Original Article
Symptomatic Pain and Fibromyalgia Treatment Through Multidisciplinary Approach for Primary Care
Tratamiento sintomático y del dolor en fibromialgia mediante abordaje multidisciplinar desde Atención Primaria
Jaime Gonzalez Gonzaleza,b,
, Maria del Mar del Teso Rubioc, Carmen Nelida Waliño Paniaguad, Juan Jose Criado-Alvareze, Javier Sanchez Holgadoa
Corresponding author
a Primary Care Physician, Centro de Salud Santa Olalla, Toledo, Spain
b Associate Medical Professor Departament Medical Science, Universidad de Castilla-La Mancha, Spain
c Occupational Therapist, Residencia Tercera Edad San Pablo de los Montes, San Pablo de los Montes, Toledo, Spain
d Occupational Therapist, Asociación Fibromialgia Talavera de la Reina (AFIBROTAR), Talavera de la Reina, Toledo, Spain
e Primary Care Physician, Centro de Salud Pueblanueva, Pueblanueva, Toledo, Spain; Associate Medical Professor Departament Medical Science, Universidad Castilla-La Mancha, Spain
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Associate Medical Professor Departament Medical Science, Universidad Castilla-La Mancha, Spain" "etiqueta" => "e" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento sintomático y del dolor en fibromialgia mediante abordaje multidisciplinar desde Atención Primaria" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Fibromyalgia (FM) is a chronic disabling disease of unknown etiology<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> whose main symptom is widespread pain, followed by fatigue and lack of sleep. It represents an emerging health problem, with a prevalence between 3% and 6% of the worldwide population; most patients present it between 20 and 50 years of age, and it is more common in women, with a male to female ratio of 16:10.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It occupies 15% of the demand for outpatient care of Rheumatology and 5%–10% of primary care visits,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> leading to an approximate expenditure of 11<span class="elsevierStyleHsp" style=""></span>000 million euros/year in Spain, both in direct and indirect costs.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> scientific-technical approach is very limited, needing a biopsychosocial approach to the disease, as well as adjunctive therapies such as<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> aerobic exercise, strength training, stretching or flexibility, cognitive behavioral therapy, meditation and feedback<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>; the goal is for each individual to know their various physiological stimuli, with the possibility to modify them in their favor, and practice and learn to control them better.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Occupational Therapy is a useful tool because it has effects on occupational functioning, cognitive and physical skills, resulting in improved performance of activities of daily life and more interaction with the global context.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The effectiveness of multidisciplinary management is currently being evaluated in order to provide the most comprehensive care for this difficult and complex group of patients<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and an improvement in their daily lives, both in quality of life and independent or dependent mild activities of daily living as well as moderate activities of daily living (ADL), and for moderate dependent instrumental activities of daily living (IADL).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The objective of this study is to evaluate the effect of a multidisciplinary intervention in patients with FM.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Sample</span><p id="par0025" class="elsevierStylePara elsevierViewall">In a population in the Health Area of Talavera de la Reina (Toledo), with 128<span class="elsevierStyleHsp" style=""></span>000 inhabitants, with a prevalence of FM of 2.4%,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> a confidence interval of 95% and a margin of error of 7%, we obtained a sample size of 19 people (3.0 Epidat Program), to which we added the non-response rate of 10% from a direct interview, obtaining a total of 21 people on a database of 446 patients with FM, all with a hospital diagnosis performed in the rheumatology clinic. Participants were contacted by telephone interview, informing them of the type of study.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Inclusion Criteria</span><p id="par0030" class="elsevierStylePara elsevierViewall">Women between 16 and 55 years, residing in the Health Area of Talavera de la Reina (Toledo) with FM who have no other problem that causes them mental or physical disability.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Exclusion Criteria</span><p id="par0035" class="elsevierStylePara elsevierViewall">Other physical illnesses that hinder intervention and have not featured, in the 6 months prior, major life events (bereavement, moving, etc.).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Measurements</span><p id="par0040" class="elsevierStylePara elsevierViewall">We used the Fibromyalgia Impact Questionnaire (FIQ)<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> designed to quantify the overall impact of FM on several dimensions (functionality, perception of pain, stiffness and fatigue, sleep disorder, depression, anxiety and ability to work in paid and domestic labor). In the case of having gainful employment, the FIQ assesses the degree to which FM has affected this activity.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> The assessment of the daily impact of FM was performed by the IADL, which are those activities that support everyday life at home and in the community, that may require more complex interactions than those used in ADL (Lawton and Brody scale).<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> For those ADL designed to personal care,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> the Barthel scale was used. For the perception of the disease and the health system related to FM, we used a questionnaire created ad hoc (Appendix 1 [available online]).</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Design and Intervention</span><p id="par0045" class="elsevierStylePara elsevierViewall">Pretest–posttest study performed with simple random sampling using the Wilcoxon test, and the statistical analysis with SPSS 15.0. Only patients who attended at least 5 of the 7 sessions were analyzed. The study was conducted between February and May 2012 and consisted of 2 parts. The first part was done by examination in primary care with 3 appointments (before, during and after the intervention), in which the patients spoke of their disease, treatment of their symptoms (analgesics, tramadol, paracetamol, pregabalin and/or ciclobenzapirine) as well as their usual medication for concomitant diseases, and conducting health education in FM, and occupational therapy sessions, with 7 sessions of between 60 and 120<span class="elsevierStyleHsp" style=""></span>min (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Ethical and Legal Aspects</span><p id="par0050" class="elsevierStylePara elsevierViewall">All participants were requested verbal consent. The project was approved by the Research Committee of the Health Care District of Talavera de la Reina.</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">Response was obtained from 20 patients with a mean age of 40 years (range 16–55 years). In a previous survey, when asked on knowledge of occupational therapy, 50% answered yes. 75% knew about psychomotor therapy. 95% of patients believed that an intervention from Occupational Therapy helped FM and, when asked whether they found improvement with treatment received before surgery, 70% responded no. 10% answered that almost always other people took seriously their disease, 55% said sometimes, 25% almost never and 10% never. As to whether doctors take seriously all presenting symptoms, 10% answered always, 10% almost always, 60% sometimes and 20% rarely.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The work of the primary care physician was viewed more positively than the Hospital Care Physician, with a difference of nearly a point on an analog scale of 0–10, in which the GP got a 6.89 and hospitalist care 5.79. 100% of FM patients fully consider that their needs are not met, but consider that public health helps. The family was, for 50% of the patients, who most understood them, followed by other patients with FM 25%, and 10% healthcare professionals.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In the post-survey, all participants thought that the intervention helped them and should be included within the treatment they currently receive.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The initial quality of life (QOL) of the study group was of 74.41 (range 63.0–93.8) placing them in the FIQ as vital moderate (50–75) to severe involvement (>75). After the speech, the QOL minimum was 36.09 (mild vital involvement) and a maximum of 60.61 (moderate vital involvement), showing a clear improvement in the overall health, so a degree of involvement of QOL as measured by the FIQ, goes from moderate to severe to moderate to mild, with a statistically significant difference (<span class="elsevierStyleItalic">P</span><.05).</p><p id="par0075" class="elsevierStylePara elsevierViewall">Regarding the degree of independence in ADL, in the pre-intervention study, 33.3% of patients were independent and 66.7% has a slight dependence, and subsequently 50% of them were independent, and 50% had mild dependence (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Regarding the degree of independence in IADL, of those participating in the pre-intervention study, 22.2% had a score of 8, 50% had a rating of 7, 22.2% a rating of 6 and 5.6% a rating of 4. The scale of Lawton and Brody is most useful for women, as many men did not realize some of the activities studied. In the subsequent evaluation, 41.7% had a score of 8 and 58.3% a rating of 7 (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">There were statistically significant differences in pre-post intervention in ADL, IADL and QOL (<span class="elsevierStyleItalic">P</span><.05).</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">FM is a highly prevalent and disabling disease<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> which, together with the high demand in the clinics, both primary care and Hospital Care (20% of consultations of Rheumatology),<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and expenditure per patient per year poses an important expense to the health system (€10 000 patient year). Patients were classified as a difficult approach, largely due to non-existence of an actual cure.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Most of the people who participated in the study expressed a social inadequacy and misunderstanding about their disease; 90% stated that the people around them are not serious about their disease, causing them difficulties in their daily lives.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Some of the most affected parameters in people with FM ADL are sleep and rest,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> leading to insomnia at night, which causes tiredness on waking in the morning.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The ADL disabilities that were more common were going up and down stairs, and in the most affected in people with FM, the AIVD most affected was “<span class="elsevierStyleItalic">shopping</span>”, which assures us the dependence of these patients and their limitations in daily life, which is inherent in their illness.</p><p id="par0105" class="elsevierStylePara elsevierViewall">In our statement, we released a set of guidelines from the Occupational Therapy and psychomotor aspects to exercise the mind, while moderate exercise, demonstrated as beneficial in this disease.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,15</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">After this study, despite not having, (limitation of the study), a control group by the difficulty to obtain controls to these particular cases, it has been shown that the combined multidisciplinary intervention significantly improved (<span class="elsevierStyleItalic">P</span><.05) quality of life, as in the embodiment of the people affected in their ADL due to FM and, therefore, the effectiveness of the combined multidisciplinary therapy to treat this disease is demonstrated.</p><p id="par0115" class="elsevierStylePara elsevierViewall">With this multidisciplinary approach we approximate the current problem, in which the Hospital Care physician (mainly Rheumatology) reaches the diagnosis, monitors and treats the disease, prolonging the reviews in time, acting on cases of exacerbation and worsening of the disease and working with primary care physicians in maintaining the health status of the patient, helping other health professionals (occupational therapists, psychologists, physiotherapists, etc.) and thus opening the door for future research with more time on this approach.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Drug treatment has failed to be, by itself, the treatment of choice for treating FM (90% doubt that the health system takes seriously their disease), although many others have been tested.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Currently, drug treatment is the only option used from the health system perspective and this means that people with FM are unhappy with the system, even raising questions about whether doctors believe their illness. Non-pharmacologic treatments have demonstrated their effectiveness, such as physical exercise, psychotherapy, feedback and occupational Therapy.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–8</span></a> However, they do not appear in the portfolio of health systems, translating into an increased workload in healthcare. This lack in resources is one of the reasons why people with FM are not fully addressed by the system.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">These results support the idea that the treatment of FM should be done from<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17–21</span></a> a multidisciplinary perspective, not only pharmacological medical treatment, supported by scientific evidence and directed mainly by Rheumatology, but by primary care as well, and that treatment should be a cofactor in the disease, including other types of treatment, be it psychiatric, psychological or from the Occupational Therapy and Physiotherapy perspctive.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> To treat these patients it is not enough to have a unique approach; it must be approached from several levels, such as social, personal and family, helping the sick and their environment, making a biopsychosocial approach to the disease and not reducing us to a medical approach.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Fibromyalgia is not a muscle or a bone breaking, it is a person who suffers from a crippling disease.</p><p id="par0130" class="elsevierStylePara elsevierViewall">The multidisciplinary team, supported in primary care due to their closeness, trust and patient accessibility, make it the axis of maintenance treatment, using a biopsychosocial approach. In patients with FM it is demonstrated that a multidisciplinary intervention approach significantly improves their quality of life and performance.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Ethical Responsibilities</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Protection of persons and animals</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that the performed procedures conformed to the ethical standards of the committee responsible for human experimentation and were in accordance with the World Medical Association Declaration of Helsinki.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Data confidentiality</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors state that patient data do not appear in this article.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Right to privacy and informed consent</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors have obtained informed consent from patients and/or subjects referred to in the article. This document is in the possession of the corresponding author.</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflict of Interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors have no disclosures to make.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres411392" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction" 2 => "Objectives" 3 => "Materials and methods" 4 => "Results and conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec387030" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres411391" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción" 2 => "Objetivos" 3 => "Material y método" 4 => "Resultados y conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec387031" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and Methods" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Sample" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Inclusion Criteria" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Exclusion Criteria" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Measurements" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Design and Intervention" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Ethical and Legal Aspects" ] ] ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0055" "titulo" => "Ethical Responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Protection of persons and animals" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0070" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0075" "titulo" => "Conflict of Interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-04-04" "fechaAceptado" => "2014-03-21" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec387030" "palabras" => array:3 [ 0 => "Fibromyalgia" 1 => "Activities of daily living" 2 => "Occupational therapy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec387031" "palabras" => array:3 [ 0 => "Fibromialgia" 1 => "Actividades de la vida diaria" 2 => "Terapia Ocupacional" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Fibromyalgia is a chronic disease of unknown etiology characterized by widespread muscle pain, with occupational, familial, social, physical and psychological performance involvement. The multidisciplinary approach to the disease leads to improvement in quality of life and symptomatology.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Objectives</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To evaluate the improvement of activities of daily living (ADL) and quality of life following a multidisciplinary intervention (Health Primary Care and Occupational Therapy).</p> <span class="elsevierStyleSectionTitle" id="sect0020">Materials and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Pretest–posttest study performed with a simple random sample of 21 patients with fibromyalgia (range 16–55 years). The measurement was performed with the Barthel scale (ADL), the scale of Lawton and Brody (IADL), the FIQ questionnaire, and no standardized surveys to assess the pre- and post-intervention situation. An intervention on motor skills (basic motor skills, pool exercise, outdoor exercise, restructuring, occupational performance and graded activity and intervention in ADL) was performed, combining pharmacological control of their symptoms and treatment.</p> <span class="elsevierStyleSectionTitle" id="sect0025">Results and conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Fibromyalgia patients are not fully satisfied with their treatment; Primary Care receives a score of 6.89, and Hospital Care 5.79, improving the Barthel, Lawton and Brody and FIQ indexes, being statistically significant (<span class="elsevierStyleItalic">P</span><.05). After the combined procedure the number of independent women in ADL and IADL increases.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La fibromialgia es una enfermedad crónica de etiología desconocida, caracterizada por dolor muscular generalizado, afectando al desempeño ocupacional, familiar, social, físico y psicológico. El abordaje multidisciplinar de la enfermedad aporta mejoría en la calidad de vida y sintomatología del paciente.</p> <span class="elsevierStyleSectionTitle" id="sect0040">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Valorar la mejoría de actividades de la vida diaria (AVD) y calidad de vida tras una intervención multidisciplinar (Atención Primaria y Terapia Ocupacional).</p> <span class="elsevierStyleSectionTitle" id="sect0045">Material y método</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio pretest-postest, con muestreo aleatorio simple, en 21 pacientes con fibromialgia (rango 16–55 años). La medición se realiza con la escala de Barthel (ABVD), la escala de Lawton y Brody (AIVD), cuestionario FIQ y encuestas no estandarizadas para valorar situación pre y postintervención. Se realizó una intervención sobre psicomotricidad (psicomotricidad básica, ejercicio en piscina, ejercicio al aire libre, reestructuración, desempeño ocupacional y actividad graduada e intervención en ABVD), asociando control farmacológico de su sintomatología y tratamiento.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Resultados y conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los enfermos de fibromialgia no están totalmente conformes con el tratamiento que reciben, Atención Primaria recibe una valoración de 6,89, y la Atención Hospitalaria de 5,79, mejorando los índices de Barthel y de Lawton y Brody, y el cuestionario FIQ, de forma estadísticamente significativa (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,05). Tras la intervención combinada, aumenta el número de mujeres independientes en ABVD y AIVD.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gonzalez Gonzalez J, del Teso Rubio MM, Waliño Paniagua CN, Criado-Alvarez JJ, Sanchez Holgado J. Tratamiento sintomático y del dolor en fibromialgia mediante abordaje multidisciplinar desde Atención Primaria. Reumatol Clin. 2015;11:22–26.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0160" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix 1" "titulo" => "Supplementary data" "identificador" => "sec0085" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Session \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Content \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Introducing the occupational and psychomotor (1) therapy. Introduce psychomotor treatment and the benefits it has on FM and promote adherence to treatment \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Psychomotor (2). Improve the ability to adapt to new situations despite restrictions, promote social relationships and contribute to improving health, enhancing the quality of life \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pool (Aquatic psychomotor). Improve resistance against gravity, improve fatigue to perform activities of daily life, and therefore the ideational and Ideomotor praxis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Psychomotor (4). Encourage social relationships, improve fatigue to carry out activities of daily living and contribute to improving health, enhancing the quality of life \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Restructuring of occupational performance and graded activity. The theoretical content of organizational skills and time management and incorporation of enjoyable activities are offered through various practical exercises \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Intervention on activities of daily living and physical activity. Positively reinforce what was learned in previous sessions and ensure tasks are performed properly \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Intervention activities of daily living and physical activity. Have participants walk 45<span class="elsevierStyleHsp" style=""></span>min along with occupational therapists and the physician. Health education to maintain the benefits. Sharing ideas \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab639759.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Occupational Therapy Sessions and Content.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Preintervention \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Postintervention \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Barthel</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Independent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Slightly dependent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Eating</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Independent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Need Help \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Washing</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Independent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dependent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Dressing</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Independent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Need Help \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Grooming</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Independent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dependent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Toilet</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Continent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Urination</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Casual accident \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Continent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Using the toilet</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Casual help \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Independent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Transfer couch/bed</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Need help \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Independent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Gait</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Minimal aid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Independent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Need help \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Up/down stairs</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Independent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Need help \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dependent \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab639760.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Results of the Barthel Pre-Intervention and Post-Intervention Scale.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Preintervention \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Postintervention \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Lawton</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Use phone</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Uses on own initiative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mark no. family \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Make purchases</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Make all purchases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Make small purchases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Need help buying \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unable to buy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Food preparation</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Prepare the meal alone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>prepare food if someone provides the ingredients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>prepares the food, but does not follow proper diet \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Home care</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Maintains house alone or with occasional assistance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Perform small tasks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Make light work without maintaining an adequate level of cleanliness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.7% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Wash clothes</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Wash clothes alone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Only washes small items \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unable to do laundry \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Uses means of transportation</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>travels alone or drives car \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>is only able to take a taxi \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Traveling by public transport accompanied \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Only taxi or car with company \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Responsibility for medication</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Able to take medication alone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Take medication previously prepared \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Money management</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Responsible alone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Small shopping, the rest with aid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.2% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab639761.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Results of the Lawton and Brody Preintervention and Postintervention Scale.</p>" ] ] 3 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 1111947 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 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| 2023 August | 38 | 20 | 58 |
| 2023 July | 42 | 26 | 68 |
| 2023 June | 45 | 29 | 74 |
| 2023 May | 64 | 20 | 84 |
| 2023 April | 47 | 15 | 62 |
| 2023 March | 114 | 33 | 147 |
| 2023 February | 58 | 23 | 81 |
| 2023 January | 65 | 20 | 85 |
| 2022 December | 69 | 30 | 99 |
| 2022 November | 76 | 32 | 108 |
| 2022 October | 93 | 47 | 140 |
| 2022 September | 59 | 41 | 100 |
| 2022 August | 75 | 30 | 105 |
| 2022 July | 79 | 47 | 126 |
| 2022 June | 50 | 39 | 89 |
| 2022 May | 48 | 45 | 93 |
| 2022 April | 74 | 65 | 139 |
| 2022 March | 55 | 57 | 112 |
| 2022 February | 56 | 50 | 106 |
| 2022 January | 47 | 28 | 75 |
| 2021 December | 44 | 38 | 82 |
| 2021 November | 65 | 52 | 117 |
| 2021 October | 56 | 59 | 115 |
| 2021 September | 42 | 56 | 98 |
| 2021 August | 36 | 39 | 75 |
| 2021 July | 28 | 41 | 69 |
| 2021 June | 34 | 23 | 57 |
| 2021 May | 51 | 31 | 82 |
| 2021 April | 149 | 101 | 250 |
| 2021 March | 70 | 35 | 105 |
| 2021 February | 52 | 31 | 83 |
| 2021 January | 67 | 35 | 102 |
| 2020 December | 45 | 27 | 72 |
| 2020 November | 45 | 30 | 75 |
| 2020 October | 24 | 11 | 35 |
| 2020 September | 51 | 38 | 89 |
| 2020 August | 38 | 16 | 54 |
| 2020 July | 24 | 17 | 41 |
| 2020 June | 32 | 26 | 58 |
| 2020 May | 63 | 17 | 80 |
| 2020 April | 53 | 29 | 82 |
| 2020 March | 14 | 7 | 21 |
| 2018 May | 9 | 3 | 12 |
| 2018 April | 96 | 11 | 107 |
| 2018 March | 208 | 14 | 222 |
| 2018 February | 110 | 9 | 119 |
| 2018 January | 60 | 7 | 67 |
| 2017 December | 104 | 9 | 113 |
| 2017 November | 72 | 13 | 85 |
| 2017 October | 34 | 15 | 49 |
| 2017 September | 54 | 12 | 66 |
| 2017 August | 51 | 11 | 62 |
| 2017 July | 53 | 11 | 64 |
| 2017 June | 78 | 18 | 96 |
| 2017 May | 101 | 19 | 120 |
| 2017 April | 83 | 26 | 109 |
| 2017 March | 58 | 24 | 82 |
| 2017 February | 32 | 7 | 39 |
| 2017 January | 28 | 9 | 37 |
| 2016 December | 90 | 14 | 104 |
| 2016 November | 67 | 11 | 78 |
| 2016 October | 70 | 26 | 96 |
| 2016 September | 101 | 17 | 118 |
| 2016 August | 71 | 3 | 74 |
| 2016 July | 36 | 10 | 46 |
| 2015 December | 2 | 0 | 2 |
| 2015 September | 2 | 0 | 2 |
| 2015 August | 1 | 0 | 1 |
| 2015 July | 28 | 8 | 36 |
| 2015 June | 58 | 16 | 74 |
| 2015 May | 87 | 28 | 115 |
| 2015 April | 98 | 19 | 117 |
| 2015 March | 81 | 23 | 104 |
| 2015 February | 96 | 28 | 124 |
| 2015 January | 56 | 15 | 71 |
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