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Abstract Background The aims of this study were to propose a Spanish Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) short form based on previously shortened versions and to study its validity, reliability, and responsiveness for patients with hip osteoarthritis undergoing total hip replacement (THR). Methods Prospective observational study of two independent cohorts (788 and 445 patients, respectively). Patients completed the WOMAC and the Short Form (SF)-36 questionnaires before THR and 6 months afterward. Patients received the questionnaires by mailing, and two reminder letters were sent to patients who had not replied the questionnaire. Based on two studies from the literature, we selected the two shortened domains, the pain domain composed of three items and the function domain composed of eight items. Thus, we proposed an 11-items WOMAC short form. A complete validation process was performed, including confirmatory factor analysis (CFA) and Rasch analysis, and a study of reliability, responsiveness, and agreement measured by the Bland-Altman approach. Results The mean age was about 69 years and about 49% were women. CFA analyses confirmed the two-factor model. The pain and function domains fit the Rasch model. Stability was supported with similar results in both cohorts. Cronbach's alpha coefficients were high, 0.74 and 0.88. The highest correlations in convergent validity were found with the bodily pain and physical function SF-36 domains. Significant differences were found according to different pain and function severity scales, supporting known-groups validity. Responsiveness parameters showed large changes (effect sizes, 2.11 and 2.29). Agreement between the WOMAC long and short forms was adequate. Conclusions Since short questionnaires result in improved patient compliance and response rates, it is very useful to have a shortened WOMAC version with the same good psychometric properties as the original version. The Spanish WOMAC short form is valid, reliable, and responsive for patients undergoing THR, and most importantly, the first WOMAC short version proposed in Spanish. Because of its simplicity and ease of application, the short form is a good alternative to the original WOMAC questionnaire and it would further enhance its acceptability and usefulness in clinical research, clinical trials, and in routine practice within the orthopaedic community.

Abstract Background To confirm the internal structure of the Health Related Quality of Life for Eating Disorders version 2 questionnaire (HeRQoLEDv2) and create and validate a shortened version (HeRQoLED-S). Methods 324 patients with eating disorders were assessed at baseline and one year later (75.6% of whom responded). We performed a confirmatory factor analysis of the HeRQoLEDv2 using baseline data, and then a Rasch analysis to shorten the questionnaire. Data obtained at year one was used to confirm the structure of the HeRQoLED short form and evaluate its validity and reliability. Results Two latent second-order factors -- social maladjustment and mental health and functionality -- fit the data for the HeRQoLEDv2. Rasch analysis was computed separately for the two latent second-order factors and shortened the HeRQoLEDv2 to 20 items. Infit and outfit indices were acceptable, with the confirmatory factor analysis of the HeRQoLED short form giving a root mean square error of approximation of 0.07, a non-normed fit index and a comparative fit index exceeding 0.90. The validity was also supported by the correlation with the convergent measures: the social maladjustment factor correlated 0.82 with the dieting concern factor of the Eating Attitudes Test-26 and the mental health and functionality factor correlated -0.69 with the mental summary component of the Short Form-12. Cronbach alphas exceeded 0.89. Conclusions Two main factors, social maladjustment and mental health and functionality, explain the majority of HeRQoLEDv2 scores. The shortened version maintains good psychometric properties, though it must be validated in independent samples.

PURPOSE: To assess motivation to change (Mch) of patients with an eating disorder (ED) and its relationship with quality-of-life (QoL) by comparing patient and psychiatrist perceptions. METHOD: Patients (n=358) with an ED completed the disease-specific Health-Related Quality of Life for Eating Disorders (HeRQoLED) questionnaire, the Eating Attitudes Test (EAT-26) and the Short-Form Health Survey (SF-12) at baseline; 273 completed them after 1year of treatment. The relationship between health-related quality of life (HRQoL) and the Mch stage was assessed using analysis of variance. Chi-square and Kappa statistical analysis assessed congruence in motivational change perception of the patients and psychiatrists. RESULTS: Higher patient-reported Mch was associated with higher HRQoL at the study beginning and end but not using the patient Mch as perceived by the psychiatrist. Initially, the patient and psychiatrist perceptions of Mch differed (kappa coefficient, -0.01); after 1year they tended to converge (k=0.34). CONCLUSIONS: Higher Mch and higher QoL are positively associated. However, patient and psychiatrist perceptions of Mch and the relationship with QoL differ. After 1year of treatment, these differences decreased. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to estimate the incidence and age of onset of mental disorders diagnosed by gender and socioeconomic status (SES) in children, adolescents, and young adults up to 30 years of age in the whole population of the Basque Country (Spain)., Methods: All mental health diagnoses documented in Basque Health Service records from 1 January 2003 to 31 December 2018, were classified into eight clusters: anxiety, attention deficit hyperactivity disorder (ADHD), conduct disorders, depression, psychosis/personality disorders, substance use, eating disorders, and self-harm. We calculated incidence and cumulative incidence for each cluster, disaggregated by gender, and socioeconomic status (SES). Poisson regression analyses were performed., Results: Overall, 9,486,853 person-years of observation were available for the 609,281 individuals included. ADHD and conduct disorders were diagnosed in the first decade, anxiety and depression disorders in the second and third decades, and psychosis/personality and substance use in the third. The cumulative incidence at 18 years of age for any type of disorder was 15.5%. The group with low SES had a statistically significantly higher incidence of all eight clusters. The incidence of ADHD, conduct disorders, depression, psychosis/personality disorders, and substance use was higher in males and that of anxiety, eating disorders and self-harm was higher in females., Conclusions: The incidence of mental disorders is high among children, adolescents, and young adults in the Basque Country underlining the need for preventive interventions. Marked differences by gender and SES highlight mental health inequalities, especially for depression and psychosis in low SES males., (© 2023. The Author(s).)

Purpose: The existing evidence suggests that a complete evaluation of mental health should incorporate both psychopathology and mental well-being indicators. However, few studies categorize European adolescents into subgroups based on such complete mental health data. This study used the data on mental well-being and symptoms of mental and behavioral disorders to explore the mental health profiles of adolescents in Europe., Methods: Data collected from adolescents (N = 3767; mean age 12.4 [SD = 0.9]) from five European countries supplied the information on their mental well-being (personal resilience, school resilience, quality of life, and mental well-being) and mental and behavioral disorder symptoms (anxiety, depression, stress, bullying, cyber-bullying, and use of tobacco, alcohol, or cannabis). Multiple correspondence analysis and cluster analysis were combined to classify the youths into mental health profiles., Results: Adolescents were categorized into three mental health profiles. The "poor mental health" profile (6%) was characterized by low levels of well-being and moderate symptoms of mental disorders. The "good mental health" profile group (26%) showed high well-being and few symptoms of mental disorders, and the "intermediate mental health" profile (68%) was characterized by average well-being and mild-to-moderate symptoms of mental disorders. Groups with higher levels of well-being and fewer symptoms of mental disorders showed lower rates of behavioral problems. Mental well-being indicators strongly contributed to this classification., Conclusion: Adolescents with the "intermediate" or "poor" mental health profiles may benefit from interventions to improve mental health. Implications for school-based interventions are discussed., Trial Registration Number (trn) and Date of Registration: ClinicalTrials.gov Identifier: NCT03951376. Registered 15 May 2019., (© 2021. The Author(s).)

Resilience is the process and outcome of healthy adaptation despite significant adversity. Proliferation of research on the resilience construct has led to scientific concerns about the operationalization and measurement of resilience for assessment science and practice. Various studies that have investigated the psychometric properties and construct validity of the Resilience Scale for Adolescents (READ) have yielded inconsistent findings, which could partly be due to variations in the methodological approaches. This study investigated the factor structure and construct validity of the READ in four European regions participating in the Universal Preventive Resilience Intervention Globally Implemented in Schools to Improve and Promote Mental Health for Teenagers (UPRIGHT) project. Participants included adolescents aged 10-15 years from Spain ( n = 391, females = 51%), Iceland ( n = 379, females = 55%), Italy ( n = 460, females = 55%), and Poland ( n = 316, females = 51%). The five-factor model of the READ was similar across gender and participating regions. Construct validity of the READ was supported. After establishing construct separability, incremental validity was supported (except for the social competence subscale). The READ is a valid and reliable measure of protective factors involved in resilience and demonstrates promise for cross-cultural applicability. Recommendations for measuring resilience and validating the READ in future investigations are provided., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Anyan, Morote, Las Hayas, Gabrielli, Mazur, Gudmundsdottir, González, Królicka-Deregowska, Zwiefka, Olafsdottir and Hjemdal.)

Background: Adolescence is crucial period for laying the foundations for healthy development and mental well-being. The increasing prevalence of mental disorders amongst adolescents makes promotion of mental well-being and prevention interventions at schools important. UPRIGHT (Universal Preventive Resilience Intervention Globally implemented in schools to improve and promote mental Health for Teenagers) is designed as a whole school approach (school community, students and families) to promote a culture of mental well-being and prevent mental disorders by enhancing resilience capacities. The present article aims at describing the rationale, conceptual framework, as well as methodology of implementation and evaluation of the UPRIGHT intervention., Methods: UPRIGHT project is a research and innovation project funded by the European Union's Horizon 2020 Research and Innovation programme under grant agreement No. 754919 (Duration: 48 months). The theoretical framework has been developed by an innovative and multidisciplinary approach using a co-creation process inside the UPRIGHT Consortium (involving seven institutions from Spain, Italy, Poland, Norway, Denmark, and Iceland). Resulted is the UPRIGHT programme with 18 skills related to 4 components: Mindfulness, Coping, Efficacy and Social and Emotional Learning. Among the five Pan-European regions, 34 schools have been currently involved (17 control; 17 intervention) and around 6000 adolescents and their families are foreseen to participate along a 3-year period of evaluation. Effectiveness of the intervention will be evaluated as a randomized controlled trial including quantitative and qualitative analysis in the five Pan-European regions representative of the cultural and socioeconomic diversity. The cost-effectiveness assessment will be performed by simulation modelling methods., Discussion: We expect a short- to medium-term improvement of mental well-being in adolescents by enhancing resilience capacities. The study may provide robust evidence on intrapersonal, familiar and social environmental resilience factors promoting positive mental well-being., Trial Registration: ClinicalTrials.gov Identifier: NCT03951376 . Registered 15 May 2019.

The aim of the current study was to validate the Work and Social Adjustment Scale (WSAS), a measure of psychosocial functional impairment, in Spanish-speaking individuals with bipolar disorder. A sample of 120 patients with bipolar disorder and 97 healthy individuals completed the WSAS to analyze its factor structure and reliability. Patients also completed measures of personal recovery and quality of life (QOL). Confirmatory factor analysis indicated that a one-factor model explained data adequately, with all factor loadings proving to be significant. Cronbach's alphas indicated excellent internal consistency in the sample of individuals with bipolar disorder and the sample of healthy individuals. Significant negative correlations between the WSAS and personal recovery and QOL demonstrated good concurrent validity. Impairment on the WSAS was higher for the patient sample, confirming known-group validity of the scale. Thus, Spanish validation of the WSAS demonstrated it to be a sound self-reported measure of psychosocial functioning impairment in individuals with bipolar disorder. [Journal of Psychosocial Nursing and Mental Health Services, 57(5), 44-51.]., (Copyright 2018, SLACK Incorporated.)

Objective: This study examined the longitudinal reciprocal associations between resilience factors, quality of life (QoL) domains, and symptoms of eating disorders (EDs). Hypotheses included predictive paths from resilience factors of "acceptance of self and life" and "personal competence" to increased QoL and predictive paths from previous levels of QoL to resilience., Method: A total of 184 patients with EDs (mean age = 29.55, SD = 9.17, 94.8% women) completed measures of resilience, QoL, and EDs symptoms over three waves spaced six month apart. Hypotheses were tested by path analysis., Results: Resilience factors predicted improvements in psychological health and social relationship domains of QoL and a reduction of ED symptoms over time. In addition, psychological health increased acceptance of self and life consistently over time, whereas physical health increased the competence component of resilience., Discussion: The relationships between resilience factors and QoL are reciprocal, with several mediational paths. A spiral of recursive influences between resilience factors and QoL can take place in people with EDs. This possibility offers new perspectives to understanding the process of recovery in patients with ED., (Copyright © 2017 Elsevier B.V. All rights reserved.)

The goal of this research project was to develop a new questionnaire to assess resilience in Bipolar Disorder (BD), the Resilience Questionnaire for Bipolar Disorder (RBD). To examine its psychometric properties, a sample of 125 patients diagnosed with BD and a comparison sample of 107 people completed the new RBD and established measures of generic resilience and health-related outcomes. Exploratory factor analysis for the RBD yielded a 23-item 5-factor solution, and confirmatory factor analysis indicated adequate fit indices. Internal consistency, stability, concurrent validation and known-groups' validity were also supported. The RBD obtained higher responsiveness (6-month follow-up) than the generic resilience scale (BD sample). The RBD is a robust measure to monitor resilience in BD., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Aims: The aim of this study was to identify factors related to a decline in function following a wrist fracture., Methods: Observational, prospective cohort study done in five public hospitals of the Basque Health Service. We recruited adults aged 65 or older with a wrist fracture due to a fall who attended the emergency department (ED) of one of these hospitals. Sociodemographic and clinical data were collected, along with information about health-related quality of life (HRQoL) and functionality., Results: A decline in function 6 months after the fracture was more likely among women (OR=3.409; 95% CI=1.920-6.053), patients receiving institutional help before the fracture (OR=5.717; 95% CI=1.644-19.883), patients who developed fracture-related complications within 6 months of the fall (OR=5.015; 95% CI=1.377-18.268), patients who visited an ED within 6 months of the fall (OR=1.646; 95% CI=1.058-2.561), patients with a displaced fracture (OR=1.595; 95% CI=1.106-2.300), and patients who broke the dominant hand (OR=1.464; 95% CI=1.019-2.103). Better baseline HRQoL and function were associated with smaller declines in function 6 months after the fall. Eighteen months after the fall, decline in function was more likely among women (OR=2.172; 95% CI=1.138-4.144) and patients visiting an ED because of fracture-related complications (OR=1.722; 95% CI=1.113-2.663). Better HRQoL and dependency level at baseline were associated with less decline in function 18 months after the fracture., Discussion: Two different models identified several parameters related to declines in upper extremity function 6 and 18 months after the fracture., Conclusions: These results can help develop preventive actions needed to avoid or reduce the consequences of these falls., (© 2016 John Wiley & Sons Ltd.)

The objectives of the authors in this study were two-fold: (1) to explore the role of resilience in recovery from eating disorders (EDs), and (2) to develop a model of resilience in women with EDs. Semi-structured interviews with ten women were conducted in April 2011, along with two focus groups with women who had recovered from EDs (n  = 5 women each; conducted in April 2012 at the University of Deusto, Spain), one focus group with clinical experts (n = 8; conducted in April 2012 at the Foundation Against EDs of Biskay, Spain), and six narratives from primary caregivers of ED patients living in Biskay, Spain (conducted in November 2012). All data were analyzed using a grounded theory approach. All female participants acknowledged experiencing resilience in their recovery. The analysis resulted in a conceptual model of resilience composed of the following categories: deep dissatisfaction with life, turning point, acceptance, hope, determination to change, accountability for the ED, active coping, getting social support, gaining self-knowledge, getting information about EDs, increase well-being, trait resilience, initiating new projects and living in the here and now. According to the model presented, resilience preceded the experience of recovery in women with EDs in this sample and could be a useful asset for future interventions.

Individualised measures of quality of life (QoL) refer to instruments that encourage the respondent to actively elicit which areas of their life are most relevant for his/her QoL. The aim of this study is to compare individualised versus standard measures of QoL in a sample of patients with eating disorder (ED). The Schedule for the Evaluation of the Individual Quality of Life (SEIQoL) and a generic measure of QoL [World Health Organization Brief Quality of Life Assessment Scale (WHOQOL-BREF)] were applied on two occasions (one-year follow-up) to a sample of 165 patients with ED, 57 recovered patients with ED, and 349 women from the general population. The areas of 'family', 'education/career or job', 'friends', 'leisure', 'romantic partner' and 'health' were identified as the most important for their QoL for all groups, both times. The WHOQOL-BREF was more sensitive than the SEIQoL in detecting changes that occurred over time. Clinical interventions for ED should consider social components as objectives of intervention., (Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.)

Background: Wrist fractures are the most common arm fractures in older adults. The impact of wrist fractures on daily functionality has been less studied than that of other types and so, less is known about the complexity of factors related to the functional impact of these fractures. This study is aimed to assess the role of individual and health care factors and its association with daily living functional changes after a wrist fracture., Methods: A prospective cohort of patients aged 65 or more, affected by a fracture due to a fall, was conducted. These patients were identified at the emergency rooms of the six participating hospitals. As independent factors, the following were studied: socio-demographic data, characteristics of the fracture, health-related quality of life, wrist function and provided treatment. The main outcome was functional status measured by the Barthel Index for daily living basic activities and the Lawton Instrumental Activities of Daily Living (IADL) Scale for daily living instrumental activities. Data were collected at baseline just after the fall and after six months of follow-up. Patients were considered to have deteriorated if their functional status as measured by Barthel Index or Lawton IADL scores decreased in a significant way during the six months of follow up., Results: Barthel Index and/or Lawton IADL scores fell at six months after the fracture in 33% of participants. This functional decline was more frequent in patients with comorbidity (p < 0.0001), polypharmacy (p < 0.0001), low health-related quality of life prior to the fall (p < 0.0001) and lower educational level (p = 0.009). The derived multivariate models show that patients that become dependent six months after the fall, have advanced age, severe chronic diseases, low functional performance prior to the fracture, and repeated episodes of accidental falls. This profile is consistent with a frailty phenotype., Conclusions: Wrist fractures are associated to the occurrence of dependence, especially in frail patients. These patients could benefit from being identified at the time the fracture is treated, in order to tackle their complex needs and so, prevent some of the burden of dependence generated by these fractures.

Purpose/objective: The authors' purpose was to develop the Questionnaire of Resilience in Caregivers of Acquired Brain Injury (QRC-ABI) and explore its psychometric properties The QRC-ABI was developed to measure the process of resilience, including resilient factors that, according to the literature, are the most relevant for caregivers., Research Method/design: This is a cross-sectional study of Spanish primary caregivers of individuals with ABI. It included 237 caregivers (77.6% women and 21.1% men) who completed the QRC-ABI, the Posttraumatic Growth Inventory (Weiss & Berger, 2006), the World Health Organization Quality of Life-BREF (Skevington, Lotfy, O'Connell, & the WHOQOL Group, 2004) assessment, and the Positive Aspects of Caregiving (Tarlow et al., 2004) assessment., Results: An item pool of 36 items was developed, from which 17 were finally selected based on a consensus among researchers and adequate symmetry indexes and kurtoses. Confirmatory factor analysis of the QRC-ABI confirmed a hierarchical solution in which 4 resilience dimensions were explained by a broader general resilience factor. The internal consistency of each scale was >.80. Convergent validity was supported through positive correlations of the QRC-ABI with quality of life, positive aspects of caregiving, and posttraumatic growth, and a negative correlation with perceived burden., Conclusion/implications: The new QRC-ABI showed good reliability and validity. Our results are consistent with previous studies that have argued that resilient qualities are important for a healthy and positive adaptation to the challenging adversities faced by caregivers of individuals with ABI. Future interventions based on resilience should promote these factors in caregivers., ((c) 2015 APA, all rights reserved).)

Problematic Internet use (PIU) and problematic alcohol use are two pervasive problems during adolescence that share similar characteristics and predictors. The first objective of this study was to analyze the temporal and reciprocal relationships among the main components of PIU from the cognitive-behavioral model (preference for online social interaction, mood regulation through the Internet, deficient self-regulation, and negative consequences). The second objective was to examine the temporal and reciprocal relationships between PIU components and problematic alcohol use. We also examined whether these relationships differ between males and females. The sample comprised 801 Spanish adolescents (mean age=14.92, SD=1.01) who completed the measures both at Time 1 (T1) and Time 2 (T2) six months apart. We used structural equation modeling to analyze the relationship among the variables. Results showed that deficient self-regulation at T1 predicted an increase in preference for online interactions, mood regulation, and negative consequences of the Internet at T2. In turn, the emergence of negative consequences of PIU at T1 predicted a rise in problematic alcohol use at T2. Longitudinal relationships between different components of PIU and between the components of PIU and problematic alcohol use were invariant across genders. Deficient self-regulation, consisting of diminished self-control over cognition and behaviors related to the Internet, plays a central role in the maintenance of PIU, increasing the preference for online interactions, mood regulation, and negative consequences from Internet use over time. In turn, adolescents who present negative consequences of PIU are vulnerable targets for problematic alcohol use., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: To date, factors that influence satisfaction with cataract surgery have not been broadly explored., Objective: To identify variables related to patient satisfaction after cataract extraction by phacoemulsification and to determine the relationship between satisfaction and visual acuity (VA) and visual function (VF)., Design: Prospective cohort study., Setting: Five hospitals belonging to the Basque Health Care Service., Participants: 4335 consecutive patients undergoing cataract extraction., Interventions: Clinical data on vision were collected before the intervention and 6 weeks afterwards. Before cataract extraction, patients answered a global question about their expectations for the procedure, answered three questions related to specific activities (reading, going out and recognizing people, and doing housework) and completed the Visual Function-14 (VF-14) and Short-Form-36 (SF-36) instruments. Three months after cataract extraction, they again completed the VF-14 and SF-36 along with questions about global satisfaction with the procedure and satisfaction with the three specific activities., Main Outcome Measures: Three months after cataract extraction, they again completed the VF-14 and SF-36 along with questions about global satisfaction with the procedure and satisfaction with the three specific activities., Results: Pre-intervention VA and VF-14 scores and their post-intervention changes were associated with both global satisfaction and satisfaction with the ability to perform specific activities. Unresolved ocular complications were related to global satisfaction with cataract extraction (OR 95% = 0.39(0.27, 0.55) , P < 0.001). Both the mental and physical component scales of the SF-36 were related to global satisfaction. A group of patients were not satisfied with the intervention in spite of achieving similar vision-related improvements as patients who were quite satisfied with the procedure., Conclusion: Satisfaction with cataract extraction is related to clinical outcomes and is also associated with patients' expectations of their improvement in visual function., (© 2012 John Wiley & Sons Ltd.)

The Health-Related Quality of Life for Eating Disorder-Short questionnaire is one of the most suitable existing instruments for measuring quality of life in patients with eating disorders. The objective of the study was to evaluate its reliability, validity, and responsiveness in a cohort of 377 patients. A comprehensive validation process was performed, including confirmatory factor analysis and a graded response model, and assessments of reliability and responsiveness at 1 year of follow-up. The confirmatory factor analysis confirmed the two second-order latent traits, social maladjustment, and mental health and functionality. The graded response model results showed that all items were good for discriminating their respective latent traits. Cronbach's alpha coefficients were high, and responsiveness parameters showed moderate changes. In conclusion, this short questionnaire has good psychometric properties. Its simplicity and ease of application further enhance its acceptability and usefulness in clinical research and trials, as well as in routine practice., (© The Author(s) 2013.)

Objectives: To validate into Spanish the Wagnild and Young Resilience Scale - 25 (RS-25), assess and compare the scores on the scale among women from the general population, eating disorder (ED) patients and recovered ED patients., Method: This is a cross-sectional study. ED participants were invited to participate by their respective therapists. The sample from the general population was gathered via an open online survey. Participants (N general population=279; N ED patients=124; and N recovered ED patients=45) completed the RS-25, the World Health Organization Quality of Life Scale-BREF and the Hospital Anxiety and Depression Scale. Mean age of participants ranged from 28.87 to 30.42years old. Statistical analysis included a multi-group confirmatory factor analysis and ANOVA., Results: The two-factor model of the RS-25 produced excellent fit indexes. Measurement invariance across samples was generally supported. The ANOVA found statistically significant differences in the RS-25 mean scores between the ED patients (Mean=103.13, SD=31.32) and the recovered ED participants (Mean=138.42, SD=22.26) and between the ED patients and the general population participants (Mean=136.63, SD=19.56)., Discussion: The Spanish version of the RS-25 is a psychometrically sound measurement tool in samples of ED patients. Resilience is lower in people diagnosed with ED than in recovered individuals and the general population., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objective: Taking care of a person with acquired brain injury (ABI) is often associated with symptoms of stress and psychological distress. However, caregiving can also be a source of satisfaction and can contribute toward an improvement in the quality of life both of the caregiver and the person with ABI. The aim of this study is to assess and adapt the Positive Aspects of Caregiving Scale (PACS) to Spanish., Method: The PACS was completed by a sample of 141 family members who are the primary caregivers of relatives with ABI (mean age = 58.3 years, SD = 12.2; 78% women). The caregivers also responded to questions evaluating quality of life, burden, and posttraumatic growth., Results: The results confirm the original structure of the PACS, which consists of 2 correlated factors: Self-Affirmation and Outlook on Life. Furthermore, these factors demonstrated adequate indices for internal consistency. The scores obtained from the PACS are positively associated with quality of psychological life, quality of social life, and posttraumatic growth and negatively associated with the perception of burden., Conclusions: The results highlight how important it is for interventions to emphasize the positive aspects of caregiving in caregivers of people affected by ABI., ((c) 2014 APA, all rights reserved.)

Eating disorders (EDs) have a strong impact on the quality of life (QoL) of caregivers. This study explores the longitudinal changes in the QoL of ED caregivers at 1 (T1; n=109) and 2 years (T2; n=32) follow-up, and identifies predictors of improvement at 1-year follow-up. ED outpatients also completed a battery of tests at T1 (n=69) and T2 (n=11). Multivariate hierarchical linear mixed models were used, in which the caregivers' 1-year changes in QoL, anxiety and depression scores were analysed as the dependent variables. Predictor variables were the caregivers' perception of burden, perception of the severity of the patient's ED, kinship data, and the ED person's scores on QoL, anxiety depression and ED symptoms. Higher scores in mental health and low perception of burden at baseline predicted improved caregiver QoL at 1-year follow-up. The caregivers' QoL improved if the perception of burden decreased over time and if depression of the patient improved. The results suggest that interventions directed to reduce the caregivers' perception of burden and to improve the mental health of the ED patients would lead to improved caregiver QoL. The high attrition rate at T2 made prediction analyses unviable., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

This study sought to translate, using a back-translation procedure, and evaluate the psychometric characteristics of Depression in the Medically Ill questionnaire (DMI-18) and its short version (DMI-10) in a Spanish population. Patients with somatic disorders (N = 366) completed the translated DMI-18 and another depression questionnaire. Among these, 167 were also assessed by a mental health professional (gold standard) to test criterion validity. Furthermore, coefficient alpha for both the versions were high (>.90), and convergent validity assessed against the Beck Depression Inventory for Primary Care, the Hospital Anxiety and Depression Scale, and the Patient Health Questionnaire-9 was satisfactory (r > .74). Confirmatory factor analysis results supported the one-factor model. When compared with the gold standard, sensitivity and specificity were 93% and 73% for DMI-18 and 87% and 74% for DMI-10, respectively. Thus, both the versions are acceptable measures that can be used by nonpsychiatric professionals to detect affective comorbidities in their patients.

One of the few instruments to evaluate coping skills among patients with chronic illnesses is the Cuestionario de Afrontamiento al Estrés para Pacientes Oncológicos (CAEPO), created initially for cancer patients. We evaluate how well CAEPO applies to patients with non-cancer chronic illnesses. A total of 344 patients (115 with chronic hepatitis C, 120 with inflammatory bowel disease and 109 with recurrent vertigo) completed the CAEPO. Exploratory factor analysis and Cronbach's alpha provide only partial support for the seven factors suggested by the original CAEPO. A streamlined version with fewer dimensions and items may be a better solution for identifying coping strategies among these patients.

Background: The aims of this study were to propose a Spanish Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) short form based on previously shortened versions and to study its validity, reliability, and responsiveness for patients with hip osteoarthritis undergoing total hip replacement (THR)., Methods: Prospective observational study of two independent cohorts (788 and 445 patients, respectively). Patients completed the WOMAC and the Short Form (SF)-36 questionnaires before THR and 6 months afterward. Patients received the questionnaires by mailing, and two reminder letters were sent to patients who had not replied the questionnaire. Based on two studies from the literature, we selected the two shortened domains, the pain domain composed of three items and the function domain composed of eight items. Thus, we proposed an 11-items WOMAC short form. A complete validation process was performed, including confirmatory factor analysis (CFA) and Rasch analysis, and a study of reliability, responsiveness, and agreement measured by the Bland-Altman approach., Results: The mean age was about 69 years and about 49% were women. CFA analyses confirmed the two-factor model. The pain and function domains fit the Rasch model. Stability was supported with similar results in both cohorts. Cronbach's alpha coefficients were high, 0.74 and 0.88. The highest correlations in convergent validity were found with the bodily pain and physical function SF-36 domains. Significant differences were found according to different pain and function severity scales, supporting known-groups validity. Responsiveness parameters showed large changes (effect sizes, 2.11 and 2.29). Agreement between the WOMAC long and short forms was adequate., Conclusions: Since short questionnaires result in improved patient compliance and response rates, it is very useful to have a shortened WOMAC version with the same good psychometric properties as the original version. The Spanish WOMAC short form is valid, reliable, and responsive for patients undergoing THR, and most importantly, the first WOMAC short version proposed in Spanish. Because of its simplicity and ease of application, the short form is a good alternative to the original WOMAC questionnaire and it would further enhance its acceptability and usefulness in clinical research, clinical trials, and in routine practice within the orthopaedic community.

Purpose: To determine the minimal clinically important difference and the patient acceptable symptom state for visual acuity and visual function, 2 key visual outcomes for patients undergoing cataract extraction, as an aid for evaluating the outcome of cataract extraction., Design: Prospective cohort study., Setting: Multicenter study of 17 hospitals., Patients: A total of 4335 consecutive patients advised to undergo cataract extraction., Main Outcome Measures: Sociodemographic and clinical data, including visual acuity (VA), patient satisfaction, and responses to the Visual Function Index 14 (VF-14) and transitional questions were collected before and after cataract extraction. The patient acceptable symptom state and minimal clinically important difference were estimated for the entire sample and for subgroups by preintervention status and presence of ocular comorbidities., Results: Among patients with simple cataract, postintervention patient acceptable symptom state values for VA ranged from 0.67 to 0.80, depending on preintervention VA, while VF-14 scores ranged from 88 to 90. For patients with any additional ocular comorbidity, VA ranged from 0.63 to 0.75, depending on preintervention VA, while VF-14 scores ranged from 86 to 92. For the entire sample, postintervention patient acceptable symptom state values were 0.75 for VA and 86.1 for VF-14 scores. Minimal clinically important difference for patients who reported being a little better ranged from 0.17 to 0.5 in VA and 0.41 to 37.46 in VF-14 scores, depending on preintervention status and presence of ocular comorbidities., Conclusion: The minimal clinically important difference and patient acceptable symptom state values are complementary parameters that may help in the clinical decision-making process by providing more meaningful estimates of the impact of cataract extraction on 2 important outcomes, visual acuity and visual function., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Purpose: To examine the relation between Visual Function Index-14 (VF-14) scores and VA by accounting for concurrent ocular comorbidities, effect of the better seeing eye (BSE), and VA before and after cataract surgery., Design: Prospective cohort study., Participants: A total of 4335 patients with cataract who completed the VF-14 before and after cataract surgery., Methods: Collaborating clinicians provided demographic and clinical data before and after cataract surgery. Lowess curves, general linear models, and Spearman correlation coefficients were used to study the relation between the VF-14 and the VA., Main Outcome Measures: Scores in the VF-14 preintervention, change in VF-14 after surgery, VA before surgery, and VA change after surgery., Results: General linear models and Spearman correlation coefficients showed a significant (P < 0.0001) association between VF-14 score and VA (measured in decimal fraction) when the preoperative VA was ≤0.5 (20/40) and no association (P > 0.4020) when the VA was >0.5 (20/40). Small VA gains (≤0.5) after surgery only led to significant gains (P < 0.0001) in functionality in patients with other ocular pathologies and whose BSE was the surgical eye. Gains in VA >0.5 had a significant (P < 0.02) effect on VF-14 change scores in most patients., Conclusions: The VF-14 seems to be more sensitive when the preoperative VA is <0.5 (20/40), especially in patients whose BSE is the surgical eye. The VF-14 seems responsive to increases in VA if the gains exceed 0.5. For gains <0.5, the VF-14 seems unresponsive, except for patients with other ocular pathologies in whom the BSE before and after surgery is the surgical eye., (Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare the discriminatory ability and sensitivity to change of the standard summative score of the Visual Function Index (VF)-14 with two alternative Rasch-based scoring systems., Methods: A total of 4335 prospective patients with cataracts completed the VF-14 before surgery and 3 months after surgery. Rasch analysis was applied to the VF-14 patient responses before surgery and the VF-14 joint patient responses before and after surgery. To study the discriminatory ability, the VF-14 patient responses were grouped according to the preoperative visual acuity (VA) and the presence of ocular morbidities besides cataracts. For analysis of the sensitivity to change, the overall mean change in VF-14 scores was calculated after surgery, and the patients were grouped according to the presence of other ocular morbidities, postoperative VA gain, and satisfaction with the surgical outcome. The relative precision (RP) index and the effect size were used to compare the different scoring systems., Results: Rasch analysis confirmed the unidimensional structure of the VF-14. All items and scales adjusted well to the model (fit indices range, 0.71-1.34). The RP index for discrimination by ocular morbidity was 0.82 and by preoperative VA level, 1.02. Regarding sensitivity to change, the RP was 2.68 based on ocular morbidity and 1.78 with samples grouped by postoperative VA gain., Conclusions: For longitudinal studies in which change is the relevant outcome, Rasch scores should be used, rather than the traditional score. However, for cross-sectional studies, both scoring systems were similarly precise.

Objective: The purpose of this study is to compare the diagnostic accuracy of four depression screening tools commonly used in patients with medical disorders, relative to a reference diagnostic standard-a structured psychiatric interview., Methods: The Depression in the Medically Ill-18 (DMI-18) questionnaire was administered to 167 patients with medical disorders; of those, 53 completed the Beck Depression Inventory for Primary Care (BDI-PC), 67 the Hospital Anxiety and Depression Scale (HADS), and 46 the Patient Health Questionnaire-9 (PHQ-9). The entire sample was also interviewed with a structured psychiatric interview conducted by a mental health professional. Sensitivity, specificity, likelihood ratios (LRs), and area under the curve (AUC) were calculated and compared for the different measures., Results: At their respective recommended cutoff points, sensitivities [95% confidence interval (CI)] were 86% (70-95), 82% (63-94), 93% (86-97), and 68% (47-85) for the HADS-D, BDI-PC, DMI-18, and PHQ-9, respectively, while specificities ranged from 72% (47-90) for BDI-PC to 89% (72-98) for PHQ-9. The sensitivities of DMI-18 were significantly higher compared to those of HADS-D (P=.045) and PHQ-9 (P=.01). The PHQ-9 questionnaire obtained the most favorable positive LR (6.35; 95% CI, 2.48-18.36). In contrast, the DMI-18 showed the best negative LR (0.09; 95% CI, 0.04-0.18). Areas under the curves (95% CI) ranged from 0.92 (0.83-1.02) to 0.84 (0.74-0.94). Statistically significant differences were found between the AUCs of the DMI-10 and the BDI-PC., Conclusion: Our results suggest that all evaluated scales have acceptable abilities and can be used as screening instruments for depression in patients with medical disorders. The DMI stands out for its sensitivity., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Objectives: To determine whether a system originally developed to ascertain the appropriateness of cataract intervention may also be used to prioritize patients on cataract extraction waiting lists., Methods: The IRYSS-appropriateness of indication for cataract surgery tool and the IRYSS-Cataract Priority Score were applied to a sample of 5448 patients consecutively placed on waiting lists for cataract surgery. Clinical data were gathered by ophthalmologists, and patients self-completed the Visual Function Index-14. The general linear model (GLM) was used to assign scores to the categories of the appropriateness and priority criteria. The relationship between both systems was evaluated by correlating scores. To assess the validity of the new appropriateness and priority scores, correlations with visual acuity (VA) and visual function were calculated., Results: The GLM method generated highly similar scores for both appropriateness and prioritization systems. The correlation between scores was very strong (r=0.96). The appropriateness scoring system correlated 0.29 with VA and 0.21 with gain in visual function. The priority system correlated -0.54 with VA and -0.28 with preintervention visual function., Conclusions: The new appropriateness scoring system strongly correlates with the priority scoring system. This easy-to-use appropriateness rating could serve as a tool for simultaneously assessing the appropriateness of cataract surgery and assigning priority., (Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.)

Objective: As the demand for cataract surgery grows, patients in some health care systems are assigned to a waiting list. Several explicit priority tools have been developed. We compared 3 of these: the IRYSS-Cataract Priority Score (ICPS), Catalan Agency for Health Technology Assessment and Research cataract priority system (CCPS), and Western Canada Waiting List project for cataract surgery (WCWL)., Design: Prospective cohort study., Participants: A total of 1723 consecutive patients awaiting cataract surgery at 5 hospitals., Methods: The ICPS, CCPS, and WCWL were applied to these patients after the collection of data. The 3 prioritization systems were compared using correlation methods, 95% limits of agreement, and the kappa coefficient., Results: Means and standard deviations for the different prioritization systems were 60.9 (22.2) for the ICPS, 35.7 (20.4) for the CCPS, and 25.7 (21.5) for the WCWL. Pearson's correlation coefficients were 0.56 between the ICPS and the CCPS, 0.62 between the WCWL and CCPS, and 0.71 between the ICPS and WCWL. The kappa value among them ranged from 0.13 to 0.40, and the intraclass correlation coefficients ranged from 0.31 to 0.55., Conclusions: These 3 prioritization tools showed acceptable correlations but assigned significantly different point scores to similar scenarios. This may have consequences when using these tools for managing a waiting list for cataract extraction.

Objective: To test 2 systems developed to prioritize patients on waiting lists for cataract surgery, the Western Canadian Waiting List (WCWL), and the Catalan Agency for Health Technology Assessment and Research Cataract Priority System (CCPS), as tools for judging the appropriateness of the intervention., Design: Cross-sectional study with follow-up., Participants: A total of 1723 prospective patients awaiting cataract extraction in 5 hospitals were included in the study., Methods: Priority scores using the WCWL and the CCPS systems were calculated and compared with visual acuity (VA) and visual function, measured by the Visual Function-14 index, before and after surgery. The sensitivity of each priority system to different groups was evaluated using a validated appropriateness of indications tool for cataract extraction. One-way analysis of variance and the Jonckheere-Terpstra test were used to detect differences in group scores. Spearman correlation coefficients were also examined., Results: The WCWL and CCPS systems produced different mean values according to the preoperative levels of VA and visual function (p < 0.0001). Neither system showed a significant difference in mean scores based on gains in VA and visual function. Both systems produced different mean scores according to the different groups of appropriateness set by the appropriateness of indications tool for cataract (p < 0.0001)., Conclusions: Given that appropriateness tools should correlate with outcomes, we recommend using neither the WCWL nor the CCPS for appropriateness purposes. Incorporating new criteria into these systems may improve the correlation with important outcomes and their adequacy for use as appropriateness tools.

Background: To confirm the internal structure of the Health Related Quality of Life for Eating Disorders version 2 questionnaire (HeRQoLEDv2) and create and validate a shortened version (HeRQoLED-S)., Methods: 324 patients with eating disorders were assessed at baseline and one year later (75.6% of whom responded). We performed a confirmatory factor analysis of the HeRQoLEDv2 using baseline data, and then a Rasch analysis to shorten the questionnaire. Data obtained at year one was used to confirm the structure of the HeRQoLED short form and evaluate its validity and reliability., Results: Two latent second-order factors -- social maladjustment and mental health and functionality -- fit the data for the HeRQoLEDv2. Rasch analysis was computed separately for the two latent second-order factors and shortened the HeRQoLEDv2 to 20 items. Infit and outfit indices were acceptable, with the confirmatory factor analysis of the HeRQoLED short form giving a root mean square error of approximation of 0.07, a non-normed fit index and a comparative fit index exceeding 0.90. The validity was also supported by the correlation with the convergent measures: the social maladjustment factor correlated 0.82 with the dieting concern factor of the Eating Attitudes Test-26 and the mental health and functionality factor correlated -0.69 with the mental summary component of the Short Form-12. Cronbach alphas exceeded 0.89., Conclusions: Two main factors, social maladjustment and mental health and functionality, explain the majority of HeRQoLEDv2 scores. The shortened version maintains good psychometric properties, though it must be validated in independent samples.

Objective: The aim of this article is to provide a narrative review of empirical studies related to health-related quality of life (HRQOL) and eating disorders and to report recent changes in the measurement of HRQOL in eating disorders., Method: Twenty-five articles of central importance to the topic were identified in a systematic search of six databases. All articles were selected based on a consensus relevancy rating process. Key themes were extracted from the articles and validated by all authors., Results: We identify six themes in the extant empirical literature., Discussion: We discuss these six themes and review them in light of the fact that they are identified in studies using only generic measures of HRQOL. Four recently developed disease-specific HRQOL measures specific to patients with eating disorder are discussed.

Objectives: To assess the responsiveness of the Health-Related Quality of Life for Eating Disorders questionnaire version-2 (HeRQoLEDv2) and present the psychometric characteristics of a new binge domain., Study Design and Setting: Patients with an eating disorder completed the HeRQoLEDv2, the Eating Attitudes Test-26, Short Form Health Survey-12, and two items from the Eating Disorder Inventory-2, at baseline and after 1 year. At the second assessment, patients completed the HeRQoLEDv2, as part of the battery of tests, along with health transitional questions. Validity and reliability analyses of the new binge domain were performed. Responsiveness was evaluated using distributional and anchor-based approaches, comparison of mean changes, mean change correlations, the minimal detectable change (MDC) at the individual and group level, and the minimal important difference (MID)., Results: Items in the binge domain loaded above 0.40. Cronbach alpha was 0.82. Regarding responsiveness, the mean changes detected by the HeRQoLEDv2 correlated above 0.30 with the criterion measures. Patients who reported improvement showed significant changes, and effect sizes above 0.30. The MDC(90%ind) was larger than the MID., Conclusion: The HeRQoLEDv2 includes the new binge domain. It responded to change at the group level. Further research regarding the MID is needed.

Background and Objectives: To describe the development and investigate the psychometric properties of a new instrument to measure health-related quality of life (HRQoL) for individuals with an eating disorder (ED)., Methods: Seven focus groups were convened and an extensive literature review was carried out to generate the items. The first draft of the questionnaire was pilot tested. Three hundred twenty-four ED patients took part in the final field study. The 12-Item Short Form Health Survey, the Eating Attitudes Test-26, and two items from the Eating Disorders Inventory-2 also were applied to examine the concurrent validity. Factor analysis, item scale correlation correcting for overlap, test-retest, Cronbach's alpha coefficient, known-groups validation, and the sensitivity of the questionnaire in different populations also were examined., Results: The final Health-Related Quality of Life in Eating Disorders (HeRQoLED) questionnaire consisted of 50 items. Principal axis factor analysis identified eight subscales. Concurrent validity showed correlations >.40 with the criteria measures. Excellent reliability and stability were obtained. The HeRQoLED was sensitive in discriminating both between known-different groups and from the general population., Conclusion: The results provide evidence of the good psychometric properties of the new HeRQoLED questionnaire, except for one domain, which had to be eliminated.

Objective: To identify patients' views on the criteria used to prioritize patients on the waiting list for total hip or knee prostheses. This study is part of a wider project whose objective is to design an instrument to prioritize patients on the waiting list for both procedures., Material and Methods: We performed a descriptive study with qualitative methodology that provides valuable information on how to improve various aspects of clinical practice and detect solutions that could be useful in decision making. There were 4 focus groups; 2 before the design of the instrument and 2 after. These focus group were composed of patients on the waiting list for knee or hip replacement., Results: Thirty-one patients agreed to participate in the focus groups. All the patients were dissatisfied with the current waiting lists. The most salient factors discussed in meetings were pain, functional capability, and the repercussions of these on the patient's social role., Conclusions: Although the instrument is designed to be used by health professionals, patients' participation in its design and evaluation allows them to feel more involved in the healthcare process and provides information that more accurately reflects their experiences. The use of this information by health professionals will improve resource optimization and the response to patient needs.