Encuesta sobre la situación de investigación en rehabilitación en España. Resultados / Survey on the state of investigation in rehabilitation in Spain: Results

En la vocalía de investigación, formación e innovación de la sociedad Española de Medicina Física y Rehabilitación (SERMEF), quisimos aproximarnos a cuál es el estado de la investigación en nuestra especialidad en España. Para ello, se elaboró y distribuyó una encuesta online entre médicos rehabilitadores de España, que obtuvo 253 respuestas. De estos, el 65% afirmó que en su centro de trabajo sí se realiza actividad investigadora en rehabilitación; el número de proyectos activos en sus centros según declararon era de: ninguno en el 35,7%; uno en el 17,7%, 2 en el 23,3%, 3 en el 8,4% y 4 o más en el 14,9%. Entre las principales dificultades que se encuentran los encuestados el 89% destacan que no se dispone de personal contratado para investigación y el 95% que en sus centros no se destina parte de la jornada laboral para investigación. En cuanto a la actividad investigadora personal, el 56% atestiguan participar en investigación, siendo el rol más habitual el de investigador principal (58%). El 95% de los encuestados refiere que el principal obstáculo para desarrollar un proyecto de investigación es la presión asistencial y la falta de tiempo, y correspondientemente, una amplia mayoría (83%) alega que disponer de tiempo estipulado para investigar en su jornada laboral sería una motivación.(AU)

The research, training and innovation committee of the Spanish Society of Physical Medicine and Rehabilitation (SERMEF) wanted to know the state of research in our speciality. To this end, an online survey was developed and distributed among rehabilitation doctors in Spain, which obtained 253 responses. Of these, 65% stated that research activity in rehabilitation does take place in their work centre; the number of active projects in their centres as stated by them was: none in 35.7%; one in 17.7%, two in 23.3%, three in 8.4% and four or more in 14.9%. Among the main difficulties encountered, 89% highlight that there is no staff hired for research and 95% that in their centres part of the working day is not allocated to research. In terms of personal research activity, 56% reported that they were involved in research, with the most common role being that of principal investigator (58%). Ninety-five percent of respondents report that the main obstacle to developing a research project is the pressure of care and lack of time, and correspondingly, a large majority (83%) claim that having stipulated time for research in their working day would be a motivation.(AU)

Publication Rate of Presentations at a National Physical Medicine and Rehabilitation Scientific Conference From 2009 to 2018.

ABSTRACT: Conferences are important platforms for sharing research, but full-text publication is necessary for broader dissemination and impact. Few studies have examined the abstract-to-publication rate for physical medicine and rehabilitation. This study aimed to determine the abstract-to-publication rate of research abstracts presented from 2009-2018 at the Canadian Association of Physical Medicine and Rehabilitation annual scientific meetings. Using the official book of abstracts from 2009 to 2018, year of conference, abstract title, author names, and the affiliation/level of training of the first author were extracted. Systematic searches of abstract key words, authors' names, and the abstract title were performed using PubMed and Google Scholar to determine whether an abstract proceeded to full-text publication; if so, the date and journal of publication were extracted. Of the 524 total abstracts presented at the Canadian Association of Physical Medicine and Rehabilitation from 2009 to 2018, 187 went on to full-text publication for an abstract-to-publication rate of 35.8%. The mean time to full-text publication was 23.4 ± 8.63 mos. The abstract-to-publication rate was 18.6% for medical students, 28.7% for residents, 41.1% for physical medicine and rehabilitation consultants, and 49.4% for nonphysician presenters. This study highlights that low abstract-to-publication rates for novel research presented at the Canadian Association of Physical Medicine and Rehabilitation disproportionately affects trainees. Further research is needed to identify and remedy barriers to publication.

The Hirsch Index and Self-Citation in Academic Physiatry Among Graduate Medical Education Program Directors.

ABSTRACT: The Hirsch Index is a measure of academic productivity which captures both the quantity and quality of an author's output. A well-accepted bibliometric, the Hirsch Index still may be influenced by self-citation, which has been assessed in other medical and surgical specialties. This study aims to evaluate research output and self-citation in physiatry, establishing a benchmark for the field, in addition to identifying differences between physical medicine and rehabilitation subspecialties. This study identified physical medicine and rehabilitation residency and fellowship program directors and analyzed the number of publications, citations, self-citations, and h-indices. A total of 169 program directors were identified, and the mean number ± SD of publications, citations, and Hirsch Index for the cohort were 16.7 ± 29.5, 348 ± 753, and 5.7 ± 6.7, respectively. When self-citation was excluded, less than 2% of program directors (3 of 169) had changes in Hirsch Index greater than one integer, and none greater than two integers. The Hirsch Index remained unchanged for 90% (152 of 169). Spinal cord injury fellowship directors had significantly higher mean number of publications (28, P = 0.04), mean number of citations (672, P = 0.03), and Hirsch Index (9.2, P < 0.01; 95% confidence interval). Overall, self-citation is infrequent in physical medicine and rehabilitation, and spinal cord injury directors had more robust academic profiles.

African American Patient Disparities in COVID-19 Outcomes: A Call to Action for Physiatrists to Provide Rehabilitation Care to Black Survivors.

SARS-CoV-2 is a novel and highly contagious coronavirus that has been a major threat to the public's health. As the pandemic has spread across the United States, it has become abundantly clear that vulnerable populations include not only the elderly and individuals with disabilities but also those who are homeless or incarcerated, Latinx Americans, African Americans, and Native Americans. This report is focused on the experience of Black patients, inclusive of African Americans, and recognizes the higher morbidity and mortality in this population. Physiatrists can provide care for the sequelae faced by survivors and prioritize rehabilitation services. Programs must be administered in a way that is geographically accessible to Black communities and demonstrate cultural competence. Future research should focus on the social determinants of health to better understand at-risk populations and improve outcomes.

Academic Interest in Pain: Comparison of Four Specialties With Long-Standing Involvement in Pain Medicine.

PURPOSE: One of the most interesting signs of growth in a medical specialty is the addition of pain medicine as a clinical subspecialty to it. The aim of this study was to analyze publication-based academic interest in pain medicine among clinical specialties with long-standing involvement in pain management. METHODS: We assessed the activity within several specialties in the development of an academic foundation for pain medicine by measuring the frequency of the most common pain topics (1998-2017) in academic journals representing such specialties. The selection of materials for the analysis of publication-based academic interest associated with the development of pain medicine followed a three-step process: (1) Medical specialties, limited to those with accredited fellowship training in pain medicine for more than 20 years - anesthesiology, neurology, physiatry, and psychiatry; (2) Pain topics, based on the degree of topic association with the work of pain clinics - a total of 34 topics; (3) Specialty journals, mostly official journals of societies publishing articles representing all aspects of a specialty - four journals per specialty. Specialty-related academic interest was characterized in two dimensions: its breadth (the number of different topics of interest with distinctly high shares of publications) and its intensity (maximal number of publications on a particular topic). RESULTS: According to the number of topics with a distinctly high share of articles per topic (≥ 5%), the rank order of specialties was as follows (of 34 topics): anesthesiology (22), physiatry (20), neurology (10), and psychiatry (0). Regarding comparative intensity of interest, anesthesiology has prevailing interest in 16 topics (especially in postoperative pain and pharmacologic pain treatment), physiatry in 13 topics (especially in physical methods of pain therapy), and neurology in one topic (headache disorders). CONCLUSION: Publication-based academic interest in pain management was most intensive in two specialties, anesthesiology and physiatry, with anesthesiology being somewhat more multifaceted, especially in the methods of pain treatment.

Retractions in Rehabilitation and Sport Sciences Journals: A Systematic Review.

OBJECTIVE: To identify the characteristics of retracted publications in rehabilitation and sport sciences journals. DATA SOURCES: The Web of Science, PubMed, and Retraction Watch databases were searched from inception to August 2019. STUDY SELECTION: Retracted publications published in rehabilitation or sport sciences journals, indexed in the Science Citation Index Expanded (SCIE) and Social Sciences Citation Index (SSCI) were included. DATA EXTRACTION: One author extracted the data. Two other authors checked the data. DATA SYNTHESIS: A total of 37 and 52 retracted publications and their retraction notices were identified for rehabilitation and sport sciences, respectively. The majority of retracted publications (68% of all retracted papers in rehabilitation and 54% of all retracted papers in sport sciences) were published in the past decade. Retracted publications in rehabilitation and sport sciences were published in 21 and 22 different journals and originated from 18 and 21 different countries, respectively. The full-text of the retracted publications was available with a retraction watermark or note for 59% of cases in rehabilitation and 58% in sport sciences. The reasons for the retractions were more often attributed to misconduct (79% and 61%) than to honest error (21% and 39%) in rehabilitation and sport sciences, respectively. However, a reason was not stated for 15% of the publications. The median time interval between publication and retraction was 622 days in rehabilitation and 607 days in sport sciences publications. CONCLUSIONS: The total number of retracted publications in rehabilitation and sport sciences journals was small. The retracted publications have been published in a variety of rehabilitation and sport sciences journals and came from different countries across the world. Several retracted publications and retraction notices failed to adhere to The Committee on Publication Ethics guidelines in the handling of full-text (retain with a watermark or note) or stating the underlying reasons for the retraction.

An Evaluation of Age-Based Differences in the Demographic Features and Clinical Outcomes of Trauma Rehabilitation Patients.

OBJECTIVE: The aims of the study were to describe potential age-related differences in injury type and mechanism, comorbidities, and physical medicine and rehabilitation-relevant complications in patients admitted after major trauma and to examine whether functional outcomes vary by age group after traumatic injury. DESIGN: This is a subanalysis of a pre-post study. Individuals admitted to a level 1 trauma center who sustained major trauma were divided into three age groups (young, middle age, and elderly). The demographic, acute care, and rehabilitation factors for these patients were then compared across the three age groups. RESULTS: Based on an age distribution plot, the age categories were defined as follows: young, 18-39 yrs (n = 120); middle age, 40-64 yrs (n = 124); and elderly, 65 yrs or older (n = 85). Patients 65 yrs or older demonstrated a greater frequency of comorbidities (P < 0.001) and complications (P < 0.001). For individuals admitted to inpatient rehabilitation, admission and discharge functional independence measure scores were lower for the elderly individuals, but functional independence measure change was not significantly different between groups. CONCLUSIONS: Although the elderly trauma patient demonstrates important differences from the younger one, capacity for improvement with rehabilitation seems similar.

Environmental characteristics of older people attending physical medicine and rehabilitation outpatient clinics.

OBJECTIVE: A residential environment refers to the physical and social characteristics in a neighbourhood. The physical characteristics include interior housing qualities, exterior neighbourhood characteristics, and the accessibility of essential facilities and services outside the neighbourhood. Older adults especially may be vulnerable to the negative impacts of the residential environment. The aim of this study is to elucidate the problems ageing people face in their neighbourhoods, buildings and public areas. METHODS: The study group consisted of a total of 1,001 people over the age of 65 who were admitted to physical medicine and rehabilitation clinics in Turkey and consented to participate. A questionnaire covering demographic, social and environmental information was used. RESULTS: Of the study group, 58.6% was living in an apartment building, but only 23.6% of these buildings had an elevator, and the stairs were inconvenient in 46.7% of the buildings. Only 49% of the elderly people went for a walk regularly. The most frequent complaint about the hospitals, community health centres and other public areas was the inappropriate restroom conditions. Eighty-six percent of the study group were not members of an organization, a foundation or a group, and 73.6% did not have personal hobbies. CONCLUSIONS: The layouts of buildings and surroundings are inappropriate for older people, and the opportunities for them to participate in social activities are limited. Health and social programmes and governmental and local policies for older people are needed, and public awareness about this issue should be raised.

The State of the Field: Results from the 2014 and 2017 Pediatric Rehabilitation Medicine Practice Surveys.

BACKGROUND: Childhood disability is on the rise and there is a national shortage of pediatric physiatrists in the United States. The 2009 Pediatric Rehabilitation Medicine Practice Survey identified concerns regarding inadequate geographic dispersion of providers, salary inequities, and limited academic competitiveness and external funding for research. OBJECTIVE: To describe the current state of the field of pediatric rehabilitation medicine. DESIGN: Survey of pediatric physiatrists in the United States in 2014 and 2017. SETTING: National. PARTICIPANTS: Pediatric physiatrists INTERVENTIONS: Not applicable. MAIN OUTCOME MEASUREMENTS: Characteristics; clinical activities, responsibilities, and comfort; academic activities; and salaries and productivity. RESULTS: In both 2014 and 2017, the majority of pediatric physiatrists who responded were women (~63%) and worked at an academic teaching hospital (~68%). Pediatric physiatrists most commonly held the title of assistant professor and were overrepresented in the Midwest. Overall, 55.8% of providers felt that access was adequate in their area whereas only 3.7% felt access was adequate across the country. In 2017, 52.5% of pediatric physiatrists participated in research or other scholarly activities with 44.2% reporting having published original research at some point in their careers. The inflation adjusted mean salary in 2014 ($227 360) was not statistically different than in 2017 ($232 634, P = .422). In both years, full professors reported the highest academic full-time salaries. Individuals having at least one leadership title also reported significantly higher average full-time salaries than individuals with no titles. CONCLUSIONS: Although gains have been made in terms of academic competitiveness and engagement in research in pediatric physiatry, there are areas of ongoing concern including large geographic practice variations with associated access to care problems, challenges with recruiting physicians to the field, and salary malalignment within the field of PM&R.

Image guidance used for large joint and bursa injections; a survey study.

Objectives: To determine the current rates of use of available image guidance modalities for large joint and bursal injections, in addition to their relationships to physician demographics.Methods: An electronic survey was sent to 3,400 members of the American Medical Society for Sports Medicine (AMSSM), examining types of guidance used for each large joint and bursal injection.Results: A total of 674 sports medicine physicians responded to the survey. Intra-articular hip and glenohumeral joint injections were more commonly performed with ultrasound guidance, while palpation-guidance was more common with all other injections. Physicians who specialized in Physical Medicine & Rehabilitation (PM&R) were more likely to use ultrasound for trochanteric bursa (p = 0.007, OR = 4.16 [1.46-11.8]), while internal medicine-, pediatrics-, and family medicine-trained physicians were more likely to use palpation guidance for at least one joint (p < 0.05). Physicians with fewer years of experience were more likely to use ultrasound for glenohumeral joint injections (p ≤ 0.002 for all age groups with less than 20 years of experience, ORs ranging from 6.3 to 9.2).Conclusion: Palpation-guidance is the most common technique used for large joint and bursal injections, other than for glenohumeral and hip joint injections. PM&R-trained physicians and those with less experience tend to use ultrasound more frequently.

The Archivesof Physical Medicine and Rehabilitation at 100: A Century of Authorship.

OBJECTIVE: To describe the authors who have contributed articles to the Archives of Physical Medicine and Rehabilitation (APM&R) over the 100 years of its existence. DESIGN: Extraction of relevant information from a sample of APM&R articles. SETTING: Not applicable. PARTICIPANTS: A total of 4933 authors contributing to 1787 articles. MAIN OUTCOME MEASURES: Number of authors and their gender, professional education, and country of residence. RESULTS: The average number of authors per article increased from 1.1 in 1922 to 5.8 in 2017. The percentage of women authors grew from <5% to about 40%. In 1922 the majority of authors had an MD degree (85%); this declined to <30% by 2017, while the percentage of authors with a PhD grew from about 10% to about 30%. The percentage of contributors with a bachelor's degree initially was about 1%, grew to 13%, and then declined again. While in APM&R's early years, >90% of authors were from the United States, this percentage went into a steep decline beginning in about 1997 and now is around 35%. CONCLUSIONS: The APM&R has seen major transformations in the nature of its contributors over a century of publication; many of these parallel the changes seen in other areas of health care and medical science, but some characteristics and shifts (especially in gender and level of training of its authors) appear unique.

Disparities in Health Care for Hispanic Patients in Physical Medicine and Rehabilitation in the United States: A Narrative Review.

In the United States, the number of people with Hispanic backgrounds is rapidly increasing. This growth, along with other factors, may put them at increased risk for healthcare disparities. Thus, physical medicine and rehabilitation should evaluate disparities in health services through the lens of the evidence base. To our knowledge, this is the first review describing the literature on healthcare disparities for Hispanic patients in the field of physical medicine and rehabilitation. This review explores healthcare utilization, risk factors, access, and health conditions specific to Hispanic populations. Articles used in this narrative review were collected for a 10-yr span (2009-2018) from online databases.Our findings highlight disparities across common conditions and injuries in the physical medicine and rehabilitation literature, including poststroke rehabilitation, hip fracture treatment and rehabilitation, spinal cord injury, and traumatic brain injury. Our review suggests that Hispanic patients may be at risk for worse outcomes after these conditions, because of low access to rehabilitation services and disparities in the referral process. Similar results are reported for pain management and Parkinson disease. As we strive to provide optimal care to an increasingly diverse patient population, researchers and clinicians must consider effects of race and ethnicity on access to and utilization of rehabilitation services.

Coexistence of malnutrition, frailty, physical frailty and disability in patients with COPD starting a pulmonary rehabilitation program.

BACKGROUND & AIMS: Malnutrition, frailty, physical frailty, and disability are common conditions in patients with chronic obstructive pulmonary disease (COPD). Insight in the coexistence and relations between these conditions may provide information on the nature of the relationship between malnutrition and frailty. Such information may help to identify required interventions to improve the patient's health status. We therefore aimed to explore whether malnutrition, frailty, physical frailty, and disability coexist in patients with COPD at the start of pulmonary rehabilitation. METHODS: For this cross-sectional study, from March 2015 to May 2017, patients with COPD were assessed at the start of a pulmonary rehabilitation program. Nutritional status was assessed with the Scored Patient-Generated Subjective Global Assessment (PG-SGA) based Pt-Global app. Frailty was assessed by the Evaluative Frailty Index for Physical activity (EFIP), physical frailty by Fried's criteria, and disability by the Dutch version of World Health Organization Disability Assessment Schedule 2.0 (WHODAS). These variables were dichotomized to determine coexistence of malnutrition, frailty, physical frailty, and disability. Associations between PG-SGA score and respectively EFIP score, Fried's criteria, and WHODAS score were analyzed by Pearson's correlation coefficient. Two tailed P-values were used, and significance was set at P < 0.05. RESULTS: Of the 57 participants included (age 61.2 ± 8.7 years), malnutrition and frailty coexisted in 40%. Malnutrition and physical frailty coexisted in 18%, and malnutrition and disability in 21%. EFIP score and PG-SGA score were significantly correlated (r = 0.43, P = 0.001), as well as Fried's criteria and PG-SGA score (r = 0.37, P = 0.005). CONCLUSIONS: In this population, malnutrition substantially (40%) coexists with frailty. Although the prevalence of each of the four conditions is quite high, the coexistence of all four conditions is limited (11%). The results of our study indicate that nutritional interventions should be delivered by health care professionals across multiple disciplines.

Association of Participation in the American Board of Physical Medicine and Rehabilitation Maintenance of Certification Program and Physician Disciplinary Actions.

OBJECTIVE: The study analyzed the relationship between participation in the American Board of Physical Medicine and Rehabilitation maintenance of certification program and the incidence of disciplinary actions by state medical boards over a physician's career. The hypothesis is that physicians who do not maintain their board certification have a higher likelihood of state medical board disciplinary actions. DESIGN: This retrospective cohort study analyzed American Board of Physical Medicine and Rehabilitation maintenance of certification data from all board-certified physiatrists who were enrolled in the American Board of Physical Medicine and Rehabilitation maintenance of certification program from 1993 to 2007. RESULTS: Matching examination and license data were available for 4794 physicians, who received a total of 212 disciplinary action reports through the Federation of State Medical Boards. The results showed that physicians who have a lapse in completing the American Board of Physical Medicine and Rehabilitation maintenance of certification program have a 2.5-fold higher incidence of receiving a disciplinary action report through the Federation of State Medical Boards (95% confidence interval = 1.76-3.63) and had higher severity violations (χ = 7.14, P < 0.05) than physicians whose certificate never lapsed. CONCLUSIONS: For physicians in physical medicine and rehabilitation, loss of board certification through failure to fulfill the maintenance of certification program requirements is associated with an increased risk of disciplinary action from a state medical licensing board.

The Struggle for Evidence in Physical and Rehabilitation Medicine: Publication Rate of Randomized Controlled Trials and Systematic Reviews Is Growing More Than in Other Therapeutic Fields.

OBJECTIVE: The aim of the study was to evaluate the rate of publication of randomized controlled trials, systematic reviews, and meta-analysis in physical and rehabilitation medicine and its variation over time. DESIGN: We performed a bibliometric study and searched PubMed from inception to 2017, using National Library of Medicine 3rd level MeSH terms ("rehabilitation," "physical therapy modalities," and "drug therapy") and filters ("randomized controlled trial," "systematic reviews," and "meta-analysis"). We used descriptive statistics, and we calculated the best-fitting regression model for all data considered. RESULTS: The absolute number of articles is growing in rehabilitation as much as in other treatment fields such as drug therapy. Whereas the rate of growth of publications for all studies relative to PubMed is bigger for drug therapies than for rehabilitation and physical therapy, the rate of growth of randomized controlled trials, systematic reviews, and meta-analysis is significantly greater for rehabilitation and physical therapy (P < 0.001). In 2017, 19.3% and 28.2% of the total production of scientific articles for rehabilitation and physical therapy (respectively) were for randomized controlled trials and systematic reviews versus 11.3% for drug therapy. CONCLUSIONS: Production of the highest form of research evidence (randomized controlled trials, systematic reviews, and meta-analysis) is continuously increasing in physical and rehabilitation medicine at a higher rate than in other treatment fields such as drug therapy. The quality and results of this evidence should be evaluated in future studies.

Geriatric Assessment in a Primary Care Environment: A Standardized Patient Case Activity for Interprofessional Students.

Introduction: Given the aging population and the benefits of comprehensive geriatric assessment to this subset of patients, an interprofessional education training approach may be advantageous for learners from a number of different health professions. Methods: Through intercollegiate collaborations involving seven different colleges, an interprofessional simulation using standardized patients was developed and instituted for learners in medicine, nursing, pharmacy, occupational therapy, physical therapy, dental hygiene, and dietitian programs. Herein, we describe the design of the simulation experience and examine its impact on students, as assessed primarily via written reflective comments provided via exit slips at the conclusion of the activity. Results: Of the 340 student participants, 83% submitted exit slips describing something gained from the interprofessional session that would not have occurred if students had completed the activity with only students from their own discipline. Three key themes were identified from these reflections: new understanding of roles and responsibilities of other disciplines, new knowledge or skills pertaining to geriatric assessments, and the value of teamwork. Discussion: Reflective comments from students regarding the interprofessional experience are evidence of this initiative's benefits, which include increasing knowledge of geriatric medical and allied health-provided care and attainment of interprofessional competencies.

State of the States: Growing Physiatry: Association of Academic Physiatrists Position Statement Addressing Academic Physiatry and Physical Medicine and Rehabilitation Growth.

The growth of physiatry in the United States is dependent on academic exposure at both the undergraduate and graduate medical education levels. Undergraduate medical education provides students with knowledge of physiatry, as well as proper understanding of human function, medical rehabilitation treatments, and of physiatrists as consultants. Graduate medical education contributes more directly to the total number of practicing physiatrists. This article presents disparities in medical student exposure to physiatry, physical medicine and rehabilitation residency positions, the number of practicing physiatrists, and physical medicine and rehabilitation-relevant patient care needs, by state. In the model, these disparities are highlighted to provide guidance and expose gaps/opportunities for targeted physiatric growth.

Basic bibliometrics for dummies and others: an overview of some journal-level indicators in physical and rehabilitation medicine.

This report aims to complement and update a series of papers published in the last decade on bibliometrics regarding journals related to physical and rehabilitation medicine (PRM). It targets clinicians and researchers (academic and non-academic) in our discipline who would like to use bibliometric indicators as a complementary "tool" to integrate into their expert practice of journal evaluation. Different journal-based metrics are analysed in order to provide a wide (albeit general) view of the performance of top PRM journals. First, we provide some brief preliminary remarks useful for an informed understanding of our results: 1) an update on bibliometric indicators and multidisciplinary databases of peer-reviewed literature; 2) the meaning of some bibliometric indicators; 3) the practical message related to this report: "keep it simple." Then, we profile the performance of 22 PRM core journals, according to six widely used bibliometric indicators. Indicators are grouped into three categories defined by their quartile classification (Three Star: top quartile; Two Star: second upper quartile; One Star: under the median). In conclusion, bibliometrics is just one of the key methods used for measuring the (supposed) 'impact' of scholarly publications and it represents only a raw proxy for the real impact or value of the research. This report wishes to add a small contribution for a simplified understanding of journal-level indicators in PRM, to support informed decisions on which high-level journals merit special attention by clinicians and researchers working in our discipline.

Conductas motoras funcionales y componentes cualitativos observables en el desarrollo motor de bebés entre 2 y 15 meses: consenso Delphi / Functional motor strategies and observable qualitative components in the motor development of infants aged 2 to 15 months. A Delphi consensus study

Introducción. Las escalas que evalúan desarrollo motor en lactantes con retraso del desarrollo motor o parálisis cerebral, en su mayoría no se ajustan al rango etario de este estudio, y/o no abordan la calidad del control motor y movimiento o estrategias asociadas. Objetivo. Identificar vía consenso, desde el modelo de neurodesarrollo, aspectos cualitativos del control motor, asociados al desarrollo postural y la funcionalidad, con el propósito de elaborar una escala de evaluación cualitativa del desarrollo motor para bebés entre 2 y 15 meses de edad, previamente pesquisados con retraso del desarrollo motor o diagnosticados con parálisis cerebral. Materiales y método. Treinta y un profesionales médicos, kinesiólogos y terapeutas ocupacionales, que cumplieron requisitos de selección, participaron en un consenso Delphi, constituido inicialmente por dos rondas de encuestas, con retroalimentación y codificación de conceptos mediante Atlas.ti, luego un panel de expertos que organizó la escala en su estructura y contenido, y finalmente una tercera ronda de consenso sobre estos, cuyos resultados se midieron a través de análisis de frecuencia. Resultados. Se identificaron variados componentes cualitativos del control motor observables clínicamente, seleccionando vía consenso, alineación, movimiento y base de soporte. Estos se integraron a la escala preliminar, elaborada para detectar conductas motoras funcionales del desarrollo motor de 2 a 15 meses y a sus estrategias cualitativas observables. Conclusiones. El consenso fue alcanzado en diferentes componentes cualitativos a observar en las estrategias típicas y atípicas en el desarrollo motor de lactantes, lo que permitiría incluir esta información en la construcción de una escala de evaluación cualitativa específica (AU)

Introduction. Currently, most scales that assess motor development in infants with developmental delay or cerebral palsy do not fit infants aged 2 to 15 months and/or do not address the quality of motor control and movement or associated strategies to perform a task. Objective. To identify through consensus and from a neurodevelopmental perspective, qualitative aspects of motor control associated with postural development and functionality, with a view to developing a qualitative assessment for motor development in infants aged 2 to 15 months, previously identified with developmental delay or diagnosed with cerebral palsy. Material and method. Thirty-one health professionals, including physicians, physiotherapists and occupational therapists, who met the selection criteria, participated in a Delphi consensus study, initially consisting of two rounds of surveys, with feedback and coding of concepts using the Atlas.ti software. Subsequently, an expert panel organised the structure and content of the scale. Finally, a third consensus round was conducted and the results were measured through a frequency analysis. Results. A variety of qualitative components of clinically-observable motor control were found. Alignment, movement and support base, selected through consensus, were integrated into a preliminary scale, developed to detect functional motor behaviour of motor development and observable qualitative strategies in infants aged 2 to 15 months. Conclusions. Consensus was reached on several qualitative components that can be observed in typical and atypical developmental strategies in infants, allowing the inclusion of this information in the design of a specific qualitative assessment scale (AU)