A guide for standardized interpretation of lumbar multifidus ultrasonography; an observational study.

BACKGROUND: Inconsistent descriptions of Lumbar multifidus (LM) morphology were previously identified, especially in research applying ultrasonography (US), hampering its clinical applicability with regard to diagnosis and therapy. The aim of this study is to determine the LM-sonoanatomy by comparing high-resolution reconstructions from a 3-D digital spine compared to standard LM-ultrasonography. METHODS: An observational study was carried out. From three deeply frozen human tissue blocks of the lumbosacral spine, a large series of consecutive photographs at 78 µm interval were acquired and reformatted into 3-D blocks. This enabled the reconstruction of (semi-)oblique cross-sections that could match US-images obtained from a healthy volunteer. Transverse and oblique short-axis views were compared from the most caudal insertion of LM to L1. RESULTS: Based on the anatomical reconstructions, we could distinguish the LM from the adjacent erector spinae (ES) in the standard US imaging of the lower spine. At the lumbosacral junction, LM is the only dorsal muscle facing the surface. From L5 upwards, the ES progresses from lateral to medial. A clear distinction between deep and superficial LM could not be discerned. We were only able to identify five separate bands between every lumbar spinous processes and the dorsal part of the sacrum in the caudal anatomical cross-sections, but not in the standard US images. CONCLUSION: The detailed cross-sectional LM-sonoanatomy and reconstructions facilitate the interpretations of standard LM US-imaging, the position of the separate LM-bands, the details of deep interspinal muscles, and demarcation of the LM versus the ES. Guidelines for electrode positioning in EMG studies should be refined to establish reliable and verifiable findings. For clinical practice, this study can serve as a guide for a better characterisation of LM compared to ES and for a more reliable placement of US-probe in biofeedback.

Functional and morphological lumbar multifidus characteristics in subgroups with low back pain in primary care.

BACKGROUND: Since the contribution of the lumbar multifidus(LM) is not well understood in relation to non-specific low back pain(LBP), this may limit physiotherapists in choosing the most appropriate treatment strategy. OBJECTIVES: This study aims to compare clinical characteristics, in terms of LM function and morphology, between subacute and chronic LBP patients from a large clinical practice cohort compared to healthy controls. DESIGN: Multicenter case control study. METHOD: Subacute and chronic LBP patients and healthy controls between 18 and 65 years of age were included. Several clinical tests were performed: primary outcomes were the LM thickness from ultrasound measurements, trunk range of motion(ROM) from 3D kinematic tests, and median frequency and root mean square values of LM by electromyography measurements. The secondary outcomes Numeric Rating Scale for Pain(NRS) and the Oswestry Disability Index(ODI) were administered. Comparisons between groups were made with ANOVA, p-values<0.05, with Tukey's HSD post-hoc test were considered significant. RESULTS: A total of 161 participants were included, 50 healthy controls, 59 chronic LBP patients, and 52 subacute LBP patients. Trunk ROM and LM thickness were significantly larger in healthy controls compared to all LBP patients(p < 0.01). A lower LM thickness was found between subacute and chronic LBP patients although not significant(p = 0.11-0.97). All between-group comparisons showed no statistically significant differences in electromyography outcomes (p = 0.10-0.32). NRS showed no significant differences between LBP subgroups(p = 0.21). Chronic LBP patients showed a significant higher ODI score compared to subacute LBP patients(p = 0.03). CONCLUSIONS: Trunk ROM and LM thickness show differences between LBP patients and healthy controls.

Influence of respiration frequency on heart rate variability parameters: A randomized cross-sectional study.

BACKGROUND: Many patients visiting physiotherapists for musculoskeletal disorders face psychosocial challenges which may form a large barrier to recover. There are only a limited number of evidence based psychosocial therapies, but they are mainly based on breathing exercises. OBJECTIVE: to study which respiration frequency would lead to the highest relaxation, reflected in vagal tone derived from the heart rate variability (HRV) in healthy subjects. METHODS: A randomized controlled cross sectional study was performed. Respiration cycles of four, five, six, seven and eight breaths per minute (BPM) were delivered in randomized order for two minutes each. HRV metrics were measured during the sessions with electrocardiogram (ECG). Repeated Measures ANOVA's were performed to analyze differences between breathing frequencies. RESULTS: 100 healthy volunteers were included (40 male). Standard Deviation of inter beat intervals (SDNN) values were significantly highest at 5 BPM, whereas the Root Mean Square of Successive Differences (RMSSD) values appeared highest at 7 breaths per minute (p< 0.01). High Frequency (HF) power was lowest at 4 BPM, whereas Low Frequency (LF) power was not significantly influenced by respiration frequency. CONCLUSIONS: Breathing at a frequency of 5 to 7 breaths per minute leads to highest HRV values, but there is no single respiration ratio that maximizes all metrics. Physiotherapists may use five to seven BPM as guidance to determine ideal breathing frequencies.

Changes in kinematics and work physiology during progressive lifting in healthy adults.

PURPOSE: To analyze progression of changes in kinematics and work physiology during progressive lifting in healthy adults. METHODS: Healthy participants were recruited. A standardized lifting test from the WorkWell Functional Capacity Evaluation (FCE) was administered, with five progressive lifting low series of five repetitions. The criteria of the WorkWell observation protocol were studied: changes in muscle use (EMG), heart rate (heart rate monitor), base of support, posture and movement pattern (motion capture system). Repeated measures ANOVA's were used to analyze changes during progressive workloads. RESULTS: 18 healthy young adults participated (8 men, 10 women; mean age 22 years). Mean maximum weight lifted was 66 (±3.2) and 44 (±7.4) kg for men and women, respectively. With progressive loads, statistically significant (p < 0.01) differences were observed: increase in secondary muscle use at moderate lifting, increase of heart rate, increase of base of support and movement pattern changes were observed; differences in posture were not significant. CONCLUSIONS: Changes in 4 out of 5 kinematic and work physiology parameters were objectively quantified using lab technology during progressive lifting in healthy adults. These changes appear in line with existing observation criteria.

Ethical Considerations of Using Machine Learning for Decision Support in Occupational Health: An Example Involving Periodic Workers' Health Assessments.

Purpose Computer algorithms and Machine Learning (ML) will be integrated into clinical decision support within occupational health care. This will change the interaction between health care professionals and their clients, with unknown consequences. The aim of this study was to explore ethical considerations and potential consequences of using ML based decision support tools (DSTs) in the context of occupational health. Methods We conducted an ethical deliberation. This was supported by a narrative literature review of publications about ML and DSTs in occupational health and by an assessment of the potential impact of ML-DSTs according to frameworks from medical ethics and philosophy of technology. We introduce a hypothetical clinical scenario from a workers' health assessment to reflect on biomedical ethical principles: respect for autonomy, beneficence, non-maleficence and justice. Results Respect for autonomy is affected by uncertainty about what future consequences the worker is consenting to as a result of the fluctuating nature of ML-DSTs and validity evidence used to inform the worker. A beneficent advisory process is influenced because the three elements of evidence based practice are affected through use of a ML-DST. The principle of non-maleficence is challenged by the balance between group-level benefits and individual harm, the vulnerability of the worker in the occupational context, and the possibility of function creep. Justice might be empowered when the ML-DST is valid, but profiling and discrimination are potential risks. Conclusions Implications of ethical considerations have been described for the socially responsible design of ML-DSTs. Three recommendations were provided to minimize undesirable adverse effects of the development and implementation of ML-DSTs.

Inconsistent descriptions of lumbar multifidus morphology: A scoping review.

BACKGROUND: Lumbar multifidus (LM) is regarded as the major stabilizing muscle of the spine. The effects of exercise therapy in low back pain (LBP) are attributed to this muscle. A current literature review is warranted, however, given the complexity of LM morphology and the inconsistency of anatomical descriptions in the literature. METHODS: Scoping review of studies on LM morphology including major anatomy atlases. All relevant studies were searched in PubMed (Medline) and EMBASE until June 2019. Anatomy atlases were retrieved from multiple university libraries and online. All studies and atlases were screened for the following LM parameters: location, imaging methods, spine levels, muscle trajectory, muscle thickness, cross-sectional area, and diameter. The quality of the studies and atlases was also assessed using a five-item evaluation system. RESULTS: In all, 303 studies and 19 anatomy atlases were included in this review. In most studies, LM morphology was determined by MRI, ultrasound imaging, or drawings - particularly for levels L4-S1. In 153 studies, LM is described as a superficial muscle only, in 72 studies as a deep muscle only, and in 35 studies as both superficial and deep. Anatomy atlases predominantly depict LM as a deep muscle covered by the erector spinae and thoracolumbar fascia. About 42% of the studies had high quality scores, with 39% having moderate scores and 19% having low scores. The quality of figures in anatomy atlases was ranked as high in one atlas, moderate in 15 atlases, and low in 3 atlases. DISCUSSION: Anatomical studies of LM exhibit inconsistent findings, describing its location as superficial (50%), deep (25%), or both (12%). This is in sharp contrast to anatomy atlases, which depict LM predominantly as deep muscle. Within the limitations of the self-developed quality-assessment tool, high-quality scores were identified in a majority of studies (42%), but in only one anatomy atlas. CONCLUSIONS: We identified a lack of standardization in the depiction and description of LM morphology. This could affect the precise understanding of its role in background and therapy in LBP patients. Standardization of research methodology on LM morphology is recommended. Anatomy atlases should be updated on LM morphology.

Reliability and validity of the Microgate Gyko for measuring range of motion of the low back.

BACKGROUND: The aim of this study was to test the inter- and intrarater reliability and the concurrent validity of the Gyko Microgate for the assessment of lumbar range of motion. METHODS: A cross-sectional study was carried out with two groups of healthy participants. The first group, consisting of 91 subjects, was tested to determine the inter- and intrarater reliability. Concurrent validity was assessed with comparisons with an optical motion system (Vicon) in a second group of 20 subjects. Lumbar range of motion in flexion, extension, left and right lateral flexion were performed. Intraclass correlation coefficient (ICC) was calculated for both analyses. Measurement error was calculated with standard error of the measurement (SEM), smallest detectable change (SDC) and Limits of Agreement (LoA). ICCs were considered good when ICC ≥0.80 and excellent with ICC ≥0.90. RESULTS: Interrater reliability was good to excellent with ICCs ranging from 0.82 to 0.94. Intrarater reliability was good to excellent with ICCs ranging from 0.84 to 0.95. Concurrent validity was excellent with ICCs varying from 0.90 to 0.95. LoA were highest in interrater reliability and smallest in concurrent validity. SEM ranged from 2.2 to 4.0° in lateral flexion left and flexion respectively. SDC varied from 6.1 to 11.1°. CONCLUSION: Gyko has good inter- and intrarater reliability and excellent concurrent validity compared to the optical motion system for lumbar range of motion. Gyko may be considered as objective measure to measure range of motion for clinical purposes, however trials with patients are currently lacking.

Measurement properties and implications of the Brief Resilience Scale in healthy workers.

OBJECTIVES: The aim of this study was to study measurement properties of the Dutch Language Version of the Brief Resilience Scale (BRS-DLV) in blue and white collar workers employed at multiple companies and to compare the validity and factor structure to other language versions. METHODS: Workers (n = 1023) were assessed during a cross-sectional health surveillance. Construct validity was tested with exploratory and confirmatory factor analyses (EFA and CFA) and hypothesis testing. Reliability was tested with Cronbach's alpha. RESULTS: A two-factor structure of the BRS-DLV had good model fit in both EFA and CFA, which could be explained by difficulties of workers with reversed order items. After excluding these inconsistent answering patterns, a one-factor structure showed good model fit resembling the original BRS (χ2  = 16.5; CFI & TLI = 0.99; SRMR = 0.02;RMSEA = 0.04). Internal consistency is sufficient (Cronbach's α = 0.78). All five hypotheses were confirmed, suggesting construct validity. CONCLUSIONS: Reliability of the BRS-DLV is sufficient and there is evidence of construct validity. Inconsistent answering, however, caused problems in interpretation and factor structure of the BRS-DLV. This can be easily detected and handled because item 2, 4 and 6 are in reversed order. Other language versions differ in factor structure, most likely because systematic errors are not corrected for. To collect valid data, it is advised to be aware of inconsistent answering of respondents.

Does the Lever Sign Test Have Added Value for Diagnosing Anterior Cruciate Ligament Ruptures?

BACKGROUND: Diagnosing an anterior cruciate ligament (ACL) rupture based on a physical examination remains a challenge for both surgeons and physical therapists. The lever sign test was developed to overcome the practical limitations of other tests and to optimize diagnosis. An evaluation of the measurement properties of the lever sign test is needed to make adequate interpretations in practice. PURPOSE: To evaluate the reliability and diagnostic value of the lever sign test. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: A total of 94 patients were recruited between November 2014 and July 2016. Patients were included if they were at least 16 years old, suffered from knee trauma, and had indications for knee arthroscopic surgery. Lever sign, anterior drawer, Lachman, and pivot-shift test outcomes were examined by an orthopaedic/trauma surgeon and a physical therapist. A test-retest design was used to investigate interrater reliability. Moreover, the lever sign test outcomes, alone and in combination with the other diagnostic tests, were compared with arthroscopic results, which served as the gold standard for the test's diagnostic value. RESULTS: The lever sign test and pivot-shift test had kappa values exceeding 0.80 for interrater reliability. The kappa values for the anterior drawer test and Lachman test were 0.80 and 0.77, respectively. The lever sign test showed the highest specificity (100%) and the lowest sensitivity (39%) when compared with the other 3 tests. Moreover, its positive and negative predictive values were 100% and 65%, respectively, while an accuracy of 71% was calculated. Clustering the lever sign test parallel with the other 3 tests resulted in the highest accuracy of 91%. CONCLUSION: The lever sign test appears to have high interrater reliability and is the most specific test, showing a maximal positive predictive value. A positive lever sign test result indicates an ACL rupture. These results support the added value of the lever sign test for diagnosing ACL ruptures.

Implementation and effects of Movement-oriented Restorative Care in a nursing home - a quasi-experimental study.

BACKGROUND: The prevalence of dementia is expected to increase rapidly, and institutionalization is a common consequence of the disease. Dependence in activities of daily living (ADL) is a predictor for institutionalization and a determinant for the quality of life (QoL). A promising method to increase functional independence in nursing homes is a restorative care or function focused care (FFC) approach. Movement-oriented restorative care (MRC) is derived from the concept of FFC and restorative care and focuses on the integration of physical activity in the daily lives of nursing home residents with dementia using a multidisciplinary approach. The objective of this study was to assess the effectiveness of MRC in preservation of ADL independence and QoL in nursing home residents with dementia. METHODS: In this quasi-experimental 12-month study, the effects of MRC were compared to care as usual in 61 nursing home residents with moderate to severe dementia. The outcome measures were ADL independence and QoL. These outcomes were measured five times (i.e. at baseline, and after 3, 6, 9, and 12 months). Additionally, data was collected regarding the degree of implementation, and the barriers to the implementation process. The effect of the intervention was analyzed using linear mixed model analyses. RESULTS: There was no significant overall intervention effect on ADL independence and QoL. A significant group-by-time interaction was found for the QoL subscale positive self-image: after a 12 month intervention period, the MRC group scored significantly better than the control group on positive self-image. Regarding the other subscales and the total score of the QoL, as well as ADL, no significant group-by-time interactions were found. CONCLUSIONS: MRC did not demonstrate significant improvements in ADL or QoL. After a 12-month intervention period, residents who received MRC showed higher scores on positive self-image compared to the control group. This study contributes to the limited research regarding the effect of MRC on resident outcomes. Further large-scale studies are recommended. TRIAL REGISTRATION: The trial was retrospectively registered in http://clinicaltrials.gov on February 2, 2017: NCT03001232 .

Can an early perceptuo-motor skills assessment predict future performance in youth table tennis players? An observational study (1998-2013).

This study intended to investigate the capability of the 4 test items "sprint", "agility", "speed while dribbling" and "throwing a ball" of the Dutch perceptuo-motor skills assessment used at the age of 7-10 years to predict table tennis performance (U13, U15 and U18) in an observational study. Data of 1191 young table tennis players, collected from 1998 to 2013, were analysed in univariable and multivariable logistic and linear regression models. The test items "sprint" and "throwing a ball" showed to be significant predictors for table tennis performance outcomes in boys (P < 0.05). For girls, besides these test items also "speed while dribbling" had a significant contribution (P < 0.05). Since the accuracies of the models were low, it is advised to include other determinants to enhance the predictive value of a model for table tennis performance. Nevertheless, it can be concluded that a perceptuo-motor skills assessment might improve the effectiveness of talent programmes in table tennis as an additional method to objectively estimate a youth players' potential. Future research focusing on the inclusion of test items specifically assessing eye hand coordination and other domains, for example, the psychological and the environmental domain, related to table tennis performance are recommended.

Increasing Performance of Professional Soccer Players and Elite Track and Field Athletes with Peak Performance Training and Biofeedback: A Pilot Study.

The aim of this pilot study was to investigate the effects of an intervention consisting of mental coaching combined with either electro encephalogram (EEG) alpha power feedback or heart rate variability (HRV) feedback on HRV, EEG outcomes and self-reported factors related to stress, performance, recovery and sleep quality in elite athletes. A prospective pilot study was performed with two distinct cohorts. Soccer players were provided with four sessions of mental coaching combined with daily HRV biofeedback (Group A); track and field athletes were provided with four sessions of mental coaching in combination with daily neurofeedback (Group B). Measurements were performed at baseline, post intervention and at 5 weeks follow-up. Objective measures: EEG and ECG. Subjective measures: Numeric Rating Scale for performance, Pittsburgh Sleep Quality Index, Rest and Stress Questionnaire and Sports Improvement-60. Group characteristics were too distinct to compare the interventions. Linear mixed models were used to analyze differences within groups over time. In Group A, significant changes over time were present in alpha power at 5 of 7 EEG locations (p < 0.01-0.03). LF/HF ratio significantly increased (p = 0.02) and the concentration (p = 0.02) and emotional scale (p = 0.03) of the SIM-60 increased significantly (p = 0.04). In Group B, the HRV low frequency power and recovery scale of the REST-Q significantly increased (p = 0.02 and <0.01 resp.). Other measures remained stable or improved non-significantly. A mental coaching program combined with either HRV or EEG alpha power feedback may increase HRV and alpha power and may lead to better performance-related outcomes and stress reduction. Further research is needed to elucidate the effects of either type of feedback and to compare effects with a control group.

Can Perceptuo-Motor Skills Assessment Outcomes in Young Table Tennis Players (7-11 years) Predict Future Competition Participation and Performance? An Observational Prospective Study.

Forecasting future performance in youth table tennis players based on current performance is complex due to, among other things, differences between youth players in growth, development, maturity, context and table tennis experience. Talent development programmes might benefit from an assessment of underlying perceptuo-motor skills for table tennis, which is hypothesized to determine the players' potential concerning the perceptuo-motor domain. The Dutch perceptuo-motor skills assessment intends to measure the perceptuo-motor potential for table tennis in youth players by assessing the underlying skills crucial for developing technical and tactical qualities. Untrained perceptuo-motor tasks are used as these are suggested to represent a player's future potential better than specific sport skills themselves as the latter depend on exposure to the sport itself. This study evaluated the value of the perceptuo-motor skills assessment for a talent developmental programme by evaluating its predictive validity for competition participation and performance in 48 young table tennis players (7-11 years). Players were tested on their perceptuo-motor skills once during a regional talent day, and the subsequent competition results were recorded half-yearly over a period of 2.5 years. Logistic regression analysis showed that test scores did not predict future competition participation (p >0.05). Yet, the Generalized Estimating Equations analysis, including the test items 'aiming at target', 'throwing a ball', and 'eye-hand coordination' in the best fitting model, revealed that the outcomes of the perceptuo-motor skills assessment were significant predictors for future competition results (R2 = 51%). Since the test age influences the perceptuo-motor skills assessment's outcome, another multivariable model was proposed including test age as a covariate (R2 = 53%). This evaluation demonstrates promising prospects for the perceptuo-motor skills assessment to be included in a talent development programme. Future studies are needed to clarify the predictive value in a larger sample of youth competition players over a longer period in time.

Assessing personal talent determinants in young racquet sport players: a systematic review.

Since junior performances have little predictive value for future success, other solutions are sought to assess a young player's potential. The objectives of this systematic review are (1) to provide an overview of instruments measuring personal talent determinants of young players in racquet sports, and (2) to evaluate these instruments regarding their validity for talent development. Electronic searches were conducted in PubMed, PsychINFO, Web of Knowledge, ScienceDirect and SPORTDiscus (1990 to 31 March 2014). Search terms represented tennis, table tennis, badminton and squash, the concept of talent, methods of testing and children. Thirty articles with information regarding over 100 instruments were included. Validity evaluation showed that instruments focusing on intellectual and perceptual abilities, and coordinative skills discriminate elite from non-elite players and/or are related to current performance, but their predictive validity is not confirmed. There is moderate evidence that the assessments of mental and goal management skills predict future performance. Data on instruments measuring physical characteristics prohibit a conclusion due to conflicting findings. This systematic review yielded an ambiguous end point. The lack of longitudinal studies precludes verification of the instrument's capacity to forecast future performance. Future research should focus on instruments assessing multidimensional talent determinants and their predictive value in longitudinal designs.

The Dutch motor skills assessment as tool for talent development in table tennis: a reproducibility and validity study.

A motor skills assessment could be helpful in talent development by estimating essential perceptuo-motor skills of young players, which are considered requisite to develop excellent technical and tactical qualities. The Netherlands Table Tennis Association uses a motor skills assessment in their talent development programme consisting of eight items measuring perceptuo-motor skills specific to table tennis under varying conditions. This study aimed to investigate this assessment regarding its reproducibility, internal consistency, underlying dimensions and concurrent validity in 113 young table tennis players (6-10 years). Intraclass correlation coefficients of six test items met the criteria of 0.7 with coefficients of variation between 3% and 8%. Cronbach's alpha valued 0.853 for internal consistency. The principal components analysis distinguished two conceptually meaningful factors: "ball control" and "gross motor function." Concurrent validity analyses demonstrated moderate associations between the motor skills assessment's results and national ranking; boys r = -0.53 (P < 0.001) and girls r = -0.45 (P = 0.015). In conclusion, this evaluation demonstrated six test items with acceptable reproducibility, good internal consistency and good prospects for validity. Two test items need revision to upgrade reproducibility. Since the motor skills assessment seems to be a reproducible, objective part of a talent development programme, more longitudinal studies are required to investigate its predictive validity.

Does an eye-hand coordination test have added value as part of talent identification in table tennis? A validity and reproducibility study.

This study investigated the added value, i.e. discriminative and concurrent validity and reproducibility, of an eye-hand coordination test relevant to table tennis as part of talent identification. Forty-three table tennis players (7-12 years) from national (n = 13), regional (n = 11) and local training centres (n = 19) participated. During the eye-hand coordination test, children needed to throw a ball against a vertical positioned table tennis table with one hand and to catch the ball correctly with the other hand as frequently as possible in 30 seconds. Four different test versions were assessed varying the distance to the table (1 or 2 meter) and using a tennis or table tennis ball. 'Within session' reproducibility was estimated for the two attempts of the initial tests and ten youngsters were retested after 4 weeks to estimate 'between sessions' reproducibility. Validity analyses using age as covariate showed that players from the national and regional centres scored significantly higher than players from the local centre in all test versions (p<0.05). The tests at 1 meter demonstrated better discriminative ability than those at 2 meter. While all tests but one had a positive significant association with competition outcome, which were corrected for age influences, the version with a table tennis ball at 1 meter showed the highest association (r = 0.54; p = 0.001). Differences between the first and second attempts were comparable for all test versions (between -8 and +7 repetitions) with ICC's ranging from 0.72 to 0.87. The smallest differences were found for the test with a table tennis ball at 1 meter (between -3 and +3 repetitions). Best test version as part of talent identification appears to be the version with a table tennis ball at 1 meter regarding the psychometric characteristics evaluated. Longitudinal studies are necessary to evaluate the predictive value of this test.

Prognostic factors for sustained work participation in early osteoarthritis: a follow-up study in the Cohort Hip and Cohort Knee (CHECK).

OBJECTIVE: To identify prognostic factors for the 2-year course of work participation in early osteoarthritis (OA) of hips or knees. METHODS: In this prospective cohort study, questionnaire data from 925 subjects was analyzed. Rate ratios were calculated to compare work participation with the general Dutch population, corrected for age, sex and education. The overall participation rate at T(2) was compared to baseline. Personal factors, self-reported health status (Western Ontario McMasters Arthritis Index-WOMAC), medical consumption and physical work demands were compared between subjects with sustained work participation and subject who stopped working; factors that differed significantly were included in a logistic regression analysis. RESULTS: Work participation in the cohort (mean age 58, 79 % females) decreased from 51 to 46 %, a similar rate to the general population. Subjects who continued working were younger than those who stopped working (mean 4.2 years) and they had less frequently reported sick-leave at baseline; the regression model included both factors. 11 % Of the workers reported sick-leave in the past year because of hip/knee complaints (similar to baseline). 20 % Reported work adaptations, compared to 14 % at baseline. CONCLUSION: The 2-year course of work participation of people with early OA was similar to the general Dutch population. Sustained work participation was predicted by lower age, not by OA related factors.

The effect of osteoarthritis of the hip or knee on work participation.

In our systematic literature search, we included studies involving patients with hip or knee osteoarthritis (OA) and outcome measures of work participation. Methodological quality was assessed using 11 criteria; a qualitative data analysis was performed. Fifty-three full-text articles were selected out of 1861 abstracts; finally, data were extracted from 14 articles. Design, populations, definitions, and measurements in the studies showed large variations; work outcomes were often only secondary objectives. The outcomes were summarized as showing a mild negative effect of OA on work participation. Many patients had paid work and managed to stay at work despite limitations. However, research on the effect of OA on work participation is scarce and the methodological quality is often insufficient. The longitudinal course of work participation in individuals with OA has not been described completely.

The delirium observation screening scale recognizes delirium early after cardiac surgery.

BACKGROUND: Delirium or acute confusion is a temporary mental disorder which occurs frequently among hospitalized elderly patients. Patients who undergo cardiac surgery have an increased risk of developing delirium. Prevention or early recognition of delirium is essential. The Delirium Observation Screening (DOS) scale was developed to facilitate early recognition of delirium by nurses' observations during routine clinical care. AIM: The aim of this study was to validate the DOS scale in accordance with the diagnosis of the psychiatrist, using the DSM-IV criteria as the gold standard. METHODS: In this observational study, the DOS scale was used to assess whether 112 patients who underwent elective cardiac surgery had developed a postoperative delirium. The psychiatrist was consulted to confirm or refute the diagnosis delirium. Wilcoxon's Rank Sum Test was utilized to compare patients with and without delirium on duration of hospital stay. A Receiver Operating Characteristic Curve of the DOS scale was constructed with accompanying Area Under the Curve (AUC). RESULTS: Based on the diagnosis of the psychiatrist, the incidence of delirium following cardiac surgery was 21.4% and the mean duration of delirium was two and a half days. The time to discharge was 11 days longer in patients with delirium. In 27 of the 112 patients a DOS score of >or=3 was found, that indicates delirium. The sensitivity and specificity of the DOS scale was 100% and 96.6% respectively. The AUC was 0.98. CONCLUSION: The DOS scale is a very good instrument to facilitate early recognition of delirium by nurses' observation of patients who undergo cardiac surgery. Early recognition will expedite good postoperative management such as implementation of appropriate interventions, and may decrease negative consequences caused by postoperative delirium.

Delirium after cardiac surgery and predictive validity of a risk checklist.

BACKGROUND: Delirium or acute confusion is a temporary mental disorder that occurs frequently among hospitalized elderly patients. Patients who undergo cardiac surgery have an increased risk of delirium, which is associated with many negative consequences. Therefore, prevention or early recognition of delirium is essential. METHODS: In this observational study, a risk checklist for delirium was used during the preoperative outpatient screening in 112 patients who underwent elective cardiac surgery. The Delirium Observation Screening (DOS) scale was used before and after surgery to assess whether delirium had developed in patients. The psychiatrist was consulted to confirm or refute the diagnosis delirium. RESULTS: The incidence of delirium after cardiac surgery was 21%, and the mean duration of delirium was 2.5 days. The time to discharge was 11 days longer for patients with delirium. The delirium risk checklist could accurately predict postoperative delirium in patients who underwent elective cardiac surgery based on a disturbance in the electrolytes sodium and potassium and on EuroSCORE (European System for Cardiac Operative Risk Evaluation). When using a probability of delirium of 50%, the sensitivity of the risk checklist was 25.0% and specificity was 95.5%. The predictive value of a positive test was 60.0%, and the predictive value of a negative test was 82.4%. The area under the receiver-operating characteristic curve was 0.75. CONCLUSIONS: With the risk checklist for delirium, patients at an increased risk of delirium after elective cardiac surgery can be identified.