Validation of Psychometric Instrumentswith Classical Test Theory in Social and Health Sciences: A practical guide / Validación de instrumentos psicométricos en ciencias sociales y de la salud: una guía práctica

Recientemente se ha incrementado significativamente el número de estudios psicométricos junto a avances estadísticos cruciales para evaluar las evidencias defiabilidad y validez de los testsy escalas de medida. Dada la importancia de proporcionar procedimientos más exactos tanto en la metodología como en la interpretación de las puntuaciones, los editores de la revista Anales de Psicología proponen esta guía para abordar los tópicos más relevantes en el campo de la psicometría aplicada. Con esta finalidad, el presente manuscrito analiza los tópicos principales de la TeoríaClásica de Tests (e.g., análisis factorial exploratorio/confirmatorio, fiabilidad, validez, sesgo, etc.) con vistas a sintetizar y clarificarlas aplicaciones prácticas, y mejorar los estándares de publicación de estos trabajos.(AU)

In recent years,there has been a significant rise in the number of psychometric studies, together with crucial statistical advances for validity and reliability measures. Given the importance of providingaccurate procedures both in methodology and score interpretationof tests and/or measurement scales, the editors-in-chie fof the journal Annals of Psychology have draftedthis guide to address the most relevant issues in the field of applied psychometry. To this end, the present manuscript analyses the main topics under the Classical Test Theory framework (e.g., exploratory/confirmatory factor analysis; reliability, bias, etc.) aimingto synthesizeand clarifythe best practical applications;and improve publication standards.(AU)

Improving Sleep Quality, Daytime Sleepiness, and Cognitive Function in Patients with Dementia by Therapeutic Exercise and NESA Neuromodulation: A Multicenter Clinical Trial.

Dementia is a progressive decline in cognitive functions caused by an alteration in the pattern of neural network connections. There is an inability to create new neuronal connections, producing behavioral disorders. The most evident alteration in patients with neurodegenerative diseases is the alteration of sleep-wake behavior. The aim of this study was to test the effect of two non-pharmacological interventions, therapeutic exercise (TE) and non-invasive neuromodulation through the NESA device (NN) on sleep quality, daytime sleepiness, and cognitive function of 30 patients diagnosed with dementia (non-invasive neuromodulation experimental group (NNG): mean ± SD, age: 71.6 ± 7.43 years; therapeutic exercise experimental group (TEG) 75.2 ± 8.63 years; control group (CG) 80.9 ± 4.53 years). The variables were evaluated by means of the Pittsburg Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Mini-Cognitive Exam Test at four different times during the study: at baseline, after 2 months (after completion of the NNG), after 5 months (after completion of the TEG), and after 7 months (after 2 months of follow-up). Participants in the NNG and TEG presented significant improvements with respect to the CG, and in addition, the NNG generated greater relevant changes in the three variables with respect to the TEG (sleep quality (p = 0.972), daytime sleepiness (p = 0.026), and cognitive function (p = 0.127)). In conclusion, with greater effects in the NNG, both treatments were effective to improve daytime sleepiness, sleep quality, and cognitive function in the dementia population.

Hemophilic Arthropathy of the Knee and Its Association with Reduced Muscle Strength and Activation and the Pressure Pain Threshold: A Case-Control Study.

(1) Background: Hemophilia is characterized by recurrent hemarthrosis leading to degenerative arthropathy. The aim was to evaluate the differences in muscle strength and activity and the pressure pain threshold between patients with knee arthropathy and their healthy peers; (2) Methods: A case-control study in which 23 adult patients with knee arthropathy and 24 healthy peers matched in terms of characteristics were recruited. The study variables were quadriceps muscle strength, muscle activation and the pressure pain threshold; (3) Results: There were significant differences between the two groups in quadriceps strength on the dominant (CI95%: 64.69, 129.2) and non-dominant (CI95%: 29.95, 93.55) sides and in the pressure pain threshold on the dominant (CI95%: 3.30, 43.54) and non-dominant (CI95%: 3.09, 45.25) sides. There were differences in neuromuscular fatigue on the non-dominant side in the vastus medialis (CI95%: 8.72, 21.51), vastus lateralis (CI95%: 4.84, 21.66) and rectus femoris (CI95%: 6.48, 24.95) muscles; (4) Conclusions: Muscle strength and the pressure pain threshold are lower in patients with hemophilia. Quadriceps muscle activation in patients with hemophilic knee arthropathy does not in any way differ from activation in healthy subjects. However, muscle fatigue is greater in patients with knee arthropathy. Strength training in patients with hemophilia should focus on the activation of the vastus medialis and lateralis muscles.

180-degree immersive VR motion visualization in the treatment of haemophilic ankle arthropathy.

BACKGROUND: Patients with haemophilic arthropathy suffer chronic pain that affects and restricts their quality of life. Visualization of movement through immersive virtual reality is used for pain management. AIM: To evaluate the efficacy of 180-degree immersive VR motion visualization therapy in patients with haemophilic ankle arthropathy. METHODS: Prospective, multicentre pilot study. Fifteen adult patients with bilateral haemophilic ankle arthropathy were recruited (mean age: 42.73 ± 12.36 years). The intervention lasted 4 weeks, with daily home sessions of 180-degree immersive motion visualization. The patients were given virtual reality glasses to use with their smartphones. From the YouTube mobile app® they accessed the recorded video with access from the He-Mirror App®. The study variables were joint state (Haemophilia Joint Health Score), pressure pain threshold (pressure algometer), muscle strength (dynamometry) and range of motion (goniometry). Three evaluations were performed: at baseline (T0), after the intervention (T1) and at the end of a 16-week follow-up period (T2). RESULTS: No patient developed ankle hemarthrosis during the experimental phase. In the repeated measures analysis we found statistically significant differences in joint state (F = 51.38; η2 p = .63), pressure pain threshold of the lateral malleolus (F = 12.34; η2 p = .29) and range of motion (F = 11.7; η2 p = .28). CONCLUSIONS: Therapy using immersive motion visualization does not cause hemarthrosis. This intervention can improve joint condition, pressure pain threshold and range of motion in patients with ankle arthropathy. Changes greater than the MDC were reported in more than 40% of patients for the variables pressure pain threshold, anterior tibialis strength and range of motion, which were considered clinically relevant.

Approach to Knee Arthropathy through 180-Degree Immersive VR Movement Visualization in Adult Patients with Severe Hemophilia: A Pilot Study.

(1) Background: Hemarthrosis is a typical clinical manifestation in patients with hemophilia. Its recurrence causes hemophilic arthropathy, characterized by chronic joint pain. Watching movement recorded from a first-person perspective and immersively can be effective in the management of chronic pain. The objective of this study was to evaluate the effectiveness of an immersive virtual reality intervention in improving the pain intensity, joint condition, muscle strength and range of motion in patients with hemophilic knee arthropathy. (2) Methods: Thirteen patients with hemophilic knee arthropathy were recruited. The patients wore virtual reality glasses and watched a flexion-extension movement of the knee on an immersive 180° video, recorded from a first-person perspective over a 28-day period. The primary variable was the pain intensity (visual analog scale). The secondary variables were the joint status (Hemophilia Joint Health Score), quadriceps and hamstring strength (dynamometry), and range of motion (goniometry). (3) Results: After the intervention period, statistically significant differences were observed in the intensity of the joint pain (Standard error [SE] = 19.31; 95% interval confidence [95%CI] = -1.05; -0.26), joint condition (SE = 18.68; 95%CI = -1.16; -0.52) and quadriceps strength (SE = 35.00; 95%CI = 2.53; 17.47). We found that 38.46% and 23.07% of the patients exhibited an improvement in their quadriceps muscle strength and joint condition above the minimum detectable change for both variables (8.21% and 1.79%, respectively). (4) Conclusions: One hundred and eighty degree immersive VR motion visualization can improve the intensity of joint pain in patients with hemophilic knee arthropathy. An intervention using immersive virtual reality can be an effective complementary approach to improve the joint condition and quadriceps strength in these patients.

Effect of a Fascial Therapy Treatment on Quality of Life in Patients With Hemophilic Elbow Arthropathy: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the effect of fascial therapy on the perceived quality of life, pain intensity, and joint health in people with hemophilia. DESIGN: Single-blind randomized controlled trial. SETTING: Hemophilia Patient Associations. PARTICIPANTS: Patients with hemophilia (N=69) were randomly allocated to an experimental group (fascial therapy protocol) or to a control group (no intervention whatsoever). INTERVENTIONS: The fascial therapy intervention lasted 3 consecutive weeks with one 45-minute weekly session. MAIN OUTCOME MEASURES: The variables evaluated were perceived quality of life (Short Form Health Survey-36), pain intensity (visual analog scale) and joint health (Hemophilia Joint Health Score) at baseline and at 3 and 12 weeks. RESULTS: The mean values of the physical (38.64±9.41 and 41.92±12.16) and mental (45.77±6.25 and 55.02±9.73) components of the Short Form Health Survey-36 improved after the intervention in the experimental group, as well as those for pain intensity and joint health (P<.001). There were differences (P<.001) in the intergroup effect in the physical role variables (F=49.22), emotional role (F=229.71), mental component (F=9.86), intensity of pain (F=24.74), and joint health (F=55.31). CONCLUSIONS: A fascial therapy protocol for patients with hemophilic elbow arthropathy can improve their perceived quality of life. Elbow pain intensity improved in patients treated with fascial therapy. This technique can improve elbow joint health.

A Reliability Generalization Meta-Analysis of the Padua Inventory-Revised (PI-R) / Meta-análisis de generalización de la fiabilidad del Padua Inventory-Revised (PI-R)

Background/Objective: The Padua Inventory-Revised (PI-R) is a widely applied instrument to measure obsessive-compulsive symptoms in clinical and nonclinical samples. We conducted a reliability generalization meta-analysis on the PI-R. Method: An exhaustive literature search yielded 118 empirical studies that had applied the PI-R, from which 30 studies (33 samples) reported an original reliability estimate. Results: Assuming a random-effects model, the average internal consistency reliability (Cronbach's alpha) was .92 (95% CI [.91, .93]) for the total scores, and ranged from .74 to .89 for the subscales. Assuming mixed-effects models, moderator analyses showed a positive statistically significant association between the standard deviation of the total scores and the reliability coefficients (p = .002; R2 = .38). Conclusions: In terms of reliability, the PI-R scale was found to be adequate for both research and clinical purposes, although exhibiting large heterogeneity across studies. Future empirical studies using the PI-R should be required to provide at least one reliability estimate based on their own data

Antecedentes/Objetivo: El Padua Inventory-Revised (PI-R) es un instrumento ampliamente utilizado para medir los síntomas obsesivo-compulsivos en muestras clínicas y no clínicas. Llevamos a cabo un meta-análisis de generalización de la fiabilidad del PI-R. Método: Una búsqueda exhaustiva de la literatura arrojó 118 estudios empíricos que habían aplicado el PI-R, de los cuales 30 estudios (33 muestras) reportaron una estimación propia de la fiabilidad. Resultados: Asumiendo un modelo de efectos aleatorios, la fiabilidad en términos de consistencia interna promedio (alfa de Cronbach) fue de 0,92 (IC del 95% [0,91, 0,93]) para las puntuaciones totales, y osciló entre 0,74 y 0,89 para las subescalas. Asumiendo modelos de efectos mixtos, los análisis de moderadores mostraron una relación positiva estadísticamente significativa entre la desviación típica de las puntuaciones totales y los coeficientes de fiabilidad (p = 0,002; R2 = 0,38). Conclusiones: En términos de fiabilidad, se encontró que el PI-R es adecuado tanto para fines clínicos como de investigación, aunque con una alta heterogeneidad entre los estudios. Es necesario que los estudios empíricos futuros que apliquen el PI-R proporcionen al menos una estimación de la fiabilidad basada en sus propios datos.

The relationship between chronic pain and psychosocial aspects in patients with haemophilic arthropathy. A cross-sectional study.

BACKGROUND: Pain is a major characteristic in haemophilic arthropathy. Identifying the psychosocial variables affected by pain can help when addressing these patients. AIM: To assess the relationship between perceived intensity of chronic pain and joint damage, kinesiophobia, catastrophism, anxiety and perceived quality of life in adult patients with haemophilic arthropathy. METHODS: Multicentre cross-sectional descriptive study. Seventy-seven adult patients with haemophilic arthropathy were recruited. The usual and maximum pain intensity (Visual Analog Scale), joint status (Haemophilia Joint Health Score), Kinesiophobia (Tampa Scale of Kinesiophobia), catastrophism (Pain catastrophizing scale), anxiety (State-Trait Anxiety inventory) and perceived quality of life (36-Item Short Form Health Survey) were evaluated. The correlation between usual and maximum pain intensity with quantitative variables was obtained with Spearman`s correlation test. Kruskal-Wallis one-way ANOVA analysed differences in perceived pain according to the severity and type of treatment, and development of inhibitors. RESULTS: The usual intensity of perceived pain correlated positively with catastrophism, kinesiophobia, and state and trait anxiety. The same results were obtained when analysing the maximum perception of pain. We found an inverse correlation between the physical component of perceived quality of life and usual and maximum pain intensity perceived by patients. CONCLUSION: Psychosocial factors affect the painful experience of patients with haemophilic arthropathy. Pain intensity affects the quality of life of these patients.

A Reliability Generalization Meta-analysis of the Padua Inventory-Revised (PI-R).

Background/Objective: The Padua Inventory-Revised (PI-R) is a widely applied instrument to measure obsessive-compulsive symptoms in clinical and nonclinical samples. We conducted a reliability generalization meta-analysis on the PI-R. Method: An exhaustive literature search yielded 118 empirical studies that had applied the PI-R, from which 30 studies (33 samples) reported an original reliability estimate. Results: Assuming a random-effects model, the average internal consistency reliability (Cronbach's alpha) was .92 (95% CI [.91, .93]) for the total scores, and ranged from .74 to .89 for the subscales. Assuming mixed-effects models, moderator analyses showed a positive statistically significant association between the standard deviation of the total scores and the reliability coefficients (p = .002; R2  = .38). Conclusions: In terms of reliability, the PI-R scale was found to be adequate for both research and clinical purposes, although exhibiting large heterogeneity across studies. Future empirical studies using the PI-R should be required to provide at least one reliability estimate based on their own data.

Antecedentes/Objetivo: El Padua Inventory-Revised (PI-R) es un instrumento ampliamente utilizado para medir los síntomas obsesivo-compulsivos en muestras clínicas y no clínicas. Llevamos a cabo un meta-análisis de generalización de la fiabilidad del PI-R. Método: Una búsqueda exhaustiva de la literatura arrojó 118 estudios empíricos que habían aplicado el PI-R, de los cuales 30 estudios (33 muestras) reportaron una estimación propia de la fiabilidad. Resultados: Asumiendo un modelo de efectos aleatorios, la fiabilidad en términos de consistencia interna promedio (alfa de Cronbach) fue de 0,92 (IC del 95% [0,91, 0,93]) para las puntuaciones totales, y osciló entre 0,74 y 0,89 para las subescalas. Asumiendo modelos de efectos mixtos, los análisis de moderadores mostraron una relación positiva estadísticamente significativa entre la desviación típica de las puntuaciones totales y los coeficientes de fiabilidad (p = 0,002; R2  = 0,38). Conclusiones: En términos de fiabilidad, se encontró que el PI-R es adecuado tanto para fines clínicos como de investigación, aunque con una alta heterogeneidad entre los estudios. Es necesario que los estudios empíricos futuros que apliquen el PI-R proporcionen al menos una estimación de la fiabilidad basada en sus propios datos.

Manual therapy reduces the frequency of clinical hemarthrosis and improves range of motion and perceived disability in patients with hemophilic elbow arthropathy. A randomized, single-blind, clinical trial.

PURPOSE: To evaluate the effectiveness of manual therapy in reducing the frequency of clinical hemarthrosis, increasing range of motion and improving the perception of disability in the upper limbs in patients with hemophilic elbow arthropathy. MATERIALS AND METHODS: Sixty-nine patients were randomized into experimental (N = 35) and control group (N = 34). The outcome measures were: frequency of clinical hemarthrosis, the elbow range of motion and the perception of disability in the upper limbs (DASH questionnaire). The intervention included one 50 min weekly session, for three weeks, of upper limb fascial therapy according to our treatment protocol. RESULTS: There were differences (p < 0.001) in the repeated measures analysis for frequency of elbow clinical hemarthrosis (F = 20.64) and range of motion in flexion (F = 17.37) and extension (F = 21.71). No differences were found in the overall perceived disability (F = 0.91; p = .37). We found group interaction with the (p < 0.001) in the frequency of elbow clinical hemarthrosis, range of motion and overall perceived disability. CONCLUSIONS: Manual therapy is safe in patients with hemophilia and elbow arthropathy. Fascial therapy reduces the frequency of hemarthrosis, increases the range of motion and improves the perceived disability in the upper limbs. Trial registration number: id NCT03009591IMPLICATIONS FOR REHABILITATIONImpairments in the range of motion, pain and disability may occur in patients with hemophilic elbow arthropathy since early age.There is a need to validate safe and effectiveness protocols of rehabilitation to treat these patients.Prophylactic replacement is the most effective treatment for the prevention of hemarthrosis.Physiotherapists need to be trained in the specific management of patients with hemophilia.Manual therapy can be a safe and effective tool in the treatment of hemophilic arthropathy.

One Session Effects of Knee Motion Visualization Using Immersive Virtual Reality in Patients with Hemophilic Arthropathy.

(1) Background: Hemophilic knee arthropathy is characterized by a loss of muscle mass and decreased strength of the quadriceps muscle. The visualization of movement aims to favor the recruitment of the motor system in the same premotor and parietal areas, as would happen with the active execution of the observed action. The aim was to evaluate changes in quadriceps activation in patients with hemophilic knee arthropathy following immersive VR visualization of knee extension movements. (2) Methods: We recruited 13 patients with severe hemophilia A and knee arthropathy. Patients underwent a 15 min session of immersive VR visualization of knee extension movements. The quadriceps muscle activation was evaluated by surface electromyography. (3) Results: After the intervention, there were no changes in the muscle activation of vastus medialis, vastus lateralis, or rectus femoris muscles. There was a large effect size of changes in rectus femoris muscle activation. Age and knee joint damage did not correlate with changes in quadriceps activation. Dominance, inhibitor development, and type of treatment were not related with post-intervention muscle activation. (4) Conclusions: A session of immersive VR visualization of knee extension movement does not modify quadriceps muscle activation. A specific protocol for patients with hemophilic knee arthropathy may be effective in improving the activation of the rectus femoris muscle.

Quality of Life, Perception of Disease and Coping Strategies in Patients with Hemophilia in Spain and El Salvador: A Comparative Study.

BACKGROUND: Hemophilia is characterized by the development of joint bleeds that cause long-term joint damage (hemophilic arthropathy). Joint damage leads to disability and affects psychosocial aspects in patients with hemophilia. OBJECTIVE: To compare the clinical situation, perception of disease and quality of life, and coping strategies in adult patients with hemophilia in El Salvador and Spain. METHODS: In this comparative clinical study, 43 patients with hemophilia aged between 18 and 50 years old from Spain and El Salvador participated. After obtaining the patients' consent, they completed the Illness Perception Questionnaire-Revised (IPQ-R), Hemophilia-QoL and Inventory of Coping strategies questionnaires. Joint status was assessed using the Hemophilia Joint Health Score and based on a record of clinical and treatment data. RESULTS: Hemophilia patients from Spain showed an improved perception of quality of life (p <0.05), although there were only differences in the self-criticism variable (p = 0.04) for coping strategies. Joint damage and age correlated (p <0.05) negatively with perception of disease, perceived quality of life and coping strategies in both populations. There were differences (p <0.05) between the two populations based on HIV and HCV coinfections in perception of disease and perceived quality of life. CONCLUSION: Patients with hemophilia in El Salvador exhibit a poorer perception of disease and quality of life. Despite differences in access to treatment from one country to the other, there is no difference in coping with the disease. Older patients are better able to adapt to the disease.

Validation of the Spanish Version of the VERITAS-PRN Scale to Assess Adherence to on Demand Regimens in Patients with Hemophilia.

INTRODUCTION: The episodic or on-demand administration of clotting factor concentrates in hemophilia patients in the event of hemorrhage is employed to restore hemostasis. Adherence to on-demand treatments needs to be assessed in order to improve patient management, avoiding adverse effects and serious clinical complications. AIM: To validate the Spanish version of the treatment adherence scale in patients with hemophilia, namely, Validated Hemophilia Regimen Treatment Adherence Scale-PRN (VERITAS-PRN). METHODS: Eighty-five patients were recruited in three hemophilia patient associations in Spain. The VERITAS-PRN scale was adapted through a back-translation process from English to Spanish. A native Spanish bilingual translator translated the scale from English to Spanish, and subsequently another native English bilingual translator translated the scale from Spanish to English. The scale was applied twice (two months apart) to assess test-retest reliability. RESULTS: Internal consistency reliability was slightly lower in the VERITAS-PRN in Spanish (0.80) versus the English version (0.85). There were no differences (p > 0.05) between the means of the dimensions or in the total scores between the sample of patients in Spain and the USA. The test-retest reliability coefficient of the scores on the total scale was 0.80 [CI, 0.74-0.86]. The test-retest reliability coefficient was greater than 0.90 in all subscales. CONCLUSION: The Spanish version of VERITAS-PRN has high consistency and empirical validity. This scale is useful for assessing the degree of adherence to treatment in adult patients with hemophilia following episodic infusion treatment.

Quality of life and its predictors among adult patients with haemophilic arthropathy. An observational study.

BACKGROUND: Recurrent hemarthrosis that begin in childhood lead to progressive joint deterioration. Patients with haemophilia have chronic pain, functional disability and a reduced perception of health-related quality of life. PURPOSE: To analyse the perceived quality of life of adult patients with haemophilic arthropathy and its relationship with pain, joint condition, kinesiophobia and catastrophism. METHODS: Eighty-three adult patients with haemophilia were included in this multicentre, cross-sectional, descriptive study. Perceived quality of life (36-Item Short Form Health Survey), perceived usual and maximum pain (visual analogue scale), joint condition (Haemophilia Joint Health Score), kinesiophobia (Tampa Scale of Kinesiophobia) and catastrophism (Pain Catastrophizing Scale) were assessed. Sociodemographic, clinical and therapeutic variables and drug consumption for pain control were collected. Descriptive statistics used means and standard deviations. The correlation of quality of life with the dependent variables was calculated with the Pearson correlation test. The differences in quality of life as a function of the binomial variables were calculated with Student's t-test for independent samples. RESULTS: Physical component of quality of life perceived by patients with hemophilia is lower than Spanish population (30.51 VS 48.85). Regarding the mental component, patients with hemophilia showed higher values (56.07 VS 49.97). Catastrophism correlated (p < .05) with all items of quality of life questionnaire. Kinesiophobia correlated (p < .05) with all items of quality of life except to role-emotional (r = -.18; p > .05). Habitual and maximal joint pain correlated with all items except to role-emotional (r = - .19 and r = - .09, respectively) and mental component score (r = - .16 and r = - .07, respectively). Catastrophism and weekly drug intake were inversely correlated with quality of life. Age was positively correlated with perceived quality of life. There were differences in quality of life as a function of the severity of haemophilia and the intake of drugs for pain control. CONCLUSIONS: The perceived quality of life of adult patients with haemophilia is worse than that of the Spanish population. Pain, kinesiophobia, catastrophism, haemophilia severity and the intake of pain-control medication influence the quality of life of these patients.

Effects of myofascial release on frequency of joint bleedings, joint status, and joint pain in patients with hemophilic elbow arthropathy: A randomized, single-blind clinical trial.

BACKGROUND: Chronic joint injury of the elbow joint is common in patients with hemophilia. Myofascial release is used for the management of pain and functionality in patients with chronic restrictions. OBJECTIVE: To evaluate the effectiveness of myofascial release in patients with hemophilic elbow arthropathy. METHODS: Sixty-nine patients with hemophilia took part in this randomized controlled trial. They were recruited from 10 hemophilia patient Associations. They were randomly allocated to experimental (n = 35) or control group (n = 34). The intervention consisted of three 50-min sessions of fascial therapy over a 3-week period. The intervention included 11 bilaterally administered maneuvers in both upper limbs (from shoulder girdle to forearm). The study variables were frequency of elbow bleeding (self-report), joint status (Hemophilia Joint Health Score), and joint pain (visual analog scale) at baseline, after the intervention, and at the 3-month follow-up. RESULTS: There were significant changes (P < .001) in the repeated measures factor in the frequency of hemarthrosis (F = 20.64), joint status (F = 31.45), and perceived joint pain (F = 30.08). We found group interaction with the (P < .001) in the frequency of hemarthrosis (F = 21.57), joint status (F = 99.98), and perceived joint pain (F = 44.26). There were changes (P < .01) in the pairwise comparison analysis between the pretreatment assessment and the posttreatment and follow-up assessments. CONCLUSIONS: Myofascial release decreases frequency of elbow bleedings, and improved joint status and perception of elbow pain in patients with hemophilic elbow arthropathy. Myofascial release may be recommended to improve joint status and joint pain in patients with hemophilic elbow arthropathy.

Improving the reporting quality of reliability generalization meta-analyses: The REGEMA checklist.

Reliability generalization (RG) is a meta-analytic approach that aims to characterize how reliability estimates from the same test vary across different applications of the instrument. With this purpose RG meta-analyses typically focus on a particular test and intend to obtain an overall reliability of test scores and to investigate how the composition and variability of the samples affect reliability. Although several guidelines have been proposed in the meta-analytic literature to help authors improve the reporting quality of meta-analyses, none of them were devised for RG meta-analyses. The purpose of this investigation was to develop REGEMA (REliability GEneralization Meta-Analysis), a 30-item checklist (plus a flow chart) adapted to the specific issues that the reporting of an RG meta-analysis must take into account. Based on previous checklists and guidelines proposed in the meta-analytic arena, a first version was elaborated by applying the nominal group methodology. The resulting instrument was submitted to a list of independent meta-analysis experts and, after discussion, the final version of the REGEMA checklist was reached. In a pilot study, four pairs of coders applied REGEMA to a random sample of 40 RG meta-analyses in Psychology, and results showed satisfactory inter-coder reliability. REGEMA can be used by: (a) meta-analysts conducting or reporting an RG meta-analysis and aiming to improve its reporting quality; (b) consumers of RG meta-analyses who want to make informed critical appraisals of their reporting quality, and (c) reviewers and editors of journals who are considering submissions where an RG meta-analysis was reported for potential publication.

The effectiveness of manual therapy in addition to passive stretching exercises in the treatment of patients with haemophilic knee arthropathy: A randomized, single-blind clinical trial.

BACKGROUND: Haemophilic arthropathy is characterized by joint restrictions. One of the most affected joints in haemophilia patients is the knee. AIM: This study evaluates the effectiveness of manual therapy and passive muscle stretching exercises for reducing the frequency of hemarthrosis and pain and improving joint health and range of motion in patients with haemophilic knee arthropathy. METHODS: Twenty eight patients with haemophilic knee arthropathy were randomized to an experimental group or to a control group (without intervention). Manual therapy sessions included joint traction and gliding manoeuvers, in addition to passive muscle stretching. The intervention included one 60-minute with two weekly sessions over a 12-week period. We evaluated the frequency of knee hemarthrosis (self-reporting), joint health (Hemophilia Joint Health Score), range of motion (goniometry) and perceived knee pain (visual analogue scale). A baseline evaluation was performed at the end of the intervention and after a 12-week follow-up period. RESULTS: The frequency of hemarthrosis dropped significantly in the experimental group compared to the control group (F = 11.43; P < .001). Compared to the control group, the experimental group had consistently better results in the variables for joint health (F = 13.80; P < .001), range of motion in knee flexion (F = 24.29; P < .001) and loss of extension (F = 8.90; P < .001), and perceived pain (F = 49.73; P < .001). CONCLUSIONS: Manual therapy using joint traction and gliding manoeuvers, in addition to passive muscle stretching, reduces the frequency of hemarthrosis in patients with haemophilia. Manual therapy with passive muscle stretching exercises improves joint health, range of motion and perceived joint pain.

Functionality and range of motion in patients with hemophilic ankle arthropathy treated with fascial therapy. A randomized clinical trial.

BACKGROUND: Hemophilic arthropathy is characterized by loss of function and range motion. Fascial therapy mobilizes the connective tissue, intervening in the state of the injured fascial complex. OBJECTIVES: The aim of this study is to assess the safety and effectiveness of a fascial therapy treatment in patients with hemophilic ankle arthropathy. DESIGN: Randomized clinical trial. METHODS: Sixty-five adult patients with hemophilia from 18 to 65 years of age were recruited. The intervention through fascial therapy lasted 3 consecutive weeks with a weekly session of 45 min each. The dependent variables were frequency of bleeding (selfregistration), ankle range of motion (goniometer) and lower limb functionality (6-Minute Walking Test). Three assess were made: baseline, posttreatment and after follow-up period. ANOVA of repeated measures was performed to compare both groups at the three assess time points. Bonferroni correction has been applied to control the error rate of the significance level. RESULTS: Improvements were found (p < 0.001) in terms of a reduced frequency of ankle hemarthrosis. Significant differences were found in the experimental group following intervention (p < 0.001), and when comparing baseline and follow-up assessments (p < 0.05) in all variables. The frequency of hemarthrosis (p = 0.04) and functionality (p = 0.01) improved in patients who received manual therapy as compared to the control group. CONCLUSIONS: Fascial therapy achieves improvements in terms of frequency of hemarthrosis in patients with hemophilic ankle arthropathy. Ankle functionality improved in patients treated with manual therapy. This technique can improve ankle range of motion.

Self-Myofascial Release Intervention and Mobile App in Patients With Hemophilic Ankle Arthropathy: Protocol for a Randomized Controlled Trial.

BACKGROUND: Hemophilic ankle arthropathy is manifested by degenerative functional alterations and chronic pain. Myofascial release techniques are used to treat soft tissue adhesions, relieve pain, and reduce tissue sensitivity. OBJECTIVE: This study aims to evaluate the safety and efficacy of a protocol using self-myofascial release with a foam roller to be applied in patients with hemophilic ankle arthropathy. METHODS: Patients with ankle arthropathy (N=70) will be recruited, enrolled, and assigned to one of two groups-experimental or control-in a 1:1 allocation ratio. Patients will be recruited from 5 centers in different regions of Spain. Patient data will be collected at baseline, posttreatment, and follow-up. The primary outcome will be frequency of ankle joint bleeding (self-reported). The secondary outcomes will be ankle range of motion (measured with a digital goniometer); joint pain (measured with a visual analog scale and an algometer); joint status (measured using the Hemophilia Joint Health Score); muscle strength (measured with a dynamometer); functionality of lower limbs (measured using the 6-minute walking test); activity (self-reported); and muscle flexibility (measured using the fingertip-to-floor test). The treatment program includes 11 exercises that must be administered bilaterally. A mobile app will be developed where each patient will be able to observe the exercises to be carried out. Each session will last 15 minutes with 5 physiotherapy sessions per week for a period of 3 months. It is expected that patients with hemophilia who receive the foam roller intervention will show improvement in mobility, pain, and status of the ankle joint; muscle strength; and function in the lower extremities. RESULTS: The study has been approved by the institutional review board of the University of Murcia. Patient recruitment will begin in September 2020, and the intervention period will last until June 2021. Data collection will take place between September 2020 and October 2021. CONCLUSIONS: This protocol describes a randomized clinical trial to examine the safety and efficacy of a self-myofascial release intervention using a foam roller in patients with hemophilic ankle arthropathy. TRIAL REGISTRATION: ClinicalTrials.gov NCT03914287; http://clinicaltrials.gov/ct2/show/NCT03914287. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/15612.

Haemo-Adhaesione: A New Measure of Adherence for Adolescent and Adult Patients with Haemophilia.

PURPOSE: To build a multidimensional questionnaire of adherence for a patient with hemophilia that includes not only clinical but also psychosocial aspects. PATIENTS AND METHODS: One hundred and forty-six patients with haemophilia (A and B) were recruited from several Hemophilia Treatment Centers for this study. The recruitment was performed through a personal interview (20-25 mins for each patient). A literature review was carried out (different databases). In the first version (136 items), all items were subjected to an external judgment (experts in hemophilia) and also presented and discussed with a group of patients. It was made a study of content validity and homogeneity index and reliability coefficients of score were calculated with an alpha coefficient. Empirical validation was made with Pearson correlation. RESULTS: The Haemo-Adhaesione scale was composed of 5 dimensions and 10 questions about basic haemophilia concepts. It was shown to be valid and reliable to assess adherence in the Spanish population. Its internal consistency was good in all dimensions. The Rasch model was used to confirm the multidimensional structure of the scale. Significant and negative correlations were observed with the VERITAS-Pro and VERITAS-PRN scale in all dimensions, and in the total score. CONCLUSIONS: The Haemo-Adhaesione scale is a good measure of adherence for PWH. Its multidimensional structure favors the inclusion of the objective and subjective aspects implicit in its definition, as well as its dynamic nature. Patients with greater adherence are those who have more awareness of their disease, and as a result, they are more compliant with prescription and their self-care. It also discriminates between patients who follow one treatment or another.