Association of kinesiophobia with pain, disability and functional limitation in adults with knee osteoarthritis: A systematic review and meta-analysis.

Knee osteoarthritis (KOA) is a prevalent degenerative joint disease associated with pain, disability, and functional limitations. Kinesiophobia, the fear of movement, has been linked to disability and pain in KOA patients. This study aimed to analyze the relationship between kinesiophobia and symptoms of KOA. A comprehensive literature search was conducted in four electronic databases (PubMed/Medline, Web of Science, Scopus and Science Direct) with the following inclusion criteria: 1) recruited participants with diagnostic of knee osteoarthritis; 2) measures of pain, disability and/or functional limitation through questionnaires or physical tests; 3) articles exploring the correlation between kinesiophobia, and pain, disability, and/or functional limitation as principal or secondary outcome; 4) primary data studies (observational and experimental). A total of 17 studies involving 1,574 participants (mean age 61.04 ± 5.79 years) were included in the corresponding meta-analyses. Results showed a moderate correlation between kinesiophobia and disability (r = 0.519; p-value=0.004), and fair correlations of kinesiophobia with pain (r = 0.362; p-value<0.001), and functional limitation (r = 0.270; p-value<0.001). Despite high heterogeneity (I2: 89.4% for pain, 94.6% for disability, and 90.4% for functional limitation), 52% of studies displayed low risk of bias. In conclusion, kinesiophobia positively correlates with pain, disability, and functional limitation in KOA patients.

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.

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.

Wishes and perceptions about exercise programs in exercising institutionalized older adults living in long-term care institutions: A qualitative study.

The level of exercise among older adults is low, particularly among those living in health-care institutions. To gain insight into the perceptions of institutionalized older adults towards the exercise programs developed in long-term care institutions and to identify their wishes and needs regarding these programs, we conducted a qualitative study using focus group discussions. Thirty-six institutionalized participants (≥ 65 years) were recruited. Six common themes emerged: participants' attitudes and motivations towards the exercise programs, self-perceived health, knowledge of the concept of physical exercise, perceived effects of the exercise programs, and wishes or expectations for the exercise programs. The main wishes were to increase frequency of exercise sessions, to exercise outdoor and to increase walking times. The results suggest the need for changes in the development of exercise programs, including changes in the frequency, performance environment and types of exercises performed.

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.

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.

Gait speed in knee osteoarthritis: A simple 10-meter walk test predicts the distance covered in the 6-minute walk test.

BACKGROUND: The 6-Minute Walk Test (6MWT) is a common performance-measure in Knee Osteoarthritis (KOA), but the pain and functional impairment characterizing the condition may interfere its adequate performance. OBJECTIVES: The shorter 10-m Walk Test (10mWT) could predict the distance performed on the 6MWT, therefore decreasing the burden on patients, enhancing efficiency, and reducing space- and time-constraints in clinical settings. DESIGN: A cross sectional study was conducted. METHODS: The scores from the 6MWT and the shorter 10mWT of 58 ambulatory subjects with KOA were compared. Correlation, and a univariate regression analysis to explore the predictive ability of the 10mWT, were calculated. RESULTS: Correlation was excellent (r = 0.913, p-value<0.001), and the predictive equation based on the 10mWT scores (R2 = 0.834, p-value<0.001) estimates the distance walked in the 6MWT with a relative error of 7.62%. CONCLUSIONS: The 10mWT may be an excellent assessment-tool to predict the distance walked in the 6MWT, due to its low strain on patients and as a means of improving efficiency and reducing time-constraints.

The effects of combined transcranial direct Current stimulation with physiotherapy for physical function in subjects with knee osteoarthritis: a systematic review and meta-analysis.

BACKGROUND: Transcranial Direct Current Stimulation (tDCS) emerges as a promising therapeutic intervention for knee osteoarthritis (KOA), yet its impact on physical function remains insufficiently explored. OBJECTIVES: To evaluate the relative effects of tDCS for physical function in patients with KOA. METHODS: Pubmed, Web of Science, Scopus and Cochrane Database were explored as of August 2023 to identify studies to be included in the current systematic review and metaanalysis. Randomized controlled trials in patients with KOA comparing tDCS with placebo were included. The outcomes defined were measures of physical function (questionnaires, gait, or physical performance). The Risk of Bias tool was used to assess bias in the randomized controlled trials, whereas the PEDro scale was applied for methodological quality, and the certainty of evidence for each outcome was assessed through GRADE. Results for each outcome were synthesized using meta-analysis (random-effects model, I2-test for heterogeneity) and a subgroup analysis was performed to improve the sensitivity of the results and to explore potential moderating factors of the effect sizes. RESULTS: Ten studies with good to excellent quality were included, analyzing a total of 628 participants. Regarding physical function, tDCS showed a favorable effect (ES: -0.58; 95%CI -0.82, -0.33; I2: 52.1%) with a low risk of bias and low to moderate certainty of evidence. The concurrent application of physiotherapy interventions and tDCS improved the effects on pain and function. Applying physiotherapy interventions, as well as adding peripheral currents, increased the effect sizes (ES: -0.95, k = 3, p = .018; ES: -0.95, k = 4 p = .001, respectively). The pattern of application of the tDCS, either daily or in alternate days, did not moderate the effect size (p = .619). Meta-regression revealed that the number of tDCS sessions did not moderate the effect size either (p = .242). CONCLUSION: The tDCS might be a promising therapeutic approach to enhance physical function in subjects affected with KOA. However, further systematic reviews with meta-analyses should be performed with standardized and proven-efficacy physiotherapy programs, as well as with long-term results, to ascertain whether the improvement may be sustained over time. This study provides valuable insights into optimizing tDCS interventions for enhanced outcomes in the management of KOA.Protocol available via PROSPERO [CRD42023440676].

Movement-evoked pain is not associated with pain at rest or physical function in knee osteoarthritis.

INTRODUCTION: Knee Osteoarthritis (KOA) is mainly characterized by pain. The assessment of KOA-related pain frequently focuses on different constructs subject to sources of bias or drawbacks, as the classical Pain at Rest (PAR). Movement-evoked pain (MEP), recently defined as 'pain during walking', emerges as a differential concept, since PAR and MEP are driven by different underlying mechanisms. Given the novelty of the MEP approach, its association with PAR or with different performance-based tests has not been studied in KOA yet. MATERIALS AND METHODS: A cross sectional study was conducted. PAR was measured, alongside the performance of four mobility tests and their corresponding MEP: Timed Up and Go Test, 10-metre Walk Test, 2-Minute Walk Test, and 6-Minute Walk Test. Association and agreement were explored for MEP versus PAR, while the correlation of the tests versus each corresponding MEP-measure was assessed. RESULTS: Neither association nor agreement were found in the duality MEP versus PAR. Also, the lack of association between the performance of a mobility test and the perceived level of pain during the development of the test was stated. CONCLUSION: Movement-evoked pain is neither related to pain at rest nor to functional performance in subjects affected by knee osteoarthritis. The results from our study suggest that MEP and pain at rest measure and refer to different constructs in knee osteoarthritis. The implementation of MEP as an outcome in exercise-therapy could enhance the tracking of results, as well as the development of tailored interventions under different conditions. SIGNIFICANCE: This research elucidates the relevance of MEP, recently defined as 'pain during walking', through the analysis of its association with PAR and with functional performance (measured through four mobility tests) in knee osteoarthritis. The results from our study highlight the absence of either association or agreement between MEP and PAR, fact that supports and endorses the idea that both concepts measure and refer to different constructs in knee osteoarthritis.

The Efficacy of the Addition of tDCS and TENS to an Education and Exercise Program in Subjects with Knee Osteoarthritis: A Randomized Controlled Trial.

Knee osteoarthritis (KOA) has a significant impact on patients' quality of life. This study aimed to assess the effectiveness of integrating transcranial direct current stimulation (tDCS) and transcutaneous electrical nerve stimulation (TENS) into an education and exercise program with the aim of decreasing pain and improving physical function in KOA. A randomized controlled trial with 65 KOA patients was conducted. The subjects were assigned to one of the following three groups: education and active exercise plus (1) double active tDCS and TENS, (2) active tDCS and sham TENS, and (3) double sham tDCS and TENS. Sessions were conducted over a 20 min period, whilst data on pain, chronic pain clinical variables, and physical function were collected. Although all groups showed improvement in pain-related symptoms in the short and medium term, the addition of tDCS and/or TENS did not significantly enhance the benefits of the exercise and education program. These findings suggest that an education and active exercise program in the treatment of KOA has a positive effect on pain, with or without the addition of tDCS and/or TENS.

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.

What elements of the informational, management, and relational continuity are associated with patient satisfaction with rehabilitation care and global rating change?

OBJECTIVE: To describe the quality of patients' continuity experiences in a population of outpatients receiving postacute rehabilitation care, and to check which elements and types of continuity most strongly determine their satisfaction with care and functional changes. DESIGN: Cross-sectional self-report survey. SETTING: Three postacute ambulatory centers in metropolitan areas. PARTICIPANTS: Outpatients (N=218; mean age ± SD, 38.5±11.7y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The questionnaire included experiences regarding aspects of informational (transference of information, accumulated knowledge), management (consistency and flexibility of care), and relational (established relation and consistency of provider) continuity, as well as questions concerning patients' sociodemographic characteristics, satisfaction with care, and global rating change. RESULTS: Respondents indicated more problems in terms of management and relational continuity than in informational continuity. For all patient groups, experiences regarding elements of management continuity (R(2)=15.3%-22.4%), followed by relational continuity (R(2)=14.3%-25.2%), explained most of the variance of satisfaction. Consistency and flexibility of care, together with an established relation, were the most determining elements of satisfaction. Experiences regarding elements of management continuity explained most of the variance of change (18.5%), and flexibility was the most decisive element. CONCLUSIONS: Patient satisfaction and functional changes are related with experiences in aspects of management continuity, where there is room for improvement. Measures of management continuity may be promising as indicators of continuity, and they should be prioritized.

The pain attitudes and beliefs scale for physiotherapists: development and psychometric assessment of the Spanish version among physiotherapy students.

INTRODUCTION: Pain might be approached from a biomedical or biopsychosocial perspective. There is a lack of research on the attitudes and beliefs about pain among physiotherapy students. In this context, the Pain Attitudes and Belief Scale for Physiotherapists (PABS-PT) is an instrument widely used from a clinical and educational perspective, but its psychometric properties have not yet been tested in a student-based population. OBJECTIVE: To develop the Spanish version of the PABS-PT scale and to assess its psychometric properties among students in physiotherapy. METHODS: The study was carried out among 103 students in their final years of academic studies in the Degree in Physiotherapy in the University of Murcia (Spain). Sociodemographic and PABS-PT related variables were collected. The instrument was translated into Spanish and tested through factor analysis, internal consistency, test-retest reliability, and known-groups validity. The 95% minimal detectable change of the instrument was also calculated. RESULTS: The factor analysis revealed two factors within the instrument: Biomedical (9 items) and Biopsychosocial (7 items) factors, with Cronbach's alpha values of 0.730 and 0.708, respectively. The Intraclass Correlation Coefficient (3,2) was 0.851 for the Biomedical factor and 0.699 for the Biopsychosocial factor. The minimal detectable changes (95% CI) for the Biomedical and Biopsychosocial factors were 6.01 and 5.56, respectively. The pre-specified hypothesis for the known-groups validity test was met and revealed large effect sizes (d = 1.24). CONCLUSION: The Spanish version of the instrument PABS-PT-SP covers two factors. It shows satisfactory psychometric properties and it is therefore an effective framework to discriminate between the biomedical and/or biopsychosocial thoughts and attitudes toward pain in physiotherapy.

Older persons' expressed perceptions on exercise programs in long-term care institutions: Influence of professionals and institutions.

OBJECTIVE: To explore the perceptions of institutionalised older people about the professionals and institutions regarding exercise programs in long-term care institutions DESIGN, SETTING, AND PARTICIPANTS: A qualitative study was carried out using focus group discussions. Forty-seven institutionalised participants (≥ 65 years old) with a score of > 23 in the Mini-Mental State Examination (MMSE) were recruited. RESULTS: Most participants believed that the frequency of the exercise sessions could be increased by enhancing the number of staff assisting them and by adapting the facilities to their needs. They also suggested using outdoor spaces and avoiding childish activities and treatment. Participants' beliefs were grouped into three major themes (i) Perceptions about the health professionals delivering the exercise programs (ii) Perceptions about the institution or centre regarding exercise programs; (iii) Perceptions about the exercise programs. CONCLUSION: Participants proposed certain changes that could take place in the institutions to promote engagement with exercise programs: tailored exercise programs, avoiding puerile treatment, increasing the number of staff members, and the creation of well-equipped spaces to perform the exercise. PRACTICAL IMPLICATIONS: Professionals should spend time designing tailored exercise programs and avoid puerile treatment. Institutions must review the need for spaces and the personnel assigned.

Concurrent validity of the 2-and 6-minute walk test in knee osteoarthritis.

BACKGROUND: The 6-Minute Walk Test (6MWT) is frequently used for the assessment of walking distances in several conditions, as knee osteoarthritis, but it can be both time-consuming for the researcher or clinician, and exhausting of painful for the subject suffering from this condition. The objective of our study was to analyze the concurrent validity of the 2-Minute Walk Test (2MWT) for patients with knee osteoarthritis compared to the 6-Minute Walk Test (6MWT). METHODS: Cross-sectional validation study. Scores from the 6MWT of 42 ambulatory patients affected by knee osteoarthritis were compared to those from the shorter 2MWT. An initial correlation test was used to assess correlation between both measures, and a subsequent univariate regression analysis was performed with the aim of comparing the estimated outcomes of the 6MWT versus the actual 6MWT. RESULTS: The scores from the 2MWT and 6MWT showed excellent correlation (Pearson's correlation coefficient r = 0.976; p-value < 0.001); the predictive equation based on the scores from the 2MWT (R2 = 0.952, p-value < 0.001) estimates the 6MWT scores with a relative error of 3.23%. CONCLUSIONS: The 2MWT may be a practical assessment tool in replacement for the 6MWT in clinical assessment due to its low burden on patients and as a means of improving efficiency in a timely manner.

Addition of tDCS and TENS to an education and exercise program in subjects with knee osteoarthritis: A study protocol.

BACKGROUND: Knee osteoarthritis often leads to chronic pain that frequently becomes disabling.Osteoarthritis has been linked to maladaptive plasticity in the brain, which can contribute to chronic pain. Therapies including neuromodulation and peripheral electrical stimulation are used to counteract the maladaptive plasticity of the brain. OBJECTIVE: To determine the efficacy of the addition of tDCS and TENS to an education and exercise program in reducing pain. METHODS: Over a 2-week study period, 60 participants will complete an exercise and educational intervention. Eligible participants accepting to participate will be subsequently randomized into one of the three treatment groups: 1) Active Transcranial Direct Current Stimulation (tDCS) and active Transcutaneous Electrical Nerve Stimulation (TENS); 2) Active tDCS and sham TENS; 3) Sham tDCS and sham TENS. RESULTS: The primary outcome will be subjective pain intensity. SECONDARY OUTCOMES: quality of life, physical function, central sensitization, and pain adjuvants (uncertainty, catastrophizing kinesiophobia, adverse events). CONCLUSION: This clinical trial will provide data on the effect that the addition of tDCS and/or TENS to an education and exercise program may have to counteract maladaptive plastic changes and improve the benefits of exercises, and whether the combination of both neuromodulator techniques may have a higher magnitude of effect.

Development of the ESEx index: a tool for predicting risk of recurrent severe COPD exacerbations.

Background: In chronic obstructive pulmonary disease (COPD), multiple recurrent severe exacerbations that require hospitalization can occur. These events are strongly associated with death and other clinical complications. Objectives: We aimed to develop a prognostic model that could identify patients with COPD that are at risk of multiple recurrent severe exacerbations within 3 years. Design: Prospective cohort. Methods: The derivation cohort comprised patients with stable, moderate-to-severe COPD. Multivariable logistic regression analyses were performed to develop the final model. Based on regression coefficients, a simplified index (ESEx) was established. Both, model and index, were assessed for predictive performance by measuring discrimination and calibration. Results: Over 3 years, 16.4% of patients with COPD experienced at least three severe recurrent exacerbations. The prognostic model showed good discrimination of high-risk patients, based on three characteristics: the number of severe exacerbations in the previous year, performance in the five-repetition sit-to-stand test, and in the 6-minute-walk test. The ESEx index provided good level of discrimination [areas under the receiver operating characteristic curve (AUCs): 0.913]. Conclusions: The ESEx index showed good internal validation for the identification of patients at risk of three recurrent severe COPD exacerbations within 3 years. These tools could be used to identify patients who require early interventions and motivate patients to improve physical performance to prevent recurrent exacerbations.

Knowledge and Attitudes towards Patient Safety among Students in Physical Therapy in Spain: A Longitudinal Study.

(1) Background: Patient safety is a discipline of health care management aiming to prevent and reduce errors and harm to patients. The assessment of knowledge and attitudes on patient safety among students in physical therapy is still scarce; no studies have yet explored the changes that internship periods may produce. Objectives: 1. to determine the attitudes and knowledge of students in physical therapy with respect to patient safety in a Spanish University; and 2. to explore changes following a practical internship period. (2) Methods: Longitudinal study. Data from the Attitudes to Patient Safety Questionnaire III (APSQ-III) before and after the internship period were obtained from an initial sample of 125 students and average positive response rates were compared. (3) Results: "Team functioning", "Importance of patient safety in the curriculum", and "Error inevitability" displayed the highest scores, in accordance with the current literature. After the internship period, the dimensions "Patient safety training received" (p = 0.001), "Error reporting confidence" (p = 0.044), and "Professional incompetence as an error cause" (p = 0.027) showed significant changes. (4) Conclusions: The current study, highlighting areas of strengths and weaknesses in the knowledge and attitudes of students in physical therapy towards patient safety, may be a foundation to adopt tailored programs to enhance students' competencies in patient safety.

Mobility activities measurement for outpatient rehabilitation settings.

OBJECTIVE: To investigate the factor structure and scale properties of items underlying the mobility activities subdomains of the International Classification of Functioning, Disability and Health (ICF). DESIGN: A cross-sectional self-report-based psychometric study. SETTING: Outpatient rehabilitation settings (N=3) in 3 urban areas of Spain. PARTICIPANTS: Convenience sample of 615 patients with musculoskeletal conditions (mean age, 38.1y) participating in an active physiotherapy program. INTERVENTIONS: Not applicable. MAIN OUTCOMES MEASURES: A 22-item Mobility Activities Measure by using a self-report questionnaire that assessed whether patients had limitations on daily activities across major ICF categories of mobility subdomains. Factor analysis, tests of item scaling, internal consistency reliability analysis, Rasch item response theory modeling, and modified parallel analysis were used. RESULTS: Initial exploratory factor analysis results for each ICF subdomain produced a total of 5 distinct and interpretable factors or dimensions: changing and maintaining body position involving sitting and/or lying; changing and maintaining body position involving standing up; carrying, moving, and handling objects using the hand and shoulder; carrying, moving, and handling objects using the hand and/or forearm; and walking and moving. Dimensionality of these 5 factors was verified by using confirmatory factor analyses and scaling assumptions were met for each dimension. Rasch scaling and modified parallel analysis supported the unidimensionality. CONCLUSIONS: The Mobility Activities Measure is a promising new self-report measure of mobility activities as defined by the ICF. Information about Mobility Activities Measure items and dimensions from this study will be useful in the future operationalization and implementation of ICF.