Patients with longstanding psoriatic arthritis can achieve DAPSA remission or low disease activity and it correlates to better functional outcomes: results from a Latin-American real-life cohort

Abstract Background Patients with psoriatic arthritis (PsA) experience reduced physical function and impaired quality of life. Better patient-reported functional outcomes are found when lower disease activity is achieved. Objectives To evaluate the variation of physical function by HAQ-DI over time in PsA patients treated with standard therapy in a real-life setting: to verify predictors of achieving a minimum clinically important difference (MCID) in function by HAQ-DI (ΔHAQ-DI ≤ − 0.35) and to measure the impact of achieving REM/LDA on long-term function by HAQ-DI. Methods This is a longitudinal analysis of a real-life retrospective cohort. Data from PsA patients with at least 4 years of follow-up in the PsA clinic from 2011 to 2019 were extracted from electronic medical records. The variations of physical function by HAQ-DI and disease activity by DAPSA over time were calculated. A multivariate hierarchical regression model was applied to verify predictors of MCID in HAQ-DI. A comparison of HAQ-DI variation between patients with DAPSA REM, LDA, moderate and high disease activity was made using the generalized estimating equation model (GEE), adjusted by Bonferroni test. The Spearman correlation method was applied to verify the correlation of ΔDAPSA and ΔHAQ-DI over time. Statistical analysis was performed in SPSS program version 21.0. Results Seventy-three patients were included in the analysis. Physical function measured by HAQ-DI was determined by PsA disease activity measured by DAPSA (p < 0.000). A moderate and statistically significant correlation between ΔDAPSA and ΔHAQ-DI was observed (rs = 0.60; p < 0.001). Only patients in DAPSA REM demonstrated a constant decline in HAQ-DI scores during the follow-up. White ethnicity and older age at baseline were predictors for not achieving MCID in HAQ-DI [RR 0.33 (0.16-0.6795% CI p = 0.002) and RR 0.96 (0.93-0.9895% CI p < 0.000), respectively, while higher scores of HAQ-DI at baseline were predictors of achieving MCID [RR 1.71 (1.12-2.6095%CI p = 0.013)]. Conclusion In PsA, patients who maintained DAPSA REM/LDA over time had better long-term functional outcomes. Higher HAQ-DI scores at baseline, non-white ethnicity and younger age were predictors for achieving a clinical meaningful improvement of HAQ-DI.

Factors associated with delayed diagnosis of leprosy in an endemic area in Northeastern Brazil: a cross-sectional study / Fatores associados ao atraso no diagnóstico da hanseníase em área endêmica no Nordeste do Brasil: um estudo transversal / Factores asociados con el diagnóstico tardío de la lepra en un área endémica del Nordeste de Brasil: un estudio transversal

Abstract: This study aimed to investigate the factors related to the individual and the health system that contribute to delayed diagnosis of leprosy in an endemic area in the Northeastern Brazil. This is a cross-sectional study of 120 individuals with leprosy. Demographic and clinical data and information on the factors related to the individual and the health system that contribute to delayed diagnosis of leprosy were obtained. Delayed diagnosis in months was estimated for each participant by interviews. A multivariate Poisson's regression analysis was performed between the outcome and the independent variables. The median delay in the diagnosis of leprosy was 10.5 (4.0-24.0) months. Approximately 12.6% of participants had grade 2 disability (G2D) at the time of diagnosis. In the multivariate Poisson regression analysis, males, older age, low schooling level, residing in urban areas, multibacellar or tuberculoid leprosy, not seeking healthcare immediately after symptom onset, suspected leprosy, excessive referrals, and the need for three or more consultations to confirm the diagnosis were associated with longer diagnostic delay. This study found a significant delay in the diagnosis of leprosy in Arapiraca, Northeastern Brazil, which may explain the continuously high rate of G2D among new cases. Factors related to the individual and the health system were associated with longer diagnostic delay. Interventions to raise awareness of the disease among the general population and strengthen primary health care are urgently needed.

Resumo: Neste estudo objetivou-se investigar os fatores relacionados ao indivíduo e ao sistema de saúde que contribuem para o atraso no diagnóstico da hanseníase em uma área endêmica no Nordeste do Brasil. Trata-se de um estudo transversal que incluiu 120 pacientes com hanseníase. Foram obtidos dados demográficos, clínicos e informações sobre fatores relacionados ao indivíduo e ao sistema de saúde que contribuem para o atraso no diagnóstico da hanseníase. O atraso do diagnóstico em meses foi estimado para cada participante por meio de entrevistas. Foi realizada uma análise multivariada por regressão de Poisson entre o resultado e as variáveis independentes. A mediana de atraso no diagnóstico da hanseníase foi de 10,5 (4,0-24,0) meses. Aproximadamente 12,6% dos participantes apresentavam grau de incapacidade física 2 (GIF 2) no momento do diagnóstico. Na análise multivariada por regressão de Poisson, homens, idosos, baixa escolaridade, residir em área urbana, hanseníase multibacilar, hanseníase tuberculóide, não procurar atendimento imediatamente após perceber os primeiros sintomas, suspeita de hanseníase, encaminhamentos excessivos e três ou mais consultas necessárias para confirmação diagnóstica associaram-se ao maior atraso diagnóstico. Este estudo encontrou um atraso significativo no diagnóstico da hanseníase em Arapiraca, Nordeste do Brasil, o que pode explicar a taxa continuamente alta de GIF 2 entre os casos novos. Fatores relacionados ao indivíduo e ao sistema de saúde foram associados ao maior atraso no diagnóstico. Intervenções para aumentar a conscientização sobre a doença entre a população geral e fortalecer a atenção primária à saúde são urgentemente necessárias.

Resumen: El objetivo de este estudio fue investigar los factores relacionados con el individuo y el sistema de salud que contribuyen al diagnóstico tardío de la lepra en un área endémica del Nordeste de Brasil. Se trata de un estudio transversal que incluyó a 120 pacientes con lepra. Se obtuvieron datos demográficos, clínicos e informaciones sobre los factores relacionados con el individuo y el sistema de salud que contribuyen al diagnóstico tardío de la lepra. Se estimó el retraso del diagnóstico en meses para cada participante a través de entrevistas. Se realizó un análisis multivariante por regresión de Poisson entre el resultado y las variables independientes. La mediana de retraso en el diagnóstico de lepra fue de 10,5 (4,0-24,0) meses. Aproximadamente el 12,6% de los participantes tenían grado de discapacidad física 2 (GIF 2) en el momento del diagnóstico. En el análisis multivariante por regresión de Poisson se encontró que los hombres, ancianos, la baja escolaridad, vivir en área urbana, la lepra multibacilar, la lepra tuberculoide, no buscar atención médica inmediatamente tras notar los primeros síntomas, la sospecha de lepra, las derivaciones excesivas y la necesidad de tres o más consultas para confirmar el diagnóstico se asociaron con un mayor retraso del diagnóstico. Este estudio encontró un retraso significativo en el diagnóstico de la lepra en Arapiraca, Nordeste de Brasil, lo que puede explicar la tasa continuamente alta de GIF 2 entre los nuevos casos. Factores relacionados con el individuo y el sistema de salud se asociaron con el mayor retraso del diagnóstico. Intervenciones para aumentar la concienciación sobre la enfermedad entre la población general y fortalecer la atención primaria de salud son urgentemente necesarias.

Adaptación lingüística y cultural al español chileno del cuestionario de autovaloración vocal para cantantes Singing Voice Handicap Index (S-VHI)

Objetivo: Adaptar lingüística y culturalmente el cuestionario Singing Voice Handicap Index (SVHI) al español chileno. Metodología: Se realizó la traducción directa al español chileno del SVHI y posteriormente la retrotraducción al idioma original inglés; ambas traducciones fueron revisadas por un juicio de expertos bilingües, quienes definieron qué ítems conformarían la primera versión de la herramienta traducida. Esta versión fue respondida por 15 cantantes chilenos con diagnóstico de disfonía, con el objetivo de identificar discrepancias, las que fueron revisadas y consensuadas por el comité de expertos; una segunda versión modificada fue aplicada a 5 cantantes más con diagnóstico de disfonía, no encontrándose en esta fase preguntas incomprendidas o inapropiadas para la cultura chilena. Resultados: Se modificaron 5 de los 9 ítems cuestionados para llegar la versión final que refleja la versión original del inglés, tanto en la cantidad de ítems como en los dominios de la encuesta. Limitaciones: Por la cantidad de personas participantes, se pudo realizar solamente la adaptación cultural y no la validación del instrumento que considere puntajes de corte para la población estudiada. Por lo tanto, la herramienta puede ser usada para realizar un análisis cualitativo y no cuantitativo. Valor: Contar con esta encuesta traducida, siguiendo un proceso metodológico riguroso, permite que cantantes chilenos manifiesten su desventaja vocal relacionada con el canto, además de identificar los dominios más afectados y, de esa forma, planificar de manera más específica la intervención vocal. Conclusión: Se cuenta con el cuestionario Índice de desventaja en voz cantada para el español chileno para su aplicación al idioma y cultura chilena.

Purpose: To adapt the Singing Voice Handicap Index (SVHI) questionnaire linguistically and culturally to Chilean Spanish. Methodology: The SVHI was directly translated into Chilean Spanish and later back-translated into the original English language; both translations were reviewed by a judgment of bilingual experts, who defined which items would make up the first version of the translated tool. This version was answered by 15 Chilean singers with a diagnosis of dysphonia, with the aim of identifying discrepancies, which were reviewed and agreed upon by the committee of experts; a second modified version was applied to 5 more singers with a diagnosis of dysphonia, not finding misunderstood or inappropriate questions for Chilean culture at this stage. Results: 5 of the 9 items questioned were modified to reach the final version that reflects the original English version, both in the number of items and in the domains of the survey. Limitations: Due to the number of participating people, only the cultural adaptation could be carried out and not the validation of the instrument that considers cut-off scores for the population studied. Therefore, the tool can be used to carry out a qualitative and not quantitative analysis. Value: Having this survey translated, following a rigorous methodological process, allows Chilean singers to express their singing-related vocal disadvantage and identify the most affected domains and, thus, plan the vocal intervention more specifically. Conclusion: The Singing Voice Disadvantage Index questionnaire for Chilean Spanish is available for its application to the Chilean language and culture.

Corrélation of EQ-5D and mRS in ischémie stroke: a multicenter cross-sectional study

Introduction: Assessing Health-Related Quality of Life (HRQOL), in addition to evaluating functional status in stroke patients could complement clinician practice. Objective: To assess HRQOL, applying EuroQol-5-dimensions (EQ-5D) in Colombian patients with stroke and correlating its results with the modified Rankin Scale (mRS). Methods: Analytical cross-sectional study in a cohort of ischemic stroke patients in Colombia at three months as a median follow-up (Q1: 1- Q3:3) after their event. We correlated EQ-5D domains, EQ-5D index, mRS with EQ-5D VAS score. We generated a simple linear regression robust model to evaluate the variability between using r2. Results: A total of 91 patients completed the EQ-5D questionnaire, with a mean age of 71.2 years; 59.3% were male. We identified an inverse correlation between EQ-5D VAS and EQ-5D domains with the highest for mobility (rs = -0.69) and the lowest for pain/discomfort (rs -0.52, p<0.001). The r2 ranged from 0.25 (pain/discomfort) to 0.47 (EQ-5D index). Patients with mRS ≥ 3 significantly reduced their EQ-5D VAS score by 25.64 points (95% CI -33.04, -18.24). Variability in EQ-5D VAS scores occurred by EQ-5D index (47%) and by mRS (34%). Conclusions: The correlation between EQ-5D and mRS was favorable. Although EQ-5D and mRS evaluated different spheres on stroke patients, applying the EQ-5D instrument in real-world clinical settings might contribute multidimensional information on how life is affected after a stroke. This kind of information serves to orientate rehabilitation strategies on specific domains such as depression, self-care, anxiety, and pain. This is especially relevant for patients with disabilities (mRS ≥ 3).

Introducción: La evaluación de la Calidad de Vida Relacionada con la Salud (CVRS) y el estado funcional de pacientes con Ataque Cerebrovascular (ACV), podría complementar la práctica clínica. Objetivo: Evaluar la CVRS, aplicando EuroQol-5-dimensiones (EQ-5D) en pacientes colombianos con ACV y correlacionar sus resultados con la escala de Rankin Modificada (mRS). Métodos: Estudio de corte transversal analítico anidado a una cohorte de pacientes con ACV isquémico en Colombia con mediana de 3 meses de seguimiento (Q1: 1- Q3:3) post-ictus. Correlacionamos los dominios del EQ-5D, índice EQ-5D y mRS con la puntuación de EQ-5D VAS. Generamos un modelo de regresión lineal simple para evaluar la variabilidad usando r2. Resultados: Un total de 91 pacientes con una edad media 71,2 años; 59,3 % hombres. Se encontró correlación inversa entre los dominios EQ-5D, mayor para movilidad (rs = -0,69) y menor para dolor/malestar (rs -0,52, p < 0,001). El r2 osciló entre 0,25 (dolor/malestar) y 0,47 (índice EQ-5D). Los pacientes con mRS ≥ 3 redujeron significativamente su puntuación EQ-5D VAS en 25,64 puntos (IC 95%: -33,04; -18,24). La variabilidad en las puntuaciones EQ-5D VAS se produjo por el índice EQ-5D (47 %) y por mRS (34 %). Conclusiones: La correlación entre EQ-5D y mRS fue favorable. Aunque EQ-5D y mRS evalúan diferentes esferas en los pacientes con ACV, la aplicación del EQ-5D en podría aportar información multidimensional sobre cómo se afecta la vida después de un ictus, así como orientar estrategias de rehabilitación en esferas como depresión, autocuidado, ansiedad y dolor; especialmente relevante para pacientes con discapacidades (mRS ≥ 3).

Gravedad de accidentes cerebrovasculares para determinar síntomas osteomusculares en cuidadores familiares / Stroke severity to determine musculoskeletal symptoms in family caregivers / Gravidade do AVC e determinação dos sintomas musculoesqueléticos dos cuidadores familiares

Objetivo: el objetivo de este estudio es examinar la relación entre los problemas osteomusculares sufridos por cuidadores familiares que tienen a su cargo velar por pacientes que han sufrido un accidente cerebrovascular y los niveles de salud física y discapacidad. Método: los sujetos incluidos en el estudio eran pacientes y cuidadores familiares atendidos en la clínica de servicios ambulatorios de Fisioterapia y Rehabilitación del Hospital Universitario y de Investigación Kanuni Sultan Suleyman por diagnósticos de ACV entre el 30 de mayo de 2019 y el 30 de mayo de 2021. Los cuidadores fueron evaluados mediante el Extended Nordic Musculoskeletal Questionnaire. Se emplearon escalas validadas para evaluar los niveles de salud física y discapacidad de los sobrevivientes de accidentes cerebrovasculares. Resultados: los participantes de este estudio fueron 104 sobrevivientes de accidentes cerebrovasculares y 104 cuidadores que cumplieron con nuestros criterios de inclusión. Las quejas relacionadas con la región lumbar durante el último mes se asociaron con las puntuaciones obtenidas por los pacientes en el Functional Ambulation Score (FAS), la Functional Independence Measure (FIM) y la Stroke Impact Scale (SIS), además de las puntuaciones Brunnstrom. El dolor de cuello fue la segunda queja osteomuscular, aunque no se asoció estadísticamente con factores relacionados con los pacientes. Los problemas en las extremidades superiores se asociaron con las puntuaciones obtenidas en los instrumentos FAS, FIM, SIS, Brunnstrom y Modified Ashworth Scale. Conclusión: de acuerdo con nuestros hallazgos, la región lumbar es la parte del cuerpo más afectada por quejas osteomusculares en cuidadores familiares de sobrevivientes de accidentes cerebrovasculares, demostrando una estrecha relación con los niveles de capacidad funcional y discapacidad de los pacientes. Número de registro de ensayos clínicos: NCT04901637

Objective: the objective of this study is to examine the relationship between the musculoskeletal problems experienced by the family members who care for stroke patients, physical health and disability levels. Method: the subjects included in the study were patients and family caregivers admitted to the Kanuni Sultan Suleyman Training and Research Hospital Physical Medicine and Rehabilitation outpatient clinic with a stroke diagnosis between May 30 th, 2019, and May 30 th, 2021. The caregivers were assessed using the Extended Nordic Musculoskeletal Questionnaire. Validated scales were employed to evaluate stroke patients' physical health and disability level. Results: a total of 104 stroke patients and 104 caregivers who met our inclusion criteria took part in this study. Low back complaints in the last month were associated with the patients' Functional Ambulation Score (FAS), Functional Independence Measure (FIM), Stroke Impact Scale (SIS) and Brunnstrom scores. Neck pain was the second musculoskeletal complaint, but was not statistically associated with patient-related factors. Upper limb problems were associated with FAS, FIM, SIS, Brunnstrom and the Modified Ashworth Scale scores. Conclusion: according to our findings, the low back is the body area most affected by musculoskeletal complaints in family caregivers of stroke patients, closely related to the patients' functional capacity and disability levels. Clinical trials number: NCT04901637

Objetivo: o objetivo deste estudo é examinar a relação entre os problemas musculoesqueléticos vivenciados pelos familiares que cuidam de pacientes com AVC, a saúde física e o nível de deficiência do paciente. Método: foram incluídos no estudo pacientes e familiares cuidadores admitidos no hospital Kanuni Sultan Suleyman com diagnóstico de AVC entre 30 de maio de 2019 e 30 de maio de 2021. Os cuidadores foram avaliados utilizando o questionário Extended Nordic Musculoskeletal Questionnaire. Escalas validadas foram usadas para avaliar a saúde física e o grau de incapacidade dos pacientes com AVC. Resultados: um total de 104 pacientes com AVC e 104 cuidadores atenderam aos critérios de inclusão do estudo. As queixas lombares no último mês foram associadas aos escores do Functional Ambulation Score (FAS), Functional Independence Measure (FIM), Stroke Impact Scale (SIS) e teste de Brunnstrom do paciente. A dor no pescoço foi a segunda queixa musculoesquelética, mas não foi estatisticamente associada a fatores relacionados ao paciente. Os problemas nas extremidades superiores foram associados aos escores FAS, FIM, SIS, Brunnstrom e à Modified Ashworth Scale. Conclusão: e acordo com os nossos achados, a região lombar é a área do corpo mais afetada por queixas musculoesqueléticas nos cuidadores familiares de pacientes com AVC, que estão intimamente relacionadas ao nível de capacidade funcional e ao grau de incapacidade dos pacientes. Número do estudo clínico: NCT04901637.

Perfil funcional de pessoas com dores persistentes na coluna baseado na Classificação Internacional de Funcionalidade / Functioning profile of people with persistent back pain based on International Classification of Functioning

Traçar o perfil de funcionalidade de pessoas com dores persistentes na coluna por meio da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Trata-se de um estudo transversal com aplicação do método SCEBS (Somatic, Cognition, Emotion, Behavior and Social), Escala de catastrofização da dor, escala de cinesiofobia e percepção corporal. O discurso dos participantes foi analisado para identificação de conteúdos da CIF. O estudo incluiu 49 participantes com média de 25 anos. A partir do discurso foram identificadas 2.053 citações relacionadas a 108 diferentes categorias da CIF. As categorias mais identificadas foram: segmento vertebral lombar (s76002), funções relacionadas aos aspectos emocionais (b1522 e b152), cuidados da própria saúde (d570) e educação (d838). A catastrofização e cinesiofobia interferiram no perfil de funcionalidade dos participantes. As pessoas com dor persistente na coluna enfrentam prejuízos nas estruturas e funções corporais, limitação nas atividades e participação, fatores ambientais e pessoais.

To outline the functional profiles of individuals with persistent back pain using the International Classification of Functioning, Disability, and Health (ICF). This cross-sectional study employed the Somatic, Cognition, Emotion, Behavior, and Social (SCEBS) method, the Pain Catastrophizing Scale, the Kinesiophobia Scale, and body perception measures. The participants' discourses were analyzed to identify the content related to the ICF. This study included 49 participants with an average age of 25 years. From the discourse analysis, 2,053 citations related to 108 ICF categories were identified. The most frequently identified categories were the lumbar vertebral column (s76002), functions related to emotional aspects (b1522 and b152), self-care (d570), and education (d838). Catastrophizing and kinesiophobia influenced participants' functional profiles. Individuals with persistent back pain experience impairments in body structure and function, limitations in activities and participation, and environmental and personal factors.

Pruebas funcionales en esclerosis múltiple y su comparabilidad con los valores de administración autónoma: estudio piloto / Multiple sclerosis functional tests and their comparability with self-administered values: A pilot study

Introducción. El deterioro neurológico en la esclerosis múltiple es variable para cada paciente y su cuantificación se dificulta con el tiempo. El Multiple Sclerosis Outcome Assessment Consortium estableció medidas clínicas sensibles, costo-efectivas y reproducibles para medir los resultados de los estudios clínicos. Sin embargo, sus valores de referencia se desconocen y, en la atención habitual, su uso no está extendido por limitaciones de tiempo y entrenamiento. Objetivo. Establecer la factibilidad de la administración autónoma de las pruebas de marcha de 25 pies, símbolos y dígitos, y clavijas y nueve hoyos en individuos sanos. Materiales y métodos. Se realizó un estudio piloto descriptivo. Se incluyeron individuos sanos entre los 18 y los 80 años. Las pruebas de Timed 25-Foot Walking Test (T25-FWT) [caminata cronometrada de 25 pies], Symbol Digit Modality Test (SDMT) [símbolos y dígitos] y Nine-Hole Peg Test (9-HPT) [clavijas y nueve agujeros] fueron administradas por un médico capacitado, quien también instruyó a los sujetos sobre la administración autónoma de las pruebas. La correlación y la concordancia entre la prueba guiada y la autónoma se evaluaron con los coeficientes de Pearson y Spearman, y el análisis gráfico de Bland-Altman. Resultados. Se incluyeron 38 voluntarios sanos. La mediana de edad fue de 36 (rango: 23-55 años) y el 55,26 % eran mujeres. El coeficiente de correlación entre la prueba de administración guiada y la autónoma fue de 0,37 para la T25-FWT (p=0,01), de 0,54 para la SDMT (p<0,001) y de 0,64 y 0,65 para la 9-HPT, en las manos dominante y no dominante, respectivamente (p<0,001). Ambas formas de administración fueron concordantes para las pruebas T25-FWT (IC95%: -1,49 a 1,43), 9-HPT con la mano dominante (IC95%: -5,23 a 4,09), 9-HPT con la mano no dominante (IC95%: -7,75 a 7,14) y SDMT (IC95%: -20,94 a 24,10). Conclusiones. Los resultados de este estudio ayudan a determinar los valores de normalidad poblacional obtenidos con las pruebas T25-FWT, 9-HPT y SDMT; además, establecen la posibilidad de practicarlas de forma autónoma.

Introduction. Neurological impairment in multiple sclerosis is highly variable among patients and over time it is difficult to quantify. The Multiple Sclerosis Outcome Assessment Consortium established sensitive, cost-effective, clinically significant, and reproducible measures of different functional systems to measure outcomes in clinical trials. However, their use in clinical care routines is not widespread due to time and training constraints. Objective. To evaluate the self-administration feasibility of the timed 25-foot walking, symbol-digit-modality, and 9-peg hole tests in healthy individuals. Materials and methods. We performed a descriptive pilot study. Healthy individuals between 18 and 80 years of age were included. The Timed 25-Foot Walking Test (T25- FWT), the Symbol Digit Modality Test (SDMT), and the Nine-Hole Peg Test (9-HPT) (using the dominant and non-dominant hand) were administered by a trained physician, who also instructed the subjects about test self-administration. The correlation and agreement, between the guided and self-administered tests were assessed with Pearson and Spearman coefficients and the Bland-Altman method. Results. Thirty-eight healthy volunteers were included. The median age was 36 (range: 23-55) years old, and 55.26% were female. The correlation coefficient between guided and selfadministered tests was 0.37 for the T25-FWT (p=0.01), 0.54 for the SDMT (p<0.001), and 0.64 and 0.65 for the 9-HPT, in the dominant and non-dominant hands, respectively (p<0,001). Both forms of administration were concordant for the T25-FWT (95%CI: -1,49 to 1,43), the 9-HPT with dominant hand (95%CI: -5,23 to 4,09), the 9-HPT with non-dominant hand (95%CI: -7,75 to 7,14) and the SDMT (95% CI: -20,94 to 24,10). Conclusions. We provide a proof of concept related to the feasibility of the selfadministration of the T25-FWT, the 9-HPT, and the SDMT, as a tool to improve monitoring in routine clinical practice.

Validation of a Simple Instrument of Fast Application to Track Disability in Leprosy Patients / Validação de um instrumento simples e de aplicação rápida para rastrear incapacidade em pacientes com hanseníase

Abstract Objective To evaluate a simple and fast diagnostic instrument to be used by any health professional to track the disability presented by leprosy patients. Method Validation study of a diagnostic test performed in a sample of 156 leprosy patients to track functional disability through the shortened disabilities of arm, shoulder, and hand (QuickDASH) questionnaire. The simplified neurological assessment proposed by the World Health Organization was used as a reference. A receiver operating characteristic (ROC) curve was constructed to determine the cutoff point of QuickDASH that best discriminated patients with functional disability caused by leprosy. Results We identified 86 (55.5%) patients with functional disability by simplified neurological evaluation. The performance of the QuickDASH instrument showed that, at a cut-off point of 30 points, the sensitivity and specificity were 72.1% and 68.1% (accuracy of 70.3%), respectively, to identify functional disability, with a positive predictive value of 73.8%. Conclusion The QuickDASH instrument showed good accuracy to track functional disability in leprosy patients, and it may be useful in clinical practice of primary and general outpatient care, with the goal of identifying patients who need specialized reference for the prevention and treatment of this condition.

Resumo Objetivo Avaliar um instrumento diagnóstico simples e rápido a ser utilizado por qualquer profissional da saúde para rastrear a incapacidade apresentada por pacientes com hanseníase. Método Estudo de validação de teste de diagnóstico realizado em uma amostra de 156 pacientes com hanseníase para rastrear incapacidade funcional, por meio do questionário abreviado disabilities of arm, shoulder, and hand (QuickDASH). A avaliação neurológica simplificada proposta pela Organização Mundial da Saúde foi utilizada como referência. Construiu-se a curva de características operacionais do receptor (ROC) para determinação do ponto de corte do QuickDASH que melhor discriminou pacientes com incapacidade funcional provocada pela hanseníase. Resultados Foram identificados 86 (55,5%) pacientes com incapacidade funcional pela avaliação neurológica simplificada. O desempenho do QuickDASH mostrou que, em ponto de corte de 30 pontos, a sensibilidade e a especificidade foram de 72,1% e 68,1% (acurácia de 70,3%), respectivamente, para identificar incapacidade funcional, com um valor preditivo positivo de 73,8%. Conclusão O instrumento QuickDASH mostrou boa acurácia para rastrear incapacidade funcional no paciente com hanseníase, podendo ser útil na prática clínica da atenção básica e ambulatorial geral, com o objetivo de identificar pacientes que necessitam de referência especializada para sua prevenção e tratamento.

Evaluation of functionality and socioeconomic status of patients with chronic pain

SUMMARY OBJECTIVE: This study aimed to evaluate the influence of chronic pain on functionality and its consequences on work and patient income. METHODS: A total of 103 patients from the Multidisciplinary Pain Center of the Clinics Hospital of Universidade Federal de Minas Gerais were interviewed between January 2020 and June 2021, applying questionnaires on mobile devices. Socioeconomic data, multidimensional characterization of pain, and instruments for assessing pain functionality and intensity were analyzed. Pain intensity was categorized as mild, moderate, or intense for comparative analysis. Ordinal logistic regression was used to identify risk factors and variables that jointly influence the outcome of pain intensity. RESULTS: The patients had a median age of 55 years, were predominantly female, married or in a stable relationship, white race, and completed high school. The median family income was R$2,200. Most patients were retired due to disability and pain-related causes. Functionality analysis showed severe disability directly associated with pain intensity. The financial impacts observed were correlated with the pain intensity of the patients. Age was a risk factor for pain intensity, while sex, family income, and duration of pain served as protective factors. CONCLUSION: Chronic pain was associated with severe disability, decreased productivity, and exit from the labor market, with a negative impact on financial condition. Age, sex, family income, and duration of pain were directly associated with pain intensity.

Frecuencia de migraña y discapacidad generada en estudiantes de medicina humana de una universidad privada en Lima, Perú / Frequency of migraine and disability generated in medical students at a private university in Lima Peru

Objetivo : Estimar la frecuencia de migraña, y discapacidad generada en estudiantes de medicina de una universidad privada de Lima Metropolitana. Métodos : Estudio transversal en una muestra no probabilística por conveniencia, mediante la aplicación online del autocuestionario ALCOI-95, para evaluar la presencia de migraña, seguido por el cuestionario MIDAS para medir la discapacidad en los positivos al primer cuestionario. El rendimiento académico fue evaluado mediante el promedio ponderado de sus calificaciones. Resultados : Cuarenticinco (21,6%) de 208 estudiantes experimentaron migraña (12,5% con aura y 9,1% sin aura), 14 (33,3%) de los cuales mostraron discapacidad severa y 12 (28,6%) moderada. Los portadores de migraña con aura tuvieron una media menor del promedio ponderado acumulado de sus calificaciones, comparado con aquellos con migraña sin aura. Los factores independientemente asociados a la migraña fueron tener un miembro de la familia nuclear con migraña y problemas para mantener el sueño. Conclusión : Dos de cada 10 estudiantes presentaron migraña y 1/3 de los afectados experimentó discapacidad severa.

SUMMARY Objective: To estimate the frequency of migraine, associated factors and disability generated (including its relationship with academic performance) in medical students at a private university in Metropolitan Lima. Methods: Cross-sectional study in a non-probabilistic convenience sample using the online application of the ALCOI-95 self-questionnaire, to assess the presence of migraine, followed by the MIDAS questionnaire to measure disability in those positive to the first questionnaire. . Results: Fourty-five (21.6%) of 208 students experienced migraine (12.5% with aura and 9.1% without aura), 14 (33.3%) of whom showed severe, and 12 (28.6%) moderate disability. Migraine with aura carriers had a lower mean than the cumulative weighted average of their academic scores. Independent factors associated with migraine were to have a nuclear family member with migraine, and sleep-maintenance problems. Conclusion: Two out of 10 students had migraine, and one third of them had severe disability.

Functional disability and associated factors in older adults seen at a primary health care unit / Incapacidade funcional e fatores associados em idosos atendidos na atenção primária

OBJECTIVES: To assess functional disability and associated factors in older patients cared for at a large Brazilian urban area. METHODS: This is a cross-sectional study performed at a primary health care unit in the city of São Paulo, Brazil. Participants were selected via probabilistic sampling of 400 older individuals. We used a sociodemographic and health questionnaire along with instruments for assessing fear of falling (FES-I), cognitive function (MMSE), and depression symptoms (GDS-15). For dependent variables, we used instruments for assessing basic activities (BADL; Katz) and instrumental activities of daily living (IADL; Lawton). Factors associated with functional disability were analyzed via logistic regression models. RESULTS: The mean age of participants was 75.23 (SD = 8.53); 63.20% were female, 27.00% were dependent in BADL and 39.25%, in IADL. Older individuals with better cognitive function and who had not been hospitalized in the previous year were less prone to functional disabilities. Factors such as older age, more depression symptoms, and greater fear of falling were more linked to disabilities in BADL. Factors such as older age, female sex, and greater fear of falling were more linked to disabilities in IADL. CONCLUSIONS: The prevalence of disability in BADL and IADL in the studied sample was high. Modifiable and non-modifiable factors were associated with functional disability. These results may help primary health care professionals understand the risk factors for functional disability in the older population

OBJETIVOS: Avaliar a incapacidade funcional e fatores associados em pacientes idosos atendidos em um grande centro urbano brasileiro. METODOLOGIA: Estudo transversal realizado em uma Unidade Básica de Saúde na cidade de São Paulo, Brasil. A seleção dos participantes foi por meio de amostragem probabilística de 400 indivíduos idosos. Foi utilizado um questionário sociodemográfico, de saúde e instrumentos para avaliar medo de queda (FES-I), status cognitivo (MEEM) e sintomas depressivos (GDS-15). Para as variáveis dependentes, utilizou-se os instrumentos para avaliar as atividades básicas (ABVD; Katz) e atividades instrumentais de vida diária (Lawton; AIVD). Os fatores associados à incapacidade funcional foram analisados por meio de modelos de regressão logística. RESULTADOS: A média de idade dos participantes foi de 75,23 (DP = 8,53), 63,20% eram do sexo feminino, 27,00% eram dependentes para ABVD e 39,25% para as AIVD. Indivíduos idosos com melhor status cognitivo e que não estiveram internados no último ano eram menos propensos às incapacidades funcionais. Fatores como ter mais idade, mais sintomas depressivos e mais medo de queda eram mais propensos às incapacidades das ABVD. Fatores como ter mais idade, ser do sexo feminino e mais medo de queda foram mais propensos às incapacidades das AIVD. CONCLUSÕES: A prevalência de incapacidade para ABVD e AIVD na amostra estudada foi alta. Fatores modificáveis e não modificáveis foram associados à incapacidade funcional. Esses resultados podem ajudar os profissionais da atenção primária à saúde a entenderem os fatores de risco de incapacidade funcional na população mais velha

¿Basta con el habla? Evaluación del desarrollo del lenguaje en niños sordos prelocutivos durante los primeros seis años de vida. Una revisión sistemática / Is speech enough? Language development evaluation in the first 6 years of prelingually deaf children. A systematic review

RESUMEN Objetivo Sintetizar la información científica relevante sobre la evaluación del desarrollo del lenguaje en niños sordos prelocutivos durante los primeros seis años de vida, con el fin de determinar si es suficientes para confirmar la presencia de algún desarrollo de lenguaje en esta población, o si se requiere un enfoque más integral. Estrategia de investigación Se realizó una revisión estructurada de la literatura científica en las siguientes bases de datos: PubMed, Lilacs, Ibecs, Trip DataBase, Cochrane library, Clinical Trial y Nice. Criterios de selección revisiones sistemáticas, evaluaciones de tecnologías sanitarias, ensayos clínicos aleatorizados, estudios observacionales de cohorte y casos - controles; incluyendo publicaciones sobre evaluación de cualquier aspecto del desarrollo de lenguaje, cualquier intervención y en cualquier idioma, se excluyeron si únicamente evalúan audición o habla, sordera central, súbita, transitoria, sordoceguera, con otras discapacidades o con trastornos del espectro autista. Análisis de datos se usó la metodología GRADE para analizar la calidad de la evidencia. Resultados es factible realizar evaluaciones del desarrollo de lenguaje a niños sordos prelocutivos. Se obtiene una calidad de la evidencia moderada que sugiere cierta confianza en los resultados de las evaluaciones, siempre y cuando vengan acompañadas de una apreciación integral de otros elementos lingüísticos. Conclusión los resultados de las evaluaciones de lenguaje deben sostenerse, en mayor medida, en datos sobre el lenguaje receptivo y expresivo, y que cuyas evidencias pueden enriquecerse al adjuntar evaluaciones de elementos lingüísticos formales tanto de la modalidad oral como gestual, y de los componentes pragmáticos de los procesos comunicacionales.

ABSTRACT Purpose To synthesize the relevant scientific information regarding the assessment of language development in prelingually deaf children during their first six years of life, in order to determine whether it is sufficient to confirm the presence of some language development in this population, or if a more integrated approach would be more appropriate. Research strategies A structured review of the relevant scientific literature was carried out in the following databases: PubMed, Lilacs, Ibecs, Trip DataBase, Cochrane library, Clinical Trial and Nice. Selection criteria Systematic reviews, health technology assessments, randomized clinical trials, observational cohorts and case-control studies; including publications of assessments concerning any aspect of language development or any intervention in any language. Evaluations related exclusively to hearing and speech, to central, sudden or transient deafness, to deaf-blindness, to further disabilities or to autism spectrum disorders, were excluded. Data analysis GRADE methodology was used to analyze evidence quality. Results It is possible to evaluate the language development of prelingually deaf children. A moderate quality of evidence was obtained, suggesting that the evaluations' results are fairly trustworthy, provided that the assessments are conducted within an integrated approach of other linguistic elements. Conclusion The results of the language evaluations must be supported mostly by receptive and expressive language data, and the found evidence can be improved by combining the assessments of the formal linguistic elements of both oral and gestural modalities with the pragmatic components of the communication process.

Home care for the elderly with dementia: a systematic review / Atenção domiciliar ao idoso com demência: uma revisão sistemática

Abstract Objetive: With the global population aging, there is a growing need for home-based care to meet the health needs of the elderly. However, the quality of care provided to the aged population is now arguably a significant challenge for most healthcare systems worldwide. Methods: The present review included 13 original studies on home care and its effects on dementia patients, describing how patient care and adequate treatment can be collaborative for their improvement, for case management, and optimizing pain control and specificities. Results: Among the findings, it was evidenced that the environment impacts the form of care, once being at home can improve communication and global monitoring of dementia patients. Conclusion: In addition to the results analyzed in this review, there is a need for future, well-designed studies on the different aspects of home care, highlighting the importance of evaluating the type of care for each patient in the quest to optimize the care.

RESUMO Objetivo: Com o envelhecimento da população mundial, há uma necessidade crescente de cuidados domiciliares para atender às necessidades de saúde dos idosos. No entanto, a qualidade dos cuidados prestados à população idosa é hoje indiscutivelmente um grande desafio para a maioria dos sistemas de saúde em todo o mundo. Métodos: A presente revisão incluiu 13 estudos originais sobre cuidados domiciliares e seus efeitos em pacientes com demência, descrevendo como o cuidado e o tratamento adequado do paciente podem ser colaborativos para sua melhora, para o gerenciamento de casos e a otimização do controle de sua dor e especificidades. Resultados: Entre os achados, evidenciou-se que o ambiente impacta a forma de atendimento, pois estar em casa pode melhorar a comunicação e o acompanhamento global dos pacientes em quadro demencial. Conclusão: Além dos resultados analisados nesta revisão, há a necessidade de futuros estudos bem elaborados sobre os diferentes aspectos da atenção domiciliar, destacando a importância de avaliar o tipo de cuidado de cada paciente na busca de otimizar o cuidado.

Use of the Oswestry Disability Index in ankylosing spondylitis

SUMMARY OBJECTIVE: The Oswestry Disability Index is considered the gold standard in the evaluation of disability in patients with chronic mechanical back pain. The aim of this study was to assess the applicability of Oswestry Disability Index in patients with ankylosing spondylitis and its relationship with disease assessment parameters for ankylosing spondylitis. METHODS: A total of 100 patients diagnosed with ankylosing spondylitis were included in the study group. The control group consisted of 50 individuals with nonspecific low back pain. The Oswestry Disability Index and Bath Ankylosing Spondylitis Disease Activity Index were applied to both groups. In addition, the Visual Analog Scale, the Ankylosing Spondylitis Disease Activity Score C-Reactive Protein, the Ankylosing Spondylitis Disease Activity Score-the Erythrocyte Sedimentation Rate, the Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, and the Ankylosing Spondylitis Quality of Life scales were applied in the study group. the Erythrocyte Sedimentation Rate, C-Reactive Protein levels, and HLA-B27 analysis were noted as laboratory markers in ankylosing spondylitis patients. RESULTS: The scores of Oswestry Disability Index had a significant correlation with scores of Bath Ankylosing Spondylitis Disease Activity Index in ankylosing spondylitis patients (r=0.543) and in the control group (r=0.401). There was a significant correlation between the scores of Oswestry Disability Index and the Bath Ankylosing Spondylitis Functional Index (r=0.544), Bath Ankylosing Spondylitis Metrology Index (r=0.317), the Ankylosing Spondylitis Quality of Life (r=0.723), the Ankylosing Spondylitis Disease Activity Score-the Erythrocyte Sedimentation Rate (r=0.501), the Ankylosing Spondylitis Disease Activity Score C-Reactive Protein (r=0.530), Visual Analog Scale-Rest (r=0.476), and Visual Analog Scale-Activity (r=0.441) values in patients with ankylosing spondylitis. CONCLUSION: Evaluation of Oswestry Disability Index in conjunction with Bath Ankylosing Spondylitis Disease Activity Index may warn the physician to interpret high Bath Ankylosing Spondylitis Disease Activity Index scores in the context of mechanical pain. Therefore, the use of Oswestry Disability Index in patients with ankylosing spondylitis will be beneficial.

Relationship between chronic pain, depressive symptoms, and functional disability in community-dwelling older adults: mediating role of frailty

ABSTRACT Objective To evaluate the direct and indirect effects of chronic pain, depressive symptoms, frailty components, and functional disability through a pathway analysis approach in a sample of community-dwelling older adults. Methods Data of 419 participants were cross-sectionally evaluated for the presence of depressive symptoms (Geriatric Depression Scale [15 items]), physical frailty components (phenotype criteria), chronic pain, and limitations in performing instrumental activities of daily living (functional disability scale by Lawton and Brody). Structural equation modeling via path analysis was used to explore the direct and indirect effects among these four variables. Statistical significance was set at p<0.05. Results Of the total participants, 69.8% were women and 59.3% had low education (1-4 years); the mean age was 80.3±4.6 years. Chronic pain and depressive symptoms were directly related and were associated to frailty. The number of frailty components and depressive symptoms were directly associated with functional disability. Frailty had an indirect effect on the association between chronic pain, depressive symptoms, and functional disabilities. Conclusion The pathway from chronic pain and depressive symptoms to functional disability is potentially mediated by the number of frailty components.

Translation and cross-cultural adaptation of the Model Disability Survey (MDS) for Brazil / Tradução e adaptação transcultural do Model Disability Survey (MDS) para o Brasil

ABSTRACT OBJECTIVE This study has as objective the translation and cross-cultural adaptation of the Model Disability Survey (MDS), a World Health Organization instrument that provides comprehensive information on disability/functioning, for Brazil. METHODS This is a cross-sectional methodological study, carried out through five stages - initial translation, synthesis of translations, reverse translation, review by a specialist committee, and pre-test -, considering properties such as semantic, idiomatic, experimental, and conceptual equivalence. Translators, researchers, a mediating team, health professionals, a methodologist and a language specialist were needed to pass through the stages. Statistical analysis was produced from absolute and relative frequencies, measures of central tendency and dispersion, normality tests and content validity index (CVI) > 0.80. RESULTS The MDS has 474 items, which generated 1,896 analyzes of equivalence. Of these, 160 items had a CVI < 0.80 in at least one of the four types of equivalence and required adjustments. After adaptations and approval by the judges, the pre-final version went on to the pre-test with 30 participants from four regions of the Brazilian Northeast. Regarding this sample, 83.3% are women, single, with an average age of 33.7 years (SD 18.8), self-declared as black or brown, active workers, with technical education and living with three residents. Interviews lasted 123 minutes on average, where 127 health conditions were mentioned, and the most frequent cited were anxiety and back pain. Answers were analyzed and 63 items were cited as needing some adjustment, two of which were submitted for analysis by the committee because they presented a CVI < 0.80. The instrument, guide and presentation cards were adjusted after a new pre-test. CONCLUSIONS The MDS was translated and cross-culturally adapted to Brazilian Portuguese and showed adequate content validity.

RESUMO OBJETIVO Traduzir e adaptar transculturalmente o Model Disability Survey (MDS), instrumento da Organização Mundial da Saúde que fornece informações abrangentes a respeito de deficiência/funcionalidade, para o Brasil. MÉTODOS Trata-se de um estudo metodológico de corte transversal, realizado por meio de cinco etapas - tradução inicial, síntese das traduções, retrotradução, revisão por comitê de especialistas e pré-teste -, considerando propriedades como equivalência semântica, idiomática, experimental e conceitual. Para realização das etapas foram necessários tradutores, pesquisadores, equipe mediadora, profissionais da saúde, metodologista e especialista em idiomas. A análise estatística foi produzida a partir de frequências absolutas e relativas, medidas de tendência central e dispersão, testes de normalidade e índice de validade de conteúdo (IVC) > 0,80. RESULTADOS O instrumento MDS apresenta 474 itens, o que gerou 1.896 análises de equivalências. Destes, 160 itens apresentaram IVC < 0,80 em pelo menos uma das quatro equivalências e necessitaram de ajustes. Após adequações e aprovação dos juízes, a versão pré-final seguiu para o pré-teste com 30 participantes, de quatro regiões do Nordeste brasileiro. Desta amostra, 83,3% são mulheres, solteiras, com idade média de 33,7 (DP 18,8) anos, autodeclaradas pretas ou pardas, trabalhadoras ativas, com escolaridade a partir do ensino técnico e que residiam com três moradores. O tempo médio das entrevistas foi de 123 minutos de duração. Foram mencionadas 127 condições de saúde, sendo as mais frequentes ansiedade e dores nas costas. As respostas foram analisadas e 63 itens foram citados como necessitando de algum ajuste, sendo dois destes encaminhados para análise pelo comitê por possuírem IVC < 0,80. O instrumento, manual e cartões de apresentação foram ajustados após um novo pré-teste. CONCLUSÕES O MDS foi traduzido e adaptado transculturalmente para o português brasileiro e apresentou adequada validade de conteúdo.

Adaptação transcultural e análise da confiabilidade da versão brasileira do questionário de reabilitação para o trabalho - WORQ / Cross-cultural adaptation and reliability analysis of the Brazilian version of the Work Rehabilitation Questionnaire (WORQ)

Resumo Introdução O Work Rehabilitation Questionnaire (WORQ) é um instrumento internacional baseado na Classificação Internacional de Funcionalidade, Incapacidade e Saúde para avaliar a capacidade funcional em pessoas com deficiência para o trabalho. Objetivo Realizar adaptação transcultural e análise da confiabilidade para a população brasileira. Métodos A adaptação transcultural consistiu em tradução, síntese das traduções, retrotraduções, análise do comitê de juízes, pré-teste e teste piloto. Os resultados foram obtidos pelo cálculo da taxa de concordância para equivalência semântica, idiomática, experiencial e conceitual. A confiabilidade foi testada por análise de estabilidade, equivalência e consistência interna por meio do cálculo de α-Cronbach e Coeficiente de Correlação Intraclasse (ICC). Resultados Participaram da primeira etapa 05 tradutores, 08 juízes e 14 possíveis usuários no pré-teste. A taxa de concordância foi menor que 90% apenas na equivalência idiomática, resultando em ajustes ortográficos sem alterar o construto do instrumento. A confiabilidade foi testada em 34 trabalhadores com deficiência, idade média de 40,3 (±4,2) anos, ambos os sexos, funcionários de uma instituição de ensino de São Paulo inseridos pela lei de cotas (8.213/91). A Consistência Interna apresentou valores superiores a 80% em todos os domínios e foi maior que 90% para o escore total. Após 15 dias da primeira avaliação, foram sorteados 20 desses participantes para reavaliação. O ICC para estabilidade foi 82,5% (p=0,008) e equivalência foi 95,4% (p<0,001). Conclusão O questionário WORQ foi traduzido e adaptado transculturalmente para o português brasileiro e apresentou confiabilidade para responder aos domínios da CIF. A versão brasileira está disponível na home page do WORQ, no endereço eletrônico http://www.myworq.org/questionnaire_en.php.

Abstract Introduction The Work Rehabilitation Questionnaire (WORQ) is an international instrument, based on the International Classification of Functioning, Disability and Health (ICF), used to assess the functional capacity of people with work disabilities. Objective To perform a cross-cultural adaptation and a reliability analysis of this instrument for the Brazilian population. Method The cross-cultural adaptation consisted of translation, synthesis of translations, back translations, analysis by the committee of judges, pre-test, and pilot test. The results were obtained by calculating the agreement rate for semantic, idiomatic, experiential, and conceptual equivalence. Reliability was tested by analysis of stability, equivalence, and internal consistency by calculating Cronbach's Alpha and Intraclass Correlation Coefficient (ICC). Results Five translators, eight judges, and 14 possible users in the pre-test participated in the first stage. The agreement rate was <90% only for idiomatic equivalence, resulting in orthographic adjustments without changing the instrument construct. The reliability was tested on 34 workers with disabilities, with a mean age of 40.3 (±4.2) years, of both sexes, employees of an educational institution in the state of São Paulo, Brazil, hired through the Quotas Law (8,213/91). The internal consistency showed values >80% in all domains and was >90% for the total score. Fifteen days after the first assessment, 20 of these participants were randomly selected for reassessment. The ICC values for stability and equivalence were 82.5% (p=0.008) and 95.4% (p<0.001), respectively. Conclusion The WORQ was translated and cross-culturally adapted to Brazilian Portuguese and reliably responded to the ICF domains. The Brazilian version of the WORQ is available at http://www.myworq.org/questionnaire_en.php.

Descripción de la discapacidad y sus determinantes en personas con hemiparesia/hemiplejia del suroccidente de Colombia / Description of disability and its determinants in people with hemiparesia/hemiplegia in southwestern of Colombia / Descrição da deficiência e seus determinantes em pessoas com hemiparesia/hemiplegia do sul ocidente da Colômbia

Resumen Objetivo: el propósito del estudio fue conocer el grado de discapacidad y sus determinantes socioeconómicos, clínicos y de acceso a los servicios de salud y rehabilitación en personas con hemiplejía o hemiparesia en la ciudad de Popayán, Cauca. Metodología: estudio descriptivo, correlacional y transversal. Participaron 52 personas mayores de edad, con hemiplejia o hemiparesia. Se aplicó el cuestionario de evaluación de la discapacidad WHODAS 2.0. Resultados: El 100 % de las personas estudiadas tiene discapacidad, el promedio total de discapacidad fue de 44,7 %, correspondiente a discapacidad moderada. Los participantes mostraron dificultades en todos los dominios de funcionamiento, con dificultad moderada en los dominios cognición, cuidado personal, actividades cotidianas y dificultad severa para movilidad y participación. Conclusión: la hemiparesia y hemiplejia provocan discapacidad en diferentes grados de severidad, determinada por el estado patológico y la interacción e influencia de múltiples factores socioeconómicos, clínicos y de acceso a los servicios de salud y rehabilitación.

Abstract Objective: The purpose of the study was to determine the degree of disability and its socioeconomic and clinical determinants as well as the access to health and rehabilitation services in people with hemiplegia or hemiparesis in the city of Popayán, Cauca, Colombia. Methodology: descriptive, correlational and cross-sectional study. The sample consisted of 52 people of legal age, with a diagnosis of hemiplegia or hemiparesis. The WHODAS 2.0 disability assessment questionnaire was applied. Results: A hundred percent of the people studied had a disability, and the disability average total was 44.7%, corresponding to moderate disability. The participants showed difficulties in all domains of functioning, with moderate difficulty in the cognition, personal care and daily activities domains, and severe difficulty with mobility and participation. Conclusions: Hemiparesis and hemiplegia cause disability in different degrees of severity determined by the pathological state and the interaction and the influence of multiple socioeconomic, clinical factors and access to health and rehabilitation services.

Resumo Objetivo: o propósito do estudo foi conhecer o grau de deficiência e seus determinantes socioeconômicos, clínicos e de aceso aos serviços de saúde e reabilitação em pessoas com hemiplegia ou hemiparesia na cidade de Popayán, Cauca. Metodologia: estudo descritivo, correlacional e transversal. Participaram 52 pessoas maiores de idade, com hemiplegia ou hemiparesia. Aplicou-se o questionário de avaliação da deferência WHODAS 2.0. Resultados: O 100 % das pessoas estudadas tem deficiência, a média total de deficiência foi de 44,7 %, correspondente à deficiência moderada. Os participantes amostraram dificuldades em todos os domínios de funcionamento, com dificuldade moderada nos domínios cognição, cuidado pessoal, atividades cotidianas e dificuldade severa para mobilidade e participação. Conclusão: a hemiparesia e hemiplegia provocam deficiência em diferentes graus de severidade, determinada pelo estado patológico e a interação e influência de múltiplos fatores socioeconômicos, clínicos e de aceso aos serviços de saúde e reabilitação.

Implantação de um protocolo de avaliação e acolhimento baseado na Classificação Internacional de Funcionalidade, Incapacidade e Saúde em um centro especializado de reabilitação / Implementation of an assessment and user embracement protocol based on the International Classification of Functioning, Disability and Health in a specialized rehabilitation center

O Protocolo de Levantamento de Problemas para a Reabilitação (PLPR) é um instrumento de triagem baseado no modelo da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF), que sistematiza o acolhimento e possibilita a formação de bancos de dados sobre as demandas funcionais dos usuários de serviços de reabilitação. Objetivo: Relatar e analisar a partir da percepção dos profissionais o processo de implantação do PLPR em uma Unidade de Tratamento Neurológico Adulto de um Centro Especializado de Reabilitação (CER II). Métodos: Trata-se de uma pesquisa descritiva exploratória do tipo qualitativa. Para coleta dos dados foram utilizadas informações documentais e um grupo focal, adotado para compreender a percepção dos profissionais sobre as mudanças no processo de triagem após implementação do PLPR. Utilizou-se como ferramentas de processamento dos dados o software IRAMUTEQ. Resultados: A classificação hierárquica descendente apresentou cinco categorias temáticas de análise: Fluxo e Rede; Acolhimento e Cuidado; PLPR; Triagem; Reabilitação. Conclusão: A falta de uma rede de cuidados à pessoa com deficiência constituída e consolidada foi apontada como uma barreira importante que influencia o processo de reabilitação. A equipe demonstrou compreender a necessidade de reformular os atendimentos, através do modelo conceitual da CIF. Ressaltando que a aplicação do PLPR foi a primeira ação de estruturação deste modelo no serviço, todavia, não houve um consenso se o uso do instrumento promoveu um atendimento mais próximo deste modelo.

The Protocol for Identification of Problems for Rehabilitation (PLPR) is a screening tool based on the International Classification of Functioning, Disability and Health (ICF) model, which systematizes the reception and enables the formation of databases on the functional demands of users of rehabilitation services. Objective: Report and evaluate, from the perception of professionals, the process of implementing the PLPR in an Adult Neurological Treatment Unit of a Specialized Rehabilitation Center (CER II). Methods: This is a descriptive exploratory qualitative research. For data collection, documentary information and a focus group were used to understand the perception of professionals about the changes in the triage process after the implementation of PLPR. IRAMUTEQ software was used as data processing tools. Results: The descending hierarchical classification presented five thematic categories of analysis: Flow and Network; Reception and Care; PLPR; Triage; Rehabilitation. Conclusion: The lack of a consolidated care network for people with disabilities was pointed out as an important barrier that influences the rehabilitation process. The team showed an understanding of the need to reformulate care through the ICF conceptual model. It is noteworthy that the application of the PLPR was the first action to structure this model in the servisse, however, there was no consensus whether the use of the instrument promoted a care closer to this model.

Tracking the impact of multiple sclerosis on employment status: the development of a questionnaire / Avaliação do impacto da esclerose múltipla na situação laboral: desenvolvimento de um questionário

Abstract Background Multiple sclerosis (MS) has a negative effect on employment status. Objective To present the preliminary results of a special questionnaire designed to collect employment information on patients with MS. Methods The questionnaire on the impact of MS on employment status was completed by 63 patients. Fatigue, cognition, and depression were also evaluated, and 33 healthy participants were recruited as a control group. Results Regarding the patients' employment status, we found rates of 31.7% of fulltime employment, 28.6% of part-time employment, 7.9% of unemployment due to MS, 4.8% of housewives, 1.6% retirement due to age, 15.9% of retirement due to disability, 7.9% of medical leave due to MS, and 1.6% of medical leave for other reasons. The rate of unemployment among the patients was significantly higher compared with that of the control group. Out of 38 working patients, 31% had been absent from work for the previous 3 months due to MS, and 50% had to make changes in their work to remain employed. Out of the 19 unemployed patients, 78% said that walking difficulties were the cause of unemployment, while 52% thought cognitive impairment was the cause. Conclusions The questionnaire provides a record of the employment status of patients with MS and describes the impact on work from their point of view.

Resumo Antecedentes A esclerose múltipla (EM) tem um efeito negativo na situação laboral. Objetivo Apresentar os resultados preliminares de um questionário elaborado para coletar informações sobre a situação laboral de pacientes com EM. Métodos O questionário sobre o impacto da EM na situação laboral foi preenchido por 63 pacientes. Fadiga, cognição e depressão também foram avaliadas, e 33 pacientes saudáveis foram incluídos como grupo controle. Resultados Quanto à situação laboral dos pacientes, foram encontradas taxas de 31,7% de emprego em tempo integral, 28,6% de emprego em meio período, 7,9% de desemprego por EM, 4,8% de donas de casa, 1,6% aposentadoria por idade, 15,9% de aposentadoria por invalidez, 7,9% por licença médica por EM, e 1,6% de licença médica por outros motivos. A taxa de desemprego entre os pacientes foi significativamente mais alta em comparação coma do grupo controle. Dos 38 pacientes empregados, 31% tiveram que se afastar do trabalho nos 3 meses anteriores por causa da EM, e 50% tiveram que fazer mudanças em seu trabalho para permanecer empregado. Dos 19 pacientes desempregados, 78% mencionaram que as dificuldades de locomoção foram a causa do desemprego, enquanto 52% reportaram que a deterioração cognitiva foi a causa. Conclusões Este questionário fornece um registro da situação laboral dos pacientes com EM e descreve o seu impacto no emprego do ponto de vista deles.