[Effectiveness of the Assessment of Burden of COPD tool: a cluster-randomised controlled trial]. / Effectiviteit van de 'Ziektelastmeter COPD'.

OBJECTIVE: Assessment of the effectiveness of the Assessment of Burden of COPD (ABC) tool on disease-specific quality of life in patients with Chronic Obstructive Pulmonary Disease (COPD). DESIGN: Cluster-randomised controlled trial. METHOD: This concerned a trial in 39 Dutch primary care practices and 17 hospitals, involving 357 patients with COPD (postbronchodilator FEV1/FVC ratio < 0.7) aged ≥ 40 years. Healthcare providers were randomized to an intervention or control group. Patients in the intervention group were treated with the ABC tool. This innovative tool consists of a short validated questionnaire and a number of objective parameters, which collectively give a visual overview of the combined integral health; the tool subsequently produces an individualized treatment plan by means of a treatment algorithm. Patients in the control group received usual care. The primary outcome measure was the proportion of patients with a clinically relevant improvement in disease-specific quality of life measured, as measured by means of the St. George's Respiratory Questionnaire (SGRQ) score, between baseline and 18 months follow-up. Secondary outcomes included the SGRQ total score and the Patient Assessment of Chronic Illness Care (PACIC) score. RESULTS: At 18-month follow-up, a significant and clinically relevant improvement in the SGRQ score was seen in 34% of the patients (N=49) in the intervention group, and in the control group this figure was 22% (N=33). This difference between the two groups was significant (OR 1.85, 95% CI 1.08 to 3.16). Patients in the intervention group experienced a higher quality of care than patients in the control group (0.32 points difference in PACIC, 95% CI 0.14 to 0.50). CONCLUSION: Use of the ABC tool increases the disease-specific quality of life and the quality of care for COPD patients; it may therefore offer a valuable contribution to improvements in the daily care of COPD. Replication of this study in other (non-Dutch) health-care settings is recommended.

Psychological characteristics of patients with newly developed psychogenic seizures.

OBJECTIVES: To assess psychopathological symptoms and history of childhood trauma in patients with newly developed psychogenic seizures. METHODS: Using validated scales, 178 patients from the general population diagnosed with newly developed seizures were assessed, at a point in time when the nature of their seizures was yet unknown to either doctors or patients. After standardised neurological examination, 138 patients were diagnosed with non-psychogenic seizures (NPS), while 40 patients were found to have psychogenic seizures (PS). To evaluate possible differences between the genders and the diagnostic groups, univariate analyses of variance were done. RESULTS: PS patients reported significantly more comorbid psychopathological complaints, dissociative experiences, anxiety, and self-reported childhood trauma than NPS patients. In addition, PS patients had lower quality of life ratings than NPS patients. These effects were not modulated by gender. CONCLUSIONS: The results of the present study indicate that patients with newly developed PS constitute a group with complex psychopathological features that warrant early detection and treatment.

Isokinetic aerobic power output testing of the quadriceps muscle.

A stepwise increasing exercise protocol to measure the maximal aerobic power output of the quadriceps muscle is proposed for use in rehabilitation medicine. Sixteen healthy volunteers performed isokinetic knee extension/flexion exercises at an angular velocity of 180 degrees x s(-1). The protocol consisted of stages of 200 knee movements from 100 flexion to full extension, starting at 10% peak torque (PT) and increasing by 10% PT each following stage until exhaustion. Quadriceps work, oxygen uptake, heart rate, plasma lactate concentration and surface electromyography were monitored. Quadriceps power output (Pext) was highly related (r = 0.95) to the extension torque at which the subjects were instructed to exercise. The test-retest (r = 0.82) and left to right (r = 0.94) correlations of maximum quadriceps power output (Pmax) were high. Both sexes (males 43+/-9W, females 36+/-8W) achieved their Pmax at 47% PT. At submaximal power output stages oxygen uptake (r = 0.85) and EMG-amplitude (r = 0.88) were linearly related to Pext. Mechanical efficiency (optimum at 60% Pmax) showed a large variation between power output stages and between subjects. The relationship between relative oxygen uptake and heart rate or plasma lactate concentration was similar to that of whole body exercise, e.g. running. We conclude that the proposed test is reliable for assessing the maximal aerobic power output of the quadriceps muscle. This parameter of the muscle function may add useful information for assessing the rehabilitation process after knee immobilization.

Physical fitness and sports skills in relation to sports injuries. A four-year prospective investigation of sports injuries among physical education students.

In order to study the relationship between physical fitness/sport-specific skills and sports injuries 136 physical education students were studied during their 4-years of training in a prospective investigation. Physical fitness was measured every year using a battery of fitness tests, and the performance marks of a number of sports scored at the exams of the academy were used as parameters for the sport-specific skills. Sports injuries were recorded every 3 weeks on standard forms. Relative risk ratios were calculated between the tertile groups good, average and poor for all variables of physical fitness and sport-specific skills. Injury-proneness was defined for all and for acute and chronic injuries separately near the median number of injuries sustained. In only 6 out of 126 computed relative risks was a significant difference found. Discriminant analysis revealed an explanation of 16%, 14% and 11% of the variance for respectively all, acute and chronic injuries, at which 5 or 6 variables in varying combination were included. From our findings it may be concluded that physical fitness and sport-specific skills have little impact on sports injuries for the following two main reasons. Firstly, subjects at risk for sports injuries participate per definition in sports activities and have consequently developed their fitness and skills compared to the sedentary population. Thus, the range in physical fitness or sports skills in the population at risk is relatively small (physical education students belong to the 7th-10th decile in fitness test scores within a general college student population) and therefore an effect is hard to show. Secondly, the total number of sports injuries is very small and moreover, it should be distributed over several categories for analysis. The favourable advantages of using physical education students to study intrinsic risk factors (comparable and varied sports program, excellent compliance) appeared to be insufficient to compensate for drawbacks of selection.

Physical characteristics as risk factors for sports injuries: a four year prospective study.

A variety of physical characteristics of athletes has been proposed to be related to the risk to sustain a sports injury. The aim of the present study was to determine the influence of flexibility, anthropometric characteristics and malalignment of the lower extremities on the risk to sustain a sports injury, using a prospective study design and subjects exposed to rather equal extrinsic risk factors. Physical education students (N = 136) were followed during their four-year education. Sixteen flexibility indices, four anthropometric characteristics and five malalignment indices of the lower extremities were assessed at the start of the study and all sports injuries sustained in that four-year period were recorded. No influence of flexibility or anthropometric variables on the total number of injuries or the number of several specific injuries (ankle sprain, muscle rupture, dislocation, shin splints, backache) could be established. Malalignments of the lower extremities (average prevalence 18% and only minor deviations) did show some but inconsistent relations with the number of (specific) injuries. For pelvic obliquity it was positive as predicted, but for malalignment of the rearfoot and a deviant footprint it appeared to be negative. Leg length inequality and malalignment of the knees were not related to injuries. The most likely explanation for these (poor) findings is the relatively low number and great variety of sports injuries recorded. Further, the homogeneity in physical characteristics of the population under study makes it difficult to find significant relationships. A study design that meets both the criterium of similar extrinsic risk factors and that of a wide range of physical characteristics in a representative sporting population, however, is not practicable.

Is prevention of sports injuries a realistic goal? A four-year prospective investigation of sports injuries among physical education students.

To assess the reliability of injury registration and to determine the incidence of injury in intramural (program of the institution) and extramural (leisure time) sports activities, we prospectively recorded information on sports injuries for 4 years in a group of 136 physical education students. Registration forms were completed every 3 weeks, and data on medical consultations were recorded. During the last year, we asked 59 students to recall all injuries sustained to establish the reliability of retrospective injury registration. In the prospective study, 525 sports injuries were recorded: 58% during intramural activities and 42% during extramural. The incident rate per 1000 hours of intramural activities (1.26) was significantly lower than that for extramural activities (1.77). A gradual decline in response rate from 98.4% the 1st year to 87.7% in the final year indicated a decreasing compliance during the study period. Eighteen percent of all injuries with recorded medical consultations were not reported by the students. At the retrospective injury registration in the final year of the study, students had forgotten 54% of the recorded injuries and 50 injuries (20% of all recorded injuries) were mentioned that had not been recorded during the previous years. We conclude that, even in a well-supervised population, prospective injury registration is not complete, and the reliability of retrospective injury registration is even poorer.

[Ankle sprains. Comparison of long-term results of functional treatment methods with adhesive tape and bandage ("brace") and stability measurement]. / Das Knöchelinversionstrauma. Vergleich der Langzeitergebnisse funktioneller Behandlungsmethoden mit Klebeverband und Bandage ("Brace") und die Eignung der Stabilometrie.

Both taping and bracing can be applied in the early functional treatment of ankle sprains. In this study the long-term (2.3 +/- 0.5 years) results of functional treatment with two types of bandages were compared. Out of 165 patients treated, 112 were available for interview, 60 of whom had been treated with adhesive, non-elastic tape and 52, with a confection brace. In 93 of these patients (47 in the tape group), the ankle was examined and stabilometry was performed. The distance (D) and area (A) covered by each patient's centre of gravity while he/she stood on one leg for 30 s were measured. The following symptoms were found on the total population: pain on movement in 5%, swelling in 8% and functional instability (recurrent sprain or a feeling of giving way) in 38%. Mechanical instability was found in 34%. Pain on palpation of the lateral ligaments was the only symptom whose frequency differed significantly (P < 0.05) between the tape group (47%) and the brace group (20%). Stabilometric measurements revealed no substantial difference between the tape group (D: 436 +/- 100 mm; A: 192 +/- 87 mm2) and the brace group (D: 459 +/- 111 mm; A: 206 +/- 92 mm2). Nor was any difference in stability observed between the injured and the non-injured ankle, between the stable and the unstable ankle, or between the unstable ankle with and without brace application. Stabilometry is thus not an appropriate means of quantifying the symptoms of ankle instability.(ABSTRACT TRUNCATED AT 250 WORDS)