BackgroundAlthough reduced work ability is a substantial problem among people with inflammatory arthritis (IA), work ability is an underexposed area in clinical practice. Evidence on vocational... Show moreBackgroundAlthough reduced work ability is a substantial problem among people with inflammatory arthritis (IA), work ability is an underexposed area in clinical practice. Evidence on vocational interventions in IA is limited, but favourable results of delivery by a physiotherapist (PT) warrant the need for further research. Therefore, we aim to evaluate the (cost-)effectiveness of a multimodal, PT-led, vocational intervention in (self-)employed people with IA compared to usual care.MethodsThis randomized controlled trial will include 140 people with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA) who are (self-)employed and have reduced work ability (Work Ability Index – Single Item Scale (WAS) ≤ 7/10) and/or RA/axSpA related sick leave (≤ 6 months). Participants will be randomized 1:1 to the intervention or control condition (usual care). The intervention, delivered by primary care PTs, will be personalized to each patient, consisting of 10 to 21 sessions over 12 months. The intervention will be multimodal, comprising of 1) exercise therapy and a physical activity plan, 2) education/self-management support, 3) work-roadmap to guide participants in finding relevant other care, with optionally 4) online self-management course and 5) workplace examination. Assessments will be performed at baseline and after 3, 6, and 12 months. The primary outcome measure of effectiveness is work ability, as measured with the WAS at 12 months. For the cost-effectiveness analysis, the EuroQol (EQ-5D-5L), self-reported healthcare use, sick leave and productivity while at work will be used to estimate the trial based cost-utility from a societal perspective. A process evaluation, including assessments of adherence and treatment fidelity, will be undertaken using the registrations of the PTs and semi-structured interviews at 12 months follow-up in a random sample of the intervention group.DiscussionThe results of this study will provide insights in the (cost-)effectiveness of a multimodal, PT-led, vocational intervention in people with IA and a reduced work ability. 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
Background: Generating a force at the hand requires moments about multiple joints by a theoretically infinite number of arm and shoulder muscle force combinations. This allows for learning and... Show moreBackground: Generating a force at the hand requires moments about multiple joints by a theoretically infinite number of arm and shoulder muscle force combinations. This allows for learning and adaptation and can possibly be captured using the complexity (entropy) of an isometrically generated force curve. Patients with Subacromial Pain Syndrome have difficulty to explore alternative, pain-avoiding, motor strategies and we questioned whether loss of motor complexity may contribute to this. We assessed whether patients with Subacromial Pain Syndrome have reduced entropy of an isometrically generated abduction and adduction force curve.Methods: Forty patients and thirty controls generated submaximal isometric ab- and adduction force at the wrist. The force curve was characterized by the magnitude of force variability [standard deviation and coefficient of variation], and the entropy (complexity) of force variability [approximate entropy].Findings: Patients showed reduced entropy both during the abduction (-0.16, confidence interval: [-0.33; 0.00], p: 0.048) and adduction task (-0.20, confidence interval: [-0.37; 0.03], p: 0.024) and reduced force variability during abduction (standard deviation: 0.006, confidence interval: [-0.011; -0.001], p: 0.013 and coefficient of variation: -0.51, confidence interval: [-0.93; -0.10], p: 0.016).Interpretations: Isometric force curves of patients with Subacromial Pain Syndrome show reduced complexity compared to asymptomatic controls, which may indicate more narrow and stereotype use of motor options. In future studies, it should be investigated whether the finding of reduced force (motor) entropy indicates functional decline, contributing to decreased ability to acquire and optimize motor strategies in Subacromial Pain Syndrome. Show less
In the first part an update of a guideline for the physiotherapy treatment of patients with hip and knee OA is described. Then a set of quality indicators for the physiotherapy management is... Show moreIn the first part an update of a guideline for the physiotherapy treatment of patients with hip and knee OA is described. Then a set of quality indicators for the physiotherapy management is developed to be used as an instrument to measure guideline adherence. Subsequently the effect of educational strategies to enhance their uptake by physiotherapists in daily clinical practice is investigated. An interactive approach with patient colaboration and following a proces of clinical reasoning has shown to be the most effective strategy. The second part describes the extent of the provision of physiotherapy before and after joint replacement surgery from the physiotherapists__ and patients__ perspective. Results showed a large variation in provided interventions before and after surgery, although evidence for physiotherapy before joint replacement surgery is lacking. This indicates that more research is necessary focussing on effectiveness for specific groups of patients. In addition it was concluded that the presence of severe back pain in THA and dizziness in THA and TKA, should maybe ascertained before surgery and if present be treated if possible in order to decrease the chance of unfavourable outcome, although the predictive value of dizziness should be confirmed in a study with a prospective design. Show less
Oosterhuis, T.; Tulder, M. van; Peul, W.; Bosmans, J.; Vleggeert-Lankamp, C.; Smakman, L.; ... ; Ostelo, R. 2013
The PelFIs is new practical and conceptually clear questionnaire that focus on micturition, defecation and/or sexual dysfunction, related to pelvic floor dysfunction. The use of PelFIs may provide... Show moreThe PelFIs is new practical and conceptually clear questionnaire that focus on micturition, defecation and/or sexual dysfunction, related to pelvic floor dysfunction. The use of PelFIs may provide a better and reliable insight in the patients__ experience of specific complaints of pelvic floor dysfunction. o In our opinion the interaction of a patient and clinician during the administration of a questionnaire is essential in order to gain the patients__ trust and thus acquire a true perspective of FSDs and past or prevalent sexual abuse. We believe that a questionnaire administered by a clinician should be preferred to a self-administered questionnaire. o Pelvic floor dysfunction is correlated with urinary, sexual or gastroenterological complaints. In our retrospective study we found that 77, 2 % of patients who presented to the clinic with urinary, gastro or sexual complaints had measurable pelvic floor dysfunction (69, 3 % overactive rest tone and 7, 9 % under active rest tone). In relation to the ICS terminology there is a need for a well defined normal versus elevated rest tone of the pelvic floor. o The electrodes of the probes, as we use them now during electrostimulation and biofeedback training in the treatment of pelvic floor dysfunction, are not optimal for the structures we want to stimulate or to register. o Extracorporeal Magnetic Innervation (ExMI) appeared to have no beneficial effect on pelvic floor function. o We were able to demonstrate an acute effect of one application of TENS in the combined setting on bladder function using urodynamic parameters in patients with the overactive bladder syndrome o We were able to demonstrate an acute effect of one application of intravaginal ES (8 Hz, pulse duration 1000 _seconds and no pulse to rest) on bladder function using urodynamic parameters in patients with symptoms of the OAB. 137 131 It has been established and it is my personal believe that pelvic floor physiotherapy has an important place in the treatment of micturition-, defecation problems and sexual dysfunction. Pelvic Floor Physiotherapy should be at least considered before irreversible surgery is advocated. The treatment is safe, minimal invasive and not costly. A consensus should be reached on treatment indications, patient selection and treatment protocol. Further research is necessary to determine the mechanisms of action, the efficacy and the proper placement of probes in the treatment of pelvic floor dysfunction. This thesis is an effort towards evidenced based pelvic floor physiotherapy, but more fundamental research in pelvic floor science is necessary. Show less
