Simplificación de la escala de Barthel para el cribado de fragilidad y dependencia severa en pacientes pluripatológicos / Simplification of the Barthel scale for screening for frailty and severe dependency in polypathological patients

OBJETIVOS: Analizar la sensibilidad (S), la especificidad (E) y los valores predictivos positivo (VPP) y negativo (VPN) de cada dimensión del índice de Barthel (IB) con respecto al cuestionario completo en pacientes pluripatológicos (PPP). MÉTODOS: Estudio transversal multicéntrico. Se consideraron dos puntos de corte del IB (≥90 puntos para el cribado de fragilidad y <60 puntos para el diagnóstico de dependencia severa). Para cada dimensión y combinaciones de dos dimensiones se calcularon la S, la E, el VPP y el VPN con respecto al IB completo. RESULTADOS: El IB medio de los 1.632 PPP incluidos (edad media de 77,9+/-9,8años, 53% varones) fue 69+/-31 (<90 en el 58,7% y <60 en el 31,4% de pacientes). La dimensión «alimentación» obtuvo los mayores VPN para tener un IB≥60 y ≥90 puntos (87% y 99,6%, respectivamente). Las dimensiones «deambular» y «subir y bajar escaleras» obtuvieron el mayor VPP para tener un IB≥60 y ≥90 (99,2/99,5% y 81/92%, respectivamente; la combinación de ambas preguntas aumentó el VPP al 95 y al 99,6%, respectivamente. CONCLUSIONES: Los PPP de ámbito hospitalario presentan con elevada frecuencia deterioro funcional. La dimensión referente a alimentarse obtuvo el mayor VPN, por lo que se puede utilizar para el diagnóstico de dependencia severa, mientras que la combinación de deambular y subir y bajar escaleras obtuvo el mayor VPP, pudiendo utilizarse para plantear el cribado de fragilidad de los PPP

OBJECTIVES: To analyse the sensitivity, specificity and positive predictive (PPV) and negative predictive (NPV) values of each measure of the Barthel index (BI) compared with the full questionnaire for polypathological patients (PPPs). METHODS: Multicentre cross-sectional study. We considered 2 cut-off points for the BI (≥90 points for screening frailty and <60 points for diagnosing severe dependence). For each measure and combination of 2 measures, we calculated the sensitivity, specificity, PPV and NPV with respect to the full BI. RESULTS: The mean BI of the 1,632 included PPPs (mean age, 77.9+/-9.8years; 53% men) was 69+/-31 (<90 for 58.7% and <60 for 31.4% of the patients). The "feeding" measure achieved the highest NPV, for a BI ≥60 and ≥90 points (87% and 99.6%, respectively). The "walking" and "going up and down stairs" measures achieved the highest PPV, for a BI ≥60 and ≥90 (99.2%/99.5% and 81%/92%, respectively. The combination of the 2 measures increased the PPV to 95% and 99.6%, respectively. CONCLUSIONS: PPPs in hospital settings have a high rate of functional impairment. The measure for feeding achieved the highest NPV and can therefore be employed for diagnosing severe dependence. The combination of the measures for walking and going up and down stairs achieved the highest PPV and can therefore be employed to propose frailty screening for PPPs

Simplification of the Barthel scale for screening for frailty and severe dependency in polypathological patients. / Simplificación de la escala de Barthel para el cribado de fragilidad y dependencia severa en pacientes pluripatológicos.

OBJECTIVES: To analyse the sensitivity, specificity and positive predictive (PPV) and negative predictive (NPV) values of each measure of the Barthel index (BI) compared with the full questionnaire for polypathological patients (PPPs). METHODS: Multicentre cross-sectional study. We considered 2 cut-off points for the BI (≥90 points for screening frailty and <60 points for diagnosing severe dependence). For each measure and combination of 2 measures, we calculated the sensitivity, specificity, PPV and NPV with respect to the full BI. RESULTS: The mean BI of the 1,632 included PPPs (mean age, 77.9±9.8years; 53% men) was 69±31 (<90 for 58.7% and <60 for 31.4% of the patients). The "feeding" measure achieved the highest NPV, for a BI ≥60 and ≥90 points (87% and 99.6%, respectively). The "walking" and "going up and down stairs" measures achieved the highest PPV, for a BI ≥60 and ≥90 (99.2%/99.5% and 81%/92%, respectively. The combination of the 2 measures increased the PPV to 95% and 99.6%, respectively. CONCLUSIONS: PPPs in hospital settings have a high rate of functional impairment. The measure for feeding achieved the highest NPV and can therefore be employed for diagnosing severe dependence. The combination of the measures for walking and going up and down stairs achieved the highest PPV and can therefore be employed to propose frailty screening for PPPs.

Estratificación pronóstica y abordaje asistencial de los pacientes pluripatológicos / Prognostic stratification and healthcare approach in patients with multiple pathologies

Los pacientes pluripatológicos constituyen una población prevalente y homogénea, caracterizada por su complejidad clínica, vulnerabilidad, consumo de recursos y mortalidad que requiere una asistencia integral y coordinada. Establecer un pronóstico certero en esta población resulta de utilidad para la toma de decisiones clínicas por parte de los profesionales, la planificación de las preferencias de pacientes y familiares, y el diseño de estrategias en el ámbito de la gestión sanitaria. También es importante para la investigación clínica, al facilitar la posible incorporación de estos pacientes a ensayos clínicos y otros estudios de intervención. Los índices PROFUND y PROFUNCTION son 2 instrumentos pronósticos que predicen de manera fidedigna el riesgo de fallecer o de sufrir un deterioro funcional, respectivamente. Para el abordaje asistencial de los pacientes pluripatológicos se propugna la construcción y ejecución de un plan de acción personalizado, consensuado y adaptado a la realidad del paciente. Este tendrá en cuenta el pronóstico, la evidencia y viabilidad de las intervenciones, así como la sinergia de las metas y estrategias del equipo sanitario con los valores y las preferencias de las personas para conseguir un modelo de salud centrado en apoyar la capacidad de las mismas para gestionar sus enfermedades. En este plan los principales ámbitos de intervención son: la promoción y prevención de la salud, la activación y autogestión del paciente y el cuidador, la red de apoyo social, la optimización farmacoterapéutica, la rehabilitación y medidas de preservación funcional y cognitiva, y la planificación anticipada de decisiones (AU)

Polypathological patients constitute a prevalent, fairly homogeneous population, which is characterised by high clinical complexity, substantial vulnerability and significant resource consumption, in addition to high mortality and the need for comprehensive, coordinated care. It is particularly important to establish a reliable prognosis in these patients. It is also extremely useful for professionals involved in the decision-making process for patients and their families in vital planning and their preferences, for strategic health planning in management fields, and for clinical research, by facilitating their incorporation into clinical trials and other intervention studies. Two prognostic instruments stand out in terms of suitability for polypathological patients: PROFUND and PROFUNCTION. The former faithfully stratifies the risk of dying at 12 months and four years and the latter, the risk of suffering a significant functional deterioration at 12 months. In terms of the healthcare approach in patients with multiple pathologies, creating and executing a consensual, personalised action plan that is adapted to the patient's reality is encouraged. The plan will consider the prognosis, and the evidence and viability of interventions; its ultimate aim will be to ensure the synergy and alignment of the health team's goals and strategies with peoples’ values and preferences, in order to achieve a more proactive health model focused on supporting patients in their ability to manage their illnesses. In the personalised action plan, the main areas of intervention are: health promotion and prevention; patient and caregiver activation and self-management; activation of a social support network and social support; optimisation of pharmacotherapy; rehabilitation, functional and cognitive preservation measures; and anticipated decision planning (AU)

Valor diagnóstico de un cuestionario de Pfeiffer simplificado en pacientes pluripatológicos / Diagnostic value of a simplified Pfeiffer questionnaire for polypathological patients

Objetivos. Analizar la concordancia, sensibilidad, especificidad y valores predictivos positivo (VPP) y negativo (VPN) de cada pregunta del cuestionario de Pfeiffer (SPMSQ) con respecto al cuestionario completo en pacientes pluripatológicos (PPP). Métodos. Estudio transversal multicéntrico. El SPMSQ se consideró patológico si se registraban 3 o más errores. Para cada pregunta y combinaciones de 2 preguntas se calcularon la concordancia (índice kappa), sensibilidad, especificidad y valores predictivos con respecto al SPMSQ completo. Resultados. De los 1.632 pacientes pluripatológicos incluidos (edad media 77,9±9,8 años, 53% varones), se realizó el SPMSQ a 1.434 (los restantes presentaban delirium) y resultó patológico en el 39%. Las preguntas «¿qué día es hoy?» y «reste de 3 en 3 desde 20» obtuvieron buena concordancia y VPN (85% y 89%, respectivamente); la combinación de ambas aumentó el VPN al 97%. La pregunta «¿cuándo nació?» alcanzó buena concordancia y el mayor VPP (93%). Conclusiones. La combinación de las preguntas «¿qué día es hoy?» y «reste de 3 en 3 desde 20» obtuvo un VPN elevado, y la relacionada con la fecha de nacimiento fue la que consiguió el mayor VPP (AU)

Objectives. To analyse the correlation, sensitivity, specificity and positive predictive (PPV) and negative predictive (NPV) values of each question on the Pfeiffer questionnaire (SPMSQ) compared with the full questionnaire for polypathological patients (PPPs). Methods. Multicentre cross-sectional study. An SPMSQ score is considered pathological if 3 or more errors are recorded. For each question and combination of 2 questions, we calculated the correlation (kappa index), sensitivity, specificity and predictive values compared with the full SPMSQ. Results. Of the 1632 PPPs included (mean age, 77.9±9.8 years, 53% men), 1434 performed the SPMSQ (the remaining presented delirium); 39% of the PPPs were pathological. The question 'What day is it today?' and the command 'Count backwards by 3s from 20' obtained good correlation and NPV (85 and 89%, respectively); the combination of both increased the NPV to 97%. The question "When were you born?" achieved good correlation and greater PPV (93%). Conclusions. The combination of the question 'What day is it today?' and the command 'Count backwards by 3s from 20' achieved a high NPV. The question related to the date of birth achieved the highest PPV (AU)

Diagnostic value of a simplified Pfeiffer questionnaire for polypathological patients. / Valor diagnóstico de un cuestionario de Pfeiffer simplificado en pacientes pluripatológicos.

OBJECTIVES: To analyse the correlation, sensitivity, specificity and positive predictive (PPV) and negative predictive (NPV) values of each question on the Pfeiffer questionnaire (SPMSQ) compared with the full questionnaire for polypathological patients (PPPs). METHODS: Multicentre cross-sectional study. An SPMSQ score is considered pathological if 3 or more errors are recorded. For each question and combination of 2 questions, we calculated the correlation (kappa index), sensitivity, specificity and predictive values compared with the full SPMSQ. RESULTS: Of the 1632 PPPs included (mean age, 77.9±9.8 years, 53% men), 1434 performed the SPMSQ (the remaining presented delirium); 39% of the PPPs were pathological. The question "What day is it today?" and the command "Count backwards by 3s from 20" obtained good correlation and NPV (85 and 89%, respectively); the combination of both increased the NPV to 97%. The question "When were you born?' achieved good correlation and greater PPV (93%). CONCLUSIONS: The combination of the question "What day is it today?" and the command "Count backwards by 3s from 20" achieved a high NPV. The question related to the date of birth achieved the highest PPV.

Prognostic stratification and healthcare approach in patients with multiple pathologies. / Estratificación pronóstica y abordaje asistencial de los pacientes pluripatológicos.

Polypathological patients constitute a prevalent, fairly homogeneous population, which is characterised by high clinical complexity, substantial vulnerability and significant resource consumption, in addition to high mortality and the need for comprehensive, coordinated care. It is particularly important to establish a reliable prognosis in these patients. It is also extremely useful for professionals involved in the decision-making process for patients and their families in vital planning and their preferences, for strategic health planning in management fields, and for clinical research, by facilitating their incorporation into clinical trials and other intervention studies. Two prognostic instruments stand out in terms of suitability for polypathological patients: PROFUND and PROFUNCTION. The former faithfully stratifies the risk of dying at 12 months and four years and the latter, the risk of suffering a significant functional deterioration at 12 months. In terms of the healthcare approach in patients with multiple pathologies, creating and executing a consensual, personalised action plan that is adapted to the patient's reality is encouraged. The plan will consider the prognosis, and the evidence and viability of interventions; its ultimate aim will be to ensure the synergy and alignment of the health team's goals and strategies with peoples' values and preferences, in order to achieve a more proactive health model focused on supporting patients in their ability to manage their illnesses. In the personalised action plan, the main areas of intervention are: health promotion and prevention; patient and caregiver activation and self-management; activation of a social support network and social support; optimisation of pharmacotherapy; rehabilitation, functional and cognitive preservation measures; and anticipated decision planning.

Comorbilidad, discapacidad y mortalidad en pacientes pluripatológicos con enfermedad pulmonar obstructiva crónica / Comorbidity, discapacity and mortality in patients with multiple conditions and chronic obstructive pulmonary disease

Objetivo. Estudiar la asociación entre diferentes comorbilidades y condiciones clínicas con la mortalidad en pacientes pluripatológicos (PPP) con enfermedad pulmonar obstructiva crónica (EPOC). Pacientes y métodos Estudio observacional, prospectivo y multicéntrico. Se han incluido pacientes consecutivos con EPOC y criterios de PPP. Se han recogido las variables: edad, sexo, índice de Charlson, comorbilidades, índice de Barthel, índice de Lawton-Brody, test de Pfeiffer, escala de Gijón, nivel de educación, hospitalizaciones en los últimos 3 y 12 meses y supervivencia al cabo de un año. Mediante un análisis univariante y una regresión logística se ha establecido la relación de las variables con la mortalidad. Resultados. Se han incluido 688 PPP con EPOC con edad media 77,9 años. La puntuación media (DE) en el índice de Charlson fue 3,99 (2,07). Las comorbilidades más frecuentes son insuficiencia cardiaca (59%), diabetes (48%), infarto de miocardio (29,4%), insuficiencia renal moderada (22%), enfermedad cerebrovascular (19%), hipertensión arterial (71%), anemia (62%), fibrilación auricular (34%), dislipemia (28%) y obesidad (21%). El 26% tenía dependencia para las actividades básicas de la vida diaria, el 47% precisaba de un cuidador y el 54% tenía riesgo de problema social. Al cabo de un año fallecieron 258 pacientes (37%). El índice de Charlson, la dependencia para las actividades de la vida diaria y la anemia se asocian con una mayor mortalidad y la hipertensión arterial y saber leer y escribir con menor mortalidad. Conclusiones. La comorbilidad y la discapacidad son dos factores pronósticos en los pacientes con EPOC(AU)

Aims. To determine the association between different comorbidities and other clinical conditions with mortality in patients with multiple diseases (PMD) suffering from chronic obstructive pulmonary disease (COPD). Subjects and methods. Patients with COPD and PMD criteria were included in an observational, prospective and multicentrer study. Data on age, gender, Charlson index, Barthel index, Lawton-Brody index, Pfeiffer test, sociofamilial Gijon scale, education level, hospitalizations during the previous 3 and 12 months and survival at one year were collected. The relationship between the variables and mortality were established by means of a univariate analysis and logistic regression model. Results. A total of 688 PMD with COPD and mean age of 77.9 years were included. The mean score one the Charlson index was 3.99 (2.07). The most frequent comorbidities were heart failure (59%), diabetes (48%), myocardial infarction (29%), moderate kidney failure (22%), cerebrovascular disease (19%), hypertension (71%), anemia (62%), atrial fibrillation (34%), dyslipidemia (28%) and obesity (21%). A total of 26% of patients were dependent for activities of daily living, 47% needed a caregiver and 54% were at risk of having social problems. At one year, 258 patients (37%) had died. The Charlson index, dependency for activities of daily living and anemia were associated with mortality and hypertension and capacity for reading and writing were associated with survival(AU)

[Comorbidity, discapacity and mortality in patients with multiple conditions and chronic obstructive pulmonary disease]. / Comorbilidad, discapacidad y mortalidad en pacientes pluripatológicos con enfermedad pulmonar obstructiva crónica.

AIMS: To determine the association between different comorbidities and other clinical conditions with mortality in patients with multiple diseases (PMD) suffering from chronic obstructive pulmonary disease (COPD). SUBJECTS AND METHODS: Patients with COPD and PMD criteria were included in an observational, prospective and multicentrer study. Data on age, gender, Charlson index, Barthel index, Lawton-Brody index, Pfeiffer test, sociofamilial Gijon scale, education level, hospitalizations during the previous 3 and 12 months and survival at one year were collected. The relationship between the variables and mortality were established by means of a univariate analysis and logistic regression model. RESULTS: A total of 688 PMD with COPD and mean age of 77.9 years were included. The mean score one the Charlson index was 3.99 (2.07). The most frequent comorbidities were heart failure (59%), diabetes (48%), myocardial infarction (29%), moderate kidney failure (22%), cerebrovascular disease (19%), hypertension (71%), anemia (62%), atrial fibrillation (34%), dyslipidemia (28%) and obesity (21%). A total of 26% of patients were dependent for activities of daily living, 47% needed a caregiver and 54% were at risk of having social problems. At one year, 258 patients (37%) had died. The Charlson index, dependency for activities of daily living and anemia were associated with mortality and hypertension and capacity for reading and writing were associated with survival. CONCLUSIONS: Comorbidity and discapacity are two prognostic factors in COPD patients.