What Are the Predictors of Self-Reported Change in Physical Activity in Older Adults with Knee or Hip Osteoarthritis?

BACKGROUND: Although physical activity (PA) has been shown to be beneficial in older adults with osteoarthritis (OA), most show low levels of PA. This study evaluated if self-efficacy, attitude, social norm, and coping styles predicted change in PA in older adults with OA in the knee and/or hip. METHODS: Prospective study following 105 participants in a self-management intervention with baseline, post-test (6 weeks), and follow-up (6 months). Univariate associations and multivariate regression with self-reported change in PA as the dependent variable were measured. Potential predictors in the model: demographic, illness-related, and behavioral variables (attitude, self-efficacy, social norm, and intention), coping style, and pain coping. RESULTS: Forty-eight percent of participants reported increased PA at 6 weeks and 37% at 6 months which corresponded with registered PA levels. At 6 weeks, use of the pain coping style "resting," intention, and participation in the intervention was univariately and multivariately, positively associated with more self-reported change, whereas being single and less use of the pain coping style "distraction" predicted less change. Higher pain severity only predicted less change multivariately. At 6 months, univariate associations for age, general coping style "seeking support," and participation in the intervention were found; higher age was associated multivariately with less self-reported change. CONCLUSION: At short term, self-reported change of PA was predicted by the behavioral factors intention and several pain coping styles. Together with other predictors of self-reported change (pain severity, higher age, being single), these could be addressed in future interventions for enhancing PA in older adults with OA.

Development and validation of the Dutch version of the London Handicap Scale.

BACKGROUND: The London Handicap Scale (LHS) was found to be a valid and reliable scale for measuring participation restrictions in adults. OBJECTIVE: This paper describes the development and assesses the construct-related validity of a Dutch version of the London Handicap Scale (DLHS). METHODS: The DLHS was tested in 798 adults (mean age: 50.7 years, SD=14.5, range 16 to 85) and validated with the 'Impact on Participation and Autonomy' (IPA) questionnaire, the Dutch version of the EQ-5D and questions concerning comorbidity and use of medical devices. The study population consisted of patients with rheumatoid arthritis, chronic obstructive pulmonary disease (COPD), epilepsy, laryngectomy and multiple sclerosis. RESULTS: Feasibility was satisfactory. Large correlations (ρ > 0.6) for the DLHS sum score were found with the IPA subscales 'autonomy outdoors', 'perceiving problems', 'family role', autonomy indoors', 'work and education' and with the EQ-5D. The DLHS sum score differs significantly between subgroups based on the number of chronic diseases, number of medical devices and self-reported burden of disease or handicap (p< 0.001). CONCLUSIONS: Based on this evaluation the questionnaire seems feasible and valid for assessing differences in level of participation between subgroups of chronically ill or disabled persons in the Netherlands.

Prevalence of use of performance enhancing drugs by fitness centre members.

Studies on the use of performance enhancing drugs (PED) in fitness centres rely predominately on conventional survey methods using direct questioning. However, research indicates that direct questioning of sensitive information is characterized by under-reporting. The aim of the present study was to contrast direct questioning of different types of PED use by Dutch fitness centre members with results obtained with the Randomized Response Technique (RRT). Questionnaires were conducted among members of fitness centres. PED were classified into the following categories: anabolic steroids, prohormones, substances to counteract side-effects, growth hormone and/or insulin, stimulants (to reduce weight), and miscellaneous substances. A total of 718 athletes from 92 fitness centres completed the questionnaire. The conventional method resulted in prevalences varying between 0% and 0.4% for the different types of PED with an overall prevalence of 0.4%. RRT resulted in prevalences varying between 0.8% and 4.8% for the different types of PED with an overall prevalence of 8.2%. The overall prevalence of the two survey methods differed significantly. The current study showed that the conventional survey method using direct questioning led to an underestimation of the prevalence. Based on the RRT results, the percentage of users of PED among members of fitness centres is approximately 8.2%. Stimulants to lose weight had the highest prevalence, even higher than anabolic steroids. The key task for future preventive health work is to not only focus on anabolic steroid use, but also include interventions focusing on the use of stimulants to lose weight.

Cost of rheumatic disorders in the Netherlands.

Rheumatic disorders concern a broad spectrum of painful disorders affecting the musculoskeletal system, and are responsible for a considerable amount of disease burden and also a substantial economic burden. This economic burden consists of direct and indirect costs, but also the so-called intangible costs. In this study, we estimated the societal cost of rheumatic disorders in the Netherlands, including intangible costs. Data from the National Monitor on Musculoskeletal System 2010 were used to assess resource used, multiplied with standard prices for the Netherlands to obtain total costs for the 1.8 million people suffering from rheumatic disorders. These estimates were supplemented with data from secondary sources. Total societal costs of rheumatic disorders in the Netherlands amount to €4.7 million a year, that is, €2665 per person with rheumatic disorders. Rheumatic disorders have considerable costs, which justify more attention in discussing investments in facing the challenges in our ageing Western societies.

Dairy consumption and 10-y total and cardiovascular mortality: a prospective cohort study in the Netherlands.

BACKGROUND: The consumption of dairy products (milk, cheese, and butter) has been positively associated with the risk of ischemic heart disease (IHD), stroke, and total mortality because of the saturated fat content of these products; and protective effects against these outcomes have been attributed to the calcium content and low-fat choices of dairy products. However, robust evidence on the net effect of dairy product consumption on mortality is limited. OBJECTIVE: The objective was to investigate the association between dairy product consumption and the risk of death (from all causes, IHD, and stroke) in the Netherlands Cohort Study (NLCS). DESIGN: The NLCS was initiated in 120,852 men and women aged 55-69 y at baseline in 1986. After 10 y of follow-up, 16,136 subjects with complete dietary information had died. Twenty-nine percent (men) and 22% (women) of these deaths were due to IHD or stroke. The validated 150-item food-frequency questionnaire provided detailed information on dairy products. RESULTS: Multivariate survival analyses following a case-cohort approach showed only a few statistically significant, but mostly weak, associations. A slightly increased risk of all-cause and IHD mortality was found for both butter and dairy fat intake (per 10 g/d; rate ratio(mortality): 1.04; 95% CI: 1.01, 1.06) only in women. Fermented full-fat milk was inversely associated with all-cause and nonsignificantly with stroke mortality in both sexes. CONCLUSIONS: The role of dairy product consumption in mortality generally appeared to be neutral in men. In women, dairy fat intake was associated with slightly increased all-cause and IHD mortality. More research is warranted on a possible protective effect of fermented milk on stroke mortality.

The FARE: a new way to express FAlls Risk among older persons including physical activity as a measure of exposure.

BACKGROUND: Common expressions of falls risk do not include exposure to hazards. We compared two expressions: the commonly used population incidence (fallers per 1000 person-years) and the FARE (FAlls Risk by Exposure): the number of fallers per 1000 physically active person-days. METHODS: Prospective follow-up study among community dwelling older persons (N=771) aged between 71 and 96 years in The Netherlands, 2005. Baseline data on age, gender, disabilities (vision, mobility), and number of days per week with minimally 30 min of physical activity were collected. Falls were registered monthly. Falls risk was expressed as the number of falls per 1000 person-years and as the FARE. A balance control difficulty score was based on the sumscore of 11 disability items. RESULTS: Increased difficulty controlling balance was linearly associated with reduced exposure to risky situations (Spearman correlation coefficient=-.56) and to an increased falls risk per 1000 person-years. In contrast, the FARE score increased exponentially, which is more indicative of the real risk people face, taking into account their activity restriction. CONCLUSIONS: The FARE is recommended for use in public health policy and research on falls prevention because it takes into account reduced physical activity of older persons who experience increased difficulty controlling their balance.

Fragility, fear of falling, physical activity and falls among older persons: some theoretical considerations to interpret mediation.

BACKGROUND: In their letters to the editor, Lacherez et al. [Lacherez, P.F., Wood, J.M., Kerr, G.K., 2007. Does activity level mediate or suppress the association between fear of falling and falls? Prev. Med. 31; (Electronic publication ahead of print)] and Hafeman and Schwartz [Hafeman, D., Schwartz, S., 2007. Assessing mediation: The necessity of theoretical considerations. Prev. Med. 26; (Electronic publication ahead of print)] questioned the correctness of using the term 'mediation' in our paper [Wijlhuizen, G.J., Jong, R. de, Hopman-Rock, M., 2007. Older persons afraid of falling reduce physical activity to prevent outdoor falls. Prev. Med. 44, 260-264.]. In this paper, we concluded that (outdoor) Physical activity mediates the relationship between Fear of falling and outdoor Falls. We investigated whether the term 'inconsistent mediation' might be a more appropriate term to use in this context. METHODS: Based on literature, we describe the relationship between fear of falling, physical activity, and falls within a causal model. RESULTS: Two causal pathways between Fear and Falls exist, with the causal pathway going from Fear of falling via Physical activity to Falls counteracting (is inconsistent with) the causal pathway going from Fear of falling via Hesitancy to Falls. CONCLUSION: The term 'inconsistent mediation' might be more appropriate to describe the causal relationships between Fear of falling, Falls, and Physical activity.

The 24-h distribution of falls and person-hours of physical activity in the home are strongly associated among community-dwelling older persons.

OBJECTIVES: Most research on falls among older persons focuses on health-related factors that affect the ability to maintain balance. The objective of the study is to determine the association between physical activity and occurrence of falls among community-dwelling older persons. METHODS: The distribution of falls and person-hours of physical activity in the home over 24 h was compared. The falls data (n=501) were extracted from a pooled dataset of three follow-up studies conducted between 1994 and 2005 (n=3587). The 1995 Dutch National Time-Budget Survey provided hour-by-hour information on activities performed by older individuals (n=459) in the home; this sample was representative for the Netherlands. The association between the 24-h distribution of falls and physical activity and the risk of falling (the ratio between the distribution of falls and physical activity) were determined. Participants were community-dwelling older persons aged 65 years and older. RESULTS: More physical activity was positively associated with more falls (Spearman correlation=.89, p<.000). The risk of falling at night (1 a.m.-6 a.m.) was almost eight times higher compared to 7 a.m.-12 p.m. CONCLUSIONS: Physical activity is strongly associated with the number of falls in the home, measured over 24 h. Older persons may be at increased risk of falling if they are encouraged to become more physically active, or if they often get out of bed at night. Thus in addition to health-related factors, changes in level of physical activity should also be taken into account when estimating a person's risk of falling.

Modelling and estimation of valuations for the Dutch London Handicap Scale.

This paper presents a study to estimate a preference-based participation index from the Dutch London Handicap Scale (LHS) classification system that can be applied to past or future Dutch LHS data sets. A subset of 60 states were valued by a representative sample of 285 respondents of the Dutch general adult population. Different models were estimated for predicting health state valuations for all 46,656 states defined by the LHS. Several criteria were used for comparison of the different models and for arguing which one is the most preferred model to use. Our data showed that using the English index would give systematic errors for the Dutch population preferences.

Measuring participation according to the International Classification of Functioning, Disability and Health (ICF).

PURPOSE: To report which existing survey instruments assess participation according to the International Classification of Functioning, Disability and Health (ICF). METHOD: A literature search for relevant survey instruments was conducted. Subsequently, survey instruments were evaluated of which the complete questionnaire, published in the English language, was obtained. Items on participation were evaluated according to the ICF, defined as involvement in life situations, including being autonomous to some extent or being able to control your own life. RESULTS AND CONCLUSIONS: Eleven survey instruments were identified, of which nine were evaluated on participation. All of the nine instruments measure participation to some extent. The two instruments closest to solely involve items on participation level are the Perceived Handicap Questionnaire (PHQ) and the London Handicap Scale (LHS). The PHQ is measuring the perception of participation. In the LHS, the items are formulated in terms of participation, while the response categories include all components of the ICF, from problems in body function to participation. Much more discussion is needed to be able to get an unambiguous picture to distinguish between activity and participation.