Concordancia intra- e interevaluadores

Simulation in physiotherapy students for clinical decisions during interaction with people with low back pain: randomised controlled trial

BACKGROUND

Low back pain (LBP) is a condition with a high global prevalence, which is getting health professionals' attention, including physiotherapists as they must have the skills to provide treatment that increases the patient's quality of life. Clinical simulations could be a pedagogic strategy that facilitates adequate training for students to acquire skills to improve their professional reasoning in this clinical situation.

OBJECTIVE

This study sought to determine the effects of clinical simulations with simulated patients (SP) on the physiotherapy students' clinical decision-making within a role-playing (RP) scenario while caring of LBP patients.

METHODS

This experimental study included 42 participants from two Colombian universities, randomized into two groups (SP, n = 21; RP, n = 21). The clinical skill of performing the Objective Structured Clinical Examination (OSCE-LBP) was evaluated while students cared for patients with LBP; after that, a pedagogical method was conducted that included clinical simulation and, finally, the OSCE-LBP was applied again to compare both groups.

RESULTS

Changes occurred in the OSCE-LBP among both groups of students: the scores increased (0.66 and 0.59 in RP and SP, respectively), and neither of the two was superior (p value 0.01; 95%CI - 0.21 to 0.23).

CONCLUSION

Both types of simulation favor decision-making in professional reasoning in physiotherapy students during interactions with individuals with LBP. Trial registration https://clinicaltrials.gov/ct2/show/NCT04428892 Identifying number: NCT04428892. It was retrospectively registered.

Caracterización psicosocial de deportistas y reconocimiento de la importancia del psicólogo deportivo

Objetivo. Desarrollar la caracterización psicosocial de un grupo de deportistas del departamento del Huila (Colombia), e identificar su percepción acerca de la labor del psicólogo deportivo. Método. Investigación descriptiva, transversal, en la que participaron 817 deportistas (72.3% hombres, edad promedio 17.26 años [DE = 4.28]). La información fue obtenida mediante un instrumento ad hoc de autorreporte, validado por expertos, guardando las consideraciones éticas del caso. Resultados. Se evidenciaron asociaciones significativas (p < 0.05) entre los factores psicológicos emocionales (principalmente ansiedad y estrés) y cognitivos (atención, concentración, cohesión, motivación, autoconfianza y cohesión), con las variables sexo, sometimiento a cirugías, trabajo actual, asociación a club deportivo, participación en competencias y acompañamiento con psicólogo deportivo. Muchos de los encuestados no tenían acceso a los profesionales en psicología deportiva, pero resaltaron su importancia para el mejoramiento del rendimiento deportivo. Conclusión. El estudio permitió tener una panorámica general de las condiciones sociodemográficas de los deportistas y de sus necesidades psicosociales. No obstante, se deben llevar a cabo ejercicios más rigurosos que permitan no solo establecer relaciones estadísticas entre las variables reportadas, sino también realizar intervenciones efectivas.

Behavioural disorder or borderline personality disorder? The importance of early intervention

Diagnosing borderline personality disorder during adolescence is usually controversial. In this paper we present a clinical case in which an outline of the main characteristics of borderline personality disorder during adolescence is summarised. The need of taking into consideration the precursor characteristics of borderline personality disorder in young people is also highlighted. At the same time, other significant behavioural disorders found in young people are emphasized as possible forerunners of a borderline personality disorder diagnosis. Finally, we insist upon the need to implement early intervention programmes for these patients based on current models.

[Clinical validation of 2 morbidity groups in the primary care setting]

INTRODUCTION

Adjusted Morbidity Groups (GMAs) and the Clinical Risk Groups (CRGs) are population morbidity based stratification tools which classify patients into mutually exclusive categories.

OBJETIVE

To compare the stratification provided by the GMAs, CRGs and that carried out by the evaluators according to the levels of complexity.

DESIGN

Random sample stratified by morbidity risk.

LOCATION

Catalonia.

PARTICIPANTS

Forty paired general practitioners in the primary care, matched pairs.

INTERVENTIONS

Each pair of evaluators had to review 25 clinical records.

MAIN OUTPUTS

The concordance by evaluators, and between the evaluators and the results obtained by the 2 morbidity tools were evaluated according to the kappa index, sensitivity, specificity, and positive and negative predicted values.

RESULTS

The concordance between general practitioners pairs was around the kappa value 0.75 (mean value=0.67), between the GMA and the evaluators was similar (mean value=0.63), and higher than for the CRG (mean value=0.35). The general practitioners gave a score of 7.5 over 10 to both tools, although for the most complex strata, according to the professionals' assignment, the GMA obtained better scores than the CRGs. The professionals preferred the GMAs over the CRGs. These differences increased with the complexity level of the patients according to clinical criteria. Overall, less than 2% of serious classification errors were found by both groupers.

CONCLUSION

The evaluators considered that both grouping systems classified the studied population satisfactorily, although the GMAs showed a better performance for more complex strata. In addition, the clinical raters preferred the GMAs in most cases.