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Background Physiotherapy (PT) education must foster both clinical competencies and non-technical skills such as communication, empathy, and self-efficacy to prepare students for professional practice. Simulation-Based Learning (SBL) offers a structured and safe environment to develop these skills. While the benefits of SBL have been documented in nursing and medical education, evidence in PT programs, particularly across different academic years, remains limited. This study examined changes in perceived self-efficacy, academic engagement, and empathy following SBL participation, and to explore differences between second-, third-, and fourth-year PT students. Methods A prospective quasi-experimental study was conducted between December 2023 and June 2024 involving second-, third-, and fourth-year undergraduate PT students from a single Spanish university (corresponding to the fourth, sixth, and eighth semesters, respectively). Students participated in SBL sessions designed according to international standards and adapted to their academic level. Outcomes were assessed pre- and post-SBL through validated questionnaires: the Academic Situation-Specific Perceived Self-Efficacy Scale, the Utrecht Work Engagement Scale for Students, and the Jefferson Scale of Empathy. All instruments demonstrated adequate internal consistency in the study sample (Chronbach’s α ≥ 0.80). Post-SBL perceptions were further assessed using the Student Satisfaction and Self-Confidence in Learning Questionnaire and the Educational Practices Questionnaire-Spanish Version. Results Out of 451 eligible students, 409 participated in the baseline assessment and 378 completed post-SBL assessments. Statistically significant improvements were found in self-efficacy ( p  = 0.001), academic engagement (vigor, absorption, and total score; p  = 0.008; p  = 0.007, and p  = 0.023, respectively), and empathy (compassionate care and total score; p  < 0.001, and p  = 0.007, respectively) across the full sample. When results were examined by academic year, patterns of change differed, with third- and fourth-year students showing consistent improvements across most dimensions, while second-year students exhibited more variable responses, including small decreases in selected engagement and empathy subscales. Post-SBL evaluations indicated high levels of satisfaction and self-confidence in learning, with large effect sizes observed in the more advanced academic years. Students’ perceptions indicated strong endorsement of SBL practices, especially in high expectations and learning diversity. Conclusions SBL was associated with improvements in key learning-related competencies, particularly among students in more advanced academic years. Differences across cohorts highlight the need to tailor SBL design to students’ developmental stage, especially during early exposure. Future studies should incorporate control groups, qualitative data, and follow-up assessments to better understand the sustainability and contextual factors influencing SBL outcomes. Trial registration NCT06852482 (registered on 28 February 2025).

Background Urinary incontinence (UI) is a common geriatric syndrome with high health and socio-economic impacts in nursing home (NH) residents. Objectives To estimate the prevalence and types of UI and its associated factors in older people living in NHs in Central Catalonia (Spain). We also determined the proportion of residents who were receiving behavioural strategies to prevent/manage UI. Design and setting Cross-sectional study in 5 NHs conducted from January to March 2020. Methods We included consenting residents aged 65 + permanently living in the NHs. Residents who were hospitalized, in a coma or palliative care were excluded. UI was assessed using Section H of the Minimum Data Set. Sociodemographic and health-related variables were examined. Descriptive, bivariate, and multivariate (logistic regression) analyses were performed. Results We included 132 subjects (82.6% women), mean age of 85.2 (SD = 7.4) years. The prevalence of UI was 76.5% (95% CI: 68.60-82.93). The most common type was functional UI (45.5%), followed by urgency UI (11.4%). Only 46.2% of residents received at least one behavioural strategy to manage UI. Most sedentary behaviour (SB) variables presented a p -value lower than 0.001 in the bivariate analyses, but none remained in the final model. Moderate-severe cognitive impairment (OR = 4.44, p  =.003), anticholinergic activity (OR = 3.50, p  =.004) and risk of sarcopenia using SARC-F (OR = 2.75, p  =.041) were associated with UI. Conclusions The prevalence of UI was high in this sample of NH residents compared to the literature, yet less than half received prompted voiding as a strategy to prevent/reduce UI.UI was associated with cognitive impairment, anticholinergic activity, and risk of sarcopenia.

Background: Stroke is the leading cause of physical disability in adults in Catalonia. Despite this, there is a lack of evidence of physiotherapy interventions on functional capacity during the chronic phase of the pathology. This multicenter clinical trial will be conducted with a sample size of 75 participants. Objectives: The objective of the study is to evaluate the effectiveness of a therapeutic exercise program in physiotherapy using telerehabilitation to optimize functional recovery and quality of life in people with chronic stroke, and to determine its impact on adherence to the exercise program. Methods: This is a multicenter randomized controlled trial. Three parallel groups will be compared, and two will undergo the same type of therapy. A control group (CG) will perform conventional intervention in primary care. There will be two experimental groups; (EG1) will perform document-guided therapeutic exercises at home and (EG2) will perform therapeutic exercises at home guided by a telerehabilitation program. The outcomes to be measured are degree of independence of a person in their activities of daily living, assessed by the Barthel Index, motor function, muscle tone of the affected limbs, muscle strength of the affected limbs, balance, gait efficiency, perception of musculoskeletal pain, perception of fatigue, risk of falls, perception of quality of life, and the perception of perceived subjective change after treatment. These outcomes will be evaluated at baseline (T0), at ten weeks (T1) (end of the intervention), and at 18 weeks (T2). The study duration per patient will be 18 weeks (a ten-week intervention, followed by an eight-week intervention follow-up). The analysis will be performed using a mixed linear model (ANOVA 3X3) and significance level p < 0.05.

Background In 2018, the European Working Group on Sarcopenia in Older People (EWGSOP2) updated the original definition of sarcopenia, establishing new criteria to be used globally. Early diagnosis of sarcopenia in nursing home residents and the identification of contributing factors would target interventions to reduce the incidence of malnutrition, social isolation, functional decline, hospitalization and mortality. Aim Verify the prevalence and the degree of severity of sarcopenia according to the new EWSGOP2 criteria and to analyse its associated factors in residents living in nursing homes in Central Catalonia (Spain). Design A cross-sectional multicenter study was conducted in 4 nursing homes. SARC-F test was applied as the initial screening, muscle strength was measured by a dynamometer, skeletal muscle mass by bioimpedance analysis and physical performance by Gait Speed. Four categories were used: total probable sarcopenia, probable sarcopenia, confirmed sarcopenia and severe sarcopenia. Results Among the total sample of 104 nursing home residents (mean age 84.6, ± 7.8; median 86, IQR 110), 84.6% were women and 85 (81.7%) (95% confidence interval [CI] 73.0-88.0) had total probable sarcopenia, 63 (60.5%) had probable sarcopenia, 19 (18.3%) had confirmed sarcopenia and 7 (6.7%) had severe sarcopenia. In the bivariate analysis, obesity was negatively associated and total time in sedentary behavior positively associated with all sarcopenia categories. In addition, malnutrition and urinary continence were positively associated with total and probable sarcopenia. Urinary incontinence was a positive associated factor of total and probable sarcopenia. In the multivariate analysis, obesity represented a negative associated factor: OR = 0.13 (0.03 - 0.57), p  = 0.007 and OR = 0.14 (0.03 - 0.60), p  = 0.008 with total and probable sarcopenia, respectively, adjusted by urinary incontinence status. For confirmed sarcopenia, obesity also represented a negative associated factor OR = 0.06 (0.01 - 0.99), p  = 0.049 and the total time in sedentary behavior a positive associated factor OR = 1.10 (1.00- 1.20), p  = 0.040. Conclusions According the EWGSOP2 criteria, high prevalence of sarcopenia was found in institutionalized older people, ranging from 6.7 to 81.7% depending on the category. Malnutrition, urinary incontinence and total time in sedentary behavior were associated with sarcopenia, whilst obesity represented a protective factor in this population.

Background Population ageing presents increasing challenges for health systems. Identifying complex needs and planning individualized care through Comprehensive Geriatric Assessment (CGA), promoting intergenerational engagement and empowerment via Service-Learning, are key strategies to support healthy and active aging. The general aim of the study is to evaluate the impact of a Service-Learning program that brings undergraduate health students into contact with community-dwelling older adults, assessing its benefits for students’ professional development and for older adults’ knowledge regarding their health. Methods Research protocol for Service-Learning program with a mixed methodology and experimental intervention design, involving undergraduate students from Nursing, Physiotherapy, Human Nutrition and Dietetics, Occupational Therapy and Psychology degrees, and older adults from the community over 60 years old. The intervention at the university, consisting of three sessions, will be based on CGA. Student data will be collected during the final session using the questionnaire developed and validated by León-Carrascosa et al. (2020) to evaluate Service-Learning in higher education. After the first and last session, an additional questionnaire will assess satisfaction and perceived competency development. Older participants will be assessed with VIG-Frail, Integrated Care of Older People (ICOPE) screening tool, EuroQol 5D-5L, Nursing Outcomes Classification and sociodemographic data. They will complete a post intervention questionnaire regarding their satisfaction, perceived health status, knowledge of healthy lifestyle habits, and awareness of community resources, whose items will be evaluated using a 5-point Likert scale. Data will be collected through the REDCap platform and analysed using SPSS. Qualitative data from focus groups will undergo thematic analysis. Discussion This study seeks to enhance both education and community health by integrating Service-Learning into health sciences training aligned with the WHO ICOPE framework. It aims to assess students’ perceptions of their preparation in geriatric assessment and person-centred care, while supporting early frailty detection and promoting healthy ageing in the community. Overall, it contributes to preparing future professionals for population ageing. Trial registration This study was registered in Clinical Trials with the registration number NCT06890325 on March 24, 2025. As the registration occurred after the enrolment of the first participant, the trial was retrospectively registered.

Loneliness, little studied in Nursing Homes (NHs), can affect physical and mental health. We aimed to analyze the factors associated with overall, social, and emotional loneliness in 65 residents of 5 NHs from Central Catalonia (Spain), and to verify its prevalence. The sample consisted of 81.5% women with a mean age of 84±7.13 years. The cross-sectional study included older adults aged 65 or over and with preserved cognitive status. De Jong Gierveld Loneliness Scale was used to assess overall loneliness and its subtypes; and sociodemographic and health-related variables were collected. The chi-square (or Fisher’s) test and logistic regression were used for bivariate and multivariate analysis respectively. Prevalence of overall loneliness was 70.7% (95%CI:58.2-81.4), social loneliness 44.6% (95% CI: 33.1-56.6) and emotional loneliness 46.2% (95% CI: 34.5–58.1). Overall loneliness was associated with lower perceived quality of life (Odds Ratio-OR = 5.52, 95% CI:1.25-24.38) and NHs with state subsidized places (OR = 0.19, 95% CI: .05-.74); social loneliness with having 0-1 children (OR = .25, 95% CI: .08-.77), and emotional loneliness with depression (OR = 4.54, 95% CI: 1.28-16.08) and urinary incontinence (UI) (OR = 4.65, 95% CI: 1.23-17.52). Loneliness was present in almost 71% of residents and was associated with type of NH and poorer quality of life, the emotional with depression and UI and the social one with having less than 2 children. La soledad, poco estudiada en las residencias de ancianos, puede afectar a la salud física y mental. Nuestro objetivo es analizar los factores asociados a la soledad global, social y emocional de un total de 65 residentes de 5 residencias de la Cataluña Central (España), y comprobar su prevalencia. La muestra estuvo formada por 81.5% mujeres con una edad media de 84±7.13 años. El estudio transversal incluyó a adultos mayores de 65 años y con estado cognitivo preservado. Se utilizó la Escala de Soledad de De Jong Gierveld para evaluar la soledad general y sus subtipos; y se recogieron variables sociodemográficas y relacionadas con la salud. Se utilizó la prueba de chi-cuadrado (o de Fisher) y la regresión logística para el análisis bivariante y multivariante, respectivamente. La prevalencia de la soledad global fue del 70.7% (IC 95%: 58.2-81.4), la soledad social del 44.6% (IC 95%: 33.1-56.6) y la soledad emocional del 46.2% (IC 95%: 34.5-58.1). La soledad global se asoció con una menor calidad de vida percibida (Odds Ratio-OR = 5.52, IC 95%: 1.25-24.38) y las residencias concertadas (OR = 0.19, IC 95%: 0.05-0. 74); la soledad social con tener 0-1 hijos (OR = 0.25, IC 95%: 0.08-0.77), y la soledad emocional con la depresión (OR = 4.54, IC 95%: 1.28-16.08) y la incontinencia urinaria (UI) (OR = 4.65, IC 95%: 1.23-17.52). La soledad estuvo presente en casi el 71% de los residentes y se asoció con el tipo de residencia y la peor calidad de vida, la emocional con la depresión y la IU y la social con tener menos de 2 hijos.

Background/Objectives: Sarcopenia is an age-related muscle disease that reduces strength and function in older adults. Exercise is a key intervention, but existing protocols vary widely and often lack adaptation to sarcopenia severity. The present study aims to review the effectiveness of exercise protocols developed after the EWGSOP2 consensus and evaluate their adaptation to sarcopenia severity stages. Methods: This systematic review followed PRISMA guidelines. PubMed and Scopus were searched for studies published after the EWGSOP2 consensus involving participants of 65 years and over with primary sarcopenia and managed through exercise-only interventions. Risk of bias was assessed with the Cochrane Risk of Bias tool, and quality and transparency of exercise intervention were assessed with the Consensus on Exercise Reporting Template. Results: Ten studies met the inclusion criteria, with a total of 558 participants. Most interventions included resistance training, often within multicomponent programs. Statistically significant improvements were reported in muscle strength, mass, and physical performance. Additional benefits included enhancements in sleep quality, respiratory function, and specific biomarkers. However, only two studies classified sarcopenia severity, and reporting quality varied considerably. Conclusions: Exercise interventions, especially multicomponent and individualized protocols, are effective at improving outcomes related to sarcopenia in older adults. However, better alignment with diagnostic classifications and standardized reporting are needed to improve clinical translation and program replication.

IntroductionSeveral studies have shown that physical activity (PA) levels and sedentary behaviour (SB) are independent risk factors for many health-related issues. However, there is scarce evidence supporting the relationship between SB and urinary incontinence (UI) in community-dwelling older adults, and no information on any possible association in institutionalised older adults. Stage I of this project has the main objective of determining the prevalence of UI and its associated factors in nursing home (NH) residents, as well as analysing the association between UI (and its types) and SB. Stage II aims to investigate the incidence and predictive factors of functional and continence decline, falls, hospitalisations, mortality and the impact of the COVID-19 pandemic among NH residents.Methods and analysisStage I is an observational, multicentre, cross-sectional study with mixed methodology that aims to explore the current status of several health-related outcomes in NH residents of Osona (Barcelona, Spain). The prevalence ratio will be used as an association measure and multivariate analysis will be undertaken using Poisson regression with robust variance. Stage II is a 2-year longitudinal study that aims to analyse functional and continence decline, incidence of falls, hospitalisations, mortality and the impact of the COVID-19 pandemic on these outcomes. A survival analysis using the actuarial method for functional decline and continence, evaluated every 6 months, and the Kaplan-Meier method for falls, hospitalisations and deaths, and Cox regression for multivariate analysis will be undertaken.Ethics and disseminationThe study received the following approvals: University of Vic - Central University of Catalonia Ethics and Research Committee (92/2019 and 109/2020), Clinical Research Ethics Committee of the Osona Foundation for Health Research and Education (FORES) (code 2020118/PR249). Study results will be disseminated at conferences, meetings and through peer-reviewed journals.Trial registration numberNCT04297904.

Urinary incontinence (UI) is a common geriatric syndrome affecting bladder health and is especially prevalent in nursing homes (NHs). The aim of the study was to determine the prevalence of UI and its associated factors in five Spanish NHs. UI (measured with Minimum Data Set 3.0), sociodemographic, and health-related variables were collected. Chi-square (or Fisher’s) or Student’s t-test (or Mann Whitney U) for bivariate analysis were used, with Prevalence Ratio (PR) as an association measure. The prevalence of UI was 66.1% (CI:95%, 53.6–77.2) in incontinent (n = 45, mean age 84.04, SD = 7.7) and continent (n = 23, mean age 83.00, SD = 7.7) groups. UI was significantly associated with frailty (PR = 1.84; 95%CI 0.96–3.53), faecal incontinence (PR = 1.65; 95%CI 1.02–2.65), anxiety (PR = 1.64; 95%CI 1.01–2.66), physical performance (PR = 1.77; 95%CI 1.00–3.11), and cognitive state (PR = 1.95; 95%CI 1.05–3.60). Statistically significant differences were found between incontinent and continent NH residents for limitations in activities of daily living (ADL), mobility, quality of life, sedentary behaviour, and handgrip strength. It can be concluded that two out of three of the residents experienced UI, and significant associated factors were mainly physical (sedentary behaviour, frailty, physical performance, ADL limitations, mobility, faecal incontinence, and handgrip strength) followed by psycho-cognitive factors (cognition, anxiety, and quality of life).

Background Age, multimorbidity, immunodeficiency and frailty of older people living in nursing homes make them vulnerable to COVID-19 and overall mortality. Objective To estimate overall and COVID-19 mortality parameters and analyse their predictive factors in older people living in nursing homes over a 2-year period. Method Design : A 2-year prospective longitudinal multicentre study was conducted between 2020 and 2022. Setting : This study involved five nursing homes in Central Catalonia (Spain). Participants : Residents aged 65 years or older who lived in the nursing homes on a permanent basis. Measurements : Date and causes of deaths were recorded. In addition, sociodemographic and health data were collected. For the effect on mortality, survival curves were performed using the Kaplan-Meier method and multivariate analysis using Cox regression. Results The total sample of 125 subjects had a mean age of 85.10 years (standard deviation = 7.3 years). There were 59 (47.2%) deaths at 24 months (95% confidence interval, CI, 38.6–55.9) and 25 (20.0%) were due to COVID-19, mostly in the first 3 months. In multivariate analysis, functional impairment (hazard ratio, HR 2.40; 95% CI 1.33–4.32) was a significant risk factor for mortality independent of age (HR 1.17; 95% CI 0.69–2.00) and risk of sarcopenia (HR 1.40; 95% CI 0.63–3.12). Conclusion Almost half of this sample of nursing home residents died in the 2‑year period, and one fifth were attributed to COVID-19. Functional impairment was a risk factor for overall mortality and COVID-19 mortality, independent of age and risk of sarcopenia.