Showing papers by "Martin Stevens published in 2012"
TL;DR: Although the incidence of shoulder complaints in general practice is as high as 29.3 per 1000 person-years, GPs’ workload is generally low, as nearly half of these patients consult their GP only once for their complaint.
Abstract: Objective: To study the incidence, prevalence, and consultation rates of patients with shoulder complaints in general practice in the Netherlands during 10 years following initial presentation. Methods: A primary care database with an average population of 30 000 patients per year aged 18 years or older was used to select patients who consulted their general practitioner (GP) with shoulder complaints in the northern part of the Netherlands in the year 1998. Information about consultations for shoulder complaints was extracted. Incidence and prevalence for men, women, and different age groups were calculated for 9 and 10 years. Results: A total of 526 patients consulted their GP with a new shoulder complaint. During an average follow-up of 7.6years, these patients consultedtheir GP1331timesbecause of theirshouldercomplaints (average of0.33 consultations per year). Almost half of the patients consulted their GP only once. Patients in the 45–64 age category had the highest probability of repeated GP consultations during follow-up. Average incidence was 29.3 per 1000 person-years. Women and patients in the 45–64 age category have the highest incidence. The annual prevalence of shoulder complaints ranged from 41.2 to 48.4 per 1000 person-years, calculated for the period 1998 to 2007, and was higher among women than among men. Conclusion: Although the incidence of shoulder complaints in general practice is as high as 29.3 per 1000 person-years, GPs’ workload is generally low, as nearly half of these patients consult their GP only once for their complaint.
146 citations
TL;DR: In this article, the authors present evidence about the motiology of why people want to be social workers and why they want to work in social work education and for the profession as a whole.
Abstract: • Summary: Understanding why people want to be social workers is important both for developing social work education and for the profession as a whole. This article presents evidence about the moti...
85 citations
TL;DR: In this article, the authors describe the way they measured outcomes, the effects they found and how they varied between and within service user groups, for some groups, there were clear benefits from IBs.
Abstract: In England, ‘personal budgets’ are being implemented at a time of financial austerity. They are part of a growing trend internationally to give users of publicly funded social care and support more choice and control. In the individual budgets' (IB) pilot, people were allocated and had control over the way their IB was managed and spent, offering the opportunity to explore the potential of IBs to deliver better outcomes for people than conventional services and support. We describe the way we measured outcomes, the effects we found and how they varied between and within service user groups. For some groups, there were clear benefits from IBs. However, it should not be a ‘one-size-fits-all’ approach, and, in taking personal budgets forward, it is important to consider how best to address the particular challenges for older people, effects on social work practice and resource implications if the potential benefits are to be achieved. Social workers may find themselves implementing a policy with considerable potential, but which may prove very difficult to achieve in the current financial climate.
83 citations
TL;DR: Distinctive patterns of frontal plane angular trunk movements during gait could be objectively quantified in healthy subjects and in persons with hip osteoarthritis using a body-fixed-sensor based gait analysis approach.
Abstract: Background: Compensatory trunk movements during gait, such as a Duchenne limp, are observed frequently in subjects with osteoarthritis of the hip, yet angular trunk movements are seldom included in clinical gait assessments. Hence, the objective of this study was to quantify compensatory trunk movements during gait in subjects with hip osteoarthritis, outside a gait laboratory, using a body-fixed-sensor based gait analysis. Frontal plane angular movements of the pelvis and thorax and spatiotemporal parameters of persons who showed a Duchenne limp during gait were compared to healthy subjects and persons without a Duchenne limp. Methods: A Body-fixed-sensor based gait analysis approach was used. Two body-fixed sensors were positioned at the dorsal side of the pelvis and on the upper thorax. Peak-to-peak frontal plane range of motion (ROM) and spatiotemporal parameters (walking speed, step length and cadence) of persons with a Duchenne limp during gait were compared to healthy subjects and persons without a Duchenne limp. Participants were instructed to walk at a self-selected low, preferred and high speed along a hospital corridor. Generalized estimating equations (GEE) analyses were used to assess group differences between persons with a Duchenne limp, without a Duchenne limp and healthy subjects. Results: Persons with a Duchenne limp showed a significantly larger thoracic ROM during walking compared to healthy subjects and to persons without a Duchenne limp. In both groups of persons with hip osteoarthritis, pelvic ROM was lower than in healthy subjects. This difference however only reached significance in persons without a Duchenne limp. The ratio of thoracic ROM relative to pelvic ROM revealed distinct differences in trunk movement patterns. Persons with hip osteoarthritis walked at a significantly lower speed compared to healthy subjects. No differences in step length and cadence were found between patients and healthy subjects, after correction for differences in walking speed. Conclusions: Distinctive patterns of frontal plane angular trunk movements during gait could be objectively quantified in healthy subjects and in persons with hip osteoarthritis using a body-fixed-sensor based gait analysis approach. Therefore, frontal plane angular trunk movements should be included in clinical gait assessments of persons with hip osteoarthritis.
46 citations
TL;DR: In this article, a study was conducted to determine the habitual physical activity behavior of people who had undergone total knee arthroplasty (TKA) 1 to 5 years after surgery and to examine to what extent they adhered to international guidelines for healthenhancing physical activity.
Abstract: Background Previous studies on physical activity after total knee arthroplasty (TKA) concentrated mainly on a return to sports activities.
Objective The objectives of this study were to determine the habitual physical activity behavior of people who had undergone TKA (TKA group) 1 to 5 years after surgery and to examine to what extent they adhered to international guidelines for health-enhancing physical activity. Additional aims were to compare younger (<65 years old) and older (≥65 years old) people as well as men and women in the TKA group and to compare the results for the TKA group with those for a sex- and age-matched normative population (normative group).
Design This investigation was a cohort study.
Methods All people who had a primary TKA at 1 of 2 participating hospitals between 2002 and 2006 were sent the Short Questionnaire to Assess Health-Enhancing Physical Activity at least 1 year after surgery.
Results The TKA group spent, on average, 1,347 minutes per week on physical activity, most of which was light-intensity activity (780 minutes per week). Participants younger than 65 years of age spent significantly more time on physical activity than participants 65 years of age or older. There was no significant difference between male and female participants. Compared with the sex- and age-matched normative group, the TKA group spent significantly less time on the total amount of physical activity per week and met the guidelines for health-enhancing physical activity less often (55% versus 64%).
Limitations A self-administered questionnaire was used to assess habitual physical activity, and presurgery data on physical activity were not available.
Conclusions Almost half of the TKA group did not meet the health-enhancing physical activity guidelines, and the TKA group was not as physically active as the normative group. People who have undergone TKA should be encouraged to be more physically active.
43 citations
TL;DR: This study shows that the SMFA-NL is a valid, reliable and moderately responsive method for the assessment of functional status of patients who have a broad range of musculoskeletal disorders.
Abstract: A B S T R A C T The purpose of this study was to translate and culturally adapt the Dutch version of the Short Musculoskeletal Function Assessment questionnaire (SMFA-NL) and to investigate the internal consistency, validity, repeatability and responsiveness of the translated version. The original SMFA was first translated and culturally adapted from English into Dutch according to a standardised procedure and subsequently tested for clinimetric quality. The study population consisted of 162 patients treated for various musculoskeletal injuries or disorders at the departments of Orthopedics and Traumatology. All respondents filled in the SMFA-NL and the SF-36 and a region-specific questionnaire. To determine repeatability, 87 respondents filled in the SMFA-NL for a second time after a time interval of three to four weeks. To determine responsiveness, 29 respondents who were treated for their injury within three months before the first assessment filled in the SMFA-NL for a second time after two to three months. The following analyses were performed to evaluate clinimetric quality of the SMFANL: factor analysis and Cronbach’s alpha (internal consistency), floor and ceiling effects, Spearman’s Rho (construct validity), intraclass correlation coefficients and the Bland & Altman method (repeatability), and standardised response means (SRM) (responsiveness). Factor analysis demonstrated four subscales of the SMFA-NL. Both the newly identified subscales of the SMFA-NL and the conventional subscales of the SMFA showed good internal consistency. No floor and some ceiling effects were found. Construct validity was good, as high correlations were found between the subscales of the SMFA-NL and the respective subscales of the SF-36 and the region-specific questionnaires. Repeatability of the SMFA-NL subscales was high, with no systematic bias between first and second assessment. Responsiveness of the SMFA-NL was moderate, as small to moderate SRMs were found. We successfully translated and culturally adapted a Dutch version of the Short Musculoskeletal Function Assessment questionnaire (SFMA-NL). This study shows that the SMFA-NL is a valid, reliable and moderately responsive method for the assessment of functional status of patients who have a broad range of musculoskeletal disorders. Furthermore, it will allow for comparison between different patient groups as well as for cross-cultural comparisons.
41 citations
TL;DR: In this paper, the authors present trends in the international labour mobility of social workers migrating to work in England alongside information on the supply of UK-trained social workers and conclude that demographic changes and policy imperatives have accentuated structural issues making it difficult to ensure an adequate supply in the number of domestically trained social workers.
Abstract: Recent years have seen considerable increases in the number of internationally-qualified social workers in England. This article presents trends in the international labour mobility of social workers migrating to work in England alongside information on the supply of UK-trained social workers. It concludes that demographic changes and policy imperatives have accentuated structural issues making it difficult to ensure an adequate supply in the number of domestically-trained social workers. We suggest that more cross-national research is needed to achieve a better understanding of the factors influencing social workers’ decisions to work in international settings and the extent to which this reflects permanent or temporary migration between countries.
31 citations
TL;DR: Physiotherapists should encourage people with a total knee arthroplasty to undertake the recommended exercise regimens to maintain health and fitness, with particular attention to those people with characteristics known to be associated with poor adherence to the recommendations.
27 citations
TL;DR: The influence of overweight/obesity on physical functioning and health-related quality of life is low and Refusing a patient a THA solely on the basis of overweight or obesity does not seem justified.
Abstract: Background Overweight/obesity in patients after total hip arthroplasty (THA) is a growing problem and is associated with postoperative complications and a negative effect on functional outcome. The objective of this study is to determine to what extent overweight/obesity is associated with physical functioning and health-related quality of life 1 year after primary THA. Methods A retrospective analysis of prospectively collected data from 653 patients who had undergone a primary THA was conducted. Physical functioning, health-related quality of life, body mass index (BMI), comorbidity, and postoperative complications were assessed by means of a questionnaire and from medical records. To determine to what extent overweight/obesity is associated with physical functioning and health-related quality of life after THA, a structural equation model (SEM) analysis was conducted. Results The association of BMI corrected for age, gender, complications, and comorbidity with physical functioning is �0.63. This means that an increase in 1 kg/m 2 BMI leads to a reduction of 0.63 points in the physical functioning score as measured with the Western Ontario and McMaster Universities Osteoarthritis Index (100-point scale). The prevalence of complications or comorbidity leads to a reduction of, respectively, 5.63 and 7.25 (one or two comorbidities) and 14.50 points in the case of more than two comorbidities on the physical functioning score. The same pattern is observed for health-related quality of life. Conclusions The influence ofoverweight/obesityonphysical functioning and health-related quality of life is low. The impact of complications and comorbidity is considerable. Refusing a patient a THA solely on the basis of overweight or obesity does not seem justified.
27 citations
TL;DR: It can be concluded that no clinically relevant reduction of weight occurred after total hip arthroplasty, except in the long term for patients who were obese.
Abstract: Background. Elevated body weight is associated with hip osteoarthritis (OA) and subsequently with total hip arthroplasty (THA). Patients with hip OA who are overweight often mention their restricted mobility as a factor that thwarts their attempts to be physically active and lose weight. There is some evidence that THA increases physical activity, but none for losing body weight after THA. Objective. The purpose of this study was to analyze the short-term (1-year) and long-term (4.5-year) effects of a THA on body weight. Design. This was an observational, multicenter cohort study. Methods. For the short-term effect, all patients (N618) were analyzed; for the long-term effect, a random subgroup (n100) was analyzed. Preoperative and postoperative body weight and height were self-reported. Patients were categorized according to their preoperative body mass index (BMI 25 kg/m 2 normal weight, 25–30 kg/m 2 overweight, 30 kg/m 2 obese). Clinical relevancy was set at a minimum of 5% weight loss compared with baseline.
24 citations
TL;DR: The objective of this paper is to review the benefits ofPhysical activity after THA/TKA, the potential negative consequences of physical activity on hip or knee prosthesis, the measurement of physicalActivity, physical activity behavior, and the current opinion of health care professionals regarding types of physical activities recommended for patients afterTHA/ TKA.
TL;DR: In this article, the authors explored practice issues in rural areas when supporting the mental health and well-being of older people from Black and minority ethnic groups in social care and housing with care services in the United Kingdom.
TL;DR: In this paper, a literature review and secondary data analysis of an existing dataset was conducted to discuss what is known about this topic and specifically considers the impact of a financial incentive to undertake social work qualifying education in England, the social work bursary.
Abstract: The financial support available to students on social work qualifying programmes appears to be a neglected topic in published social work research. This article draws on a literature review and secondary data analysis of an existing dataset to discuss what is known about this topic and specifically considers the impact of a financial incentive to undertake social work qualifying education in England, the social work bursary. In the context of major changes to the funding of higher education in England, it suggests that the introduction of the social work bursary has helped increase the number of students enrolling on social work qualifying programmes in England and supported some students whose personal and financial circumstances might have prevented them from undertaking social work qualifying education. While students report their appreciation of financial assistance in the form of the bursary, many have additional needs in the form of support for children and other dependants, and for help in defraying the costs of travel while undertaking practice placements. The paper concludes that attention needs to be paid to the specific needs of social work students when considering the impact of changes to funding higher education.
TL;DR: It is concluded that the marginal position of both social care users and migrant workers is reflected in these micro encounters that are reported between service users and carers with migrant workers.
Abstract: There have been few studies of people’s experiences of receiving care from migrant workers. This is despite the growing move to employ migrants to provide care and support for older and disabled people in the developed world. This article reports empirical findings from a study of migrants working in social care in England conducted between 2007 and 2009. It focuses on the reported interactions between service users and carers with migrant workers. Face-to-face semi-structured interviews were conducted with 35 adults receiving social care services and family carers in home and residential settings who had a variety of needs for care and with support. Analysis highlighted the range of their experiences. An emerging theme arising from the interviews was that of communication and the difficulties experienced by people using care services, or family carers speaking on their behalf, of understanding and being understood by care workers whose spoken English was not easy for them to comprehend. Social workers wi...
TL;DR: It is observed that preferences for care workers and satisfaction with social care services may be linked, but highlighted that the concept of meeting a preference is personal to the individual.
Abstract: This paper develops a typology of people using social care services’ preferences for care workers and satisfaction with social care services from a large multimethod study that explored international recruitment to the English social care sector (home and health care, including residential homes). We developed this typology with two questions in mind: (a) what led to satisfaction of care and (b) what led to preference and satisfaction with workers? Data were collected from face-to-face interviews with 35 people who were using social care services and carers (2007–2009) and these data were used to develop the typology. Using the theoretical concept of homophily, we explored contentions that people might prefer to receive care and support from individuals resembling themselves. We observed that preferences for care workers and satisfaction with social care services may be linked, but highlighted that the concept of meeting a preference is personal to the individual. The implications of users’ prefe...
TL;DR: The authors' evaluation of individual budgets found that levels of allocated resources reflected a range of factors, including informal or carer support and disability levels, and individual budgets were found to be cost-neutral compared with conventional social care delivery.
Abstract: Individual or personal budgets are part of a growing international trend to encourage greater choice and control over social care services at a time of financial austerity. The authors' evaluation of individual budgets found that levels of allocated resources reflected a range of factors, including informal or carer support and disability levels. Furthermore, individual budgets were found to be cost-neutral compared with conventional social care delivery.
TL;DR: It can be concluded that because of the aging society, an increasing number of elderly people will be undergoing total joint arthroplasty, and it seems that compared with younger patients, elderly patients benefit more from a minimally invasive approach.
Journal Article•
01 Jan 2012
TL;DR: This article discusses Hip Osteoarthritis and Are Overweight or Effect of Exercise and Weight Loss in People Whofound online at: http://ptjournal.apta.org/content/early/2012/12/06/ptj.20110418.
Abstract: doi: 10.2522/ptj.20110418Originally published online September 27, 2012PHYS THER.€ Published online September 27, 2012Bulstra and Martin StevensDilling, Martine Bos, Klaas van der Meer, Sjoerd K. Nienke Paans, Inge van den Akker-Scheek, Roelien G.Obese: A Prospective Cohort StudyHave Hip Osteoarthritis and Are Overweight or Effect of Exercise and Weight Loss in People Whofound online at: http://ptjournal.apta.org/content/early/2012/12/06/ptj.20110418The online version of this article, along with updated information and services, can beCollections €€€€ Therapeutic Exercise €€€€ Patient/Client-Related Instruction €€€€ Osteoarthritis €€€€ Osteoarthritis €€€€ Obesity €€€€ Injuries and Conditions: Hip in the following collection(s): This article, along with others on similar topics, appearsE-mail alerts Sign up here to receive free e-mail alerts corrections and replace the original author manuscript. Page proofs: edited and typeset versions of articles that incorporate any author€ readers almost immediate access to accepted papers. accepted for publication but have not yet been copyedited or typeset. This allows PTJAuthor manuscripts: PDF versions of manuscripts that have been peer-reviewed and€ Physical Therapy (PTJ). PTJ publishes 2 types of Online First articles: Online First articles are published online before they appear in a regular issue of Downloaded from http://ptjournal.apta.org/