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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Propuesta de abordaje pr&#225;ctico de evaluaci&#243;n de independencia funcional &#40;&#237;ndice de Barthel &#8805;<span class="elsevierStyleHsp" style=""></span>90 puntos&#41; y de dependencia funcional severa &#40;&#237;ndice de Barthel &#60;<span class="elsevierStyleHsp" style=""></span>60 puntos&#41; mediante el &#237;ndice de Barthel simplificado a tres dimensiones&#44; en pacientes pluripatol&#243;gicos&#44; para el ulterior cribado de fragilidad&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La fragilidad constituye uno de los principales s&#237;ndromes geri&#225;tricos y su prevalencia en la poblaci&#243;n anciana es elevada<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; Cuando adicionalmente coexisten enfermedades cr&#243;nicas y comorbilidades esta prevalencia se incrementa significativamente&#59; de hecho&#44; en pacientes pluripatol&#243;gicos &#40;PPP&#41; alcanza el 60&#37;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">3</span></a>&#46; La fragilidad constituye un marcador pron&#243;stico independiente a corto&#44; medio y largo plazo de mortalidad y malos resultados en salud&#46; Hoy en d&#237;a la fragilidad se considera un estado de pre-discapacidad y de equilibrio homeost&#225;tico inestable con riesgo de desarrollar una nueva discapacidad desde una situaci&#243;n de limitaci&#243;n funcional incipiente&#46; Pero lo m&#225;s importante es que puede ser detectada y tratada&#44; por lo que es posible prevenir el desarrollo de discapacidad actuando sobre la fragilidad<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">4-6</span></a>&#46; Por ello su abordaje social y sanitario constituye uno de los pilares de los sistemas de salud en la atenci&#243;n a poblaciones mayores<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a>&#46; Para el cribado de fragilidad se ha propuesto la realizaci&#243;n del &#237;ndice de Barthel &#40;IB&#41;&#44; considerando a los pacientes con puntuaciones por debajo de 90 como dependientes&#44; y solo si el paciente obtuviera una puntuaci&#243;n igual o superior a 90 puntos realizar los test de ejecuci&#243;n espec&#237;ficos para el diagn&#243;stico de fragilidad<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Por otro lado&#44; el deterioro funcional para las actividades b&#225;sicas de la vida diaria &#40;ABVD&#41; y la discapacidad son muy prevalentes en los PPP&#46; En distintos estudios multic&#233;ntricos la mayor&#237;a de los PPP presentaban dependencia&#44; siendo esta severa &#40;IB<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>60 puntos&#41; en un porcentaje superior al 30&#37;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">7&#44;8</span></a>&#46; La identificaci&#243;n de dependencia severa es importante a la hora de valorar y estructurar las intervenciones sociosanitarias dirigidas a los PPP&#44; pues estas variar&#225;n en tipo e intensidad en funci&#243;n del dintel de discapacidad del paciente&#59; adicionalmente&#44; la detecci&#243;n de PPP con dependencia severa permitir&#225; establecer sistemas espec&#237;ficos de apoyo y soporte que mitiguen la cascada progresiva de la discapacidad y sus consecuentes efectos delet&#233;reos&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La realizaci&#243;n del IB para valorar la funcionalidad para las ABVD antes de proceder a realizar pruebas de ejecuci&#243;n espec&#237;ficas para el diagn&#243;stico de fragilidad aumenta el tiempo cl&#237;nico que se precisa para llevar a cabo la evaluaci&#243;n&#44; por lo que el poder simplificar al m&#225;ximo el cribado previo mediante el IB facilitar&#225; y reducir&#225; el tiempo necesario para ello&#44; facilitando al cl&#237;nico el abordaje diagn&#243;stico de la fragilidad&#46; Asimismo&#44; para el cribado de dependencia severa y la consiguiente programaci&#243;n asistencial y sociosanitaria resultar&#237;a de utilidad el disponer de una versi&#243;n resumida del &#237;ndice que facilitara a los profesionales su detecci&#243;n&#46; Sin embargo&#44; hasta ahora no existen evidencias suficientes para recomendar una evaluaci&#243;n de las ABVD mediante una versi&#243;n resumida del IB&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Por todo lo anterior&#44; nos hemos planteado el objetivo de explorar la sensibilidad &#40;S&#41;&#44; la especificidad &#40;E&#41; y los valores predictivos positivo &#40;VPP&#41; y negativo &#40;VPN&#41; de las 10 dimensiones del IB con respecto a su puntuaci&#243;n total&#44; y valorar si una versi&#243;n abreviada de una o dos dimensiones pudiera utilizarse para el cribado de fragilidad y de dependencia severa&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Realizamos un estudio transversal utilizando los datos a la inclusi&#243;n de una muestra consecutiva multic&#233;ntrica de 1&#46;632 PPP reclutados en 37 hospitales espa&#241;oles &#40;17 de tercer nivel&#44; 7 de segundo nivel y 12 comarcales&#41; a lo largo de 17<span class="elsevierStyleHsp" style=""></span>meses para el proyecto PROFUND&#46; Este proyecto se realiz&#243; en el seno del Grupo de Trabajo de Paciente Pluripatol&#243;gico y Edad Avanzada de la Sociedad Espa&#241;ola de Medicina Interna&#46; La inclusi&#243;n se realiz&#243; en el 75&#37; de los pacientes al alta hospitalaria&#44; en el 17&#44;5&#37; ambulatoriamente y en el 7&#44;5&#37; desde hospitalizaci&#243;n a domicilio&#46; A todos los pacientes se les recabaron diferentes par&#225;metros demogr&#225;ficos&#44; cl&#237;nicos&#44; anal&#237;ticos&#44; funcionales&#44; psicom&#233;tricos y asistenciales&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El IB se determin&#243; en todos los pacientes por los investigadores del proyecto&#44; considerando dependencia valores menores de 90 puntos y dependencia severa valores menores de 60 puntos&#46; Estos dos valores se consideraron como el patr&#243;n oro de presencia o ausencia de dependencia y dependencia severa&#44; respectivamente&#46; Para cada una de las 10 dimensiones del &#237;ndice se calcularon la concordancia mediante el &#237;ndice kappa&#44; la S&#44; la E&#44; el VPP y el VPN con respecto al patr&#243;n oro previamente comentado&#46; Posteriormente se analiz&#243; si mejoraban los &#237;ndices de validez diagn&#243;stica mediante la utilizaci&#243;n de todas las posibles combinaciones de dos dimensiones&#46; Para la realizaci&#243;n de los c&#225;lculos se utiliz&#243; el paquete estad&#237;stico SPSS 20&#46;0&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0035" class="elsevierStylePara elsevierViewall">Se incluyeron 1&#46;632 PPP &#40;edad media de 77&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;8<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; 53&#37; varones&#41;&#46; Las principales caracter&#237;sticas cl&#237;nicas y funcionales de los pacientes se recogen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">La concordancia y los &#237;ndices de validez diagn&#243;stica de cada una de las 10 dimensiones&#44; y de las combinaciones de 2 preguntas con &#237;ndices m&#225;s elevados&#44; se detallan en las <a class="elsevierStyleCrossRefs" href="#tbl0010">tablas 2 y 3</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Resumidamente&#44; con respecto a una ejecuci&#243;n del IB de 90 o m&#225;s puntos las dimensiones con mayor VPN fueron la capacidad para alimentarse y arreglarse &#40;96&#44;6&#37; para ambas&#41;&#59; la combinaci&#243;n de ambas dimensiones no aument&#243; el VPN &#40;este fue del 99&#37;&#41;&#46; Por otra parte&#44; la capacidad para deambular y para subir y bajar escaleras aut&#243;nomamente fueron las dimensiones con mayor VPP &#40;81 y 92&#37;&#44; respectivamente&#41;&#59; la combinaci&#243;n de ambas dimensiones proporcion&#243; un aumento del VPP con respecto al m&#225;ximo obtenido en las preguntas individualmente consideradas &#40;aument&#225;ndolo al 95&#37;&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Con respecto a una ejecuci&#243;n del IB con una puntuaci&#243;n de 60 o m&#225;s puntos&#44; las dimensiones con mayor VPN tambi&#233;n fueron la capacidad para alimentarse y arreglarse &#40;87&#37; para ambas&#41;&#59; la combinaci&#243;n de ambas dimensiones no aument&#243; el VPN &#40;este fue del 81&#37;&#41;&#46; Asimismo&#44; la capacidad para deambular y para subir y bajar escaleras aut&#243;nomamente fueron las dimensiones con mayor VPP &#40;92&#44;2 y 95&#44;5&#37;&#44; respectivamente&#41;&#59; finalmente&#44; la combinaci&#243;n de ambas dimensiones proporcion&#243; un aumento del VPP con respecto al m&#225;ximo obtenido en las preguntas individualmente consideradas &#40;aument&#225;ndolo al 99&#44;5&#37;&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Tras la obtenci&#243;n de estos resultados proponemos una secuencia simplificada para la estratificaci&#243;n funcional y el abordaje del cribado de fragilidad en PPP&#44; que detallamos en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0060" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas cl&#237;nicas de la cohorte reclutada son las propias de las poblaciones de PPP del &#225;mbito hospitalario&#44; con edad avanzada&#44; importante carga de comorbilidades&#44; repercusi&#243;n sintom&#225;tica y funcional y sometidos a polifarmacia<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">8&#44;9</span></a>&#46; Es destacable que casi el 60&#37; ten&#237;an una dependencia moderada y en torno al 30&#37; presentaban una dependencia severa para las ABVD&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En la evaluaci&#243;n de la independencia funcional para las ABVD&#44; las dimensiones que obtuvieron el VPN m&#225;s elevado fueron &#171;alimentaci&#243;n&#187; y &#171;arreglarse&#187;&#44; tanto para obtener un IB &#8805;<span class="elsevierStyleHsp" style=""></span>90 puntos como para obtener un IB &#8805;<span class="elsevierStyleHsp" style=""></span>60 puntos&#46; Sin embargo&#44; la combinaci&#243;n de ser independiente para ambas dimensiones no aument&#243; significativamente el VPN de ninguna de las dos dimensiones tomadas individualmente&#46; Por ello&#44; cualquiera de las dos dimensiones pueden utilizarse como cribado de dependencia en los PPP&#46; De manera que en los pacientes que tuvieran alg&#250;n grado de dependencia en la &#171;alimentaci&#243;n&#187; o en &#171;arreglarse&#187; se podr&#237;a descartar con elevada certeza que en la ejecuci&#243;n completa del IB obtuvieran 60 o m&#225;s puntos&#46; Para el algoritmo de trabajo optamos por la dimensi&#243;n &#171;alimentaci&#243;n&#187; frente a &#171;arreglarse&#187; por tener un menor intervalo de confianza entre sus valores extremos&#46; De hecho&#44; la capacidad de alimentarse aut&#243;nomamente es una de las funciones ejecutivas b&#225;sicas que se mantienen hasta los estadios m&#225;s avanzados de la dependencia&#44; perdi&#233;ndose antes la mayor&#237;a de las restantes ABVD&#44; como tambi&#233;n se ha encontrado en otros estudios<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">La independencia para ejecutar las dimensiones &#171;deambular&#187; y &#171;subir y bajar escaleras&#187; obtuvo un elevado VPP&#44; tanto para el obtener un IB &#8805;<span class="elsevierStyleHsp" style=""></span>90 puntos como para obtener un IB &#8805;<span class="elsevierStyleHsp" style=""></span>60 puntos&#46; Adicionalmente la combinaci&#243;n de ser independiente para ambas dimensiones aument&#243; al 95 y al 99&#44;6&#37; para obtener un IB &#8805;<span class="elsevierStyleHsp" style=""></span>90 y un IB &#8805;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>puntos&#44; respectivamente&#46; Esta combinaci&#243;n de dimensiones podr&#237;a utilizarse para la independencia funcional&#44; de manera que un PPP capaz de deambular y subir y bajar escaleras solo lo podr&#237;amos considerar independiente para la realizaci&#243;n de las ABVD&#44; y se plantear&#237;a como candidato para cribado de fragilidad&#44; tal y como se propone en los diferentes consensos<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">6&#44;11</span></a>&#46; A la vista de nuestros resultados&#44; con esta combinaci&#243;n de tres preguntas se podr&#237;a determinar con elevada fiabilidad y eficiencia de tiempo la independencia funcional por un lado&#44; y la dependencia severa por otro&#46; As&#237;&#44; en la muestra reclutada&#44; 474 pacientes &#40;un 31&#37;&#41;&#44; fueron independientes para deambular y para subir y bajar escaleras y ten&#237;an un IB &#8805;<span class="elsevierStyleHsp" style=""></span>90 puntos &#40;verdaderos positivos&#41;&#59; por otro lado&#44; 316 pacientes &#40;un 21&#37;&#41; ten&#237;an alg&#250;n grado de dependencia para alimentarse y presentaban un IB &#60;<span class="elsevierStyleHsp" style=""></span>60 puntos &#40;verdaderos negativos&#41;&#46; Por tanto&#44; en m&#225;s del 50&#37; de los PPP se podr&#237;a ahorrar la realizaci&#243;n del IB completo&#46; Otros autores han realizado simplificaciones del IB a 5 y a 3 dimensiones pero solo en el &#225;mbito de la enfermedad cerebrovascular aguda y la valoraci&#243;n de sus secuelas&#44; comparando su utilidad con escalas espec&#237;ficas para ictus&#59; no existen&#44; por tanto&#44; aproximaciones para pacientes con multimorbilidad y pluripatolog&#237;a<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">12-14</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Los resultados del actual estudio presentan como debilidad su ausencia de validaci&#243;n&#44; siendo recomendable validar en un futuro estos hallazgos en una conhorte independiente de pacientes para confirmar su fiabilidad y su validez externa&#46; Otra posible debilidad es la elevada representaci&#243;n en la muestra de pacientes hospitalizados incluidos al alta&#44; lo que podr&#237;a plantear alguna duda sobre su validez en pacientes estables ambulatorios&#46; Su principal fortaleza&#44; sin embargo&#44; es su desarrollo sobre una amplia muestra multic&#233;ntrica y de elevada dispersi&#243;n geogr&#225;fica que hace que probablemente mantenga su validez en ulteriores muestras de pacientes&#46; Su principal utilidad cl&#237;nica estriba en facilitar y acortar los tiempos a la hora de realizar el cribado de fragilidad y de dependencia severa en un porcentaje elevado de PPP&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; la capacidad para alimentarse solo obtuvo un elevado VPN en la detecci&#243;n de dependencia severa para las ABVD&#44; mientras que poder deambular y subir y bajar escaleras obtuvo un elevado VPP para el cribado de independencia funcional&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Financiaci&#243;n</span><p id="par0085" class="elsevierStylePara elsevierViewall">El estudio ha sido financiado por el Instituto de Salud Carlos<span class="elsevierStyleHsp" style=""></span>III &#40;ISCIII&#44; FIS 07&#47;0047&#41;&#44; Ministerio de Sanidad y Consumo&#44; Espa&#241;a&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Autor&#237;a</span><p id="par0090" class="elsevierStylePara elsevierViewall">Concepci&#243;n y dise&#241;o del manuscrito&#58; M&#225;ximo Bernabeu-Wittel&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Recogida de datos&#58; M&#225;ximo Bernabeu-Wittel&#44; Jes&#250;s D&#237;ez-Manglano&#44; Dolores Nieto Mart&#237;n&#44; Nieves Ram&#237;rez-Duque y Manuel Ollero-Baturone&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">An&#225;lisis e interpretaci&#243;n de los datos&#58; M&#225;ximo Bernabeu-Wittel&#44; Jes&#250;s D&#237;ez-Manglano&#44; Dolores Nieto Mart&#237;n&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Redacci&#243;n&#44; revisi&#243;n&#44; aprobaci&#243;n del manuscrito remitido&#58; M&#225;ximo Bernabeu-Wittel&#44; Jes&#250;s D&#237;ez-Manglano&#44; Dolores Nieto Mart&#237;n&#44; Nieves Ram&#237;rez-Duque y Manuel Ollero-Baturone&#46;</p></span></span>"
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    "fechaRecibido" => "2019-02-09"
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            1 => "Deterioro funcional"
            2 => "Fragilidad"
            3 => "Cribado"
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            5 => "Multimorbilidad"
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            0 => "Polypathology"
            1 => "Functional impairment"
            2 => "Frailty"
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            4 => "Barthel index"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizar la sensibilidad &#40;S&#41;&#44; la especificidad &#40;E&#41; y los valores predictivos positivo &#40;VPP&#41; y negativo &#40;VPN&#41; de cada dimensi&#243;n del &#237;ndice de Barthel &#40;IB&#41; con respecto al cuestionario completo en pacientes pluripatol&#243;gicos &#40;PPP&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal multic&#233;ntrico&#46; Se consideraron dos puntos de corte del IB &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>90 puntos para el cribado de fragilidad y &#60;<span class="elsevierStyleHsp" style=""></span>60 puntos para el diagn&#243;stico de dependencia severa&#41;&#46; Para cada dimensi&#243;n y combinaciones de dos dimensiones se calcularon la S&#44; la E&#44; el VPP y el VPN con respecto al IB completo&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">El IB medio de los 1&#46;632 PPP incluidos &#40;edad media de 77&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;8<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; 53&#37; varones&#41; fue 69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31 &#40;&#60;<span class="elsevierStyleHsp" style=""></span>90 en el 58&#44;7&#37; y &#60;<span class="elsevierStyleHsp" style=""></span>60 en el 31&#44;4&#37; de pacientes&#41;&#46; La dimensi&#243;n &#171;alimentaci&#243;n&#187; obtuvo los mayores VPN para tener un IB<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>60 y &#8805;<span class="elsevierStyleHsp" style=""></span>90 puntos &#40;87&#37; y 99&#44;6&#37;&#44; respectivamente&#41;&#46; Las dimensiones &#171;deambular&#187; y &#171;subir y bajar escaleras&#187; obtuvieron el mayor VPP para tener un IB<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>60 y &#8805;<span class="elsevierStyleHsp" style=""></span>90 &#40;99&#44;2&#47;99&#44;5&#37; y 81&#47;92&#37;&#44; respectivamente&#59; la combinaci&#243;n de ambas preguntas aument&#243; el VPP al 95 y al 99&#44;6&#37;&#44; respectivamente&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los PPP de &#225;mbito hospitalario presentan con elevada frecuencia deterioro funcional&#46; La dimensi&#243;n referente a alimentarse obtuvo el mayor VPN&#44; por lo que se puede utilizar para el diagn&#243;stico de dependencia severa&#44; mientras que la combinaci&#243;n de deambular y subir y bajar escaleras obtuvo el mayor VPP&#44; pudiendo utilizarse para plantear el cribado de fragilidad de los PPP&#46;</p></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To analyse the sensitivity&#44; specificity and positive predictive &#40;PPV&#41; and negative predictive &#40;NPV&#41; values of each measure of the Barthel index &#40;BI&#41; compared with the full questionnaire for polypathological patients &#40;PPPs&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Multicentre cross-sectional study&#46; We considered 2 cut-off points for the BI &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>90 points for screening frailty and &#60;<span class="elsevierStyleHsp" style=""></span>60 points for diagnosing severe dependence&#41;&#46; For each measure and combination of 2 measures&#44; we calculated the sensitivity&#44; specificity&#44; PPV and NPV with respect to the full BI&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The mean BI of the 1&#44;632 included PPPs &#40;mean age&#44; 77&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;8<span class="elsevierStyleHsp" style=""></span>years&#59; 53&#37; men&#41; was 69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>31 &#40;&#60;<span class="elsevierStyleHsp" style=""></span>90 for 58&#46;7&#37; and &#60;<span class="elsevierStyleHsp" style=""></span>60 for 31&#46;4&#37; of the patients&#41;&#46; The &#8220;feeding&#8221; measure achieved the highest NPV&#44; for a BI &#8805;<span class="elsevierStyleHsp" style=""></span>60 and &#8805;<span class="elsevierStyleHsp" style=""></span>90 points &#40;87&#37; and 99&#46;6&#37;&#44; respectively&#41;&#46; The &#8220;walking&#8221; and &#8220;going up and down stairs&#8221; measures achieved the highest PPV&#44; for a BI &#8805;<span class="elsevierStyleHsp" style=""></span>60 and &#8805;<span class="elsevierStyleHsp" style=""></span>90 &#40;99&#46;2&#37;&#47;99&#46;5&#37; and 81&#37;&#47;92&#37;&#44; respectively&#46; The combination of the 2 measures increased the PPV to 95&#37; and 99&#46;6&#37;&#44; respectively&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">PPPs in hospital settings have a high rate of functional impairment&#46; The measure for feeding achieved the highest NPV and can therefore be employed for diagnosing severe dependence&#46; The combination of the measures for walking and going up and down stairs achieved the highest PPV and can therefore be employed to propose frailty screening for PPPs&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">El resto de los investigadores del Proyecto PROFUND est&#225;n relacionados en el <a class="elsevierStyleCrossRef" href="#sec0035">anexo</a>&#46;</p>"
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            "apendice" => "<p id="par0110" class="elsevierStylePara elsevierViewall">Lucy Abella-V&#225;zquez&#44; Hospital Nuestra Sra&#46; de la Candelaria&#44; Tenerife&#46;</p> <p id="par0115" class="elsevierStylePara elsevierViewall">Mariano Aguayo-Canela&#44; Hospital Virgen Macarena&#44; Sevilla&#46;</p> <p id="par0120" class="elsevierStylePara elsevierViewall">M&#243;nica Albert-Coll&#44; Hospital de Manacor&#44; Mallorca&#46;</p> <p id="par0125" class="elsevierStylePara elsevierViewall">Antonio Alem&#225;n&#44; Hospital Morales Meseguer&#44; Murcia&#46;</p> <p id="par0130" class="elsevierStylePara elsevierViewall">Jordi Aligu&#233;&#44; Hospital de Manresa&#44; Barcelona&#46;</p> <p id="par0135" class="elsevierStylePara elsevierViewall">Jos&#233; Barb&#233; Gil-Ortega&#44; Hospital Vall d&#8217;Hebr&#243;n&#44; Barcelona&#46;</p> <p id="par0140" class="elsevierStylePara elsevierViewall">Bosco Bar&#243;n-Franco&#44; Hospital Juan Ram&#243;n Jim&#233;nez&#44; Huelva&#46;</p> <p id="par0145" class="elsevierStylePara elsevierViewall">M&#225;ximo Bernabeu-Wittel&#44; Hospital Virgen del Roc&#237;o&#44; Sevilla&#46;</p> <p id="par0150" class="elsevierStylePara elsevierViewall">Cristina de la Calle-Cabrera&#44; Hospital Universitario&#44; Salamanca&#46;</p> <p id="par0155" class="elsevierStylePara elsevierViewall">Manuel Cassani-Garza&#44; Hospital Virgen del Roc&#237;o&#44; Sevilla&#46;</p> <p id="par0160" class="elsevierStylePara elsevierViewall">Manuela Castillo-Blasco&#44; Hospital Dr&#46; Moliner&#44; Valencia&#46;</p> <p id="par0165" class="elsevierStylePara elsevierViewall">Felipe D&#237;ez&#44; Hospital de Torrec&#225;rdenas&#44; Almer&#237;a&#46;</p> <p id="par0170" class="elsevierStylePara elsevierViewall">Jes&#250;s D&#237;ez-Manglano&#44; Hospital Royo Villanova&#44; Zaragoza&#46;</p> <p id="par0175" class="elsevierStylePara elsevierViewall">Alberto Escalera-Zalvide&#44; Hospital Juan Ram&#243;n Jim&#233;nez&#44; Huelva&#46;</p> <p id="par0180" class="elsevierStylePara elsevierViewall">Luis Feliu-Mazaria&#44; Hospital General de Palma&#44; Mallorca&#46;</p> <p id="par0185" class="elsevierStylePara elsevierViewall">Manuel Francisco Fern&#225;ndez-Miera&#44; Hospital Marqu&#233;s de Valdecilla&#44; Santander&#46;</p> <p id="par0190" class="elsevierStylePara elsevierViewall">Antonio Fern&#225;ndez-Moyano&#44; Hospital San Juan de Dios del Aljarafe&#44; Sevilla&#46;</p> <p id="par0195" class="elsevierStylePara elsevierViewall">Francesc Formiga&#44; Hospital de Bellvitge&#44; Barcelona&#46;</p> <p id="par0200" class="elsevierStylePara elsevierViewall">Jordy Forteza-Rey&#44; Hospital Son Dureta&#44; Mallorca&#46;</p> <p id="par0205" class="elsevierStylePara elsevierViewall">Aurelio Fuertes-Mart&#237;n&#44; Hospital Universitario&#44; Salamanca&#46;</p> <p id="par0210" class="elsevierStylePara elsevierViewall">Javier Galindo-Oca&#241;a&#44; Hospital Virgen del Roc&#237;o&#44; Sevilla&#46;</p> <p id="par0215" class="elsevierStylePara elsevierViewall">Pilar Giner&#44; Hospital San Cecilio&#44; Granada&#46;</p> <p id="par0220" class="elsevierStylePara elsevierViewall">Montserrat Godoy&#44; Hospital de la Serran&#237;a&#44; M&#225;laga&#46;</p> <p id="par0225" class="elsevierStylePara elsevierViewall">Sandra G&#243;mez-Lesmes&#44; Hospital Universitario&#44; Salamanca&#46;</p> <p id="par0230" class="elsevierStylePara elsevierViewall">Hern&#225;n Llorente-Cancho&#44; Hospital Universitario&#44; Salamanca&#46;</p> <p id="par0235" class="elsevierStylePara elsevierViewall">Carolina Luque-Amado&#44; Hospital de la Serran&#237;a&#44; M&#225;laga&#46;</p> <p id="par0240" class="elsevierStylePara elsevierViewall">Jos&#233; Manuel Mach&#237;n-L&#225;zaro&#44; Hospital de Guadalajara&#46;</p> <p id="par0245" class="elsevierStylePara elsevierViewall">Mar&#237;a Maiz-Jim&#233;nez&#44; Hospital de la Serran&#237;a&#44; M&#225;laga&#46;</p> <p id="par0250" class="elsevierStylePara elsevierViewall">Francisco Mart&#237;nez&#44; Hospital Virgen Macarena&#44; Sevilla&#46;</p> <p id="par0255" class="elsevierStylePara elsevierViewall">Tom&#225;s Mart&#237;nez&#44; Hospital Juan Ram&#243;n Jim&#233;nez&#44; Huelva&#46;</p> <p id="par0260" class="elsevierStylePara elsevierViewall">Francisco Martos&#44; Hospital de Benalm&#225;dena&#44; M&#225;laga&#46;</p> <p id="par0265" class="elsevierStylePara elsevierViewall">Beatriz Massa&#44; Hospital de Villajoyosa&#44; Alicante&#46;</p> <p id="par0270" class="elsevierStylePara elsevierViewall">Jes&#250;s Medina&#44; Hospital 12 de Octubre&#44; Madrid&#46;</p> <p id="par0275" class="elsevierStylePara elsevierViewall">Francisco Medrano-Gonz&#225;lez&#44; Hospital de Albacete&#46;</p> <p id="par0280" class="elsevierStylePara elsevierViewall">Manuel Montero P&#233;rez-Barquero&#44; Hospital Reina Sof&#237;a&#44; C&#243;rdoba&#46;</p> <p id="par0285" class="elsevierStylePara elsevierViewall">Antonia Mora-Rufete&#44; Hospital General de Elche&#46;</p> <p id="par0290" class="elsevierStylePara elsevierViewall">Clotilde Morales&#44; Hospital de Manresa&#44; Barcelona&#46;</p> <p id="par0295" class="elsevierStylePara elsevierViewall">Lourdes Moreno-Gavi&#241;o&#44; Hospital Virgen del Roc&#237;o&#44; Sevilla&#46;</p> <p id="par0300" class="elsevierStylePara elsevierViewall">Alberto Muela-Molinero&#44; Hospital de Le&#243;n&#46;</p> <p id="par0305" class="elsevierStylePara elsevierViewall">Jos&#233; Murcia-Zaragoza&#44; Hospital General de Alicante&#46;</p> <p id="par0310" class="elsevierStylePara elsevierViewall">M&#46; Dolores Nieto-Mart&#237;n&#44; Hospital Virgen del Roc&#237;o&#44; Sevilla&#46;</p> <p id="par0315" class="elsevierStylePara elsevierViewall">Ignacio Novo Valeiro&#44; Hospital Universitario&#44; Salamanca&#46;</p> <p id="par0320" class="elsevierStylePara elsevierViewall">Manuel Ollero-Baturone&#44; Hospital Virgen del Roc&#237;o&#44; Sevilla&#46;</p> <p id="par0325" class="elsevierStylePara elsevierViewall">Blanca Pinilla&#44; Hospital Gregorio Mara&#241;&#243;n&#44; Madrid&#46;</p> <p id="par0330" class="elsevierStylePara elsevierViewall">Nieves Ram&#237;rez-Duque&#44; Hospital Virgen del Roc&#237;o&#44; Sevilla&#46;</p> <p id="par0335" class="elsevierStylePara elsevierViewall">Carmen Ramos-Cantos&#44; Hospital de la Axarqu&#237;a&#44; M&#225;laga&#46;</p> <p id="par0340" class="elsevierStylePara elsevierViewall">Manuel Rinc&#243;n-G&#243;mez&#44; Hospital Virgen del Roc&#237;o&#44; Sevilla&#46;</p> <p id="par0345" class="elsevierStylePara elsevierViewall">M&#46; Luisa Rodr&#237;guez-Benedito&#44; Hospital General de Requena&#44; Valencia&#46;</p> <p id="par0350" class="elsevierStylePara elsevierViewall">Virginia Rodr&#237;guez-Mart&#237;nez&#44; Hospital de Torrec&#225;rdenas&#44; Almer&#237;a&#46;</p> <p id="par0355" class="elsevierStylePara elsevierViewall">Manuel Romero-Jim&#233;nez&#44; Hospital Infanta Elena&#44; Huelva&#46;</p> <p id="par0360" class="elsevierStylePara elsevierViewall">Sixto Ruiz&#44; Hospital de Inca&#44; Mallorca&#46;</p> <p id="par0365" class="elsevierStylePara elsevierViewall">Alberto Ruiz-Cantero&#44; Hospital de la Serran&#237;a&#44; M&#225;laga&#46;</p> <p id="par0370" class="elsevierStylePara elsevierViewall">Emilio Sacanella&#44; Hospital Cl&#237;nic&#44; Barcelona&#46;</p> <p id="par0375" class="elsevierStylePara elsevierViewall">Mar&#237;a S&#225;nchez-Ledesma&#44; Hospital Universitario&#44; Salamanca&#46;</p> <p id="par0380" class="elsevierStylePara elsevierViewall">Antonio Sanjos&#233;-Laporte&#44; Hospital Vall d&#8217;Hebr&#243;n&#44; Barcelona&#46;</p> <p id="par0385" class="elsevierStylePara elsevierViewall">Carlos Sanrom&#225;n&#44; Hospital de la Axarqu&#237;a&#44; M&#225;laga&#46;</p> <p id="par0390" class="elsevierStylePara elsevierViewall">M&#46; &#193;ngeles Soria-L&#243;pez&#44; Cl&#237;nica Virgen de la Vega&#44; Murcia&#46;</p> <p id="par0395" class="elsevierStylePara elsevierViewall">Alicia Tejera-Concepci&#243;n&#44; Hospital Nuestra Sra&#46; de la Candelaria&#44; Tenerife&#46;</p> <p id="par0400" class="elsevierStylePara elsevierViewall">Pedro Tenllado-Doblas&#44; Hospital Dr&#46; Moliner&#44; Valencia&#46;</p> <p id="par0405" class="elsevierStylePara elsevierViewall">Guillermo Ternavasio&#44; Hospital Universitario&#44; Salamanca&#46;</p> <p id="par0410" class="elsevierStylePara elsevierViewall">Eulalia Villegas-Bruguera&#44; Hospital Dos de Maig&#44; Barcelona&#46;</p>"
            "etiqueta" => "Anexo"
            "titulo" => "Investigadores del Proyecto PROFUND"
            "identificador" => "sec0035"
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                  \t\t\t\t">1&#46;264 &#40;77&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Categor&#237;a C &#40;enfermedades pulmonares&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">271 &#40;16&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Categor&#237;a D &#40;enfermedades hep&#225;ticas&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">112 &#40;6&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;3 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#46;170 &#40;71&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">603 &#40;36&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;1&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">478 &#40;29&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">473 &#40;29&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">179 &#40;11&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">170 &#40;10&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">114 &#40;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#205;ndice de Charlson &#47; &#205;ndice de Charlson ajustado por edad</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#91;2&#93; &#47; 6&#44;3 &#91;2&#44;4&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Pacientes con disnea basal III-IV de la NYHA &#47;&#47; III-IV de la mMRC</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">777 &#40;47&#44;6&#37;&#41; &#47;&#47; 855 &#40;52&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Pacientes con neoplasia activa en la inclusi&#243;n &#47; enfermedad metast&#225;sica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">188 &#40;11&#44;2&#37;&#41; &#47; 70 &#40;37&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Hospitalizaciones en &#250;ltimos 12 meses &#47; 3 meses</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;9 &#40;1&#44;2&#41; &#47; 1 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#205;ndice de Barthel basal</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Pacientes con &#237;ndice de Barthel basal &#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">90</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">958 &#40;58&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Pacientes con &#237;ndice de Barthel basal &#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">60</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">512 &#40;31&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">N&#250;mero de f&#225;rmacos de prescripci&#243;n cr&#243;nica por paciente</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dimensi&#243;n<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">99&#44;6&#37;</span> &#40;98&#44;5-100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">79&#37; &#40;76-82&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">93&#44;6&#37; &#40;91-95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Vestirse&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;76 &#40;0&#44;73-0&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">96&#37; &#40;94-97&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">96&#44;6&#37; &#40;95-98&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;46 &#40;0&#44;36-0&#44;48&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&#44;8&#37; &#40;99-100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#44;2&#37; &#40;53-59&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#37; &#40;59-65&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Deposici&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">97&#44;6&#37; &#40;96-98&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#37; &#40;53-59&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96&#37; &#40;94-98&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Micci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;46 &#40;0&#44;41-0&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&#37; &#40;90-94&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#44;6&#37; &#40;53-60&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#37; &#40;57-63&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#37; &#40;89-94&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Retrete&nbsp;\t\t\t\t\t\t\n
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Considerando la dimensi&#243;n dicot&#243;micamente &#40;independencia <span class="elsevierStyleItalic">versus</span> cualquier grado de dependencia para la ejecuci&#243;n de esa dimensi&#243;n&#41;&#46;</p> <p class="elsevierStyleNotepara" id="npar0010">Muestra multic&#233;ntrica de 1&#46;632 pacientes pluripatol&#243;gicos&#46; En <span class="elsevierStyleBold">negrita</span> los VPP y VPN m&#225;ximos obtenidos en las preguntas individuales&#59; en <span class="elsevierStyleItalic"><span class="elsevierStyleBold">negrita y cursiva</span></span> los VPP y VPN m&#225;ximos obtenidos en las combinaciones de dos dimensiones&#46; Entre par&#233;ntesis el intervalo de confianza del 95&#37;&#46;</p>"
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          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Considerando la dimensi&#243;n dicot&#243;micamente &#40;independencia <span class="elsevierStyleItalic">versus</span> cualquier grado de dependencia para la ejecuci&#243;n de esa dimensi&#243;n&#41;&#46;</p> <p class="elsevierStyleNotepara" id="npar0020">Muestra multic&#233;ntrica de 1&#46;632 pacientes pluripatol&#243;gicos&#46; En <span class="elsevierStyleBold">negrita</span> los VPP y VPN m&#225;ximos obtenidos en las preguntas individuales&#59; en <span class="elsevierStyleItalic"><span class="elsevierStyleBold">negrita y cursiva</span></span> los VPP y VPN m&#225;ximos obtenidos en las combinaciones de dos dimensiones&#46; Entre par&#233;ntesis el intervalo de confianza del 95&#37;&#46;</p>"
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          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Resultados de concordancia &#40;&#237;ndice kappa&#41;&#44; sensibilidad &#40;S&#41;&#44; especificidad &#40;E&#41;&#44; valor predictivo positivo &#40;VPP&#41; y valor predictivo negativo &#40;VPN&#41; de cada dimensi&#243;n del &#237;ndice de Barthel&#44; y sus combinaciones &#243;ptimas para el diagn&#243;sticos de un &#237;ndice de Barthel &#8805;<span class="elsevierStyleHsp" style=""></span>60 puntos y su utilizaci&#243;n en el cribado de dependencia severa</p>"
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                    0 => array:2 [
                      "doi" => "10.1016/j.cger.2010.08.009"
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                        "tituloSerie" => "Clin Geriatr Med"
                        "fecha" => "2011"
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