RESUMO
Although the Gerontological Personality Disorders Scale (GPS) can aid in detecting personality disorders (PDs) in older adults in general practice, its availability does not guarantee its use. This study therefore aimed to examine the feasibility and acceptability of the GPS from an older adult, informant, and professional perspective. A convergent parallel mixed methods study was conducted. Qualitative data were collected through semistructured interviews with four general practitioners and four nurse practitioners and were analyzed thematically. Quantitative data were collected through a 5-item questionnaire completed by 329 older adults and 329 informants. The thematic analysis revealed five major themes regarding feasibility and acceptability according to the professionals: taboo to ask intimate questions, quite unfamiliar with these disorders, assets, PDs are a topic of interest in general practice, and preconditions. Descriptive statistics showed that most older adults and informants found the GPS items to be clearly phrased, easy to understand, and nonconfrontational or not unpleasant to answer. The GPS is a feasible and acceptable instrument for detecting PDs in older adults in general practice. Educating professionals about PDs in older adults and the GPS is important prior to its use in daily practice and might further increase its acceptability.
Assuntos
Atitude do Pessoal de Saúde , Clínicos Gerais/normas , Avaliação Geriátrica/métodos , Transtornos da Personalidade/diagnóstico , Padrões de Prática Médica/normas , Idoso , Estudos de Viabilidade , Feminino , Psiquiatria Geriátrica , Humanos , Masculino , Pesquisa Qualitativa , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: Personality disorders (PDs) often remain unrecognized in older adults by doctors in general practice. Therefore, this study evaluated the diagnostic accuracy of a screening instrument, the Gerontological Personality Disorder Scale (GPS), in a Dutch general-practice population of older adults. METHOD: The psychometric properties of the GPS patient (GPS-pv) and informant (GPS-iv) versions were assessed in a sample of 302 (144 male) patients (average age: 69.9 years) and 302 (124 male) informants (average age: 64.7 years), respectively, using an informant-based personality questionnaire (the Hetero-Anamnestische Persoonlijkheidsvragenlijst ) as a reference criterion. RESULTS: The internal consistency (average item correlation) of the subscale and total scores of the GPS-pv and GPS-iv were .12 (HAB), .16 (BIO), and .10 (total); and .16 (HAB), .15 (BIO), and .12 (total), respectively. The test--retest reliability was strong for both the GPS-pv (rs = .56 [HAB], rs = .67 [BIO], rs = .66 [total]) and the GPS-iv (rs = .52 [HAB], rs = .65 [BIO], rs = .68 [total]) versions. The sensitivity and specificity of the GPS-pv were .83 and .27, respectively, with a cutoff score of ≥1. Raising the cutoff score to ≥2, the sensitivity dropped to .59, whereas the specificity rose to .57. For the GPS-iv, a cutoff score of ≥3 maximized the sensitivity (.78) and specificity (.65). CONCLUSION: The diagnostic accuracy of the GPS-iv was preferable to that of the GPS-pv. This is the first psychometric study to use the GPS as an age-specific screening instrument for PDs.
Assuntos
Avaliação Geriátrica/métodos , Transtornos da Personalidade/diagnóstico , Escalas de Graduação Psiquiátrica/normas , Psicometria/instrumentação , Idoso , Idoso de 80 Anos ou mais , Feminino , Medicina Geral , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Although communication failures between professionals in acute care delivery occur, explanations for these failures remain unclear. We aim to gain a deeper understanding of interprofessional communication failures by assessing two different explanations for them. A multiple case study containing six cases (i.e. acute care chains) was carried out in which semi-structured interviews, physical artifacts and archival records were used for data collection. Data were entered into matrices and the pattern-matching technique was used to examine the two complementary propositions. Based on the level of standardization and integration present in the acute care chains, the six acute care chains could be divided into two categories of care processes, with the care chains equally distributed among the categories. Failures in communication occurred in both groups. Communication routines were embedded within organizations and descriptions of communication routines in the entire acute care chain could not be found. Based on the results, failures in communication could not exclusively be explained by literature on process typology. Literature on organizational routines was useful to explain the occurrence of communication failures in the acute care chains. Organizational routines can be seen as repetitive action patterns and play an important role in organizations, as most processes are carried out by means of routines. The results of this study imply that it is useful to further explore the role of organizational routines on interprofessional communication in acute care chains to develop a solution for failures in handover practices.
Assuntos
Comunicação , Relações Interprofissionais , Transferência da Responsabilidade pelo Paciente/normas , Continuidade da Assistência ao Paciente , Feminino , Grupos Focais , Guias como Assunto , Humanos , Entrevistas como Assunto , MasculinoRESUMO
BACKGROUND: Preventive home visits including comprehensive geriatric assessment for potentially frail older people are increasingly implemented in general practice. It remains unclear how to select older people who benefit most from it. OBJECTIVES: To determine which community-dwelling older people benefit most from a comprehensive geriatric assessment by a practice nurse during a home visit in terms of detected problems. METHODS: A cross-sectional study in 45 general practices in the Netherlands. Practice nurses visited 562 randomly selected older people (aged ≥ 75 years) and 1180 purposefully selected based on the following criteria: last visit to general practice >6 months ago; partner or child(ren) deceased within past 12 months; cognitive or psychosocial functioning unknown to GP; ≥2 chronic conditions; uses ≥5 medications and/or living alone. RESULTS: Mean age of older people was 82.50 years, 65.50% was female. More problems were detected among women, higher age groups, those living alone and the less educated (all P < 0.001). Overall, more problems were detected in purposefully selected older people than in randomly selected older people (P < 0.001). Selection of older people with ≥2 chronic conditions and those using ≥5 medications resulted in more detected problems in general (both P < 0.05). CONCLUSION: Although the findings are in favour of purposeful selection, observed differences in detected problems between the two selection procedures are relatively small. GPs should at least target older people with ≥2 chronic conditions, using ≥5 medications, being female, of an older age, living alone and the less educated.
Assuntos
Idoso Fragilizado , Avaliação Geriátrica/métodos , Visita Domiciliar , Vida Independente/estatística & dados numéricos , Seleção de Pacientes , Enfermagem de Atenção Primária/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Efeitos Psicossociais da Doença , Estudos Transversais , Depressão/diagnóstico , Escolaridade , Feminino , Perda Auditiva/diagnóstico , Humanos , Hipertensão/diagnóstico , Masculino , Transtornos da Memória/diagnóstico , Limitação da Mobilidade , Países Baixos , Sobrepeso/diagnóstico , Polimedicação , Fatores Sexuais , Magreza/diagnóstico , Incontinência Urinária/diagnóstico , Transtornos da Visão/diagnósticoRESUMO
BACKGROUND: Accurate information transfer is an important element of continuity of care and patient safety. Despite the demonstrated urge for improvement of communication in acute care, there is a lack of data on improvements of communication. This study aims to describe the barriers to implementation of a redesign of the existing model for information transfer and feedback. METHODS: A case study with six cases (i.e. acute care chains), using mixed methods was carried out in the Netherlands. The redesign was implemented in one acute care chain while the five other acute care chains served as control groups. Focus group interviews were held with members of the acute care chains and questionnaires were sent to care providers working in the acute care chains. RESULTS: Respondents reported three sets of barriers for implementation of the model: (a) existing routines for information transfer and feedback in organizations within the acute care chain; (b) barriers related to the implementation method and time period; and (c) the absence of a high 'sense of urgency' amongst providers in the acute care chain which would aid in improving the communication process. CONCLUSIONS: This study shows that organizational factors play an important role in the success or failure of redesigning a communication process. Organizational routines can hamper implementation of a redesign if it differs too much from the routines of care providers involved. Besides focussing on provider characteristics in the implementation of a redesigned process, specific attention should be paid to unlearning existing organizational routines.
Assuntos
Comunicação , Medicina de Emergência/normas , Continuidade da Assistência ao Paciente , Retroalimentação , Grupos Focais , Humanos , Modelos Organizacionais , Países Baixos , Estudos de Casos Organizacionais , Segurança do Paciente , Melhoria de Qualidade , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Population ageing fosters new models of care delivery for older people that are increasingly integrated into existing care systems. In the Netherlands, a primary-care based preventive home visitation programme has been developed for potentially frail community-dwelling older people (aged ≥75 years), consisting of a comprehensive geriatric assessment during a home visit by a practice nurse followed by targeted interdisciplinary care and follow-up over time. A theory-based process evaluation was designed to examine (1) the extent to which the home visitation programme was implemented as planned and (2) the extent to which general practices successfully redesigned their care delivery. METHODS: Using a mixed-methods approach, the focus was on fidelity (quality of implementation), dose delivered (completeness), dose received (exposure and satisfaction), reach (participation rate), recruitment, and context. Twenty-four general practices participated, of which 13 implemented the home visitation programme and 11 delivered usual care to older people. Data collection consisted of semi-structured interviews with practice nurses (PNs), general practitioners (GPs), and older people; feedback meetings with PNs; structured registration forms filled-out by PNs; and narrative descriptions of the recruitment procedures and registration of inclusion and drop-outs by members of the research team. RESULTS: Fidelity of implementation was acceptable, but time constraints and inadequate reach (i.e., the relatively healthy older people participated) negatively influenced complete delivery of protocol elements, such as interdisciplinary cooperation and follow-up of older people over time. The home visitation programme was judged positively by PNs, GPs, and older people. Useful tools were offered to general practices for organising proactive geriatric care. CONCLUSIONS: The home visitation programme did not have major shortcomings in itself, but the delivery offered room for improvement. General practices received useful tools to redesign their care delivery from reactive towards proactive care, but perceived barriers require attention to allow for sustainability of the home visitation programme over time.
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Prática Avançada de Enfermagem/métodos , Medicina Geral/métodos , Avaliação Geriátrica/métodos , Enfermagem Geriátrica/métodos , Nível de Saúde , Visita Domiciliar , Padrões de Prática em Enfermagem , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Feminino , Idoso Fragilizado , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Avaliação de Processos em Cuidados de Saúde , Adulto JovemRESUMO
BACKGROUND: Evaluating large-scale disease management interventions implemented in actual health care settings is a complex undertaking for which universally accepted methods do not exist. Fundamental issues, such as a lack of control patients and limited generalizability, hamper the use of the 'gold-standard' randomized controlled trial, while methodological shortcomings restrict the value of observational designs. Advancing methods for disease management evaluation in practice is pivotal to learn more about the impact of population-wide approaches. Methods must account for the presence of heterogeneity in effects, which necessitates a more granular assessment of outcomes. METHODS: This paper introduces multilevel regression methods as valuable techniques to evaluate 'real-world' disease management approaches in a manner that produces meaningful findings for everyday practice. In a worked example, these methods are applied to retrospectively gathered routine health care data covering a cohort of 105,056 diabetes patients who receive disease management for type 2 diabetes mellitus in the Netherlands. Multivariable, multilevel regression models are fitted to identify trends in clinical outcomes and correct for differences in characteristics of patients (age, disease duration, health status, diabetes complications, smoking status) and the intervention (measurement frequency and range, length of follow-up). RESULTS: After a median one year follow-up, the Dutch disease management approach was associated with small average improvements in systolic blood pressure and low-density lipoprotein, while a slight deterioration occurred in glycated hemoglobin. Differential findings suggest that patients with poorly controlled diabetes tend to benefit most from disease management in terms of improved clinical measures. Additionally, a greater measurement frequency was associated with better outcomes, while longer length of follow-up was accompanied by less positive results. CONCLUSIONS: Despite concerted efforts to adjust for potential sources of confounding and bias, there ultimately are limits to the validity and reliability of findings from uncontrolled research based on routine intervention data. While our findings are supported by previous randomized research in other settings, the trends in outcome measures presented here may have alternative explanations. Further practice-based research, perhaps using historical data to retrospectively construct a control group, is necessary to confirm results and learn more about the impact of population-wide disease management.
Assuntos
Gerenciamento Clínico , Medicina Baseada em Evidências/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde/normas , Benchmarking , Pesquisa sobre Serviços de Saúde , Humanos , Análise Multinível , Países Baixos , Vigilância da PopulaçãoRESUMO
BACKGROUND: Due to the ageing of the population, the number of frail older people who suffer from multiple, complex health complaints increases and this ultimately threatens their ability to function independently. Many interventions for frail older people attempt to prevent or delay functional decline, but they show contradicting results. Recent studies emphasise the importance of embedding these interventions into existing primary care systems and tailoring care to older people's needs and wishes. This article presents the design of an evaluation study, aiming to investigate the effects and feasibility of the early detection of health problems among community-dwelling older people and their subsequent referral to appropriate care and/or well-being facilities by general practices. METHODS/DESIGN: A longitudinal, quasi-experimental study is designed comparing 13 intervention practices with 11 control practices. General practices select eligible community-dwelling older people (≥ 75 years). Practice nurses from intervention practices (1) visit older people at home for a comprehensive assessment of their health and well-being; (2) discuss results with the GP; (3) formulate - if required - a care and treatment plan together with the patient; (4) refer patient to care and/or well-being facilities; and (5) monitor and coordinate care and follow-up. Control practices provide usual care and match the intervention practices on the presence of different primary care professionals within the practice. Primary outcome measures are health-related quality of life and disability. Additionally, attitude towards ageing, care satisfaction, health care utilisation, nursing home admission and mortality are measured. Some outcomes are assessed by means of a postal questionnaire (at baseline and after 6, 12, and 18 months follow-up), others through continuous registration over the 18-month period. A profound process evaluation will provide insight into barriers and facilitators for implementing the intervention protocol within general practices from both the patient and caregiver perspective. DISCUSSION: The proposed approach requires redesigning care delivery within general practices for accomplishing appropriate care for older people. A quasi-experimental design is chosen to closely resemble a real-life situation, which is desirable for future implementation after this innovation proves to be successful. Results of the effect and process evaluation will become available in 2013. TRIAL REGISTRATION: The Netherlands National Trial Register NTR2737.
Assuntos
Idoso Fragilizado , Medicina Geral/métodos , Avaliação Geriátrica/métodos , Nível de Saúde , Visita Domiciliar , Características de Residência , Idoso , Diagnóstico Precoce , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Países Baixos/epidemiologiaRESUMO
BACKGROUND: Although guidelines advise against massage, it is one of the methods widely regarded and used by nurses to prevent pressure ulcers (PU). OBJECTIVES: The purpose of this study was to examine the effectiveness of different variations of massage in preventing pressure ulcers. METHODS: A randomized, double-blind cross-over design, in which patients of nursing homes who are prone to PU underwent two of the three possible interventions; 'position changes only', 'massaging with an indifferent cream' and 'massaging with a dimethyl sulfoxide (DMSO) cream'. RESULTS: The results of three interventions did not differ significantly. DMSO did not fulfil the expectations raised by literature and a previous pilot-study.
Assuntos
Dimetil Sulfóxido/uso terapêutico , Sequestradores de Radicais Livres/uso terapêutico , Massagem/métodos , Úlcera por Pressão/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Estudos Cross-Over , Fármacos Dermatológicos/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Países Baixos , Casas de Saúde , Postura , Úlcera por Pressão/patologiaRESUMO
INTRODUCTION: Teamwork between healthcare providers is conditional for the delivery of integrated care. This study aimed to assess the usefulness of the conceptual framework Integrated Team Effectiveness Model for developing and testing of the Integrated Team Effectiveness Instrument. THEORY AND METHODS: Focus groups with healthcare providers in an integrated care setting for people with chronic obstructive pulmonary disease (COPD) were conducted to examine the recognisability of the conceptual framework and to explore critical success factors for collaborative COPD practice out of this framework. The resulting items were transposed into a pilot instrument. This was reviewed by expert opinion and completed 153 times by healthcare providers. The underlying structure and internal consistency of the instrument were verified by factor analysis and Cronbach's alpha. RESULTS: The conceptual framework turned out to be comprehensible for discussing teamwork effectiveness. The pilot instrument measures 25 relevant aspects of teamwork in integrated COPD care. Factor analysis suggested three reliable components: teamwork effectiveness, team processes and team psychosocial traits (Cronbach's alpha between 0.76 and 0.81). CONCLUSIONS AND DISCUSSION: The conceptual framework Integrated Team Effectiveness Model is relevant in developing a practical full-spectrum instrument to facilitate discussing teamwork effectiveness. The Integrated Team Effectiveness Instrument provides a well-founded basis to self-evaluate teamwork effectiveness in integrated COPD care by healthcare providers. Recommendations are provided for the improvement of the instrument.
RESUMO
General information about the effects of massage to prevent pressure ulcers is limited. A literature search was conducted to provide more detailed knowledge about the effects of massage in general and in preventing the development of pressure ulcers in particular. Using the keywords massage, rubbing, prevention of pressure ulcers/pressure ulcers, and paying particular attention to referenced articles yielded a summary of different manual massage techniques and indications/contraindications of this intervention for both healthy tissues and tissues in patients at risk for developing pressure ulcers. A careful review of this information; the clinical, physical, and pathophysiological aspects of pressure ulcers, including extrinsic and intrinsic factor; and the time-pressure relationship suggests that one type of massage may be beneficial for persons who are at risk for developing pressure ulcers. Specifically, effleurage applied with moderate pressure is the most preferred massage in the treatment of pressure ulcers, although based on currently existing studies, it cannot be proven statistically that massage is an adequate preventive method for pressure ulcers. Although many guidelines advised against use of massage in people at risk for pressure ulcers, current evidence suggests that research to increase knowledge about the mechanism behind the effects of massage as part of an individualized prevention and treatment plan should be conducted.
Assuntos
Massagem , Úlcera por Pressão/prevenção & controle , Humanos , Imunidade , Massagem/métodos , Úlcera por Pressão/imunologia , Úlcera por Pressão/fisiopatologia , Fluxo Sanguíneo Regional , Pele/irrigação sanguíneaAssuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Diabetes Mellitus Tipo 2/enfermagem , Implementação de Plano de Saúde/organização & administração , Comportamento Cooperativo , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Enfermagem Baseada em Evidências/organização & administração , Humanos , Comunicação Interdisciplinar , Países Baixos , Equipe de Assistência ao Paciente/organização & administraçãoRESUMO
The integration within existing health care systems of preventive initiatives to maintain independent living among older people is increasingly emphasized. This article describes the development and refinement of the [G]OLD home visitation programme: an eight-step programme, including a comprehensive geriatric assessment, for the early detection of health and well-being problems among older people (≥75 years) by general practices. A single group post-test study using a mixed model design is performed to evaluate (a) the feasibility of the home visitation programme in general practice, (b) the practical usefulness of the geriatric assessment instrument, and (c) programme implementation with respect to reinventions introduced by general practitioners (GPs) and practice nurses (PNs). Within 3 months time, 22 PNs of 18 participating general practices visited 240 community-dwelling older people (mean age = 82.0 years; SD 4.2) who had not been in contact with their general practice for more than 6 months. Mean time investment of the programme per older person was 118.1 min (SD 27.0) for GPs and PNs combined. Evaluation meetings revealed that GPs and PNs considered the home visitation programme to be feasible in daily practice. They judged the geriatric assessment to be useful, although minor adjustments are needed (e.g., lay-out, substitution of tests). PNs often failed to register follow-up actions for detected problems in a care and treatment plan. Future training for PNs should address this issue. No reinventions were introduced that threatened fidelity of implementation. The findings are used to improve the home visitation programme before its evaluation in a large-scale controlled trial.
Assuntos
Diabetes Mellitus Tipo 2/enfermagem , Gerenciamento Clínico , Enfermagem Primária , Competência Clínica , Comportamento Cooperativo , Alemanha , Humanos , Registros de Enfermagem , Equipe de Assistência ao Paciente , Garantia da Qualidade dos Cuidados de Saúde , Especialidades de EnfermagemAssuntos
Diabetes Mellitus Tipo 2/enfermagem , Gerenciamento Clínico , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Benchmarking/organização & administração , Diabetes Mellitus Tipo 2/diagnóstico , Humanos , Países Baixos , Diagnóstico de Enfermagem/organização & administração , Satisfação do Paciente , Guias de Prática Clínica como Assunto , Indicadores de Qualidade em Assistência à Saúde/organização & administraçãoAssuntos
Diabetes Mellitus Tipo 2/enfermagem , Educação Continuada em Enfermagem , Medicina Baseada em Evidências , Equipe de Assistência ao Paciente/organização & administração , Autocuidado/métodos , Especialização , Idoso , Automonitorização da Glicemia , Comportamento Cooperativo , Currículo , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Países Baixos , Registros de Enfermagem , Guias de Prática Clínica como AssuntoRESUMO
OBJECTIVES: To assess the differentiated effects of population-based disease management programs (DMPs) for type 2 diabetes on intermediary clinical outcomes in The Netherlands. METHODS: Data covering a period from 20 to 24 months between January 2008 and December 2010 were collected from 18 Dutch care groups (primary care provider networks that have bundled payment contracts for delivery of diabetes DMPs). Meta-analysis and meta-regression methods were used to conduct differentiated analyses of these programs' effects over time on 4 clinical indicators: glycated hemoglobin, lowdensity lipoprotein, systolic blood pressure, and body mass index. Heterogeneous average results were stratified according to various patient and process characteristics to investigate whether differences in these features could explain variation in outcomes. RESULTS: Between 56% and 71% of patients (N = 105,056) had valid first- and second-year measurements of the study outcomes. Although average changes in these measures over time were small, stratified analyses demonstrated that clinically relevant improvements were achieved in patients with poor first-year health values. Interactions with age, disease duration, comorbidity, and smoking status were not consistent across outcomes; nonetheless, heterogeneity in results decreased considerably when simultaneously correcting for known patient characteristics. Positive effects tended to diminish with longer length of follow-up, while greater measurement frequency was associated with improved results, especially in patients with poor health. CONCLUSIONS: Our data suggest that tailored disease management, in which not only evidencebased guidelines but also patient characteristics directly determine care processes, including self-management support, has great potential to improve the cost-effectiveness of current chronic care delivery.
Assuntos
Diabetes Mellitus Tipo 2/terapia , Gerenciamento Clínico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea , Índice de Massa Corporal , Hemoglobinas Anormais/análise , Humanos , Lipoproteínas LDL/sangue , Pessoa de Meia-Idade , Países Baixos , Indicadores de Qualidade em Assistência à Saúde , Qualidade da Assistência à Saúde , Adulto JovemRESUMO
BACKGROUND: Health promotion has become an integral part of primary healthcare for patients with chronic illness. A practical instrument to identify patient needs in health promotion will support patient-centered health counseling. OBJECTIVE: The objective of the study was to develop and pilot test the 'Health Promotion Diabetes' (HEPRODIA) instrument, which aims to identify the needs of patients with diabetes mellitus for health-promoting activities with regard to their preferred lifestyle behavior change. METHODS: Scale development of the instrument was guided by existing insights and expert opinion. Questionnaire data were collected in a sample of patients (n = 221) from eight primary care practices in the southern part of the Netherlands. The resulting instrument comprised a fixed set of 14 items to elicit patients' preferred lifestyle change, plus a variable set of 4-20 items concerning specific barriers and support needs regarding the chosen change. The instrument provides a starting point for discussion with a practice nurse about healthy lifestyle changes. Internal consistency (Cronbach's α) and feasibility of the instrument, as well as experiences of the practice nurses using the instrument, were evaluated. RESULTS: Cronbach's α of the different scales ranged from 0.46 to 0.74. The practice nurses perceived the instrument as useful in daily practice and that it may be improved by further adjustment of patient segments. CONCLUSION: The HEPRODIA instrument is an aid to assess patient needs concerning health-promoting activities and to facilitate health counseling. Patients and practice nurses can benefit from using the instrument for patient-orientated health-promotion counseling. The psychometric properties of the instrument can be further improved.
Assuntos
Diabetes Mellitus Tipo 2/psicologia , Comportamentos Relacionados com a Saúde , Promoção da Saúde/métodos , Avaliação das Necessidades , Inquéritos e Questionários , Idoso , Aconselhamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Profissionais de Enfermagem , Projetos Piloto , Atenção Primária à Saúde , PsicometriaRESUMO
AIMS: We evaluated the associations of diabetic complications and underlying pathology with daily walking activity in type 2 diabetic patients without manifest mobility limitations. METHODS: 100 persons with type 2 diabetes (mean age 64.5 ± 9.4 years) were studied. Persons with manifest mobility limitations were excluded. Possible determinants measured: peripheral neuropathy, neuropathic pain, peripheral arterial disease, cardiovascular disease, decreased muscle strength (handgrip strength), BMI, depression, falls and fear of falling. Walking activity was measured during one week with a pedometer. Functional capacity was measured with the 6 min walk test, the timed "up and go" test and a stair climbing test. RESULTS: prevalence of neuropathy (40%) and obesity (53%) was high. Persons took a median of 6429 steps/day. In multivariate regression analysis, adjusted for age and sex, neuropathy was associated with a reduction of 1967 steps/day, decreased muscle strength with 1782 steps/day, and an increase in BMI of 1 kg/m(2) with a decrease of 210 steps/day (all p<0.05). Decreased muscle strength and BMI, but not neuropathy, were associated with outcome of functional capacity tests in multiple regression analysis. CONCLUSIONS: peripheral neuropathy, decreased muscle strength and obesity are strongly associated with walking in persons with type 2 diabetes without manifest mobility limitations.