U. Trampisch

Optimal Jamar dynamometer handle position to assess maximal isometric hand grip strength in epidemiological studies.

PURPOSE Hand grip strength is an indicator of general muscle strength that is measured using a hand dynamometer. In some studies, a subjects grip strength is taken to be the maximal grip strength achieved from measurements taken at several different dynamometer handle positions. However, little is known about the influence of these different positions on the measured grip strength. The aim of the study was to identify one standard handle position that could be used to assess the grip strength of all subjects. METHODS Grip strength was assessed with a hand dynamometer (Jamar Plus+; Sammons Preston, Rolyon, Bolingbrook, IL). Each participants grip strength was measured 3 times in each of 5 different handle positions with each hand. The best position for each participant was defined as the position at which they achieved maximal grip strength. RESULTS The mean (± standard deviation) age of the 50 participants was 41 (± 13) years. Maximal grip strength was 43.7 (± 12.4) kg for all participants; 55.0 (± 10.2) kg for men and 35.4 (± 5.2) kg for women. Handle position 2 was the best position for 70% of participants. The mean difference between the grip strength achieved by each participant at handle position 2 and that achieved at each participants best position was 0.8 (± 1.78) kg. CONCLUSIONS Our results show that measurements taken at a single standard handle position are sufficiently accurate to assess grip strengths for all subjects. We therefore recommend handle position 2 as the standard position for measuring grip strength with the Jamar Plus+ hand dynamometer. CLINICAL RELEVANCE The assessment of grip strength with the Jamar Plus+ dynamometer is easier and faster if a single, standard handle position is used rather than multiple different positions. As well as providing accurate results, a single, standard handle position also reduces fatigue and increases the comparability of results between subjects.

Physical activity patterns in older men and women in Germany: a cross-sectional study

BackgroundData on physical activity in older adults in Germany is scarce. The aim of this study was to analyze physical activity patterns and to explore factors associated with physical activity in different domains, i.e. sporting activities (SA) and domestic activities (DA), in older men and women.MethodsAs part of the 7-year follow-up telephone interviews of the getABI cohort (community-dwelling older adults in Germany), the PRISCUS-PAQ was used to survey participants about their everyday physical activity patterns. Time per week (hh:mm) spent in SA and DA (heavy housework, gardening) was analyzed for men and women. Multivariate logistic regression analyses were performed in order to assess the odds of participating in SA and DA for at least 2.5 hours/week in association with sociodemographic factors, a broad range of physical health-related factors and interview date (season of the year).ResultsA total of 1,610 primary health care patients (51.6% women) with a median age of 77 (range 72-93) years were included in the analyses. Men engaged in SA more often than women (01:45 vs. 01:10), whereas women did more DA per week than men (04:00 vs. 03:00).Being interviewed in spring or summer was associated with increased performance of DA in both sexes. Participation in these activities was reduced in more highly educated men and women. Living alone increased the odds of sports participation in women, but not in men. Most physical health-related factors were only selectively associated with either SA or DA, in men or women, respectively. The need for a walking aid was the only factor that consistently lowered the odds of being active in both activity domains and sexes.ConclusionsThis exploratory study delivers reliable and relevant data on the participation in and correlates of sporting and domestic activities of community-dwelling older adults for whom there had previously been only limited information at a population level in Germany. Findings are discussed and implications for epidemiological research and health promotion practice are provided.

General practitioner advice on physical activity: Analyses in a cohort of older primary health care patients (getABI)

BackgroundAlthough the benefits of physical activity for health and functioning are recognized to extend throughout life, the physical activity level of most older people is insufficient with respect to current guidelines. The primary health care setting may offer an opportunity to influence and to support older people to become physically active on a regular basis. Currently, there is a lack of data concerning general practitioner (GP) advice on physical activity in Germany. Therefore, the aim of this study was to evaluate the rate and characteristics of older patients receiving advice on physical activity from their GP.MethodsThis is a cross-sectional study using data collected at 7 years of follow-up of a prospective cohort study (German epidemiological trial on ankle brachial index, getABI). 6,880 unselected patients aged 65 years and above in the primary health care setting in Germany were followed up since October 2001. During the 7-year follow-up telephone interview, 1,937 patients were asked whether their GP had advised them to get regular physical activity within the preceding 12 months. The interview also included questions on socio-demographic and lifestyle variables, medical conditions, and physical activity. Logistic regression analysis (unadjusted and adjusted for all covariables) was used to examine factors associated with receiving advice. Analyses comprised only complete cases with regard to the analysed variables. Results are expressed as odds ratios (ORs) with 95% confidence intervals (95% CI).ResultsOf the 1,627 analysed patients (median age 77; range 72-93 years; 52.5% women), 534 (32.8%) stated that they had been advised to get regular physical activity. In the adjusted model, those more likely to receive GP advice on physical activity were men (OR [95% CI] 1.34 [1.06-1.70]), patients suffering from pain (1.43 [1.13-1.81]), coronary heart disease and/or myocardial infarction (1.56 [1.21-2.01]), diabetes mellitus (1.79 [1.39-2.30]) or arthritis (1.37 [1.08-1.73]), and patients taking a high (> 5) number of medications (1.41 [1.11-1.80]).ConclusionsThe study revealed a relatively low rate of older primary health care patients receiving GP advice on physical activity. GPs appeared to focus their advice on patients with chronic medical conditions. However, there are likely to be many more patients who would benefit from advice.

Falls and EQ-5D rated quality of life in community-dwelling seniors with concurrent chronic diseases: a cross-sectional study

BackgroundAlthough recommended for use in studies investigating falls in the elderly, the European Quality of Life Group instrument, EQ-5D, has not been widely used to assess the impact of falls on quality of life. The aim of this study was to investigate the association of single and frequent falls with EQ-5D rated quality of life in a sample of German community-dwelling seniors in primary care suffering a variety of concurrent chronic diseases and conditions.MethodsIn a cross-sectional study, a sample of community-dwelling seniors aged ≥ 72 years was interviewed by means of a standardised telephone interview. According to the number of self-reported falls within twelve months prior to interview, participants were categorised into one of three fall categories: no fall vs. one fall vs. two or more falls within twelve months. EQ-5D values as well as other characteristics were compared across the fall categories. Adjustments for a variety of concurrent chronic diseases and conditions and further variables were made by using multiple linear regression analysis, with EQ-5D being the target variable.ResultsIn total, 1,792 participants (median age 77 years; 53% female) were analysed. The EQ-5D differed between fall categories. Participants reporting no fall had a mean EQ-5D score of 81.1 (standard deviation [s.d.]: 15.4, median: 78.3), while participants reporting one fall (n = 265; 14.8%) and participants with two or more falls (n = 117; 6.5%) had mean total scores of 77.0 (s.d.: 15.8, median: 78.3; mean difference to participants without a fall: -4.1, p < 0.05) and 72.1 (s.d.: 17.6, median: 72.5; mean difference: -9.0, p < 0.05), respectively. The mean difference between participants with one fall and participants with two or more falls was -4.9 (p < 0.05). Under adjustment for a variety of chronic diseases and conditions, the mean decrease in the total EQ-5D score was about -1.0 score point for one fall and about -2.5 points for two or more falls within twelve months. In quantity, this decrease is comparable to other chronic diseases adjusted for. Among the variables with the greatest negative association with EQ-5D ratings in multivariate analysis were depression and fear of falling.ConclusionsThe findings suggest that falls are negatively associated with EQ-5D rated quality of life independent of a variety of chronic diseases and conditions.

[Prerequisites for a new health care model for elderly people with multiple morbidities: results and conclusions from 3 years of research in the PRISCUS consortium].

BACKGROUND The concurrent presence or manifestation of multiple chronic conditions, i.e. multimorbidity, poses a challenge to affected patients and their relatives, physicians, and practitioners, and to the health care system in general. Aiming to improve medical care for different chronic diseases, the Chronic Care Model also appears to be suited for multimorbidity. The established research consortium PRISCUS is trying to create some of the prerequisites for a new care model for multimorbid, elderly patients oriented along the lines of the Chronic Care Model. METHODS AND RESULTS Four out of seven subprojects of the research consortium provide an overview of some of their findings. Topics in a sports medicine subproject were the assessment of physical activity by means of a newly developed questionnaire and the development and feasibility testing of an exercise program for elderly people with chronic conditions and mobility impairment. Partners from family medicine implemented geriatric assessment in a primary care setting and evaluated its consequences. In a pharmacological subproject, potentially inappropriate medication as well as drug-drug interactions and dosing errors were addressed. The health economic subproject investigated quality of life impairment due to multiple chronic diseases and the effects of multimorbidity on costs. CONCLUSIONS The results of the PRISCUS research consortium allow a better description of consequences of multimorbidity and illustrate at least some new approaches towards prevention, diagnosis, and treatment of patients suffering from multimorbidity. Ongoing projects will test the efficacy of a physical activity program and a new complex intervention to reduce potentially inappropriate medication in the elderly. With this, the research consortium will create some prerequisites for a new health care model for patients with multimorbidity comparable to the Chronic Care Model.ZusammenfassungHintergrundDas gleichzeitige Auftreten oder Vorhandensein mehrerer chronischer Erkrankungen im Sinne einer Multimorbidität stellt den Betroffenen und seine Angehörigen, Ärzte und Therapeuten, aber auch das Gesundheitssystem vor große Herausforderungen. Für eine verbesserte medizinische Versorgung bietet sich das für chronisch Kranke entwickelte Chronic Care Modell an. Der Forschungsverbund PRISCUS versucht, die Voraussetzungen für ein daran orientiertes, neues Versorgungsmodell für multimorbide, ältere Patienten zu schaffen.Methoden und ErgebnisseÜbersichtsartig werden Ergebnisse aus vier der insgesamt sieben Teilprojekte des Forschungsverbunds dargestellt. Im sportmedizinischen Teilprojekt geht es um die Erfassung körperlicher Aktivität über ein neues Fragebogeninstrument sowie die Entwicklung eines Heimübungsprogramms für chronisch kranke und in der Mobilität eingeschränkte Ältere. Das allgemeinmedizinische Teilprojekt befasst sich mit der Implementierung eines geriatrischen Assessments in der hausärztlichen Versorgung sowie dessen Auswirkungen. Im pharmakologischen Teilprojekt geht es um potenziell inadäquate Medikation für Ältere, Interaktionen und Nebenwirkungen. Das gesundheitsökonomische Teilprojekt eruiert Auswirkungen von Multimorbidität bei Älteren auf Lebensqualität und gesundheitsassoziierte Kosten.SchlussfolgerungDie Ergebnisse des Forschungsverbunds erlauben eine Abschätzung der Krankheitsfolgen von Multimorbidität und zeigen einige neue Ansätze zu Prävention, Diagnostik und Therapie bei Multimorbidität auf. Folgeprojekte werden sich mit der Wirksamkeit eines hausärztlich vermittelten, multidimensionalen Bewegungsprogramms sowie mit einem Interventionsprogramm zur Reduktion potenziell inadäquater Medikation bei Älteren befassen. Damit werden erste Voraussetzungen geschaffen, durch Anpassung der Versorgung nach Vorbild des Chronic Care Modell ein verbessertes Management von Patienten mit Multimorbidität zu erreichen.AbstractBackgroundThe concurrent presence or manifestation of multiple chronic conditions, i.e. multimorbidity, poses a challenge to affected patients and their relatives, physicians, and practitioners, and to the health care system in general. Aiming to improve medical care for different chronic diseases, the Chronic Care Model also appears to be suited for multimorbidity. The established research consortium PRISCUS is trying to create some of the prerequisites for a new care model for multimorbid, elderly patients oriented along the lines of the Chronic Care Model.Methods and resultsFour out of seven subprojects of the research consortium provide an overview of some of their findings. Topics in a sports medicine subproject were the assessment of physical activity by means of a newly developed questionnaire and the development and feasibility testing of an exercise program for elderly people with chronic conditions and mobility impairment. Partners from family medicine implemented geriatric assessment in a primary care setting and evaluated its consequences. In a pharmacological subproject, potentially inappropriate medication as well as drug–drug interactions and dosing errors were addressed. The health economic subproject investigated quality of life impairment due to multiple chronic diseases and the effects of multimorbidity on costs.ConclusionsThe results of the PRISCUS research consortium allow a better description of consequences of multimorbidity and illustrate at least some new approaches towards prevention, diagnosis, and treatment of patients suffering from multimorbidity. Ongoing projects will test the efficacy of a physical activity program and a new complex intervention to reduce potentially inappropriate medication in the elderly. With this, the research consortium will create some prerequisites for a new health care model for patients with multimorbidity comparable to the Chronic Care Model.

Voraussetzungen für ein neues Versorgungsmodell für ältere Menschen mit Multimorbidität

BACKGROUND The concurrent presence or manifestation of multiple chronic conditions, i.e. multimorbidity, poses a challenge to affected patients and their relatives, physicians, and practitioners, and to the health care system in general. Aiming to improve medical care for different chronic diseases, the Chronic Care Model also appears to be suited for multimorbidity. The established research consortium PRISCUS is trying to create some of the prerequisites for a new care model for multimorbid, elderly patients oriented along the lines of the Chronic Care Model. METHODS AND RESULTS Four out of seven subprojects of the research consortium provide an overview of some of their findings. Topics in a sports medicine subproject were the assessment of physical activity by means of a newly developed questionnaire and the development and feasibility testing of an exercise program for elderly people with chronic conditions and mobility impairment. Partners from family medicine implemented geriatric assessment in a primary care setting and evaluated its consequences. In a pharmacological subproject, potentially inappropriate medication as well as drug-drug interactions and dosing errors were addressed. The health economic subproject investigated quality of life impairment due to multiple chronic diseases and the effects of multimorbidity on costs. CONCLUSIONS The results of the PRISCUS research consortium allow a better description of consequences of multimorbidity and illustrate at least some new approaches towards prevention, diagnosis, and treatment of patients suffering from multimorbidity. Ongoing projects will test the efficacy of a physical activity program and a new complex intervention to reduce potentially inappropriate medication in the elderly. With this, the research consortium will create some prerequisites for a new health care model for patients with multimorbidity comparable to the Chronic Care Model.ZusammenfassungHintergrundDas gleichzeitige Auftreten oder Vorhandensein mehrerer chronischer Erkrankungen im Sinne einer Multimorbidität stellt den Betroffenen und seine Angehörigen, Ärzte und Therapeuten, aber auch das Gesundheitssystem vor große Herausforderungen. Für eine verbesserte medizinische Versorgung bietet sich das für chronisch Kranke entwickelte Chronic Care Modell an. Der Forschungsverbund PRISCUS versucht, die Voraussetzungen für ein daran orientiertes, neues Versorgungsmodell für multimorbide, ältere Patienten zu schaffen.Methoden und ErgebnisseÜbersichtsartig werden Ergebnisse aus vier der insgesamt sieben Teilprojekte des Forschungsverbunds dargestellt. Im sportmedizinischen Teilprojekt geht es um die Erfassung körperlicher Aktivität über ein neues Fragebogeninstrument sowie die Entwicklung eines Heimübungsprogramms für chronisch kranke und in der Mobilität eingeschränkte Ältere. Das allgemeinmedizinische Teilprojekt befasst sich mit der Implementierung eines geriatrischen Assessments in der hausärztlichen Versorgung sowie dessen Auswirkungen. Im pharmakologischen Teilprojekt geht es um potenziell inadäquate Medikation für Ältere, Interaktionen und Nebenwirkungen. Das gesundheitsökonomische Teilprojekt eruiert Auswirkungen von Multimorbidität bei Älteren auf Lebensqualität und gesundheitsassoziierte Kosten.SchlussfolgerungDie Ergebnisse des Forschungsverbunds erlauben eine Abschätzung der Krankheitsfolgen von Multimorbidität und zeigen einige neue Ansätze zu Prävention, Diagnostik und Therapie bei Multimorbidität auf. Folgeprojekte werden sich mit der Wirksamkeit eines hausärztlich vermittelten, multidimensionalen Bewegungsprogramms sowie mit einem Interventionsprogramm zur Reduktion potenziell inadäquater Medikation bei Älteren befassen. Damit werden erste Voraussetzungen geschaffen, durch Anpassung der Versorgung nach Vorbild des Chronic Care Modell ein verbessertes Management von Patienten mit Multimorbidität zu erreichen.AbstractBackgroundThe concurrent presence or manifestation of multiple chronic conditions, i.e. multimorbidity, poses a challenge to affected patients and their relatives, physicians, and practitioners, and to the health care system in general. Aiming to improve medical care for different chronic diseases, the Chronic Care Model also appears to be suited for multimorbidity. The established research consortium PRISCUS is trying to create some of the prerequisites for a new care model for multimorbid, elderly patients oriented along the lines of the Chronic Care Model.Methods and resultsFour out of seven subprojects of the research consortium provide an overview of some of their findings. Topics in a sports medicine subproject were the assessment of physical activity by means of a newly developed questionnaire and the development and feasibility testing of an exercise program for elderly people with chronic conditions and mobility impairment. Partners from family medicine implemented geriatric assessment in a primary care setting and evaluated its consequences. In a pharmacological subproject, potentially inappropriate medication as well as drug–drug interactions and dosing errors were addressed. The health economic subproject investigated quality of life impairment due to multiple chronic diseases and the effects of multimorbidity on costs.ConclusionsThe results of the PRISCUS research consortium allow a better description of consequences of multimorbidity and illustrate at least some new approaches towards prevention, diagnosis, and treatment of patients suffering from multimorbidity. Ongoing projects will test the efficacy of a physical activity program and a new complex intervention to reduce potentially inappropriate medication in the elderly. With this, the research consortium will create some prerequisites for a new health care model for patients with multimorbidity comparable to the Chronic Care Model.

The risk of peripheral artery disease in older adults - seven-year results of the getABI study

BACKGROUND To assess the risk of peripheral artery disease (PAD) in older adults and the contribution of traditional and novel risk factors to the incidence of PAD. PATIENTS AND METHODS 344 general practitioners (GPs), trained by vascular specialists all over Germany, enrolled 6,880 unselected participants aged 65 years or older (getABI study). The onset of PAD was determined by a regression method in the course of repeated measurements of the ankle brachial index (ABI) over seven years. PAD onset was defined by the declining linear regression ABI line reaching 0.9 or by PAD symptoms. RESULTS The cumulative PAD incidence over seven years was 12.9%, corresponding to an incidence rate of 20.3 per 1000 person years (95% confidence interval [95%CI] 18.8 to 21.7). Logistic regression analysis showed that traditional risk factors contributed significantly to the risk of PAD: current smoker status (odds ratio 2.65, 95%CI 2.08 to 3.37), diabetes (1.35, 95%CI 1.13 to 1.62), and low-density lipoprotein >130 mg/dl (1.26, 95%CI 1.07 to 1.48). Three novel risk factor candidates showed significant impact on PAD incidence: elevated sensitive C-reactive protein level (1.23, 95%CI 1.05 to 1.45), impaired estimated glomerular filtration rate (1.27, 95%CI 1.03 to 1.56), and elevated homocysteine level (1.19, 95%CI 1.01 to 1.41). CONCLUSIONS Older adults in Germany have a PAD risk of 12.9% per seven years. Potentially modifiable traditional PAD risk factors yield high impact on PAD incidence. Novel risk factor candidates may contribute to the risk of PAD.

Comparison of the efficacy and safety of two starting dosages of prednisolone in early active rheumatoid arthritis (CORRA): study protocol for a randomized controlled trial

BackgroundAlthough glucocorticoids are widely used in the treatment of patients with early rheumatoid arthritis, the best dosage of glucocorticoids with regards to efficacy and safety is not known.The aim of the study ‘Comparison of the efficacy and safety of two starting dosages of prednisolone in early active rheumatoid arthritis’ (CORRA) is to compare two standard glucocorticoid starting dosages and the non-use of glucocorticoids in the treatment of patients with early active rheumatoid arthritis on the background of the established ‘anchor’ therapy with methotrexate.Methods/designCORRA is an investigator-initiated, randomized, multicenter, double-blind, placebo-controlled trial with two treatment arms, starting with 60 mg or 10 mg prednisolone per day, tapered down to 5 mg prednisolone within eight weeks, and one placebo arm, each arm comprising 150 patients. The duration of the intervention is 12 weeks. In parallel, all patients will be treated with methotrexate (usual dosage 15 mg/week). The primary efficacy endpoint is the progression of radiographic joint damage after one year compared to baseline. Important secondary endpoints are the percentage of patients in remission, patient global assessment of disease activity, and changes of functional capacity. Safety monitoring is performed.The statistical analysis is performed in three hierarchical steps. The first step is an analysis of covariance (α = 0.05) to compare the group with the initial prednisolone dosage of 60 mg and the placebo group. In case of a statistically significant result, the comparison of the group starting with 10 mg prednisolone with the placebo group will be performed as a second step (α = 0.05). In case of superiority of the 10 mg prednisolone group versus the placebo group, the third step will be a non-inferiority test for the 10 mg prednisolone group versus the 60 mg prednisolone group (α = 0.025).DiscussionThe CORRA trial will yield information concerning the optimal glucocorticoid dosage schedule in the treatment of patients with early rheumatoid arthritis.Trial registrationThis trial was registered on 19 November 2013 at ClinicalTrials.gov. Registration number: NCT02000336.

[Measurement of physical activity in older adults. Correlation between the PRISCUS-PAQ and accelerometry].

BACKGROUND The German questionnaire PRISCUS-PAQ was developed to measure actual physical activity of older adults in a telephone interview. PRISCUS-PAQ consists of ten main questions to assess the time spend in domestic activities (e.g., housework, gardening), sporting activities (e.g., riding a bicycle), and inactivity (e.g., sedentary activity, sleeping during the day) during the prior week. By assessing the number of days for each activity and the mean duration of performing this activity, a total score can be calculated. The total score corresponds to the energy consumption for 1 week. The aim of this study is to estimate the correlation of the PRISCUS-PAQ total score and accelerometry as an objective measurement method for the assessment of physical activity. MATERIAL AND METHODS A total of 114 participants (58% women) with a mean age of 76 years participated in the study. PRISCUS-PAQ was initially analyzed descriptively. To assess the validity of PRISCUS-PAQ, the correlation (correlation coefficient of Spearman) was calculated between the total score of the questionnaire PRISCUS-PAQ and the 95% trimmed sum of an accelerometer with a measurement period of 1 week. RESULTS The correlation coefficient for the association of the PRISCUS-PAQ total score and the 95% trimmed sum of the acceleration values was r = 0.28 (95% confidence interval 0.10–0.44). Activities of daily life like cleaning and other domestic activities highly contributed to the weekly energy consumption of the participants. CONCLUSION The association between the PRISCUS-PAQ questionnaire and accelerometry measured physical activity is comparable to other validated and established international questionnaires. The PRISCUS-PAQ is the first German questionnaire that allows the measurement of physical activity of older adults in a telephone interview.

Messung körperlicher Aktivität bei älteren Erwachsenen

BACKGROUND The German questionnaire PRISCUS-PAQ was developed to measure actual physical activity of older adults in a telephone interview. PRISCUS-PAQ consists of ten main questions to assess the time spend in domestic activities (e.g., housework, gardening), sporting activities (e.g., riding a bicycle), and inactivity (e.g., sedentary activity, sleeping during the day) during the prior week. By assessing the number of days for each activity and the mean duration of performing this activity, a total score can be calculated. The total score corresponds to the energy consumption for 1 week. The aim of this study is to estimate the correlation of the PRISCUS-PAQ total score and accelerometry as an objective measurement method for the assessment of physical activity. MATERIAL AND METHODS A total of 114 participants (58% women) with a mean age of 76 years participated in the study. PRISCUS-PAQ was initially analyzed descriptively. To assess the validity of PRISCUS-PAQ, the correlation (correlation coefficient of Spearman) was calculated between the total score of the questionnaire PRISCUS-PAQ and the 95% trimmed sum of an accelerometer with a measurement period of 1 week. RESULTS The correlation coefficient for the association of the PRISCUS-PAQ total score and the 95% trimmed sum of the acceleration values was r = 0.28 (95% confidence interval 0.10–0.44). Activities of daily life like cleaning and other domestic activities highly contributed to the weekly energy consumption of the participants. CONCLUSION The association between the PRISCUS-PAQ questionnaire and accelerometry measured physical activity is comparable to other validated and established international questionnaires. The PRISCUS-PAQ is the first German questionnaire that allows the measurement of physical activity of older adults in a telephone interview.