Contextual Factors-Enriched Standard Care on mechanical neck pain (ContextualizAR trial): Protocol for a randomised controlled trial.

BACKGROUND: Understanding the influence of contextual factors (CFs) on interventions for mechanical neck pain (MNP) is essential for evidence-based practice in physical therapy. However, the specific effects and synergies of combining different CFs remain unclear. OBJECTIVE: The primary purpose of this study will be to determine if a CFs-Enriched Standard Care (SC) approach is an effective treatment for MNP in terms of reducing pain and improving function. METHODS: This will be an assessor-blinded, 2-group (1:1) randomised clinical trial (RCT) aiming to enrol 94 participants with neck pain persisting for more than 4 weeks. Both groups will undergo 4 weeks of SC twice weekly, following established clinical practice guidelines. In the intervention group, CFs will be enhanced, encompassing the physical, psychological, and social elements inherent in the clinical encounter, based on existing evidence. The primary outcomes will encompass changes in pain and disability after 4 weeks of treatment, with a follow-up reassessment at week 12 post-treatment. Secondary outcomes will include changes in Active Range of Motion, Global Rating of Change, and Satisfaction with treatment. The change between groups after treatment and at the 12-week follow-up will be reported for all outcomes, considering the difference from scores recorded at baseline. RESULTS: We hypothesise that a 4-week CFs-Enriched SC approach will be superior to SC alone in terms of patient-reported disability and pain, with measurements conducted using the Northwick Park Neck Pain Questionnaire and the Numeric Pain Rating Scale, respectively. CONCLUSION: This RCT rigorously assesses the effect of purposeful manipulation of CFs during MNP treatment. By elucidating the role of these factors, our findings have the potential to significantly refine clinical practice in managing MNP, thereby enhancing patient care, and advancing the fields of physical therapy and rehabilitation.

Teoría de la complejidad en la atención del paciente con dolor musculoesquelético / Complexity theory in the management of patients with musculoskeletal pain

Los sistemas no lineales no son susceptibles de ser investigados con métodos reduccionistas. En este sentido, la teoría de la complejidad ofrece un enfoque alternativo para cuantificar la importancia de los factores contextuales en el paciente con dolor musculoesquelético. El resultado del uso positivo (placebo) o negativo (nocebo) de factores contextuales en el entorno terapéutico, podría ser responsable de gran parte de un componente inespecífico en la eficacia del tratamiento, afectando directamente la calidad de los resultados relacionados con la salud del paciente (por ejemplo, dolor, funcionalidad o satisfacción). En los últimos años, se ha incrementado la comprensión del valor de estos efectos. A pesar del creciente interés, el conocimiento y el reconocimiento de los efectos terapéuticos, continúan siendo limitados y heterogéneos entre los fisioterapeutas, lo cual reduce su valor traslacional en el campo de la fisioterapia. El propósito de este estudio es presentar el abordaje el paciente con dolor musculoesquelético desde la perspectiva la teoría de la complejidad.

Nonlinear systems are not susceptible to research with a reductionist approach. In this sense, the complexity theory provides an alternative approach to quantify the importance of contextual factors in patients with musculoskeletal pain. The use of positive (placebo) or negative (nocebo) contextual factors in the therapeutic setting could largely account for the non-specific component of treatment efficacy, directly affecting the quality of patients' health-related outcomes (e.g., pain, disability, or satisfaction). In recent years, there has been a better understanding of the effects of contextual factors. However, the knowledge and awareness of them is limited and heterogeneous among physical therapists, reducing their translational value in the field of physiotherapy. The purpose of this essay is to describe the management of patients with musculoskeletal pain from the complexity theory perspective.

Is the p-value properly interpreted by critical care professionals? Online survey. / O valor de p é adequadamente interpretado pelos profissionais de terapia intensiva? Uma pesquisa on-line.

OBJECTIVE: To determine the prevalence of and risk factors for insufficient knowledge related to p-values among critical care physicians and respiratory therapists in Argentina. METHODS: This cross-sectional online survey contained 25 questions about respondents' characteristics, self-perception and p-value knowledge (theory and practice). Descriptive and multivariable logistic regression analyses were conducted. RESULTS: Three hundred seventy-six respondents were analyzed. Two hundred thirty-seven respondents (63.1%) did not know about p-values. According to the multivariable logistic regression analysis, a lack of training on scientific research methodology (adjusted OR 2.50; 95%CI 1.37 - 4.53; p = 0.003) and the amount of reading (< 6 scientific articles per year; adjusted OR 3.27; 95%CI 1.67 - 6.40; p = 0.001) were found to be independently associated with the respondents' lack of p-value knowledge. CONCLUSION: The prevalence of insufficient knowledge regarding p-values among critical care physicians and respiratory therapists in Argentina was 63%. A lack of training on scientific research methodology and the amount of reading (< 6 scientific articles per year) were found to be independently associated with the respondents' lack of p-value knowledge.

OBJETIVO: Determinar a prevalência e os fatores de risco para conhecimento insuficiente sobre valores de p entre médicos e terapeutas respiratórios atuantes em terapia intensiva na Argentina. MÉTODOS: Levantamento transversal on-line com 25 questões relativas às características dos participantes, autopercepção e conhecimento sobre valores de p (teoria e prática). Realizaram-se análises de estatística descritiva e regressão logística multivariada. RESULTADOS: Analisaram-se 376 participantes. Não tinham conhecimento a respeito dos valores de p 237 participantes (63,1%). Segundo análise de regressão logística multivariada, falta de treinamento em metodologia científica (RC ajustadas 2,50; IC95% 1,37 - 4,53; p = 0,003) e a quantidade de leitura (< 6 artigos científicos por ano; RC ajustadas 3,27; IC95% 1,67 - 6,40; p = 0,001) foram identificados como independentemente associados com a falta de conhecimento sobre valores de p por parte dos participantes. CONCLUSÃO: A prevalência de conhecimento insuficiente com relação a valores de p entre médicos e terapeutas respiratórios na Argentina foi de 63%. Falta de treinamento em metodologia científica e quantidade de leitura (< 6 artigos científicos por ano) foram identificados como independentemente associados com a falta de conhecimento sobre valores de p por parte dos participantes.

O valor de p é adequadamente interpretado pelos profissionais de terapia intensiva? Uma pesquisa on-line / Is the p-value properly interpreted by critical care professionals? Online survey

RESUMO Objetivo: Determinar a prevalência e os fatores de risco para conhecimento insuficiente sobre valores de p entre médicos e terapeutas respiratórios atuantes em terapia intensiva na Argentina. Métodos: Levantamento transversal on-line com 25 questões relativas às características dos participantes, autopercepção e conhecimento sobre valores de p (teoria e prática). Realizaram-se análises de estatística descritiva e regressão logística multivariada. Resultados: Analisaram-se 376 participantes. Não tinham conhecimento a respeito dos valores de p 237 participantes (63,1%). Segundo análise de regressão logística multivariada, falta de treinamento em metodologia científica (RC ajustadas 2,50; IC95% 1,37 - 4,53; p = 0,003) e a quantidade de leitura (< 6 artigos científicos por ano; RC ajustadas 3,27; IC95% 1,67 - 6,40; p = 0,001) foram identificados como independentemente associados com a falta de conhecimento sobre valores de p por parte dos participantes. Conclusão: A prevalência de conhecimento insuficiente com relação a valores de p entre médicos e terapeutas respiratórios na Argentina foi de 63%. Falta de treinamento em metodologia científica e quantidade de leitura (< 6 artigos científicos por ano) foram identificados como independentemente associados com a falta de conhecimento sobre valores de p por parte dos participantes.

ABSTRACT Objective: To determine the prevalence of and risk factors for insufficient knowledge related to p-values among critical care physicians and respiratory therapists in Argentina. Methods: This cross-sectional online survey contained 25 questions about respondents' characteristics, self-perception and p-value knowledge (theory and practice). Descriptive and multivariable logistic regression analyses were conducted. Results: Three hundred seventy-six respondents were analyzed. Two hundred thirty-seven respondents (63.1%) did not know about p-values. According to the multivariable logistic regression analysis, a lack of training on scientific research methodology (adjusted OR 2.50; 95%CI 1.37 - 4.53; p = 0.003) and the amount of reading (< 6 scientific articles per year; adjusted OR 3.27; 95%CI 1.67 - 6.40; p = 0.001) were found to be independently associated with the respondents' lack of p-value knowledge. Conclusion: The prevalence of insufficient knowledge regarding p-values among critical care physicians and respiratory therapists in Argentina was 63%. A lack of training on scientific research methodology and the amount of reading (< 6 scientific articles per year) were found to be independently associated with the respondents' lack of p-value knowledge.

Traducción y adaptación transcultural del cuestionario Visual Vertigo Analogue Scale para uso en Argentina / Translation and cross-cultural adaptation of the Visual Vertigo Analogue Scale for use in Argentina

ANTECEDENTES Y OBJETIVO: El mareo visual surge cuando la compensación de la lesión vestibular se ve interferida por una alta dependencia visual, lo que lleva a una intolerancia en situaciones de conflicto visual. El Visual Vertigo Analogue Scale (VVAS) es un cuestionario autoadministrado, válido y confiable que evalúa específicamente el mareo visual. El uso de cuestionarios en culturas y lenguas diferentes requiere que los ítems sean traducidos y adaptados culturalmente. No existe una versión del VVAS en Argentina. Los objetivos del trabajo fueron traducir y adaptar transculturalmente el VVAS al castellano para su uso en la población argentina, en pacientes con trastornos vestibulares. MATERIALES Y MÉTODOS: Se llevó a cabo desde noviembre de 2015 y enero de 2016 en el Servicio de Kinesiología de un Hospital público de la Ciudad de Buenos Aires con pacientes argentinos mayores de 18 años que presentaban algún trastorno vestibular. El proceso de traducción y adaptación transcultural se basó en la guía del proceso de adaptación transcultural de mediciones autoadministradas de Beaton et al. RESULTADOS: Se incluyeron 39 pacientes para la adaptación transcultural del VVAS. Todas las decisiones de los cambios realizados por el comité de expertos fueron para asegurar la equivalencia semántica, idiomática, experimental y conceptual entre las versiones. CONCLUSIÓN: Se ha traducido y adaptado con éxito la versión original del VVAS al castellano para ser utilizado en la población argentina con trastornos vestibulares

BACKGROUND AND OBJECTIVE: Visual dizziness occurs when high visual dependence interferes with compensation for a vestibular lesion and leads to intolerance in situations of visual conflict. The Visual Vertigo Analogue Scale (VVAS) is a self-administered, valid and reliable questionnaire that serves to assess visual dizziness. The use of questionnaires in different cultures and languages requires that they be translated and adapted to the local culture. There is no version of the VVAS in Argentina. The objectives of this study were to translate and carry out a cross-cultural adaptation of the VVAS into Spanish for use with vestibular patients in Argentina. MATERIALS AND METHODS: This study was carried out from November 2015 to January 2016 in the Kinesiology Service of a public hospital in the city of Buenos Aires. Patients were Argentines older than 18 years who suffered from a vestibular disorder. The translation and cross-cultural adaptation were based on the guide to the process of cross-cultural adaptation of self-administered measurements by Beaton et al. RESULTS: 39 patients were included in the VVAS cross-cultural adaptation process. All changes made by the committee of experts were for the purpose of ensuring the semantic, idiomatic, experimental and conceptual equivalence of the two versions. CONCLUSION: The original version of the VVAS has been translated into Spanish and adapted for use in the Argentine population with vestibular disorders

Incidence of immediate postextubation complications in critically Ill adult patients.

BACKGROUND: Postextubation complication rates vary among studies. It is necessary to standardize a method to identify postextubation complications and determine their potential association with extubation failure and reintubation in critically ill adult patients. OBJECTIVES: To describe immediate (up to 60 min) endotracheal postextubation complications in critically ill adult patients and determine whether these complications are associated with extubation failure. METHODS: Secondary analysis of a Randomized Clinical Trial that included 240 critically ill adult patients, who were eligible for extubation. Overall complications include at least one major complication (upper airway obstruction, desaturation, vomiting, post-obstructive pulmonary edema) and/or minor complications (bronchospasm, severe cough, hypertension, tachycardia, tachypnea, poor respiratory mechanics). RESULTS: Incidence of overall, major and minor complications was 71.2%, 30.9% and 62.7%, respectively. Forty (16.9%) patients failed extubation, and thirty (12.7%) were reintubated. Of 168 patients who developed a postextubation complication, 137 (81.5%) were successfully extubated. Only major complications were significantly associated with reintubation after extubation failure (p<0.001). CONCLUSION: We have observed high incidence rates of overall, major and minor complications. The development of major complications was statistically significantly associated with extubation failure and reintubation. It is still unknown whether the identification and treatment of immediate postextubation complications have positive effects on patients' clinical course or whether the complications are a mere effect of the extubation procedure.

Translation and cross-cultural adaptation of the Visual Vertigo Analogue Scale for use in Argentina. / Traducción y adaptación transcultural del cuestionario Visual Vertigo Analogue Scale para uso en Argentina.

BACKGROUND AND OBJECTIVE: Visual dizziness occurs when high visual dependence interferes with compensation for a vestibular lesion and leads to intolerance in situations of visual conflict. The Visual Vertigo Analogue Scale (VVAS) is a self-administered, valid and reliable questionnaire that serves to assess visual dizziness. The use of questionnaires in different cultures and languages requires that they be translated and adapted to the local culture. There is no version of the VVAS in Argentina. The objectives of this study were to translate and carry out a cross-cultural adaptation of the VVAS into Spanish for use with vestibular patients in Argentina. MATERIALS AND METHODS: This study was carried out from November 2015 to January 2016 in the Kinesiology Service of a public hospital in the city of Buenos Aires. Patients were Argentines older than 18 years who suffered from a vestibular disorder. The translation and cross-cultural adaptation were based on the guide to the process of cross-cultural adaptation of self-administered measurements by Beaton et al. RESULTS: 39 patients were included in the VVAS cross-cultural adaptation process. All changes made by the committee of experts were for the purpose of ensuring the semantic, idiomatic, experimental and conceptual equivalence of the two versions. CONCLUSION: The original version of the VVAS has been translated into Spanish and adapted for use in the Argentine population with vestibular disorders.

Encuesta sobre el procedimiento de extubación en las unidades de cuidados intensivos de Buenos Aires, Argentina / Survey on the extubation procedure in intensive care units in Buenos Aires, Argentina

RESUMEN Objetivo: Conocer la práctica habitual del manejo de la vía aérea durante el procedimiento de extubación mediante una encuesta online a profesionales de las unidades de cuidados intensivos de la Ciudad Autónoma de Buenos Aires y Provincia de Buenos, Argentina. Métodos: Estudio descriptivo transversal de tipo encuesta online del 11 de febrero al 11 de marzo de 2013. Se envió por correo electrónico una invitación voluntaria y anónima para acceder a la encuesta a 500 participantes a partir de una base de datos confeccionada por los investigadores de este estudio. Resultados: De un total de 500 participantes, 217 (44%) respondieron la encuesta. El 59,4% son kinesiólogos. Ciento noventa y cinco (89,9%) profesionales se desempeñan en atención de adultos. Con respecto al procedimiento de desinflado del balón y extubación, 203 (93,5%) realizan aspiración endotraqueal y 27 (12,5%) emplean presión positiva. El 53,5% de los participantes informó haber tenido en los últimos 3 meses complicaciones inmediatas a este procedimiento. Se informaron un total de 163 complicaciones, siendo el estridor el más prevalente (52,7%). Conclusión: La mayoría de los profesionales de unidades de cuidados intensivos de la Ciudad Autónoma de Buenos Aires y Provincia de Buenos Aires, Argentina, emplea aspiración endotraqueal sin aplicar presión positiva durante el procedimiento de extubación.

ABSTRACT Objective: To examine the usual practice of airway management during the extubation procedure through an online survey to professionals working in intensive care units in the Autonomous City of Buenos Aires and in the Province of Buenos Aires, Argentina. Methods: A cross-sectional descriptive study online survey was conducted from February 11 to March 11, 2013. A database was generated, and a voluntary and anonymous invitation to access the survey was sent by email to 500 participants. Results: Out of a total of 500 participants, 217 (44%) responded to the survey, of whom 59.4% were physical therapists. One hundred ninety-five (89.9%) professionals were working in adult care. Regarding the cuff deflation procedure and extubation, 203 (93.5%) performe endotracheal suctioning, and 27 (12.5%) use positive pressure. Approximately 53.5% of participants reported having experienced immediate complications with this procedure in the last three months. In all, 163 complications were reported, and stridor was the most prevalent (52.7%). Conclusion: Most professionals working in intensive care units in the Autonomous City of Buenos Aires and in the Province of Buenos Aires, Argentina, use endotracheal suctioning without applying positive pressure during extubation.

Survey on the extubation procedure in intensive care units in Buenos Aires, Argentina. / Encuesta sobre el procedimiento de extubación en las unidades de cuidados intensivos de Buenos Aires, Argentina.

OBJECTIVE: To examine the usual practice of airway management during the extubation procedure through an online survey to professionals working in intensive care units in the Autonomous City of Buenos Aires and in the Province of Buenos Aires, Argentina. METHODS: A cross-sectional descriptive study online survey was conducted from February 11 to March 11, 2013. A database was generated, and a voluntary and anonymous invitation to access the survey was sent by email to 500 participants. RESULTS: Out of a total of 500 participants, 217 (44%) responded to the survey, of whom 59.4% were physical therapists. One hundred ninety-five (89.9%) professionals were working in adult care. Regarding the cuff deflation procedure and extubation, 203 (93.5%) performe endotracheal suctioning, and 27 (12.5%) use positive pressure. Approximately 53.5% of participants reported having experienced immediate complications with this procedure in the last three months. In all, 163 complications were reported, and stridor was the most prevalent (52.7%). CONCLUSION: Most professionals working in intensive care units in the Autonomous City of Buenos Aires and in the Province of Buenos Aires, Argentina, use endotracheal suctioning without applying positive pressure during extubation.

OBJETIVO: Conocer la práctica habitual del manejo de la vía aérea durante el procedimiento de extubación mediante una encuesta online a profesionales de las unidades de cuidados intensivos de la Ciudad Autónoma de Buenos Aires y Provincia de Buenos, Argentina. MÉTODOS: Estudio descriptivo transversal de tipo encuesta online del 11 de febrero al 11 de marzo de 2013. Se envió por correo electrónico una invitación voluntaria y anónima para acceder a la encuesta a 500 participantes a partir de una base de datos confeccionada por los investigadores de este estudio. RESULTADOS: De un total de 500 participantes, 217 (44%) respondieron la encuesta. El 59,4% son kinesiólogos. Ciento noventa y cinco (89,9%) profesionales se desempeñan en atención de adultos. Con respecto al procedimiento de desinflado del balón y extubación, 203 (93,5%) realizan aspiración endotraqueal y 27 (12,5%) emplean presión positiva. El 53,5% de los participantes informó haber tenido en los últimos 3 meses complicaciones inmediatas a este procedimiento. Se informaron un total de 163 complicaciones, siendo el estridor el más prevalente (52,7%). CONCLUSIÓN: La mayoría de los profesionales de unidades de cuidados intensivos de la Ciudad Autónoma de Buenos Aires y Provincia de Buenos Aires, Argentina, emplea aspiración endotraqueal sin aplicar presión positiva durante el procedimiento de extubación.