Rinie Geenen

EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis

The objective was to develop evidence -based recommendations and a research and educational agenda for the non-pharmacological management of hip and knee osteoarthritis (OA). The multidisciplinary task force comprised 21 experts: nurses, occupational therapists, physiotherapists, rheumatologists, orthopaedic surgeons, general practitioner, psychologist, dietician, clinical epidemiologist and patient representatives. After a preliminary literature review, a first task force meeting and five Delphi rounds, provisional recommendations were formulated in order to perform a systematic review. A literature search of Medline and eight other databases was performed up to February 2012. Evidence was graded in categories I–IV and agreement with the recommendations was determined through scores from 0 (total disagreement) to 10 (total agreement). Eleven evidence-based recommendations for the non-pharmacological core management of hip and knee OA were developed, concerning the following nine topics: assessment, general approach, patient information and education, lifestyle changes, exercise, weight loss, assistive technology and adaptations, footwear and work. The average level of agreement ranged between 8.0 and 9.1. The proposed research agenda included an overall need for more research into non-pharmacological interventions for hip OA, moderators to optimise individualised treatment, healthy lifestyle with economic evaluation and long-term follow-up, and the prevention and reduction of work disability. Proposed educational activities included the required skills to teach, initiate and establish lifestyle changes. The 11 recommendations provide guidance on the delivery of non-pharmacological interventions to people with hip or knee OA. More research and educational activities are needed, particularly in the area of lifestyle changes.

Psychological adjustment to chronic disease

This Review discusses physiological, emotional, behavioural, and cognitive aspects of psychological adjustment to chronic illness. Reviewing the reports of the past decade, we identify four innovative and promising themes that are relevant for understanding and explaining psychological adjustment. In particular, the emphasis on the reasons why people fail to achieve a healthy adjustment has shifted to the identification of factors that help patients make that adjustment. To promote psychological adjustment, patients should remain as active as is reasonably possible, acknowledge and express their emotions in a way that allows them to take control of their lives, engage in self-management, and try to focus on potential positive outcomes of their illness. Patients who can use these strategies have the best chance of successfully adjusting to the challenges posed by a chronic illness.

Pain coping and social support as predictors of long-term functional disability and pain in early rheumatoid arthritis

Pain-related avoidance factors and social resources, as assessed by pain coping and social support, are supposed to have lasting effects on functional disability and pain in chronic pain disorders. As a follow-up to a prospective study demonstrating short-term effects after one year (Behaviour Research and Therapy, 36, 179-193, 1998), the role of pain coping and social support at the time of diagnosis was investigated in relationship to the long-term course of functional disability and pain after three and five years in 78 patients with rheumatoid arthritis (RA), taking into account personality characteristics of neuroticism and extraversion, clinical status and use of medication. In line with findings at the one-year follow-up, results showed that more passive pain coping predicted functional disability at the three-year, but not the five-year follow-up. In addition, low levels of social support at the time of diagnosis consistently predicted both functional disability and pain at the three and five-year follow-ups. Results indicate that pain coping and social support, assessed very early in the disease process, can affect long-term functional disability and pain in RA, and suggest that early interventions focusing on pain-related avoidance factors and social resources for patients at risk may beneficially influence long-term outcomes in RA.

Development and Validation of a Dutch Translation of the Big Five Inventory (BFI)

In this article, we describe the translation and validation of the Dutch Big Five Inventory (BFI; John & Srivastava, 1999), a short instrument designed to measure the Big Five factors of personality. We obtained evidence of the instruments good psychometric properties in terms of factorial equivalence to the English original and other BFI translations and the relative independence and internal consistency of the five scales. The findings suggest that the instrument can be used in diverse age groups without substantial changes in factor structure. The Dutch BFI scales showed similar demographic correlates as the English original, with higher Agreeableness and Conscientiousness and lower Neuroticism values in older participants, higher Neuroticism values in women, and higher Openness and Conscientiousness values in better educated participants. Use of the Dutch BFI will allow researchers to integrate their findings with the extant Big Five research literature. The brevity of the instrument will be appealing to researchers who are concerned about taxing the time and motivation of their participants.

Psychosocial Predictors of functional change in recently diagnosed rheumatoid arthritis patients.

In order to examine the influence of active and passive pain-coping strategies and social support characteristics on the change in functional status in the first stage of the disease in rheumatoid arthritis patients, self-report data and clinical and laboratory measures were collected from 91 patients (70% female, mean age 57 yr) shortly after diagnosis and 1 yr later. Multiple regression analyses indicated that, after taking the influence of demographic variables, disease activity and pain into account, a decrease in functional status (mobility, self-care, grip strength) after 1 yr could be predicted by an initially more frequent use of the passive pain-coping strategies of worrying and resting. A decrease in mobility could be additionally predicted by an initially smaller social network. Results indicate the impact of passive pain-coping strategies and social network characteristics for the prognosis of functional outcome in the first stage of the disease and suggest the early manifestation of avoidance mechanisms, including behavioral, cognitive-emotional and social components, in face of a chronic stressor.

Determinants of Psychological Distress and Its Course in the First Year After Diagnosis in Rheumatoid Arthritis Patients

In order to examine determinants of psychological distress and its course in the first year after diagnosis in rheumatoid arthritis patients, self-report data and clinical and laboratory measures were collected in 91 patients (70% female, mean age 57 years) shortly after diagnosis and 1 year later. Multiple regression analysis indicated that sex, pain and functional status, disease impact on daily life, life events, and perceived social support were related to psychological distress (anxiety and depressed mood) shortly after diagnosis. Coping strategies were related to distress levels only 1 year later. Multiple regression analysis of change in anxiety and depressed mood revealed that a decrease of psychological distress after 1 year could be predicted by male sex, an initially less severe inflammatory activity and an initially more extended social network. In addition, a decrease in distress was related to parallel improvements in clinical status. Results indicate the importance of a multimodal assessment of demographic variables, clinical and life stressors and social resources for the understanding of distress and the identification of risk factors in the first stage of the disease. Personal coping resources appear to become more important predictors of distress in a later phase of the disease.

Binge Eating and its Relationship to Outcome after Laparoscopic Adjustable Gastric Banding

Background: The aim of this cross-sectional study was to examine short and long-term eating behavior after laparoscopic adjustable gastric banding (LAGB) and the relationship of binge eating with weight and quality of life outcome. Methods: 250 patients (221 female, 29 male, mean age 39.6 years, age range 22-61) filled out questionnaires to evaluate quality of life and eating behavior: 93 patients before LAGB, 48 with a follow-up duration of 8 through 24 months, and 109 patients 25 through 68 months after LAGB. Results: Compared with patients before surgery, patients after surgery, in both follow-up groups, reported less binge eating, fat intake, external eating, and more restrained eating and eating self-efficacy. After surgery, about one-third of the patients showed binge eating problems, which were associated with a worse postoperative outcome. Conclusion: Our results suggest that eating behavior improves both short- and long-term after surgery for severe obesity. Although LAGB could be a long-term solution to part of preoperatively eating disordered patients, the identification and treatment of postoperative binge eating appear critical to promote successful outcome after bariatric surgery.

Cardiovascular and Immune Responses to Acute Psychological Stress in Young and Old Women: A Meta-Analysis

Objective To describe the relationships between cardiovascular and natural killer (NK) cell number changes on acute psychological stress in women. Method Data from eight different studies were analyzed. A total of 128 healthy female subjects, 85 younger (18-45 years) and 43 older (49-87 years), had been subjected to a speech stressor (N = 80) or a mental effort stressor (N = 48), mental arithmetic, or the Stroop test. Correlations between changes in NK cell numbers, systolic (SBP) and diastolic (DBP) blood pressure, and heart rate (HR) were computed. Meta-analysis programs were used to study correlations across studies and to examine whether correlations differed with stressors or age. Results In all studies, significant increases over baseline were observed for each variable. Across studies, the mean weighted r between changes in HR, DBP, and SBP was medium (rw = .25) to large (rw = .64). A medium to large average correlation between HR and NK changes (rw = .37) was observed, whereas average correlations of changes in NK cell numbers with blood pressure changes were small to medium (rw <or=to .23). Correlations between changes in NK cell numbers and cardiovascular variables were homogeneous across studies, whereas mutual correlations between cardiovascular variables were heterogeneous. One moderator variable showed itself: correlations between HR and DBP reactions were larger in studies with older than younger subjects. Conclusion NK cell changes and HR responses induced by acute stress in women are regulated, to some extent, by the same mechanisms. Neither the type of stressor nor age seem to be very important when considering correlations between NK cell and cardiovascular changes. This study integrates information about NK cell and cardiovascular responses in women that can be used as reference material in future studies.

The effect of cognitive behavior therapy in patients with rheumatoid arthritis

In order to examine the effectiveness of cognitive behavioral therapy for patients with rheumatoid arthritis (RA) three patients groups were studied: a cognitive behavioral therapy group (CBT), an occupational therapy group (OT), and a waiting-list control group. The CBT received a comprehensive, 10-session treatment package that taught progressive relaxation, rational thinking and the differential use of pain coping strategies. CBT resulted in minor changes in pain coping behavior at posttreatment, while CBT and OT showed an increase of knowledge of RA. No therapeutic effects with regard to health status were demonstrated at posttreatment and at 6 months follow-up. Clinical and laboratory measures of disease activity revealed progressive deterioration of the patients during the course of the study. It is suggested that the ineffectiveness of CBT might be due to the progressive course of RA in the patients studied, as well as to the rather small changes in coping behavior.

Evaluation and management of endocrine dysfunction in fibromyalgia.

Fibromyalgia-like symptoms such as muscle pain and tenderness, exhaustion, reduced exercise capacity, and cold intolerance, resemble symptoms associated with endocrine dysfunction like hypothyroidism, and adrenal or growth hormone insufficiency. To investigate the potential of management of endocrine abnormalities for relieve of symptoms of patients with fibromyalgia, we reviewed experimental and clinical studies of endocrine functioning and endocrine treatment. Serum GH, androgen, and 24-hour urinary cortisol levels of patients with fibromyalgia tend to be in the lower part of the normal range, while serum levels of thyroid hormone, female sex hormones, prolactin, and melatonin are normal. With exception of GH, these conclusions are based on studies in small samples. With respect to dynamic responsiveness of the hypothalamic-pituitary-adrenal (HPA) axis, the dexamethasone suppression test and stimulation with ACTH show normal results, while patients show marked ACTH hypersecretion in response to severe acute stressors, perhaps indicative of chronic CRH hyposecretion. This finding and slightly altered responsiveness of growth hormone, thyroid hormone, and prolactin in pharmacologic stimulation tests suggest a central rather than peripheral origin of endocrine deviations. Because hormone level deviations were not severe, occurred in subgroups of patients only, and few controlled clinical trials were performed, there is--unless future research shows otherwise--little support for hormone supplementation as a general therapy in the common patient with fibromyalgia. In patients with clinically overt hormone deficiency, hormonal supplementation is an option. In patients with hormone levels that are in the lower part of the normal range, interventions aimed at pain, fatigue, sleep or mood disturbance, and physical deconditioning may indirectly improve endocrine functioning.