Thomas Cochrane

Tests for physical function of the elderly with knee and hip osteoarthritis.

This study reports the results of a battery of physical function tests used to assess physical function of older patients with clinical knee and/or hip osteoarthritis (OA), and the correlation to the WOMAC Index (disease‐specific questionnaire). A total of 106 sedentary subjects, aged >60 years (mean 69.4, S.D. 5.9) with hip and/or knee OA (mean 12.2 yrs, S.D. 11.0) participated in the study. Mobility, joint flexibility and muscle strength were evaluated by recording time to: walk a distance of 8′, ascend/descend 4 stairs, rise from/sit down from a chair (5 times). Hip/knee flexion and isometric quadriceps strength were also measured. Categories of performance were formed by dividing data into quartiles for each test (1=highest, 4=lowest score, 5=unable to complete) and, by summing the category scores, a total summary score (TSS) was obtained. The battery of physical function tests showed an acceptable test–retest reliability (ICC of all tasks ≥0.80) and internal consistency (Cronbachs alpha ≥0.80). Performance scores on walking, stair climb, chair‐rise and ROM of affected OA joints were significantly correlated with each other, and with the WOMAC Index (P<0.05, Spearmans correlation). Lower scores on the TSS were associated with lower scores on all the WOMAC Index items (P<0.001). This study shows that a simple battery of physical function tests in combination with the WOMAC Index are reliable and may be useful outcome measures in the evaluation of therapeutic interventions and geriatric rehabilitation.

Cost effectiveness of a community based exercise programme in over 65 year olds: cluster randomised trial

Objective: To assess the cost effectiveness of a community based exercise programme as a population wide public health intervention for older adults. Design: Pragmatic, cluster randomised community intervention trial. Setting: 12 general practices in Sheffield; four randomly selected as intervention populations, and eight as control populations. Participants: All those aged 65 and over in the least active four fifths of the population responding to a baseline survey. There were 2283 eligible participants from intervention practices and 4137 from control practices. Intervention: Eligible subjects were invited to free locally held exercise classes, made available for two years. Main outcome measures: All cause and exercise related cause specific mortality and hospital service use at two years, and health status assessed at baseline, one, and two years using the SF-36. A cost utility analysis was also undertaken. Results: Twenty six per cent of the eligible intervention practice population attended one or more exercise sessions. There were no significant differences in mortality rates, survival times, or admissions. After adjusting for baseline characteristics, patients in intervention practices had a lower decline in health status, although this reached significance only for the energy dimension and two composite scores (p<0.05). The incremental average QALY gain of 0.011 per person in the intervention population resulted in an incremental cost per QALY ratio of €17 174 (95% CI = €8300 to €87 120). Conclusions: Despite a low level of adherence to the exercise programme, there were significant gains in health related quality of life. The programme was more cost effective than many existing medical interventions, and would be practical for primary care commissioning agencies to implement.

In-school and out-of-school physical activity in primary and secondary school children.

Abstract The aim of this study was to compare in-school and out-of-school physical activity within a representative sample. Socio-demographic, physical activity, and anthropometric data were collected from a random sample of children (250 boys, 253 girls) aged 3–16 years attending nine primary and two secondary schools. Actigraph GT1M accelerometers, worn for seven days, were used to estimate physical activity levels for in-school (typically 09.00–15.00 h), out-of-school (weekday), and weekend periods. Physical activity as accelerometer counts per minute were lower in school versus out of school overall (in school: 437.2 ± 172.9; out of school: 575.5 ± 202.8; P < 0.001), especially in secondary school pupils (secondary: 321.6 ± 127.5; primary: 579.2 ± 216.3; P < 0.001). Minutes of moderate-to-vigorous physical activity accumulated in school accounted for 29.4 ± 9.8% of total weekly moderate-to-vigorous physical activity overall but varied by sector (preschool: 37.4 ± 6.2%; primary: 33.6 ± 8.1%; secondary: 23.0 ± 9.3%; F = 114.3, P < 0.001). Approximately half of the children with the lowest in-school activity compensated out of school during the week (47.4%) and about one-third at the weekend (30.0%). Overall, physical activity during the school day appears to be lower than that out of school, especially in secondary school children, who accumulate a lower proportion of their total weekly moderate-to-vigorous physical activity at school than younger children. As low in-school activity was compensated for beyond the school setting by less than half of children, promoting physical activity within the school day is important, especially in secondary schools.

Cross-sectional review of the response and treatment uptake from the NHS Health Checks programme in Stoke on Trent

Background As part of national policy to manage the increasing burden of chronic diseases, the Department of Health in England has launched the NHS Health Checks programme, which aims to reduce the burden of the major vascular diseases on the health service. Methods A cross-sectional review of response, attendance and treatment uptake over the first year of the programme in Stoke on Trent was carried out. Patients aged between 32 and 74 years and estimated to be at ≥20% risk of developing cardiovascular disease were identified from electronic medical records. Multi-level regression modelling was used to evaluate the influence of individual- and practice-level factors on health check outcomes. Results Overall 63.3% of patients responded, 43.7% attended and 29.8% took up a treatment following their health check invitation. The response was higher for older age and more affluent areas; attendance and treatment uptake were higher for males and older age. Variance between practices was significant (P < 0.001) for response (13.4%), attendance (12.7%) and uptake (23%). Conclusions The attendance rate of 43.7% following invitation to a health check was considerably lower than the benchmark of 75%. The lack of public interest and the prevalence of significant comorbidity are challenges to this national policy innovation.

Assessment of ground reaction force during scoliotic gait

Although the causes and progression of adolescent idiopathic scoliosis (AIS) are still unclear, a recent extensive review has indicated a number of possible aetiological factors. Previous investigations, employing gait measurements, have indicated asymmetries in the ground reaction forces and suggest a relationship between these asymmetries, neurological dysfunction and spinal deformity. Using a strain-gauge force platform, the present study has examined the time-domain parameters of various components of the ground reaction force together with impulse. Symmetry indices (SI) between left and right sides have also been estimated. The results show that the patients with a left compensatory curve had a greater SI for a left-side impulse, whilst subjects with little or no compensation had a greater rightside impulse. This indicates that a possible gait compensation is occurring, so that the subjects compensate on the opposite pelvis/lower limb to that of the curve. While indicating the asymmetries between left and right, the results also serve to highlight the value of using kinetic parameters in developing the understanding of the pathogenesis and aetiology of scoliosis.

Computer-assisted Cobb measurement of scoliosis

Abstract. This study was devised to develop a simple computerised method for measuring and quantifying the magnitude of spinal curvatures. A digitally scanned antero-posterior radiographic image was used. The vertebral column was defined as a line that can be subdivided into a number of segments, rather than into the exact number of vertebrae. The technique developed allows an observer to measure the spinal curvature with a high resolution and accuracy. One important advantage of the technique is that the assessor does not need to be skilled or experienced in measurement of a spinal curvature.

NHS health checks through general practice: randomised trial of population cardiovascular risk reduction

BackgroundThe global burden of the major vascular diseases is projected to rise and to remain the dominant non-communicable disease cluster well into the twenty first century. The Department of Health in England has developed the NHS Health Check service as a policy initiative to reduce population vascular disease risk. The aims of this study were to monitor population changes in cardiovascular disease (CVD) risk factors over the first year of the new service and to assess the value of tailored lifestyle support, including motivational interview with ongoing support and referral to other services.MethodsRandomised trial comparing NHS Health Check service only with NHS Health Check service plus additional lifestyle support in Stoke on Trent, England. Thirty eight general practices and 601 (365 usual care, 236 additional lifestyle support) patients were recruited and randomised independently between September 2009 and February 2010. Changes in population CVD risk between baseline and one year follow-up were compared, using intention-to-treat analysis. The primary outcome was the Framingham 10 year CVD risk score. Secondary outcomes included individual modifiable risk measures and prevalence of individual risk categories. Additional lifestyle support included referral to a lifestyle coach and free sessions as needed for: weight management, physical activity, cook and eat and positive thinking.ResultsAverage population CVD risk decreased from 32.9% to 29.4% (p <0.001) in the NHS Health Check only group and from 31.9% to 29.2% (p <0.001) in the NHS Health Check plus additional lifestyle support group. There was no significant difference between the two groups at either measurement point. Prevalence of high blood pressure, high cholesterol and smoking were reduced significantly (p <0.01) in both groups. Prevalence of central obesity was reduced significantly (p <0.01) in the group receiving additional lifestyle support but not in the NHS Health Check only group.ConclusionsThe NHS Health Check service in Stoke on Trent resulted in significant reduction in estimated population CVD risk. There was no evidence of further benefit of the additional lifestyle support services in terms of absolute CVD risk reduction.

Relative importance of physical and social aspects of perceived neighbourhood environment for self-reported health

OBJECTIVE To explore the relative importance of the perceived physical and social neighbourhood environment for physical and mental health. METHODS A representative random sample of adults was recruited from 10 areas across Stoke-on-Trent, UK (June-September 2007). Interview-administered surveys were used to record data on the perceived neighbourhood environment (physical and social), self-reported health, and socio-demographics. Multiple regression analysis was used to explore independent associations between environmental factors and physical and mental health. RESULTS Independent physical and social environmental factors respectively explained 6.0% and 3.2% of variability in physical health and 2.8% and 4.4% of variability in mental health. Diversity of land use was the strongest and only physical environmental predictor of physical health (Beta=0.27, p<0.001), explaining more variability than social environmental factors combined. Conversely, social support was the most important (and only) social environmental factor for mental health (Beta=-0.20, p<0.001); again, this explained more variability in mental health than the combined effect of four physical environmental predictors. CONCLUSION Perceived physical and social environmental characteristics were important for physical and mental health, independent of socio-demographic factors. Living in neighbourhoods with greater land use diversity appears particularly important for physical health, whereas social support appears more closely linked to mental health.

Increasing uptake of physical activity: a social ecological approach

Aims: Increasing population physical activity (PA) is a public health priority. An approach to increasing PA in an urban community, based on the social ecology model, is presented and evaluated. Methods: A quasi-experimental (non-equivalent control group) design was chosen to test whether this approach can increase, significantly, the population proportion that is physically active. Two deprived inner-city electoral ward areas of Sheffield, UK, with similar socio-demographic and health profiles were selected. Implementation was carried out in five phases over 21 months: preparation and piloting, initial survey estimates, community awareness campaign, PA intervention and evaluation. Impact was evaluated by recording uptake and attendance at all sessions, and using a post-intervention postal survey. At follow-up, questionnaires were sent to 2500 randomly selected addresses in both areas, which assessed changes in PA, health and PA participation over the last year. Results: A pilot baseline survey confirmed similar proportions taking some form of PA on most days: intervention 36% (25—47), control 33% (21—45). At follow-up, 38 different activity groups were in place and 1275 individuals had attended at least one activity. Satisfactorily completed responses were received from 1532 (31%), 55% (846) intervention, 45% (686) control. Relative to the control, the intervention sample demonstrated trends towards: being more physically active compared with one year ago, greater readiness to take up PA, better general health and improved health compared with one year ago (p ≤ 0.001). Further, 30.6% (intervention) vs 18.3% (control) reported an increase in PA compared with one year ago, while 13.7% (intervention) vs 24.5% (control) reported no intention to exercise. These differences in proportions translated to an overall effect size estimate of 0.23 for the intervention. Relative to those whose PA had remained the same, intervention area residents were more likely to report being more active (odds ratio (95% confidence interval) = 1.79 (1.38—2.32), p < 60; 0.001). Conclusion: These results suggest that, even within one of the most deprived inner-city areas in the UK, a community-based social ecological approach can positively change PA behaviour and attitudes.

Correlates of Agreement between Accelerometry and Self-reported Physical Activity

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