Impact of foot functionality in patients with systemic sclerosis: Cross-sectional study.

BACKGROUND: Progressive systemic sclerosis or systemic scleroderma (SS) is a chronic and rare autoimmune disease that mainly affects the skin and various internal organs. Raynaud's phenomenon and digital ulcers are some of the symptoms that affect the foot, causing a decrease in the quality of life of patients. The objective of this study is to determine the functionality of the feet in patients with SS and determine the impact on their daily lives. METHODS: A sample of 165 patients (154 women, 11 men) diagnosed with SS with a mean age of 46.29 ± 11.36 years and a mean body mass index (BMI) of 24.90 ± 5.77 was recruited. Each participant completed the Foot Function Index (FFI) questionnaire and the Systemic Sclerosis Questionnaire (SySQ). A multivariate analysis was performed to determine which factors were related to a higher score in both questionnaires. RESULTS: 32.1% of the participants (n = 53) had claw toe deformities, 79.4% (n = 131) Raynaud's disease and 20% (n = 33) a history of foot ulcers. 51.5% of the participants (n = 85) presented symptoms in their nails, the most frequent sign being thickening, hardening and yellow coloration. The final score of the FFI questionnaire was 3.51 ± 2.41 (0-9.9), the pain subscale being the highest, with a score of 5.06 ± 2.75, followed by foot disability (3.26 ± 2.91) and difficulty performing activities (1.55 ± 2.22). The final score of the SySQ questionnaire was 0.95 ± 0.45 (0.18-2.45), and the subscales with the highest score were symptom frequency (1.30 ± 0.47), symptom intensity (1.11 ± 0.55), and general skill limitation (0.47 ± 0.51). A high correlation was observed between the final FFI score and the final SySQ score (r = 0.712; p=<0.001). Also, between foot activity limitation and general skill limitation (r = 0.658; p=<0.001). A moderate correlation was observed between foot pain score and overall symptom intensity (r = 0.482; p=<0.001). Also, between foot disability and overall symptom frequency (r = 0.556; p=<0.001). The multivariate analysis (R2 0.51) showed that the final FFI score had a significant relationship with the final SySQ score (p < 0.001). No significant correlation was found between age (p = 0.15), gender (p = 0.49), BMI (p = 0.74) or time of diagnosis (p = 0.57) and FFI. CONCLUSION: SS is a disease that affects foot functionality in patients, with a greater impact on the pain scale. There is a correlation between the final FFI score and the final SySQ score, so improving foot functionality could help to improve the overall functionality of the patient with sclerosis.

Update of Modified Version of the Foot Function Index Tool Spanish Version (FFI-Sp), in Patients with Rheumatoid Arthritis: Cross Sectional Study.

Background and Objectives: The Foot Function Index (FFI) is a widely recognized patient-reported outcome measure (PROM) for assessing foot functionality and its impact on quality of life in individuals with rheumatoid arthritis (RA). This study aimed to observe the behavior of the tool in the Spanish population with RA, optimize the tool, and check its functionality. Materials and Methods: A total of 549 RA patients, with a predominant female participation (75.6%). This study involved a comprehensive statistical analysis, leading to a refined version of the FFI for a Spanish-speaking population. Results: The original 23-item FFI was revised, resulting in a 15-item version by excluding items that caused confusion or were considered redundant. This modified version maintained the original's subscales of pain, disability, and activity limitation, but with an adjusted item distribution. The construct validity was confirmed through exploratory factor analysis, demonstrating excellent fit indices (Kaiser-Meyer-Olkin test = 0.926, Bartlett's test of sphericity = 4123.48, p < 0.001). The revised FFI demonstrated good internal consistency (Cronbach's alpha = 0.96) and test-retest reliability (ICC = 0.89). Conclusions: This study highlights the applicability of the FFI in Spanish-speaking RA populations, offering a valid and reliable tool for clinicians and researchers. The modifications enhance the FFI's relevance for RA patients, facilitating better assessment and management of foot-related functional impairments.

Influence of blistering lesions on foot functionality in hikers.

BACKGROUND: Friction blisters are formed by abrasion from frictional forces on the upper layer of the epidermis and can make physical activity an uncomfortable experience. To our knowledge, no previous studies have considered how these injuries affect the functionality of the foot. For this reason, the main aim of this study was to evaluate foot function in hikers, with or without blisters. MATERIAL AND METHODS: This case-control study examined 298 hikers who walked the Camino de Santiago long-distance trail (in northern Spain); 207 had one or more blistering foot lesions and 91 had no blisters. Sociodemographic and clinical variables were collected, and the number of blisters and their locations on the foot were recorded. All participants self-completed the Foot Function Index (FFI) questionnaire, in their native language. RESULTS: Pain and disability were significantly greater among the hikers with blisters (pain p=<0.001; disability p = 0.015). However, there were no significant differences in the limitation of physical activity between those with blisters (case group) and the control group (p = 0.144). Neither was there any correlation between the number of blisters and pain, disability or limitation of activity. However, the location of the lesion did influence foot functionality. Blisters on the metatarsal heads were more limiting and caused greater pain (right foot p = 0.009; left foot p = 0.017), greater disability (right foot p = 0.005; left foot p = 0.005), greater limitation of activity (on right foot p = 0.012) and more loss of foot functionality (right foot p = 0.002; left foot p = 0.007). CONCLUSION: The hikers with blisters experienced reduced foot functionality in terms of pain and disability. The number of blisters was not related to foot functionality. Blisters located on the metatarsal heads caused the greatest increase in pain, disability and limitation of activity.

Correlation between the foot pressure index and the prevalence of plantar hyperkeratosis.

BACKGROUND: Plantar hyperkeratosis (HK) is a very prevalent foot lesion formed due to an alteration in the keratinisation process, thereby increasing keratynocites and accumulating multiple layers of the stratum corneum that leads to plantar pain. As foot shape and plantar pressures is related with their appearance, the aim of this study is to examine how foot posture and plantar pressure influence the appearance of this keratopathy. MATERIAL AND METHODS: On a sample of 400 subjects (201 men and 199 women), the plantar pressures were evaluated by the Footscan® platform in 10 zones. The clinical exploration consisted in the valuation of the Foot Posture Index (FPI), and the assessment of the appeerance (and location) or not of plantar calluses or hyperkeratosis. RESULTS: 6.3% of the feet presented a highly supinated FPI, 15.5% were supinated, 57.3% corresponded to neutral, 17.3% were pronated and 3.8% were highly pronated. The participants with HK on the hallux, on the 1st, 2nd, 3rd or 5th MTH or on the lateral heel had a significantly higher pressure index (p < 0.001), ranging from 24.3 to 44% higher than those with no such alteration. Of the highly pronated feet, 66.7% presented HK in the hallux, while 32.3% of the supinated feet and 60% of the highly supinated feet presented it beneath the first MTH. CONCLUSION: Foot posture influences the appearance of HK, though its association with plantar pressures. The participants with HK presented a mean foot pressure that was 32.3% higher than in those with no such condition. These values can be considered predictive for the appearance of HK and should be indicative of the need for preventive treatment.

Impact of fibromyalgia and related factors on foot function and quality of life: Cross-sectional study.

BACKGROUND: The aim of study is to examine the factors that may influence pain, disability and the limitation of activity due to the presence of fibromyalgia in the foot. METHODS: 323 patients diagnosed with fibromyalgia were recruited. Each participant completed the Foot Function Index questionnaire (FFI) and the Revised Fibromyalgia Impact Questionnaire (FIQR). A multivariate analysis was performed to determine the factors associated with high scores in each of these questionnaires. RESULTS: In both questionnaires, the subscales presenting the highest scores were foot pain (FFI score: 71.18 ± 20.40) and symptom intensity (FIQR score: 36.23 ± 8.04). According to the multivariate analysis, foot function is influenced by age (p = <0.001), BMI (p = 0.001), lack of physical activity (p = <0.001), the presence of rheumatoid arthritis (p = 0.012), retirement due to disability (p = <0.001) and being unemployed (p < 0.001). CONCLUSION: Fibromyalgia affects foot function, provoking significant pain. Related factors include age, BMI, lack of physical activity, the presence of rheumatoid arthritis, and employment status.

Relationship between potential barriers to early mobilization in adult patients during intensive care stay using the Perme ICU Mobility score.

BACKGROUND: Identifying barriers to early mobilization is essential for the management of patients in the intensive care unit (ICU). Our objective was to identify the potential barriers to early mobilization in adult patients using the Perme ICU Mobility Score (Perme Score) and its relationship with days of mechanical ventilation (MV) and length of stay in ICU. METHODS: This was a pilot, observational, and prospective study. We included 142 adult patients admitted to a 14-bed ICU, in a fourth-level complexity hospital in Cali, Colombia. The Perme Score was used to evaluate potential barriers to mobility. We used the Spearman's correlation coefficient to find potential correlations between the number of barriers to mobility per patient and the duration of MV and ICU stay. RESULTS: We identified significant inverse correlations between total days in MV and the total score of barriers to mobility at ICU admission (r = -0.773; p < 0.05) and at ICU discharge (r = -0.559; p < 0.05). Also, between ICU length of stay and total score of barriers to mobility at ICU admission (r = -0.420; p < 0.05) and at ICU discharge (r = -0.283; p < 0.05). Moreover, we found a significant correlation between total score of the barriers item and total Perme score (r = 0.91; p < 0.01). CONCLUSIONS: Using the Perme Score we identified potential barriers to mobility upon admission to the ICU that were maintained until discharge. Our findings indicate a strong positive correlation at ICU admission between the total Perme Score and the total score of "Category #2 - Potential Mobility Barriers" in the Perme Score.

Foot health among the Roma population of southern Spain according to the foot health status questionnaire.

BACKGROUND: Foot health of the Roma population is a challenge for the health professionals where this minority is significant, as is the case in Spain. At present, little is known about foot health of the Roma population and their knowledge would promote the training of these professionals at the community level. Foot pain is common and a reason for consulting podiatry services. The purpose of this study was to determine foot health among the Roma population according to the Foot Health Status Questionnaire. METHOD: An observational, cross-sectional and quantitative study conducted at the Roma population living in Spain in 2018. Self-reported data and the Foot Health Status Questionnaire were recorded. Examining the general health and foot health (foot pain, foot function, footwear and general health) and general (general health, social capacity, physical activity and vigour). This questionnaire is recommended as a valid and reliable patient-reported outcome. The obtained scores were compared. RESULTS: A sample made up of 624 men and women from the Roma population took part in this study. 45% were Roma men and 55% Roma women. In the first section of the FHSQ, a lower score of values was recorded in the footwear domain (62.5) and in the general foot health domain (60). Gypsy women obtained lower scores in all the domains. In the second section, lower scores were obtained in the vigour (56) domain and in the general health (60) domain. A large effect size (r-Rosenthal) was found by gender in the footwear domain (0.334) and in the vigour domain (0.195). Roma women showed higher values in cardiac disorders, serious illnesses, doctor visits and foot problems. 67.8% reported that they had never been assisted by a podiatrist. CONCLUSIONS: The studied Roma population has foot health problems, and these are more pronounced among women. They show lower values in the footwear and vigour domains. More professional training is required for health workers in this field to avoid cultural diversity stereotypes.

Prevalence and risk factors associated with the formation of dermal lesions on the foot during hiking.

BACKGROUND: The aim of this study is to assess the prevalence of blisters on the foot during hiking and the factors associated with this condition. MATERIAL AND METHODS: A cross-sectional observational comparative study was conducted of 315 patients treated at two hostels, located on the Way of Saint James, in northern Spain. The study participants were interviewed and clinically examined to obtain sociodemographic and clinical variables. The variables recorded concerned the type of terrain covered (asphalt or dirt trails), the weight carried (backpack), the footwear used (weight, type, impermeability), the type of socks worn and the hydration of the skin obtained. The inclusion criteria were at least 18 years and to walk at least 20 km in the last five days. RESULTS: 74% (n = 233) of the hikers presented a bullous lesion on the foot after completing several stages of hiking. The most frequent locations were the first or second metatarsal head and the fifth toe. Logistic regression showed that risk factors for the appearance of blistering were the number of kilometres walked on asphalt (p = .001 [95% CI (1.019-1.064)]) and having wet socks at the end of the day (p = . 006 [95% CI (1.286-4.479)]). The protective factors identified were walking on a dirt, grass or gravel surface (p < .001 [95% CI (0.982- 0.995)]) and using customised plantar orthoses (p = .001 [95% CI (0.085) - 0.512)]). CONCLUSIONS: The type of terrain is a determining factor in the appearance of blisters. Walking on a dirt trail reduces the risk. Using custom made insoles and controlling humidity are other factors that should be considered as preventive measures.

Predictive model to identify the risk of losing protective sensibility of the foot in patients with diabetes mellitus.

Diabetic neuropathy is defined as the presence of symptoms and signs of peripheral nerve dysfunction in diabetics. The aim of this study is to develop a predictive logistic model to identify the risk of losing protective sensitivity in the foot. This descriptive cross-sectional study included 111 patients diagnosed with diabetes mellitus. Participants completed a questionnaire designed to evaluate neuropathic symptoms, and multivariate analysis was subsequently performed to identify an optimal predictive model. The explanatory capacity was evaluated by calculating the R2 coefficient of Nagelkerke. Predictive capacity was evaluated by calculating sensitivity, specificity, and estimation of the area under the receiver operational curve. Protective sensitivity loss was detected in 19.1% of participants. Variables associated by multivariate analysis were: educational level (OR: 31.4, 95% CI: 2.5-383.3, P = .007) and two items from the questionnaire: one related to bleeding and wet socks (OR: 28.3, 95% CI: 3.7-215.9, P = .001) and the other related to electrical sensations (OR: 52.9, 95% CI: 4.3-643.9, P = .002), which were both statistically significant. The predictive model included the variables of age, sex, duration of diabetes, and educational level, and it had a sensitivity of 81.3% and a specificity of 95.5%. This model has a high predictive capacity to identify patients at risk of developing sensory neuropathy.

[Prevalence of peripheral arterial disease and associated factors in elderly patients using an automated oscillometric device]. / Prevalencia de enfermedad arterial periférica y factores asociados en pacientes mayores de 65 años mediante dispositivo automático oscilométrico.

The objective is to determine the presence of peripheral arterial disease (PAD) and the factors associated in elderly patients, analyzing variables such as sex, age, smoking, diabetes, hypertension, dyslipidemia, and cardiovascular problems. The investigation was conducted in 257 patients by assessing their ankle-brachial index (ABI). To do this, WatchBP Office, a specific automatic blood pressure measurement device for assessing ABI, was used. A greater presence of arterial occlusion (ABI < 0.90) was observed in males, and a greater predominance of calcification (ABI > 1.3) occurred in females. Also standing out was the significant relationship between the presence of arterial occlusion an the advanced age of the patient (p = 0.00), diabetes (p = 0.04), hypertension (p = 0.02), heart problems (p = 0.004), and smoking (p = 0.01). No significant relationship was found between the presence of occlusion and dyslipidemia (p = 0.92). In multivariate analysis, age (OR = 1.082; p = 0.02), cardiovascular problems (OR = 2.76; p = 0.03) and systolic blood pressure (OR = 1.03; p = 0.04) showed an association with the occlusion.

Comparative analysis of pulmonary ventilation distribution between low-cost and branded incentive spirometers using electrical impedance tomography in healthy adults: Study protocol.

BACKGROUND: The Incentive Spirometer (IS) increases lung volume and improves gas exchange by visually stimulating patients to take slow, deep breaths. It prevents respiratory complications and treats postoperative atelectasis in patients undergoing abdominal, thoracic, and neurosurgical procedures. Its effectiveness has been validated in studies that support improved lung capacities and volumes in individuals with respiratory complications, postoperative thoracic surgery, upper abdominal surgery, and bariatric surgery. The modified Pachón incentive spirometer (MPIS) is a cost-effective alternative to branded IS. It is crucial to validate whether the MPIS distributes ventilation as effectively as commercial devices do. Ventilation distribution will be measured using electrical impedance tomography. OBJECTIVE: The aim is to compare the distribution of pulmonary ventilation between the MPIS and another commercial IS in healthy adults using electrical impedance tomography. METHODS: A crossover clinical trial is proposed to evaluate the measurement of pulmonary ventilation distribution using EIT in a sample of healthy adults. All participants will use a commercial flow IS and the MPIS, with the order of assignment randomized. This research will use electrical impedance tomography to validate the operation of the MPIS. CONCLUSIONS: This study protocol will compare two incentive spirometers' impact on pulmonary ventilation, potentially endorsing the adoption of a cost-effective device to enhance accessibility for targeted populations. TRIAL REGISTRATION: The study was registered in ClinicalTrials.gov (NTC05532748).

Age-related variations in stratum corneum hydration in the foot.

OBJECTIVE: The aims of the study are to identify which region of the foot has lower hydration according to age, measure the variation in the level of stratum corneum hydration of the foot across the a wide age range, and examine hydration differences of the foot according to gender. STUDY DESIGN: A descriptive observational study was conducted to assess stratum corneum hydration of the foot among 504 participants recruited between November 2023 and March 2024. MAIN OUTCOMES MEASURES: Stratum corneum hydration assessment was conducted using a Corneometer 825® probe at 10 specific points on the foot. Data on sociodemographic variables, medical history, foot care habits, and hydration-related factors were collected. Statistical analyses were performed using SPSS v. 24.0. RESULTS: Stratum corneum hydration of the foot varied significantly across regions, with higher hydration in the digital zone and lower hydration in the heel. An inverse correlation was found between age and hydration, with younger participants exhibiting higher hydration levels. Women showed higher hydration than men. Differences in hydration were observed between the right and left feet. CONCLUSION: This study highlights the importance of localized assessment of foot skin dehydration. Aging significantly affects stratum corneum hydration of the foot. Gender differences in hydration suggest the importance of personalized approaches to skin care. Differential hydration between feet underscores the influence of mechanical load.

Exploring the influence of dietary habits on foot risk in type 2 diabetes patients: An observational study.

BACKGROUND & AIM: To date, there are no studies demonstrating the impact of the Mediterranean diet on the risk of diabetic foot ulcer. The aim of this research was to examine the connection between adherence to the Mediterranean diet and the level of risk of diabetic foot ulcers in individuals with type 2 diabetes. METHODS: Observational pilot study collecting sociodemographic, anthropometric, lifestyle, and type 2 diabetes-related data. Loss of protective sensation was assessed using the Semmes Weinstein 5.07-10 g monofilament, considered altered when not perceived in four points. Vascular status was assessed by palpating pulses and ankle-brachial index, indicating peripheral arterial disease if ankle-brachial index was less than 0.9 or if both pulses were absent. Foot deformities were recorded. The risk of diabetic foot ulcers was stratified into two categories: no risk and risk of diabetic foot ulcers. Adherence to the Mediterranean diet was evaluated using the Mediterranean Diet Adherence Screener-14 questionnaire (good adherence with score >7). RESULTS: Of the 174 patients with type 2 diabetes mellitus who participated (61.5% men and 38.5% women) with a mean age of 69.56 ± 8.86 years and a mean duration of type 2 diabetes of 15.34 ± 9.83 years. Non-adherent patients to the Mediterranean diet exhibited a higher association of diabetic foot ulcers (p = 0.030) and a lower average score on the Mediterranean Diet Adherence Screener-14 (p = 0.011). Additionally, a lower incidence of diabetic foot ulcers was observed in those who consumed nuts three or more times a week (p = 0.003) and sautéed foods two or more times a week (p = 0.003). Multivariate analysis highlighted the importance of physical activity (OR = 0.25, 95% CI 0.11-0.54; p < 0.001), podiatric treatment (OR = 2.59, 95% CI 1.21-5.56; p = 0.014), and duration of type 2 diabetes (OR = 3.25, 95% CI 1.76-5.99; p < 0.001) as significantly associated factors related to the risk of diabetic foot ulcers. CONCLUSIONS: Adhering to the Mediterranean diet correlates with a lower incidence of diabetic foot ulcers in individuals diagnosed with type 2 diabetes mellitus. Furthermore, factors such as regular physical activity, podiatric treatment, and the duration of type 2 diabetes mellitus emerge as pivotal in preventing diabetic foot ulcers.

Perme ICU Physical Therapy Competency: Development of an ICU Knowledge and Skills Assessment Tool.

BACKGROUND: Physical therapy for patients in the ICU is advanced practice demanding specialized knowledge and skills. However, ICU physical therapy competency standards lack uniformity or defined processes. OBJECTIVES: To describe the development process of the Perme ICU Physical Therapy Competency and to assess its face and content validity. METHODS: Quantitative research study for the content validation of the Perme ICU Physical Therapy Competency using a panel of experts. The face validity assessment consisted of two informal surveys and discussions with clinicians representing various disciplines in ICU. MAIN OUTCOME MEASURES: A content validation survey included analysis of sufficiency, clarity, coherence, and relevance for items in the Perme ICU Physical Therapy Competency. For the quantitative analysis of content validity, the item-level content validity index (I-CVI) was used. Scale-level content validity index based on the universal agreement method (S-CVI/UA) was calculated as the proportion of items on the scale that achieve a relevance scale of 3 or 4 by all experts. Scale-level content validity index was calculated based on the average method (S-CVI/Ave). RESULTS: The sufficiency, clarity, coherence, and relevance of the Perme ICU Physical Therapy Competency items presented S-CVI/Ave greater than 80 % (97 %, 97 %, 99 %, 95 %, respectively). CONCLUSION: This study establishes that the Perme ICU Physical Therapy Competency has a satisfactory level of face and content validity. IMPLICATIONS FOR CLINICAL PRACTICE: The Perme ICU Physical Therapy Competency, with its solid framework, is a valuable assessment tool applicable for integration in any ICU competency program. It can be utilized as a self-assessment tool by individual therapists or in collaboration with mentors and evaluators to evaluate knowledge and skills effectively. This innovative tool not only enhances clinical practice but also presents an opportunity for advancing the physical therapy profession within the ICU setting.

Validation of a New Ankle Brachial Index Measurement System Using Pulse Wave Velocity.

Peripheral artery disease (PAD) is a common circulatory disorder characterized by the accumulation of fats, cholesterol, and other substances in the arteries that restrict blood flow to the extremities, especially the legs. The ankle brachial index (ABI) is a highly reliable and valid non-invasive test for diagnosing PAD. However, the traditional method has limitations. These include the time required, the need for Doppler equipment, the training of clinical staff, and patient discomfort. PWV refers to the speed at which an arterial pressure wave propagates along the arteries, and this speed is conditioned by arterial elasticity and stiffness. To address these limitations, we have developed a system that uses electrocardiogram (ECG) and photoplethysmography (PPG) signals to calculate pulse wave velocity (PWV). We propose determining the ABI based on this calculation. Validation was performed on 22 diabetic patients, and the results demonstrate the accuracy of the system, maintaining a margin of ±0.1 compared with the traditional method. This confirms the correlation between PWV and ABI and positions this technique as a promising alternative to overcome some of the limitations of the conventional method.

The stress experienced in an emergency medical service (EMS): A descriptive study.

INTRODUCTION: Stress, described as an adaptation of the body to an event, is a considerable problem among health workers, especially for those who work in emergency situations, as they very often have to face complex situations. It has been proven that stress affects the performance of health professionals, which is why it is interesting to measure it in these situations, to be able to know what methods to implement to reduce it in future events. Despite having previous measurements in healthcare personnel during clinical simulations, this study is relevant because stress has never before been measured in EMS professionals when performing their work. OBJECTIVE: To determine the acute stress experienced by professionals in an Emergency Medical Service (EMS) when handling five types of clinical emergencies. As secondary objectives, to determine if there were differences in the increases in stress in relation to sex, age, profession, team, and above all, type of emergency handled. METHOD: The following were measured for the analysis: physiological (mean heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure), and biochemical (salivary alpha amylase (sAA) activity) markers, before (Basal) and after (Post-Stress) the interventions of 27 professionals from an EMS. RESULTS: In general, the results obtained showed significant differences between the baseline measurement of physiological and biochemical markers versus the post-exposure measurement. Some of the differences in stress levels in relation to sex and professional role are striking. CONCLUSION: The determination of acute stress experienced by professionals from an EMS in a real emergency showed significant increases in the sAA enzymatic marker of acute stress. These results are the first data published in this regard, and could be used as a reference to follow in clinical simulation in the training of students and the training of nursing professionals. IMPLICATIONS FOR CLINICAL PRACTICE: Evidence based studies are needed to improve the education and training of emergency and intensive care professionals. The results from are a great step in the analysis of the real stress that professionals are subjected to when they handle different emergencies.

[Impact of training schoolchildren how to perform cardiopulmonary resuscitation using stories and animated cartoons].

BACKGROUND: We compared the outcome of training schoolchildren how to perform CPR by parents/legal guardians in the family environment versus by teachers at school. METHODS: Randomized study of CPR learning in primary school children (1st and 2nd grades) in the Region of Murcia. Parents/legal guardians (family group) and teachers (teacher group) trained the children using didactic material adapted for that age population (one story and one cartoon video) from the educational series Jacinto y sus Amigos©. We evaluated eight theoretical knowledge items and five practical skills. RESULTS: One hundred and sixty schoolchildren were selected and 116 completed the study; in the family group, 51.3% did not finish the study. Children trained by teachers obtained significantly higher median scores in comparison with the family group both in theoretical knowledge (6.7; IQR=1.8 vs 4.7; IQR=3.1, respectively; p < 0.001) and in all practical skills except for "recognizing an emergency situation". Children in the family group, learning CPR with one story and one cartoon video achieved significantly better scores in five theoretical knowledge items and four skills than with only the story. CONCLUSIONS: Using non-technological educational resources, e.g., stories and animated cartoons for teaching CPR to primary school students, increases their knowledge and skills. Schoolchildren trained in the educational environment acquired more knowledge and skills than those trained by parents. Within the family environment, CPR teaching was more effective through one story and one cartoon video than when only the story was used.

Transcultural adaptation and validation of the Spanish version of the Global Pain Scale.

The aim of this study was to perform a cross-cultural adaption and validation of the Global Pain Scale (GPS) to produce a Spanish-language version (GPS-Sp) and to determine the psychometric properties of this instrument. The GPS was cross-culturally translated into Spanish following the guidelines of the International Society for Pharmacoeconomics and Outcomes Research. The initial study population was composed of 384 patients recruited from February to May 2021. All participants were aged at least 18 years and were currently experiencing pain. All gave signed informed consent to take part and completed the Brief Inventory-Sp and GPS-Spain questionnaires. Cronbach's É‘ and test/retest reliability values were calculated and floor/ceiling effects analyzed. Construct validity was assessed by confirmatory factor analysis (CFA). The 370 patients included in the final analysis presented the following characteristics: 36.2% were male and 63.8% were female; mean age 42.6 (19-88) years; mean body mass index 24.99. Internal consistency was good. The Cronbach's ɑ for GPS-Sp was 0.86 and the intraclass correlation coefficient was 0.94 (95% CI; 0.87-0.97). Five main explanatory factors were identified by CFA, which produced the following values: RMSEA = 0.057; CFI = 0.807; GFI = 0.809; NFI = 0.763. No floor/ceiling effect was observed. The GPS-Sp is a valid, reliable and sensitive instrument for assessing pain in a Spanish-speaking population and could facilitate pain relief in this population.

Transcultural Adaptation and Validation of the Spanish Version of the Visual Analogue Scale for the Foot and Ankle (VASFA).

BACKGROUND: The main aim of this study is to perform a cross-cultural adaptation and validation of the Visual Analogue Scale for the Foot and Ankle (VASFA) questionnaire, creating a Spanish-language version (VASFA-Sp), and to determine the measurement properties of this instrument. METHODS: VASFA was cross-culturally translated into Spanish following the guidelines of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). The study sample was composed of 228 participants who were recruited from February to May 2022. All were at least 18 years old, gave signed informed consent to take part and properly completed the Foot and Ankle Ability Measures-Sp and VASFA-Sp questionnaires. Cronbach's alpha and test/re-test reliability values were calculated. Structural validity was assessed via exploratory factor analysis. RESULTS: The 228 patients included in the final analysis presented the following characteristics: 35.53% were male and 64.47% were female; the mean age was 35.95 (18-81) years; and the mean body mass index was 23.79. Internal consistency was excellent. The Cronbach's alpha for VASFA-Sp was 0.96 and the intraclass correlation coefficient was 0.932 (95% CI; 0.84 to 0.97). Exploratory factor analysis identified one main factor. CONCLUSIONS: VASFA-Sp is a reliable, valid and sensitive questionnaire that is suitable for measuring perceived foot and ankle function impairment in a Spanish-speaking population.

Consensus-based recommendations on physical activity and exercise in patients with diabetes at risk of foot ulcerations: a Delphi study.

BACKGROUND: Patients with diabetes mellitus are exposed to important complications. Currently little evidence exist on the guidelines that these patients, at some risk of foot ulceration, should follow for physical exercise. OBJECTIVES: To reach a consensus among multidisciplinary and international experts on physical activity/exercise recommendations for patients with diabetes, according to foot ulcer risk. METHODS: Using a three-round Delphi method, a panel composed of 28 multidisciplinary experts in the management of diabetic foot assessed 109 recommendations on physical activity/exercise for patients with diabetes mellitus, according to their risk of foot ulcer. Consensus was assumed when 80% of responses matched the same category (agreement/disagreement). RESULTS: Twenty-nine experts participated in the first and second rounds of consultation, and twenty-eight did so in the third, reaching final agreement on 86 of the 109 recommendations considered (78.9%). The study, thus, generated a consensus set of recommendations concerning different aspects of diabetic footcare before, during, and after exercise (e.g. when to examine the foot, how to assess it, what type of sock and insole to use, what types of exercise to perform, and when it is advisable to return to activity after an ulceration). CONCLUSION: This Delphi study generated recommendations based on the consensus of international experts on physical activity and exercise by patient with diabetes at risk of ulceration. Recommendations considered the state of the foot and the patient's history and status before physical activity and included information on intensity, duration, frequency, and progressions of physical activity/exercise, and the use of custom-made plantar orthoses, shoe prescription, and the convenience of returning to physical activity after an ulceration.