Maximal Respiratory Pressure Reference Equations in Healthy Adults and Cut-off Points for Defining Respiratory Muscle Weakness

Introduction: Maximal inspiratory and expiratory pressures (PImax/PEmax) reference equations obtained in healthy people are needed to correctly interpret respiratory muscle strength. Currently, no clear cut-off points defining respiratory muscle weakness are available. We aimed to establish sex-specific reference equations for PImax/PEmax in a large sample of healthy adults and to objectively determine cut-off points for respiratory muscle weakness. Methods: A multicentre cross-sectional study was conducted across 14 Spanish centres. Healthy non-smoking volunteers aged 18–80 years stratified by sex and age were recruited. PImax/PEmax were assessed using uniform methodology according to international standards. Multiple linear regressions were used to obtain reference equations. Cut-off points for respiratory muscle weakness were established by using T-scores. Results: The final sample consisted of 610 subjects (314 females; 48 [standard deviation, SD: 17] years). Reference equations for PImax/PEmax included body mass index and a squared term of the age as independent variables for both sexes (p<0.01). Cut-off points for respiratory muscle weakness based on T-scores ≥2.5 SD below the peak mean value achieved at a young age were: 62 and 83cmH2O for PImax and 81 and 109cmH2O for PEmax in females and males, respectively. Conclusion: These reference values, based on the largest dataset collected in a European population to date using uniform methodology, help identify cut-off points for respiratory muscle weakness in females and males. These data will help to better identify the presence of respiratory muscle weakness and to determine indications for interventions to improve respiratory muscle function. (AU)

Maximal Respiratory Pressure Reference Equations in Healthy Adults and Cut-off Points for Defining Respiratory Muscle Weakness.

INTRODUCTION: Maximal inspiratory and expiratory pressures (PImax/PEmax) reference equations obtained in healthy people are needed to correctly interpret respiratory muscle strength. Currently, no clear cut-off points defining respiratory muscle weakness are available. We aimed to establish sex-specific reference equations for PImax/PEmax in a large sample of healthy adults and to objectively determine cut-off points for respiratory muscle weakness. METHODS: A multicentre cross-sectional study was conducted across 14 Spanish centres. Healthy non-smoking volunteers aged 18-80 years stratified by sex and age were recruited. PImax/PEmax were assessed using uniform methodology according to international standards. Multiple linear regressions were used to obtain reference equations. Cut-off points for respiratory muscle weakness were established by using T-scores. RESULTS: The final sample consisted of 610 subjects (314 females; 48 [standard deviation, SD: 17] years). Reference equations for PImax/PEmax included body mass index and a squared term of the age as independent variables for both sexes (p<0.01). Cut-off points for respiratory muscle weakness based on T-scores ≥2.5 SD below the peak mean value achieved at a young age were: 62 and 83cmH2O for PImax and 81 and 109cmH2O for PEmax in females and males, respectively. CONCLUSION: These reference values, based on the largest dataset collected in a European population to date using uniform methodology, help identify cut-off points for respiratory muscle weakness in females and males. These data will help to better identify the presence of respiratory muscle weakness and to determine indications for interventions to improve respiratory muscle function.

[Developing a questionnaire about violence(s) suffered by professionals in the field of Physiotherapy.] / Elaboración de un cuestionario sobre violencia(s) sufrida(s) por profesionales del ámbito de la Fisioterapia.

OBJECTIVE: Violence in the health sector is a big problem and it has serious consequences. The prevalence of clinical violence suffered by Spanish physiotherapists is unknown. The objective of this paper was to create and validate a tool in order to detect cases of sexual, physical and psychological and/or verbal violence in the Spanish physiotherapists. METHODS: A questionnaire was elaborated according to the available bibliography. It was analyzed by a group of six physiotherapists in charge of the Union observation and management of violence or from Me-Too Fisio movement. Finally, a pilot test was carried out on a convenience sample of fourteen physiotherapists. RESULTS: The questionnaire obtained includes questions about the facts suffered by the professionals in this discipline, as well as the main data on the profile of the aggressor (sex, age, mental condition…), the contexts where violence is more prevalent (clinical field, size of the population where the center is located…), and the main characteristics of the professional who suffers it (sex, age, professional experience…). Moreover, information about formal and informal strategies used to deal with violence and perception of its impact, will be assessed. CONCLUSIONS: The annual use of this tool will allow the exposure of this group of professionals to be assessed specifically and, also, to assess the evolution over time of each violence separately for providing direction for successful policies and training.

OBJETIVO: La violencia en el sector sanitario es un problema importante y con graves consecuencias. Se desconoce la prevalencia de la violencia en el ámbito clínico sobre los fisioterapeutas en España. El objetivo de este trabajo fue crear y validar una herramienta para detectar casos de violencia sexual, física y psicológica y/o verbal ejercida por pacientes/acompañantes/familiares sobre la población de fisioterapeutas de España. METODOS: A partir de la bibliografía disponible, se elaboró un cuestionario que fue analizado por un grupo de seis fisioterapeutas del Consejo a cargo de la gestión y observación de la violencia sufrida por fisioterapeutas o profesionales destacadas en el movimiento Me Too Fisio. Finalmente, se realizó una prueba piloto en una muestra de conveniencia de catorce fisioterapeutas. RESULTADOS: El cuestionario obtenido incluye preguntas sobre los hechos sufridos por los/las profesionales de esta disciplina, así como los principales datos del perfil de persona agresora (sexo, edad, condición mental, etc.), el contexto en el que la violencia es más prevalente (campo laboral, tamaño del municipio, etc.) y las principales características del/de la profesional que sufre la violencia (sexo, edad, experiencia profesional, etc.). Además se recoge información sobre estrategias formales e informales utilizadas para enfrentar la violencia y la percepción de su impacto. CONCLUSIONES: Una utilización anual de esta herramienta ayudará a valorar la exposición de este grupo de profesionales de forma específica y, también, la evolución en el tiempo de cada violencia por separado, con la finalidad de establecer políticas y programas formativos exitosos.

Elaboración de un cuestionario sobre violencia(s) sufrida(s) por profesionales del ámbito de la Fisioterapia / Developing a questionnaire about violence(s) suffered by professionals in the field of Physiotherapy

FUNDAMENTOS: La violencia en el sector sanitario es un problema importante y con graves consecuencias. Se desconoce laprevalencia de la violencia en el ámbito clínico sobre los fisioterapeutas en España. El objetivo de este trabajo fue crear y validar unaherramienta para detectar casos de violencia sexual, física y psicológica y/o verbal ejercida por pacientes/acompañantes/familiaressobre la población de fisioterapeutas de España. MÉTODOS: A partir de la bibliografía disponible, se elaboró un cuestionario que fue analizado por un grupo de seis fisioterapeutasdel Consejo a cargo de la gestión y observación de la violencia sufrida por fisioterapeutas o profesionales destacadas en el movimien-toMe Too Fisio. Finalmente, se realizó una prueba piloto en una muestra de conveniencia de catorce fisioterapeutas. RESULTADOS: El cuestionario obtenido incluye preguntas sobre los hechos sufridos por los/las profesionales de esta disciplina,así como los principales datos del perfil de persona agresora (sexo, edad, condición mental, etc.), el contexto en el que la violencia esmás prevalente (campo laboral, tamaño del municipio, etc.) y las principales características del/de la profesional que sufre la violencia(sexo, edad, experiencia profesional, etc.). Además se recoge información sobre estrategias formales e informales utilizadas paraenfrentar la violencia y la percepción de su impacto. CONCLUSIONES: Una utilización anual de esta herramienta ayudará a valorar la exposición de este grupo de profesionales deforma específica y, también, la evolución en el tiempo de cada violencia por separado, con la finalidad de establecer políticas yprogramas formativos exitosos.(AU)

BACKGROUND: Violence in the health sector is a big problem and it has serious consequences. The prevalence of clinical violencesuffered by Spanish physiotherapists is unknown. The objective of this paper was to create and validate a tool in order to detect casesof sexual, physical and psychological and/or verbal violence in the Spanish physiotherapists. METHODS: A questionnaire was elaborated according to the available bibliography. It was analyzed by a group of six physiotherapistsin charge of the Union observation and management of violence or from Me-Too Fisio movement. Finally, a pilot test was carried out ona convenience sample of fourteen physiotherapists.RESULTS: The questionnaire obtained includes questions about the facts suffered by the professionals in this discipline, as wellas the main data on the profile of the aggressor (sex, age, mental condition…), the contexts where violence is more prevalent (clinicalfield, size of the population where the center is located…), and the main characteristics of the professional who suffers it (sex, age,professional experience…). Moreover, information about formal and informal strategies used to deal with violence and perception ofits impact, will be assessed. CONCLUSIONS: The annual use of this tool will allow the exposure of this group of professionals to be assessed specifically and,also, to assess the evolution over time of each violence separately for providing direction for successful policies and training.(AU)

Adaptations of the Walking Corsi Test (WalCT) for 2- and 3-year-old preterm and term-born toddlers: A preliminary study.

Introduction: Topographical memory is crucial for navigation and environmental representation. The Walking Corsi Test (WalCT) has been used to evaluate topographical memory in children from 4 years upward. The present study aims to determine whether adapted versions of the WalCT- by simplifying instructions and increasing motivation- can be adopted to test topographical memory in 2- and 3-year-old toddlers born at term and preterm. Assessing this skill in such young children is important in light of recent studies that have shown how spatial cognition underlies the development of skills in other cognitive domains as well. Methods: For this purpose, 47 toddlers (27.39 ± 4.34 months, 38.3% females), 20 born at term and 27 preterm, performed two aimed-designed versions of WalCT. Results: The results showed better performance of the term groups with increasing age and for both versions. On the other hand, performance was better in 2-year-old term toddlers vs. preterm. When rising motivation, 2-year-old preterm toddlers improve their performance but differences between both groups were still significant. The preterm group showed lower performance related to lower levels of attention. Discussion: This study provides preliminary data on the suitability of the adapted versions of WalCT in early ages and prematurity conditions.

Mapping the field of physical therapy and identification of the leading active producers. A bibliometric analysis of the period 2000- 2018.

OBJECTIVES: The objectives of the study were: 1) Describe the thematic structure and evolution of the field of physical therapy; 2) identify the main research producers (i.e. countries and institutions); and 3) compare their research output and citation impact. METHODS: Papers related to physical therapy indexed in Web of Science (2000-2018) were identified to delineate the field, using keywords, journals, and citation networks. VOSviewer software, advanced bibliometric text mining, and visualization techniques were used to evaluate the thematic structure. We collected data about the country and institutional affiliation of all the authors and calculated production and citation impact indicators. RESULTS: 85,697 papers were analyzed. Eleven thematic clusters were identified: 1) "health care and education"; 2) "biomechanics"; 3) "psychosocial, chronic pain and quality of life outcomes"; 4) "evidence-based physical therapy research methods"; 5) "traumatology and orthopedics"; 6) "neurological rehabilitation"; 7) "psychometrics and cross-cultural adaptation"; 8) "gait-balance analysis and Parkinson's disease"; 9) "exercise"; 10) "respiratory physical therapy"; and 11) "back pain." The United States, the United Kingdom, and Australia were the most productive countries. Netherlands, Norway, and Sweden had the highest citation impact. CONCLUSIONS: Our bibliometric visualization approach makes it possible to comprehensively study the thematic structure of physical therapy. The ranking of producers has evolved and now includes China and Brazil. High research production does not imply a high citation impact.

Evolution of the thematic structure and main producers of physical therapy interventions research: A bibliometric analysis (1986 to 2017).

BACKGROUND: Bibliometric studies are used to analyse and map scientific areas, and study the scientific output and impact of institutes and countries. OBJECTIVES: Describe the thematic structure and evolution of the field of physical therapy interventions using articles indexed in Physiotherapy Evidence Database (PEDro). Also, identify and compare the main producers (countries, institutions) over time (research output, citation impact). METHODS: Eligible articles were those indexed in PEDro (1986-2017) and matched to Web of Science. VOSviewer software, bibliometric text mining, and visualisation techniques were used to evaluate the thematic structure of the included articles. We collected data about authors' country and institutional affiliation, and calculated bibliometric indicators (production, citation impact). RESULTS: A total of 29 090 articles were analysed. Eight topics were identified: "neurological rehabilitation"; "methods"; "exercise for prevention and rehabilitation of lifestyle diseases"; "assessment and treatment of musculoskeletal pain"; "physical activity", "health promotion and behaviour change"; "respiratory physical therapy"; "hospital, primary care and health economics"; "cancer and complementary therapies". The most productive countries were United States, United Kingdom, Australia, and Canada. The most impactful countries were United States, France, Finland, and Canada. The most productive institutions were University of Sydney, VU University of Amsterdam, University of Queensland, and University of Toronto. CONCLUSIONS: The thematic structure of physical therapy interventions has evolved over time with "neurological rehabilitation", "methods", "exercise related to lifestyle diseases", and "physical activity" becoming increasingly important. Main producers of this research were traditionally located in North America and Europe but now include countries like China and Brazil.

Thirty Minutes Identified as the Threshold for Development of Pain in Low Back and Feet Regions, and Predictors of Intensity of Pain during 1-h Laboratory-Based Standing in Office Workers.

This study with 40 office workers investigated (a) the effect of time spent standing on low- back and lower limb pain during a 1-h laboratory-based task; (b) the standing time after which a significant increase in pain is likely; and (c) the individual, physical and psychosocial factors that predict pain. The primary outcome was bodily location of pain and pain intensity on a 100-mm Visual Analogue Scale recorded at baseline and every 15 min. Physical measures included trunk and hip motor control and endurance. Self-report history of pain, physical activity, psychosocial job characteristics, pain catastrophizing and general health status were collected. Univariate analysis and regression models were included. The prevalence of low-back pain increased from 15% to 40% after 30 min while feet pain increased to 25% from 0 at baseline. The intensity of low-back and lower limb pain also increased over time. A thirty-minute interval was identified as the threshold for the development and increase in low-back and feet pain. Modifiable factors were associated with low-back pain intensity-lower hip abductor muscle endurance and poorer physical health, and with feet symptoms-greater body mass index and less core stability.

What Psychosocial and Physical Characteristics Differentiate Office Workers Who Develop Standing-Induced Low Back Pain? A Cross-Sectional Study.

This study examines demographic, physical and psychosocial factors associated with an increase in low back pain (LBP) during a one-hour standing task. A cross-sectional survey with 40 office workers was conducted. The primary outcome was pain severity during a one-hour standing task recorded every 15 min using a 100 mm Visual Analogue Scale (VAS). Participants were defined as pain developers (PD), if they reported a change in pain of ≥10 mm from baseline, or non-pain developers (NPD). Physical outcomes included participant-rated and examiner-rated trunk and hip motor control and endurance. Self-report history of LBP, physical activity, psychosocial job characteristics, general health and pain catastrophising were collected. Fourteen participants were PD. Hip abduction, abdominal and spinal muscle endurance was lower for PD (p ≤ 0.05). PD had greater self-reported difficulty performing active hip abduction and active straight leg raise tests (p ≤ 0.04). Those reporting a lifetime, 12 month or 7-day history of LBP (p < 0.05) and lower self-reported physical function (p = 0.01) were more likely to develop LBP during the standing task. In conclusion, a history of LBP, reduced trunk and hip muscle endurance and deficits in lumbopelvic/hip motor control may be important to consider in office workers experiencing standing-induced LBP.

Bayesian Methods in the Field of Rehabilitation.

Bayesian techniques, as an alternative method of statistical analysis in rehabilitation studies, have some advantages such as handling small sample sizes, allowing incorporation of previous experience of the researchers or clinicians, being suitable for different kinds of studies, and managing highly complex models. These characteristics are important in rehabilitation research. In the present article, the Bayesian approach is displayed through three examples in previously analyzed data with traditional or frequentist methods. The studies used as examples have small sample sizes and show that the Bayesian procedures enhance the statistical information of the results. The Bayesian credibility interval includes the true value of the corresponding parameter diminishing uncertainty about the treatment effect. In addition, the Bayes factor value quantifies the evidence provided by the data in favor of the alternative hypothesis as opposed to the null hypothesis. Bayesian inference could be an interesting and adaptable alternative statistical method for physical medicine and rehabilitation applications.

Comparing Simultaneous and Pointwise Confidence Intervals for Hydrological Processes.

Distribution function estimation of the random variable of river flow is an important problem in hydrology. This issue is directly related to quantile estimation, and consequently to return level prediction. The estimation process can be complemented with the construction of confidence intervals (CIs) to perform a probabilistic assessment of the different variables and/or estimated functions. In this work, several methods for constructing CIs using bootstrap techniques, and parametric and nonparametric procedures in the estimation process are studied and compared. In the case that the target is the joint estimation of a vector of values, some new corrections to obtain joint coverage probabilities closer to the corresponding nominal values are also presented. A comprehensive simulation study compares the different approaches, and the application of the different procedures to real data sets from four rivers in the United States and one in Spain complete the paper.

Analysis of high level ozone concentrations using nonparametric methods.

Controlling emissions of air pollutants and establishing air quality objectives to improve and protect ambient air quality are very important tasks of Governments. Ozone (O(3)), one of those pollutants of concern, is not emitted directly into the atmosphere, but is a secondary pollutant produced by reaction between nitrogen dioxide (NO(2)), hydrocarbons and sunlight. High levels of ozone can produce harmful effects on human health and the environment in general. Therefore, the study of extreme values of ozone represents an important topic of research in environmental problems. Classical extreme value theory has been usually used in air-pollution studies. It consists of fitting a parametric generalized extreme value (GEV) distribution to a data set of extreme values and using the estimated distribution to compute quantities like the probability of exceedance, the quantiles, the return levels or the mean return periods. In this paper, we propose nonparametric methods to estimate those quantities. Additionally, nonparametric estimators of the trends of very high values of ozone are proposed. The nonparametric estimators are applied to real samples of maximum ozone values obtained from several monitoring stations belonging to the Automatic Urban and Rural Network (AURN) from the UK. Results show that nonparametric estimators work satisfactorily, generally outperforming the behaviour of classical parametric estimators.

Nonparametric functional data estimation applied to ozone data: prediction and extreme value analysis.

The study of extreme values and prediction of ozone data is an important topic of research when dealing with environmental problems. Classical extreme value theory is usually used in air-pollution studies. It consists in fitting a parametric generalised extreme value (GEV) distribution to a data set of extreme values, and using the estimated distribution to compute return levels and other quantities of interest. Here, we propose to estimate these values using nonparametric functional data methods. Functional data analysis is a relatively new statistical methodology that generally deals with data consisting of curves or multi-dimensional variables. In this paper, we use this technique, jointly with nonparametric curve estimation, to provide alternatives to the usual parametric statistical tools. The nonparametric estimators are applied to real samples of maximum ozone values obtained from several monitoring stations belonging to the Automatic Urban and Rural Network (AURN) in the UK. The results show that nonparametric estimators work satisfactorily, outperforming the behaviour of classical parametric estimators. Functional data analysis is also used to predict stratospheric ozone concentrations. We show an application, using the data set of mean monthly ozone concentrations in Arosa, Switzerland, and the results are compared with those obtained by classical time series (ARIMA) analysis.