Miren Orive

Validation of the Spanish version of the Lawton IADL Scale for its application in elderly people

BackgroundThe adequate information about the functional capacity of elderly populations is a key for the comprehensive assessment of their health status and autonomy. The Lawton IADL (instrumental activities of daily living) Scale is a very often used scale to assess independent living skills, but has never been validated for its use in Spanish-speaking populations. The purpose of this study was to assess the validity, the reliability, and responsiveness of this widely used scale.MethodsThe validation was based on a prospective cohort of 1,965 patients aged 65 or over who suffered an accidental fall with a hip or wrist fracture as a result. These patients were followed up six months after the production of the fracture. Cronbach’s alpha was used to assess reliability, and exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) for the construct validity. Convergent and discriminant validity were examined by the correlation of the IADL Scale with the Barthel Index, SF-12, WOMAC short form, and QuickDASH questionnaires. Known-groups validity was also studied comparing IADL Scale according to different groups, and responsiveness was assessed by means of effect sizes.ResultsThe mean age was 80.04 years (SD 8.04). The Cronbach alpha coefficient was 0.94. In the EFA, factor loadings ranged from 0.67 to 0.90, and CFA confirmed the homogeneity of the construct. Regarding the convergent validity, all correlation coefficients were higher than 0.40. Significant differences were found according to different groups, supporting known-groups validity. Responsiveness parameters showed moderate to large changes (effect sizes, 0.79 and 0.84 among patients classified as worsened).ConclusionsThese results confirm that the Spanish version of the Lawton IADL Scale has excellent reliability and validity and a moderate to large sensitivity to change. This study provides a proper validation, not only of the Spanish version of the Lawton IADL Scale, but also of the original instrument.

Validation of a proposed WOMAC short form for patients with hip osteoarthritis

BackgroundThe aims of this study were to propose a Spanish Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) short form based on previously shortened versions and to study its validity, reliability, and responsiveness for patients with hip osteoarthritis undergoing total hip replacement (THR).MethodsProspective observational study of two independent cohorts (788 and 445 patients, respectively). Patients completed the WOMAC and the Short Form (SF)-36 questionnaires before THR and 6 months afterward. Patients received the questionnaires by mailing, and two reminder letters were sent to patients who had not replied the questionnaire. Based on two studies from the literature, we selected the two shortened domains, the pain domain composed of three items and the function domain composed of eight items. Thus, we proposed an 11-items WOMAC short form. A complete validation process was performed, including confirmatory factor analysis (CFA) and Rasch analysis, and a study of reliability, responsiveness, and agreement measured by the Bland-Altman approach.ResultsThe mean age was about 69 years and about 49% were women. CFA analyses confirmed the two-factor model. The pain and function domains fit the Rasch model. Stability was supported with similar results in both cohorts. Cronbachs alpha coefficients were high, 0.74 and 0.88. The highest correlations in convergent validity were found with the bodily pain and physical function SF-36 domains. Significant differences were found according to different pain and function severity scales, supporting known-groups validity. Responsiveness parameters showed large changes (effect sizes, 2.11 and 2.29). Agreement between the WOMAC long and short forms was adequate.ConclusionsSince short questionnaires result in improved patient compliance and response rates, it is very useful to have a shortened WOMAC version with the same good psychometric properties as the original version. The Spanish WOMAC short form is valid, reliable, and responsive for patients undergoing THR, and most importantly, the first WOMAC short version proposed in Spanish. Because of its simplicity and ease of application, the short form is a good alternative to the original WOMAC questionnaire and it would further enhance its acceptability and usefulness in clinical research, clinical trials, and in routine practice within the orthopaedic community.

Changes in health‐related quality of life and activities of daily living after hip fracture because of a fall in elderly patients: a prospective cohort study

The impact of hip fracture because of a fall on health‐related quality of life (HRQoL) and activities of daily living (ADL) have not been well established.

Health‐related quality of life and functionality in elderly men and women before and after a fall‐related wrist fracture

To evaluate health‐related quality of life (HRQoL) and functionality among older men and women who suffered a wrist fracture because of a fall and to identify postfracture consequences.

A randomized controlled trial of a 10 week group psychotherapeutic treatment added to standard medical treatment in patients with functional dyspepsia.

OBJECTIVE Epidemiological evidence suggests an association between psychological factors and functional dyspepsia (FD). Yet few randomized controlled trials (RCTs) of psychological interventions have been conducted for FD. We conducted an RCT to evaluate the efficacy of psychotherapy among chronic FD. METHODS One hundred fifty-eight consecutive patients with FD were randomized to medical therapy plus psychotherapy consisted in 8 group and 2 individual sessions focused on teaching techniques for coping with FD (intensive treatment (IT); n=76) or medical therapy alone (conventional treatment (CT); n=82). Patients completed validated self-reported questionnaires before and after the 10-week treatment and 6 months later. Linear mixed-effects models were used, in intention-to-treat analysis. RESULTS At the end of treatment period, statistically significant improvements were observed for IT compared with CT for dyspepsia-related quality of life (DRQoL). DRQoL mean changes of 6.09 and 3.54 were obtained in IT and CT patients, respectively (p=<0.0001); and SS mean changes of 11.55 and 4.57 were obtained in IT and CT patients, respectively (p=0.0013). Those improvements, measured by minimum clinically important difference (MCID), were clinically significant (DRQoL: 77% of the IT patients exceeded the MCID vs. the 45% of the CT; SS: 75% vs. 48%). Six months after treatment, those statistically significant improvements persisted for DRQoL (p=0.0067) and for SS (p=0.0405). Clinical improvements persisted for SS (63% vs. 41%). CONCLUSIONS These findings suggest that adding psychotherapy to standard medical therapy improves short-term outcomes in patients with FD and may have long-term effects as well. The cost-effectiveness of intensive therapy needs to be evaluated. Registration number and name of trial registry: NCT01802710.

Detecting depression in medically ill patients: Comparative accuracy of four screening questionnaires and physicians' diagnoses in Spanish population

OBJECTIVE The purpose of this study is to compare the diagnostic accuracy of four depression screening tools commonly used in patients with medical disorders, relative to a reference diagnostic standard-a structured psychiatric interview. METHODS The Depression in the Medically Ill-18 (DMI-18) questionnaire was administered to 167 patients with medical disorders; of those, 53 completed the Beck Depression Inventory for Primary Care (BDI-PC), 67 the Hospital Anxiety and Depression Scale (HADS), and 46 the Patient Health Questionnaire-9 (PHQ-9). The entire sample was also interviewed with a structured psychiatric interview conducted by a mental health professional. Sensitivity, specificity, likelihood ratios (LRs), and area under the curve (AUC) were calculated and compared for the different measures. RESULTS At their respective recommended cutoff points, sensitivities [95% confidence interval (CI)] were 86% (70-95), 82% (63-94), 93% (86-97), and 68% (47-85) for the HADS-D, BDI-PC, DMI-18, and PHQ-9, respectively, while specificities ranged from 72% (47-90) for BDI-PC to 89% (72-98) for PHQ-9. The sensitivities of DMI-18 were significantly higher compared to those of HADS-D (P=.045) and PHQ-9 (P=.01). The PHQ-9 questionnaire obtained the most favorable positive LR (6.35; 95% CI, 2.48-18.36). In contrast, the DMI-18 showed the best negative LR (0.09; 95% CI, 0.04-0.18). Areas under the curves (95% CI) ranged from 0.92 (0.83-1.02) to 0.84 (0.74-0.94). Statistically significant differences were found between the AUCs of the DMI-10 and the BDI-PC. CONCLUSION Our results suggest that all evaluated scales have acceptable abilities and can be used as screening instruments for depression in patients with medical disorders. The DMI stands out for its sensitivity.

Validity and reliability of the Spanish version of the Involvement Evaluation Questionnaire among caregivers of patients with eating disorders

The Involvement Evaluation Questionnaire (IEQ) was developed to evaluate burden among caregivers of patients with schizophrenia. We aimed to examine its psychometric properties among caregivers of patients with eating disorders (ED). A prospective study was carried out, recruiting caregivers of patients with an ED attending two outpatient clinics in Bizkaia, Spain. Caregivers provided sociodemographic information and completed the Involvement Evaluation Questionnaire (IEQ), the Hospital Anxiety and Depression Scale (HADS), the Short-Form 12 (SF-12) and the Anorectic Behaviour Observation Scale (ABOS). The same information was requested one year later. The confirmatory factor analysis (CFA) provided satisfactory fit indexes. Almost all of the factor loadings were above 0.40. Cronbachs alpha coefficients were mostly superior to 0.70. The correlation coefficients between the IEQ domains and the other questionnaires were lower than the Cronbachs alpha coefficients. Known-groups validity was supported by significant differences in the IEQ mean scores according to certain variables, as contact hours, living with the patient, type of caregiver and gender. The indexes employed for the evaluation of responsiveness were between 0.13 and 0.99. The IEQ has good psychometric properties and can be used to evaluate burden among caregivers of patients with ED.

Use of the Long and Short Forms of the Depression in the Medically Ill Questionnaire in a Spanish Population

This study sought to translate, using a back-translation procedure, and evaluate the psychometric characteristics of Depression in the Medically Ill questionnaire (DMI-18) and its short version (DMI-10) in a Spanish population. Patients with somatic disorders (N = 366) completed the translated DMI-18 and another depression questionnaire. Among these, 167 were also assessed by a mental health professional (gold standard) to test criterion validity. Furthermore, coefficient alpha for both the versions were high (>.90), and convergent validity assessed against the Beck Depression Inventory for Primary Care, the Hospital Anxiety and Depression Scale, and the Patient Health Questionnaire–9 was satisfactory (r > .74). Confirmatory factor analysis results supported the one-factor model. When compared with the gold standard, sensitivity and specificity were 93% and 73% for DMI-18 and 87% and 74% for DMI-10, respectively. Thus, both the versions are acceptable measures that can be used by nonpsychiatric professionals to detect affective comorbidities in their patients.

Factors related to a decline in upper extremity function among patients with a wrist fracture due to a fall.

The aim of this study was to identify factors related to a decline in function following a wrist fracture.

Applying a coping with stress questionnaire for cancer patients to patients with non-cancer chronic illnesses:

One of the few instruments to evaluate coping skills among patients with chronic illnesses is the Cuestionario de Afrontamiento al Estrés para Pacientes Oncológicos (CAEPO), created initially for cancer patients. We evaluate how well CAEPO applies to patients with non-cancer chronic illnesses. A total of 344 patients (115 with chronic hepatitis C, 120 with inflammatory bowel disease and 109 with recurrent vertigo) completed the CAEPO. Exploratory factor analysis and Cronbach’s alpha provide only partial support for the seven factors suggested by the original CAEPO. A streamlined version with fewer dimensions and items may be a better solution for identifying coping strategies among these patients.