Physiotherapy students are underprepared to work with people living with dementia: a qualitative study.

OBJECTIVES: To 1) explore physiotherapy students' experience in caring for people with dementia; 2) develop a rich understanding of their perceived preparedness to work with people with dementia upon graduation; and 3) identify opportunities to improve dementia education from the perspectives of students. DESIGN: A qualitative study comprised of semi-structured interviews via web conferencing software. Thematic analysis was undertaken, with themes/subthemes derived and a qualitative framework generated. SETTING: Three Victorian Universities in Australia. PARTICIPANTS: Physiotherapy students of entry-to-professional practice education programs (n = 17; mean age 23.7 years, 65% female), having completed at least 15 weeks of clinical placements. RESULTS: The overarching theme was that students' experience of providing care for people with dementia was variable. The three sub-themes were: 1) students experience significant challenges when working with people with dementia, 2) students experience a range of emotions when working with people with dementia, and 3) the quality of dementia learning experiences during entry-to-professional practice training is mostly inadequate. Students described the importance of the supervisor during clinical placements, and suggested incorporating 'real-life' scenario training in the classroom to assist them learn to manage the challenging symptoms of dementia. CONCLUSION: Physiotherapy students believe that entry-to-practice dementia education is insufficient. These findings have important implications for the future planning and delivery of physiotherapy dementia education. CONTRIBUTION OF THE PAPER.

Accessibility in health professions education: The Flexner Report and barriers to diversity in American physical therapy.

Health professionals do not reflect the broader racial/ethnic diversity of the United States. Historical barriers to accessing health professions education have played a major role in initiating and perpetuating these disparities. Sociologists of professions have highlighted the role of educational reform in professions' efforts to enhance their status, but have overlooked the central role of government bodies in facilitating or impeding these strategies. The Flexner Report (1910) enhanced the status of medicine, but only after state medical boards adopted its recommendations, leading to the closure of half of the nation's medical schools and limiting opportunities for marginalized populations to enter the medical profession. Physical therapy leaders have espoused Flexner's precepts in seeking to advance their field's professionalization. In doing so, they consistently overlooked the more insidious impacts of Flexnerian approaches on student and practitioner diversity. This article examines how physical therapy's Flexnerian ambitions disrupted its parallel efforts to increase the field's racial/ethnic diversity. I argue that physical therapy leaders' focus on enhancing their profession's status and indifference toward facilitating educational access and mobility played a significant role in the field's racial/ethnic homogeneity. To increase practitioner diversity in the future, especially following the 2023 US Supreme Court decision (600 U.S. 181) restricting race conscious affirmative action, health professions must do more to address barriers to student access. This will involve moving away from the Flexnerian model and pursuing approaches that have helped more diverse and inclusive health professions, like nursing, to achieve greater educational opportunity and mobility.

Grado de implementación en España de las recomendaciones terapéuticas para la hipotonía de origen central según el consenso de expertos de la AACPDM / Degree of implementation in Spain of the therapeutic recommendations for hypotonia of central origin according to the consensus of experts of the American Academy for Cerebral Palsy and Developmental Medicine

Introducción: En la primera infancia existen diferentes condiciones y síndromes neurológicos que presentan hipotonía de origen central. La American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) elaboró una guía en 2019 sobre recomendaciones terapéuticas para esta población de 0 a 6 años, basadas en un consenso de expertos y en la evidencia científica. El objetivo de este estudio fue ver cómo esas recomendaciones terapéuticas se están implementando en España. Sujetos y métodos: Se realizó una encuesta a fisioterapeutas pediátricos que tratan niños con hipotonía central de 0 a 6 años a través de un cuestionario que constaba de 31 preguntas: 10 preguntas sobre datos sociodemográficos y relativos al ejercicio de la profesión, y las 21 restantes relacionadas con el uso de las recomendaciones terapéuticas basadas en la guía de la AACPDM dirigidas a niños con hipotonía de origen central. Resultados: A partir de una muestra de 199 fisioterapeutas, se pudo objetivar que el conocimiento de la guía de la AACPDM se asociaba de forma significativa con los años de experiencia clínica, el nivel de titulación y la comunidad donde ejercen.Conclusión: Esta guía puede servir para concienciar y unificar los criterios en cuanto al abordaje terapéutico de los niños con hipotonía central. Los resultados indican que, excepto algunas técnicas, la mayoría de las estrategias terapéuticas se está implementado en nuestro país en el marco de la atención temprana.

Introduction: In early childhood, there are a number of different neurological conditions and syndromes that present with hypotonia of central origin. In 2019, the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) drew up a set of guidelines on therapeutic recommendations for the population aged from 0 to 6 years, based on the consensus of experts and on scientific evidence. The aim of this study is to determine how those therapeutic recommendations are being implemented in Spain. Subjects and methods: A survey of paediatric physiotherapists treating 0-6-year-old children with central hypotonia was carried out by means of a questionnaire consisting of 31 questions: 10 questions on sociodemographic and practice-related data, and the remaining 21 related to the use of the therapeutic recommendations based on the AACPDM guidelines for children with hypotonia of central origin. Results: From a sample of 199 physiotherapists, it was found that familiarity with the AACPDM guidelines was significantly associated with the number of years of clinical experience, level of qualification and the community in which the professionals practise. Conclusion: These guidelines can serve to raise awareness and unify criteria regarding the therapeutic approach to children with central hypotonia. The results indicate that, with the exception of a few techniques, in our country most of the therapeutic strategies are being implemented within the framework of early care.(AU)

Evidence-based practice confidence and behavior throughout the curriculum of four physical therapy education programs: a longitudinal study.

BACKGROUND: Evidence-based practice (EBP) is a foundational process taught in health professional education, yet it is unclear when EBP confidence and skills are obtained. Increases in EBP confidence and behaviors from the start of physical therapy programs to post graduation have been reported in studies that evaluated a single program or used non-valid questionnaires. This study aimed to describe changes in EBP confidence and behavior using validated questionnaires of students from four physical therapy education programs throughout their curriculum and one year post graduation. METHODS: One hundred and eighty-one students from a potential pool of 269 (67.3%) consented to participate. Students completed the Evidence-Based Practice Confidence (EPIC) Scale and the Evidence-Based Practice Implementation Scale (EBPIS) at 6 timepoints: start of the program, prior to first clinical experience, after first clinical experience, at the end of classroom instruction, graduation, and one year post. Medians (Mdn) and 25th and 75th percentiles (P25, P75) were calculated for 42 (23.2%) students with complete data across all timepoints. Change between timepoints was assessed using Friedman's test and Wilcoxon signed rank test with a Bonferroni correction for post hoc analysis. RESULTS: There were significant changes in EPIC scores (p < 0.001) from enrollment (Mdn 50.0, P25, P75 35.5, 65.9) to prior to first clinical experience (Mdn 65.5, P25, P75 57.3, 72.5) and after the first clinical experience (Mdn 67.3, P25, P75, 58.9, 73.2) to the end of classroom instruction (Mdn 78.6, P25, P75, 72.0, 84.1). Significant increases on the EBPIS (p < 0.01) were only seen from after the first year of training (Mdn 15, P25, P75, 10.0, 22.5) to end of the first clinical experience (Mdn 21.5, P25, P75 12.0, 32.0). CONCLUSIONS: EBP confidence increased significantly after classroom instruction but remained the same after clinical experiences and at one year post graduation. EBP behavior significantly increased only after the first clinical experience and remained the same through graduation. Confidence and behavior scores were higher than were previously reported in practicing professionals. Ongoing assessment of EBP confidence and behavior may help instructors build appropriate curricula to achieve their outlined EBP objectives.

Physical therapists' perspectives of patient values and their place in clinical practice: a qualitative study.

BACKGROUND: In physical therapy practice patients and therapists exchange their perspectives on musculoskeletal health problems and their meaning for both of them. However, literature indicates that physical therapists find it difficult to enquire about the patients' values during clinical encounters. OBJECTIVES: The aim of this study was to gain deeper insight into the perspectives of physical therapists about patient values. DESIGN: Explorative qualitative focus group study. METHOD: Twenty-three physical therapists were interviewed in the Netherlands from March to May 2021. Two researchers analyzed the interviews and derived relevant codes. After an iterative process of comparing, analyzing, conceptualizing and discussing the codes, themes were identified through a thematic framework, illustrated with meaningful quotes. RESULTS: Three major themes were identified: Humane, Tacit, and Responsive. It appeared that patient values play unconsciously a major role in daily practice and are associated with humanity, not technical or procedural aspects of the encounter. Responsive denotes that all values require interaction in which aligning with the individual patient forms the basis of treatment. Barriers for being responsive are identified as subthemes: Choices, Trust, Diverseness, and Boundaries. CONCLUSION: The concept of patient values appeared to be implicit. The professional intuitively attunes as a fellow human being to values and expectations of the individual patient. This study contributes to finding a balance and mutual reinforcement of implicit and explicit knowledge. With all found experiences and insights the concept of patient values became more explicit in physical therapy to create a framework for education and research in the future.

Percepciones sobre la rehabilitación durante la pandemia por COVID-19 de las personas con discapacidad motora / People's perceptions with motor disabilities of rehabilitation during the COVID-19 pandemic

Antecedentes y objetivo: La Organización Mundial de la Salud declaró a la infección por COrona VIrus Disease 19 (COVID-19) como pandemia y recomendó, como medida preventiva, el distanciamiento social. Esto afectó a todos los tratamientos médico-clínicos, incluidos los relacionados con el proceso de rehabilitación física. El objetivo fue describir las percepciones sobre el proceso de rehabilitación debido a las modificaciones experimentadas por las personas con discapacidad motora de un hospital de rehabilitación durante la pandemia por COVID-19. Pacientes y métodos: Diseño cualitativo. La muestra elegida fue por conveniencia y el análisis de datos fue por análisis temático, el cual permite identificar, analizar y reportar temas relevantes. Las entrevistas se realizaron a pacientes atendidos en la División de Kinesiología. Criterios de inclusión: adultos> 18 años, diagnóstico de discapacidad motora, en tratamiento kinésico ≥ 1 mes de forma ambulatoria, con alta temprana de internación o internados en el momento de la realización del estudio y firma del consentimiento informado. Criterios de exclusión: alta kinésica por motivos diferentes a la COVID-19 y diagnóstico de enfermedad psiquiátrica. Resultados: La muestra se compuso de 16 participantes. El 31,2% era de sexo femenino. Doce presentaron diversas alteraciones neurológicas y 4, secuelas de amputación. Se identificaron 4 temas principales: importancia de la rehabilitación, modificaciones/interrupción del tratamiento, actividades de la vida diaria y telerrehabilitación. Conclusiones: Se describieron las percepciones sobre el proceso de rehabilitación y el impacto en las modificaciones experimentadas en las personas con discapacidad motora. Destacamos la importancia de la telerrehabilitación como un recurso alternativo.(AU)

Background and objective: The World Health Organization declared COrona VIrus Disease 19 (COVID-19) a pandemic and recommended social distancing as a preventive measure. This affected all medical–clinical treatments, including those related to the physical rehabilitation process. The objective was to describe the perceptions about the rehabilitation process due to the modifications experienced by people with motor disabilities in a rehabilitation hospital during the COVID-19 pandemic. Patients and methods Qualitative design. The sample chosen was for convenience and the data analysis was by thematic analysis, which allows to identify, analyze and report themes. The interviews were conducted with patients seen in the physiotherapy división of the hospital. Inclusion criteria: adults >18 years old, diagnosis of motor disability, undergoing physical treatment ≥1 month on an outpatient basis, with early discharge from hospitalization or hospitalization at the time of the study and signing of the informed consent. Exclusion criteria: physical discharge for reasons other than COVID-19 and diagnosis of psychiatric illness. Results: The sample consisted of 16 participants. 31.2% were female. Twelve presented various neurological alterations and 4 amputation effects. Four main themes were identified: importance of rehabilitation, treatment modifications/interruption, activities of daily living and tele-rehabilitation. Conclusions: Perceptions about the rehabilitation process and the impact on the modifications experienced in people with motor disabilities were described. We highlight the importance of tele-rehabilitation as an alternative resource.(AU)

Revisión sistemática y coste efectividad del tratamiento con abobotulinumtoxinA Para la espasticidad post-ictus en comparación con fisioterapia / Systematic review and cost-effectiveness analysis of the treatment of post-stroke spasticity with abobotulinumtoxinA compared to physiotherapy

Objective Post-stroke spasticity (PSS) is a common complication in stroke survivors, causing severe burden to patients living with it. The aim of this review was to conduct a cost-effectiveness analysis (CEA) of the treatment of post-stroke spasticity, in adults, with abobotulinumtoxinA compared to the best supportive care, based on results from a systematic literature review. Given that abobotulinumtoxinA (aboBoNT-A) is always accompanied by the best supportive care treatment, the CEA compared aboBoNT-A plus the best supportive care with the best supportive care alone. Methods A systematic literature review in EMBASE (including Medline and PubMed), Scopus, and other sources (Google Scholar) was conducted. Articles of all types, providing information on the costs and/or effectiveness measures for the current treatments of PSS in adults were included. The synthesis of information from the review provided the parameters for the design of a cost-effectiveness analysis of the mentioned treatment of interest. The societal perspective was compared to a perspective where only direct costs were observed. Results In total, 532 abstracts were screened. Full information was revised from 40 papers and 13 of these were selected as core papers for full data extraction. Data from the core publications formed the basis for the development of a cost-effectiveness model. In all the included papers physiotherapy was the best supportive care treatment (SoC)... (AU)

Antecedentes La espasticidad post-ictus es una enfermedad común que afecta a los adultos y causa una carga grave a los pacientes que la padecen. El objetivo de la revisión fue realizar un análisis coste-efectividad (ACE) del tratamiento de la espasticidad post-ictus, en adultos, con abobotulinumtoxinA (aboBoNT-A) en comparación con el tratamiento convencional, basado en los resultados de una revisión sistemática de la literatura. Dado que este tratamiento se proporciona siempre al mismo tiempo que el tratamiento convencional, el ACE se realizó del tratamiento aboBoNT-A con el tratamiento convencional, en comparación con recibir únicamente el tratamiento convencional. Métodos Se realizó una revisión sistemática de la literatura en EMBASE (incluyendo Medline y Pubmed), Scopus y otras fuentes (Google Scholar). Se incluyeron artículos de todo tipo que proporcionaran información sobre los costes y/o las medidas de efectividad de los tratamientos actuales del PSS en adultos. La síntesis de la información de la revisión proporcionó los parámetros para el diseño de un análisis coste-efectividad del mencionado tratamiento de interés. Se comparó la perspectiva social con una perspectiva donde solo se observaron los costes directos del tratamiento. Resultados Se revisaron un total de 532 resúmenes. Se revisó la información completa de 40 artículos y se seleccionaron 13 artículos para la extracción completa de datos. La información de estos documentos se sintetizó y utilizó para desarrollar un modelo de coste-efectividad. En todos los artículos incluidos se identificó el tratamiento con fisioterapia como el tratamiento convencional principal... (AU)

Características demográficas y clínicas de los pacientes sometidos a artroscopia del manguito rotador del hombro: estudio observacional / Demographic and clinical characteristics of patients undergoing rotator cuff arthroscopy of the shoulder: an observational study

Fundamentos: La causa más común de dolor de hombro son los cuadros clínicos relacionados con problemas del manguitorotador. Uno de los tratamientos más habituales es la cirugía artroscópica. El objetivo del estudio fue describir las característicasclínicas y epidemiológicas de los pacientes sometidos a este tipo de cirugías en España. Métodos: Se realizó un estudio de tipo descriptivo, observacional y de corte transversal con noventa participantes. Se recogieronlos datos de edad, sexo, realización de actividad laboral con sobreuso de miembros superiores (MMSS), índice de masa corporal (IMC),consumo de tabaco, diagnóstico de diabetes, realización de actividad física-deportiva y antecedentes de tratamientos prequirúrgicos.Finalmente, se realizó un análisis descriptivo de las variables y un análisis de correlaciones, mediante la prueba estadística de Pearson y Spearman según el tipo de variable.Resultados: La media de edad fue de 57,21 años con una desviación estándar (DE) de 8,5 (Intervalo de Confianza [IC] del 95%,55,41-59,00). En cuanto a su IMC, la media fue de 28,49 con una DE de 4,9 (IC del 95%, 27,49-29,53), siendo el 35,6% personas conobesidad (IMC mayor de 30). El diagnóstico médico de los sujetos fue en un 51,1% de rotura total del manguito rotador. Por otro lado,la intensidad de realización de actividad física fue de una hora o menos a la semana en el 87,8% de la muestra. Por último, en relacióncon el tratamiento previo de fisioterapia, el 69,7% de los sujetos habían recibido algún tipo de intervención. Conclusiones: Las características demográficas y clínicas encontradas están en consonancia con las de otras poblacionesestudiadas previamente, y los factores de asociación entre ellas refrendan los factores de riesgo ya señalados previamente (edad,obesidad, sobreuso de MMSS), cobrando especial importancia la edad avanzada.(AU)

Background: The most common cause of shoulder pain is clinical pictures related to rotator cuff problems. One of the mostcommon treatments is arthroscopic surgery. The objective was to describe the clinical and epidemiological characteristics of patientsundergoing this type of surgery in Spain. Methods: A descriptive, observational and cross-sectional study with ninety participants was carried out. Data on age, sex, perfor-mance of work activity with overuse of upper limbs, body mass index (BMI), smoking habit, diagnosis of diabetes, performance of physi-cal-sports activity and history of pre-surgical treatments were collected. Finally, a descriptive analysis of the variables and an analysis ofcorrelations were carried out, using the Pearson and Spearman statistical test according to the type of variable.Results: The mean age was 57.21 years with a standard deviation (SD) of 8.5 (95% CI, 55.41-59.00). Regarding their BMI, the meanwas 28.49 with a SD of 4.9 (95% CI, 27.49-29.53), with 35.6% being obese (BMI greater than 30). The medical diagnosis of the subjectswas 51.1% total rotator cuff tear. On the other hand, the intensity of physical activity was one hour or less per week in 87.8% of thesample. Finally, in relation to the previous physiotherapy treatment, 69.7% of the subjects had received some type of intervention. Conclusions: The demographic and clinical characteristics found are consistent with those of other previously studied populations,and the association factors between them endorse the previously mentioned risk factors, with advanced age gaining special importance.(AU)

Entrenamiento de equilibrio en la inestabilidad crónica de tobillo. Una revisión sistemática / Treino de equilíbrio na instabilidade crónica do tornozelo. Uma revisão sistemática. / Balance training in chronic ankle instability. A systematic review

Introducción: El objetivo de este trabajo es conocer la evidencia científica de los tratamientos centrados en el equilibrio en pacientes con inestabilidadcrónica de tobillo. Métodos: Se realizó una revisión de la literatura científica mediante una búsqueda sistematizada en febrero de 2022 en las siguientes bases de datos:PubMed, Scopus, PEDro, Web of Science, y Medline. Resultados: Se incluyeron ensayos clínicos aleatorizados en los últimos 5 años, obteniendo un total de 16 artículos para el análisis de esta revisiónsistemática. La calidad metodológica fue evaluada mediante la escala PEDro. Los principales resultados obtenidos mostraron mejoras en el equilibrioestático y dinámico en comparación con el grupo control. Sin embargo, en su mayoría, se muestran diferencias poco significativas entre gruposexperimentales. Conclusión: Los efectos que produce el entrenamiento de equilibrio en pacientes con inestabilidad crónica de tobillo parecen ser positivos.(AU)

Background: The aim of this work is to know the scientific evidence of treatments focused on balance in patients with chronic ankle instability. Methods: A review of the scientific literature was carried out by means of a systematized search in February 2022 in the following databases: PubMed,Scopus, PEDro, Web of Science, and Medline. Results: Randomized clinical trials in the last 5 years were included, obtaining a total of 16 articles for the analysis of this systematic review. Themethodological quality was evaluated using the PEDro scale. The main results obtained showed improvements in static and dynamic balance comparedto the control group. However, for the most part, insignificant differences between experimental groups were shown. Conclusion: The effects of balance training in patients with chronic ankle instability appear to be positive.(AU)

Introdução: O objectivo deste estudo é descobrir as provas científicas de tratamentos centrados no equilíbrio em pacientes com instabilidade crónica dotornozelo. Métodos: Foi realizada uma revisão da literatura científica através de uma pesquisa sistematizada em Fevereiro de 2022 nas seguintes bases de dados:PubMed, Scopus, PEDro, Web of Science, e Medline. Resultados: Foram incluídos ensaios clínicos aleatórios nos últimos 5 anos, obtendo-se um total de 16 artigos para a análise desta revisão sistemática. Aqualidade metodológica foi avaliada utilizando a escala PEDro. Os principais resultados obtidos mostraram melhorias no equilíbrio estático e dinâmicoem comparação com o grupo de controlo. No entanto, na sua maioria, foram mostradas diferenças insignificantes entre os grupos experimentais.Conclusão: Os efeitos do treino de equilíbrio em pacientes com instabilidade crónica do tornozelo parecem ser positivos.(AU)

Anatomic donor surgeries increase self-efficacy in physical therapy education: Use of live versus recorded viewing.

Anatomy serves as a foundational course in physical therapy education, but, due to its early placement in the curriculum, may have limited clinical application at that point of a student's education. Thus, augmenting a standard dissection course with surgical procedures can enhance the clinical relevance and knowledge of the anatomical structures involved in those surgeries. Doctor of Physical Therapy students viewed a variety of cadaveric orthopedic and cardiothoracic surgeries performed by a surgeon. Students unable to participate live viewed the recorded surgeries. Participants completed a 10-point Likert scale survey, developed by the researchers, pre- and post-viewing, on self-efficacy of knowledge, patient intervention and communication. Data analysis revealed improved self-efficacy of knowledge of the anatomy and the surgical procedures, confidence in treating patients undergoing those surgeries, and confidence communicating with surgeons, regardless of whether students viewed the surgeries live or recorded. Students participating in this experience expressed a clear value enhancement on their education. Programs should feel confident that this type of experience in the curriculum, whether live or recorded, will have a positive effect on student self-efficacy as related to the relationships and pertinence of anatomical structures involved in the surgeries, the surgical procedures, treating patients having undergone those surgeries, and interprofessional communication.

Barriers, facilitators and implementation strategies for guideline-adherence in physiotherapy: a scoping review protocol.

INTRODUCTION: Guideline-adherent physiotherapy can improve patient outcomes and reduce costs in the healthcare system. However, although there are numerous guidelines for physiotherapy practice, services are not consistently based on clinical practice guidelines. While various systematic and scoping reviews have highlighted barriers, facilitators and implementation strategies for guideline-adherent practice in other health professions, this scoping review aims to explore the barriers and facilitators for guideline-adherent physiotherapy and summarises the strategies used to implement such practice. METHODS AND ANALYSIS: This scoping review will be based on Arksey and O'Malley's scoping review methodology and the methodological guidance for conducting scoping reviews published by Joanna Briggs Institute. Relevant publications will be first searched from the beginning of June 2023 on the MEDLINE and CINAHL databases before we expand the search to other databases such as EMBASE, the Cochrane Library and PEDro at the end of June 2023. Two reviewers will independently screen the titles and abstracts of all retrieved citations for inclusion against the eligibility criteria before conducting an independent full-text screening. The criteria will be tested on a sample of abstracts before beginning the abstract review to ensure that they are robust enough to capture any articles that may relate. The extracted data will finally be collated and charted to summarise key findings regarding our research question. ETHICS AND DISSEMINATION: This scoping review will provide an extensive overview of the barriers, facilitators and implementation strategies for guideline-adherent physiotherapy. As scoping reviews are a form of secondary data analysis, ethical review is not required. Results will be disseminated through a peer-reviewed publication and stakeholder meetings. TRIAL REGISTRATION NUMBER: This scoping review has been registered on 3 April 2023 on the Open Science Framework under https://doi.org/10.17605/OSF.IO/SEUW6.

Rehabilitación domiciliara de pacientes con síndrome post UCI por COVID-19 / Home rehabilitation of patients with post ICU síndrome due to COVID-19

Objetivo: En marzo del año 2020, se declaró pandemia la enfermedad producida por el coro-navirus SARS-CoV-2 (COVID 19). Se estimaba inicialmente que el 5% de la población afectada por COVID-19 requeriría ingreso a unidades de cuidados intensivos con soporte de ventilación mecánica invasiva, pudiendo desarrollar secue-las a partir de la hospitalización. El equipo de rehabilitación domiciliaria se propone el desafío de realizar una serie de evaluaciones con la fi-nalidad de poder valorar la rehabilitación en el ámbito domiciliario.Método: Ensayo clínico no controlado de pa-cientes de la unidad de hospitalización domici-liaria que hayan sufrido COVID-19 con uso de VMI, entre junio 2020 y junio 2021. Ingresaron 193 pacientes, a los cuales se le realizó eva-luaciones al inicio y al final del proceso de re-habilitación por un equipo multidisciplinar en el domicilio del paciente.Resultados: Prevalencia de comorbilidades de hipertensión arterial y obesidad. en la forma grave de dicha enfermedad. Diferencia significa en todas las evaluaciones P (Wilcoxon)<0,001 entre el estado inicial y posterior a la rehabilita-ción, presencia de mayor deterioro en extremi-dades superiores.Conclusión: Pacientes con múltiples secuelas que requieren de la evaluación e intervención precoz de un equipo multidisciplinario, siendo la hospitalización domiciliaria una alternativa segura, eficiente y eficaz. Se logró el restable-cimiento de la deambulación segura e indepen-diente, la prevención de caídas, alimentación segura, recuperación de las destrezas cogniti-vas-comunicativas, y el empoderamiento de la familia en un contexto domiciliario. (AU)

Objective: In March 2020, the disease caused by the coronavirus SARS-CoV-2 (COVID-19) was declared a pandemic. It was initially esti-mated that 5% of the population affected by COVID-19 required admission to intensive care units with invasive mechanical ventilation sup-port, and may develop sequelae from hospitali-zation. The home rehabilitation team proposes the challenge of carrying out a series of evalua-tions in order to be able to assess rehabilitation in the home environment.Method: Uncontrolled clinical trial of patients from the home hospitalization unit who have suf-fered from COVID-19 with the use of IMV, be-tween June 2020 and June 2021. 193 patients were admitted, who underwent surgery at the beginning and at the end of the rehabilitation process for a multidisciplinary team at the pa-tient’s home.Results: Prevalence of comorbidities of arterial hypertension and obesity. in the severe form of this disease. Mean difference in all P (Wilcoxon) scores <0.001 between baseline and post-reha-bilitation status, presence of greater impairment in upper extremities.Conclusions: Patients with multiple sequelae that require early evaluation and intervention by a multidisciplinary team, home hospitalization being a safe, efficient and effective alternative. The restoration of safe and independent ambu-lation, the prevention of falls, safe eating, recov-ery of cognitive-communicative skills, and the empowerment of the family in a home context were achieved. (AU)

Rol enfermero en la prevención de muerte súbita del deportista y detección de enfermedades no conocidas / The nursing role in the prevention of sudden death in sports and detection of unknown diseases

Objetivo: identificar alteraciones cardiacas en deportistas de entre 3 a 17 años de las provincias de Granada y Almería (España). Método: estudio descriptivo transversal en 7.340 deportistas de clubes deportivos de Granada y Almería en el año 2021. Se les realizó un reconocimiento médico deportivo (RMD) obligatorio para la competición, llevado a cabo por un equipo multidisciplinar (Medicina, Enfermería, Fisioterapia) y acorde a las directrices de la European Society of Cardiology. Tras finalizar el RMD, el personal de Enfermería llevó a cabo una intervención educativa, facilitando consejos sobre la práctica deportiva y realizando el seguimiento de quienes requirieron una valoración por especialistas.Resultados: un 50% de la muestra (7.340) practicaba fútbol. Fueron detectados 52 deportistas con patologías cardiacas no conocidas (0,69%), que sumados a los 60 de quienes ya se conocía que tenían patologías cardiacas ascienden a un 1,5%. De las 52 personas de nueva detección, su edad media fue de 10,8, el 71,4% era hombre y el deporte más practicado fue el fútbol (67,3%). La patología cardiaca más frecuente detectada fue la inversión de la onda T (42,3%). Conclusiones: existe una baja prevalencia de enfermedades cardiacas, representando el 1,5% de la muestra. El RMD aplicado en población infantil y adolescente deportista es efectivo para detectar patología cardiaca. El personal de Enfermería tiene un papel relevante en los RMD para ayudar en la detección de patologías cardiacas y en la prevención de la muerte súbita del deportista, abarcando desde lo educativo, la supervisión del equipamiento, la valoración y el asesoramiento necesario a los deportistas.(AU)

Objectives: to detect cardiac alterations in 3-to-17-year-old sportsmen from the provinces of Granada and Almería (Spain).Method: a descriptive cross-sectional study conducted in 7,340 sportsmen from sports clubs of Granada and Almería in 2021. A sports medical examination (SME) was conducted, which was compulsory for the competition, by a multidisciplinary team (Medicine, Nursing, Physiotherapy) and according to the guidelines by the European Society of Cardiology. After completing the SME, the Nursing team conducted an educational intervention, providing advice about the sports practice and conducting follow-up for those who required assessment by specialists.Results: of the sample, 50% (7,340) played football. Fifty-two (52) sportsmen with not-known cardiac conditions were detected (0.69%); added to the 60 with already known cardiac conditions, they amounted to 1.5%. The mean age of the 52 persons with new detection was 10.8; 71.4% were male and the most practiced sport was football (67.3%). The most frequently detected cardiac condition was T-wave inversion (42.3%).Conclusions: there is a low prevalence of cardiac conditions, representing 1.5% of the sample. The SME applied in the population of child and adolescent athletes is effective in order to detect cardiac conditions. The Nursing staff plays a relevant role in SMEs to help detect cardiac conditions and in the prevention of sudden deaths in sports, including the educational aspect, equipment supervision, and the required assessment and counselling provided to sportsmen.(AU)

Fisioterapia precoz en transferencia del trapecio inferior para lesiones masivas e irreparables del manguito rotador. A propósito de un caso clínico / Early physiotherapy in lower trapezius transfer for massive and irreparable rotator cuff injuries. A case report

Las lesiones masivas e irreparables del maguito rotador son frecuentes entre la población mayor de 60 años. La transferencia del trapecio inferior con aloinjerto de tendón de Aquiles ha demostrado buenos resultados para restaurar la función del hombro. Para este tipo de cirugía, se recomienda inmovilización absoluta en abducción de hombro a 90° y rotación externa máxima entre 6-8 semanas. Mujer de 57 años intervenida quirúrgicamente con transferencia de trapecio inferior para reparar el manguito rotador por rotura masiva e irreparable. Inició fisioterapia acuática a los 15 días de la intervención, acompañada de tratamiento de fisioterapia convencional a los 25 días, con un seguimiento hasta los 12 meses. Se obtuvieron buenos resultados funcionales del hombro intervenido, que se mantuvieron en el seguimiento postoperatorio realizado. En este caso la fisioterapia precoz no supuso ningún riesgo de fallo de sutura, aflojamiento o destensado del injerto.(AU)

Massive and irreparable lesions of the rotator cuff are frequent between people over 60 years old. Recently, inferior trapezium transference with Achilles tendon allograft has demonstrated very good results to restore shoulder's function. For this kind of surgery, it is recommended an absolute immobilization in shoulder abduction at 90° and maximal external rotation between 6-8 weeks. A 57-year-old woman underwent surgery with a lower trapezius transfer to repair the rotator cuff due to a massive and irreparable tear. She started aquatic physiotherapy 15 days after surgery and conventional physiotherapy treatment at 25 days, with a follow-up of 12 months. Good functional results of the operated shoulder were obtained, which were maintained in the postoperative follow-up. In this case early physiotherapy did not result in any risk of suture dehiscence, loosen or distressing of the allograft.(AU)

Consenso nacional sobre los contenidos de Grado en Fisioterapia cardiorrespiratoria: estudio Delphi / National consensus on cardiorespiratory physiotherapy curricula in Bachelor's degree programs: A Delphi study

Antecedentes y objetivos El plan de estudios del Grado en Fisioterapia debe dar respuesta a las demandas de los usuarios de Fisioterapia en las principales áreas de su práctica profesional y preparar a los fisioterapeutas para actuar en un entorno complejo y cambiante. El objetivo del presente estudio es elaborar y validar un listado de conocimientos (syllabus) de Fisioterapia cardiorrespiratoria en el título de Grado. Material y métodos Estudio Delphi con tres rondas de consulta realizadas entre febrero y marzo de 2021, mediante encuesta digital. Para ello, se formó un grupo de 14 expertos en Fisioterapia cardiorrespiratoria, de toda España, con diferentes perfiles profesionales. Para establecer el grado de acuerdo en las diferentes rondas se empleó el índice estadístico Free-Marginal Multirater Kappa, siendo necesario al menos un 70% de consenso. Para analizar la estabilidad en las respuestas se empleó el estadístico Kappa de Cohen (K). Resultados Se obtuvieron un 100% de respuestas en las tres rondas de consulta realizadas. Al final del proceso se alcanzó un syllabus formado por 11 bloques temáticos, con 48 ítems, con un porcentaje medio de acuerdo del 90,64%, y una estabilidad en las repuestas de K=0,57 (p<0,001), lo que equivale a una concordancia moderada. Conclusiones El syllabus validado por un grupo de 14 fisioterapeutas expertos y expertas en Fisioterapia respiratoria y cardíaca define los contenidos que deberían formar parte del Grado en Fisioterapia para poder dar respuesta a las necesidades asistenciales en afecciones cardiorrespiratorias, en un contexto complejo y cambiante, acorde a una intervención contemporánea (AU)

Background and objectives The curricula of the Bachelor's degree in physiotherapy must respond to the current demands of physiotherapy clients in the main areas of their professional practice and prepare physiotherapists to act in a challenging and complex context. The aim of this study is to elaborate and validate a list of knowledge (syllabus) about cardiorespiratory physiotherapy in Bachelor's degree programs. Material and methods A digital survey conducted a three-round Delphi study between February and March 2021. A group of 14 experts in cardiorespiratory physiotherapy from all over Spain and with different professional profiles were contacted. To establish the degree of agreement in the consultation rounds, the free-marginal multirater kappa statistical index was used, requiring at least 70% of consensus. Cohen's kappa statistic (K) was used to analyze the responses’ stability. Results Hundred percentage of responses were obtained in the three rounds of consultation conducted with the expert panel. At the end of the process, a syllabus made up of 11 thematic sections and 48 items was reached. An average of 90.64% of agreement and a stability in the responses of K=0.57 (p<0.001), which equates to moderate agreement, was achieved. Conclusions This syllabus validated by 14 respiratory and cardiac physiotherapy experts, determines the contents that should be part of physiotherapy in Bachelor's degree programs. This knowledge is crucial to address the rehabilitation necessities of cardiorespiratory alterations in a challenging and complex context, according to a contemporary approach of physiotherapy (AU)

Relación terapéutica e influencia de la formación en la calidad de la misma en fisioterapeutas españoles: estudio observacional / 10.1016/j.ft.2022.11.005

Objetivo La relación terapéutica (RT) es determinante para el desarrollo y los resultados terapéuticos en fisioterapia. Se precisa formación del personal sanitario en métodos para llevarla a cabo. No se han encontrado publicaciones sobre la repercusión de este tipo de formación en la RT entre fisioterapeutas y pacientes. El objetivo fue evaluar las competencias de los fisioterapeutas españoles para el establecimiento de la RT y determinar si la realización de formación específica en RT influye en dicha relación. Métodos Estudio descriptivo transversal mediante encuesta electrónica a fisioterapeutas colegiados en España. Se incluyeron datos sociodemográficos, el cuestionario Working Alliance Inventory-Short (WAI-S) compuesto por 3 subescalas: establecimiento del vínculo y acuerdo en objetivos y tareas entre fisioterapeuta y paciente, y una pregunta dicotómica sobre la formación específica en RT de más de 5horas de duración. Resultados Participaron 264 fisioterapeutas. La puntuación más alta se obtuvo en la subescala vínculo y la más baja en metas. Las mujeres obtuvieron mayores puntuaciones en la subescala vínculo. Los fisioterapeutas con formación puntuaron más en todas las subescalas, y significativamente en la subescala metas. Una proporción mayor de mujeres realizó formación específica. Existe asociación directa entre la experiencia y las subescalas vínculo y tareas. No se encontraron diferencias significativas en los resultados del WAI-S en función de ninguna de las variables laborales analizadas. Conclusiones Los fisioterapeutas españoles tienen dificultades para establecer objetivos conjuntos. La formación específica en RT mejora todos los componentes del WAI-S, sobre todo la instauración conjunta de objetivos. Mayor experiencia profesional y ser mujer influye positivamente en una mejor RT (AU)

Objective The therapeutic relationship (RT) is determinant for the development and therapeutic results in physiotherapy. Training of health personnel in methods to carry it out is required. No publications have been found on the impact of this type of training on the RT between physiotherapists and patients. To evaluate the competencies of Spanish physiotherapists in establishing RT and to determine whether specific training in RT influences this relationship. Methods Cross-sectional descriptive study by means of an electronic survey of registered physiotherapists in Spain. We included sociodemographic data, the Working Alliance Inventory-Short (WAI-S) questionnaire composed of three subscales: establishment of the BOND and agreement on OBJETIVES and TASKS between physiotherapist and patient, and a dichotomous question on specific training in RT of more than 5h duration. Results A total of 264 physical therapists participated. The highest score was obtained in the subscale BOND, the lowest in GOAL. Women obtained higher scores on the BOND subscale. Physiotherapists with training scored higher on all subscales, and significantly higher on the GOAL subscale. A higher proportion of women undertook specific training. There was a direct association between experience and the subscales BOND and TASK. No significant differences were found in WAI-S scores as a function of any of the work variables analyzed. Conclusions Spanish physiotherapists have difficulties in establishing joint objectives. Specific training in RT improves all the components of the WAI-S, especially the joint establishment of objectives. More professional experience and being a woman have a positive influence on a better RT (AU)

Elaboración de un cuestionario sobre violencia(s) sufrida(s) por profesionales del ámbito de la Fisioterapia / Developing a questionnaire about violence(s) suffered by professionals in the field of Physiotherapy

FUNDAMENTOS: La violencia en el sector sanitario es un problema importante y con graves consecuencias. Se desconoce laprevalencia de la violencia en el ámbito clínico sobre los fisioterapeutas en España. El objetivo de este trabajo fue crear y validar unaherramienta para detectar casos de violencia sexual, física y psicológica y/o verbal ejercida por pacientes/acompañantes/familiaressobre la población de fisioterapeutas de España. MÉTODOS: A partir de la bibliografía disponible, se elaboró un cuestionario que fue analizado por un grupo de seis fisioterapeutasdel Consejo a cargo de la gestión y observación de la violencia sufrida por fisioterapeutas o profesionales destacadas en el movimien-toMe Too Fisio. Finalmente, se realizó una prueba piloto en una muestra de conveniencia de catorce fisioterapeutas. RESULTADOS: El cuestionario obtenido incluye preguntas sobre los hechos sufridos por los/las profesionales de esta disciplina,así como los principales datos del perfil de persona agresora (sexo, edad, condición mental, etc.), el contexto en el que la violencia esmás prevalente (campo laboral, tamaño del municipio, etc.) y las principales características del/de la profesional que sufre la violencia(sexo, edad, experiencia profesional, etc.). Además se recoge información sobre estrategias formales e informales utilizadas paraenfrentar la violencia y la percepción de su impacto. CONCLUSIONES: Una utilización anual de esta herramienta ayudará a valorar la exposición de este grupo de profesionales deforma específica y, también, la evolución en el tiempo de cada violencia por separado, con la finalidad de establecer políticas yprogramas formativos exitosos.(AU)

BACKGROUND: Violence in the health sector is a big problem and it has serious consequences. The prevalence of clinical violencesuffered by Spanish physiotherapists is unknown. The objective of this paper was to create and validate a tool in order to detect casesof sexual, physical and psychological and/or verbal violence in the Spanish physiotherapists. METHODS: A questionnaire was elaborated according to the available bibliography. It was analyzed by a group of six physiotherapistsin charge of the Union observation and management of violence or from Me-Too Fisio movement. Finally, a pilot test was carried out ona convenience sample of fourteen physiotherapists.RESULTS: The questionnaire obtained includes questions about the facts suffered by the professionals in this discipline, as wellas the main data on the profile of the aggressor (sex, age, mental condition…), the contexts where violence is more prevalent (clinicalfield, size of the population where the center is located…), and the main characteristics of the professional who suffers it (sex, age,professional experience…). Moreover, information about formal and informal strategies used to deal with violence and perception ofits impact, will be assessed. CONCLUSIONS: The annual use of this tool will allow the exposure of this group of professionals to be assessed specifically and,also, to assess the evolution over time of each violence separately for providing direction for successful policies and training.(AU)