Moving instead of asking? performance-based tests and BASFI-questionnaire measure different aspects of physical function in ankylosing spondylitis

INTRODUCTION: Ankylosing Spondylitis (AS) is characterised by limitations in physical function. The Bath Ankylosing Spondylitis Functional Index (BASFI) is considered to be the gold-standard to assess physical function in AS patients. However, the BASFI questionnaire is a self-reported outcome measure and susceptible to subjective interpretation (under- or over-estimation). More objective outcome measures, like performance-based tests, could provide an objective outcome measurement for the evaluation of limitations in physical function. Therefore, the primary aim of this study was to determine the association between performance-based measures and the BASFI questionnaire. METHODS: In this cross-sectional study 126 AS patients completed the BASFI questionnaire and eight performance-based tests based on BASFI-items. Each test received three scores: one for performance (time or points) and a score for exertion and pain experienced during performance (using modified Borg-scale and VAS 0-100 mm, respectively). Linear regression analyses were used to assess the associations between the BASFI questionnaire and performance-based tests. RESULTS: The univariable association between performance and BASFI-score was moderate with a R-square of 0.31 and Beta of 0.56 (p's < 0.05). In a multivariable analysis, the association between performance, exertion and pain on the one hand and BASFI-score on the other was assessed; R-square increased to 0.54: the Beta's for exertion and pain during performance were 0.38 and 0.26, respectively; the Beta for performance decreased to 0.19 (p's < 0.05). CONCLUSIONS: This study demonstrates that alongside actual performance, patients seem to incorporate exertion and pain in their assessment of perceived physical function on the BASFI questionnaire. Performance-based tests could provide an objective outcome measurement for the evaluation of physical function and give relevant new information in addition to the BASFI questionnaire

Biomechanical mechanisms underlying treatment effects of exercise therapy in patients with knee osteoarthritis: data from a randomized controlled trial

The aim of this paper is to briefly show the importance of the spatial organisation and of the temporal evolution of road transport in Belgium (freight, passengers). Attention is particularly put on the negative externalities produced by this transportation mode type (pollution, road damages, road accidents).L'objectif de cet article est de montrer brièvement l'importance de l'organisation spatiale et de l'évolution temporelle du transport routier de marchandises et de passagers en Belgique. Une attention particulière est portée aux externalités négatives produites par ce mode de transport (pollution, dégradations routières, accidents de la route).Het opzet van deze bijdrage bestaat erin om op een beknopte wijze het belang aan te tonen van de ruimtelijke organisatie en evolutie doorheen de tijd van het wegtransport in België (perso-nen zowel als vracht). Er is ook aandacht besteed aan negatieve externaliteiten veroorzaakt door dit type van transportmodus.Thomas Isabelle, Verhetsel Ann. Transport routier et mobilité durable : un état de la question pour la Belgique. In: Hommes et Terres du Nord, 1999/3. La Belgique. pp. 198-204

Structural joint changes, malalignment, and laxity in osteoarthritis of the knee

OBJECTIVE: To assess the relationship between (i) structural joint changes (i.e. joint space narrowing and osteophyte formation) and laxity and (ii) joint malalignment and laxity in osteoarthritis (OA) of the knee. METHODS: A cross-sectional study was carried out on 35 outpatients with osteoarthritis of the knee. Weight-bearing radiographs of the knees were used to assess joint space narrowing (JSN) and osteophyte formation. Knee joint laxity was assessed using a device that measures the angular deviation of the knee in the frontal plane (varus-valgus laxity). Malalignment was assessed using a goniometer. All analyses were performed using knees as units of analysis (i.e. 70 knees). RESULTS: The mean laxity of 70 knees was 8.0+/-4.1 degrees. Knees with minute JSN were significantly more lax than knees with no JSN. There was no significant relationship between osteophyte formation and laxity. Malaligned knees were significantly more lax than aligned knees. CONCLUSION: Both joint space narrowing and malalignment are related to laxity. These results support the premise that biomechanical factors play a role in the degeneration of the osteoarthritic knee join

Osteoarthritis of the hip or knee: which coexisting disorders are disabling?

Exercise therapy is generally recommended in osteoarthritis (OA) of the hip or knee. However, coexisting disorders may bring additional impairments, which may necessitate adaptations to exercise for OA of the hip or knee. For the purpose of developing an adapted protocol for exercise therapy in OA patients with coexisting disorders, information is needed on which specific coexisting disorders in OA are associated with activity limitations and pain. To describe the relationship between specific coexisting disorders, activity limitations, and pain in patients with OA of the hip or knee, a cross-sectional cohort study among 288 older adults (50-85 years of age) with OA of hip or knee was conducted. Subjects were recruited from three rehabilitation centers and two hospitals. Demographic data, clinical data, information about coexisting disorders (i.e., comorbidity and other disorders), activity limitations (WOMAC: physical functioning domain), and pain (visual analogue scale (VAS)) were collected by questionnaire. Statistical analysis included descriptive statistics and multivariate regression analysis. Coexisting disorders associated with activity limitations were chronic back pain or hernia, arthritis of the hand or feet, and other chronic rheumatic diseases (all musculoskeletal disorders); diabetes and chronic cystitis (non-musculoskeletal disorders); hearing impairments in a face-to-face conversation, vision impairments in long distances, and dizziness in combination with falling (all sensory impairments); and overweight and obesity. Coexistent disorders associated with pain were arthritis of the hand or feet, other chronic rheumatic diseases (musculoskeletal disorders), and diabetes (non-musculoskeletal disorder). Specific disorders coexisting next to OA and associated with additional activity limitations and pain were identified. These coexisting disorders need to be addressed in exercise therapy and rehabilitation for patients with OA of the hip or knee.(aut. ref.

Measurement properties of the Dutch version of the Western Ontario Shoulder Instability Index (WOSI)

Optimising joint reconstruction management in arthritis and bone tumour patient

WOMAC-pf as a measure of physical function in patients with Parkinson's disease and late-onset sequels of poliomyelitis: unidimensionality and item behaviour

Item does not contain fulltextPURPOSE: To assess psychometric properties of the Western Ontario and MacMasters Universities Osteoarthritis Index (WOMAC)-pf, an osteoarthritis (OA)-specific questionnaire used to establish the level of physical functioning in patients with late-onset sequels of poliomyelitis (LOSP) and Parkinson's disease (PD). STUDY DESIGN AND SETTING: Unidimensionality (using principal component analyses [PCA] and Rasch analyses) was separately established for three diagnostic groups: OA (n = 288), LOSP (n = 168) and PD (n = 200). Additionally, differential item functioning (DIF) among the three diagnostic groups was assessed using ordinal regression (Polytomous Universal Model) analyses. Baseline data were used from an ongoing cohort study of these three patient populations. RESULTS: Unidimensionality was adequate, with all items loading on the first principal component. The Rasch analyses revealed that item fit was generally good. Uniform and non-uniform DIF were found to be present among the three diagnostic groups in three and one of the 17 physical functioning subscale (WOMAC-pf) items, respectively. CONCLUSION: The WOMAC-pf is a unidimensional measure of physical functioning in patients with LOSP and PD, in addition to its established use in OA. [IMPLICATIONS FOR REHABILITATION:* Disability in physical functioning related to mobility(walking, stair climbing, etc.) is a common feature of many chronic diseases, including osteoarthritis, late-onset sequels of poliomyelitis and Parkinson's disease.* In this study, the Western Ontario and MacMasters Universities Osteoarthritis Index-pf was shown to bea useful and adequate tool to assess physical functioning in these patient groups.* The study highlighted that, despite differences in diagnosis,history and course of the disease, patients with different conditions experience similar disabilities in their physical functioning.

Fatigue in patients with chronic widespread pain participating in multidisciplinary rehabilitation treatment: a prospective cohort study

Purpose: To explore the associations between (improvement in) fatigue and (improvement in) clinical and cognitive factors in patients with chronic widespread pain (CWP), participating in multidisciplinary rehabilitation treatment. Methods: Data were used from baseline, 6 and 18 months of follow-up during a prospective cohort study of 120 CWP patients who completed multidisciplinary rehabilitation treatment. Cross-sectional and longitudinal relationships were analyzed between fatigue, clinical (i.e. pain, interference of pain and depression) and pain related cognitive factors (i.e. negative emotional cognitions, active cognitive coping, and control and chronicity beliefs). Results: Higher levels of pain, interference of pain, depression, negative emotional cognitions, and negative control and chronicity beliefs were associated with a higher level of fatigue. Improvement in depression was related to improvement in fatigue. Conclusions: In CWP patients, worse clinical status, and dysfunctional pain-related cognitions are associated with a higher level of fatigue. Our results suggest that improvement in depression might be a mechanism of improvement in fatigue. Furthermore, improvement in fatigue seems to be independent of improvement in pain related cognitions. Targeting fatigue in multidisciplinary pain treatment may need specific strategies.Implications for RehabilitationImprovement in depression may be a mechanism of change to improve the level of fatigue in CWP.Improvement in dysfunctional (pain related) cognitions seems to be independent of improvement in fatigue.Targeting fatigue in multidisciplinary treatment may need specific strategies (e.g. additional interventions focusing on reducing fatigue and specific attention to improvement of sleep)