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Una de las limitaciones para el uso de los Cuestionarios de Calidad de Vida Relacionada con la Salud y de los resultados reportados por pacientes es la dificultad de interpretar los valores obtenidos. La diferencia mínima clínica importante es una medida que ayuda a comprender los resultados de estos cuestionarios y valorar la relevancia clínica del efecto conseguido por la intervención realizada. En este trabajo revisamos el concepto de diferencia mínima clínica importante, describimos los métodos utilizados para su obtención y exponemos sus dificultades, limitaciones y aplicabilidad. Dentro de los resultados reportados por pacientes y, particularmente, en los de calidad de vida, la diferencia mínima clínica importante es una herramienta que ayuda a los clínicos a utilizar correctamente las escalas de medida e interpretar el efecto de las intervenciones. Con este artículo esperamos facilitar la implantación y uso de la diferencia mínima clínica importante y los Cuestionarios de Calidad de Vida Relacionada con la Salud en la práctica habitual con nuestros pacientes.

Introduction: The Toe Walking Tool (TWT) is a clinical screening instrument which helps in the differentiation of children with normal development, idiopathic toe-walking or toe-walking due to a medical cause., Aim: To carry out the translation and cross-cultural adaptation of the TWT for the Spanish pediatric population and to evaluate its content validity., Subjects and Methods: This paper was carried out following an inverted method of translation and back-translation. Once the pre-final Spanish version was obtained, its analysis was conducted through the Delphi method by a panel of experts. The content validity of the tool explores its clarity, viability, applicability and usefulness., Results: An expert panel composed by 15 professionals determine the content validity of the Spanish version of the TWT. The questionnaire translated and adapted transculturally into Spanish presented an excellent global content validity index (0.94) and the expert committee considered that the scale was easily understandable, viable, simple to apply and useful in the pediatric setting., Conclusions: The Spanish version of the TWT presents an excellent content validity and is an understandable, viable, simple and useful assessment tool. It is necessary to carry out future studies to analyze its psychometric properties with a Spanish pediatric population.

The CRAFFT Substance Abuse Screening Instrument, developed by the Center for Adolescents Substance Abuse Research (CeASAR) (Knight et al., 1999), is a screening tool for high-risk alcohol and drug risk consumption designed for use with adolescents. Since its publication it has been the subject of translations and validations in different countries, populations and contexts that have demonstrated its enormous potential. However, there is still no empirical validation study that would ensure its good psychometric performance in Spain. The aim of this paper is to develop an adapted version of the CRAFFT in Spanish and to analyze its psychometric properties in a sample of Spanish adolescents. For this purpose an individual interview was conducted on 312 adolescents aged between 12 and 18 years of age (M = 15.01; SD = 1.83) from the Galician community. The interview included a part of the Adolescent Diagnostic Interview (ADI) and the Problem Oriented Screening Instrument for Teenagers (POSIT). The results obtained, similar to those found in other countries, allow us to report that the Spanish version of the CRAFFT has a good psychometric behaviorproperties. It was found to have a satisfactory internal consistency with a Cronbach’s alpha value of .74. In terms of sensitivity and specificity, values of 74.4% and 96.4% respectively, were obtained and the area under the ROC curve was .946. The Spanish version of the CRAFFT is made available to researchers and professionals in the field of addictive behaviors, so that it can be used with the necessary psychometric guarantees.

Introduction: There is a major gap in knowledge about the epidemiology of epilepsy in Mediterranean countries. The EPIBERIA group was formed with the aim of promoting the conducting of epidemiological studies in this region in order to improve this situation. This paper deals with the validation of a brief questionnaire for screening patients with epilepsy in the general population., Methods: We selected an English-language questionnaire previously validated by the Ottman group. It was translated, modified to suit the characteristics of the Spanish population, and administered to a sample of 200 patients (93 epileptics and 107 non-epileptic patient controls) sampled consecutively from 5 epilepsy units in different cities in Spain. Both groups were homogeneous in demographic variables and the control group was representative of the general population., Results: We obtained a sensitivity of 100% and a specificity of 74.77% for the least rigorous correction model for the questionnaire, with a sensitivity of 94.62% and a specificity of 99.07% for the most stringent correction model. The PPV ranged from 7.48% for the first case to 69.49% in the second, assuming an epilepsy prevalence of 2%., Conclusions: The questionnaire EPIBERIA is a valid Spanish tool for epilepsy screening in the general population in Spain., (Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.)

Social support is a variable that has a great influence in the sport context. In fact, this variable not only affects the athlete's performance but it has also shown to be related to psychological disorders such as Burnout Syndrome. The aim of this paper was to illustrate the Spanish adaptation of a social support scale in the sport context. The normative group who took part in the final version of the research was composed of 397 athletes aged between 13 and 64 years old (mean= 19.23 and standard deviation= 6.67). The scale shows: adequate factorial and construct validity, acceptable fit indexes (Kaiser-Meyer-Olkin= 0.785, Root Mean Square Residual= 0.078; Kelly's criterion= 0.075), a negative correlation with the dimensions of burnout and no relationship with respect to self-esteem. In addition, it also shows high reliability (a= 0.88). Furthermore, statistically significant differences have been found in relation to genders - where women require greater social support. In contrast, males tend to display a lower level of social support with team players and international athletes. Moreover, differential item functioning (DIF) was carried out to explore sex bias, however, none of the items exhibit DIF problems.

Background: Frailty is a syndrome with important epidemiological and clinical implications in older adults. One of the most accepted definitions of frailty is that of Fried and Walston, who operationalised it according to five well defined criteria. However, their criteria are not readily applicable in primary care, where practitioners need tools to identify patients who require priority access to more specialised resources. With that objective in mind, our research group published the Frailty Instrument of the Survey of Health, Ageing and Retirement in Europe (SHARE-FI). The present paper reports the results of the Spanish sample., Methods: In the wave 1 of SHARE (2004), the Spanish sample was composed of 1,279 women and 933 men, all living in the community (mean age: 65.6 years). For each sex, a latent class analysis was used to summarise the five (adapted) frailty criteria into three incremental frailty classes. We tested the association of the frailty classes against a biopsychosocial range of wave 1 variables; the predictive validity of the frailty classes was tested using mortality data from the second wave of SHARE (2006-2007), which were available for 846 women and 660 men., Results: The frailty classes had the expected cross-sectional associations. The age-adjusted Odds ratio for mortality (with 95% confidence interval) associated with the frail class was 3.2 (1.0-10.2) for women and 8.3 (3.1-22.1) for men., Discussion: SHARE-FI is a valid and freely accessible instrument, which is intended to facilitate the adoption of the frailty paradigm in primary care., (Copyright © 2011 SEGG. Published by Elsevier Espana. All rights reserved.)

This paper describes the development of a self-report scale for adolescents to assess positive youth development values. It presents a substantial number of psychometric results performed on a sample of 2,400 adolescents (1,068 boys and 1,332 girls) from 12 to 17 years ( M = 14.73, SD = 1.25), who were studying secondary education in Western Andalusia. The results provide evidence of the psychometric quality of items, cross-validity of a structure of eight first-order factors and three second-order factors, obtained through exploratory and confirmatory factor analysis, and adequate reliability. This study concludes that the scale presents adequate evidence of validity and reliability that allows assessment, especially in school contexts, of a broad set of values of particular relevance to positive youth development.

Introduction: Monitoring health-related behaviors in adolescence requires instruments capable of providing valid data The objective of this paper is to review and assess existing information sources on smoking and alcohol and cannabis use by age and sex among adolescents in Spain., Methods: A search was carried out for studies with repeated observations over time, and their methods and characteristics reviewed. For each study, the number of surveys, their frequency and their sample size are assessed, as well as the instrument used, the available indicators, and the availability, accessibility and comparability of the information., Results: Five sources of information providing data over extended periods of time with accessible data are identified: the National survey on drug use in secondary-school children (Encuesta estatal sobre uso de drogas en estudiantes de secundaria; ESTUDES); the Health behavior in school-aged children study (ECERSHBSC); the Monitoring system for risk factors associated with non-transmissible diseases in young people (Sistema de Vigilancia de Factores de Riesgo Asociados a Enfermedades No Transmisibles dirigido a poblacion juvenil; SIVFRENT-J); the Study of risk factors in secondary school children (Estudio de factores de riesgo en estudiantes de secundaria; FRESC); and the Monitoring study of health behaviors in adolescents (Estudio de monitorizacion de las conductas de salud de los adolescents; EMCSAT). Two of the surveys cover the whole of Spain, one is regional, and two are city-specific. All use solid methods and representative sampling techniques. In some, changes have occurred that make comparison of the evolution of some indicators difficult. Report accessibility is variable; comparability is limited for some surveys. Some provide almost no stratified data., Conclusions: There are valuable sources of data, but all have shortcomings. Changing the measurement instrument in a survey for comparison with others raises dilemmas as to the internal comparability of series.

Validation of the Questionnaire of Emotional Maladjustment and Adaptive Resources in Infertility (DERA). Given the absence of measures to help psychologists working with infertile couples, this paper presents the process of developing a standardized measure to assess emotional maladjustment and adaptive resources in this population. A cross-sectional design was utilized to gather data from the assisted reproduction units of two public hospitals. Preliminary analyses were performed with a sample of 85 infertile patients. Psychometric properties of the measure were tested with a second sample of 490 infertile patients. Concerning reliability analyses, alpha indexes were adequate both for the measure and its factors. Concerning validity, second-order factor analysis yielded a four-factor solution that conjointly explains 56% of the total variance. Additional analyses with a third sample of 50 participants from the general population matched with a sample of 50 infertile participants were performed. In sum, this measure seems to be a useful psychological assessment tool to determine emotional adjustment, and individual, and interpersonal resources, for coping with infertility diagnosis and treatment.

Introduction: The aim of this paper is to examine the reliability and external validity of the Spanish adaptation of the Scale to Assess Unawareness of Mental Disorder (SUMD)., Method: A translation-backtranslation of the original scale was elaborated, and a panel of professionals participated to assess conceptual equivalence and naturality. The scale consists of 3 general items: awareness of mental disorder, awareness of the effects of medication and awareness of the social consequences of the disorder; and of 17 items related to specific symptoms, which make up two subscales: awareness and attribution. Thirty-two patients diagnosed of schizophrenic or schizoaffective disorder following DSM-IV criteria were evaluated. The evaluations were performed using interviews with an observer. Intraclass Correlation Coefficient (ICC) was calculated for the reliability analysis and the Spearman correlation coefficient between the SUMD scores and one independent score of global insight for external validity., Results: The ICC were all over 0.70. Convergent validity with the independent global measurement of insight was found for the general items of awareness of mental disorder and awareness of the effects of medication, and for the subscale on awareness of symptoms. The awareness of the social consequences of the disorder and the subscale on attribution did not correlate significantly with the global measurement of awareness (insight). These results are consistent with the hypothesis that awareness (insight) is a multidimensional phenomenon., Conclusion: The Spanish adaptation of the SUMD scale is conceptually equivalent and displays a similar reliability and external validity as the original version.

Background: In order to improve the quality of health care it is necessary to know the point of view of the patients through satisfaction surveys. Satisfaction surveys need some psychometric properties to guarantee its reliability and validity. The aim of this paper is to design and to validate a questionnaire to determine the satisfaction of patients of the hospital outpatient clinics., Methods: Validation of a satisfaction questionnaire, designed by an expert group and composed for 12 questions. The questionnaire was given to a sample of 677 patients attended in the hospital Gregorio Marañón outpatient clinics. The psychometric properties of the questionnaire were established: construct validity, concurrent criterion validity, predictive capacity and internal consistency., Results: Two dimensions were identified in the construct validity analyses, explaining 63% of the variance: "clinical quality" and "administrative quality". The concurrent validity analysis showed a Spearman's rank correlation coefficient of 0.85 related to the standard criterion "global satisfaction with the attention provided in outpatient clinics" and an OR of 1.19 related to the criterion "do you know the name of the physician who attended you?" The predictive capacity of the questionnaire was measured by discriminated analysis, obtaining 84% of correct classified, and the internal consistency test gave a Cronbach's alpha of 0.90., Conclusions: Our questionnaire has enough psychometric properties to be considered an useful and feasible tool to measure the satisfaction of patients of the hospital outpatient clinics.

Background and Objective: Sense of Coherence (SOC) is a construct relating to coping strategies in the face of traumatic events. SOC is defined as a personal disposition towards perceiving life experiences as understandable, manageable and meaningful. The construct has shown itself to be a predictor of self-reported and objective health in a variety of contexts. Although the SOC construct has been studied, among the elderly in particular, the scale has never been validated in the Spanish aged population. This paper reports on the cross-cultural validation of Antonovsky's Sense of Coherence Scale (OLQ-13) in a sample of Spanish senior citizens., Subjects and Method: We studied a sample of population from 8 locations across Spain, totaling 419 subjects aged 70 years or over. The psychometric attributes of the scale were studied. These included acceptability, scale assumptions, internal consistency, factor structure, construct validity (convergent validity, differential analyses, inter-domains correlation), and precision., Results: The internal consistency of the scale was adequate (Cronbach = 0.80). SOC showed moderate correlations with self-reported indices of physical health, quality of life and depression. The scale was found valid in differential analyses conducted for gender, age groups, levels of disability and functional impact of diseases. Principal components analysis yielded four factors accounting for 65.59% of the variance. The Meaningfulness domain acted as an independent factor., Conclusions: The OLQ-13 is a valid and reliable instrument for use on Spanish elderly populations, including those with low educational level.

Adaptation to Spanish of the Vividness of Visual Imagery Questionnaire-Revised Version (VVIQRV). The main goal of this paper was to adapt to Spanish language and to examine the psychometric properties of the "Vividness of Visual Imagery Questionnaire-Revised Version" (VVIQRV), an instrument that can be used to assess vividness of visual imagery. The adaptation was carried out starting from the Spanish version of VVIQ and taking into consideration improvement proposals suggested in other studies. The questionnaire was then administered to a sample of 414 Spanish university students and the psychometric characteristics were estimated on the basis of the classic theory and the Rasch rating scale model (RSM). The results were convergent with previous studies and indicated that the Spanish VVIQRV has good internal consistency and can be characterized by a single main factor structure. Also, the RSM analysis showed that the increment in the number of response categories, a proposal to improve the instrument, was not appropriate.

Introduction: Many studies show that subjects with sequelae after stroke have a worse health perception in western societies. Due to the shortage of papers on the Spanish population in this regard, a study was carried out to assess health perception in hemiplegic patients 2 years after stroke in comparison with that of the general population and correlate health perception with demographic, clinical and functional variables., Methods: Cross-sectional study of 212 community stroke survivors. The main variables collected were: health perception assessed with the Short Form 36 (SF-36), disability assessed with the motor Functional Independence Measure (FIM) and Geriatric Depression Scale (GDS). Statistical tests used: chi2, Student t test and Spearman correlation coefficient., Results: In comparison with the Spanish general population, health perception in hemiplegic male stroke patients is diminished in all areas. In hemiplegic female patients, physical function is the only subscale significantly affected in all age groups. Variables related to worse health perception are: presence of depression, dependence and the belief of the need for kind of social support, A significant correlation was observed between SF-36 values and the motor FIM (r = 0.737 with physical function) and the GDS (r = -0.821 with mental health)., Conclusions: Health perception in hemiplegic patients 2 years after stroke is diminished in comparison with that 348 of the general population. Factors which determine worst health perception are depression, motor dependence, need of caregiver assistance and need of social support.

The aim of this paper is to adapt to Spanish the D. van Direndonck version of Carol Ryff's Psychological Well-Being Scales, and to analyse its consistency and factorial validity. All the scales exhibited good internal reliabilities, with Cronbach alpha's ranging from 0.83 (Self-acceptance) to 0.68 (Personal growth). However, confirmatory factor analyses didn't corroborate the six-factor model (Self-acceptance, Positive relations, Autonomy, Environmental mastery, Purpose in life, and Personal growth) with a second order factor called Psychological Well-Being . To improve the psychometric properties, a new reduced version was proposed that indeed will facilitate the application. The scales of the new version maintain and raise its internal consistency (Cronbach alpha's 0.84 to 0.70). Furthermore, the scales shown an excellent fit to the theoretical model proposed by D. van Dierendonck.

Background: The development reached by many countries of our planet has allowed that in them most of the infectious diseases have diminished and that the life expectancy is over the 75 years of life. As a result of this, degenerative and chronic diseases are every day more prevalent and their treatments are longer and complex. To value quality of life in these patients and the effect of the therapy on health is at the moment a main goal of public health., Objectives: To know the origin, the evolution, and the theoretical foundation of the concept of the quality of life, as well as their measurement methods. On the other hand, to describe the characteristics of the different available questionnaires in Spain to measure the quality of life, either of generic or specific for neurologic illness., Material and Methods: The most important questionnaires which have been adapted and validated into Spanish have been revised. An exhaustive revision of the bibliography related with quality of life and neurology was carried out, and all the questionnaires described in these processes were revised., Results: We describe the philosophy and concepts of health, quality of life (QOL) and health related quality of life (HRQL). The following generic questionnaires are described: the Nottingham Health Profile (NHP), the Sickness Impact Profile (SIP), the Medical Outcomes Study Short Form (SF-36), the European Profile of Quality of Life (EuroQoL), the Questionnaire of Quality of Life (CCV) and the Profile of Life quality in the Chronically ill (PLC). In an exhaustive bibliographical revision on quality of life and neurology, 52 indexed papers appeared, of those which only twelve were related with those subject. The following specific questionnaires are described: Qualité de Vie et Migraine (QVM), the Parkinson's Disease Questionnaire (PDQ-39), the Functional Status Questionnaire (FSQ), the Quality of Life in Epilepsy Inventory (QOLIE-89) and their variant of 31 items. Finally two questionnaires ad hoc are described to study migraine and epilepsy., Conclusions: The incorporation of HRQL measures in patients with neurological illnesses is an increasing and valued practice by its specialists. We observe that the availability of generic tools to measure the HRQL in Spanish is wider every day, although most of these come from other cultures. The process continued in their transcultural adaptation and validation allows us to have some tools of great reliability and effectiveness that facilitate its use. In relation to the specific questionnaires on neurologic process, the supply is considerably smaller due to the recent appearance of these methods in this clinic area.

The aim of the present paper is to present the initial phases of the development of the Spanish version of the "World Health Organization Disablement Assessment Schedule II" WHO-DAS-II and also to describe the quantitative and qualitative methodological strategies used in the elaboration process of an instrument: i) compatible with the new International Classification of Functioning and Disability -ICIDH-2- of the World Health Organisation; ii) with criteria of cross-cultural applicability and; iii) to allow us to assess the disability in all its dimensions.

Introduction: In this paper, a collective of Psychiatry Residents from Valencia surveys the degree of achievement and satisfaction with the Spanish programme., Method: Every resident received an enquiry and a letter with instructions to fill it. Colleagues who did not answer back, were contacted and sent a new enquiry., Results: We received a total of 142 enquiries from 52 institutions (80% of the total). The results are distributed in supervision, theoretical training, research, rotatories, assistential pressure, staff-resident ratio, training out of the programme and satisfaction., Conclusions: This work show that the programme is not being carried out properly. There are still some deficiencies in many rotatories, even though they have been improved. In spite of it, the level of satisfaction with the residence is acceptable.