Limitations In Everyday Activities Research Articles

Life-course Factors and Later Life Health in Eastern and Western Europe

Human development and ageing are lifelong processes, where earlier life conditions and events are interlinked with later life outcomes. Patterns of inequality within and among cohorts emerge over time as products of the interplay between institutional arrangements and individual life, often dependent on childhood or earlier life circumstances. The life conditions and experiences of older adults in Eastern and Western Europe differ significantly, but whether their cumulative effects on later life outcomes vary across these two regions has not been compared. We explore the effects of socioeconomic position, the experience of a period of hunger, the dispossession of assets, and discrimination suffered by parents in respondents’ life courses on later life health inequalities in Europe. Self-reported health, everyday activity limitations, and cognitive functioning are the main outcomes that provide an adequate overview of different health domains. We mainly use data from the seventh wave of the Survey of Health, Ageing, and Retirement in Europe (SHARE 2017) and restrict our sample to respondents aged 65 and older from 26 European countries (N=41,566). We find that older people in Eastern Europe fare worse in self-rated health and everyday activity limitations than Western Europeans, while Eastern Europeans indicate somewhat better outcomes in cognitive functioning. A disadvantaged socioeconomic position in childhood and adulthood has the strongest association with all health outcomes, followed by the experience of hunger over the life course for the whole of Europe. However, we do not find diverging associations between life-course factors and health outcomes in Eastern and Western Europe. We argue that self-reported health, everyday activity limitations and cognitive functioning have to be analysed within their own frameworks and cannot yield conclusions that are uniform for all health outcomes. Moreover, major generalisations either about Eastern or Western Europe must be treated with caution as the regions have very different historical as well as demographic developments and thus cannot be treated as uniform. * This article belongs to a special issue on “Demographic Developments in Eastern and Western Europe Before and After the Transformation of Socialist Countries”.

Long-Term Functional Outcomes After Surgery of Functional Popliteal Artery Entrapment Syndrome

Functional popliteal artery entrapment syndrome (fPAES) is a subtype of PAES without anatomic abnormalities entrapment of the popliteal artery. One of the management of symptomatic fPAES is surgical exploration of the popliteal region with popliteal artery release with lysis of fibrous bands. There is a lack of data regarding the long term functional results of this surgery, most of the studies focusing on vascular patency in anatomical PAES. The aim of this study was to assess the efficacy of surgery in functional PAES, focusing on long term physical activity return after surgery with the Tegner activity scale. All patients that underwent surgery for fPAES from January 1st 2010 to December 31th 2020 were searched. After ethical approved, all patients were called to evaluate physical activity since surgery. The Tegner activity scale is a numerical scale with each value (0 to 10) representing specific activity. The aim was to evaluate everyday activity limitations and participation restriction after surgery. The results for each patient were recorded: « before symptoms », « before surgery » and « after surgery ». Over the study period, 33 patients were included with 61 symptomatic legs. The mean time between surgery and phone call was 38.6± 21.9 months. The median score of the Tegner activity scale "before symptoms" was 7 (4-7), the median score "before surgery" was 3 (2-3) and the median score at the time of the phone call, "after surgery" was 5 (3-7). P-value was <0.0001 by comparing results "before surgery" and "after surgery". Results demonstrated that the sport activity and intensity level is significantly higher after surgery even if patients did not reach their initial sport activity level.

Determine the Functional Limitations in Activities of Daily Living Through Short Physical Performance Battery Test Among Asthmatic Adults

Background: To determine the functional restrictions in functional activities of daily lives in middle aged asthmatic adults and association of BMI with limitations in their daily life activities. Method: An observational cross sectional study was carried out at pulmonology opd of Shalamar hospital. A sample of 36 diagnosed asthmatic adults of middle aged with moderate to severe allergic asthma was taken. A Purposive sampling technique was used to conduct the study. Prediction of functional limitations in everyday activities through Short Physical Performance Battery test was determined. Three series of tests named balance test, gait speed test, repeated chair stand test were conducted which were the part of short physical performance battery test. Each test scored 4 and there was the total of 12 score. Those subjects who had less than 10 score were at risk of limitations in their daily life activities in future. Result: Sample of 30 participants were included for this study from age 35 to 55. Out of which 13 participants were of normal weight with BMI of less than 23.9 and 17 were overweight with the BMI ranges from 24.0 to 30.0. Participants with greater BMI were at the high risk of mortality. The results showed that the 13 subjects were overweight had the high risk of mortality, 13 had the risk of functional limitations in activities of daily living and 4 had the good functional status. There was statistical difference between the BMI and Short Physical Performance Battery test score. (P value= 0.001) Conclusion: This study concluded that middle aged asthmatic adults with moderate allergic asthma had greater risk of functional limitations and high risk of mortality due to the disease effect. This study also showed that the predictive value of functional limitations was more pronounced in females with greater BMI than males. Keywords: Allergic asthma, Activities of daily living, Functional Limitations, Short Physical Performance Battery test,

Temporomandibular Joint Disorders in Females with Adolescent Idiopathic Scoliosis: Long-Term Effects of Milwaukee Brace Treatment.

Patients with adolescent idiopathic scoliosis (AIS) more frequently suffer dysfunctions of dento-skeletal complex. To our knowledge, no study has ever evaluated the temporomandibular joint disorders (TMD) of AIS patients at least 23 years after the completion of Milwaukee brace treatment. We aimed to provide a complex assessment of TMD and AIS patients treated with a Milwaukee brace, in a minimum 23-year follow-up, using radiological, clinical, and socio-demographical data, and to adapt the TMD Disability Index Questionnaire (TMDQ) and Fonseca’s questionnaire (FQ) to Polish conditions. In total, 42 healthy females and 30 AIS patients with a minimum of 23 years after a completed Milwaukee brace treatment were asked to complete the Polish version of (TMDQ-PL) and (FQ-PL). AIS patients present higher TMD levels than healthy controls. Significant differences exist between TMDQ-PL and FQ-PL (both in total scores and particular sub-sections), and AIS patients. Clinical and radiological factors affected the TMDQ-PL and FQ-PL results. Adult patients with scoliosis treated conservatively present limitations in everyday activities connected with the temporomandibular joint (TMJ). The variety of curve-related factors in a long-term follow-up of wearing the Milwaukee brace influence TMJ.

Prediction of Shoulder Stiffness After Arthroscopic Rotator Cuff Repair

Background: Postoperative shoulder stiffness (POSS) is a prevalent adverse event after arthroscopic rotator cuff repair (ARCR) that is associated with major limitations in everyday activities and prolonged rehabilitation. Purpose/Hypothesis: The purpose was to develop a predictive model for determining the risk of POSS within 6 months after primary ARCR. We hypothesized that sufficient discrimination ability of such a model could be achieved using a local institutional database. Study Design: Case-control study; Level of evidence, 3. Methods: Consecutive primary ARCRs documented in a local clinical registry between 2013 and 2017 were included, and patients who experienced POSS before the final clinical 6-month follow-up were identified. A total of 29 prognostic factor candidates were considered, including patient-related factors (n = 7), disease-related factors (n = 9), rotator cuff integrity factors (n = 6), and operative details (n = 7). We used imputed data for the primary analysis, and a sensitivity analysis was conducted using complete case data. Logistic regression was applied to develop a model based on clinical relevance and statistical criteria. To avoid overfitting in the multivariable model, highly correlated predictors were not included together in any model. A final prognostic model with a maximum of 8 prognostic factors was considered. The model’s predictive accuracy was assessed by the area under the receiver operating characteristic curve (AUC). Internal validation was performed using bootstrapping. Results: Of 1330 ARCR cases (N = 1330 patients), 112 (8.4%) patients had POSS. Our final model had a moderate predictive ability with an AUC of 0.67. The predicted risks of POSS ranged from 2.3% to 38.9% and were significantly higher in women; patients with partial tears, low baseline passive shoulder abduction, and lack of tendon degeneration; and when no acromioplasty was performed. Conclusion: A prognostic model for POSS was developed for patients with ARCR, offering a personalized risk evaluation to support the future decision process for surgery and rehabilitation.

Everyday activities at home: Experiences of older repeatedly readmitted people

Introduction Limitations in everyday activities are a risk factor for hospital readmission. Despite this, few studies have focussed on everyday activities of repeatedly readmitted older people. The experiences and specific needs of this group have been poorly described regarding their everyday activities at home. A deeper understanding may help occupational therapists and other health professions to facilitate readiness for this group at and after discharge. The aim of this study was, therefore, to describe the experiences of performing everyday activities of older people repeatedly readmitted to hospital and discharged to home. Methods A qualitative interview study was used to collect data from sixteen participants (75 years and older). Data were analysed using qualitative content analysis. Results One theme ‘trying to manage an unpredictable everyday life’ and two categories describe experiences of everyday activities at home. The participants expressed the importance of continuing everyday activities after discharge where support from relatives and healthcare seemed to be of importance. Conclusion It was found that performance of everyday activities and contact with family members were of importance in their everyday life. Therefore, assessments and support were of particular importance for the group of older people who do not have close social relations at home.

Quality of life of cervical cancer patients after specialized treatment in Kazakhstan.

e18024 Background: In Kazakhstan cervical cancer (CC) ranks 2nd in morbidity and mortality among women with malignant neoplasms. 88% of women are diagnosed in stages 1-2. Age range of patients with cervical cancer is becoming younger with women age 35-55 years old. This urges implementation of an effective system for assessing and maintaining the quality of life of people with CC who undergo special treatment. Methods: During study we used The EORTC quality of life questionnaire (QLQ C-30) Version 3.0 on 157 patients with stage 1-2 CC, 1+ year after chemoradiotherapy (CRT, n = 65) and surgical treatment (ST, n = 92). For statistical analysis, we used the Wilcoxon rank-sum test and the chi-square test using SPSS version 22.0. Results: When analyzing limitations in everyday activities (work etc) (sign 1), 13.8% -18.5% of patients with cervical cancer noted “significant” and “very strong” impact on quality of life after CRT compared with 1.1% - 3.3% of patients after ST (p &lt; 0.001). Study showed that there is a strong correlation between treatment method and quality of life (table 1). 35.4% of patients after CRT have noted “significant” difficulties in carrying out work requiring a higher level of physical effort (sign 2). In contrast, only 16.3% of patients after ST noted “significant” difficulties, which is 2.2 times less (p &lt; 0.006). Assessment revealed a moderate quantitative correlation (table 1). 16.9% of patients after CRT noted severe pain (sign 3) compared with 2.2% of patients who received ST (p &lt; 0.001). Assessment revealed a moderate quantitative correlation (table 1). Absence of feeling of weakness (sign 4) was greater among patients from the ST group - 21.7% compared with CRT - 9.2% (p &lt; 0.03). Assessment revealed a strong quantitative correlation (table). 15.4% of patients after CRT, compared with 2.2% of patients who received ST (p &lt; 0.001) have noted that their physical condition and treatment had a “very strong” impact on their personal life (sign 5). Conclusions: Assessment revealed that CC patients who received CRT showed lower physical and social indicators of quality of life. [Table: see text]

Effect of Using Additional Readers for Flash Glucose Monitoring System on Metabolic Control, Safety, and the Incidence of Complications in Patients With Diabetes Mellitus.

The FreeStyle Libre is a flash glucose monitoring (FGM) system, and glucose levels are measured when the reader is brought to the sensor. Additional readers allow for the conversion into a continuous glucose monitoring (CGM) system. These transmitters read data from the sensor and send them to a bluetooth-enabled device thanks to which the user acquires glucose measurements automatically. This modification allows the patient to receive alerts when blood glucose values are abnormal. The study relied on the results of an anonymous online survey conducted among patients with diabetes or their caregivers who use Facebook groups. A total of 132 respondents who met certain criteria (diabetic who use FGM system longer than 3 months, at least 14 days per month) were enrolled in the study. A significant decrease in self-reported glycated hemoglobin levels was found in adults and children using readers (variable: age P = .008; time P < .001), regardless of the age. The use of additional readers was associated with a significant decrease in the number of self-reported episodes of hypoglycemia (P < .001) and an improvement in the quality of life (based on self-reported limitations in everyday activities, social contacts, work/school, or doing sports). The use of additional readers for FGM system improves the metabolic control of diabetes and the quality of life, and has a positive effect on the safety of treatment. Flash glucose monitoring used together with additional readers operates as a CGM system and seems to be helpful for patients for the monitoring of interstitial levels of glucose; however, they should be careful when they use do it yourself solution.

Factors associated with incidence of depressiveness among the middle-aged and older Estonian population.

Objective:Relatively scant research among older Estonian population describes factors associated with the incidence of depressive symptoms. This study identifies factors associated with the incidence of depressiveness among middle-aged and older Estonians over 2- and 4-year periods.Method:In this cross-sectional analysis, logistic regression models are used to identify the factors associated with the incidence of depressiveness over 2- and 4-year periods. The data were drawn from the Survey of Health, Ageing and Retirement in Europe (SHARE) 2011–2015 which included Estonian population aged 53 years and older in 2013. After excluding those younger than 53 years, not interviewed 2 years later, those with depressive symptoms at baseline in 2013, and missing values for depressiveness or other variables, our analytical sample comprised 2513 people.Results:Among those who were not depressive in 2013, 21.9% became depressive within 2 years; 16.1% of non-depressive individuals since 2011 became depressive by 2015. No age differences in incidence remained in adjusted models. Women have almost 50% higher odds of becoming depressive. A previous history of depressiveness and the presence of everyday activity limitations were important factors increasing the incidence of depression.Discussion:Changes related to the individual’s unique ageing experience are important explanatory factors related to the likelihood of developing depressive symptoms, rather than age itself. To diminish the incidence of depressive symptoms among older Estonian population, public health interventions should attempt to address factors which complicate existing health problems and facilitate continued independence and community involvement, both of which contribute to overall satisfaction with life.

Health and voting over the course of adulthood: Evidence from two British birth cohorts.

Systematic differences in voter turnout limit the capacity of public institutions to address the needs of under-represented groups. One critical question relates to the role of health as a mechanism driving these inequalities. This study explores the associations of self-rated health (SRH) and limitations in everyday activities with voting over the course of adulthood in the 1958 National Child Development Study and the 1970 British Cohort Study. We used data from participants who reported voting in the last general election at least once between the ages of 23 and 55 in the 1958 cohort and between the ages of 30 and 42 in the 1970 cohort. We examined associations controlling for a range of early-life and adult circumstances using random-effects models. Compared with those in good or better health: those in fair health had 15% and 18% lower odds of voting in the 1958 and 1970 cohorts; those in poor or worse health had 17% and 32% lower odds of voting in the 1958 and 1970 cohorts. These effects varied with age and were most marked among those in poor health at the ages of 23/30 in the 1958 and 1970 cohorts. Controlling for SRH, having limitations in everyday activities was not associated with voting in main models. Examining age-based differences, however, we found that reporting limitations was associated with a higher probability of voting at the age of 55 in the 1958 cohort and at the age of 30 in the 1970 cohort. Building on the qualities of the British birth cohorts, we offer nuanced evidence about the role of health on voting, which involves considerable life-course processes. Future studies need to examine how these findings progress after the age of 55, extend to mental wellbeing and health practices, and contribute to explain social inequalities in voter turnout.

Search and Match Task: Development of a Taskified Match-3 Puzzle Game to Assess and Practice Visual Search.

BackgroundVisual search declines with aging, dementia, and brain injury and is linked to limitations in everyday activities. Recent studies suggest that visual search can be improved with practice using computerized visual search tasks and puzzle video games. For practical use, it is important that visual search ability can be assessed and practiced in a controlled and adaptive way. However, commercial puzzle video games make it hard to control task difficulty, and there are little means to collect performance data.ObjectiveThe aim of this study was to develop and initially validate the search and match task (SMT) that combines an enjoyable tile-matching match-3 puzzle video game with features of the visual search paradigm (taskified game). The SMT was designed as a single-target visual search task that allows control over task difficulty variables and collection of performance data.MethodsThe SMT is played on a grid-based (width × height) puzzle board, filled with different types of colored polygons. A wide range of difficulty levels was generated by combinations of 3 task variables over a range from 4 to 8 including height and width of the puzzle board (set size) and the numbers of tile types (distractor heterogeneity). For each difficulty level, large numbers of playable trials were pregenerated using Python. Each trial consists of 4 consecutive puzzle boards, where the goal of the task is to find a target tile configuration (search) on the puzzle board and swap 2 adjacent tiles to create a line of 3 identical tiles (match). For each puzzle board, there is exactly 1 possible match (single target search). In a user study with 28 young adults (aged 18 to 31 years), 13 older (aged 64 to 79 years) and 11 oldest (aged 86 to 98 years) adults played the long (young and older adults) or short version (oldest adults) of the difficulty levels of the SMT. Participants rated their perception and the usability of the task and completed neuropsychological tests that measure cognitive domains engaged by the puzzle game.ResultsResults from the user study indicate that the target search time is associated with set size, distractor heterogeneity, and age. Results further indicate that search performance is associated with general cognitive ability, selective and divided attention, visual search, and visuospatial and pattern recognition ability.ConclusionsOverall, this study shows that an everyday puzzle game–based task can be experimentally controlled, is enjoyable and user-friendly, and permits data collection to assess visual search and cognitive abilities. Further research is needed to evaluate the potential of the SMT game to assess and practice visual search ability in an enjoyable and adaptive way. A PsychoPy version of the SMT is freely available for researchers.

Anxiety spectrum disorders are common in patients with orthostatic tremor

BackgroundOrthostatic Tremor (OT) is a rare movement disorder characterized by a sensation of unsteadiness while standing and associated with high frequency tremors. Patients with OT commonly report a fear of falling and significant limitations in everyday activities. The prevalence of psychiatric comorbidities in OT patients has not been well-studied. MethodsSubjects were evaluated by trained psychiatry researchers using the Mini International Neuropsychiatric Interview (M.I.N.I.). The M.I.N.I is a validated screening tool for psychiatric disorders. A standardized history covering previous psychiatric symptoms and illnesses was also obtained. Results29 OT subjects were evaluated. The mean age was 67.7 years with female preponderance (89.3%). The average disease symptom duration was 18.2 years. 58.6% of the subjects had seen a mental health professional during the course of their OT illness. 24.1% of the subjects had a past history of depression, and 10.3% reported a family history of any psychiatric condition. 37.9% of the subjects screened positive for agoraphobia. Two of 29 subjects (6.9%) were classified as having a current major depressive episode and one subject (3.4%) was at risk for suicide. ConclusionsPsychiatric comorbidities are highly prevalent in OT patients, especially anxiety-spectrum disorders. Further studies are needed to understand if psychiatric disorders appear as a secondary response to the patient's symptoms, or are a primary non-motor manifestation of OT.

Implementation of the International Classification of Functioning, Disability, and Health (ICF) Core Sets for Children and Youth with Cerebral Palsy: Global Initiatives Promoting Optimal Functioning.

Background: The International Classification of Functioning, Disability, and Health (ICF) Core Sets for children and youth with cerebral palsy (CP) offer service providers and stakeholders a specific framework to explore functioning and disability for assessment, treatment, evaluation, and policy purposes in a global context. Objective: Describe global initiatives applying the ICF Core Sets for children and youth with CP, with a focus on contributions to clinical practice and challenges in their implementation. Methods: This is a descriptive cross-sectional study. Ongoing initiatives applying the ICF Core Sets for CP in Russia, Poland, Malawi, and Brazil are included. Results: The main contributions of applying the ICF Core Sets for children and youth with CP include: (1) an objective description of abilities and limitations in everyday activities; (2) a consistent identification of facilitators and barriers influencing functioning; (3) a practical communication tool promoting client-centered care and multidisciplinary teamwork; and, (4) a useful guideline for measurement selection. The main challenges of adopting the ICF Core Sets are related to lack of ICF knowledge requiring intense training and translating results from standardized measures into the ICF qualifiers in a consistent way. Conclusions: Global initiatives include research and clinical applications at the program, service and system levels. The ICF Core Sets for CP are useful tools to guide service provision and build profiles of functioning and disability. Global interprofessional collaboration, capacity training, and informatics (e-records) will maximize their applications and accelerate adoption.

Measuring everyday functional competence using the Rasch assessment of everyday activity limitations (REAL) item bank

ObjectiveTraditional patient-reported physical function instruments often poorly differentiate patients with mild-to-moderate disability. We describe the development and psychometric evaluation of a generic item bank for measuring everyday activity limitations in outpatient populations.Study design and settingSeventy-two items generated from patient interviews and mapped to the International Classification of Functioning, Disability and Health (ICF) domestic life chapter were administered to 1128 adults representative of the Dutch population. The partial credit model was fitted to the item responses and evaluated with respect to its assumptions, model fit, and differential item functioning (DIF). Measurement performance of a computerized adaptive testing (CAT) algorithm was compared with the SF-36 physical functioning scale (PF-10).ResultsA final bank of 41 items was developed. All items demonstrated acceptable fit to the partial credit model and measurement invariance across age, sex, and educational level. Five- and ten-item CAT simulations were shown to have high measurement precision, which exceeded that of SF-36 physical functioning scale across the physical function continuum. Floor effects were absent for a 10-item empirical CAT simulation, and ceiling effects were low (13.5%) compared with SF-36 physical functioning (38.1%). CAT also discriminated better than SF-36 physical functioning between age groups, number of chronic conditions, and respondents with or without rheumatic conditions.ConclusionThe Rasch assessment of everyday activity limitations (REAL) item bank will hopefully prove a useful instrument for assessing everyday activity limitations. T-scores obtained using derived measures can be used to benchmark physical function outcomes against the general Dutch adult population.

Change and Impact of Illness Perceptions among Patients with Non-cardiac Chest Pain or Benign Palpitations Following Three Sessions of CBT

Many patients with non-cardiac chest pain or benign palpitations have poor prognosis in terms of symptom persistence, limitations in everyday activities, and reduced health-related quality of life (HRQOL). The aims of the study were to evaluate the changes and impact of illness perceptions during a three-session cognitive behavioural therapy (CBT) intervention for patients with non-cardiac chest pain or benign palpitations. Patients with persistent complaints 6 months after a negative cardiac evaluation were invited to participate in a randomized controlled trial. Patients in the intervention group (n = 21) received three manualized sessions with CBT, including one physical activity exposure session; the control group (n = 19) received usual care from their general practitioner. Brief Illness Perception Questionnaire (BIPQ) was used to measure illness perceptions. Patients were assessed at start and end of the intervention and at 3- and 12-month follow-up. The intervention and control group differed significantly on five of the eight items of BIPQ at least at one follow-up assessment. At end of treatment and at 3-month follow-up change in illness concern (Item 6 in BIPQ) mediated about 40% of the change in depression from baseline, and at 12-month follow-up about 50% of the change in depression was mediated by change in personal control (Item 3 in BIPQ). Illness perceptions measured with BIPQ may mediate the short and long term treatment effects of a three-session CBT-programme for patients with non-cardiac chest pain and benign palpitations.

Antepartum depression and anxiety associated with disability in African women: cross-sectional results from the CDS study in Ghana and Côte d'Ivoire.

BackgroundCommon mental disorders, particularly unipolar depressive disorders, rank among the top 5 with respect to the global burden of disease. As a major public health concern, antepartum depression and anxiety not only affects the individual woman, but also her offspring. Data on the prevalence of common mental disorders in pregnant women in sub-Saharan Africa are scarce. We provide results from Ghana and Côte d'Ivoire.MethodsWe subsequently recruited and screened n = 1030 women in the third trimester of their pregnancy for depressed mood, general anxiety, and perceived disability using the Patient Health Questionnaire depression module (PHQ-9), the 7-item Anxiety Scale (GAD-7), and the World Health Organisation Disability Assessment Schedule II (WHO-DAS 2.0, 12-item version). In addition to estimates of means and prevalence, a hierarchical linear regression model was calculated to determine the influence of antepartum depression and anxiety on disability.ResultsIn Ghana, 26.6% of women showed substantially depressed mood. In Côte d'Ivoire, this figure was even higher (32.9%). Clear indications for a generalized anxiety disorder were observed in 11.4% and 17.4% of pregnant women, respectively. Comorbidity of both conditions was common, affecting about 7.7% of Ghanaian and 12.6% of Ivorian participants. Pregnant women in both countries reported a high degree of disability regarding everyday activity limitations and participation restrictions. Controlled for country and age, depression and anxiety accounted for 33% of variance in the disability score.ConclusionsAntepartum depression and anxiety were highly prevalent in our sample and contributed substantially to perceived disability. These serious threats to health must be further investigated and more data are needed to comprehensively quantify the problem in sub-Saharan Africa.

Illness perception among patients with chest pain and palpitations before and after negative cardiac evaluation.

BackgroundPatients with chest pain or palpitations often have poor outcomes following a negative cardiac evaluation, with symptom persistence, limitations in everyday activities, and reduced health-related quality of life. The aims of this study were to evaluate illness perceptions before and after negative cardiac evaluations and measure the ability of a self-report questionnaire to predict outcomes.MethodsPatients (N = 138) referred for chest pain or palpitations to a cardiac outpatient clinic were assessed before and six months after a negative cardiac evaluation. In addition to Brief Illness Perception Questionnaire (BIPQ), all patients completed the Beck Depression Inventory and SF-36 Health Survey.ResultsThe emotional reactions to and understanding of symptoms had not improved six months after a negative cardiac evaluation. A stronger correlation between illness perceptions and health at follow-up than before the cardiac evaluation might explain the tendency for poor outcomes among these patients. Most of the eight BIPQ item scores before the negative cardiac evaluation were predictive of the outcome six months later. A single question asking about the perceived consequences of the complaints (BIPQ Item 1) rated before the cardiac evaluation was collapsed into a dichotomous variable with a cut-off at ≥4 which yields a sensitivity of 51%, a specificity of 85%, a positive predictive value of 71%, a negative predictive value of 69%, and an odds ratio of 5.7 (r = .38, p < .001) in predicting poor outcomes.ConclusionsAssessing illness perceptions is important in patients with negative cardiac tests for understanding and predicting outcomes.

Short-term cognitive behavioral therapy for non-cardiac chest pain and benign palpitations: A randomized controlled trial

Objectives Many patients with noncardiac chest pain or benign palpitations have poor prognosis in terms of symptom persistence, limitations in everyday activities, and reduced health-related quality of life (HRQOL). The aim of the study was to compare a three-session manualized cognitive behavioral therapy (CBT) intervention with normal care for patients with noncardiac chest pain or benign palpitations in a randomized controlled trial. Methods Patients with persistent complaints six months after a negative evaluation at a cardiological outpatient clinic were invited to participate. Of the 94 eligible patients, 40 agreed to participate and were randomly assigned to either an intervention or control group. Patients in the intervention group received three manualized sessions with CBT, including one physical activity exposure session. The control group received usual care from their general practitioner. Results There were significantly larger improvements in the treatment group regarding fear of bodily sensations, avoidance of physical activity, depression and some domains of HRQOL at the end of treatment, and at three- and 12-month follow-up. A substantial proportion (about three-quarters) of the intervention effects on depression and avoidance of physical activity could be attributed to (was mediated by) the large reduction in catastrophic interpretations of bodily sensations. Conclusion A three-session program of manualized CBT, including exposure to physical activity, was effective treatment for patients with noncardiac chest pain and benign palpitations up to the 12-month follow-up.

In which ways do unhealthy people older than 50 exit the labour market in France?

Among 55-64 year olds, poor health is a reason for leaving the labour market early within the framework of schemes such as not only Early Retirement for Certain Employees (or Early Retirement for Asbestos Workers), but also by absence from the workforce (sick pay and disability pensions, respectively). It is interesting to single out the controlling factors for participation in or absence from the labour market after 50 and the link between poor health and employment status. The prevalence of functional limitations in everyday activities leads to a more pronounced exclusion of those over 50 years old from the labour market. Some of those aged between 55 and 59 on disability benefits become unemployed and do not look for work; in other words, they are potentially exempted from job-seeking. This would confirm the hypothesis that some of those exempted from job-seeking are in poor health.

The role of patient expectations in predicting outcome after total knee arthroplasty

IntroductionPatient's expectations are variably reported to influence self-rated outcome and satisfaction after medical treatment; this prospective study examined which of the following was the most important unique determinant of global outcome/satisfaction after total knee arthroplasty (TKA): baseline expectations; fulfilment of expectations; or current symptoms and function.MethodsOne hundred and twelve patients with osteoarthritis of the knee (age, 67 ± 9 years) completed a questionnaire about their expectations regarding months until full recovery, pain, and limitations in everyday activities after TKA surgery. Two years postoperatively, they were asked what the reality was for each of these domains, and rated the global outcome and satisfaction with surgery. Multivariable regression analyses using forward conditional selection of variables (and controlling for age, gender, other joint problems) identified the most significant determinants of outcome.ResultsPatients significantly underestimated the time for full recovery (expected 4.7 ± 2.8 months, recalled actual time, 6.1 ± 3.7 months; P = 0.005). They were also overly optimistic about the likelihood of being pain-free (85% expected it, 43% were; P < 0.05) and of not being limited in usual activities (52% expected it, 20% were; P < 0.05). Global outcomes were 46.2% excellent, 41.3% good, 10.6% fair and 1.9% poor. In multivariable regression, expectations did not make a significant unique contribution to explaining the variance in outcome/satisfaction; together with other joint problems, knee pain and function at 2 years postoperation predicted global outcome, and knee pain at 2 years predicted satisfaction.ConclusionsIn this group, preoperative expectations of TKA surgery were overly optimistic. The routine analysis of patient-orientated outcomes in practice should assist the surgeon to convey more realistic expectations to the patient during the preoperative consultation. In multivariable regression, expectations did not predict global outcome/satisfaction; the most important determinants were other joint problems and the patient's pain and functional status 2 years postoperatively.