Deepening the understanding of the structural validity of the Tilburg Frailty Indicator.

BACKGROUND: Psychometric properties of the Tilburg Frailty Indicator (TFI) have shown low internal consistency for psychological and social domains, and evidence for its structure validity is controversial. Moreover, research on TFI is frequently limited to community dwellings. AIMS: To evaluate structural validity, reliability, and convergent and divergent validity of the Spanish version of the Tilburg Frailty Indicator (TFI) in both community-dwelling and institutionalized older people. MATERIALS AND METHODS: A cross-sectional study was conducted on Spanish older adults (n = 457) recruited from both community settings (n = 322) and nursing homes (n = 135). Participants completed the TFI and other frailty instruments: Fried's Frailty Phenotype, Edmonton Frailty Scale, FRAIL Scale, and Kihon Checklist (KCL). Confirmatory Factor Analysis (CFA), and reliability and validity coefficients were estimated. RESULTS AND DISCUSSION: Some items from physical and social domains showed low factor loadings (< 0.40). The three-factor CFA model showed better fit indices after depurating these items. Reliability estimates were good (CRI ≥ 0.70) for physical and psychological domains in the institutionalized sample, while in the community dwellings, only physical domain reliability was adequate. Convergent and divergent validity of physical and psychological domains was good, except for some alternative psychological measures highly correlating with the TFI physical component (KCL-depressive mood and Edmonton mood). However, the social domain showed low correlations with some social indicators. CONCLUSION: The findings of this study clarify some of the controversial validation results of the TFI structure and provide evidence to improve its use in psychometric terms. CLINICAL TRIAL REGISTRATION NUMBER: NCT03832608.

Using the Updated EWGSOP2 Definition in Diagnosing Sarcopenia in Spanish Older Adults: Clinical Approach.

Recently the European Working Group on Sarcopenia in Older People (EWGSOP2) has updated diagnostic criteria for sarcopenia, which consist of one or more measures of muscle strength, muscle mass, and physical performance, plus an initial screening test called SARC-F. The main objective was to compare the number of cases of sarcopenia, using the different measurements and screening options. A cross-sectional study was conducted on Spanish older adults (n = 272, 72% women). Combining the different measures proposed by the steps described in the EWGSOP2 algorithm, 12 options were obtained (A-L). These options were studied in each of the three models: (1) using SARC-F as initial screening; (2) not using SARC-F; and (3) using SARC-CalF instead of SARC-F. A χ2 independence test was statistically significant (χ2(6) = 88.41, p < 0.001), and the association between the algorithm used and the classification of sarcopenia was moderate (Cramer's V = 0.226). We conclude that the different EWGSOP2 measurement options imply case-finding differences in the studied population. Moreover, when applying the SARC-F, the number of people classified as sarcopenic decreases. Finally, when SARC-CalF is used as screening, case finding of sarcopenic people decreases. Thus, clinical settings should consider these outcomes, since these steps can make preventive and therapeutic interventions on sarcopenia vary widely.

Functional and Clinical Characteristics for Predicting Sarcopenia in Institutionalised Older Adults: Identifying Tools for Clinical Screening.

BACKGROUND: Recently, the European Working Group on Sarcopenia in Older People (EWGSOP2) has updated the sarcopenia definition based on objective evaluation of muscle strength, mass and physical performance. The aim of this study was to analyse the relationship between sarcopenia and clinical aspects such as functionality, comorbidity, polypharmacy, hospitalisations and falls in order to support sarcopenia screening in institutionalised older adults, as well as to estimate the prevalence of sarcopenia in this population using the EWGSOP2 new algorithm. METHODS: A multicentre cross-sectional study was conducted on institutionalised older adults (n = 132, 77.7% female, mean age 82 years). Application of the EWGSOP2 algorithm consisted of the SARC-F questionnaire, handgrip strength (HG), appendicular skeletal muscle mass index (ASMI) and Short Physical Performance Battery (SPPB). Clinical study variables were: Barthel Index (BI), Abbreviated Charlson's Comorbidity Index (ACCI), number of medications, hospital stays and falls. RESULTS: Age, BI and ACCI were shown to be predictors of the EWGSOP2 sarcopenia definition (Nagelkerke's R-square = 0.34), highlighting the ACCI. Sarcopenia was more prevalent in older adults aged over 85 (p = 0.005), but no differences were found according to gender (p = 0.512). CONCLUSION: BI and the ACCI can be considered predictors that guide healthcare professionals in early sarcopenia identification and therapeutic approach.

Impact of hypertonic saline nebulisation combined with oscillatory positive expiratory pressure on sputum expectoration and related symptoms in cystic fibrosis: a randomised crossover trial.

OBJECTIVE: To evaluate the impact of combining nebulised hyaluronic acid plus hypertonic saline (HA+HS) with oscillatory positive expiratory pressure (oscillatory-PEP) on sputum expectoration and related symptoms in adults with cystic fibrosis (CF). DESIGN: Randomised crossover trial. SETTING: Seven centres. PARTICIPANTS: Twenty-two outpatients with CF. INTERVENTIONS: Usual care (HA+HS followed by autogenic drainage) and combined therapy (HA+HS with oscillatory-PEP followed by autogenic drainage]. Each treatment was performed for 5 days. MAIN OUTCOME MEASURES: Sputum expectoration was measured during the nebulisation period (primary outcome), during autogenic drainage and for 24hours post intervention. The Cough and Sputum Assessment Questionnaire (CASA-Q) and its domains (cough symptoms, cough impact, sputum symptoms and sputum impact), the Leicester Cough Questionnaire (LCQ) and lung function tests were used. Tolerance and patient preference were registered. RESULTS: Twenty-two participants [mean age 25 (standard deviation 8) years, percentage predicted forced expiratory volume in 1second 67 (22)] were recruited. Combined therapy promoted greater sputum expectoration than usual care during the nebulisation period {median difference 1.8ml [95% confidence interval (CI) 0.2-6.2]}. Both treatments led to similar expectoration during autogenic drainage and for 24hours post intervention. Combined therapy led to a greater improvement in the sputum symptoms domain [6.7 points (95% CI 3.3-13.3] and total CASA-Q score [2.4 points (95% CI 0.1-9.3)] compared with usual care. No differences in LCQ score or lung function were observed. Fewer adverse events were reported using combined therapy, which was selected as the preferred intervention. CONCLUSIONS: Combined nebulisation increased immediate sputum expectoration, improved sputum symptoms and reduced adverse events compared with usual care in patients with CF. CLINICAL TRIAL NUMBER: NCT02303808.

Dimensions underlying frailty indicators in the Kihon Checklist.

AIM: Frailty has become a current topic of debate in recent years among researchers as a key concept of clinical care in old age. One of the scales developed for its measurement is the Kihon Checklist (KCL). However, the dimensionality of the KCL has not been tested yet, and therefore the aim of the present study was to validate its dimensional structure. METHODS: This was a cross-sectional study carried out between March and September 2018 in Valencia province (Spain). Participation in the study was voluntary. A total of 251 participants were sampled. They answered sociodemographic and medical indicators, as well as five frailty scales, including the KCL. RESULTS: Five confirmatory models with different dimensionalities were tested and none of them fit the data well. Therefore, all models were depurated. Goodness of fit indices showed that the best fitting model was a one-factor solution, with 15 items. This reduced model had very good estimates of internal consistency and showed good levels of criterion-related validity with four different measures of frailty. CONCLUSIONS: This work constitutes the first study on the dimensionality of the KCL and the first validation of the Spanish version in a Spanish sample of community-dwelling older adults. A translation exists into Spanish, but there are no data on the reliability and validity of the KCL for its use in Spanish-speaking countries. The KCL, once depurated, offers a valid and reliable measure of frailty to be used in Spanish-speaking populations. Geriatr Gerontol Int 2019; 19: 982-987.

Evolution of Functional Exercise Capacity in Lung Transplant Patients With and Without Bronchiolitis Obliterans Syndrome: A Longitudinal Case-Control Study / Evolución de la capacidad funcional al ejercicio en pacientes con trasplante pulmonar con y sin síndrome de bronqueolitis obliterante: estudio longitudinal de casos-control

Introduction: Bronchiolitis Obliterans Syndrome (BOS) is a debilitating disease with limited treatment options that threatens both the quality of life and long-term survival of lung transplant (LTx) recipients. This retrospective longitudinal case-control study was performed to compare the long-term functional evolution of LTx recipients with and without BOS. Methods: Twenty-four LTx recipients with BOS (BOS=Cases) and 24 without BOS (NON-BOS=Controls) were selected and individually matched according to age, gender, diagnosis and LTx characteristics. Measurements of 6-minute walking distance (6MWD), symptoms of dyspnea (BORG CR-10 scale), and comprehensive pulmonary function testing were performed before LTx and at annual follow-up assessments after LTx. Results: Peak FEV1 after LTx was similar in both groups [FEV1 (% predicted) 101 ± 25 vs. 101 ± 31, p = 0.96] and BOS diagnosis in cases was established 3.6 ± 2.5 years after LTx. At the final follow-up assessment (6.5 ± 3.2 years after LTx) FEV1 (% predicted) was 86 ± 34 in NON-BOS vs. 44 ± 17 in BOS (p < 0.001). Evolution of 6MWD was different between groups (group by time interaction: p = 0.002). Borg dyspnea scores were also significantly different between groups at the final evaluation (NON-BOS 3.3 ± 1.7 vs. BOS 5.0 ± 2.2; p = 0.024). Conclusions: We observed gradual reductions in functional exercise capacity and increasing symptoms of dyspnea in patients who developed BOS after LTx. As such, prospective studies seem warranted to explore whether rehabilitative interventions might be useful to improve symptoms and slow down deterioration of exercise capacity in these patients from the onset of BOS

Introducción: El síndrome de bronquiolitis obliterante (BOS) es una enfermedad debilitante con opciones de tratamiento limitadas que amenaza tanto la calidad de vida como la supervivencia a largo plazo de los trasplantados pulmonares (LTx). Este estudio longitudinal retrospectivo de casos-controles se realizó para comparar la evolución functional de los LTx con y sin BOS a largo plazo. Métodos: Se seleccionaron 24 LTx con BOS (BOS = casos) y 24 sin BOS (NON-BOS = controles). Los casos y controles se emparejaron individualmente atendiendo a la edad, el sexo, el diagnóstico y las características del trasplante. Las mediciones incluyeron: la distancia recorrida en la prueba de 6min marcha (6MWD), la disnea (BORG CR-10) y la función pulmonar, antes del LTx y anualmente en el post-LTx. Resultados: El FEV1 pico post-LTx fue similar en ambos grupos (FEV1 [% predicho] 101 ± 25 vs. 101 ± 31; p = 0,96) y el diagnóstico de BOS en los casos se estableció a los 3,6 ± 2,5 años del LTx. En la evaluación del seguimiento final (6,5 ± 3,2 años tras el LTx) el FEV1 (% predicho) fue del 86±34 en los NON-BOS vs. 44 ± 17 en los BOS (p < 0,001). La evolución del 6MWD fue diferente entre grupos (interacción tiempo por grupo: p = 0,002). La puntuación de disnea en la evaluación final también fue diferente significativamente entre grupos (NON-BOS 3,3 ± 1,7 vs. BOS 5,0 ± 2,2; p = 0,024). Conclusiones: Se ha observado una reducción gradual de la capacidad funcional de ejercicio y un incremento de la disnea en los pacientes con BOS tras el LTx. Así pues, parecen pertinentes estudios prospectivos para examinar si la rehabilitación puede mejorar la sintomatología y enlentecer el deterioro de la capacidad de ejercicio en los pacientes que desarrollan el BOS tras el trasplante

Evolution of Functional Exercise Capacity in Lung Transplant Patients With and Without Bronchiolitis Obliterans Syndrome: A Longitudinal Case-Control Study.

INTRODUCTION: Bronchiolitis Obliterans Syndrome (BOS) is a debilitating disease with limited treatment options that threatens both the quality of life and long-term survival of lung transplant (LTx) recipients. This retrospective longitudinal case-control study was performed to compare the long-term functional evolution of LTx recipients with and without BOS. METHODS: Twenty-four LTx recipients with BOS (BOS=Cases) and 24 without BOS (NON-BOS=Controls) were selected and individually matched according to age, gender, diagnosis and LTx characteristics. Measurements of 6-minute walking distance (6MWD), symptoms of dyspnea (BORG CR-10 scale), and comprehensive pulmonary function testing were performed before LTx and at annual follow-up assessments after LTx. RESULTS: Peak FEV1 after LTx was similar in both groups [FEV1 (% predicted) 101±25 vs. 101±31, p=0.96] and BOS diagnosis in cases was established 3.6±2.5 years after LTx. At the final follow-up assessment (6.5±3.2 years after LTx) FEV1 (% predicted) was 86±34 in NON-BOS vs. 44±17 in BOS (p<0.001). Evolution of 6MWD was different between groups (group by time interaction: p=0.002). Borg dyspnea scores were also significantly different between groups at the final evaluation (NON-BOS 3.3±1.7 vs. BOS 5.0±2.2; p=0.024). CONCLUSIONS: We observed gradual reductions in functional exercise capacity and increasing symptoms of dyspnea in patients who developed BOS after LTx. As such, prospective studies seem warranted to explore whether rehabilitative interventions might be useful to improve symptoms and slow down deterioration of exercise capacity in these patients from the onset of BOS.

Effects of Resistance Training of Peripheral Muscles Versus Respiratory Muscles in Older Adults With Sarcopenia Who are Institutionalized: A Randomized Controlled Trial.

This study compares the effects of two resistance training programs in peripheral and respiratory musculature on muscle mass and strength and physical performance and identifies the appropriate muscle mass parameter for assessing the intervention effects. Thirty-seven institutionalized older Spanish adults with sarcopenia were analyzed: control group (n = 17), respiratory muscle training group (n = 9), and peripheral muscle training group (n = 11). Measured outcomes were appendicular skeletal muscle mass (ASM/height2, ASM/weight, and ASM/BMI), isometric knee extension, arm flexion and handgrip strength, maximal inspiratory and expiratory pressures, and gait speed pre- and postintervention. Trained groups participated in a 12-week program and improved in maximum static inspiratory pressure, maximum static expiratory pressure, knee extension, and arm flexion (p < .05), whereas nonsignificant changes were found in gait speed and ASM indexes pre- and postintervention in the three groups. In conclusion, resistance training improved skeletal muscle strength in the studied population, and any ASM index was found to be appropriate for detecting changes after physical interventions.

Nueva evidencia sobre la Statistical Anxiety Scale (SAS) / New evidence on the Statistical Anxiety Scale (SAS)

Las asignaturas relacionadas con la estadística suelen tener problemas de rendimiento académico. La ansiedad se relaciona de forma negativa con el rendimiento y en particular, la ansiedad estadística puede ser un constructo clave en la mejora de la enseñanza de esta materia y afines. La Statistical Anxiety Scale (Vigil-Colet, Lorenzo-Seva y Condon, 2008) se creó con la pretensión de ser útil para predecir el rendimiento académico en estadística. Se fundamenta en tres dimensiones de ansiedad referidas a tres aspectos específicos: respecto al examen, cuando se pide ayuda en la comprensión de estadística y en el proceso de interpretación de resultados. Esta estructura de tres factores fue hallada en un primer momento por los auto-res de la escala y en una primera validación corroborada en estudiantes italianos y españoles. El presente estudio pretende añadir nueva evidencia sobre la fiabilidad y validez de la escala, empleando en el estudio de fiabilidad técnicas estadísticas robustas, y ampliando el estudio de la validez respecto a su principal criterio, el rendimiento académico, ya que no puede ser considerado sinónimo de autoeficacia

As anxiety is negatively related to academic performance, and it is broadly known the existence of both anxiety towards statistics and negative statistics results, statistical anxiety may play a role of mediating negative outcomes in this subject. In this context, the Statistical Anxiety Scale (Vigil-Colet, Lorenzo-Seva, & Condon, 2008) aims to be a useful tool in the comparison of the predictive power of specific and general measures of statistics performance. In order to achieve this goal, the scale is based on three dimensions of anxiety, referred to three specific issues: regarding the exam, when asking for help or advice in statistics understanding and during the process of results interpretation. This three-factor structure was found in the scale first validation, in a sample composed by Italian and Spanish students. The aim of the current study is to add new evidence on the reliability and validity of the scale, using robust statistical techniques for the reliability study, and extending the validity of the study regarding its main criteria: academic performance, as it shouldn’t be considered as synonymous of self-efficacy