Biomedical subjects

Sijmen A Duursma

Publications and source records attributed to Sijmen A Duursma.

14 recordsLinked to original sources

PubMed2006

The effect of functional tasks exercise and resistance exercise on health-related quality of life and physical activity. A randomised controlled trial.

BACKGROUND: Data regarding the effect of exercise programmes on older adults' health-related quality of life (HRQOL) and habitual physical activity are inconsistent. OBJECTIVE: To determine whether a functional tasks exercise programme (enhances functional capacity) and a resistance exercise programme (increases muscle strength) have a different effect on the HRQOL and physical activity of community-dwelling older women. METHODS: Ninety-eight women were randomised to a functional tasks exercise programme (function group), a resistance exercise programme (resistance group), or normal activity group (control group). Participants attended exercise classes three times a week for 12 weeks. The SF-36 Health Survey questionnaire and self-reported physical activity were obtained at baseline, directly after completion of the intervention (3 months), and 6 months later (9 months). RESULTS: At 3 months, no difference in mean change in HRQOL and physical activity scores was seen between the groups, except for an increased SF-36 physical functioning score for the resistance group compared with the control group (p = 0.019) and the function group (p = 0.046). Between 3 and 9 months, the self-reported physical functioning score of the function group decreased to below baseline (p = 0.026), and physical activity (p = 0.040) decreased in the resistance group compared with the function group. CONCLUSIONS: Exercise has a limited effect on the HRQOL and self-reported physical activity of community-living older women. Our results suggest that in these subjects HRQOL measures may be affected by ceiling effects and response shift. Studies should include performance-based measures in addition to self-report HRQOL measures, to obtain a better understanding of the effect of exercise interventions in older adults.

Activities of Daily Living↗

PubMed2006

Reliability and validity of the Assessment of Daily Activity Performance (ADAP) in community-dwelling older women.

BACKGROUND AND AIMS: The Assessment of Daily Activity Performance (ADAP) test was developed, and modeled after the Continuous-scale Physical Functional Performance (CS-PFP) test, to provide a quantitative assessment of older adults' physical functional performance. The aim of this study was to determine the intra-examiner reliability and construct validity of the ADAP in a community-living older population, and to identify the importance of tester experience. METHODS: Forty-three community-dwelling, older women (mean age 75 yr +/-4.3) were randomized to the test-retest reliability study (n=19) or validation study (n=24). The intra-examiner reliability of an experienced (tester 1) and an inexperienced tester (tester 2) was assessed by comparing test and retest scores of 19 participants. Construct validity was assessed by comparing the ADAP scores of 24 participants with self-perceived function by the SF-36 Health Survey, muscle function tests, and the Timed Up and Go test (TUG). RESULTS: Tester 1 had good consistency and reliability scores (mean difference between test and retest scores (DIF), -1.05+/-1.99; 95% confidence interval (CI), -2.58 to 0.48; Cronbach's alpha (alpha) range, 0.83 to 0.98; intraclass correlation (ICC) range, 0.75 to 0.96; Limits of Agreement (LoA), -2.58 to 4.95). Tester 2 had lower reliability scores (DIF, -2.45+/-4.36; 95% CI, -5.56 to 0.67; alpha range, 0.53 to 0.94; ICC range, 0.36 to 0.90; LoA, -6.09 to 10.99), with a systematic difference between test and retest scores for the ADAP domain lower-body strength (-3.81; 95% CI, -6.09 to -1.54), ADAP correlated with SF-36 Physical Functioning scale (r=0.67), TUG test (r=-0.91) and with isometric knee extensor strength (r=0.80). CONCLUSIONS: The ADAP test is a reliable and valid instrument. Our results suggest that testers should practise using the test, to improve reliability, before applying it to clinical settings.

Activities of Daily Living↗

PubMed2005

Functional-task exercise versus resistance strength exercise to improve daily function in older women: a randomized, controlled trial.

OBJECTIVES: To determine whether a functional-task exercise program and a resistance exercise program have different effects on the ability of community-living older people to perform daily tasks. DESIGN: A randomized, controlled, single-blind trial. SETTING: Community leisure center in Utrecht, the Netherlands. PARTICIPANTS: Ninety-eight healthy women aged 70 and older were randomly assigned to the functional-task exercise program (function group, n=33), a resistance exercise program (resistance group, n=34), or a control group (n=31). Participants attended exercise classes three times a week for 12 weeks. MEASUREMENTS: Functional task performance (Assessment of Daily Activity Performance (ADAP)), isometric knee extensor strength (IKES), handgrip strength, isometric elbow flexor strength (IEFS), and leg extension power were measured at baseline, at the end of training (at 3 months), and 6 months after the end of training (at 9 months). RESULTS: The ADAP total score of the function group (mean change 6.8, 95% confidence interval (CI)=5.2-8.4) increased significantly more than that of the resistance group (3.2, 95% CI=1.3-5.0; P=.007) or the control group (0.3, 95% CI=-1.3-1.9; P<.001). Moreover, the ADAP total score of the resistance group did not change significantly compared with that of the control group. In contrast, IKES and IEFS increased significantly in the resistance group (12.5%, 95% CI=3.8-21.3 and 8.6%, 95% CI=3.1-14.1, respectively) compared with the function group (-2.1%, 95% CI=-5.4-1.3; P=.003 and 0.3%, 95% CI=-3.6-4.2; P=.03, respectively) and the control group (-2.7%, 95% CI=-8.6-3.2, P=.003 and 0.6%, 95% CI=-3.4-4.6; P=.04, respectively). Six months after the end of training, the increase in ADAP scores was sustained in the function group (P=.002). CONCLUSION: Functional-task exercises are more effective than resistance exercises at improving functional task performance in healthy elderly women and may have an important role in helping them maintain an independent lifestyle.

Activities of Daily Living↗

PubMed2004

Sodium valproate in aggressive behaviour in dementia: a twelve-week open label follow-up study.

INTRODUCTION: Short-term randomised clinical trials on valproate in distinct types of disturbed behaviour in dementia showed no effects on aggressive behaviour. OBJECTIVES: To assess the course of disturbed behaviour during medium term treatment with sodium valproate for aggressive behaviour. DESIGN: An open label observational 12-week follow-up study consecutive to a preceding randomised control trial; assessments at 4-week interval. SETTING: A psychogeriatric medium-stay ward at a psychiatric teaching hospital and psychogeriatric nursing home wards. PARTICIPANTS: Patients who completed a preceding randomised placebo controlled clinical trial on sodium valproate in aggressive behaviour in dementia were included. INTERVENTION: The starting dose of sodium valproate was 2 x 6 ml of a 40 mg/ml suspension (daily defined dose of 480 mg). The patient's regular physicians managed all treatment decisions, including decisions on dosage and plasma level measurements of sodium valproate and decisions regarding discontinuation. Co-medication was allowed and any change in prescription was recorded. MEASUREMENTS: The Social Dysfunction and Aggression Scale-9 (SDAS-9), the Behaviour Observation scales for Intramural Psychogeriatrics (in Dutch: Gedragsobservatieschaal voor Intramurale Psychogeriatrie (GIP) and the Clinical Global Impression of aggressive behaviour (CGI) were performed at the last week of each 4-week interval. RESULTS: Data of 39 patients (F=24 and M=15) were analysed. At week 12 compared to week 0 mean sodium valproate prescriptions were higher; aggressive behaviour as measured by the SDAS-9 improved. Non-social behaviour, apathetic behaviour, disoriented behaviour and distorted memory improved, but rebellious behaviour increased as measured by the GIP. Seven patients died during this study. LIMITATIONS OF THE STUDY: Open label observational design; absence of placebo/reference prescription; no systematic measurements of sodium valproate plasma levels and the allowance of psychotropic co-medication. CONCLUSION: Low dose sodium valproate may be effective reducing a broad range of types of disturbed behaviours in aggressive demented patients. The high death rate underlines the fragility of demented patients with aggressive behaviour.

Aged↗

PubMed2004

Strength, mobility and falling in women referred to a geriatric outpatient clinic.

BACKGROUND AND AIMS: Mobility impairment and falling have a multifactorial etiology in frail older people. Muscle weakness is one of the risk factors and is accessible to intervention. The aim of this study was to determine the most important contributors of mobility and indicators of fall occurrence in women referred to a geriatric outpatient clinic. METHODS: Mobility was assessed using the Timed 'Get-Up-and-Go' test (TGUG) and the modified Coopertest (COOP). Falling was assessed retrospectively and isometric knee extension force was measured using fixed dynamometry. Habitual physical activity was quantified using a questionnaire for the elderly. Height, weight, medical conditions and current medication were recorded. RESULTS: Isometric knee extension strength and habitual physical activity, which consisted predominantly of household work, were independent variables of performance on TGUG and COOP and together explained 57% of the variance in TGUG (r=0.75, p<0.001), and 64% of that in COOP, (r=0.80, p<0.001). Age, total number of medical conditions, and presence of cardiovascular disease were not significant in the model. Women in the lowest tertile of knee extension strength had a significantly higher probability of falling (0.75, 95% CI 0.56-0.91) compared with women in the highest tertile (0.27, 95% CI 0.14-0.50). CONCLUSIONS: Knee extension strength remains a strong determinant of mobility and fall occurrence in women referred to a geriatric outpatient clinic. Performing light to moderate household work remains independently associated with functional mobility.

Accidental Falls↗

PubMed2004

Functional tasks exercise versus resistance exercise to improve daily function in older women: a feasibility study.

OBJECTIVE: To evaluate the feasibility of a new functional tasks exercise program, designed to improve functional performance of community-dwelling older women, by comparing it with a resistance exercise program. DESIGN: A 12-week, randomized, single-blind pilot study. SETTING: A community leisure center. PARTICIPANTS: Twenty-four community-dwelling, medically stable women (mean age, 74.6+/-4.8 y) were randomized to the functional tasks exercises (function group) or the resistance exercises (resistance group). Three participants withdrew from the study. INTERVENTIONS: Exercises were given 3 times weekly for 12 weeks. The functional tasks exercise program aimed to improve daily tasks in the domains first affected in older adults, whereas the resistance exercise program focused on strengthening the muscle groups that are important for functional performance. MAIN OUTCOME MEASURES: Participant satisfaction with the exercises, Assessment of Daily Activity Performance (ADAP), and, as a secondary outcome, muscle strength and power. RESULTS: Exercise adherence was 81% in the function group and 90% in the resistance group. Participants reported greater satisfaction with the resistance exercises than with the functional exercises. The ADAP total score improved with time (P =.001; mean change function group, 7.5 U; 95% confidence interval [CI], 2.1-12.8; resistance group, 2.8 U, 95% CI, -0.4 to 5.9), as did isometric knee extensor strength (P =.001; mean change function group, 6.4%; 95% CI, -1.6 to 14.5; resistance group, 14.4%; 95% CI, 6.4-22.2). Testing for differences in outcomes between the 2 groups showed no statistically significant differences. CONCLUSIONS: The functional tasks exercise program is feasible and shows promise of being more effective for functional performance than a resistance exercise program. A randomized controlled trial with a larger sample size is needed to test the difference between the 2 programs.

Activities of Daily Living↗

PubMed2003

Geriatric medicine in the European Union: unification of diversity.

The numbers of older people in the European Union are increasing and, with their associated health needs, there is a requirement for the specialty of Geriatric Medicine to be available throughout Europe. At present, specialists in Geriatric Medicine are not recognised in some of the European Union member countries. It is imperative that training in Geriatric Medicine should take place throughout Europe, starting at undergraduate level and progressing through postgraduate training. There must be a programme of continuing medical education and personal development. This paper highlights some of these challenges and suggests a possible way forward.

Accreditation↗

PubMed2003

Elderly patients with a hip fracture: the risk for delirium.

This prospective study investigated risk factors for delirium in elderly hip fracture patients that could be recognized by nurses. Data were collected on predisposing and precipitating factors for delirium from 92 elderly patients with a hip fracture. Predisposing factors included age, gender, sensory impairments, functional impairment before the hip fracture, residency before admission, pre-existing cognitive impairment, comorbidities, and medication use. Precipitating factors included factors related to surgery and to the postoperative period. Factors related to surgery included time between admission and surgery, type of surgery, type of anesthesia, duration of surgery and anesthesia, and complications during surgery. Factors studied in the postoperative period were slow recovery, malnutrition, dehydration, addition of three or more medications, introduction of bladder catheter, infections, complications and falls, and use of morphine. Eighteen patients developed delirium, as diagnosed by a geriatrician by using the Diagnostic Statistical Manual-IV criteria. Data on delirious patients were compared with the data on non-delirious patients. The findings confirm that elderly hip fracture patients with premorbid ADL dependency, psychiatric comorbidities (including dementia), and a high number of other comorbid problems are at risk for the development of delirium. Based on these findings, it is recommended that nurses should assess patients' pre-fracture functional and cognitive capacities in an early stage of the hospital stay. Nurses should also be alert to postoperative delirium in "healthy elderly" patients. Monitoring of symptoms postoperatively in all elderly patients is advised.

Activities of Daily Living↗

PubMed2003

The Delirium Observation Screening Scale: a screening instrument for delirium.

The Delirium Observation Screening (DOS) scale, a 25-item scale, was developed to facilitate early recognition of delirium, according to the Diagnostic and Statistical Manual-IV criteria, based on nurses' observations during regular care. The scale was tested for content validity by a group of seven experts in the field of delirium. Internal consistency, predictive validity, and concurrent and construct validity were tested in two prospective studies with high risk groups of patients: geriatric medicine patients and elderly hip fracture patients. Among the patients admitted to a geriatric department (N = 82), 4 became delirious; among the elderly hip fracture patients (N = 92), 18 became delirious. The DOS scale was determined to be content valid and showed high internal consistency, alpha = 0.93 and alpha = 0.96. Predictive validity against the Diagnostic and Statistical Manual-IV diagnosis of delirium made by a geriatrician was good in both studies. Correlations of the DOS scale with the Mini Mental State Examination (MMSE) were Rs -0.79 (p < or = 0.001) in the hip fracture patients and Rs -0.66 (p < or = 0.001) in the geriatric medicine patients. Concurrent validity, as tested by comparison of the research nurse's ratings of the DOS scale and the Confusion Assessment Method (CAM), for the group of hip fracture patients was 0.63 (p < or = 0.001). Construct validity of the DOS was tested against the Informant Questionnaire of Cognitive Decline in Elderly (IQCODE), a preexisting psychiatric diagnosis and the Barthel Index. Correlation with the IQCODE was 0.74 (p < or = 0.001) in the study with the hip fracture patients and 0.33 (p < or = 0.05) in the study with the geriatric medicine patients. Correlation with the Barthel Index was -0.26 (p < or = 0.05) in the geriatric medicine patients and -0.55 (p < or = 0.001) in the hip fracture patients. The overall conclusion of these studies is that the DOS scale shows satisfactory validity and reliability, to guide early recognition of delirium by nurses' observation.

Activities of Daily Living↗

PubMed2003

The measurement of delirium: review of scales.

This review describes the characteristics and evaluates the psychometric qualities (process of testing and the results) of thirteen delirium instruments. Delirium instruments differ in goal (diagnosis, screening symptoms severity), type of data on which the rating is based (observation, interview or test of patients), the rater qualities required, the number of items and the rating time needed. Most instruments are based on the Diagnostic Statistical Manual criteria and measure signs and symptoms as described by these criteria. Reliability of delirium instruments shows good to excellent results. Validity of the delirium instruments is overall fair to good. Differences exist, however, in the degree to which reliability and validity were tested and the quality of the testing procedures. Most instruments are not further developed and tested after the initial study. Conclusion of this review is that most delirium instruments show promising results but need further testing. Testing is needed in different samples and on a broader range of aspects with regard to reliability and validity. Much emphasis should be given to the procedures used in future studies. Ease of use is an aspect of testing that is so far not taken into account, however, is important for use of instruments in clinical practice. A minority of instruments can be seen as "ready to use" instruments meaning well tested in more than one sample with good results. For screening high-risk, elderly hospitalized patients, the NEECHAM Confusion Scale and the Delirium Observation Screening Scale are recommended. The Confusion Assessment Method is the best diagnostic tool and the Delirium Rating Scale shows best results in screening symptom severity. For ICU patients the CAM-ICU is recommended. The MDAS is well tested in cancer patients. Nurses, however, have not yet tested the DRS and MDAS in practice.

Delirium↗

PubMed2002

The influence of tibolone on quality of life in postmenopausal women.

OBJECTIVES: To examine the effect of tibolone, a synthetic steroid with tissue-specific activity, on quality of life in a randomised, double-blind, placebo-controlled study in healthy postmenopausal women. MATERIAL AND METHODS: A total of 85 women (54.2+/-4.7 years), were randomised to 2.5 mg tibolone (Livial) or to identically appearing placebo pills daily for 12 months. Quality of life was assessed with the Nottingham Health Profile (NHP). Also, information on the occurrence of climacteric complaints and incidences of vaginal bleeding/spotting was gathered. RESULTS: Compared to baseline values, the tibolone group significantly improved on three out of six NHP domains: overall 46.8-25.3, emotional reactions 6.8-2.9 and sleep 19.0-7.2. In the placebo group a significant difference from baseline was observed on the 'physical mobility' parameter: 6.9-3.0. Significant between-group difference was only reached on the domains 'sleep': tibolone 7.2 versus placebo 15.2 and 'physical mobility': tibolone 3.8 versus placebo 3.0. The occurrence of hot flushes and nightly sweats was significantly lower in the tibolone group compared to placebo after 12 months of treatment. Throughout the study period a total of four women in the placebo, compared to 16 women in the tibolone group, reported vaginal bleeding/spotting. CONCLUSIONS: A trend favouring tibolone was observed. However, improvements from baseline were only reflected in a significant between-group difference on the domains of sleep and physical mobility. The limited sample size might have caused this ambiguity. Further research in a larger population is recommended to clear this inconsistency.

Anabolic Agents↗

PubMed2002

Sodium valproate in the treatment of aggressive behavior in patients with dementia--a randomized placebo controlled clinical trial.

OBJECTIVES: The efficacy and tolerability of sodium valproate 2 x 240 mg compared to placebo were investigated in aggressive behavior in dementia. DESIGN: A randomized, placebo controlled, double-blind cross-over design. The trial included a baseline period (one week); a placebo period (three weeks); a wash-out period with placebo (one week); and a treatment period with sodium valproate (three weeks). SETTING: A psychogeriatric short-stay ward at a psychiatric teaching hospital. PARTICIPANTS: Demented patients who met Patel's criteria for aggressive behavior and had a score of > or =3 on at least one of the items of the Social Dysfunction and Aggression scale-9 (SDAS-9). INTERVENTION: A fixed dose of sodium valproate 2 x 6 ml of a 40 mg/ml suspension (daily defined dose of 480 mg) was compared to placebo. MEASUREMENTS: Primary outcome variables were changes of the score of SDAS-9 and Clinical Global Impression scale (CGI) performed at the last week of each treatment period. RESULTS: Data of 42 patients (F=25 and M=17; age 80.4+/-6.8 years) were analyzed. Treatment with sodium valproate showed no differences compared to placebo on aggressive behavior. The mean plasma level of sodium valproate was 40.9+/-10.8 microg/ml. Regression analysis showed a trend for improvement between the plasma levels of sodium valproate and the SDAS-9 and the CGI scores. Adverse events were not related to the plasma levels of sodium valproate. Secondary outcome measurements showed significant improvement on restless, melancholic and anxious behavior; a trend for improvement was found on suspicious and dependent behavior. Possible limitations of this study are the low dose of sodium valproate, the relatively short treatment period (three weeks), and the absence of statistical corrections for multiple comparisons. CONCLUSION: This study showed no effect of sodium valproate 2 x 240 mg over placebo on aggressive behavior in dementia.

Aged↗

PubMed2002

Muscle strength and tibolone: a randomised, double-blind, placebo-controlled trial.

OBJECTIVE: To investigate the effects of tibolone, a tissue-specific compound with a mixed (estrogenic, progestogenic and androgenic) hormonal profile, on skeletal muscle strength in a group of healthy postmenopausal women. DESIGN: Randomised, parallel group, double-blind, placebo-controlled, single-centre trial conducted between August 1997 and July 1999. PARTICIPANTS: Eighty-five healthy women, between one and 15 years postmenopausal, (mean [SD] age, 54.2 [4.7] years) recruited from local paper advertisements. Participants were randomly assigned to 2.5 mg tibolone or to identically appearing placebo pills daily for 12 months, taken orally in the morning. METHODS: Both maximal handgrip strength, representing upper body strength, and maximal quadriceps strength, representing lower body strength, were measured isometrically. MAIN OUTCOME MEASURES: Treatment effect estimates (between group differences) in handgrip strength and isometric knee extension at last visit. RESULTS: Tibolone significantly (P = 0.04) increased handgrip strength compared with placebo (difference 0.99 kg, [95% CI 0.1-1.9]). No significant treatment effect (P = 0.61) was observed in isometric knee extension strength. Isometric strength adjusted for body mass index resulted in a trend favouring tibolone (P = 0.06). Individual trend analysis showed a significant difference in rate of change throughout the year (6.8% [95% CI 2.1-10.7]) favouring tibolone. CONCLUSIONS: Administration of tibolone increased handgrip strength in postmenopausal women compared with placebo. A trend indicating a positive effect in isometric knee extension strength adjusted for body mass index was observed. Tibolone seems to mitigate the menopause-related decline in muscle strength.

Administration, Oral↗

PubMed2002

Tibolone does not affect muscle power and functional ability in healthy postmenopausal women.

Maintenance of neuromuscular function into old age is critical to maintain normal daily activity and functional independence. Maximal muscle strength declines with age, and the age-related loss in power might be even greater. An accelerated loss of muscle strength and power has been observed in women around the time of the menopause. The aim of the present study was to examine the effects of tibolone, a synthetic steroid with oestrogenic, progestogenic and androgenic activities, on muscle power, endurance and functional ability. A total of 85 healthy women, between 1 and 15 years postmenopausal, were recruited from local paper advertisements. Participants were randomly assigned to 2.5 mg of tibolone or to placebo pills of identical appearance; pills were taken daily for 12 months, orally in the morning. Muscle power was assessed as explosive leg extensor power. Endurance was measured on a 2 min walk test and a 3.5 m walk. Functional ability was determined with the timed Get Up and Go test and a Postural/Locomotor/Manual test. No significant between-group differences were observed for any of the parameters. Possible explanations for this lack of effect are either the absence of an effect of tibolone on muscle power and functional ability, or that our participants were too far above their strength-related functional limits to derive benefit from intervention. Further research is required to resolve this issue.

Anabolic Agents↗