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Sánchez-Martínez MP, Crisostomo MJ, Martín-San Agustín R, Montilla-Herrador J, Escolar-Reina MP, Valera-Novella E, Medina-Mirapeix F. Determination of Five Sit-to-Stand Test Performance at Discharge of Stroke Patients. Diagnostics (Basel) 2024; 14:521. [PMID: 38472993 DOI: 10.3390/diagnostics14050521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
The early identification of performance in the five-repetition sit-to-stand test (5-STS) at discharge in stroke patients could be of interest because it can determine independence for community-based activities. This study aimed to determine whether the initial measurement of the 5-STS test can be a determinant of the performance level prediction and amount of change in the 5-STS test at discharge in stroke patients. A prospective cohort study was conducted with a sample of 56 patients aged ≤60 d post-stroke. The 5-STS test results, as well as changes in patient condition, were measured at admission (T0) to an outpatient rehabilitation program, after the first month (T1), and at discharge (T2). The mean age was 62.7 (SD = 13.0), 58.9% of the subjects were male, and 75% had suffered an ischemic stroke. A multivariate linear regression model using the 5-STS test at T0 explained 57.7% of the variance in the performance at discharge. Using the 5-STS at T1 increased the variance to 75.5% (p < 0.001). Only the time from stroke onset at T0 significantly contributed to the two models. The measurement of the 5-STS at T0 and the amount of change in its performance at T2 explained 60.2% (p < 0.001) of the variance, while reassessment at T1 explained only 19.3% (p < 0.001). The level of patient performance on the 5-STS test at discharge, as well as any potential change, can be predicted by the admission measure of 5-STS in stroke patients.
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Affiliation(s)
| | | | - Rodrigo Martín-San Agustín
- Clinimetry and Technological Development in Therapeutic Exercise Research Group (CLIDET), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
| | | | | | | | - Francesc Medina-Mirapeix
- Department of Physiotherapy, University of Murcia, 30100 Murcia, Spain
- Clinimetry and Technological Development in Therapeutic Exercise Research Group (CLIDET), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
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Lozano-Meca JA, Gacto-Sánchez M, Montilla-Herrador J. Movement-evoked pain is not associated with pain at rest or physical function in knee osteoarthritis. Eur J Pain 2024. [PMID: 38186263 DOI: 10.1002/ejp.2236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/01/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Knee Osteoarthritis (KOA) is mainly characterized by pain. The assessment of KOA-related pain frequently focuses on different constructs subject to sources of bias or drawbacks, as the classical Pain at Rest (PAR). Movement-evoked pain (MEP), recently defined as 'pain during walking', emerges as a differential concept, since PAR and MEP are driven by different underlying mechanisms. Given the novelty of the MEP approach, its association with PAR or with different performance-based tests has not been studied in KOA yet. MATERIALS AND METHODS A cross sectional study was conducted. PAR was measured, alongside the performance of four mobility tests and their corresponding MEP: Timed Up and Go Test, 10-metre Walk Test, 2-Minute Walk Test, and 6-Minute Walk Test. Association and agreement were explored for MEP versus PAR, while the correlation of the tests versus each corresponding MEP-measure was assessed. RESULTS Neither association nor agreement were found in the duality MEP versus PAR. Also, the lack of association between the performance of a mobility test and the perceived level of pain during the development of the test was stated. CONCLUSION Movement-evoked pain is neither related to pain at rest nor to functional performance in subjects affected by knee osteoarthritis. The results from our study suggest that MEP and pain at rest measure and refer to different constructs in knee osteoarthritis. The implementation of MEP as an outcome in exercise-therapy could enhance the tracking of results, as well as the development of tailored interventions under different conditions. SIGNIFICANCE This research elucidates the relevance of MEP, recently defined as 'pain during walking', through the analysis of its association with PAR and with functional performance (measured through four mobility tests) in knee osteoarthritis. The results from our study highlight the absence of either association or agreement between MEP and PAR, fact that supports and endorses the idea that both concepts measure and refer to different constructs in knee osteoarthritis.
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Poveda-López S, Lillo-Navarro C, Sánchez-Pérez A, Gacto-Sánchez M, Montilla-Herrador J. Older persons' expressed perceptions on exercise programs in long-term care institutions: Influence of professionals and institutions. Patient Educ Couns 2023; 117:107985. [PMID: 37734250 DOI: 10.1016/j.pec.2023.107985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/30/2023] [Accepted: 09/16/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To explore the perceptions of institutionalised older people about the professionals and institutions regarding exercise programs in long-term care institutions DESIGN, SETTING, AND PARTICIPANTS: A qualitative study was carried out using focus group discussions. Forty-seven institutionalised participants (≥ 65 years old) with a score of > 23 in the Mini-Mental State Examination (MMSE) were recruited. RESULTS Most participants believed that the frequency of the exercise sessions could be increased by enhancing the number of staff assisting them and by adapting the facilities to their needs. They also suggested using outdoor spaces and avoiding childish activities and treatment. Participants' beliefs were grouped into three major themes (i) Perceptions about the health professionals delivering the exercise programs (ii) Perceptions about the institution or centre regarding exercise programs; (iii) Perceptions about the exercise programs. CONCLUSION Participants proposed certain changes that could take place in the institutions to promote engagement with exercise programs: tailored exercise programs, avoiding puerile treatment, increasing the number of staff members, and the creation of well-equipped spaces to perform the exercise. PRACTICAL IMPLICATIONS Professionals should spend time designing tailored exercise programs and avoid puerile treatment. Institutions must review the need for spaces and the personnel assigned.
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Affiliation(s)
- Salud Poveda-López
- Faculty of Health Sciences, UCAM Catholic University of Murcia, Murcia, Spain
| | - Carmen Lillo-Navarro
- Center for Translational Research in Physiotherapy (CEIT). Department of Pathology and Surgery. Miguel Hernández University, Alicante, Spain.
| | - Alicia Sánchez-Pérez
- Department of Pathology and Surgery, Miguel Hernández University, Alicante, Spain. Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Mariano Gacto-Sánchez
- CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain
| | - Joaquina Montilla-Herrador
- CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain
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Gacto-Sánchez M, Medina-Mirapeix F, Benítez-Martínez JC, Montilla-Herrador J, Palanca A, Agustín RMS. Estimating Quadriceps and Hamstrings Strength Through Myoton Among Recreational Athletes. J Sport Rehabil 2023; 32:827-833. [PMID: 37611914 DOI: 10.1123/jsr.2022-0437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/04/2023] [Accepted: 05/10/2023] [Indexed: 08/25/2023]
Abstract
CONTEXT The assessment of strength is one of the most usual practices among professionals involved in health care or sport. Quadriceps and hamstrings are the most commonly assessed muscle groups. Generally, the methods used to assess muscle strength are active and, therefore, alternative passive methods could be useful. Myoton provides measures on 3 mechanical properties of the muscle: tone, elasticity, and stiffness. OBJECTIVE This study aimed to analyze the association of Myoton, an easy-to-use tool not requiring voluntary stimulus from the subject, with strength values in quadriceps and hamstrings. STUDY DESIGN Experimental. SETTING University kinesiology laboratory. PARTICIPANTS Thirty-eight recreational athletes were evaluated. MAIN OUTCOME MEASURES Anthropometric and demographic data, Myoton-based measures of vastus lateralis, rectus femoris, vastus medialis, biceps femoris, and semitendinosus, and the maximum voluntary isometric contraction of quadriceps and hamstrings. PROCEDURES The association was examined using multiple regression models to estimate strength through Myoton-based parameters and different patient characteristics. The models encompassed either 2 or 3 independent variables. RESULTS The adjusted R2 values for predicting quadriceps strength were .666 for rectus femoris, .726 for vastus lateralis, and .667 for vastus medialis, while in regard to hamstrings, they were .617 for biceps femoris and .604 for semitendinosus. CONCLUSIONS The main finding was that acceptable relationships were found between muscle strength and Myoton-based parameters when variables such as gender and/or age are considered. Our study reveals a new tool for estimating strength with outstanding advantages: it is easy, time-efficient, adaptable, and highly manageable through the feasible equations provided.
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Affiliation(s)
| | | | | | | | - Ana Palanca
- Endocrinology and Nutrition Department, University Hospital of Valencia, Valencia,Spain
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Morera-Balaguer J, Lillo-Navarro C, de Oliveira-Sousa SL, Montilla-Herrador J, Escolar-Reina P, Rodríguez-Nogueira Ó, Medina-Mirapeix F. Parents of children with disabilities' perceptions regarding the quality of interaction with Health professionals working in early intervention: A qualitative descriptive study. J Clin Nurs 2023; 32:6519-6532. [PMID: 36380463 DOI: 10.1111/jocn.16580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study is to explore the perceptions of parents of children with physical disabilities concerning the quality of their interaction with health professionals in early intervention programs. BACKGROUND Despite the consensus on the need for Patient and Family-Centered Care, there are still difficulties when executing such care. The quality of interaction among patients, families, and professionals is essential to facilitate the implementation of the programs. DESIGN A qualitative descriptive study with thematic analysis using a Modified Grounded Theory approach. METHODS Data were collected through seven focus groups with 28 parents of children with physical disabilities who were undergoing early intervention programs in three centres. The study followed the COREQ guidelines and checklist. RESULTS Two themes emerged from the experiences: 'exchange of information and education', which included all the activities, procedures, exercises and skills taught by the professionals to help parents care for their child; and 'interpersonal skills', which focused on the way the professional relates with the child and the parents. Several subthemes emerged within each theme. CONCLUSIONS This study identified which elements of the professional-parent interaction are considered by parents when evaluating the quality of their interaction with the health care provider of their children. RELEVANCE TO CLINICAL PRACTICE The results of this study bring to light certain behaviours and interactions that health professionals should consider in order to improve the perceptions of parents of children with disabilities regarding the quality of interaction in the context of early childhood intervention. PATIENT OR PUBLIC CONTRIBUTION Parents contributed to the data collected. Early intervention professionals were involved in participant checking to ensure the rigour of the study.
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Affiliation(s)
| | - Carmen Lillo-Navarro
- Department of Pathology and Surgery and Center for Translational Research in Physical Therapy (CEIT), University Miguel Hernandez, Alicante, Spain
| | - Silvana-Loana de Oliveira-Sousa
- Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigacion Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
| | - Joaquina Montilla-Herrador
- Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigacion Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
| | - Pilar Escolar-Reina
- Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigacion Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
| | - Óscar Rodríguez-Nogueira
- University of León, Health Sciences School, Nursing and Physical Therapy Department, León, Spain
| | - Francesc Medina-Mirapeix
- Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigacion Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain
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Gacto-Sánchez M, Lozano-Meca JA, Lozano-Guadalajara JV, Montilla-Herrador J. Concurrent validity of the 2-and 6-minute walk test in knee osteoarthritis. Knee 2023; 43:34-41. [PMID: 37269795 DOI: 10.1016/j.knee.2023.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/14/2023] [Accepted: 05/11/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND The 6-Minute Walk Test (6MWT) is frequently used for the assessment of walking distances in several conditions, as knee osteoarthritis, but it can be both time-consuming for the researcher or clinician, and exhausting of painful for the subject suffering from this condition. The objective of our study was to analyze the concurrent validity of the 2-Minute Walk Test (2MWT) for patients with knee osteoarthritis compared to the 6-Minute Walk Test (6MWT). METHODS Cross-sectional validation study. Scores from the 6MWT of 42 ambulatory patients affected by knee osteoarthritis were compared to those from the shorter 2MWT. An initial correlation test was used to assess correlation between both measures, and a subsequent univariate regression analysis was performed with the aim of comparing the estimated outcomes of the 6MWT versus the actual 6MWT. RESULTS The scores from the 2MWT and 6MWT showed excellent correlation (Pearson's correlation coefficient r = 0.976; p-value < 0.001); the predictive equation based on the scores from the 2MWT (R2 = 0.952, p-value < 0.001) estimates the 6MWT scores with a relative error of 3.23%. CONCLUSIONS The 2MWT may be a practical assessment tool in replacement for the 6MWT in clinical assessment due to its low burden on patients and as a means of improving efficiency in a timely manner.
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Affiliation(s)
- Mariano Gacto-Sánchez
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain.
| | - José Antonio Lozano-Meca
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain.
| | | | - Joaquina Montilla-Herrador
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain.
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Gacto-Sánchez M, Lozano-Meca JA, Montilla-Herrador J. The pain attitudes and beliefs scale for physiotherapists: development and psychometric assessment of the Spanish version among physiotherapy students. Physiother Theory Pract 2023:1-11. [PMID: 36942636 DOI: 10.1080/09593985.2023.2190396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Pain might be approached from a biomedical or biopsychosocial perspective. There is a lack of research on the attitudes and beliefs about pain among physiotherapy students. In this context, the Pain Attitudes and Belief Scale for Physiotherapists (PABS-PT) is an instrument widely used from a clinical and educational perspective, but its psychometric properties have not yet been tested in a student-based population. OBJECTIVE To develop the Spanish version of the PABS-PT scale and to assess its psychometric properties among students in physiotherapy. METHODS The study was carried out among 103 students in their final years of academic studies in the Degree in Physiotherapy in the University of Murcia (Spain). Sociodemographic and PABS-PT related variables were collected. The instrument was translated into Spanish and tested through factor analysis, internal consistency, test-retest reliability, and known-groups validity. The 95% minimal detectable change of the instrument was also calculated. RESULTS The factor analysis revealed two factors within the instrument: Biomedical (9 items) and Biopsychosocial (7 items) factors, with Cronbach's alpha values of 0.730 and 0.708, respectively. The Intraclass Correlation Coefficient (3,2) was 0.851 for the Biomedical factor and 0.699 for the Biopsychosocial factor. The minimal detectable changes (95% CI) for the Biomedical and Biopsychosocial factors were 6.01 and 5.56, respectively. The pre-specified hypothesis for the known-groups validity test was met and revealed large effect sizes (d = 1.24). CONCLUSION The Spanish version of the instrument PABS-PT-SP covers two factors. It shows satisfactory psychometric properties and it is therefore an effective framework to discriminate between the biomedical and/or biopsychosocial thoughts and attitudes toward pain in physiotherapy.
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Affiliation(s)
- Mariano Gacto-Sánchez
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Spain
| | - José Antonio Lozano-Meca
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Spain
| | - Joaquina Montilla-Herrador
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Spain
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Valera-Novella E, Bernabeu-Mora R, Montilla-Herrador J, Escolar-Reina P, García-Vidal JA, Medina-Mirapeix F. Development of the ESEx index: a tool for predicting risk of recurrent severe COPD exacerbations. Ther Adv Chronic Dis 2023; 14:20406223231155115. [PMID: 38405221 PMCID: PMC10893840 DOI: 10.1177/20406223231155115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/18/2023] [Indexed: 02/27/2024] Open
Abstract
Background In chronic obstructive pulmonary disease (COPD), multiple recurrent severe exacerbations that require hospitalization can occur. These events are strongly associated with death and other clinical complications. Objectives We aimed to develop a prognostic model that could identify patients with COPD that are at risk of multiple recurrent severe exacerbations within 3 years. Design Prospective cohort. Methods The derivation cohort comprised patients with stable, moderate-to-severe COPD. Multivariable logistic regression analyses were performed to develop the final model. Based on regression coefficients, a simplified index (ESEx) was established. Both, model and index, were assessed for predictive performance by measuring discrimination and calibration. Results Over 3 years, 16.4% of patients with COPD experienced at least three severe recurrent exacerbations. The prognostic model showed good discrimination of high-risk patients, based on three characteristics: the number of severe exacerbations in the previous year, performance in the five-repetition sit-to-stand test, and in the 6-minute-walk test. The ESEx index provided good level of discrimination [areas under the receiver operating characteristic curve (AUCs): 0.913]. Conclusions The ESEx index showed good internal validation for the identification of patients at risk of three recurrent severe COPD exacerbations within 3 years. These tools could be used to identify patients who require early interventions and motivate patients to improve physical performance to prevent recurrent exacerbations.
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Affiliation(s)
- Elisa Valera-Novella
- Department of Physical Therapy, University of Murcia, Murcia, Spain
- Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria Virgen de La Arrixaca (IMIB), Murcia, Spain
| | - Roberto Bernabeu-Mora
- Department of Pneumology, Hospital General Universitario Morales Meseguer, Adva. Marqués de los Vélez s/n, Murcia 30008, Spain
- Department of Internal Medicine, University of Murcia, Murcia, Spain
- Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Joaquina Montilla-Herrador
- Department of Physical Therapy, University of Murcia, Murcia, Spain
- Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria Virgen de La Arrixaca (IMIB), Murcia, Spain
| | - Pilar Escolar-Reina
- Department of Physical Therapy, University of Murcia, Murcia, Spain
- Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria Virgen de La Arrixaca (IMIB), Murcia, Spain
| | - José Antonio García-Vidal
- University of Murcia, Murcia, Spain
- Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria Virgen de La Arrixaca (IMIB), Murcia, Spain
| | - Francesc Medina-Mirapeix
- Department of Physical Therapy, University of Murcia, Murcia, Spain
- Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria Virgen de La Arrixaca (IMIB), Murcia, Spain
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Gacto-Sánchez M, Lozano-Meca JA, Lozano-Guadalajara JV, Baño-Alcaraz A, Lillo-Navarro C, Montilla-Herrador J. Addition of tDCS and TENS to an education and exercise program in subjects with knee osteoarthritis: A study protocol. J Back Musculoskelet Rehabil 2022; 36:299-307. [PMID: 36530073 DOI: 10.3233/bmr-220015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Knee osteoarthritis often leads to chronic pain that frequently becomes disabling.Osteoarthritis has been linked to maladaptive plasticity in the brain, which can contribute to chronic pain. Therapies including neuromodulation and peripheral electrical stimulation are used to counteract the maladaptive plasticity of the brain. OBJECTIVE To determine the efficacy of the addition of tDCS and TENS to an education and exercise program in reducing pain. METHODS Over a 2-week study period, 60 participants will complete an exercise and educational intervention. Eligible participants accepting to participate will be subsequently randomized into one of the three treatment groups: 1) Active Transcranial Direct Current Stimulation (tDCS) and active Transcutaneous Electrical Nerve Stimulation (TENS); 2) Active tDCS and sham TENS; 3) Sham tDCS and sham TENS. RESULTS The primary outcome will be subjective pain intensity. SECONDARY OUTCOMES quality of life, physical function, central sensitization, and pain adjuvants (uncertainty, catastrophizing kinesiophobia, adverse events). CONCLUSION This clinical trial will provide data on the effect that the addition of tDCS and/or TENS to an education and exercise program may have to counteract maladaptive plastic changes and improve the benefits of exercises, and whether the combination of both neuromodulator techniques may have a higher magnitude of effect.
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Affiliation(s)
- Mariano Gacto-Sánchez
- Departament of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain
| | - José Antonio Lozano-Meca
- Departament of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain
| | | | - Aitor Baño-Alcaraz
- Departament of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain
| | - Carmen Lillo-Navarro
- Center for Translational Research in Physical Therapy (CEIT), Department of Pathology and Surgery, Faculty of Medicine, University Miguel Hernández, Alicante, Spain
| | - Joaquina Montilla-Herrador
- Departament of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain
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Montilla-Herrador J, Lozano-Meca JA, Baño-Alcaraz A, Lillo-Navarro C, Martín-San Agustín R, Gacto-Sánchez M. Knowledge and Attitudes towards Patient Safety among Students in Physical Therapy in Spain: A Longitudinal Study. Int J Environ Res Public Health 2022; 19:11618. [PMID: 36141888 PMCID: PMC9517046 DOI: 10.3390/ijerph191811618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/30/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Patient safety is a discipline of health care management aiming to prevent and reduce errors and harm to patients. The assessment of knowledge and attitudes on patient safety among students in physical therapy is still scarce; no studies have yet explored the changes that internship periods may produce. Objectives: 1. to determine the attitudes and knowledge of students in physical therapy with respect to patient safety in a Spanish University; and 2. to explore changes following a practical internship period. (2) Methods: Longitudinal study. Data from the Attitudes to Patient Safety Questionnaire III (APSQ-III) before and after the internship period were obtained from an initial sample of 125 students and average positive response rates were compared. (3) Results: "Team functioning", "Importance of patient safety in the curriculum", and "Error inevitability" displayed the highest scores, in accordance with the current literature. After the internship period, the dimensions "Patient safety training received" (p = 0.001), "Error reporting confidence" (p = 0.044), and "Professional incompetence as an error cause" (p = 0.027) showed significant changes. (4) Conclusions: The current study, highlighting areas of strengths and weaknesses in the knowledge and attitudes of students in physical therapy towards patient safety, may be a foundation to adopt tailored programs to enhance students' competencies in patient safety.
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Affiliation(s)
- Joaquina Montilla-Herrador
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, 30100 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, 30120 Murcia, Spain
| | - José A. Lozano-Meca
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, 30100 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, 30120 Murcia, Spain
| | - Aitor Baño-Alcaraz
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, 30100 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, 30120 Murcia, Spain
| | - Carmen Lillo-Navarro
- Department of Pathology and Surgery and Center for Translational Research in Physical Therapy (CEIT), University Miguel Hernández, Sant Joan, 03202 Alicante, Spain
| | | | - Mariano Gacto-Sánchez
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, 30100 Murcia, Spain
- Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, 30120 Murcia, Spain
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Medina-Mirapeix F, Bernabeu-Mora R, Gacto-Sánchez M, Montilla-Herrador J, Escolar-Reina P, Sánchez-Martínez MP. The prognosis of pre-frail chronic obstructive pulmonary disease patients for hospitalizations and mortality depends on their level of functional physical performance. Chron Respir Dis 2022; 19:14799731221119810. [PMID: 36071021 PMCID: PMC9459488 DOI: 10.1177/14799731221119810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective To determine if pre-frail Chronic obstructive pulmonary disease (COPD)
patients with poor and non-poor performance in the five-repetition
sit-to-stand test (5-STS) had a worse prognosis for hospitalization and
mortality at 2 years and for mortality at 5 years than non-frail
patients. Methods We prospectively included patients with stable COPD, between 40 and 80 years,
from a hospital in Spain. Patients were classified according their
performance on the 5-STS test and level of frailty. Timing, number of
hospitalizations, length of stay, and timing and rate of mortality were
outcome measures. Patients were followed for 2 years for exacerbations and
for 5 years for mortality. Kaplan-Meier curves and univariate and
multivariate Cox proportional-hazard analyses, ANOVA tests and univariate
and multivariate linear and logistic regression models were used. Results Of the 125 patients included, 25.6% were pre-frail with poor performance, 57%
pre-frail with non-poor performance, and 17.4% non-frail with non-poor
performance. Pre-frail patients with poor performance had a higher number of
hospitalizations (adjusted beta: 0.49; 95% CI: 0.01–0.96), mortality rates
(odds ratio: 11.33; 95% CI: 1.15–110.81), and risk at 5 years (adjusted
hazard ratio: 8.77; 95% CI: 1.02–75.51) than non-frail patients. Pre-frail
patients with poor performance also had worse prognoses than non-frail
patients with respect to length of hospital stays (increased by 4.16 days)
and timing to first hospitalization (HR: 6.01) in unadjusted models, but not
when adjusted. Conclusion The COPD prognosis of pre-frail patients with respect to the number of
exacerbations with hospitalization and the timing and rate of mortality is
dependent of functional performance.
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Affiliation(s)
- Francesc Medina-Mirapeix
- Department of Physical Therapy, 16751University of Murcia, Murcia, Spain.,Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Roberto Bernabeu-Mora
- Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain.,Department of Pneumology, 16270Hospital General Universitario Morales Meseguer, Murcia, Spain.,Department of Internal Medicine, 16751University of Murcia, Murcia, Spain
| | - Mariano Gacto-Sánchez
- Department of Physical Therapy, 16751University of Murcia, Murcia, Spain.,Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Joaquina Montilla-Herrador
- Department of Physical Therapy, 16751University of Murcia, Murcia, Spain.,Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - Pilar Escolar-Reina
- Department of Physical Therapy, 16751University of Murcia, Murcia, Spain.,Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - María Piedad Sánchez-Martínez
- Department of Physical Therapy, 16751University of Murcia, Murcia, Spain.,Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
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12
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Poveda-López S, Montilla-Herrador J, Gacto-Sánchez M, Romero-Galisteo RP, Lillo-Navarro C. Wishes and perceptions about exercise programs in exercising institutionalized older adults living in long-term care institutions: A qualitative study. Geriatr Nurs 2021; 43:167-174. [PMID: 34902751 DOI: 10.1016/j.gerinurse.2021.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 01/24/2023]
Abstract
The level of exercise among older adults is low, particularly among those living in health-care institutions. To gain insight into the perceptions of institutionalized older adults towards the exercise programs developed in long-term care institutions and to identify their wishes and needs regarding these programs, we conducted a qualitative study using focus group discussions. Thirty-six institutionalized participants (≥ 65 years) were recruited. Six common themes emerged: participants' attitudes and motivations towards the exercise programs, self-perceived health, knowledge of the concept of physical exercise, perceived effects of the exercise programs, and wishes or expectations for the exercise programs. The main wishes were to increase frequency of exercise sessions, to exercise outdoor and to increase walking times. The results suggest the need for changes in the development of exercise programs, including changes in the frequency, performance environment and types of exercises performed.
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Affiliation(s)
- Salud Poveda-López
- Faculty of Health Sciences, UCAM Catholic University of Murcia, Murcia. Spain
| | - Joaquina Montilla-Herrador
- Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain.
| | - Mariano Gacto-Sánchez
- Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain
| | - Rita P Romero-Galisteo
- Departament of Physical therapy. Biomedical Research Institute of Málaga (IBIMA), University of Málaga. Málaga, Spain
| | - Carmen Lillo-Navarro
- Department of Pathology and Surgery and Center for Translational Research in Physical Therapy (CEIT). University Miguel Hernández, Sant Joan, Alicante, Spain
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13
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Martinez-Gonzalez M, Montilla-Herrador J, García-Vidal JA, Escolar-Reina P, Gacto-Sánchez M, Medina-Mirapeix F. Intra- and inter-rater reliability of electrical impedance myography using adhesive electrodes in healthy volunteers. J Electromyogr Kinesiol 2020; 55:102456. [PMID: 32905888 DOI: 10.1016/j.jelekin.2020.102456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 12/14/2022] Open
Abstract
In spite of the growing use of the electrical impedance myography (EIM) measures for clinical assessment and follow-up of diseased muscle tissue, reliability studies are scarce. We evaluate the reliability of the (EIM) technique using four adhesive electrodes over the muscle of interest. Intra- and inter-rater reliability was studied within the same session and between sessions. Thirty-one healthy and volunteer subjects aged between 20 and 26 years were recruited. Phase angle, reactance and resistance were assessed for each EIM measurement. Intraclass correlation coefficient (ICC) was used to determine the relative reliability. Absolute reliability was expressed as the standard error of measurement and the minimum detectable change. Relative reliability within the same session and between sessions for the EIM technique was excellent (ICCs > 0.9) concerning both intra- and inter-rater reliability, except for the component reactance. The absolute reliability was very high for the three EIM components. EIM measures using four adhesive electrodes over the area of interest is a reliable technique to assess muscle tissue status. This study confirms that these measurement results barely vary depending on the examiner and the moment. The present study also confirms phase angle as the least affected EIM component by examiner and evaluation moment.
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Affiliation(s)
- Mariano Martinez-Gonzalez
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain; Department of Physical Therapy, University of Murcia, Murcia, Spain.
| | - Joaquina Montilla-Herrador
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain; Department of Physical Therapy, University of Murcia, Murcia, Spain
| | - Jose A García-Vidal
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain; Department of Physical Therapy, University of Murcia, Murcia, Spain
| | - Pilar Escolar-Reina
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain; Department of Physical Therapy, University of Murcia, Murcia, Spain
| | - Mariano Gacto-Sánchez
- Department of Physical Therapy, EUSES University School, University of Girona, Spain
| | - Francesc Medina-Mirapeix
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain; Department of Physical Therapy, University of Murcia, Murcia, Spain
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14
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Bernabeu-Mora R, Sánchez-Martínez MP, Montilla-Herrador J, Oliveira-Sousa SL, Gacto-Sánchez M, Medina-Mirapeix F. 2011 GOLD Stages of COPD: Transitions, Predictor Factors and Comparison with 2017 GOLD Stages. Int J Chron Obstruct Pulmon Dis 2020; 15:1519-1527. [PMID: 32636620 PMCID: PMC7335284 DOI: 10.2147/copd.s254434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/12/2020] [Indexed: 11/23/2022] Open
Abstract
Background Despite wide use of the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) 2011, little is known about between-stage transitions and what factors predict worsening transitions in patients with chronic obstructive pulmonary disease (COPD). Objective To investigate the transition frequency between GOLD 2011 stages among patients with stable COPD over a 2-year follow-up, to identify potential non-pulmonary predictor factors for worsening transitions, and to compare transition frequencies between GOLD 2011 stages and the new GOLD 2017 stages. Patients and Methods We prospectively included 137 patients with stable COPD (mean age, 66.9 ± 8.3 years). GOLD 2011 and GOLD 2017 stages were measured at baseline, 1-year follow-up, and 2-year follow-up. To evaluate non-pulmonary variables as potential predictors of worsening transitions, we used regression models adjusted for sociodemographic, clinical, and pulmonary variables using generalized estimating equations. Results The study period included 246 opportunities for transition, and 39 worsening transitions occurred within GOLD 2011 stages. Predictors of worsening transitions included BODE index (OR, 1.20; 95% CI, 1.00–1.44), quadriceps strength (OR, 0.87; 95% CI, 0.76–0.99), and limited mobility activities (OR, 1.02; 95% CI, 1.00–1.05). The frequency of worsening transitions for stages B and C differed between GOLD 2011 and GOLD 2017. Stages A and D were the most stable in both classifications. Conclusion Non-pulmonary factors predicted worsening transitions among the GOLD 2011 stages of COPD severity. The choice of GOLD 2011 versus GOLD 2017 may influence transition identification, especially for stages B and C.
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Affiliation(s)
- Roberto Bernabeu-Mora
- Division of Pneumology, Hospital General Universitario Morales Meseguer, Murcia, Spain.,Department of Internal Medicine, University of Murcia, Murcia, Spain.,Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain
| | - M Piedad Sánchez-Martínez
- Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain.,Department of Physical Therapy, University of Murcia, Murcia, Spain
| | - Joaquina Montilla-Herrador
- Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain.,Department of Physical Therapy, University of Murcia, Murcia, Spain
| | - Silvana L Oliveira-Sousa
- Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain.,Department of Physical Therapy, University of Murcia, Murcia, Spain
| | - Mariano Gacto-Sánchez
- Department of Physical Therapy, EUSES University School, University of Girona, Girona, Spain
| | - Francesc Medina-Mirapeix
- Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain.,Department of Physical Therapy, University of Murcia, Murcia, Spain
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15
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Medina-Mirapeix F, Bernabeu-Mora R, Sánchez-Martínez MP, Gacto-Sánchez M, Martín San Agustín R, Montilla-Herrador J. Patterns and Predictors of Recovery from Poor Health Status Measured with the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test in Patients with Stable COPD: A Longitudinal Study. J Clin Med 2019; 8:jcm8070946. [PMID: 31261894 PMCID: PMC6679022 DOI: 10.3390/jcm8070946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 06/24/2019] [Accepted: 06/27/2019] [Indexed: 01/26/2023] Open
Abstract
Recent recommendations for chronic obstructive pulmonary disease (COPD) suggest that evaluation and management should focus on patient health status. Despite the frequency of poor health status and its negative impact on patients with COPD, little is known about how poor or non-poor health status persists and/or remits over time or what factors might predict recovery from a poor health status. The aim was to determine the likelihood of transitioning between poor and non-poor health status in patients with stable COPD followed for 2 years and to investigate factors that might predict recovery from poor health status. We prospectively included 137 patients with stable COPD (mean age, 66.9 years ± 8.3). Health status was measured at baseline and after 1 and 2 years with the COPD assessment test (CAT). Higher scores indicated worse health status, and 10 was the cut-off score for discriminating between non-poor and poor health status. The likelihoods of annual transitions to new episodes and recovery were calculated. We evaluated demographic, non-respiratory, and respiratory variables as potential predictors with generalized estimating equations. At baseline, 37 patients (27%) reported non-poor health status. Within the group of patients displaying poor health status at the beginning of the year, 176 annual transitions were identified during the study period: 15.9% were transitions to recovery from poor health status. In contrast, of the 70 transitions from a starting non-poor health status, 32.4% worsened. Predictors of transitions to recovery were: current non-smoker status (odds ratio (OR) = 3.88; 95% confidence interval (CI): 0.64–5.54) and handgrip strength (OR = 1.08; 95% CI: 1.00–1.16). This study suggests that self-reported health status, measured with the CAT, has a dynamic nature in patients with COPD. Annual transitions towards recovery from poor health status are most likely among current non-smoking patients and those with high handgrip strength.
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Affiliation(s)
- Francesc Medina-Mirapeix
- Department of Physical Therapy, University of Murcia, 30100 Murcia, Spain
- Research group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), 30120 El Palmar Murcia, Spain
| | - Roberto Bernabeu-Mora
- Department of Physical Therapy, University of Murcia, 30100 Murcia, Spain.
- Research group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), 30120 El Palmar Murcia, Spain.
- Department of Pneumology, Hospital General Universitario J M Morales Meseguer, 30008 Murcia, Spain.
| | - Maria Piedad Sánchez-Martínez
- Department of Physical Therapy, University of Murcia, 30100 Murcia, Spain
- Research group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), 30120 El Palmar Murcia, Spain
| | - Mariano Gacto-Sánchez
- Department of Physical Therapy, EUSES University School, University of Girona, 17190 Salt Girona, Spain
| | | | - Joaquina Montilla-Herrador
- Department of Physical Therapy, University of Murcia, 30100 Murcia, Spain
- Research group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), 30120 El Palmar Murcia, Spain
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16
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Medina-Mirapeix F, Bernabeu-Mora R, Sánchez-Martínez MP, Montilla-Herrador J, Bernabeu-Mora M, Escolar-Reina P. Mobility limitations related to reduced pulmonary function among aging people with chronic obstructive pulmonary disease. PLoS One 2018; 13:e0196152. [PMID: 29715295 PMCID: PMC5929546 DOI: 10.1371/journal.pone.0196152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 04/07/2018] [Indexed: 01/27/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a major cause of disability. We aimed to analyse the impact of reduced pulmonary function on non-respiratory impairments and mobility activity limitations in an elderly population with COPD and to elucidate which specific limitations on mobility are related to reduced pulmonary function Methods Cross-sectional study of 110 patients with COPD, recruited from public and university hospital. The effect of impaired pulmonary function on the risk of non-respiratory impairments and mobility limitations was analysed using validated measures, including: the 6-Minute Walk Test (6MWT), skeletal muscle strength, the Short Physical Performance Battery (SPPB), and self-reported mobility questionnaire. Multivariate analysis was used to control for confounders such as age, sex, height, education, and cigarette smoking. Results Greater impairment of pulmonary function was associated with less distance walked during the 6MWT, poorer SPPB scores, and greater risk of self-reported mobility limitations (p<0.05). Lower forced expiratory volume in 1 s was also associated with a greater risk of limitations in carrying items under 10 pounds (4.54 kg), walking alone up and down a flight of stairs, and walking two or three neighbourhood blocks. There was no clear statistical relationship between pulmonary function impairment and skeletal muscle strength. Conclusions Impaired pulmonary function was associated with the 6MWT score and limitations on performance-based and self-reported mobility activities, but not with skeletal muscle strength among elderly COPD patients.
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Affiliation(s)
| | - Roberto Bernabeu-Mora
- Department of Physical Therapy, University of Murcia, Murcia, Spain
- Department of Pneumology, Hospital General Universitario J M Morales Meseguer, Murcia, Spain
- * E-mail:
| | | | | | - Myriam Bernabeu-Mora
- Department of Internal Medicine. Hospital Vega Baja de Orihuela, Alicante, Spain
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17
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Medina-Mirapeix F, Bernabeu-Mora R, Giménez-Giménez LM, Montilla-Herrador J, García-Vidal JA, Benítez-Martínez J. Patterns and predictors of exhaustion episodes in patients with stable COPD: A longitudinal study. Int J Clin Pract 2018; 72:e13068. [PMID: 29436160 DOI: 10.1111/ijcp.13068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/18/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Exhaustion is the perception of low energy. Little is known about how exhaustion persists, remits or reappears over time in patients with chronic obstructive pulmonary disease (COPD) or how to predict these events. We determined the likelihood of transitions between states of exhaustion and no exhaustion among patients with stable COPD followed up for 2 years. We investigated combinations of potential factors for their abilities to predict new-onset exhaustion episodes. METHODS We prospectively included 137 patients with stable COPD (mean age, 66.9 years ± 8.3). Exhaustion states were measured at baseline and 1 and 2 years later. Exhaustion was defined as an answer of "most of the time" or "a moderate amount of time" to 1 of 2 questions: "How often have you found it hard to get going?" and "How often does everything seem to require effort?" We evaluated demographic, non-respiratory and respiratory variables as potential predictors. The likelihoods of new episodes and recovery were calculated. Predictors were evaluated with generalised estimating equations. RESULTS At baseline, 27 patients (19.7%) displayed exhaustion. Of the 110 patients without exhaustion at baseline, 17 (15.5%) displayed exhaustion at least once during the follow-up period. During the study period, a total of 204 annual transitions displaying no exhaustion at the beginning were identified. Of them, 10.3% transitioned to exhaustion in the next year. The likelihood of recovery after exhaustion was 50%. Independent predictors of new-onset exhaustion episodes within the following year were: the COPD assessment test score (odds ratio [OR] = 1.10; 95% confidence interval [CI] 1.01-1.21), depression (OR = 6.89; 95% CI: 1.00-47.41) and female gender (OR = 6.88; 95% CI: 1.83-25.73). CONCLUSIONS Patients in stable COPD with high CAT scores and depression were most likely to experience new-onset exhaustion episodes Thus, exhaustion might be predicted by a combination of psychological factors and respiratory health status. Nevertheless, exhaustion is dynamic in COPD; half of patients recover from exhaustion.
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Affiliation(s)
| | - Roberto Bernabeu-Mora
- Department of Physical Therapy, University of Murcia, Murcia, Spain
- Department of Pneumology, Hospital General Universitario JM Morales Meseguer, Murcia, Spain
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18
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Navarro-Pujalte E, Gacto-Sánchez M, Montilla-Herrador J, Escolar-Reina P, Ángeles Franco-Sierra M, Medina-Mirapeix F. Sensitivity to change of mobility measures in musculoskeletal conditions on lower extremities in outpatient rehabilitation settings. Disabil Rehabil 2018; 41:1268-1274. [PMID: 29327598 DOI: 10.1080/09638288.2018.1424948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
STUDY DESIGN Prospective longitudinal study. OBJECTIVE To examine the sensitivity of the Mobility Activities Measure for lower extremities and to compare it to the sensitivity of the Physical Functioning Scale (PF-10) and the Patient-Specific Functional Scale (PSFS) at week 4 and week 8 post-hospitalization in outpatient rehabilitation settings. BACKGROUND Mobility Activities Measure is a set of short mobility measures to track outpatient rehabilitation progress: its scales have shown good properties but its sensitivity to change has not been reported. METHODS Patients with musculoskeletal conditions were recruited at admission in three outpatient rehabilitation settings in Spain. Data were collected at admission, week 4 and week 8 from an initial sample of 236 patients (mean age ± SD = 36.7 ± 11.1). MAIN OUTCOME MEASURES Mobility Activities Measure scales for lower extremity; PF-10; and PSFS. RESULTS All the Mobility Activities Measure scales were sensitive to both positive and negative changes (the Standardized Response Means (SRMs) ranged between 1.05 and 1.53 at week 4, and between 0.63 and 1.47 at week 8). The summary measure encompassing the three Mobility Activities Measure scales detected a higher proportion of participants who had improved beyond the minimal detectable change (MDC) than detected by the PSFS and the PF-10 both at week 4 (86.64% vs. 69.81% and 42.23%, respectively) and week 8 (71.14% vs. 55.65% and 60.81%, respectively). CONCLUSIONS The three Mobility Activities Measure scales assessing the lower extremity can be used across outpatient rehabilitation settings to provide consistent and sensitive measures of changes in patients' mobility. Implications for rehabilitation All the scales of the Mobility Activities Measure for the lower extremity were sensitive to both positive and negative change across the follow-up periods. Overall, the summary measure encompassing the three Mobility Activities Measure scales for the lower extremity appeared more sensitive to positive changes than the Physical Functioning Scale, especially during the first four weeks of treatment. The summary measure also detected a higher percentage of participants with positive change that exceeded the minimal detectable change than the Patient-Specific Functional Scale and the Physical Functioning Scale at the first follow-up period. By demonstrating their consistency and sensitivity to change, the three Mobility Activities Measures scales can now be considered in order to track patients' functional progress. Mobility Activities Measure can be therefore used in patients with musculoskeletal conditions across outpatient rehabilitation settings to provide estimates of change in mobility activities focusing on the lower extremity.
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Affiliation(s)
| | - Mariano Gacto-Sánchez
- b Department of Physical Therapy , EUSES University School, University of Girona , Girona , Spain
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19
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Bernabeu-Mora R, Giménez-Giménez LM, Montilla-Herrador J, García-Guillamón G, García-Vidal JA, Medina-Mirapeix F. Determinants of each domain of the Short Physical Performance Battery in COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:2539-2544. [PMID: 28883721 PMCID: PMC5574685 DOI: 10.2147/copd.s138402] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The Short Physical Performance Battery (SPPB) is an assessment tool with good prognostic value in COPD. It includes the following: standing balance, 4 m gait speed test (4MGS), and the timed five-repetition sit-to-stand test (5STS). The specific differences in determinants between these three tasks have not been adequately characterized in COPD patients. We aimed to identify health-related, functional, and psychological determinants of each SPPB test. METHODS We conducted a cross-sectional analysis of 137 patients with stable COPD. Patients performed the SPPB, quadriceps muscle strength (QMS), exercise tolerance test (6-min walk test [6MWT]), and pulmonary function; and health-related and psychological factors, physical activity, the COPD assessment test (CAT), body mass index, age, and depression were assessed. RESULTS Separate multivariable regression models predicting the 4MGS, 5STS, and balance test results described 31%, 39.1%, and 12.1% of the variance for each test, respectively. QMS was negatively associated with all three tests. The 6MWT was negatively associated with the 4MGS and 5STS. Depression and age were positively associated with 4MGS scores, whereas CAT and age were positively associated with 5STS scores. CONCLUSION The three SPPB tests did not provide equivalent information regarding a COPD patient's status. The 5STS was associated with health status factors, while the 4MGS was associated with psychological factors.
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20
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Medina-Mirapeix F, Lillo-Navarro C, Montilla-Herrador J, Gacto-Sánchez M, Franco-Sierra MÁ, Escolar-Reina P. Predictors of parents' adherence to home exercise programs for children with developmental disabilities, regarding both exercise frequency and duration: a survey design. Eur J Phys Rehabil Med 2017; 53:545-555. [PMID: 28466627 DOI: 10.23736/s1973-9087.17.04464-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Many families have problems adhering to home exercise programs (HEP) for children with developmental disabilities. However, parental participation in HEP is known to have a positive effect on child-related outcome variables, as well as on parental functioning. AIM This study examined whether the different behaviours of health professionals, and the behaviour and social characteristics of parents determine rates of parental adherence to both the frequency per week, and duration per session, of HEP for children with developmental disabilities attending paediatric services in early intervention centres. In this study, developmental disabilities include those caused by developmental delay or specific health conditions such as cerebral palsy, congenital illness, or others. DESIGN Survey. SETTING Eighteen early intervention centers. POPULATION Parents of children with developmental disabilities receiving HEP. METHODS A self-reported questionnaire was used to examine: whether frequency and duration of weekly exercise sessions was prescribed by physiotherapists; whether the child had received the HEP according to what was prescribed; and items related to the individual, social support, illnesses and the involvement of the health professional. Multiple logistic regression analyses examined their relative relevance. RESULTS In this study 219 parents participated. The rate of adherence to the prescribed frequency and duration of the HEP was similar (61.4-57.2%). The probability of adherence to both components increased for parents who had a low perception of the existence of barriers for integrating the exercises into their daily routine (OR=2.62 and 4.83). Furthermore, other cognitive factors of parents had a variable influence. The involvement of the professional had a significant impact regarding the frequency of the HEP. Professional involvement increased the probability of exercises being followed accurately by adopting strategies such as: providing information about the progress and evolution of the exercises (OR=3.75); justifying their usefulness (OR=2.17); giving advice on how to include them into the daily routine (OR=2.54); checking skills during follow-up (OR=2.21) and asking about home adherence (OR=2.20). CONCLUSIONS Providing information during clinical encounters, advising how to include exercises into the daily routine, and checking skills and adherence during follow-up represent practical targets for clinicians aiming to improve the frequency of HEP for children with developmental disabilities. CLINICAL REHABILITATION IMPACT This study contributes to the knowledge of physicians and therapists regarding how their interventions (in particular, information, instructions for HEP and follow-up) influence parents regarding their adherence to HEP.
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Affiliation(s)
- Francesc Medina-Mirapeix
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB), Murcia, Spain - .,Department of Physical Therapy, University of Murcia, Murcia, Spain -
| | - Carmen Lillo-Navarro
- Department of Pathology and Surgery, University "Miguel Hernández", Alicante, Spain
| | - Joaquina Montilla-Herrador
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB), Murcia, Spain.,Department of Physical Therapy, University of Murcia, Murcia, Spain
| | | | | | - Pilar Escolar-Reina
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB), Murcia, Spain.,Department of Physical Therapy, University of Murcia, Murcia, Spain
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Bernabeu-Mora R, García-Guillamón G, Montilla-Herrador J, Escolar-Reina P, García-Vidal JA, Medina-Mirapeix F. Rates and predictors of depression status among caregivers of patients with COPD hospitalized for acute exacerbations: a prospective study. Int J Chron Obstruct Pulmon Dis 2016; 11:3199-3205. [PMID: 28008245 PMCID: PMC5167454 DOI: 10.2147/copd.s118109] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Hospitalization is common for acute exacerbation of COPD, but little is known about its impact on the mental health of caregivers. OBJECTIVE The aim of this study was to determine the rates and predictors of depressive symptoms in caregivers at the time of hospitalization for acute exacerbation of COPD and to identify the probability and predictors of subsequent changes in depressive status 3 months after discharge. MATERIALS AND METHODS This was a prospective study. Depression symptoms were measured in 87 caregivers of patients hospitalized for exacerbation at hospitalization and 3 months after discharge. We measured factors from four domains: context of care, caregiving demands, caregiver resources, and patient characteristics. Univariate and multivariate multiple logistic regressions were used to determine the predictors of depression at hospitalization and subsequent changes at 3 months. RESULTS A total of 45 caregivers reported depression at the time of hospitalization. After multiple adjustments, spousal relationship, dyspnea, and severe airflow limitation were the strongest independent predictors of depression at hospitalization. Of these 45 caregivers, 40% had a remission of their depression 3 months after discharge. In contrast, 16.7% of caregivers who were not depressive at hospitalization became depressive at 3 months. Caregivers caring >20 hours per week for patients with dependencies had decreased odds of remission, and patients having dependencies after discharge increased the odds of caregivers becoming depressed. CONCLUSION Depressive symptoms are common among caregivers when patients are hospitalized for exacerbation of COPD. Although illness factors are determinants of depression at hospitalization, patient dependence determines fluctuations in the depressive status of caregivers.
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Affiliation(s)
- Roberto Bernabeu-Mora
- Division of Pneumology, Hospital Morales Meseguer; Department of Physical Therapy, University of Murcia; Physiotherapy and Disability Research Group, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB), Murcia, Spain
| | | | - Joaquina Montilla-Herrador
- Department of Physical Therapy, University of Murcia; Physiotherapy and Disability Research Group, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB), Murcia, Spain
| | - Pilar Escolar-Reina
- Department of Physical Therapy, University of Murcia; Physiotherapy and Disability Research Group, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB), Murcia, Spain
| | | | - Francesc Medina-Mirapeix
- Department of Physical Therapy, University of Murcia; Physiotherapy and Disability Research Group, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB), Murcia, Spain
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Lillo-Navarro C, Medina-Mirapeix F, Escolar-Reina P, Montilla-Herrador J, Gomez-Arnaldos F, Oliveira-Sousa SL. Parents of children with physical disabilities perceive that characteristics of home exercise programs and physiotherapists' teaching styles influence adherence: a qualitative study. J Physiother 2015; 61:81-6. [PMID: 25804826 DOI: 10.1016/j.jphys.2015.02.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/27/2015] [Accepted: 02/05/2015] [Indexed: 11/27/2022] Open
Abstract
QUESTION What are the perceptions of parents of children with physical disabilities about the home exercise programs that physiotherapists prescribe? How do these perceptions affect adherence to home exercise programs? DESIGN Qualitative study using focus groups and a modified grounded theory approach. PARTICIPANTS Parents of children with physical disabilities who have been prescribed a home exercise program by physiotherapists. RESULTS Twenty-eight parents participated in the focus groups. Two key themes that related to adherence to home exercise programs in young children with physical disabilities were identified: the characteristics of the home exercise program; and the characteristics of the physiotherapist's teaching style. In the first theme, the participants described their experiences regarding their preference for exercises, which was related to the perceived effects of the exercises, their complexity, and the number of exercises undertaken. These factors determined the amount of time spent performing the exercises, the effect of the exercises on the family's relationships, and any sense of related burden. In the second theme, participants revealed that they adhered better to prescribed exercises when their physiotherapist made an effort to build their confidence in the exercises, helped the parents to incorporate the home exercise program into their daily routine, provided incentives and increased motivation. CONCLUSION Parents perceive that their children's adherence to home-based exercises, which are supervised by the parents, is more successful when the physiotherapist's style and the content of the exercise program are positively experienced. These findings reveal which issues should be considered when prescribing home exercise programs to children with physical disabilities. [Lillo-Navarro C, Medina-Mirapeix F, Escolar-Reina P, Montilla-Herrador J, Gomez-Arnaldos F, Oliveira-Sousa SL (2015) Parents of children with physical disabilities perceive that characteristics of home exercise programs and physiotherapists' teaching styles influence adherence: a qualitative study.Journal of Physiotherapy61: 81-86].
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Affiliation(s)
- Carmen Lillo-Navarro
- Department of Pathology and Surgery, Physiotherapy Area, Miguel Hernández University, San Juan de Alicante
| | - Francesc Medina-Mirapeix
- Department of Physiotherapy, Regional Campus of International Excellence 'Campus Mare Nostrum', University of Murcia
| | - Pilar Escolar-Reina
- Department of Physiotherapy, Regional Campus of International Excellence 'Campus Mare Nostrum', University of Murcia
| | - Joaquina Montilla-Herrador
- Department of Physiotherapy, Regional Campus of International Excellence 'Campus Mare Nostrum', University of Murcia
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Medina-Mirapeix F, Gacto-Sánchez M, Navarro-Pujalte E, Montilla-Herrador J, Lillo-Navarro C, Escolar-Reina P. Development and initial psychometric evaluation of the Mobility Activities Measure for Inpatient Rehabilitation Settings (Mobam-in). Arch Phys Med Rehabil 2014; 95:2367-75. [PMID: 25128716 DOI: 10.1016/j.apmr.2014.07.407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 07/03/2014] [Accepted: 07/19/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the development and the initial psychometric evaluation of a mobility measure for inpatient postacute rehabilitation settings—the Mobility Activities Measure for Inpatient Rehabilitation Settings (Mobam-in). DESIGN Self-report-based psychometric study. SETTING Postacute rehabilitation unit of a public hospital. PARTICIPANTS A consecutive sample of inpatients (N=239) receiving postacute rehabilitation care. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We developed a 30-item mobility measure, using the Mobility Activities Measure (Mobam) framework, to assess functioning across 5 mobility activity domains classified within the International Classification of Functioning, Disability and Health. These were (1) changing and maintaining body position involving only sitting and/or lying (4 items); (2) changing and maintaining body position involving standing up (6 items); (3) carrying and moving objects using the hand and shoulder (6 items); (4) handling objects using only the hand and/or forearm (7 items); and (5) walking and moving (7 items). Psychometric analyses were conducted to test assumptions underlying the scaling and scoring of Mobam-in scales, and to test both the reliability and validity. RESULTS Multitrait scaling and confirmatory factor analyses (with Tucker-Lewis Index median, .99; root mean square error of approximation median, .025) supported the assumption of unidimensionality concerning each domain. Five dimensions appeared to be stable across diverse diagnostic groups (the percentage of items with discriminant validity ranged from 93% to 100%, Cronbach coefficient ranged from .859 to .966). Rasch model (Masters' 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. CONCLUSIONS Mobam-in covers 5 dimensions of mobility activities. The Mobam framework is an effective reference for building outcome instruments.
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Affiliation(s)
- Francesc Medina-Mirapeix
- Department of Physical Therapy, Regional Campus of International Excellence "Campus Mare Nostrum," University of Murcia, Murcia, Spain.
| | - Mariano Gacto-Sánchez
- Department of Physical Therapy, EUSES University School, University of Girona, Girona, Spain
| | | | - Joaquina Montilla-Herrador
- Department of Physical Therapy, Regional Campus of International Excellence "Campus Mare Nostrum," University of Murcia, Murcia, Spain
| | - Carmen Lillo-Navarro
- Department of Pathology and Surgery, University "Miguel Hernández", Alicante, Spain
| | - Pilar Escolar-Reina
- Department of Physical Therapy, Regional Campus of International Excellence "Campus Mare Nostrum," University of Murcia, Murcia, Spain
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Del Baño-Aledo ME, Medina-Mirapeix F, Escolar-Reina P, Montilla-Herrador J, Collins SM. Relevant patient perceptions and experiences for evaluating quality of interaction with physiotherapists during outpatient rehabilitation: a qualitative study. Physiotherapy 2013; 100:73-9. [PMID: 23778264 DOI: 10.1016/j.physio.2013.05.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 05/06/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To identify elements of the physiotherapist-patient interaction considered by patients when they evaluate the quality of care in outpatient rehabilitation settings. DESIGN A qualitative study with nine focus groups, Two researchers conducted the focus groups, and a topic guide with predetermined questions was used. Each group discussion was audiotaped,, transcribed verbatim and analyzed thematically according to a modified grounded theory approach. SETTING Three postacute ambulatory centers in Barcelona, Madrid and Seville (Spain). PARTICIPANTS Fifty-seven adults undergoing outpatient rehabilitation for musculoskeletal conditions/injuries. RESULTS Patients based their evaluations of quality of care on their assessment of physiotherapists' willingness to provide information and education, technical expertise and interpersonal manners (eg. respect, emotional support and sensitivity changes in the patient's status). Both positive and negative aspects of the physiotherapist-patient interaction emerged under all these themes, except for friendly and respectful communication. CONCLUSION This study identified which elements of the physiotherapist-patient interaction are considered by patients when evaluating the quality of care in rehabilitation outpatient settings. Further research should work to develop self-report questionnaires about patients' experiences of the physiotherapist-patient interaction in rehabilitation services to provide empirical and quantitative evidence.
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Affiliation(s)
| | - Francesc Medina-Mirapeix
- Department of Physiotherapy, Regional Campus of International Excellence 'Campus Mare Nostrum', University of Murcia, Murcia, Spain.
| | - Pilar Escolar-Reina
- Department of Physiotherapy, Regional Campus of International Excellence 'Campus Mare Nostrum', University of Murcia, Murcia, Spain
| | - Joaquina Montilla-Herrador
- Department of Physiotherapy, Regional Campus of International Excellence 'Campus Mare Nostrum', University of Murcia, Murcia, Spain
| | - Sean M Collins
- Department of Physical Therapy, University of Massachusetts, Lowell, MA, USA
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Medina-Mirapeix F, Jimeno-Serrano FJ, Del Baño-Aledo ME, Escolar-Reina P, Montilla-Herrador J, Lomas-Vega R, Franco-Sierra MA. Outpatients' perceptions of their experiences in musculoskeletal rehabilitation care. Eur J Phys Rehabil Med 2012; 48:475-482. [PMID: 22820822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND While patients' satisfaction with rehabilitation care is often measured, the knowledge of their experiences during delivery of care and of which characteristics may lead them to experience problems remains largely undocumented. AIM To assess the quality of patients' experiences receiving post-acute care for musculoskeletal disorders in outpatient rehabilitation settings. To describe the extent to which variations in reported quality of patients' experiences were related to their characteristics. DESIGN A cross sectional, self-reported survey. SETTING 3 outpatient rehabilitation units. POPULATION Four hundred sixty-five outpatients. Mean age 39.4 (SD=11.9). METHODS A problem score (from 0 to 100%) of self-reported experiences was calculated on 7 specific aspects of care (belonging to organizational environment and professionals' attitudes and behaviors) and compared among participants' subgroups. RESULTS Mean scores of the organizational environment area showed higher amount of problems (43.3%) than the professionals' attitudes and behaviours area (34.7%). Two multivariate linear regression models (with adjusted R(2) 9.3% and 4.9%) indicated that older patients and those with high global rating change were less likely to experience problems in the two areas. CONCLUSION Problems on aspects of care were commonly experienced by patients with musculoskeletal disorders in outpatient rehabilitation settings. The age and health of patients were associated to these problems, but explained only a small variation in them. CLINICAL REHABILITATION IMPACT Surveys measuring patients' experiences can be used to monitor the actual performance of rehabilitation settings and to pinpoint the exact issues needing to be addressed to improve quality as well as to make comparison among centres.
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Affiliation(s)
- F Medina-Mirapeix
- Department of Physiotherapy, Faculty of Medicine, University of Murcia, Murcia, Spain.
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Medina-Mirapeix F, Navarro-Pujalte E, Escolar-Reina P, Montilla-Herrador J, Valera-Garrido JF, Collins SM. Mobility Activities Measurement for Outpatient Rehabilitation Settings. Arch Phys Med Rehabil 2011; 92:632-9. [DOI: 10.1016/j.apmr.2010.11.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 11/20/2010] [Indexed: 10/18/2022]
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Medina-Mirapeix F, Oliveira-Sousa S, Sobral-Ferreira M, Del Baño-Aledo ME, Escolar-Reina P, Montilla-Herrador J, Collins SM. Continuity of rehabilitation services in post-acute care from the ambulatory outpatients' perspective: a qualitative study. J Rehabil Med 2011; 43:58-64. [PMID: 21103848 DOI: 10.2340/16501977-0638] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To explore ambulatory outpatient experiences and perceptions in post-acute care settings and how these experiences may have led to perceived gaps in continuity of rehabilitation care. SUBJECTS Fifty-seven adults undergoing outpatient rehabilitation for musculoskeletal conditions/injuries, who had had more than 10 physiotherapy treatment sessions. METHODS Qualitative study using a modified grounded theory approach. Data collection was carried out through 9 focus groups. Each group was recorded, transcribed literally and analyzed thematically. RESULTS Participants described 3 main themes in continuity; relational, informational, and management continuity. Several factors that led to gaps in the 3 types of continuity were described. The relevant factors for relational continuity were: consistency of the multi-professional rehabilitation team; and an established provider-patient relationship. Factors for informational continuity were: transfer of information among providers; and accumulated knowledge regarding patients' disability experiences. Factors for management continuity included: consistency of care among rehabilitation providers; flexibility of the team in adapting care to functional changes; and involvement of the team in achieving patient collaboration. CONCLUSION This study provides evidence of gaps in different types of continuity of care within the post-acute rehabilitation services in ambulatory settings. Outpatients often perceive their experiences of rehabilitation care as non-connected or non-coherent over time.
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Escolar-Reina P, Medina-Mirapeix F, Gascón-Cánovas JJ, Montilla-Herrador J, Jimeno-Serrano FJ, de Oliveira Sousa SL, del Baño-Aledo ME, Lomas-Vega R. How do care-provider and home exercise program characteristics affect patient adherence in chronic neck and back pain: a qualitative study. BMC Health Serv Res 2010; 10:60. [PMID: 20219095 PMCID: PMC2847560 DOI: 10.1186/1472-6963-10-60] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Accepted: 03/10/2010] [Indexed: 11/23/2022] Open
Abstract
Background The aim of this study is to explore perceptions of people with chronic neck or low back pain about how characteristics of home exercise programs and care-provider style during clinical encounters may affect adherence to exercises. Methods This is a qualitative study consisting of seven focus groups, with a total of 34 participants presenting chronic neck or low back pain. The subjects were included if they were receiving physiotherapy treatment and were prescribed home-based exercises. Results Two themes emerged: home-based exercise programme conditions and care provider's style. In the first theme, the participants described their positive and negative experiences regarding time consumption, complexity and effects of prescribed exercises. In the second theme, participants perceived more bonding to prescribed exercises when their care provider presented knowledge about the disease, promoted feedback and motivation during exercise instruction, gave them reminders to exercise, or monitored their results and adherence to exercises. Conclusions Our experiential findings indicate that patient's adherence to home-based exercise is more likely to happen when care providers' style and the content of exercise programme are positively experienced. These findings provide additional information to health care providers, by showing which issues should be considered when delivering health care to patients presenting chronic neck or back pain.
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Medina-Mirapeix F, Escolar-Reina P, Gascón-Cánovas JJ, Montilla-Herrador J, Jimeno-Serrano FJ, Collins SM. Predictive factors of adherence to frequency and duration components in home exercise programs for neck and low back pain: an observational study. BMC Musculoskelet Disord 2009; 10:155. [PMID: 19995464 PMCID: PMC2796992 DOI: 10.1186/1471-2474-10-155] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 12/09/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence suggests that to facilitate physical activity sedentary people may adhere to one component of exercise prescriptions (intensity, duration or frequency) without adhering to other components. Some experts have provided evidence for determinants of adherence to different components among healthy people. However, our understanding remains scarce in this area for patients with neck or low back pain. The aims of this study are to determine whether patients with neck or low back pain have different rates of adherence to exercise components of frequency per week and duration per session when prescribed with a home exercise program, and to identify if adherence to both exercise components have distinct predictive factors. METHODS A cohort of one hundred eighty-four patients with chronic neck or low back pain who attended physiotherapy in eight primary care centers were studied prospectively one month after intervention. The study had three measurement periods: at baseline (measuring characteristics of patients and pain), at the end of physiotherapy intervention (measuring characteristics of the home exercise program) and a month later (measuring professional behaviors during clinical encounters, environmental factors and self-efficacy, and adherence behavior). RESULTS Adherence to duration per session (70.9% +/- 7.1) was more probable than adherence to frequency per week (60.7% +/- 7.0). Self-efficacy was a relevant factor for both exercise components (p < 0.05). The total number of exercises prescribed was predictive of frequency adherence (p < 0.05). Professional behaviors have a distinct influence on exercise components. Frequency adherence is more probable if patients received clarification of their doubts (adjusted OR: 4.1; p < 0.05), and duration adherence is more probable if they are supervised during the learning of exercises (adjusted OR: 3.3; p < 0.05). CONCLUSION We have shown in a clinic-based study that adherence to exercise prescription frequency and duration components have distinct levels and predictive factors. We recommend additional study, and advise that differential attention be given in clinical practice to each exercise component for improving adherence.
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Escolar-Reina P, Medina-Mirapeix F, Gascón-Cánovas JJ, Montilla-Herrador J, Valera-Garrido JF, Collins SM. Self-management of chronic neck and low back pain and relevance of information provided during clinical encounters: an observational study. Arch Phys Med Rehabil 2009; 90:1734-9. [PMID: 19801064 DOI: 10.1016/j.apmr.2009.05.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 05/13/2009] [Indexed: 11/24/2022]
Abstract
UNLABELLED Escolar-Reina P, Medina-Mirapeix F, Gascón-Cánovas JJ, Montilla-Herrador J, Valera-Garrido JF, Collins SM. Self-management of chronic neck and low back pain and relevance of information provided during clinical encounters: an observational study. OBJECTIVE To assess the relative influence of information provided during physical therapy on a patient's adherence to self-management strategies in relation to other predictors of adherence (patient and pain characteristics, use of self-management strategies before intervention). DESIGN A longitudinal observational study of the relationship between the information provided during physical therapy and adherence to self-management strategies. SETTING Data came from a clinical-based population in 8 primary health care centers. PARTICIPANTS Patients (N=184) with chronic neck or low back pain (77% under the age of 59y) were surveyed at the beginning and 1 month after completion of physical therapy. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Specific and overall adherence to 2 types of strategies: (1) nonpharmacologic pain management strategies, and (2) neck/back care in activities of daily life. RESULTS Adherence to strategies of nonpharmacologic self-management of pain was more probable when patients received information explaining the effectiveness of the self-management strategies (adjusted odds ratio [AOR]=10.1; P<.05) and information about their illness (AOR=3.4; P<.05) during clinical encounters. Information provided by the physical therapist did not have any influence on the adherence to neck/back care in activity of daily life (P>.05). CONCLUSIONS Information provided during clinical encounters is associated with adherence to different kinds of self-management strategies. While further study is required, it is suggested that more attention be given to clinical practice strategies for improving adherence to self-management of chronic pain.
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Medina-Mirapeix F, Escolar-Reina P, Gascón-Cánovas JJ, Montilla-Herrador J, Collins SM. Personal characteristics influencing patients’ adherence to home exercise during chronic pain: A qualitative study. J Rehabil Med 2009; 41:347-52. [DOI: 10.2340/16501977-0338] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Medina-Mirapeix F, Meseguer-Henarejos AB, Montilla-Herrador J, Escolar-Reina P, Collins SM, Saturno-Hernández PJ. RELIABILITY AND VALIDITY OF PATIENT REPORTS FOR PHYSICAL THERAPY QUALITY ASSESSMENT: AN EMPIRICAL ANALYSIS REGARDING THE USE OF EXERCISES FOR NECK PAIN IN SPAIN. J Rehabil Med 2006; 38:354-9. [PMID: 17067968 DOI: 10.1080/16501970600766541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To determine usefulness and reliability of patient reports as a data source on the use of exercises for neck pain in primary healthcare. DESIGN Survey research. SUBJECTS A total of 176 patients with mechanical neck pain, surveyed about their physical therapy experience. METHOD A questionnaire was constructed on the selection of exercises, instructions for carrying them out and follow-up provided by the physical therapist. The same items reported by the surveyed patients were also reviewed in the physical therapy record. We analysed the reliability and validity of the questionnaire, and used the valid information from the survey to estimate a total of 8 indicators on the quality of care provided. RESULTS Sensitivity of the items was high (>75%), suggesting that most of the recorded information could be provided by patients, and specificity was quite low, suggesting that they also provide relevant information that was not recorded. These results, particularly low specificity, were not homogeneous among items. Estimates for the indicators demonstrate room for improvement. CONCLUSION Patient reports could be useful as a complement to other sources of information for physical therapy quality assessment, and they can be reliable and valid substitutes for recorded data about specific aspects of the care provided.
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