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OBJECTIVE:: To determine the relation between body mass index (BMI) and absenteeism. METHODS:: Data were collected in a prospective cohort study (n = 1284). Multilevel analyses (linear mixed model with random intercept) with two levels (employee and company) were used to test whether BMI was related to duration and frequency of absenteeism and whether this relation was influenced by sports participation. RESULTS:: Obese employees were absent 14 days a year more than normal-weight employees. Also the frequency of absenteeism of more than 7 days was significantly higher. The differences in absenteeism between obese and normal-weight employees were larger for employees who did not practice sport regularly. CONCLUSIONS:: Obese employees are more often absent and are absent longer, especially when they do not practice sport regularly. An active company policy to prevent obesity is needed, both from a health and a business efficiency perspective. [ABSTRACT FROM AUTHOR]

Background: The Functional Task Exercise programme is an evidence-based exercise programme for elderly people living at home. It enhances physical capacity with sustainable effects. FTE is provided by physiotherapists and remedial therapists. Although the intervention was found to be effective in a Randomised Controlled Trial, we may not assume that therapists will automatically supply the programme or that elderly people will automatically join the programme. This study protocol focuses on identifying determinants of implementation, developing implementation strategies and studying the effects of the implementation in daily practice., Methods/design: Phase 1: The systematic identification of determinants of the implementation of FTE among therapists and the elderly. A questionnaire study was conducted in a random sample of 100 therapists, and interviews took place with 23 therapists and 8 elderly people (aged 66 to 80 years). The determinants were broken down into four categories: the characteristics of the environment, the organisation, the therapists, and the training programme.Phase 2: Developing and applying strategies adapted to the determinants identified. Fifteen physiotherapists will be trained to provide FTE and to recruit elderly people living at home. The therapists will then deliver the 12-week programme to two groups of elderly, each consisting of six to twelve people aged 70 years or older.Phase 3: Study of implementation and the impact. To study the actual use of FTE: 1) therapists record information about the selection of participants and how they apply the key features of FTE, 2) the participating elderly will keep an exercise logbook, 3) telephone interviews will take place with the therapists and the elderly and there will be on-site visits. The effects on the elderly people will be studied using: 1) the Patient-Specific Questionnaire, the Timed Up and Go test and a two performance tests. All tests will be performed at the start of the FTE programme, half way through, and at the end of the programme., Discussion: The number of older people will increase in many countries in the years to come and so the project outcomes will be of interest to policy-makers, insurance companies, health-care professionals and implementation researchers.

Objective: To investigate the feasibility and preliminary effectiveness of a home-based intensive exercise program to improve physical health of frail elderly patients scheduled for elective total hip arthroplasty (THA)., Design: Single-blind pilot randomized controlled trial., Setting: Patients' homes and a general hospital in The Netherlands., Participants: Frail patients (N=30) older than 65 years., Intervention: A preoperative, home-based program supervised by an experienced physical therapist to train functional activities and walking capacity. The control group received usual care consisting of 1 session of instructions., Main Outcome Measures: Feasibility was determined on the basis of adherence to treatment, patient satisfaction, adverse events, walking distance (measured with a pedometer), and intensity of exercise (evaluated with the Borg scale). Preliminary pre- and postoperative effectiveness was determined by the Timed Up & Go (TUG) test, 6-minute walk test (6MWT), Chair Rise Time, and self-reported measures of functions, activities, and participation., Results: Patient satisfaction and adherence to the training were good (median=5 on a 5-point Likert scale) and no serious adverse events occurred. The Borg score during training was 14 (range, 13-16). Preoperative clinical relevant differences on the TUG test (2.9 s; 95% confidence interval [CI], -0.9 to 6.6) and significant differences on the 6MWT (41 m; 95% CI, 8 to 74) were found between groups., Conclusions: Intensive preoperative training at home is feasible for frail elderly patients waiting for THA and produces relevant changes in functional health. A larger multicenter randomized controlled trial is in progress to investigate the (cost-)effectiveness of preoperative training., (Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To examine the reproducibility, construct validity, and unidimensionality of the Dutch translation of the de Morton Mobility Index (DEMMI), a performance-based measure of mobility for older patients., Design: Cross-sectional study., Setting: Rehabilitation center (reproducibility study) and hospital (validity study)., Participants: Patients (N=28; age >65y) after orthopedic surgery (reproducibility study) and patients (N=219; age >65y) waiting for total hip or total knee arthroplasty (validity study)., Intervention: Not applicable., Main Outcome Measures: Not applicable., Results: The intraclass correlation coefficient for interrater reliability was high (.85; 95% confidence interval, 71-.93), and minimal detectable change with 90% confidence was 7 on the 100-point DEMMI scale. Rasch analysis identified that the Dutch translation of the DEMMI is a unidimensional measure of mobility in this population. DEMMI scores showed high correlations with scores on other performance-based measures of mobility (Timed Up and Go test, Spearman r=-.73; Chair Rise Time, r=-.69; walking test, r=.74). A lower correlation of .44 was identified with the self-report measure Western Ontario and McMaster Universities Osteoarthritis Index., Conclusions: The Dutch translation of the DEMMI is a reproducible and valid performance-based measure for assessing mobility in older patients with knee or hip osteoarthritis., (Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

An important challenge in Web-based health promotion is to increase the reach of the target audience by taking the target groups' desires into consideration. Data from 505 members of a Dutch Internet panel (representative for Dutch Internet users) were used to asses the target group's interests and needs. 28% participated in Web-based tailored lifestyle programs, 57% expressed an interest in such programs, and 15% expressed no interest. Interest in Web-based programs was predominantly caused by a general interest in lifestyle and online tests. Participation in Web-based tailored lifestyle programs should not take more than 17 minutes per occasion. 84% were interested in follow-up testing after the initial participation. Responders were particularly interested in physical activity and nutrition. Hardly anyone was willing to pay for participation. The results from this study support the use of Web-based tailored lifestyle programs in behavior change efforts.

Background: Sedentary behavior is an independent risk factor for excess body weight and other health problems. There are no published data on sitting time at work, or how this is related to occupation and sector (branch of business). No published study has shown whether extended sitting at work is compensated for by sitting less during leisure time., Methods: This study used data from a continuous cross-sectional survey, from 2000 to 2005 (N=7720). Workers were asked how many minutes they spent sitting during the preceding day, both at work and in their leisure time. To test differences in sitting times among occupational groups and sectors, descriptive analyses and analyses of variance were carried out in 2006., Results: On average, the Dutch working population reported sitting for 7 hours each day, one third of which was at work. Occupational groups and sectors differed significantly in sedentary behavior, mainly involving sitting periods at work. Workers spending long periods sitting at work did not compensate by sitting less during their leisure time., Conclusions: Workers spend a substantial part of their waking and working time seated. Those who sat for long periods at work did not compensate for this lack of activity by adopting less-sedentary behaviors during leisure time. To prevent health problems, the best approach may be to reduce sedentary behavior at work, when traveling to and from work, and during leisure time.

Background: In recent years, many tailored lifestyle counseling programs have become available through the Internet. Previous research into such programs has shown selective enrollment of relatively healthy people. However, because of the known dose-response relationship between the intensity and frequency of counseling and the behavior change outcomes, selective retention may also be a concern., Objective: The aim of this study was to identify rates and determinants of repeat participation in a Web-based health behavior change program., Methods: A Web-based health behavior change program aimed to increase people's awareness of their own lifestyle, to promote physical activity, and to prevent overweight and obesity was available on the Internet from July 2004 onward at no cost. Univariate and multivariate logistic regression analyses were conducted to identify characteristics of people who participated in the program more than once. Age, compliance with physical activity guidelines, body mass index, smoking status, and the consumption of fruit, vegetables, and alcohol were included in the analyses., Results: A total of 9774 people participated in the baseline test, of which 940 used the site more than once (9.6%). After exclusion of individuals with incomplete data, 6272 persons were included in the analyses. Of these 6272 people, 5560 completed only the baseline test and 712 also participated in follow-up. Logistic regression predicting repeated use determined that older individuals were more likely to participate in follow-up than people aged 15-20 years. The odds ratios for the age categories 41-50, 51-60, and > 60 years were 1.40 (95% CI = 1.02-1.91), 1.43 (95% CI = 1.02-2.01), and 1.68 (95% CI = 1.03-2.72), respectively. Individuals who never smoked were more likely to participate repeatedly than current smokers and ex-smokers (OR = 1.44, 95% CI = 1.14-1.82 and OR = 1.49, 95% CI = 1.17-1.89, respectively). People meeting the guidelines for physical activity of moderate intensity (OR = 1.23 95% CI = 1.04-1.46) and for vegetable consumption (OR = 1.26 95% CI = 1.01-1.57) were also more likely to participate repeatedly than people who did not, as were obese people compared to individuals with normal weight (OR = 1.41 95% CI = 1.09-1.82)., Conclusions: For some variables, this study confirms our concern that behavioral intervention programs may reach those who need them the least. However, contrary to most expectations, we found that obese people were more likely to participate in follow-up than people of normal body weight. The non-stigmatizing way of addressing body weight through the Internet may be part of the explanation for this. Our findings suggest that Web-based health behavior change programs may be more successful in the area of weight management than in many other health-related areas. They also stress the importance of adequate coverage of weight management in Web-based health promotion programs, as a driver to continue participation for overweight and obese people.

Aims: To investigate the longitudinal relation between strenuous leisure time physical activity and psychological complaints (depression and emotional exhaustion) in a Dutch working population in order to find evidence for the preventive role of physical activity in the development of psychological complaints., Methods: All data came from the Study on Musculoskeletal disorders, Absenteeism, Stress, and Health (SMASH), a three year follow up study that started between 1994 and 1995. The study population consisted of 1747 workers from 34 companies. Generalised estimating equation (GEE) analyses were performed to investigate the longitudinal relation between strenuous leisure time physical activity and psychological complaints using models with and without a time lag. Logistic regression analyses were performed to study the relation between physical activity and sickness absence due to psychological complaints during the three year follow up study., Results: Only in workers with a sedentary job was strenuous leisure time physical activity (1-2 times per week) significantly associated with a reduced risk of future depression and emotional exhaustion. This was not the case for physical activity at higher frequencies (> or =3 times per week). There was a dose-response relation between strenuous leisure time physical activity and poor general health which was strongest in workers with a sedentary job. Strenuous leisure time physical activity (1-2 times per week) was associated with a lower risk of long term absenteeism (>21 days), whereas physical activity at a higher frequency was not., Conclusions: Results suggest that strenuous leisure time physical activity might play a role in the prevention of future psychological complaints, poor general health, and long term absenteeism in a working population. Workers with a sedentary job seem to benefit more from strenuous leisure time physical activity than workers without a sedentary job.

Background: : Little is known of the preventive effects of physical activity in leisure time on neck and upper limb symptoms., Methods: : A cohort of 1742 employees was selected from a prospective cohort study with a follow-up period of 3 years. Independent variables were sporting activities and physically active commuting. Outcome measures were neck/shoulder symptoms and elbow/wrist/hand symptoms as well as sickness absence due to these symptoms. To analyze the data, the generalized estimating equation (GEE) method was used, with adjustment for individual characteristics, such as age, gender, lifestyle, and the outcome at baseline., Results: : Practicing sports for at least 10 months a year decreased the risk of neck/shoulder symptoms (OR: 0.82; CI: 0.67-0.99), sickness absence (OR: 0.48; CI: 0.28-0.84), and long-term sickness absence (OR: 0.37; CI: 0.17-0.84) due to neck or upper limb symptoms. A high mean intensity (> or = 3 h per week) of sporting activities had less effect than the continuation of these activities throughout the year., Conclusion: : Sustained sporting activities have a favorable effect on neck/shoulder symptoms and on sickness absence due to neck or upper limb symptoms. An effect of physically active commuting could not be demonstrated, although there was a tendency towards a favorable effect on sickness absence.

Objectives: To assess interobserver reproducibility (agreement and reliability) of visually estimated shoulder range of motion (ROM) and to study the influence of clinical characteristics on the reproducibility., Design: Test-retest analyses., Setting: Various health care settings in the Netherlands., Participants: Consecutive patients with shoulder complaints (N = 201) referred by 20 general practitioners, 2 orthopedic physicians, and 20 rheumatologists., Interventions: Not applicable., Main Outcome Measures: Independent visual estimation by 2 physiotherapists of the ROM. Agreement was calculated as the mean difference in visual estimation between examiners +/-1.96 x standard deviations of this mean difference. The intraclass correlation coefficient (ICC) was calculated as a measure of reliability, based on a 2-way random effects analysis of variance., Results: The lowest level of agreement was for visual estimation of active and passive elevation (limits of agreement, -43.4 to 39.8 and -46.7 to 41.5, respectively, for the difference between the affected and contralateral sides), for which the level of agreement was most clearly associated with pain severity and disability. The ability to differentiate between subjects was acceptable for all movements for the difference between the affected and contralateral sides (ICCs, > .70) except for horizontal adduction (ICC = .49)., Conclusions: Interobserver agreement was low for the assessment of active and passive elevation, especially for patients with a high pain severity and disability. Except for horizontal adduction, visual estimation seems suitable for distinguishing differences between affected and contralateral ROM between subjects.

Background: Reproducible measurements of the range of motion are an important prerequisite for the interpretation of study results. The digital inclinometer is considered to be a useful instrument because it is inexpensive and easy to use. No previous study assessed inter-observer reproducibility of range of motion measurements with a digital inclinometer by physical therapists in a large sample of patients., Methods: Two physical therapists independently measured the passive range of motion of the glenohumeral abduction and the external rotation in 155 patients with shoulder pain. Agreement was quantified by calculation of the mean differences between the observers and the standard deviation (SD) of this difference and the limits of agreement, defined as the mean difference +/- 1.96*SD of this difference. Reliability was quantified by means of the intraclass correlation coefficient (ICC)., Results: The limits of agreement were 0.8 +/- 19.6 for glenohumeral abduction and -4.6 +/- 18.8 for external rotation (affected side) and quite similar for the contralateral side and the differences between sides. The percentage agreement within 10 degrees for these measurements were 72% and 70% respectively. The ICC ranged from 0.28 to 0.90 (0.83 and 0.90 for the affected side)., Conclusions: The inter-observer agreement was found to be poor. If individual patients are assessed by two different observers, differences in range of motion of less than 20-25 degrees can not be distinguished from measurement error. In contrast, acceptable reliability was found for the inclinometric measurements of the affected side and the differences between the sides, indicating that the inclimeter can be used in studies in which groups are compared.

Objective: To evaluate a project to implement guidelines on the management of patients with asthma or chronic obstructive pulmonany disease (COPD) in terms of the health outcomes of these patients., Design: A before-and-after study of 1 year with a non-randomized but comparable reference group., Setting: General practices in the Netherlands., Study Participants: Two-hundred and eighty patients from 14 practices in the intervention group and 90 patients from five practices in the reference group (receiving usual care)., Intervention: The project included a comprehensive implementation programme, involving identification of barriers, documentation of the care provided, specific education, feedback on compliance with the guidelines, and peer review. This project has been found to bring the process of care more in agreement with the guidelines., Main Outcome Measures: Mean peak expiratory flow rate (PEFR) as a percentage of the predicted value, number of days with a diurnal variation in PEFR > or = 15%, number of days with respiratory symptoms (all recorded by patients for a period of 14 days), and perceived health status (Nottingham Health Profile)., Results: After 1 year, the intervention group showed statistically significant improvements with regard to the mean PEFR, the diurnal variation in PEFR, respiratory symptoms and the pain score of the Nottingham Health Profile. Comparing the changes within the intervention group with the changes within the reference group, only a positive effect of the intervention on the mean PEFR was found., Conclusion: The comprehensive implementation programme improved the lung function and symptoms of asthma and COPD patients in the intervention group. However, in comparison with a reference group, the positive effect on the lung function was only small.

Context: During the past decade, several guidelines on the management of chronic obstructive pulmonary disease and asthma have been developed. However, strategies for implementing these guidelines have not been systematically evaluated., Objective: To test a quality system intended to improve general practitioners' compliance with recently established guidelines., Design: Before-after study with concurrent controls. UNIT OF ANALYSIS: 19 general medical practices in the Netherlands (14 intervention practices and 5 control practices)., Intervention: A quality system with five components: identification of barriers, documentation, education, feedback, and peer review., Patients: Outpatients 16 to 70 years of age with asthma or chronic obstructive pulmonary disease., Measurements: The number of consultations for respiratory symptom monitoring, measurement of peak expiratory flow rate, prescription of anti-inflammatory agents, monitoring of medication compliance and inhalation technique, and influenza vaccination., Results: The percentage of patients who had two or more consultations per year increased significantly in the intervention practices (median, 27% of patients before the intervention vs 82% of patients after the intervention; P < 0.01), as did the percentage of patients who had at least one measurement of peak expiratory flow rate (median, 10% of patients before the intervention vs 84% of patients after the intervention; P < 0.01). The percentage of patients who received a prescription for anti-inflammatory agents did not increase significantly. No significant changes were seen in the control practices. Physicians in the intervention practices were more likely to monitor medication compliance and inhalation technique. No difference was found in frequency of influenza vaccination., Conclusion: The quality system improved guideline compliance in some areas but not in others.

This cross-sectional study among patients with asthma or Chronic Obstructive Pulmonary Disease (COPD) in general practice examined the psychometric properties of the Nottingham Health Profile (NHP). From 380 asthma patients and 170 COPD patients, data were obtained on the NHP, subjective measurements (i.e. sleep disturbances, problems in performing household activities, dyspnoea) and more objective measurements (peak expiratory flow rate, consultation rate, comorbidity). These data were used to compute score distributions, internal consistency (Cronbach's alpha-coefficient) and construct validity. Score distributions were very skewed, with more than 50% of the patients achieving the best score. The internal consistency was moderate in the asthma group (mean alpha = 0.68) and acceptable in the COPD group (mean alpha = 0.74). Acceptable construct validity was found in both groups. Correlations between the NHP and the subjective measurements were, in general, statistically significant and higher than between the NHP and the more objective measurements. In conclusion, acceptable internal consistency and construct validity implies that the NHP can be used in cross-sectional studies concerning asthma and COPD patients in general practice, and in studies comparing these patients with other patient populations. Further research on the responsiveness of the NHP is needed to justify its use in longitudinal studies.

Objectives: To assess the interobserver agreement on the diagnostic classification of shoulder disorders, based on history taking and physical examination, and to identify the determinants of diagnostic disagreement., Methods: Consecutive eligible patients with shoulder pain were recruited in various health care settings in the Netherlands. After history taking, two physiotherapists independently performed a physical examination and subsequently the shoulder complaints were classified into one of six diagnostic categories: capsular syndrome (for example, capsulitis, arthritis), acute bursitis, acromioclavicular syndrome, subacromial syndrome (for example, tendinitis, chronic bursitis), rest group (for example, unclear clinical picture, extrinsic causes) and mixed clinical picture. To quantify the interobserver agreement Cohen's kappa was calculated. Multivariate logistic regression analysis was applied to determine which clinical characteristics were determinants of diagnostic disagreement., Results: The study population consisted of 201 patients with varying severity and duration of complaints. The kappa for the classification of shoulder disorders was 0.45 (95% confidence intervals (CI) 0.37, 0.54). Diagnostic disagreement was associated with bilateral involvement (odds ratio (OR) 1.9; 95% CI 1.0, 3.7), chronic complaints (OR 2.0; 95% CI 1.1, 3.7), and severe pain (OR 2.7; 95% CI 1.3, 5.3)., Conclusions: Only moderate agreement was found on the classification of shoulder disorders, which implies that differentiation between the various categories of shoulder disorders is complicated. Especially patients with high pain severity, chronic complaints and bilateral involvement represent a diagnostic challenge for clinicians. As diagnostic classification is a guide for treatment decisions, unsatisfactory reproducibility might affect treatment outcome. To improve the reproducibility, more insight into the reproducibility of clinical findings and the value of additional diagnostic procedures is needed.

Objective: To examine the feasibility of the application of guidelines to the management of asthma and chronic obstructive pulmonary disease (COPD) by assessing compliance with the guidelines and listing the barriers general practitioners (GPs) encountered during implementation. Insight into the feasibility of individual items in the guidelines can guide implementation strategies in the future and, if necessary, support revision of the guidelines., Design: Descriptive study of care delivered during the implementation of guidelines by means of documentation of the care provided, education, feedback on compliance and peer review., Setting: General practice., Study Participants: Sixteen GPs in 14 general practices., Main Outcome Measures: Compliance was expressed as the percentage of patients per practice managed by the GPs according to the guidelines. For each patient (n=413) data were collected on the care delivered during the first year of the implementation. Barriers encountered were derived from the summaries of the discussions held during the monthly meetings., Results: The GPs were most compliant on the items 'PEFR measurement at every consultation' (98%), 'allergy test' (78%) and 'advice to stop smoking' (82%), and less compliant on the items 'four or more consultations a year' (46%), 'ordering spirometry' (33%), 'adjustment of medication' (42%), 'check on inhalation technique' (38%) and referral to a chest physician (17%) or a district nurse (5%). The main barriers were the amount of time to be invested, doubts about the necessity of regular consultations and about the indications for ordering spirometry and for referral to a chest physician or a district nurse., Conclusion: Although the feasibility was assessed in a fairly optimal situation, compliance with the guidelines was not maximal, and differed between the individual items of care. Suggestions are given for further improvements in compliance with the guidelines and for revision of the guidelines.

Determining the separate energy costs of the positive and negative mechanical work in repetitive lifting or lowering is quite complex, as a mixture of both work components will always be involved in the up- and downward motion of the lifter's body mass. In the current study, a new method was tested in which coefficients specifically related to the positive and negative work were estimated by multiple regression on a data set of weight-lifting and weight-lowering tasks. The energy cost was obtained from oxygen uptake measurements. The slopes of the regression lines for energy cost and mechanical work were steeper for positive than for negative work. The cost related to the negative work was approximately 0.3-0.5 times the cost of the positive work. This finding is well in line with data obtained directly from other isolated activities of either positive or negative work (e.g., ladder climbing vs. descending). However, the intercept values of the regression lines were not significantly different from zero or were even negative. This was most likely due to the metabolic energy not related to processes that yield mechanical work (e.g., isometric muscle actions) that was not constant among trials.