Prevalence of falls in noninstitutionalized people aged 65-80 and associations with sex and functional tests: A multicenter observational study.

Falls have a considerable impact on the functional prognosis of older adults. The main focus of this multicenter, retrospective, observational study was to examine the prevalence of falls in Spanish people aged 65-80 years still living at home. The secondary aims included examining the overall sociodemographic and clinical variables associated with a history of falls and then stratifying these findings by sex. We also aimed to determine the differences between sexes with regard to the history and consequences of falls and to evaluate associations between fall history and functional performance tests. The 747 older adults had all participated in the otago exercise program, which is a progressive home program of strength, balance, and endurance exercises. They were recruited by nurses in 21 primary care centers in 10 Spanish provinces between September 2017 to December 2018. The participants' mean age was 72.2 (SD: 4.3) years, and 67% were women. We recorded sociodemographic and clinical variables, functional performance test results, and any falls and/or injuries in the last 12 months. We found that 32% had fallen, 36% of those had fallen more than once, and 48% had sustained injuries when they fell. The bivariate analysis showed that women had more than twice the odds of falling than men and that living alone and being obese or overweight increased the odds of a fall, although living alone was not associated with falls in the multivariable analysis. Our results could guide the development of risk-specific fall prevention programs to prevent disabilities in older people.

Use of a gamified website to increase pain neurophysiology knowledge and improve satisfaction and motivation among students studying for a degree in physiotherapy: a quasi-experimental study.

BACKGROUND: The scientific evidence highlights the difficulties that healthcare professionals experience when managing patients with chronic pain. One of the causes of this difficulty could be related to the acquired training and the lack of knowledge about the neurophysiology of pain. In the present study, we assessed the effectiveness of a gamified web platform in acquiring knowledge about pain neurophysiology and determining the satisfaction and motivation of students of the Degree in Physiotherapy at the University of Lleida. METHODS: A quasi-experimental study was carried out with a sample of 60 students who had access to a gamified web platform that included notes, videos, and clinical cases prepared by the teaching staff and was based on a previous study that included patients and healthcare professionals. RESULTS: The results show that after the intervention, there was a statistically significant increase in knowledge about the neurophysiology of pain, and the effect size was in the desired area of ​​effect. Likewise, many students considered that their motivation had increased as a result of the methodology used in the present study. CONCLUSIONS: The results support the use of this methodology to promote knowledge about the neurophysiology of pain while improving students' motivation.

Misbeliefs about non-specific low back pain and attitudes towards treatment by primary care providers in Spain: a qualitative study.

AIM: To identify misbeliefs about the origin and meaning of non-specific chronic low back pain and to examine attitudes towards treatment by primary health care providers. DESIGN: Generic qualitative study. METHODS: Ten semi-structured interviews were conducted between October and November 2016 with physicians and nurses from primary health care centres in Lleida. The interviews were transcribed and analysed using inductive thematic analysis via Atlas.ti-8 software. RESULTS: Five themes were identified: i. beliefs about the origin and meaning of chronic low back pain, ii. psychosocial aspects of pain modulators, iii. Therapeutic exercise as a treatment for chronic low back pain, iv. biomedical attitudes of primary health care providers, and v. difficulties in the clinical approach to chronic low back pain. CONCLUSION: Primary health care providers have a unifactorial view of chronic low back pain and base their approach on the biomedical model. Professionals attribute chronic low back pain to structural alterations in the lumbar spine while psychosocial factors are only recognized as pain modulators. For professionals, therapeutic exercise represents a possible solution to chronic low back pain; however, they still do not prescribe it and continue to educate on postural hygiene and recommend limiting physical and/or occupational activities, as opposed to clinical practice guidelines. These findings suggest that to improve the adherence of primary health care providers to the biopsychosocial model, it may be necessary first to modify their misbeliefs about non-specific chronic low back pain by increasing their knowledge on pain neurophysiology. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02962817 . Date of registration: 11/11/2016.

Cognitive behavioral therapy for insomnia (CBT-i) in patients with fibromyalgia: a systematic review and meta-analysis.

PURPOSE: We aimed to evaluate the effectiveness of CBT-i in patients with fibromyalgia in comparison with other non-pharmacological treatments. METHODS: Randomized controlled trials assessing the effects of CBT-i in adults with fibromyalgia, published in English or Spanish, were eligible. Electronic searches were performed using PubMed, Scopus, The Cochrane Library, WebOfKnowledge and Psicodoc databases in March 2021. The main outcome measures were sleep efficiency and sleep quality. Secondary outcomes included pain, depression, and anxiety. RESULTS: Of 226 studies reviewed, five were included in the meta-analysis. CBT-i compared with non-pharmacological treatments showed no significant improvements in sleep efficiency (p = 0.05; standardized mean difference (SMD) [95% CI] 0.31 [-0.00 to 0.61]). CBT-i showed significant improvements in sleep quality (p = 0.009; SMD [95% CI] - 0.53 [-0.93 to -0.13]), pain (p = 0.002; SMD [95% CI] - 0.41 [-0.67 to -0.16]), anxiety (p = 0.001; SMD [95% CI] - 0.46 [-0.74 to 0.18]) and depression (p = 0.02; SMD [95% CI] - 0.33 [-0.61 to -0.05]), compared to non-pharmacological treatments. Effect sizes ranged from small to moderate. CONCLUSIONS: CBT-i was associated with a significant improvement in sleep quality, pain, anxiety, and depression, although these results are retrieved from very few studies with only very low to low quality evidence. Trial registration: The review protocol was registered with PROSPERO (Record ID = CRD42016030161).IMPLICATIONS FOR REHABILITATIONCBT-i has been proven to improve sleep quality, pain, anxiety and depression, although with small effect sizes.Implementing hybrid CBT for pain and sleep or combining CBT and mindfulness may improve symptoms in people diagnosed with FM.This meta-analysis results highlight the need to enhance sleep management skills among people suffering from this health condition.

Improving risk assessment and prevention of pressure injuries during the implementation of a best practice clinical guideline. / Mejora de la valoración del riesgo y la prevención de las lesiones por presión durante la implantación de una Guía de buenas prácticas clínicas.

OBJECTIVE: To evaluate the indicators of quality of care in pressure injuries (PI) before and after 6 months of the implementation of the Good Clinical Practice Guideline of the Registered Nurses' Association of Ontario in the geriatric unit of the Hospital Universitari Santa Maria de Lleida. METHOD: Longitudinal descriptive observational study throughout the implementation of the Good Clinical Practice Guideline (GCP) "Risk Assessment and Pressure Injury Prevention" carried out by the Ontario Nurses' Professional Association. The main variables - incidence and category of nosocomial pressure injuries, risk assessment of PI during the first 24hours of admission and risk level according to the EMINA scale, continuous assessment according to the risk of PI and special surface for pressure management recorded in the care plan - were extracted from the electronic medical records for subsequent descriptive analysis and hypothesis contrasting for comparison of proportions. RESULTS: A total of 154 subjects were included, most of them being women (57%), average age of 86 years and an average stay of admission of 8 days. With the implementation of the guide it was possible to improve, not always with statistical significance, the quality indicators: the incidence of PI decreased by 14.54%, risk assessments of PI 24hours after admission increased by 2.90%, while periodic risk assessments increased by 280.35%, recording 48.19% compared to 12.67% for the baseline situation. In addition, the recording of special surfaces in patients at risk of PI also increased by 13.33%. CONCLUSIONS: The implementation of the RNAO GCP improved the results related to the assessment and prevention of PI, with a positive impact on the quality of care indicators.

Patients' and primary healthcare professionals' perceptions regarding chronic low back pain and its management in Spain: a qualitative study.

PURPOSE: This study aimed to explore and compare the perceptions of patients and primary healthcare professionals regarding the management of chronic low back pain. METHODS: Qualitative study using 26 semi-structured individual interviews, and one discussion group, carried out in primary care in Lleida, Spain. RESULTS: Patients and primary healthcare professionals both had assumptions pertaining to: (1) the diagnosis and meaning of chronic low back pain, (2) expectations regarding treatment for pain reduction, and (3) communication between primary healthcare professionals and patients with chronic low back pain. Results suggest a mutual dissatisfaction with the diagnosis of chronic low back pain and a lack of understanding between primary healthcare professionals and patients. Some contradictions between them were also noted: the patients wanted quick solutions to reduce their pain, but the primary healthcare professionals required an accurate etiology to prescribe treatment, and the patients did not always follow the primary healthcare professionals' recommendations. CONCLUSIONS: Diagnosing and treating chronic low back pain is compromised due to differing expectations and the communication barriers that exist between healthcare professionals and their patients. Primary healthcare professionals should be aware of the power of their explanations and recommendations to patients.Implications for RehabilitationPrimary healthcare professionals should negotiate treatments with patients and adapt them to their individual needs, according to a Patient-Centered approach and the biopsychosocial model of pain.Primary healthcare professionals should explain to patients the underlying mechanisms and multifactorial nature of chronic low back pain.Primary healthcare professional-patient communication needs to be improved to help patients to better understand their chronic condition.The healthcare professionals in Spain should be more trained into the (bio)psychosocial model of long-term pain, stop searching for non-evident pathologies and change their biomedical beliefs.

A web-based therapeutic patient education intervention for pain and sleep for women with fibromyalgia: A sequential exploratory mixed-methods research protocol.

AIMS: To evaluate cognitive and behavioural factors related to pain and poor sleep quality in women diagnosed with fibromyalgia and to develop and test the effects of a web-based therapeutic education intervention on pain intensity, pain catastrophizing, chronic pain self-efficacy, sleep quality, dysfunctional beliefs and attitudes about sleep and quality of life and health status related to fibromyalgia. DESIGN: The project will employ a sequential exploratory mixed methods research design. METHODS: For the qualitative phase, a theoretical sample living in the community will be recruited to participate in personal, semi-structured interviews. For the quantitative phase, a sample of adult women with fibromyalgia will be recruited from secondary care centres and randomly allocated an intervention or a control group. The study protocol was approved in 2019. DISCUSSION: Fibromyalgia is the most common central sensitivity syndrome and one of the principal worldwide causes of chronic widespread pain among the adult population. Poor sleep quality is a highly prevalent and troublesome symptom for people with fibromyalgia. Psychosocial and behavioural factors have been shown to relate intimately with the symptom experiences of people with fibromyalgia; pain catastrophizing and dysfunctional beliefs and attitudes about sleep can perpetuate those and other fibromyalgia symptoms. CONCLUSION: It is imperative to reflect people's actual symptom experiences to develop effective symptom management strategies. In the Internet era, this project's proposed web-based therapeutic education intervention could offer women with fibromyalgia a new avenue for treatment as part of standard fibromyalgia management programs in primary and secondary healthcare services. IMPACT: Pain and poor sleep quality are highly prevalent and troublesome symptoms for people with fibromyalgia. The web-based therapeutic education intervention proposed in this project could provide women with fibromyalgia a new avenue for treatment in primary and secondary healthcare services. Protocol registration: ClinicalTrials.gov Identifier: NCT03686410.

The influence of an educational internet-based intervention in the beliefs and attitudes of primary care professionals on non-specific chronic low back pain: study protocol of a mixed methods approach.

BACKGROUND: Personal convictions in referral to pain cause misbeliefs in health professionals, which can influence patients who suffer from non-specific chronic low back pain. Likewise, health professionals' beliefs affect their advice and attitudes towards patients' treatment, becoming a possible cause of greater disability. The development of educational interventions based on the best scientific evidence in neurophysiology of pain could be a way to provide information and advice to primary care health professionals to change their cognition towards chronic non-specific low back pain. The use of Information and Communication Technologies allows the development of web sites, which might be one of the effective resources to modify misbeliefs and attitudes, in relation to the origin and meaning of non-specific chronic low back pain, of primary care professionals and that may modify their attitudes in patients' treatment. METHODS: The aim of this project is to identify misbeliefs and attitudes of primary care physicians and nurses about chronic non-specific low back pain to develop a web-based educational tool using different educational formats and gamification techniques. This study has a mixed-method sequential exploratory design. The participants are medical and nursing staff working in primary care centers in the city of Lleida, Spain. For the qualitative phase of this study, the authors will use personal semi-structured interviews. For the quantitative phase the authors will use an experimental study design. Subjects will be randomly allocated using a simple random sample technique. The intervention group will have access to the web site where they will find information related to non-specific chronic low back pain, based on the information obtained in the qualitative phase. The control group will have access to a video explaining the clinical practice guidelines on low back pain. DISCUSSION: This study has been designed to explore and modify the beliefs and attitudes about chronic low back pain of physicians and nurses working in primary care settings, using a web-based educational tool with different educational formats and gamification techniques. The aim of the educational intervention is to change their knowledge about the origin and meaning of pain, with the result of reducing their misbeliefs and attitudes of fear avoidance. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02962817 . Date of registration: 11/09/2016.