Training physiotherapy students in basic wheelchair provision. Experiences at two universities in Colombia.

Wheelchair provision training is essential to overcome barriers related to the lack of knowledge of health professionals on this topic. Appropriate knowledge of the service provision process may lead to higher quality service and products, and thus be more likely to help people with mobility impairments achieve the fundamental human right of personal mobility. This study aimed to describe a training intervention for two groups of future physiotherapists in Colombia, assess cohort differences in performance on a knowledge test, and explore their post-training perceptions. A quantitative retrospective study with a historical, descriptive-comparative design was conducted. 525 sixth-semester participants completed the International Society of Wheelchair Professionals Wheelchair Service Provision - Basic Test online in Spanish after curriculum modifications were implemented. The test assesses knowledge in seven domains: Assessment; Prescription; Products; Fitting; User training; Follow-up, maintenance, and repairs; and Process. The training intervention was successfully implemented with Physiotherapy students from two institutions, resulting in a 57% increase in test approval rates. Participants demonstrated increased knowledge, satisfaction with the course content, and application of learning to their current work. These results suggest implications for what pedagogical approach to employ, when curricular change may be warranted, and specific considerations for the Colombian context. Furthermore, identifying the minimal knowledge basis for undergraduate programs and facilitating its dissemination can support interprofessional education and enhance professionals' capacity to support wheelchair provision services.

Developing pedagogical materials and resources should address academic needs while also being adaptable to the healthcare system and cultural and economic resources.Establishing minimal knowledge bases for physiotherapists and facilitating their dissemination to support interprofessional education are crucial steps.Sharing pedagogical experiences that improve health workforce training promotes the quality of wheelchair service provision, benefiting the functional independence and well-being of people with disabilities.The use of international resources such as the ISWP test in the training of the health workforce contributes to the standardization of the training process regardless of the context.

Neuromuscular exercise in children with Down Syndrome: a systematic review.

The effects and the prescription parameters of therapeutic exercise are not clear. For this reason, is needed to determine the effect of neuromuscular exercise on balance, muscle strength and flexibility specifying the parameters and characteristics of effective interventions in children between 6 and 12 years and adolescent between 13 and 18 years with Down Syndrome. The present study is a systematic review of effectiveness outcomes balance, muscle strength and flexibility in this population. The databases of PubMed, PEDro, EMBASE, SCIELO, Lilacs, Cochrane library were searched from May to December 2021. We recruited randomized controlled trials (RCTs) which met the inclusion criteria in our study. Ten studies were included. The interventions included mechanotherapy, vibration, and use of different unstable surfaces. The exercise frequency ranged from 3 to 5 days a week, and the duration of each session was between six and 15 min. The frequency was between two and three times a week for 6 and 12 weeks and the intensity were between 60 and 80% of maximal voluntary contraction. Neuromuscular exercise in different modes of application was associated with increases in chest and lower limb muscle strength mean 8.51, CI [2.35-14.67] kg and (21.54 [1.64, 41.43]) kg. Balance also improved when the mode of application was isokinetic training and core stability exercises (- 0.20 [- 0.29, - 0.12]) evaluated with stability index. Neuromuscular exercise appears to be effective for the improvement of both lower limb and chest muscle strength and balance in children over 8 years. No evidence was found in children under 8 years.

Therapeutic exercise to improve motor function among children with Down Syndrome aged 0 to 3 years: a systematic literature review and meta­analysis.

The effects and the prescription parameters of therapeutic exercise are not clear. For this reason, is needed to determine the effect of therapeutic exercises on the motor function of children with Down Syndrome (DS) aged 0 to 3 years. The present study is systematic review and meta-analysis of effectiveness outcomes in this population: gait, balance, motor development, fine motor skills, and executive functions. The databases of PubMed, PEDro, EMBASE, SCIELO, Lilacs, Cochrane library were searched from January to December 2019. We recruited Randomized Controlled Trials (RCTs) which met the inclusion criteria in our study. Six studies and 151 participants were included. Two types of therapeutic exercises, aerobic and neuromuscular, were identified. Both types of exercise were effective in improving outcomes. There were no differences between the modes of application of the exercise. No differences were identified between the treadmill and the physiotherapy plan for the reduction of the time to reach independent walking, Mean Difference (MD) 46.79, 95% Confidence Interval (IC) (- 32.60, 126.19), nor for the increase in walking speed MD 0.10 IC (- 0.02, 0.21) m/s. This study suggests that aerobic exercise therapy has a potentially effective role to promote the gait and motor development of children with DS aged 0 to 3 years when it is applied using a treadmill with a frequency of 5 days, a duration of 6-8 min, and an intensity of between 0.2 and 0.5 m/s. Studies with less heterogeneity and larger sample sizes are required.

[Identification of quality indicators for physiotherapy: a systematic review.] / Identificación de indicadores de calidad para fisioterapia: una revisión sistemática.

BACKGROUND: Despite the emerging role that indicators have for the evaluation of quality in physiotherapy, these have been developed mainly for other areas of health and only some are relevant and applicable for physiotherapy. The objective of this review was to identify the quality indicators (QI) described or developed in the evidence that can be used to assess the quality of the provision of physiotherapy services. METHODS: A systematic review was carried out, in the databases Embase, Web of science SciELO, LILACS and OPEN GREY, until March 2021, in search of studies published in Spanish, English and Portuguese that described the development of QI specifically for the practice of physiotherapy. The methodological quality of the indicators was evaluated using the AIRE instrument. The indicators were classified following the Donabedian model. RESULTS: 8 studies were included that described 8 sets of QIs, with a total of 199 indicators. Six of the sets were published in the Netherlands. 62.5% of the total indicators were process, mostly related to the care of patients with musculoskeletal pathologies. Of the total of studies, 37.5% achieved high quality in three domains of the AIRE instrument. CONCLUSIONS: The QI described in the evidence were designed for specific national contexts based on their own health system, have a methodological quality and are focused on evaluating the care processes of physiotherapy services mainly in patients with musculoskeletal diseases.

OBJETIVO: A pesar del papel emergente que tienen los indicadores para la evaluación de la calidad en fisioterapia, estos han sido desarrollados principalmente para otras áreas de la salud y sólo algunos son relevantes y aplicables para la fisioterapia. El objetivo de esta revisión fue identificar los indicadores de calidad (IC) descritos o desarrollados en la evidencia que puedan ser utilizados para evaluar la calidad en la prestación de servicios de fisioterapia. METODOS: Se realizó una revisión sistemática, en las bases de datos Embase, Web of science SciELO, LILACS y OPEN GREY, hasta Marzo del 2021, en busca de estudios publicados en español, inglés y portugués que describieron el desarrollo de IC específicamente para la práctica de fisioterapia. Se evaluó la calidad metodológica de los indicadores por medio del instrumento AIRE. Se clasificaron los indicadores siguiendo el modelo de Donabedian. RESULTADOS: Se incluyeron 8 estudios que describieron 8 conjuntos de IC, con un total de 199 indicadores. Seis de los conjuntos fueron publicados en países bajos. El 62,5% del total de los indicadores eran de proceso, relacionados en su gran mayoría con la atención de pacientes con patologías musculoesqueléticas. Del total de estudios, el 37,5% alcanzó una alta calidad en tres dominios del instrumento AIRE. CONCLUSIONES: Los IC descritos en la evidencia fueron diseñados para contextos nacionales específicos basados en su propio sistema de salud, tienen una baja calidad metodológica y están concentrados en evaluar los procesos de atención de los servicios de fisioterapia principalmente en pacientes con enfermedades musculoesqueléticas.

Identificación de indicadores de calidad para fisioterapia: una revisión sistemática / Identification of quality indicators for physiotherapy: a systematic review

Fundamentos: A pesar del papel emergente que tienen los indicadores para la evaluación de la calidad en fisioterapia, estos han sido desarrollados principalmente para otras áreas de la salud y sólo algunos son relevantes y aplicables para la fisioterapia. El objetivo de esta revisión fue identificar los indicadores de calidad (IC) descritos o desarrollados en la evidencia que puedan ser utilizados para evaluar la calidad en la prestación de servicios de fisioterapia. Métodos: Se realizó una revisión sistemática, en las bases de datos Embase, Web of science SciELO, LILACS y OPEN GREY, hasta Marzo del 2021, en busca de estudios publicados en español, inglés y portugués que describieron el desarrollo de IC específicamente para la práctica de fisioterapia. Se evaluó la calidad metodológica de los indicadores por medio del instrumento AIRE. Se clasificaron los indicadores siguiendo el modelo de Donabedian. Resultados: Se incluyeron 8 estudios que describieron 8 conjuntos de IC, con un total de 199 indicadores. Seis de los conjuntos fueron publicados en países bajos. El 62,5% del total de los indicadores eran de proceso, relacionados en su gran mayoría con la atención de pacientes con patologías musculoesqueléticas. Del total de estudios, el 37,5% alcanzó una alta calidad en tres dominios del instrumento AIRE. Conclusiones: Los IC descritos en la evidencia fueron diseñados para contextos nacionales específicos basados en su propio sistema de salud, tienen una baja calidad metodológica y están concentrados en evaluar los procesos de atención de los servicios de fisioterapia principalmente en pacientes con enfermedades musculoesqueléticas.(AU)

Background: Despite the emerging role that indicators have for the evaluation of quality in physiotherapy, these have been developed mainly for other areas of health and only some are relevant and applicable for physiotherapy. The objective of this review was to identifythe quality indicators (QI) described or developed in the evidence that can be used to assess the quality of the provision of physiotherapy services. Methods: A systematic review was carried out, in the databases Embase, Web of science SciELO, LILACS and OPEN GREY, until March 2021, in search of studies published in Spanish, English and Portuguese that describedthe development of QI specifically for the practice of physiotherapy. The methodological quality of the indicatorswas evaluated using the AIRE instrument. The indicators were classified following the Donabedian model. Results: 8 studies were included that described 8 sets of QIs, with a total of 199 indicators. Six of the sets were published in the Netherlands. 62.5% of the total indicators were process, mostly related to the care of patientswith musculoskeletal pathologies. Of the total of studies, 37.5% achieved high quality in three domains of the AIRE instrument. Conclusions: The QI described in the evidence were designed for specific national contexts based on their own health system, have a methodological quality and are focused on evaluating the care processes of physiotherapyservices mainly in patients with musculoskeletal diseases.(AU)

Validación del BESTest en población de adultos mayores colombianos / Validation of the BESTestest in a population of older Colombian adults

Introducción. El envejecimiento y las comorbilidades afectan la cognición y el sistema sensoriomotor de las personas. La pérdida de equilibrio es una de las principales causas de caídas en adultos mayores, por lo que monitorear su desempeño funcional es importante. El sistema de evaluación de equilibrio identifica factores de riesgo para caídas. Objetivos. Identificar las propiedades psicométricas de validez y confiabilidad entre evaluadores y estimar el valor de corte óptimo del BESTest para así diferenciar entre adultos que tienen o no riesgo de caídas. Métodos. Estudio observacional de validez y confiabilidad en el que participaron 221 adultos de entre 50 y 80 años capaces de caminar, con o sin dispositivo de asistencia, de forma independiente durante seis metros y de realizar tareas de equilibrio sin fatiga. Se indagaron datos sociodemográficos, clínicos e historial de caídas. Resultados. Se encontró una correlación significativa entre el sistema de equilibrio con la escala de confianza en las actividades cotidianas (r=0,47, p<0,01), una consistencia interna adecuada para la prueba en general (alfa de Cronbach de 0,90), una sensibilidad del 78% y una especificidad del 66%. El área bajo la curva fue de 0,76, con una discriminación aceptable, es decir, se estableció que las personas que obtienen un puntaje <80 en la prueba tienen alto riesgo de caídas. Conclusiones. El sistema de equilibrio cuenta con buenas propiedades psicométricas que permiten su aplicación confiable en población colombiana. La prueba aporta a la toma de decisiones clínicas gracias a que discrimina el riesgo de caída y el perfil funcional del adulto.

Introduction. Aging and comorbidities affect cognition and the sensorimotor system of individuals. Loss of balance is one of the main causes of falls in older adults, so monitoring their functional performance is important. The balance assessment system identifies risk factors for falls. Objectives. To identify the psychometric properties of validity and inter-rater reliability and to estimate the optimal cut-off value of the BESTest in order to differentiate between adults who are or are not at risk for falls. Methods. Observational validity and reliability study involving 221 adults aged 50 to 80 years able to walk, with or without an assistive device, independently for six meters and to perform balance tasks without fatigue. Sociodemographic and clinical data and history of falls were investigated. Results. We found a significant correlation between the balance system with the confidence in activities of daily living scale (r=0.47, p<0.01), adequate internal consistency for the test overall (Cronbach's alpha of 0.90), sensitivity of 78% and specificity of 66%. The area under the curve was 0.76, with acceptable discrimination, i.e., it was established that persons scoring <80 on the test are at high risk of falls. Conclusions. The balance system has good psychometric properties that allow its reliable application in the Colombian population. The test contributes to clinical decision making because it discriminates the risk of falling and the functional profile of the adult.

Exploración del constructo calidad de vida relacionado con la salud en niños, niñas y adolescentes con síndrome de Down / Exploration of the health-related quality of life construct in children and adolescents with Down syndrome

El constructo de calidad de vida relacionada con la salud (CVRS) en niños, niñas y adolescentes con síndrome de Down no ha sido definido, así como tampoco existen instrumentos para evaluarlo. De esta forma, el objetivo del presente estudio es explorar este constructo en niños, niñas, adolescentes con síndrome de Down, y en sus padres y cuidadores, para establecer las bases conceptuales de un instrumento de evaluación. Se realizó una revisión de información y evidencia relacionada con calidad de vida en páginas web de organizacio- nes de todo el mundo y en bases de datos científicas, con lo cual se logró una aproximación al constructo de CVRS. Se realizaron siete entrevistas y dos grupos focales con niños, niñas y adolescentes con síndrome de Down y cuatro entrevistas y tres grupos focales con padres y cuidadores. Con base en la metodología desarrollada, emergieron las categorías de capacidad física, funcional, psicológica y social.

The construct of health-related quality of life (HRQOL) in children and adolescents with Down syndrome has not been defined, nor are there any instruments to assess it. Thus, the aim of the present study is to explore this construct in children and adolescents with Down syndrome, and in their parents and caregivers, in order to establish the conceptual basis for an assessment instrument. A review of information and evidence related to quality of life was carried out in web pages of organizations from all over the world and in scientific databases, with which an approximation to the HRQoL construct was achieved. Seven interviews and two focus groups were conducted with children and adolescents with Down syndrome and four interviews and three focus groups with parents and caregivers. Based on the methodology developed, the categories of physical, functional, psychological and social capacity emerged.

Undergraduate physiotherapy students' basic wheelchair provision knowledge: a pilot study in two universities in Colombia.

Purpose: Access to an appropriate wheelchair is a human right. Only between 5-15% of people who need a wheelchair have access to one. One of the key barriers to access is the lack of appropriately trained rehabilitation professionals. The objective of this study was to evaluate basic manual wheelchair provision knowledge in final-year physiotherapy undergraduate students in two programs in Colombia.Materials and methods: Students took the International Society of Wheelchair Professionals Wheelchair Service Provision - Basic Test which was administered online and in Spanish. The minimum score to pass the test is 70%; it assesses seven domains: Assessment; Prescription; Products; Fitting; User training; Follow-up, maintenance, and repairs; and Process.Results and conclusions: One-hundred sixteen students took the test and no one passed the test. The highest median domain scores were in Assessment and Process while the lowest were in Fitting and Products. The limitations of this study include that this sample does not represent all physiotherapy programmes or students in Colombia, there may be potential errors in the Spanish translation of the outcome measure, and students encountered Internet connectivity issues during the test that may have impacted their scores. Immediate interventions are required to improve teaching and students' learning outcomes related to basic manual wheelchair provision in these two programs. This study may serve as a foundation for future regional or national studies that assess the situation of wheelchair provision training in rehabilitation programs that will inform improvement actions. This manuscript is also available in Spanish as Supplemental Material.Implications for rehabilitationThis study indicates that students' current knowledge on basic appropriate manual wheelchair provision from two physiotherapy programs in Colombia is insufficient. Students' knowledge does not align with the minimum guidelines recommended for wheelchair service provision by the World Health Organization.Objectively identifying the gap in knowledge in rehabilitation trainees (i.e., physiotherapy students) is a strategy to promote the inclusion of assistive technology related content in formal academic training.The need to include formal training of appropriate wheelchair provision persists and without this training, people with disabilities who require a wheelchair for mobility will continue to face barriers to full participation in society.

Validity and reproducibility of a tool for assessing clinical competencies in physical therapy students.

BACKGROUND: The evaluation of competencies in the clinical field is essential for health professionals, as it allows the acquisition of these competencies to be tracked. The objective of this study was to create and evaluate the validity and reliability of a tool for measuring clinical competencies in physical therapy (PT) students to assess the quality of their performance in a professional context. METHODS: A descriptive study was designed. The Measurement Tool for Clinical Competencies in PT (MTCCP) was developed based on the evaluation of 39 experts: 15 clinicians and 24 instructors. The content validity was evaluated using the Content Validity Index (CVI). Three professors were invited to apply the tool to 10 students. Cronbach's alpha, exploratory factor analysis, and the intraclass correlation coefficient were used to determine the reliability and validity of the scale. RESULTS: The CVI was positive-higher than 0.8. Principal component analysis confirmed the construct validity of the tool for two main factors: clinical reasoning (first factor) and professional behavior (second factor). With regard to reliability, the MTCCP achieved an internal congruence of 0.982. The inter-evaluator reproducibility for clinical reasoning, professional behavior, and the total MTCCP score was almost perfect; the ICCs were 0.984, 0.930, and 0.983, respectively. CONCLUSIONS: The MTCCP is a valid and reliable instrument for assessing the performance of PT students in hospital settings and can be used to determine what skills students feel less confident using and what additional training/learning opportunities could be provided. Further research is needed to determine whether the MTCCP has similar validity and reproducibility in other Spanish-speaking national and international PT programs.

Función motora en adultos que viven con VIH / Motor function in adults living with HIV

Resumen Introducción. El VIH/sida es un problema de salud pública mundial que requiere de la identificación de estrategias para mejorar las condiciones funcionales de las personas que presentan esta condición. Objetivo. Caracterizar la función motora de individuos que viven con VIH en una población de Bogotá D.C. Materiales y métodos. Estudio descriptivo trasversal en el que participaron personas que viven con VIH y son atendidas por un programa de atención integral. Se evaluaron variables clínicas, composición corporal, fuerza de agarre, equilibrio dinámico y capacidad aeróbica. Se analizaron datos sociodemográficos y clínicos con sus medias y desviaciones estándar. Resultados. Participaron 30 pacientes, 77% hombres con valores promedio de edad de 54 años, peso corporal de 68kg y talla de 165cm. Todos los pacientes estaban recibiendo terapia antirretroviral por tiempo >15 años. Se encontró déficit sensorial, debilidad en la fuerza de agarre y buena capacidad aeróbica. Conclusiones. Conocer las características de la función motora a partir de la capacidad sensorial, el equilibrio, la fuerza muscular y la composición corporal permite diseñar estrategias específicas que regulen el deterioro funcional que pueden tener las personas que viven con VIH/sida en el proceso de envejecimiento.

Abstract Introduction: HIV/AIDS is a major global public health issue that requires identifying strategies to improve the functional conditions of people living with this condition. Objective: To characterize the motor function of individuals living with HIV in Bogotá D.C, Colombia. Materials and methods: Transversal descriptive study involving people living with HIV and enrolled in a comprehensive care program. Clinical variables, body composition, grip strength, dynamic balance and aerobic capacity were assessed. Sociodemographic and clinical data were analyzed to obtain means and standard deviations. Results: Thirty patients were included in the study, of which 77% were males with an average age of 54 years, body weight of 68kg, and height of 165cm. All patients had received antiretroviral therapy for >15 years. Sensory deficit, weak grip strength and good aerobic capacity were observed. Conclusions: Knowing the characteristics of motor function, including sensory capacity, balance, muscle strength and body composition, allows designing specific strategies to regulate the functional impairment that people living with HIV/AIDS may develop during the aging process.

El capital social de la comunidad científica / The social capital of the scientific community

La utilidad del conocimiento está en la manera como la sociedad se beneficia de él, por esto los académicos buscan divulgar los resultados de sus reflexiones y proyectos de investigación. Socializar el conocimiento es un pretexto para construir comunidad académica, de ahí que las revistas científicas se convierten en un instrumento que contribuye con este propósito. La construcción de comunidades académicas congrega las capacidades técnicas, científicas y humanas de los individuos que las conforman para hacer posible el desarrollo social. La formación y el desempeño de los profesionales de la salud requiere conocer y actuar en consecuencia con el compromiso que tenemos con el desarrollo, al ser parte de comunidades generadoras de capital social. Para esto es preciso recordar el significado de este compromiso. En las últimas décadas el concepto de capital social se incluye en los procesos de desarrollo. Este concepto gira alrededor de factores intangibles como los valores, las normas y las actitudes de confianza, e incluso las redes sociales que facilitan la coordinación y cooperación para lograr propósitos conjuntos. La CEPAL entiende el concepto como "el conjunto de normas, instituciones y organizaciones que promueven la confianza y la cooperación entre las personas, las comunidades y la sociedad en su conjunto"

The usefulness of knowledge lies in the way society benefits from it, which is why academics seek to disseminate the results of their reflections and research projects. Socializing knowledge is a pretext to build academic community, hence scientific journals become an instrument that contributes to this purpose. The construction of academic communities brings together the technical, scientific and human capacities of the individuals who make them up to make social development possible. The training and performance of health professionals requires knowing and acting accordingly with the commitment we have to development, being part of communities that generate social capital. For this, it is necessary to remember the meaning of this commitment. In recent decades, the concept of social capital has been included in development processes. This concept revolves around intangible factors such as values, norms and attitudes of trust, and even social networks that facilitate coordination and cooperation to achieve joint purposes. ECLAC understands the concept as "the set of norms, institutions and organizations that promote trust and cooperation among individuals, communities and society as a whole."

El profesor universitario, un agente de desarrollo moral / The High Education Teacher, an Agent of Moral Development

El artículo plantea una reflexión sobre la manera como el aula de clase constituye un escenario que dinamiza el desarrollo moral, a partir de la interacción entre estudiantes y profesores, en el ambiente universitario. Propone elementos para llevar a la práctica la formación ética como un transversal curricular. Asume la ética, desde una perspectiva plural, fundada en el conocimiento y la acción humana. Vincula la formación integral con las concepciones de educación, currículo, modelos pedagógicos y metodologías de enseñanza. Propone acciones para evidenciar el compromiso del profesor con la formación integral. Concluye que el profesor es agente de desarrollo moral y que en el aula de clase se construye identidad, autonomía y responsabilidad, a partir de una relación abierta y plural, entre profesores y estudiantes y entre éstos y el conocimiento.

The article shows the classroom like an workplace to move moral development, from the relationship between students and professors in the university atmosphere. It proposes elements to take to the practice the ethics education a transverse curriculum line. It assumes the ethics, from a plural perspective, founded on the knowledge and the human action. It joins the integral formation with the conceptions of education, curriculum, pedagogical models and methodologies of education. It proposes actions to demonstrate the commitment of the professor with the integral formation. Finally, concludes that the professor is agent of moral development and that in the classroom is constructed: identity, autonomy and responsibility, from open and plural relation between professors and students and between these and the knowledge.