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Introducción: La artroplastia total de rodilla (PTR) es eficaz en el alivio del dolor y la función en los casos de artrosis de rodilla (AR) grave. Representa un problema de salud pública por su prevalencia. A pesar de los resultados clínicos obtenidos con la PTR, diversos estudios refieren que entre un 14-30% de pacientes se muestran insatisfechos con el resultado, al no alcanzar los beneficios esperados, lo que conlleva que otros desestimen el tratamiento quirúrgico. El modelo de cuidados de M. Mishel pertenece al paradigma de la transformación, parte de la teoría social crítica e incorpora principios de la teoría del caos para elaborar su teoría de la incertidumbre; la enfermedad crónica desencadena un desequilibrio y las personas que la experimentan pueden incorporar esta incertidumbre para adquirir un nuevo sentido de la vida.

Pilar Isla Pera,1 Ma Carmen Olivé Ferrér,1 Montserrat Nuñez Juarez,2 Esther Nuñez Juarez,3 Loreto Maciá Soler,4 Carmen López Matheu,1 Assumpta Rigol Cuadra,1 María Honrubia Pérez,1 Diana Marre5 1School of Nursing, University of Barcelona, 2Department of Rheumatology, Musculoskeletal Clínic Institute Hospital Clínic, 3Institut Català de la Salut, Barcelona, 4Nursing Department, University of Alicante, Alicante, 5Universitat Autònoma de Barcelona, Barcelona, Spain Aim: We aimed to explore the meaning of obesity in elderly persons with knee osteoarthritis (KO) and to determine the factors that encourage or discourage weight loss.Background: Various studies have demonstrated that body mass index is related to KO and that weight loss improves symptoms and functional capacity. However, dietary habits are difficult to modify and most education programs are ineffective.Design: A phenomenological qualitative study was conducted. Intentional sampling was performed in ten older persons with KO who had lost weight and improved their health-related quality of life after participating in a health education program. A thematic content analysis was conducted following the stages proposed by Miles and Huberman.Findings: Participants understood obesity as a risk factor for health problems and stigma. They believed that the cause of obesity was multifactorial and criticized health professionals for labeling them as “obese” and for assigning a moral value to slimness and diet. The factors identified as contributing to the effectiveness of the program were a tolerant attitude among health professionals, group education that encouraged motivation, quantitative dietary recommendations, and a meaningful learning model based on social learning theories.Conclusion: Dietary self-management without prohibitions helped participants to make changes in the quantity and timing of some food intake and to lose weight without sacrificing some foods that were deeply rooted in their culture and preferences. Dietary education programs should focus on health-related quality of life and include scientific knowledge but should also consider affective factors and the problems perceived as priorities by patients. Keywords: obesity, elderly, polypathology, therapeutic education, diet, nursing, knee osteoarthritis

Background: Non-specific low back pain is a common cause for consultation with the general practitioner, generating increased health and social costs. This study will analyse the effectiveness of a multidisciplinary intervention to reduce disability, severity of pain, anxiety and depression, to improve quality of life and to reduce the incidence of chronic low back pain in the working population with non-specific low back pain, compared to usual clinical care.Methods/design: A Cluster randomised clinical trial will be conducted in 38 Primary Health Care Centres located in Barcelona, Spain and its surrounding areas. The centres are randomly allocated to the multidisciplinary intervention or to usual clinical care. Patients between 18 and 65 years old (n = 932; 466 per arm) and with a diagnostic of a non-specific sub-acute low back pain are included. Patients in the intervention group are receiving the recommendations of clinical practice guidelines, in addition to a biopsychosocial multidisciplinary intervention consisting of group educational sessions lasting a total of 10 hours. The main outcome is change in the score in the Roland Morris disability questionnaire at three months after onset of pain. Other outcomes are severity of pain, quality of life, duration of current non-specific low back pain episode, work sick leave and duration, Fear Avoidance Beliefs and Goldberg Questionnaires. Outcomes will be assessed at baseline, 3, 6 and 12 months. Analysis will be by intention to treat. The intervention effect will be assessed through the standard error of measurement and the effect-size. Responsiveness of each scale will be evaluated by standardised response mean and receiver-operating characteristic method. Recovery according to the patient will be used as an external criterion. A multilevel regression will be performed on repeated measures. The time until the current episode of low back pain takes to subside will be analysed by Cox regression.Discussion: We hope to provide evidence of the effectiveness of the proposed biopsychosocial multidisciplinary intervention in avoiding the chronification of low back pain, and to reduce the duration of non-specific low back pain episodes. If the intervention is effective, it could be applied to Primary Health Care Centres.Trial Registration: ISRCTN21392091. [ABSTRACT FROM AUTHOR]

Objective: To characterize rheumatoid arthritis patients seen in Rheumatology Units at different health care levels., Material and Methods: Questionnaire and clinical examination of rheumatoid arthritis patients seen as outpatients in Rheumatology Units from Primary Care, county Hospitals and Reference Hospitals. Demographic, social, labour and disease data were collected. Statistical study included a description of the variables and a multiple correspondence analysis to define patient profiles., Results: Eight hundred and twelve patients with rheumatoid arthritis were included. There were significant differences in patient profiles at the different care level. In Primary Care, patients were older, with basic studies, and with short duration and generally mild rheumatoid arthritis. In local hospitals the typical patient was a man, qualified worker, with low income, and an erosive disease with extraarticular manifestations. At reference Hospitals prevailing patients were young women with a long duration disease and requiring biological therapy., Conclusion: There are significant differences in rheumatoid arthritis patient profiles at different health care levels., (Copyright © 2008 Elsevier España, S.L. All rights reserved.)