Jane Andreasen

Short and long-term effects of supervised versus unsupervised exercise training on health-related quality of life and functional outcomes following lung cancer surgery – A randomized controlled trial

OBJECTIVE Surgical resection enhances long-term survival after lung cancer, but survivors face functional deficits and report on poor quality of life long time after surgery. This study evaluated short and long-term effects of supervised group exercise training on health-related quality of life and physical performance in patients, who were radically operated for lung cancer. METHODS A randomized, assessor-blinded, controlled trial was performed on 78 patients undergoing lung cancer surgery. The intervention group (IG, n=41) participated in supervised out-patient exercise training sessions, one hour once a week for ten weeks. The sessions were based on aerobic exercises with target intensity of 60-80% of work capacity, resistance training and dyspnoea management. The control group (CG, n=37) received one individual instruction in exercise training. Measurements consisted of: health-related quality of life (SF36), six minute walk test (6MWT) and lung function (spirometry), assessed three weeks after surgery and after four and twelve months. RESULTS Both groups were comparable at baseline on demographic characteristic and outcome values. We found a statistically significant effect after four months in the bodily pain domain of SF36, with an estimated mean difference (EMD) of 15.3 (95% CI:4 to 26.6, p=0.01) and a trend in favour of the intervention for role physical functioning (EMD 12.04, 95% CI: -1 to 25.1, p=0.07) and physical component summary (EMD 3.76, 95% CI:-0.1 to 7.6, p=0.06). At 12 months, the tendency was reversed, with the CG presenting overall slightly better measures. We found no effect of the intervention on 6MWT or lung volumes at any time-point. CONCLUSION Supervised compared to unsupervised exercise training resulted in no improvement in health-related quality of life, except for the bodily pain domain, four months after lung cancer surgery. No effects of the intervention were found for any outcome after one year.

Danish version of the Tilburg Frailty Indicator – Translation, cross-cultural adaption and validity pretest by cognitive interviewing

The Tilburg Frailty Indicator (TFI) is a self-administered questionnaire with a bio-psycho-social integrated approach that measures the degree of frailty in elderly persons. The TFI was developed in the Netherlands and tested in a population of elderly Dutch men and women. The aim of this study was to translate and culturally adapt the TFI to a Danish context, and to test face validity of the Danish version by cognitive interviewing. An internationally recognized procedure was applied as a basis for the translation process. The primary tasks were forward translation, reconciliation, back translation, harmonization and pretest. Pretest and review of the preliminary version by cognitive interviewing, were performed at a local community center and in an acute medical ward at the University Hospital in Aalborg, Denmark respectively. A large agreement regarding meaning of the items in the forward translation and reconciliation process was seen. Minor discrepancies were solved by consensus. Back translation revealed unclear wording in one matter. The harmonization committee agreed on a version for cognitive interviewing after revision of minor issues and thirty-four participants were interviewed. Two issues became evident and these were revised. The cognitive interviews and final lay-out resulted in minor adjustments as text type size, specific font, and lining for optimizing readability. In conclusion, we consider the TFI to be translated in such rigorous manner that the instrument can be further tested in clinical practice. The overall objective of the questionnaire being to identify frailty and improve the interventions relating to frail elderly persons in Denmark.

The experience of daily life of acutely admitted frail elderly patients one week after discharge from the hospital

Introduction Frail elderly are at higher risk of negative outcomes such as disability, low quality of life, and hospital admissions. Furthermore, a peak in readmission of acutely admitted elderly patients is seen shortly after discharge. An investigation into the daily life experiences of the frail elderly shortly after discharge seems important to address these issues. The aim of this study was to explore how frail elderly patients experience daily life 1 week after discharge from an acute admission. Methods The qualitative methodological approach was interpretive description. Data were gathered using individual interviews. The participants were frail elderly patients over 65 years of age, who were interviewed at their home 1 week after discharge from an acute admission to a medical ward. Results Four main categories were identified: “The system,” “Keeping a social life,” “Being in everyday life,” and “Handling everyday life.” These categories affected the way the frail elderly experienced daily life and these elements resulted in a general feeling of well-being or non-well-being. The transition to home was experienced as unsafe and troublesome especially for the more frail participants, whereas the less frail experienced this less. Conclusion and discussion Several elements and stressors were affecting the well-being of the participants in daily life 1 week after discharge. In particular, contact with the health care system created frustrations and worries, but also physical disability, loneliness, and inactivity were issues of concern. These elements should be addressed by health professionals in relation to the transition phase. Future interventions should incorporate a multidimensional and bio-psycho-social perspective when acutely admitted frail elderly are discharged. Stakeholders should evaluate present practice to seek to improve care across health care sectors.

Exercise therapy and custom-made insoles are effective in patients with excessive pronation and chronic foot pain—A randomized controlled trial

BACKGROUND Excessive foot pronation is a causal mechanisms described in relation to injuries of the lower extremities. Evidence to support an effective treatment is insufficient. OBJECTIVE To investigate the effect of exercise and custom-made insoles to patients with excessive pronation and chronic pain conditions in the foot at short and long term follow-up. METHODS Single blinded Randomized Controlled Trial with 80 subjects randomized: (1) Standard Intervention, (2) Insole, (3) Exercise, and (4) Insole+Exercise. Exercise - 12 week supervised program. Insoles - individually molded and posted. Pain was measured during walking, resting and running. Static and dynamic foot postures were measured as calcaneal angle, navicular drift, drop and height. RESULTS The average duration of foot pain was 7.3 years. There was a significant pain reduction during walking within all groups at 4 and 12 months follow-up. No differences were seen between groups in any of the pain parameters. Weak correlations between changes in pain and foot postures were observed at baseline and one-year follow-up. CONCLUSION A significant pain reduction was seen in all groups, none of the treatment modalities seem to be superior with the number of patients included. Compliance in the standard intervention group was a concern at 12 months.

Danish translation and validation of the Oslo Sports Trauma Research Centre questionnaires on overuse injuries and health problems.

The Oslo Sports Trauma Research Centre Overuse Injury Questionnaire (OSTRC‐O) and the Oslo Sports Trauma Research Centre questionnaire on Health Problems (The OSTRC‐H) make it possible to monitor illness and injury at regular intervals capturing prevalence and incidence of acute injury, overuse injury, and illnesses. The aim of this study was to translate, culturally adapt, and establish the face validity of the OSTRC‐O and the OSTRC‐H into a Danish context (DK) through cognitive interviews and the assessment of test–retest reliability. The OSTRC‐O.DK was distributed to 57 heterogenous respondents; response rate was 89%. The OSTRC‐H was distributed to 58 heterogenous respondents; response rate was 86%. No major disagreements were observed between the original and translated versions of the questionnaires. The OSTRC‐O had high internal consistency (Cronbachs alpha 0.80–0.93). The primary reliability analyses including all participants, showed reliability ICC: 0.62 (95% CI: 0.42–0.77. The secondary reliability analyses that only included subjects who did not change injury region from the test to the retest showed an ICC of 0.86 (95% CI: 0.77–0.92).The questionnaires were found to be valid, reliable, and acceptable for use in a Danish population.

Translation and validation of the Danish Foot Function Index (FFI-DK)

The objective of this study was to translate the Foot Function Index (FFI) for use in Danish‐speaking patients with foot complaints. The FFI consists of 23 items scored on a numeric rating scale from 0 to 10. The 23 items are grouped into three subscales: pain (nine items), activity limitation (five items), and disability (nine items). The Danish FFI was developed according to the recommended forward/backward translation protocol. The data analysis included reliability [intraclass correlation coefficient (ICC) 2.1] and internal consistency (Cronbachs alpha). Excellent internal consistency was shown for the three subscales: pain (0.99), disability (0.98), and activity limitation (0.98), as for the total score (0.97). The test‐retest reliability was excellent: pain subscale: ICC 0.98 [95% confidence interval (CI): 0.97–0.99]; activity limitation subscale: ICC: 0.95 (95% CI: 0.91–0.98); disability subscale: ICC 0.97 (95% CI: 0.95–0.98); total score: ICC: 0.95 (95% CI: 0.91 to 0.98). The mean difference between test and retest was below 1 point and P > 0.08. Bland–Altman plots showed no significant or clinically relevant differences from test to retest in any of the subscales or in the total score. The Danish version of the FFI was found to be valid and reliable and therefore acceptable for use in the Danish population.

Content validation of the Tilburg Frailty Indicator from the perspective of frail elderly. A qualitative explorative study

UNLABELLED The Tilburg Frailty Indicator is a questionnaire with a bio-psycho-social approach, which measures frailty by 15 questions. A questionnaire about frailty should be in alignment with experiences of frail elderly themselves as a target population is an important source of knowledge in content validation. AIM To validate the Tilburg Frailty Indicator on content in relation to the physical, psychological and social domain by exploring the experience of daily life of community dwelling frail elderly. METHODS The design was a qualitative content validation study. The participants were acutely admitted frail elderly discharged to home and interviewed one week after discharge. A deductive content analysis, with categories structured in advance, was performed. RESULTS A total of 422 meaning units were extracted from the transcriptions; 131 units related to the physical domain, 106 units to the psychological domain and 185 units to the social domain. 56 units were not linked into the existing structure of the questionnaire. 14 of 15 questions were confirmed from a target population perspective. The four issues pain, sleep quality, spirituality and meaningful activities that seem to be important elements for frail elderly were not directly covered by the questionnaire. DISCUSSION It seems likely that the majority of important items related to frailty are covered in the questionnaire. The findings add to the scientific body of knowledge in relation to the validity of the questionnaire. Future research should investigate the importance of the four issues pain, sleep quality, spirituality and meaningful activities in relation to the screening of frailty.

Factors affecting patient and nursing staff adherence to an integrated physical activity and nutritional intervention targeting functional decline on an acute medical ward: a qualitative study

Background Medical patients are particularly at risk of developing complications during and after hospitalization, due to impaired nutritional intake, physical inactivity, or immobilization. Evaluations of implementation studies on health-promoting interventions for medical patients in hospitals are scarce. The aim of this study was to identify factors affecting the adherence of patients and staff to an integrated physical activity and nutritional intervention on a medical ward. Methods Two focus group interviews were conducted: one with patients and another with staff. Three individual telephone interviews were conducted, as three patients were not available at the time of the group interview. An inductive thematic analysis was fundamental to the findings of the study. Findings Nine themes describe factors affecting adherence to integrated physical activity and nutrition intervention. Positive factors described by the patients were new knowledge and insight, and that they felt seen and believed in, which made a significant difference to their motivation. The nursing staff felt that the intervention provided important knowledge related to daily practice, prevented bad consciences due to time issues, and that they experienced happier and more active patients. Both staff and patients found that the approaches of the physiotherapist and the dietician positively changed their behavior, however staff members experienced limited resources as a barrier, and a lack of knowledge seemed to hinder full integration of the intervention. Patients reported that their illness situation, “being on their own,” and failure to negotiate a shared goal with the project staff were barriers to adherence. Conclusions Both the nursing staff and patients described positive experiences with the integration of a multifaceted health promotion intervention on physical activity and nutrition, however the nursing staff did not fully participate in the intervention and patient adherence differed; particularly, it tended to diminish when the patients were expected to act on their own.

Associations and predictions of readmission or death in acutely admitted older medical patients using self-reported frailty and functional measures. A Danish cohort study

OBJECTIVE To assess whether frailty in acutely admitted older medical patients, assessed by a self-report questionnaire and evaluation of functional level at discharge, was associated with readmission or death within 6 months after discharge. A second objective was to assess the predictive performance of models including frailty, functional level, and known risk factors. METHODS A cohort study including acutely admitted older patients 65+ from seven medical and two acute medical units. The Tilburg Frailty Indicator (TFI), Timed-Up-and-Go (TUG), and grip strength (GS) exposure variables were measured. Associations were assessed using Cox regression with first unplanned readmission or death (all-causes) as the outcome. Prediction models including the three exposure variables and known risk factors were modelled using logistic regression and C-statistics. RESULTS Of 1328 included patients, 50% were readmitted or died within 6 months. When adjusted for gender and age, there was an 88% higher risk of readmission or death if the TFI scores were 8-13 points compared to 0-1 points (HR 1.88, CI 1.38;2.58). Likewise, higher TUG and lower GS scores were associated with higher risk of readmission or death. The area under the curve for the prediction models ranged from 0.64 (0.60;0.68) to 0.72 (0.68;0.76). CONCLUSION In acutely admitted older medical patients, higher frailty assessed by TFI, TUG, and GS was associated with a higher risk of readmission or death within 6 months after discharge. The performance of the prediction models was mediocre, and the models cannot stand alone as risk stratification tools in clinical practice.

Functional training and timed nutrition intervention in infectious medical patients

Background/Objectives:Bed rest and decreased nutrition intake in hospitalized patients have been shown to impair the clinical course negatively, including reduced function after hospital stay. Recent reviews have shown that early physical rehabilitation for acute hospitalized old adults leads to functional benefits. The aim of our study was to assess whether it was possible to influence nutrition intake, loss of muscle function and quality of life, with an evidence-based intervention in acutely ill hospitalized infectious medical patients.Subjects/Methods:For potentially frail patients, functional training three times weekly, and an individually adjusted self-training program for use 1–2 times daily, was given by a physiotherapist. Oral nutritional supplement with 5–10 g whey protein was timed straight after training 2 times daily, and dietetic advice was provided. A historical control group was used to compare nutrition intake. Functional measures and health-related quality of life (HRQoL) were done on admission and discharge.Results:The study included 59 patients in the intervention group. Historic control included 145. Energy and protein intake increased by 3053 kJ (P<0.001) and 28 g of protein (P<0.001), compared with historic controls. Functional parameters (De Mortons Mobility Index (DEMMI), Timed Up and Go and the 30-s chair test) and HRQoL improved significantly for the overall group, most remarkably in patients >70 years of age, from hospitalization to discharge.Conclusion:The intervention with dietician and timed oral supplement to functional training by physiotherapist in hospitalized infectious medical patients improved function as well as nutrition intake and HRQoL.