Emilia Barrot Cortés

Health-Related Quality of Life of Patients Receiving Home May Mechanical Ventilation: The Spanish Version of the Severe Respiratory Insufficiency Questionnaire

OBJECTIVE Home mechanical ventilation is used with patients with severe, chronic respiratory failure, a condition that has a serious impact on quality of life. The aim of this study was to produce a translation and cultural adaptation of the Severe Respiratory Insufficiency. Questionnaire for the Spanish population, the first health-related quality of life questionnaire specifically designed for patients receiving home mechanical ventilation. METHODS Four bilingual German-Spanish translators were used to translate and back-translate the questionnaire. Meetings were held with the translators following each step of the translation process to produce a single version that could be used in the next step. At the end of the process, the questionnaire was piloted to assess its comprehensibility. A scoring system using a scale of 1 (lowest) to 10 (highest) was used to rate both translation difficulty and the naturalness of the language produced. The equivalence of the original and translated items was also evaluated. RESULTS Three Spanish versions of the questionnaire were produced. Task difficulty was rated as quite low: the mean (SD) ratings were 1.4 (0.6) for translation and 2.2 (1.1) for back translation. The naturalness of the translated items was rated as very high, with scores improving with the successive versions (version 1, 8.4; version 2, 8.7; version 3, 9.1; P< .001). Thirty of the questionnaire items (61.2%) were judged to be fully equivalent, 13 (26.5%) to be similar, and 6 (12.2%) to be non-equivalent. The meaning conveyed by 5 of the items was changed or clarified during piloting. CONCLUSIONS The translation of the questionnaire using the translation-back-translation procedure has produced a version that is both comparable to the original and accessible to the Spanish population. Its validity is currently being tested in a multicenter study.

Calidad de vida relacionada con la salud de pacientes en programa de ventilación mecánica domiciliaria. La versión española del cuestionario SRI

Objetivo La ventilacion mecanica domiciliaria se aplica a pacientes con insuficiencia respiratoria cronica y grave, lo que tiene un impacto considerable en su calidad de vida. El objetivo de este trabajo ha sido realizar una traduccion y adaptacion transcultural para la poblacion espanola del cuestionario Severe Respiratory Insuficiency (SRI), el primer cuestionario de calidad de vida relacionada con la salud especifico para estos pacientes. Metodos Intervinieron 4 traductores bilingues aleman-espanol siguiendo el metodo de la traduccion y retrotraduccion. Despues de cada paso se realizaron reuniones con los traductores para obtener una version unica antes de continuar. Al final del proceso se realizo una prueba piloto para valorar su comprensibilidad. El proceso de traduccion se evaluo en dificultad y naturalidad, mediante una escala entre 1 (minimo) y 10 (maximo), asi como en equivalencia de los items con la version original. Resultados Se obtuvieron 3 versiones en espanol. La dificultad de la traduccion fue considerablemente baja para la traduccion (media ± desviacion estandar 1,4 ± 0,6) y la retrotraduccion (2,2 ± 1,1). La naturalidad de los items fue muy elevada y mejoro con las sucesivas versiones (version 1: 8,4; version 2: 8,7; version 3: 9,1; p Conclusiones La traduccion del cuestionario siguiendo el metodo de la traduccion-retrotraduccion ha dado una version espanola equiparable a la original y asequible para los pacientes. Actualmente se esta llevando a cabo la validacion del cuestionario mediante un estudio multicentrico.

Components of physical capacity in patients with chronic obstructive pulmonary disease: relationship with phenotypic expression

Background More accurate phenotyping of COPD is of great interest since it may have prognostic and therapeutic consequences. We attempted to explore the possible relationship between the extent of emphysema, as assessed by high-resolution computed tomography (HRCT), and COPD severity. We also included some study variables involving exercise tolerance evaluation and peripheral muscle strength (PMS) measurement. Methods Sixty-four patients with COPD (mean age 64 ± 7 years) were enrolled in a prospective observational cross-sectional study. All patients underwent clinical and functional evaluations: assessment of dyspnea, body mass index (BMI), health status assessment, spirometry testing, and arterial blood gas analysis. The extent of emphysema was graded using HRCT. Functional capacity was evaluated by a cardiopulmonary maximal exercise testing (CPET), the shuttle walking test, and by estimation of PMS. Results Half of the study patients had an emphysematous phenotype. There was a significant correlation between the score derived from analysis of HRCT images and BMI and respiratory functional parameters, as well as VO2 max (maximal oxygen uptake) and chest pull 1RM (1 rep max). Compared with subjects with a nonemphysematous phenotype, those with an emphysematous phenotype showed a lower BMI, a reduced PMS, and displayed a lower power at CPET. Significant differences in lung function tests were found for diffusing capacity and hyperinflation. No significant differences in quality of life were observed between the two study groups. Conclusions Compared with subjects with a nonemphysematous phenotype, subjects with an emphysematous phenotype has a different profile in terms of BMI, lung function, PMS, and exercise capacity.

Randomized trial of non-invasive ventilation combined with exercise training in patients with chronic hypercapnic failure due to chronic obstructive pulmonary disease

BACKGROUND Non-invasive ventilation and exercise training might prove beneficial in the management of COPD patients. OBJETIVE to compare the combined use of exercise training and non-invasive ventilation with the two interventions separately in chronic respiratory failure due to chronic obstructive pulmonary disease. As primary objective exercise capacity and secondary objectives gas exchange, peripheral muscle strength, BODE index, quality of life and systemic inflammatory response. METHODS Forty-five patients with severe chronic obstructive pulmonary disease were randomized into three groups for an intervention of 12 weeks: exercise training alone, ventilation alone and combined treatment. We assessed exercise capacity, pulmonary function, BODE index, perception of dyspnoea, quality of life and several biomarkers. RESULTS All exercise capacity parameters improved after training and the combined treatment. In addition, peripheral muscle strength and six-minute walk distance increased after ventilation. We found differences between the combined group and the ventilation group in submaximal effort and in oxygen consumption. Changes in respiratory function were observed in blood gases that improved after ventilation and the combined treatment, with differences between these groups. BODE index, perception of dyspnoea and quality of life improved in all three groups without differences between groups. Levels of interleukin 8 and tumour necrosis factor α decreased after ventilation, and interleukin 8, C-reactive protein and surfactant protein D decreased after training, while all four of these markers fell after the combined treatment. No differences between groups were found. CONCLUSIONS The combination of ventilation and exercise training had greater benefits than the separate treatments: improvements were observed in both blood gases and the levels of more biomarkers decreased. In addition, submaximal exercise capacity increased in all groups. The improvements seen in BODE index, perception of dyspnoea and quality of life were similar in all groups.