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Hogenbirk RNM, Wijma AG, van der Plas WY, Hentzen JEKR, de Bock GH, van der Schans CP, Kruijff S, Klaase JM. Actual physical activity after major abdominal cancer surgery: Far from optimal. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107949. [PMID: 38215551 DOI: 10.1016/j.ejso.2024.107949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Enhanced recovery after surgery protocols emphasize the importance of early postoperative mobilization. However, literature quantifying actual physical activity after major abdominal cancer surgery is scarce and inconclusive. MATERIAL AND METHODS A single-center prospective cohort study was conducted at the University Medical Center Groningen from 2019 to 2021. Patients' postoperative physical activity was measured using an accelerometer, with the primary aim of assessing daily physical activity. Secondary aims were identifying patient-related factors associated with low physical activity and studying the consequences of low physical activity in terms of complication rate and length of hospital stay. RESULTS 143 patients included (48 % male; mean age 65 years), 38.5 %, 24.5 %, 19.6 %, and 14 % underwent pancreatic, hepatic, colorectal, or cytoreductive surgery with hyperthermic intraperitoneal chemotherapy, respectively. Median daily step count was low; from median 71 steps on the first to 918 steps on the seventh postoperative day. An association between physical activity and age (OR 3.597, p = 0.013), preoperative weight loss ≥10 % (OR 4.984, p = 0.004), Eastern Cooperative Oncology Group performance status ≥2 (OR 4.016, p = 0.001), midline laparotomy (OR 2.851, p = 0.025), and operation duration (OR 1.003, p = 0.044) was found. An association was observed between physical activity and the occurrence of complications (OR 3.197, p = 0.039) and prolonged hospital stay (β 4.068, p = 0.013). CONCLUSION Postoperative physical activity is low in patients undergoing major abdominal cancer surgery and is linked to postoperative outcomes. Although physical activity should be encouraged in all patients, patient-specific risk factors were identified that can aid early recognition of patients at risk of low physical activity.
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Affiliation(s)
- Rianne N M Hogenbirk
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Allard G Wijma
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Willemijn Y van der Plas
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Judith E K R Hentzen
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Cees P van der Schans
- Department of Health Psychology and Department of Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Research Group Healthy Ageing, Allied Health Care and Nursing, Center of Expertise Healthy Ageing, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Schelto Kruijff
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Joost M Klaase
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Nakanishi K, Goto H. A New Index for the Quantitative Evaluation of Surgical Invasiveness Based on Perioperative Patients' Behavior Patterns: Machine Learning Approach Using Triaxial Acceleration. JMIR Perioper Med 2023; 6:e50188. [PMID: 37962919 PMCID: PMC10685283 DOI: 10.2196/50188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/12/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The minimally invasive nature of thoracoscopic surgery is well recognized; however, the absence of a reliable evaluation method remains challenging. We hypothesized that the postoperative recovery speed is closely linked to surgical invasiveness, where recovery signifies the patient's behavior transition back to their preoperative state during the perioperative period. OBJECTIVE This study aims to determine whether machine learning using triaxial acceleration data can effectively capture perioperative behavior changes and establish a quantitative index for quantifying variations in surgical invasiveness. METHODS We trained 7 distinct machine learning models using a publicly available human acceleration data set as supervised data. The 3 top-performing models were selected to predict patient actions, as determined by the Matthews correlation coefficient scores. Two patients who underwent different levels of invasive thoracoscopic surgery were selected as participants. Acceleration data were collected via chest sensors for 8 hours during the preoperative and postoperative hospitalization days. These data were categorized into 4 actions (walking, standing, sitting, and lying down) using the selected models. The actions predicted by the model with intermediate results were adopted as the actions of the participants. The daily appearance probability was calculated for each action. The 2 differences between 2 appearance probabilities (sitting vs standing and lying down vs walking) were calculated using 2 coordinates on the x- and y-axes. A 2D vector composed of coordinate values was defined as the index of behavior pattern (iBP) for the day. All daily iBPs were graphed, and the enclosed area and distance between points were calculated and compared between participants to assess the relationship between changes in the indices and invasiveness. RESULTS Patients 1 and 2 underwent lung lobectomy and incisional tumor biopsy, respectively. The selected predictive model was a light-gradient boosting model (mean Matthews correlation coefficient 0.98, SD 0.0027; accuracy: 0.98). The acceleration data yielded 548,466 points for patient 1 and 466,407 points for patient 2. The iBPs of patient 1 were [(0.32, 0.19), (-0.098, 0.46), (-0.15, 0.13), (-0.049, 0.22)] and those of patient 2 were [(0.55, 0.30), (0.77, 0.21), (0.60, 0.25), (0.61, 0.31)]. The enclosed areas were 0.077 and 0.0036 for patients 1 and 2, respectively. Notably, the distances for patient 1 were greater than those for patient 2 ({0.44, 0.46, 0.37, 0.26} vs {0.23, 0.0065, 0.059}; P=.03 [Mann-Whitney U test]). CONCLUSIONS The selected machine learning model effectively predicted the actions of the surgical patients with high accuracy. The temporal distribution of action times revealed changes in behavior patterns during the perioperative phase. The proposed index may facilitate the recognition and visualization of perioperative changes in patients and differences in surgical invasiveness.
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Affiliation(s)
- Kozo Nakanishi
- Department of General Thoracic Surgery, National Hospital Organization Saitama Hospital, Wako Saitama, Japan
| | - Hidenori Goto
- Department of General Thoracic Surgery, National Hospital Organization Saitama Hospital, Wako Saitama, Japan
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Ladha KS, Lu J, McIsaac DI, van Vlymen JM, Lebovic G, Ehtesham S, Pazmino-Canizares J, Clarke H, Parotto M, Lorello GR, Wijeysundera DN. Peri-Operative Wearables in Elder Recover after Surgery (POWERS) study: a protocol for a multicentre, prospective cohort study to evaluate perioperative activity with postoperative disability in older adults after non-cardiac surgery. BMJ Open 2023; 13:e073612. [PMID: 37770257 PMCID: PMC10546154 DOI: 10.1136/bmjopen-2023-073612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/31/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION The ageing population has led to an increasing proportion of surgical patients with greater frailty and comorbidity. Complications and mortality within 30 days of a surgical procedure are often used to evaluate success in the perioperative period however these measures can potentially underestimate a substantial level of morbidity associated with surgery. Personal wearable technologies are now readily available and can offer detailed information on activity intensity, sedentary behaviour and sleeping patterns. These devices may provide important information perioperatively by acting as a non-invasive, and cost-efficient means to risk stratify patients. METHODS AND ANALYSIS The Peri-Operative Wearables in Elder Recover After Surgery (POWERS) study is a multicentre observational study of 200 older adults (≥65 years) having major elective non-cardiac surgery. The objectives are to characterise the association between preoperative and postoperative activity monitor measurements with postoperative disability and recovery, as well as characterise trajectories of activity and sleep in the perioperative period. Activity will be monitored with the ActiGraph GT3X device and measured for 7-day increments, preoperatively, and at 1 week, 1 month and 3 months postoperatively. Disability will be assessed using the WHO Disability Assessment Schedule 2.0 assessed at 1 week, 1 month and 3 months postoperatively. ETHICS AND DISSEMINATION The POWERS study received research ethics board approval at all participating sites on 1 August 2019 (REB # 19-121 (CTO 1849)). Renewal was granted on 19 May 2022.
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Affiliation(s)
- Karim S Ladha
- Department of Anesthesia, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Justin Lu
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Janet M van Vlymen
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Gerald Lebovic
- Applied Health Research Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | - Sahar Ehtesham
- Applied Health Research Centre, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Hance Clarke
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Pain Research Unit, University Health Network, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
| | - Matteo Parotto
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
| | - Gianni R Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
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Porserud A, Aly M, Nygren-Bonnier M, Hagströmer M. Association between early mobilisation after abdominal cancer surgery and postoperative complications. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106943. [PMID: 37296020 DOI: 10.1016/j.ejso.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Postoperative complications and readmission to hospital after major cancer surgery are common. Early mobilisation in hospital is thought to reduce complications, and patients are recommended to mobilise for at least 2 h on the day of surgery, and thereafter at least 6 h per day. Evidence for early mobilisation is limited and therefore also how early mobilisation may influence the development of postoperative complications. The aim of this study was to evaluate the association between early mobilisation after abdominal cancer surgery and readmission to hospital due to postoperative complications. MATERIAL AND METHODS Adult patients who had abdominal cancer surgery due to ovarian, colorectal, or urinary bladder cancer between January 2017 and May 2018 were included in the study. Exposure was set to the mean number of steps taken over the first three postoperative days, measured with an activity monitor. Primary outcome was readmission to hospital within 30 days after discharge, and secondary outcome was severity of complications. Data were obtained from medical records. Logistic regression was used to investigate the association between exposure and outcomes. RESULTS Of 133 patients included in the study, 25 were readmitted to the hospital within 30 days after discharge. The analysis showed no association between early mobilisation and readmission or severity of complications. CONCLUSION Early mobilisation does not seem to increase the odds of readmission, nor the severity of complications. This study contributes to the limited research on the association between early mobilisation and postoperative complications after abdominal cancer surgery.
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Affiliation(s)
- Andrea Porserud
- Karolinska Institutet, Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Alfred Nobels Allé 23, 23100, 141 83, Huddinge, Sweden; Karolinska University Hospital, Medical Unit Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals Theme, 171 76, Stockholm, Sweden.
| | - Markus Aly
- Karolinska Institutet, Department of Molecular Medicine and Surgery, 171 77, Stockholm, Sweden; Karolinska University Hospital, Patient Area Pelvic Cancer, Theme Cancer, 171 76, Stockholm, Sweden.
| | - Malin Nygren-Bonnier
- Karolinska Institutet, Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Alfred Nobels Allé 23, 23100, 141 83, Huddinge, Sweden; Karolinska University Hospital, Medical Unit Occupational Therapy and Physiotherapy, Women's Health and Allied Health Professionals Theme, 171 76, Stockholm, Sweden.
| | - Maria Hagströmer
- Karolinska Institutet, Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Alfred Nobels Allé 23, 23100, 141 83, Huddinge, Sweden; Academic Primary Health Care Centre, Region Stockholm, 113 65, Stockholm, Sweden; Sophiahemmet University, Department of Health Promoting Science, 114 28, Stockholm, Sweden.
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Comprehensive assessment of postoperative mobility during the first days after mini-invasive lung surgery: A prospective observational study. J Clin Anesth 2023; 86:111048. [PMID: 36716650 DOI: 10.1016/j.jclinane.2022.111048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/29/2022] [Accepted: 12/28/2022] [Indexed: 01/30/2023]
Abstract
STUDY OBJECTIVE Postoperative physical therapy and early mobilization are major elements for enhanced recovery after surgery. In contrast with supervised physical therapy sessions that can be monitored, self-mobilization is not easily quantifiable and has so far been estimated mainly through patient auto-reports. This study aimed to perform a comprehensive and objective evaluation of postoperative mobility. DESIGN Prospective observational study. SETTING Postoperative setting. PATIENTS Patients undergoing mini-invasive lung surgery. INTERVENTIONS Measurement of postoperative mobility during the first five postoperative days using an accelerometer (ActiGraph GT3X). MEASUREMENTS The primary outcome was the number of daily steps. Secondary outcomes included physical activity duration and intensity, sedentary time, number of breaks in sedentary time, sedentary patterns, daily evaluation by physiotherapists, postoperative complications, and acceptability of wearing the accelerometer. MAIN RESULTS Sixty patients were included in the study, of whom 56 provided at least one day of valid accelerometry data. There was no significant change during the first four PODs concerning the number of daily steps nor the mean cadence. One-minute cadence peak, total activity counts, and duration of light-intensity physical activity increased over time (p = 0.032, p = 0.001 and p = 0.001, respectively). Sedentary patterns changed favorably over time, with a decrease in prolonged sedentary bouts (≥ 60 consecutive min) (p < 0.001), and an increase in shorter bouts (< 10 min) (p = 0.001). Similar results were observed when analysis was adjusted for the day of the week when the surgery took place. The median acceptability of wearing the accelerometer was excellent (median 10 [9-10] on a 10-point Likert scale). Three patients had major complications. CONCLUSIONS Our findings suggest that daily steps may not be the only relevant indicator of early mobility following thoracic surgery and that accelerometry is suitable to follow patients' early postoperative activity.
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Straat AC, Maarleveld JM, Smit DJM, Visch L, Hulsegge G, Huirne JAF, van Dongen JM, van Geenen RC, Kerkhoffs GMMJ, Anema JR, Coenen P, Kuijer PPFM. (Cost-)effectiveness of a personalized multidisciplinary eHealth intervention for knee arthroplasty patients to enhance return to activities of daily life, work and sports - rationale and protocol of the multicentre ACTIVE randomized controlled trial. BMC Musculoskelet Disord 2023; 24:162. [PMID: 36869330 PMCID: PMC9984288 DOI: 10.1186/s12891-023-06236-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/09/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND With the worldwide rising obesity epidemic and the aging population, it is essential to deliver (cost-)effective care that results in enhanced societal participation among knee arthroplasty patients. The purpose of this study is to describe the development, content, and protocol of our (cost-)effectiveness study that assesses a perioperative integrated care program, including a personalized eHealth app, for knee arthroplasty patients aimed to enhance societal participation post-surgery compared to care as usual. METHODS The intervention will be tested in a multicentre randomized controlled trial with eleven participating Dutch medical centers (i.e., hospitals and clinics). Working patients on the waiting-list for a total- or unicompartmental knee arthroplasty with the intention to return to work after surgery will be included. After pre-stratification on medical centre with or without eHealth as usual care, operation procedure (total- or unicompartmental knee arthroplasty) and recovery expectations regarding return to work, randomization will take place at the patient-level. A minimum of 138 patients will be included in both the intervention and control group, 276 in total. The control group will receive usual care. On top of care as usual, patients in the intervention group will receive an intervention consisting of three components: 1) a personalized eHealth intervention called ikHerstel ('I Recover') including an activity tracker, 2) goal setting using goal attainment scaling to improve rehabilitation and 3) a referral to a case-manager. Our main outcome is quality of life, based on patient-reported physical functioning (using PROMIS-PF). (Cost-)effectiveness will be assessed from a healthcare and societal perspective. Data collection has been started in 2020 and is expected to finish in 2024. DISCUSSION Improving societal participation for knee arthroplasty is relevant for patients, health care providers, employers and society. This multicentre randomized controlled trial will evaluate the (cost-)effectiveness of a personalized integrated care program for knee arthroplasty patients, consisting of effective intervention components based on previous studies, compared to care as usual. TRIAL REGISTRATION Trialsearch.who.int; reference no. NL8525, reference date version 1: 14-04-2020.
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Affiliation(s)
- A Carlien Straat
- Amsterdam UMC, Department of Public and Occupational Health, Van Der Boechorststraat 7, Amsterdam, 1081 BT, the Netherlands.,Amsterdam Public Health Research Institute, Societal Participation and Health, Amsterdam, the Netherlands.,Amsterdam Movement Sciences Research Institute, Musculoskeletal Health, Sports, Amsterdam, the Netherlands
| | - Jantine M Maarleveld
- Amsterdam UMC, Department of Public and Occupational Health, Van Der Boechorststraat 7, Amsterdam, 1081 BT, the Netherlands
| | - Denise J M Smit
- Amsterdam UMC, Department of Public and Occupational Health, Van Der Boechorststraat 7, Amsterdam, 1081 BT, the Netherlands.,Amsterdam Public Health Research Institute, Societal Participation and Health, Amsterdam, the Netherlands.,Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Lara Visch
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Gerben Hulsegge
- Sustainable Productivity & Employability, Netherlands Organization for Applied Scientific Research TNO, Leiden, the Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynecology, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - J M van Dongen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands.,Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Rutger C van Geenen
- Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care Education), Amphia Hospital, Breda, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes R Anema
- Amsterdam UMC, Department of Public and Occupational Health, Van Der Boechorststraat 7, Amsterdam, 1081 BT, the Netherlands.,Amsterdam Public Health Research Institute, Societal Participation and Health, Amsterdam, the Netherlands
| | - Pieter Coenen
- Amsterdam UMC, Department of Public and Occupational Health, Van Der Boechorststraat 7, Amsterdam, 1081 BT, the Netherlands. .,Amsterdam Public Health Research Institute, Societal Participation and Health, Amsterdam, the Netherlands.
| | - P Paul F M Kuijer
- Amsterdam UMC, Department of Public and Occupational Health, Van Der Boechorststraat 7, Amsterdam, 1081 BT, the Netherlands.,Amsterdam Movement Sciences Research Institute, Musculoskeletal Health, Sports, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, Societal Participation and Health, Quality of Care, Amsterdam, the Netherlands
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Bor P, de Leeuwerk ME, Valkenet K, van Hillegersberg R, Veenhof C. Physical functioning and physical activity after gastrointestinal or bladder oncological surgery: An observational cohort study. Eur J Cancer Care (Engl) 2022; 31:e13739. [PMID: 36250336 PMCID: PMC9786746 DOI: 10.1111/ecc.13739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the recovery of physical functioning and objective physical activity levels up to 3 months after oncological surgery and to determine the association between physical activity levels and the recovery of physical functioning. METHODS A longditudinal observational cohort study was conducted in patients who underwent gastrointestinal or bladder oncological surgery. Recovery of physical functioning was measured preoperatively, and 1 and 3 months after discharge. Physical activity was objectively measured with an accelerometer during hospitalisation, and 1 and 3 months after discharge. RESULTS Between February and November 2019, 68 patients were included. Half of the patients (49%) were not recovered in physical functioning 3 months after surgery. During hospitalisation, physical activity increased from 13 to 46 median active minutes per day. At 1 and 3 months after discharge, patients were physically active for 138 and 159 median minutes per day, respectively. Patients with higher levels of physical activity 1 month after discharge showed to have higher levels of physical functioning up to 3 months after discharge. CONCLUSION At 3 months after surgery, physical functioning is still diminished in half of the patients. It is important to evaluate both physical activity levels and physical functioning levels after surgery to enable tailored postoperative mobility care.
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Affiliation(s)
- Petra Bor
- Department of Rehabilitation, Physiotherapy Science and SportUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Marijke Elizabeth de Leeuwerk
- Department of Rehabilitation Medicine, Amsterdam University Medical CentersVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Karin Valkenet
- Department of Rehabilitation, Physiotherapy Science and SportUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | - Cindy Veenhof
- Department of Rehabilitation, Physiotherapy Science and SportUniversity Medical Center UtrechtUtrechtThe Netherlands,Research Group Innovation of Human Movement CareHU University of Applied Sciences UtrechtUtrechtThe Netherlands
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Barber EL, Garg R, Strohl A, Roque D, Tanner E. Feasibility and Prediction of Adverse Events in a Postoperative Monitoring Program of Patient-Reported Outcomes and a Wearable Device Among Gynecologic Oncology Patients. JCO Clin Cancer Inform 2022; 6:e2100167. [PMID: 35427184 PMCID: PMC9848580 DOI: 10.1200/cci.21.00167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE The objective of this study was to test the feasibility of implementing a postoperative monitoring program for women with gynecologic cancers composed of patient-reported outcomes (PROs) and a wearable activity monitor. METHODS We prospectively enrolled patients undergoing gynecologic cancer surgery to this single-arm study. Enrolled patients completed PROs (Patient-Reported Outcomes Measurement Information System physical function, sleep disturbance, anxiety, fatigue, and pain intensity) at baseline and one-week intervals for 4 weeks. They also wore a wearable accelerometer device that measured steps, heart rate, and intensity of physical activity. The primary outcome was feasibility. The secondary outcome was prediction of unscheduled contacts with the health care system on a given postoperative day. RESULTS We enrolled 34 women. Three patients were unevaluable. The mean age was 58 years. The mean body mass index was 31 kg/m2; 17 patients were White (54.8%), 12 patients were Black (38.7%), and two patients (6.5%) were Asian. The overall wear time was 83.8%, and patients responded to 80.4% of the PRO instruments. Twenty-two patients (71%) had an unscheduled contact with the health care system postoperatively (median 1.5, 0.0-8.0). The day of an unscheduled health care utilization event was predicted with acceptable discrimination (area under the receiver operating characteristic curve 0.75; 95% CI, 0.67 to 0.81). PROs of fatigue and physical function were most predictive followed by wearable device outputs of lightly active minutes and average daily heart rate. CONCLUSION Implementation of a postoperative monitoring program of patient-reported outcomes and a wearable device was feasible. The specific day of an unscheduled contact with the health care system was predicted with acceptable discrimination.
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Affiliation(s)
- Emma L. Barber
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL,Surgical Outcomes and Quality Improvement Center, Institute for Public Health in Medicine, Chicago, IL,Emma L. Barber, MD, MS, Department of Gynecologic Oncology, Northwestern University, 250 E Superior Suite 05-138, Chicago, IL 60611; e-mail:
| | - Ravi Garg
- Surgical Outcomes and Quality Improvement Center, Institute for Public Health in Medicine, Chicago, IL
| | - Anna Strohl
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University Hospitals, Cleveland, OH
| | - Dario Roque
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Edward Tanner
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
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Ruder MC, Zauel R, Diefenbach BJ, Bey MJ. Quantifying shoulder activity after rotator cuff repair: Technique and preliminary results. J Orthop Res 2022; 40:917-924. [PMID: 34191325 DOI: 10.1002/jor.25122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 04/13/2021] [Accepted: 06/25/2021] [Indexed: 02/04/2023]
Abstract
Repair tissue healing after rotator cuff repair remains a significant clinical problem, and excessive shoulder activity after surgical repair is believed to contribute to re-tears. In contrast, small animal studies have demonstrated that complete removal of activity impairs tendon healing and have advocated for an "appropriate" level of activity, but in humans the appropriate amount of shoulder activity to enhance healing is not known. As an initial step toward understanding the relationship between postoperative shoulder activity and repair tissue healing, the objectives of this study were to assess the precision, accuracy, and feasibility of a wrist-worn triaxial accelerometer for measuring shoulder activity. Following assessments of precision (±0.002 g) and accuracy (±0.006 g), feasibility was assessed by measuring 1 week of shoulder activity in 14 rotator cuff repair patients and 8 control subjects. Shoulder activity was reported in terms of volume (mean acceleration, activity count, mean activity index, active time) and intensity (intensity gradient). Patients had significantly less volume (p ≤ .03) and intensity (p = .01) than controls. Time post-surgery was significantly associated with the volume (p ≤ .05 for mean acceleration, activity count, and mean activity index) and intensity (p = .03) of shoulder activity, but not active time (p = .08). These findings indicate this approach has the accuracy and precision necessary to continuously monitor shoulder activity with a wrist-worn sensor. The preliminary data demonstrate the ability to discriminate between healthy control subjects and patients recovering from rotator cuff repair and provide support for using a wearable sensor to monitor changes over time in shoulder activity.
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Affiliation(s)
| | - Roger Zauel
- Henry Ford Health System, Detroit, Michigan, USA
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Wells CI, Xu W, Penfold JA, Keane C, Gharibans AA, Bissett IP, O’Grady G. OUP accepted manuscript. BJS Open 2022; 6:6564495. [PMID: 35388891 PMCID: PMC8988014 DOI: 10.1093/bjsopen/zrac031] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/03/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background Wearable devices have been proposed as a novel method for monitoring patients after surgery to track recovery, identify complications early, and improve surgical safety. Previous studies have used a heterogeneous range of devices, methods, and analyses. This review aimed to examine current methods and wearable devices used for monitoring after abdominal surgery and identify knowledge gaps requiring further investigation. Methods A scoping review was conducted given the heterogeneous nature of the evidence. MEDLINE, EMBASE, and Scopus databases were systematically searched. Studies of wearable devices for monitoring of adult patients within 30 days after abdominal surgery were eligible for inclusion. Results A total of 78 articles from 65 study cohorts, with 5153 patients were included. Thirty-one different wearable devices were used to measure vital signs, physiological measurements, or physical activity. The duration of postoperative wearable device use ranged from 15 h to 3 months after surgery. Studies mostly focused on physical activity metrics (71.8 per cent). Continuous vital sign measurement and physical activity tracking both showed promise for detecting postoperative complications earlier than usual care, but conclusions were limited by poor device precision, adherence, occurrence of false alarms, data transmission problems, and retrospective data analysis. Devices were generally well accepted by patients, with high levels of acceptance, comfort, and safety. Conclusion Wearable technology has not yet realized its potential to improve postoperative monitoring. Further work is needed to overcome technical limitations, improve precision, and reduce false alarms. Prospective assessment of efficacy, using an intention-to-treat approach should be the focus of further studies.
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Affiliation(s)
- Cameron I. Wells
- Correspondence to: Cameron Wells, Department of Surgery, University of Auckland, Private Bag 92019, Auckland Mail Centre 1142, New Zealand (e-mail:)
| | - William Xu
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - James A. Penfold
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Celia Keane
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Armen A. Gharibans
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Ian P. Bissett
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Department of Surgery, Auckland District Health Board, Auckland, New Zealand
| | - Greg O’Grady
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
- Department of Surgery, Auckland District Health Board, Auckland, New Zealand
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11
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Mylius CF, Krijnen WP, Takken T, Lips DJ, Eker H, van der Schans CP, Klaase JM. Objectively measured preoperative physical activity is associated with time to functional recovery after hepato-pancreato-biliary cancer surgery: a pilot study. Perioper Med (Lond) 2021; 10:33. [PMID: 34602089 PMCID: PMC8489102 DOI: 10.1186/s13741-021-00202-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 06/16/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Surgical resection is currently the cornerstone of hepato-pancreato-biliary (HPB) cancer treatment. A low preoperative aerobic fitness level has been identified as a modifiable risk factor associated with complications after major abdominal surgery. A person's aerobic fitness is influenced by performing moderate to vigorous physical activity (MVPA). This study aims to determine the activity monitor measured levels of MVPA performed among patients on the waiting list for HPB cancer surgery and their association with postoperative outcomes. METHODS A prospective, observational multi-center cohort pilot study was conducted. Patients enlisted for resection surgery on suspicion of HPB (pre)malignancy were enrolled. Performed MVPA was measured by an Actigraph wGT3X-BT. Additionally, aerobic fitness was measured via the Incremental Shuttle Walk Test, and (post)operative variables were collected from the electronic patient files. The association between MVPA and the pre- and postoperative variables was determined by univariate and multivariable (logistic) robust regression. RESULTS A total of 38 participants, median age 66.0 (IQR 58.25-74.75) years, were enrolled. The median daily MVPA was 10.7 (IQR 6.9-18.0) min; only 8 participants met the Dutch MVPA guidelines. Participant's age and aerobic fitness were associated with MVPA by multivariable statistical analysis. Time to functional recovery was 8 (IQR 5-12) days and was associated with MVPA and type of surgery (major/minor) in multivariable analysis. CONCLUSION Seventy-six percent of patients enlisted for resection of HPB (pre)malignancy performed insufficient MVPA. A higher level of MVPA was associated with a shorter time to functional recovery.
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Affiliation(s)
- Caspar F Mylius
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA, Groningen, The Netherlands.
| | - Wim P Krijnen
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA, Groningen, The Netherlands
| | - Tim Takken
- Child Development and Exercise Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daan J Lips
- Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | - Hasan Eker
- Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Cees P van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA, Groningen, The Netherlands.,Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Health Psychology Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joost M Klaase
- Department of Hepatobiliary Surgery and Liver Transplantation, University Medical Centre Groningen, Groningen, The Netherlands
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12
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Ibrahim HAF, Elgzar WT, Hablas RM. The Effect of Jacobson's Progressive Relaxation Technique on Postoperative Pain, Activity Tolerance, and Sleeping Quality in Patients Undergoing Gynecological Surgery. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:295-302. [PMID: 34422608 PMCID: PMC8344632 DOI: 10.4103/ijnmr.ijnmr_180_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/24/2020] [Accepted: 03/26/2021] [Indexed: 11/29/2022]
Abstract
Background: Inadequate pain management and sleep disturbances of patients undergoing gynecological surgery are associated with delayed recovery time. This study aimed to assess the effect of Jacobson's Progressive Relaxation Technique (JPRT) on postoperative pain, activity tolerance, and sleeping quality in patients undergoing gynecological surgery. Materials and Methods: A randomized controlled clinical trial conducted at Obstetrics and Gynecology Department/Damanhour educational institute, Elbehira, Egypt. The study sample involved 116 patients undergoing gynecological surgery who were equally distributed between intervention and control groups. Data collected from April to September 2019. Four tools were used for data collection: Demographic data interview schedule, pain analog scale, activity tolerance questionnaire, and the Groningen sleeping quality scale. For the intervention group, the women were asked to perform JPRT for 30 min on the second and third postoperative day, three times a day. SPSS 23.0 is used to analyze data using Chi-square, Fisher's exact, independent t-test, and Analysis of Covariance (ANCOVA). A significance level considered at p < 0.05. Results: The study results showed that JPRT significantly improves pain, sleep quality, and activity tolerance mean scores among the intervention group compared to the control group (F1 = 119.13, p < 0.001), (F1 = 361.49, p < 0.001), and (F1 = 157.49, p < 0.001), respectively. ANCOVA results showed that 33% of the decreased pain score, 12% of decreased sleeping quality score, and 26% of improved activity tolerance score are due to JPRT. Conclusion: JPRT should be offered as a part of standard postoperative nursing care for patients undergoing gynecological surgery to control pain and improve sleeping quality and activity tolerance.
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Affiliation(s)
- Heba Abdel-Fatah Ibrahim
- Department of Obstetrics and Woman Health Nursing, Nursing College, Benha University, Egypt.,Department of Maternity and Childhood Nursing, Nursing College, Najran University, KSA
| | - Wafaa Taha Elgzar
- Department of Maternity and Childhood Nursing, Nursing College, Najran University, KSA.,Department of obstetrics and Gynecology Nursing, Nursing College Damanhour University, Egypt
| | - Reda Mhmoud Hablas
- Obstetrics and Gynecologic Nursing, Nursing College, Alexandria University, Egypt.,Nursing Department (CAMS) university of Hafr-Al Batin, KSA
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13
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Callahan MJ, Parr EB, Snijders T, Conceição MS, Radford BE, Timmins RG, Devlin BL, Hawley JA, Camera DM. Skeletal Muscle Adaptive Responses to Different Types of Short-Term Exercise Training and Detraining in Middle-Age Men. Med Sci Sports Exerc 2021; 53:2023-2036. [PMID: 33867497 DOI: 10.1249/mss.0000000000002684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Whether short-term, single-mode exercise training can improve physical fitness prior to a period of reduced physical activity (e.g. post-surgery recovery) is not well characterized in clinical populations nor middle-age adults. We investigated skeletal muscle adaptive responses following endurance exercise training (ENT), high-intensity interval training (HIIT) or resistance exercise training (RET), and a subsequent period of detraining, in sedentary, middle-age men. METHODS Thirty-five sedentary, males (39±3 yr) were randomized to parallel groups and undertook six weeks of either ENT (n=12), HIIT (n=12) or RET (n=11) followed by 2.5 weeks of detraining. Skeletal muscle fiber characteristics, body composition, muscle thickness, muscle strength, aerobic capacity, resting energy expenditure and glucose homeostasis were assessed at baseline, and after exercise training and detraining. RESULTS Lean mass increased after RET and HIIT (+3.2±1.6% and +1.6±2.1%, P<0.05). Muscle strength (sum of leg press, leg extension and bench press 1RMs) increased after all training interventions (RET: +25±5%; HIIT: +10±5%; ENT: +7±7%, P<0.05). Aerobic capacity increased only after HIIT and ENT (+14±7% and +11±11%, P<0.05). Type I and II muscle fiber size increased for all groups post-training (main effect of time, P<0.05). Following a period of detraining, the gains in lean mass and maximal muscle strength were maintained in RET and HIIT groups, but maximal aerobic capacity declined below post-training levels in HIIT and ENT (P<0.05). CONCLUSION Six weeks of HIIT induced widespread adaptations prior to detraining in middle-age men. Exercise training-induced increases in aerobic capacity declined during 2.5 weeks of detraining but gains in lean mass and muscle strength were maintained.
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Affiliation(s)
- Marcus J Callahan
- Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil School of Exercise Science, Australian Catholic University, Melbourne, VIC, Australia Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Australia Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Australia Department of Health and Medical Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
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14
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Halfwerk FR, van Haaren JHL, Klaassen R, van Delden RW, Veltink PH, Grandjean JG. Objective Quantification of In-Hospital Patient Mobilization after Cardiac Surgery Using Accelerometers: Selection, Use, and Analysis. SENSORS 2021; 21:s21061979. [PMID: 33799717 PMCID: PMC7999757 DOI: 10.3390/s21061979] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/03/2021] [Accepted: 03/07/2021] [Indexed: 01/06/2023]
Abstract
Cardiac surgery patients infrequently mobilize during their hospital stay. It is unclear for patients why mobilization is important, and exact progress of mobilization activities is not available. The aim of this study was to select and evaluate accelerometers for objective qualification of in-hospital mobilization after cardiac surgery. Six static and dynamic patient activities were defined to measure patient mobilization during the postoperative hospital stay. Device requirements were formulated, and the available devices reviewed. A triaxial accelerometer (AX3, Axivity) was selected for a clinical pilot in a heart surgery ward and placed on both the upper arm and upper leg. An artificial neural network algorithm was applied to classify lying in bed, sitting in a chair, standing, walking, cycling on an exercise bike, and walking the stairs. The primary endpoint was the daily amount of each activity performed between 7 a.m. and 11 p.m. The secondary endpoints were length of intensive care unit stay and surgical ward stay. A subgroup analysis for male and female patients was planned. In total, 29 patients were classified after cardiac surgery with an intensive care unit stay of 1 (1 to 2) night and surgical ward stay of 5 (3 to 6) nights. Patients spent 41 (20 to 62) min less time in bed for each consecutive hospital day, as determined by a mixed-model analysis (p < 0.001). Standing, walking, and walking the stairs increased during the hospital stay. No differences between men (n = 22) and women (n = 7) were observed for all endpoints in this study. The approach presented in this study is applicable for measuring all six activities and for monitoring postoperative recovery of cardiac surgery patients. A next step is to provide feedback to patients and healthcare professionals, to speed up recovery.
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Affiliation(s)
- Frank R. Halfwerk
- Thoraxcentrum Twente, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA Enschede, The Netherlands; (J.H.L.v.H.); (J.G.G.)
- Department of Biomechanical Engineering, TechMed Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
- Correspondence:
| | - Jeroen H. L. van Haaren
- Thoraxcentrum Twente, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA Enschede, The Netherlands; (J.H.L.v.H.); (J.G.G.)
| | - Randy Klaassen
- Human Media Interaction Lab, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands; (R.K.); (R.W.v.D.)
| | - Robby W. van Delden
- Human Media Interaction Lab, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands; (R.K.); (R.W.v.D.)
| | - Peter H. Veltink
- Department of Biomedical Signals and Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands;
| | - Jan G. Grandjean
- Thoraxcentrum Twente, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA Enschede, The Netherlands; (J.H.L.v.H.); (J.G.G.)
- Department of Biomechanical Engineering, TechMed Centre, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
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15
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Jonker LT, Hendriks S, Lahr MMH, van Munster BC, de Bock GH, van Leeuwen BL. Postoperative recovery of accelerometer-based physical activity in older cancer patients. Eur J Surg Oncol 2020; 46:2083-2090. [DOI: 10.1016/j.ejso.2020.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/13/2020] [Accepted: 06/09/2020] [Indexed: 12/20/2022] Open
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16
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Ratcliffe AM, Zhai B, Guan Y, Jackson DG, Sneyd JR. Patient-centred measurement of recovery from day-case surgery using wrist worn accelerometers: a pilot and feasibility study. Anaesthesia 2020; 76:785-797. [PMID: 33015830 DOI: 10.1111/anae.15267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 01/08/2023]
Abstract
This pilot and feasibility study evaluated wrist-worn accelerometers to measure recovery from day-case surgery in comparison with daily quality of recovery-15 scores. The protocol was designed with extensive patient and public involvement and engagement, and delivered by a research network of anaesthesia trainees. Forty-eight patients recruited through pre-operative assessment clinics wore wrist accelerometers for 7 days before (pre-operative) and immediately after elective surgery (early postoperative), and again at 3 months (late postoperative). Validated activity and quality of recovery questionnaires were administered. Raw accelerometry data were archived and analysed using open source software. The mean (SD) number of valid days of accelerometer wear per participant in the pre-operative, early and late postoperative periods were 5.4 (1.7), 6.6 (1.1) and 6.6 (1.0) days, respectively. On the day after surgery, Euclidian norm minus one (a summary measure of raw accelerations), step count, light physical activity and moderate/vigorous physical activity decreased to 57%, 47%, 59% and 35% of baseline values, respectively. Activity increased progressively on a daily basis but had not returned to baseline values by 7 days. Patient questionnaires suggested subjective recovery by postoperative day 3 to 4; however, accelerometry data showed that activity levels had not returned to baseline at this point. All activity measures had returned to baseline by 3 months. Wrist-worn accelerometery is acceptable to patients and feasible as a surrogate measure for monitoring postoperative recovery from day-case surgery. Our results suggest that patients may overestimate their rate of recovery from day-case surgery, which has important implications for future research.
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Affiliation(s)
- A M Ratcliffe
- Department of Anaesthesia, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - B Zhai
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | - Y Guan
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | - D G Jackson
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, UK
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- South West Anaesthesia Research Matrix (SWARM), https://www.ukswarm.com/
| | - J R Sneyd
- Peninsula Medical School, University of Plymouth, Plymouth, UK
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17
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Quantifying postoperative sleep loss associated with increased pain in children undergoing a modified Nuss operation. J Pediatr Surg 2020; 55:1846-1849. [PMID: 31982091 DOI: 10.1016/j.jpedsurg.2019.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/10/2019] [Accepted: 12/02/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE The presence of pain may interrupt sleep and impede normal postoperative recovery; however, no prior studies have quantified sleep loss due to pain in children undergoing inpatient surgery. Wearable accelerometers objectively measure sleep patterns in children. We aimed to quantify sleep loss associated with patient reported pain scores after a Modified Nuss operation. METHODS Ten patients undergoing Modified Nuss operations were recruited during their inpatient stay. Children wore an Actigraph GT3X-BT accelerometer postoperatively during their hospital stay. Hourly sleep minutes were recorded using the Actigraph between 10 pm and 6 am. Patient reported pain scores were abstracted from patient charts. Mixed linear regression models, adjusting for within-subject random effects, were estimated to quantify the association between hourly sleep minutes and patient reported pain scores. RESULTS Patients were 30% female, with an average age of 15.7 years (range 13-22). The majority (70%) of patients were white non-Hispanic. All patients received a patient controlled analgesic pump. Average postoperative length of stay was 4.8 days (range 4.0-6.0; SD = 0.8). A total of 240 sleep hours and associated pain scores were analyzed. Patients slept on average 48 min per hour. Mixed model analysis predicted that a 1-point increase in pain score was associated with 2.5 min per hour less sleep time. CONCLUSION Increases in patient-reported pain scores are associated with sleep loss after a Modified Nuss operation. Objectively quantifying sleep loss associated with postoperative pain using accelerometer data may help clinicians better understand their patient's level of pain control. Our findings provide the basis for future studies aimed at more accurately titrating pain medication to optimize sleep and speed up recovery. LEVEL OF EVIDENCE Case Series Without Comparison Group, Level IV.
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18
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Arunachalam D, Heit MH. Impact of postoperative instructions on physical activity following pelvic reconstructive surgery: a randomized controlled trial. Int Urogynecol J 2020; 31:1337-1345. [DOI: 10.1007/s00192-020-04239-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/23/2020] [Indexed: 12/11/2022]
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19
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Porserud A, Aly M, Nygren-Bonnier M, Hagströmer M. Objectively measured mobilisation is enhanced by a new behaviour support tool in patients undergoing abdominal cancer surgery. Eur J Surg Oncol 2019; 45:1847-1853. [DOI: 10.1016/j.ejso.2019.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/09/2019] [Accepted: 04/16/2019] [Indexed: 02/07/2023] Open
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20
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Rauwerdink A, Jansen M, de Borgie CAJM, Bemelman WA, Daams F, Schijven MP, Buskens CJ. Improving enhanced recovery after surgery (ERAS): ERAS APPtimize study protocol, a randomized controlled trial investigating the effect of a patient-centred mobile application on patient participation in colorectal surgery. BMC Surg 2019; 19:125. [PMID: 31477107 PMCID: PMC6719362 DOI: 10.1186/s12893-019-0588-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/19/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Perioperative care in colorectal surgery is systematically defined in the Enhanced Recovery After Surgery (ERAS) protocol. The ERAS protocol improves perioperative care in a multimodal way to enhance early and safe release from the hospital. Adequate compliance to the elements of the ERAS protocol is multifactorial. There are still opportunities to improve compliance of the protocol by actively involving the patient. The main objective of this study is to investigate whether compliance of selected items in the ERAS protocol can be improved through actively involving patients in the ERAS care pathway through the use of a patient-centred mobile application. METHODS A multicentre randomized controlled trial will be conducted. Patients undergoing elective colorectal surgery, who are 18 years or older and in possession of an eligible smartphone, will be included. Patients assigned to the intervention group will install a patient-centred mobile application to be guided through the ERAS care pathway. Patients in the control group will receive care as usual. Both groups will wear an activity tracker. The primary outcome is overall compliance to selected active elements of the ERAS protocol, as registered by the patient. Secondary outcomes include Patient Reported Outcome Measures (PROMs) such as health-related quality of life, physical activity, and patient satisfaction of received care. Care-related outcomes, such as length of hospital stay, number of complications, re-intervention, and readmission rates, will also be assessed. RESULTS The enrolment of patients will start in the second quarter of 2019. Data collection had not begun by the time this protocol was submitted. CONCLUSION We hypothesize that by providing patients with a patient-centred mobile application, compliance to the active elements of ERAS protocol can be improved, resulting in an increased health-related quality of life, physical activity, and patient satisfaction. TRIAL REGISTRATION Netherlands Trial Register, NTR7314 , prospectively registered on the 9th of November 2017 ( http://www.trialregister.nl ).
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Affiliation(s)
- A. Rauwerdink
- Department of surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - M. Jansen
- Department of surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - C. A. J. M. de Borgie
- Clinical Research Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - W. A. Bemelman
- Department of surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - F. Daams
- Department of surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - M. P. Schijven
- Department of surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - C. J. Buskens
- Department of surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
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Romanelli JR, Fuchshuber PR, Stulberg JJ, Kowalski RB, Sinha P, Aloia TA, Orlando R. Public reporting and transparency: a primer on public outcomes reporting. Surg Endosc 2019; 33:2043-2049. [PMID: 31161288 DOI: 10.1007/s00464-019-06756-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 02/06/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Healthcare consumers seeking accurate information about where to find quality surgical care face a confusing constellation of rating systems that lack transparency or consistency of opinion. For example, a 2016 report in Health Affairs demonstrated that no hospital was rated as a high performer by all four prominent national ratings systems: Consumer Reports, Leapfrog, Healthgrades and U.S. News & World Report (Austin et al. Health Aff 34:423-430, 2015). Surgeons should have an understanding of the current state of public reporting of quality; hospital ratings and data sources; physician ratings and data sources; and transparency of reporting. METHODS We conducted a non-systematic review of the literature. RESULTS Hospital quality ratings remain nebulous and there is not universal opinion on the utility of voluntary participation in ranking systems, leaving the current systems largely opinion-based. Early attempts at physician ranking systems are rudimentary at best and suffer from methodological concerns. Publicly reported metrics should be easily understandable, accessible, clinically relevant, reliable, non-punitive, and shielded from legal discovery. Transparency is increasing within institutions to help align staff to institutional objectives, while specialty specific registries are helping to standardize care pathways and outcomes measures across organizations. Measuring surgical outcomes beyond 30-day morbidity and mortality has been plagued by a lack of understanding on how to create metrics that matter; the four attributes of relevance, scientific soundness, feasibility and comprehensiveness set a high bar for the development of effective and efficient quality measures in surgery. DISCUSSION SAGES, via the Quality, Outcomes, and Safety Committee, is committed to learning how to develop meaningful quality metrics in general surgery and will continue to work in other areas that impact quality, such as opioid prescribing, and surgeon wellness.
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Affiliation(s)
- John R Romanelli
- Department of Surgery, Baystate Medical Center, 759 Chestnut Street, S3656, Springfield, MA, 01085, USA.
| | | | | | | | | | - Thomas A Aloia
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Au D, Matthew AG, Lopez P, Hilton WJ, Awasthi R, Bousquet-Dion G, Ladha K, Carli F, Santa Mina D. Prehabilitation and acute postoperative physical activity in patients undergoing radical prostatectomy: a secondary analysis from an RCT. SPORTS MEDICINE-OPEN 2019; 5:18. [PMID: 31119491 PMCID: PMC6531507 DOI: 10.1186/s40798-019-0191-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/08/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Physical activity via early mobilization after surgery is recommended to help reduce the risk of postoperative adverse effects and to improve recovery. We explored whether prehabilitation is associated with differences in physical activity during the postoperative inpatient stay and the week after discharge in men undergoing abdominal surgery. METHODS This study was a pre-planned secondary analysis of a larger randomized controlled trial of home-based exercise prehabilitation versus control for men undergoing radical prostatectomy. Twenty-one participants in both the prehabilitation and control groups wore accelerometers from postoperative day 1 until 7 days after discharge. Mean physical activity (minutes) during postoperative day 1 (inpatient) and 1 week following hospital discharge (outpatient) were estimated using ANCOVA. Pearson's correlation coefficients were conducted for mean in- an outpatient physical activity with length of stay and changes in 6-min walk test (6MWT) over the course of the prehabilitation period. RESULTS Nineteen participants in each group provided usable accelerometry data for analysis. Inpatient physical activity of light or greater activity during postoperative day 1 for prehabilitation and control groups were 442.5 ± 40.2 and 324.0 ± 40.2 min, respectively (∆ = 117.5 ± 57.8 min, 95%CI [0.04, 235.0]). During the outpatient period, mean daily physical activity was 448.4 ± 31.2 and 491.42 ± 31.2 min for prehabilitation and control participants, respectively (∆ = 42.6 ± 44.9 min; 95% CI [- 134.0, 48.7]). There were no correlations between in- or outpatient physical activity and preoperative changes in 6MWT or length of stay. CONCLUSIONS Accelerometry-based measurement of physical activity in the acute postoperative period is feasible in older men undergoing abdominal surgery. Prehabilitation may be associated with increased inpatient physical activity; however, larger and longer studies are needed to elucidate any associated effects on clinical and patient outcomes. TRIAL REGISTRATION Clinicaltrials.gov: NCT02036684 registered January 15, 2014.
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Affiliation(s)
- Darren Au
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada. .,University Health Network, Toronto, Ontario, Canada.
| | - Andrew G Matthew
- University Health Network, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paty Lopez
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
| | | | - Rashami Awasthi
- Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Karim Ladha
- University Health Network, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Franco Carli
- Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada.,Department of Surgery, Division of Urology, McGill University, Montreal, Quebec, Canada.,Department of Anesthesia, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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23
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Kaplan SJ, Trottman PA, Porteous GH, Morris AJ, Kauer EA, Low DE, Hubka M. Functional Recovery After Lung Resection: A Before and After Prospective Cohort Study of Activity. Ann Thorac Surg 2019; 107:209-216. [DOI: 10.1016/j.athoracsur.2018.07.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/15/2018] [Accepted: 07/30/2018] [Indexed: 01/01/2023]
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24
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Pontzer H, Wood BM, Raichlen DA. Hunter-gatherers as models in public health. Obes Rev 2018; 19 Suppl 1:24-35. [PMID: 30511505 DOI: 10.1111/obr.12785] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 09/11/2018] [Indexed: 11/30/2022]
Abstract
Hunter-gatherer populations are remarkable for their excellent metabolic and cardiovascular health and thus are often used as models in public health, in an effort to understand the root, evolutionary causes of non-communicable diseases. Here, we review recent work on health, activity, energetics and diet among hunter-gatherers and other small-scale societies (e.g. subsistence farmers, horticulturalists and pastoralists), as well as recent fossil and archaeological discoveries, to provide a more comprehensive perspective on lifestyle and health in these populations. We supplement these analyses with new data from the Hadza, a hunter-gatherer population in northern Tanzania. Longevity among small-scale populations approaches that of industrialized populations, and metabolic and cardiovascular disease are rare. Obesity prevalence is very low (<5%), and mean body fat percentage is modest (women: 24-28%, men: 9-18%). Activity levels are high, exceeding 100 min d-1 of moderate and vigorous physical activity, but daily energy expenditures are similar to industrialized populations. Diets in hunter-gatherer and other small-scale societies tend to be less energy dense and richer in fibre and micronutrients than modern diets but are not invariably low carbohydrate as sometimes argued. A more integrative understanding of hunter-gatherer health and lifestyle, including elements beyond diet and activity, will improve public health efforts in industrialized populations.
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Affiliation(s)
- H Pontzer
- Department of Evolutionary Anthropology, Duke University, Durham, NC, USA
| | - B M Wood
- Department of Anthropology, University of California, Los Angeles, CA, USA.,Department of Human Behavior, Ecology, and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - D A Raichlen
- School of Anthropology, University of Arizona, Tucson, AZ, USA
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van der Meij E, Anema JR, Huirne JAF, Terwee CB. Using PROMIS for measuring recovery after abdominal surgery: a pilot study. BMC Health Serv Res 2018; 18:128. [PMID: 29458373 PMCID: PMC5819257 DOI: 10.1186/s12913-018-2929-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 02/12/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND To assess the construct validity and responsiveness of the PROMIS Physical Function v1.2 short form 8b (PROMIS-PF), and the PROMIS Ability to Participate in Social Roles and Activities v2.0 short form 8a (PROMIS-APS) in postoperative recovery. METHODS An observational pilot study was conducted in which 30 patients participated, undergoing various forms of abdominal surgery. Patients completed the PROMIS-PF and PROMIS-APS, the Short Form 36 Health Survey (SF-36) and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS) at several time points before and after surgery. The construct validity and responsiveness of the two PROMIS short forms were evaluated by testing pre-defined hypotheses and were considered adequate when at least 75% of the data was consistent with the hypotheses. Construct validity was evaluated by calculating Spearman correlations and the responsiveness by calculating effect sizes. RESULTS 6/7 (85.7%) of the results were consistent with the hypotheses supporting the construct validity of the PROMIS-PF. For the PROMIS-APS this was the case in 7/15 (46.7%) of the results. For the PROMIS-PF, 6/7 (85.7%) of the results were consistent with the hypotheses, supporting responsiveness. Regarding the responsiveness of the PROMIS-APS, only 7 out of 13 (53.8%) of these results were consistent with the hypotheses. CONCLUSIONS This study supported the construct validity and the responsiveness of the PROMIS-PF v1.2 short form 8b for measuring recovery in abdominal surgery. Considering the major advantages of PROMIS, we recommend the use of the PROMIS-PF in abdominal surgery.
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Affiliation(s)
- Eva van der Meij
- Department of Obstetrics and Gynecology, VU University Medical Center, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, van der Boechorsstraat 7, 1081 BT Amsterdam, The Netherlands
| | - Johannes R. Anema
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, van der Boechorsstraat 7, 1081 BT Amsterdam, The Netherlands
| | - Judith A. F. Huirne
- Department of Obstetrics and Gynecology, VU University Medical Center, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, van der Boechorsstraat 7, 1081 BT Amsterdam, The Netherlands
| | - Caroline B. Terwee
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
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Varin M, Kergoat MJ, Belleville S, Li G, Rousseau J, Roy-Gagnon MH, Moghadaszadeh S, Freeman EE. Age-Related Eye Disease and Participation in Cognitive Activities. Sci Rep 2017; 7:17980. [PMID: 29269882 PMCID: PMC5740122 DOI: 10.1038/s41598-017-18419-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/11/2017] [Indexed: 11/26/2022] Open
Abstract
Studies have found a benefit to living a cognitively active life in older age. Our goal was to quantify participation in cognitively stimulating activities in adults with and without age-related eye disease. We conducted a cross-sectional hospital-based study in Montreal, Canada of older adults (n = 303) having either age-related macular degeneration (AMD) (n = 96), glaucoma (n = 93), or normal vision (n = 114). To be eligible, the AMD group had to have bilateral late stage AMD with a better eye visual acuity of 20/30 or worse. The glaucoma group had to have a diagnosis of bilateral primary open-angle glaucoma with visual field mean deviation < = −4 dB in their better eye. Further inclusion criteria included age ≥ 65 and a Mini-Mental State Exam Blind score ≥ 10. Cognitive activities were measured using the Victoria Longitudinal Study Activity Questionnaire. Linear regression was used. Patients with AMD (β = −4.2, 95% confidence interval (CI) −6.0, −2.4) and glaucoma (β = −1.8, 95% CI −3.3, −0.3) participated in fewer cognitive activities per month compared to those with normal vision after adjusting for age, sex, education, diabetes, number of comorbidities, cognition, and cataract. People with AMD and glaucoma participated in fewer cognitive activities, which could put them at risk for future cognitive impairment.
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Affiliation(s)
- Melanie Varin
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Marie-Jeanne Kergoat
- Centre de Recherche, Institut universitaire de gériatrie de Montréal, Montréal, Canada
| | - Sylvie Belleville
- Centre de Recherche, Institut universitaire de gériatrie de Montréal, Montréal, Canada
| | - Gisele Li
- Centre de Recherche, Hôpital Maisonneuve-Rosemont, Montréal, Canada.,Department of Ophthalmology, Université de Montréal, Montréal, Canada
| | - Jacqueline Rousseau
- Centre de Recherche, Institut universitaire de gériatrie de Montréal, Montréal, Canada
| | | | | | - Ellen E Freeman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada. .,Centre de Recherche, Hôpital Maisonneuve-Rosemont, Montréal, Canada. .,Department of Ophthalmology, Université de Montréal, Montréal, Canada. .,Ottawa Hospital Research Institute, Ottawa, Canada.
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27
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Bouwsma EVA, Anema JR, Vonk Noordegraaf A, de Vet HCW, Huirne JAF. Using patient data to optimize an expert-based guideline on convalescence recommendations after gynecological surgery: a prospective cohort study. BMC Surg 2017; 17:129. [PMID: 29212492 PMCID: PMC5719670 DOI: 10.1186/s12893-017-0317-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 11/20/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Convalescence advice is often based on tradition and anecdote from health care providers, rather than being based on experiences from patients themselves. The aim of this study was to analyse recovery in terms of resumption of various daily activities including work, following different laparoscopic and abdominal surgery in order to optimize an expert-based guideline on convalescence recommendations. METHODS This is a prospective cohort study conducted in nine general and one university hospital in the Netherlands. Women aged 18-65 years and scheduled for a hysterectomy (laparoscopic, vaginal, abdominal) and/or laparoscopic adnexal surgery (n = 304) were eligible to participate. Preoperatively, participants were provided with tailored expert-based convalescence recommendations on the graded resumption of several daily activities including sitting, standing, walking, climbing stairs, bending, lifting, driving, cycling, household chores, sport activities and return to work (RTW). Postoperatively, time until the resumption of these activities was tracked. Convalescence recommendations were considered correct when at least 25% and less than 50% of the women were able to resume an activity before or at the recommended recovery time. RESULTS There was a wide variation in the duration until the resumption of daily activities within and between groups of patients undergoing different types of surgery. Recovery times lengthened with increasing levels of physical burden as well as with increasing levels of invasiveness of the surgery. For the majority of activities actual recovery times exceeded the recovery time recommended by the expert panel. CONCLUSIONS This study provided insight in the resumption of daily activities after gynecological surgery and the adequacy of an expert-based convalescence guideline in clinical practice. Patient data was used to optimize the convalescence recommendations. TRIAL REGISTRATION Dutch trial registry, NTR2087 (August 2009) and NTR2933 (June 2011).
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Affiliation(s)
- Esther V. A. Bouwsma
- Department of Obstetrics and Gynecology, VU University Medical Center, P.O. Box 7057, Amsterdam, 1007 MB The Netherlands
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Johannes R. Anema
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - A. Vonk Noordegraaf
- Department of General Practice, VU University Medical Center, Amsterdam, The Netherlands
| | - Henrica C. W. de Vet
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
- Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Judith A. F. Huirne
- Department of Obstetrics and Gynecology, VU University Medical Center, P.O. Box 7057, Amsterdam, 1007 MB The Netherlands
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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28
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Goudman L, Smet I, Mariën P, De Jaeger M, De Groote S, Huysmans E, Putman K, Van Buyten JP, Buyl R, Moens M. Is the Self-Reporting of Failed Back Surgery Syndrome Patients Treated With Spinal Cord Stimulation in Line With Objective Measurements? Neuromodulation 2017; 21:93-100. [PMID: 29105225 DOI: 10.1111/ner.12719] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/12/2017] [Accepted: 09/22/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To understand the subjective pain experience of patients, healthcare providers rely heavily on self-reporting. However, to quantify this unique pain experience, objective parameters are not yet available in daily clinical practice. With regard to patients with failed back surgery syndrome (FBSS) treated with spinal cord stimulation (SCS), pain therapists may recover the individual functional information about the patient's posture from the implantable pulse generator (IPG) of the stimulator. The aim of this study is to investigate whether subjective self-reporting is in correlation with the functional capacities of a patient. MATERIALS AND METHODS Thirty-nine patients with FBSS, treated with SCS were included. The accelerometer in the IPG detects positional changes and provides an objective output of seven functional positions (lying back, lying prone, lying left, lying right, transition, upright, and upright + mobile). The Oswestry Disability Index (ODI), VAS-diary, and the Pittsburgh Sleep Quality Index (PSQI) were assessed to evaluate physical functioning, pain intensities, and subjective sleep quality. Additionally, 21 patients wore a wearable actigraph device to objectify sleep quality. The agreement and Spearman correlations between objective and subjective parameters were assessed. RESULTS Spearman rank correlations revealed no significant correlations between the ODI (subscales walking, sitting, standing, and sleeping) and the output of the IPG (percentage upright + mobile, transition, upright, and lying, respectively). Sleep parameters measured with the Actiwatch and the PSQI were not in agreement. CONCLUSIONS This study demonstrated that self-reporting questionnaires do not correlate with the findings of objective measurements. Therefore, we recommend using both subjective and objective parameters when determining treatment options for FBSS patients.
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Affiliation(s)
- Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium.,Pain in Motion International Research Group, www.paininmotion.be.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Jette, Belgium
| | - Iris Smet
- Pain Clinic, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Peter Mariën
- Department of Clinical and Experimental Neurolinguistics, Free University of Brussels, Brussels, Belgium.,Department of Neurology and Memory Clinic, ZNA Middelheim, Antwerp, Belgium
| | - Mats De Jaeger
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium
| | - Sander De Groote
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium
| | - Eva Huysmans
- Pain in Motion International Research Group, www.paininmotion.be.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Jette, Belgium.,Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Jette, Belgium.,I-CHER (Inter University Centre for Health Economics Research), Vrije Universiteit Brussel, Jette, Belgium
| | - Koen Putman
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Jette, Belgium.,I-CHER (Inter University Centre for Health Economics Research), Vrije Universiteit Brussel, Jette, Belgium
| | | | - Ronald Buyl
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Jette, Belgium.,Department of Biostatistics and Medical Informatics, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Jette, Belgium
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium.,Department of Radiology, Universitair Ziekenhuis Brussel, Jette, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Jette, Belgium
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