Pleural irregularity, a new ultrasound sign for the study of interstitial lung disease in systemic sclerosis and antisynthetase syndrome.

OBJECTIVES: To evaluate a new ultrasound sign, pleural irregularity (PI), for the study of interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) and antisynthetase syndrome (ASS). METHODS: The study included patients from our SSc and ASS cohorts with varying degrees of ILD, enrolled from 2011 to 2014. Chest high-resolution computed tomography (HRCT), pulmonary function tests (FVC and DLCO) and chest sonography were performed in each patient. Ultrasound PI and B-lines were quantified using a 72-sonographic point score and HRCT lung abnormalities were quantified using Warrick and Wells scores and categorised through Goh's algorithm. PI was correlated with HRCT and pulmonary function test parameters and its diagnostic performance to detect and classify the extent of ILD was evaluated and compared with B-lines. RESULTS: Thirty-seven patients were studied, 21 with ASS and 16 with SSc (8 without ILD). PI correlated with the Warrick score both in SSc (r=0.6, p=0.01) and ASS patients (r=0.6, p=0.005), showing a higher performance to detect ILD than using B-lines (p=0.01). In SSc patients PI also correlated with Wells score (r=0.7, p<0.001) and with DLCO (r=-0.5, p=0.05), showing a high diagnostic value for detecting ILD (AUC=0.85, 95% CI 0.64-1) and classifying it into limited or extensive (AUC=0.81, 95% CI 0.57-1). A modification of the Goh algorithm including PI was developed as a screening tool to avoid the use of HRCT in SSc patients without ultrasound evidence of extensive ILD. CONCLUSIONS: PI is useful for evaluation of ILD in SSc and ASS patients, and can be incorporated into a diagnostic algorithm in SSc patients to reducing the need for exposure to ionising radiation.

Perioperative hyperglycaemia and incidence of post-operative complications in patients undergoing total knee arthroplasty.

PURPOSE: The aim of this study was to assess whether hyperglycaemia in the post-operative period of total knee arthroplasty (TKA) affects post-operative complications regardless of diabetes mellitus (DM) diagnosis. METHODS: All patients who had undergone primary TKA were included in the study. The following data were recorded: DM diagnosis, and pre- (BGL1), intra- (BGL2) and post-operative blood glucose levels (BGL3). After 1-year follow-up, medical, infectious and mechanical or surgery-related complications were recorded. RESULTS: Of the 833 patients included, 130 (15.6 %) were diabetic. Median BGL1, BGL2 and BGL3 were 106.13, 93.49 and 134.16 mg/dl, respectively. After follow-up, 173 (20.8 %) patients presented complications, including 48 (5.76 %) medical complications and 94 (11.28 %) infections. Surgery-related complications presented in 31 (3.72 %) patients. A statistically significant association was found between BGL3 ≥ 126 mg/dl and complications (OR 1.95, p < 0.001), medical complications (OR 3.98, p < 0.001), and infections (OR 1.76, p < 0.006). CONCLUSIONS: Hyperglycaemia during the post-operative period in diabetic and non-diabetic patients undergoing TKA increases post-operative medical and infectious complications. Glycemic control during this period must be performed in order to reduce these complications. LEVEL OF EVIDENCE: Retrospective case series, Level IV.

Branch retinal vein occlusion and vitreovascular traction: a preliminary spectral domain OCT case-control study.

OBJECTIVE: Branch retinal vein occlusion (BRVO) typically occurs at an arteriovenous (AV) crossing site. Although the pathogenesis is unclear, vitreovascular traction might have a significant role in some BRVO cases. The purpose of present study was to determine the incidence of vitreoretinal traction at the obstruction site in patients diagnosed with BRVO. METHODS: In this prospective observational case­control study, 32 consecutive BRVO patients were studied with spectral-domain optical coherence tomography (SD-OCT) to detect the presence of vitreovascular traction or vitreous adherence at the occlusion site. RESULTS: SD-OCT directed to the occlusion site revealed a vitreovascular traction at this point in eight eyes (25 %). Fourteen eyes (43.75 %) were associated with an adherence of posterior hyaloids without signs of retinal traction, whereas ten eyes (31.25 %) had neither vitreoretinal adherence nor vitreous traction. Regarding either the same vessel segment of the fellow eye, none of the cases revealed vitreovascular traction in the correspondent AV crossing site; 12 cases (37.5 %) presented vitreoretinal adherence; and the remaining 20 cases (62.5 %) showed neither traction nor adhesion. Thus, vitreovascular traction in the occlusion site was significantly associated with BRVO (p = 0.024, chi-squared test). B-scan ultrasonography showed that the posterior vitreous cortex remains more frequently attached in eyes with BRVO compared to unaffected fellow eyes (p = 0.041, chi-squared test). CONCLUSIONS: A common firm vitreous adhesion at the obstruction site is reported herein, pointing out the possible role of vitreovascular traction in the etiology of some cases of BRVO. Likewise, although not all BRVO cases can be explained by this pathogenic mechanism, an attached posterior vitreous cortex might be a cofactor in the origin of this entity.

Health-related quality of life and direct costs in patients with anterior cruciate ligament injury: single-bundle versus double-bundle reconstruction in a low-demand cohort--a randomized trial with 2 years of follow-up.

PURPOSE: To evaluate health-related quality of life (HRQL) in patients undergoing anterior cruciate ligament (ACL) reconstructive surgery by use of 2 procedures and to estimate the direct costs of surgery. METHODS: We performed a 2-year randomized, prospective intervention study of 2 surgical ACL reconstruction techniques (anatomic single bundle [SB] v double bundle [DB]). Fifty-five consecutive outpatients, with a mean age of 30.88 years, were randomized to SB or DB ACL reconstruction. The Medical Outcomes Study 36-item Short Form Health Survey (SF-36) was used to measure HRQL (primary outcome). ACL injuries were assessed by the International Knee Documentation Committee (IKDC) score (secondary outcome). The use of medical resources and their costs were evaluated. RESULTS: We included 52 patients in the final analyses (23 in the SB group and 29 in the DB group). At baseline, there were no significant differences in study variables. At 2 years of follow-up, there were no significant differences in SF-36 and IKDC scores between groups. However, compared with baseline, the SF-36 physical function, physical role, bodily pain, social function, and emotional role scores were significantly better in the SB group (P < .05), whereas only the physical function dimension score was better in the DB group (P = .047). IKDC scores at 2 years improved significantly in the SB group (P < .001) and DB group (P = .004) compared with baseline. There was a significant correlation between the SF-36 physical function, physical role, and bodily pain dimensions and the IKDC score at 2 years (P < .05). The costs were € 3,251 for the SB group and € 4,172 for the DB group. CONCLUSIONS: HRQL and medical outcomes were similar between SB and DB ACL reconstruction techniques, 2 years after surgery. However, the SB technique was more cost-effective.

[Perception in chronic illnesses: linguistic validation of the revised Illness Perception Questionnaire and the Brief Illness Perception Questionnaire for a Spanish population]. / Percepción en enfermedades crónicas: validación lingüística del Illness Perception Questionnaire Revised y del Brief Illness Perception Questionnaire para la población española.

OBJECTIVE: To obtain adapted versions for the Spanish population of a specific version of the Revised Illness Perception Questionnaire Revised (IPQ-R(e)) and the Brief Illness Perception Questionnaire (BIPQ), conceptually and linguistically equivalent to the original questionnaires. DESIGN: Cultural adaptation of questionnaires: linguistic validation. SETTING: Five primary care centres and a tertiary hospital. PARTICIPANTS: A multidisciplinary team was selected. A pilot study was performed on 30 people with chronic diseases (hypertension, diabetes mellitus, stable ischaemic heart disease, asthma, chronic obstructive pulmonary disease or osteoarthritis) METHOD: The project proceeded in 3 phases: I) Double forward-translation, II) Pilot study and III) Double back-translation. Three consensus meetings were held, one in each phase. Another meeting was held with one of the authors of the original questionnaire, where we knew about a short version, the BIPQ. It was also included in the study. Double forward and back-translations were performed and consensus was reached in both stages. RESULTS: Phase I) The majority of IPQ-R(e) items did not raise problems of translation. Phase II) In the pilot study we detected that patients found some difficulties in connection with the comprehension and self administration of some items. Therefore it was decided to employ trained interviewers, to introduce changes in the IPQ-R(e) format and vocabulary and to adapt a specific version with fewer items that solved most of these difficulties Phase III) Back-translations were very similar to the original version. The BIPQ forward and back-translation process caused no difficulties. CONCLUSIONS: After lingüistic validation, IPQ-R(e) and BIPQ versions conceptually and lingüistically equivalent to original instruments were obtained.

Factors influencing health-related quality of life after TKA in patients who are obese.

BACKGROUND: Although the health-related quality of life (HRQL) for patients who are obese seems to improve after TKA, the magnitude of improvement and the associated factors remain controversial. We previously found body mass index was not associated with changes in HRQL after TKA. QUESTIONS/PURPOSES: The purposes of this secondary analysis were to determine which patient characteristics and surgical factors were associated with worse health status after TKA in patients who are severe or morbidly obese. METHODS: We assessed 60 patients (53 females; mean age, 70 years) 12 months after surgery. The mean number of comorbidities was 2.5. Mean lower limb anthropometric index scores were: suprapatellar, 1.6; infrapatellar, 2; and suprapatellar/infrapatellar, 1.2. Intraoperative difficulty (IOD) was Grade 0, 40%; Grade 1, 48%; and Grade 2, 12%. Ten patients (17%) had complications. We measured HRQL using the disease-specific WOMAC questionnaire. Patient characteristics (sociodemographic variables, BMI, comorbidity, lower limb anthropometry) and surgical factors (IOD, complications, postoperative medical data) were collected. Associations between WOMAC dimension scores at 12 months and patient characteristics and surgical factors were analyzed using linear regression models. RESULTS: Factors associated with worse WOMAC dimension scores in patients who were obese included the number of comorbidities, an infrapatellar index percentile less than 75, IOD Grade 2, and the number of complications after discharge. CONCLUSIONS: For patients with knee osteoarthritis who were severe or morbidly obese, various lower limb anthropometric features, degree of IOD, and postoperative complications negatively influenced postoperative WOMAC scores. LEVEL OF EVIDENCE: Level II Prognostic Study. See Guidelines for a complete description of levels of evidence.

Recombinant Protein-Based Nanoparticles: Elucidating their Inflammatory Effects In Vivo and their Potential as a New Therapeutic Format.

Bacterial inclusion bodies (IBs) are protein-based nanoparticles of a few hundred nanometers formed during recombinant protein production processes in different bacterial hosts. IBs contain active protein in a mechanically stable nanostructured format that has been broadly characterized, showing promising potential in different fields such as tissue engineering, protein replacement therapies, cancer, and biotechnology. For immunomodulatory purposes, however, the interference of the format immunogenic properties-intrinsic to IBs-with the specific effects of the therapeutic protein is still an uncovered gap. For that, active and inactive forms of the catalytic domain of a matrix metalloproteinase-9 (MMP-9 and mutMMP-9, respectively) have been produced as IBs and compared with the soluble form for dermal inflammatory effects in mmp9 knock-out mice. After protein injections in air-pouches in the mouse model, MMP-9 IBs induce local neutrophil recruitment and increase pro-inflammatory chemokine levels, lasting for at least two days, whereas the effects triggered by the soluble MMP-9 format fade out after 3 h. Interestingly, the IB intrinsic effects (mutMMP-9 IBs) do not last more than 24 h. Therefore, it may be concluded that IBs could be used for the delivery of therapeutic proteins, such as immunomodulating proteins while preserving their stability in the specific tissue and without triggering important unspecific inflammatory responses due to the protein format.

Role of musculoskeletal disorders as concurrent chronic conditions: are they underestimated in the discharge?

BACKGROUND: Differences in recording concurrent chronic conditions (CCs) could change the weight of the influence of the different CCs on health status. OBJECTIVES: To determine the role of musculoskeletal disorders as concurrent CCs. METHODS: Cross-sectional study. Discharged patients with CCs were selected by random stratification. Sociodemographic and clinical variables, health status (SF-36), type and number of self-reported and hospital discharge summary CCs were recorded. Relationships were analyzed using linear regression models. RESULTS: In the 227 patients included, mean self-reported CCs were 6.22 (SD 3.37) and mean hospital discharge CCs were 3.1 (SD 1.95). The most-frequent self-reported CCs were hypertension 48.4%, back pain 40.4%, neck pain 39.6%, and musculoskeletal disorders 38.4%. The most frequent discharge CCs were arterial hypertensive disease 38.3%, all cancers 22.0%, ischemic heart diseases, and angina 15.9%. Musculoskeletal disorders had the greatest negative influence on SF-36 dimensions (p < 0.05). CONCLUSIONS: Musculoskeletal disorders were underestimated in the discharge summary in comparison with those reported by patients.

Prevalence of knee osteoarthritis and analysis of pain, rigidity, and functional incapacity.

Knee osteoarthritis is one of the most prevalent health problems in our society. It accounts for 10% of all primary care visits in general medicine and 30% of outpatient appointments. The objectives of this cross-sectional descriptive study of 100 patients suffering from gonarthritis were to assess pain, functional capacity, and joint damage in patients diagnosed with knee osteoarthritis, as well as the possible repercussions for subsequent surgical treatment. Sociodemographic, clinical, and radiological data were collected, and pain and functional capacity were evaluated by using the Western Ontario and McMaster Universities Osteoarthritis Index. The majority (71) of patients were women, mean age 71 years (SD=7.84), of low educational (66%) and financial (89%) status, with mean disease duration of 11.8 years. Of the total, 87% presented with comorbidity. Radiographs revealed a varus malalignment in 31% of patients and a valgus malalignment in 17%, with bone collapse in 39% of these. The factors that most affect surgery and subsequent rehabilitation are closely linked to social status, the general state of the patient, and the radiological severity of gonarthritis. Most of the patients were obese and suffered from comorbid conditions, and some presented with psychopathology. These factors may influence surgery, and thus improvements in primary care should be made as a way of offering a simpler and more effective treatment for gonarthritis.

Fast 1.5 T chest MRI for the assessment of interstitial lung disease extent secondary to systemic sclerosis.

This study aims to evaluate the utility of magnetic resonance imaging (MRI) to assess interstitial lung disease (ILD) extent in patients with systemic sclerosis (SSc). Patients with SSc and varying degrees of ILD with a high-resolution computed tomography (HRCT), pulmonary function tests (PFTs), and a chest MRI containing an ultrafast SE sequence performed less than 1 year apart were included in the study. Wells global disease extent and Goh's staging algorithm were used to measure and categorize ILD both for MRI and HRCT. Correlation and diagnostic performance of MRI compared with HRCT and PFTs were calculated. Eighteen SSc patients were studied. MRI showed a good performance to detect ILD (AUC = 0.96) and was correlated with forced vital capacity (r = -0.60, p = 0.01), diffusing capacity of the lung for carbon monoxide (r = -0.79, p = 0.04), and also with HRCT (r = 0.85, p < 0.001), but MRI extent values were consistently lower than HRCT and, thus, not directly comparable. Goh's algorithm using HRCT and transformed to be used with MRI showed a good agreement (kappa = 0.73, p < 0.001) and MRI-measured ILD extent presented good intra-observer (ICC = 0.86) and inter-observer (ICC = 0.90) reliability. In SSc patients, MRI proved to be a good technique to detect and categorize ILD extent compared with HRCT, suggesting that it may be a valuable x-ray sparing technique for selected cases.

Health-related quality of life in patients with chronic fatigue syndrome: group cognitive behavioural therapy and graded exercise versus usual treatment. A randomised controlled trial with 1 year of follow-up.

Chronic fatigue syndrome (CFS) produces physical and neurocognitive disability that significantly affects health-related quality of life (HRQL). Multidisciplinary treatment combining graded exercise therapy (GET) cognitive behavioural therapy (CBT) and pharmacological treatment has shown only short-term improvements. To compare the effects on HRQL of (1) multidisciplinary treatment combining CBT, GET, and pharmacological treatment, and (2) usual treatment (exercise counselling and pharmacological treatment) at 12 months of follow-up. Prospective, randomized controlled trial with a follow-up of 12 months after the end of treatment. Patients consecutively diagnosed with CFS (Fukuda criteria) were randomly assigned to intervention (n = 60) or usual treatment (n = 60) groups. HRQL was assessed at baseline and 12 months by the Medical Outcomes Study Short-Form questionnaire (SF-36). Secondary outcomes included functional capacity for activities of daily living measured by the Stanford Health Assessment Questionnaire (HAQ) and comorbidities. At baseline, the two groups were similar, except for lower SF-36 emotional role scores in the intervention group. At 12 months, the intervention did not improve HRQL scores, with worse SF-36 physical function and bodily pain scores in the intervention group. Multidisciplinary treatment was not superior to usual treatment at 12 months in terms of HRQL. The possible benefits of GET as part of multidisciplinary treatment for CFS should be assessed on an individual patient basis.

Good quality of life in severely obese total knee replacement patients: a case-control study.

BACKGROUND: The impact of obesity on total knee replacement (TKR) outcomes is unclear. Studies use different classifications of obesity and heterogeneous methods, making comparisons difficult. The aim of this study was to evaluate health-related quality of life (HRQL) preoperatively and at 12 months of follow-up in severe and morbidly obese patients with knee osteoarthritis and a control group of nonobese patients undergoing TKR. METHODS: Case-control study with 12 months follow-up. HRQL was measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Sociodemographic variables, comorbidity, body mass index (BMI), degree of intra-operative difficulty (IOD), in-patient data, and postoperative medical data were collected. The effect size (ES) was measured for the different outcome measures. Comparison of the two groups after 12 months of follow-up was made using the t test. STUDY GROUP: sixty patients (88% women) with a mean age of 70.2 years (SD 6.7) and mean total WOMAC dimension score 61.4 (SD 16.7). CONTROL GROUP: 60 matched controls. There were 88% women, with a mean age of 71.7 years (SD 6.7), and a mean WOMAC score of 58.2 (SD 13.4). There were significant improvements in all WOMAC dimensions compared to baseline (p < 0.001) in both groups. There were no differences in WOMAC dimension scores between the two groups at 12 months. The study group had more IOD (p = 0.014) and more-severe complications in the follow up. CONCLUSIONS: Severe and morbidly obese and nonobese patients had similar change scores and TKR outcomes in terms of HRQL at 12 months after TKR. Obese patients had more intraoperative difficulties and more-severe postoperative complications.

Total knee replacement and health-related quality of life: factors influencing long-term outcomes.

OBJECTIVE: To evaluate health-related quality of life (HRQOL) in patients with osteoarthritis undergoing total knee replacement (TKR); identify the influence of sociodemographic, clinical, intraoperative, and postoperative variables on HRQOL; and determine patient perceptions at 7 years. METHODS: We conducted a prospective study with 7 years of followup. HRQOL measures (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] and Short Form 36 [SF-36]); sociodemographic, clinical, intraoperative, inpatient, and postoperative data; patient perceptions of TKR outcomes; and physical activity at 7 years were determined. Associations were analyzed using linear regression models. RESULTS: Of 146 eligible patients, 112 (86 women, mean age 67.3 years) completed followup data. There were significant differences between pre- and postoperative WOMAC pain, stiffness, and function scores (P < 0.001). Variables retained in each of the models explained 14-32% (adjusted R(2)) of variability of the WOMAC dimensions. Obesity and postdischarge complications were associated with worse scores in all WOMAC dimensions (P < 0.05). Eighty-six percent of patients were satisfied with TKR, 80% would undergo the operation again, and 56% did regular physical activity and had better WOMAC scores (P < 0.05, except for stiffness [not significant]). Mean +/- SD SF-36 scores for men and women at 7 years were 55.1 +/- 27.1 and 39.5 +/- 22.9 for physical function, 71.2 +/- 36.5 and 51.5 +/- 42.7 for physical role, 66.2 +/- 26 and 55.6 +/- 28.9 for bodily pain, and 60.7 +/- 17.1 and 50.7 +/- 21.2 for general health, respectively. CONCLUSION: WOMAC dimension scores, especially pain, significantly improved at 7 years and were negatively influenced by obesity and postdischarge complications. HRQOL measures may help identify an increased risk of negative outcomes after TKR.

Patients' perceptions of health-related quality of life in rheumatoid arthritis.

The purpose of this study is to determine how health-related quality of life (HRQL) is perceived by patients with rheumatoid arthritis using textual analysis and to identify associations between sociodemographic and clinical variables and patients' perceptions. Multicentre, cross-sectional study, including 781 patients (78.8% females, mean age 60.65 years, standard deviation 14.22). Sociodemographic and clinical variables were collected. A questionnaire was used which included an open question, "What does HRQL mean to you?" Cluster analysis was used, and answers to the open question were analysed using textual analysis. Cluster analysis showed three typologies differentiated by gender, age, and socioeconomic level and by the terms used to describe perceptions of HRQL with no marked clinical differences. Characteristic phrases were "to be totally independent, to have no pain, and to do things without thinking about the negative effects" (typology 1); "to have no pain and control my moods and my illness has made me a little excitable" (typology 2); and "to feel well enough to do things for myself" (typology 3). Three representative typologies of patients were identified who differed clearly in their perceptions of HRQL. Textual analysis may be considered as a valid tool for the analysis of complex issues such as quality of life.

Patients' perceptions of health related quality of life in rheumatoid arthritis and chronic low back pain.

OBJECTIVES: To determine how health related quality of life (HRQL) is perceived by patients with rheumatoid arthritis (RA) and chronic low back pain (CLBP) using a textual analysis approach. PATIENTS: Two-hundred and forty-eight outpatients (85% female), mean age 58+/-13 years (40% RA and 60% CLBP). METHODS: Observational descriptive study. Sociodemographic and clinical variables were determined. A questionnaire was designed which included an open question "What does health related quality of life mean to you." which patients answered in writing. Textual data analysis was performed using a previous described method based on multivariate descriptive statistical methods. RESULTS: The two groups were homogenous with respect to gender, educational level, disease duration, comorbid conditions and global functional status. Patients with RA and CLBP used clearly differentiated terms to describe HRQL (RA: to be able (capable), house; CLBP: life, health, quality). RA patients were specific and primarily concerned with functional status and CLBP patients with health and life. The most characteristic phrase used by RA patients was: "to be able to do housework" and for CLBP: "health is the most important thing for quality of life." In the factorial representation, the two pathologies were markedly separated. CONCLUSIONS: A series of characteristic answers on HRQL may be identified in patients with RA and CLBP, showing that they have different perceptions about what HRQL is according to their pathology. The use of open questions in a group of homogenous patients with specific pathologies could result in more disease-specific responses. Textual statistical analysis of open questions may provide more information than standard methods, and may be considered as valid for the analysis of subjective issues such as quality of life.

Health-related quality of life in rheumatoid arthritis: therapeutic education plus pharmacological treatment versus pharmacological treatment only.

OBJECTIVE: To determine whether therapeutic education added to conventional drug therapy reduced disability and pain in patients with early rheumatoid arthritis (RA). METHODS: Fourty-three patients with RA, 29F/14 M, were included in a randomized, controlled trial and assigned to a control group receiving conventional pharmacological treatment only (n=21), or an intervention group receiving therapeutic education added to conventional pharmacological treatment (n=22). The main outcome variable was self-reported disability on the Stanford health assessment questionnaire (HAQ). RESULTS: At 18 months, patients in the intervention group had less disability (HAQ), pain intensity, number of tender and swollen joints, and patient's and physician's global assessments (p=0.003, 0.031, 0.003, 0.001, 0.014, and 0.004, respectively) compared with baseline, and improvements in disability and number of tender and swollen joints (p=0.024, 0.040, and 0.003, respectively), compared with controls. CONCLUSIONS: Patients receiving pharmacological treatment and therapeutic education had a better evolution than those receiving only pharmacological treatment.

Percepción en enfermedades crónicas: validación lingüística del Illness Perception Questionnaire Revised y del Brief Illness Perception Questionnaire para la población española / Perception in chronic illnesses: linguistic validation of the revised Illness Perception Questionnaire and the Brief Illness Perception Questionnaire for a Spanish population

Objetivo: Obtener versiones adaptadas para la población española de una versión específica del Illness Perception Questionnaire Revised (IPQ-Re) y el Brief Illness Perception Questionnaire (BIPQ), conceptual y lingüísticamente equivalentes a los originales. Diseño: Adaptación cultural de cuestionarios: validación lingüística. Emplazamiento: Cinco equipos de atención primaria y un hospital de tercer nivel. Participantes: Se seleccionó un equipo investigador multidisciplinario. Se realizó un estudio piloto en 30 pacientes con enfermedades crónicas (hipertensión, diabetes mellitus tipo 2, cardiopatía isquémica estable, asma, enfermedad pulmonar obstructiva crónica o artrosis). Método: Se procedió en 3 fases: I) doble traducción, II) estudio piloto y III) doble retrotraducción. Se realizaron 3 reuniones de consenso, una en cada fase y otra con uno de los autores del cuestionario original. En esta última se conoció el BIPQ, una versión reducida del IPQ-R. Se decidió incluir su validación realizando una doble traducción, doble retrotraducción y consenso en ambas etapas. Resultados: Fase I) La mayoría de ítems del IPQ-Re no planteó problemas de traducción. Fase II) En el estudio piloto se detectaron algunas dificultades para la autoadministración y la comprensión de algunos ítems. Se decidió disponer de entrevistadores entrenados, introducir cambios en el vocabulario y formato del cuestionario y adaptar una versión específica con menor cantidad de ítems, que solventaba gran parte de las dificultades encontradas. Fase III) Las retrotraducciones fueron muy similares al cuestionario original. El proceso de traducción-retrotraducción del BIPQ no presentó dificultades. Conclusiones: Tras la validación lingüística del IPQ-Re y del BIPQ, se obtuvieron versiones conceptual y lingüísticamente equivalentes a los cuestionarios originales(AU)

Objective: To obtain adapted versions for the Spanish population of a specific version of the Revised Illness Perception Questionnaire Revised (IPQ-Re) and the Brief Illness Perception Questionnaire (BIPQ), conceptually and linguistically equivalent to the original questionnaires. Design: Cultural adaptation of questionnaires: linguistic validation. Setting: Five primary care centres and a tertiary hospital. Participants: A multidisciplinary team was selected. A pilot study was performed on 30 people with chronic diseases (hypertension, diabetes mellitus, stable ischaemic heart disease, asthma, chronic obstructive pulmonary disease or osteoarthritis). Method: The project proceeded in 3 phases: I) Double forward-translation, II) Pilot study and III) Double back-translation. Three consensus meetings were held, one in each phase. Another meeting was held with one of the authors of the original questionnaire, where we knew about a short version, the BIPQ. It was also included in the study. Double forward and back-translations were performed and consensus was reached in both stages. Results: Phase I) The majority of IPQ-Re items did not raise problems of translation. Phase II) In the pilot study we detected that patients found some difficulties in connection with the comprehension and self administration of some items. Therefore it was decided to employ trained interviewers, to introduce changes in the IPQ-Re format and vocabulary and to adapt a specific version with fewer items that solved most of these difficulties Phase III) Back-translations were very similar to the original version. The BIPQ forward and back-translation process caused no difficulties. Conclusions: After lingüistic validation, IPQ-Re and BIPQ versions conceptually and lingüistically equivalent to original instruments were obtained(AU)