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Rubén Cuesta-Barriuso,1,2 Ana Torres-Ortuño,3 Joaquín Nieto-Munuera,3 José Antonio López-Pina4 1Department of Physiotherapy, University of Murcia, Murcia, Spain; 2Royal Victoria Eugenia Foundation, Madrid, Spain; 3Department of Psychiatry and Social Psychology, University of Murcia, Murcia, Spain; 4Department of Basic Psychology and Methodology, University of Murcia, Murcia, SpainCorrespondence: Rubén Cuesta-BarriusoDepartment of Physiotherapy, University of Murcia, Campus Espinardo, Murcia, 30200, SpainTel +34 868 887 286Email ruben.cuestab@gmail.comBackground: Hemophilia is characterized by the development of joint bleeds that cause long-term joint damage (hemophilic arthropathy). Joint damage leads to disability and affects psychosocial aspects in patients with hemophilia.Objective: To compare the clinical situation, perception of disease and quality of life, and coping strategies in adult patients with hemophilia in El Salvador and Spain.Methods: In this comparative clinical study, 43 patients with hemophilia aged between 18 and 50 years old from Spain and El Salvador participated. After obtaining the patients’ consent, they completed the Illness Perception Questionnaire-Revised (IPQ-R), Hemophilia-QoL and Inventory of Coping strategies questionnaires. Joint status was assessed using the Hemophilia Joint Health Score and based on a record of clinical and treatment data.Results: Hemophilia patients from Spain showed an improved perception of quality of life (p < 0.05), although there were only differences in the self-criticism variable (p = 0.04) for coping strategies. Joint damage and age correlated (p < 0.05) negatively with perception of disease, perceived quality of life and coping strategies in both populations. There were differences (p < 0.05) between the two populations based on HIV and HCV coinfections in perception of disease and perceived quality of life.Conclusion: Patients with hemophilia in El Salvador exhibit a poorer perception of disease and quality of life. Despite differences in access to treatment from one country to the other, there is no difference in coping with the disease. Older patients are better able to adapt to the disease.Keywords: hemophilia, joint disease, quality of life, illness perception, coping strategies

Ana Torres-Ortuño,1 Rubén Cuesta-Barriuso,2,3 Joaquín Nieto-Munuera,1 Álvaro Castiello-Munuera,1 José Antonio López-Pina4 1Department of Psychiatry and Social Psychology, University of Murcia, Murcia, Spain; 2Department of Physiotherapy, University of Murcia, Murcia, Spain; 3Royal Foundation Victoria Eugenia, Madrid, Spain; 4Department of Basic Psychology and Methodology, University of Murcia, Murcia, SpainCorrespondence: Rubén Cuesta-BarriusoDepartment of Physiotherapy, University of Murcia, Murcia, SpainTel +34 868887286Email ruben.cuestab@gmail.comIntroduction: The episodic or on-demand administration of clotting factor concentrates in hemophilia patients in the event of hemorrhage is employed to restore hemostasis. Adherence to on-demand treatments needs to be assessed in order to improve patient management, avoiding adverse effects and serious clinical complications.Aim: To validate the Spanish version of the treatment adherence scale in patients with hemophilia, namely, Validated Hemophilia Regimen Treatment Adherence Scale-PRN (VERITAS-PRN).Methods: Eighty-five patients were recruited in three hemophilia patient associations in Spain. The VERITAS-PRN scale was adapted through a back-translation process from English to Spanish. A native Spanish bilingual translator translated the scale from English to Spanish, and subsequently another native English bilingual translator translated the scale from Spanish to English. The scale was applied twice (two months apart) to assess test–retest reliability.Results: Internal consistency reliability was slightly lower in the VERITAS-PRN in Spanish (0.80) versus the English version (0.85). There were no differences (p > 0.05) between the means of the dimensions or in the total scores between the sample of patients in Spain and the USA. The test–retest reliability coefficient of the scores on the total scale was 0.80 [CI, 0.74– 0.86]. The test–retest reliability coefficient was greater than 0.90 in all subscales.Conclusion: The Spanish version of VERITAS-PRN has high consistency and empirical validity. This scale is useful for assessing the degree of adherence to treatment in adult patients with hemophilia following episodic infusion treatment.Keywords: hemophilia, adherence, validity, reliability, on-demand treatment, VERITAS-PRN

Ana Torres-Ortuño,1,2 Rubén Cuesta-Barriuso,3,4 Joaquín Nieto-Munuera,1 Álvaro Castiello-Munuera,1 Manuel Moreno-Moreno,2,4,5 José Antonio López-Pina6 1Department of Psychiatry and Social Psychology, Faculty of Medicine, University of Murcia, Murcia, Spain; 2Association of Hemophilia, Murcia, Spain; 3Department of Physiotherapy, School of Biomedical and Health Sciences, European University of Madrid, Madrid, Spain; 4Royal Foundation Victoria Eugenia, Madrid, Spain; 5Hematology and Hemotherapy Service, University Clinical Hospital Virgen de la Arrixaca, Murcia, Spain; 6Department of Basic Psychology and Methodology, Faculty of Psychology, University of Murcia, Murcia, SpainCorrespondence: Ana Torres-OrtuñoDepartment of Psychiatry and Social Psychology, Faculty of Medicine, University of Murcia, Campus de Espinardo s/n, 30100, SpainTel +34 868887170Fax +34 913508Email atorres.ortuno@gmail.comPurpose: To build a multidimensional questionnaire of adherence for a patient with hemophilia that includes not only clinical but also psychosocial aspects.Patients and Methods: One hundred and forty-six patients with haemophilia (A and B) were recruited from several Hemophilia Treatment Centers for this study. The recruitment was performed through a personal interview (20– 25 mins for each patient). A literature review was carried out (different databases). In the first version (136 items), all items were subjected to an external judgment (experts in hemophilia) and also presented and discussed with a group of patients. It was made a study of content validity and homogeneity index and reliability coefficients of score were calculated with an alpha coefficient. Empirical validation was made with Pearson correlation.Results: The Haemo-Adhaesione scale was composed of 5 dimensions and 10 questions about basic haemophilia concepts. It was shown to be valid and reliable to assess adherence in the Spanish population. Its internal consistency was good in all dimensions. The Rasch model was used to confirm the multidimensional structure of the scale. Significant and negative correlations were observed with the VERITAS-Pro and VERITAS-PRN scale in all dimensions, and in the total score.Conclusions: The Haemo-Adhaesione scale is a good measure of adherence for PWH. Its multidimensional structure favors the inclusion of the objective and subjective aspects implicit in its definition, as well as its dynamic nature. Patients with greater adherence are those who have more awareness of their disease, and as a result, they are more compliant with prescription and their self-care. It also discriminates between patients who follow one treatment or another.Keywords: hemophilia, adherence, young, adults, scale

Rubén Cuesta-Barriuso,1–3 Ana Torres-Ortuño,4 Pilar Galindo-Piñana,4 Joaquín Nieto-Munuera,4 Natalie Duncan,5 José Antonio López-Pina6 1Department of Physiotherapy, School of Biomedical and Health Sciences, European University of Madrid, 2Fishemo, Centro Especial de Empleo, Spanish Federation of Hemophilia, 3Royal Foundation Victoria Eugenia, Madrid, 4Department of Psychiatry and Social Psychology, Faculty of Medicine, University of Murcia, Murcia, Spain; 5Indiana Hemophilia & Thrombosis Center, Indianapolis, IN, USA; 6Department of Basic Psychology and Methodology, Faculty of Psychology, University of Murcia, Murcia, Spain Purpose: We aimed to conduct a validation in Spanish of the Validated Hemophilia Regimen Treatment Adherence Scale – Prophylaxis (VERITAS-Pro) questionnaire for use in patients with hemophilia under prophylactic treatment.Patients and methods: The VERITAS-Pro scale was adapted through a process of back translation from English to Spanish. A bilingual native Spanish translator translated the scale from English to Spanish. Subsequently, a bilingual native English translator translated the scale from Spanish to English. The disagreements were resolved by agreement between the research team and translators. Seventy-three patients with hemophilia, aged 13–62 years, were enrolled in the study. The scale was applied twice (2 months apart) to evaluate the test–retest reliability.Results: Internal consistency reliability was lower on the Spanish VERITAS-Pro than on the English version. Test–retest reliability was high, ranging from 0.83 to 0.92. No significant differences (P>0.05) were found between test and retest scores in subscales of VERITAS-Pro. In general, Spanish patients showed higher rates of nonadherence than American patients in all subscales.Conclusion: The Spanish version of the VERITAS-Pro has high levels of consistency and empirical validity. This scale can be administered to assess the degree of adherence of prophylactic treatment in patients with hemophilia. Keywords: hemophilia, adherence treatment, validity, reliability

Background: Hemophilic arthropathy is characterized by loss of function and chronic pain. Fascial therapy mobilizes the connective tissue and is thus involved in the condition of the injured fascial complex and the surrounding tissues. Objective: To evaluate the safety of a physiotherapy program using fascial therapy in patients with hemophilic elbow arthropathy. Methods: Fourteen adult patients with hemophilia were randomly assigned to a control group and an intervention group. The intervention consisted of three 45-min sessions of fascial therapy over a 3-week period. Assessment was carried out at baseline, after treatment, and at follow-up. The study variables were bleeding frequency using a self-registration of bleeding; joint pain using the visual analog scale; range of motion with a universal goniometer; and joint status assessed with Hemophilia Joint Health Score. Results: None of the patients developed joint bleeding during the experimental period. Joint pain in the experimental group decreased by 1.43 out of 2.43 (95% CI 0.52 to 2.33) and 2.14 out of 2.57 (95% CI 0.18 to 4.10) in right and left elbow, respectively, more than the control group by 3 weeks. Flexion increased by 3.57 degrees out of 129.14 (95% CI 5.48 to 1.65) in right elbow and joint condition improved by 1.14 points out of 6.0 (95% CI 0.01 to 2.26) more than the control group by 3 weeks. Conclusion: Fascial therapy does not appear to produce elbow hemarthrosis in patients with hemophilia. This treatment can improve joint pain, range of motion, and elbow status in patients with hemophilia.

The Padua Inventory (PI) of obsessions and compulsions is one of the most usually applied tests to assess obsessive-compulsive symptomatology in research contexts as well as for clinical and screening purposes. A reliability generalization meta-analysis was accomplished to estimate the average reliability of the PI scores and to search for characteristics of the samples and studies that can explain the variability among reliability estimates. An exhaustive literature search enabled us to select 39 studies (53 independent samples) that reported alpha and/or test-retest coefficients with the data at hand for the PI total score and subscales. An excellent average coefficient alpha was found for the PI total score (M = .935; 95%CI = .922-.949) and for Impaired Mental Control subscale (M = .911; 95%CI = .897-.924), being good for Contamination (M = .861; 95%CI = .841-.882) and Checking (M = .880; 95%CI = .856-.903), and fair for Urges and Worries (M = .783; 95%CI = .745-.822). The average test-retest reliability for PI total score was also satisfactory (M = .835; 95%CI = .782-.877). Moderator analyses showed larger coefficients alpha for larger standard deviation of the PI total scores (p = .0005; R 2 = .46), for adapted versions of the test (p = .002; R 2 = .32), and for samples composed of clinical participants (p = .066; R 2 = .10). The practical implications of these results are discussed as well as the need for researchers to report reliability estimates with the data at hand.

Introduction: Anxiety has negative effects on the cognitive performance and psychosocial adjustment of elderly people. Given the high prevalence of anxiety symptoms in patients suffering from cognitive impairment, it has been suggested that these symptoms may be an early marker of dementia. The State-Trait Anxiety Inventory (STAI) is one of the most widely-used scales for evaluating anxiety in elderly people. However, inasmuch as the STAI may be difficult to apply to older people, having a short form of it would be desirable., Methods: The participants comprised 489 community-dwelling individuals aged 68 years and over. All of them were volunteers in a longitudinal study for early detection of Alzheimer' Disease (Proyecto Vallecas). The full sample was divided in two homogeneous subgroups: Group A, used to reduce the number of items and response options, and Group B, the group used to determine the psychometric properties of the new short form (STAIr)., Results: A dichotomous Rasch model was used to obtain the STAIr. No statistically significant differences for STAIr scores were found with respect to sociodemographic variables. Psychometric properties and normative data were obtained for the new short version., Conclusions: The STAIr is composed of 13 items and data fits the model well. Since it is short and easy to apply to elderly people, STAIr will be very useful in clinical and research settings., (Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.)

In the psychological measurement, especially in personality, the paper-pencil method is the usual device between the psychologist and allied professions. The score obtained by a person examined can have questionable validity if the responses were random. To identify this problem, different methods have been used. The random response is a challenging situation for the measurement research and diagnosis in cognitive performance and personality, when they have been measured by test of dichotomous type. In this study a computer program that implements the Charter's method of point estimate and confidence intervals is presented in order to identify if the score obtained can be considered random. We analyze and discuss this program uses in the research and professional practice.