Traducción y adaptación de la escala Disability Assessment for Dementia en población española / Translation and adaptation of the Disability Assessment for Dementia scale in the Spanish population

Antecedentes y objetivo La evaluación funcional es relevante en pacientes con deterioro cognitivo (DC). La escala Disability Assessment for Dementia (DAD) mide la capacidad funcional y su uso está cada vez más extendido. El objetivo es realizar una traducción y adaptación cultural de la escala DAD para generar una versión española: DAD-E. Pacientes y método: Se ha desarrollado un proceso de doble traducción y traducción inversa, un estudio piloto con 14 cuidadores de pacientes con deterioro cognitivo y 3 reuniones de consenso. Resultados: El DAD-E mantiene los 40 ítems originales. Se han añadido a la codificación de respuestas y puntuaciones originales 4 opciones de respuesta y 8 puntuaciones con el objetivo de detectar la discapacidad funcional exclusivamente causada por DC. Se han modificado y ampliado las instrucciones de administración para mejorar la fiabilidad del contenido. Conclusiones: La versión DAD-E supone una adaptación lingüística y cultural equivalente de la escala original, lo que permite su uso en nuestro contexto español. Puede ser un instrumento de gran utilidad clínica, ya que proporciona una evaluación más precisa de la discapacidad funcional causada por DC (AU)

Background and objective: Functional assessment is especially relevant in patients with cognitive impairment (CI). The Disability Assessment for Dementia (DAD) scale assesses functional ability and its use is becoming increasingly popular. This study aims to perform the translation and cultural adaptation of the DAD scale in order to create a Spanish version: DAD-E. Patients and method: A double translation/back-translation process was developed, as well as a pilot study with 14 caregivers of patients with CI, and 3 review meetings to achieve general agreement. Results: The DAD-E includes the 40 original items. Four response options and 8 scores were added in order to detect functional disability induced by CI independently of other possible causes. More detailed instructions for administration and scoring of the scale have been provided in order to improve the reliability of the content. Conclusions: The DAD-E was shown to be a cultural and linguistic adaptation equivalent of the original scale, which allows it to be applied to the Spanish population. It may be a useful instrument in clinical practice since it provides a more accurate assessment of functional disability due to cognitive impairment (AU)

Translation and adaptation of the Disability Assessment for Dementia scale in the Spanish population. / Traducción y adaptación de la escala Disability Assessment for Dementia en población española.

BACKGROUND AND OBJECTIVE: Functional assessment is especially relevant in patients with cognitive impairment (CI). The Disability Assessment for Dementia (DAD) scale assesses functional ability and its use is becoming increasingly popular. This study aims to perform the translation and cultural adaptation of the DAD scale in order to create a Spanish version: DAD-E. PATIENTS AND METHOD: A double translation/back-translation process was developed, as well as a pilot study with 14 caregivers of patients with CI, and 3 review meetings to achieve general agreement. RESULTS: The DAD-E includes the 40 original items. Four response options and 8 scores were added in order to detect functional disability induced by CI independently of other possible causes. More detailed instructions for administration and scoring of the scale have been provided in order to improve the reliability of the content. CONCLUSIONS: The DAD-E was shown to be a cultural and linguistic adaptation equivalent of the original scale, which allows it to be applied to the Spanish population. It may be a useful instrument in clinical practice since it provides a more accurate assessment of functional disability due to cognitive impairment.

The relationship of sexism and gender ideology to self-concept and self-esteem in persons with spinal cord injury / Relaciones entre sexismo e ideología de género con autoconcepto y autoestima en personas con LM

Adjustment to an unexpected physical disability is usually complex and multidimensional. Many variables may affect this adjustment, a process that would facilitate or limit adequate vital adjustment and psychological well-being. This research dealt with the specific effects that sexism and gender stereotypes have on the self-concept and self-esteem of people with spinal injuries. The research was a cross-sectional survey. The sample consisted of 127 people with long tern spinal injuries, 95 of them were men and 32 were women. MANOVAs were calculated to test for gender differences on self-esteem, self-concept, traditional sexism and neosexism. No significant differences were found. Additionally sexism measures were correlated to self-esteem and self-concept for both men and women. Results have shown that men with highest levels of neosexism had lower levels of emotional and family self-concept. That result did not hold for women, suggesting a buffer of gender on sexism and self-concept relationships. Discussion suggests the relevant role that intervention programs may play to improve gender equality in order to reduce sexism

El proceso de adaptación a una discapacidad física sobrevenida es complejo y multidimensional. En él influyen muchas variables que pueden condicionar un adecuado ajuste vital y conseguir bienestar psicológico. Este estudio aborda los efectos específicos del sexismo y los estereotipos de género en la autoestima y autoconcepto de las personas con lesión medular (LM). El diseño es transversal y correlacional. La muestra está constituida por 127 personas con lesión medular de larga evolución, 95 varones y 32 mujeres. Los resultados de los MANOVAS no muestran diferencias estadísticamente significativas en función del género en las siguientes variables: Autoestima, Autoconcepto, Sexismo Tradicional y Neosexismo. Las relaciones entre variables sugieren que existen relaciones negativas entre neosexismo, autoestima y autoconcepto emocional y familiar en varones con LM, pero no en mujeres con LM. La discusión plantea el relevante papel que pueden tener los programas de intervención que fomenten la igualdad de género para disminuir el sexismo

Walking Beliefs in Women With Fibromyalgia: Clinical Profile and Impact on Walking Behavior.

Although exercise is essential for the treatment of fibromyalgia, adherence is low. Walking, as a form of physical exercise, has significant advantages. The aim of this article is to describe, in 920 women with fibromyalgia, the prevalence of certain walking beliefs and analyze their effects both on the walking behavior itself and on the associated symptoms when patients walk according to a clinically recommended way. The results highlight the high prevalence of beliefs related to pain and fatigue as walking-inhibitors. In the whole sample, beliefs are associated with an increased perception that comorbidity prevents walking, and with higher levels of pain and fatigue. In patients who walk regularly, beliefs are only associated with the perception that comorbidity prevents them from walking. It is necessary to promote walking according to the established way (including breaks to prevent fatigue) and to implement interventions on the most prevalent beliefs that inhibit walking.

Prevalence and predictors of unsupervised walking and physical activity in a community population of women with fibromyalgia.

Physical exercise is recognized as a component of the evidence-based guidelines for treatment of fibromyalgia. Walking is a low-moderate intensity exercise easily adaptable to a fibromyalgia patient's situation. The present study aims to estimate the prevalence of unsupervised walking for exercise in women with fibromyalgia, to describe their level of physical activity and to identify their predictors among socio-demographic, symptom perception and medical advice to walk. A cross-sectional survey with 920 women (all members of fibromyalgia associations) completed the International Physical Activity Questionnaire-Short Form and self-reported scales to assess symptom perception, walking, medical advice to walk and physical comorbidity. The prevalence of reported walking regularly as physical exercise was 30.8 % and it was predicted by medical advice (odds ratio, OR 1.876), age (OR 1.021) and fatigue intensity (OR 0.912). The prevalence of physical activity was 16 % for high-intensity activity, 40 % for moderate activity and 44 % for low activity. Predictors of low versus moderate and high physical activity were pain intensity (OR 1.171) and fatigue impact perception (OR 1.076). Evidence shows a low percentage of women with fibromyalgia walking regularly for physical exercise. Most reported low or moderate physical activity. The results indicate the importance of doctors' advice in promoting walking. Symptom perception and socio-demographic characteristics were weak predictors. Further work is required to examine other determinants of these low levels.

To walk or not to walk: insights from a qualitative description study with women suffering from fibromyalgia.

Walking improves health outcomes in fibromyalgia; however, there is low adherence to this practice. The aim of this research was to explore the beliefs of women suffering from fibromyalgia toward walking, and the meaning that they attribute to the behavior of walking as part of their fibromyalgia treatment. This study is a qualitative description research. Forty-six (46) women suffering from fibromyalgia and associated with local fibromyalgia associations located in four different Spanish cities (Elche, Alicante, Madrid, and Talavera de la Reina) participated in focus group discussions in the summer 2012. Thematic content analysis was performed in transcribed verbatim from interviews. Participants perceived several inhibitors for walking even when they had positive beliefs toward its therapeutic value. Whereas participants believed that walking can generate improvement in their disease and their health in general, they did not feel able to actually do so given their many physical impediments. Furthermore, participants struggled with social isolation and stigma, which was lessened through the conscious support of family. Advice from family doctors was also a very important facilitator to participants. In a health care delivery context that favors person-centered care, and in order to foster adherence to walking-based fibromyalgia treatments, it is recommended that therapeutic walking programs be tailored to each woman' individual circumstances, and developed in close collaboration with them to help them increase control over their health and their condition.

Validation Study of the Spanish Version of the Disability Assessment for Dementia Scale.

The aim of this study was to determine reliability and validity of the Spanish version of the Disability Assessment for Dementia Scale (DAD-E) in the following areas: content, response process, internal structure, and relation to other constructs.We designed a cross-sectional observational study. The DAD-E was administered to 132 participants diagnosed with mild cognitive decline, prodromal Alzheimer disease, Alzheimer disease, or no cognitive decline. For the reliability study, we performed analyses of internal consistency, test-retest, and equivalent measures. To study validity, we performed item analysis, principal components analysis, and correlations with other measures.The sample was composed of 37 healthy participants (28%) and 95 patients (72%). In the total scale, Cronbach alpha was 0.963, intraclass correlation coefficient in the test-retest analysis was 0.983 (95% CI [95% confidence interval] = 0.969-0.991), and the analysis for equivalent measures was 0.949 (95% CI = 0.897-0.975). Out of the 40 items, we found that 37 presented a correlation index with the total score above 0.40. The principal components analysis suggests that 61.7% of the variance is explained by a single component that groups all scores on Activities of Daily Living. The DAD total score presents correlations with Barthel's Index of 0.882 (P = 0.000) and with Lawton and Brodie's Index of 0.877 (P = 0.000) and with the Mini Mental State Examination of 0.679 (P = 0.000).The DAD-E is a reliable and valid instrument to assess functional disability in people with cognitive decline in Spanish population.

Walking as physical exercise in Fibromyalgia: an elicitation study from the theory of planned behavior / Andar como forma de ejercicio físico en la Fibromialgia: un estudio de identificación de creencias desde la Teoría de la Acción Planeada

This study is the first phase of the formative research recommended in the Theory of Planned Behavior for the development of an intervention. Our aims are to identify modal beliefs about the performance of an exercise pattern in people with fibromyalgia, to test the items designed for direct evaluation of the predictive constructs and to explore their relationships with the behavior. We assessed 46 women with fibromyalgia. Content analysis showed more positive than negative consequences related to the performance of exercise guidelines (behavioral beliefs). Families and friends are the important referents (normative beliefs) and we identified facilitating and inhibiting factors in the performance of exercise behavior related to aspects of fibromyalgia (control beliefs) such as pain, fatigue and emotional state. The subjective norm scale showed the lowest internal consistency (alfa= .78). The results confirmed the sedentary lifestyle of the participants (previous behavior: Mean=3.67; rank=1-7) although they also suggested that participants intended to perform the behavior (Mean=5.67). The relationships between constructs are coherent with the theory, and support the relevance of applying it to the selected behavior and population

Este estudio corresponde a la primera fase de investigación formativa recomendada en la teoría de la Acción Planeada para desarrollar una intervención. Nuestros objetivos son identificar las creencias modales sobre la realización de una pauta de ejercicio en personas con fibromialgia, probar los ítems para la evaluación directa de los constructos predictivos y explorar sus relaciones con la conducta. Evaluamos a 46 mujeres con fibromialgia. El análisis de contenido mostró un mayor número de consecuencias positivas que negativas asociadas a la ejecución de la pauta de ejercicio (creencias comportamentales); la familia y los amigos son los referentes importantes (creencias normativas) y se detectaron factores facilitadores e inhibidores de la ejecución de la conducta de ejercicio, relacionados con aspectos de la fibromialgia (creencias de control) como el dolor, la fatiga y el estado de ánimo. El índice de consistencia interna más bajo fue el de la escala de norma subjetiva (alfa= .78). Los resultados confirman el sedentarismo de la muestra (conducta previa: Media=3.67; rango=1-7) aunque también sugieren que estas personas tienen intención de realizar la conducta (Media= 5.67). Las relaciones obtenidas entre los constructos son las esperadas desde la teoría, apoyando la pertinencia de aplicarla en la conducta y población seleccionada

Combining motivational and volitional strategies to promote unsupervised walking in patients with fibromyalgia: study protocol for a randomized controlled trial.

BACKGROUND: Fibromyalgia patients are often advised to engage in regular low- to moderate-intensity physical exercise. The need of fibromyalgia patients to walk has been stressed in previous research. Behavioral self-regulation theories suggest that a combination of motivational aspects (to develop or strengthen a behavioral intention: Theory of Planned Behavior) and volitional aspects (engagement of intention in behavior: implementation intentions) is more effective than a single intervention. In this paper, we describe a protocol for identifying the motivational processes (using the Theory of Planned Behavior) involved in the practice of walking (phase I) and for studying the efficacy of an intervention that combines motivational and volitional contents to enhance the acquisition and continuation of this exercise behavior (phase II). The paper also shows the characteristics of eligible individuals (women who do not walk) and ineligible populations (women who walk or do not walk because of comorbidity without medical recommendation to walk). Both groups consist of members of any of four patients' associations in Spain who are between 18 and 70 years of age and meet the London Fibromyalgia Epidemiology Study Screening Questionnaire criteria for fibromyalgia. Furthermore, using this study protocol, we will explore the characteristics of participants (eligible women who agreed to participate in the study) and nonparticipants (eligible women who refused to participate). METHODS/DESIGN: Two studies will be conducted: Phase I will be a cross-sectional study, and phase II will be a triple-blind, randomized longitudinal study with two treatment groups and one active control group. The questionnaires were sent to a total of 2,227 members of four patients' associations in Spain. A total of 920 participants with fibromyalgia returned the questionnaires, and 582 were ultimately selected to participate. DISCUSSION: The first data gathered have allowed us to identify the characteristics of the study population and they support the appropriateness of the inclusion criteria.. When the study is complete, the results will enable us to establish whether this kind of intervention can be used as a self-regulation tool for increasing and maintaining walking as unsupervised physical exercise of low to moderate intensity in fibromyalgia patients. TRIAL REGISTRATION NUMBER: ISRCTN68584893.

Autoeficacia clínica y creencias sobre la enfermedad en problemas de dolor crónico: El manejo de la Fibromialgia en médicos de Atención Primaria / Clinical self-efficacy and illness beliefs in ambiguous chronic pain conditions: General Practitioners’ management of Fibromyalgia

Objetivos: En problemas de dolor crónico, el comportamiento de los profesionales puede estar influido por sus conocimientos científicos y por sus creencias sobre la enfermedad. Nuestro objetivo es identificar las creencias sobre la Fibromialgia (representación mental y autoeficacia clínica) de los médicos de atención primaria y estudiar sus relaciones con el manejo del paciente. Método: 208 médicos participantes en talleres de formación sobre Fibromialgia, completaron una versión adaptada del "Brief Illness Perception Questionnaire" y diferentes medidas de autoeficacia clínica, conducta clínica y satisfacción. Realizamos correlación de Pearson, regresión múltiple, pruebas t y ANOVA. Resultados: La Fibromialgia se consideró un problema importante, con poco control sobre él y asociado a causas psicológicas; la autoeficacia clínica fue moderada. Los componentes de la representación mental predijeron el manejo clínico, aunque con bajos porcentajes de varianza explicada (entre 3% y 11%) mientras que la autoeficacia clínica predijo la satisfacción con el manejo (entre 46% y 61%). Conclusiones: Es necesario incrementar la percepción de control y de autoeficacia de los médicos de atención primaria. Mientras que la fibromialgia siga siendo un problema ambiguo, las variaciones en las cogniciones de los profesionales serán importantes en el tipo de cuidado que recibe el paciente (AU)

Aims: In ambiguous chronic pain conditions, professional behaviour may be affected not only by scientific knowledge but also by beliefs about illness. In Spain, Fibromyalgia is the most frequent cause of chronic pain at Primary Care level. Our aims are to identify General Practitioners’ beliefs about Fibromyalgia, in terms of mental representation and clinical self-efficacy, and to study their relationships with patient management. Methods: 208 General Practitioners recruited on a voluntarily basis while attending educational workshops on Fibromyalgia, completed an adapted version of the Brief Illness Perception Questionnaire and ad hoc scales of clinical self-efficacy, clinical behaviour and satisfaction. Pearson correlation, multiple regression, t test and ANOVA were performed. Results: Doctors see Fibromyalgia as a severe condition and they perceived low control and moderate clinical self-efficacy. The main causes of Fibromyalgia were seen to be psychological. Regression analysis showed that mental representation components predicted clinical management with low explained variance (from 3% to 11%) while clinical self-efficacy predicted satisfaction with clinical management (from 46% to 61%). Conclusions: GPs self-efficacy and control perception of Fibromyalgia need to be enhanced. While FM continues to be an ambiguous condition, variations in clinicians' cognitions will be important for the care patients receive (AU)

Reputación e identificación profesional con la práctica de la medicina de familia en estudiantes de medicina: Un estudio de caso español / The reputation and professional identity of family medicine practice according to medical students: A Spanish case study

ObjectiveOver the last decade, family medicine has been progressively rejected by medical students as a career choice in many Western countries. Our objective is to contribute to a better understanding of this phenomenon by examining the reputation of and identification processes with family medicine by medical students.DesignA qualitative case study.MethodsFocus groups and document analysis were used for generating empirical material. Focus groups (n=6) were conducted (2008–2009). Thematic analysis was adopted as the technique for analyzing data gathered.SettingA faculty of medicine of a Spanish university.ParticipantsSecond and sixth year undergraduate medical students (N=48).ResultsFamily medicine appears to be largely devalued as a professional activity, among medical students, being viewed as a monotonous and non-technological medical practice with no intellectual challenge. Such a negative view, which already appears in early stages of medical training, leads to a lack of identification with this medical practice by students.ConclusionMisconceptions about the practice of family medicine, created and reproduced in health care system and societal contexts, encourage the practice of specialized medicine. In addition, the academic environment appears to promote organ- and disease-based medical knowledge, which goes against the holistic and patient-centered approach characteristic of the practice of family medicine. In order to improve the reputation of family medicine and for it to be considered as an attractive career path by medical students, it is recommended that family medicine is developed as an academic medical field, and that improvements are made in the conditions and status of this medical practice within the health care system(AU)

ObjetivoEn la última década, los estudiantes de medicina han ido descartando progresivamente la medicina de familia como opción de carrera en muchos países occidentales. El objetivo de este artículo es contribuir a comprender mejor este fenómeno mediante el examen de la reputación y los procesos de identificación de los estudiantes de medicina con la medicina de familia.DiseñoEstudio de caso cualitativo.MétodoGrupos focales y análisis documental fueron los métodos utilizados para generar datos. Se desarrollaron seis grupos focales (2008–2009). El análisis temático fue la técnica de análisis del material recogido.EmplazamientoUna facultad de medicina española.Participantes48 estudiantes de 2.o y 6.o año.ResultadosLa medicina de familia aparece devaluada como actividad profesional entre los estudiantes, siendo su práctica considerada como monótona, no tecnológica y sin desafío intelectual. Esta visión negativa, que ya aparece en primeras etapas de la formación, estimula la falta de identificación con esta especialidad.ConclusiónLos conceptos erróneos sobre la práctica de la medicina de familia se crean y reproducen tanto en el sistema de salud como en otros contextos sociales, donde se prima la práctica de medicina especializada. Así mismo, el contexto académico promueve el conocimiento médico basado en el órgano y la enfermedad, en claro contraste con la visión holística característica de la medicina de familia. Para mejorar la reputación de esta especialidad y su consideración como opción profesional atractiva, se sugiere estimular su desarrollo como disciplina académica así como mejorar las condiciones de su práctica en el sistema sanitario(AU)

The reputation and professional identity of family medicine practice according to medical students: a Spanish case study.

OBJECTIVE: Over the last decade, family medicine has been progressively rejected by medical students as a career choice in many Western countries. Our objective is to contribute to a better understanding of this phenomenon by examining the reputation of and identification processes with family medicine by medical students. DESIGN: A qualitative case study. METHODS: Focus groups and document analysis were used for generating empirical material. Focus groups (n=6) were conducted (2008-2009). Thematic analysis was adopted as the technique for analyzing data gathered. SETTING: A faculty of medicine of a Spanish university. PARTICIPANTS: Second and sixth year undergraduate medical students (N=48). RESULTS: Family medicine appears to be largely devalued as a professional activity, among medical students, being viewed as a monotonous and non-technological medical practice with no intellectual challenge. Such a negative view, which already appears in early stages of medical training, leads to a lack of identification with this medical practice by students. CONCLUSION: Misconceptions about the practice of family medicine, created and reproduced in health care system and societal contexts, encourage the practice of specialized medicine. In addition, the academic environment appears to promote organ- and disease-based medical knowledge, which goes against the holistic and patient-centered approach characteristic of the practice of family medicine. In order to improve the reputation of family medicine and for it to be considered as an attractive career path by medical students, it is recommended that family medicine is developed as an academic medical field, and that improvements are made in the conditions and status of this medical practice within the health care system.

Comparing fibromyalgia patients from primary care and rheumatology settings: clinical and psychosocial features.

The aim of this study was to compare clinical symptoms, perceived health status, health resource use and psychosocial features in fibromyalgia (FM) patients at different health care levels. A total of 315 participants were recruited from primary care (PC) (n=101) and rheumatology settings (RS) (n=214). Subjects completed a protocol of clinical features and health resource use, hospital anxiety and depression scale, sickness impact profile, chronic pain self-efficacy scale, multidimensional pain locus of control scale, perceived health competence scale and chronic pain coping inventory. Student's t test, effect size, and contrast and power test were performed to examine differences between samples. FM patients treated in PC and RS were similar in most variables assessed and only differed significantly in tender points, sleep disturbance, wellness-focused coping strategies and in self-efficacy beliefs. The similarities do not support patient selection through care levels and thus, in the Spanish health care system at least, endorse PC as a reference unit for treatment and questioning the benefits of referring patients to RS.