Proposal for a physiotherapy assessment form for the evaluation of women patients with uro-gynecological disorders: A Delphi study.

BACKGROUND: The correct selection of treatment techniques and methods in physiotherapy depends directly on a well-structured anamnesis, examination and assessment. Within urogynecological and obstetric physiotherapy there is no standardized and protocolized assessment that allows to follow established steps. For all this, the main objective of this study was to identify the assessment items that should be included in the a physiotherapeutic uro-gynecological assessment. METHODS: Delphi study through a group of experts. Prior to this, a systematic search was carried out, accompanied by a review of grey literature, to obtain the possible items to be included in the forms. Subsequently, a Delphi study with two consecutive rounds of questionnaires was developed. A total of 6 expert physiotherapists participated in the study. RESULTS: The initial questionnaire had 97 items and after two rounds one item was eliminated to obtain a total of 96 items in the final questionnaire. CONCLUSIONS: The experts agreed on most of the choices and finally obtained a standardized and protocolized assessment in uro-gynecological physiotherapy. Furthermore, this proposal should be considered by other professionals involved in the process of evaluation and treatment of pelvi-perineal alterations.

Tango-therapy vs physical exercise in older people with dementia; a randomized controlled trial.

BACKGROUND: Dementia is a growing health concern that affects millions of people worldwide. Gait and mobility disorders are often present and represent a major risk factor for falls. The purpose of this study was to investigate the effectiveness of tango-therapy in gait speed, functional mobility, balance, falls, ability to perform activities of daily living and quality of life. METHODS: A randomised controlled trial with 31 participants living in a specialised dementia unit, aged 65 to 93 years old, who were randomly assigned to tango group (IG) or physical exercise group (CG). The primary outcome was gait speed and Timed Up and Go test. The secondary outcomes include the Short Physical Performance Battery, the ability to perform activities of daily living (Katz Index) and quality of life (Quality of life in Alzheimer Disease). Measurements were performed at baseline, and after one and three months of training. RESULTS: After 3 months, IG improved gait speed (p = 0.016), implying a statistically significant difference between groups in favour of IG (p = 0.003). CG significantly worsened the time to complete the TUG (p = 0.039). Both groups declined in their ability to perform activities of daily living, being statistically significant only in the CG (p < 0.001). CONCLUSION: Tango interventions showed efficacy in improving gait speed and in mitigating the decline in functional mobility and ADL skill capacities. Allowing older people with dementia access to non-pharmacological interventions may be a successful strategy to prevent functional decline. TRIAL REGISTRATION: Registered at ClinicalTrials.gov (ID: NCT05744011).

Tango-Therapy Intervention for Older Adults with Cognitive Impairment Living in Nursing Homes: Effects on Quality of Life, Physical Abilities and Gait.

Cognitive impairment in older adults is associated with poor gait performance, physical decline, falls and poor quality of life. This paper analyzes the feasibility and efficacy of tango-based intervention in older people living in nursing homes with and without cognitive impairment. A multicenter study, with pre- and post-test, was carried out. Intervention attendance, well-being, physical abilities (short physical performance battery), walking performance, functional capacities (Katz Index) and quality of life (quality of life in Alzheimer's disease) were assessed. Fifty-four participants (84.9 ± 6.7 years, mini mental state examination 14.5 ± 7.4) completed the protocol. Intervention attendance was 92%, and the mean subjective well-being after each session was 4.5 ± 0.5 (on a five-point scale). A statistically significant improvement was found in the quality of life (p = 0.030). Non-statistically significant changes were found in walking performance (p = 0.159), physical abilities (p = 0.876) and in functional capacities (p = 0.253). This study shows feasibility and suggests evidence for the effects of tango therapy on well-being and quality of life. Further studies are necessary to contrast these findings and to support the role of tango interventions as a holistic approach to prevent functional decline in older people with cognitive impairment.

Health-Related Quality of Life (HRQOL) Instruments and Mobility: A Systematic Review.

Physical function is one of the most important constructs assessed in health-related quality of life (HRQOL), and it could be very useful to assess movement ability from the perspective of the patient. The objective of this study was to compare the content of the domains related to mobility covered by the HRQOL questionnaires based on the International Classification of Functioning, Disability and Health (ICF) and to evaluate their quality according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance. For this, a systematic review was carried out in the databases Scopus, Web of Science and Science Direct. The inclusion criteria were development and/or validation studies about generic HRQOL measures, and the instruments had to include items related to mobility and studies written in English or Spanish. The comparison of content was performed using the ICF coding system. A total of 3614 articles were found, 20 generic HRQOL instruments were identified and 120 (22.4%) mobility-related items were found. Walking was the most represented category. Low-quality evidence on some measurement properties of the generic HRQOL instruments was revealed. The CAT-Health is a useful questionnaire to be used in rehabilitation due to its psychometric properties and its content.

Relationship between competency for evidence-based practice and level of burnout of physical therapists with the establishment of the therapeutic relationship.

BACKGROUND: Evidence-based practice (EBP) interventions and effective therapeutic alliance (TA) are associated with greater treatment success. Furthermore, burnout syndrome could be detrimental to the development of such TA. OBJECTIVE: To examine the association between EBP competencies and burnout level with the quality of TA among Spanish physiotherapists. METHODS: Cross-sectional research with an electronic survey including the EBP Questionnaire-19, Maslach Burnout Inventory and Working Alliance Inventory-Short (WAI-S) and administered to 471 physiotherapists. RESULTS: Regarding the EBP Questionnaire-19, physiotherapists scored highest on attitude and lowest on knowledge. For WAIS which achieved appropriate results of internal consistency and validity in the sample analyzed, bond scored the highest and goals the lowest. Years of experience was significantly associated with the task (r = 0.5; p = .003) and bond (r = 0.7; p = .002) and the WAIS total score (r = 0.8; p < .001), and all burnout subscales (-0.7 < r > 0.7; p < .001 for all). CONCLUSION: Lower levels of burnout and improved EBP competencies are associated with a TA of greater quality. The association between attitudes toward EBP, a higher level of self-confidence and a lower perception of depersonalization appear to be determinant factors for improving TA.

A competency model for nurse executives.

BACKGROUND: Nurses capable of adequately developing their competencies in the management field are essential for the sustainability of health-care organizations. Such competencies should be included in a model of specific competencies. AIM: The aim of this research is to propose a competency model for nurse executives. METHODS: The Delphi method was applied to reach a consensus on the required competencies, and Principal Component Analysis (PCA) was applied to determine the construct validity and reduce the data set's dimensionality. Consensus was defined based on at least 80% of the experts agreeing with the proposed competencies. For each competency, the development levels were beginner, advanced beginner, competent, highly competent and expert. RESULTS: From among the 51 competencies that were identified to define a model for nurse executives, decision-making, leadership and communication stood out. The PCA indicated the structural validity of the proposed model by saturation of the principal components (Cronbach's α > 0.631). CONCLUSION: Nurses wishing to develop their professional careers as nurse executives must first develop the competencies shown in the proposed model. Nurse executives should follow the educational programmes specified in this study, to adapt their knowledge to this role's requirements.

The association between empathy and the physiotherapy-patient therapeutic alliance: A cross-sectional study.

BACKGROUND: The central component of person-centred care is in having a therapeutic realtionship. Furthermore, the empathy of the physiotherapist is one of the most important attributes in achieving a successful therapeutic alliance. OBJECTIVE: The aim of the research was to determine the association between the constructs of empathy and therapeutic alliance in Spanish physical therapists and the possible influence of socio-professional variables on them. DESIGN: Cross-sectional research. METHODS: An electronic survey including the Working Alliance Inventory-Short Form, the Interpersonal Reactivity Index and sociodemographic data with 473 Spanish physiotherapists. A descriptive, bivariate and simple lineal regression analysis was carried out. RESULTS: Work experience has a positive influence on bonding and the agreement on objectives and tasks (0.04 < B > 0.06; p < 0.01). The perspective taking dimensions and empathic concern positively influence the agreement on achievement (0.14 < B > 0.19; p < 0.001). Personal distress inversely influences bonding and the agreement on achievements and tasks (-0.13 < B > -0.09; p < 0.01). CONCLUSIONS: The dimensions of perspective taking and empathic concern seem to facilitate successful shared decision making in terms of treating objectives. Furthermore, the physiotherapist's personal distress acts as an obstacle to the development of the three subcomponents of the therapeutic alliance analysed.

Modelo de competencias para la gestora enfermera de nivel operativo / Competency-based model for the Nurse Manager at Operational Level

Objetivo: evaluar la validez estructural del modelo de competencias para la gestora enfermera de nivel operativo en el sistema sanitario español. Método: la investigación llevó a cabo un análisis de componentes principales (ACP) para determinar la validez de constructo, reduciendo la dimensionalidad del conjunto de datos. Para este propósito se siguió la teoría de Thurstone en tres fases. La idoneidad de los datos se realizó a través de la prueba de Kaiser-Meyer-Olkin. Resultados: las 51 competencias que integran el modelo de competencias para la gestora enfermera de nivel operativo fueron sometidas al análisis de componentes principales. Los resultados indican la validez estructural del modelo propuesto por saturación de los componentes principales y de cada una de las dimensiones que se compone: Gestión (α Cronbach > 0,631), Comunicación y tecnología (α Cronbach > 0,6), Liderazgo y equipos de trabajo (α Cronbach > 0,876), Conocimiento del sistema sanitario (α Cronbach > 0,749), Conocimiento enfermero (α Cronbach > 0,808), Personalidad (α Cronbach > 0,809). Conclusiones: del análisis de los componentes principales del modelo de competencias para la gestora enfermera de nivel operativo se concluye la validez del constructo del modelo. La toma de decisiones emerge como factor crítico, dada su elevada carga factorial. Analizada la varianza explicada puede concluirse que los factores liderazgo, esencia, calidad y proyección personal deben estar presentes en el perfil de la gestora enfermera de nivel operativo. Las gestoras enfermeras pueden utilizarlo para planificar su carrera profesional. Las organizaciones sanitarias podrían para establecer procesos de selección de las gestoras enfermeras a nivel operativo en España.(AU)

Objective: to evaluate the structural validity of the competency model for the Nurse Manager at Operational Level in the Spanish Health System. Method: the research consisted in a principal component analysis (PCA) to determine the validity of the construct and reduce the dimensionality of the data set. Thurstone’s theory was followed for this purpose in three stages. Data adequacy was conducted through the Kaiser-Meyer-Olkin Test. Results: the 51 skills included in the Competency model for the Nurse Manager at Operational Level were submitted to the principal component analysis. Results showed the structural validity of the model proposed by saturation of the principal components and of each of the dimensions included: Management (α Cronbach > 0.631), Communication and Technology (α Cronbach > 0-6), Leadership and Work Teams (α Cronbach > 0.876), Knowledge of the Health System (α Cronbach > 0.749), Nursing Knowledge (α Cronbach > 0.808), Personality (α Cronbach > 0.809). Conclusions: the analysis of the principal components of the competency model for the Nurse Manager at Operational Level showed the validity of the model construct. Decision-making appeared as a critical factor, due to its high factor loading. The analysis of the explained variance led to the conclusion that the leadership, essence, quality and personal projection factors must be present in the profile of the Nurse Manager at Operational Level. It can be used by Nurse managers in order to plan their professional career. Healthcare organizations could develop selection processes for the Nurse Managers at Operational Level in Spain.(AU)

Identification of cohesive subgroups in a university hall of residence during the COVID-19 pandemic using a social network analysis approach.

THE AIMS: (i) analyze connectivity between subgroups of university students, (ii) assess which bridges of relational contacts are essential for connecting or disconnecting subgroups and (iii) to explore the similarities between the attributes of the subgroup nodes in relation to the pandemic context. During the COVID-19 pandemic, young university students have experienced significant changes in their relationships, especially in the halls of residence. Previous research has shown the importance of relationship structure in contagion processes. However, there is a lack of studies in the university setting, where students live closely together. The case study methodology was applied to carry out a descriptive study. The participation consisted of 43 university students living in the same hall of residence. Social network analysis has been applied for data analysis. Factions and Girvan-Newman algorithms have been applied to detect the existing cohesive subgroups. The UCINET tool was used for the calculation of the SNA measure. A visualization of the global network will be carried out using Gephi software. After applying the Girvan-Newman and Factions, in both cases it was found that the best division into subgroups was the one that divided the network into 4 subgroups. There is high degree of cohesion within the subgroups and a low cohesion between them. The relationship between subgroup membership and gender was significant. The degree of COVID-19 infection is related to the degree of clustering between the students. College students form subgroups in their residence. Social network analysis facilitates an understanding of structural behavior during the pandemic. The study provides evidence on the importance of gender, race and the building where they live in creating network structures that favor, or not, contagion during a pandemic.

Examining the Association between Evidence-Based Practice and Burnout among Spanish Physical Therapists: A Cross-Sectional Study.

The aim of this study was to quantify the level of burnout and competence for evidence-based practice among Spanish physical therapists and to determine if there is a relationship between these and other socio-professional factors. A cross-sectional study with 472 Spanish Physiotherapists. An electronic survey was conducted that included the Maslach Burnout Inventory, Evidence-Based Practice Questionnaire and sociodemographic data. The three subscales of the Burnout correlated with attitude and total Evidence-Based Practice Questionnaire. Attitude and practice for evidence-based practice, educational level and experience were the variables that showed the greatest influence on burnout. Burnout and the degree of evidence-based practice were identified as being discretely related. Specifically, it seems that the evidence-based practice could improve the lack of personal accomplishment, meaning that through interventions perceived as more effective and advantageous, a sense of mastery and self-efficacy is experienced.

Nurse managers' competencies: A scoping review.

AIM: To describe and synthesize scientific literature on nurse managers' competencies. BACKGROUND: The key strategy for the success of health organisations currently resides in the capacity of the nurse manager to develop advanced competencies in management. However, there is a lack of systematic reviews that synthesize knowledge about nurse managers' competencies. EVALUATION: A scoping review was conducted using electronic databases including Web of Science, Scopus, PubMed and Cumulative Index to Nursing and Allied Health Literature. KEY ISSUES: After the first analysis, 392 competencies were observed from 76 studies. Finally, 53 competencies were grouped according to their characteristics. The two most-cited competencies were communication and finance. CONCLUSIONS: Knowing the competencies required by nurse managers can help organisations create strategies to develop competent managers. In addition, from the results we can infer what might be the core competencies, since 22 main competencies from the total number were identified. IMPLICATIONS FOR NURSING MANAGEMENT: The competencies identified constitute the body of knowledge necessary for nurse managers. In addition, it is possible to generate a pathway for learning and professional development for nurses before they work at the microlevel of management. The starting point for this pathway could be the 22 core competencies.

Competency Model for the Middle Nurse Manager (MCGE-Logistic Level).

Healthcare systems are immersed in transformative processes, influenced by economic changes, together with social and health instability. The middle nurse manager plays a fundamental role, since he or she is responsible for translating the strategic vision, values and objectives of the organization. The objective of this study was to propose the model of competencies to be developed by the middle nurse manager in the Spanish healthcare system. Our methodology consisted in the application of the Delphi method in order to reach an agreement on the necessary competencies, and principal component analysis (PCA) was used to determine the construct validity, reducing the dimensionality of the set of data. Fifty-one competencies were identified for the definition of the model, highlighting decision-making, leadership and communication. The PCA pointed out the structural validity of the proposed model through the saturation of the main components (α Cronbach > 0.631). The results show the model of competencies which the middle nurse manager in the Spanish healthcare system must develop. Middle nurse managers may use these as criteria to plan their professional strategies in the context of management. This model of competencies can be applied to establishing selection processes or training programs for the role of middle nurse manager.

Musculoskeletal Pain and Non-Classroom Teaching in Times of the COVID-19 Pandemic: Analysis of the Impact on Students from Two Spanish Universities.

The lockdown, due to the coronavirus, has led to a change in lifestyle and physical activity in Spanish university students. The objective of this study was to analyze the prevalence of musculoskeletal pain and changes in physical activity and self-perceived stress in the student bodies of two Spanish Universities during the lockdown. A cross-sectional study was carried out in a sample of 1198 students (70.6% women). The main instruments used for measuring were the Standardized Kuorinka Modified Nordic Questionnaire and the Perceived stress scale (the questionnaire regarding the practice of physical activity). A reduction in the prevalence of musculoskeletal pain (p < 0.001) was identified in the sample of men and women, an increase (12.5%) in the frequency of carrying out physical activity from moderate to frequent, and the preference for strength training (15.1%), especially among women, was identified. All of this may be taken into account by health institutions when implementing measures to encourage physical activity in both suitable amounts and types, which improves the quality of life of the students.

Musculoskeletal Pain and Teleworking in Times of the COVID-19: Analysis of the Impact on the Workers at Two Spanish Universities.

The special situation brought about by the coronavirus pandemic and the confinement imposed by the Government, has given rise to numerous changes in working habits. The workers at the universities have had to start a period of teleworking that could give rise to consequences for the musculoskeletal system. The objective of this article is to analyze the impact of the confinement on the musculoskeletal health of the staff of two Spanish universities. A cross-sectional, observational study was carried out on the workers. Data was taken in April-May 2020 and included: The Standardized Kuorinka Modified Nordic Questionnaire, the Perceived Stress Scale and another one on sociodemographic data. This study comprised 472 people. The areas of pain noted during the confinement period concluded that it was less in all cases (p < 0.001). The frequency of physical activity carried out increased significantly during the period of confinement (p < 0.04), especially in women. The type of physical activity done was also seen to modify during this period (p < 0.001), with a preference for strength training and stretching exercises. In conclusion, the confinement gave rise to changes in the lifestyle and in the musculoskeletal pain of the workers at the universities. All of this must be taken into account by health institutions and those responsible for the Prevention of Occupational Risks at Spanish universities.

Significant socio-emotional learning and improvement of empathy in physiotherapy students through service learning methodology: A mixed methods research.

BACKGROUND: Research into service learning (SL) in education has increased since the 1990s. In higher education physiotherapy programmes, this technique is used to achieve real practical learning and to grasp how to recognize and manage emotions, to be concerned for others and to take decisions in clinical contexts. OBJECTIVES: To create a community experience through SL methodology for physiotherapy university students and to analyse their perceptions of the learning experience and changes in empathy. DESIGN: A mixed research method, a quasi-experimental quantitative approach with pre- and post-measurements of a single group and a qualitative approach through reflective diaries subjected to a contents analysis. PARTICIPANTS: 29 students of the Faculty of Health Sciences (Department of Nursing and Physiotherapy) designed and put into practice a workshop for promoting physical activity in 277 children from the first and the sixth year of compulsory primary education. METHODS: The project was divided into three phases: planning, performing and reflecting on the service. At the start, participants completed a questionnaire to determine their scale of empathy on the Interpersonal Reactive Index (IRI). One week after performing the service they handed over reflective diaries and completed a second IRI scale survey. An analysis was carried out of the contents of the reflective diaries. RESULTS: Twenty-nine students agreed to participate. These learners consolidated their skills in the subject, indicating their satisfaction with the significant learning they achieved. The IRI scale showed a significant improvement in the Personal Distress dimension (p = 0.002). CONCLUSIONS: Active learning in the context of processes of a participatory and reflective type implies greater understanding of the phenomenon studied. It allows an enhance awareness of the importance of inclusivity and involvement of users in the context of clinical practice. It also provides socio-emotional learning, improving interpersonal abilities and the capacity to face up to stressful situations.

Nurse Manager Core Competencies: A Proposal in the Spanish Health System.

Nurses who are capable of developing their competencies appropriately in the field of management are considered fundamental to the sustainability and improvement of health outcomes. These core competencies are the critical competencies to be developed in specific areas. There are different core competencies for nurse managers, but none in the Spanish health system. The objective of this research is to identify the core competencies needed for nurse managers in the Spanish health system. The research was carried out using the Delphi method to reach a consensus on the core competencies and a Principal Component Analysis (PCA) to determine construct validity, reducing the dimensionality of a dataset by finding the causes of variability in the set and organizing them by importance. A panel of 50 experts in management and healthcare engaged in a four-round Delphi study with Likert scored surveys. We identified eight core competencies from an initial list of 51: decision making, relationship management, communication skills, listening, Leadership, conflict management, ethical principles, collaboration and team management skills. PCA indicated the structural validity of the core competencies by saturation into three components (α Cronbach >0.613): communication, leadership and decision making. The research shows that eight competencies must be developed by the nursing managers in the Spanish health system. Nurse managers can use these core competencies as criteria to develop and plan their professional career. These core competencies can serve as a guideline for the design of nurse managers' development programs in Spain.

Modelo de competencias para la gestora enfermera / Competency model for the Nurse Manager

Objetivo: identificar las competencias necesarias para desempeñar el rol de gestora enfermera en España en cada uno de los niveles funcionales. Metodología: partiendo de la realización de una revisión bibliográfica de la literatura especializada se diseñó un estudio Delphi estructurado en cuatro rondas para consensuar las competencias necesarias para la gestora enfermera. Resultados: se obtuvo el consenso de 51 competencias, distribuidas en seis dominios. El nivel de experto se alcanza mediante estudios de máster y doctorado. La gestora enfermera tiene que desarrollar sus competencias al nivel de competente, muy competente y experto. El 96% de los integrantes del panel manifestó que para alcanzar el nivel de experto es necesario desarrollar estudios de máster o doctorado. El 60,78% de las competencias de la gestora enfermera de alta dirección debe ser desarrollada al nivel de experto mediante el desarrollo de estudios de máster, experto universitario y especialización universitaria, frente al 9,8% de la dirección logística y al 21,57% de las competencias requeridas para la dirección operativa. Para el nivel de competente serán necesarios estudios de experto, especialista universitario y formación continuada. Conclusiones: el modelo de competencias para la gestora enfermera en España se compone de 51 competencias, de las cuales ocho son básicas. De los resultados se evidencia el grado de desarrollo para cada competencia, y la formación requerida para alcanzar este grado

Objective: to identify the skills needed to play the role of Nurse Manager in Spain at each function level. Methodology: based on a bibliographic review conducted in specialized literature, a Delphi study was designed, structured into four rounds, in order to reach a consensus about the skills needed by the Nurse Manager. Results: a consensus was reached about 51 skills, classified into six domains. The level expert is achieved through master and doctorate courses. Nurse Managers must develop their skills at the following levels: Competent, Very Competent and Expert. Out of the panel members, 96% declared that in order to reach the expert level it is necessary to acquire master or doctorate degrees; 60.78% of the skills of the High Management Nurse Manager must be developed at Expert level, through Master, University Expert and University Specialty degrees, vs. 9.8% of logistical management and 21.57% of skills required for operational management. The Competent level requires Expert, University Specialist and Continuous Education degrees. Conclusions: the competency model for the Nurse Manager in Spain consists of 51 skills, including eight basic skills. The level of development for each skill is shown in results, as well as the training required to achieve said degree

Validity, Reliability, and Responsiveness of the Spanish Version of the OPTIMAL Instrument.

BACKGROUND: The Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL) is a self-report instrument developed to measure the ability to perform mobility actions. OBJECTIVE: To validate a Spanish version of the OPTIMAL instrument. DESIGN: Cross-cultural adaptation and validation study. SETTING: Primary and specialized outpatient care settings. PARTICIPANTS: Three hundred seven patients beginning physical therapy treatment and 30 subjects from the general population. METHODS: A 2-part study was designed based on guidelines for cultural adaptation of patient-reported outcome measures. OUTCOMES: Reliability was estimated by internal consistency (Cronbach α), SE of measurement, and test-retest reliability (intraclass correlation coefficient) at 2 weeks. Confirmatory factor analysis was performed to examine structural validity. The association with the Physical Functioning Subscale was assessed with Spearman correlation coefficients. OPTIMAL scores across different groups were compared with Mann-Whitney U and Kruskal-Wallis tests. Effect size, standardized response mean, and minimal detectable change were determined for responsiveness. RESULTS: The Spanish version of the OPTIMAL instrument showed a similar structure to the original English questionnaire. Cronbach α was 0.95 for the difficulty and confidence scales. Intraclass correlation coefficient was 0.91 (95% CI 0.87-0.94) for the difficulty scale and 0.90 (95% CI 0.85-0.93) for the confidence scale. The SE of measurement was 5.11 for the difficulty scale and 6.54 for the confidence scale. The association with the Physical Functioning Subscale was strong and significant (P < .001). The 2 scales showed significantly different scores for each of the established patient groups. The effect size was 0.61 (95% CI 0.48-0.74) for the difficulty scale and 0.53 (95% CI 0.38-0.69) for the confidence scale. The standardized response mean was 0.97 (95% CI 0.78-1.13) for the difficulty scale and 0.76 (95% CI 0.48-1.01) for the confidence scale. The minimal detectable change, of a possible score of 100, was 14.2 for the difficulty scale and 18.1 for the confidence scale. CONCLUSION: The Spanish version of the OPTIMAL has appropriate reliability, validity, and responsiveness and it is an adequate self-report instrument for the assessment of mobility actions. LEVEL OF EVIDENCE: III.

Pilates for women with breast cancer: A systematic review and meta-analysis.

OBJECTIVES: To identify and evaluate the characteristics and methodological quality of the studies that have proposed Pilates as a rehabilitation strategy for women with breast cancer and to determine its benefits on health outcomes in this population. METHODS: A systematic review and meta-analysis were conducted. Medline/PubMed, Pedro, SPORTDiscuss, Scopus and Web of Science were systematically searched up to January 2017. The methodological quality was evaluated by means of the Jadad Scale and the Quality Assessment Tool for Before-After Studies with No Control Group. Risk of bias was assessed by means of the Cochrane Collaboration's tool. RESULTS: Five randomized controlled trials and two un-controlled studies were selected. Four of the randomized controlled trials were pooled in the meta-analysis for effects of Pilates on shoulder range of motion, quality of life, pain, and self-reported upper extremity function. According to the findings reported in the studies analysed in the review, Pilates had a positive and significant effect on the aforementioned variables, as well as on functional status, mood, fitness and upper extremity circumference. The meta-analysis carried out showed that the effects that Pilates had on shoulder range of motion and quality of life, was not significantly greater than those resulting from other exercise programs. CONCLUSIONS: Pilates relieves the impact of breast cancer-related symptoms. These effects are not significantly greater than those derived from the performance of other therapies, with the exception of pain and self-reported upper extremity function. Systematic review registration number: PROSPERO CRD42018076852.

The Influence of Adolescents' Social Networks on Alcohol Consumption: A Descriptive Study of Spanish Adolescents Using Social Network Analysis.

In adolescence, friends are important due to their influence on the acquisition of habits such as alcohol consumption. However, there is a lack of studies that describe the structural context of adolescents, which would be useful to implement prevention strategies. Therefore, our research question was how adolescent friendship networks influence alcohol consumption. Our goal was to determine the structural profile of adolescent at-risk alcohol users and their relational context in the classroom. We designed a descriptive cross-sectional study based on social network analysis to analyze structural patterns. We recruited 195 students. Social-network and alcohol-consumption variables were analyzed using the UCINET and STATA programs. Some 86.67% of participants had consumed alcohol at some time in their lives and the prevalence of at-risk alcohol use was higher in females (50.48% vs. 49.52%; OR: 1.84; CI 95%: 0.99⁻3.43%; p = 0.036). The lower the intensity of friendship, the more contacts adolescent at-risk alcohol users had within the network, and the easier it was for them to access their peers. Consequently, we conclude that the structure of a class is a key factor that merits further research.