Prevalence of Psychoneurological Symptoms and Symptom Clusters in Women with Breast Cancer Undergoing Treatment: Influence on Quality of Life.

OBJECTIVES: To identify subgroups of psychoneurological symptoms (PNS) and their relationship to different clinical variables in a sample of women with breast cáncer (BC) with different type of treatment, and the possible influence of these on quality of life (QoL), using a factorial principal components analysis. DATA SOURCES: Observational, cross-sectional, non-probability study (2017-2021) at Badajoz University Hospital (Spain). A total of 239 women with BC receiving treatment were included. RESULTS: 68% of women presented fatigue, 30% depressive symptoms, 37.5% anxiety, 45% insomnia, and 36% cognitive impairment. The average score obtained for pain was 28.9. All the symptoms were related between themselves, and within the cluster of PNS. The factorial analysis showed three subgroups of symptoms, which accounted for 73% of variance: state and trait anxiety (PNS-1), cognitive impairment, pain and fatigue (PNS-2), and sleep disorders (PNS-3). The depressive symptoms were explained equally by PNS-1 and PNS-2. Additionally, two dimensions of QoL were found (functional-physical and cognitive-emotional. These dimensions correlated with the three PNS subgroups found. A relationship was found between chemotherapy treatment and PNS-3, and its negative impact on QoL. CONCLUSIONS: A specific pattern of grouped symptoms in a psychoneurological cluster with different underlying dimensions has been identified which negatively influences QoL of survivors of BC. IMPLICATION FOR NURSING PRACTICE: It is important to raise awareness among professionals and patients about the existence of a cluster of PNS, the patient's profile, as well as the factors that exacerbate them. This will allow them to be treated more effectively and comprehensively.

Repeatability and reliability of the footwear assessment tool in Spanish patients: A transcultural adaptation.

BACKGROUND: The footwear assessment tool was designed to advise an appropriate footwear for each situation and patient. Footwear alterations structures can influence in musculoskeletal disorders, developing foot ulcers, increase the peak plantar pressure, bacterial growth, low back pain. METHODS: To validate the study 101 subjects were recruited. The study was tested by two expert podiatrists using the tool for the assessment of footwear characteristics that is composed by five domains, fit, general features, general structure, motion control properties and cushioning system. Each domain analyzes different shoe items. RESULTS: An excellent agreement between the test-retest. A suitable Cronbach's α was suggested for the five domains of fit (α = 0.952), general features (α = 0.953), general structure (α = 0.947), motion control properties (α = 0.951), and cushioning system (α = 0.951). Test-retest reliability was excellent for all domains. There were no significant differences between any domain (p > 0.05). There was only statistically significant difference in the item forefoot height (p = 0.011). For all the domains items there were no statistically significant difference (p > 0.05). CONCLUSIONS: The tool for the assessment European footwear is a suitable repeatability and reliability footwear tool that can be used in Spanish language subjects.

Impact of Depression on Patients With Hemophilia: A Retrospective Case-Control Research.

Background: Hemophilia is an inherited recessive hemorrhagic disorder of the X-linked type, suffered by the male sex. Adults with hemophilia are coping with numerous diagnostics, associated comorbidities, pain, and difficult gait by arthropathy in ankles and feet. Physical pains contribute to depression in patients with hemophilia. Purpose: The study aimed to assess the impact of depression in adult patient with hemophilia and to compare it with healthy matched-paired controls. Methods: The sample consisted of 100 participants (median age 42.50 ± 30). Patients with hemophilia were recruited from Spanish Hemophiliac Associations (n = 50) and healthy subjects (n = 50) from a Clinic Podiatry Practices (University of Malaga, Spain). Results: Results and categories of the Spanish-translated version of the Beck Depression Inventory (BDI) were gathered. A clear statistically significant difference (p < 0.001) was presented in the variation of the BDI scores between both groups. Patients with hemophilia presented worse results with a BDI = 7.50 ± 11.25 points compared to healthy subjects with BDI = 2.50 ± 5 points. In the BDI categories, statistically significant differences (p = 0.004) were found in greater BDI categories in the Hemophilia group compared with healthy subjects. Moderate and severe depression categories were only shown in patients with hemophilia. Conclusions: Greater depression scores and range status were observed in patients with hemophilia compared to non-patients with hemophilia. Patients with hemophilia are at increased risk of depressiveness.

Influence on Depression, Anxiety, and Satisfaction of the Relatives' Visit to Intensive Care Units prior to Hospital Admission for Elective Cardiac Surgery: A Randomized Clinical Trial.

Background: Intensive care units (ICUs) may produce stress on the relatives of patients that have long-term physiological and psychological implications. Objectives: This study aimed to evaluate the effects of the relatives´ visit prior to hospital admission(s) on the patient's scheduled cardiac surgery regarding depression, anxiety, and satisfaction of the patient's family in an ICU. Methods: A randomized clinical trial [NCT03605420] was carried out according to the CONSORT criteria. Thirty-eight relatives of ICU patients were recruited at an ICU and randomized into study groups. Experimental group participants (n = 19) consisted of relatives who received 1 ICU visit prior to the patient's admission. Control group participants (n = 19) consisted of patients' relatives who received standard care alone. A self-report test battery, including the Impact of Event Scale-Revised (IES-R) and the Hospital Anxiety and Depression Scale (HADS), was completed by the patient's relative prior to the patient's ICU admission and again three and 90 days after ICU discharge. Furthermore, the Family Satisfaction with Care in the Intensive Care Unit (FS-ICU) and Critical Care Family Needs Inventory (CCFNI) were administered to help determine the respondents' satisfaction three days after the patient's ICU discharge. Results: Statistically significant differences in FS-ICU results were found between control and experimental groups; no statistically significant differences were found in IES-R, HADS, and CCFNI results. Thus, members in the control group were more satisfied with the time elapsed to raise their concerns (p=0.005), emotional support provided (p=0.020), quality of care (p=0.035), opportunities to express concerns and ask questions (p=0.005), and general satisfaction with the ICU's decision-making (p=0.003). Conclusions: Relatives' satisfaction during patients' ICU admission may be impaired after their prior visit to the hospital admission. Relative's anxiety and depression scores did not seem to be significantly affected. Relatives´ visit prior to elective cardiac surgery hospital admission impaired their satisfaction in an ICU and may not be advisable for healthcare practice.

Reliability of Frail and Barthel Tests for Detecting Frailty in Palliative Oncological Patients in a Home Hospitalization Unit: A Comparative Study.

Cancer is a condition that can increase the risk of frailty. In addition, palliative oncological patients in home hospitalization can find their activities of daily living affected. The main objective was to measure the degree of frailty in the oncological population in home hospitalization comparing Barthel and Frail-VIG Indexes. This is a descriptive cross-sectional study. A sample of oncological patients in home hospitalization (n = 50) that included 27 men and 23 women were recruited, and disability due to frailty was measured using the VIG frailty index and the Barthel scale for Activities of Daily Living (ADLs). Spearman's correlation coefficients were categorized as weak (rs ≤ 0.40), moderate (0.41 ≤ rs ≥ 0.69) or robust (0.70 ≤ rs ≥ 1.00), with a strong indirect correlation between the domains using the toilet, transferring and wandering on the Frail-VIG scale with an r (s) value -0.810 (p < 0.001), -0.831 (p < 0.001) and -0.805 (p < 0.001), respectively, and a moderate indirect correlation for the domains of eating -0.718 (p < 0.001), dressing -0.770 (p < 0.001) and urination -0.704 (<0.001). The Frail-VIG index above 0.35 points, that is, from moderate to severe, does not affect ADLs except in the nutritional dimension in a palliative oncological population in home hospitalization. The preliminary outcomes obtained should be considered to determine the impact of nutritional status with regard to ADLs in palliative oncological patients in a home hospitalization unit.

Effect of foot health and quality of life in patients with Parkinson disease: A prospective case-control investigation.

BACKGROUND: Parkinson's disease (PD) is a common neurodegenerative disorder, characterised by the presence of motor disturbances. Therefore, it can be related to musculoskeletal and orthopaedic problems, particularly in the foot status, that are linked to a negative effect on overall health, mobility and social function. OBJECTIVE: The aim was to analyse the impact of foot health and quality of life in patients with Parkinson's disease and people without Parkinson's disease, with normalised reference scores, in the light of the values recorded with regard to foot health status and overall health. MATERIAL AND METHODS: This is a prospective case-control investigation. A sample of Parkinson's patients (n = 62) including 24 men and 38 women was recruited, and foot HQoL was measured using the Foot Health Status Questionnaire Spanish (Sp_FHSQ). RESULTS: The PD group recorded lower levels of foot health quality of life (HQoL) with lower scores on the Sp_FHSQ in general foot health, general health, physical activity, social capacity and vigour sub-scales. Regarding the rest of the sub-scales of the Sp_FHSQ, foot pain showed higher values in the PD group. Differences between the cases and control groups were analysed by means of a Mann-Whitney U test, showing statistical significance (P < 0.05). CONCLUSIONS: PD presents an increased negative impact on foot health and quality of life which appears to be related to the chronic neurodegenerative disease.

Repeatability and reliability of the diabetic foot self-care questionnaire in Arabic patients: A transcultural adaptation.

PURPOSE: The diabetic foot self-care questionnaire is considered a self-care evaluation tool with 16 questions for assessing diabetic foot health disorders. To date, the DFSQ has been validated in different languages, but an Arabic version was lacking. Consequently, the purpose of this study was to translate and validate the Arabic version of the DFSQ (DFSQ-AR). METHOD: A suitable method was developed for the translation protocol and cross-cultural validation from Spanish to Arabic. Regarding the total marks from each sub-scale, agreement degrees and confidence were analyzed using Cronbach's α and intraclass correlation coefficient (ICC), respectively. In addition, the mean ± standard deviation differences between pre and post-tests were calculated and completed using Bland-Altman distribution plots. RESULTS: Excellent agreement between the two versions was demonstrated based on Cronbach's α. Three sub-scales consisting of knowledge of foot hygiene, the appropriate use of footwear and socks, and podiatric self-care were added together to obtain the total score. Excellent retest reliability was shown for the total score. Test/retest reliability was excellent for the self-care and shoe and socks sub-scales. There were no significant differences among any domains (p > 0.05). There were no statistically significant differences (P = 0.000) for the mean ± standard deviations (SD) between pre- and post-tests (98.09 ± 15.42) [93.75-102.43] and 97.96 ± 13.88 [94.5-101.86] points, respectively). Bland-Altman plots or clinically pertinent variations were not statistically significantly different. CONCLUSIONS: The DFSQ-AR is considered a strong and valid questionnaire with adequate repeatability in the Arabic language population.

Effect of Foot Orthoses and Shoes in Parkinson's Disease Patients: A PRISMA Systematic Review.

Reduced plantar foot sensation, postural instability, and gait difficulties are characteristic of Parkinson´s disease patients. A systematic review was carried out to determine the effect of the different types of insoles and shoes in these patients. Several databases were used to search for relevant articles reporting Parkinson´s disease patients undergoing treatment with any type of insole and footwear. All titles and abstracts were reviewed independently by two reviewers and the available data were extracted. The study eligibility criteria were any type of experimental study that included Parkinson's disease patients treated with any type of insole or footwear. Eight studies were selected. Interventions used were textured insoles, footwear modifications, and habitual footwear. Three different outcomes were evaluated in each study: gait parameters, balance, and plantar sensation. According to the data available from this systematic review, the most important conclusion is that more controlled studies are needed in this research field. There are indications to suggest that textured insoles have positive effects on gait parameters, balance, and plantar sensation in Parkinson's disease patients.

Influence of foot pain on frailty symptoms in an elderly population: a case-control study

ABSTRACT BACKGROUND: Frailty is a condition that can increase the risk of falls. In addition, foot disorders can negatively influence elderly people, thus affecting their condition of frailty. OBJECTIVE: To determine whether foot pain can influence a greater degree of frailty. DESIGN AND SETTING: Cross-sectional descriptive study conducted at the University of Valencia, Valencia, Spain. METHODS: A sample older than 60 years (n = 52), including 26 healthy subjects and 26 foot pain patients, was recruited. Frailty disability was measured using the 5-Frailty scale and the Edmonton Frailty scale (EFS). RESULTS: There were statistically significant differences in the total EFS score and in most of its subscales, according to the Mann-Whitney U test (P < 0.05). In addition, foot pain patients presented worse scores (higher 5-Frailty scores) than did healthy patients, regarding matched-paired subjects (lower EFS scores). With regard to the rest of the measurements, there were no statistically significant differences (P > 0.05). The highest scores (P < 0.001) were for fatigue on the 5-Frailty scale and the EFS, and for the subscale of independence function in EFS. CONCLUSIONS: These elderly patients presented impairment relating to ambulation and total 5-Frailty score, which seemed to be linked to the presence of frailty syndrome and foot disorders.

Influence of foot pain on frailty symptoms in an elderly population: a case-control study.

BACKGROUND: Frailty is a condition that can increase the risk of falls. In addition, foot disorders can negatively influence elderly people, thus affecting their condition of frailty. OBJECTIVE: To determine whether foot pain can influence a greater degree of frailty. DESIGN AND SETTING: Cross-sectional descriptive study conducted at the University of Valencia, Valencia, Spain. METHODS: A sample older than 60 years (n = 52), including 26 healthy subjects and 26 foot pain patients, was recruited. Frailty disability was measured using the 5-Frailty scale and the Edmonton Frailty scale (EFS). RESULTS: There were statistically significant differences in the total EFS score and in most of its subscales, according to the Mann-Whitney U test (P < 0.05). In addition, foot pain patients presented worse scores (higher 5-Frailty scores) than did healthy patients, regarding matched-paired subjects (lower EFS scores). With regard to the rest of the measurements, there were no statistically significant differences (P > 0.05). The highest scores (P < 0.001) were for fatigue on the 5-Frailty scale and the EFS, and for the subscale of independence function in EFS. CONCLUSIONS: These elderly patients presented impairment relating to ambulation and total 5-Frailty score, which seemed to be linked to the presence of frailty syndrome and foot disorders.

Transcultural adaptation and validation of Italian Selfcare diabetic foot questionnaire.

The Italian Selfcare diabetic foot questionnaire, (SDFQ-IT) is considered a diabetic foot self-care evaluation tool with 16 questions for assessing diabetic foot health disorders. To date, SDFQ has been validated in different languages, but an Italian version was lacking. Consequently, the purpose of this study was to translate and validate the Italian version of the SDFQ-IT (SDFQ-IT). A suitable method was developed for the translation protocol and cross-cultural validation from Spanish to Italian. Regarding the total marks from each sub-scale, agreement degrees, and confidence were analysed using the Cronbach's α and intraclass correlation coefficient (ICC), respectively. In addition, the mean ± SD differences between pre and post-tests were calculated and completed using the Bland and Altman distribution plots. Excellent agreement between the two versions based on Cronbach's α was demonstrated. Three sub-scales consisting of knowledge of foot hygiene, the appropriate use of footwear and socks, and podiatric self-care were added together to obtain the total score. Excellent retest reliability was shown for the total score. Test/retest reliability was excellent for the self-care domain, and shock and shoe sub-scales. There were no significant differences among any domain (P > .05). There were no statistically significant differences (P = .000) for the mean ± SDs differences between pre-and post-tests (92.9200 ± 12.914) [89.25-96.59] and 92.9200 ± 13.012 [89.22-96.62] points, respectively). Bland and Altman plots or clinically pertinent variations were not statistically significantly different. The SDFQ-IT is considered a strong and valid questionnaire with adequate repeatability in the Italian community.

Kinesiophobia Levels in Patients with Parkinson's Disease: A Case-Control Investigation.

BACKGROUND: Kinesiophobia can be an obstacle to physical and motor activity in patients with Parkinson's disease (PD). PD affects patients' independence in carrying out daily activities. It also impacts a patient's biopsychosocial well-being. The objective of this study was to analyze the levels and scores of kinesiophobia in PD patients and compare them with healthy volunteers. METHODS: We deployed a case-control study and recruited 124 subjects (mean age 69.18 ± 9.12). PD patients were recruited from a center of excellence for Parkinson's disease (cases n = 62). Control subjects were recruited from the same hospital (control n = 62). Kinesiophobia total scores and categories were self-reported using the Spanish version of the Tampa Scale of Kinesiophobia (TSK-11). RESULTS: Differences between cases and control groups were analyzed using the Mann-Whitney U test. Statistically significant differences (p < 0.05) were shown between groups when comparing kinesiophobia categories (or levels) and total scores, revealing higher kinesiophobia symptoms and levels in PD patients. All of the PD patients reported some degree of kinesiophobia (TSK-11 ≥ 18), while the majority of PD patients (77.3%) had kinesiophobia scores rated as moderate to severe (TSK-11 ≥ 25). On the other hand, ~45.1% of controls reported no or slight kinesiophobia and 53.2% reported moderate kinesiophobia. CONCLUSIONS: Total kinesiophobia scores were significantly higher in PD patients compared with healthy controls, with moderate to severe kinesiophobia levels prevailing in PD patients. Therefore, individuals living with PD should be evaluated and controlled in order to detect initial kinesiophobia symptoms.

The Impact of Depression Symptoms in Patients with Parkinson's Disease: A Novel Case-Control Investigation.

Parkinson's disease is a common neurodegenerative disease and it is known to cause motor disturbances associated with musculoskeletal problems of the locomotor apparatus, and non-motor symptoms, that are believed to have a harmful effect on health, social functioning and mobility. The aim of this study was to evaluate depression in patients with Parkinson's Disease (PD) compared to subjects who do not have it. The sample consisted of 124 participants (mean age 69.18 ± 9.12). Patients with PD were recruited from a center of excellence for Parkinson's disease (cases n = 62) and healthy subjects without PD from their relatives and caregivers (control n = 62). The Spanish version of Beck's Depression Inventory (BDI) scores and categories were collected. A clear statistically significant difference (p < 0.05) was evident in the BDI scores between both groups. Parkinson's patients presented worse results on the BDI = 15.48 ± 7.24 points compared to healthy subjects with BDI = 7.03 ± 6.99 points. Regarding BDI categories, there were statistically significant differences (p < 0.001) for the greater BDI categories in the Parkinson's group compared with healthy subjects. The depression represents an important potential risk for increased symptoms and negative impact among patients with PD compared with healthy subjects.

Heart Rate Variability Monitoring during Interferential Current Application in the Lower Back Area: A Cross-Sectional Study.

Vasovagal reactions may occur occasionally during electrical stimulation using interferential current (IFC). The purpose of this study was to examine variations in autonomic activity during the application of IFC in asymptomatic participants by analysis of their heart rate variability (HRV). Seventy-three male volunteers were randomly assigned to a placebo group (n = 36; HRV was documented for 10 min, both at rest and during a placebo intervention) and an intervention group (n = 37; HRV was documented for 10 min in two conditions labelled as (1) rest and (2) application of IFC technique on the lumbar segment). The diameters of the Poincaré plot (SD1, SD2), stress score (SS), and the ratio between sympathetic and parasympathetic activity (S/PS) were measured. After interventions, differences amongst the placebo group and the IFC group were found in SD2 (p < 0.001), SS (p = 0.01) and S/PS ratio (p = 0.003). The IFC technique was associated with increased parasympathetic modulation, which could induce a vasovagal reaction. Monitorization of adverse reactions should be implemented during the application of IFC technique. HRV indicators might have a part in prevention of vasovagal reactions. Further studies in patients with lumbar pain are needed to explore possible differences in HRV responses due to the presence of chronic pain.

Impact of chronic kidney diseases in feet health & quality of life: A case-series study.

PURPOSE: The objective of this study is examine Quality of Life in subjects with chronic kidney disease utilizing Foot Health Status Questionnaire (FHSQ). MATERIAL AND METHODS: 101 subjects with chronic kidney disease (CKD) was studied in specialized clinics, in Extremadura (Spain). An observational descriptive study. The FHSQ was utilized to assess specific foot health (first section) and overall health (second division). The differences between clumps they were assessed using a t-test to independent samples. RESULTS: 59.40% (n = 60) were men and 40.59% (n = 41) women. The mean age was 68.77 ± 14.07. In first division of the FHSQ, a less score was registered in footwear domain (39.25) and in general foot health domain (46.37). In second division, less scores were resulted in general health domain (72) and vigour domain (60.43). CKD women got less scores in every domain. Women with CKD obtained significantly less scores in dimensions of foot pain, foot function, footwear, general foot health, general health and physical activity and there was no difference contrasted with men in the dimensions of social capacity and vigour. CONCLUSIONS: The studied CKD population has problems their feet. Quality of life of CKD subjects is negatively impacted by health of their feet, difficulties with footwear, their overall health, and lack of vitality. Women with CKD show lower values of quality of life contrasted to male patients, associated with inability to perform physical activity, lack of energy and tiredness.

Degree of Impact of Tailor's Bunion on Quality of Life: A Case-Control Study.

Tailor's bunion (TB) disease should be considered one of the foot injuries that causes disability in feet as well as general health. This case-control descriptive study investigated and contrasted the effects of different TB types in a sociodemographic population using the Foot Health Status Questionnaire (FHSQ). A sample of 100 subjects with a mean age of 51.70 ± 17.78 years was recruited and requested to reply to a foot health survey. Results were self-reported. Subjects were scored. Participants with TB type III (TB3) registered lower scores for foot pain, foot function, footwear, and foot health. Physical activity and social capacity had higher scores, and vigor and general health were lower. A Kruskal-Wallis test was used for systematic differences between the FHSQ and different TB types. In all analyses, statistical significance was considered a p-value <0.05 with a 95% confidence interval. Statistically significant differences were found between all domains of the FHSQ and TB, except for the social capacity domain and vigor. The FHSQ is an important measurement tool in TB subjects, showing that factors such as sex, age, and footwear used throughout an individual's life are significantly associated with the development of TB3 and its influence on foot pain and foot health.

Repeatability and Reliability of the Rheumatoid Arthritis Foot Disease Activity Index in Spanish Patients: A Transcultural Adaptation.

Background: The Rheumatoid Arthritis Foot Disease Activity Index (RADAI-F5) questionnaire, based on five questions, is used to assess the severity of rheumatoid arthritis disease in the foot. Nowadays, RADAI-F5 has been validated in different languages; however a Spanish version was lacking. Therefore, the purpose of this research was to translate and validate the Spanish version (RADAI-F5-es). Methods: A cross-cultural translation of the RADAI-F5 questionnaire was performed from English to Spanish. To validate its use, 50 subjects with rheumatoid arthritis who responded to the translated questionnaire two times in an interval of less than 3 months were selected in order to verify the psychometric properties. Results: Excellent agreement between the two versions according to the Cronbach's α was shown. Five domains with regards to arthritis activity in foot joint tenderness and swelling, foot arthritis pain, general foot health and joint stiffness were added together to obtain the total score. Excellent retest reliability was shown for the total score. Test/retest reliability was excellent for joint stiffness on awakening and foot arthritis pain domains. There were no significant differences among any domains (p > 0.05). There were no statistically significant differences (p = 0.000) for the mean ± standard deviations (SD) between pre- and post-tests (98.09 ± 15.42) [93.75-102.43] and 97.96 ± 13.88 [94.5-101.86] points, respectively). Bland-Altman plots or clinically pertinent variations were not statistically significantly different. Conclusions: The RADAI-F5-es is considered a valid and strong tool with adequate repeatability in the Spanish community.

Citation Network Study on the Use of New Technologies in Neurorehabilitation.

New technologies in neurorehabilitation is a wide concept that intends to find solutions for individual and collective needs through technical systems. Analysis through citation networks is used to search scientific literature related to a specific topic. On the one hand, the main countries, institutions, and authors researching this topic have been identified, as well as their evolution over time. On the other hand, the links between the authors, the countries, and the topics under research have been analyzed. The publications analysis was performed through the Web of Science database using the search terms "new technolog*," "neurorehabilitation," "physical therapy*," and "occupational therapy*." The selected interval of publication was from 1992 to December 2020. The results were analyzed using CitNetExplorer software. After a Web of Science search, a total of 454 publications and 135 citation networks were found, 1992 being the first year of publication. An exponential increase was detected from the year 2009. The largest number was detected in 2020. The main areas are rehabilitation and neurosciences and neurology. The most cited article was from Perry et al. in 2007, with a citation index of 460. The analysis of the top 20 most cited articles shows that most approach the use of robotic devices and brain-computer interface systems. In conclusion, the main theme was found to be the use of robotic devices to address neuromuscular rehabilitation goals and brain-computer interfaces and their applications in neurorehabilitation.

The reliability, validity, and sensitivity of the Edmonton Frail Scale (EFS) in older adults with foot disorders.

The Edmonton Frail Scale (EFS) is an index employed to measure alterations related to frailty. The main objective in this research was to develop the EFS short-form (EFS-SF) and to evaluate its validity, reliability, and sensitivity to predict frailty disability outcomes in elderly patients with foot disabilities. RESULTS: Exploratory factor analysis (EFA) of the EFS-SF revealed the presence of three components, as in the original EFA. There were significant differences (p < 0.05) in the study population for several of the EFS and 5-item FRAIL scale indicators. The highest correlation (Pearson R = 0.871; p < 0.001) was found for the first component of the EFS-SF. Finally, the Cronbach alpha was 0.864 which indicated a high level of internal consistency. CONCLUSION: The EFS-SF is a reliable and valid instrument to measure frailty in patients with and without foot disabilities. METHOD: A cross sectional descriptive study was carried out. The study population was aged over 60 years (n = 66) and comprised 29 men and 37 women. Frailty disorders were registered by using the EFS, 5-item FRAIL scale, and the Geriatricians' Clinical Impression of Frailty (GCIF) scale. EFA was employed to locate potential constituents of the EFS, with scores ranging from 0.596 to 0.946 for each of the sub scales: (1) cognitive and general health status; (2) medication and nutrition status; and (3) functional and physiological status, thus revealing that the EFS-SF comprised three components, a reduction compared to the nine in the original EFS.

Understanding Resilience Factors Among Caregivers of People with Alzheimer's Disease in Spain.

INTRODUCTION: Alzheimer's disease (AD) caregivers resilience involves the interaction between different risk and protective factors. Context of care, objective stressors, perceived stressors caregiver assessment, mediators factors and consequences of care were associated with resilience. We have developed a more integrated and operational conceptual model of resilience and care than previous models in our sociocultural environment. PURPOSE: To assess the resilience of caregivers of people with AD and the related factors grouped according to an established operational conceptual model of Alzheimer´s caregivers stress. PATIENTS AND METHODS: A total of 120 primary informal caregivers of AD persons in Badajoz (Spain) were included in a cross-sectional design. The following variables have been measured on AD persons and caregivers: socio-demographic data, dependency level, cognitive decline, neuropsychiatric and behavioral symptoms, anxiety, depression, severity of somatic symptoms, level of burden, self-esteem, coping, social support, health-related quality of life (HRQOL) and resilience. RESULTS: Most of the caregivers reported symptoms of anxiety (63.3%) and depression (62.5%). We found out higher levels of resilience in caregivers with lower dependence caring (p=0.004). Higher resilience levels of caregivers were related to minor depressive (p=0.006) and anxiety symptoms (p=0.000), and higher HRQOL (p=0.000). Coping dimension mostly used was problem-based strategies such as active coping, positive reinterpretation and acceptance (p= 0.000). CONCLUSION: Those caregivers reporting higher levels of resilience exhibited moderate to intense indicators of burden, fewer symptoms of depression and anxiety and fewer somatic symptoms. They also used adequate problem-focused coping strategies, showed higher levels of HRQOL and demonstrated an appropriate perception of social support. Despite the fact that the characteristics relating to the care context and to social support exert an undeniable influence on caregiver resilience, it would appear that the caregiver's own intra-psychic resources reveal stronger correlations. RELEVANCE FOR CLINICAL PRACTICE: The early and accurate identification of caregivers with lower levels of resilience could enable the implementation of vital psychological and educative support interventions to help caregivers to improve their well-being.