[Validation of the stroke-specific quality of life scale (ECVI-38)]. / Validación de la escala de calidad de vida para el ictus (ECVI-38).

INTRODUCTION: The stroke-specific quality of life scale (ECVI-38) is the first Spanish-language instrument for evaluating the quality of life in individuals who have survived a stroke. AIM: To evaluate the psychometric properties of the third version of the ECVI-38. PATIENTS AND METHODS: A total of 243 stroke survivors were interviewed 2 months-2 years after the event; 61 of them were surveyed again 7-14 days later and 74 others were interviewed on beginning and ending a two-month period of rehabilitation. Gold standard methods for this type of research were used to evaluate the psychometric properties (acceptability, reliability, validity and sensitivity to change). RESULTS. The ECVI was acceptable, with means close to the medians, a high degree of variability of the sample and a ceiling/floor effect below 20%, except for the odd exception. It displayed good reliability with internal consistence, with a Cronbach's alpha value of between 0.79 and 0.95, and a test-retest with intraclass correlation coefficients between 0.81 and 0.96. It satisfied the validity criteria both in analyses within the scale and in analyses against external criteria: it distinguishes well between different degrees of neurological, emotional and cognitive compromise. Sensitivity to change, at eight weeks after rehabilitation, was between moderate and high in most domains: there were significant differences between the scores for the domains, and the size of the effect was above 0.5. CONCLUSIONS: The ECVI-38 is acceptable, valid and reliable for evaluating the spectrum of consequences and recovery from a stroke, and its result changes in proportion to recovery.

Validación de la escala de calidad de vida para el ictus (ECVI-38) / Validation of the stroke-specific quality of life scale (ECVI-38)

La escala de calidad de vida para el ictus (ECVI-38) es el primer instrumento desarrollado en hablahispana para valorar la calidad de vida en los supervivientes a un accidente cerebrovascular. Objetivo. Evaluar las propiedades psicométricas de la tercera versión de la ECVI-38. Pacientes y métodos. Se entrevistó a 243 supervivientes a un ictus despuésde 2 meses a 2 años del evento; 61 de éstos volvieron a ser encuestados 7-14 días después, y otros 74 fueron entrevistados al ingreso y al alta tras dos meses de rehabilitación. Para evaluar las propiedades psicométricas (aceptabilidad, fiabilidad,validez y sensibilidad al cambio), se emplaron métodos de referencia para este tipo de trabajos. Resultados. La ECVI fue aceptable: medias cercanas a las medianas, gran variabilidad de la muestra y efecto suelo-techo inferior a 20%, salvo excepciones.Mostró buena fiabilidad: consistencia interna con coeficiente alfa de Cronbach entre 0,79 y 0,95, y prueba test-retest con coeficientes de correlación intraclase entre 0,81 y 0,96. Cumplió los criterios para la validez, tanto en análisis dentro dela escala como en análisis contra criterio externo: diferencia bien entre distintos grados de afectación neurológica, emocional y cognitiva. La sensibilidad al cambio, después de ocho semanas de rehabilitación, fue entre moderada y alta en la mayoríade los dominios: diferencias significativas entre las puntuaciones de los dominios y tamaño del efecto por encima de 0,5. Conclusión. La ECVI-38 es aceptable, válida y fiable para valorar el espectro de consecuencias y la recuperación de un ictus,y su resultado cambia proporcionalmente a la recuperación

The stroke-specific quality of life scale (ECVI-38) is the first Spanish-language instrument forevaluating the quality of life in individuals who have survived a stroke. Aim. To evaluate the psychometric properties of the third version of the ECVI-38. Patients and methods. A total of 243 stroke survivors were interviewed 2 months-2 years after the event; 61 of them were surveyed again 7-14 days later and 74 others were interviewed on beginning and ending a twomonthperiod of rehabilitation. Gold standard methods for this type of research were used to evaluate the psychometricproperties (acceptability, reliability, validity and sensitivity to change). Results. The ECVI was acceptable, with means close to the medians, a high degree of variability of the sample and a ceiling/floor effect below 20%, except for the odd exception. It displayed good reliability with internal consistence, with a Cronbach’s alpha value of between 0.79 and 0.95, and a test-retest with intraclass correlation coefficients between 0.81 and 0.96. It satisfied the validity criteria both in analyses within the scale and in analyses against external criteria: it distinguishes well between different degrees of neurological, emotional and cognitive compromise. Sensitivity to change, at eight weeks after rehabilitation, was between moderate and high in most domains: there were significant differences between the scores for the domains, and the size of the effect was above 0.5. Conclusions. The ECVI-38 is acceptable, valid and reliable for evaluating the spectrum of consequences and recovery from a stroke, and its result changes in proportion to recovery

[The development of a scale to evaluate the quality of life in stroke survivors]. / Desarrollo de una escala para evaluar la calidad de vida en supervivientes a un ictus.

INTRODUCTION: The selection of a measure that can be used to evaluate the outcome of therapeutic interventions in stroke patients has had a conceptual problem in that there is a need to detect a wide range of deficiencies, disabilities and handicaps as part of a patient-based model. It has also suffered from a methodological problem due to the lack of systematic attention given to the development of standard instruments. AIMS: We conducted this study with the aim of getting over these limitations by developing a scale to evaluate the quality of life in stroke survivors. SUBJECTS AND METHODS: We followed a methodology that had previously been standardised by other authors based on using the opinion given by patients and caregivers in the generation of the items to be included. This has several stages that include individual interviews with patients, caregivers and experts, focal groups with patients and experts, quantitative and qualitative analyses of these interviews, two panels of experts to actually draw up the instrument, and a pilot test carried out in a sample of 50 patients to reduce and group the items. This reducing and grouping process was performed taking into account the following: 1. The percentage of responses left unanswered; 2. A factorial analysis of the main components; 3. Cronbach's alpha coefficient. RESULTS: We interviewed 20 patients and 12 experts; these results were later used to classify the above mentioned aspects in order of priority according to the frequency with which they appeared in the surveys. Then, we elaborated the questionnaire with four areas or subscales by including the questions or items in these categories: I. Physical status (17 items); II. Emotional status (13 items); III. Activities of daily living (13 items); IV. Social and familial functions (13 items). After the pilot study 38 items were reorganised into eight domains, according to the factorial analysis: 1. Physical problems; 2. Communication; 3. Cognition; 4. Emotions; 5. Feelings; 6. Activities of daily living; 7. Familial functions; 8. Social functions. They displayed high coefficients of internal consistency. CONCLUSIONS: We developed a new scale for evaluating the quality of life for stroke patients and it is now ready to undergo its validation process.

Desarrollo de una escala para evaluar la calidad de vida en supervivientes a un ictus / The development of a scale to evaluate the quality of life in stroke survivors

The selection of a measure that can be used to evaluate the outcome of therapeutic interventions in stroke patients has had a conceptual problem in that there is a need to detect a wide range of deficiencies, disabilities and handicaps as part of a patient-based model. It has also suffered from a methodological problem due to the lack of systematic attention given to the development of standard instruments. AIMS: We conducted this study with the aim of getting over these limitations by developing a scale to evaluate the quality of life in stroke survivors. We followed a methodology that had previously been standardised by other authors based on using the opinion given by patients and caregivers in the generation of the items to be included. This has several stages that include individual interviews with patients, caregivers and experts, focal groups with patients and experts, quantitative and qualitative analyses of these interviews, two panels of experts to actually draw up the instrument, and a pilot test carried out in a sample of 50 patients to reduce and group the items. This reducing and grouping process was performed taking into account the following...(AU)

Desarrollo de una escala para evaluar la calidad de vida en los supervivientes a un ictus / The development of a scale to evaluate the quality of life in stroke survivors

Introducción. La selección de una medida para evaluar el resultado de las intervenciones terapéuticas en los pacientes con ictus ha tenido un problema conceptual en la necesidad de detectar un amplio intervalo de deficiencias, discapacidades y minusvalías, como parte de un modelo basado en el paciente, y un problema metodológico en la falta de atención sistemática para el desarrollo de instrumentos estándares. Objetivo. Para resolver estas limitaciones realizamos este trabajo, con el objetivo de desarrollar una escala para evaluar la calidad de vida en los supervivientes a un ictus. Sujetos y métodos. Seguimos una metodología estandarizada por otros autores, que se basa en la opinión de los pacientes y los cuidadores para generar los ítems a incluir. Ésta tiene varias etapas, que incluyen: entrevistas individuales a pacientes, cuidadores y expertos, grupos focales con pacientes y expertos, análisis cuantitativo y cualitativo de estas entrevistas, dos paneles de consenso para la confección del instrumento y prueba piloto para reducir y agrupar los ítems en una muestra de 50 pacientes. Para reducir y agrupar los ítems tuvimos en cuenta: 1. El porcentaje de respuestas en blanco; 2.El análisis factorial de componentes principales, y 3. El coeficiente de Cronbach. Resultados. Entrevistamos a 20 pacientes y 12 expertos; con esos resultados, ordenamos los aspectos mencionados en orden de prioridad según la frecuencia de aparición en las encuestas. Posteriormente, confeccionamos el cuestionario con cuatro áreas o subescalas, que incluían las preguntas o ítems en las siguientes categorías: I. Estado físico (17 ítems); II. Estado emocional (13 ítems); III. Actividades de la vida diaria (13 ítems); IV. Funciones sociofamiliares (13 ítems). Después del estudio piloto se reorganizaron 38 ítems en ocho dominios, de acuerdo al análisis factorial: 1.Problemas físicos; 2. Comunicación; 3. Cognición; 4. Emociones; 5. Sentimientos; 6. Actividades de la vida diaria; 7. Funciones familiares; 8. Funciones sociales. Mostraron altos coeficientes de consistencia interna. Conclusión. Se ha desarrollado una nueva escala para evaluar la calidad de vida para el ictus, que se encuentra lista para su proceso de validación (AU)

[Characterization of the patients with cerebral infarcts discharged from a hospital in La Havana in 1998]. / Caracterización de los pacientes con infarto cerebral dados de alta en un hospital de La Habana durante 1998.

OBJECTIVE: We made a study of the 79 patients who were discharged from the Instituto Nacional de Neurología (La Havana, Cuba) during 1998, with the diagnosis of cerebral infarct, with the objective of analysing their behavior. PATIENTS AND METHODS: In this analysis we considered: the previous clinical history of factors and illnesses of risk, the certainty of the diagnosis in the emergency room, presenting symptoms, clinical signs, vascular territory, etiopathogenic category and results of cranial computerized axial tomography (CAT). RESULTS AND CONCLUSIONS: Arterial hypertension, smoking, cerebrovascular disease and ischemic cardiopathy were the commonest clinical features seen. There was close agreement between the diagnosis made in the emergency room and the final diagnosis. The presenting symptoms and clinical signs found in these patients were related to the vascular territory and motor involvement was the most constant. There was predominance of the carotid territory, especially of the left side. We also found predominance of atherothrombotic etiopathogenesis, with fewer cardio-embolic or unknown causes. There were few abnormal cranial CAT findings in patients with lacunar infarcts or infarcts localized to the posterior territory.

Caracterización de los pacientes con infarto cerebral dados de alta en un hospital de La Habana durante 1998 / Characterization of the patients with cerebral infarcts discharge from a hospital in La Havana in 1998

Objetivo. Se realizó un estudio en los 79 pacientes que fueron dados de alta durante 1998 del Instituto Nacional de Neurología (La Habana, Cuba) con el diagnóstico de infarto cerebral, con el objetivo de analizar su comportamiento. Pacientes y métodos. Se consideraron para este análisis los antecedentes personales de factores y enfermedades de riesgo, la certeza del diagnóstico en la sala de emergencias, síntomas de debut, signos clínicos, territorio vascular, categoría etiopatogénica y resultado de la tomografía axial computarizada (TAC) craneal. Resultados y conclusiones. La hipertensión arterial, el tabaquismo, la enfermedad cerebrovascular y la cardiopatía isquémica fueron los antecedentes más frecuentemente encontrados. Se observó una alta concordancia del diagnóstico en la sala de emergencias con el diagnóstico final. Los síntomas de debut y los signos clínicos encontrados en estos pacientes estuvieron relacionados con el territorio vascular, siendo más constantes los de afectación motora. Predominó el territorio carotídeo sobre todo del lado izquierdo. Se encontró, además, un predominio de la etiopatogenia aterotrombótica a expensas de bajas frecuencias de las causas cardioembólica e indeterminada. La positividad de la TAC de cráneo fue baja en pacientes con infarto lacunar o infartos de localización en territorio posterior (AU)