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Background Osteoarthritis is one of the most common chronic joint diseases, mostly affecting the knee or hip through pain, joint stiffness and decreased physical functioning in daily life. Regular physical activity (PA) can help preserve and improve physical functioning and reduce pain in patients with osteoarthritis. Interventions aiming to improve movement behaviour can be optimized by tailoring them to a patients’ starting point; their current movement behaviour. Movement behaviour needs to be assessed in its full complexity, and therefore a multidimensional description is needed. Objectives The aim of this study was to identify subgroups based on movement behaviour patterns in patients with hip and/or knee osteoarthritis who are eligible for a PA intervention. Second, differences between subgroups regarding Body Mass Index, sex, age, physical functioning, comorbidities, fatigue and pain were determined between subgroups. Methods Baseline data of the clinical trial ‘e-Exercise Osteoarthritis’, collected in Dutch primary care physical therapy practices were analysed. Movement behaviour was assessed with ActiGraph GT3X and GT3X+ accelerometers. Groups with similar patterns were identified using a hierarchical cluster analysis, including six clustering variables indicating total time in and distribution of PA and sedentary behaviours. Differences in clinical characteristics between groups were assessed via Kruskall Wallis and Chi2 tests. Results Accelerometer data, including all daily activities during 3 to 5 subsequent days, of 182 patients (average age 63 years) with hip and/or knee osteoarthritis were analysed. Four patterns were identified: inactive & sedentary, prolonged sedentary, light active and active. Physical functioning was less impaired in the group with the active pattern compared to the inactive & sedentary pattern. The group with the prolonged sedentary pattern experienced lower levels of pain and fatigue and higher levels of physical functioning compared to the light active and compared to the inactive & sedentary. Conclusions Four subgroups with substantially different movement behaviour patterns and clinical characteristics can be identified in patients with osteoarthritis of the hip and/or knee. Knowledge about these subgroups can be used to personalize future movement behaviour interventions for this population. Trial registration Dutch clinical trial registration number of e-Exercise Osteoarthritis: NTR4224.

Contains fulltext : 221004.pdf (Publisher’s version ) (Closed access) OBJECTIVE: To gain insight into patient participation in general practice by examining if and how patients' question-asking behaviour has changed over the years (2007-2016). METHODS: A random set of real-life video-recorded consultations collected in 2015-2016 (n = 437) was observed and compared with that of a former study in 2007-2008 (n = 533). Patients' question-asking behaviour was coded using an adapted RIAS protocol containing six categories: medical condition/therapeutic regimen; psychosocial; social context; lifestyle; ask for opinion doctor; practical. GPs and patients completed questionnaires about their background characteristics. Data were analysed using multi-level analysis. RESULTS: Patients asked fewer questions in 2016 than in 2007. The type of question-asking behaviour changed significantly: in particular medical questions decreased while practical questions increased. Less educated patients asked significantly more practical questions than higher educated patients. CONCLUSION: Contrary to our expectations, patients' question-asking has decreased in 2016 compared to 2007, while the average consultation length has increased. The type of questions shifted from medical to practical, especially in less educated patients. It seems that GPs' professional role has expanded over time, since patients nowadays ask their GP more non-medical questions. PRACTICE IMPLICATIONS: GPs probably could continue facilitating patient involvement by more frequently using partnership-building and supportive communication.

Background Patients with glioma often suffer from cognitive deficits. Physical exercise has been effective in ameliorating cognitive deficits in older adults and neurological patients. This pilot randomized controlled trial (RCT) explored the possible impact of an exercise intervention, designed to improve cognitive functioning in glioma patients, regarding cognitive test performance and patient-reported outcomes (PROs). Methods Thirty-four clinically stable patients with World Health Organization grades II/III glioma were randomized to a home-based remotely coached exercise group or an active control group. Patients exercised 3 times per week for 20–45 minutes, with moderate to vigorous intensity, during 6 months. At baseline and immediate follow-up, cognitive performance and PROs were assessed with neuropsychological tests and questionnaires, respectively. Linear regression analyses were used to estimate effect sizes of potential between-group differences in cognitive performance and PROs at 6 months. Results The exercise group (n = 21) had small- to medium-sized better follow-up scores than the control group (n = 11) on several measures of attention and information processing speed, verbal memory, and executive function, whereas the control group showed a slightly better score on a measure of sustained selective attention. The exercise group also demonstrated small- to medium-sized better outcomes on measures of self-reported cognitive symptoms, fatigue, sleep, mood, and mental health–related quality of life. Conclusions This small exploratory RCT in glioma patients provides a proof of concept with respect to improvement of cognitive functioning and PROs after aerobic exercise, and warrants larger exercise trials in brain tumor patients.

Background In the last decade many countries in Europe have implemented patient choice and managed competition. Policymakers assume that patients behave as active rational consumers and actively choose the provider that best fits their needs and preferences. With the introduction of managed competition, health insurers make up an important third party. On behalf of their customers, they purchase services and are allowed to contract selectively. Taking one’s insurance into account when choosing a provider became therefore increasingly important. There is, however, little evidence that patients make active choices in the way policymakers assumed. Instead, many patients visit the provider that is recommended by their general practitioner (GP). Aim This research aims to investigate the role of patients in choosing a healthcare provider at the point of referral and what the roles of the GP and the health insurer are in this process. Methods In 2015-2016, we videotaped Dutch GP-patient consultations. The videotaped consultations between 475 patients and 28 GPs in which the patient was referred to a healthcare provider were coded by three observers. We used an observation protocol to describe the referral process. Results Patients were divided into three groups: patients with little or no input, with some input and with much input. More than half of the patients (56%) seemed to have some or much input into the choice of a healthcare provider at point of referral by their GP. In almost half of the consults (47%) GPs asked for the patients’ preferences. The health insurance of a patient was rarely discussed at the point of referral. Conclusions More than half of the patients seem to have some or much input into the choice of a healthcare provider at point of referral by their GP. However, still half of the patients had little or no input. If patient choice remains important for policy, GPs should discuss more options with their patients and should also name the health insurer. Key messages In 53% of the consultations the GP does not ask the patient about the preference of a provider. The health insurance of a patient is rarely discussed during GP-patient consultations.