Assessment of activities and participation of people by rehabilitation-focused clinical registries: a systematic scoping review.

INTRODUCTION: Rehabilitation is considered a key intervention in health care. Clinical registries, defined as an organized system that uses observational methods to collect information to assess specific outcomes in a defined population, can contribute to assessing the impact of the rehabilitation intervention. This review aims to identify and describe rehabilitation-specific registry systems with an emphasis on identifying outcomes that enable the assessment of vital areas and activities of daily living. EVIDENCE ACQUISITION: A systematic scoping review was conducted. A systematic search was conducted up to August 2022 in MEDLINE/PubMed, Embase, Cochrane Library, Epistemonikos, and other search resources. Studies related to rehabilitation registries presented data on people with health problems that could limit their functioning were selected. The inclusion of studies/clinical registries was not limited by methodological design, year of publication, country, or language. The unit of analysis was rehabilitation registries. The measurement instruments used to assess the outcomes were explored to estimate the domain assessed from the vital areas related to functioning and disability as described by the International Classification of Functioning, Disability and Health (ICF). The vital areas were classified according to activities of daily living (ADLs). EVIDENCE SYNTHESIS: Seventy-one registries in rehabilitation were identified. The registries included a median of 3 (IQR 2-5) assessment instruments designed to assess the impact of different rehabilitation programs. In total, 137 different assessment scales or instruments were identified. Each rehabilitation registry assessed 6 (IQR 2-8) domains of the ICF, and 15.4% of registries assessed all domains. The most assessed domain was "Mobility" (89.7%), and the least assessed was "General Tasks and Demands" (25.6%). In addition, 92.3% of rehabilitation registries assessed basic ADLs, 76.9% advanced ADLs, and 71.8% instrumental ADLs. CONCLUSIONS: Although clinical registries do not claim to directly assess the impact of rehabilitation programs on people's functioning according to the ICF framework, it was identified that a low percentage of them assessed the nine vital areas through different outcome assessment instruments. However, most rehabilitation registries directly or indirectly assess some basic, instrumental, and advanced ADLs. The findings of this review highlight the need to improve the design of clinical registries focused on assessing the impact of rehabilitation programs to assess people in all areas of their lives.

Reseña Histórica de la Kinesiología Respiratoria en Chile / History of Respiratory Physiotherapy in Chile

Aunque la historia de Kinesiología Respiratoria en Chile es relativamente breve, al igual que nuestra profesión, a lo largo de la historia mundial han existido hitos relevantes para el aprendizaje y desarrollo de los diferentes procedimientos que ejecutamos hoy en día. La evolución en los procesos investigativos y las mejoras tecnológicas han permitido que la Kinesiología Respiratoria se apegue a la ciencia y que el uso de técnicas y procedimientos se acerquen cada vez más a lo estrictamente efectivo de acuerdo a la evidencia.

Although the history of Respiratory Physiotherapy in Chile is relatively new, as is our profession, throughout world history there have been relevant milestones for the learning and development of the different procedures that we perform today. The evolution in research processes and technological improvements have allowed Respiratory Physiotherapy to stick to science and the use of techniques and procedures are increasingly closer to the strictly effective according to the evidence.

Effectiveness of neuromuscular electrostimulation in COPD subjects on mechanical ventilation. A systematic review and meta-analysis.

OBJECTIVE: To estimate the effectiveness of Neuromuscular Electrostimulation (NMES) in adults with COPD undergoing MV. METHOD: A sensitive search was performed in MEDLINE, Embase, CENTRAL, CINAHL and other resources. Randomized Controlled Clinical Trials (RCTs) or non-RCTs that enrolled adults with COPD on MV due to an exacerbation of their disease were included. Two independent reviewers screened, extracted information, and assessed the risk of bias (RoB 2 tool) and the certainty of evidence (GRADE approach) from the included studies. RESULTS: Four RCTs (144 participants) were included. Subjects who underwent NMES were able to move from bed to chair independently in less time (MD = 4.98 days less; 95% CI -8.55 to -1.47; 2 RCTs; low certainty of the evidence) and they were fewer days on MV (MD = 2.89 days less; 95% CI -4.58 to -1.21); 3 RCTs; low certainty of the evidence) than the control group. However, the effect of NMES on muscle strength is unclear (very low certainty of the evidence). CONCLUSIONS: NMES may improve functional independence and decrease MV time in adults with COPD; however, its effectiveness on muscle strength is uncertain. More and better RCTs are needed to determine with greater certainty the effectiveness of NMES in this population.

Effectiveness of neuromuscular electrostimulation in COPD subjects on mechanical ventilation. A systematic review and meta-analysis

Abstract Objective: To estimate the effectiveness of Neuromuscular Electrostimulation (NMES) in adults with COPD undergoing MV. Method: A sensitive search was performed in MEDLINE, Embase, CENTRAL, CINAHL and other resources. Randomized Controlled Clinical Trials (RCTs) or non-RCTs that enrolled adults with COPD on MV due to an exacerbation of their disease were included. Two independent reviewers screened, extracted information, and assessed the risk of bias (RoB 2 tool) and the certainty of evidence (GRADE approach) from the included studies. Results: Four RCTs (144 participants) were included. Subjects who underwent NMES were able to move from bed to chair independently in less time (MD = 4.98 days less; 95% CI -8.55 to -1.47; 2 RCTs; low certainty of the evidence) and they were fewer days on MV (MD = 2.89 days less; 95% CI -4.58 to -1.21); 3 RCTs; low certainty of the evidence) than the control group. However, the effect of NMES on muscle strength is unclear (very low certainty of the evidence). Conclusions: NMES may improve functional independence and decrease MV time in adults with COPD; however, its effectiveness on muscle strength is uncertain. More and better RCTs are needed to determine with greater certainty the effectiveness of NMES in this population.

Characteristics of the coronavirus disease 2019: A review of emerging literature. / Características de la enfermedad por coronavirus 2019: una revisión de literatura emergente.

BACKGROUND: The 2019 coronavirus disease outbreak (COVID-19) spread rapidly around the world. The extent and ultimate effect are still unclear, as it is an ongoing and constantly evolving pandemic. AIMS: To compile the literature and synthesize in Spanish-Latin American language the available international information describing the etiological, pathophysiological, epidemiological and management aspects of COVID-19. METHODS: Narrative review, using specific sections created in the databases. The criteria for selecting studies depended on the specific area addressed: etiological, pathophysiological, epidemiological aspects, treatment alternatives, etc. References in Spanish and English were included. RESULTS: The World Health Organization reports that COVID-19 is a disease of zoonotic origin that was transmitted to a human host. The first cases were identified in late 2019 and January 2020, in Wuhan city, China. It was categorized as highly contagious and transmissible between humans, which is attributed to the structural features of this novel coronavirus. The clinical presentation is variable and nonspecific, as well as its severity. With a clear tropism for the respiratory system, the most severe cases may develop pneumonia, respiratory failure, multiorgan failure and thus death. It occurs in all age groups, with a lower percentage in children under 19 years of age (2.4%). Mortality varies between countries and regions (between 1.5 to 9.3% over the total of reported cases). Associated risk factors are the presence of comorbidities, advanced age, and immunosuppression. CONCLUSIONS: To date there have been thousands of scientific articles that attempt to explain the onset, progression, possible treatment options and global impact of the disease. There is still no certainty about the level or quality of this evidence. It is essential to generate documents synthesized and translated into Spanish or other languages that can bring this information to all the places and countries that are being impacted by this disease.

ANTECEDENTES: El brote de la enfermedad por coronavirus 2019 o COVID-19 se expandió rápidamente por todo el mundo. El alcance y efecto final aún no es claro, ya que es una pandemia en curso y constante evolución. OBJETIVOS: Recopilar la literatura y sintetizar en idioma español-latinoamericano la información internacional disponible que describa los aspectos etiológicos, fisiopatológicos, epidemiológicos y manejo de COVID-19. MÉTODO: Revisión narrativa. Se utilizaron apartados específicos creados en las bases de datos. Los criterios para seleccionar estudios dependieron del ámbito específico tratado: aspectos etiológicos, fisiopatológicos, epidemiológicos, alternativas de tratamiento, entre otras. Se incluyeron trabajos en idioma inglés y español. RESULTADOS: La Organización Mundial de la Salud informó que COVID-19 es una enfermedad de origen zoonótico que se transmitió a un huésped humano. Se identificaron los primeros casos a fines de 2019 y enero de 2020, en la ciudad de Wuhan, China. Esta enfermedad se catalogó como altamente contagiosa y transmisible entre los humanos, características estructurales particulares que se atribuyen a este nuevo coronavirus. La presentación clínica es variable e inespecífica, al igual que su gravedad. Los casos más severos pueden desarrollar neumonía, insuficiencia respiratoria, falla multiorgánica y, con esto, la muerte, presentando un claro tropismo por el sistema respiratorio. Se presenta en todas las edades, con un menor porcentaje en menores de 19 años (2,4%). La mortalidad varía entre países y regiones (entre 1,5 y 9,3% del total casos reportados). Los factores de riesgo asociados son la presencia de comorbilidades, edad avanzada e inmunodepresión. CONCLUSIONES: A la fecha de redacción de este trabajo, han surgido miles de artículos científicos que intentan explicar el inicio, progresión, posibles tratamientos e impacto mundial de la enfermedad. Aún no hay certeza del nivel o calidad de esta evidencia. Es imprescindible generar documentos sintetizados y traducidos al español, u otros idiomas, que puedan llevar esta información a todos los lugares y países que están siendo impactados producto de esta enfermedad.

Effectiveness of Telerehabilitation in Physical Therapy: A Rapid Overview.

OBJECTIVE: The purpose of this article was to summarize the available evidence from systematic reviews on telerehabilitation in physical therapy. METHODS: We searched Medline/PubMed, EMBASE, and Cochrane Library databases. In addition, the records in PROSPERO and Epistemonikos and PEDro were consulted. Systematic reviews of different conditions, populations, and contexts-where the intervention to be evaluated is telerehabilitation by physical therapy-were included. The outcomes were clinical effectiveness depending on specific condition, functionality, quality of life, satisfaction, adherence, and safety. Data extraction and risk of bias assessment were carried out by a reviewer with non-independent verification by a second reviewer. The findings are reported qualitatively in the tables and figures. RESULTS: Fifty-three systematic reviews were included, of which 17 were assessed as having low risk of bias. Fifteen reviews were on cardiorespiratory rehabilitation, 14 on musculoskeletal conditions, and 13 on neurorehabilitation. The other 11 reviews addressed other types of conditions and rehabilitation. Thirteen reviews evaluated with low risk of bias showed results in favor of telerehabilitation versus in-person rehabilitation or no rehabilitation, while 17 reported no differences between the groups. Thirty-five reviews with unclear or high risk of bias showed mixed results. CONCLUSIONS: Despite the contradictory results, telerehabilitation in physical therapy could be comparable with in-person rehabilitation or better than no rehabilitation for conditions such as osteoarthritis, low-back pain, hip and knee replacement, and multiple sclerosis and also in the context of cardiac and pulmonary rehabilitation. It is imperative to conduct better quality clinical trials and systematic reviews. IMPACT: Providing the best available evidence on the effectiveness of telerehabilitation to professionals, mainly physical therapists, will impact the decision-making process and therefore yield better clinical outcomes for patients, both in these times of the COVID-19 pandemic and in the future. The identification of research gaps will also contribute to the generation of relevant and novel research questions.

Effectiveness of telerehabilitation in physical therapy: A protocol for an overview in a time when rapid responses are needed. / Efectividad de la telerehabilitación en terapia física: protocolo de una revisión global en tiempos que exigen respuestas rápidas.

INTRODUCTION: Rehabilitation and physical therapy have been adapting to the telehealth era, increasing accessibility and improving the continuity of attention in geographically remote populations with disabilities. Due to the spread of infection by SARS-CoV-2, many professionals have had to adapt their work to telerehabilitation practices, which require the best evidence at short notice and in summarized form. In this context, this protocol has been developed to evaluate the effectiveness of telerehabilitation as a care strategy in physical therapy for different conditions, populations, and contexts. METHOD AND ANALYSIS: An overview will be carried out in the format of a rapid review. It will include systematic reviews of different conditions, populations, and contexts, where the intervention to be evaluated is telerehabilitation by physical therapy. The outcomes considered will be clinical effectiveness depending on the specific condition, functionality, quality of life, satisfaction, adherence, and safety. A search will be carried out of the MEDLINE/PubMed, EMBASE, and Cochrane Library databases. Studies will be selected in duplicate with any discrepancies resolved by a third reviewer. Data extraction and risk of bias assessment will be carried out by a reviewer with non-independent verification by a second reviewer. The findings will be reported qualitatively by tables and figures. ETHICS AND DISSEMINATION: The principles of the value of the research question, the methodological rigor, scientifically qualified investigators, an independent evaluation of the protocol, and timely and accurate publication of the results will be complied with. The complete review will lead to the publication of at least one article, and the results will be widely disseminated at various levels of decision-making. REGISTER: This protocol has been registered in PROSPERO with the number CRD42020185640.

INTRODUCCIÓN: La rehabilitación y las acciones de terapia física se han ido adaptando a la era de la telesalud, permitiendo aumentar la accesibilidad y mejorar la continuidad de la atención en poblaciones con discapacidades y alejadas geográficamente. En la actualidad, y debido a expansión de la infección por SARS-CoV-2, muchos profesionales han debido adaptar su trabajo a una modalidad de telerehabilitación, por lo que es necesario acceder a la mejor evidencia disponible de manera resumida y oportuna. Es en este contexto que se ha desarrollado el presente protocolo, con el objetivo de evaluar la efectividad de la telerehabilitación como estrategia de atención en terapia física para diferentes condiciones, poblaciones y contextos. MÉTODO Y ANÁLISIS: Se conducirá una revisión global o revisión de revisiones, en un formato de revisión rápida siguiendo las recomendaciones PRISMA-P. Se incluirán revisiones sistemáticas de diferentes condiciones, poblaciones y contextos, donde la intervención a evaluar es la telerehabilitación en terapia física. Los desenlaces de interés a considerar son la efectividad clínica dependiendo de la condición específica, la funcionalidad, calidad de vida, satisfacción, adherencia y seguridad. Se realizará una búsqueda en las bases de datos MEDLINE/PubMed, EMBASE y Cochrane Library. La selección de los estudios será realizada en duplicado con resolución de discrepancias por un tercer revisor. La extracción de datos y la evaluación del riesgo de sesgos serán realizadas por un revisor con verificación no independiente de un segundo revisor. Los hallazgos serán reportados cualitativamente a través de tablas y figuras. ÉTICA Y DISEMINACIÓN: Se considera el cumplimiento de los principios éticos del valor de la pregunta de investigación, rigor metodológico, investigadores científicamente cualificados, evaluación independiente del protocolo y publicación puntual y precisa de los resultados. Se espera publicar la revisión completa en al menos un artículo y los resultados se difundirán ampliamente en diversos niveles de decisión. REGISTRO: El protocolo está registrado en PROSPERO con el número CRD42020185640.

Efectividad de la telerehabilitación en terapia física: protocolo de una revisión global en tiempos que exigen respuestas rápidas / Effectiveness of telerehabilitation in physical therapy: a protocol for an overview in a time when rapid responses are needed

INTRODUCCIÓN: La rehabilitación y las acciones de terapia física se han ido adaptando a la era de la telesalud, permitiendo aumentar la accesibilidad y mejorar la continuidad de la atención en poblaciones con discapacidades y alejadas geográficamente. En la actualidad, y debido a expansión de la infección por SARS-CoV-2, muchos profesionales han debido adaptar su trabajo a una modalidad de telerehabilitación, por lo que es necesario acceder a la mejor evidencia disponible de manera resumida y oportuna. Es en este contexto que se ha desarrollado el presente protocolo, con el objetivo de evaluar la efectividad de la telerehabilitación como estrategia de atención en terapia física para diferentes condiciones, poblaciones y contextos. MÉTODO Y ANÁLISIS: Se conducirá una revisión global o revisión de revisiones, en un formato de revisión rápida siguiendo las recomendaciones PRISMA-P. Se incluirán revisiones sistemáticas de diferentes condiciones, poblaciones y contextos, donde la intervención a evaluar es la telerehabilitación en terapia física. Los desenlaces de interés a considerar son la efectividad clínica dependiendo de la condición específica, la funcionalidad, calidad de vida, satisfacción, adherencia y seguridad. Se realizará una búsqueda en las bases de datos MEDLINE/PubMed, EMBASE y Cochrane Library. La selección de los estudios será realizada en duplicado con resolución de discrepancias por un tercer revisor. La extracción de datos y la evaluación del riesgo de sesgos serán realizadas por un revisor con verificación no independiente de un segundo revisor. Los hallazgos serán reportados cualitativamente a través de tablas y figuras. ÉTICA Y DISEMINACIÓN: Se considera el cumplimiento de los principios éticos del valor de la pregunta de investigación, rigor metodológico, investigadores científicamente cualificados, evaluación independiente del protocolo y publicación puntual y precisa de los resultados. Se espera publicar la revisión completa en al menos un artículo y los resultados se difundirán ampliamente en diversos niveles de decisión.

INTRODUCTION: Rehabilitation and physical therapy have been adapting to the telehealth era, increasing accessibility and improving the continuity of attention in geographically remote populations with disabilities. Due to the spread of infection by SARS-CoV-2, many professionals have had to adapt their work to telerehabilitation practices, which require the best evidence at short notice and in summarized form. In this context, this protocol has been developed to evaluate the effectiveness of telerehabilitation as a care strategy in physical therapy for different conditions, populations, and contexts. METHOD AND ANALYSIS: An overview will be carried out in the format of a rapid review. It will include systematic reviews of different conditions, populations, and contexts, where the intervention to be evaluated is telerehabilitation by physical therapy. The outcomes considered will be clinical effectiveness depending on the specific condition, functionality, quality of life, satisfaction, adherence, and safety. A search will be carried out of the MEDLINE/PubMed, EMBASE, and Cochrane Library databases. Studies will be selected in duplicate with any discrepancies resolved by a third reviewer. Data extraction and risk of bias assessment will be carried out by a reviewer with non-independent verification by a second reviewer. The findings will be reported qualitatively by tables and figures. ETHICS AND DISSEMINATION: The principles of the value of the research question, the methodological rigor, scientifically qualified investigators, an independent evaluation of the protocol, and timely and accurate publication of the results will be complied with. The complete review will lead to the publication of at least one article, and the results will be widely disseminated at various levels of decision-making.