Effect of radiosynoviorthesis on the progression of arthropathy and haemarthrosis reduction in haemophilic patients.

INTRODUCTION: Repeated haemarthrosis is widely accepted as the triggering cause of synovitis and haemophilic arthropathy. A first-line treatment of chronic synovitis is radiosynoviorthesis (RS). The aim of this study was to evaluate the RS effects on the progression of arthropathy and on a reduction in bleeding in patients with haemophilia. METHODS: An observational-retrospective study was performed. Bleeding episodes in the 12 months following and in the 12 months preceding RS was compared. The arthropathy was clinically and radiologically analysed by age range, joint and subject, comparing those undergoing RS (Radiosynoviorthesis Group, RSG) against those not undergoing this treatment (Non-Radiosynoviorthesis Group, Non-RSG). RESULTS: One hundred and seventy-four RS were performed in 71 patients (90 Y in Knees and 186 Re in elbows/ankles/shoulder). RS resulted in significant reduction in bleeding (582 preintervention and 168 postintervention, P < .001). In general, the level of arthropathy measured clinically and radiologically was greater with age increase in both groups (RSG and Non-RSG), especially in the 25-40 age range. A significant increase (P < .05) in the progression of arthropathy was also observed, both globally by patient and specifically for each joint, in non-RSG and RSG group. CONCLUSION: RS is an effective method to reduce the number of haemarthrosis episodes in chronic synovitis. Moreover, RS can positively affect arthropathy by slowing down its progression. However, the results obtained suggest that arthropathy may be conditioned by the subject's age, regardless of whether or not the joint has undergone RS.

Elaboración y validación del «Cuestionario de actitudes hacia la ética profesional en Fisioterapia» / Elaboration and validation of the «Attitudes questionnaire towards professional ethics in Physiotherapy»

Objetivo: En el contexto universitario resulta necesaria la elaboración y validación de cuestionarios para ser aplicados en la valoración de nuevos modelos formativos que garanticen la adquisición de la competencia ética. El objetivo de este estudio es presentar la elaboración, evaluación de la fiabilidad y unidimensionalidad del «Cuestionario de actitudes hacia la ética profesional en Fisioterapia» (CAEPFIS). Material y método: Se procedió a la elaboración de un cuestionario que analizara las actitudes hacia la ética profesional en estudiantes de Fisioterapia (CAEPFIS) mediante un estudio piloto con estudiantes de Fisioterapia de último curso (n=100). Se llevó a cabo un análisis de consistencia interna (alfa de Cronbach) y se detectaron y eliminaron los ítems indiferenciadores. Posteriormente, se analizó la unidimensionalidad del cuestionario (análisis factorial de componentes principales, prueba de esfericidad de Barlett y medida de adecuación muestral de Kaiser-Meyer-OIkin [KMO]). Finalmente, el cuestionario constó de 33 ítems. Se empleó Predictive Analytics Software (PASW) 18.0 (SPSS Inc., Chicago, IL, EE. UU.). Resultados: El CAEPFIS presenta una elevada consistencia interna (coeficiente alfa de Cronbach=0,898). Los ítems del CAEPFIS se acercan a la unidimensionalidad deseada (análisis factorial de componentes principales: KMO=0,762; χ2=1.871,874; df=528; p<0,001). El primer factor muestra una buena proporción de la varianza total, explica el 25,8% de la misma y todos los ítems presentan pesos por encima de 0,3. Conclusiones: El CAEPFIS muestra fiabilidad y unidimensionalidad para ser empleado como instrumento de recogida de datos para analizar las actitudes hacia la ética profesional en estudiantes de Fisioterapia

Purpose: In the university context the creation and validation of questionnaires to be applied in assessment of new teaching models that guarantee the acquisition of ethical competence is necessary. This study aims at presenting the creation, assessment of internal consistence and unidimensionality of the ‘Attitudes questionnaire towards professional ethics in Physiotherapy’ (CAEPFIS). Material and method: A questionnaire analyzing attitudes towards professional ethics in Physiotherapy students (CAEPFIS) was created by means of a study carried out with physiotherapy students in the last year of their degree (n=100). An analysis of internal consistency (Cronbach's Alpha) was carried out, whilst differentiator elements were detected and deleted. Afterwards, unidimensionality of the questionnaire was analyzed (factorial analysis of principal components, Barlett's test of sphericity and Kaiser-Meyer-OIkin KMO). Finally, the questionnaire comprised 33 items. Predictive Analytics Software (PASW) 18.0 (SPSS Inc., Chicago, IL, USA) was used. Results: CAEPFIS shows a high internal consistency (Cronbach's Alfa=0.898). Items of CAEPFIS are close to the desired unidimensionality (Factorial Analysis of Principal Components: KMO=0.762; χ2=1,871.874; df=528; p<0.001). The first factor shows a good proportion of total variance, explains the 25.8% of it and all items present weights higher than 0.3. Conclusions: CAEPFIS shows internal consistency and unidimensionality to be used as a tool of data collection to analyze attitudes towards professional ethics in physiotherapy students

Balance evaluation in haemophilic preadolescent patients using Nintendo Wii Balance Board®.

INTRODUCTION: Alterations in the musculoskeletal system, especially in the lower limbs, limit physical activity and affect balance and walking. Postural impairments in haemophilic preteens could increase the risk of bleeding events and deteriorate the physical condition, promoting the progression of haemophilic arthropathy. AIM: This study aims to evaluate static postural balance in haemophilic children, assessed by means of the Wii Balance Board® (WBB). METHODS: Nineteen children with haemophilia and 19 without haemophilia aged 9-10 years, have participated in this study. Postural balance was assessed by performing four tests, each one lasting 15 s: bipodal eyes open (BEO), bipodal eyes closed (BEC), monopodal dominant leg (MD) and monopodal non-dominant leg (MND). Two balance indices, standard deviation of amplitude (SDA) and standard deviation of velocity (SDV) were calculated in the anterior-posterior (AP) and medial-lateral (ML) directions. RESULTS: Index values were higher in haemophilic group and the differences were statistically significant (P < 0.05) in only six (SDAAP in BEO, BEC and MD conditions, SDAML in BEO, SDVAP in BEO and SDVML in MND condition) of 16 parameters analysed. CONCLUSION: Tests performed indicate a poorer static postural balance in the haemophilic cohort compared to the control group. Accordingly, physiotherapy programmes, physical activity and sports should be designed to improve the postural balance with the aim of preventing joint deterioration and improving quality of life.

Adaptation and validation of the Spanish self-report version of the Spinal Cord Independence Measure (SCIM III).

STUDY DESIGN: This is a cross-sectional validation study. OBJECTIVE: The objective of this study was to adapt and validate a self-report version of the Spinal Cord Independence Measure (SCIM III) for the Spanish population. METHODS: A cross-cultural adaptation of the self-report version of the SCIM III for the Spanish population was performed on the basis of international guidelines. A total of 100 patients with spinal cord injury (SCI) were recruited. A team of healthcare professionals administered the SCIM III by observation. In addition, the patients completed the Spanish self-report version (eSCIM-SR). Data from both questionnaires were analysed jointly. RESULTS: A high correlation was observed between SCIM III and eSCIM-SR. Lin's concordance correlation coefficient for the global score was 0.998 (95% confidence interval: 0.997, 0.998), and the subscale scores were 0.988 (0.982, 0.992) for self-care, 0.992 (0.988, 0.995) for respiration and sphincter management and 0.997 (0.995, 0.998) for Mobility. Bland-Altman plots showed a small bias of -0.32 (95% limits of agreement: -3.01, 2.37). The estimated bias was low in all three domains, with values of -0.22 (-2.12, 1.68), -0.1 (-2.02, 1.82) and -0.03 (-1.69, 1.63) for the self-care, respiration and sphincter management and mobility subscales, respectively. CONCLUSION: Our study validates the eSCIM-SR as a tool for the functional assessment of patients with SCI, principally in the outpatient setting.

Relación de los factores de riesgo y comorbilidad en el programa de prevención de caídas en usuarios hospitalizados en un hospital psiquiátrico del sector salud / Ratio risk factors and comorbidity in the program prevention of falls in users hospitalized in a hospital mental health sector

Introducción: Los pacientes hospitalizados en una unidad de salud mental tienen el riesgo potencial de enfrentar factores de riesgo. Con la intensión de prevenir caídas en los usuarios hospitalizados Ruelas y Sarabia (10, 11), han elaborado, un modelo de valoración de los factores de riesgo como son: falta iluminación adecuada, desorden del mobiliario, falta de limpieza del área física, desconocimiento de las medidas de seguridad dentro de las instalaciones de la unidad, así como factores inherentes al paciente y su condición como son: sexo, edad, estilo de vida, movilidad, factores relacionados con el estado físico, sensoriales, estado neurológico y emocional alterados, tratamiento farmacológico y los relacionados con los dispositivos para deambular. Material y Método: Se realizó una investigación de tipo transversal y descriptiva, de Mayo del 2008 a Mayo del 2009, la muestra la conformaron 285 pacientes hospitalizados a los cuales se les aplicó una cédula de evaluación de riesgo de caídas al ingreso y cada 7 días hasta su egreso. Resultados: Durante el tiempo de hospitalización 5% de los pacientes presentaron caída, entre las características de estos tenemos el ser mujer 76%, recibir tratamiento con benzodiacepinas (clonazepan) 100%, con diagnóstico de ingreso episodios depresivos graves con pensamiento o intento suicida 53%, con conducta disruptiva, por episodio maniaco o trastorno psicótico 38%, con reporte de resonancia magnética de pérdida de volumen de parénquima cerebral 61% y factores extrínsecos 28%. Conclusión: Se identificó que los factores de riesgo predominantes en nuestros pacientes son la combinación de psicofármacos, y la enfermedad mental, la falta de identificación del riesgo en pacientes, familiares, cuidadores y equipo de salud. En menor porcentaje influyen los factores estructurales.

Introduction: Hospitalized patients in a Mind Health Unit face factors of risk.Some authors (10, 11) have made a model to value the factors for preventing falling such as: inadequate lighting, lack of placement of furniture, lack of cleaning the physical area, lack of security measures and patient characteristics like: sex, age, life style, mobility, fitness-related factors, sensory factors, being emotional and neurological altered pharmacology treatment and related devices for wandering. Material and Methods: This is a descriptive, and transversal research realized from May 2008 to May 2009, a card falling schedule was applied to 285 patients since their income to the mind health unit and every 7 days until their discharge. Results: During the hospitalization time 5% of patients were falling; 76% were women, 100% with benzodiazepines (clonazepan) treatment, 53% with depressing episodes and suicide attempts, 38% with disruptive conduct for manic episode or psychotic disorder, 61% with loss brain parenchyma volume and 28% for extrinsic factors. The most frequently risk factors founded in our patients are the combination of drugs and mental illness, unknown ledge of risk by patients, their family, their careers, and health team. Structural factors risks have the lower percentage.