events. The most important one is functional impairment, due to its high prevalence and the serious impact it has on the quality of life. The main risk factors for functional decline associated with hospitalization are, age, immobility, cognitive impairment, and functional status prior to admission. It is necessary to detect patients at risk in order to implement the necessary actions to prevent this deterioration, with physical exercise and multidisciplinary geriatric care being the most important (AU)

Hybridization between multi-objective genetic algorithm and support vector machine for feature selection in walker-assisted gait.

Walker devices are often prescribed incorrectly to patients, leading to the increase of dissatisfaction and occurrence of several problems, such as, discomfort and pain. Thus, it is necessary to objectively evaluate the effects that assisted gait can have on the gait patterns of walker users, comparatively to a non-assisted gait. A gait analysis, focusing on spatiotemporal and kinematics parameters, will be issued for this purpose. However, gait analysis yields redundant information that often is difficult to interpret. This study addresses the problem of selecting the most relevant gait features required to differentiate between assisted and non-assisted gait. For that purpose, it is presented an efficient approach that combines evolutionary techniques, based on genetic algorithms, and support vector machine algorithms, to discriminate differences between assisted and non-assisted gait with a walker with forearm supports. For comparison purposes, other classification algorithms are verified. Results with healthy subjects show that the main differences are characterized by balance and joints excursion in the sagittal plane. These results, confirmed by clinical evidence, allow concluding that this technique is an efficient feature selection approach.

Influencia del ámbito, rural o urbano, en la percepción de los apoyos y las necesidades de las personas cuidadoras en el hospital / Influence of environment, rural or urban, in the perception of the supports and needs of caregivers in hospitals

Fundamento. Tras implementar un Plan Funcional con medidas de apoyo a personas cuidadoras en dos hospitales de Granada, se analizan la eficacia y el efecto del medio en la percepción y las necesidades de la persona cuidadora. Material y método. Se realizó un estudio cualitativo, fenomenológico, a través de entrevistas semi-estructuradas. Participaron 45 personas cuidadoras incluidas en el Plan Funcional. Se midieron además apoyo social percibido, función familiar y nivel de ansiedad mediante los cuestionarios Duke-unc, Apgar familiar y Escala de Goldberg, respectivamente. El análisis de los datos cualitativos se llevó a cabo mediante codificación abierta, axial y selectiva, y los cuestionarios mediante estadística descriptiva .Resultado. Las personas cuidadoras del ámbito urbano valoraron más los apoyos que les facilitaban la vida en el hospital y los apoyos sociales para el domicilio y las del ámbito rural los apoyos hospitalarios orientados a educación en cuidados para cuando estuviesen en su domicilio, todos ellos vinculados a la personalización de cuidados. Las alteraciones personales por el cuidado están presentes en ambos ámbitos aunque difieren en las repercusiones psíquicas y en el tipo de fármacos y su consumo. Existen diferencias en cuanto a los apoyos necesarios y las dificultades encontradas. Conclusiones. El ámbito donde habitualmente viven las personas cuidadoras condiciona sus percepciones del cuidado y algunas de sus necesidades en el hospital. Se deberán revisar las medidas del Plan Funcional cuestionadas, redefinir algunas prioridades e incluir medidas adicionales en función de la situación familiar de las personas cuidadoras (AU)

Background. After the Functional Plan was implemented with support measures for caregivers in hospitals of Granada (Spain), the effectiveness and impact of environment on the perception and needs of caregivers was analysed. Materials and methods. A qualitative, phenomenological study was made through semi-structured interviews. A total of 45 caregivers included in the Functional Plan participated. In addition, perceived social support, family functioning, and the anxiety level was measured, respectively, through the Duke-UNC, Apgar Family, and Goldberg Scale questionnaires. The data were qualitatively analysed by open, axial, and selective coding, and the questionnaires by descriptive statistics. Results. The caregivers of the urban setting valued more the support that made their life easier in the hospital and the social support at home, while caregivers in rural settings valued the hospital support oriented towards education in care for life after returning home, all linked to the personalization of care. The personal disturbances due to care occurred in all the settings, although differences appeared in psychic repercussions and in the type of drugs and their consumption. There were differences in terms of support needed and the difficulties encountered. Conclusions. The setting where caregivers live determine their perceptions of the care and some of their needs in the hospital. The measures questioned in the Functional Plan should be reviewed and some priorities should be redefined, including additional measures, depending on the family situation of the caregivers (AU)

Mobilidade física prejudicada em idosos institucionalizados / Movilidad física perjudicada en los ancianos institucionalizados / Impaired physical mobility in institutionalized elderly

Objetivos: Caracterizar os idosos institucionalizados e associar a mobilidade física prejudicada com sexo, faixa etária, presença de diabetes mellitus, hipertensão arterial sistêmica, dor e realização de atividade física. Métodos: Estudo transversal, analítico, realizado com 124 idosos institucionalizados. Resultados: A maioria dos idosos apresentou mobilidade física prejudicada, prevalência das faixas etárias de 70? 80 anos e 80 anos ou mais; sexo feminino; prevalência de hipertensão arterial e diabetes mellitus; sequela de acidente vascular encefálico, fraqueza, dor e problemas musculoesqueléticos como principais motivos para mobilidade física prejudicada. Houve significância estatística (p<0,05) entre mobilidade física prejudicada e atividade física. Conclusão: Estes achados apontam para a importância de um trabalho multiprofissional para prevenir e minimizar as consequências da mobilidade física prejudicada entre os idosos institucionalizados

Objectives: To characterize institutionalized elderly and associate impaired physical mobility with gender, age, presence of diabetes mellitus, hypertension, pain and physical activity. Methods: Cross-sectional, analytical study carried out with 124 institutionalized elderly. Results: The majority of the elderly showed impaired physical mobility, prevalence in the age groups of 70 ? 80 years and 80 years or more were female; prevalence of hypertension and diabetes mellitus; CVA sequel, weakness, pain and musculoskeletal problems as the main reasons for impaired physical mobility. There was statistical significance (p<0.05) between impaired physical mobility and physical activity. Conclusion: These findings identify the importance of a multidisciplinary work to prevent and minimize the consequences of impaired physical mobility among institutionalized elderly

Objetivos: Caracterizar los ancianos institucionalizados y asociar la movilidad física perjudicada con el sexo, el grupo de edad, la presencia de diabetes mellitus, hipertensión arterial sistémica, dolor y realización de actividad física. Métodos: Estudio transversal, analítico realizado con 124 ancianos institucionalizados. Resultados: La mayoría de los ancianos presentaron movilidad física perjudicada, predominio de grupos de edad de 70-80 años y 80 años o más; sexo femenino; predominio de hipertensión arterial y diabetes mellitus; secuela accidente cerebrovascular, flaqueza, dolor y problemas musculo esqueléticos como principales motivos para movilidad física perjudicada. Hubo significante estadísticas (p<0,05) entre movilidad física perjudicada y actividad física. Conclusión: Estos hallados apuntan para la importancia de un trabajo multiprofesional para prevenir y minimizar las consecuencias de movilidad física perjudicada entre los ancianos institucionalizados

Construct validity and test-retest reliability of the walking questionnaire in people with a lower limb amputation.

OBJECTIVE: To investigate the construct validity and test-retest reliability of the Walking Questionnaire, a patient-reported measure of activity limitations in walking in people with a lower limb amputation. DESIGN: Cross-sectional study. SETTING: Outpatient department of a rehabilitation center. PARTICIPANTS: People with a lower limb amputation (N=172; mean age ± SD, 65±12y; 71% men; 82% vascular cause) participated in the study, 33 of whom also participated in the reliability study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Construct validity was investigated by testing 11 hypotheses: limitations in walking according to the Walking Questionnaire will be greater in people with a lower limb amputation who (1) are older, (2) have a bilateral amputation, (3) have a higher level of amputation, (4) underwent their rehabilitation treatment in a nursing home, (5) walk less (in terms of time), and (6) walk shorter distances. Furthermore, limitations in walking will be positively related to activity limitations according to the (7) Locomotor Capabilities Index, (8) "distance walked" question on the Prosthetic Profile of the Amputee Questionnaire, (9) Questionnaire Rising and Sitting Down, (10) Climbing Stairs Questionnaire, and (11) Special Interest Group on Amputation Medicine/Dutch Working Group on Amputations and Prosthetics mobility scale. Construct validity was quantified by using the Mann-Whitney U test and Spearman correlation coefficient. Test-retest reliability was assessed with a 3-week interval and quantified using the intraclass correlation coefficient. RESULTS: Construct validity (10 of 11 hypotheses not rejected) and test-retest reliability were good (intraclass correlation coefficient =.73; 95% confidence interval, .43-.88). CONCLUSIONS: The Walking Questionnaire has good construct validity and test-retest reliability in people with a lower limb amputation.

Diabetes mellitus and hip fracture: a study of 5966 cases.

INTRODUCTION: Diabetes mellitus, and especially type II diabetes, is a widespread and increasing problem in the western world due to the high rates of obesity. It has also been shown in previous studies that diabetics have impaired fracture healing. The aim of this study was to see exactly what role diabetes plays in hip fracture because it is a partially modifiable disease, and to see whether there are any changes that we could make to our practice to improve patient outcome. METHODS: We analysed the characteristics and outcomes for 477 hip fracture patients who were known to be diabetic at the time of admission, against 5489 non-diabetic hip fracture patients. RESULTS: At the time of admission the diabetic patients were more likely to be using walking aids [268/477 (56%) versus 2455/5489 (45%), p<0.0001], have a more restricted walking ability and a higher mean ASA grade (2.9 versus 2.6, p<0.0001). Diabetics patients were more likely to develop cardiac post-operative complications [26/477 (5.5%) versus 146/5489 (2.7%), p=0.0008] and to develop pressure ulcers [34/477 (7.1%) versus 171/5489 (3.1%), p<0.0001]. Hospital stay was increased for those with diabetes (25 days versus 21 days, p 0.006). No difference in surgical complications was seen between groups. At one year, recovery of function was similar for diabetic patients compared to those without diabetes. CONCLUSION: These findings show diabetics are at an increased risk of specific complications and have a longer length of hospital stay but generally make a normal recovery thereafter.

Valoración de la movilidad en pacientes con amputación de miembro inferior / Evaluation of mobility in patients with a lower limb amputation

Objetivo. El objetivo principal es revisar las herramientas disponibles para valorar la movilidad del paciente amputado de miembro inferior con el fin de identificar las más útiles en cuanto a información clínica, sencillez técnica y tiempo de realización para poder aplicarlas en la práctica clínica diaria. Los individuos que sufren una amputación de miembro inferior presentan un deterioro funcional que afecta a múltiples facetas de la vida, como la movilidad. La movilidad es una necesidad básica física, vital y social y su recuperación óptima es uno de los principales objetivos de los programas de rehabilitación del paciente amputado. Método. Se realizó una búsqueda sistemática de los estudios relevantes publicados desde enero de 2003 hasta enero de 2010 en MEDLINE, EMBASE, Cochrane Database y PEDro, incluyendo ensayos clínicos aleatorizados, metaanálisis, revisiones sistemáticas y artículos de revisión; también se revisaron diversas guías de práctica clínica. Resultados y conclusiones. A pesar de encontrar referencias de múltiples escalas genéricas, específicas, cuestionarios y tests de ejecución, no se encuentra en la literatura evidencia de consenso respecto a cuáles son las herramientas más adecuadas para valorar la movilidad del paciente amputado de extremidad inferior. Los tests de marcha se han demostrado fiables y sensibles a los cambios producidos por la rehabilitación, y su resultado se correlaciona con medidas de función física y con el uso de la prótesis, son prácticos y simples, por lo que pueden ser incluidos en la práctica clínica habitual, dejando los cuestionarios y tests específicos para el ámbito de la investigación(AU)

Objective. The principal objective was to review the available tools to measure mobility in lower limb amputees and to identify the most useful tools in terms of clinical information, technical simplicity and time to performance so that it can be used in the daily clinical practice. Individuals who have suffered a lower limb amputation have a functional deterioration that affects many aspects of life, including mobility. Mobility is a basic physical, vital and social need and its optimal recovery is one of the main objectives of the Rehabilitation programs for amputee patients. Methods. We conducted a systematic search for relevant studies published from January 2003 to January 2010 in MEDLINE, EMBASE, Cochrane and PEDro Database, including randomized clinical trials, review articles, systematic reviews and meta-analysis. Several clinical practice guidelines were also reviewed. Results and conclusions. Despite finding references of many generic scales, specific questionnaires and performance tests, no evidence of consensus was found in literature for the most appropriate tools to assess lower limb amputee's mobility. The Walking Tests have been found to be reliable and sensitive to changes related to the rehabilitation treatment and their outcomes are correlated with measures of physical function and the use of the prosthesis. They are practical and easy-to-use tests so that they can be included in the routine clinical practice, reserving the questionnaires and specific tests for research(AU)

Balance, attention, and dual-task performance during walking after brain injury: associations with falls history.

OBJECTIVE: To examine the relationship between balance, attention, and dual-task performance in individuals with acquired brain injury. DESIGN: Cross-sectional study. SETTING: Rehabilitation center and supported living program. PARTICIPANTS: Twenty-four individuals aged 18 to 58 years (mean = 39 years) with acquired brain injury who were able to ambulate 40 ft with (29%) or without an assistive device. Fifty-eight percent were independent community ambulators. Fifty-four percent had fallen in the past 6 months; and 42% reported feeling unsteady with standing or walking. INTERVENTIONS: Participants completed a battery of balance, attention, and dual-task assessments. MAIN OUTCOME MEASURES: Balance: Berg Balance Scale (BBS), Four Square Step Test (FSST), High Level Mobility Assessment Test (HiMAT); Attention: Symbol Digit Modalities Test (SDMT), Moss Attention Rating Scale (MARS), modified for a single test session; and a walking dual-task assessment, the Walking and Remembering Test. RESULTS: Mean scores: BBS, 48 of 56; FSST, 19.6 seconds; HiMAT, 20 of 54; SDMT, 30 correct; and MARS, 80. Dual-task costs were observed with variable patterns across subjects: 48% demonstrated primarily motor slowing, 9% had reduced cognitive accuracy without motor slowing, and 35% demonstrated decrements in both tasks. Subjects with a falls history had more impaired balance (HiMAT, BBS, and FSST, all P <.026) but were not significantly different in dual-task performance or attention measures. CONCLUSIONS: The test battery matched the range of motor and cognitive abilities of the sample. Balance was more strongly related to falls history than measures of attention or dual-task performance. Injury chronicity may have allowed some subjects to develop strategies to optimize dual-task performance. Alternatively, motor slowing in dual-task conditions may be an adaptive strategy, allowing performance of multiple tasks with reduced safety risk. Further investigation in this area is warranted to clarify the utility of dual-task methods in identifying falls risk after brain injury.

Influence of physical exercise on quality of life in individuals with spinal cord injury.

STUDY DESIGN: Retrospective cross-sectional study with anonymous postal data collection. OBJECTIVE: Regaining the best possible mobility and independence is not only the focus of the rehabilitation process for individuals with spinal cord injury (SCI), but also represents an important criterion for the individual's quality of life (QoL). Therefore, if and to what extent physical exercise (PE) influences the QoL of individuals with SCI was investigated. SETTING: The period of investigation extended from September 2007 to January 2008. Data were acquired from the BG Trauma Hospital Hamburg database and the German Wheelchair Sport Federation databases. METHODS: Analysis of 277 questionnaires of individuals with acquired SCI between the age of 16 and 65 years with complete wheelchair dependency in everyday life and lesion level lower C5. RESULTS: In all, 51.5% of all individuals were reported being actively involved in sports as opposed to 48.5% individuals not participating in sports. Individuals actively involved in sports have higher employment rate than physically inactive individuals with SCI. PE was identified as the main influencing determinant of QoL. This was particularly within the physical and psychological dimensions. CONCLUSION: In discovering the potential of individuals with SCI for getting involved in PE, the improvement of physical and coordinative skills with interaction between individuals with SCI and external sport groups should be an inherent part of the rehabilitation process. Individuals not having access to PE should be given the opportunity to participate in wheelchair mobility courses. This may improve the adherence to PE of individuals with SCI in post-clinical settings.

Caracterización de la movilidad de ancianos, según índice de katz, en el Centro de Bienestar del Anciano San José de Pereira. 2007 / Characterization of the mobility in the elder people, according to the katz index, at the Centro de Bienestar de Ancianos San José, Pereira 2007

Introducción: la gran mayoría de los adultos mayores presenta algún grado de limitación en su movilidad y sufre por esto las dificultades de adaptación para desplazarse;(7) este deterioro genera vulnerabilidad, que da como resultado la definición de personas frágiles con pronóstico reservado en algunos casos, los cuales incluyen discapacidad, dependencia, caídas, internación y mortalidad, en los adultos mayores.Métodos:se realizó una caracterización del grado de movilidad de los adultos mayores de acuerdo a la escala de Katz, en el Centro de Bienestar del Anciano San José de Pereira, durante el primer semestre de 2007.Resultados:se estudiaron todos (100 por ciento) los adultos mayores de 59 años residentes en el Centro. El 47.8 por ciento de los evaluados son autónomos, sin embargo, son sanos únicamente el 8 por ciento de los ancianos autónomos.Conclusión:los niveles de autonomía de los ancianos no son sinónimo de calidad de vida, por el contrario, éstos requieren de equipos multidisciplinarios liderados por enfermeras, quienes a través de su quehacer son garantía de calidad y bienestar, evitando los accidentes en el ejercicio de sus actividades diarias, y beneficiándolos con soportes nutricionales, terapéuticos y preventivos, que estos equipos están en capacidad de desarrollar...