RESUMO
INTRODUCTION: Lung transplant (LT) is one of the therapeutic options for patients with terminal respiratory diseases. It is highly important to incorporate the functional status and frailty assessment into the selection process of candidates for LT. OBJECTIVES: Identify the prevalence of frailty in the LT waiting list. Study the relationship between frailty, functional status, Lung Allocation Score (LAS) and muscular dysfunction. METHODOLOGY: Descriptive transversal study of patients on the waiting list for LT. POPULATION: 74 patients with chronic respiratory diseases assessed by the lung transplant committee and accepted to be transplanted in a university hospital in Barcelona. The outcome variables were frailty status was evaluate for SPPB test, functional capacity was evaluate for the six-minute walking test (6MWT) and muscular dysfunction. The results were analyzed with the statistical package STATA 12. RESULTS: Sample of 48 men and 26 women, with a median age of 56.55 years (SD 10.87. The prevalence of frailty assessed with the SPPB was 33.8% (8.1% are in frailty and 25.7% are in a state of pre-frailty). There is a relationship between the SPPB, 6MWT and maximal inspiratory pressure, but not with others force values. There is a relationship between the risk of frailty (scores below 9 in SPPB) and the meters walked in 6 but not with the LAS. CONCLUSIONS: The risk of frailty in patients with terminal chronic respiratory diseases is high. Frailty is related with functional capacity, but not with LAS.
Assuntos
Fragilidade , Estado Funcional , Transplante de Pulmão , Teste de Caminhada , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Transversais , Listas de Espera , Idoso , Prevalência , Pressões Respiratórias Máximas , Seleção de PacientesRESUMO
Introducción La enfermedad de Huntington (EH) es un trastorno raro neurodegenerativo. La información fiable del estado nutricional, especialmente de la composición corporal, es crítica en clínica y en investigación. La facilidad de aplicación y portabilidad del análisis de la bioimpedancia de múltiples frecuencias (mfBIA) la convierten en una herramienta atractiva para medirla, pero se desconoce su precisión en la EH. Objetivo Evaluar la precisión del mfBIA frente a la absorciometría dual de rayos X (DEXA) en la EH. Pacientes y métodos Estudio transversal, observacional y unicéntrico. La EH se midió con la subescala motora de la escala unificada de valoración de la EH y con la capacidad funcional total. La composición corporal se valoró según la masa libre de grasa (MLG), la masa grasa (MG), el índice de masa libre de grasa (IMLG) y el índice de masa grasa (IMG). Se utilizó el coeficiente de correlación intraclase con intervalos de confianza al 95% y estimaciones de sesgo mediante gráficos de Bland-Altman. Resultados Se incluyó a 16 pacientes, siete hombres y nueve mujeres, con edad media de 58,5 (32-68) años, capacidad funcional total de 10 (3-13) y escala unificada de valoración de la EH de 31 (7-85). La fiabilidad era alta entre el mfBIA y la DEXA para el IMLG en hombres, 0,88 (intervalo de confianza al 95%: 0,17-0,98), y mujeres, 0,9 (intervalo de confianza al 95%: 0,61-0,98); y para el IMG en hombres, 0,97 (intervalo de confianza al 95%: 0,83-0,99), y mujeres, 0,91 (intervalo de confianza al 95%: 0,68-0,98). El mfBIA sobreestimó ligeramente la MLG, la MG, el IMG y el IMLG en los hombres, pero subestimó el IMLG en las mujeres. Conclusiones El mfBIA es un método fácil de usar, seguro, no invasivo y preciso para medir la composición corporal y el estado nutricional en pacientes con EH leve-moderada. (AU)
INTRODUCTION Huntington´s disease (HD) is a rare neurodegenerative disorder. Reliable information about nutritional status, especially body composition from individuals with HD is critical for clinical care and research. The ease of application and portability of multiple frequencies bioelectrical impedance analysis (mfBIA) make it an attractive tool for measuring body composition, but its accuracy in HD is unknown. AIM To evaluate the accuracy of mfBIA vs. Dual X-ray absorptiometry (DEXA) in HD. PATIENTS AND METHODS Cross-sectional, observational, and single-center study. HD severity was measured using motor subscale of the unified Huntington´s disease rating scale (m-UHDRS) and the total functional capacity (TFC). Body composition was measured in terms of fat-free mass (FFM), fat mass (FM), fat-free mass index (FFMI), and fat mass index (FMI). Using Bland-Altman plots, we analyzed reliability between DEXA and mfBIA using the Intraclass Correlation Coefficient with 95% confidence intervals (CI) and bias estimates for all. RESULTS We included 16 patients with HD, 7 men, and 9 women, median age of 58.5 (32;68) years, TFC: 10 (3;13), and m-UHDRS: 31 (7;85). The reliability between mfBIA and DEXA were high for FFMI in men: 0.88 (95% CI 0.17-0.98), and women: 0.90 (95% CI 0.61- 0.98); for FMI, men: 0.97 (95% CI 0.83-0.99), and women: 0.91 (95% CI 0.68-0.98). Compared to DEXA, mfBIA slightly overestimated FFM, FM, FMI and FFMI in men and underestimated FFMI in women. CONCLUSIONS mfBIA is an easy-to-use, safe, non-invasive, accurate method for measuring body composition and nutritional status in patients with mild-moderate HD. (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Doença de Huntington , Absorciometria de Fóton/instrumentação , Composição Corporal , Estudos Transversais , Impedância Elétrica , Índice de Massa CorporalRESUMO
Fundamentos: El abordaje asistencial de la rehabilitación ha sufrido cambios importantes con motivo de la pandemia de la COVID-19. El objetivo del estudio fue valorar el papel de un programa de telerehabilitación respiratoria domiciliaria basada en ejercicios y educación en pacientes ingresados con COVID-19. Métodos: Se realizó un estudio observacional de una cohorte de pacientes con COVID-19 ingresados en el Hospital General La Mancha Centro desde marzo a junio de 2020, que fueron valorados y tratados por el servicio de rehabilitación, fisioterapia y terapia ocupacional. Tras el alta hospitalaria, se valoró mediante consulta telefónica a los dos, quince y treinta días, la capacidad funcional, la calidad de vida, la salud mental y la felicidad de los pacientes. Se realizó un análisis descriptivo y para el seguimiento se utilizó los test de McNemar para variables cualitativas y t de student o Wilcoxon de muestras apareados para las cuantitativas. Resultados: Treinta pacientes fueron incluidos en el estudio. La edad media fue de 60,9 años, siendo un 50% hombres y un 50% mujeres. El 80% de los pacientes ingresaron en UCI, con una media de treinta y cuatro días. El 73,3% de los pacientes desarrollaron debilidad adquirida en UCI. Existen cambios estadísticamente significativos sobre capacidad funcional (Barthel de 57,5 a 90), calidad de vida (EVA de 60 a 70), salud mental (MHI5 de 23 a 27) y felicidad (Lyubomirsky de 4 a 4,5) de los pacientes a los treinta días tras el alta hospitalaria. Conclusiones: Los pacientes ingresados por COVID-19 e incluidos en el programa de rehabilitación respiratoria domiciliaria mediante telerehabilitación mejoran de forma significativa su capacidad funcional, calidad de vida, salud mental y felicidad durante su seguimiento.(AU)
Background: The healthcare approach to rehabilitation has undergone important changes due to the COVID-19 pandemic. The objective of the study was to assess the role of a home respiratory telerehabilitation program based on exercises and education in patients admitted to COVID-19. Methods: An observational cohort study of COVID-19 patients admitted to General Hospital La Mancha Centro from March to June 2020 was carried out, who were assessed and treated by the rehabilitation, physiotherapy and occupational therapy service. After hospital discharge, the functional capacity, quality of life, mental health and happiness of the patients were assessed by telephone consultation at two, fifteen and thirty days. A descriptive analysis was carried out and for follow-up the McNemar test was used for qualitative variables and Students t or Wilcoxon paired samples test for quantitative variables.Results: Thirty patients were included in the study. The mean age was 60.9 years, with 50% male and 50% female. 80% of the patients were admitted to the ICU, with a mean of thirty four days. 73.3% of the patients developed ICU-acquired weakness. There are statistically significant changes in functional capacity (Barthel from 57.5 to 90), quality of life (EQ-VAS from 60 to 70), mental health (MHI-5 from 23 to 27) and happiness (Lyubomirsky from 4 to 4.5) of patients at thirty days after discharge. Conclusions: Patients admitted for COVID-19 and included in the home respiratory rehabilitation program through telerehabilitation significantly improve their functional capacity, quality of life, mental health, and happiness during follow-up.(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Telerreabilitação/métodos , /reabilitação , Terapia Ocupacional , Serviços de Reabilitação , Modalidades de Fisioterapia , Qualidade de Vida , Saúde Pública , Espanha/epidemiologia , /epidemiologia , Estudos de Coortes , Inquéritos e Questionários , Saúde Mental , FelicidadeRESUMO
Objetivos: Conocer la salud autopercibida, estilo de vida, capacidad funcional y relación existente entre ellas, en un grupo de adultos mayores de un centro de atención primaria rural. Métodos: Estudio observacional transversal. Los participantes diligenciaron un cuestionario compuesto por datos sociodemográficos, clínicos, de apoyo sociofamiliar, ligados al COVID-19 y 5 escalas: MEDAS-1, RAPA, Barthel, SARC-F y SF-36. Las variables se analizaron mediante contrastes de hipótesis y coeficiente de Pearson, considerando la significación estadística con un p<0.05. Resultados: La muestra se conformó por 142 adultos mayores, con una edad media de 75.85 años. La mayoría estaban casados, tenían estudios primarios, no eran cuidadores, no tenían hábitos tóxicos, estaban polimedicados, tomaban psicofármacos y no padecían temor ante el COVID-19. La muestra presentó globalmente normopeso, el 48.6% demostró una adherencia alta a la Dieta Mediterránea (DM), el 35.9% eran moderadamente activos, el 54.9% indicaron tener independencia para las ABVD y el 75.4% mostraron bajo riesgo de sarcopenia. La percepción de la salud de la muestra fue inferior en la mayoría de las subescalas analizadas del SF-36 que la de la población de referencia, siendo inferior en mujeres y conforme avanza de la edad. Los adultos mayores con baja adhesión a la DM, sedentarios, dependientes y con sarcopenia mostraron inferior percepción de salud. Los participantes con baja adhesión a la DM eran más sedentarios y los más dependientes tenían más riesgo de sarcopenia. Conclusiones: Un estilo de vida inadecuado y la limitación funcional reducen significativamente la autopercepción de la salud, debiendo intervenir para corregirlas. (AU)
Objectives: To know the self-perceived health, lifestyle, functional capacity and relationship between them, in a group of older adults from a rural primary healthcare center. Methods: Cross-sectional observational study. The participants filled out a questionnaire made up of sociodemographic, clinical, socio-family support data, linked to COVID-19 and 5 scales: MEDAS-1, RAPA, Barthel, SARC-F and SF-36. The variables were analyzed through hypothesis contrasts and Pearson's coefficient, considering statistical significance with p<0.05. Results: The sample consisted of 142 older adults, with an average age of 75.85 years. Most of them were married, had primary education, were not caregivers, did not have toxic habits, were polymedicated, took psychotropic drugs, and were not afraid of COVID-19. The sample had a normal weight overall, 48.6% demonstrated high adherence to the Mediterranean Diet (MD), 35.9% were moderately active, 54.9% indicated independence for basic activities of daily living (BADL), and 75.4% showed low risk of sarcopenia. The sample's perception of health was lower in most of the SF-36 subscales analyzed than that of the reference population, being lower in women and with increasing age. Older adults with low adherence to MD, sedentary, dependent, and with sarcopenia showed a lower perception of health. Participants with low adherence to the MD were more sedentary and those who were more dependent had a higher risk of sarcopenia. Conclusions: an inadequate lifestyle and functional limitation significantly reduce the self-perception of health, requiring intervention to correct them. (AU)
Assuntos
Humanos , Estilo de Vida , Percepção , Sarcopenia , Epidemiologia Descritiva , Estudos Transversais , Pandemias , Infecções por Coronavirus/epidemiologiaRESUMO
Background Polypharmacy is a common condition among older adults and is associated with adverse drug reactions and health outcomes, including falls, functional and cognitive impairment, and frailty. Methods A prospective observational study will be conducted on older adults with polypharmacy. The aim is to assess the impact of a specialized outpatient clinic focused on pharmacotherapy optimization recently integrated into daily clinical practice in a Spanish public tertiary teaching hospital on patients functional and cognitive abilities. Patients who attend a first consultation and meet inclusion criteria (≥75 years old, have a life expectancy≥3 months, and polypharmacy (≥5 prescribed medications) will be invited to participate in the study, until reach a calculated sample size of 104 participants. Patients will be excluded if they are enrolled in a clinical trial related to medication or in the event of a no-show or cancellation of the appointment at the first visit. Participants will receive usual care: a first consultation including multidisciplinary pharmacological optimization in the context of a CGA and subsequent face-to-face and/or telephone follow-up (∼3 and ∼6 months). The primary endpoint will be the functional (Barthel index) and cognitive change in capacities (IPCR Índice de Incapacidad psíquica de la Cruz Roja). Secondary endpoints include medication changes, changes in patients quality of life, rate of falling, and use of healthcare resources. Discussion We expect that the close collaboration between professionals from different disciplines working together will be an effective strategy to improve the functional and cognitive abilities of older adults. Trial registration ClinicalTrials.gov: NCT05408598 (March 1, 2022) (AU)
Antecedentes La polifarmacia es una condición común entre los adultos mayores, y se asocia a reacciones adversas a medicamentos y a resultados negativos en la salud como caídas, deterioro funcional y cognitivo, y fragilidad. Métodos Se realizará un estudio observacional prospectivo en adultos mayores con polifarmacia. El objetivo es evaluar el impacto de una consulta especializada ambulatoria centrada en la optimización farmacológica y recientemente integrada en la práctica clínica habitual en un hospital universitario público español, sobre las capacidades funcionales y cognitivas de los pacientes. Los pacientes que acudan a una primera consulta y cumplan los criterios de inclusión (≥75 años, tengan una esperanza de vida ≥3 meses, y polifarmacia (≥5 medicamentos prescritos) serán invitados a participar en el estudio, hasta alcanzar un tamaño muestral calculado de 104 participantes. Los pacientes serán excluidos si ya participan en un ensayo clínico relacionado con medicación o en caso de no presentarse o cancelar la consulta inicial. Los participantes recibirán la atención habitual: una primera consulta que incluirá la optimización farmacológica en el contexto de una valoración geriátrica integral (VGI) y un seguimiento posterior presencial y/o telefónico (∼3 y ∼6 meses). La variable principal será el cambio en las capacidades funcionales (índice de Barthel) y cognitivas (Índice de Incapacidad Psíquica de la Cruz Roja [IPCR]) medidas al inicio y durante el seguimiento. Las variables secundarias incluyen cambios en la medicación, en la calidad de vida de los pacientes, en la tasa de caídas y en el uso de recursos sanitarios. Discusión Esperamos que esta estrecha colaboración entre profesionales de diferentes disciplinas que trabajan conjuntamente sea una estrategia eficaz para mejorar las capacidades funcionales y cognitivas de los adultos mayores. Registro del ensayo ClinicalTrials.gov: NCT05408598 (1 de marzo de 2022) (AU)
Assuntos
Humanos , Disfunção Cognitiva/tratamento farmacológico , Pacientes Ambulatoriais , Polimedicação , Equipe de Assistência ao Paciente , Estudos ProspectivosRESUMO
Introducción y objetivos: Los inhibidores del cotransportador 2 de sodio-glucosa (iSGLT2) inducen cambios a corto plazo en la función renal y la hemoglobina y su fisiopatología se comprende de manera incompleta. Nuestro objetivo es evaluar la relación entre los cambios de la tasa de filtrago glomerular estimado (TFGre) y la hemoglobina tras el inicio de dapagliflozina en pacientes estables con insuficiencia cardiaca y fracción de eyección reducida (IC-FEr). Métodos: Este análisis post hoc de un ensayo clínico aleatorizado evaluó el efecto de la dapagliflozina sobre el consumo máximo de oxígeno a 1 y 3 meses en pacientes ambulatorios con IC-FEr estable (ensayo DAPA-VO2, NCT04197635). Se utilizó un análisis de regresión lineal mixta para evaluar la relación entre los cambios en la TFGe y la hemoglobina a 1 y 3 meses. Resultados: Se evaluó a 87 pacientes. La media de edad era 67,0±10,5 años, y 21 pacientes (24,1%) eran mujeres. Las medias basales de TFGe y hemoglobina fueron de 66,9±20,7ml/min/1,73 m2 y 14,3±1,7g/dl respectivamente. En comparación con el placebo, la TFGe no cambió significativamente en el grupo de dapagliflozina, pero la hemoglobina aumentó significativamente a 1 y 3 meses. A 1 mes, el aumento de la hemoglobina se relacionó con la disminución de la TFGe solo en el grupo de dapagliflozina (p <0,001). A los 3 meses no había asociación significativa (p=0,123). Los cambios de la TFGe a 1 y 3 meses no se asociaron con cambios en el consumo pico de oxígeno, la calidad de vida o los péptidos natriuréticos. Conclusiones: En pacientes con IC-FEr estable, los cambios en la TFGe a 1 mes inducidos por la dapagliflozina están en relación inversa con cambios en la hemoglobina. Esta asociación no se observa a los 3 meses. (AU)
Introduction and objectives: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) induce short-term changes in renal function and hemoglobin. Their pathophysiology is incompletely understood. We aimed to evaluate the relationship between 1- and 3-month estimated glomerular filtration rate (eGFR) and hemoglobin changes following initiation of dapagliflozin in patients with stable heart failure with reduced ejection fraction (HFrEF). Methods: This is a post hoc analysis of a randomized clinical trial that evaluated the effect of dapagliflozin on 1- and 3-month peak oxygen consumption in outpatients with stable HFrEF (DAPA-VO2 trial, NCT04197635). We used linear mixed regression analysis to assess the relationship between eGFR and hemoglobin changes across treatment arms. Results: A total of 87 patients were evaluated in this substudy. The mean age was 67.0± 10.5 years, and 21 (24.1%) were women. The mean baseline eGFR and hemoglobin were 66.9±20.7mL/min/1.73m2 and 14.3±1.7g/dL, respectively. Compared with placebo, eGFR did not significantly change at either time points in the dapagliflozin group, but hemoglobin significantly increased at 1 and 3 months. At 1 month, the hemoglobin increase was related to decreases in eGFR only in the dapagliflozin arm (P <.001). At 3 months, there was no significant association in either treatment arms (P=.123). Changes in eGFR were not associated with changes in peak oxygen consumption, quality of life, or natriuretic peptides. Conclusions: In patients with stable HFrEF, 1-month changes in eGFR induced by dapagliflozin are inversely related to changes in hemoglobin. This association was no longer significant at 3 months. (AU)
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Inibidores do Transportador 2 de Sódio-Glicose , Insuficiência Cardíaca/tratamento farmacológico , Hemoglobinas/administração & dosagem , Taxa de Filtração Glomerular , Inibidores do Transportador 2 de Sódio-Glicose/farmacologia , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêuticoRESUMO
Background The intensity of the home care interventions for dependent older people offered in Spain may not be sufficient to help keep older people living at home, being the institutionalization in a nursing home (NH) an unavoidable consequence. Objective To evaluate the effect of intensification in home care interventions on users with grade II or III dependency, as well as training for their informal caregivers in order to delay or avoid their institutionalization in a NH. Methods A randomized clinical trial with two parallel arms and blinded assessment will be conducted at the community level in two municipalities in Catalonia (Spain). The study will include those older people (aged 65 and over) living in the community, with degree II or III of dependency, users of the public home care unwilling to be institutionalized and with a main informal caregiver in charge, who will also participate in the study. The assessments will be performed monthly up to 15 months, when the intervention will be finished. The main outcome will be the time until the willingness for admission to a NH. Secondary variables will be composed of sociodemographic, health, psychosocial, resource use, and follow-up variables. A multivariate Cox regression model will be carried out to estimate the effectiveness of the intervention. Discussion A multimodal home care intervention could improve the health and psychosocial status of dependent people and their informal caregivers and facilitate their permanence at home (AU)
Introducción La intensidad de las intervenciones del servicio de atención domiciliaria (SAD) para personas mayores en situación de dependencia que se ofrece en España puede no ser suficiente para ayudarles a permanecer viviendo en su domicilio, siendo la institucionalización en una residencia geriátrica una consecuencia inevitable. Objetivo Evaluar el efecto de una intensificación en las intervenciones del SAD en personas con grado de dependencia II o III, así como una formación de sus personas cuidadoras no profesionales para retrasar o evitar su institucionalización en una residencia geriátrica. Métodos Se realizará un ensayo clínico aleatorizado con dos brazos paralelos y evaluación ciega a nivel comunitario en dos municipios de Cataluña (España). El estudio incluirá a aquellas personas mayores (de 65 años o más) que vivan en la comunidad, con grado II o III de dependencia, usuarias del SAD público, sin voluntad de institucionalización y con una persona cuidadora no profesional principal a cargo, quien participará en el estudio. Las valoraciones se realizarán mensualmente hasta los 15 meses, cuando finalizará la intervención. La variable principal será el tiempo transcurrido hasta la voluntad de ingreso en una residencia geriátrica. Las variables secundarias se diferenciarán entre sociodemográficas, de salud, psicosociales, de uso de recursos y de seguimiento. Para estimar la eficacia de la intervención se realizará un modelo de regresión de Cox multivariante. Discusión Una intervención multimodal podría mejorar el estado de salud y psicosocial de las personas dependientes y sus personas cuidadoras no profesionales y facilitar su permanencia en el hogar (AU)
Assuntos
Humanos , Serviços de Saúde para Idosos , Serviços Hospitalares de Assistência Domiciliar , Terapia Combinada , Protocolos Clínicos , Idoso FragilizadoRESUMO
BACKGROUND: The intensity of the home care interventions for dependent older people offered in Spain may not be sufficient to help keep older people living at home, being the institutionalization in a nursing home (NH) an unavoidable consequence. OBJECTIVE: To evaluate the effect of intensification in home care interventions on users with grade II or III dependency, as well as training for their informal caregivers in order to delay or avoid their institutionalization in a NH. METHODS: A randomized clinical trial with two parallel arms and blinded assessment will be conducted at the community level in two municipalities in Catalonia (Spain). The study will include those older people (aged 65 and over) living in the community, with degree II or III of dependency, users of the public home care unwilling to be institutionalized and with a main informal caregiver in charge, who will also participate in the study. The assessments will be performed monthly up to 15 months, when the intervention will be finished. The main outcome will be the time until the willingness for admission to a NH. Secondary variables will be composed of sociodemographic, health, psychosocial, resource use, and follow-up variables. A multivariate Cox regression model will be carried out to estimate the effectiveness of the intervention. DISCUSSION: A multimodal home care intervention could improve the health and psychosocial status of dependent people and their informal caregivers and facilitate their permanence at home. TRIAL REGISTRATION: NCT05567965.
Assuntos
Serviços de Assistência Domiciliar , Humanos , Idoso , Cuidadores/psicologia , Casas de Saúde , Hospitalização , Espanha , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Polypharmacy is a common condition among older adults and is associated with adverse drug reactions and health outcomes, including falls, functional and cognitive impairment, and frailty. METHODS: A prospective observational study will be conducted on older adults with polypharmacy. The aim is to assess the impact of a specialized outpatient clinic focused on pharmacotherapy optimization recently integrated into daily clinical practice in a Spanish public tertiary teaching hospital on patients' functional and cognitive abilities. Patients who attend a first consultation and meet inclusion criteria (≥75 years old, have a life expectancy≥3 months, and polypharmacy (≥5 prescribed medications) will be invited to participate in the study, until reach a calculated sample size of 104 participants. Patients will be excluded if they are enrolled in a clinical trial related to medication or in the event of a no-show or cancellation of the appointment at the first visit. Participants will receive usual care: a first consultation including multidisciplinary pharmacological optimization in the context of a CGA and subsequent face-to-face and/or telephone follow-up (â¼3 and â¼6 months). The primary endpoint will be the functional (Barthel index) and cognitive change in capacities (IPCR - Índice de Incapacidad psíquica de la Cruz Roja). Secondary endpoints include medication changes, changes in patients' quality of life, rate of falling, and use of healthcare resources. DISCUSSION: We expect that the close collaboration between professionals from different disciplines working together will be an effective strategy to improve the functional and cognitive abilities of older adults. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05408598 (March 1, 2022).
Assuntos
Fragilidade , Pacientes Ambulatoriais , Humanos , Idoso , Qualidade de Vida , Estudos Prospectivos , Cognição , Estudos Observacionais como AssuntoRESUMO
Introducción: La diabetes mellitus es una enfermedad caracterizada por un aumento sostenido de las cifras de glucemia. Las manifestaciones clínicas y complicaciones de la enfermedad generan discapacidad funcional y afectación de la percepción calidad de vida. El control de la glucemia es fundamental para mejorar el estado de salud de los pacientes. Objetivo: Implementar una intervención de salud integral en pacientes con diagnóstico de DM tipo II residentes en el cantón Riobamba. Métodos: Se realizó una investigación aplicada, con diseño cuasiexperimental, descriptivo y longitudinal. El universo estuvo constituido por 256 pacientes con diagnóstico de diabetes mellitus tipo II, de los cuales 155 formaron parte de la muestra del estudio. Se analizaron, al inicio y final de la intervención, el control glucémico, estado nutricional, circunferencia de la cintura y nivel de conocimiento; así como las características generales al inicio del estudio. Se utilizó la prueba de rangos con signos de Wilcoxon para identificar si la intervención generó cambios en las variables de estudio comparando los resultados antes y después de la intervención. Resultados: Promedio de edad de 63,28 años, predominio de pacientes femeninas (69,68 %) y sin comorbilidades asociadas (66,45 %). Al inicio del estudio predominó el nivel de conocimiento bajo (60,00 %), control glucémico admisible (34,19 %) y circunferencia de la cintura con riesgo elevado en hombres (37,96 %) y mujeres (38,30 %). Después de terminado el estudio predominó el nivel medio de conocimiento (38,71%), los pacientes con normopeso (57,4 2%), control glucémico adecuado (34,84 %). Conclusiones: la intervención aplicada generó cambios positivos en las variables estudiadas.
Introduction: Diabetes mellitus is a disease characterized by a sustained increase in blood glucose levels. The clinical manifestations and complications of the disease generate functional disability and affect the perception of quality of life. Glycemic control is essential to improve the health status of patients. Objective: To implement a comprehensive health intervention in patients diagnosed with type II DM residing in the Riobamba canton. Methods: Applied research was carried out, with a quasi-experimental, descriptive and longitudinal design. The universe consisted of 256 patients diagnosed with type II diabetes mellitus, of which 155 were part of the study sample. Glycemic control, nutritional status, waist circumference and level of knowledge were analyzed at the beginning and end of the intervention; as well as the general characteristics at the beginning of the study. The Wilcoxon signed rank test was used to identify whether the intervention generated changes in the study variables by comparing the results before and after the intervention. Results: Average age of 63.28 years, predominance of female patients (69.68 %) and no associated comorbidities (66.45 %). At the beginning of the study, the low level of knowledge (60.00 %), admissible glycemic control (34.19%) and waist circumference with high risk prevailed in men (37.96 %) and women (38.30 %). . After completing the study, the average level of knowledge (38.71 %), patients with normal weight (57.42 %), adequate glycemic control (34.84 %) predominated. Conclusions: the applied intervention generated positive changes in the variables studied.
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Introducción: Las enfermedades reumáticas son conceptualizadas como un grupo de afecciones que generan grados variables de discapacidad funcional y disminución de la percepción de calidad de vida relacionada con la salud. Su diagnóstico precoz resulta vital para minimizar el riesgo de aparición de complicaciones y deformidades articulares. Objetivo: Identificar el nivel de conocimiento sobre los elementos básicos del diagnóstico de enfermedades reumáticas en médicos del primer nivel de atención de salud. Métodos: Se realizó una investigación básica, no experimental, descriptiva y transversal. El universo estuvo constituido por 428 médicos generales que laboran en el primer nivel de atención de salud de la zona 3 en Ecuador. La muestra quedó conformada por 204 profesionales. Se aplicó un modelo de recolección de información que permitió identificar características generales y nivel de conocimiento sobre elementos básicos del diagnóstico de las enfermedades reumáticas. Resultados: Promedio de edad de 28,39 años, predominio de médicos femeninas (63,24 %), entre 4 y 6 años de graduados (35,78 %) y haber recibido capacitaciones sobre los elementos básicos del diagnóstico de las enfermedades reumáticas (98,04 %). El nivel de conocimiento predominante sobre este tema fue el bajo (89,70 %). Conclusiones: El nivel de conocimiento sobre elementos básicos del diagnóstico de enfermedades reumáticas en médicos del primer nivel de atención de salud es bajo.
Introduction: Rheumatic diseases are conceptualized as a group of conditions that generate variable degrees of functional disability and decreased perception of health-related quality of life. Its early diagnosis is vital to minimize the risk of complications and joint deformities. Objective: To identify the level of knowledge about the basic elements of the diagnosis of rheumatic diseases in doctors of the first level of health care. Methods: A basic, non-experimental, descriptive and cross-sectional investigation was carried out. The universe consisted of 428 general practitioners who work in the first level of health care in zone 3 in Ecuador. The sample was made up of 204 professionals. An information collection model was applied that allowed the identification of general characteristics and level of knowledge about basic elements of the diagnosis of rheumatic diseases. Results: Average age of 28.39 years, predominance of female doctors (63.24 %), between 4 and 6 years of graduation (35.78 %) and having received training on the basic elements of diagnosis of rheumatic diseases (98.04 %). The predominant level of knowledge on this topic was low (89.70 %). Conclusions: The level of knowledge about basic elements of the diagnosis of rheumatic diseases in doctors of the first level of health care is low.
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Introducción: La COVID-19 genera afectación durante el proceso de la enfermedad en el aparato respiratorio y cardiovascular; sin embargo, se desconoce si esta afectación desaparece con la resolución del proceso inflamatorio o se mantienen en forma de secuela con el de cursar del tiempo. Objetivo: Analizar la capacidad funcional cardiorrespiratoria en pacientes entre 30 y 60 años post COVID-19. Métodos: Se realizó una investigación básica, no experimental, descriptiva y transversal que incluyó 328 pacientes, de los cuales 178 formaron parte de la muestra. Se analizaron características generales, la capacidad funcional respiratoria y cardiovascular. Resultados: Promedio de edad de 53,48 años con predominio de pacientes femeninas (55,62 %). El 33,15 % de los pacientes refirió una comorbilidad asociada. El 15,73 % de los pacientes presentaba bradicardia y el 8,99 % taquicardia. En el 42,70 % de los casos se identificó enfermedad hipertensiva. Las manifestaciones respiratorias estuvieron dadas por la presencia de disnea y porcentaje elevado de pacientes con taquipnea y trastornos de la saturación de oxígeno. Conclusiones: Después de transcurridos 6 meses de la presencia de COVID-19 un elevado porcentaje de pacientes presentaban manifestaciones cardiorrespiratorias que afectaban la capacidad funcional de ambos aparatos.
Introduction: COVID-19 affects the respiratory and cardiovascular systems during the disease process; however, it is unknown if this affectation disappears with the resolution of the inflammatory process or if it remains in the form of a sequel over time. Objective: To analyze the cardiorespiratory functional capacity in patients between 30 and 60 years old post COVID-19. Methods: A basic, non-experimental, descriptive and cross-sectional investigation was carried out that included 328 patients, of which 178 were part of the sample. General characteristics, respiratory and cardiovascular functional capacity were analyzed. Results: Average age of 53,48 years with a predominance of female patients (55.62 %). 33.15 % of the patients reported an associated comorbidity. 15.73 % of the patients presented bradycardia and 8.99 % tachycardia. Hypertensive disease was identified in 42.70 % of the cases. The respiratory manifestations were given by the presence of dyspnea and a high percentage of patients with tachypnea and oxygen saturation disorders. Conclusions: After 6 months of the presence of COVID-19, a high percentage of patients presented cardiorespiratory manifestations that affected the functional capacity of both devices.
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Las enfermedades reumáticas constituyen uno de los grupos de enfermedades que con mayor frecuencia se presentan en el primer nivel de atención de salud. Dentro de sus características más distintivas destacan la generación de distintos grados de discapacidad funcional y la afectación a la percepción de calidad de vida relacionada con la salud. El diagnóstico precoz y el tratamiento oportuno constituyen las herramientas que se orientan al mejor control de la enfermedad; sin embargo, para lograrlo se necesita aumentar el nivel de preparación y competencia profesional del equipo de salud que labora en el primer nivel de atención. El objetivo de esta investigación es exponer, desde el punto de vista de la formación médica, los mecanismos que pueden formar parte de herramientas de superación profesional en el primer nivel de atención en base al reconocimiento de los elementos que permiten el diagnóstico de las enfermedades reumáticas y la correcta orientación diagnóstica. Se realiza un breve bosquejo de los elementos que deben ser incluidos tanto en la educación médica de pregrado como de posgrado. Se concluye que el abordaje de las enfermedades reumáticas debe constituir una práctica de superación permanente, como alternativa viable a disminuir la discapacidad funcional y aumentar la percepción de calidad de vida relacionada con la salud de estos pacientes.
Rheumatic diseases constitute one of the groups of diseases that most frequently occur in the first level of health care. Among its most distinctive characteristics, the generation of different degrees of functional disability and the affectation of the perception of health-related quality of life stand out. Early diagnosis and timely treatment are the tools that are aimed at better control of the disease; however, to achieve this, it is necessary to increase the level of preparation and professional competence of the health team that works at the first level of care. The objective of this research is to expose, from the point of view of medical training, the mechanisms that can be part of professional improvement tools in the first level of care based on the recognition of the elements that allow the diagnosis of rheumatic diseases. and the correct diagnostic orientation. A brief outline of the elements that should be included in both undergraduate and postgraduate medical education is made. It is concluded that the approach to rheumatic diseases should constitute a permanent improvement practice, as a viable alternative to reduce functional disability and increase the perception of quality of life related to the health of these patients.
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Objetivo: Proponer una modificación consensuada del Health Assessment Questionnaire (HAQ) según los valores, idioma y cultura predominantes en la sociedad española actual. Métodos: En primer lugar, se realizó una revisión de alcance de la literatura y una encuesta a usuarios del HAQ para identificar las limitaciones de este cuestionario. En una segunda fase se celebró una reunión con profesionales expertos para discutir los resultados y diseñar propuestas de modificación. Resultados: La revisión de alcance permitió describir las principales versiones del HAQ, así como sus propiedades psicométricas. En la encuesta a usuarios del HAQ se valoraron el grado de comprensión, la utilidad, la actualidad y la universalidad de cada uno de los ítems y se admitieron sugerencias y opiniones sobre sus principales inconvenientes. Durante la reunión de discusión se propusieron modificaciones de los ítems en función de los resultados de la revisión de alcance y de la encuesta a usuarios. Además, se tuvieron en cuenta la dificultad de comprensión de los ítems, su dificultad para evaluar los movimientos previstos, el carácter redundante, su obsolescencia y el posible sesgo de género. Conclusiones: Se propone una actualización de la versión española del HAQ en base a la revisión de la literatura y a la opinión de expertos que pone de manifiesto el cambio de paradigma en los valores culturales y que pretende aumentar la validez de contenido y capacidad de discriminación de este cuestionario.(AU)
Objective: To propose a consensus modification of the HAQ according to the predominant values, language, and culture of the society. Methods: First, a scoping review of the literature and a survey of HAQ users were conducted to identify the problems of this questionnaire. In a second phase, a meeting was held with expert professionals to discuss the results and design proposals for modification. Results: The scoping review allowed us to describe the main versions of the HAQ, as well as their psychometric properties. The HAQ users survey assessed the degree of comprehension, usefulness, timeliness, and universality of each of the items, and suggestions and opinions on its main limitations were accepted. During the discussion meeting, modifications to the items were proposed based on the results of the scoping review and the users survey. In addition, the difficulty of understanding the items, their difficulty in assessing intended movements, redundancy, obsolescence, and possible gender bias were taken into account. Conclusions. An update of the Spanish version of the HAQ is proposed based on the literature review and expert opinion that highlights the paradigm shift in cultural values and aims to increase the content validity and discrimination capacity of this questionnaire.(AU)
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Humanos , Masculino , Feminino , Tradução , Inquéritos e Questionários , Nível de SaúdeRESUMO
INTRODUCTION: Despite the benefits of physical exercise (PE) for patients with chronic kidney disease (CKD), the number of Nephrology services that have PE programs is limited. OBJECTIVES: To describe the degree of knowledge of PE benefits in patients with CKD among professionals, as well as the level of implementation and characteristics of PE programs in Nephrology services in Spain. METHODS: A questionnaire on the degree of knowledge and prescription of PE in patients with CKD was designed and sent to members of the Spanish Nephrology and Nephrology Nursing Societies, as well as to physiotherapists and professionals in the Sciences of Physical Activity and Sport (PASS). RESULTS: 264 professionals participated. 98.8% agreed on the importance of prescribing PE, but only 20.5% carry out an assessment of functional capacity and 19.3% have a PE program for patients with CKD in their centre. The most frequent programs are performed for haemodialysis patients and strength and aerobic resistance exercises are combined. A physiotherapist or a PASS usually participates in its prescription. The main barriers were the absence of human and/or physical resources and the lack of training. CONCLUSIONS: Healthcare workers know the benefits of PE in patients with CKD. However, the implementation of these programs in Spain is low, motivated by the lack of resources and training of professionals. We must establish strategies to guarantee an adequate functional capacity within the care of our patients.
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Insuficiência Renal Crônica , Humanos , Insuficiência Renal Crônica/terapia , Terapia por Exercício/métodos , Exercício Físico , Rim , Inquéritos e QuestionáriosRESUMO
El Método Pilates (MP) se propone como una estrategia no farmacológica para el manejo del dolor. Sin embargo, se sabe poco sobre la seguridad del método aplicado a los ancianos. El objetivo fue identificar el impacto de la MP en mujeres ancianas sin quejas de dolor musculoesquelético severo general y específico, considerando el dolor musculoesquelético físico, funcional y crónico. 19 ancianas se sometieron a 24 semanas de intervención con MP. Medimos la percepción de funcionalidad, dolor general y segmentación respectivamente por tres subescalas del SF-36 (capacidad funcional, aspectos físicos y dolor) y el Cuestionario Nórdico Musculoesquelético (NMQ). Para SF-36 tuvimos: capacidad funcional χ 2 (2) = 1.529, p = 0.465, limitaciones por aspectos físicos χ 2 (2) = 1.960, p = 0.375 y dolor χ 2 (2) = 1.213, p = 0.545 , no se encontraron diferencias significativas para ninguna de las variables a lo largo del tiempo. En cuanto al NMQ, observamos una diferencia significativa solo para la cadera / muslo, disminuyendo las quejas de dolor, hormigueo y entumecimiento en Q2 en comparación con Q1 (p = 0.01) y aumentando en Q3 en comparación con Q2 (p = 0.03). Se sugiere que el MP es seguro y aplicable en este público, ya que presentó resultados estables y no agravó la condición de dolor (general y localizado). (AU)
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Humanos , Feminino , Idoso , Idoso de 80 Anos ou mais , Técnicas de Exercício e de Movimento , Dor , Treinamento Resistido , Inquéritos e Questionários , Envelhecimento , Dor MusculoesqueléticaRESUMO
INTRODUCTION AND OBJECTIVES: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) induce short-term changes in renal function and hemoglobin. Their pathophysiology is incompletely understood. We aimed to evaluate the relationship between 1- and 3-month estimated glomerular filtration rate (eGFR) and hemoglobin changes following initiation of dapagliflozin in patients with stable heart failure with reduced ejection fraction (HFrEF). METHODS: This is a post hoc analysis of a randomized clinical trial that evaluated the effect of dapagliflozin on 1- and 3-month peak oxygen consumption in outpatients with stable HFrEF (DAPA-VO2 trial, NCT04197635). We used linear mixed regression analysis to assess the relationship between eGFR and hemoglobin changes across treatment arms. RESULTS: A total of 87 patients were evaluated in this substudy. The mean age was 67.0± 10.5 years, and 21 (24.1%) were women. The mean baseline eGFR and hemoglobin were 66.9±20.7mL/min/1.73m2 and 14.3±1.7g/dL, respectively. Compared with placebo, eGFR did not significantly change at either time points in the dapagliflozin group, but hemoglobin significantly increased at 1 and 3 months. At 1 month, the hemoglobin increase was related to decreases in eGFR only in the dapagliflozin arm (P <.001). At 3 months, there was no significant association in either treatment arms (P=.123). Changes in eGFR were not associated with changes in peak oxygen consumption, quality of life, or natriuretic peptides. CONCLUSIONS: In patients with stable HFrEF, 1-month changes in eGFR induced by dapagliflozin are inversely related to changes in hemoglobin. This association was no longer significant at 3 months.
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Insuficiência Cardíaca , Inibidores do Transportador 2 de Sódio-Glicose , Disfunção Ventricular Esquerda , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Masculino , Insuficiência Cardíaca/tratamento farmacológico , Taxa de Filtração Glomerular , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Volume Sistólico , Qualidade de Vida , Compostos Benzidrílicos/uso terapêutico , Hemoglobinas/uso terapêuticoRESUMO
Introducción: A pesar de los beneficios del ejercicio físico (EF) para pacientes con enfermedad renal crónica (ERC), el número de servicios de Nefrología que han implementado programas de EF es limitado. Objetivos: Describir el grado de conocimiento del EF en pacientes con ERC entre los profesionales, así como el nivel de implementación y las características de los programas de EF en los servicios de Nefrología en España. Métodos: Se diseñó un cuestionario sobre el grado de conocimiento y de prescripción del EF en pacientes con ERC que se envió a los socios de la Sociedad Española de Nefrología y de la Sociedad Española de Enfermería Nefrológica, así como a fisioterapeutas y profesionales de las Ciencias de la Actividad Física y del Deporte (CAFyD). Resultados: Participaron 264 profesionales. El 98,8% coincidían en la importancia de prescribir EF, pero solo el 20,5% realizan una valoración de la capacidad funcional y solo el 19,3% disponen de un programa de EF para pacientes con ERC en su centro. Los programas más frecuentes están dirigidos a pacientes en hemodiálisis y combinan ejercicios de fuerza y de resistencia aeróbica. En la prescripción habitualmente interviene un fisioterapeuta o un CAFyD. Las principales barreras fueron la ausencia de recursos humanos y/o físicos y la falta de formación. Conclusiones: Los profesionales sanitarios conocen los beneficios del EF en el paciente renal. Sin embargo, la implementación de estos programas en España es baja, debido a la falta de recursos y a la falta de formación de los profesionales. Debemos establecer estrategias para garantizar una adecuada capacidad funcional dentro de los cuidados de nuestros pacientes. (AU)
Introduction: Despite the benefits of physical exercise (PE) for patients with chronic kidney disease (CKD), the number of Nephrology services that have PE programs is limited. Objective: To describe the degree of knowledge of PE benefits in patients with CKD among professionals, as well as the level of implementation and characteristics of PE programs in Nephrology services in Spain. Methods: A questionnaire on the degree of knowledge and prescription of PE in patients with CKD was designed and sent to members of the Spanish Nephrology and Nephrology Nursing Societies, as well as to physiotherapists and professionals in the Sciences of Physical Activity and Sport (CAFyD). Results: 264 professionals participated. 98.8% agreed on the importance of prescribing PE, but only 20.5% carry out an assessment of functional capacity and 19.3% have a PE program for patients with CKD in their center. The most frequent programs are performed for hemodialysis patients and strength and aerobic resistance exercises are combined. A physiotherapist or a CAFyD usually participates in its prescription. The main barriers were the absence of human and/or physical resources and the lack of training. Conclusions: Healthcare workers know the benefits of PE in patients with CKD. However, the implementation of these programs in Spain is low, motivated by the lack of resources and training of professionals. We must establish strategies to guarantee an adequate functional capacity within the care of our patients. (AU)
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Exercício Físico , Insuficiência Renal Crônica , Nefrologia , Inquéritos e Questionários , Espanha , DiáliseRESUMO
OBJECTIVE: To propose a consensus modification of the HAQ according to the predominant values, language, and culture of the society. METHODS: First, a scoping review of the literature and a survey of HAQ users were conducted to identify the problems of this questionnaire. In a second phase, a meeting was held with expert professionals to discuss the results and design proposals for modification. RESULTS: The scoping review allowed us to describe the main versions of the HAQ, as well as their psychometric properties. The HAQ users survey assessed the degree of comprehension, usefulness, timeliness, and universality of each of the items, and suggestions and opinions on its main limitations were accepted. During the discussion meeting, modifications to the items were proposed based on the results of the scoping review and the users survey. In addition, the difficulty of understanding the items, their difficulty in assessing intended movements, redundancy, obsolescence, and possible gender bias were taken into account. CONCLUSIONS: An update of the Spanish version of the HAQ is proposed based on the literature review and expert opinion that highlights the paradigm shift in cultural values and aims to increase the content validity and discrimination capacity of this questionnaire.
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Idioma , Sexismo , Humanos , Masculino , Feminino , Reprodutibilidade dos Testes , Inquéritos e Questionários , PsicometriaRESUMO
Introducción: La fibromialgia es un trastorno reumatológico caracterizado por dolor generalizado de localización imprecisa que afecta principalmente a mujeres. Se asocia a fatiga, ansiedad, depresión y la capacidad funcional de estos pacientes se ve afectada por la coexistencia de dichos trastornos. Métodos: Serie de casos de corte transversal con uso de datos secundarios de 126 pacientes con fibromialgia que acudieron a consultorio externo del servicio de reumatología de un hospital en Lima durante febrero de 2020. Se buscó determinar la frecuencia de discapacidad funcional y explorar factores asociados en pacientes con diagnóstico de fibromialgia con o sin depresión. La capacidad funcional y la presencia de síntomas depresivos fueron medidas mediante uso de escalas validadas. Se realizó un análisis multivariado de regresión logística múltiple para valorar si la depresión es un factor de riego independiente de discapacidad. Resultados: La edad tuvo una mediana de 53,5 (RIQ: 46-60) años y 122 participantes eran mujeres, además 42 (33,33%) pacientes presentaban depresión y 76 (60,32%) presentaban discapacidad funcional. En el análisis multivariado, se encontró que la depresión es un factor de riesgo independiente de discapacidad funcional luego de ajustar a diabetes, presencia de 3 o más comorbilidades, intensidad de fatiga y síntomas asociados [OR de 3.09 (1.24 - 7.70); p: 0.015]. Conclusiones: La depresión es un factor independiente para discapacidad funcional en pacientes con fibromialgia.
Background: Fibromyalgia is a rheumatological disorder characterized by generalized pain of imprecise localization that mainly affects women. It is associated with fatigue, anxiety, depression, and functional capacity is greatly affected by the coexistence of these disorders. Methods: It is a series of cross-sectional cases, using secondary data from 126 patients with fibromyalgia who attended the outpatient clinic of a hospital at Lima at the rheumatology service during February 2020. We try to determine the frequency of functional disability and explore associated factors in patients diagnosed with fibromyalgia with or without depression. Functional capacity and the presence of depressive symptoms were measure by validated scales. A multivariate multiple logistic regression analysis was performed to assess whether depression is an independent risk factor for disability. Results: The age had a median of 53.5 (IQR: 46-60) years, 122 participants were women. In addition, 42 (33.33%) patients had depression and 76 (60.32%) patients had functional disability. In the multivariate analysis, it was found that depression is an independent risk factor for functional disability after adjusting for diabetes, presence of 3 or more comorbidities, intensity of fatigue and associated symptoms [OR 3.09 (1.24 - 7.70); p: 0.015]. Conclusions: Depression is an independent factor for functional incapacity in patients with fibromyalgia.