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OBJECTIVE: The aim of this study was to adapt a disability questionnaire in mobility activities (DIAMO-EPOC) incorporating scales based on the conceptual framework of the International Classification of Functioning, Disability and Health, and to examine its structure, reliability and validity in a cohort of patients with COPD. METHODS: A total of 137 patients with stable COPD were recruited. Two scales of 4 items each were designed and their structure was verified by exploratory factor analysis and multitrait scaling analysis. Additionally, reliability indices (internal consistency and test-retest) were calculated. Construct validity was analysed by known groups and convergence-divergence. RESULTS: The questionnaire had 2 scales, with 4 items each, corresponding to the domains of the International Classification of Functioning, Disability and Health "change and maintain the position of the body" and "walk and move". The reliability and internal consistency of the scales were acceptable and the test-retest was excellent with an ICC of 0.86 and 0.94, respectively. The scales showed a moderate association with dyspnoea, health status and muscle strength and a different score among participants with different physical performance in the Short Physical Performance Battery. CONCLUSIONS: The 2 scales of the DIAMO-EPOC questionnaire are one-dimensional and have a solid internal consistency, test-retest stability and validity, allowing the identification of specific areas of limited mobility in patients with COPD.
Subject(s)
Disability Evaluation , Health Status , Pulmonary Disease, Chronic Obstructive/physiopathology , Surveys and Questionnaires , Aged , Cohort Studies , Dyspnea/etiology , Female , Humans , Male , Middle Aged , Muscle Strength/physiology , Reproducibility of ResultsABSTRACT
OBJETIVO: El objetivo del estudio fue adaptar un cuestionario de discapacidad en actividades de movilidad (DIAMO-EPOC) incorporando escalas basadas en el marco conceptual de la Clasificación Internacional del Funcionamiento, Discapacidad y Salud, y examinar su estructura, fiabilidad y validez en una cohorte de pacientes con EPOC. MÉTODOS: Un total de 137 pacientes con EPOC estable fueron reclutados. Se diseñaron dos escalas de cuatro ítems cada una y se verificó su estructura mediante análisis factorial y de multirrasgo. Adicionalmente, se calcularon los índices de fiabilidad (consistencia interna y test-retest). La validez de constructo se analizó mediante grupos conocidos y la convergencia-divergencia. RESULTADOS: El cuestionario resultó tener 2 escalas, con 4 ítems cada una, correspondientes a los dominios de la Clasificación Internacional del Funcionamiento, Discapacidad y Salud «cambiar y mantener la posición del cuerpo» y «andar y moverse». La fiabilidad y consistencia interna de las escalas resultaron aceptables y el test-retest excelente con CCI de 0,86 y 0,94, respectivamente. Las escalas mostraron una asociación moderada con la disnea, el estado de salud y la fuerza muscular de los pacientes y una diferente puntuación entre sujetos con distinto desempeño físico en la Short Physical Performance Battery. CONCLUSIONES: Las dos escalas del cuestionario DIAMO-EPOC son unidimensionales y tienen una sólida consistencia interna, estabilidad test-retest y validez, permitiendo identificar áreas específicas de movilidad limitada en pacientes con EPOC
OBJECTIVE: The aim of this study was to adapt a disability questionnaire in mobility activities (DIAMO-EPOC) incorporating scales based on the conceptual framework of the International Classification of Functioning, Disability and Health, and to examine its structure, reliability and validity in a cohort of patients with COPD. METHODS: A total of 137 patients with stable COPD were recruited. Two scales of 4 items each were designed and their structure was verified by exploratory factor analysis and multitrait scaling analysis. Additionally, reliability indices (internal consistency and test-retest) were calculated. Construct validity was analysed by known groups and convergence-divergence. RESULTS: The questionnaire had 2 scales, with 4 items each, corresponding to the domains of the International Classification of Functioning, Disability and Health "change and maintain the position of the body" and "walk and move". The reliability and internal consistency of the scales were acceptable and the test-retest was excellent with an ICC of 0.86 and 0.94, respectively. The scales showed a moderate association with dyspnoea, health status and muscle strength and a different score among participants with different physical performance in the Short Physical Performance Battery. CONCLUSIONS: The 2 scales of the DIAMO-EPOC questionnaire are one-dimensional and have a solid internal consistency, test-retest stability and validity, allowing the identification of specific areas of limited mobility in patients with COPD
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Disability Evaluation , Health Status , Pulmonary Disease, Chronic Obstructive/physiopathology , Surveys and Questionnaires , Cohort Studies , Dyspnea/ethnology , Muscle Strength/physiology , Reproducibility of ResultsABSTRACT
AIMS: To evaluate the presence of perforating cutaneous vessels (PCV) in different lower limb acupuncture points (AP) using thermography. MATERIAL AND METHODS: An analytical cross-sectional study was performed on the two lower limbs (n=6) of volunteer subjects. In total, 144 AP and 144 control points (CP) were analysed, one for each AP. First, the AP and CP were located on each individual. Subsequently, both the real and thermographic images were created. In the real images, the location of the AP and the established CP were highlighted with boxes. FLIR Tools Plus and Physio Thermal Imaging software were used to merge the real image with the AP and the CP and to merge the thermographic image with the PCV. By superimposing both images, we were able to verify the presence of PCV among the AP and CP. RESULTS: PCV were identified in 87.5% of the 144 AP examined and in 18.1% of the respective CP. All the AP had a higher percentage of PCV compared to their respective CP, with statistically significant differences in all points, except for ST33 and ST34. The probability of finding PCV in AP was 11 times higher than the probability of not finding it. DISCUSSION: Thermography may serve as a useful tool in the assessment and treatment of patients using acupuncture. The presence of PCV in the area of the acupuncture needle insertion could partially influence the effects generated by the acupuncture technique from the vascular autonomic point of view. CONCLUSIONS: There is a high proportion of PCV in the AP area located in the lower limb.
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Introducción. Existe insuficiente conocimiento sobre qué confianza tienen los pacientes en quienes prestan cuidados de rehabilitación, sus determinantes y la asociación con la evaluación del servicio. Objetivos. Examinar la confianza en la profesionalidad del fisioterapeuta por parte de pacientes en fases post-agudas en Unidades externas de Rehabilitación; determinar los aspectos asistenciales de los pacientes que la condicionan y su relación con la satisfacción del paciente. Material y métodos. Estudio transversal mediante cuestionario autocumplimentado, realizado en Unidades de Rehabilitación de 3 hospitales de la red MAPFRE. Las medidas de resultado fueron: puntuación de problemas (de 0 a 100%) de las experiencias autoinformadas en 7 aspectos de los cuidados (pertenecientes al ambiente organizacional y las actitudes del profesional), satisfacción, confianza en la profesionalidad y, características sociodemográficas y de salud de los participantes. Resultados. Participaron 465 pacientes (respuesta: 90%) con una media de 39,4 (DE=11,9) años. La confianza fue completa en el 61,1% de los participantes. Mientras que la odds ratio (OR)de completa confianza se incrementa con la percepción de cambio funcional (OR=3,77), de crece con tener experiencias problemáticas en algunos aspectos asistenciales: «educación e información» (OR=0,99), «apoyo emocional» (OR=0,97) e «interrupciones durante las sesiones» (OR=0,99). La confianza presenta una correlación positiva con los niveles de satisfacción (p<0,01). Conclusiones. Son muchos los pacientes que desarrollan una completa confianza en los fisioterapeutas, especialmente los que presentan notable mejora funcional y pocas situaciones problemáticas en determinados aspectos asistenciales. Aunque no todos los aspectos asistenciales son igualmente determinantes de la confianza, esta siempre se relaciona con la satisfacción (AU)
Introduction. There is still insufficient knowledge about levels of trust in those who provide rehabilitation care, its determinants and association with service evaluation. Objectives. To examine trust in the professionalism of the physiotherapist who treats patients in post-acute phases in external rehabilitation units. To determine the care aspects of the patients that condition it and its relation with the patients' satisfaction. Materials and methods. A cross-sectional study using a self-administered questionnaire was carried out in the rehabilitation units of 3 private hospitals, belonging to the private network of MAPFRE. Outcome measurements were: scoring problems (from 0 to 100%) of the self-reported experiences in 7 care aspects (belonging to organizational setting and professionals' attitudes), satisfaction, trust in professionalism, and the patients' socio-demographic and health characteristics. Results. A total of 465 patients (response 90%) took part. Mean age was 39.4 years (SD=11.9) and 61.1% of participants had full trust in their physiotherapists. While the odds ratio of full trust increases with perception of functional change (OR=3.77), it decreases with having problematic experiences in certain care aspects: "education and information" (OR=.99), "emotional support" (OR=.97) and "interruptions during the sessions" (OR=.99). Trust has a positive correlation with satisfaction (P<.01). Conclusions. Many patients develop full trust in their physiotherapists, particularly those who experience functional improvement and have few problematic situations in certain care aspects. Although not all care aspects are equally decisive for trust, the latter is always associated with satisfaction (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Physical Therapy Department, Hospital , Physical Therapy Department, Hospital , Physical Therapy Specialty , Exercise Movement Techniques , Patient Satisfaction/statistics & numerical data , Trust , Health Knowledge, Attitudes, Practice , /ethics , Physical Therapy Specialty/ethics , Patient Satisfaction/economics , Patient Acceptance of Health Care/statistics & numerical data , Outcome and Process Assessment, Health Care/trends , Cross-Sectional Studies/methods , Surveys and Questionnaires , Data Collection/methods , Data Collection , Logistic ModelsABSTRACT
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.
Subject(s)
Attitude to Health , Disabled Persons/rehabilitation , Musculoskeletal Diseases/rehabilitation , Outpatients/psychology , Patient Satisfaction , Quality of Health Care , Adolescent , Adult , Attitude of Health Personnel , Cross-Sectional Studies , Disabled Persons/psychology , Female , Humans , Male , Middle Aged , Musculoskeletal Diseases/psychology , Psychometrics , Surveys and Questionnaires , Young AdultABSTRACT
Objetivo: Desarrollar un instrumento basado en el auto-informe para medir la discapacidad en cada uno de los subdominios de las actividades de movilidad de la Clasificación internacional del Funcionamiento, de la Discapacidad y de la Salud (CIF), que pueda ser usado en pacientes ambulatorios con problemas musculoesqueléticos. Material y métodos: El cuestionario se desarrolló en tres etapas implicando a 718 pacientes ambulatorios con problemas musculoesqueléticos de tres centros con Fisioterapia, y a 24 expertos en discapacidad. El proceso de generación de ítems utilizó aportaciones de literatura relevante, expertos y pacientes. La reducción inicial se logró con las aportaciones de investigadores, expertos y pacientes. La reducción final se realizó usando análisis factoriales (AF) y pruebas de comprobación de la unidimensionalidad de cada factor identificado. Resultados: Se obtuvo un cuestionario (DIAM) de 22 ítems con cinco opciones de respuesta. Los resultados de los AF produjeron dos factores unidimensionales en el subdominio «cambiar y mantener la posición del cuerpo» (1. Implicando bipedestación; 2. Implicando sólo sedestación y/o decúbito), dos en el subdominio «llevar, mover y usar objetos» (1. Usando la mano y el hombro; 2. Usando la mano y/o antebrazo), y un factor en el subdominio «andar y moverse» (AU)
Purpose: To develop a questionnaire to measure perception for disability in International Classification of Functioning, Disability and Health (ICF) subdomains of mobility activities, that can be used in outpatients with musculoskeletal problems. Material and methods: The questionnaire was developed by a three-step process involving a 718 outpatients with musculoskeletal problems from three physiotherapy setting and 24 experts in disability issues. The item-generation process utilized input from relevant literature, experts and outpatients. Initial item reduction utilized researchers and the same experts and outpatients. Final item reduction was achieved by FA and tests for unidimensionalidad of identified factors. Results: The final questionnaire, called DIAM, is a 22-item self-administered questionnaire with five response categories. Results of AF provided two unidimensional factors in subdomain «Changing and maintaining body position » (1. Involving the standing; 2. Involving only sitting and/or lying down position), two in subdomain «Carrying, moving and handling objects» (1. Using hand and shoulder; 2. Using hand and/or forearm), and one factor in subdomain «Walking and moving» (AU)
Subject(s)
Humans , Male , Female , Adult , Disability Evaluation , Statistics on Sequelae and Disability , Physical Therapy Modalities/statistics & numerical data , Physical Therapy Specialty , Disabled Persons/classification , Disabled Persons/statistics & numerical data , Mobility Limitation , Surveys and Questionnaires , Factor Analysis, StatisticalABSTRACT
OBJECTIVE: To identify the characteristics associated with better structural quality of protocols.Design. Analytic and transversal.Setting. Health centres in Spain with physiotherapy protocols. PARTICIPANTS: Guidelines for physiotherapy practice or protocols worked out between 1990 and 1996, inclusive. MAIN MEASUREMENTS: The design quality of the documents was evaluated by using percentages of compliance with eight explicit validated criteria and the proportion of criteria complied with in each protocol out of the total possible. To identify the characteristics linked to structural quality, multiple and logistic regression multivariate analyses were performed. RESULTS: There was greater structural quality in documents worked out by teams of over five authors and after 1992. Variables that did not affect structural quality were the source of the protocol (Insalud or autonomous community with devolved powers) and the kind of professional (only physiotherapists or multi-disciplinary) who worked it out. CONCLUSIONS: The quality of the documents varies according to the date and the number of authors who work them out. There was significantly greater quality when this was after 1992 and there were over five authors. Therefore, under the opposite circumstances (few authors), there is greater risk of low-quality documents.
Subject(s)
Physical Therapy Modalities , Primary Health Care , Humans , SpainABSTRACT
OBJECTIVE: To compare the repercussion on requests for follow-up treatment of the inclusion of health education in the physiotherapist's primary care work. SETTING: Health centre (A). Hospital (B). PATIENTS AND INTERVENTION: Patients attending over a six month period two physiotherapy units due to back-ache, cervical pain or a painful shoulder. Group A had 50 patients; and B, 97. The groups were homogeneous by age and gender: A averaged 47 years old (+ 13.4) and was 64% women; B was 45 (+ 12.1) and 69% women. The percentage of pathologies was also homogeneous with a p > 0.1 in back-ache and cervical pain and p > 0.90 for painful shoulders. At centre B (catchment population 73,000) individualised therapy (electrotherapy) was used. At A (catchment 16,000) there was a complete intervention plus health education. A monitoring period for the six following months was set up to observe, for both groups, the number of people who requested Physiotherapy for the same pathology. MEASUREMENTS AND MAIN RESULTS: A statistical analysis contrasting equality of proportions by analysing contingency tables with the Chi2 test was performed. During the monitoring period five new treatments in group A (10%) and 29 in B (30%) were requested, which meant a significant difference between the two groups with a p < 0.01 confirmed by an analysis of remainders. CONCLUSIONS: Incorporating health education into the Physiotherapist's activities provided in the medium term fewer requests from relapsed patients. It would be interesting to perform longer studies to check if these differences last.
