Browsing by Author "Gutierrez-Arias, Ruvistay"

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    Assessment of redundancy, methodological and reporting quality, and potential discrepancies of results of systematic reviews of early mobilisation of critically ill adults: a meta-research protocol
    (2023) Gutierrez-Arias, Ruvistay; Pieper, Dawid; Nydahl, Peter; Gonzalez-Seguel, Felipe; Jalil, Yorschua; Oliveros, Maria-Jose; Torres-Castro, Rodrigo; Seron, Pamela
    IntroductionSeveral systematic reviews (SRs) have been conducted to determine the effectiveness of early mobilisation in critically ill adults with heterogeneous methodology and results. Redundancy in conducting SRs, unclear justification when leading new SRs or updating, and discordant results of SRs on the same research question may generate research waste that makes it difficult for clinicians to keep up to date with the best available evidence. This meta-research aims to assess the redundancy, methodological and reporting quality, and potential reasons for discordance in the results reported by SRs conducted to determine the effectiveness of early mobilisation in critically ill adult patients. Methods and analysisA meta-research of early mobilisation SRs in critically ill adult patients will be conducted. A search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Cochrane Library, Epistemonikos and other search resources will be conducted. Two independent reviewers will perform study selection, data extraction and quality appraisal. Discrepancies will be resolved by consensus or a third reviewer. The redundancy of SRs will be assessed by the degree of overlap of primary studies. In addition, the justification for conducting new SRs will be evaluated with the 'Evidence-Based Research' framework. The methodological quality of the SRs will be assessed with the A MeaSurement Tool to Assess systematic Reviews 2 tool, and the quality of the reports through compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. To assess the potential reasons for discordance in the results of the SRs considering divergence in results and their interpretation. Ethics and disseminationAs meta-research, this study does not involve the participation of people whose rights may be violated. However, this overview will be developed rigorously and systematically to achieve valid and reliable results. The findings of this meta-research study will be presented at conferences and published in a peer-reviewed journal related to rehabilitation, critical care or research methodology.
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    Effectiveness of neuromuscular electrostimulation in COPD subjects on mechanical ventilation. A systematic review and meta-analysis
    (2022) Gutierrez-Arias, Ruvistay; Jalil Contreras, Yorschua Frederick; Fuentes-Aspe, Rocío; Seron, Pamela
    OBJECTIVE: To estimate the effectiveness of Neuromuscular Electrostimulation (NMES) in adults with COPD undergoing MV. METHOD: A sensitive search was performed in MEDLINE, Embase, CENTRAL, CINAHL and other resources. Randomized Controlled Clinical Trials (RCTs) or non-RCTs that enrolled adults with COPD on MV due to an exacerbation of their disease were included. Two independent reviewers screened, extracted information, and assessed the risk of bias (RoB 2 tool) and the certainty of evidence (GRADE approach) from the included studies. RESULTS: Four RCTs (144 participants) were included. Subjects who underwent NMES were able to move from bed to chair independently in less time (MD = 4.98 days less; 95% CI -8.55 to -1.47; 2 RCTs; low certainty of the evidence) and they were fewer days on MV (MD = 2.89 days less; 95% CI -4.58 to -1.21); 3 RCTs; low certainty of the evidence) than the control group. However, the effect of NMES on muscle strength is unclear (very low certainty of the evidence). CONCLUSIONS: NMES may improve functional independence and decrease MV time in adults with COPD; however, its effectiveness on muscle strength is uncertain. More and better RCTs are needed to determine with greater certainty the effectiveness of NMES in this population.
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    Effectiveness of telerehabilitation in physical therapy: A rapid overview.
    (2021) Seron, Pamela; Oliveros, María-Jose; Gutierrez-Arias, Ruvistay; Fuentes-Aspe, Rocío; Torres-Castro, Rodrigo C.; Merino-Osorio, Catalina; Nahuelhual, Paula; Inostroza, Jacqueline; Jalil Contreras, Yorschua Frederick; Solano, Ricardo; Marzuca-Nassr, Gabriel N.; Aguilera-Eguía, Raul; Lavados-Romo, Pamela; Soto-Rodríguez, Francisco J.; Sabelle, Cecilia; Villarroel Silva, Gregory; Gomolán, Patricio; Huaiquilaf, Sayen; Sanchez, Paulina
    Objective: The purpose of this article was to summarize the available evidence from systematic reviews on telerehabilitation in physical therapy.Methods: We searched Medline/PubMed, EMBASE, and Cochrane Library databases. In addition, the records in PROSPERO and Epistemonikos and PEDro were consulted. Systematic reviews of different conditions, populations, and contexts-where the intervention to be evaluated is telerehabilitation by physical therapy-were included. The outcomes were clinical effectiveness depending on specific condition, functionality, quality of life, satisfaction, adherence, and safety. Data extraction and risk of bias assessment were carried out by a reviewer with non-independent verification by a second reviewer. The findings are reported qualitatively in the tables and figures.Results: Fifty-three systematic reviews were included, of which 17 were assessed as having low risk of bias. Fifteen reviews were on cardiorespiratory rehabilitation, 14 on musculoskeletal conditions, and 13 on neurorehabilitation. The other 11 reviews addressed other types of conditions and rehabilitation. Thirteen reviews evaluated with low risk of bias showed results in favor of telerehabilitation versus in-person rehabilitation or no rehabilitation, while 17 reported no differences between the groups. Thirty-five reviews with unclear or high risk of bias showed mixed results.Conclusions: Despite the contradictory results, telerehabilitation in physical therapy could be comparable with in-person rehabilitation or better than no rehabilitation for conditions such as osteoarthritis, low-back pain, hip and knee replacement, and multiple sclerosis and also in the context of cardiac and pulmonary rehabilitation. It is imperative to conduct better quality clinical trials and systematic reviews.Impact: Providing the best available evidence on the effectiveness of telerehabilitation to professionals, mainly physical therapists, will impact the decision-making process and therefore yield better clinical outcomes for patients, both in these times of the COVID-19 pandemic and in the future. The identification of research gaps will also contribute to the generation of relevant and novel research questions.
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    Specific Training Improves the Detection and Management of Patient-Ventilator Asynchrony
    (2024) Ramirez, Ivan I.; Gutierrez-Arias, Ruvistay; Damiani, L. Felipe; Adasme, Rodrigo S.; Arellano, Daniel H.; Salinas, Francisco A.; Roncalli, Angelo; Nunez-Silveira, Juan; Santillan-Zuta, Milton; Sepulveda-Barisich, Patrick; Gordo-Vidal, Federico; Blanch, Lluis
    BACKGROUND: Patient -ventilator asynchrony is common in patients undergoing mechanical ventilation. The proportion of health-care professionals capable of identifying and effectively managing different types of patient -ventilator asynchronies is limited. A few studies have developed specific training programs, but they mainly focused on improving patient -ventilator asynchrony detection without assessing the ability of health-care professionals to determine the possible causes. METHODS: We conducted a 36-h training program focused on patient -ventilator asynchrony detection and management for health-care professionals from 20 hospitals in Latin America and Spain. The training program included 6 h of a live online lesson during which 120 patient -ventilator asynchrony cases were presented. After the 6-h training lesson, health-care professionals were required to complete a 1-h training session per day for the subsequent 30 d. A 30 -question assessment tool was developed and used to assess health-care professionals before training, immediately after the 6-h training lecture, and after the 30 d of training (1 -month follow-up).RESULTS: One hundred sixteen health-care professionals participated in the study. The median (interquartile range) of the total number of correct answers in the pre -training, post -training, and 1 -month follow-up were significantly different (12 [8.75-15], 18 [13.75-22], and 18.5 [14-23], respectively). The percentages of correct answers also differed significantly between the time assessments. Study participants significantly improved their performance between pre -training and post -training (P < .001). This performance was maintained after a 1 -month follow-up (P 5 .95) for the questions related to the detection, determination of cause, and management of patient -ventilator asynchrony. CONCLUSIONS: A specific 36-h training program significantly improved the ability of health-care professionals to detect patient -ventilator asynchrony, determine the possible causes of patient -ventilator asynchrony, and properly manage different types of patient -ventilator asynchrony.