Martin Stevens

The Validity of the Sit-and-Reach Test and the Modified Sit-and-Reach Test in Middle-Aged to Older Men and Women

Flexibility is an important component of physical fitness in middle-aged and older adults (Shephard, Berridge, & Montelpare, 1990). A lack of flexibility is associated with problems in executing and sustaining motor activities in daily life (Bergstrom et al., 1985; Johnston & Smidt, 1970; Myers & Huddy, 1985). There are some indications that poor flexibility in the hamstrings and lower back is related to muscular pain in the lower back, gait limitation, and increased risk offalling in older adults (American College of Sports Medicine, 1998; Grabiner, Koh, Lundin, &Jahnigen, 1993; Skinner & Oja, 1994). Because of these associations, some version of a sit-and-reach test has been included in every fitness battery for middle-aged and older adults (Lemmink, van Heuvelen, Rispens, Brouwer, & Bult, 1995; Osness et al., 1990; Rikli &Jones, 1999). The sit-and-reach test wasdeveloped to measure hamstring and lower back flexibility and wasfirst described by Wellsand Dillon (1952). Most sit-and-reach tests include severalvarietiesofa two-legfloor,raised platform orchair sit-and-reach with or without a sit-and-reach box (Ameri-

Incidence, prevalence, and consultation rates of shoulder complaints in general practice

Objective: To study the incidence, prevalence, and consultation rates of patients with shoulder complaints in general practice in the Netherlands during 10 years following initial presentation. Methods: A primary care database with an average population of 30 000 patients per year aged 18 years or older was used to select patients who consulted their general practitioner (GP) with shoulder complaints in the northern part of the Netherlands in the year 1998. Information about consultations for shoulder complaints was extracted. Incidence and prevalence for men, women, and different age groups were calculated for 9 and 10 years. Results: A total of 526 patients consulted their GP with a new shoulder complaint. During an average follow-up of 7.6 years, these patients consulted their GP 1331 times because of their shoulder complaints (average of 0.33 consultations per year). Almost half of the patients consulted their GP only once. Patients in the 45–64 age category had the highest probability of repeated GP consultations during follow-up. Average incidence was 29.3 per 1000 person-years. Women and patients in the 45–64 age category have the highest incidence. The annual prevalence of shoulder complaints ranged from 41.2 to 48.4 per 1000 person-years, calculated for the period 1998 to 2007, and was higher among women than among men. Conclusion: Although the incidence of shoulder complaints in general practice is as high as 29.3 per 1000 person-years, GPs’ workload is generally low, as nearly half of these patients consult their GP only once for their complaint.

Physical Functioning Before and After Total Hip Arthroplasty: Perception and Performance

Background and Purpose: Self-report and performance-based measures of physical functioning in people before and after total hip arthroplasty seem to present different information. The relationship between these different measures is not well understood, and little information is available about changes in this relationship over time. The aims of this study were: (1) to determine the relationship between self-report and performance-based measures of physical functioning before and after total hip arthroplasty, (2) to assess the influence of pain on the relationship, and (3) to determine whether the relationship changes over time. Subjects and Methods: Seventy-five subjects admitted for total hip arthroplasty were included and examined before and 6 and 26 weeks after surgery. The relationships between the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical functioning subscale and walking speed and gait variability were examined by use of generalized estimating equations, which included interactions with time and the WOMAC pain subscale. Results: The relationship between self-report and performance-based measures of physical functioning was poor. Pain appeared to have a considerable influence on self-reported physical functioning. The relationship did not appear to change over time. Discussion and Conclusion: The influence of pain on self-reported physical functioning serves as an explanation for the poor relationship between self-reported and performance-based physical functioning. When using a self-report measure such as the WOMAC, one should realize that it does not seem to assess the separate constructs—physical functioning and pain—that are claimed to be measured.

Habitual Physical Activity Behavior of Patients After Primary Total Hip Arthroplasty

Background and Purpose: Despite recognized health benefits of physical activity, little is known about the habitual physical activity behavior of patients after total hip arthroplasty (THA). The purpose of this study was to analyze this behavior and the fulfillment of guidelines for health-enhancing physical activity of these patients compared with a normative population. Subjects and Methods: The participants were 273 patients who had undergone a primary THA (minimum of 1 year postoperatively). Comparisons were made between this group and 273 age- and sex-matched individuals from a normative population. Comparisons also were made between participants with THA under 65 years of age and those 65 years of age and older and among participants with THA in different Charnley classes. Level of physical activity was assessed with the Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH). Results: No significant differences in total amount of physical activity or time spent in different categories of physical activity were found between the THA group and the normative group. Participants with THA spent significantly more minutes in activities of moderate intensity compared with the normative group. Participants with THA who were under 65 years of age were significantly more active than older participants with THA. Charnley class had significant effects on time spent at work, time spent in moderate-intensity activities, and total amount of activity, with the least activity performed by participants in Charnley class C. The guidelines were met by 51.2% of the participants with THA and 48.8% of the normative population. Female participants met the guidelines less frequently than male participants in both the combined groups (odds ratio=0.50, 95% confidence interval=0.35–0.72, P<.001) and the THA group (odds ratio=0.48, 95% confidence interval=0.28–0.80, P=.001). Discussion and Conclusion: The results suggest that patients after THA are at least as physically active as a normative population. Nevertheless, a large percentage of these patients do not meet the guidelines; therefore, they need to be stimulated to become more physically active.

Habitual Physical Activity After Total Knee Replacement: Analysis in 830 Patients and Comparison With a Sex- and Age-Matched Normative Population

Background Previous studies on physical activity after total knee arthroplasty (TKA) concentrated mainly on a return to sports activities. Objective The objectives of this study were to determine the habitual physical activity behavior of people who had undergone TKA (TKA group) 1 to 5 years after surgery and to examine to what extent they adhered to international guidelines for health-enhancing physical activity. Additional aims were to compare younger (<65 years old) and older (≥65 years old) people as well as men and women in the TKA group and to compare the results for the TKA group with those for a sex- and age-matched normative population (normative group). Design This investigation was a cohort study. Methods All people who had a primary TKA at 1 of 2 participating hospitals between 2002 and 2006 were sent the Short Questionnaire to Assess Health-Enhancing Physical Activity at least 1 year after surgery. Results The TKA group spent, on average, 1,347 minutes per week on physical activity, most of which was light-intensity activity (780 minutes per week). Participants younger than 65 years of age spent significantly more time on physical activity than participants 65 years of age or older. There was no significant difference between male and female participants. Compared with the sex- and age-matched normative group, the TKA group spent significantly less time on the total amount of physical activity per week and met the guidelines for health-enhancing physical activity less often (55% versus 64%). Limitations A self-administered questionnaire was used to assess habitual physical activity, and presurgery data on physical activity were not available. Conclusions Almost half of the TKA group did not meet the health-enhancing physical activity guidelines, and the TKA group was not as physically active as the normative group. People who have undergone TKA should be encouraged to be more physically active.

The Groningen Orthopedic Exit Strategy (GOES): a home-based support program for total hip and knee arthroplasty patients after shortened hospital stay.

The number of total hip and knee arthroplasty patients in The Netherlands will increase progressively in the coming decades. A reaction to this trend is a shortening of hospital stays. This however should not result in uncertainty, lack of information and unnecessary medical consumption by patients at home. Based on insights from social cognitive theory, an exit strategy is described to support patients during their rehabilitation at home. It is our hypothesis that patients who participate in such a support program will be able to resume activities of daily living more quickly and effectively, and will reach higher levels of physical activity compared to patients who only follow the shortened program. To determine the effectiveness of the exit strategy, mediating variables (self-efficacy, social support and pain coping) and outcome variables (activities of daily living, physical activity behavior, health-related quality of life and gait analysis) will be measured.

Physical Activity Behavior of Patients 1 Year After Primary Total Hip Arthroplasty: A Prospective Multicenter Cohort Study

Background Besides the important beneficial effects of regular physical activity on general health, some of the musculoskeletal effects of physical activity are of particular interest for older adults after total hip arthroplasty (THA). However, research on physical activity behavior of patients after THA is scarce. Objective The purpose of this study was to gain insight into the physical activity behavior and fulfillment of guidelines for health-enhancing physical activity of patients 1 year after THA. Design This was a prospective multicenter cohort study. Methods To determine level of physical activity, 653 participants (response rate=77%) completed the Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH). Comparisons were made between participants in 2 age groups (≤75 and >75 years). Determinants of physical activity behavior were assessed. Results The participants were physically active a mean of 1,468 minutes per week. Most time was spent in household and leisure activities. Younger participants were physically more active than older participants. A lower body mass index was predictive of a higher level of physical activity. Participants adhered to the guidelines of health-enhancing physical activity in 67% of cases. The guidelines were met more often by younger participants, male participants, and those without problems in the lower extremities. Limitations A nonresponse analysis was not conducted; thus, there might have been a selection bias. Use of a self-administered recall questionnaire to assess physical activity behavior may have been subject to memory and recall skill limitations of the participants, and patients tend to overestimate their physical activity level. Conclusions This study gives detailed insight into the physical activity of patients 1 year after primary THA. As among the general population, a considerable number of patients were found to be insufficiently physically active.

A Dutch Version of the Social Support for Exercise Behaviors Scale

We studied the reliability of a Dutch version of the Social Support for Exercise Behaviors Scale, originally developed by Sallis, Grossman, Pinski, Patterson, and Nader, using a sample of 461 older adults between 55 and 65 years of age. Cronbach alpha for the three subscales was calculated, respectively, as .69, .71, and .26, which are lower than the alphas reported in the original study. This may be due to the cultural differences between The Netherlands and the United States and differences between the samples of the two studies.

Changes in Body Weight After Total Hip Arthroplasty: Short-term and Long-term Effects

Background Elevated body weight is associated with hip osteoarthritis (OA) and subsequently with total hip arthroplasty (THA). Patients with hip OA who are overweight often mention their restricted mobility as a factor that thwarts their attempts to be physically active and lose weight. There is some evidence that THA increases physical activity, but none for losing body weight after THA. Objective The purpose of this study was to analyze the short-term (1-year) and long-term (4.5-year) effects of a THA on body weight. Design This was an observational, multicenter cohort study. Methods For the short-term effect, all patients (N=618) were analyzed; for the long-term effect, a random subgroup (n=100) was analyzed. Preoperative and postoperative body weight and height were self-reported. Patients were categorized according to their preoperative body mass index (BMI <25 kg/m2=normal weight, 25–30 kg/m2=overweight, >30 kg/m2=obese). Clinical relevancy was set at a minimum of 5% weight loss compared with baseline. Results The mean age of the study group was 70 years (SD=8), 74% were women, and mean preoperative body mass was 79 kg (SD=14). One year after THA, a significant decrease in body weight of 1% and 3.4% occurred for the overweight and obese BMI categories, respectively. After 4.5 years, a significant decrease in body weight of 6.4% occurred for the obese BMI category. Limitations Height and weight—and thus BMI—were self-reported. Conclusion Patients in the overweight and obese groups showed a decrease, albeit not clinically relevant, in body weight after 1 year. After 4.5 years, a decrease that was relevant clinically was observed in the patients who were obese. It can be concluded that no clinically relevant reduction of weight occurred after THA, except in the long term for patients who were obese.

The Groningen Enjoyment Questionnaire: A measure of enjoyment in leisure-time physical activity

The purpose of this study was to develop a short and easily used questionnaire to measure enjoyment in leisure-time physical activity. The first part of the study involved the questionnaires composition. A set of 30 positively formulated potential items was generated and subsequently completed by 59 subjects. We used these results to trim the questionnaire to 10 items. In the second part of the study, the questionnaire was administered to 82 subjects and research was done into reliability and validity. The results indicate that the Groningen Enjoyment Questionnaire can be considered reliable and valid.