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Biomedical subjects

J Dekker

Publications and source records attributed to J Dekker.

At least 19 recordsLinked to original sources
PubMed2006

Joint laxity and the relationship between muscle strength and functional ability in patients with osteoarthritis of the knee.

OBJECTIVE: To establish the impact of knee joint laxity on the relationship between muscle strength and functional ability in osteoarthritis (OA) of the knee. METHODS: A cross-sectional study of 86 patients with OA of the knee was conducted. Tests were performed to determine varus-valgus laxity, muscle strength, and functional ability. Laxity was assessed using a device that measures the angular deviation of the knee in the frontal plane. Muscle strength was measured using a computer-driven isokinetic dynamometer. Functional ability was assessed by observation (100-meter walking test) and self report (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]). Regression analyses were performed to assess the impact of joint laxity on the relationship between muscle strength and functional ability. RESULTS: In regression analyses, the interaction between muscle strength and joint laxity contributed to the variance in both walking time (P = 0.002) and WOMAC score (P = 0.080). The slope of the regression lines indicated that the relationship between muscle strength and functional ability (walking time, WOMAC) was stronger in patients with high knee joint laxity. CONCLUSION: Patients with knee OA and high knee joint laxity show a stronger relationship between muscle strength and functional ability than patients with OA and low knee joint laxity. Patients with OA, high knee joint laxity, and low muscle strength are most at risk of being disabled.

Aged↗
PubMed2006

Responsiveness of functional health status measures frequently used in stroke research.

PURPOSE: To compare the responsiveness of several functional health status measures frequently used in stroke research, namely the Barthel Index (BI), Functional Independence Measure (FIM), Frenchay Activities Index (FAI) and Stroke-Adapted Sickness Impact Profile 30 (SA-SIP 30). METHOD: Patients with a first-ever supratentorial stroke admitted for inpatient rehabilitation were included. Complete datasets for 163 patients were available for analysis. Floor/ceiling effects and responsiveness, quantified by effect sizes, were studied for the periods between rehabilitation admission and six months post stroke (subacute phase) and between six and 12 months post stroke (chronic phase). RESULTS: Effect sizes in the subacute phase were similar and were classified as large for the BI, FIM total and FIM motor score. The FIM cognitive score showed a considerable ceiling effect and had the smallest effect size in the subacute phase. In the chronic phase, the FAI and SA-SIP 30 detected the most changes and had moderate effect sizes. CONCLUSIONS: BI, FIM total and FIM motor score, FAI and SA-SIP 30 were responsive measures. We recommend the use of the BI in the subacute phase and the use of the FAI and SA-SIP 30 in the chronic phase, especially for the stroke rehabilitation population.

Activities of Daily Living↗
PubMed2006

The threshold for diagnosing impaired fasting glucose: a position statement by the European Diabetes Epidemiology Group.

The category of IFG was introduced in the late 1990s to denote a state of non-diabetic hyperglycaemia defined by a fasting plasma glucose (FPG) concentration between 6.1 and 6.9 mmol/l. In 2003 the American Diabetes Association recommended that this diagnostic threshold be lowered to 5.6 mmol/l. The justification for lowering the threshold has been questioned. This simple change in cut-off value creates a pandemic of IFG, with a two- to five-fold increase in the prevalence of IFG across the world. Such a change in threshold has far-reaching public health implications. The European Diabetes Epidemiology Group (EDEG) has reviewed the evidence for this lower cut-off point for the definition of IFG and concludes that the previous definition should not be altered. EDEG further recommends that the value of all categorical definitions of non-diabetic hyperglycaemia should be reconsidered.

Blood Glucose↗
PubMed2006

Performance-based methods for measuring the physical function of patients with osteoarthritis of the hip or knee: a systematic review of measurement properties.

OBJECTIVE: To systematically review the measurement properties (i.e. internal consistency, reproducibility, validity, responsiveness and interpretability) of all performance-based methods which have been used to measure the physical function of patients with osteoarthritis of the hip or knee. METHODS: A systematic search was conducted in Medline, CINAHL, PsychINFO and Embase. Standardized criteria were applied to assess the quality of the clinimetric studies and the measurement properties. RESULTS: Twenty-six performance-based methods were included: 13 walking tests, two stair-climb tests, one chair test and ten multi-item tests. Three out of seven multi-activity tests were tested for internal consistency and two were rated positively. Fourteen tests were tested for reliability and five were rated positively. The absolute measurement error (agreement) was assessed for 10 tests. Only one test received a positive rating. Fourteen tests were tested for construct validity. Only two tests received positive ratings. Responsiveness was assessed for 12 tests, but none of them received a positive rating. A lot of indeterminate ratings were given, mostly for small studies or non-optimal analyses. CONCLUSION: Many more well-designed studies are needed to assess the measurement properties of performance-based methods. More importantly, however, before one can make a justified choice of a particular performance-based method, consensus is needed on what activities should be included in a performance-based test for patients with hip or knee osteoarthritis and which aspects of function should be measured.

Exercise Test↗
PubMed2006

[Intakes for (day) clinical psychotherapy. A cohort study].

Little is known about the type of patient who is referred for clinical psychotherapy. A descriptive, retrospective cohort study was performed involving 100 patients who attended a (day) clinic for personality, anxiety and eating disorders. Sociodemographic and clinical characteristics of these patients are described. Most of the patients had multiple disorders of a serious nature, displayed a high degree of functional impairment and were relatively treatment-resistant. Of the 70% who were diagnosed as requiring treatment, 79% agreed to have the treatment that was offered.

Adult↗
PubMed2005

Reproducibility of instrumented knee joint laxity measurement in healthy subjects.

OBJECTIVE: To determine the reproducibility of frontal plane knee joint laxity measurement through the assessment of intra- and inter-rater reliability coefficients and intra- and inter-rater agreement coefficients. METHODS: Two raters independently assessed the laxity of the knee joint in the frontal plane by three repeated measurements. Fourteen days later the assessment was repeated. Complete data were obtained from 20 healthy subjects. Laxity was assessed using a device which consisted of a chair with a free-moving arm that supported the subject's lower leg. Medial and lateral loads were applied, resulting in a varus and valgus movement in the knee joint. The intra- and inter-rater reliability coefficients [intraclass correlation coefficients (ICC)] were estimated, as were the intra- and inter-rater agreement parameters [standard error of measurement (SEM) and minimal detectable difference (MDD)]. RESULTS: Adequate intra-rater reliability (ICC>0.80) was calculated for each rater's measurements of laxity. The inter-rater reliability was less adequate (ICC=0.65) when calculated using the first day's measurements. However, inter-rater reliability was adequate (ICC=0.88) when calculated using the day 14 measurements. The intra-rater measurement error calculated across occasions was 1.3 degrees for individual subjects. This resulted in an MDD of 3.7 degrees. The inter-rater measurement error, i.e. the SEM and MDD, was higher (1.5 degrees and 4.3 degrees, respectively). CONCLUSIONS: Intra-rater reliability of knee joint laxity measurement is good. Adequate training of raters establishes the basis for good inter-rater reliability. In clinical trials, it is preferable for one trained rater to perform the laxity measurement. The measurement of knee joint laxity is limited due to its relatively high measurement error in individual subjects; therefore, this measurement should be restricted to group assessment rather than individual patient assessment.

Adult↗
PubMed2005

Forefoot joint damage, pain and disability in rheumatoid arthritis patients with foot complaints: the role of plantar pressure and gait characteristics.

OBJECTIVE: To assess (i) the relationship between forefoot joint damage and foot function (expressed as gait and pressure parameters), (ii) the relationship between foot function and pain, and (iii) the relationship between foot function and disability in patients with foot complaints secondary to rheumatoid arthritis (RA). METHODS: Sixty-two patients with RA-related foot complaints were included. Measurements of joint damage, gait characteristics, plantar pressure, pain and disability were obtained. Data were analysed using descriptive and correlational techniques. RESULT: s. Joint damage on radiographs of the forefoot correlated significantly with forefoot pressure (r = 0.296, P = 0.020). Further investigation of the metatarsophalangeal joints (MTPs) showed joint damage to correlate significantly with peak pressure and pressure-time integral (PTI) of MTP1 and MTP4. A significant correlation between PTI under the forefoot and barefoot pain was found (r = 0.290, P = 0.022). Gait parameters (total contact time and the duration of heel loading) and disability, measured with the Foot Function Index, were significantly correlated (r = 0.315, P = 0.013 and r = 0.266, P = 0.037, respectively). CONCLUSION: Forefoot joint damage in the rheumatoid foot is related to increased pressure under the forefoot, especially pressure under the first and fourth MTP joints. High forefoot pressure is associated with pain during barefoot walking. A prolonged stance phase and delayed heel lift are related to disability in daily activities.

Activities of Daily Living↗
PubMed2005

The incidences of and consultation rate for lower extremity complaints in general practice.

OBJECTIVE: To estimate the incidence and consultation rate of lower extremity complaints in general practice. METHODS: Data were obtained from the Second Dutch National Survey of General Practice, in which 195 general practitioners (GPs) in 104 practices recorded all contacts with patients during 12 consecutive months in computerised patient records. GPs classified the symptoms and diagnosis for each patient at each consultation according to the International Classification of Primary Care (ICPC). Incidence densities and consultation rates for different complaints were calculated. RESULTS: During the registration period 63.2 GP consultations per 1000 person-years were attributable to a new complaint of the lower extremities. Highest incidence densities were seen for knee complaints: 21.4 per 1000 person-years for women and 22.8 per 1000 person-years for men. The incidence of most lower extremity complaints was higher for women than for men and higher in older age. CONCLUSIONS: Both incidences of and consultation rates for lower extremity complaints are substantial in general practice. This implies a considerable impact on the workload of the GP.

Adolescent↗
PubMed2005

[Psychological treatment of depression; a systematic review of meta-analyses].

OBJECTIVE: To provide a review of the meta-analyses of the efficacy of psychological treatment of patients with a depressive disorder. DESIGN: Systematic review. METHOD: A search was performed in Pubmed, Psycinfo and DARE, in earlier reviews and in the lists of references of recovered articles. The inclusion criteria were: statistical meta-analyses of randomised studies that had been published in English in the period 2000-2004. 3 types of outcome measures were distinguished: effects on recovery, effects on the severity of the depressive symptoms, and dropping out. RESULTS: 10 meta-analyses were included with a total of 132 primary studies, of which 25 (19%) appeared in more than one meta-analysis. Psychological interventions in general appeared to have a significant effect on recovery (oddsratio: 3.01) and on the reduction of the depressive symptoms (standardized effect size: -0.90). Cognitive behaviour therapy had been especially thoroughly investigated; there was no convincing evidence that this type of therapy was more effective than other psychological treatments. Minimal psychological interventions also had major effects. Psychological treatment was also effective in children and adolescents. Treatment with antidepressants alone was less effective than combined therapy with antidepressants and psychological intervention. There were no indications that the drop-out rate during psychotherapy was different from that in controls. CONCLUSION: There is much empirical support for the efficacy of psychological treatment of patients with depressive disorders.

Adolescent↗
PubMed2005

Course and prognosis of elbow complaints: a cohort study in general practice.

OBJECTIVE: To describe the course of new episodes of elbow complaints in general practice, and to identify predictors of short term and long term outcome in terms of pain intensity and functional disability. METHODS: 181 patients with elbow complaints filled in questionnaires at baseline and at 3, 6, and 12 months of follow up. Baseline scores of pain and disability, characteristics of the complaint, sociodemographic and psychosocial factors, physical activity, general health, and comorbidity were investigated as possible predictors of outcome. Outcome measures were analysed separately using multiple regression analyses. RESULTS: 13% of the patients reported recovery at the 3 month follow up and 34% at 12 months. Irrespective of outcome and length of follow up, a longer duration of the complaint before consulting the general practitioner, having musculoskeletal comorbidity, and using "retreating" as coping style increased the likelihood of an unfavourable outcome. Less social support was associated with an unfavourable outcome at 3 months, and having a history of elbow complaints and using "worrying" as coping style were associated with an unfavourable outcome at 12 months. The explained variance of the models ranged from 46% to 49%. CONCLUSIONS: Recovery of patients with elbow complaints in general practice was poor. Besides characteristic of the complaint, passive coping and less social support were related to a worse prognosis. The results of this study may help general practitioners to provide patients with more accurate information about their prognosis.

Adaptation, Psychological↗
PubMed2005

Manual therapy in osteoarthritis of the hip: outcome in subgroups of patients.

OBJECTIVE: To investigate whether manual therapy has particular benefit in subgroups of patients defined on the basis of hip function, range of joint motion, pain and radiological deterioration. METHODS: The study was performed in the out-patient clinic of physical therapy of a large hospital. Data on 109 patients with OA of the hip (clinical ACR criteria) participating in a randomized clinical trial on the effects of manual therapy were used. The outcomes for hip function (Harris hip score), range of joint motion (ROM) and pain (VAS) were compared for specific subgroups. Subgroups were assigned by the median split method. The interaction effect between subgroup and treatment was tested using multiple regression analysis. RESULTS: No differences were observed in the effect of manual therapy in specific subgroups of patients defined on the basis of baseline levels of hip function, pain and ROM. On the basis of radiological grading of osteoarthritis (OA), we found that patients with severe radiological grading of OA had significantly worse outcome on ROM as a result of manual therapy than patients with mild or moderate radiological grading of OA. CONCLUSION: A significant interaction effect was found for only 1 out of 12 hypotheses investigated. Therefore, we conclude that there is no evidence for the particular benefit of manual therapy in subgroups of patients.

Aged↗
PubMed2005

Dose-effect relations in time-limited combined psycho-pharmacological treatment for depression.

BACKGROUND: A limited number of psychotherapy sessions in combination with medication is preferable to pharmacotherapy only in the treatment of ambulatory patients with major depression. Whether there is a relation between the number of sessions and the efficacy of the treatment is uncertain. METHOD: Randomized clinical trial comparing two treatment conditions in outpatients with major depression. All patients studied had a baseline score of at least 14 points on the 17-item Hamilton Depression Rating Scale. The two conditions consist of 8-session or 16-session Short Psychodynamic Supportive Psychotherapy, both in combination with pharmacotherapy. Efficacy was assessed using the 17-item HDRS, the CGI of Severity and of Improvement, the depression subscale of the SCL-90 and the Quality of Life Depression Scale. RESULTS: The rate of change would seem to indicate that eight sessions are preferable for both moderately and severely depressed patients, although the results converged again at the end. Furthermore, in terms of satisfaction with the number of sessions and drop-out percentages during treatment, no differences were found between the conditions. CONCLUSION: In the light of the outcome analysis (faster remission after fewer sessions), a short version of the psychotherapy treatment in a combined course of treatment seems to be justified.

Adolescent↗
PubMed2005

Incidence and prevalence of complaints of the neck and upper extremity in general practice.

OBJECTIVE: To study the incidence and prevalence of neck and upper extremity musculoskeletal complaints in Dutch general practice. METHODS: Data were obtained from the second Dutch national survey of general practice. In all, 195 general practitioners (GPs) from 104 practices across the Netherlands recorded all contacts with patients during 12 consecutive months. Incidence densities and consultation rates were calculated. RESULTS: The total number of contacts during the registration period of one year was 1 524 470. The most commonly reported complaint was neck symptoms (incidence 23.1 per 1000 person-years), followed by shoulder symptoms (incidence 19.0 per 1000 person-years). Sixty six GP consultations per 1000 person-years were attributable to a new complaint or new episode of complaint of the neck or upper extremity (incidence density). In all, the GPs were consulted 147 times per 1000 registered persons for complaints of the neck or upper extremity. For most complaints the incidence densities and consultation rates were higher for women than for men. CONCLUSIONS: Neck and upper extremity symptoms are common in Dutch general practice. The GP is consulted approximately seven times each week for a complaint relating to the neck or upper extremity; of these, three are new complaints or new episodes. Attention should be paid to training GPs to deal with neck and upper limb complaints, and to research on the prognosis and treatment of these common complaints in primary care.

Adolescent↗
PubMed2005

The reproducibility of the Canadian Occupational Performance Measure.

OBJECTIVE: To assess the reproducibility (reliability and inter-rater agreement) of the client-centred Canadian Occupational Performance Measure (COPM). DESIGN: The COPM was administered twice, with a mean interval of seven days (SD 1.6, range 4-14), by two different occupational therapists. Data analysis was based on intraclass correlation coefficients, the Bland and Altman method and Cohen's weighted kappas. SETTING: Occupational therapy departments of two university medical centres. SUBJECTS: Consecutive clients, with various diagnoses, newly referred to the outpatient clinic of two occupational therapy departments, were included. They were all over 18 years of age and perceived limitations in more than one activity of daily life. Complete data on 95 clients were obtained: 31 men and 64 women. RESULTS: Sixty-six per cent of the activities prioritized at the first assessment were also prioritized at the second assessment. The intraclass correlation coefficients were 0.67 (95% confidence interval (CI) 0.54-0.78) for the mean performance score and 0.69 (95% CI 0.56-0.79) for the mean satisfaction score. The limits of agreement were -2.5 to 2.4 for the mean performance score and -2.3 to 2.7 for the mean satisfaction score. For the separate prioritized problems, the weighted kappas ranged from 0.37 to 0.49. CONCLUSIONS: Inter-rater agreement of the prioritized problems was moderate. The reproducibility of the mean performance and satisfaction scores was moderate, but it was poor for the scores of the separate problems. Therefore, the mean scores should be used for individual assessment.

Activities of Daily Living↗
PubMed2004

Occupational therapy for rheumatoid arthritis.

BACKGROUND: For persons with rheumatoid arthritis (RA) the physical, personal, familial, social and vocational consequences are extensive. Occupational therapy (OT), with the aim to facilitate task performance and to decrease the consequences of rheumatoid arthritis for daily life activities, is considered to be a cornerstone in the management of rheumatoid arthritis. Till now the efficacy of occupational therapy for patients with rheumatoid arthritis on functional performance and social participation has not been systematically reviewed. OBJECTIVES: To determine whether OT interventions (classified as comprehensive therapy, training of motor function, training of skills, instruction on joint protection and energy conservation, counseling, instruction about assistive devices and provision of splints) for rheumatoid arthritis patients improve outcome on functional ability, social participation and/or health related quality of life. SEARCH STRATEGY: Relevant full length articles were identified by electronic searches in Medline, Cinahl, Embase, Amed, Scisearch and the Cochrane Musculoskeletal group Specialised Register. The reference list of identified studies and reviews were examined for additional references. Date of last search: December 2002. SELECTION CRITERIA: Controlled (randomized and non-randomized) and other than controlled studies (OD) addressing OT for RA patients were eligible for inclusion. DATA COLLECTION AND ANALYSIS: The methodological quality of the included trials was independently assessed by two reviewers. Disagreements were resolved by discussion. A list proposed by Van Tulder et al. (Van Tulder 1997) was used to assess the methodological quality. For outcome measures, standardized mean differences were calculated. The results were analysed using a best evidence synthesis based on type of design, methodological quality and the significant findings of outcome and/or process measures. MAIN RESULTS: Thirty-eight out of 58 identified occupational therapy studies fulfilled all inclusion criteria. Six controlled studies had a high methodological quality. Given the methodological constraints of uncontrolled studies, nine of these studies were judged to be of sufficient methodological quality. The results of the best evidence synthesis shows that there is strong evidence for the efficacy of "instruction on joint protection" (an absolute benefit of 17.5 to 22.5, relative benefit of 100%) and that limited evidence exists for comprehensive occupational therapy in improving functional ability (an absolute benefit of 8.7, relative benefit of 20%). Indicative findings for evidence that "provision of splints" decreases pain are found (absolute benefit of 1.0, relative benefit of 19%). REVIEWER'S CONCLUSIONS: There is evidence that occupational therapy has a positive effect on functional ability in patients with rheumatoid arthritis.

Arthritis, Rheumatoid↗
PubMed2004

Prescription of technical aids by general practitioners in the Netherlands.

This study focused on the allocation of technical aids, in particular which technical aids general practitioners (GPs) prescribe for what patients. Data was collected by 64 Dutch GPs participating in a nationwide representative sentinel practice network. The GPs gathered information on type of technical aid prescribed, patient characteristics, and diagnosis (coded according to the International Classification of Primary Care (ICPC)). The most frequently prescribed technical aids include incontinence supplies, anti-oedema stockings, and rollators. The number of prescribed technical aids increased strongly with the age of the patients and almost all technical aids were prescribed more often for women than for men. Most technical aids were prescribed based on the initiative of the patients. The GPs made a wide range of diagnoses in the prescription of technical aids. Diagnoses involving the musculoskeletal system, the circulatory system, and the urinary system were the most frequently made. Implications of these findings for policy and further research are discussed.

Female↗