Wim van Lankveld

Does osteoporosis predispose falls? a study on obstacle avoidance and balance confidence

The aim of the study was to investigate whether obstacle avoidance ability was affected in persons with osteoporosis compared to a comparison group of a community sample of older adults.BackgroundOsteoporosis is associated with changes in balance and physical performance and has psychosocial consequences which increase the risk of falling. Most falls occur during walking; therefore an efficient obstacle avoidance performance might contribute to a reduction in fall risk. Since it was shown that persons with osteoporosis are unstable during obstacle crossing it was hypothesized that they more frequently hit obstacles, specifically under challenging conditions.MethodsObstacle avoidance performance was measured on a treadmill and compared between persons with osteoporosis (n = 85) and the comparison group (n = 99). The obstacle was released at different available response times (ART) to create different levels of difficulty by increasing time pressure. Furthermore, balance confidence, measured with the short ABC-questionnaire, was compared between the groups.ResultsNo differences were found between the groups in success rates on the obstacle avoidance task (p = 0.173). Furthermore, the persons with osteoporosis had similar levels of balance confidence as the comparison group (p = 0.091). The level of balance confidence was not associated with the performance on the obstacle avoidance task (p = 0.145).ConclusionObstacle avoidance abilities were not impaired in persons with osteoporosis and they did not experience less balance confidence than the comparison group. These findings imply that persons with osteoporosis do not have an additional risk of falling because of poorer obstacle avoidance abilities.

Tailored cognitive-behavioral therapy and exercise training for high-risk patients with fibromyalgia.

The treatment of patients with fibromyalgia (FM), a high‐prevalence chronic pain condition with a high impact on both patients and society, poses a great challenge to clinicians due to a lack of effective treatments. In view of the large individual variability in outcome, selecting patients at risk of long‐term dysfunction and offering tailored treatment may be promising for beneficial treatment effects.

Psychological health and well-being in systemic sclerosis: State of the science and consensus research agenda.

Introduction Systemic sclerosis (SSc; scleroderma) is a multisystem disorder characterized by disturbance in fibroblast function, microvascular disease, and immune system activation, culminating in fibrosis of the skin and internal organs (1,2). SSc is associated with extensive morbidity, including disfiguring skin thickening, finger ulcers, joint contractures, pulmonary hypertension, interstitial lung disease, chronic diarrhea, and renal failure (1,2). The rate of disease onset is highest between 30 and 50 years of age, with the risk for women being 4 to 5 times higher than for men (3,4). Median survival time from diagnosis is 11 years, and patients are 3.7 times more likely to die within 10 years of diagnosis (44.9% mortality) than age-, sex-, and race-matched individuals without SSc (12.0% mortality) (3).

Efficacy of a Short Multidisciplinary Falls Prevention Program for Elderly Persons With Osteoporosis and a Fall History: A Randomized Controlled Trial

OBJECTIVE To evaluate the efficacy of the Nijmegen Falls Prevention Program (NFPP) for persons with osteoporosis and a fall history in a randomized controlled trial. Persons with osteoporosis are at risk for fall-related fractures because of decreased bone strength. A decrease in the number of falls therefore is expected to be particularly beneficial for these persons. DESIGN Randomized controlled trial. SETTING Hospital. PARTICIPANTS Persons with osteoporosis and a fall history (N=96; mean ± SD age, 71.0±4.7y; 90 women). INTERVENTION After baseline assessment, participants were randomly assigned to the exercise (n=50; participated in the NFPP for persons with osteoporosis [5.5wk]) or control group (n=46; usual care). MAIN OUTCOME MEASURES Primary outcome measure was fall rate, measured by using monthly fall calendars for 1 year. Secondary outcomes were balance confidence (Activity-specific Balance Confidence Scale), quality of life (QOL; Quality of Life Questionnaire of the European Foundation for Osteoporosis), and activity level (LASA Physical Activity Questionnaire, pedometer), assessed posttreatment subsequent to the program and after 1 year of follow-up. RESULTS The fall rate in the exercise group was 39% lower than for the control group (.72 vs 1.18 falls/person-year; risk ratio, .61; 95% confidence interval, .40-.94). Balance confidence in the exercise group increased by 13.9% (P=.001). No group differences were observed in QOL and activity levels. CONCLUSION The NFPP for persons with osteoporosis was effective in decreasing the number of falls and improving balance confidence. Therefore, it is a valuable new tool to improve mobility and independence of persons with osteoporosis.

Disease-related and psychosocial factors associated with depressive symptoms in patients with systemic sclerosis, including fear of progression and appearance self-esteem

OBJECTIVE The prevalence of depressive symptoms is high in patients with systemic sclerosis (SSc, scleroderma). This study was conducted to determine which disease-related and psychosocial factors are associated with depressive symptoms, independent of sociodemographic factors. METHODS In total, 215 patients with SSc completed questionnaires on sociodemographics, physical functioning (HAQ-DI), pain (VAS), fatigue (CIS), psychosocial characteristics (CISS, ICQ, PRQ, ASE, FoP-Q-SF) and depressive symptoms (CES-D). Disease characteristics (disease duration, disease subtype, modified Rodnan Skin Score) were collected. Hierarchical linear regression analyses were conducted to assess associations with depressive symptoms. RESULTS The mean CES-D score was 12.9 (SD=9.7) and the prevalence of patients scoring>= 16 and>=19 were 32.1% and 25.1%, respectively. The variance explained by sociodemographics and disease characteristics was negligible (R(2)≤.09). Fatigue and pain were independently associated with depressive symptoms (R(2) change=.35). After adding psychological factors (R(2) change=.21), satisfaction with social support, emotion-focused coping and helplessness were also significantly associated with depressive symptoms. Higher fear of progression was associated with more depressive symptoms (P≤.01), and appearance self-esteem showed a marginally significant association (P=.08). CONCLUSION Depressive symptoms were common in the present sample of patients with SSc and were independently associated with pain, fatigue, social support, emotion-focused coping, helplessness and fear of progression. Results suggest that, in addition to assessment of disease characteristics, attention should be given also to psychosocial factors found to be associated with depressive symptoms. For the development and trialling of psychological interventions, fear of progression could be an important target.

Longitudinal association between coping and psychological distress in rheumatoid arthritis: a systematic review

Objective To examine the longitudinal association between coping and psychological distress in rheumatoid arthritis (RA). Methods Bibliographic databases up to July 2010 were searched for longitudinal studies with a follow-up of ≥6 months. Two reviewers assessed the methodological quality of the included studies. Study characteristics, coping strategies and coping-psychological distress associations were extracted. Coping strategies were categorised using a hierarchical taxonomy. A best-evidence synthesis determined the level of evidence for a prognostic association of coping with depression, anxiety and general distress. Results From an initial set of 2605 potentially relevant studies, 19 studies (14 cohorts) met the predefined selection criteria. In all, 10 studies were of ‘high quality’ (≥12 of 18 quality criteria). Unadjusted bivariate correlations showed that baseline approach-oriented coping correlated with lower psychological distress (r between 0.007–0.46, p values <0.05) and baseline avoidant-oriented coping correlated with higher psychological distress (r between 0.29–0.64, p values <0.05) at follow-up. Adjusted for baseline psychological distress, limited evidence was found that avoidant-oriented coping was longitudinally associated with an increase in psychological distress. Specifically, the categories helplessness, avoidance and wishful thinking were prognostically associated with increased general psychological distress. Approach-oriented coping was not associated with subsequent psychological distress. Conclusions The prognostic value of coping strategies for later psychological distress in RA is weak. Limited evidence suggests that avoidant-oriented coping is associated with increased subsequent psychological distress. No evidence was found that approach-oriented coping protects against an increase of psychological distress.

The short version of the sequential occupational dexterity assessment based on individual tasks' sensitivity to change

OBJECTIVE The Sequential Occupational Dexterity Assessment (SODA) is a reliable and valid instrument to measure bimanual hand function in rheumatoid arthritis. Since administering SODA is time-consuming, the aim of this study is to construct a short SODA (SODA-S). METHODS Dexterity was measured with the SODA twice (with an interval of one year) in 94 patients. Item analyses based on the different SODA tasks were carried out to determine which of the 12 individual tasks were most responsible for the observed changes in dexterity. RESULTS Six of the 12 SODA tasks were identified as sensitive to change. Based on these 6 tasks, the SODA-S was computed. Internal consistency of the SODA-S is good (Cronbachs alphas at baseline and followup were 0.82 and 0.85, respectively). The correlation between the SODA and SODA-S is 0.92. This means that the information gathered from the SODA-S is almost equal to the information gathered from the full SODA. Norm scores are provided for both instruments. CONCLUSION The SODA-S is a good alternative to the full SODA in following patients dexterity in daily practice. However, when evaluating the effect of specific hand treatment, the full SODA may be preferred.

A short, intensive cognitive behavioral pain management program reduces health-care use in patients with chronic low back pain: two-year follow-up results of a prospective cohort.

PurposeCognitive behavioral interventions are recommended as non-invasive treatment options for patients with chronic low back pain (CLBP). However, most treatment effects are small and short-lived. Although a 2-week intensive pain management program for patients with CLBP seems to be effective, the long-term results are not known. The purpose of this study is to evaluate the stability of the 2-year follow-up results and whether this is reflected in the use of health-care services.MethodsA prospective cohort study was performed. Pre-treatment characteristics of patients and data of outcomes obtained at 1-year follow-up were used. At 2-year follow-up a structured interview was conducted following the principles of a post-marketing survey. Outcomes included daily functioning, quality of life, current intensity of pain, disturbance of pain during daily activities, and indicators of the use of pain medication and health-care services.ResultsOf the 90 eligible patients 85 (94%) participated in the post-marketing survey. The 1-year clinical relevant effects are maintained at 2-year follow-up. Effect sizes for functioning and quality of life were large. More than 65% reached preset minimal clinically important differences. At pre-treatment all patients consulted their general practitioner (GP) and medical specialist (MS). At 2-year follow-up 73% reported having consulted neither a GP nor an MS during the previous year. Most of the patients indicated not to use any pain medication (57%) and the percentage patients using opioids have decreased (14%). Moreover, 81% reported to be at work.ConclusionsThe gained results from selected and motivated patients with longstanding CLBP at 1-year follow-up are stable at 2-year follow-up. Above all, most of the participants are at work and results indicate that the use of both pain medication and health care have decreased substantially.

Risk factors for longer term psychological distress in well-functioning fibromyalgia patients: A prospective study into prognostic factors

OBJECTIVE Psychological distress is a key risk factor for long-term complaints in fibromyalgia (FM). Prognostic factors for psychological distress might facilitate an early identification of patients at risk to help prevent long-term dysfunction, especially for the relatively well-functioning patients showing little distress who are usually not considered for treatment. This study hence examines potential prognostic factors in this subgroup. METHODS Psychological distress, physical functioning, illness cognitions (helplessness, acceptance), pain-avoidance factors (passive pain-coping, fear of pain, hypervigilance), and social factors (social support, social reinforcement) was assessed in 78 low-distress FM patients at baseline and after a mean of 9 months (SD=3.3). RESULTS Baseline physical functioning did not predict changes in psychological distress, whereas a higher level of hypervigilance, less acceptance, and less perceived social support predicted an increase in psychological distress at follow-up. CONCLUSION Illness cognitions, pain-avoidance factors, and social support can be considered as prognostic factors predicting changes in psychological distress in FM. More research is needed to investigate additional factors that could also be implicated (e.g. personality factors, stressful events). PRACTICE IMPLICATIONS Timely assessment of illness cognitions, pain-avoidance factors, and social support may help identify subgroups of relatively well-functioning FM patients at risk of longer term aggravated psychological distress.

Development and content of a group-based intervention to improve medication adherence in non-adherent patients with rheumatoid arthritis

OBJECTIVE To describe the systematic development and content of a short intervention to improve medication adherence to disease-modifying anti-rheumatic drugs in non-adherent patients with rheumatoid arthritis (RA). METHODS The intervention mapping (IM) framework was used to develop the intervention. The following IM steps were conducted: (1) a needs assessment; (2) formulation of specific intervention objectives; (3) inventory of methods and techniques needed to design the intervention and (4) production and piloting of the intervention. RESULTS The intervention (consisting of two group sessions led by a pharmacist, a homework assignment, and a follow-up call) aims to improve the balance between necessity and concern beliefs about medication, and to resolve practical barriers in medication taking. The central communication method used is motivational interviewing. CONCLUSION By applying the IM framework, we were able to create a feasible, time-efficient and promising intervention to improve medication adherence in non-adherent RA patients. Intervention effects are currently being assessed in a randomized controlled trial. PRACTICE IMPLICATIONS This paper could serve as a guideline for other health care professionals when developing similar interventions. If the RCT demonstrates sufficient effectiveness of this intervention in reducing medication non-adherence in RA patients, the intervention could be embedded in clinical practice.