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Percutaneous needle electrolysis (PNE) is a physiotherapy technique that has been shown to be effective in different pathologies such as tendinopathies or mammary fistula. For many years, theoretical bactericidal and germicidal effects have been attributed to this type of galvanic currents, partly explained by the changes in pH that it generates. However, these effects have not yet been demonstrated. The aim of this study was to evaluate the bactericidal effect and the changes in pH caused by PNE. S. aureus were prepared in two different solutions (TSB and saline solution) and in different concentrations (from 9 to 6 Log10 CFU/mL). Bacteria were treated with three experimental PNE doses to assess bacterial death levels and the changes caused to the pH of the medium. The viable cell count showed that all experimental PNE doses had a bactericidal effect against a high concentration (9 Log10 CFU/mL) of S. aureus in saline solution (p S. aureus and the level of this effect was mainly modulated by the solution, the bacterial concentration and the dose. Changes affecting pH were modulated by the type of solution and there was no relationship between this and bacterial death.

The NLRP3 inflammasome coordinates inflammation in response to different pathogen- and damage-associated molecular patterns, being implicated in different infectious, chronic inflammatory, metabolic and degenerative diseases. In chronic tendinopathies lesions, different non-resolving mechanisms produce a degenerative condition that impairs tissue healing, complicating their clinical management. Percutaneous needle electrolysis consist in the application of a galvanic current and is emerging as a novel treatment for tendinopathies. Here we found that galvanic current activates the NLRP3 inflammasome and the induction of an inflammatory response promoting a collagen-mediated regeneration of the tendon. This study establish the molecular mechanism of percutaneous electrolysis for the treatment of chronic lesions and the beneficial effects of an induced inflammasome-related response.

In spite of the growing use of the electrical impedance myography (EIM) measures for clinical assessment and follow-up of diseased muscle tissue, reliability studies are scarce. We evaluate the reliability of the (EIM) technique using four adhesive electrodes over the muscle of interest. Intra- and inter-rater reliability was studied within the same session and between sessions. Thirty-one healthy and volunteer subjects aged between 20 and 26 years were recruited. Phase angle, reactance and resistance were assessed for each EIM measurement. Intraclass correlation coefficient (ICC) was used to determine the relative reliability. Absolute reliability was expressed as the standard error of measurement and the minimum detectable change. Relative reliability within the same session and between sessions for the EIM technique was excellent (ICCs > 0.9) concerning both intra- and inter-rater reliability, except for the component reactance. The absolute reliability was very high for the three EIM components. EIM measures using four adhesive electrodes over the area of interest is a reliable technique to assess muscle tissue status. This study confirms that these measurement results barely vary depending on the examiner and the moment. The present study also confirms phase angle as the least affected EIM component by examiner and evaluation moment.

OBJECTIVES This study was designed to address the current relative void of valid measures by developing evidence-based quality indicators for pain management of chronic nonmalignant pain. METHODS We performed a 10-year literature search to identify guidelines and review articles on chronic pain management to identify evidence-based recommendations for the different conditions associated to chronic pain. A complementary search of indicators and indicator-related articles was also performed. Then, we built new indicators or adapted existing ones to cover all the evidence-based recommendations we found. The resulting set was pilot tested for feasibility, reliability (kappa), and usefulness to identify quality problems, using the Lot Quality Acceptance method (α ≤ 0.05 and β ≤ 0.01) for 75% (40% threshold) and 95% (70% threshold) compliance standards, and estimates with binomial exact 95% confidence intervals. We reviewed clinical records from a primary care center, a medium-size hospital (250 beds), and a large hospital (500 beds). RESULTS Forty-six indicators were developed (6 general and 40 condition specific). Thirty-three were feasible in primary care and/or hospitals. Feasible indicators were also reliable (most kappa > 0.7). Regarding compliance, 4 quality indicators obtained compliance levels over 60%, addressing pharmacological treatment, multimodal approach, and appropriate use of neuro-image tests, while 16 obtained compliance scores under 15% (6 with 0% compliance). CONCLUSIONS The created set has tested to be feasible, reliable, and useful, with the capacity to serve as the baseline for developing the necessary strategies to improve the management of chronic nonmalignant pain, by monitoring and evaluating quality of care.

Objective To determine if pre-frail Chronic obstructive pulmonary disease (COPD) patients with poor and non-poor performance in the five-repetition sit-to-stand test (5-STS) had a worse prognosis for hospitalization and mortality at 2 years and for mortality at 5 years than non-frail patients. Methods We prospectively included patients with stable COPD, between 40 and 80 years, from a hospital in Spain. Patients were classified according their performance on the 5-STS test and level of frailty. Timing, number of hospitalizations, length of stay, and timing and rate of mortality were outcome measures. Patients were followed for 2 years for exacerbations and for 5 years for mortality. Kaplan-Meier curves and univariate and multivariate Cox proportional-hazard analyses, ANOVA tests and univariate and multivariate linear and logistic regression models were used. Results Of the 125 patients included, 25.6% were pre-frail with poor performance, 57% pre-frail with non-poor performance, and 17.4% non-frail with non-poor performance. Pre-frail patients with poor performance had a higher number of hospitalizations (adjusted beta: 0.49; 95% CI: 0.01–0.96), mortality rates (odds ratio: 11.33; 95% CI: 1.15–110.81), and risk at 5 years (adjusted hazard ratio: 8.77; 95% CI: 1.02–75.51) than non-frail patients. Pre-frail patients with poor performance also had worse prognoses than non-frail patients with respect to length of hospital stays (increased by 4.16 days) and timing to first hospitalization (HR: 6.01) in unadjusted models, but not when adjusted. Conclusion The COPD prognosis of pre-frail patients with respect to the number of exacerbations with hospitalization and the timing and rate of mortality is dependent of functional performance.

Prospective longitudinal study.To examine the sensitivity of the Mobility Activities Measure for lower extremities and to compare it to the sensitivity of the Physical Functioning Scale (PF-10) and the Patient-Specific Functional Scale (PSFS) at week 4 and week 8 post-hospitalization in outpatient rehabilitation settings.Mobility Activities Measure is a set of short mobility measures to track outpatient rehabilitation progress: its scales have shown good properties but its sensitivity to change has not been reported.Patients with musculoskeletal conditions were recruited at admission in three outpatient rehabilitation settings in Spain. Data were collected at admission, week 4 and week 8 from an initial sample of 236 patients (mean age ± SD = 36.7 ± 11.1).Mobility Activities Measure scales for lower extremity; PF-10; and PSFS.All the Mobility Activities Measure scales were sensitive to both positive and negative changes (the Standardized Response Means (SRMs) ranged between 1.05 and 1.53 at week 4, and between 0.63 and 1.47 at week 8). The summary measure encompassing the three Mobility Activities Measure scales detected a higher proportion of participants who had improved beyond the minimal detectable change (MDC) than detected by the PSFS and the PF-10 both at week 4 (86.64% vs. 69.81% and 42.23%, respectively) and week 8 (71.14% vs. 55.65% and 60.81%, respectively).The three Mobility Activities Measure scales assessing the lower extremity can be used across outpatient rehabilitation settings to provide consistent and sensitive measures of changes in patients' mobility. Implications for rehabilitation All the scales of the Mobility Activities Measure for the lower extremity were sensitive to both positive and negative change across the follow-up periods. Overall, the summary measure encompassing the three Mobility Activities Measure scales for the lower extremity appeared more sensitive to positive changes than the Physical Functioning Scale, especially during the first four weeks of treatment. The summary measure also detected a higher percentage of participants with positive change that exceeded the minimal detectable change than the Patient-Specific Functional Scale and the Physical Functioning Scale at the first follow-up period. By demonstrating their consistency and sensitivity to change, the three Mobility Activities Measures scales can now be considered in order to track patients' functional progress. Mobility Activities Measure can be therefore used in patients with musculoskeletal conditions across outpatient rehabilitation settings to provide estimates of change in mobility activities focusing on the lower extremity.

Highlights • Continuity of care is a multidimensional construct. • Three types of continuity are relevant for inpatients receiving rehabilitation. • Management continuity is the component with the most negative experiences. • Most problems experienced by the participants are aspects that can be modified., Background Few empirical studies have been conducted on the continuity of rehabilitation services, despite the fact that it may affect clinical outcomes, patient satisfaction, the perception of quality, and safety. Objectives The aim of this study was to explore experiences and perceptions of inpatients receiving physical rehabilitation in an acute care hospital and how these experiences may have led to perceived gaps in the continuity of rehabilitation care. Method Using qualitative research methods, fifteen semi-structured interviews were conducted with patients who received physical rehabilitation during hospital stay in an acute care hospital in Murcia, Spain. Interviews were transcribed verbatim, analyzed, and grouped into predetermined and emergent codes. Results Patients described three main themes in continuity of care: informational, management, and relational continuity. Several factors were described as influencing the perceived gaps in these three types of continuity. Informational continuity was influenced by the transfer of information among care providers. Relational continuity was influenced by patient–therapist relations and consistency on the part of the provider. Management continuity was influenced by consistency of care between providers and the involvement of patients in their own care. Conclusion The participants in this study identified several gaps in three types of continuity of care (informational, management, and relational). Inpatients often perceive their experiences of rehabilitation as being disconnected or incoherent over time.

Background and Objectives: Within the clinical evaluation of multiple pathologies of the lower limb, the measurement of range of motion (ROM) of its joints is fundamental. To this end, there are various tools, from the goniometer as a reference to more recent devices such as inclinometry-based applications, photo capture applications, or motion capture systems. This study aimed to assess the validity, intra-rater, and inter-rater reliability of the VeloFlex system (VS), which is a new camera-based tool designed for tracking joint trajectories and measuring joint ROM. Materials and Methods: Thirty-five healthy volunteers (16 females, aged 18&ndash, 61 years) participated in this study. All participants were assessed on two separate occasions, one week apart. During the first assessment session, measurements were obtained using a goniometer and the VS, whereas, in the second session, only the VS was used. In each assessment session, nine active movements were examined. For each movement, three trials were tested, and the mean of these three measures was used for analysis. To evaluate the concurrent validity and agreement, the Pearson correlation coefficient (r) and Bland-Altmann plots were used. Intra-rater and inter-rater reliability were evaluated using intra-class correlation (ICC), standard error of measurement (SEM), and minimal detectable change (MDC). Results: Both devices showed excellent correlations for all movements (r ranged from 0.992 to 0.999). The intra-rater reliability of the VS was excellent (ICC ranged from 0.93 to 0.99), SEMs ranged from 0.53% to 2.61% and the MDC ranged from 0.68&deg, to 3.26&deg, The inter-rater reliability of the VS was also excellent (ICC ranged from 0.88 to 0.98), SEMs ranged from 0.81% to 4.76% and the MDC ranged from 2.27&deg, to 4.42&deg, Conclusions: The VS is a valid and reliable tool for the measurement of ROM of lower limb joints in healthy subjects.

There is a lack of knowledge with regard to the adherence to different types of exercises prescribed for children with disabilities. The aim was to examine parents&rsquo, adherence to prescriptions of different types of home exercises, to identify associated factors related to the parents, the children and the environment, and to assess the relative influence of the behaviour of health professionals. Parents (393) were recruited from 18 early intervention centres. A cross-sectional survey using a self-reported questionnaire was used to examine whether three types of exercises (&ldquo, flexibility exercises&rdquo, &ldquo, neuromotor development training&rdquo, and &ldquo, body mechanics and postural stabilisation&rdquo, ) were prescribed in their home programs, if the child had received exercises according to a prescription, and items related to the parents, child, environment, and health professionals. The adherence rates were different among the types of exercises. Parents with low perception of barriers and high self-efficacy had a higher adherence to neuromotor development training and postural stabilization, whereas parents with a high level of knowledge increased their odds of adherence to flexibility exercises. Health professionals&rsquo, behaviour had a distinct influence on the adherence to different exercises. This study suggests the need to specifically consider the types of exercises prescribed in the management of adherence to home programs.

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]

Background Chronic obstructive pulmonary disease (COPD) is a major cause of disability. We aimed to analyse the impact of reduced pulmonary function on non-respiratory impairments and mobility activity limitations in an elderly population with COPD and to elucidate which specific limitations on mobility are related to reduced pulmonary function Methods Cross-sectional study of 110 patients with COPD, recruited from public and university hospital. The effect of impaired pulmonary function on the risk of non-respiratory impairments and mobility limitations was analysed using validated measures, including: the 6-Minute Walk Test (6MWT), skeletal muscle strength, the Short Physical Performance Battery (SPPB), and self-reported mobility questionnaire. Multivariate analysis was used to control for confounders such as age, sex, height, education, and cigarette smoking. Results Greater impairment of pulmonary function was associated with less distance walked during the 6MWT, poorer SPPB scores, and greater risk of self-reported mobility limitations (p

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.

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

Identifying those patients who underperform in the 6-minute walk test (6MWT

Objective: To assess the relationships between patient experiences and two overall evaluations – satisfaction and service quality – in outpatient rehabilitation settings. Design: A cross-sectional, self-reported survey carried out in the year 2009. Setting: Three outpatient rehabilitation units belonging to Spanish hospitals located in Barcelona, Madrid and Seville. Subjects: Four hundred and sixty-five outpatients (response rate 90%) mean age 39.4 (SD = 11.9) years. Main measures: Self-reported experiences on aspects of care, participants’ perception of service quality, satisfaction with care, socio-demographic and health characteristics. Results: Satisfaction and service quality were highly correlated (rho = 0.72, P< 0.001). Two multivariate logistic regression models using satisfaction and service quality (with adjusted R2 31.5% and 37.1%, respectively) indicated that patients’ experiences and global rating of health improvement have more effect on those evaluations than socio-demographic characteristics. Mean satisfaction was 8.9 (SD = 1.2), and 88% of respondents described high service quality. However, nearly 25% of the respondents who reported high-quality evaluations also indicated a problem score of more than 50% in almost all aspects of care studied. Conclusions: Satisfaction and service quality provide a poor indicator of patients’ experiences. Both are two proxies but distinct constructs in rehabilitation care. Besides, not all problems encountered by patients are equally important to them.

Resumen Introduccion Existe insuficiente conocimiento sobre que confianza tienen los pacientes en quienes prestan cuidados de rehabilitacion, sus determinantes y la asociacion con la evaluacion del servicio. Objetivos Examinar la confianza en la profesionalidad del fisioterapeuta por parte de pacientes en fases post-agudas en Unidades externas de Rehabilitacion; determinar los aspectos asistenciales de los pacientes que la condicionan y su relacion con la satisfaccion del paciente. Material y metodos Estudio transversal mediante cuestionario autocumplimentado, realizado en Unidades de Rehabilitacion de 3 hospitales de la red MAPFRE. Las medidas de resultado fueron: puntuacion de problemas (de 0 a 100%) de las experiencias autoinformadas en 7 aspectos de los cuidados (pertenecientes al ambiente organizacional y las actitudes del profesional), satisfaccion, confianza en la profesionalidad y, caracteristicas sociodemograficas y de salud de los participantes. Resultados Participaron 465 pacientes (respuesta: 90%) con una media de 39,4 (DE = 11,9) anos. La confianza fue completa en el 61,1% de los participantes. Mientras que la odds ratio (OR)de completa confianza se incrementa con la percepcion de cambio funcional (OR = 3,77), de crece con tener experiencias problematicas en algunos aspectos asistenciales: «educacion e informacion» (OR = 0,99), «apoyo emocional» (OR = 0,97) e «interrupciones durante las sesiones» (OR = 0,99). La confianza presenta una correlacion positiva con los niveles de satisfaccion (p Conclusiones Son muchos los pacientes que desarrollan una completa confianza en los fisioterapeutas, especialmente los que presentan notable mejora funcional y pocas situaciones problematicas en determinados aspectos asistenciales. Aunque no todos los aspectos asistenciales son igualmente determinantes de la confianza, esta siempre se relaciona con la satisfaccion.

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.

Objective: The main goal of this study was to exemplify the development of a measure of continuity of care (COC) from inpatients’ perspective. This measure is focused on several aspects related to physiotherapy.Methods: A cross-sectional self-report based psychometric study was carried out in a public hospital in southeast Spain. One hundred and fifty two patients with neurological and orthopaedic disorders who received rehabilitation care during stay at hospital were included in the study. A self-report questionnaire was used to examine experiences of patients related to the three types of COC, relational, management and informational continuity. The questionnaire also includes questions about sociodemographic characteristics, patient/therapist affiliation and trust with therapist. To examine reliability were used test-retest and internal consistency. For validation analysis, there were used convergent and known group strategies.Results: Of the 19 indicators included, 13 were selected to demonstrate adequate reliability and validity. From these indicators were generated three composite measures (Relational, management and COC index) and one individual measure (Informational continuity). Test-retest reliability indicated excellent agreement (intraclass correlation coefficient [ICC] > 0.75) for the three indexes. The range of Cronbach’s value was from 0.60 to 0.73. Total scores of all the indexes were moderately correlated with the satisfaction scale (r > 0.30). Regarding the known groups, all indexes scores were similar for men and woman. However, significant differences were found for management index and for relational index, based on trust with therapist and patient/therapist affiliation, respectively.Conclusions: The continuity self-reported measures is a valid and reliable method to assessing the COC in hospitalized patients receiving physiotherapy.

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.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).A longitudinal observational study of the relationship between the information provided during physical therapy and adherence to self-management strategies.Data came from a clinical-based population in 8 primary health care centers.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.Not applicable.Specific and overall adherence to 2 types of strategies: (1) nonpharmacologic pain management strategies, and (2) neck/back care in activities of daily life.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).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.

To identify the beliefs and perceptions of patients with chronic neck and low back pain that influence adherence to home exercise during exacerbation and/or remission of pain.Qualitative study using a focus group technique.Thirty-four patients (23 women, age range 26-70 years) with chronic neck or low back pain who had participated in a home exercise programme.Seven focus groups were formed. Participants were sampled purposefully from all patients with chronic neck or low back pain who attended for physiotherapy at 4 primary healthcare centres. Patients were interviewed about how they perceived their adherence to a home exercise programme during chronic pain. Data were analysed using a phenomenographic method.Several themes about patients' beliefs and perceptions were identified as factors related to adherence. These factors change when pain or disabilities appear, decrease or disappear for an extended period. Beliefs about illness and treatment are more likely when pain is present and when pain disappears for an extended period. However, patients consider perceptions about barriers, social support and physical environment when pain decreases.These findings may represent an important potential for improving the adherence of patients with chronic pain to home exercise programmes.

Resumen Objetivos Describir y comparar la frecuencia en la que los pacientes con cervicalgia perciben diferentes aspectos relacionados con la calidad percibida en la atencion fisioterapica, ofrecida en diversos centros de salud. Material y metodo Se realizo un estudio descriptivo transversal analitico. Se incluyo a pacientes con cervicalgia mecanica no traumatica. La recogida de informacion se llevo a cabo mediante un cuestionario tipo autoinforme sobre calidad percibida previamente validado. Se analizo la tasa de respuesta y el sesgo de no respuesta. Se realizo un analisis descriptivo ajustado mediante indicadores y se comparo la calidad percibida entre centros segun cada uno de los indicadores compuestos en cada centro, asi como el valor promedio y los percentiles respecto al conjunto de los centros. Resultados Se entrego un total de 162 cuestionarios y se recogieron 111. No se han detectado diferencias significativas entre los que han respondido y los que no al cuestionario, en relacion con el sexo y el nivel de estudios, y si para la edad y el previo uso de fisioterapia. Las dimensiones “Tiempo de espera” y “Competencia profesional” son las que presentan mayor porcentaje de problemas de calidad percibida, 61,4 % (52,4-70,4) y 51,7 % (42,4-61,0) respectivamente. La dimension “Organizacion” es la que presenta menor porcentaje de problemas (24,4%) (16,4-32,4). Hay diferencias en los niveles de calidad percibida entre la mayoria de los centros respecto a las dimensiones “Informacion” y “Competencia profesional”, y solo entre algunos en relacion con “Tiempo de espera” y “Organizacion”. Conclusiones Las areas de informacion y competencia profesional son las que acumulan mas problemas de calidad percibida. Entre los centros de salud participantes hay variabilidad en los niveles de calidad percibida.

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.

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.

Objective To identify elements of the physiotherapist–patient interaction considered by patients when they evaluate the quality of care in outpatient rehabilitation settings. Design A qualitative study with nine focus groups, Two researchers conducted the focus groups, and a topic guide with predetermined questions was used. Each group discussion was audiotaped,, transcribed verbatim and analyzed thematically according to a modified grounded theory approach. Setting Three postacute ambulatory centers in Barcelona, Madrid and Seville (Spain). Participants Fifty-seven adults undergoing outpatient rehabilitation for musculoskeletal conditions/injuries. Results Patients based their evaluations of quality of care on their assessment of physiotherapists’ willingness to provide information and education, technical expertise and interpersonal manners (eg. respect, emotional support and sensitivity changes in the patient's status). Both positive and negative aspects of the physiotherapist–patient interaction emerged under all these themes, except for friendly and respectful communication. Conclusion This study identified which elements of the physiotherapist–patient interaction are considered by patients when evaluating the quality of care in rehabilitation outpatient settings. Further research should work to develop self-report questionnaires about patients’ experiences of the physiotherapist–patient interaction in rehabilitation services to provide empirical and quantitative evidence.

Objective: To explore ambulatory outpatient experiences and perceptions in post-acute care settings and how these experiences may have led to perceived gaps in continuity of rehabilitation care. Subjects: Fifty-seven adults undergoing outpatient rehabilitation for musculoskeletal conditions/injuries, who had had more than 10 physiotherapy treatment sessions. Methods: Qualitative study using a modified grounded theory approach. Data collection was carried out through 9 focus groups. Each group was recorded, transcribed literally and analyzed thematically. Results: Participants described 3 main themes in continuity; relational, informational, and management continuity. Several factors that led to gaps in the 3 types of continuity were described. The relevant factors for relational continuity were: consistency of the multi-professional rehabilitation team; and an established provider–patient relationship. Factors for informational continuity were: transfer of information among providers; and accumulated knowledge regarding patients’ disability experiences. Factors for management continuity included: consistency of care among rehabilitation providers; flexibility of the team in adapting care to functional changes; and involvement of the team in achieving patient collaboration. Conclusion: This study provides evidence of gaps in different types of continuity of care within the post-acute rehabilitation services in ambulatory settings. Outpatients often perceive their experiences of rehabilitation care as non-connected or non-coherent over time.

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.

This study aimed to assess the relationship between adverse events (AEs) and changes in the levels of disability from admission to discharge during inpatient rehabilitation programs. A prospective cohort study was conducted among a cohort of inpatients (216 older adults) admitted to a rehabilitation unit. The occurrences of any AE were reported. The level of disability regarding mobility activities was estimated using the disability qualifiers from the International Classification of Functioning, Disability, and Health. Changes in the levels of disability between admission and discharge were assessed. Baseline-measured covariates were also selected. Regarding all 4 disability levels (“no limitation,” “mild,” “moderate,” “severe,” and “complete disability”), a total of 159 participants experienced an improvement at discharge (126 participants progressed 1 level, whereas 33 improved 2 disability levels), 56 made no change, and no participants experienced a decline. The occurrence of fall-related events and the diagnostic group (musculoskeletal system) are specific predictive factors of change in the level of disability. The odds of undergoing a change in any disability level between admission and discharge decreases by 68% (1–0.32) when patients experience fall-related events (odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.11–0.97, P = 0.041) and increases for individuals with musculoskeletal conditions (OR = 3.91, 95% CI = 1.34–11.38, P = 0.012). Our findings suggest that increased efforts to prevent the occurrence of these AEs, together with early interventions suited to the diagnosis of the affected system, may have a positive influence on the improvement of disability. Further studies should evaluate disability over time after discharge to obtain a better sense of how transient or permanent the associated disability may be.

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.

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.