Validation of the Collett-Lester fear of death scale in occupational therapy students: psychometric testing and implications for palliative care education.

BACKGROUND: The fear of death is a common experience among healthcare students and professionals that may impact the quality of care provided to patients, particularly those receiving palliative care. The Collett-Lester Fear of Death Scale is a widely used instrument to assess this fear, although its psychometric properties have not been extensively studied in Occupational Therapy students. The present study aimed to validate the Collett-Lester Fear of Death Scale (CL-FODS) in a sample of Occupational Therapy students and to explore its implications for palliative care education. METHOD: A cross-sectional study was conducted to perform psychometric testing of the CL-FODS in Occupational Therapy undergraduate students. Structural validity, internal consistency, and test-retest reliability were analysed. A total of 195 Occupational Therapy students were included in this study. Additionally, the participants completed a brief survey on their experiences and attitudes towards palliative care. RESULTS: The internal consistency was satisfactory (α = 0.888). The exploratory factor analysis to evaluate the internal structure yielded four factors. The model fit indices were: comparative fit index = 0.89, and root mean square error of approximation = 0.06). The test-retest reliability was satisfactory and demonstrated an intraclass correlation coefficient of 0.939. CONCLUSION: The Spanish version of the CL-FODS showed satisfactory psychometric properties; therefore, assessing fear of death in Occupational Therapy students is helpful. This study highlights the importance of addressing fear of death and palliative care education in Occupational Therapy undergraduates to improve future professional attitudes and, consequently, the quality of patient care at the end of life.

Effectiveness of a cardiac rehabilitation program on biomechanical, imaging, and physiological biomarkers in elderly patients with heart failure with preserved ejection fraction (HFpEF): FUNNEL + study protocol.

BACKGROUND: Patients with heart failure with preserved ejection fraction (HFpEF) have a low functional status, which in turn is a risk factor for hospital admission and an important predictor of survival in HFpEF. HFpFE is a heterogeneous syndrome and recent studies have suggested an important role for careful, pathophysiological-based phenotyping to improve patient characterization. Cardiac rehabilitation has proven to be a useful tool in the framework of secondary prevention in patients with HFpEF. Facilitating decision-making and implementing cardiac rehabilitation programs is a challenge in public health systems for HFpEF management. The FUNNEL + study proposes to evaluate the efficacy of an exercise and education-based cardiac rehabilitation program on biomechanical, physiological, and imaging biomarkers in patients with HFpEF. METHODS: A randomised crossover clinical trial is presented among people older than 70 years with a diagnosis of HFpEF. The experimental group will receive a cardiac rehabilitation intervention for 12 weeks. Participants in the control group will receive one educational session per week for 12 weeks on HFpEF complications, functional decline, and healthy lifestyle habits. VO2peak is the primary outcome. Biomechanical, imaging and physiological biomarkers will be assessed as secondary outcomes. Outcomes will be assessed at baseline, 12 weeks, and 24 weeks. DISCUSSION: Identifying objective functional parameters indicative of HFpEF and the subsequent development of functional level stratification based on functional impairment ("biomechanical phenotypes") may help clinicians identify cardiac rehabilitation responders and non-responders and make future clinical decisions. In this way, future pharmacological and non-pharmacological interventions, such as exercise, could be improved and tailored to improve quality of life and prognosis and reducing patients' hospital readmissions, thereby reducing healthcare costs. TRIAL REGISTRATION: NCT05393362 (Clinicaltrials.gov).

Professional grief among nurses in Spanish public health centers after caring for COVID-19 patients.

AIMS AND OBJECTIVES: The aim of the present study is to investigate the professional grief suffered by nurses in various medical units, after coping with the COVID-19 pandemic for the last 18 months. BACKGROUND: Addressing and acknowledging the reality of professional grief is of fundamental importance to nurses' mental health, as this condition has both professional and personal consequences. DESIGN: A qualitative, content analysis approach was taken. METHODS: Based on 25 interviews with nursing professionals working in different health centers units were performed. The following sampling schemes were used: first, convenience sampling, then nominated sampling, and finally theoretical sampling. RESULTS: From our analysis of the data obtained, three main themes were identified: the impact on nurses of COVID-19 outcomes; the symptoms of professional grief; and cognitive reactions. These core elements interacted with 12 subtopics, including symptoms of grief and the cognitive impact produced. CONCLUSIONS: A large proportion of the nurses consulted in this study have suffered and suffered professional grief and report many related symptoms. In response to the present pandemic and any future occurrence, the question of professional grief needs to be addressed. RELEVANCE TO CLINICAL PRACTICE: To help them cope better with this type of situation, nurses should receive appropriate training. Moreover, healthcare institutions should be made aware of the problem and be encouraged to offer assistance to address the impact produced on nurses by the deaths of their patients. CLINICAL RELEVANCE: This study shows the impact of professional grief on nurses in the context of the COVID-19 pandemic. Nurses are affected personally by the deaths of patients and by alterations to their working conditions. In many cases, this grief remains unresolved and its various symptoms persist.

Cancer-related fatigue measures in palliative care: A psychometric systematic review.

INTRODUCTION: In palliative care, the prevention and relief of fatigue are regarded as crucial goals in patients with cancer. METHODS: A systematic review was carried out according to the COnsensus-based Standards for the selection of health status Measurement INstruments methodology. Searches were conducted in Medline (through PubMed), Web of Science, Open Gray, Scielo, Cochrane, CINAHL and EMBASE. All instruments found in each study were assessed using the COnsensus-based Standards for the selection of health status Measurement INstruments checklist and Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS: A total of 5598 articles were identified in the different databases. In total, 57 studies describing 19 instruments were included in this study. The main properties evaluated were internal consistency, cross-cultural validity, hypotheses testing and responsiveness. All studies were evaluated with the Strobe scale with a score greater than 6 points. CONCLUSIONS: According to the quality methodological results, Edmonton Symptom Assessment System, Problems and Needs in Palliative Care Questionnaire, European Organisation for Research and Treatment of Cancer Quality of Life 15-item Questionnaire for Palliative Care and Palliative Care Quality of Life Instrument are the recommended instruments used for assessing cancer-related fatigue in palliative care. PROPESRO registration number: CRD42020206783.

The Benefits of a Therapeutic Exercise and Educational Intervention Program on Central Sensitization Symptoms and Pain-Related Fear Avoidance in Breast Cancer Survivors.

BACKGROUND: Central sensitization symptoms and pain-related fear avoidance are two common problems in breast cancer survivors. Non-pharmacologic interventions such as therapeutic exercise and patient education can be effective in this population. AIMS: This study aimed to: (1) analyze the benefits of a therapeutic exercise and educational program on central sensitization symptoms and pain-related fear avoidance in breast cancer survivors, and (2) explore the association between pain-related fear avoidance and central sensitization symptoms. DESIGN: A single group pre-post intervention study was conducted. METHODS: Patients were recruited from the service of Medical Oncology of the University Clinical Hospital Virgen de la Victoria, in Málaga (Spain). The intervention consisted of a therapeutic exercise and educational program that lasted 12 weeks, twice a week, for 1 hour. Two instruments were used: the Spanish version of the Central Sensitization Inventory and the Spanish Fear Avoidance Components Scale. RESULTS: A total of 82 breast cancer survivors participated in the study. Pre-post change on Central Sensitization Inventory was statistically significant (p = .007). There was a trend towards a significant difference for the Spanish Fear Avoidance Components Scale (p = .062). There was a statistically significant correlation between pain-related fear avoidance and central sensitization symptoms (r = 0.536, p < .001). CONCLUSIONS: The current study has provided preliminary evidence on the benefits of this intervention in pain-related fear avoidance and central sensitization symptoms in breast cancer survivors. The Spanish version of the Central Sensitization Inventory and the Spanish Fear Avoidance Components Scale demonstrated responsiveness to change.

Validity and reliability of the Spanish fear-avoidance components scale in breast cancer survivors.

OBJECTIVE: The aim of this study was to carry out a psychometric analysis of the Fear-Avoidance Components Scale (FACS-Sp) in Spanish breast cancer survivors (BCS). METHODS: A validation study was carried out in 154 BCS. Participants were recruited from the service of Medical Oncology of the University Clinical Hospital Virgen de la Victoria, in Málaga (Spain). A psychometric analysis of internal consistency, internal structure and convergent validity of the FACS-Sp was performed. Cronbach's alpha was calculated for internal consistency. Exploratory Factor Analysis was used to determine the internal structure of the FACS-Sp. Convergent validity with the Tampa Scale of Kinesiophobia (TSK) and the Pain Catastrophizing Scale (PCS) was determined using the Pearson correlation coefficient. RESULTS: The internal consistency was high (McDonald's ω = 0.91). The Exploratory Factor Analysis yielded one factor explaining the 40.80% of total variance. Convergent validity with the TSK and the PCS was demonstrated. CONCLUSIONS: The FACS-Sp has demonstrated to be a valid and reliable measure for assessing pain-related fear avoidance in BCS based on internal consistency, structural validity and convergent validity. Further studies that analyse other measurement properties in different Spanish cancer populations are needed.

The dietary knowledge measurement instruments in diabetes: A systematic psychometric review.

AIMS: To identify, critically appraise, and summarize instruments to measure dietary knowledge in patients with diabetes mellitus type 1 or 2. DESIGN: Psychometric systematic review. DATA SOURCES: A comprehensive search was carried out during March 2020 in the followed databases: Medline, Web of Science, Open Grey, Cochrane Library, COSMIN database, and Scielo. REVIEW METHODS: In accordance with the most up-to-date COnsensus-based Standards for the selection of health status Measurement INstruments methodology (COSMIN) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. A systematic review of the measurement properties of the instruments that assess the level of dietary knowledge in the diabetic population was carried out. The COSMIN checklist was used to assess the measurement properties of existing patient-reported outcome measures to select the most appropriate outcome measurement instrument. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42020186516). RESULTS: Nine instruments were identified. The Michigan Diabetes Knowledge Test (DKT) was the questionnaire included in the largest volume of studies. The Diabetes Knowledge Questionnaire (DKQ) was the questionnaire with the most evaluated psychometric characteristics. The Personal Diabetes Questionnaire (PDQ) was the second with the highest number of psychometric characteristics evaluated and with a better score regarding the quality of the evidence. CONCLUSION: According to the quality methodological results; DKT, DKQ and PDQ are the recommended instruments to assess dietary knowledge in people with diabetes types 1 and 2. IMPACT STATEMENT: What problem did the study address? One of the main factors that lead to greater difficulty for patients with diabetes mellitus is dietary management, and it is necessary to evaluate whether the patient has sufficient knowledge about dietetics to practice a healthy diet. What were the main findings? Nine instruments were identified that were specifically designed to assess dietary knowledge in patients with diabetes mellitus (DM) type 1 or 2. Michigan Diabetes Knowledge Test, Diabetes Knowledge Questionnaire, and Personal Diabetes Questionnaire are the recommended instruments to assess dietary knowledge in people with diabetes. Where and on whom will the research have impact? The evaluation of this construct is very useful both in clinical practice; at hospital, community and primary care levels, in patients with type 1 and / or 2 diabetes mellitus (DM), as in research.

Structural validity and reliability of the Spanish Central Sensitization Inventory in breast cancer survivors.

INTRODUCTION: One of the most widely used instruments to identify symptoms that may be related to central sensitization is the Central Sensitization Inventory (CSI). Although this instrument has been translated and validated in Spanish patients with chronic musculoskeletal pain, no psychometric analysis has been carried out in breast cancer survivors. The aim of this study was to perform a psychometric analysis of the Spanish version of the Central Sensitization Inventory (CSI-Sp) in Spanish breast cancer survivors. MATERIALS AND METHODS: A validation study was carried out in 183 breast cancer survivors. A psychometric analysis of internal consistency, factor structure, and test-retest reliability of the CSI-Sp was performed. Internal consistency was determined using Cronbach's alpha. Test-retest reliability was evaluated using the Intraclass Correlation Coefficient (ICC) Type 2.1. Exploratory factor analysis was used to determine the internal structure of the questionnaire. RESULTS: The internal consistency was high (α = 0.91). The test-retest reliability was satisfactory with excellent values (ICC 2.1 = 0.95). The exploratory factor analysis yielded a one factor structure explaining the 33.88% of total variance. CONCLUSIONS: The CSI-Sp has demonstrated to be a psychometrically strong measure for assessing central sensitization symptoms in breast cancer survivors based on internal consistency, test-retest reliability, and structural validity. Further studies that analyze other measurement properties in different Spanish clinical populations are needed.

The quality of dying and death measurement instruments: A systematic psychometric review.

AIMS: To identify instruments that could assess the quality of dying and death and their psychometric properties. To assess the methodological quality of studies on measurement properties. BACKGROUND: A high quality of death is regarded as a goal at the end of life and, therefore, an assessment of the end of life experience is essential. Many instruments have been developed to evaluate the quality of dying and death. The selection of the most appropriate measure to be used in clinical and research settings is crucial. DESIGN: Psychometric systematic review. DATA SOURCES: We systematically searched ProQuest Medline, SciELO and ProQuest PsycINFO from 1970 - May 2016. REVIEW METHODS: Identification and evaluation of instruments that assessed quality of dying and death. Papers were evaluated by two independent reviewers according to the COSMIN checklist with a 4-point scale. RESULTS: A total of 19 studies were included in this review. Seven instruments were found that were specifically designed for assessing quality of dying and death. A retrospective carer proxy report to evaluate this construct was used in most of the papers. The methodological quality of the studies was fair for most of the psychometric characteristics analyzed. CONCLUSION: Many instruments have been developed to assess the quality of dying and death. The Quality of Dying and Death Questionnaire is the best available measure of the quality of dying and death. It is the only questionnaire identified in this review where all psychometric properties according to the COSMIN checklist have been evaluated.

Agave tequilana bagasse for methane production in batch and sequencing batch reactors: Acid catalyst effect, batch optimization and stability of the semi-continuous process.

Agave tequilana bagasse is the main solid waste of the tequila manufacturing and represents an environmental issue as well as a potential feedstock for biofuel production due to its lignocellulosic composition and abundance. In this contribution, this feedstock was subjected to pretreatments with HCl and H2SO4 for sugar recovery and methane was produced from the hydrolysates in batch and sequencing batch reactors (AnSBR). Sugar recovery was optimized by using central composite designs at different levels of temperature, acid concentration and hydrolysis time. Results showed that at optimal conditions, the HCl pretreatment induced higher sugar recoveries than the H2SO4 one, 0.39 vs. 0.26 g total sugars/g bagasse. Furthermore, the H2SO4 hydrolysate contained higher concentrations of potential inhibitory compounds (furans and acetic acid). Subsequent anaerobic batch assays demonstrated that the HCl hydrolysate is a more suitable substrate for methane production; a four-fold increase was found. A second optimization by using HCl as acid catalyst and methane production as the response variable demonstrated that softer hydrolysis conditions are required to optimize methane production as compared to sugar recovery (1.8% HCl, 119 °C and 103min vs. 1.9% HCl, 130 °C and 133min). This softer conditions were used to feed an AnSBR for 110 days and evaluate its stability at three different cycle times (5, 3 and 2 days). Results showed stable reactor performances at cycle times of 5 and 3 days, obtaining the highest methane yield and production at 3 days, 0.28 NL CH4/g-COD and 1.04 NL CH4/d respectively. Operation at shorter cycle times is not advised due to microbial imbalance.

Spanish modified version of the palliative care outcome scale-symptoms renal: cross-cultural adaptation and validation.

BACKGROUND: Patients with chronic kidney disease (CKD) have a high symptoms burden that is related to a poor health-related quality of life (HRQoL) and high costs of care. Validated instruments may be useful for assessing the symptoms and monitoring outcomes in these patients. The Palliative care Outcome Scale-Symptoms Renal (POS-S Renal) is a patient-reported outcome measure for assessing symptoms in CKD stage 4-5. This study is the first cross-cultural adaptation and psychometric analysis of this clinical tool. The purpose of this study is to carry out a cross-cultural adaptation of the POS-S Renal for Spanish-speaking patients, and to perform an analysis of the psychometric properties of this questionnaire. METHODS: The English version of the POS-S Renal was culturally adapted and translated into Spanish using a double forward and backward method. An expert panel evaluated the content validity. The questionnaire was pilot-tested in 30 patients. A total of 200 patients with CKD stage 4-5 filled in a modified Spanish version of the POS-S Renal and the MSAS-SF. Statistical analysis to evaluate the psychometric properties of the questionnaire was carried out. RESULTS: The content validity index (CVI) was 0.97, which indicated that the content of the instrument is an adequate reflection of the symptoms in advanced CKD (ACKD). The factor analysis indicated a two-factor solution explaining 35.05% of total variance. The confirmatory factor analysis (CFA) demonstrated that the two factor model was well supported (comparative fit index = 0.98, root mean square error of approximation = 0.068). This assessment tool demonstrated a satisfactory test-retest reliability (r = 0.909 to factor 1, r = 0.695 to factor 2, r = 0.887 to total score), good internal consistency to factor 1 (α = 0.78) and moderate internal consistency to factor 2 (α = 0.56). Concurrent criterion-related validity with MSAS-SF was also demonstrated, with r = 0.860, which indicated a high degree of correlation with a validated instrument that has been used in patients with ACKD. CONCLUSIONS: The Spanish modified version of the POS-S Renal is a reliable and valid instrument that can be used to assess symptoms in Spanish patients with CKD stage 4-5.

Systematic Review of Therapeutic Alliance Measurement Instruments in Physiotherapy.

Purpose: Interest in measuring the therapeutic alliance has grown in recent years in both the clinical field and the literature. Several instruments can be used to measure the therapeutic alliance in physiotherapy, and choosing the most appropriate one is challenging. The purpose of this systematic review was to (1) identify the instruments that have been used to evaluate the therapeutic alliance in physiotherapy and (2) appraise the methodological quality of studies of the psychometric properties of these instruments. Method: The researchers carried out a systematic search in MEDLINE, SciELO, PsycINFO, Theseus, Cochrane Library, and Open Grey. Only articles published in English and Spanish were included. The articles were evaluated by two independent reviewers in accordance with the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) and Preferred Reporting items for Systematic Review and Meta-Analysis standards, using the four-point COSMIN checklist. Results: Four studies were included in this review, and four instruments evaluated the therapeutic alliance in physiotherapy. The methodological quality of the studies was fair for most of the psychometric characteristics analyzed. Conclusions: The Working Alliance Inventory is the best instrument to measure therapeutic alliance and the measure that had the greatest number of psychometric properties evaluated against the COSMIN standard. More studies of high methodological quality are required to evaluate the psychometric properties of the instruments used to assess the therapeutic alliance in physiotherapy.

Objectif : l'intérêt à mesurer l'alliance thérapeutique s'est accru ces dernières années, tant sur le terrain que dans les publications. Plusieurs instruments peuvent servir à mesurer l'alliance thérapeutique en physiothérapie, et il est difficile de choisir le plus approprié. La présente analyse systématique visait à 1) déterminer les instruments utilisés pour évaluer l'alliance thérapeutique en physiothérapie et 2) évaluer la qualité méthodologique des études sur les propriétés psychométriques de ces instruments. Méthodologie : recherche systématique dans MEDLINE, SciELO, PsycINFO, Theseus, la Bibliothèque Cochrane et Open Grey. Les chercheurs n'ont retenu que les articles publiés en anglais et en espagnol. Deux analystes indépendants ont évalué les articles, conformément aux normes consensuelles pour la sélection des instruments de mesure de la santé (COSMIN, selon l'acronyme de COnsensus-based Standards for the selection of health Measurement Instruments) et celles des points de déclaration favorisés pour l'analyse systématique et la méta-analyse (PRISMA, selon l'acronyme anglais de Preferred Reporting items for Systematic Review and Meta-Analysis) au moyen de la liste COSMIN en quatre points. Résultats : quatre études ont fait partie de l'analyse, et quatre instruments ont servi à évaluer l'alliance thérapeutique en physiothérapie. La plupart des caractéristiques psychométriques évaluées dans les études présentaient une qualité méthodologique modérée. Conclusion : Le Working Alliance Inventory est le meilleur instrument pour mesurer l'alliance thérapeutique. Ce questionnaire possédait le plus grand nombre de caractéristiques psychométriques évaluées par rapport à la norme COSMIN. Plus d'études de qualité méthodologique élevée s'imposent pour évaluer les propriétés psychométriques des instruments utilisés pour évaluer l'alliance thérapeutique en physiothérapie.

Instruments for assessing health professionals' skills in breaking bad news: protocol for a systematic review of measurement properties.

INTRODUCTION: Health professionals are often involved in the process of breaking bad news (BBN), which remains a difficult challenge, as it requires not only theoretical knowledge, but also the development of humanistic, emotional and communication skills. Therefore, optimal BBN assessment is essential. In this regard, sound measurement instruments are needed to evaluate BBN properly in research, teaching and clinical settings. Several instruments have been designed and validated to assess BBN. In this context, choosing the most appropriate instrument for assessing health professionals' skills in BBN is essential. The aims of this systematic review are to: (1) identify all the instruments used for assessing health professionals' skills in BBN; and (2) critically appraise their measurement properties. METHODS: A systematic review will be undertaken according to the most up-to-date COnsensus-based Standards for the selection of health status Measurement INstruments' (COSMIN) methodology. The protocol of this systematic review was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search strategy will be performed following the Peer Review of Electronic Search Strategies. The search strategy will be conducted in CINAHL, MEDLINE, Embase, PsycINFO, SciELO and Open Grey. Two review authors will independently appraise the full-text articles according to the COSMIN Risk of Bias checklist. Quality ratings and evidence synthesis will be performed using a modified Grading of Recommendations Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION: Ethical approval is not necessary for systematic review protocols. The results will be disseminated by publication in a peer-reviewed journal and presented at a relevant conference. PROSPERO REGISTRATION NUMBER: CRD42020207586.

Psychometric Testing of the Spanish Modified Version of the Mini-Suffering State Examination.

BACKGROUND: The mini-suffering state examination is a valid and reliable measure that have been used to assess suffering in patients with advanced cancer. The aim of this study was to carry out a psychometric analysis of the Spanish version of the mini-suffering state examination. METHOD: A validation study was conducted. Seventy-two informal caregivers of deceased patients in palliative care were included in this study. A psychometric testing of content validity, internal consistency, and convergent validity with the Spanish version of the quality of dying and death questionnaire was performed. RESULTS: The original instrument was modified to be used by informal caregivers. The content validity was acceptable (0.96), and the internal consistency was moderate (α = 0.67). Convergent validity was demonstrated (r = -0.64). CONCLUSION: The Spanish modified version of the MSSE showed satisfactory measurement properties. The Spanish modified version of MSSE can be useful to facilitate screening, monitor progress, and guide treatment decisions in end-of-life cancer patients.

The Quality of Dying and Death of Advanced Cancer Patients in Palliative Care and Its Association With Place of Death and Quality of Care.

The quality of dying and death is currently considered an objective to achieve at the end of life. The aim of this study is to analyze the quality of dying and death of advanced cancer patients in palliative care and its association with place of death and quality of care from the perspective of family caregivers. This is a cross-sectional study. The study sample included 72 family caregivers of advanced cancer patients in palliative care. For the evaluation of the quality of dying and death, the Spanish version of the Quality of Dying and Death Questionnaire was used. Quality of care was evaluated with the Palliative Care Outcome Scale. The mean (SD) total score on the Spanish version of the Quality of Dying and Death Questionnaire was 64.56 (20.97). The quality of dying and death was higher when the patients died at home, 70.45 (19.70), and it was positively correlated with quality of care (r = 0.61). Palliative care contributes to achieving a satisfactory quality of dying and death in Spanish advanced cancer patients. Further studies that evaluate interventions for improving the quality of dying and death in the advanced cancer population are needed.

Instruments for Measuring Satisfaction With Physical Therapy Care: A Systematic Review.

OBJECTIVE: Several instruments to measure patient satisfaction have been developed to assess satisfaction with physical therapy care. The selection of the most appropriate instrument is very important. The purpose of this study was to identify instruments for assessing satisfaction with physical therapy care and their psychometric properties and to evaluate the methodological quality of studies on psychometric properties. METHODS: A systematic search was conducted in ProQuest Medline, SciELO, ProQuest PsycINFO, Theseus, Cochrane Library, and Google Scholar. Articles published from 1990 to 2019, in English and Spanish, were used as limits. This systematic review followed the Consensus-based Standards for the Selection of Health Measurement Instruments and Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. The articles were evaluated by 2 independent reviewers using the Consensus-based Standards for the Selection of Health Measurement Instruments 4-point checklist. Eighteen studies were included. RESULTS: Nine instruments were found to be specifically designed to assess satisfaction with physical therapy care. The methodological quality of the studies was "fair" for most of the psychometric characteristics analyzed (43 items), with 24 properties scored as "poor," 5 as "good," and 3 as "excellent." CONCLUSIONS: Different instrument characteristics-such as the scope and population with which the instrument will be used, its dimensions, the number of items, and the evidence shown in the evaluation of each psychometric property-should be considered by clinicians and researchers to decide which instrument is the best to measure the construct of patient satisfaction with physical therapy. IMPACT: Evaluating patient satisfaction is very useful in clinical practice at the hospital, community, and primary care levels. Physical therapist clinicians and researchers can use this systematic review to select instruments whose characteristics will best measure their patients' satisfaction with physical therapy care.

The suffering measurement instruments in palliative care: A systematic review of psychometric properties.

BACKGROUND: The relief of suffering is considered one of the main goals to reach at the end of life, and nurses play an essential role in the prevention and relief of suffering. Validated instruments for assessing suffering can be useful, and selection of the most appropriate measure is crucial. To date, no systematic review has been performed that contrasts the measurement properties of instruments assessing suffering in the palliative care population, according to the most up-to-date COnsensus-based Standards for the selection of health status Measurement INstruments methodology. OBJECTIVES: The aim of this systematic review is twofold: (1) identify the measures assessing suffering in the palliative care population, and (2) assess the measurement properties of these measures. DESIGN: A systematic review of the measurement properties of instruments assessing suffering in palliative care was carried out. DATA SOURCES: The search strategy was conducted in Medline, CINAHL, PsycINFO, Web of Science, Cochrane Library, SciELO, Scopus, Cosmin database of systematic reviews and Open gray. REVIEW METHODS: The following methodologies were applied: updated COnsensus-based Standards for the selection of health status Measurement INstruments, the Meta-Analysis of Observational Studies in Epidemiology, and the Assessing the Methodological Quality of Systematic Reviews tool. A protocol for this systematic review was registered in PROSPERO (Registration number: CRD42018106488). Eligible studies were those that satisfied the following criteria: a) validation studies of measures assessing suffering in the palliative care population, b) assessing at least one measurement property of a measure, c) published in English or Spanish and d) published between January 1980 and September 2019. The included studies were assessed for the methodological quality of the measurement properties and then compared in terms of both the measurement properties and the methodological quality of the processes used. The evidence for each measurement property was summarised and the quality of the evidence was graded using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS: The search strategy yielded a total of nine studies and six instruments assessing suffering. The methodological quality of the studies was doubtful and the quality of the evidence was moderate for most of the measurement properties analysed. The Suffering Pictogram was the instrument with the best rating for methodological quality and quality of evidence, for most of the measurement properties evaluated. CONCLUSIONS: Instruments assessing suffering in palliative care have been identified in this systematic review. The Suffering Pictogram seems to be the most useful instrument identified. Tweetable abstract: The relief of suffering is one of the main goals to reach at the end of life, and the selection of the most appropriate measure for assessing this construct is crucial.

Hospitalised patients with palliative care needs: Spain and Sweden compared.

OBJECTIVES: This study aimed to describe and compare symptoms, care needs and types of diagnoses in hospitalised patients with palliative care needs in Spain and Sweden. METHODS: A cross-sectional, population-based study was carried out at two hospitals in both Spain and Sweden. Using a questionnaire, we performed 154 one-day inventories (n=4213) in Spain and 139 in Sweden (n=3356) to register symptoms, care needs and diagnoses. Descriptive analyses were used. RESULTS: The proportion of patients with care needs in the two countries differed (Spain 7.7% vs Sweden 12.4%, p<0.001); however, the percentage of patients with cancer and non-cancer patients was similar. The most prevalent symptoms in cancer and non-cancer patients in both countries were deterioration, pain, fatigue and infection. The most common cancer diagnosis in both countries was lung cancer, although it was more common in Spain (p<0.01), whereas prostate cancer was more common among Swedish men (p<0.001). Congestive heart failure (p<0.001) was a predominant non-cancer diagnosis in Sweden, whereas in Spain, the most frequent diagnosis was dementia (p<0.001). Chronic obstructive pulmonary disease was common in both countries, although its frequency was higher in Spain (p<0.05). In total, patients with cancer had higher frequencies of pain (p<0.001) and nausea (p<0.001), whereas non-cancer patients had higher frequencies of deterioration (p<0.001) and infections (p<0.01). CONCLUSIONS: The similarities in symptoms among the patients indicate that the main focus in care should be on patient care needs rather than diagnoses. Integrating palliative care in hospitals and increasing healthcare professional competency can result in providing optimal palliative care.

Symptom Burden Clustering in Chronic Kidney Disease Stage 5.

Patients with chronic kidney disease (CKD) Stage 5, experience multiple symptoms that negatively affect the health-related quality of life (HRQoL). This study examined the cluster of symptoms and their association with disease severity and comorbidities. The study sample included 123 patients with CKD Stage 5; 60 patients were in the dialysis group and 63 patients in the Conservative Kidney Management group. Symptom data were collected using the Spanish modified version of Palliative Care Outcome Scale-Symptoms (POS-S) Renal, a validated questionnaire to assess symptoms in this population. More than half of the patients described weakness, difficulty sleeping, and feeling depressed. Two symptom clusters were identified. There was no significant statistical correlation between disease severity and symptoms and between comorbidities and symptoms. The tendency of these symptoms to occur together has implications for improving symptom management in this population. Routine symptom assessment can be useful in clinical and research settings.

Suffering measurement instruments in palliative care: protocol for a systematic psychometric review.

INTRODUCTION: The prevention and relief of suffering are regarded as a goal at the end of life; therefore, suffering assessment at the end of life is essential. In this regard, we need instruments that allow us to evaluate this construct for gathering more evidence, as the assessment of suffering is increasingly used in research and the clinical setting. Many measures have been designed to assess this construct, and the selection of the most appropriate instrument is crucial. The aims of this systematic review are to (1) identify the measures assessing suffering in patients with advanced disease and their psychometric properties and (2) evaluate the methodological quality of studies on measurement properties. METHODS AND ANALYSIS: The protocol of this systematic review was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols Guidelines. A systematic psychometric review of measures assessing suffering in patients with advanced disease and their psychometric properties will be carried out according to the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN). The search strategy will be performed following the Peer Review of Electronic Search Strategies. Searches will be conducted in Cumulative Index to Nursing and Allied Health Literature, Medline, PsycINFO, Cochrane Library, SciELO, Open Grey, Scopus, Web of Science and COSMIN database of systematic reviews, and it will be limited by time (1980-2018) and language (only literature in English and Spanish). Literature will be evaluated by two independent reviewers according to the COSMIN checklist, and measurement properties data of each study that meet the inclusion criteria will be scored independently by two researchers according to COSMIN quality ratings. ETHICS AND DISSEMINATION: Ethical approval is not necessary for systematic review protocols. The results will be disseminated by publication in a peer-reviewed journal and presented at a relevant conference. PROSPERO REGISTRATION NUMBER: CRD42018106488.