Community Wise-effects and participant perceptions of a community- based -positive health intervention for older inhabitants of low SES neighbourhoods: a mixed-methods approach.

BACKGROUND: The Community Wise (CW) intervention applies a community-based approach to improve the physical fitness, self-management ability, loneliness, social cohesion, and well-being of older adults living in neighbourhoods characterized by lower socioeconomic status (SES). METHODS: Participants (N = 108) were recruited using several strategies, including door-to-door visits and community key peers. The study was based on a pre-test/post-test design. Outcomes were assessed through mixed methods using questionnaires, performance tests, semi-structured interviews, and focus-group sessions. RESULTS: Results showed significant improvements on aerobic endurance and shoulder flexibility, but no significant improvements on self-management ability, social cohesion, loneliness, or well-being. Qualitative data analysis did indicate that participants experienced improvements on social connectedness with members of the group, as well as on self-management ability. CONCLUSION: The results of the intervention seem to depend on programme fidelity and method of assessment. Adapting the intervention and including more older adults with poor health status could lead to better outcomes in the future. This results of this study should be interpreted in light of the complexity and methodological challenges of conducting a community-based health-promotion intervention for this target group. TRAIL REGISTRATION: Retrospective registration.

A systematic review of the association between nursing staff and nursing-sensitive outcomes in long-term institutional care.

AIMS: To examine the association between type of nursing staff and nursing-sensitive outcomes in long-term institutional care. DESIGN: This systematic review included studies published in English, German, and Dutch between January 1997 and January 2020. DATA SOURCES: The databases Medline (PubMed), CINAHL, PsycINFO, Embase, and the Cochrane Library were searched. Original quantitative studies were included. REVIEW METHODS: The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was used to critically appraise the reporting of the studies. RESULTS: Fifteen articles were included. Of 33 quality of care outcomes, 21 were identified as nursing-sensitive outcomes of which 13 showed a significant association with nursing staff, specifically: Activities of daily living, aggressive behavior, bladder/bowel incontinence, contractures, expressive language skills, falls, infection (including vaccination), range of motion, pain, pressure ulcers, and weight loss. However, studies reported inconsistent results regarding the association among RNs, LPNs, CNAs, and HCAs and these nursing-sensitive outcomes, evidence shows that more RNs have a positive impact on nursing-sensitive outcomes. As to the evidence regarding the other type of nursing staff, especially HCA, findings regularly showed a negative association. CONCLUSION: Future research should be expanded with structure and process variables of which the mediating and moderating effect on nursing-sensitive outcomes is known. These may explain variances in quality of care and guide quality improvement initiatives. Researchers should consider fully applying Donabedian's structure-process-outcomes framework as it is a coherent entirety for quality assessment. IMPACT: This review provides an overview of quality of care outcomes that are responsive to nursing interventions in long-term institutional care. As the effects can be monitored and documented, quality assessment should focus on these nursing-sensitive outcomes. The inconclusive results make it difficult to provide recommendations on who should best perform which care.

Pilot testing a stretching regimen for prevention of night time nocturnal leg cramps.

Nocturnal leg cramps (NLC) are painful, involuntary muscle contractions that affect the quality of sleep. The aim of this study was to examine the feasibility and effectiveness of a stretching regimen in frail older adults aged over 75 years with NLC. The experimental group (n = 15) received an intervention, which they were instructed to perform three daily exercises to stretch the calves and hamstrings. After six weeks, frequency and pain intensity of NLC were both significantly decreased in the experimental group compared to the control group. A paired samples t-test reveals a statistically significant decrease in cramp frequency (t = 2.2, df 28, P = 0.04) and cramp intensity (t = 2.7, df 28, P = 0.01). Therefore, a six-week stretching regimen is likely to reduce the frequency and pain intensity of NLC in frail older adults aged over 75 years.

The consistency between planned and actually given nursing care in long-terminstitutional care.

Continuous information exchange between healthcare professionals is facilitated by individualized care plans. Compliance with the planned care as documented in care plans is important to provide person-centered care which contributes to the continuity of care and quality of care outcomes. Using the Nursing Interventions Classification, this study examined the consistency between documented and actually provided interventions by type of nursing staff with 150 residents in long-term institutional care. The consistency was especially high for basic (93%) and complex (79%) physiological care. To a lesser extent for interventions in the behavioral domain (66%). Except for the safety domain, the probability that documented interventions were provided was high for all domains (≥ 91%, p > 0.05). NAs generally provided the interventions as documented. Findings suggest that HCAs worked beyond there scope of practice. The results may have implications for the deployment of nursing staff and are of importance to managers.

Randomized Trial of a Lifestyle Program in Obese Infertile Women.

BACKGROUND: Small lifestyle-intervention studies suggest that modest weight loss increases the chance of conception and may improve perinatal outcomes, but large randomized, controlled trials are lacking. METHODS: We randomly assigned infertile women with a body-mass index (the weight in kilograms divided by the square of the height in meters) of 29 or higher to a 6-month lifestyle intervention preceding treatment for infertility or to prompt treatment for infertility. The primary outcome was the vaginal birth of a healthy singleton at term within 24 months after randomization. RESULTS: We assigned women who did not conceive naturally to one of two treatment strategies: 290 women were assigned to a 6-month lifestyle-intervention program preceding 18 months of infertility treatment (intervention group) and 287 were assigned to prompt infertility treatment for 24 months (control group). A total of 3 women withdrew consent, so 289 women in the intervention group and 285 women in the control group were included in the analysis. The discontinuation rate in the intervention group was 21.8%. In intention-to-treat analyses, the mean weight loss was 4.4 kg in the intervention group and 1.1 kg in the control group (P<0.001). The primary outcome occurred in 27.1% of the women in the intervention group and 35.2% of those in the control group (rate ratio in the intervention group, 0.77; 95% confidence interval, 0.60 to 0.99). CONCLUSIONS: In obese infertile women, a lifestyle intervention preceding infertility treatment, as compared with prompt infertility treatment, did not result in higher rates of a vaginal birth of a healthy singleton at term within 24 months after randomization. (Funded by the Netherlands Organization for Health Research and Development; Netherlands Trial Register number, NTR1530.).

Criteria in diagnosing nocturnal leg cramps: a systematic review.

BACKGROUND: Up to 33% of the general population over 50 years of age are affected by nocturnal leg cramps. Currently there are no generally accepted clinical characteristics, which identify nocturnal leg cramps. This study aims to identify these clinical characteristics and to differentiate between them and the characteristics of restless leg syndrome and periodic limb disorder. METHOD: A systematic literature study was executed from December 2015 to May 2016. This study comprised of a systematic literature review of randomized clinical trials, observational studies on nocturnal and rest cramps of legs and other muscles, and other systematic and narrative reviews. Two researchers independently extracted literature data and analyzed this using a standardized reviewing protocol. Modified versions of the Cochrane Collaboration tools assessed the risk of bias. A Delphi study was conducted to assess agreement on the characteristics of nocturnal leg cramps. RESULTS: After systematic and manual searches, eight randomized trials and ten observational studies were included. On the basis of these we identified seven diagnostic characteristics of nocturnal leg cramps: intense pain, period of duration from seconds to maximum 10 minutes, location in calf or foot, location seldom in thigh or hamstrings, persistent subsequent pain, sleep disruption and distress. CONCLUSION: The seven above characteristics will enhance recognition of the condition, and help clinicians make a clear distinction between NLC and other sleep-related musculoskeletal disorder among older adults.

Accuracy of documentation in the nursing care plan in long-term institutional care.

Nursing staff working in long-term institutional care attend to residents with an increasing number of severe physical and cognitive limitations. To exchange information about the health status of these residents, accurate nursing documentation is important to ensure the safety of residents. This study examined the accuracy of nursing documentation in 197 care plans of five long-term institutional care facilities. Based on the phases of the nursing process, the D-Catch instrument measures the accuracy of the content and coherence of documentation. Inadequacies were especially found in the description of residents' care needs and stated nursing diagnoses as well as in progress and outcome reports. In somatic and psycho-geriatric units, higher accuracy scores were determined compared with residential care units. Investments in resources (e.g., time), reasoning skills of nursing staff, and implementation of professional standards in accordance with legal requirements may be needed to enhance the quality of nursing documentation.

Effect of diagnosis with a chronic disease on physical activity behavior in middle-aged women.

OBJECTIVE: Although regular physical activity is an effective secondary prevention strategy for patients with a chronic disease, it is unclear whether patients change their daily physical activity after being diagnosed. Therefore, the aims of this study were to (1) describe changes in levels of physical activity in middle-aged women before and after diagnosis with a chronic disease (heart disease, diabetes, asthma, breast cancer, arthritis, depression); and to (2) examine whether diagnosis with a chronic disease affects levels of physical activity in these women. METHODS: Data from 5 surveys (1998-2010) of the Australian Longitudinal Study on Women's Health (ALSWH) were used. Participants (N=4840, born 1946-1951) completed surveys every three years, with questions about diseases and leisure time physical activity. The main outcome measure was physical activity, categorized as: nil/sedentary, low active, moderately active, highly active. RESULTS: At each survey approximately half the middle-aged women did not meet the recommended level of physical activity. Between consecutive surveys, 41%-46% of the women did not change, 24%-30% decreased, and 24%-31% increased their physical activity level. These proportions of change were similar directly after diagnosis with a chronic disease, and in the years before or after diagnosis. Generalized estimating equations showed that there was no statistically significant effect of diagnosis with a chronic disease on levels of physical activity in women. CONCLUSION: Despite the importance of physical activity for the management of chronic diseases, most women did not increase their physical activity after diagnosis. This illustrates a need for tailored interventions to enhance physical activity in newly diagnosed patients.

Assessing time use in long-term institutional care: development, validity and inter-rater reliability of the Groningen Observational instrument for Long-Term Institutional Care (GO-LTIC).

BACKGROUND: Limited research has examined what is actually done in the process of care by nursing staff in long-term institutional care. The applied instruments employed different terminologies, and psychometric properties were inadequately described. This study aimed to develop and test an observational instrument to identify and examine the amount of time spent on nursing interventions in long-term institutional care using a standardized language. METHODS: The Groningen Observational instrument for Long-Term Institutional Care (GO-LTIC) is based on the conceptual framework of the Nursing Interventions Classification. Developmental, validation, and reliability stages of the GO-LTIC included: 1) item generation to identify potential setting-specific interventions; 2) examining content validity with a Delphi panel resulting in relevant interventions by calculating the item content validity index; 3) testing feasibility with trained observers observing nursing assistants; and 4) calculating inter-rater reliability using (non) agreement and Cohen's kappa for the identification of interventions and an intraclass correlation coefficient for the amount of time spent on interventions. Bland-Altman plots were applied to visualize the agreement between observers. A one-sample student T-test verified if the difference between observers differed significantly from zero. RESULTS: The final version of the GO-LTIC comprised 116 nursing interventions categorized into six domains. Substantial to almost perfect kappa's were found for interventions in the domains basic (0.67-0.92) and complex (0.70-0.94) physiological care. For the domains of behavioral, family, and health system interventions, the kappa's ranged from fair to almost perfect (0.30-1.00). Intraclass correlation coefficients for the amount of time spent on interventions ranged from fair to excellent for the physiological domains (0.48-0.99) and poor to excellent for the other domains (0.00-1.00). Bland Altman plots indicated that the clinical magnitude of differences in minutes was small. No statistical significant differences between observers (p > 0.05) were found. CONCLUSIONS: The GO-LTIC shows good content validity and acceptable inter-rater reliability to examine the amount of time spent on nursing interventions by nursing staff. This may provide managers with valuable information to make decisions about resource allocation, task allocation of nursing staff, and the examination of the costs of nursing services.

Changes in the endurance shuttle walk test in COPD patients with chronic respiratory failure after pulmonary rehabilitation: the minimal important difference obtained with anchor- and distribution-based method.

BACKGROUND: Although the endurance shuttle walk test (ESWT) has proven to be responsive to change in exercise capacity after pulmonary rehabilitation (PR) for COPD, the minimally important difference (MID) has not yet been established. We aimed to establish the MID of the ESWT in patients with severe COPD and chronic hypercapnic respiratory failure following PR. METHODS: Data were derived from a randomized controlled trial, investigating the value of noninvasive positive pressure ventilation added to PR. Fifty-five patients with stable COPD, GOLD stage IV, with chronic respiratory failure were included (mean (SD) FEV1 31.1 (12.0) % pred, age 62 (9) y). MID estimates of the ESWT in seconds, percentage and meters change were calculated with anchor based and distribution based methods. Six minute walking distance (6MWD), peak work rate on bicycle ergometry (Wpeak) and Chronic Respiratory Questionnaire (CRQ) were used as anchors and Cohen's effect size was used as distribution based method. RESULTS: The estimated MID of the ESWT with the different anchors ranged from 186-199 s, 76-82% and 154-164 m. Using the distribution based method the MID was 144 s, 61% and 137 m. CONCLUSIONS: Estimates of the MID for the ESWT after PR showed only small differences using different anchors in patients with COPD and chronic respiratory failure. Therefore we recommend using a range of 186-199 s, 76-82% or 154-164 m as MID of the ESWT in COPD patients with chronic respiratory failure. Further research in larger populations should elucidate whether this cut-off value is also valid in other COPD populations and with other interventions. TRIAL REGISTRATION: ClinicalTrials.Gov (ID NCT00135538).

Selecting the increment size for a maximal incremental cycle test in patients with COPD.

Currently, to our knowledge, there are no chronic obstructive pulmonary disease (COPD)-specific formulas to predict the maximum workload of an incremental cycle ergometer test. The aim of the study was to investigate different prediction models including COPD-specific variables of maximum workload in 113 mild to very severe COPD patients. This study shows that simple measures like forced expiratory volume in 1 s, chair-stand test and modified Medical Research Council dyspnoea score may improve the accuracy of the predicted maximum workload in COPD patients.

What type, or combination of exercise can improve preferred gait speed in older adults? A meta-analysis.

BACKGROUND: Improved preferred gait speed in older adults is associated with increased survival rates. There are inconsistent findings in clinical trials regarding effects of exercise on preferred gait speed, and heterogeneity in interventions in the current reviews and meta-analyses. OBJECTIVE: to determine the meta-effects of different types or combinations of exercise interventions from randomized controlled trials on improvement in preferred gait speed. DATA SOURCES: A literature search was performed; the following databases were searched for studies from 1990 up to 9 December 2013: PubMed, EMBASE, EBSCO (AMED, CINAHL, ERIC, Medline, PsycInfo, and SocINDEX), and the Cochrane Library. STUDY ELIGIBILITY CRITERIA: Randomized controlled trials of exercise interventions for older adults ≥ 65 years, that provided quantitative data (mean/SD) on preferred gait speed at baseline and post-intervention, as a primary or secondary outcome measure in the published article were included. Studies were excluded when the PEDro score was ≤4, or if participants were selected for a specific neurological or neurodegenerative disease, Chronic Obstructive Pulmonary Disease, cardiovascular disease, recent lower limb fractures, lower limb joint replacements, or severe cognitive impairments. The meta-effect is presented in Forest plots with 95 % confidence STUDY APPRAISAL AND SYNTHESIS METHODS: intervals and random weights assigned to each trial. Homogeneity and risk of publication bias were assessed. RESULTS: Twenty-five studies were analysed in this meta-analysis. Data from six types or combinations of exercise interventions were pooled into sub-analyses. First, there is a significant positive meta-effect of resistance training progressed to 70-80 % of 1RM on preferred gait speed of 0.13 [CI 95 % 0.09-0.16] m/s. The difference between intervention- and control groups shows a substantial meaningful change (>0.1 m/s). Secondly, a significant positive meta-effect of interventions with a rhythmic component on preferred gait speed of 0.07 [CI 95 % 0.03-0.10] m/s was found. Thirdly, there is a small significant positive meta-effect of progressive resistance training, combined with balance-, and endurance training of 0.05 [CI 95 % 0.00-0.09] m/s. The other sub-analyses show non-significant small positive meta-affects. CONCLUSIONS: Progressive resistance training with high intensities, is the most effective exercise modality for improving preferred gait speed. Sufficient muscle strength seems an important condition for improving preferred gait speed. The addition of balance-, and/or endurance training does not contribute to the significant positive effects of progressive resistance training. A promising component is exercise with a rhythmic component. Keeping time to music or rhythm possibly trains higher cognitive functions that are important for gait. LIMITATIONS: The focus of the present meta-analysis was at avoiding as much heterogeneity in exercise interventions. However heterogeneity in the research populations could not be completely avoided, there are probably differences in health status within different studies.

Building from a conceptual model of the resilience process during ageing, towards the Groningen Aging Resilience Inventory.

AIM: To develop and psychometrically test the Groningen Ageing Resilience Inventory. BACKGROUND: Ageing is a process that is often accompanied by functional limitation, disabilities and losses. Instead of focusing on these negative events of ageing, there are opportunities in focusing on adaptation mechanisms, like resilience, that are helpful to cope with those adversities. DESIGN: Cross-sectional study. METHOD: The study was conducted from 2011-2012. First, a conceptual model of resilience during the ageing process was constructed. Next, items were formulated that made up a comprehensive template questionnaire reflecting the model. Finally, a cross-sectional study was performed to evaluate the construct validity and internal consistency of this template 16-item questionnaire. FINDINGS: Participants (N = 229) with a mean age of 71·5 years, completed the template 16-item Groningen Ageing Resilience Inventory, and performance based tests and psychological questionnaires. Exploratory factor analysis resulted in a two factor solution of internal and external resources of resilience. Three items did not discriminate well between the two factors and were deleted, remaining a final 13-item questionnaire that shows evidence of good internal consistency. The direction and magnitude of the correlations with other measures support the construct validity. CONCLUSION: The Groningen Ageing Resilience Inventory is a useful instrument that can help nurses, other healthcare workers, researchers and providers of informal care to identify the internal and external resources of resilience in individuals and groups. In a multidisciplinary biopsychosocial approach this knowledge provides tools for empowering older patients in performing health promoting behaviors and self-care tasks.

Understanding how older adults living in deprived neighbourhoods address ageing issues.

Older adults living in deprived areas are at risk of developing frailty and becoming care dependent. The aim of this qualitative study is to explore how community-dwelling, older adults living in deprived neighbourhoods address ageing issues. In-depth interviews were conducted with 20 participants who were community-dwelling (independently living), aged 65 years and older, not dependent on care, and living in a socioeconomically deprived urban neighbourhood in the northern part of the Netherlands. Data were analysed using the constant comparative method. Our findings emphasise the resourcefulness of these older adults when coping with apparent adversities. Simultaneously, the findings convey deficits concerning knowledge about ageing and health. Despite this, it appeared that these older adults possess an optimistic view of life, accept their situation, and are content with the capacities they still possess. Perspectives on how older adults address ageing issues are important for developing leads for nursing practice. Nurses will be challenged to recognise the coping strategies of older adults, particularly considering their deficits in health knowledge. The results of this study may serve as a basis for community nurses to manage care for older adults in deprived neighbourhoods.

Physical activity recommendations in patients with chronic obstructive pulmonary disease.

BACKGROUND: Physical activity recommendations are hardly studied in patients with chronic obstructive pulmonary disease (COPD), and specifically recommendations that are individualized to a patient's aerobic fitness level are not studied. OBJECTIVES: To compare individualized (relative) and nonindividualized (absolute) physical activity recommendations in patients with COPD and to assess whether there are differences between patients with mild to moderate and (very) severe COPD. METHODS: We compared 7 different physical activity recommendations that were described in the literature. Four recommendations were individualized based on the patient's aerobic fitness level measured by a maximal cycle ergometer test. Three recommendations were nonindividualized. The recommendations were measured with an accelerometer, pedometer or questionnaire in 115 patients with mild to very severe COPD (68% male, mean age 65 years, mean FEV1 58% predicted). RESULTS: The percentage of patients that met the different recommendations ranged from 22 to 86% and only 8 patients met all 7 recommendations. The agreement between the different recommendations was poor (intraclass correlation coefficient, 0.28). Individualizing the recommendations resulted in a higher number of patients with severe or very severe COPD meeting the individualized recommendations compared to the nonindividualized recommendations. In contrast, patients with mild to moderate COPD less frequently met the individualized recommendations. CONCLUSIONS: Our study showed that applying various physical activity recommendations with small differences in frequency, intensity or time led to large differences in the classification of patients with COPD into being sufficiently physically active or not. Consequently, the used recommendation will highly affect the proposed physical activity advice to the patient.

Daily physical activity in stable heart failure patients.

BACKGROUND: Physical activity is the only nonpharmacological therapy that is proven to be effective in heart failure (HF) patients in reducing morbidity. To date, little is known about the levels of daily physical activity in HF patients and about related factors. OBJECTIVE: The objectives of this study were to (a) describe performance-based daily physical activity in HF patients, (b) compare it with physical activity guidelines, and (c) identify related factors of daily physical activity. METHODS: The daily physical activity of 68 HF patients was measured using an accelerometer (SenseWear) for 48 hours. Psychological characteristics (self-efficacy, motivation, and depression) were measured using questionnaires. To have an indication how to interpret daily physical activity levels of the study sample, time spent on moderate- to vigorous-intensity physical activities was compared with the 30-minute activity guideline. Steps per day was compared with the criteria for healthy adults, in the absence of HF-specific criteria. Linear regression analyses were used to identify related factors of daily physical activity. RESULTS: Forty-four percent were active for less than 30 min/d, whereas 56% were active for more than 30 min/d. Fifty percent took fewer than 5000 steps per day, 35% took 5000 to 10 000 steps per day, and 15% took more than 10 000 steps per day. Linear regression models showed that New York Heart Association classification and self-efficacy were the most important factors explaining variance in daily physical activity. CONCLUSIONS: The variance in daily physical activity in HF patients is considerable. Approximately half of the patients had a sedentary lifestyle. Higher New York Heart Association classification and lower self-efficacy are associated with less daily physical activity. These findings contribute to the understanding of daily physical activity behavior of HF patients and can help healthcare providers to promote daily physical activity in sedentary HF patients.

Cancer survivors' experiences of a physical activity program in primary care: a qualitative study.

PURPOSE: This study aimed to gain insight into the experiences of, and reasons for, cancer survivors participating in a primary care PA program. METHODS: We interviewed 17 patients from 11 Dutch GP practices. Patients were selected by purposive sampling based on their general practice, gender, educational level, motivation for PA, and change in PA. Interviews were audio recorded, transcribed verbatim, and pseudonymized for inductive thematic analysis. RESULTS: Three domains were identified with five themes: institutional domain: GP practice; program-specific domain: content sessions and PA, and activity tracker and goal setting; individual domain: experienced benefits, and personalized care needs. Participants valued the PA program because it was offered close to home, without additional costs, and by a trusted practice nurse familiar with the patients' medical background. Activity tracker use and goal setting motivated many participants but also led to demotivation and feelings of failure in others. Reported benefits included behavior change and favorable health outcomes. Many patients expressed the need to personalize psychological support and the program's timing. CONCLUSIONS: Access to a PA program in a primary care setting is valued for its accessibility and experienced health benefits, but also seems to meet an unmet need for support in picking up life during cancer recovery. IMPLICATIONS FOR CANCER SURVIVORS: Primary care is important for continued care of cancer survivors. An accessible PA program in this setting may fulfil a need for not only lifestyle support but also continuing life after cancer treatment.

Physical and psychosocial factors associated with physical activity in patients with chronic obstructive pulmonary disease.

OBJECTIVES: To assess physical activity and sitting time in patients with chronic obstructive pulmonary disease (COPD) and to investigate which physical and psychosocial factors are associated with physical activity and sitting time. DESIGN: Cross-sectional study. SETTING: Patients were recruited at outpatient clinics of general hospitals and from general practitioners. PARTICIPANTS: Patients (N=113) with mild to very severe COPD. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Physical activity and sitting time were measured with a triaxial accelerometer (24h/d). RESULTS: Mean locomotion time per 24 hours was 6.8% (range, 0.7%-20.4%). Elevated physical activity was independently associated with higher self-efficacy, higher functional exercise capacity, and lower lung hyperinflation. Decreased physical activity was strongest in more severe stages of COPD, in which the patients were mainly limited by physical disease-specific factors (higher lung hyperinflation, worse dyspnea severity, worse leg muscle function, and oxygen use). In less severe patients, physical activity was independently associated with more generic factors (higher self-efficacy and the spring/summer season). Sitting time did not differ between severity stages, and longer sitting time in the total group was independently associated with more positive perception of treatment control, less autonomous motivation to exercise, not using sleep medication, and oxygen use. CONCLUSIONS: Both physical and psychosocial factors were associated with physical activity in patients with COPD. The factors associated with physical activity differed between disease severity stages, raising the question of whether physical activity enhancement programs should differ as well. Sitting time should be investigated further.

Multidimensional structure of the Groningen Frailty Indicator in community-dwelling older people.

BACKGROUND: Due to the rapidly increasing number of older people worldwide, the prevalence of frailty among older adults is expected to escalate in coming decades. It is crucial to recognize early onset symptoms to initiate specific preventive care. Therefore, early detection of frailty with appropriate screening instruments is needed. The aim of this study was to evaluate the underlying dimensionality of the Groningen Frailty Indicator (GFI), a widely used self-report screening instrument for identifying frail older adults. In addition, criterion validity of GFI subscales was examined and composition of GFI scores was evaluated. METHODS: A cross-sectional study design was used to evaluate the structural validity, internal consistency and criterion validity of the GFI questionnaire in older adults aged 65 years and older. All subjects completed the GFI questionnaire (n = 1508). To assess criterion validity, a smaller sample of 119 older adults completed additional questionnaires: De Jong Gierveld Loneliness Scale, Hospital Anxiety Depression Scale, RAND-36 physical functioning, and perceived general health item of the EuroQol-5D. Exploratory factor analysis and Mokken scale analysis were used to evaluate the structural validity of the GFI. A Venn diagram was constructed to show the composition of GFI subscale scores for frail subjects. RESULTS: The factor structure of the GFI supported a three-dimensional structure of the scale. The subscales Daily Activities and Psychosocial Functioning showed good internal consistency, scalability, and criterion validity (Daily Activities: Cronbach's α = 0.81, H(s) = .84, r = -.62; Psychosocial Functioning: Cronbach's α = 0.80, H(s) = .35, r = -.48). The subscale Health Problems showed less strong internal consistency but acceptable scalability and criterion validity (Cronbach's α = .57, H(s) = .35, r = -.48). The present data suggest that 90% of the frail older adults experience problems in the Psychosocial Functioning domain. CONCLUSIONS: The present findings support a three-dimensional factor structure of the GFI, suggesting that a multidimensional assessment of frailty with the GFI is possible. These GFI subscale scores produce a richer assessment of frailty than with a single overall sum GFI score, and likely their use will contribute to more directed and customized care for older adults.

Measurement of acute nonspecific low back pain perception in primary care physical therapy: reliability and validity of the brief illness perception questionnaire.

BACKGROUND: The eight-item Brief Illness Perception Questionnaire is used as a screening instrument in physical therapy to assess mental defeat in patients with acute low back pain, besides patient perception might determine the course and risk for chronic low back pain. However, the psychometric properties of the Brief Illness Perception Questionnaire in common musculoskeletal disorders like acute low back pain have not been adequately studied. Patients' perceptions vary across different populations and affect coping styles. Thus, our aim was to determine the internal consistency, test-retest reliability and validity of the Dutch language version of the Brief Illness Perception Questionnaire in acute non-specific low back pain patients in primary care physical therapy. METHODS: A non-experimental cross-sectional study with two measurements was performed. Eighty-four acute low back pain patients, in multidisciplinary health care center in Dutch primary care with a sample mean (SD) age of 42 (12) years, participated in the study. Internal consistency (Cronbach's α) and test-retest procedures (Intraclass Correlation Coefficients and limits of agreement) were evaluated at a one-week interval. The concurrent validity of the Brief Illness Perception Questionnaire was examined by using the Mental Health Component of the Short Form 36 Health Survey. RESULTS: The Cronbach's α for internal consistency was 0.73 (95% CI, 0.67 - 0.83); and the Intraclass Correlation Coefficient test-retest reliability was acceptable: 0.72 (95% CI, 0.53 - 0.82), however, the limits of agreement were large. The Intraclass Correlation Coefficient measuring concurrent validity 0.65 (95% CI, 0.46 - 0.80). CONCLUSION: The Dutch version of the Brief Illness Perception Questionnaire is an appropriate instrument for measuring patients' perceptions in acute low back pain patients, showing acceptable internal consistency and reliability. Concurrent validity is adequate, however, the instrument may be unsuitable for detecting changes in low back pain perception over time.