My thesis primarily focused on projects concerning the role of autoantibodies in patients with systemic sclerosis (SSc), disease outcomes, and the assessment of non-pharmacological interventions... Show moreMy thesis primarily focused on projects concerning the role of autoantibodies in patients with systemic sclerosis (SSc), disease outcomes, and the assessment of non-pharmacological interventions for this group. SSc is a rare and complex disease that presents challenges in both diagnosis and management. Further understanding of the role of autoantibodies in SSc would aid in risk stratification and potentially offer new treatment avenues. In the first part of my thesis, we identified possible indications for a pathogenic role of SSc-specific autoantibodies, particularly anti-topoisomerase I antibodies (ATA). Regarding disease outcomes, we gained deeper insight into the trajectory of the Health Assessment Questionnaire, disease duration and severity in SSc patients from the Leiden CCISS cohort. In the last part, we evaluated two non-pharmacologic interventions: silver fiber gloves and physical therapy. We conducted a randomized controlled cross-over trial to assess the effect of silver fiber gloves on the burden of Raynaud’s Phenomenon in SSc patients. Lastly, we evaluated the levels of physical activity in SSc patients, assessed the contents, use, and preferences of physical therapy care from the perspective of patients and their physical therapists, and proposed recommendations for improved communication between physical therapists, patients, and other healthcare providers, as well as postgraduate education on SSc for physical therapists. Show less
In the young and healthy shoulder, cranially directed forces during abduction are counteracted by co-contraction of the rotator cuff muscles. In this way, it is prevented that the humerus moves... Show moreIn the young and healthy shoulder, cranially directed forces during abduction are counteracted by co-contraction of the rotator cuff muscles. In this way, it is prevented that the humerus moves cranially towards the acromion, thus entrapping subacromial tissues. During ageing however, shoulder tissues are subject to marked degeneration, which particularly concerns the rotator cuff muscles. This may have two consequences. First, due to reduced contribution of the upper parts of the rotator cuff to the abduction movement, the deltoid has to compensate, which results in a more cranially, instead of mediocranially directed force. Second, reduced stabilising force by the rotator cuff may jeopardise counteraction of cranial deltoid forces. These changes could lead to cranialisation of the humerus with painful compression of subacromial tissues, as observed in patients with Subacromial Pain Syndrome (SAPS). Previous studies have shown that by co-contraction of arm adductors, humeral-head depression may be accomplished, for the purpose of unloading subacromial tissues. In this thesis, we investigated the role of adductor co-contraction in the ageing asymptomatic population and in patients with SAPS. This has resulted in eight scientific publications with which the fundaments for evidence-based therapy in SAPS have been built, with as cornerstone training of adductor co-contraction. Show less
Physical Activity (PA) is one of the most important lifestyle factors influencing human health. The general and disease-specific health benefits of PA are well known to the general population and... Show morePhysical Activity (PA) is one of the most important lifestyle factors influencing human health. The general and disease-specific health benefits of PA are well known to the general population and to those people living with rheumatic musculoskeletal diseases (RMDs). The importance of PA as an intervention for the management of RMDs has been endorsed by various stakeholders, e.g. the World Health Organisation and the European Alliance of Associations for Rheumatology/EULAR. The early translation of research evidence into clinical care benefits patients with RMDs greatly.This thesis is focused on the effects and promotion of PA and exercise on people with RMDs, and particularly those with axial Spondyloarthritis (axSpA).The overall aim of this thesis was to document the journey from the development of the EULAR PA recommendations for people with RMDs (including axSpA) to the practical implementation of a concept for group exercise therapy for people with axSpA living in Switzerland that conforms to these recommendations. Show less
This thesis showed that there appears much room for improvement in optimizing physical activity and exercise of people with axial spondyloarthritis (axSpA), both in patients using and not using... Show moreThis thesis showed that there appears much room for improvement in optimizing physical activity and exercise of people with axial spondyloarthritis (axSpA), both in patients using and not using individual physical therapy and axSpA-specific group exercise. Although recommended, only a minority engages in high-intensity aerobic physical activity and in strengthening and mobility exercise with the recommended frequency. This is also the case in people with axSpA using physical therapy. Furthermore, certain evidence-based enhancements in axSpA-specific exercise groups seem warranted. A pilot implementation of these enhancements was found to be partially successful and a number of barriers remain to be overcome in a larger-scale implementation. Because only a small minority of people with axSpA participate in such exercise groups, it is also desired to implement modifications to individual physical therapy as well as interventions in which people with axSpA can participate independently (without supervision). A number of components of such interventions were identified in this thesis. Show less
Background: Total hip or knee arthroplasties (THA/TKA) show favorable long-term effects, yet the recovery process may take weeks to months. Physical therapy (PT) following discharge from hospital... Show moreBackground: Total hip or knee arthroplasties (THA/TKA) show favorable long-term effects, yet the recovery process may take weeks to months. Physical therapy (PT) following discharge from hospital is an effective intervention to enhance this recovery process. To investigate the relation between recovery and postoperative PT usage, including the presence of comorbidities, 6 months after THA/TKA.Methods: Multicenter, observational study in primary THA/TKA patients who completed preoperative and 6 months postoperative assessments. The assessments included questions on PT use (yes/no and duration; long term use defined as >= 12 weeks), comorbidities (musculoskeletal, non-musculoskeletal, sensory comorbidities and frequency of comorbidities). Recovery was assessed with the HOOS/KOOS on all 5 subdomains. Logistic regression with long term PT as outcome was performed adjusted for confounding including an interaction term (comorbidity*HOOS/KOOS-subdomain).Results: In total, 1289 THA and 1333 TKA patients were included, of whom 95% received postoperative PT, 56% and 67% received postoperative PT >= 12 weeks respectively. In both THA and TKA group, less improvement on all HOOS/KOOS domain scores was associated with >= 12 weeks of postoperative PT (range Odds Ratios 0.97-0.99). In the THA group the impact of recovery was smaller in patient with comorbidities as non- musculoskeletal comorbidities modified all associations between recovery and postoperative PT duration (Odds Ratios range 1.01-1.05). Musculoskeletal comorbidities modified the associations between Function-in-Daily-Living-and Sport-and-recreation recovery and postoperative PT. Sensory comorbidities only had an effect on Sport-and-recreation recovery and postoperative PT. Also the frequency of comorbidities modified the relation between Function-in-Daily-Living, pain and symptoms recovery and postoperative PT. In the TKA group comorbidity did not modify the associations.Conclusion: Worse recovery was associated with longer duration of postoperative PT suggesting that PT provision is in line with patients' needs. The impact of physical recovery on the use of long-term postoperative PT was smaller in THA patients with comorbidities. Show less
Osthoff, A.K.R.; Vlieland, T.P.M.V.; Meichtry, A.; Bodegom-Vos, L. van; Topalidis, B.; Buchi, S.; ... ; Niedermann, K. 2022
Background: The Ankylosing Spondylitis Association of Switzerland (SVMB) aimed to implement physical activity recommendations (PAR) within their exercise groups (EGs). The PAR promote exercise in... Show moreBackground: The Ankylosing Spondylitis Association of Switzerland (SVMB) aimed to implement physical activity recommendations (PAR) within their exercise groups (EGs). The PAR promote exercise in all fitness dimensions at the correct dose. To implement the PAR within EGs, they were translated into a new EG concept with five key activities: (a) training for supervising physiotherapists (PTs), (b) correctly dosed exercises in all fitness dimensions, (c) exercise counselling, (d) bi-annual fitness assessments, and (e) individual exercise training, in addition to EG. All these activities were realized in close coordination with SVMB management.Objectives: To analyse the implementation success by evaluating adherence/fidelity, feasibility, and satisfaction at the patient, PTs, and organisational level.Methods: The five key activities of the new EG concept were developed, executed, and assessed after 6 months. The primary outcomes for implementation success were adherence of patients to the recommended exercise behaviour, self-reported by electronic diary; fidelity of PTs to the new concept, self-reported by diary; SVMB organisational changes. Secondary outcomes were feasibility and satisfaction with the new EG concept at all three levels. The tertiary outcome, to evaluate the effectiveness of PAR, was patient fitness, assessed through fitness assessments.Results: 30 patients with axSpA (ten women, mean age 58 +/- 9 years) and four PTs (three women, mean age 46 +/- 9 years) participated. The patients' self-reporting of adherence to the PAR was insufficient (43%), possibly due to technical problems with the electronic dairy. The PTs' fidelity to the new EG concept was satisfactory. On all levels, the new concept was generally perceived as feasible and useful for supporting personalised exercise.The frequency of exercise counselling and the fitness assessments was found by patients and PTs to be too high and rigid. Patients' cardiorespiratory fitness [ES 1.21 (95%CI 0.59, 1.89)] and core strength [ES 0.61 (95%CI 0.18, 1.06)] improved over the 6 months.Conclusions: The pilot implementation of PAR showed acceptance and satisfaction to be sufficient, thus confirming the need for evidence-based EGs, provided by a patient organisation in order to support active PA behaviour. However, adaptations are necessary to increase its feasibility for nationwide implementation. Show less
Noorduyn, J.C.A.; Teuwen, M.M.H.; Graaf, V.A. van de; Willigenburg, N.W.; Schavemaker, M.; Dijk, R. van; ... ; Escape Res Grp 2021
Purpose Although physical therapy is the recommended treatment in patients over 45 years old with a degenerative meniscal tear, 24% still opt for meniscal surgery. The aim was to identify those... Show morePurpose Although physical therapy is the recommended treatment in patients over 45 years old with a degenerative meniscal tear, 24% still opt for meniscal surgery. The aim was to identify those patients with a degenerative meniscal tear who will undergo surgery following physical therapy. Methods The data for this study were generated in the physical therapy arm of the ESCAPE trial, a randomized clinical trial investigating the effectiveness of surgery versus physical therapy in patients of 45-70 years old, with a degenerative meniscal tear. At 6 and 24 months patients were divided into two groups: those who did not undergo surgery, and those who did undergo surgery. Two multivariable prognostic models were developed using candidate predictors that were selected from the list of the patients' baseline variables. A multivariable logistic regression analysis was performed with backward Wald selection and a cut-off of p < 0.157. For both models the performance was assessed and corrected for the models' optimism through an internal validation using bootstrapping technique with 500 repetitions. Results At 6 months, 32/153 patients (20.9%) underwent meniscal surgery following physical therapy. Based on the multivariable regression analysis, patients were more likely to opt for meniscal surgery within 6 months when they had worse knee function, lower education level and a better general physical health status at baseline. At 24 months, 43/153 patients (28.1%) underwent meniscal surgery following physical therapy. Patients were more likely to opt for meniscal surgery within 24 months when they had worse knee function and a lower level of education at baseline at baseline. Both models had a low explained variance (16 and 11%, respectively) and an insufficient predictive accuracy. Conclusion Not all patients with degenerative meniscal tears experience beneficial results following physical therapy. The non-responders to physical therapy could not accurately be predicted by our prognostic models. Show less
Objectives To adapt the core strength endurance test battery (aCSE), previously used for testing athletes, to a target group of patients with axial spondylarthritis (axSpA), to evaluate its intra... Show moreObjectives To adapt the core strength endurance test battery (aCSE), previously used for testing athletes, to a target group of patients with axial spondylarthritis (axSpA), to evaluate its intra-tester reliability and its associations with disease-specific factors. Methods A cross-sectional study was conducted at axSpA exercise therapy groups, including both axSpA patients and the physiotherapist group leaders (PTs). The aCSE was used to measure the isometric strength endurance of the ventral, lateral, and dorsal core muscle chains (measured in seconds), as well as to assess the disease-specific factors of functional status, self-reported pain, and perceived strength performance. The aCSE was repeated after 7-14 days to measure intra-tester reliability for the same rater (PT group leader). Reliability was calculated as an intra-class correlation coefficient (ICC) using a nested design. The associations between ventral, lateral, and dorsal strength endurance and the disease-specific factors were calculated using Pearson correlation coefficients. Results Study participants were 13 PT group leaders and 62 axSpA patients. The latter were all capable of performing the aCSE, with the exception of one individual. A moderate to substantial intra-rater reliability (ICCs (95%CI)) was found for the ventral (0.54 (0.35, 0.74)), lateral (0.52 (0.33, 0.70)), and dorsal (0.71 (0.58, 0.86)) core muscle chains. None of the aCSE measures correlated with the disease-specific factors. Conclusion The aCSE was found to be a reliable test battery for assessing core strength endurance in axSpA patients. Interestingly, aCSE performance was not associated with any disease-specific factors. Show less
Hilberdink, B.; Vlieland, T.V.; Giesen, F. van der; Gaalen, F. van; Goekoop, R.; Peeters, A.; ... ; Weely, S. van 2020
Introduction This study aimed to compare the engagement in moderate- and vigorous-intensity PA in axSpA patients with and without current physical therapy (PT). Methods In this cross-sectional... Show moreIntroduction This study aimed to compare the engagement in moderate- and vigorous-intensity PA in axSpA patients with and without current physical therapy (PT). Methods In this cross-sectional study, a survey, including current PT treatment (yes/no) and PA, using the 'Short QUestionnaire to ASsess Health-enhancing PA' (SQUASH), was sent to 458 axSpA patients from three Dutch hospitals. From the SQUASH, the proportions meeting aerobic PA recommendations (>= 150 min/week moderate-, >= 75 min/week vigorous-intensity PA or equivalent combination; yes/no) were calculated. To investigate the association between PT treatment and meeting the PA recommendations, odds ratios (OR) with 95% confidence intervals (95% CI) were estimated using logistic regression models, adjusting for sex, age, health status and hospital. Results The questionnaire was completed by 200 patients, of whom 68%, 50% and 82% met the moderate-, vigorous- or combined-intensity PA recommendations, respectively. Ninety-nine patients (50%) had PT treatment, and those patients were more likely to meet the moderate- (OR 2.09 [95% CI 1.09-3.99]) or combined-intensity (OR 3.35 [95% CI 1.38-8.13]) PA recommendations, but not the vigorous-intensity PA recommendation (OR 1.53 [95% CI 0.80-2.93]). Aerobic exercise was executed in 19% of individual PT programs. Conclusion AxSpA patients with PT were more likely to meet the moderate- and combined-intensity PA recommendations, whereas there was no difference in meeting the vigorous-intensity PA recommendation. Irrespective of having PT treatment, recommendations for vigorous-intensity PA are met by only half of the patients. Implementation should thus focus on aerobic PA in patients without PT and on vigorous-intensity PA in PT programs. 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
Quinn, L.; Hamana, K.; Kelson, M.; Dawes, H.; Collett, J.; Townson, J.; ... ; Busse, M. 2016
Rheumatoid arthritis (RA) is a complex chronic disease, which, despite the advanced pharmacological treatment, requires care provided by health professionals other than the rheumatologist in many... Show moreRheumatoid arthritis (RA) is a complex chronic disease, which, despite the advanced pharmacological treatment, requires care provided by health professionals other than the rheumatologist in many patients during the course of their disease. Physical therapy is an important part of the non-pharmacological treatment of patients with RA. However, due to the changes in the medical treatment of patients with RA the role of physical therapists and patient has changed as well. The aims of the present thesis were to describe the currently available RA guideline including recommendations concerning the physical therapy management, to develop a RA guideline specific for physical therapists, and make an inventory of the currently provided physical therapy management in patients with RA. Moreover, this thesis includes a synthesis of the evidence regarding the effectiveness and safety of supervised and home-based exercise programs in patients with RA and the maintenance of physical activity after two one-year internet-based physical activity interventions in RA patients. In addition, the role of motivation and health care providers__ practice regarding the level of physical activity of patients with RA was evaluated. Show less
In many countries physiotherapy is often prescribed to PD patients, somewhere in the course of the disease. However, information about the use and efficacy of physiotherapy in PD is sparse, often... Show moreIn many countries physiotherapy is often prescribed to PD patients, somewhere in the course of the disease. However, information about the use and efficacy of physiotherapy in PD is sparse, often lacking. Therefore, the aims of this thesis are: (a) to gain better insight into the use and merits of physiotherapy for patients with PD and (b) to take a step forward in obtaining evidence-based physiotherapy for patients with PD. As a first step in this process, the efficacy of physiotherapy in PD was evaluated by means of a systematic review (Chapter 2). Secondly, the quality and quantity of current physiotherapy care in PD was evaluated by means of questionnaires sent to patients with PD and their physiotherapists (Chapter 3). Given the frequent use of physiotherapy and the lack of PD-specific expertise amongst therapists, an evidence-based guideline with practice recommendations was developed (Chapter 4). Next, we wished to examine how effective __best practice__ physiotherapy (as described in this new guideline) is for patients with PD. According to EBM recommendations, the results of an RCT provide the highest level of evidence. Therefore, we designed an RCT. To assess the feasibility of this RCT, we first performed a pilot RCT (Chapter 5). The goals of this pilot study were to examine the recruitment rate of patients, to determine the feasibility of the proposed outcome measures, to evaluate the new guideline as a tool to standardise the intervention within the experimental group and to estimate the effect size of the intervention in order to adequately power the RCT. Based on the results of this feasibility study, steps were taken to optimise two promising outcome measures: the Parkinson Activity Scale, evaluating limitations in ADL, and the Patient Specific Index, a patient preference outcome scale (Chapters 6 and 7). At the same time, the ParkinsonNet concept was developed as a novel approach to further improve the quality of physiotherapy in PD ParkinsonNet aims to improve PD-specific expertise among allied health professionals, to improve the referrals to physiotherapy by neurologists and to enhance communication between allied health professionals and neurologists. We then designed a trial to evaluate the implementation process this new ParkinsonNet concept, as well as the possible health benefits and associated costs (Chapter 8). Finally, an overview of the evolution of physiotherapy in PD was made (Chapter 9), which are presented with future challenges (Chapter 10). 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
