Ercolie R. Bossema

Reliable change and practice effects: Outcomes of various indices compared

In this article the outcomes of three indices for the assessment of reliable change (RCIs) are compared: the null hypothesis method of Chelune, Naugle, Lüders, Sedlak, and Awad (1993), the regression-based method of McSweeny, Naugle, Chelune, and Lüders (1993), and a recently proposed adjustment to the latter procedure (Maassen, 2003). Simulated data demonstrated the importance of using large control samples. The regression-based method proved to be the most lenient in designating individuals as reliably changed, resulting in the most correct and the most incorrect designations. The adjusted procedure resulted in fewer correct designations and the lowest numbers of incorrect designations. Real-world data showed the same patterns.

Psychological interventions for patients with rheumatic diseases and anxiety or depression.

The prevalence of clinical anxiety and clinical depression in rheumatic diseases is about twice the prevalence seen in the general population. At a milder level, the occurrence of psychological distress that does not fulfil diagnostic criteria of anxiety and depression is even higher. Evidence indicates that this high prevalence is multifactorial. Correlational studies suggest that possible factors for anxiety and depression include the suffering accompanying somatic symptoms, functional limitations, pro-inflammatory cytokines, helplessness due to the uncontrollable, unpredictable and progressive nature of the disease, and other factors associated with having a chronic disease. This article reviews the prevalence and diagnosis of anxiety and depression in rheumatic diseases and it examines the contents and the impact of psychological interventions to address these difficulties for patients.

The relation between illness cognitions and quality of life in people with and without a stoma following rectal cancer treatment.

Objectives: To compare health‐related quality of life, emotional functioning and illness cognitions between people with and without a stoma after rectal cancer treatment about 8 years ago and to examine the relation between illness cognitions and health‐related quality of life and emotional functioning.

The prospective association between psychological distress and disease activity in rheumatoid arthritis: a multilevel regression analysis

Background Cross-sectional associations suggest a mutual impact of disease activity and psychological distress in rheumatoid arthritis (RA), but a prospective association has not been established. Objective To examine concurrent and prospective associations between psychological distress and disease activity. Methods Patients with RA (N=545, disease duration ≤1 year, age 18–83 years, 69% female, 64% rheumatoid factor (RF) positive) were monitored for 5 years. The Thompson joint score and erythrocyte sedimentation rate were assessed every 6 months. Depressed mood and anxiety were measured every 12 months. Multilevel regression analysis was used. RF positivity, age and female sex were included as covariates. Results Concurrent levels of psychological distress and disease activity were positively associated (p≤0.04). Prospectively, depressed mood was associated with disease activity levels 6 months later (p≤0.04). The Thompson joint score was associated with psychological distress levels 6 months later (p≤0.03) and also with an increase in depressed mood over the subsequent 6 months (p=0.02). No other significant prospective associations were found (p≥0.07). Conclusions Psychological distress and disease activity are positively associated when measured at the same time as well as when measured 6 months apart. While some support was found for the idea that a higher level of disease activity is a risk factor for an increase in psychological distress, the results do not support the notion that psychological distress is a risk factor for future exacerbation of disease activity.

Increase of body mass index in a tight controlled methotrexate-based strategy with prednisone in early rheumatoid arthritis: side effect of the prednisone or better control of disease activity?

To clarify whether increase of body weight in patients with early rheumatoid arthritis (RA) upon administration of prednisone is a side effect of prednisone or a result of better control of disease activity, we examined the association of prednisone and disease activity with a subsequent change in body mass index (BMI).

Cognitive Functions in Carotid Artery Disease before Endarterectomy

Restorative effects of carotid endarterectomy (CEA) on cognitive functioning in patients with severe atherosclerotic disease presuppose the existence of cognitive deficits prior to the intervention. Thorough examination of this premise received only minor attention. The present study assessed symptomatic and asymptomatic patients with severe unilateral or bilateral stenosis of the carotid arteries one day before CEA. Healthy volunteers with similar demographic characteristics served as control subjects. Patients overall showed decreased functioning on tests of attention, verbal and visual memory, verbal fluency, and psychomotor speed and executive functioning, even after correction for the effects of mood. Simple motor skills and visuospatial functioning were not affected. Patients grouped according to presence and type of previous clinical symptoms and severity of contralateral stenosis only slightly differed from each other. The findings leave open the potential of improving cognitive function after CEA. We thank the staff of the Department of Vascular Surgery from the St. Antonius Hospital for help in the arrangement of meetings with patients, and Nicole Dreessen, Christi-Anne van Hattum, Cindy de Graag, Lindsey Ossewaarde, Greet Huisman, Roeland van der Zouwen, and Ingrid Verkerk for their help in data collection.

Characteristics of suitable work from the perspective of patients with fibromyalgia

OBJECTIVES The evaluation of work ability of patients with FM is difficult. Our aim was to investigate the characteristics of suitable work from the perspective of patients with FM. METHODS Interviews with patients yielded statements about characteristics of suitable work. Patients individually sorted these statements according to similarity. Hierarchical cluster analysis was applied to these sortings. RESULTS The hierarchical structure included 74 characteristics of suitable work. The 10 clusters at the lowest level included (i) recovery opportunities, (ii) pace of work, (iii) not too high workload, (iv) keeping energy for home and free time, (v) match between work and capabilities, (vi) development opportunities, (vii) understanding from colleagues, (viii) help from colleagues, (ix) support from management and (x) work agreements with management. CONCLUSIONS According to patients with FM, suitable work is paced in such a way that one can perform the job well and with satisfaction while keeping energy for home and free time and having acknowledgement and help from management and colleagues. The brief suitable work checklist that is provided can help patients with FM to negotiate with employers and job professionals to improve the match between job demands and capabilities.

Physical activity and physical activity cognitions are potential factors maintaining fatigue in patients with primary Sjögren's syndrome

Background Fatigue is a prevalent and debilitating problem in Sjögrens syndrome. It has been suggested that physical activity and cognitions about physical activity can influence fatigue. Objective The aim of this study was to examine fatigue and physical activity levels in patients with Sjögrens syndrome and the associations of physical activity and physical activity cognitions with fatigue. Methods In 300 patients with primary Sjögrens syndrome and 100 demographically matched people from the general population (mean age 57 years, 93% female), fatigue (five dimensions of the multidimensional fatigue inventory) and physical activity (three dimensions of the international physical activity questionnaire) were assessed. The physical activity cognitions ‘activity avoidance’ and ‘somatic focus’ of the Tampa scale of kinesiophobia were assessed in the Sjögrens group only. Results Sjögrens patients had higher scores on all five fatigue dimensions (p<0.001) and lower scores on moderate and vigorous intensity activity (p≤0.001) compared with control participants. In the Sjögrens group, lower physical activity and higher activity avoidance and somatic focus were associated with more severe fatigue on most fatigue dimensions. For general fatigue and physical fatigue, especially the combination of low physical activity and high activity avoidance was associated with more severe fatigue (p<0.05). Conclusions The results suggest that fatigue in patients with Sjögrens syndrome might be reduced by targeting both physical activity and physical activity cognitions. This suggestion requires verification in clinical experimental studies.

Change of psychological distress and physical disability in patients with rheumatoid arthritis over the last two decades.

During the past decades, a more cautious approach with respect to prescribing medication and physical exercise progressed toward evidence‐based guidelines regarding the management of rheumatoid arthritis (RA). Currently, physical activity and other means to improve well‐being and functioning are encouraged, and the disease is targeted earlier with more intensive and aggressive pharmacologic treatment. The current study examined whether psychological distress and physical disability in patients with RA reduced over the last 2 decades and whether this is explained by a reduction of disease activity.

Cortisol during the day in patients with systemic lupus erythematosus or primary Sjogren's syndrome.

Objective. To compare the level and change of cortisol during the day of patients with systemic lupus erythematosus (SLE) and primary Sjögren’s syndrome (pSS) with low and high erythrocyte sedimentation rate (ESR). Methods. Saliva was collected in the real-life environment of 21 women with SLE, 16 women with pSS, and 30 age-matched healthy women at 9 fixed timepoints during 2 consecutive days. Repeated measures ANOVA was performed to examine whether cortisol levels during the day were different for the patients with low ESR (≤ 20 mm/h) versus those with high ESR (> 20 mm/h). Results. The groups with low and high ESR showed the characteristic change of cortisol during the day (time-of-day effect, F = 124.9, p < 0.001). The cortisol awakening level was lower for patients with high ESR than for patients with low ESR (group*time effect, F = 3.1, p = 0.02). Conclusion. The cortisol awakening level differs for patients with low and high ESR, which indicates the usefulness of further studies of hypothalamic-pituitary-adrenal axis dynamics in patients with SLE and pSS.