The behaviour and perception of illness: modulating variables of adherence in patients with haemophilia.

BACKGROUND: The recommended treatment in patients with severe haemophilia is prophylaxis. This prevents bleedings and reduces or delays the haemophilic arthropathy. Adherence defined as the follow-up of the patient to the prescriptions of the health professional to his treatment, both pharmacological and modifications in habits or stylelifes. Adherence rates in haemophilia are better than in other chronic diseases, but there remain reasons for nonadherence. The aim was to see if disease behaviour and disease perception together with coping strategies modulate adherence to treatment. MATERIAL AND METHODS: Multicenter cross-sectional descriptive study. Patients recruited in Units of Hemophilia Hospitals and Regional Haemophilia Associations. Twenty-three patients participated The instruments used are as follows: data sheet, SF-36, A36 Hemophilia-Qol, Illness Perception Questionnaire-Revised (IPQ-R), Illness Behavior Questionnaire (IBQ) and Coping Strategies Inventory (CSI) and VERITAS-Pro. RESULTS: We found that 56% of patients with haemophilia are adherent. The most relevant clinical variables were hemarthrosis, diagnosis of arthropathy and presence of any coinfection, as well as family history, labour status and sociodemographic variables. Age was not a relevant variable in adherence. The worst adherence coincides with poorer quality of life and inadequate coping style. Nonadherent patients show greater conviction of disease, perception of cyclicity, more hypochondriacal behaviour towards the illness and perception concern about possible side effects of medication. CONCLUSION: Adherence in haemophilia requires a more experiential approach and individualized education. It is important that professionals take into account the patient's perception, behaviour and attitude towards the disease to achieve a better adaptation of their coping resources.

Effectiveness of the Medtep Hemophilia online platform for adherence to prophylactic treatment in haemophilia patients: Results from a 1-year observational study.

INTRODUCTION: Medtep Hemophilia platform is an online tool that allows patients with congenital coagulopathies to keep track of their daily condition-related events with the objective of ensuring successful adherence to therapy. AIM: To assess the effectiveness of Medtep Hemophilia in improving adherence to prophylactic treatment in haemophilia A and B patients in a 1-year prospective observational study, as well as its impact on the patient's disease status. METHODS: Patients (>13 years old) received support material to familiarize themselves with Medtep Hemophilia. Adherence to treatment, quality of life (QoL) and illness perception were assessed. Values at baseline, 1, 6 and 12 months, and changes from baseline value were analysed. The Hemophilia Joint Health Score (HJHS) test was applied at baseline and study completion. RESULTS: Forty-six patients were enrolled (43 evaluable). After 1 year, 56.4% patients showed continued use of the platform (100% compliance) whereas 25.6% were inactive. Treatment adherence increased both significantly (P < .001) and progressively during the study. Similarly, improved QoL and illness perception were observed with respect to baseline in most of the questionnaire components (P < .05 after 12 months). A patient's age had no influence on the results, whereas compliant patients (>80% of platform use) tended to score better than noncompliant. The HJHS test values remained similar during the study. CONCLUSION: The Medtep Hemophilia online platform helped the studied patients with haemophilia to improve their adherence to prophylactic treatment, while increasing their QoL and illness perception, as well as joint arthropathies stabilization.

Psychometric properties of a new short version of the State-Trait Anxiety Inventory (STAI) for the assessment of anxiety in the elderly.

INTRODUCTION: Anxiety has negative effects on the cognitive performance and psychosocial adjustment of elderly people. Given the high prevalence of anxiety symptoms in patients suffering from cognitive impairment, it has been suggested that these symptoms may be an early marker of dementia. The State-Trait Anxiety Inventory (STAI) is one of the most widely-used scales for evaluating anxiety in elderly people. However, inasmuch as the STAI may be difficult to apply to older people, having a short form of it would be desirable. METHODS: The participants comprised 489 community-dwelling individuals aged 68 years and over. All of them were volunteers in a longitudinal study for early detection of Alzheimer' Disease (Proyecto Vallecas). The full sample was divided in two homogeneous subgroups: Group A, used to reduce the number of items and response options, and Group B, the group used to determine the psychometric properties of the new short form (STAIr). RESULTS: A dichotomous Rasch model was used to obtain the STAIr. No statistically significant differences for STAIr scores were found with respect to sociodemographic variables. Psychometric properties and normative data were obtained for the new short version. CONCLUSIONS: The STAIr is composed of 13 items and data fits the model well. Since it is short and easy to apply to elderly people, STAIr will be very useful in clinical and research settings.

Effectiveness of two modalities of physiotherapy in the treatment of haemophilic arthropathy of the ankle: a randomized pilot study.

Although different techniques of physiotherapy have been described for the treatment of haemophilic arthropathy (HA) of ankle, hardly any studies have been applied manual therapy or educational physiotherapy and home exercises. The aim of this study was to assess the effectiveness of manual therapy and educational physiotherapy in the treatment of HA of the ankle. Thirty-one patients with HA of the ankle with a mean age of 35.29 (SD: 12.877) years randomized to manual therapy group (n = 11), educational group (n = 10) and a control group (n = 10). The two physiotherapy programmes were one with manual therapy articular traction, passive stretching of the gastrocnemius muscles, and exercises for muscle strength and proprioception (MT group) and the other with educational sessions and home exercises (E group). The study lasted for 12 weeks. The treatment with manual therapy improved the gastrocnemius muscle circumference, and the pain of ankle (P < 0.05). Six months later, MT group still enjoyed improvement. In the educational group there were improvements, but not significant, in the measured variables. No patient had ankle haemarthrosis during the study. The treatment with manual therapy improved the circumference of gastrocnemius and lessened pain in the patients with haemophilic arthropathy of the ankle.

Generalización de la fiabilidad: un enfoque metaanalítico aplicado a la fiabilidad / Reliability generalization: A meta-analytic approach to reliability coefficients

La fiabilidad no es una propiedad inherente al test, por lo que frases del tipo “la fiabilidad del test es de 0,80” son incorrectas. Ello se debe a que la fiabilidad es una propiedad de las puntuaciones obtenidas por un test en una aplicación concreta de éste. La generalización de la fiabilidad (GF) es un nuevo tipo de metaanálisis que permite examinar empíricamente la variabilidad de las estimaciones de la fiabilidad en diferentes aplicaciones de un test. Los estudios de GF están poniendo en evidencia lo inadecuado que resulta esa práctica habitual de los investigadores de inducir la fiabilidad a partir de estimaciones previas de ésta. En este artículo se presenta una panorámica del enfoque de GF, describiendo cuáles son sus fases de realización. Además, se discuten algunos de los problemas estadísticos más importantes de los estudios GF, tales como: a) procedimientos de transformación de los coeficientes de fiabilidad; b) métodos de ponderación de los coeficientes, y c) modelos estadísticos asumibles (AU)

Reliability is not a property inherent to the test, so that sentences such as “the test reliability is 0.80” are wrong. That is because reliability is a property of scores obtained in a given application o a test. Reliability generalization (RG) is a new kind of meta-analysis which enables to empirically examine the variability of the reliability estimates across different applications of a test. The RG studies are evidencing how unadvisable is the usual practice of researchers of inducing reliability from previous estimates. In this article an overview of the RG approach is presented, describing the required steps. Moreover, some of the most important statistical issues concerning RG studies are discussed, such as: (a) transforming procedures of the reliability coefficients, (b) weighting methods of the coefficients, and (c) statistical models that can be assumed (AU)

Análisis psicométrico de la escala de marcha y equilibrio de Tinetti con el modelo de Rasch / Psychometric analysis of the Performance Oriented Mobility Scale of Tinetti with the Rasch model

ObjetivoEn este estudio se presenta una aplicación del modelo de crédito parcial de la familia de modelos de Rasch a la escala de movilidad geriátrica PMOS (Tinetti, 1986, 1988) con vistas a determinar si ofrece una estructura unidimensional que permite obtener estimaciones de parámetros de habilidad y dificultad invariantes.MaterialSe empleó una versión traducida al castellano de la escala PMOS, que se administró individualmente a los pacientes que colaboraron en el estudio.MétodoDoscientos pacientes fueron evaluados con la escala PMOS. Las valoraciones de los 17 ítems fueron sometidas a un análisis psicométrico con el modelo de crédito parcial utilizando el programa ConQuest.ResultadosDoce ítems de la PMOS se ajustaron al modelo unidimensional de Rasch, evidenciando que la habilidad de las personas se puede explicar en función de un solo atributo. El resto de ítems (1, 7, 13, 15 y 17) no obtuvieron estadísticos de ajuste que permitiera asegurar que su patrón de respuestas podría explicarse a través del modelo de Rasch.ConclusionesLa metodología basada en el estudio del ajuste de los ítems a la familia de modelos de Rasch permite obtener estimaciones invariantes de los párametros de dificultad de los ítems y de habilidad de las personas. Además, el modelo de crédito parcial permite obtener estimaciones de los umbrales de las categorías con vistas a probar si los procesos discriminales de las personas son iguales para todos los ítems o varían de ítem a ítem(AU)

ObjectivesIn this study, we present an application of the partial credit model of the Rasch family of models to the PMOS scale of geriatric mobility (Tinetti, 1986, 1988) with the aim of determining whether it offers a unidimensional structure that enables us to obtain estimates of invariant parameters of ability and difficulty.MaterialA Spanish translation of the PMOS scale was used. It was administered individually to the patients who took part in this study.MethodTwo hundred patients were assessed using the PMOS scale. The evaluations of the 17 items were analyzed psychometrically with the partial credit model using the ConQuest program.ResultsTwelve items of the PMOS fitted the unidimensional Rasch model, proving that the subjects’ ability can be explained using one single attribute. The other items (1, 7, 13, 15 and 17) did not obtain goodness-of-fit statistics that would guarantee that their response pattern could be explained using the Rasch model.ConclusionsThe methodology based on the study of the fit of the items to the Rasch family of models enables us to obtain estimates of the invariant difficulty and ability parameters. Furthermore, the partial credit model enables us to obtain estimates of the thresholds of the categories with a view to testing whether the subjects’ discriminatory processes are the same for all the items or whether they vary from item to item(AU)