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Contains fulltext : 88421.pdf (publisher's version ) (Open Access), BACKGROUND: Improving patients' health status is one of the major goals in COPD treatment. Questionnaires could facilitate the guidance of patient-tailored disease management by exploring which aspects of health status are problematic, and which aspects are not. Health status consists of four main domains (physiological functioning, symptoms, functional impairment, and quality of life), and at least sixteen sub-domains. A prerequisite for patient-tailored treatment is a detailed assessment of all these sub-domains. Most questionnaires developed to measure health status consist of one or a few subscales and measure merely some aspects of health status. The question then rises which aspects of health status are measured by these instruments, and which aspects are not covered. As it is one of the most frequently used questionnaires in COPD, we evaluated which aspects of health status are measured and which aspects are not measured by the St George's Respiratory Questionnaire (SGRQ). METHODS: One hundred and forty-six outpatients with COPD participated. Correlations were calculated between the three sections of the SGRQ and ten sub-domains of the Nijmegen Integral Assessment Framework, covering Symptoms, Functional Impairment, and Quality of Life. As the SGRQ was not expected to measure physiological functioning, we did not include this main domain in the statistical analyses. Pearson's r > or = 0.70 was used as criterion for conceptual similarity. RESULTS: The SGRQ sections Symptoms and Total showed conceptual similarity with the sub-domain Subjective Symptoms (main domain Symptoms). The sections Activity, Impacts and Total were conceptual similar to Subjective Impairment (main domain Functional Impairment). The SGRQ sections were not conceptual similar to other sub-domains of Symptoms, Functional Impairment, nor to any sub-domain of Quality of Life. CONCLUSIONS: The SGRQ could facilitate the guidance of disease management in COPD only partially. The SGRQ is appropriat

Contains fulltext : 79857.pdf (publisher's version ) (Open Access), The Global Initiative for Chronic Obstructive Lung Disease (GOLD) serves as a guide to treat and manage different severity classes of patients with COPD. It was suggested that the five categories of FEV(1) % predicted (GOLD 0-4), can be applied for selecting different therapeutic approaches. However, validation of these selective properties is very poor. To determine the relevance of the GOLD staging system for estimating the severity of clinical problems, GOLD 2 (n=70) and GOLD 3 (n=65) patients were drawn from a prospective cohort of patients with COPD and evaluated crosssectionally by a newly developed Nijmegen Integral Assessment Framework (NIAF). The NIAF is a detailed assessment of a wide range of aspects of health status (HS). Significant, though small, differences were found in Static Lung Volumes, Exercise Capacity, Subjective Pulmonary Complaints, Subjective Impairment, and Health-Related QoL, besides Airflow of course. Moreover, overlap between scores of these five HS sub-domains was substantial, indicating small clinical relevance for discernment. No significant differences were found in nine other aspects of HS. It is concluded that GOLD stages do not discriminate in any aspect of HS other than airflow obstruction, and therefore do not help the clinician in deciding which treatment modalities are appropriate.

Contains fulltext : 80284.pdf (publisher's version ) (Closed access), PURPOSE: To compose a battery of instruments that provides a detailed assessment of health status (HS) in COPD but that is applicable and clinically meaningful in routine care. METHODS: In a previous study, we developed the Nijmegen Integral Assessment Framework (NIAF) that organizes existing tests and instruments by the sub-domains of HS they measure. Based on clinical and statistical criteria (correlation coefficients and Cronbach alpha's) we selected for each sub-domain instruments from the NIAF. A COPD-study group was used to determine c-scores, and two control groups were used to determine the score ranges indicating normal functioning versus clinically relevant problems for each sub-domain. Existing questionnaire completion software (TestOrganiser) was adapted to enhance clinical applicability. RESULTS: The NCSI measures eleven sub-domains of physiological functioning, symptoms, functional impairment, and quality of life. The TestOrganiser automatically processes the data and produces the graphical PatientProfileChart, which helps to easily interpret results. This envisages the problem areas and discrepancies between the different sub-domains. CONCLUSION: The NCSI provides a valid and detailed picture of a patient's HS within 15-25 min. In combination with the PatientProfileChart, the NCSI can be used perfectly in routine care as screening instrument and as a guide in patient-tailored treatment.

Contains fulltext : 69722.pdf (publisher's version ) (Closed access), BACKGROUND: To date, many health status instruments exist, but the validity of these instruments is questionable. This is caused by the fact that health status is poorly defined. Purpose: To develop a validated framework that improves conceptual insight into health status and its domains. METHODS: Based on theoretical and clinical considerations, we defined the domains of health status into concrete sub-domains by formulating conceptual models. Guided by these conceptual models, for each sub-domain, existing instruments were selected. We validated the conceptual models in the data of 168 COPD patients. Using factor analysis, underlying concepts in the data were identified. RESULTS: The resulting framework included physiological functioning, complaints, functional impairment, and quality of life. These main domains were shown to be subdivided into 15 sub-domains. CONCLUSIONS: The present study shows that health status consists of conceptually distinct sub-domains. Integral assessment of health status thus entails measuring all sub-domains. Existing instruments measure only few sub-domains. Integral assessment of health status thus requires the combination of different instruments. The present framework of health status can help in composing such a battery of instruments. Patient profiles obtained by the framework are essential in individualizing treatment.

Contains fulltext : 69064.pdf (publisher's version ) (Closed access)

Contains fulltext : 49216.pdf (publisher's version ) (Closed access), OBJECTIVE: The aim of this prospective study was to investigate predictors of 1-year changes in sick leave in workers with asthma. METHODS: The initial cohort consisted of 111 workers with asthma. One-hundred and one participants completed the follow-up after 1 year. Self-reported sick leave over the past 12 months was reported at baseline and at follow-up. At the start of this study, all participants completed questionnaires on adaptation to functional limitations, psychosocial variables, working conditions, lung function characteristics, disease history characteristics, health complaints and functional limitations, and person characteristics ('potential predictors'). Three multivariate logistic regression models were calculated, with an increase in sick leave, a decrease in sick leave, and stable high sick leave as dependent (outcome) variables, and the potential predictors as independent (explanatory) variables. RESULTS: An increase in sick leave was predicted by a lower level of education and perceiving more functional limitations in activities of daily life. A decrease in sick leave was predicted by spending all energy at work less often and perceiving fewer health complaints in social activities (adaptation criteria 4 and 5). Stable high sick leave was predicted by less job satisfaction, perceiving more support from the employer and perceiving more health complaints in social activities (adaptation criterion 5). Lung function characteristics, or disease history characteristics were not predictive for changes in sick leave in any of the groups. CONCLUSION: We conclude that adaptation to functional limitations played a major role in changes in sick leave in workers with asthma. Lung function characteristics hardly played a role.

Contains fulltext : 48632.pdf (publisher's version ) (Closed access), We sought to investigate associations between knowledge about the disease and sick leave, health complaints, functional limitations, adaptation and perceived control. Patients with asthma (n = 101) and COPD (n = 64) underwent lung function tests and completed questionnaires. In addition, all were asked the question: 'what is the diagnosis of your disease?', with the response categories: 'asthma' and 'COPD (chronic bronchitis or emphysema)'. Thirty-five percent of the asthma patients and 30% of the COPD patients did not know their correct diagnosis. Sick leave was not associated with knowledge about the disease in asthma and COPD. In asthma, much knowledge about management of the disease was associated with better adaptation (P = 0.01) and less perceived control over health by external factors (P = 0.02). Knowing the correct diagnosis was associated with less control over health by powerful others (P = 0.02). For COPD, more knowledge about management of the disease was associated with better adaptation (P = 0.02) and less control over health by internal factors (P = 0.01). Knowing the correct diagnosis was associated with less control over dyspnea at work (P = 0.01).

Contains fulltext : 48128.pdf (publisher's version ) (Closed access), We investigated associations of sick leave in 165 workers with asthma and COPD with three components of the Model of Planned Behavior (MPB): attitudes, social norms towards sick leave, and perceived control over sick leave and over health complaints. All participants underwent lung-function tests and completed questionnaires on sick leave, and on the MPB-components. Differences were calculated between high and low sick leave (frequency and duration) for the total group of asthma and COPD and separately for asthma and COPD. The most relevant variable within each MPB-component was selected for multivariate analysis. In the total group and in the group with asthma, low sick leave was associated with more perceived control over fatigue. In COPD, the attitude 'finding the negative consequences of sick leave more unpleasant' was associated with high sick leave. It was concluded that similarities exist in a population of asthma and COPD patients, but that different MPB-components play a role in sick leave in asthma and COPD. Perceived control over health complaints is more important in asthma than in COPD. Attitudes towards sick leave appear to be more important in COPD patients.

Contains fulltext : 48127.pdf (publisher's version ) (Closed access), The aim of this exploratory study was to investigate associations between sick leave in workers with asthma or COPD and disease-related variables, psychosocial variables, and work characteristics. Hundred and eighty-nine patients with physician-diagnosed asthma (N=118) or COPD (n=71) who had paid work in the past 12 months completed questionnaires on sick leave, health complaints, functional limitations, work characteristics and psychosocial issues, and underwent a pulmonary function test (FEV1 and FVC before and after bronchodilation). Logistic regression analyses were performed to investigate variables independently associated with high sick leave (i.e. more than twice a year and/or longer than 1 month per episode). Asthma patients, not having an emotionally difficult job, with low job satisfaction, who had changed employers, utilized job control, and who encountered pulmonary aggravating factors at work were found to have a higher incidence of sick leave. COPD patients, who had informed the employer or colleagues about the disease, who did not have difficult tasks at work, who did not hide dyspnea and limitations, and who reported high fatigue were showing higher sick leave. FEV1 and FVC were not associated with sick leave in either group. It was concluded that psychosocial variables, work characteristics, functional limitations, and complaints play a more important role in sick leave in workers with asthma and COPD than FEV1.

Contains fulltext : 58577.pdf (publisher's version ) (Closed access), OBJECTIVE: Determinants of sick leave should be investigated before interventions to reduce sick leave can be designed. This cross-sectional study compares employees with asthma and chronic obstructive pulmonary disease (COPD) with and without sick leave. METHODS: One hundred and eighteen participants with asthma and 71 with COPD underwent a lung function test [one-second forced expiratory volume (FEV1), forced vital capacity (FVC)] and completed questionnaires on health complaints, work characteristics, demographic and psychosocial variables, and self-reported sick leave in the past 12 months. Backward multivariate logistic regression analyses, with sick leave (no/any) as dependent variable, were conducted for asthma, COPD, and the total group. RESULTS: Lung function measures were not significantly associated with sick leave in any group (P > 0.05). For asthma, psychosocial variables (spending all energy at work, OR 0.7) and health complaints (frequency of dyspnoea, OR 0.4 and breathing problems such as coughing, wheezing, OR 1.1) were associated with sick leave. In the COPD group, age (OR 0.9) was the only significant variable to be maintained in the model. In the total group, work characteristics (adjustment in work pace, OR 3.3), age (OR 0.9) and spending all energy at work (OR 0.7) were maintained in the final model. CONCLUSION: Severity of the disease, as measured by lung function, is not a determinant of sick leave in asthma and COPD. Different processes play a role in asthma and COPD. Interventions for reducing sick leave should aim more at psychosocial factors than at treating the severity of the disease.

KUN Katholieke Universiteit Nijmegen, 1 december 2004, Promotores : Folgering, H.T.M., Weel, C. van Co-promotores : Gulden, J.W.J. van der, Vercoulen, J.H.M.M., Contains fulltext : 58719.pdf (publisher's version ) (Open Access), Asthma and Chronic Obstructive Pulmonary Disease (COPD) have negative consequences for work performance. Sick leave and work disability not only lead to high costs for society, but also for a loss of social fulfilment in life through work, which may reduce quality of life. The objective of this thesis was to investigate associations between a broad array of different factors and sick leave in workers with asthma and COPD. Factors we investigated were disease characteristics, health complaints, functional limitations, work characteristics, psychosocial variables, and workers? knowledge about the management of the disease and about their diagnosis. We especially focused on adaptation to functional limitations regarding sick leave. Adaptation is considered as an active way of coping in which an individual adapts to the chronic disorder he is suffering from. This involves a behavioural change, in which he accepts the consequences of the chronic disorder and adapts to this situation. We conducted three studies. First, a qualitative study was conducted using focusgroup interviews (2001). For the second study, a cohort of 189 workers with asthma and COPD underwent a pulmonary function test and completed questionnaires (2002). In the third study, 165 participants completed questionnaires again after one year. The main finding of this study was that inadequate adaptation was associated with sick leave in workers with asthma and COPD. Secondly, within a population of workers with asthma and COPD, parameters expressing the severity of the disease, such as level of pulmonary obstruction (FEV1), were not associated with sick leave. Thirdly, more perceived control over health complaints was associated with less sick leave. The last conclusion was that more knowledge about the disease was associated with more adequate adaptation to functional limitations.

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KU Nijmegen, 16 juni 1977, Promotores : Meer, J.W.M. van der, Bleijenberg, G., Galama, J.M.D., Item does not contain fulltext

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