{"id":117568,"date":"2015-04-06T00:00:00","date_gmt":"2015-04-06T00:00:00","guid":{"rendered":"https:\/\/www.deberes.net\/tesis\/sin-categoria\/seguridad-declinacion-y-recuperacion-funcional-del-paciente-post-agudo-hospitalizado-en-centros-de-readaptacion-funcional\/"},"modified":"2015-04-06T00:00:00","modified_gmt":"2015-04-06T00:00:00","slug":"seguridad-declinacion-y-recuperacion-funcional-del-paciente-post-agudo-hospitalizado-en-centros-de-readaptacion-funcional","status":"publish","type":"post","link":"https:\/\/www.deberes.net\/tesis\/fisioterapia\/seguridad-declinacion-y-recuperacion-funcional-del-paciente-post-agudo-hospitalizado-en-centros-de-readaptacion-funcional\/","title":{"rendered":"Seguridad, declinaci\u00f3n y recuperaci\u00f3n funcional del paciente post-agudo hospitalizado en centros de readaptaci\u00f3n funcional"},"content":{"rendered":"<h2>Tesis doctoral de <strong> Mar\u00eda no Luis Gacto Sanchez <\/strong><\/h2>\n<p>Resumen [castellano] objetivos  describir el desarrollo y la evaluaci\u00f3n psicom\u00e9trica inicial de un instrumento de medida de movilidad para unidades postagudas de rehabilitaci\u00f3n (mobam-in). Evaluar la eficacia del marco contextual mobam para la construcci\u00f3n de instrumentos basados en actividades de movilidad. Determinar la incidencia de efectos adversos y sus determinantes en ancianos hospitalizados en unidades de rehabilitaci\u00f3n. Comparar la incidencia de efectos adversos entre ancianos a partir de 75 a\u00f1os, y menores de 75 a\u00f1os. Evaluar la relaci\u00f3n entre la ocurrencia de efectos adversos y el cambio en el nivel de discapacidad entre la admisi\u00f3n y el alta en pacientes ancianos hospitalizados en unidades de rehabilitaci\u00f3n. m\u00e9todo estudio prospectivo de cohortes realizado en la unidad de rehabilitaci\u00f3n de un hospital p\u00fablico. Se reclut\u00f3 una muestra de 239 sujetos para el estudio dirigido al desarrollo del instrumento mobam-in. Una submuestra de 216 sujetos fue seguida durante su estancia, para estudiar la incidencia de efectos adversos, sus determinantes y los cambios en niveles de discapacidad.  el desarrollo inicial del instrumento mobam-in se bas\u00f3 en la integraci\u00f3n de \u00edtems de instrumentos en categor\u00edas de actividades de movilidad de la clasificaci\u00f3n internacional del funcionamiento, de la discapacidad y de la salud (cif). El instrumento mobam-in fue usado para la evaluaci\u00f3n de niveles de discapacidad y para la medici\u00f3n inicial de la discapacidad en las actividades de movilidad. la ocurrencia y tipo de efectos adversos fueron registrados. Se consider\u00f3 tanto las variables asociadas a efectos adversos como las consecuencias de los mismos. Se us\u00f3 registros y cuestionarios autoadministrados para la recogida de variables sociodemogr\u00e1ficas, cl\u00ednicas y funcionales. resultados en la creaci\u00f3n-desarrollo de mobam-in, el escalaje multirasgo y los an\u00e1lisis factoriales confirmatorios confirmaron la asunci\u00f3n de unidimensionalidad de dominios. Las cinco dimensiones mostraron estabilidad a trav\u00e9s de grupos diagn\u00f3sticos. El modelo rasch revel\u00f3 que los \u00edtems pod\u00edan ser situados a lo largo de un continuo en cada dimensi\u00f3n, cumpliendo criterios de bondad de ajuste. La fiabilidad test-retest result\u00f3 excelente, y grupos con condiciones de mayor severidad y menor independencia puntuaron peor. veintis\u00e9is pacientes (12%) sufrieron alg\u00fan efecto adverso en el seguimiento de la cohorte, siendo las ca\u00eddas el m\u00e1s frecuente (8.3%). El grupo de pacientes de edad igual o superior a 75 a\u00f1os experiment\u00f3 mayor n\u00famero de efectos adversos que los pacientes menores de 75 a\u00f1os (15.6% vs. 4.3%, p = 0.02). los modelos de regresi\u00f3n log\u00edstica multivariable mostraron una fuerte asociaci\u00f3n entre la edad y cualquier efecto adverso (odds-ratio=1.06; 95%cl=1.03-1.12), as\u00ed como entre la edad y los efectos de ca\u00edda (odds-ratio=1.1; 95%ci=1.02-1.17). un total de 159 pacientes experimentaron mejora funcional entre admisi\u00f3n y alta, 56 permanecieron estacionarios, y nadie sufri\u00f3 declinaciones. La experiencia de efectos adversos de ca\u00edda (odds-ratio=0.32, 95%ci=0.11-0.97) y el grupo diagn\u00f3stico (odds-ratio=3.91, 95%ci=1.34-11.38) son factores predictores espec\u00edficos de mejora en el nivel de discapacidad. conclusiones el instrumento mobam-in cubre cinco dimensiones, es fiable, v\u00e1lido y capaz de discriminar entre sujetos con diferentes niveles funcionales y de severidad. El marco contextual mobam es eficaz para la construcci\u00f3n de instrumentos de medida de resultado basados en actividades de movilidad. El porcentaje de ancianos que experimentan efectos adversos en unidades postagudas de rehabilitaci\u00f3n es similar al porcentaje hallado por otros autores en unidades no-quir\u00fargicas. La edad es un determinante fundamental en la ocurrencia de efectos adversos hospitalarios en unidades de rehabilitaci\u00f3n. Pacientes ancianos con edades iguales o superiores a 75 a\u00f1os son m\u00e1s propensos a la experiencia de efectos adversos en unidades postagudas de rehabilitaci\u00f3n. La ocurrencia de efectos adversos de ca\u00edda y el grupo diagn\u00f3stico son factores predictores espec\u00edficos de cambio en el nivel de discapacidad.   abstract [english] objectives  to describe the development and initial psychometric evaluation of a mobility measure for inpatient postacute rehabilitation settings (mobam-in). To evaluate the efficacy of the mobam framework for building outcome instruments. To determine the incidence and determinants of adverse events between elderly patients aged 75 years and over, and patients under 75 years old. To assess the relationship between the occurrence of adverse events and the changes affecting the level of disability between admission and discharge during inpatient rehabilitation programs in a cohort of older adults admitted to a rehabilitation unit.  methods prospective cohort study conducted in the rehabilitation unit of a public hospital. A sample of 239 subjects was recruited for the development of the mobam-in instrument. A subsample of 216 participants was followed during their stay, to study the incidence and determinants of adverse events, as well as the changes in the levels of disability. the initial development of the mobam-in instrument was guided by integrating items from a wide variety of patient-oriented instruments to categories of mobility activities from the international classification of functioning, disability and health (icf). The mobam-in instrument was subsequently used to evaluate the levels of disability, as well as for the initial assessment of disability in mobility activities.  the occurrences and types of adverse events were reported. The variables associated either with the occurrence of adverse events or with the consequences of those events were considered. Records and auto-administrated questionnaires were used for collecting socio-demographic, clinical, and functional data. results concerning the development of the mobam-in instrument, multitrait and confirmatory analyses supported the assumption of unidimensionality. The five dimensions appeared to be stable across diverse diagnostic groups. Rasch model (masters&apos; partial credit) showed that all items could be located along a continuum in each dimension, with goodness-of-fit criteria of infit and outfit mean-square values between 0.6 and 1.4. Test-retest reliability was excellent (intraclass correlation coefficients median, .98). Groups with more severe conditions and lower functional independence scored lower on mobam-in scales, as hypothesized. twenty-six patients (12%) experienced at least an adverse event during the study. Fall-related events were the most frequent (8.3%). Patients aged 75 years old and above experienced higher number of adverse events than those aged under 75 years (15.6% vs. 4.3%, p=0.02).  when performing multivariable logistic regression models, age showed strong association with fall-related events (odds-ratio=1.1; 95% confidence interval=1.02-1.17) and overall, when all types of events were combined (odds-ratio=1.06; 95% confidence interval =1.03-1.12). a total of 159 participants experienced an improvement at discharge, 56 made no change, and no participants experienced a decline. The occurrence of fall-related events (odds-ratio=0.32, 95%ci=0.11-0.97) and the diagnostic group (odds-ratio=3.91, 95%ci=1.34-11.38) are specific predictive factors of change in the level of disability.  conclusions mobam-in covers 5 dimensions of mobility activities. It is a reliable and valid instrument, useful to discriminate on the basis of both a severity-based condition and functional independence. The mobam framework is an effective reference for building outcome instruments. The incidence rates of older inpatients experiencing adverse events in postacute rehabilitation settings are consistent with other studies using elderly patients hospitalized in non-surgical departments. Age is a major determinant in the occurrence of adverse events during hospital stays in rehabilitation units. Some older patients are more likely to experience adverse events than others, in special those aged 75 years and older. The occurrence of fall-related events and the diagnostic group are specific predictive factors for changes in the levels of disability.<\/p>\n<p>&nbsp;<\/p>\n<h3>Datos acad\u00e9micos de la tesis doctoral \u00ab<strong>Seguridad, declinaci\u00f3n y recuperaci\u00f3n funcional del paciente post-agudo hospitalizado en centros de readaptaci\u00f3n funcional<\/strong>\u00ab<\/h3>\n<ul>\n<li><strong>T\u00edtulo de la tesis:<\/strong>\u00a0 Seguridad, declinaci\u00f3n y recuperaci\u00f3n funcional del paciente post-agudo hospitalizado en centros de readaptaci\u00f3n funcional <\/li>\n<li><strong>Autor:<\/strong>\u00a0 Mar\u00eda no Luis Gacto Sanchez <\/li>\n<li><strong>Universidad:<\/strong>\u00a0 Murcia<\/li>\n<li><strong>Fecha de lectura de la tesis:<\/strong>\u00a0 04\/06\/2015<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Direcci\u00f3n y tribunal<\/h3>\n<ul>\n<li><strong>Director de la tesis<\/strong>\n<ul>\n<li>Francesc Medina  I Mirapeix<\/li>\n<\/ul>\n<\/li>\n<li><strong>Tribunal<\/strong>\n<ul>\n<li>Presidente del tribunal: victoriano Soria aledo <\/li>\n<li>josep carles Ben\u00edtez mart\u00ednez (vocal)<\/li>\n<li>Jos\u00e9 ferm\u00edn Valera garrido (vocal)<\/li>\n<li>Mar\u00eda  Elena Del ba\u00f1o aledo (vocal)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tesis doctoral de Mar\u00eda no Luis Gacto Sanchez Resumen [castellano] objetivos describir el desarrollo y la evaluaci\u00f3n psicom\u00e9trica inicial de [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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