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Roberto Bernabeu-Mora,1–3 Gloria García-Guillamón,2 Joaquina Montilla-Herrador,2,3 Pilar Escolar-Reina,2,3 José Antonio García-Vidal,2 Francesc Medina-Mirapeix2,3 1Division of Pneumology, Hospital Morales Meseguer, 2Department of Physical Therapy, University of Murcia, 3Physiotherapy and Disability Research Group, Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB), Murcia, Spain Background: Hospitalization is common for acute exacerbation of COPD, but little is known about its impact on the mental health of caregivers. Objective: The aim of this study was to determine the rates and predictors of depressive symptoms in caregivers at the time of hospitalization for acute exacerbation of COPD and to identify the probability and predictors of subsequent changes in depressive status 3 months after discharge. Materials and methods: This was a prospective study. Depression symptoms were measured in 87 caregivers of patients hospitalized for exacerbation at hospitalization and 3 months after discharge. We measured factors from four domains: context of care, caregiving demands, caregiver resources, and patient characteristics. Univariate and multivariate multiple logistic regressions were used to determine the predictors of depression at hospitalization and subsequent changes at 3 months. Results: A total of 45 caregivers reported depression at the time of hospitalization. After multiple adjustments, spousal relationship, dyspnea, and severe airflow limitation were the strongest independent predictors of depression at hospitalization. Of these 45 caregivers, 40% had a remission of their depression 3 months after discharge. In contrast, 16.7% of caregivers who were not depressive at hospitalization became depressive at 3 months. Caregivers caring >20 hours per week for patients with dependencies had decreased odds of remission, and patients having dependencies after discharge increased the odds of caregivers becoming depressed. Conclusion: Depressive symptoms are common among caregivers when patients are hospitalized for exacerbation of COPD. Although illness factors are determinants of depression at hospitalization, patient dependence determines fluctuations in the depressive status of caregivers. Keywords: caregivers, COPD, depression, acute care, family care

To compare the effectiveness of a combined treatment involving manual therapy and postural exercises in wind musicians with temporomandibular dysfunction (TMD). Methods: A randomized controlled clinical trial was conducted among a sample of TMD-affected wind-instrument musician students (NCT05893251), who were assigned to an experimental group (EG) or a control group (CG). Both groups underwent an active cervical postural treatment for 4 weeks, with the experimental group (EG) additionally receiving a cervical therapy protocol. Participants were assessed through the craniofacial pain and disability inventory (CF-PDI) test and maximum mouth opening (MMO). The treatment administered to the experimental group (EG) demonstrated higher efficacy compared to the control group (CG) in terms of MMO and CF-PDI scores (p < 0.05). A therapeutic program including manual therapy at a cervical level and a program of active postural exercises results to be more effective than solely performing postural exercises on wind musicians with DTM. • Clinical Implications: • A combined therapeutic approach of manual therapy and postural exercises is more effective than the isolated use of exercises. • The active involvement of the patient is essential for successful management. [ABSTRACT FROM AUTHOR]

Objective To evaluate the interobserver reliability of the Short Physical Performance Battery (SPPB) and hand dynamometry when measuring isometric muscle strength in people with chronic obstructive pulmonary disease (COPD). Design Reliability study. Each patient was assessed by a pulmonology physician and a physical therapist in 2 separate sessions 7 to 14 days apart (mean, 9.8±0.8d). Each rater was blinded to the other's results. Setting Pneumology unit of a public hospital. Participants Random sample of outpatients with stable COPD (N=30). Interventions Not applicable. Main Outcome Measures SPPB and muscle strength (kg) using electronic handgrip and handheld dynamometers. Reliability was assessed with intraclass correlation coefficients (ICCs), standard error of measurement values, and Bland-Altman plots. ICCs were calculated for the SPPB summary score and for its 3 subscales. Results The ICCs for the overall reliability of the SPPB summary score and for grip and quadriceps strength were .82 (95% confidence interval [CI], .62–.91), .97 (95% CI, .93–.98), and .76 (95% CI, .49–.88), respectively. The standard error of measurement values were .55 points, 1.30kg, and 1.22kg, respectively. The mean differences between the rater's scores were near zero for grip strength and SPPB summary score measures. The ICCs for the SPPB subscales were .84 (95% CI, .66–.92) for the chair subscale, .75 (95% CI, .48–.88) for gait, and .33 (95% CI, −.42 to .68) for balance. Conclusions Interobserver reliability was good for quadriceps and handgrip dynamometry and for the SPPB summary score and its chair stand and gait speed subscales. Both pulmonary physicians and physical therapists can obtain and exchange the scores. Because the reliability of the balance subscale was questionable, it is better to use the SPPB summary score. [ABSTRACT FROM AUTHOR]

Question: What are the perceptions of parents of children with physical disabilities about the home exercise programs that physiotherapists prescribe? How do these perceptions affect adherence to home exercise programs? Design: Qualitative study using focus groups and a modified grounded theory approach. Participants: Parents of children with physical disabilities who have been prescribed a home exercise program by physiotherapists. Results: Twenty-eight parents participated in the focus groups. Two key themes that related to adherence to home exercise programs in young children with physical disabilities were identified: the characteristics of the home exercise program; and the characteristics of the physiotherapist's teaching style. In the first theme, the participants described their experiences regarding their preference for exercises, which was related to the perceived effects of the exercises, their complexity, and the number of exercises undertaken. These factors determined the amount of time spent performing the exercises, the effect of the exercises on the family's relationships, and any sense of related burden. In the second theme, participants revealed that they adhered better to prescribed exercises when their physiotherapist made an effort to build their confidence in the exercises, helped the parents to incorporate the home exercise program into their daily routine, provided incentives and increased motivation. Conclusion: Parents perceive that their children's adherence to home-based exercises, which are supervised by the parents, is more successful when the physiotherapist's style and the content of the exercise program are positively experienced. These findings reveal which issues should be considered when prescribing home exercise programs to children with physical disabilities. [Lillo-Navarro C, Medina-Mirapeix F, Escolar-Reina P, Montilla-Herrador J, Gomez-Arnaldos F, Oliveira-Sousa SL (2015) Parents of children with physical disabilities perceive that characteristics of home exercise programs and physiotherapists’ teaching styles influence adherence: a qualitative study. Journal of Physiotherapy 61: 81–86] [ABSTRACT FROM AUTHOR]

Objective To describe the development and the initial psychometric evaluation of a mobility measure for inpatient postacute rehabilitation settings—the Mobility Activities Measure for Inpatient Rehabilitation Settings (Mobam-in). Design Self-report–based psychometric study. Setting Postacute rehabilitation unit of a public hospital. Participants A consecutive sample of inpatients (N=239) receiving postacute rehabilitation care. Interventions Not applicable. Main Outcome Measures We developed a 30-item mobility measure, using the Mobility Activities Measure (Mobam) framework, to assess functioning across 5 mobility activity domains classified within the International Classification of Functioning, Disability and Health. These were (1) changing and maintaining body position involving only sitting and/or lying (4 items); (2) changing and maintaining body position involving standing up (6 items); (3) carrying and moving objects using the hand and shoulder (6 items); (4) handling objects using only the hand and/or forearm (7 items); and (5) walking and moving (7 items). Psychometric analyses were conducted to test assumptions underlying the scaling and scoring of Mobam-in scales, and to test both the reliability and validity. Results Multitrait scaling and confirmatory factor analyses (with Tucker-Lewis Index median, .99; root mean square error of approximation median, .025) supported the assumption of unidimensionality concerning each domain. Five dimensions appeared to be stable across diverse diagnostic groups (the percentage of items with discriminant validity ranged from 93% to 100%, Cronbach coefficient ranged from .859 to .966). Rasch model (Masters' partial credit) showed that all items could be located along a continuum in each dimension, with goodness-of-fit criteria of infit and outfit mean-square values between 0.6 and 1.4. Test-retest reliability was excellent (intraclass correlation coefficients median, .98). Groups with more severe conditions and lower functional independence scored lower on Mobam-in scales, as hypothesized. Conclusions Mobam-in covers 5 dimensions of mobility activities. The Mobam framework is an effective reference for building outcome instruments. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To describe the quality of patients' continuity experiences in a population of outpatients receiving postacute rehabilitation care, and to check which elements and types of continuity most strongly determine their satisfaction with care and functional changes. Design: Cross-sectional self-report survey. Setting: Three postacute ambulatory centers in metropolitan areas. Participants: Outpatients (N=218; mean age ± SD, 38.5±11.7y). Interventions: Not applicable. Main Outcome Measures: The questionnaire included experiences regarding aspects of informational (transference of information, accumulated knowledge), management (consistency and flexibility of care), and relational (established relation and consistency of provider) continuity, as well as questions concerning patients' sociodemographic characteristics, satisfaction with care, and global rating change. Results: Respondents indicated more problems in terms of management and relational continuity than in informational continuity. For all patient groups, experiences regarding elements of management continuity (R 2=15.3%–22.4%), followed by relational continuity (R 2=14.3%–25.2%), explained most of the variance of satisfaction. Consistency and flexibility of care, together with an established relation, were the most determining elements of satisfaction. Experiences regarding elements of management continuity explained most of the variance of change (18.5%), and flexibility was the most decisive element. Conclusions: Patient satisfaction and functional changes are related with experiences in aspects of management continuity, where there is room for improvement. Measures of management continuity may be promising as indicators of continuity, and they should be prioritized. [Copyright &y& Elsevier]

Abstract: Objective: To identify elements of the environment that patients consider when evaluating the quality of a care experience in outpatient rehabilitation settings. Design: A qualitative study using a modified grounded theory approach. Data collection used semistructured interviewing during 9 focus groups. Setting: Three postacute ambulatory centers in metropolitan areas. Participants: Adults (N=57; 33 men, 24 women) undergoing outpatient rehabilitation for musculoskeletal conditions/injuries. Interventions: Not applicable. Main Outcome Measures: Not applicable. Results: Participants perceived the quality of rehabilitation service on the basis of their experiences with environmental factors, including 3 physical factors (facility design, ambient conditions, and social factors) and 4 organizational factors (duration of attendance, interruptions during delivery of care, waiting times in the sequence of treatment, and patient safety). Conclusions: This study identifies the specific environmental attributes that patients consider important when evaluating the quality of outpatient rehabilitation settings and develops a patient-based framework for assessing the overall perception of service quality. Further research should work to develop self-report questionnaires about patient experiences with the environment in rehabilitation services to provide empirical and quantitative evidence. [Copyright &y& Elsevier]

Abstract: Medina-Mirapeix F, Navarro-Pujalte E, Escolar-Reina P, Montilla-Herrador J, Valera-Garrido JF, Collins SM. Mobility activities measurement for outpatient rehabilitation settings. Objective: To investigate the factor structure and scale properties of items underlying the mobility activities subdomains of the International Classification of Functioning, Disability and Health (ICF). Design: A cross-sectional self-report–based psychometric study. Setting: Outpatient rehabilitation settings (N=3) in 3 urban areas of Spain. Participants: Convenience sample of 615 patients with musculoskeletal conditions (mean age, 38.1y) participating in an active physiotherapy program. Interventions: Not applicable. Main Outcomes Measures: A 22-item Mobility Activities Measure by using a self-report questionnaire that assessed whether patients had limitations on daily activities across major ICF categories of mobility subdomains. Factor analysis, tests of item scaling, internal consistency reliability analysis, Rasch item response theory modeling, and modified parallel analysis were used. Results: Initial exploratory factor analysis results for each ICF subdomain produced a total of 5 distinct and interpretable factors or dimensions: changing and maintaining body position involving sitting and/or lying; changing and maintaining body position involving standing up; carrying, moving, and handling objects using the hand and shoulder; carrying, moving, and handling objects using the hand and/or forearm; and walking and moving. Dimensionality of these 5 factors was verified by using confirmatory factor analyses and scaling assumptions were met for each dimension. Rasch scaling and modified parallel analysis supported the unidimensionality. Conclusions: The Mobility Activities Measure is a promising new self-report measure of mobility activities as defined by the ICF. Information about Mobility Activities Measure items and dimensions from this study will be useful in the future operationalization and implementation of ICF. [Copyright &y& Elsevier]

Abstract: Escolar-Reina P, Medina-Mirapeix F, Gascón-Cánovas JJ, Montilla-Herrador J, Valera-Garrido JF, Collins SM. Self-management of chronic neck and low back pain and relevance of information provided during clinical encounters: an observational study. Objective: To assess the relative influence of information provided during physical therapy on a patient''s adherence to self-management strategies in relation to other predictors of adherence (patient and pain characteristics, use of self-management strategies before intervention). Design: A longitudinal observational study of the relationship between the information provided during physical therapy and adherence to self-management strategies. Setting: Data came from a clinical-based population in 8 primary health care centers. Participants: Patients (N=184) with chronic neck or low back pain (77% under the age of 59y) were surveyed at the beginning and 1 month after completion of physical therapy. Interventions: Not applicable. Main Outcome Measures: Specific and overall adherence to 2 types of strategies: (1) nonpharmacologic pain management strategies, and (2) neck/back care in activities of daily life. Results: Adherence to strategies of nonpharmacologic self-management of pain was more probable when patients received information explaining the effectiveness of the self-management strategies (adjusted odds ratio [AOR]=10.1; P<.05) and information about their illness (AOR=3.4; P<.05) during clinical encounters. Information provided by the physical therapist did not have any influence on the adherence to neck/back care in activity of daily life (P>.05). Conclusions: Information provided during clinical encounters is associated with adherence to different kinds of self-management strategies. While further study is required, it is suggested that more attention be given to clinical practice strategies for improving adherence to self-management of chronic pain. [Copyright &y& Elsevier]

Objective: To determine usefulness and reliability of patient reports as a data source on the use of exercises for neck pain in primary healthcare.Design: Survey research.Subjects: A total of 176 patients with mechanical neck pain, surveyed about their physical therapy experience.Method: A questionnaire was constructed on the selection of exercises, instructions for carrying them out and follow-up provided by the physical therapist. The same items reported by the surveyed patients were also reviewed in the physical therapy record. We analysed the reliability and validity of the questionnaire, and used the valid information from the survey to estimate a total of 8 indicators on the quality of care provided.Results: Sensitivity of the items was high (>75%), suggesting that most of the recorded information could be provided by patients, and specificity was quite low, suggesting that they also provide relevant information that was not recorded. These results, particularly low specificity, were not homogeneous among items. Estimates for the indicators demonstrate room for improvement.Conclusion: Patient reports could be useful as a complement to other sources of information for physical therapy quality assessment, and they can be reliable and valid substitutes for recorded data about specific aspects of the care provided. [ABSTRACT FROM AUTHOR]

Mammary fistula (MF) is a recurrent condition characterised by the draining of abscesses around the areola. The best management for MF remains challenging. Moreover, the main problem is the high recurrence rate of this disease. MF is considered a chronic process. The percutaneous electrolysis (PE) technique involves the application of a galvanic current with an ultrasound-guided needle to induce ablation and repair of the affected tissue. Good results have been obtained with PE in chronic tendinopathies. Below we present a hypothesis that PE may be a new therapeutic option for MF. [ABSTRACT FROM AUTHOR]

Abstract Background The aim of this study is to explore perceptions of people with chronic neck or low back pain about how characteristics of home exercise programs and care-provider style during clinical encounters may affect adherence to exercises. Methods This is a qualitative study consisting of seven focus groups, with a total of 34 participants presenting chronic neck or low back pain. The subjects were included if they were receiving physiotherapy treatment and were prescribed home-based exercises. Results Two themes emerged: home-based exercise programme conditions and care provider's style. In the first theme, the participants described their positive and negative experiences regarding time consumption, complexity and effects of prescribed exercises. In the second theme, participants perceived more bonding to prescribed exercises when their care provider presented knowledge about the disease, promoted feedback and motivation during exercise instruction, gave them reminders to exercise, or monitored their results and adherence to exercises. Conclusions Our experiential findings indicate that patient's adherence to home-based exercise is more likely to happen when care providers' style and the content of exercise programme are positively experienced. These findings provide additional information to health care providers, by showing which issues should be considered when delivering health care to patients presenting chronic neck or back pain.

Abstract Background Evidence suggests that to facilitate physical activity sedentary people may adhere to one component of exercise prescriptions (intensity, duration or frequency) without adhering to other components. Some experts have provided evidence for determinants of adherence to different components among healthy people. However, our understanding remains scarce in this area for patients with neck or low back pain. The aims of this study are to determine whether patients with neck or low back pain have different rates of adherence to exercise components of frequency per week and duration per session when prescribed with a home exercise program, and to identify if adherence to both exercise components have distinct predictive factors. Methods A cohort of one hundred eighty-four patients with chronic neck or low back pain who attended physiotherapy in eight primary care centers were studied prospectively one month after intervention. The study had three measurement periods: at baseline (measuring characteristics of patients and pain), at the end of physiotherapy intervention (measuring characteristics of the home exercise program) and a month later (measuring professional behaviors during clinical encounters, environmental factors and self-efficacy, and adherence behavior). Results Adherence to duration per session (70.9% ± 7.1) was more probable than adherence to frequency per week (60.7% ± 7.0). Self-efficacy was a relevant factor for both exercise components (p < 0.05). The total number of exercises prescribed was predictive of frequency adherence (p < 0.05). Professional behaviors have a distinct influence on exercise components. Frequency adherence is more probable if patients received clarification of their doubts (adjusted OR: 4.1; p < 0.05), and duration adherence is more probable if they are supervised during the learning of exercises (adjusted OR: 3.3; p < 0.05). Conclusion We have shown in a clinic-based study that adherence to exercise prescription frequency and duration components have distinct levels and predictive factors. We recommend additional study, and advise that differential attention be given in clinical practice to each exercise component for improving adherence.

Background: Evidence suggests that to facilitate physical activity sedentary people may adhere to one component of exercise prescriptions (intensity, duration or frequency) without adhering to other components. Some experts have provided evidence for determinants of adherence to different components among healthy people. However, our understanding remains scarce in this area for patients with neck or low back pain. The aims of this study are to determine whether patients with neck or low back pain have different rates of adherence to exercise components of frequency per week and duration per session when prescribed with a home exercise program, and to identify if adherence to both exercise components have distinct predictive factors.Methods: A cohort of one hundred eighty-four patients with chronic neck or low back pain who attended physiotherapy in eight primary care centers were studied prospectively one month after intervention. The study had three measurement periods: at baseline (measuring characteristics of patients and pain), at the end of physiotherapy intervention (measuring characteristics of the home exercise program) and a month later (measuring professional behaviors during clinical encounters, environmental factors and self-efficacy, and adherence behavior).Results: Adherence to duration per session (70.9% +/- 7.1) was more probable than adherence to frequency per week (60.7% +/- 7.0). Self-efficacy was a relevant factor for both exercise components (p < 0.05). The total number of exercises prescribed was predictive of frequency adherence (p < 0.05). Professional behaviors have a distinct influence on exercise components. Frequency adherence is more probable if patients received clarification of their doubts (adjusted OR: 4.1; p < 0.05), and duration adherence is more probable if they are supervised during the learning of exercises (adjusted OR: 3.3; p < 0.05).Conclusion: We have shown in a clinic-based study that adherence to exercise prescription frequency and duration components have distinct levels and predictive factors. We recommend additional study, and advise that differential attention be given in clinical practice to each exercise component for improving adherence. [ABSTRACT FROM AUTHOR]