Effect of an education programme for patients with osteoarthritis in primary care - a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Osteoarthritis (OA) is a degenerative disease, considered to be one of the major public health problems. Research suggests that patient education is feasible and valuable for achieving improvements in quality of life, in function, well-being and improved coping. Since 1994, Primary Health Care in Malmö has used a patient education programme directed towards OA. The aim of this study was to evaluate the effects of this education programme for patients with OA in primary health care in terms of self-efficacy, function and self-perceived health.</p> <p>Method</p> <p>The study was a single-blind, randomized controlled trial (RCT) in which the EuroQol-5D and Arthritis self-efficacy scale were used to measure self-perceived health and self-efficacy and function was measured with Grip Ability Test for the upper extremity and five different functional tests for the lower extremity.</p> <p>Results</p> <p>We found differences between the intervention group and the control group, comparing the results at baseline and after 6 months in EuroQol-5D (p < 0.001) and in standing one leg eyes closed (p = 0.02) in favour of the intervention group. No other differences between the groups were found.</p> <p>Conclusion</p> <p>This study has shown that patient education for patients with osteoarthritis is feasible in a primary health care setting and can improve self-perceived health as well as function in some degree, but not self-efficacy. Further research to investigate the effect of exercise performance on function, as well as self-efficacy is warranted.</p> <p>Trial registration</p> <p>The trial is registered with ClinicalTrials.gov. Registration number: NCT00979914</p

Feasibility of a combined aerobic and strength training program and its effects on cognitive and physical function in institutionalized dementia patients. A pilot study

OBJECTIVES: We examined the feasibility of a combined aerobic and strength training program in institutionalized dementia patients and studied the effects on cognitive and physical function. METHODS: Thirty-three patients with dementia, recruited from one nursing home, participated in this non-randomized pilot study (25 women; age = 85.2±4.9 years; Mini Mental State Examination = 16.8±4.0). In phase 1 of the study, seventeen patients in the Exercise group (EG) received a combined aerobic and strength training program for six weeks, five times per week, 30 minutes per session, in an individually supervised format and successfully concluded the pre and posttests. In phase 2 of the study, sixteen patients in the Social group (SG) received social visits at the same frequency, duration, and format and successfully concluded the pre and posttests. RESULTS: Indices of feasibility showed that the recruitment and adherence rate, respectively were 46.2% and 86.3%. All EG patients completed the exercise program according to protocol without adverse events. After the six-week program, no significant differences on cognitive function tests were found between the EG and SG. There was a moderate effect size in favor for the EG for the Visual Memory Span Forward; a visual attention test. There were significant differences between groups in favor for the EG with moderate to large effects for the physical tests Walking Speed (p = .003), Six-Minute Walk Test (p = .031), and isometric quadriceps strength (p = .012). CONCLUSIONS: The present pilot study showed that it is feasible to conduct a combined aerobic and strength training program in institutionalized patients with dementia. The selective cognitive visual attention improvements and more robust changes in motor function in favor of EG vs. SG could serve as a basis for large randomized clinical trials. TRIAL REGISTRATION: trialregister.nl 1230

Separate physical tests of lower extremities and postural control are associated with cognitive impairment. Results from the general population study Good Aging in Sk&aring;ne (G&Aring;S-SNAC)

Eva Bramell-Risberg,1 Gun-Britt Jarnlo,2 S&ouml;lve Elmst&aring;hl11Division of Geriatric Medicine, 2Division of Physiotherapy, Department of Health Sciences, Lund University, Lund, SwedenPurpose: To investigate whether separate physical tests of the lower extremities, that assess movement speed and postural control, were associated with cognitive impairment in older community-dwelling subjects.Subjects and methods: In this population-based, cross-sectional, cohort study, the following items were assessed: walking speed, walking 2 &times; 15 m, Timed Up and Go (TUG) at self-selected and fast speeds, one-leg standing, and performance in step- and five chair-stand tests. The study comprised 2115 subjects, aged 60&ndash;93 years, with values adjusted for demographics, health-related factors, and comorbidity. Global cognitive function was assessed using the Mini-Mental State Examination (MMSE), and cognitive impairment was defined by the three-word delayed recall task of the MMSE. Subjects who scored 0/3 on the three-word delayed recall task were defined as cases (n = 328), those who scored 1/3 were defined as intermediates (n = 457), and the others as controls (n = 1330).Results: Physical tests performed rapidly were significantly associated with cognitive impairment; this was the case in increased time of five chair stands (P = 0.009, odds ratio [OR] = 1.03), TUG (P &lt; 0.001, OR = 1.11) and walking 2 &times; 15 m (P &lt; 0.001, OR = 1.05). Inability to stand on one leg for 10 seconds was associated with increased risk of being a case (P &lt; 0.001, OR = 1.78), compared to those able to stand for 30 seconds or longer. More steps during the step test (P &lt; 0.001, OR = 0.95) and higher fast walking speed (P &lt; 0.001, OR = 0.51) were associated with lower risk of being a case.Conclusion: Slower movements and reduced postural control were related to an increased risk of being cognitively impaired. All tests that were performed rapidly were able to separate cases from controls. These findings suggest that physical tests that are related to lower extremity and postural control, emphasizing velocity, might be useful in investigating relationships between physical and cognitive function; furthermore, they can be used to complement cognitive impairment diagnoses.Keywords: cognition, movement speed, TUG, walkin

The American paediatric evaluation of disability inventory (PEDI). Applicability of PEDI in Sweden for children aged 2.0-6.9 years

The American Paediatric Evaluation of Disability Inventory (PEDI) is a new instrument for evaluating functional performance in disabled children aged 6 months to 7.5 years. It was developed to determine a child's functional capacity and performance in three domains, self-care, mobility and social function, as reflected in scores on three scales: (i) functional skills (current capability in specific tasks), (ii) caregiver assistance (i.e. provided to facilitate the child's performance), and (iii) modifications (i.e. environmental or technical modifications needed to facilitate the child's function). The present study was designed to compare results obtained using the PEDI in a Swedish sample with the American normative data, and to analyse the content and relevance of PEDI items for use in Sweden. The PEDI was administered as a questionnaire in structured interview form to the parents of 52 non-disabled Swedish children aged 2.0- 6.9 years, divided into ten age groups. Correlation analysis (Pearson's r) showed scores for the Swedish sample to manifest strong correlation with the respective American normative data, both for the functional skills (r = 0.90- 0.98) and caregiver assistance (r = 0.93-0.99) scales, respectively. Scores for the modification scale were not compared. Thus, the results suggest the American normative data to be appropriate for reference purposes in Sweden

Aberrations in postural control, vibration sensation and some vestibular findings in healthy 64-92-year-old subjects

To assess changes in postural control among healthy elderly and to correlate with suspected age-related events, 33 women and 16 men were studied. Postural control was evaluated by vibration-induced body sway, measured on a force platform, and vibration sensation was tested with a tuning fork. Occurrence of spontaneous gaze and head-shake-induced nystagmus was observed with infrared charged couple device (CCD) cameras and the subjects' medical history was reviewed. Vibration perception was the major determinant for the magnitude of body sway. Although these senior citizens considered themselves healthy, they had a variety of ailments in their medical history, diminished vibration sensation and a high prevalence of vestibular asymmetry. Age per se was not a determinant factor in any of the findings. The study suggests that interest should also be directed to the status of sensation in the legs and vestibular asymmetry when assessing balance function in the elderly. Furthermore, the term "age concomitant" may be more appropriate than "age dependent" when describing decrements of functions such as postural control in elderly subjects