Juan Diego Ramos-Pichardo

Valores de referencia de la Short Physical Performance Battery para pacientes de 70 y más años en atención primaria de salud

OBJECTIVE To provide new reference values for the Short Physical Performance Battery (SPPB) for patients 70 years-old and over in primary health care (PHC), and analyse their relationship with demographic data, physical function, health and clinical status. DESIGN Baseline interviews and observations of a longitudinal study on physical function and adverse health results. SETTING Five Primary Care Centres in the provinces of Alicante and Valencia. PARTICIPANTS A total of 593 persons 70 years-old and over. MAIN MEASUREMENTS The SPPB was applied using direct observation, and the rest of the variables by interview. Reference values were calculated according to sex and three age groups (70-75, 76-80, > 80 years), and the validity of the Battery was analysed using association statistics with the demographic, clinical, and function data. RESULTS The reference values showed a poor performance in women, and a gradually poorer performance through the three age groups. The SPPB was significantly associated (P < 0.01) with age, sex, number of drugs taken, morbidity, body mass index, dependency in basic activities of daily living (BADL), instrumental activities of daily living (IADL) for health reasons, the 10-item Physical Functioning Scale (PF-10), depression and health perception. CONCLUSIONS The reference values of the complete SPPB by age and sex are provided, based category scores in Primary Care patients 70 years-old and over. The Battery results can give a rapid and valid assessment of the functional state of elderly patient in Primary Care.

What do older people understand by mobility-related difficulties?

UNLABELLED Despite the centrality of the difficulty concept in the study of disability, there has been little research on its significance from the point of view of people with functional limitations. The main objective of this study was to describe what older people understand when asked about difficulty in undertaking mobility activities. As a secondary objective, we considered whether there are any differences depending on the type of activities, according to the International Classification of Functioning (ICF) mobility domains. METHODS Seventeen community-dwelling men and women aged 70 years old or over were interviewed by means of a questionnaire containing 55 items covering the ICF mobility domains. The participants responded to the items while thinking aloud, saying what led them to give a specific answer about their level of difficulty. Inductive content analysis was conducted and categories, subthemes and themes were identified. RESULTS Causes of difficulty (pathologies, impairments, symptoms) and accommodations (task modifications and use of aids) were the two themes identified; and their importance (and that of the subthemes included) varied across the types of activity. All the participants said that they had no difficulty in at least one task, despite mentioning changes in the way they performed them. CONCLUSIONS Older peoples opinions were consistent with theoretical models of disability and with the standard practice of measuring functional limitations by asking about the degree of difficulty; however, the design of these measures needs to be improved in order to detect perceptions of no difficulty in the presence of task modification.

The Spanish version of the Prenatal Breast-feeding Self-efficacy Scale: Reliability and validity assessment

BACKGROUND Only a minority of infants are exclusively breastfed for the recommended 6 months postpartum. Breast-feeding self-efficacy is a mothers confidence in her ability to breastfeed and is predictive of breastfeeding behaviors. The Prenatal Breast-feeding Self-efficacy Scale (PBSES) was developed among English-speaking mothers to measure breastfeeding self-efficacy before delivery. OBJECTIVES To translate the PBSES into Spanish and assess its psychometric properties. DESIGN Reliability and validity assessment. SETTING A public hospital in Yecla, Spain. PARTICIPANTS A convenience sample of 234 pregnant women in their third trimester of pregnancy. METHODS The PBSES was translated into Spanish using forward and back translation. A battery of self-administered questionnaires was completed by participants, including a questionnaire on sociodemographic variables, breastfeeding experience and intention, as well as the Spanish version of the PBSES. Also, data on exclusive breastfeeding at discharge were collected from hospital database. Dimensional structure, internal consistency and construct validity of the Spanish version of PBSES were assessed. RESULTS Confirmatory factor analysis suggested the presence of one construct, self-efficacy, with four dimensions or latent variables. Cronbachs alpha coefficient for internal consistency was 0.91. Response patterns based on decision to breastfeed during pregnancy provided evidence of construct validity. In addition, the scores of the Spanish version of the PBSES significantly predicted exclusive breastfeeding at discharge. CONCLUSIONS The Spanish version of PBSES shows evidences of reliability, and contrasting group and predictive validity. Confirmatory factor analysis indicated marginal fit and further studies are needed to provide new evidence on the structure of the scale. The Spanish version of the PBSES can be considered a reliable measure and shows validity evidences.

Validation of a mobility item bank for older patients in primary care

BackgroundTo develop and validate an item bank to measure mobility in older people in primary care and to analyse differential item functioning (DIF) and differential bundle functioning (DBF) by sex.MethodsA pool of 48 mobility items was administered by interview to 593 older people attending primary health care practices. The pool contained four domains based on the International Classification of Functioning: changing and maintaining body position, carrying, lifting and pushing, walking and going up and down stairs.ResultsThe Late Life Mobility item bank consisted of 35 items, and measured with a reliability of 0.90 or more across the full spectrum of mobility, except at the higher end of better functioning. No evidence was found of non-uniform DIF but uniform DIF was observed, mainly for items in the changing and maintaining body position and carrying, lifting and pushing domains. The walking domain did not display DBF, but the other three domains did, principally the carrying, lifting and pushing items.ConclusionsDuring the design and validation of an item bank to measure mobility in older people, we found that strength (carrying, lifting and pushing) items formed a secondary dimension that produced DBF. More research is needed to determine how best to include strength items in a mobility measure, or whether it would be more appropriate to design separate measures for each construct.

Perceptions of health professionals on subcutaneous hydration in palliative care: A qualitative study

Background: Evidence indicates that hypodermoclysis is as safe and effective as intravenous rehydration in the treatment of the symptomatology produced by mild to moderate dehydration in patients for whom oral route administration is not possible. However, the knowledge about the use of the subcutaneous hydration and its correlates is still limited. Aim: To explore the perceptions, attitudes and opinions of health professionals in palliative care on the administration of subcutaneous hydration. Design: This is a qualitative focus group study with health professionals of palliative care. Four focus groups were carried out until data saturation. A qualitative content analysis was performed. Setting/participants: A total of 37 participants, physicians and nurses, were recruited from different services of palliative care in Spain. Results: In all, 856 meaning units were identified, from which 56 categories were extracted and grouped into 22 sub-themes, which were distributed among four themes: ‘factors which influence the hydration decision’, ‘factors related to the choice of the subcutaneous route for hydration’, ‘the subcutaneous hydration procedure’ and ‘performance guidelines and/or protocols’. Conclusions: Variables which most often influence the use of subcutaneous route to hydration are those that are linked to the characteristics of the patient, the team and the family, and other like the context and professionals’ subjective perceptions about this medical practice.

Efectividad de una intervención enfermera a domicilio para mejorar la independencia en las actividades de la vida diaria-actividades instrumentales de la vida diaria y la carga familiar en adultos con esquizofrenia

d i n p Roldán-Merino J, Casas-García I, Ramos-Pichardo JD, Foix-Sanjuan A, Quilez-Jover J, Montserrat-Martinez M. Impact of personalized in-home nursing care plans on dependence in ADLs/IADLs and on family burden among adults diagnosed with schizophrenia: a randomized controlled study. Perspectives in Psychiatric Care. 2012. Article in press first published online: 13 JUL 2012. doi: 10.1111/j.1744-6163.2012.00347.x