Barriers and facilitators for physical activity in rheumatic and musculoskeletal disease: a European-based survey.

Physical activity (PA) is a key strategy for improving symptoms in people with rheumatic and musculoskeletal diseases (RMDs). The aim of this study was to investigate and rank the importance of known barriers and facilitators for engaging in PA, from the perspective of people living with RMD. Five hundred thirty-three people with RMD responded to a survey (nine questions) disseminated by the People with Arthritis and Rheumatism (PARE) network of the European Alliance of Associations for Rheumatology (EULAR). The survey required participants to rank - based on their perceived importance - known PA barriers and facilitators from the literature, and specifically RMD symptoms as well as healthcare and community factors that may affect PA participation. Of the participants, 58% reported rheumatoid arthritis as their primary diagnosis, 89% were female, and 59% were between 51 and 70 years of age. Overall, participants reported fatigue (61.4%), pain (53.6%) and painful/swollen joints (50.6%) as the highest ranked barriers for engaging in PA. Conversely, less fatigue (66.8%) and pain (63.6%), and being able to do daily activities more easy (56.3%) were identified as the most important facilitators to PA. Three literature identified PA barriers, i.e., general health (78.8%), fitness (75.3%) and mental health (68.1%), were also ranked as being the most important for PA engagement. Symptoms of RMDs, such as pain and fatigue, seem to be considered the predominant barriers to PA by people with RMD; the same barriers are also the ones that they want to improve through increasing PA, suggesting a bi-directional relationship between these factors. Key Points • Symptoms of rheumatic and musculoskeletal disease (RMD) are the predominant barriers for lack of physical activity engagement. • RMD symptoms are the factors that people with RMDs want to improve when engaging in PA. • The barriers that stop people living with RMDs to do more PA are the ones that can be significantly improved through PA engagement.

[Lay version of the 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis : Translation into German and linguistic validation in German-speaking countries with people affected]. / Die laienverständliche Version der 2018 EULAR Empfehlungen zu körperlicher Aktivität von Menschen mit entzündlich-rheumatischen und degenerativen Erkrankungen : Übersetzung ins Deutsche und sprachliche Validierung im deutschsprachigen Raum mit Betroffenen.

BACKGROUND: Physical activity and exercise are beneficial for people with rheumatic diseases; however, recommendations for the management of rheumatoid arthritis (RA), spondyloarthritis (SpA) and hip- and knee osteoarthritis (HOA/KOA) are usually unspecific with respect to mode and dose of exercise. This is why the 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis were formulated. The recommendations consist of 4 overarching principles and 10 recommendations. These were also published as a lay version in the English language. AIM: Translation of the lay version into German and its linguistic validation in Austria, Germany and Switzerland. METHODS: A professional translation was reviewed by the authors, including people with, RA, SpA, HOA/KOA from the three German-speaking countries, which provided a prefinal lay version. Subsequently, eight interviews with people with RA, SpA, HOA/KOA were conducted in each country to evaluate understandability, wording, completeness and feasibility of the prefinal lay version. Finally, the authors, i.e. those with RA, SpA, and osteoarthritis, anonymously rated their agreement to the final lay version on a 0-10 scale. RESULTS: The professional translation was substantially revised by the authors and based on the interviews. Formulations were adapted to increase readability and understandability and specify statements. Comments that would have changed content or structure were not considered. Average agreement with the particular recommendations was between 10 (SD 0) and 7.6 (SD 1.67). DISCUSSION: For people with RA/SpA/HOA/KOA the EULAR physical activity recommendations should be available in their mother language. The final German lay version is valid and accepted across all three German-speaking countries. Thus, the physical activity recommendations can be provided to people with rheumatic diseases in an understandable and feasible way.

The effects of exercise on cardiovascular disease risk factors and cardiovascular physiology in rheumatoid arthritis.

Cardiovascular disease (CVD) morbidity and mortality is highly prevalent in patients with rheumatoid arthritis (RA) with debilitating effects for the individual as well as significant healthcare impact. Current evidence demonstrates that engaging in aerobic and resistance exercise (i.e. structured physical activity) can significantly improve patient-reported and clinical index-assessed outcomes in RA. In addition to this, engagement in exercise programmes improves, in a dose-dependent manner, the risk of developing CVD as well as CVD symptoms and outcomes. The present narrative review uses evidence from systematic reviews and meta-analyses as well as controlled trials, to synthesize the current state-of-the-art on the potential effects of aerobic and resistance exercise on CVD risk factors as well as on cardiac and vascular function and structure in people with RA. Where there is a lack of evidence in RA to explain potential mechanisms, relevant studies from the general population are also discussed and linked to RA.

Measurement properties of the EuroQoL EQ-5D-5L to assess quality of life in patients undergoing carpal tunnel release.

The objective of this study was to investigate the measurement properties of the EuroQol EQ-5D-5L questionnaire (EQ-5D-5L). A total of 60 patients with carpal tunnel syndrome completed the EQ-5D-5L twice before surgical decompression and once more 6 weeks after surgery. In addition, they filled out the Short Form 12 and Michigan Hand Outcomes Questionnaire at the baseline and postoperative follow-up examinations. Test-retest reliability was excellent with an intraclass correlation coefficient of 0.81. Internal consistency was high with Cronbach's alpha of 0.83. Good validity of the EQ-5D-5L was indicated by correlations of r = 0.7 and r = 0.5 with the Short Form 12 and Michigan Hand Outcomes Questionnaire, respectively. Moderate responsiveness was shown by an effect size of 0.5. The minimal important change was 0.09 points. Overall, the EQ-5D-5L demonstrates sound measurement properties and can be recommended as a suitable tool to assess quality of life in patients with carpal tunnel syndrome. LEVEL OF EVIDENCE: I.

The psychometric properties of the German version of the new Worker Role Interview (WRI-G 10.0) in people with musculoskeletal disorders.

OBJECTIVE: Occupational therapists play an important role in work rehabilitation in getting people with chronic disabilities back to work. The Worker Role Interview (WRI) is intended to detect psychosocial and environmental factors influencing the ability to return to work for injured or disabled workers. This study examined the psychometric properties of the recently modified German version (WRI-G, 10.0) in a population with work-related musculoskeletal disorders (MSD) in Switzerland. METHODS: Data were gathered from 20 participants with work-related MSD. The interviews were conducted face-to-face and videotaped. Five occupational therapists, trained in the use of the WRI-G, independently rated all 20 interview recordings following the official manual. Thus, 100 ratings were analysed by use of Rasch analysis to test construct validity and transform ordinal raw data into linear data (person locations) for interrater-reliability calculations. RESULTS: All items fit the Rasch model, except the item 'perception of boss'. The final WRI-G, consisting of 15~items, showed good overall model fit (X2 = 54.66, p = 0.04); excellent person-separation reliability (PSI 0.91) and high inter-rater reliability (mean ICC 0.90). CONCLUSIONS: Based on this sample, the WRI-G (10.0) is a valid and reliable instrument to assess psychosocial ability for return to work in a population with work-related MSD.

Perceived benefits and barriers to joint protection among people with rheumatoid arthritis and occupational therapists. A mixed methods study.

BACKGROUND: Deciding whether or not to perform a health behaviour is an active decision-making process which has an impact on current and future behaviour and can be influenced by the beliefs both of patients and their healthcare professionals. The aim of this study was to explore rheumatoid arthritis (RA) patients' and occupational therapists' (OTs) perceptions of the benefits of and barriers to performing joint protection (JP). METHODS: A mixed methods design was used. Questionnaires applied a theoretical framework of key themes to assess the relevance of JP benefits and barriers both to people with RA and OTs. Focused interviews with people with RA then enabled data triangulation. Investigator triangulation was used to check the validity of data interpretation. FINDINGS: Ten people with RA and nine OTs participated. From the questionnaires, both groups agreed that highly relevant key themes for JP benefits were physical well-being, potential benefit and personal control. By contrast, the three key themes for JP barriers - negative attitude of others, negative impact on others and taking time from other things - were relevant for the majority of the OTs but not patients. The interviews enabled an understanding of the meaning behind RA patients' ratings, particularly their differences from OTs. People with RA explained JP benefits, and disease acceptance had altered some initial barriers into perceived benefits over time. CONCLUSIONS: Emphasizing benefits and identifying individually relevant barriers could be an important communication strategy for OTs in understanding patients' rationale for whether or not to adopt JP methods.

Development and validation of a German version of the joint protection behavior assessment in patients with rheumatoid arthritis.

OBJECTIVE: Joint protection (JP) is an important part of the treatment concept for patients with rheumatoid arthritis (RA). The Joint Protection Behavior Assessment short form (JPBA-S) assesses the use of hand JP methods by patients with RA while preparing a hot drink. The purpose of this study was to develop a German version of the JPBA-S (D-JPBA-S) and to test its validity and reliability. METHODS: A manual was developed through consensus with 8 occupational therapist (OT) experts as the reference for assessing patients' JP behavior. Twenty-four patients with RA and 10 healthy individuals were videotaped while performing 10 tasks reflecting the activity of preparing instant coffee. Recordings were repeated after 3 months for test-retest analysis. One rater assessed all available patient recordings (n = 23, recorded twice) for test-retest reliability. The video recordings of 10 randomly selected patients and all healthy individuals were independently assessed for interrater reliability by 6 OTs who were explicitly asked to follow the manual. Rasch analysis was performed to test construct validity and transform ordinal raw data into interval data for reliability calculations. RESULTS: Nine of the 10 tasks fit the Rasch model. The D-JPBA-S, consisting of 9 valid tasks, had an intraclass correlation coefficient of 0.77 for interrater reliability and 0.71 for test-retest reliability. CONCLUSION: The D-JPBA-S provides a valid and reliable instrument for assessing JP behavior of patients with RA and can be used in German-speaking countries.

Loss of abdominal fat and improvement of the cardiovascular risk profile by regular moderate exercise training in patients with NIDDM.

Non-insulin-dependent diabetes mellitus (NIDDM) is associated with an increased cardiovascular risk. Glycaemic control alone is often insufficient to control diabetic dyslipidaemia and other cardiovascular risk factors associated with NIDDM. The present trial was designed to evaluate the effects of physical activity as an adjunct to standard diabetes therapy on the lipid profile, blood pressure, glycaemic control, weight and body fat. Sixteen well-controlled (HbA1c 7.5%) patients with NIDDM participated in a regular aerobic exercise training programme at 50-70% maximal effort over 3 months. Thirteen age- and sex-matched patients with NIDDM served as a control group. The 3-month intervention with an increase in physical activity from 92 (mean +/- SD) +/- 79 to 246 +/- 112 min per week (p < 0.001) by means of a structured activity programme resulted in significant improvement of plasma lipids with a 20% decrease in triglycerides (p < 0.05), unchanged total cholesterol and increases in high-density lipoprotein and high-density lipoprotein-3 subfraction of 23% (p < 0.001) and 26% (p < 0.001), respectively. Systolic and diastolic blood pressure decreased significantly from 138 +/- 16 to 130 +/- 17 mm Hg (p < 0.05) and 88 +/- 10 to 80 +/- 10 mmHg (p < 0.001), respectively. Resting heart rate decreased from 81 +/- 13 to 74 +/- 14 beats per minute (p < 0.001), waist-hip circumference ratio decreased from 0.96 +/- 0.11 to 0.92 +/- 0.10 (p < 0.001) and body fat decreased from 35.3 +/- 7.2 to 33.0 +/- 8.0% (p < 0.001). These effects occurred independently of changes in body weight and glycaemic control, which did not change during the study. This study shows that improvement in physical fitness by introducing regular physical exercise as part of the treatment programme in patients with NIDDM results in a significant amelioration of their cardiovascular risk profile.

Effect of dopamine on hepatosplanchnic blood flow.

Hepatosplanchnic blood flow (EHBF) was estimated with the single-injection method using indocyanine green in 10 patients without cardiac failure before and after 20 min of an intravenous infusion of dopamine. Five patients received 4 microgram/kg/min and another 5 patients 8 microgram/kg/min. The cardiac index (CI) was determined according to the Fick principle, and the arterio-hepatovenous oxygen difference (AV DO2 AO/HV) was measured. The mean increase in EHBF in the 10 patients was from 640 +/- 46 ml/min/m2 to 831 +/- 56 ml/min/m2 (p less than 0.001). The percentage of EHBF to CI increased from 24.1 +/- 2.0% to 26.4 +/- 1.6% (p less than 0.05). The mean AV DO2 AO/HV dropped from 49.6 +/- 3.8 ml/liter to 40.4+/- 2.9 ml/liter (p less than 0.005). We conclude that dopamine given at rates of 4 and 8 microgram/kg/min to patients whose hearts are well compensated increases hepatosplanchnic flow. Thus, the large increase in renal blood flow which occurs with dopamine is not at the expense of hepatosplanchnic blood flow.

[Liver circulation during dopamine therapy]. / Leberdurchblutung unter Dopamin.

Intravenous dopamine (4 and 8 microgram/kg/min) causes an increase of hepatic flow and cardiac index, while the ratio hepatic flow:cardiac index remains unchanged. The increase of renal flow after dopamine therefore does not occur at the expense of hepatic flow.