Advancing women's pelvic floor muscle function diagnosis: the EFSMAP examination and its reliability evaluation.

BACKGROUND: The accurate diagnosis of pelvic floor muscle impairments is essential. The plethora of terms and the lack of evidence to support widely used pelvic floor muscle function (PFMF) measurements hinder diagnostic labels. OBJECTIVE: To structure an examination of PFMF using visual observation and digital palpation and terms consistent with the ICF terminology, and to test its intra and interrater reliability/agreement. METHODS: A panel of 9 physical therapists applied Delphi method to structure the PFMF exam under ICF terminology and to verify its measurements reproducibility. For reliability and agreement, a convenience sample of women aged 51.2 ± 14.7 years had the sensitivity to pressure, pain, muscle tone, involuntary movement reaction, control of voluntary movement (contraction/relaxation), coordination, strength, and endurance examined by two raters, in the same day for interrater (n = 40), and one week apart, for intrarater reliability (n = 25). Percent agreement, linear weighted kappa, intraclass correlation coefficient, and Bland-Altman's limits of agreement were calculated (alpha = 0.05). RESULTS: Four round Delphi discussion structured the PFMF exam, named EFSMAP (Exame das Funções Sensoriais e Motoras do Assoalho Pélvico/Examination of Pelvic Floor Sensory and Motor Functions), set a list of concepts and instructions targeted at reproducibility and established PFMF diagnostic labels. Reliability, except for pain and tone, were moderate to excellent (Kw= 0.67-1.0 and ICC=0.48-0.82). Agreement was substantial for most PFMF features (0.64-1.00), except pain. CONCLUSIONS: The EFSMAP was successfully developed as a valid and reliable exam to be used in research and clinical practice; it provides labels for the diagnosis of pelvic floor muscle impairments. It might be easily adopted worldwide as it uses ICF terminology.

Characterizing Disabilities in Preschool Aged Children with Congenital Zika Virus Syndrome with the ICF Model.

Understanding functioning and disabilities in children with Congenital Zika Syndrome (CZS) is essential for health planning. We describe disabilities present in children with CZS followed in a reference hospital in Rio de Janeiro, Brazil, based on the biopsychosocial model of the International Classification of Functioning, Disability and Health (ICF). This was a cohort study of children >3 years of age with CZS. Disability was characterized through outcomes related to ICF components assessed via clinical and motor development evaluations. Among 50 children, with a median age of 40 months, 47 (94%) presented with severe impairment and 46 (92%) had microcephaly. Damage to the head and neck was found in most children, with abnormal central nervous system imaging universally present. Most children had cognitive impairment (92%), muscle tone problems (90%), and speech deficits (94%). We found movement limitations in all categories but more pervasively (80−94%), in postural transfers and displacements. The main environmental factors identified in the ICF model were the use of products or substances for personal consumption and access to health services. Children with CZS have extremely high rates of disability beyond aged 3 years, particularly regarding motor activity. ICF-based models can contribute to the assessment of health domains.

Elaboração e validação de instrumento baseado no Core Set resumido da classificação internacional da funcionalidade para indivíduos com lesão medular aguda / Development and validation of an instrument based on the summarized Core Set of the international classification of functioning for individuals with acute spinal cord injury

A Lesão de Medula Espinhal (LME) é um trauma com efeitos devastadores na vida dos indivíduos. Estima-se que mais de 130.000 pessoas sejam afetadas por LME, a cada ano, em todo o mundo. Aproximadamente, 45% de todas as lesões são completas, deixando apenas uma pequena chance de recuperação funcional. As complicações ocasionadas pela LME influenciam a qualidade de vida dos indivíduos, aumentam as demandas de cuidados e os encargos sociais e econômicos de saúde. Este é um estudo metodológico, que teve o objetivo de construir e validar instrumento baseado no Core Set resumido da CIF, para indivíduos com lesão medular aguda traumática. Essa pesquisa foi aprovada pelo Comitê de Ética e desenvolvida nas seguintes etapas: 1 - Elaboração do instrumento a partir do Core set resumido da CIF para lesão medular aguda: "Elaboração e Validação de Instrumento baseado no Core Set resumido da Classificação Internacional da Funcionalidade para indivíduos com Lesão Medular Aguda"; 2- Validação do instrumento e coleta de dados pelos juízes; 3- Aplicação do pré-teste. O instrumento para validação de face e conteúdo composto por 15 categorias que integraram os componentes da CIF: funções do corpo (6), estrutura do copo (2), atividades e participação (2), fatores ambientais e fatores pessoais (5). A validade de conteúdo do instrumento foi feita por um comitê de vinte e dois juízes. Dos 22 juízes, 18 (81,8%) eram do sexo feminino e 4 (18,2%) do sexo masculino. A maioria era constituída por jovens, com média entre 40±10 anos, sendo que 3 participantes (13,6%) tinham idade entre 20 e 29 anos, 8 (36,4%) de 30 e 39 anos, 7 (31,8%) entre 40 e 49 anos, 3 (13,6%) 50 e 59 anos e 1 (4,5%) 60 e 69 anos. Cerca de 95,5 % relataram participar, nos últimos 2 anos, de eventos científicos na área temática da pesquisa, 13 (59,1%) realizavam estudos sobre a CIF e 14 (63,6%) a utilizavam na sua prática clínica. Todas as categorias obtiveram uma concordância de IVC >0,80, sendo assim, o instrumento, pode ser considerado validado. Na maioria das categorias, os juízes fizeram sugestões que visavam às modificações de termos, para serem substituídos ou reformulados, e os qualificadores repontuados, de acordo com os percentuais da CIF. Após consenso entre os pesquisadores foram realizadas as alterações sugeridas e elaborada a versão final do instrumento, com aplicação do pré-teste. O instrumento validado poderá contribuir para prática clínica dos profissionais da saúde, no processo de avaliação da funcionalidade dos indivíduos com lesão medular aguda

Spinal Cord Injury (SCI) is a trauma with devastating effects on the lives of individuals. It is estimated that more than 130,000 people are affected by SCI each year worldwide. Approximately 45% of all injuries are complete, leaving only a small chance of functional recovery. The complications caused by SCI influence the quality of life of individuals, increase the demands for care, and increase the social and economic burden of health care. This is a methodological study, which aimed to construct and validate an instrument based on the summarized ICF Core Set for individuals with traumatic acute spinal cord injury. This research was approved by the Ethics Committee and developed in the following stages: 1 - Development of the instrument from the summarized ICF core set for acute spinal cord injury: "Development and validation of an instrument based on the summarized core set of the International Classification of Functioning for individuals with acute spinal cord injury"; 2 - Validation of the instrument and data collection by the judges; 3 - Application of the pre-test. The instrument for face and content validation consisted of 15 categories that integrated the ICF components: body functions (6), body structure (2), activities and participation (2), environmental factors and personal factors (5). The content validity of the instrument was done by a committee of twenty-two judges. Of the 22 judges, 18 (81.8%) were female and 4 (18.2%) were male. The majority were young, averaging 40±10 years, with 3 participants (13.6%) aged 20-29 years, 8 (36.4%) 30-39 years, 7 (31.8%) 40-49 years, 3 (13.6%) 50-59 years, and 1 (4.5%) 60-69 years. About 95.5% reported participating, in the last 2 years, of scientific events in the thematic area of the research, 13 (59.1%) carried out studies about the ICF and 14 (63.6%) used it in their clinical practice. All categories obtained a CVI agreement >0.80, thus, the instrument can be considered validated. In most of the categories, the judges made suggestions that aimed at the modification of terms, to be replaced or reformulated, and the qualifiers were re-assessed, according to the ICF percentages. After consensus was reached among the researchers, the suggested changes were made and the final version of the instrument was prepared, with the application of the pre-test. The validated instrument may contribute to the clinical practice of health professionals in the process of evaluating the functionality of individuals with acute spinal cord injury

Deficiências e incapacidades em vítimas de acidentes de trânsito em Mato Grosso, Brasil / Disabilities in victims of traffic accidents in Mato Grosso, Brazil

Resumo Introdução Acidentes de trânsito são importante problema de saúde pública, contudo pouco se conhece sobre as sequelas deles decorrentes. Objetivo Analisar as deficiências e incapacidades em vítimas de acidentes de trânsito. Método Estudo transversal com base em dados primários de uma amostra de vítimas de acidentes de trânsito não fatais atendidas em serviços selecionados de urgência e emergência de Mato Grosso em setembro de 2014. O instrumento de coleta foi baseado no Checklist da Classificação Internacional de Funcionalidade, Incapacidade e Saúde. Resultados Foram avaliadas 228 vítimas de acidentes de trânsito, predominando jovens, sexo masculino, motociclistas. Deficiências de função do corpo mais comprometidas foram as sensoriais e dor (49,3%) e neuromuscoloesqueléticas (45,8%), enquanto as de estrutura do corpo relacionavam-se ao movimento (85,5%); ambas apresentando gravidade moderada. Referente à limitação de atividade e restrição à participação, predominaram problemas relacionados à mobilidade (42,0%), prevalecendo gravidade moderada (30,5%). Dentre os fatores ambientais, destacaram-se como principais barreiras os serviços, sistemas e políticas (66,3%) e, como facilitadores, o apoio e relacionamento com familiares e amigos (40,9%). Conclusão Aproximadamente metade das vítimas de acidentes de trânsito apresentou deficiências e incapacidades. O estudo preenche uma lacuna importante para a compreensão deste problema de saúde pública.

Abstract Introduction Traffic accidents are an important public health problem; however, little is known about their consequences. Objective To analyze disabilities in traffic accident victims. Methods Cross-sectional study, based on primary data from a sample of victims of non-fatal traffic accidents, attended at selected emergency services in Mato Grosso in September 2014. The collection instrument was based on the International Classification Checklist Functionality, Disability, and Health. Results 228 victims of traffic accidents were evaluated, predominantly young men, motorcyclists. Body function deficiencies most affected were sensory and pain (49.3%) and neuromusculoskeletal (45.8%), while those of body structure were related to movement (85.5%); both presenting moderate severity. Regarding activity limitation and participation restriction, problems related to mobility predominated (42.0%), with moderate severity (30.5%). Among the environmental factors, services, systems, and policies stood out as barriers (66.3%) and the support and relationship with family and friends as facilitators (40.9%). Conclusion Approximately half of the victims of traffic accidents had disabilities. The study fills an important gap for understanding this public health problem.

Study protocol: functioning curves and trajectories for children and adolescents with cerebral palsy in Brazil - PartiCipa Brazil.

BACKGROUND: Gross motor development curves for children with Cerebral Palsy (CP), grouped by Gross Motor Function Classification System (GMFCS) levels, help health care professionals and parents to understand children's motor function prognosis. Although these curves are widely used in Brazil to guide clinical decision-making, they were developed with Canadian children with CP. Little is known about how these patterns evolve in children and adolescents with CP in low-income countries like Brazil. The PARTICIPA BRAZIL aims to: (i) to identify and draw a profile of functioning and disability of Brazilian children and adolescents with CP by classifying them, for descriptive purposes, with all five valid and reliable functional classifications systems (gross motor function, manual ability, communication function, visual and eating and drinking abilities); (ii) to create longitudinal trajectories capturing the mobility capacity of Brazilian children and adolescents with CP for each level of the GMFCS; (iii) to document longitudinal trajectories in the performance of activities and participation of Brazilian children and adolescents with CP across two functional classification systems: GMFCS and MACS (Manual Abilities Classification System); (iv) to document longitudinal trajectories of neuromusculoskeletal and movement-related functions and exercise tolerance functions of Brazilian children and adolescents with CP for each level of the GMFCS; and (v) to explore interrelationships among all ICF framework components and the five functional classification systems in Brazilian children and adolescents with CP. METHODS: We propose a multi-center, longitudinal, prospective cohort study with 750 Brazilian children and adolescents with CP from across the country. Participants will be classified according to five functional classification systems. Contextual factors, activity and participation, and body functions will be evaluated longitudinally and prospectively for four years. Nonlinear mixed-effects models for each of the five GMFCS and MACS levels will be created using test scores over time to create prognosis curves. To explore the interrelationships among ICF components, a multiple linear regression will be performed. DISCUSSION: The findings from this study will describe the level and nature of activities and levels of participation of children and youth with CP in Brazil. This will support evidence-based public policies to improve care to this population from childhood to adulthood, based on their prognosis.

[Identification of ICF categories representative of functioning problems in adult cancer patients at hospital discharge: National expert consensus]. / Identificación de un conjunto de categorías CIF representativas del funcionamiento al egreso hospitalario de personas adultas tratadas por cáncer: consenso nacional de expertos.

INTRODUCTION: The International Classification of Functioning, Disability and Health (ICF) provides a standardised language and conceptual framework for health and health-related conditions, aiming to unify communication between different disciplines. OBJECTIVE: To describe the process of selecting (through national expert consensus) ICF categories representative of functioning problems in cancer patients at hospital discharge. METHOD: We conducted a descriptive qualitative and quantitative study that used the expert consensus method to design a clinical instrument. The study included 21 experts, consisting of 2 patients and 19 health professionals from different disciplines. A total of 208 ICF categories obtained in a previous stage through a systematic review and linking process were evaluated in 3 rounds. Participants evaluated each code and classified it as: highly relevant, relevant, slightly relevant, and not relevant at all. Only those codes assessed as «highly relevant¼ by more than 50% of the experts were included (cut off). In addition, another 143 ICF categories were evaluated in the second round. RESULTS: In all, 24 ICF categories were obtained: 10 corresponded to the body function component, 11 to activities and participation, and 3 to environmental factors. CONCLUSIONS: Consensus using the common language of the ICF resulted in the selection of 24 representative categories of the main health problems related to functioning at hospital discharge in adults treated for cancer.

Evaluación de discapacidad en los defectos congénitos: una mirada desde la Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud (CIF) / Evaluation of Disability in Birth Defects: A view from the International Classification of Functioning (ICF) / Avaliação de deficiência nos defeitos congênitos: um olhar desde a Classificação Internacional do Funcionamento, a Deficiência e a Saúde, CIF

Introducción: en la actualidad, coexisten dos modelos contrapuestos que han servido como marco para la evaluación y tratamiento de la discapacidad: el modelo rehabilitador y el social. Sin embargo, en 2001, la üms recurre a una tercera vía de interpretación a través de la síntesis de estos dos modelos, que derivan en la Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud (CIF). Objetivo: evaluar la discapacidad a través de la CIF, en pacientes con defectos congénitos atendidos en un hospital de cuarto nivel de la ciudad de Cali. Materiales y métodos: estudio transversal que incluyó 40 pacientes (niños y adolescentes) con defectos congénitos y sus perfiles de funcionamiento obtenidos a través de la CIF. Resultados: las funciones que con mayor frecuencia se reportaron alteradas en el componente corporal fueron las mentales; las neuromusculoesqueléticas y de movimiento; las del sistema digestivo, metabólico y endocrino, y las sensoriales. En el componente de actividades y participación, las limitaciones se centraron en el aprendizaje básico, movilidad y comunicación. En el componente de factores contextuales, los profesionales de la salud y la tecnología para jugar, fueron los principales facilitadores reportados. Conclusiones: la utilización de herramientas integrales como la CIF para la evaluación, intervención y seguimiento de los pacientes con defectos congénitos, permitirá considerar al fenómeno de la discapacidad como un problema de origen social y, principalmente, como un asunto centrado en la inclusión de las personas en la sociedad

Introduction: The concept of disability has evolved throughout history going through the bases of three models that have served as a framework for the evaluation and treatment of disability: the exclusion model, the rehabilitation model, and the social model; which co-exist in different degrees. Because of this coexistence, in society there are still imaginary ideas and beliefs about disability that focus solely on the traits of people and in what they are unable to do. Objective: To evaluate the degree of disability through the International Classification of Functioning (ICF), in patients with birth defects who attend a high complexity hospital in the city of Cali. Materials and methods: Cross-sectional study that included 40 patients (children and adolescents) with birth defects and their functional profiles obtained from the ICF. Results: The altered functions that are most frequently reported in the corporal component are the mental; the neuromusculoskeletal and movement; the digestive, metabolic and endocrine system, and the sensorial functions. In the activities and participation component constraints were focused on basic learning, mobility and communication. In the contextual factors component, the health professionals and technology for playful activities were the main facilitators reported. Conclusions: the use of integrated tools such as ICF for evaluation, intervention and follow up of patients with birth defects, will allow to consider the phenomenon of disability as a problem of social origin and, mainly, as a matter centered on the inclusion of people in society

Introdução: Na atualidade, coexistem dois modelos contrapostos que têm servido como marco para a avaliação e tratamento da deficiência: o modelo reabilitador e o social. No entanto, em 2001, a OMS recorre uma terceira via de interpretação através da sintetização destes modelos, que derivam na Classificação Internacional do Funcionamento, a Deficiência e a Saúde (CIF). Objetivo: Avaliar a deficiência através da CIF, em pacientes com defeitos congênitos atendidos em um hospital de quarto nível da cidade de Cali. Materiais e métodos: Estudo transversal que incluiu 40 pacientes (crianças e adolescentes) com defeitos congênitos e seus perfis de funcionamento obtidos através da CIF. Resultados: As funções que com maior frequência reportaram-se alteradas no componente corporal foram as mentais; as neuromusculoesqueléticas e de movimento; as do sistema digestivo, metabólico e endócrino, e as sensoriais. No componente de atividades e participação, as limitações centraram-se na aprendizagem básica, mobilidade e comunicação. No componente de fatores contextuais, os profissionais da saúde e a tecnologia para brincar, foram os principais facilitadores reportados. Conclusões: A utilização de ferramentas integrais como a CIF para a avaliação, intervenção e seguimento dos pacientes com defeitos congênitos, permitirá considerar ao fenômeno da deficiência como um problema de origem social e, principalmente, como um assunto centrado na inclusão das pessoas na sociedade

Portraying the amputation of lower limbs: an approach using ICF / Retratando a amputação de membros inferiores: uma abordagem por meio da CIF

Abstract Introduction: Amputation is a trauma that involves important functional, psychological and social sequelae. The International Classification of Functioning, Disability and Health (ICF) is based on the biopsychosocial model and enables understanding functioning and disability through the interaction of its components. Objective: This study's aim was to depict functioning and disability using the ICF conceptual interaction model from the perspective of individuals who suffered a lower limb amputation. Methods: The qualitative approach was used and included a semi-structured interview held with six participants. Results: All the participants used assistive devices such as crutches, wheelchairs or walkers: three used prostheses and the other three emphasized their difficulty in acquiring prostheses from the Social Security Service or Public Health System. Social support, especially that provided by family and friends, is a major facilitator. The importance of acquiring and adapting prostheses to enable the rehabilitation of amputees became clear; however, rehabilitation is not restricted to the acquisition of prostheses. A rehabilitation program directed to restoring functionality is needed. Conclusion: The multidirectional approach using the ICF's conceptual interaction model enabled important insights concerning public health issues, such as obstacles related to the access to rehabilitation services and a lack of preparedness on the part of health professionals in relation to care provided to amputees.

Resumo Introdução: A amputação é um trauma que envolve sequelas funcionais, psicológicas e sociais importantes. A Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) baseia-se no modelo biopsicossocial e permite a compreensão dos processos de funcionalidade e incapacidade através da interação dos seus componentes. Objetivo: O objetivo deste estudo foi retratar o processo de funcionalidade e de incapacidade por meio do Modelo de Interação Conceitual da CIF a partir da percepção de pessoas que sofreram amputação de membro inferior. Métodos: Utilizou-se abordagem qualitativa com realização de uma entrevista semiestruturada, aplicadas em seis sujeitos. Resultados: Todos os entrevistados faziam uso de dispositivos auxiliares de marcha como muletas, cadeira de rodas, andadores sendo que três deles possuíam prótese, e os outros três destacaram dificuldades de aquisição da mesma por meio do SUS ou Previdência Social. O suporte social, sobretudo aquele oferecido pelos familiares e amigos, é importante facilitador. Ficou evidenciada a importância da aquisição e adaptação à prótese para reabilitação da pessoa amputada, porém reabilitar não é somente adquirir a prótese, pois é preciso da reabilitação para a funcionalidade. Conclusão: A abordagem multidirecional, por meio modelo de interação conceitual da CIF, permitiu refletir questões importantes da saúde pública, como os obstáculos relacionados ao acesso aos serviços de reabilitação e o despreparo dos profissionais de saúde no cuidado à pessoa amputada.

Validation of the 36-item version of the WHO Disability Assessment Schedule 2. 0 (WHODAS 2.0) for assessing women's disability and functioning associated with maternal morbidity / Validação da versão de 36 itens do WHO Disability Assessment Schedule 2. 0 (WHODAS 2.0) para a avaliação de incapacidade e funcionalidade da mulher associada à morbidade materna

Abstract Objective To validate the translation and adaptation to Brazilian Portuguese of 36 items from the World Health Organizaton Disability Assessment Schedule 2.0 (WHODAS 2.0), regarding their content and structure (construct), in a female population after pregnancy. Methods This is a validation of an instrument for the evaluation of disability and functioning and an assessment of its psychometric properties, performed in a tertiary maternity and a referral center specialized in high-risk pregnancies in Brazil. A sample of 638 women in different postpartum periods who had either a normal or a complicated pregnancy was included. The structure was evaluated by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), while the content and relationships among the domains were assessed through Pearson's correlation coefficient. The sociodemographic characteristics were identified, and the mean scores with their standard deviations for the 36 questions of the WHODAS 2.0 were calculated. The internal consistency was evaluated byCronbach's α. Results Cronbach's α was higher than 0.79 for both sets of questons of the questionnaire. The EFA and CFA for the main 32 questions exhibited a total variance of 54.7% (Kaiser-Meyer-Olkin [KMO] measure of sampling adequacy = 0.934; p < 0.001) and 53.47% (KMO = 0.934; p < 0.001) respectively. There was a significant correlation among the 6 domains (r = 0.571-0.876), and a moderate correlation among all domains (r = 0.476-0.694). Conclusion The version of the WHODAS 2.0 instrument adapted to Brazilian Portuguese showed good psychometric properties in this sample, and therefore could be applied to populations of women regarding their reproductive history.

Resumo Objetivo Validar a versão adaptada para o português brasileiro do instrumento World Health Organizaton Disability Assessment Schedule 2.0 (WHODAS 2.0), em seu conteúdo e estrutura (construto), em uma população de mulheres após a gravidez. Métodos Trata-se de validação de um instrumento para incapacidade e funcionalidade, incluindo suas propriedades psicométricas, realizada em uma maternidade de referência em gestação de alto risco no Brasil. Incluiu uma amostra de 638mulheres em diferentes períodos pós-parto que tiveram uma gravidez normal ou com complicações. A estrutura foi avaliada por análise fatorial exploratória (AFE) e análise fatorial confirmatória (AFC), enquanto o conteúdo e as associações entre os domínios foram avaliados por meio do coeficiente de correlação de Pearson. Foram identificadas características sociodemográficas, e os escores médios do WHODAS 2.0 para as 36 questões foram calculados. A consistência interna foi avaliada pelo método α de Cronbach. Resultados O α de Cronbach foi maior do que 0,79 para os dois conjuntos de perguntas do questionário. A AFE e a AFC para as 32 questões apresentaram uma variância total de 54,7% (medida de adequação da amostra de Kaiser-Meyer-Olkin [KMO] = 0,934; p < 0,001) e 53,47% (KMO = 0,934; p < 0,001), respectivamente. Houve uma correlação significativa entre os 6 domínios (r = 0,571-0,876), e moderada correlação entre todos os domínios (r = 0,476-0,694). Conclusão O instrumento WHODAS 2.0, adaptado para o português do Brasil, mostrou boas propriedades psicométricas nessa amostra e, portanto, pode ser aplicado a populações de mulheres com relação à sua história reprodutiva.

Esquizofrenia y funcionamiento: medición con la escala breve de evaluación del funcionamiento y correlación con los años de enfermedad / Schizophrenia and functioning: correlation between functioning assessment short test and years of disorder

Introducción. La esquizofrenia se asocia a deterioro de las capacidades de la persona, en varios ámbitos de su vida, en forma progresiva. Sin embargo, este hecho ha sido poco estudiado en nuestra población. Objetivo. Identificar la afectación en el funcionamiento según tiempo con esquizofrenia. Diseño. Estudio analítico correlacional, diseño observacional transversal. Lugar. Hospital Hermilio Valdizán, Lima, Perú. Participantes. Pacientes diagnosticados de esquizofrenia atendidos ambulatoriamente. Intervenciones. Entrevista y aplicación de escalas, a 136 pacientes, en 4 grupos de 34, según tiempo de enfermedad. El análisis se efectuó con las pruebas de t-student, Kruskall-Wallis, U de Mann Whitney y Correlación de Spearman, con intervalo de confianza 95%, p< 0,05. Principales medidas de resultados. Medida del funcionamiento empleando la escala breve de evaluación del funcionamiento (FAST) y medida de síntomas psicóticos con escala breve de valoración de síntomas psiquiátricos (BPRS). El puntaje FAST es inversamente proporcional con el funcionamiento. Resultados. El 57% fueron varones, 47,9 % en rango de 21 a 30 años. El puntaje FAST para el grupo menor de 1 año de enfermedad fue 50,2 + 9,3 DE, 1 a 5 años 57,1 + 10,6 DE, 6 a 10 años 59,0 + 9,7 DE, y con más de 10 años de enfermedad 60,2 + 10,1 DE. Se halló diferencia significativa entre el funcionamiento (p <0,005) para el grupo con menos de un año de enfermedad en relación a los otros. Conclusiones. Los pacientes con menos de un año de enfermedad mostraron mejor funcionamiento. Se observó disminución del funcionamiento después del primer año de diagnóstico, indistintamente entre los grupos. Existe la necesidad de empezar estrategias de rehabilitación tempranas.

Introduction: Schizophrenia is associated to progressive deterioration of the person's skills in several areas of life. However this fact has not been studied in our population. Objective: To identify the effect of schizophrenia on functioning according to time. Design: Analytical correlational, cross-sectional observational study. Location: Hospital Hermilio Valdizan, Lima, Peru. Participants: Outpatient subjects diagnosed with schizophrenia. Interventions. Interview and application of scales to 136 patients in 4 groups of 34 according to time of sickness. The analysis was performed with t-student tests, Kruskal-Wallis, Mann Whitney U test and Spearman correlation, with a 95% confidence interval, p <0.05. Main outcome measures: Measurement of functioning with the Short Scale Performance Review (FAST) and measurement of psychotic symptoms with the Brief Psychiatric symptoms Rating Scale (BPRS) were done. The FAST score is inversely proportional to functioning. Results: 57% of patients were male, 47.9% in the 21-30 age range. The FAST score for the group with less than 1 year of disease was 50.2 + 9.3, for 1-5 years 57.1 + 10.6, 6-10 years 59.0 + 9.7, and more than 10 years of illness 60.2 + 10.1. There was a significant difference (p <0.005) for in functioning between the group with less than one year of disease versus the other groups. Conclusions: Patients with less than one year of disease showed better functioning. Decreased functioning was observed after the first year of diagnosis, without distinction between groups. There is a need for early rehabilitation strategies starting in schizophrenia.

Guía metodológica para elaborar el diagnóstico fisioterapéutico según la Clasificación Internacional del Funcionamiento (CIF), de la discapacidad y de la salud / Methodological guide for preparing the physiotherapy diagnosis according to the International Classification of Functioning (CIF), disability and health

El presente artículo tiene como objetivo plantear una guía metodológica que permita a los estudiantes de la Carrera de Fisioterapia y Kinesiología unificar criterios para desarrollar los procesos diagnósticos desde el enfoque biopsicosocial, a partir de las evidencias obtenidas en la evaluación inicial y tomando como base la Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF). La idea surge a raíz de las dificultades que se tiene en la formulación del diagnóstico fisioterapéutico, más allá del referente “enfermedad”, asumiendo una identidad propia desde su objeto de estudio como es la función - disfunción del movimiento humano. Se propone el uso de la CIF porque incorpora en su estructura categorías desde la perspectiva corporal, individual y social, los cuales tienen relación estrecha con la naturaleza y niveles de estudio de la Fisioterapia y Kinesiología. Solo así se provee un marco inicial que dinamiza la organización de datos y opiniones clínicas facilitando un sistema de clasificación de acuerdo con las funciones y estructuras corporales, las actividades corporales y la participación en las actividades de la vida diaria, así como la identificación de barreras o facilitadores en el entorno ambiental y las características individuales que forman parte del estado de salud de las personas.

This article aims to raise a methodological guide that allows students of the School of Physiotherapy and Kinesiology unify criteria to develop diagnostic processes from the biopsychosocial approach, based on the evidence obtained in the initial evaluation and based on the ranking International of Functioning, Disability and Health (ICF). The idea stems from the difficulties you have in the formulation of physiotherapy diagnosis, beyond the reference “disease”, assuming an identity from its subject as it is the function - dysfunction of human movement. The use of ICF is proposed that incorporates in its structure categories from body, individual and societal perspective, which are closely related to the nature and levels of study of physiotherapy and kinesiology. Only then an initial framework that streamlines the organization of data and clinical opinion facilitating a classification system according to body functions and structures, bodily activities and participation in activities of daily living, as well as identifying barriers is provided or facilitators in the ambient environment and the individual characteristics that are part of the health status of people.

Participación e inclusión social en adultos con afasia: análisis bibliométrico / Participation and Social Inclusion in Adults with Aphasia: Bibliometric Analysis / Participação e inclusão social em adultos com afasia: análise bibliométrica

Objetivo: Identificar el alcance y estado de la investigación relacionada con la participación e inclusión social de personas adultas con afasia, a partir del análisis de la literatura publicada. Materiales y métodos: Estudio descriptivo-analítico sobre las publicaciones registradas en Medline/PubMed, EBSCO y EMBASE del año 2005 a 2013, se seleccionaron 97 documentos relacionados con la temática, clasificados en ocho variables comunes para su estudio, fueron analizados en función de la distribución de artículos por núcleo temático, año de publicación y base de datos. Resultados: El núcleo temático con mayor representación fue el de inclusión, participación, accesibilidad y derechos de las personas con afasia, sus familias y entornos, documentos cuya producción se incrementa entre 2010 y 2011. Los documentos relacionados con prácticas profesionales inclusivas para personas con afasia representaron el segundo núcleo temático con mayor representatividad. Conclusiones: La literatura reconoce a la familia y sus entornos cercanos como elementos fundamentales para garantizar participación y autonomía de las personas con afasia. La Clasificación Internacional de la Funcionalidad, la Discapacidad y la Salud (CIF) debe convertirse en la bitácora de los profesionales de la rehabilitación para orientar acciones terapéuticas, cuyo objetivo sea la inclusión y participación de las personas con afasia en diferentes contextos y, principalmente, promuevan el regreso exitoso a su vida productiva y cotidiana. Esta oportunidad de rehabilitación hacia la independencia y autonomía promueve la autoestima, identidad y las oportunidades de inclusión.

Objective: To identify the scope and status of related research with the participation and social inclusion of adults with aphasia connected with the published literature. Materials and Methods: Descriptive analytic study on publications registered in Medline/PubMed, EBSCO and EMBASE from 2005 to 2013, 97 related documents were selected and classified into, eight common variables for its study and were analyzed according to the article distribution by thematic core, year of publication and database. Results: The most represented core theme was inclusion, participation, access and rights of persons with aphasia and their families and environments; production of these documents is increased between 2010 and 2011. Documents related to inclusive internshIPS for people with aphasia represented the second more representative thematic focus. Conclusions: Literature recognizes that elements related to family and their immediate environments are essential to ensure participation and independence of people with aphasia. The International Classification of Functioning, Disability and Health (ICF) should become the rehabilitation log for professionals to guide therapeutic actions, aimed at the inclusion and participation of people with aphasia in different contexts, and mainly to promote a successful return to a productive daily life. This rehabilitation opportunity toward independence and autonomy promotes self-esteem, identity and inclusion opportunities.

Objetivo: Identificar o alcance e estado da pesquisa relacionada com a participação e inclusão social de pessoas adultas com afasia, a partir da análise da literatura publicada. Materiais e métodos: estudo descritivo-analítico sobre as publicações registradas em Medline/PubMed, EBSCO e embase do ano 2005 a 2013, se selecionaram 97 documentos relacionados com a temática, classificados em oito variáveis comuns para seu estudo; foram analisados em função da distribuição de artigos por núcleo temático, ano de publicação e base de dados. Resultados: o núcleo temático com maior representação foi o relativo a inclusão, participação, acessibilidade e direitos de pessoas com afasia, suas famílias e entornos, documentos cuja produção incrementa entre 2010 e 2011. Os documentos relacionados com práticas profissionais inclusivas para pessoas com afasia representaram o segundo núcleo temático com maior representatividade. Conclusões: a literatura reconhece à família e seus entornos próximos como elementos fundamentais para garantir participação e autonomia das pessoas com afasia. A Classificação Internacional da Funcionalidade, a Deficiência e a Saúde (CIF) deve se converter na guia dos profissionais da reabilitação para orientar ações terapêuticas, cujo objetivo seja a inclusão e participação das pessoas com afasia em diferentes contextos e, principalmente, promovam o regresso bem-sucedido a sua vida produtiva e cotidiana. Esta oportunidade de reabilitação à independência e autonomia promove a autoestima, identidade e as oportunidades de inclusão.

Consistencia interna y validez concurrente del cuestionario para evaluación de limitaciones y restricciones en niños con TDAH / Internal Consistency and Concurrent Validity of the Questionnaire for Limitations and Restrictions Assessment in Children with ADHD / Consistência interna e validez concorrente do questionário para avaliação de limitações e restrições em crianças com TDAH

Introducción: El TDAH es uno de los diagnósticos más frecuentes en psiquiatría infantil, su diagnóstico temprano reviste una gran importancia para su intervención familiar, escolar y social. Basándose en la clasificación internacional del funcionamiento, la discapacidad y la salud CIF, se diseñó un cuestionario para la evaluación de limitaciones en la actividad y restricciones en la participación en niños con TDAH, el cuestionario CLARP-TDAH versión padres y profesores. Objetivo: Determinar el grado de consistencia interna de los CLARP-TDAH y su validez concurrente con el cuestionario de capacidades y dificultades SDQ versión padres y maestros. Materiales y métodos: Muestra de 203 niños de 6 a 12 años con TDAH, escolarizados, en cinco ciudades de Colombia. Se aplicaron estos cuestionarios a padres y profesores. El análisis de consistencia interna se realizó por coeficiente de Cronbach, y la validez concurrente mediante coeficiente de correlación de Spearman y con predictores múltiples y únicos a través de modelos de regresión lineal múltiple y simple. Resultados: La consistencia interna fue elevada para los cuestionarios globales y para cada uno de sus dominios. El CLARP-TDAH padres obtuvo consistencia interna de 0,83 y el CLARP-TDAH profesores de 0,93. Se halló validez concurrente entre los CLARPTDAH y el SDQ padres y maestros, existe concurrencia entre el CLARP-TDAH profesores y SDQ maestros, y entre el CLARP-TDAH padres y profesores, esto dado por valores p < 0,001.

Introduction: ADHD is one of the most common diagnoses in child psychiatry, its early diagnosis is of great importance for intervention at family, school and social environment. Based on the International Classification of Functioning, Disability and Health (ICF), a questionnaire was designed to assess activity limitations and participation restrictions in children with ADHD. The questionnaire was called "CLARP-ADHD Parent and Teacher Version". Objective: To determine the degree of internal consistency of the CLARP-ADHD questionnaire, and its concurrent validity with the "Strengths and Difficulties Questionnaire SDQ parent and teacher version". Material and Methods: A sample of 203 children aged 6 to 12 with ADHD, currently attending school in five Colombian cities. The questionnaires were applied to parents and teachers. The internal consistency analysis was performed through Cronbach coefficient and concurrent validity using the Spearman correlation coefficient utilizing multiple and unique predictors through multiple linear regression as well as simple regression models. Results: A high internal consistency was found for global questionnaires for each of its domains. The CLARP-ADHD for parents gave as result an internal consistency of 0.83, and the CLARP-ADHD for teachers one of 0.93. Concurrent validity was found between the CLARP-ADHD and the SDQ Parent and Teacher version; also, concurrence between the CLARPADHD for Teachers and the SDQTeachers was found, as well as between CLARPADHD for Parents and CLARP ADHD Teachers, given by p values of p < 0.001.

Introdução: O TDAH é um dos diagnósticos mais frequentes em psiquiatria infantil, seu diagnóstico precoce reviste uma grande importância para sua intervenção no nível familiar, escola e social. Baseando-se na classificação internacional do funcionamento, a deficiência e a saúde CIF, criou-se um questionário para a avaliação de limitações na atividade e restrições na participação em crianças com TDAH, o questionário CLARP-TDAH Versão Pais e Professores. Objetivo: Determinar o grau de consistência interna dos CLARP TDAH e sua validez concorrente com o questionário de capacidades e dificuldades SDQ versão pais e professores. Materiais e Métodos: Amostra de 203 crianças de 6 e 12 anos com TDAH, escolarizados, em cinco cidades da Colômbia. Aplicaram-se estes questionários a pais e professores. A análise de consistência interna realizou-se por coeficiente de Cronbach, e a validez concorrente mediante coeficiente de correlação de Spearman e com preditores múltiplos e únicos através de modelos de regressão lineal múltipla e simples. Resultados: A consistência interna foi elevada para os questionários globais e para cada um de seus domínios. O questionário CLARP-TDAH dos pais obteve consistência interna de 0,83, e o CLARP-TDAH dos professores de 0,93. Achou-se validez concorrente entre os CLARP TDAH e o SDQ Pais e Professores, existe concorrência entre o CLARP TDAH Professores e SDQ Professores, e entre o CLARP TDAH Pais e CLARP TDAH Professores, isto dado por valores p < 0,001.