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Validación de la versión española de la escala QoL-AD en pacientes con enfermedad de Alzheimer, cuidadores y profesionales sanitarios
Validation of the Spanish version of the QoL-AD Scale in alzheimer disease patients, their carers, and health professionals
M. Gómez-Gallegoa,
Autor para correspondencia
mgomezg@um.es

Autor para correspondencia.
, J. Gómez-Amorb, J. Gómez-Garcíac
a Facultad de Ciencias de la Salud, Universidad Católica de Murcia, Murcia, España
b Departamento de Anatomía Humana y Psicobiología, Universidad de Murcia, Murcia, España
c Métodos Cuantitativos, Universidad de Murcia, Murcia
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de bio&#233;tica de la Universidad de Murcia&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Los pacientes ten&#237;an una edad media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n est&#225;ndar de 78&#44;09<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;02&#44; con una escolaridad media de 4&#44;72<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;70 a&#241;os y una duraci&#243;n media de la enfermedad de 4&#44;15<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;42 a&#241;os&#46; El 68&#44;80&#37; de los mismos eran mujeres&#44; el 56&#44;90&#37; estaban casados y el resto eran viudos&#46; El 47&#44;10&#37; de los pacientes eran amas de casa&#44; el 31&#44;30&#37; obreros especializados y un 21&#44;60&#37; obreros no especializados&#46; Las puntuaciones medias en MMSE&#44; escala de valoraci&#243;n de <span class="elsevierStyleItalic">insight</span> cl&#237;nico &#40;CIR&#41; y HUI-3 fueron 18&#44;51<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;99 &#40;rango 9-27&#41;&#44; 4&#44;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;66 &#40;rango 0-8&#41; y 18&#44;14<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;78 &#40;rango 10-28&#41;&#44; respectivamente&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Los cuidadores ten&#237;an una edad media de 58&#44;86<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;99 a&#241;os&#46; El 70&#44;60&#37; de ellos eran mujeres&#44; un 78&#44;43&#37; estaban casados y el resto eran solteros&#46; En el 41&#44;2&#37; de los casos eran c&#243;nyuges de los pacientes&#44; en el 51&#37; hijos y en el 7&#44;8&#37; cuidadores no familiares&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Instrumentos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se aplicaron los siguientes cuestionarios&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8211;</span><p id="par0030" class="elsevierStylePara elsevierViewall">Escala QoL-AD<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; Consta de 13 &#237;tems referentes a la percepci&#243;n del estado de salud&#44; &#225;nimo&#44; capacidad funcional&#44; relaciones personales y ocio&#44; situaci&#243;n financiera y de su vida en conjunto&#46; Cada &#237;tem es respondido seg&#250;n una escala tipo Likert de 1 &#40;malo&#47;a&#41; a 4 &#40;excelente&#41;&#46; En este estudio se utiliz&#243; una versi&#243;n modificada&#44; en la cual se sustituyeron&#44; como hicieron Edeman et al<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#44; los &#237;tems relativos al &#171;dinero&#187; y el &#171;matrimonio&#187; por los de &#171;capacidad de decidir&#187; y &#171;gente con la que conviven&#187;&#46; Los cuestionarios con hasta 2 &#237;tems ausentes se consideraron computables&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8211;</span><p id="par0035" class="elsevierStylePara elsevierViewall">HUI-3<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleItalic">&#46;</span> Escala gen&#233;rica de CV que comprende 8 atributos &#40;visi&#243;n&#44; audici&#243;n&#44; habla&#44; marcha&#44; destreza&#44; emoci&#243;n&#44; cognici&#243;n y dolor&#41; que&#44; a su vez&#44; incluyen 5 o 6 niveles de severidad en la afectaci&#243;n&#46; En este trabajo se han calculado las puntuaciones de utilidad multiatributo de la forma que describieron Ruiz et al<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8211;</span><p id="par0040" class="elsevierStylePara elsevierViewall">MMSE&#46; Se utiliz&#243; una versi&#243;n validada en la poblaci&#243;n espa&#241;ola&#44; corrigiendo las puntuaciones seg&#250;n edad y escolaridad<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46; Se establecieron dos grupos con fines comparativos&#44; tomando como valor de corte el correspondiente a la mediana de las puntuaciones&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8211;</span><p id="par0045" class="elsevierStylePara elsevierViewall">CIR&#46; Consta de 4 &#237;tems que miden la conciencia de situaci&#243;n&#44; d&#233;ficit cognitivo&#44; dependencia funcional y progresi&#243;n de la enfermedad&#44; y se punt&#250;an de 0 &#40;nada consciente&#41; a 2 &#40;totalmente consciente&#41;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46; Se establecieron dos grupos&#44; como hicieron Ready et al<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46;</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="par0050" class="elsevierStylePara elsevierViewall">Se aplicaron los cuestionarios a pacientes &#40;MMSE&#44; QoL-AD&#44; CIR&#41;&#44; cuidadores &#40;QoL-AD&#44; HUI-3&#41; y profesionales &#40;QoL-AD&#41;&#44; realiz&#225;ndose las entrevistas siempre por separado&#46; Se indic&#243; a los cuidadores y a los profesionales que realizasen las valoraciones sobre la CV del paciente tratando de pensar del modo que lo har&#237;a &#233;l&#46; Trascurrido un mes desde la entrevista basal&#44; se administr&#243; de nuevo la escala QoL-AD a 25 pacientes y a 25 cuidadores elegidos de forma aleatoria&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis estad&#237;stico</span><p id="par0055" class="elsevierStylePara elsevierViewall">Se evalu&#243; la aceptabilidad &#40;tasa de completado de los &#237;tems y distribuci&#243;n de las puntuaciones&#41;&#44; la consistencia interna &#40;coeficiente alfa de Cronbach y correlaci&#243;n &#237;tem-total&#41; y la fiabilidad test-retest &#40;coeficiente de correlaci&#243;n intraclase&#41;&#46; Se determin&#243; la validez de criterio concurrente y la validez divergente estudiando&#58; <span class="elsevierStyleItalic">a&#41;</span> la correlaci&#243;n entre las puntuaciones totales en QoL-AD y las de HUI-3 y el &#237;tem 13 de QoL-AD&#59; <span class="elsevierStyleItalic">b&#41;</span> la relaci&#243;n entre las puntuaciones totales en QoL-AD y la funci&#243;n cognitiva &#40;MMSE&#41; y los factores sociodemogr&#225;ficos &#40;U de Mann-Whitney y test de Kruskal-Wallis&#41;&#46; La validez de constructo se verific&#243; a trav&#233;s de un an&#225;lisis factorial &#40;m&#233;todo de componentes principales&#41; sobre las valoraciones de los pacientes &#40;12 &#237;tems&#41;&#46; Los factores obtenidos se rotaron por el m&#233;todo Varimax&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Aceptabilidad</span><p id="par0060" class="elsevierStylePara elsevierViewall">Los &#237;tems no presentaron problemas de comprensi&#243;n&#46; El tiempo medio de completado fue en pacientes&#44; cuidadores y profesionales de 15&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;3&#44; 7&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;3 y 7&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;2<span class="elsevierStyleHsp" style=""></span>min&#44; respectivamente&#46; El porcentaje de cuestionarios anulados fue inferior al 1&#37;&#46; Se observ&#243; una acumulaci&#243;n de respuestas mayor al 25&#37; en el cuartil inferior del &#237;tem 5 &#40;memoria&#41; y en el cuartil superior del &#237;tem 6 &#40;relaci&#243;n con la familia&#41;&#46; Las medias y las medianas de las puntuaciones en la escala QoL-AD fueron&#58; en los pacientes 34&#44;92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;48 y 36&#59; en cuidadores 29&#44;76<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;92 y 30&#44; y en profesionales 30&#44;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;82 y 30&#44;50&#44; respectivamente&#46; El porcentaje de variaci&#243;n de las medianas respecto de las medias es inferior al 3&#44;2&#37;&#46; Los coeficientes de asimetr&#237;a de todos los &#237;tems se encuentran comprendidos en el intervalo entre &#8211;1 y &#43;1&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Fiabilidad</span><p id="par0065" class="elsevierStylePara elsevierViewall">La consistencia interna de las valoraciones de pacientes&#44; cuidadores y profesionales fue excelente &#40;coeficiente alfa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;85&#44; 0&#44;84 y 0&#44;91&#44; respectivamente&#41;&#46; Todas las correlaciones puntuaci&#243;n &#237;tem-puntuaci&#243;n total fueron superiores a 0&#44;3&#46; Ni el grado de <span class="elsevierStyleItalic">insight</span> ni el deterioro cognitivo del paciente implicaron descensos en la consistencia interna por debajo de niveles aceptables &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; La fiabilidad test-retest fue excelente&#44; tanto en pacientes como en cuidadores &#40;CCI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;87 y 0&#44;86&#44; respectivamente&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Validez de criterio concurrente</span><p id="par0070" class="elsevierStylePara elsevierViewall">Se observaron correlaciones significativas entre las puntuaciones totales de pacientes&#44; cuidadores y profesionales en QoL-AD y las puntuaciones en HUI-3 e &#237;tem 13 de QoL-AD&#46; En el an&#225;lisis por subgrupos se comprob&#243; que las puntuaciones dadas por los pacientes con mayor deterioro cognitivo y las otorgadas por aquellos con menor nivel de <span class="elsevierStyleItalic">insight</span> correlacionaban de forma significativa con dos de las medidas adoptadas como criterio &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Validez divergente</span><p id="par0075" class="elsevierStylePara elsevierViewall">Las puntuaciones en la escala QoL-AD dadas por los pacientes y profesionales no son significativamente distintas en los grupos establecidos seg&#250;n edad&#44; g&#233;nero&#44; nivel educativo&#44; profesi&#243;n&#44; estado civil y MMSE de los pacientes &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Las puntuaciones otorgadas por los cuidadores se influyen por el estado civil y profesi&#243;n de los pacientes &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;030 y 0&#44;046&#44; respectivamente&#41; y correlacionan d&#233;bilmente con la edad de los pacientes &#40;r<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;204&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#41;&#46; Los factores sociodemogr&#225;ficos del cuidador no se asocian a diferencias significativas en la CV &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Validez de constructo</span><p id="par0080" class="elsevierStylePara elsevierViewall">La prueba de esfericidad de Bartlett fue significativo &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;000&#41; y el estad&#237;stico de Kaiser-Meyer-Oklin tuvo un valor de 0&#44;785 lo que garantizaba la adecuaci&#243;n de la muestra para el an&#225;lisis factorial&#46; En el an&#225;lisis de componentes principales se obtuvieron 3 factores con autovalores mayores que 1 que explicaban el 61&#44;30&#37; de la varianza total y una vez rotados correlacionan con las variables originales seg&#250;n se presenta en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46; El &#237;tem 5 &#40;memoria&#41; correlaciona d&#233;bilmente con los 3 factores aislados y tiene una capacidad explicativa del 7&#44;71&#37;&#46; Los factores obtenidos presentan buena consistencia interna &#40;coeficiente alfa &#8805; 0&#44;70&#41; y se interpretan de la siguiente forma&#58; factor salud &#40;r<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>29&#44;57&#37;&#41;&#44; factor relaciones sociales y ambiente &#40;r<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#44;27&#37;&#41; y factor capacidad funcional &#40;r<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#44;46&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0085" class="elsevierStylePara elsevierViewall">Este estudio apoya la tesis de que los pacientes con EA en fase leve o moderada pueden&#44; y por tanto debieran&#44; evaluar su propia CV&#46; Para ello&#44; es imprescindible disponer de un instrumento sencillo&#44; f&#225;cil y r&#225;pido de administrar&#44; de modo que se eviten sesgos por falta de comprensi&#243;n de los enunciados o disminuci&#243;n de la atenci&#243;n&#46; Esta versi&#243;n de QoL-AD cumple los requisitos exigibles para la aplicaci&#243;n en esta poblaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#44; siendo su tiempo de aplicaci&#243;n y su tasa de completado similares a los de la versi&#243;n original<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;18</span></a>&#46; Algunos autores han cuestionado la validez de las valoraciones de los pacientes sobre su CV debido a la alteraci&#243;n cognitiva y la falta de conciencia real de sus d&#233;ficits<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a>&#46; En nuestra muestra&#44; que inclu&#237;a a pacientes con MMSE de hasta 9 puntos y con total falta de <span class="elsevierStyleItalic">insight&#44;</span> la escala QoL-AD ha presentado altos &#237;ndices de consistencia interna&#44; que no difieren en los pacientes m&#225;s afectados cognitivamente o con menor nivel de <span class="elsevierStyleItalic">insight&#46;</span> Las puntuaciones de los &#237;tems pueden&#44; por tanto&#44; ser sumadas para obtener una puntuaci&#243;n total&#46; La fiabilidad de la escala en pacientes con deterioro cognitivo moderado ha sido reportada en la literatura<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;21&#44;22</span></a>&#44; existiendo m&#225;s controversia respecto las consecuencias de la falta de <span class="elsevierStyleItalic">insight&#46;</span> As&#237;&#44; tanto Ready et al<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> como Berwig et al<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> se&#241;alaron un efecto negativo de la anosognosia sobre la consistencia interna de las valoraciones de los pacientes sobre su CV&#46; Si bien&#44; ambos estudios se realizaron con escalas de mayor extensi&#243;n y complejidad que la escala QoL-AD&#46; Es destacable la excelente fiabilidad test-retest de la escala&#44; lo que demuestra que&#44; a pesar del trastorno mn&#233;sico de los pacientes&#44; las mediciones no se influyen por variaciones transitorias en el humor&#44; la salud y otros factores&#46; Nuestros resultados est&#225;n de acuerdo con lo publicado en la literatura<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;24&#8211;26</span></a> y apoyan la utilidad de la escala QoL-AD para realizar un seguimiento temporal de la CV de estos pacientes&#46; En este trabajo se ha verificado que la escala QoL-AD mide el constructo CV dada la significativa correlaci&#243;n observada con la medida global de CV y con una escala gen&#233;rica de CVRS&#44; de acuerdo con lo descrito por otros autores<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;25&#44;27</span></a>&#46; Por otra parte&#44; la ausencia de relaci&#243;n entre las puntuaciones de la escala QoL-AD y los factores sociodemogr&#225;ficos&#44; hecho reportado en algunos estudios&#44; apoya una adecuada validez divergente<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a>&#46; Si bien&#44; no todos los trabajos han observado esta independencia<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a>&#44; pues al ser la CV un concepto que abarca todos los aspectos importantes de la vida de un individuo&#44; es probable observar asociaciones que se explican por la existencia de colinealidad entre las variables<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#46; Sin embargo&#44; es com&#250;n la observaci&#243;n de un hecho en apariencia contradictorio&#44; el d&#233;bil impacto de la funci&#243;n cognitiva sobre la CV de los pacientes<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;28</span></a>&#46; Es probable que los pacientes en fase muy precoz den cierta importancia a la afectaci&#243;n de sus funciones cognitivas&#44; m&#225;s conforme avanza la enfermedad&#44; este protagonismo lo suelen adquirir los s&#237;ntomas neuropsiqui&#225;tricos y la afectaci&#243;n funcional<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31&#44;32</span></a>&#46; Los resultados del an&#225;lisis factorial est&#225;n de acuerdo con lo publicado por Thorgrimsen et al<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#46; Los factores rotados hacen referencia a los sectores de la CV incluidos en el modelo de Lawton&#58; salud&#44; capacidad funcional y ambiente<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; Revell et al<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> aislaron un factor de bienestar psicol&#243;gico que en nuestro estudio se confunde con el factor salud y&#44; sin embargo&#44; no contemplaron la dimensi&#243;n de capacidad funcional&#46; Estas diferencias podr&#237;an deberse a que su poblaci&#243;n objetivo estaba compuesta por ancianos sanos sin alteraci&#243;n cognitiva y discapacidad funcional&#46; No obstante&#44; los resultados del presente trabajo han de corroborarse mediante el an&#225;lisis factorial confirmatorio&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Podr&#237;a considerarse una limitaci&#243;n de este estudio el hecho de que su poblaci&#243;n objetivo est&#233; formada por pacientes en r&#233;gimen ambulatorio tratados en centros de d&#237;a&#46; En el futuro se deber&#225; comprobar si la modificaci&#243;n de la escala la hace &#250;til en el &#225;mbito residencial y si mantiene adecuadas propiedades psicom&#233;tricas en pacientes en estadio severo&#46; Aunque se ha contrastado que las valoraciones de cuidadores y profesionales presentan fiabilidad y validez&#44; es necesario estudiar el acuerdo que muestran con las evaluaciones que realizan los pacientes para garantizar que su uso es adecuado en fases avanzadas&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0095" class="elsevierStylePara elsevierViewall">Los autores declaran que el presente trabajo ha sido sufragado en exclusiva por sus salarios y&#44; realizado con la infraestructura de las instituciones a las que pertenecen&#46; Ninguno de los autores recibe financiaci&#243;n procedente de la industria biom&#233;dica&#46;</p></span></span>"
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    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2010-12-22"
    "fechaAceptado" => "2011-03-06"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec157771"
          "palabras" => array:4 [
            0 => "Calidad de vida"
            1 => "Enfermedad de Alzheimer"
            2 => "Escala QoL-AD"
            3 => "Validaci&#243;n"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec157770"
          "palabras" => array:4 [
            0 => "Quality of life"
            1 => "Alzheimer&#39;s disease"
            2 => "QoL-AD scale"
            3 => "Validation"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La calidad de vida &#40;CV&#41; est&#225; adquiriendo cada vez m&#225;s relevancia como medida para evaluar los resultados de las distintas intervenciones terap&#233;uticas sobre los pacientes con enfermedad de Alzheimer &#40;EA&#41;&#44; dado que contempla aspectos que son especialmente valiosos en su vida diaria&#46; Sin embargo&#44; son escasos los instrumentos para medir la CV que han sido validados en poblaci&#243;n espa&#241;ola&#46; El objetivo de este estudio es explorar las propiedades psicom&#233;tricas de la escala QoL-AD en pacientes&#44; cuidadores y profesionales sanitarios&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se seleccion&#243; a 102 pacientes con EA en fase leve-moderada&#44; sus cuidadores y 25 profesionales sanitarios&#46; La CV de los pacientes fue valorada por pacientes&#44; cuidadores y profesionales mediante la escala QoL-AD&#46; Adem&#225;s&#44; se administraron MMSE&#44; escala de valoraci&#243;n de <span class="elsevierStyleItalic">insight</span> cl&#237;nico &#40;CIR&#41; e &#237;ndice de utilidades de salud &#40;HUI-3&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La fiabilidad interna y externa de la escala QoL-AD fueron excelentes&#46; La escala presenta validez de criterio dado que sus puntuaciones correlacionaron con las de HUI-3 y la medida global de CV &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; La falta de <span class="elsevierStyleItalic">insight</span> y el deterioro cognitivo no tuvieron un efecto sobre estas propiedades&#46; Las puntuaciones en la escala QoL-AD no difirieron entre grupos establecidos seg&#250;n MMSE y factores sociodemogr&#225;ficos &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; En el an&#225;lisis factorial se obtuvo una soluci&#243;n de tres factores que explica el 61&#44;3&#37; de la varianza&#58; factor salud&#44; factor estado funcional y factor relaciones sociales-ambiente&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La escala QoL-AD es un instrumento v&#225;lido y fiable para medir la CV en la pacientes espa&#241;oles con AD que presenten deterioro cognitivo leve-moderado&#44; sea cual fuese su grado de <span class="elsevierStyleItalic">insight&#46;</span></p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Quality of life &#40;QOL&#41; is becoming increasingly important to measure the effect of interventions on the life of patients with Alzheimer&#39;s disease &#40;AD&#41;&#44; particularly on the most meaningful issues&#46; However&#44; most of the instruments used to measure QOL have not been validated in the Spanish population&#46; The aim of this study was to determine the psychometric properties of a Spanish version of QoL Scale in patients with AD&#44; carers and health professionals&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">On hundred and two patients&#44; their carers and 25 health professionals were recruited from day centres&#46; Patients&#8217; QOL was rated by patients&#44; carers and health professionals&#46; The Health Utilities Index&#44; Clinical Insight Rating Scale and Mini Mental State Examination were also administered&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The internal and external reliability of QoL-AD were excellent&#46; Criterion validity was indicated by a significant correlation of QoL-AD scores with HUI-3 and QoL-AD global item scores &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46; Lack of insight and cognitive impairment did not have an effect on these properties&#46; QoL-AD scores were not significantly different between groups made according sociodemographic characteristics and cognitive impairment &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46; The exploratory factor analysis result revealed a three factor solution&#44; which accounted for 61&#46;3&#37; of variance&#58; health factor&#44; functional status factor&#44; and social relationship-environment factor&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">QoL-AD Scale has proved to be a valid and reliable instrument to measure QoL of Spanish AD patients with mild-to-moderate cognitive impairment and a wide range of anosognosia&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Algunos resultados de este trabajo han sido presentados en la LXII Reuni&#243;n Anual de la Sociedad Espa&#241;ola de Neurolog&#237;a&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">HUI-3&#58; Health Utilities Index 3&#59; QoL-AD-13-p&#58; &#237;tem 13 de QoL-AD valorado por pacientes&#59; QoL-AD-13-c&#58; &#237;tem 13 de QoL-AD valorado por cuidadores&#59; QoL-AD-13-pr&#58; &#237;tem 13 de QoL-AD valorado por profesionales&#46; MMSE&#58; miniexamen del estado mental&#59; CIR&#58; Escala de valoraci&#243;n de insight cl&#237;nico&#59; QoL-AD-p&#58; valoraciones de los pacientes&#59; QoL-AD-c&#58; valoraciones de los cuidadores&#59; QoL-AD-pr&#58; valoraciones de los profesionales&#46; Rho&#58; coeficiente de correlaci&#243;n de Spearman&#46;</p>"
          "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"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="10" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">QoL-AD-p</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">QoL-AD-c</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">QoL-AD-pr</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Total</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">MMSE&#8805;18</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">MMSE<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>18</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">CIR<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">CIR&#8805; 7</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Rho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Rho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Rho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Rho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Rho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HUI-3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-0&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-0&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;042&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-0&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-0&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;130&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-0&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-0&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-0&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;053&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">QoL-AD-13-p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">QoL-AD-13-c&nbsp;\t\t\t\t\t\t\n
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                  """
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">AC&#58; ama de casa&#59; MMSE&#58; miniexamen del estado mental&#59; OE&#58; obrero especializado&#59; ONE&#58; obrero no especializado&#59; QoL-AD-c&#58; valoraciones de los cuidadores&#59; QoL-AD-p&#58; valoraciones de los pacientes&#59; QoL-AD-pr&#58; valoraciones de los profesionales&#59; SD&#58; desviaci&#243;n est&#225;ndar&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">G&#233;nero</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Var&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#44;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">z<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;1&#44;460&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">z<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#44;970&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#44;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">z<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;472&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Mujer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">A&#241;os educaci&#243;n</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#62;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;07&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26&#44;00&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 02134853
Idioma original: Español
DOI:10.1016/j.nrl.2011.03.006
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