Aim Although referral to phase 2 cardiac rehabilitation (CR) following open-heart surgery is recommended in professional guidelines, according to the literature, participation rates are suboptimal.... Show moreAim Although referral to phase 2 cardiac rehabilitation (CR) following open-heart surgery is recommended in professional guidelines, according to the literature, participation rates are suboptimal. This study investigates the referral and enrolment rates, as well as determinants for these rates, for phase 2 CR following open-heart surgery via sternotomy. Methods A cross-sectional survey study was conducted among patients who underwent open-heart surgery via sternotomy in a university hospital. Data on referral and enrolment rates and possible factors associated with these rates (age, sex, type of surgery, educational level, living status, employment, income, ethnicity) were collected by a questionnaire or from the patient's medical file. Univariate logistic regression analysis (odds ratio) was used to study associations of patient characteristics with referral and enrolment rates. Results Of the 717 eligible patients, 364 (51%) completed the questionnaire. Their median age was 68 years (interquartile range 61-74) and 82 (23%) were female. Rates for referral to and enrolment in phase 2 CR were 307 (84%) and 315 (87%), respectively. Female sex and older age were independently associated with both non-referral and non-enrolment. Additional factors for non-enrolment were surgery type (coronary artery bypass grafting with valve surgery and miscellaneous types of relatively rare surgery), living alone and below-average income. Conclusion Phase 2 CR referral and enrolment rates for patients following open-heart surgery were well over 80%, suggesting adequate adherence to professional guidelines. During consultation, physicians and specialised nurses should pay more attention to certain patient groups (at risk of non-enrolment females and elderly). In addition, in-depth qualitative research to identify reasons for non-referral and/or non-enrolment is needed. Show less
Background:Physical exercises targeting proprioception are part of conservative therapy for Subacromial Pain Syndrome (SAPS). However, the effect of such exercises on proprioception itself has not... Show moreBackground:Physical exercises targeting proprioception are part of conservative therapy for Subacromial Pain Syndrome (SAPS). However, the effect of such exercises on proprioception itself has not been orderly established, hampering the advancement of treatment protocols and implementation. We summarised the evidence for a loss of proprioception in SAPS and defined the type of interventions that target and improve proprioception in SAPS. Methods:Two reviewers independently analysed 12/761 articles that evaluated joint position, kinaesthetic or force sense in patients with SAPS. Results:Patients with SAPS had reduced joint position sense during abduction. There was no evidence for a loss of kinaesthetic sense or force sense. Stretching, strengthening and stabilisation exercises improved joint position and kinaesthetic sense in SAPS. Microcurrent electrical stimulation and kinesiotaping did not improve proprioception in SAPS. Conclusions:The lack of evidence on proprioception in SAPS is striking. We found limited evidence for a loss of joint position sense in the higher ranges of abduction in SAPS. Active training programmes including strengthening and stabilisation exercises showed superiority in terms of enhancing proprioception relative to passive methods like kinesiotaping. The results of this narrative synthesis should be used as a base for providing value-based and data-driven treatment solutions to SAPS. Show less
Objective:The aim of this study was to evaluate the feasibility and preliminary effects of a multicomponent intervention to decrease sedentary time during and shortly after hospitalization.Design... Show moreObjective:The aim of this study was to evaluate the feasibility and preliminary effects of a multicomponent intervention to decrease sedentary time during and shortly after hospitalization.Design:This is a quasi-experimental pilot study comparing outcomes in patients admitted before and after the implementation of the intervention.Setting:The study was conducted in a university hospital.Subjects:Participants were adult patients undergoing elective organ transplantation or vascular surgery.Interventions:In the control phase, patients received usual care, whereas in the intervention phase, patients also received a multicomponent intervention to decrease sedentary time. The intervention comprised eight elements: paper and digital information, an exercise movie, an activity planner, a pedometer and Fitbit Flex (TM), a personal activity coach and an individualized digital training program.Measures:Measures of feasiblity were the self-reported use of the intervention components (yes/no) and satisfaction (low-high = 0-10). Main outcome measure was the median % of sedentary time measured by an accelerometer worn during hospitalization and 7-14 days thereafter.Results:A total of 42 controls (mean age = 59 years, 62% male) and 52 intervention patients (58 years, 52%) were included. The exercise movie, paper information and Fitbit Flex were the three most frequently used components, with highest satisfaction scores for the fitbit, paper information, exercise movie and digital training. Median sedentary time decreased from 99.6% to 95.7% and 99.3% to 91.0% between Days 1 and 6 in patients admitted in the control and intervention phases, respectively. The difference at Day 6 reached statistical significance (difference = 41 min/day, P = 0.01). No differences were seen after discharge.Conclusion:Implementing a multicomponent intervention to reduce sedentary time appeared feasible and may be effective during but not directly after hospitalization. Show less
Objective: Inactivity during hospitalization leads to a functional decline and an increased risk of complications. To date, studies focused on older adults. This study aims to compare the physical... Show moreObjective: Inactivity during hospitalization leads to a functional decline and an increased risk of complications. To date, studies focused on older adults. This study aims to compare the physical activities performed by older adult and adult hospitalized patients. Methods: Patients hospitalized for >3 days at a university hospital completed a questionnaire regarding their physical activities (% of days on which an activity was performed divided by the length of stay) and physical activity needs during hospitalization. Crude and adjusted comparisons of older adult (>60 years) and adult (<= 60 years) patients were performed using parametric testing and regression analyses. Results: Of 524 patients, 336 (64%) completed the questionnaire, including 166 (49%) older adult patients. On average, the patients were physically active on 35% or less of the days during their hospitalization. Linear regression analysis showed no significant associations between being an older adult and performing physical activities after adjusting for gender, length of stay, surgical intervention, and meeting physical activity recommendations prior to hospitalization. Most patients were well informed regarding physical activity during hospitalization; however, the older adult patients reported a need for information regarding physical activities after hospitalization more frequently (odds ratios, 2.47) after adjusting for educational level, gender, and physical therapy during hospitalization. Conclusions: Both older adult and adult patients are physically inactive during hospitalization, and older adult patients express a greater need for additional information regarding physical activity after hospitalization than adult patients. Therefore, personalized strategies that inform and motivate patients to resume physical activities during hospitalization are needed regardless of age. Show less
AbstractPurpose: This study aimed to translate and cross-culturally adapt the Pediatric Outcome Data Collecting Instrument (PODCI) into the Dutch language and evaluate its measurement properties... Show moreAbstractPurpose: This study aimed to translate and cross-culturally adapt the Pediatric Outcome Data Collecting Instrument (PODCI) into the Dutch language and evaluate its measurement properties among children (age 3-10) with Neonatal Brachial Plexus Palsy (NBPP). Methods: The PODCI was translated and adapted according to international guidelines and administered to 10 children with NBPP before and after surgery and thereafter twice again. Subsequently, the Mallet-score, Assisting Hand Assessment and active Range of Motion (aROM) were recorded. Cronbach’s-α and correlations between the PODCI and other outcome measures were determined, as well as Intraclass Correlation Coefficients (ICC). In addition, effect sizes (ES), Standard Response Means (SRM) and change scores with the 95% Confidence Interval (95% CI) were calculated. Results: The final Dutch PODCI ‘Upper Extremity and Physical Function’ subscale and total score ‘Global Functioning’ showed good internal consistency (Cronbach’s-α 0.695/0.781) and reliability (ICC 0.97/0.80) and were significantly associated with aROM and the Mallet-score. After surgery a significant change of the total score (ES 0.57, SRM 1.23, change 4.22 points, 95% CI 1.04-7.4) was seen. Conclusion: The final Dutch PODCI had good measurement properties and appears useful in evaluating quality of life and functioning in children with NBPP. Show less
Fischer, M.J.; Krol-Warmerdam, E.M.M.; Ranke, G.M.C.; Vermeulen, H.M.; Heijden, J. van der; Nortier, J.W.R.; Kaptein, A.A. 2013
Background: To improve the quality of the physiotherapy management in patients with rheumatoid arthritis (RA) a Dutch practice guideline, based on current scientific evidence and best practice, was... Show moreBackground: To improve the quality of the physiotherapy management in patients with rheumatoid arthritis (RA) a Dutch practice guideline, based on current scientific evidence and best practice, was developed. This guideline comprised all elements of a structured approach (assessment, treatment and evaluation) and was based on the International Classification of Functioning, disability and Health (ICF) and the ICF core sets for RA. Methods: A guideline steering committee, comprising 10 expert physiotherapists, selected topics concerning the guideline chapters initial assessment, treatment and evaluation. With respect to treatment a systematic literature search was performed using various databases, and the evidence was graded (1-4). For the initial assessment and evaluation mainly review papers and textbooks were used. Based on evidence and expert opinion, recommendations were formulated. A first draft of the guideline was reviewed by 10 experts from different professional backgrounds resulting in the final guideline. Results: In total 7 topics were selected. For the initial assessment, three recommendations were made. Based on the ICF core sets for RA a list of health problems relevant for the physiotherapist was made and completed with red flags and points of attention. Concerning treatment, three recommendations were formulated; both exercise therapy and education on physiotherapy were recommended, whereas passive interventions (delivery of heat or cold, mechanical, electric and electromagnetic energy, massage, passive mobilization/manipulation and balneotherapy) were neither recommended nor discouraged. For treatment evaluation at the level of activities and participation, the Health Assessment Questionnaire was recommended. For evaluating specific body structures and functions the handheld dynamometer, 6-minute walk test or Astrand bicycle test (including Borg-scale for rating the perceived exertion), Escola Paulista de Medicina Range of Motion Scale and a Visual Analog Scale for pain and morning stiffness were recommended. Conclusion: This physiotherapy practice guideline for RA included seven recommendations on the initial assessment, treatment and evaluation, which were all based on the ICF and the ICF Core Set for RA. The implementation of the guideline in clinical practice needs further evaluation. Show less
Following the general introduction regarding the epidemiology, aetiology, assessment and treatment of the frozen shoulder in Chapter 1 this thesis is divided into two parts: Part I describes the... Show moreFollowing the general introduction regarding the epidemiology, aetiology, assessment and treatment of the frozen shoulder in Chapter 1 this thesis is divided into two parts: Part I describes the results of the physiotherapeutic treatment of the frozen shoulder by means of mobilization techniques; Part II describes the clinical evaluation of the frozen shoulder and other shoulder disorders by various measurement instruments. Part I Physiotherapeutic treatment of the frozen shoulder. Chapter 2 shows a multiple-subject case study in 7 patients with a unilateral frozen shoulder treated with end-range mobilization techniques. Chapter 3 presents the results of a randomized controlled trial, comparing two treatment strategies with mobilization techniques in 100 patients with a unilateral frozen shoulder. In this trial we performed a cost-utility analysis comparing both mobilization techniques with respect to societal costs and quality-adjusted life years. Next a burden-of-illness study is presented estimating the impact of the frozen shoulder on costs and health. The results of this economic evaluation are presented in Chapter 4. Part II Clinical evaluation of the frozen shoulder and other shoulder disorders. Chapter 5 describes a new method of measuring shoulder positions by means of a three-dimensional electromagnetic tracking system. In a group of 15 healthy volunteers, two observers performed repeated measurements to examine the inter-trial, inter-day, inter-observer and intersubject reliability. In Chapter 6 the clinical application of the three-dimensional electromagnetic tracking device was tested on 10 patients with a unilateral frozen shoulder. The three-dimensional movement patterns of affected and non-affected shoulders were compared before and after 3 months treatment by means of end-range mobilization techniques. The translation, adaptation and validation of the Shoulder Rating Questionnaire into the Dutch language is discussed in Chapter 7 while the responsiveness of the Shoulder Function Assessment scale in 35 patients with rheumatoid arthritis suffering from shoulder complaints is presented in Chapter 8. Chapter 9 describes a comparison between two portable dynamometers in the assessment of shoulder and elbow strength in order to determine the practical applicability and the measurement properties of both devices. Finally, in Chapter 10, the findings and conclusions of the preceding chapters are summarized and indications for further research are discussed. Show less
