Parents of children with disabilities' perceptions regarding the quality of interaction with Health professionals working in early intervention: A qualitative descriptive study.

AIMS AND OBJECTIVES: The aim of this study is to explore the perceptions of parents of children with physical disabilities concerning the quality of their interaction with health professionals in early intervention programs. BACKGROUND: Despite the consensus on the need for Patient and Family-Centered Care, there are still difficulties when executing such care. The quality of interaction among patients, families, and professionals is essential to facilitate the implementation of the programs. DESIGN: A qualitative descriptive study with thematic analysis using a Modified Grounded Theory approach. METHODS: Data were collected through seven focus groups with 28 parents of children with physical disabilities who were undergoing early intervention programs in three centres. The study followed the COREQ guidelines and checklist. RESULTS: Two themes emerged from the experiences: 'exchange of information and education', which included all the activities, procedures, exercises and skills taught by the professionals to help parents care for their child; and 'interpersonal skills', which focused on the way the professional relates with the child and the parents. Several subthemes emerged within each theme. CONCLUSIONS: This study identified which elements of the professional-parent interaction are considered by parents when evaluating the quality of their interaction with the health care provider of their children. RELEVANCE TO CLINICAL PRACTICE: The results of this study bring to light certain behaviours and interactions that health professionals should consider in order to improve the perceptions of parents of children with disabilities regarding the quality of interaction in the context of early childhood intervention. PATIENT OR PUBLIC CONTRIBUTION: Parents contributed to the data collected. Early intervention professionals were involved in participant checking to ensure the rigour of the study.

Mechanical Evaluation of the Resistance of Theraband CLX.

CONTEXT: Calculating the resistance provided by elastic resistance is essential with the aim of adjusting the load and controlling the progression of the exercises in programs using elastic resistance. This study aimed (1) to establish a model of the force elongation for CLX bands; (2) to examine whether these models are altered by different aspects of band elongation: the phase of elongation and shortening (concentric and eccentric phases), the elongation speed, and the initial resting length; and (3) to determine the resistance value for 100% of elongation in each color and to compare it with the values reported by Theraband. DESIGN: Cross-sectional. METHODS: Ten CLX bands of each color were elongated by 2 experienced researchers to establish their elongation force curves in series of 10 repetitions per band using a Smith machine for an anchor, examining whether elongation force models were affected by elongation and shortening phases using one 4-loop CLX band stretched to 100% and at 0.50 m/s, elongation speed stretching two 4-loop CLX bands at 0.50 m/s and at 0.70 m/s, and different starting lengths using 3 CLX bands (2, 3, and 4 loops) stretched at 0.50 m/s. RESULTS: No differences were found in the comparisons between phases, speeds, or different start lengths (mean errors ranged from 0.01 [0.07 N] for the blue band to 2.97 [0.94 N] for the gold band). Our values were higher than the reference values provided by Theraband for all colors, ranging from 2.3% to 33.1%. CONCLUSIONS: Our findings show that the values provided by the brand underestimate the resistance provided by CLX bands. To solve this, regression equations are provided so professionals can calculate the resistance of CLX bands based on their elongation. In addition, these models are not influenced by the phase of elongation and shortening, the elongation speed, and the initial resting length.

Estimating Quadriceps and Hamstrings Strength Through Myoton Among Recreational Athletes.

CONTEXT: The assessment of strength is one of the most usual practices among professionals involved in health care or sport. Quadriceps and hamstrings are the most commonly assessed muscle groups. Generally, the methods used to assess muscle strength are active and, therefore, alternative passive methods could be useful. Myoton provides measures on 3 mechanical properties of the muscle: tone, elasticity, and stiffness. OBJECTIVE: This study aimed to analyze the association of Myoton, an easy-to-use tool not requiring voluntary stimulus from the subject, with strength values in quadriceps and hamstrings. STUDY DESIGN: Experimental. SETTING: University kinesiology laboratory. PARTICIPANTS: Thirty-eight recreational athletes were evaluated. MAIN OUTCOME MEASURES: Anthropometric and demographic data, Myoton-based measures of vastus lateralis, rectus femoris, vastus medialis, biceps femoris, and semitendinosus, and the maximum voluntary isometric contraction of quadriceps and hamstrings. PROCEDURES: The association was examined using multiple regression models to estimate strength through Myoton-based parameters and different patient characteristics. The models encompassed either 2 or 3 independent variables. RESULTS: The adjusted R2 values for predicting quadriceps strength were .666 for rectus femoris, .726 for vastus lateralis, and .667 for vastus medialis, while in regard to hamstrings, they were .617 for biceps femoris and .604 for semitendinosus. CONCLUSIONS: The main finding was that acceptable relationships were found between muscle strength and Myoton-based parameters when variables such as gender and/or age are considered. Our study reveals a new tool for estimating strength with outstanding advantages: it is easy, time-efficient, adaptable, and highly manageable through the feasible equations provided.

The prognosis of pre-frail chronic obstructive pulmonary disease patients for hospitalizations and mortality depends on their level of functional physical performance.

OBJECTIVE: To determine if pre-frail Chronic obstructive pulmonary disease (COPD) patients with poor and non-poor performance in the five-repetition sit-to-stand test (5-STS) had a worse prognosis for hospitalization and mortality at 2 years and for mortality at 5 years than non-frail patients. METHODS: We prospectively included patients with stable COPD, between 40 and 80 years, from a hospital in Spain. Patients were classified according their performance on the 5-STS test and level of frailty. Timing, number of hospitalizations, length of stay, and timing and rate of mortality were outcome measures. Patients were followed for 2 years for exacerbations and for 5 years for mortality. Kaplan-Meier curves and univariate and multivariate Cox proportional-hazard analyses, ANOVA tests and univariate and multivariate linear and logistic regression models were used. RESULTS: Of the 125 patients included, 25.6% were pre-frail with poor performance, 57% pre-frail with non-poor performance, and 17.4% non-frail with non-poor performance. Pre-frail patients with poor performance had a higher number of hospitalizations (adjusted beta: 0.49; 95% CI: 0.01-0.96), mortality rates (odds ratio: 11.33; 95% CI: 1.15-110.81), and risk at 5 years (adjusted hazard ratio: 8.77; 95% CI: 1.02-75.51) than non-frail patients. Pre-frail patients with poor performance also had worse prognoses than non-frail patients with respect to length of hospital stays (increased by 4.16 days) and timing to first hospitalization (HR: 6.01) in unadjusted models, but not when adjusted. CONCLUSION: The COPD prognosis of pre-frail patients with respect to the number of exacerbations with hospitalization and the timing and rate of mortality is dependent of functional performance.

Sex Differences and Patterns of Muscle Stiffness in the Knee Flexor and Extensor Musculature Through Analysis of Isolated Bellies.

ABSTRACT: Martín-San Agustín, R, Benítez-Martínez, JC, Medina-Mirapeix, F, and Casaña-Granell, J. Sex differences and patterns of muscle stiffness in the knee flexor and extensor musculature through analysis of isolated bellies. J Strength Cond Res 35(4): 1044-1049, 2021-Muscle stiffness (MS) is one of the key factors in joint control. The purpose of this study was to determine sex differences in the MS of 5 isolated muscle bellies (biceps femoris [BF], semitendinosus [ST], rectus femoris [RF], vastus medialis [VM], and vastus lateralis [VL]) and in the pattern of differences among their respective MS. Twenty female and 20 male recreational athletes participated. Muscle stiffness was measured by tensiomyography using maximum radial deformation (Dm) as an indirect indicator of MS. Sex differences were observed only in the Dm of RF (mean difference = 2.07 mm, p < 0.05) when values were adjusted by body mass and stature. Males and females showed a similar pattern in the Dm between the muscle bellies: within the hamstrings, ST had a significantly higher Dm than BF in females (3.02 mm) and males (4.28 mm); within the quadriceps, RF also had a significantly higher value than VL and VM in females (6.50 and 7.38 mm, respectively) and males (4.87 and 4.82 mm, respectively). Sex differences in patterns were found between BF and the vastus muscles: the BF of females had a significantly higher Dm than VL (3.78 mm) and VM (4.51 mm), but this was not observed in males. Differences may imply different involvement of the bellies in countering the movements of the lower extremities. Our results can help to direct exercises to improve the MS in certain muscular bellies.

Comparison of Pain Measures Between Tendons of Elite Basketball Players With Different Sonographic Patterns.

CONTEXT: The prevalence and negative consequences of the symptoms surrounding patellar tendinopathy constitute an important problem for sports medicine professionals. The identification of potential pain mediators is, therefore, of major interest to improve both the prevention and management of this injury. OBJECTIVE: To compare the pain experienced by elite male adult basketball players and patterns of patellar tendon abnormalities. Also, to identify whether structural and vascular sonographic abnormalities (focal area of hypoechogenicity, thickening, and neovascularization [NV]) are equal in determining pain perceptions. DESIGN: An observational study with professional basketball teams (ACB-Spanish league). PARTICIPANTS: A total of 73 male basketball players (mean age 26.8 y). MAIN OUTCOME MEASURES: Patellar tendon ultrasonography images. Pain scores were compared between the identified patterns. Multiple regression analysis was used to examine the relative importance of abnormalities. RESULTS: Of the 146 tendons, 91 had some degree of sonographic abnormality. Three main patterns were identified: I (1 structural abnormality without NV), II (2 structural abnormalities without NV), and III (2 structural abnormalities and NV). A total of 31 tendons (21.2%) exhibited pattern I, 46 (31.5%) presented pattern II, and 13 tendons (8.9%) exhibited pattern III. The mean visual analog scale and the Victorian Institute of Sport assessment questionnaire-patellar tendon (VISA-P) scores for pattern III were significantly different (P < .05) compared with patterns I and II; however, the pain pressure threshold (PPT) scores were not. NV was significantly associated with worsened scores for all pain measures; however, the focal area of hypoechogenicity was only associated with PPT scores. CONCLUSION: Patterns of sonographic abnormalities, including NV, demonstrated greater pain. Although NV determined scores for the visual analog scale, VISA-P, and PPT, the presence of focal area of hypoechogenicity on its own is a determining factor for the PPT. This study suggests that the combination of 2 or more sonographic abnormalities may help explain pain variations among basketball players.

Sex Differences in the Velocity of Muscle Contraction of the Hamstring and Quadriceps Among Recreationally Active Young Adults.

Martín-San Agustín, R, Medina-Mirapeix, F, Alakhdar, Y, and Benítez-Martínez, JC. Sex differences in the velocity of muscle contraction of the hamstring and quadriceps among recreationally active young adults. J Strength Cond Res 33(5): 1252-1257, 2019-This study determines sex differences in the velocity of contraction (VC) of 5 isolated muscles (biceps femoris, semitendinosus, rectus femoris, vastus medialis, and vastus lateralis) and in the relationships between them. Thirty-six female and 34 male recreationally active young adults participated in the study. The VC was measured by tensiomyography using normalized response velocity (Vrn) to perform comparisons. Sex comparisons were adjusted by height and mass. The study of relationships was carried out by comparing and calculating means and ratios. Sex differences were observed in the VC of rectus femoris (mean difference = 6.20 mm·s; p < 0.001). Conversely, the biceps femoris only showed sex differences in the unadjusted analysis (mean difference = 6.66 mm·s; p = 0.002; d = 0.73. Both sexes showed lower VC values of the hamstring with respect to the quadriceps. Female participants showed differences greater than 15% relative to male participants between biceps femoris and quadriceps ratios and in ratios in the hamstring. Thus, our findings in the VC ratios indicate different mechanical contractile properties between sexes in the relations between the hamstring and quadriceps. Our analysis of the VC at these muscles supposes a new possibility to establish the relationships between knee agonists and antagonists, which allow monitoring the changes in the balance of the VC among the muscle groups.

An Optoelectronic System for Measuring the Range of Motion in Healthy Volunteers: A Cross-Sectional Study.

Background and Objectives: Within the clinical evaluation of multiple pathologies of the lower limb, the measurement of range of motion (ROM) of its joints is fundamental. To this end, there are various tools, from the goniometer as a reference to more recent devices such as inclinometry-based applications, photo capture applications, or motion capture systems. This study aimed to assess the validity, intra-rater, and inter-rater reliability of the VeloFlex system (VS), which is a new camera-based tool designed for tracking joint trajectories and measuring joint ROM. Materials and Methods: Thirty-five healthy volunteers (16 females; aged 18-61 years) participated in this study. All participants were assessed on two separate occasions, one week apart. During the first assessment session, measurements were obtained using a goniometer and the VS, whereas, in the second session, only the VS was used. In each assessment session, nine active movements were examined. For each movement, three trials were tested, and the mean of these three measures was used for analysis. To evaluate the concurrent validity and agreement, the Pearson correlation coefficient (r) and Bland-Altmann plots were used. Intra-rater and inter-rater reliability were evaluated using intra-class correlation (ICC), standard error of measurement (SEM), and minimal detectable change (MDC). Results: Both devices showed excellent correlations for all movements (r ranged from 0.992 to 0.999). The intra-rater reliability of the VS was excellent (ICC ranged from 0.93 to 0.99), SEMs ranged from 0.53% to 2.61% and the MDC ranged from 0.68° to 3.26°. The inter-rater reliability of the VS was also excellent (ICC ranged from 0.88 to 0.98), SEMs ranged from 0.81% to 4.76% and the MDC ranged from 2.27° to 4.42°. Conclusions: The VS is a valid and reliable tool for the measurement of ROM of lower limb joints in healthy subjects.

Development and Pilot Test of a New Set of Good Practice Indicators for Chronic Nonmalignant Pain Management.

OBJECTIVES: This study was designed to address the current relative void of valid measures by developing evidence-based quality indicators for pain management of chronic nonmalignant pain. METHODS: We performed a 10-year literature search to identify guidelines and review articles on chronic pain management to identify evidence-based recommendations for the different conditions associated to chronic pain. A complementary search of indicators and indicator-related articles was also performed. Then, we built new indicators or adapted existing ones to cover all the evidence-based recommendations we found. The resulting set was pilot tested for feasibility, reliability (kappa), and usefulness to identify quality problems, using the Lot Quality Acceptance method (α ≤ 0.05 and ß ≤ 0.01) for 75% (40% threshold) and 95% (70% threshold) compliance standards, and estimates with binomial exact 95% confidence intervals. We reviewed clinical records from a primary care center, a medium-size hospital (250 beds), and a large hospital (500 beds). RESULTS: Forty-six indicators were developed (6 general and 40 condition specific). Thirty-three were feasible in primary care and/or hospitals. Feasible indicators were also reliable (most kappa > 0.7). Regarding compliance, 4 quality indicators obtained compliance levels over 60%, addressing pharmacological treatment, multimodal approach, and appropriate use of neuro-image tests, while 16 obtained compliance scores under 15% (6 with 0% compliance). CONCLUSIONS: The created set has tested to be feasible, reliable, and useful, with the capacity to serve as the baseline for developing the necessary strategies to improve the management of chronic nonmalignant pain, by monitoring and evaluating quality of care.

Physical frailty characteristics have a differential impact on symptoms as measured by the CAT score: an observational study.

BACKGROUND: The physical frailty status affects the health status of patients with chronic obstructive pulmonary disease (COPD). The objective was to determine if the individual physical frailty characteristics have a differential impact on the CAT score. METHODS: This observational study included 137 patients with stable COPD. Physical frailty was measured with unintentional weight loss, low physical activity, exhaustion, slow walking speed and low grip strength and health status assessed with the COPD Assessment test (CAT). The following variables were evaluated as potential determinants of CAT: sex, age, body mass index, smoking, dyspnea, exacerbations, comorbidities, %FEV1, %FVC, anxiety and depression. RESULTS: The prevalence of characteristics for individual frailty was as follows: low grip strength, 60.6%; low physical activity, 27.0%; exhaustion, 19.7%; slow walking speed, 9.5%; and unintentional weight loss, 7.3%. A total of 17.5% of the patients were non-frail, 73.7% were pre-frail and only 8.7% were frail. One of the five frailty characteristics, exhaustion (adjusted ß coefficient 5.12 [standard error = 1.27], p = 0.001) was an independent determinant of CAT score in the final regression model which was adjusted by other independent determinants of CAT (dyspnea, exacerbations and anxiety). CONCLUSIONS: Due to the fact that exhaustion is a frequent and relevant psychological symptom on CAT score of patients with COPD, interventions should reduce that stress. Future research should explore how exhaustion persists or remits over time.

Patterns and predictors of exhaustion episodes in patients with stable COPD: A longitudinal study.

BACKGROUND AND OBJECTIVE: Exhaustion is the perception of low energy. Little is known about how exhaustion persists, remits or reappears over time in patients with chronic obstructive pulmonary disease (COPD) or how to predict these events. We determined the likelihood of transitions between states of exhaustion and no exhaustion among patients with stable COPD followed up for 2 years. We investigated combinations of potential factors for their abilities to predict new-onset exhaustion episodes. METHODS: We prospectively included 137 patients with stable COPD (mean age, 66.9 years ± 8.3). Exhaustion states were measured at baseline and 1 and 2 years later. Exhaustion was defined as an answer of "most of the time" or "a moderate amount of time" to 1 of 2 questions: "How often have you found it hard to get going?" and "How often does everything seem to require effort?" We evaluated demographic, non-respiratory and respiratory variables as potential predictors. The likelihoods of new episodes and recovery were calculated. Predictors were evaluated with generalised estimating equations. RESULTS: At baseline, 27 patients (19.7%) displayed exhaustion. Of the 110 patients without exhaustion at baseline, 17 (15.5%) displayed exhaustion at least once during the follow-up period. During the study period, a total of 204 annual transitions displaying no exhaustion at the beginning were identified. Of them, 10.3% transitioned to exhaustion in the next year. The likelihood of recovery after exhaustion was 50%. Independent predictors of new-onset exhaustion episodes within the following year were: the COPD assessment test score (odds ratio [OR] = 1.10; 95% confidence interval [CI] 1.01-1.21), depression (OR = 6.89; 95% CI: 1.00-47.41) and female gender (OR = 6.88; 95% CI: 1.83-25.73). CONCLUSIONS: Patients in stable COPD with high CAT scores and depression were most likely to experience new-onset exhaustion episodes Thus, exhaustion might be predicted by a combination of psychological factors and respiratory health status. Nevertheless, exhaustion is dynamic in COPD; half of patients recover from exhaustion.

Quantitative Muscle Ultrasonography Using Textural Analysis in Amyotrophic Lateral Sclerosis.

The purpose of this study was to analyze differences in gray-level co-occurrence matrix (GLCM) parameters, as assessed by muscle ultrasound (MUS), between amyotrophic lateral sclerosis (ALS) patients and healthy controls, and to compare the diagnostic accuracy of these GLCM parameters with first-order MUS parameters (echointensity [EI], echovariation [EV], and muscle thickness [MTh]) in different muscle groups. Twenty-six patients with ALS and 26 healthy subjects underwent bilateral and transverse ultrasound of the biceps/brachialis, forearm flexor, quadriceps femoris, and tibialis anterior muscle groups. MTh was measured with electronic calipers, and EI, EV, and GLCM were obtained using Image J (v.1.48) software. Sensitivity, specificity, likelihood ratios, and area under the curve (AUC) were performed by logistic regression models and receiver operating characteristic curves. GLCM parameters showed reduced granularity in the muscles of ALS patients compared with the controls. Regarding the discrimination capacity, the best single diagnostic parameter in forearm flexors and quadriceps was GLCM and in biceps brachialis and tibialis anterior was EV. The respective combination of these two parameters with MTh resulted in the best AUC (over 90% in all muscle groups and close to the maximum combination model). The use of new textural parameters (EV and GLCM) combined with usual quantitative MUS variables is a promising biomarker in ALS.

Interobserver Reliability of Peripheral Muscle Strength Tests and Short Physical Performance Battery in Patients With Chronic Obstructive Pulmonary Disease: A Prospective Observational Study.

OBJECTIVE: To evaluate the interobserver reliability of the Short Physical Performance Battery (SPPB) and hand dynamometry when measuring isometric muscle strength in people with chronic obstructive pulmonary disease (COPD). DESIGN: Reliability study. Each patient was assessed by a pulmonology physician and a physical therapist in 2 separate sessions 7 to 14 days apart (mean, 9.8±0.8d). Each rater was blinded to the other's results. SETTING: Pneumology unit of a public hospital. PARTICIPANTS: Random sample of outpatients with stable COPD (N=30). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: SPPB and muscle strength (kg) using electronic handgrip and handheld dynamometers. Reliability was assessed with intraclass correlation coefficients (ICCs), standard error of measurement values, and Bland-Altman plots. ICCs were calculated for the SPPB summary score and for its 3 subscales. RESULTS: The ICCs for the overall reliability of the SPPB summary score and for grip and quadriceps strength were .82 (95% confidence interval [CI], .62-.91), .97 (95% CI, .93-.98), and .76 (95% CI, .49-.88), respectively. The standard error of measurement values were .55 points, 1.30kg, and 1.22kg, respectively. The mean differences between the rater's scores were near zero for grip strength and SPPB summary score measures. The ICCs for the SPPB subscales were .84 (95% CI, .66-.92) for the chair subscale, .75 (95% CI, .48-.88) for gait, and .33 (95% CI, -.42 to .68) for balance. CONCLUSIONS: Interobserver reliability was good for quadriceps and handgrip dynamometry and for the SPPB summary score and its chair stand and gait speed subscales. Both pulmonary physicians and physical therapists can obtain and exchange the scores. Because the reliability of the balance subscale was questionable, it is better to use the SPPB summary score.

Development and initial psychometric evaluation of the Mobility Activities Measure for Inpatient Rehabilitation Settings (Mobam-in).

OBJECTIVE: To describe the development and the initial psychometric evaluation of a mobility measure for inpatient postacute rehabilitation settings­the Mobility Activities Measure for Inpatient Rehabilitation Settings (Mobam-in). DESIGN: Self-report-based psychometric study. SETTING: Postacute rehabilitation unit of a public hospital. PARTICIPANTS: A consecutive sample of inpatients (N=239) receiving postacute rehabilitation care. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We developed a 30-item mobility measure, using the Mobility Activities Measure (Mobam) framework, to assess functioning across 5 mobility activity domains classified within the International Classification of Functioning, Disability and Health. These were (1) changing and maintaining body position involving only sitting and/or lying (4 items); (2) changing and maintaining body position involving standing up (6 items); (3) carrying and moving objects using the hand and shoulder (6 items); (4) handling objects using only the hand and/or forearm (7 items); and (5) walking and moving (7 items). Psychometric analyses were conducted to test assumptions underlying the scaling and scoring of Mobam-in scales, and to test both the reliability and validity. RESULTS: Multitrait scaling and confirmatory factor analyses (with Tucker-Lewis Index median, .99; root mean square error of approximation median, .025) supported the assumption of unidimensionality concerning each domain. Five dimensions appeared to be stable across diverse diagnostic groups (the percentage of items with discriminant validity ranged from 93% to 100%, Cronbach coefficient ranged from .859 to .966). Rasch model (Masters' partial credit) showed that all items could be located along a continuum in each dimension, with goodness-of-fit criteria of infit and outfit mean-square values between 0.6 and 1.4. Test-retest reliability was excellent (intraclass correlation coefficients median, .98). Groups with more severe conditions and lower functional independence scored lower on Mobam-in scales, as hypothesized. CONCLUSIONS: Mobam-in covers 5 dimensions of mobility activities. The Mobam framework is an effective reference for building outcome instruments.

Measuring and describing perceived quality on physiotherapy practice management software.

INTRODUCTION: Despite the growing trend in the use of digital technologies in physiotherapy, the overall adoption and satisfaction of both, practice management software (PMS) and electronic health records in physiotherapy clinics has been low and slow over time. Satisfaction of expectations or perceived quality (PQ) is an abstract construct based on the discrepancy between expectations and perceptions, to measure the satisfaction of physiotherapists on PMS. This study aims to develop and validate an instrument to measure PQ on PMS, and to describe the PQ of the currently available physiotherapy PMS. METHODS: Instrument development study with validity and reliability testing. The development of this questionnaire was conducted in 3 phases: identification of attributes to be explored; development of the item pairs and pretesting; pilot study for item reduction, and psychometric testing. The questionnaire was distributed to chartered physiotherapists. A total of 144 participants completed the questionnaire. RESULTS: A series of analyses were conducted to assess item reduction, factor structure of the questionnaire and metric properties of multi-item scales. From the initial 43 attributes, the final version of the Quality Questionnaire on Physiotherapy Practice Management Software consisted of 24 items of PQ on PMS, structured in 3 areas (clinical care, administrative activities, and accounting), which included 11, 9, and 4 items grouped into 4, 3, and 2 scales respectively. The questionnaire proved to be reliable and valid. In multitrait scaling analysis, all scores had strong item-scale correlations, excellent item scaling success, and good internal consistency (Cronbach alpha coefficients of >0.7). CONCLUSIONS: Our study provides a valuable PQ questionnaire on PMS attributes for clinical care, administrative activities, and accounting. The attributes related to clinical care and control stock supplies showed a worse PQ. This suggests that those functions related to clinical care should be improved to facilitate greater satisfaction with physiotherapy PMS.

Identifying COPD patients with poor health status and low exercise tolerance through the five-repetition sit-to-stand test and modified Medical Research Council Dyspnea Score.

BACKGROUND: The objective of this study was to determine whether the concomitant presence of poor health status (COPD Assessment Test, CAT ≥ 10 points) and low exercise tolerance (6-Minute Walking Test, 6MWT < 350 m) is associated with worse clinical characteristics in patients with COPD. In addition, we aimed to develop a readily applicable diagnostic model to discriminate COPD patients with these conditions. METHODS: A cross-sectional multicenter study involving 208 stable COPD patients (FEV1/FVC < 0.7, smoking history of at least 10 pack-years, and chronic respiratory symptoms) was carried out. The outcome measures were the 6MWT, CAT score, 5-repetition sit-to-stand test (5STS) and modified Medical Research Council Dyspnea Scale (mMRC). Patients were categorized into three groups: no condition (6MWT ≥ 350 m and CAT < 10 points), one condition (6MWT < 350 m or CAT ≥ 10 points), and both conditions (6MWT < 350 m and CAT ≥ 10 points). RESULTS: A total of 26 patients (12,5%) presented both conditions. These patients experienced a higher degree of dyspnea (p = 0.001), smoking pack-years (p = 0.011), severe obstruction (p = 0.006), and time on 5STS (p = 0.001). The probability of having both conditions directly increased with the time spent on the 5STS (ß=0.188; p = 0.010) and the degree of dyspnea (ß=1.920; p < 0.001) (R2=0.413). The scoring system, using the 5STS and dyspnea as surrogate measures, demonstrated adequate calibration between the predicted and observed risk (linear R2=0.852). CONCLUSIONS: COPD patients with concurrent conditions have worse clinical status. The diagnostic model developed to discriminate these patients shows good internal validation.

Safety and Effectiveness of Percutaneous Ultrasound-Guided Galvanic Current in Tunnels of Patients with Hidradenitis Suppurativa: A Pilot Study.

INTRODUCTION: The recurrent nature of hidradenitis suppurativa (HS), even under maintained systemic treatment, makes it necessary to have effective local treatments; however, the response to these therapies is variable (44-81%). The application of galvanic current (GC) has demonstrated its utility in humans in treating lesions structurally similar to those of HS. With this background, the main objective of this study was to evaluate the efficacy and safety of ultrasound-guided percutaneous GC in inflamed and/or draining tunnels of HS. METHODS: This was an open study (one-way repeated measures design over time). Patients were evaluated at 4 and 12 weeks after receiving GC. A combined clinical response at week 12 (absence of suppuration/inflammation on examination and clinical interview) was considered the principal variable of efficacy. Adverse effects potentially associated with GC were reported by telephone and at each visit. RESULTS: Twenty-six patients were included, with a male/female ratio of 5:8. The mean age was 35.84 (13.14) years. At 12 weeks after the administration of GC, a complete response was achieved in 77% (20/26) of the treated lesions. No serious adverse effects were observed, and the mean procedural pain assessed by the numeric rating scale was 0.03 (0.2). CONCLUSION: GC has proven to be effective and well tolerated in inflamed and draining tunnels of patients with HS.

Five-Repetition Sit-to-Stand Test as Predictor of Mortality in High Risk COPD Patients.

OBJECTIVE: To determine if adding performance on the five-repetition sit-to-stand test (5-STS) to chronic obstructive pulmonary disease (COPD) high-risk criteria, proposed by the Spanish COPD guidelines (GesEPOC), affects mortality prognosis. METHODS: Observational study of COPD outpatients involved prospective follow-up for 5 years. Patients were classified based on 5-STS performance and risk criteria proposed by GesEPOC version 2021. Outcome measures were 5-year mortality timing and rate. Kaplan-Meier curves and univariate and multivariate Cox proportional-hazard analyses, analysis of variance, and univariate and multivariate linear and logistic regression models were used. RESULTS: One hundred and thirty-seven patients were included. Mean age was 66±8.3 years, and 87.6% were men. Of them, 115 (83.9%) were classified as high risk, 43 (34.4%) of whom had poor performance on the 5-STS. Overall mortality at 5 years was 27% and was significantly higher in the high-risk (29.6%) compared with the low-risk (13.6%) group. Among high-risk patients, mortality at 5 years was significantly worse with poor 5-STS performance (60.5%) compared with non-poor performance (11.1%). Poor performance on the 5-STS was independently associated with increased 5-year mortality risk (HR 4.70; 95% CI: 1.96-11.27) in a model adjusted for history of heart disease and dyspnea. CONCLUSION: Among high-risk COPD patients, those with poor performance on the 5-STS have a significantly higher mortality at 5 years than those with non-poor 5-STS performance.

Determination of Five Sit-to-Stand Test Performance at Discharge of Stroke Patients.

The early identification of performance in the five-repetition sit-to-stand test (5-STS) at discharge in stroke patients could be of interest because it can determine independence for community-based activities. This study aimed to determine whether the initial measurement of the 5-STS test can be a determinant of the performance level prediction and amount of change in the 5-STS test at discharge in stroke patients. A prospective cohort study was conducted with a sample of 56 patients aged ≤60 d post-stroke. The 5-STS test results, as well as changes in patient condition, were measured at admission (T0) to an outpatient rehabilitation program, after the first month (T1), and at discharge (T2). The mean age was 62.7 (SD = 13.0), 58.9% of the subjects were male, and 75% had suffered an ischemic stroke. A multivariate linear regression model using the 5-STS test at T0 explained 57.7% of the variance in the performance at discharge. Using the 5-STS at T1 increased the variance to 75.5% (p < 0.001). Only the time from stroke onset at T0 significantly contributed to the two models. The measurement of the 5-STS at T0 and the amount of change in its performance at T2 explained 60.2% (p < 0.001) of the variance, while reassessment at T1 explained only 19.3% (p < 0.001). The level of patient performance on the 5-STS test at discharge, as well as any potential change, can be predicted by the admission measure of 5-STS in stroke patients.

How the rehabilitation environment influences patient perception of service quality: a qualitative study.

OBJECTIVE: To identify elements of the environment that patients consider when evaluating the quality of a care experience in outpatient rehabilitation settings. DESIGN: A qualitative study using a modified grounded theory approach. Data collection used semistructured interviewing during 9 focus groups. SETTING: Three postacute ambulatory centers in metropolitan areas. PARTICIPANTS: Adults (N=57; 33 men, 24 women) undergoing outpatient rehabilitation for musculoskeletal conditions/injuries. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Not applicable. RESULTS: Participants perceived the quality of rehabilitation service on the basis of their experiences with environmental factors, including 3 physical factors (facility design, ambient conditions, and social factors) and 4 organizational factors (duration of attendance, interruptions during delivery of care, waiting times in the sequence of treatment, and patient safety). CONCLUSIONS: This study identifies the specific environmental attributes that patients consider important when evaluating the quality of outpatient rehabilitation settings and develops a patient-based framework for assessing the overall perception of service quality. Further research should work to develop self-report questionnaires about patient experiences with the environment in rehabilitation services to provide empirical and quantitative evidence.