Harriët Wittink

Physical functioning: self-report and performance measures are related but distinct.

Study Design. Cross-sectional study of 63 patients with chronic low back pain (CLBP). Objectives. To determine the relationship between the SF-36 physical functioning (PF) scale and physical performance on a modified symptom limited treadmill test, and to determine the effect of disability status and SF-36 mental health (MH) scores on self-reported physical functioning and on physical performance. Summary of Background Data. Patients with CLBP report low levels of physical functioning. Because self-report measures are influenced by psychosocial factors, such as disability and low MH, a common recommendation is to supplement self-report with objective or physical performance testing. Little information exists regarding whether performance testing is also influenced by disability and low MH. Materials and Methods. Patients completed the SF-36 and performed a maximal, symptom-limited, modified treadmill test. Total walking time and heart rate on the treadmill were registered. The effects of disability and low MH on self-report and performance testing were calculated by unpaired Student’s t-testing and effect size estimation. Results. A strong relationship between the PF scale of the SF-36 and treadmill walking time was found, but there was little evidence of overlap between these physical functioning domains. Both disability status and low MH had a much larger effect on self-report measures than on physical performance. Conclusions. Self-report measurements and performance-based assessments provide information about distinct, although related, domains of physical functioning. Disability and low MH are associated with lower SF-36 PF scores. Our results confirm that self-report measures require supplementation with objective performance testing to provide optimal assessment for patients with CLBP.

Physical fitness matters more than physical activity in controlling cardiovascular disease risk factors

Background Physical activity (PA) and physical fitness (PF) are inversely associated with the clustering of cardiovascular disease (CVD) risk factors (RF) associated with the metabolic syndrome (MS). However, the role of individual components of PA, that is, intensity, duration and volume, and the inter-relationship with PF in the prevention of the MS and its individual components remains elusive. Design Cross-sectional analysis. Methods The study was based on 1298 (874 male and 424 female) police employees (aged 18–62 years) who participated in the Utrecht Police Lifestyle Intervention Fitness and Training study. PA was assessed with an extensive questionnaire. Peak oxygen uptake and metabolic markers, including blood pressure, fasting glucose, triglycerides, high-density lipoprotein cholesterol and waist circumference, were determined. Results The prevalence of the MS was 18.6% (22.5% in men, 10.6% in women). After adjustment for age and sex, average PA intensity, PA duration, PA volume and PF were each associated with reduced odds of MS. Regression analyses further showed an inverse relation between total CVD risk score and average PA intensity, the hours of PA performed at high intensity (>6 metabolic equivalent values) and PF, but no relation with total hours or the hours of PA performed at low or moderate intensity. When we adjusted our analyses for PF, the relations with the components of PA became nonsignificant. Using pathway analysis, we found that peak oxygen uptake mediated 78% of the effect of average PA intensity and 93% of the effect of the hours performed at high intensity on total CVD risk score. Conclusion PA and PF are inversely associated with the clustering of metabolic abnormalities. With regard to PA, it seems that intensity and more specifically higher intensity is the main characteristic of PA determining its effect on CVD RF. However, compared with PA, PF exerts greater effects on each of these individual CVD RF and its combination.

Clinimetric Evaluation of Measurement Tools Used in Hand Therapy to Assess Activity and Participation

STUDY DESIGN Systematic review. INTRODUCTION A number of measurement tools with strong clinimetric properties address activities and participation in hand-injured persons. PURPOSE OF THE STUDY To evaluate clinimetric quality of measurement tools assessing activities and participation in patients with hand injuries. METHODS The electronic databases Medline, Cochrane library, EMBASE, PEDro, Cumulative Index to Nursing and Allied Health Literature (ClNAHL), and Allied and Complementary Medicine Database (AMED) were searched for appropriate literature. Descriptive data of included tools were given, and their clinimetric quality was scored with specific criteria. RESULTS The literature search identified 696 publications, referring to 15 measurement tools that met the inclusion criteria. For most of the included tests, applicability was good, whereas information on clinimetric properties was often lacking, especially for the performance tests. Overall, the Disabilities of the Arm, Shoulder, and Hand (DASH) was the most extensively studied tool with positive ratings for all criteria, closely followed by the Michigan Hand Outcomes Questionnaire (MHQ). Of the performance tests, the Functional Dexterity Test (FDT) received the best ratings. CONCLUSIONS Optimal measurement tool selection depends highly on the purpose of measurement and the type of hand injury. LEVEL OF EVIDENCE 2a-.

Comparison of the Redundancy, Reliability, and Responsiveness to Change among SF-36, Oswestry Disability Index, and Multidimensional Pain Inventory

Objective:To compare the Medical Outcomes Trust Short-Form-36 (SF-36), the Multidimensional Pain Inventory (MPI), and the Oswestry Disability Index (ODI) measures on internal consistency, domain overlap, and responsiveness in detecting changes following multidisciplinary pain treatment. Methods:424 patients with chronic pain referred to a multidisciplinary pain center were assessed. Of these, 87 patients were assessed prior to and following treatment. Cronbach’s alphas were calculated for each SF-36 and MPI domain, and for the ODI. Canonical correlation and regression analyses (R2) described overlap. Responsiveness to change was computed from treatment effect size and significance. Results:Cronbach’s alpha ranged from 0.69–0.92 for MPI domains, from 0.79–0.91 for SF-36 domains, and was 0.86 for the ODI. Three domains overlapped but several were unique (eg, the MPI “significant other” domains; R2 range 0.03–0.16). Significant changes following treatment were observed for the MPI Pain Severity, Interference and Outdoor Work Activities, the SF-36 Physical and Social Functioning, Bodily Pain, and the ODI. Conclusion:The MPI, SF-36, and ODI each have good psychometric properties. Three domains overlapped between the MPI and the SF-36: pain, Interference/Social functioning, and mental health. The MPI and the SF-36 each contributed unique domains such as the SF-36 General Health and Vitality domains and the MPI “significant other” and physical activity domains. Several of the MPI domains were among the most sensitive to change. Because of its large normative sample and samples of patients with diverse medical disorders, the SF-36 may be particularly useful to compare chronic pain patients to those with other medical conditions. The ODI has the lowest respondent burden. The MPI and SF-36, although containing much overlapping information, both make unique and complementary contributions to assessing patients with chronic pain.

Cause or effect? Deconditioning and chronic low back pain.

Physical inactivity is now universally accepted as the biggest public health problem of the 21st century in Western societies. Physical inactivity and the resulting physical deconditioning are associated with a host of chronic diseases of which non-specific chronic back pain (CLBP) may be one. The deconditioning paradigm hypothesizes that physical inactivity and physical deconditioning not only cause low back pain, but also contribute to ongoing intolerance of physical activities which leads to functional limitations and disability in self care and community participation [13]. According to the fear avoidance model patients may interpret their pain as threatening (catastrophizing), which can result in fear of movement, disuse (loss of physical activities in daily life (PAL)) and deconditioning, perpetuating pain, depression and disability [31]. It is unclear whether physical inactivity and deconditioning perpetuate chronicity of low back pain [28]. It has even been debated whether physical deconditioning in patients with non-specific CLBP really exists [23]. Although the influence of pain-related fear on disability has been confirmed across multiple diagnoses, its presumed negative influence on PAL in patients with non-specific CLBP is still inconclusive [3]. Nevertheless, intensive physical training remains a major component of most CLBP-treatments. While this may be an effective treatment strategy, is it being done for the wrong reasons? In this topical review, existing literature on physical inactivity and deconditioning in patients with non-specific CLBP is summarized. The impact of physical inactivity and deconditioning is reviewed in terms of the etiology of CLBP as well as the impact of the patients’ levels of physical activity and physical fitness on the chronicity of back pain. Recommendations for future research are provided.

Effects of a high-intensity task-oriented training on gait performance early after stroke: a pilot study

Objective: To investigate the feasibility and the effects on gait of a high intensity task-oriented training, incorporating a high cardiovascular workload and large number of repetitions, in patients with subacute stroke, when compared to a low intensity physiotherapy-programme. Design and subjects: Randomized controlled clinical trial: Forty-four patients with stroke were recruited at 2 to 8 weeks after stroke onset. Measures: Maximal gait speed assessed with the 10-metre timed walking test (10MTWT), walking capacity assessed with the six-minute walk test (6MWT). Control of standing balance assessed with the Berg Balance Scale and the Functional Reach test. Group differences were analysed using a Mann—Whitney U-test. Results: Between-group analysis showed a statistically significant difference in favour of the high intensity task-oriented training in performance on the 10MTWT (Z = -2.13, P = 0.03) and the 6MWT (Z = -2.26, P = 0.02). No between-group difference were found for the Berg Balance Scale (Z = —0.07, P = 0.45) and the Functional Reach test (Z = —0.21, P = 0.84). Conclusion: A high-intensity task-oriented training programme designed to improve hemiplegic gait and physical fitness was feasible in the present study and the effectiveness exceeds a low intensity physiotherapy-programme in terms of gait speed and walking capacity in patients with subacute stroke. In a future study, it seems appropriate to additionally use measures to evaluate physical fitness and energy expenditure while walking.

Deconditioning in patients with chronic low back pain: fact or fiction?

Study Design. Prospective case series with historical controls (normative data). Objectives. To compare aerobic fitness levels in patients with chronic low back pain with those published on a sample of 295 healthy subjects. Summary of Background Data. Clinical belief holds that patients with chronic low back pain have low fitness levels as a result of inactivity because of pain. Because few studies have investigated the level of aerobic fitness in these patients, however, it remains unclear how fitness levels in patients with chronic low back pain patients compare with those published a sample of the normative population. Methods. A sample of 50 patients with chronic low back pain with a mean pain duration of 40 months referred to an outpatient pain clinic performed a symptom-limited modified treadmill test. Aerobic fitness levels were determined by indirect calorimetry to measure oxygen consumption (VO2). Predicted maximum oxygen consumption (VO2max) levels were calculated for all subjects. Multiple regression analysis with adjustment for age and sex yielded prediction equations for men and women separately. Ninety-five percent confidence intervals were calculated for predicted mean oxygen consumption (VO2) and the slope of the equations. These were compared to established prediction equations on healthy subjects. Results. Prediction equations for estimated maximum oxygen consumption (VO2max) in patients with chronic low back pain equal those in healthy sedentary men and active women. Conclusions. Levels of aerobic fitness in patients with chronic low back pain are comparable with those in healthy subjects.

Factors Associated with Functional Capacity Test Results in Patients With Non-Specific Chronic Low Back Pain: A Systematic Review

Introduction: Functional capacity tests are standardized instruments to evaluate patients’ capacities to execute work-related activities. Functional capacity test results are associated with biopsychosocial factors, making it unclear what is being measured in capacity testing. An overview of these factors was missing. The objective of this review was to investigate the level of evidence for factors that are associated with functional capacity test results in patients with non-specific chronic low back pain. Methods: A systematic literature review was performed identifying relevant studies from an electronic journal databases search. Candidate studies employed a cross-sectional or RCT design and were published between 1980 and October 2010. The quality of these studies was determined and level of evidence was reported for factors that were associated with capacity results in at least 3 studies. Results: Twenty-two studies were included. The level of evidence was reported for lifting low, lifting high, carrying, and static lifting capacity. Lifting low test results were associated with self-reported disability and specific self-efficacy but not with pain duration. There was conflicting evidence for associations of lifting low with pain intensity, fear of movement/(re)injury, depression, gender and age. Lifting high was associated with gender and specific self-efficacy, but not with pain intensity or age. There is conflicting evidence for the association of lifting high with the factors self-reported disability, pain duration and depression. Carrying was associated with self-reported disability and not with pain intensity and there is conflicting evidence for associations with specific self-efficacy, gender and age. Static lifting was associated with fear of movement/(re)injury. Conclusions: Much heterogeneity was observed in investigated capacity tests and candidate associated factors. There was some evidence for biological and psychological factors that are or are not associated with capacity results but there is also much conflicting evidence. High level evidence for social factors was absent.

Cross-cultural adaptation and measurement properties of the Brief Illness Perception Questionnaire-Dutch Language Version

OBJECTIVE Ever since Engels Biopsychosocial Model (1977) emotions, thoughts, beliefs and behaviors are accepted as important factors of health. The Brief Illness Perception Questionnaire (Brief IPQ) assesses these beliefs. Aim of this study was to cross-culturally adapt the Brief IPQ into the Brief IPQ Dutch Language Version (Brief IPQ-DLV), and to assess its face validity, content validity, reproducibility, and concurrent validity. METHODS Beatons guideline was used for cross-culturally adaptation. Face and content validity were assessed in 25 patients, 15 physiotherapists and 24 first-grade students. Reproducibility was established in 27 individuals with chronic obstructive pulmonary disease using Cohens kappa coefficient (K(w)) and the Smallest Detectable Change (SDC). Concurrent validity was assessed in 163 patients visiting 11 different physical therapists. RESULTS The Brief IPQ-DLV is well understood by patients, health care professionals and first-grade students. Reliability at 1 week for the dimensions Consequences, Concern and Emotional response K(w)>0.70, for the dimensions Personal control, Treatment control, Identity, K(w)<0.70. A time interval of 3 weeks, reliability coefficients were lower for almost all dimensions. SDC was between 2.45 and 3.37 points for individual measurement purposes and between 0.47 and 0.57 points for group evaluative measurement purposes. Concurrent validity showed significant correlations (P<.05) for four out of eight illness perceptions (IPs) dimensions. CONCLUSION The face and content properties were found to be acceptable. The reproducibility and concurrent validity needs further investigated.

A Systematic Review of the Relationship between Physical Activities in Sports or Daily Life and Postural Sway in Upright Stance

BackgroundIn many sports, maintaining balance is necessary to compete at a high level. Also, in many health problems, balance is impaired. Postural sway (PS) is often used as an indicator of upright balance control, and physical activity (PA) might enhance balance control. However, the relationship between PS and PA has never been systematically reviewed.ObjectiveOur objective was to summarize the evidence regarding the relationship between PS in upright bipedal and unipedal standing and PA.MethodsWe conducted a literature search in MEDLINE, EmBase, CINAHL, the Cochrane Database, and PEDro, up to March 2012, with no limit on the starting date. Characteristics and methodological aspects of each article were extracted by two reviewers. We used centre of pressure (CoP) velocity, and variables related to the CoP area, to compare studies.ResultsA total of 39 articles were reviewed from an initial yield of 2,058. Of these 39 studies, 37 used a comparative design, one was a cohort study, and one was a randomized controlled trial.ConclusionThe main conclusion was that in general, sport practitioners sway less than controls, and high-level athletes sway less than low-level athletes. Additionally, we identified specific effects dependent on the use of vision, sport-specific postures, and frequency and duration of the (sports) activity. PS in unperturbed bipedal stance appears to have limited sensitivity to detect subtle differences between groups of healthy people.