Estudio ROSA: validación de la versión española de la Relevant Outcome Scale for Alzheimer’s Disease / Validation of the Spanish-language version of the Relevant Outcome Scale for Alzheimer's Disease

Introducción y objetivos: La escala Relevant Outcome Scale for Alzheimer's Disease (ROSA) es una herramienta útil para la evaluación y seguimiento de pacientes con demencia. Nuestro objetivo es evaluar la validez y fiabilidad de una versión española de la escala ROSA. Pacientes y métodos: Estudio multicéntrico nacional en el que 39 investigadores han incluido 237 sujetos con enfermedad de Alzheimer (78 en estadio leve, 79 moderado y 80 grave) a los que se les ha aplicado Mini-Mental, Fototest, Neuropsychiatric Inventory (NPI), escala de Blessed y una versión adaptada al español de la escala ROSA. En una submuestra de 40 sujetos se realizó un retest en los 14 días siguientes a la evaluación inicial. La validez de constructo se ha evaluado mediante el coeficiente correlación de Spearman (r), la consistencia interna con el coeficiente alfa de Cronbach (alfa) y la fiabilidad test-retest con el coeficiente correlación intraclase (CCI). Resultados: La escala ROSA se aplica en 13,8 ± 7,4 min y sus resultados están asociados de forma significativa al estadio clínico (leve 116,7 ± 23,1, moderado 92,9 ± 19,8 y grave 64,3 ± 22,6), Mini-Mental (r = 0,68), Fototest (r = 0,63), NPI (r = 0,53) y escala de Blessed (r = -0,80). La escala ROSA muestra una alta consistencia interna (alfa = 0,90) y una excelente fiabilidad test-retest (CCI = 0,97). Conclusión: La versión española de la escala ROSA es un instrumento breve, válido y fiable para la evaluación global de pacientes con demencia (AU)

Introduction and objectives: The Relevant Outcome Scale for Alzheimer's Disease (ROSA) is a useful tool for evaluating and monitoring dementia patients. This study aims to evaluate the validity and reliability of the Spanish version of ROSA. Patients and methods: Spanish multicentre study involving 39 researchers and including 237 patients with Alzheimer disease (78 mild, 79 moderate, and 80 severe). The patients were tested with the following: Mini-Mental State Examination (MMSE), Fototest, Neuropsychiatric Inventory (NPI), Blessed dementia scale, and a Spanish-language version of ROSA. A subsample of 40 subjects was retested in the 14 days following the initial evaluation. The construct validity was evaluated with the Spearman correlation coefficient (r), internal consistency with Cronbach’s alpha (alpha), and test-retest reliability with the intraclass correlation coefficient (ICC). Results: ROSA requires 13.8±7.4 minutes to administer and its results show a significant association with the clinical stage of AD (mild, 116.7±23.1; moderate, 92.9±19.8; and severe, 64.3±22.6), and with results on the MMSE (r=0.68), Fototest (r=0.63), NPI (r=0.53), and Blessed dementia scale (r=-0.80). ROSA shows high internal consistency (alpha=0.90) and excellent test-retest reliability (ICC0.97). Conclusion: The Spanish version of ROSA is a brief, valid, and reliable tool permitting overall evaluation of patients with dementia (AU)

Validation of the Spanish-language version of the Relevant Outcome Scale for Alzheimer's Disease. / Estudio ROSA: validación de la versión española de la Relevant Outcome Scale for Alzheimer's Disease.

INTRODUCTION AND OBJECTIVES: The Relevant Outcome Scale for Alzheimer's Disease (ROSA) is a useful tool for evaluating and monitoring dementia patients. This study aims to evaluate the validity and reliability of the Spanish version of ROSA. PATIENTS AND METHODS: Spanish multicentre study involving 39 researchers and including 237 patients with Alzheimer disease (78 mild, 79 moderate, and 80 severe). The patients were tested with the following: Mini-Mental State Examination (MMSE), Fototest, Neuropsychiatric Inventory (NPI), Blessed dementia scale, and a Spanish-language version of ROSA. A subsample of 40 subjects was retested in the 14 days following the initial evaluation. The construct validity was evaluated with the Spearman correlation coefficient (r), internal consistency with Cronbach's alpha (alpha), and test-retest reliability with the intraclass correlation coefficient (ICC). RESULTS: ROSA requires 13.8±7.4minutes to administer and its results show a significant association with the clinical stage of AD (mild, 116.7±23.1; moderate, 92.9±19.8; and severe, 64.3±22.6), and with results on the MMSE (r=0.68), Fototest (r=0.63), NPI (r=0.53), and Blessed dementia scale (r=-0.80). ROSA shows high internal consistency (alpha=0.90) and excellent test-retest reliability (ICC0.97). CONCLUSION: The Spanish version of ROSA is a brief, valid, and reliable tool permitting overall evaluation of patients with dementia.

High prevalence of confirmed, but also of potential and believed, neuropathic pain in pain clinics.

BACKGROUND AND AIMS: Epidemiological data about neuropathic pain are still scarce. A national survey, based on neurologic clinical diagnosis, was performed to determine its prevalence among patients attending pain clinics. METHODS: An epidemiological cross-sectional study involving pain clinics across all regions in Spain was carried out. Pain specialists evaluated the medical files and the clinical condition of patients attending their practices systematically during 1 day. They used the revised definition and grading system proposed in 2008 to decide whether a given patient had definite (i.e., confirmed), probable (potential) or possible (believed) neuropathic pain. Also, they provided a diagnostic label for neuropathic pain conditions and appraised treatment adequacy. RESULTS: In a single day, 178 pain specialists provided data from 2173 patients. Definite, probable and possible neuropathic pain was cited in 639 (29.4%), 304 (14.0%) and 97 (4.5%) patients, respectively. Almost two-thirds of these were women. A diagnostic label of primary pure central and/or peripheral neuropathic pain was cited in 344 (15.8%) patients. The most common diagnostic label (568 patients) was low back pain or sciatica causing mixed neuropathic pain. Definite neuropathic pain diagnosis was less likely in patients with mixed pain conditions and in women derived from primary care. Co-morbid depressive or anxiety symptoms were usual. CONCLUSIONS: Definite (confirmed) neuropathic pain alone was as prevalent as neuropathic pain ascertained with screening questionnaires in prior recent European studies. The clinical relevance of the surplus of patients with potential and believed neuropathic pain ascertained by clinicians is uncertain.

Incidence of oral mucositis, its treatment and pain management in patients receiving cancer treatment at Radiation Oncology Departments in Spanish hospitals (MUCODOL Study)

OBJECTIVE: To estimate the incidence of oral mucositis (OM) in patients receiving radiotherapy, describe the treatments used to manage pain in OM grades 3 and 4 and assess relief of pain and patient satisfaction. PATIENTS AND METHODS: All patients older than 18 years consecutively attending a Radiation Oncology Department over 5 working days were included in a cross-sectional study. The data recorded were RTOG scale of OM (1, 2, 3 or 4), age and sex. In a second stage, a clinical cohort was followed for 2 months. Pain management was assessed in patients with grades 3 and 4. RESULTS: Two thousand and forty-seven patients (98.5%) from 55 participating centres were eligible for the fi rst stage. The overall risk of OM was 16.4% (95% CI 14.8- 18.1); prevalence was 26.4%. In the second stage, 282 (91.6%) of the patients recruited were eligible. At the baseline visit, 95.7% of the population had OM grade 3 and 4.3% grade 4. At two months, OM was resolved in 62.3%, grade 1 in 20%, grade 2 in 10.3% and grade 3 in only 7.4% (p<0.05). 98.9% of the patients had head and neck cancer. From baseline to the two-months session, reported pain fell from 96.1% of affected patients to 39.8%(p<0.01), while chronic pain increased (19.5% vs. 38.2%, p<0.05). Verbal scale OM pain intensity indicated intense pain at baseline in 42.2% and a mean visual analogue scale (VAS) score of 5.6 (2.3). Mean VAS scores fell significantly according to pain intensity due to the OM and cancer (p<0.01). CONCLUSIONS: Pain due to OM, a common complication of chemotherapy and radiation, limits nutritional intake and oral function. Analgesia protocols need to be assessed to improve the quality of life of these patients (AU)

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[Pain in Spanish rheumatology outpatient offices: EPIDOR epidemiological study]. / El dolor en las consultas de Reumatología españolas: estudio epidemiológico EPIDOR.

OBJECTIVE: To establish the prevalence and characteristics of rheumatologic pain in Spanish adult population cared in specialized rheumatology offices. DESIGN: Cross selection study in a population of patients cared in rheumatology offices of public Spanish hospitals. SUBJECTS: 1,134 patients selected through random sampling based on waiting lists of patients, during a period of 1 week, in rheumatology offices of each participating hospital. MAIN OUTCOMES OF THE STUDY: Reason behind the consultation (a new patient [NP] or a patient for revision [RP]), characteristics of the patient (sex, age, habits [alcohol/tobacco], marital status), location, type, intensity, duration, tolerance and management of pain; treatment (pharmacological or non-pharmacological) carried out; satisfaction with the treatment; and association with fibromyalgia. RESULTS: The prevalence of pain in NP was 98.6% and in RP 95.1%, with a global prevalence of 96%, predominating mainly in adult sedentary women with fibromyalgia. The frequency of acute pain was 20.9% and this of chronic pain 79.1% [corrected] The prevalence of fibromyalgia was 12% (2.2% in men, and 15.5% in women). The most prevalent pattern of current dominant pain was this of the mechanical type. More frequent associated pathologies were: hypertension (21.7%), depression (14.4%), gastrointestinal diseases (13.8%) and anxiety (13.4%). All variables analyzed in the study showed changes according to age, sex, and type of patient (NP or RP). Most used treatment was pharmacological; more than 57.6% of patients were receiving NSAIDs. In NP, medical prescriber of the treatment was first the general practitioner (56.1%) followed by the rheumatologist (14.1%); in PR the first one was the rheumatologist (69.9%) followed by the general practitioner (16.5%). CONCLUSIONS: Our results show that the prevalence of the rheumatologic pain is very high, predominating mainly in adult women with fibromyalgia. Pain location, intensity, and type, associated pathology, and treatment vary according to age, sex, and type of patient. The most commonly used drugs for pain management were NSAIDs (58%); opiodes were only used in 6.4% of patients even though pain was intense in more than two-thirds.

El dolor en las consultas de Reumatología españolas: estudio epidemiológico EPIDOR / Pain in spanish Rheumatology outpatient offices: EPIDOR epidemiological study

Objetivo. Estimar la prevalencia y características del dolor reumatológico en la población adulta española atendida en consultas especializadas de Reumatología. Diseño. Estudio transversal de prevalencia en una población de pacientes atendidos en consultas de Reumatología de hospitales públicos españoles. Sujetos. Mil ciento treinta y cuatro elegidos mediante muestreo aleatorio a partir de listados de pacientes citados, durante un período de una semana, en consultas reumatológicas de cada uno de los hospitales participantes. Variables principales del estudio. Motivo de consulta (paciente de nuevo diagnóstico [PND] o de revisión [PR]), características del paciente (sexo, edad, hábitos [alcohol/tabaco], estado civil), localización, tipo, intensidad, duración, tolerancia y manejo del dolor, tratamiento (farmacológico o no farmacológico) realizado y satisfacción con el tratamiento. Resultados. La prevalencia de dolor en PND fue del 98,6% y en PR del 95,1%, con una prevalencia global del 96%, predominando principalmente en mujeres adultas, sedentarias y con fibromialgia. La frecuencia de dolor agudo fue del 80% y crónico del 20%. La prevalencia de fibromialgia fue del 12% (2,2% en hombres y 15,5% en mujeres). El patrón de dolor dominante actual que prevaleció fue de tipo mecánico. Las patologías asociadas más frecuentes fueron: hipertensión arterial (21,7%), depresión (14,4%), enfermedades digestivas (13,8%) y ansiedad (13,4%). Todas las variables del estudio analizadas cambiaron según edad, sexo y tipo de paciente (PND o PR). El tratamiento más usado fue farmacológico con antiinflamatorios no esteroideos (AINE) en más del 57,6%. El médico prescriptor del tratamiento fue primero el médico general (56,1%) seguido del reumatólogo (14,1 %) en PND y el primero fue el reumatólogo (69,9%) seguido del médico general (16,5 %) en PR. Conclusiones. Los resultados muestran que la prevalencia del dolor reumatológico es muy elevada, predominando principalmente en mujeres adultas con fibromialgia La localización, intensidad, tipo, patología asociada y tratamiento varían según edad, sexo y tipo de paciente. Los fármacos más utilizados para el manejo del dolor son los AINE (58%); los opioides tan sólo se utilizaron en el 6,4% de los pacientes a pesar de que el dolor fue intenso en más de dos tercios

Objective. To establish the prevalence and characteristics of rheumatologic pain in Spanish adult population cared in specialized rheumatology offices. Design. Cross selection study in a population of patients cared in rheumatology offices of public Spanish hospitals. Subjects. 1,134 patients selected through random sampling based on waiting lists of patients, during a period of 1 week, in rheumatology offices of each participating hospital. Main outcomes of the study. Reason behind the consultation (a new patient [NP] or a patient for revision [RP]), characteristics of the patient (sex, age, habits [alcohol/tobacco], marital status), location, type, intensity, duration, tolerance and management of pain; treatment (pharmacological or non-pharmacological) carried out; satisfaction with the treatment; and association with fibromyalgia. Results. The prevalence of pain in NP was 98.6% and in RP 95.1%, with a global prevalence of 96%, predominating mainly in adult sedentary women with fibromyalgia. The frequency of acute pain was 80% and this of chronic pain 20%. The prevalence of fibromyalgia was 12% (2.2% in men, and 15.5% in women). The most prevalent pattern of current dominant pain was this of the mechanical type. More frequent associated pathologies were: hypertension (21.7%), depression (14.4%), gastrointestinal diseases (13.8%) and anxiety (13.4%). All variables analyzed in the study showed changes according to age, sex, and type of patient (NP or RP). Most used treatment was pharmacological; more than 57.6% of patients were receiving NSAIDs. In NP, medical precriber of the treatment was first the general practitioner (56.1%) followed by the rheumatologist (14.1%); in PR the first one was the rheumatologist (69.9%) followed by the general practitioner (16.5%). Conclusions. Our results show that the prevalence of the rheumatologic pain is very high, predominating mainly in adult women with fibromyalgia. Pain location, intensity, and type, associated pathology, and treatment vary according to age, sex, and type of patient. The most commonly used drugs for pain management were NSAIDs (58%); opiodes were only used in 6.4% of patients even though pain was intense in more than two-thirds

Calidad de vida y depresión en el estudio EPIDOR / Quality of life and depression in the epidemiology of pain in rheumatology (EPIDOR) Study

Objetivos: Evaluar, en pacientes con enfermedades osteoarticulares, el grado de control del dolor, la calidad de vida, y la prevalencia y las características de los síntomas depresivos. Métodos: Estudio transversal, con inclusión aleatorizada de 1.134 pacientes visitados en las consultas externas de reumatología. En todos los pacientes incluidos se determinó la prevalencia y la intensidad del dolor por la Escala Visual Analógica (EVA) y por el Cuestionario Breve para la Evaluación del Dolor (BPI), el grado de satisfacción terapéutica mediante una escala tipo Likert de 5 puntos, la calidad de vida a través del cuestionario SF-36 y la presencia de síntomas depresivos por la escala de Zung. Resultado: La prevalencia de dolor fue de un 96,2%. Los tratamientos más habituales fueron los antiinflamatorios no esteroideos (AINE) (57,5%) y el paracetamol (29,8%); sólo un 18% de pacientes tomaba tratamiento analgésico combinado, y menos de un 6%, opioides. El grado de satisfacción terapéutica fue regular o malo en un 45% de los pacientes estudiados. Más del 90% de pacientes presentaba algún tipo de sintomatología depresiva. La intensidad del dolor y el grado de insatisfacción terapéutica se asoció con la intensidad de la sintomatología depresiva y con una menor calidad de vida de estos pacientes. Conclusión: Los pacientes con enfermedad osteoarticular controlados en consultas externas de reumatología refieren con frecuencia una pobre satisfacción terapéutica en el control del dolor, lo que influye en una menor calidad de vida y en la presencia de sintomatología depresiva asociada

Objectives: To evaluate pain control, quality of life, the prevalence of depressive symptoms, and their characteristics in rheumatology patients. Methods: A cross-sectional study of 1134 randomized patients attending outpatient rheumatology clinics was performed. Pain prevalence and intensity among all patients included in the study was determined by a Visual Analog Scale (VAS) and by the Brief Pain Inventory (BPI). Satisfaction with treatment was evaluated by a five-point Likert-like scale, quality of life was assessed by the SF-36 questionnaire and the presence of symptoms of depression was analyzed by the Zung scale. Result: The prevalence of chronic pain was 96.2%. The most frequent treatments were nonsteroidal anti-inflammatory drugs (NSAIDs) (57.5%) and acetaminophen (29.8%); combined analgesics were taken only by 18% of the patients and opioids by less than 6%. The degree of satisfaction with treatment was fair or poor among 45% of the studied patients. More than 90% of the patients had some kind of depressive symptoms. Pain intensity and the degree of treatment satisfaction were associated with the severity of depressive symptoms and lower quality of life in these patients. Conclusion: Patients with musculoskeletal disease managed in outpatient rheumatology clinics report a low degree of satisfaction with pain control, which influences their lower quality of life and the presence of associated depressive symptoms