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Kuypers KLAM, Cramer SJE, Dekker J, Visser R, Hooper SB, Te Pas AB. Exerted force on the face mask in preterm infants at birth is associated with apnoea and bradycardia. Resuscitation 2024; 194:110086. [PMID: 38097106 DOI: 10.1016/j.resuscitation.2023.110086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND During stabilisation of preterm infants at birth, a face mask is used to provide respiratory support. However, application of these masks may activate cutaneous stretch receptors of the trigeminal nerve, causing apnoea and bradycardia. This study investigated the amount of force exerted on the face mask during non-invasive ventilation of preterm infants at birth and whether the amount of exerted force is associated with apnoea and bradycardia. METHODS A prospective observational study was performed in preterm infants born <32 weeks of gestation who were stabilised at birth. During the first 10 minutes of respiratory support, we measured breathing and heart rate as well as the amount of force exerted on a face mask using a custom-made pressure sensor placed on top of the face mask. RESULTS Thirty infants were included (median (IQR) gestational age(GA) 28+3 (27+0-30+0) weeks, birthweight 1104 (878-1275) grams). The median exerted force measured was 297 (198-377) grams, ranging from 0 to 1455 grams. Significantly more force was exerted on the face mask during positive pressure ventilation when compared to CPAP (410 (256-556) vs 286 (190-373) grams, p = 0.009). In a binary logistic regression model, higher forces were associated with an increased risk of apnoea (OR = 1.607 (1.556-1.661), p < 0.001) and bradycardia (OR = 1.140 (1.102-1.180), p < 0.001) during the first 10 minutes of respiratory support at birth. CONCLUSION During mask ventilation, the median exerted force on a face mask was 297 grams with a maximum of 1455 grams. Higher exerted forces were associated apnoea and bradycardia during the first 10 minutes of respiratory support at birth.
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Affiliation(s)
- K L A M Kuypers
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, Netherlands.
| | - S J E Cramer
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, Netherlands
| | - J Dekker
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, Netherlands
| | - R Visser
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, Netherlands
| | - S B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - A B Te Pas
- Division of Neonatology, Department of Paediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Centre, Leiden, Netherlands
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Dekker J. Harmonization of pain scores - interesting and relevant findings. Osteoarthritis Cartilage 2023; 31:9-10. [PMID: 36089230 DOI: 10.1016/j.joca.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 02/02/2023]
Affiliation(s)
- J Dekker
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Psychiatry and Department of Rehabilitation Medicine, PO Box 7057, 1007 MB, Amsterdam, the Netherlands.
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Basten M, van Tuijl L, Pan K, Spaan M, de Graeff A, Dekker J, Hoogendoorn A, Lamers F, Ranchor A, Vermeulen R, Voogd A, Geerlings M. Depression, anxiety and the risk of breast cancer among premenopausal and postmenopausal women: an individual participant data meta-analysis. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01606-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Dekker J, Quilter M, Qian H. Comparison of two probiotics in follow-on formula: Bifidobacterium animalis subsp. lactis HN019 reduced upper respiratory tract infections in Chinese infants. Benef Microbes 2022; 13:341-354. [PMID: 36004715 DOI: 10.3920/bm2022.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A randomised, double-blind, placebo-controlled trial was performed to investigate the health benefits of probiotic bacteria in infants when delivered in a follow-on infant formula. The study was conducted in Fuyang (Anhui Province, China) during winter and enrolled 192 healthy infants aged six to 12 months. Infants received one of three follow-on formulae daily for 12 weeks: supplemented with 106 cfu/g Bifidobacterium animalis subsp. lactis HN019 (n=64); 106 cfu/g Lacticaseibacillus rhamnosus HN001 (n=64); or without added probiotics (n=64). The primary endpoint was physician-confirmed bacterial or viral infections during the treatment period. Secondary endpoints included parentally reported (confirmed and unconfirmed) infections; antiviral or antibiotic treatments, and hospitalisation; stool frequency and consistency; infant growth; infant temperament; and adverse events. There were 8 cases of confirmed infection, all upper respiratory tract infections (URTIs). Confirmed URTIs were observed in 9.4% of the control group, compared to 3.1% in the HN001 group (P=0.273), and 0.0% in the HN019 group (P=0.028). A similar trend was observed for parentally reported URTIs, with 25.0% in the control group, compared with 14.1% in the HN001 group (P=0.119) and 9.4% in the HN019 group (P=0.019). No infants in the HN019 group were prescribed antibiotics or antivirals, compared with 3 (4.7%) in the HN001 group and 7 (10.9%) in the control group. No infants required hospitalisation. The probiotic-containing formulae were well-tolerated: there were no cases of diarrhoea or differences in stool frequency or characteristics, no differences in infant growth or temperament, and no treatment-related adverse events. This study directly compared the benefits of two different probiotics when added to follow-on infant formula at 106 cfu/g and consumed over a 12-week period. While HN001 showed trends toward reduced infections, HN019 showed better performance in terms of significantly reduced incidence of both physician-confirmed and parentally reported URTIs, and antibiotic/antiviral use compared to a control in Chinese infants. The trial is registered at ClinicalTrials.gov (NCT01724203).
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Affiliation(s)
- J Dekker
- Fonterra Research and Development Centre, Palmerston North, Private Bag 11029, 4442 Palmerston North, New Zealand
| | - M Quilter
- Fonterra Research and Development Centre, Palmerston North, Private Bag 11029, 4442 Palmerston North, New Zealand
| | - H Qian
- School of Public Health, Anhui Medical University, Hefei, China P.R
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Arshad R, Saccon F, Bag P, Biswas A, Calvaruso C, Bhatti AF, Grebe S, Mascoli V, Mahbub M, Muzzopappa F, Polyzois A, Schiphorst C, Sorrentino M, Streckaité S, van Amerongen H, Aro EM, Bassi R, Boekema EJ, Croce R, Dekker J, van Grondelle R, Jansson S, Kirilovsky D, Kouřil R, Michel S, Mullineaux CW, Panzarová K, Robert B, Ruban AV, van Stokkum I, Wientjes E, Büchel C. A kaleidoscope of photosynthetic antenna proteins and their emerging roles. Plant Physiol 2022; 189:1204-1219. [PMID: 35512089 PMCID: PMC9237682 DOI: 10.1093/plphys/kiac175] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/17/2022] [Indexed: 05/17/2023]
Abstract
Photosynthetic light-harvesting antennae are pigment-binding proteins that perform one of the most fundamental tasks on Earth, capturing light and transferring energy that enables life in our biosphere. Adaptation to different light environments led to the evolution of an astonishing diversity of light-harvesting systems. At the same time, several strategies have been developed to optimize the light energy input into photosynthetic membranes in response to fluctuating conditions. The basic feature of these prompt responses is the dynamic nature of antenna complexes, whose function readily adapts to the light available. High-resolution microscopy and spectroscopic studies on membrane dynamics demonstrate the crosstalk between antennae and other thylakoid membrane components. With the increased understanding of light-harvesting mechanisms and their regulation, efforts are focusing on the development of sustainable processes for effective conversion of sunlight into functional bio-products. The major challenge in this approach lies in the application of fundamental discoveries in light-harvesting systems for the improvement of plant or algal photosynthesis. Here, we underline some of the latest fundamental discoveries on the molecular mechanisms and regulation of light harvesting that can potentially be exploited for the optimization of photosynthesis.
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Affiliation(s)
- Rameez Arshad
- Department of Biophysics, Centre of the Region Haná for Biotechnological and Agricultural Research, Faculty of Science, Palacký University, Olomouc 783 71, Czech Republic
- Electron Microscopy Group, Groningen Biomolecular Sciences and Biotechnology Institute, University of Groningen, Groningen 9747 AG, The Netherlands
| | - Francesco Saccon
- School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Pushan Bag
- Department of Plant Physiology, Umeå Plant Science Centre, Umeå University, Umeå 901 87, Sweden
| | - Avratanu Biswas
- Department of Physics and Astronomy and LaserLaB, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam 1081 HV, The Netherlands
| | - Claudio Calvaruso
- Institute for Molecular Biosciences, Goethe University of Frankfurt, Frankfurt 60438, Germany
| | - Ahmad Farhan Bhatti
- Laboratory of Biophysics, Wageningen University, Wageningen, the Netherlands
| | - Steffen Grebe
- Department of Life Technologies, MolecularPlant Biology, University of Turku, Turku FI–20520, Finland
| | - Vincenzo Mascoli
- Department of Physics and Astronomy and LaserLaB, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam 1081 HV, The Netherlands
| | - Moontaha Mahbub
- School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
- Department of Botany, Jagannath University, Dhaka 1100, Bangladesh
| | - Fernando Muzzopappa
- Institute for Integrative Biology of the Cell (I2BC), CEA, CNRS, Université Paris-Sud, Université Paris-Saclay, Gif sur Yvette 1198, France
| | - Alexandros Polyzois
- Université de Paris, Faculté de Pharmacie de Paris, CiTCoM UMR 8038 CNRS, Paris 75006, France
| | | | - Mirella Sorrentino
- Photon Systems Instruments, spol. s.r.o., Drásov, Czech Republic
- Department of Agricultural Sciences, University of Naples Federico II, Naples 80138, Italy
| | - Simona Streckaité
- Institute for Integrative Biology of the Cell (I2BC), CEA, CNRS, Université Paris-Sud, Université Paris-Saclay, Gif sur Yvette 1198, France
| | | | - Eva-Mari Aro
- Department of Life Technologies, MolecularPlant Biology, University of Turku, Turku FI–20520, Finland
| | - Roberto Bassi
- Dipartimento di Biotecnologie, Università di Verona, Verona, Italy
| | - Egbert J Boekema
- Electron Microscopy Group, Groningen Biomolecular Sciences and Biotechnology Institute, University of Groningen, Groningen 9747 AG, The Netherlands
| | - Roberta Croce
- Department of Physics and Astronomy and LaserLaB, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam 1081 HV, The Netherlands
| | - Jan Dekker
- Department of Physics and Astronomy and LaserLaB, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam 1081 HV, The Netherlands
| | - Rienk van Grondelle
- Department of Physics and Astronomy and LaserLaB, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam 1081 HV, The Netherlands
| | - Stefan Jansson
- Department of Plant Physiology, Umeå Plant Science Centre, Umeå University, Umeå 901 87, Sweden
| | - Diana Kirilovsky
- Institute for Integrative Biology of the Cell (I2BC), CEA, CNRS, Université Paris-Sud, Université Paris-Saclay, Gif sur Yvette 1198, France
| | - Roman Kouřil
- Department of Biophysics, Centre of the Region Haná for Biotechnological and Agricultural Research, Faculty of Science, Palacký University, Olomouc 783 71, Czech Republic
| | - Sylvie Michel
- Université de Paris, Faculté de Pharmacie de Paris, CiTCoM UMR 8038 CNRS, Paris 75006, France
| | - Conrad W Mullineaux
- School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Klára Panzarová
- Photon Systems Instruments, spol. s.r.o., Drásov, Czech Republic
| | - Bruno Robert
- Institute for Integrative Biology of the Cell (I2BC), CEA, CNRS, Université Paris-Sud, Université Paris-Saclay, Gif sur Yvette 1198, France
| | - Alexander V Ruban
- School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Ivo van Stokkum
- Department of Physics and Astronomy and LaserLaB, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam 1081 HV, The Netherlands
| | - Emilie Wientjes
- Laboratory of Biophysics, Wageningen University, Wageningen, the Netherlands
| | - Claudia Büchel
- Institute for Molecular Biosciences, Goethe University of Frankfurt, Frankfurt 60438, Germany
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Knoop J, de Joode JW, Brandt H, Dekker J, Ostelo RWJG. Patients' and clinicians' experiences with stratified exercise therapy in knee osteoarthritis: a qualitative study. BMC Musculoskelet Disord 2022; 23:559. [PMID: 35681162 PMCID: PMC9178540 DOI: 10.1186/s12891-022-05496-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background We have developed a model of stratified exercise therapy that distinguishes three knee osteoarthritis (OA) subgroups (‘high muscle strength subgroup’, ‘low muscle strength subgroup’, ‘obesity subgroup’), which are provided subgroup-specific exercise therapy (supplemented by a dietary intervention for the ‘obesity subgroup’). In a large clinical trial, this intervention was found to be no more effective than usual exercise therapy. The present qualitative study aimed to explore experiences from users of this intervention, in order to identify possible improvements. Methods Qualitative research design embedded within a cluster randomized controlled trial in a primary care setting. A random sample from the experimental arm (i.e., 15 patients, 11 physiotherapists and 5 dieticians) was interviewed on their experiences with receiving or applying the intervention. Qualitative data from these semi-structured interviews were thematically analysed. Results We identified four themes: one theme regarding the positive experiences with the intervention and three themes regarding perceived barriers. Although users from all 3 perspectives (patients, physiotherapists and dieticians) generally perceived the intervention as having added value, we also identified several barriers, especially for the ‘obesity subgroup’. In this ‘obesity subgroup’, physiotherapists perceived obesity as difficult to address, dieticians reported that more consultations are needed to reach sustainable weight loss and both physiotherapists and dieticians reported a lack of interprofessional collaboration. In the ‘high muscle strength subgroup’, the low number of supervised sessions was perceived as a barrier by some patients and physiotherapists, but as a facilitator by others. A final theme addressed barriers to knee OA treatment in general, with lack of motivation as the most prominent of these. Conclusion Our qualitative study revealed a number of barriers to effective application of the stratified exercise therapy, especially for the ‘obesity subgroup’. Based on these barriers, the intervention and its implementation could possibly be improved. Moreover, these barriers are likely to account at least partly for the lack of superiority over usual exercise therapy. Trial registration The Netherlands National Trial Register (NTR): NL7463 (date of registration: 8 January 2019). Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05496-2.
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Affiliation(s)
- J Knoop
- Vrije Universiteit Amsterdam, Department of Health Sciences, Amsterdam, De Boelelaan 1105, Amsterdam, 1081 HV, Netherlands.
| | - J W de Joode
- Vrije Universiteit Amsterdam, Department of Health Sciences, Amsterdam, De Boelelaan 1105, Amsterdam, 1081 HV, Netherlands
| | - H Brandt
- Vrije Universiteit Amsterdam, Department of Health Sciences, Amsterdam, De Boelelaan 1105, Amsterdam, 1081 HV, Netherlands
| | - J Dekker
- Amsterdam UMC, Location VUmc, Department of Rehabilitation Medicine, Amsterdam, Netherlands
| | - R W J G Ostelo
- Vrije Universiteit Amsterdam, Department of Health Sciences, Amsterdam, De Boelelaan 1105, Amsterdam, 1081 HV, Netherlands.,Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Amsterdam UMC, Location VUmc, Department of Epidemiology and Data Science, Amsterdam, Netherlands
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Knoop J, Dekker J, van Dongen H, van der Leeden M, de Rooij M, Peter WF, van Berkel-de Joode W, van Bodegom-Vos L, Lopuhaä N, Bennell K, Lems W, van der Esch M, Vliet Vlieland TPM, Ostelo R. OP0188 CLINICAL EFFECTIVENESS OF STRATIFIED EXERCISE THERAPY COMPARED TO USUAL EXERCISE THERAPY IN PATIENTS WITH KNEE OSTEOARTHRITIS: A CLUSTER RANDOMIZED CONTROLLED TRIAL (OCTOPuS-STUDY). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThere is strong, high-quality evidence for the effectiveness of exercise therapy in people with knee osteoarthritis (OA).1 However, although effective, the average effect size is only moderate (approximately 0.5).1 This may be attributed to the current ‘one-size-fits-all’ exercise approach, while a stratified approach may yield superior clinical and economic outcomes. We are the first to test a model of stratified exercise therapy in patients in knee OA. This model was based on 3 previously identified subgroups2 that are aligned with well-accepted OA phenotypes3, namely a ‘low muscle strength subgroup’ (‘age-induced phenotype’), ‘high muscle strength subgroup’ (‘post-traumatic phenotype’) and ‘obesity subgroup’ (‘metabolic phenotype’). For each subgroup, a subgroup-specific exercise therapy intervention was developed and pilot-tested4, which was supplemented by a dietary intervention for the ‘obesity subgroup’.ObjectivesThe OCTOPuS-trial aimed to determine the effectiveness of stratified exercise therapy in reducing knee pain and improving physical function, compared to usual, ‘non-stratified’ exercise therapy, in patients with knee OA.MethodsWe conducted a pragmatic cluster randomized controlled trial in a primary care setting in 335 people with knee osteoarthritis: 153 in the experimental arm and 182 in the control arm. Physiotherapy practices were randomized into the experimental arm providing the model of stratified exercise therapy supplemented by a dietary intervention from a dietician for the ‘obesity subgroup’ or the control arm proving usual, ‘non-stratified’ exercise therapy. Primary outcomes were knee pain severity (NRS pain, 0-10) and physical function (KOOS subscale daily living, 0-100). Measurements were performed at baseline, and 3- (primary endpoint), 6-, and 12-months follow-up. Intention-to-treat, multilevel, regression analysis was performed.ResultsWe found statistically non-significant differences in knee pain (mean difference (95% confidence interval): 0.19 (-0.31, 0.69)) and physical function (-0.40 (-3.91, 3.12)) at 3-months follow-up, with within-group effect sizes ranging between 0.5 and 0.7. Non-significant differences were also found for all other time points and for nearly all secondary outcome measures. Moreover, effects of experimental and control intervention were similar in each of the 3 subgroup separately.ConclusionThis trial demonstrated no added value with respect to clinical outcomes of our model of stratified exercise therapy compared to usual exercise therapy. This could be attributed to the experimental arm therapists facing difficulty in effectively applying the model (especially in the ‘obesity subgroup’) and to elements of the model possibly being applied in the control arm.References[1]Fransen M et al. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2015 Jan 9;1:CD004376.[2]Knoop J et al. Identification of phenotypes with different clinical outcomes in knee osteoarthritis: data from the Osteoarthritis Initiative. Arthritis Care Res (Hoboken). 2011;63(11):1535-1542.[3]Bijlsma JW et al. Osteoarthritis: an update with relevance for clinical practice. Lancet. 2011; Jun 18;377(9783):2115-26.[4]Knoop J et al. Is a model of stratified exercise therapy by physical therapists in primary care feasible in patients with knee osteoarthritis? A mixed methods study. Physiotherapy. 2019.Disclosure of InterestsNone declared
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Kaufmann M, Mense L, Springer L, Dekker J. Tactile stimulation in the delivery room: past, present, future. A systematic review. Pediatr Res 2022:10.1038/s41390-022-01945-9. [PMID: 35124690 DOI: 10.1038/s41390-022-01945-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/05/2021] [Accepted: 12/14/2021] [Indexed: 11/08/2022]
Abstract
In current resuscitation guidelines, tactile stimulation is recommended for infants with insufficient respiratory efforts after birth. No recommendations are made regarding duration, onset, and method of stimulation. Neither is mentioned how tactile stimulation should be applied in relation to the gestational age. The aim was to review the physiological mechanisms of respiratory drive after birth and to identify and structure the current evidence on tactile stimulation during neonatal resuscitation. A systematic review of available data was performed using PubMed, covering the literature up to April 2021. Two independent investigators screened the extracted references and assessed their methodological quality. Six studies were included. Tactile stimulation management, including the onset of stimulation, overall duration, and methods as well as the effect on vital parameters was analyzed and systematically presented. Tactile stimulation varies widely between, as well as within different centers and no consensus exists which stimulation method is most effective. Some evidence shows that repetitive stimulation within the first minutes of resuscitation improves oxygenation. Further studies are warranted to optimize strategies to support spontaneous breathing after birth, assessing the effect of stimulating various body parts respectively within different gestational age groups.
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Affiliation(s)
- M Kaufmann
- Division of Neonatology and Paediatric Intensive Care Medicine, Department of Paediatrics, Medical Faculty, TU Dresden, Dresden, Germany.
| | - L Mense
- Division of Neonatology and Paediatric Intensive Care Medicine, Department of Paediatrics, Medical Faculty, TU Dresden, Dresden, Germany
- Saxony Center for Feto-Neonatal Health, Medical Faculty, TU Dresden, Dresden, Germany
| | - L Springer
- Division of Neonatology, Department of Paediatrics, University Children's Hospital Tuebingen, Tuebingen, Germany
| | - J Dekker
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Center, Leiden, The Netherlands
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Spigel D, Anand B, Carroll K, Dekker J, Georgy A, Hankins S, Rethy A. P47.13 First-in-Human, Dose Escalation and Expansion Study of MT-6402 in Patients With PD-L1 Expressing Advanced Solid Tumors. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Knoop J, Ostelo R, Van der Esch M, De Zwart A, Bennell K, Van der Leeden M, Dekker J. POS0157-HPR CONSTRUCT VALIDITY OF THE OCTOPUS STRATIFICATION ALGORITHM FOR ALLOCATING PATIENTS WITH KNEE OSTEOARTHRITIS INTO CLINICALLY RELEVANT SUBGROUPS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:We recently developed a model of stratified exercise therapy [1], consisting of (i) a stratification algorithm allocating patients with knee osteoarthritis (OA) into clinically relevant subgroups, and (ii) subgroup-specific exercise therapy. More specifically, in our model we distinguish the following subgroups with proposed underlying phenotypes: ‘high muscle strength subgroup’ representing a post-traumatic phenotype, ‘low muscle strength subgroup’ representing an age-induced phenotype and ‘obesity subgroup’ representing a metabolic phenotype.Objectives:In the present study, we aimed to validate the construct of this algorithm, focusing on 3 research questions: (i) are the proportions of patients in each subgroup similar across cohorts?; (ii) are the characteristics of each of the subgroups in line with their proposed underlying phenotypes?; (iii) are the effects of usual exercise therapy in the 3 subgroups in line with the proposed effect sizes?Methods:Data from five studies (four trials and one cross-sectional cohort) were used to validate the construct of our algorithm by 63 a priori formulated hypotheses regarding the research questions.Results:Baseline data from a total of 1,211 patients with knee OA were analyzed for the first and second research question, and follow-up data from 584 patients who were part of an exercise arm within a trial for the third research question. In total, the vast majority (73%) of the hypotheses were confirmed. Regarding our first research question, we found similar proportions in each of the three subgroups across cohorts, especially for three cohorts. Regarding our second research question, subgroup characteristics were almost completely in line with the proposed underlying phenotypes. Regarding our third research question, unexpectedly, usual exercise therapy resulted in similar, moderate to large effect sizes for knee pain and physical function for all three subgroups.Conclusion:This study suggests that our algorithm might be a valid instrument to allocate patients with knee OA into clinically relevant subgroups, as most of our a priori hypotheses could be confirmed. On the other hand, subgroups did not differ substantially in effects of usual exercise therapy, contrary to our expectation. An ongoing trial [1] will assess whether this algorithm accompanied by subgroup-specific exercise therapy improves clinical and economic outcomes.References:[1]Knoop J, Dekker J, van der Leeden M, de Rooij M, Peter WFH, van Bodegom-Vos L, van Dongen JM, Lopuhäa N, Bennell KL, Lems WF, van der Esch M, Vliet Vlieland TPM, Ostelo RWJG. Stratified exercise therapy compared with usual care by physical therapists in patients with knee osteoarthritis: A randomized controlled trial protocol (OCTOPuS study). Physiother Res Int. 2020 Apr;25(2):e1819. doi: 10.1002/pri.1819. Epub 2019 Nov 28.Disclosure of Interests:None declared
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Knoop J, Van Berkel-de Joode W, Brandt H, Dekker J, Ostelo R. POS1470-HPR BARRIERS AND FACILITATORS OF A NEW MODEL OF STRATIFIED EXERCISE THERAPY IN KNEE OSTEOARTHRITIS: A QUALITATIVE STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:We have developed a model of stratified exercise therapy, in which three knee osteoarthritis (OA) subgroups (i.e., ‘high muscle strength subgroup’, ‘low muscle strength subgroup’ and ‘obesity subgroup’) can be distinguished and provided a subgroup-specific intervention. Currently, the (cost-)effectiveness of this model compared to usual exercise therapy is tested in a large-scaled randomized controlled trial (OCTOPuS-study [1]). Alongside this trial, we performed a qualitative study to explore perceived barriers and facilitators of the application of this model in primary care.Objectives:To explore barriers and facilitators of the application of this model in primary care, as perceived by patients, physiotherapists and dieticians.Methods:Qualitative data were collected through semi-structured interviews in a random sample of 15 patients (5 from each subgroup), 11 physiotherapists and 5 dieticians, from the experimental arm of the OCTUPuS trial. A thematic analysis of the data was performed.Results:We identified 14 themes in 5 categories. In general, patients and therapists were positive about the added value and applicability of the model, although some physiotherapists would prefer more flexibility. Regarding the ‘high muscle strength subgroup’, both patients and physiotherapists reported mixed feelings on the low number of supervised sessions, with some perceiving this low number as advantageous for stimulating the patient’s own responsibility, whereas others as hindering an optimally guided treatment. Regarding the ‘obesity subgroup’, dieticians and physiotherapists acknowledged the added value of the combined intervention, but both were disappointed by the lack of interdisciplinary collaboration. Moreover, those patients in this subgroup already following a diet restriction, therefore not perceiving any added value of the diet intervention.Conclusion:This qualitative study revealed relevant barriers and facilitators of our new model of stratified exercise therapy, which will help us interpreting the upcoming results on its (cost-) effectiveness [1]. If proven to be (cost-)effective, implementation strategies should specifically focus on guidance of patients from the ‘high muscle strength subgroup’ within only a few sessions, collaboration between physiotherapist and dietician in the ‘obesity subgroup’, and adequate use of booster sessions after the supervised period to optimize treatment adherence.References:[1]Knoop J, Dekker J, van der Leeden M, de Rooij M, Peter WFH, van Bodegom-Vos L, van Dongen JM, Lopuhäa N, Bennell KL, Lems WF, van der Esch M, Vliet Vlieland TPM, Ostelo RWJG. Stratified exercise therapy compared with usual care by physical therapists in patients with knee osteoarthritis: A randomized controlled trial protocol (OCTOPuS study). Physiother Res Int. 2020 Apr;25(2):e1819. doi: 10.1002/pri.1819. Epub 2019 Nov 28.Disclosure of Interests:None declared
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Huijbrechts EJ, Dekker J, Tenten-Diepenmaat M, Gerritsen M, van der Leeden M. Correction to: Clinical guidance for podiatrists in the management of foot problems in rheumatic disorders: evaluation of an educational programme for podiatrists using a mixed methods design. J Foot Ankle Res 2021; 14:37. [PMID: 33957928 PMCID: PMC8101093 DOI: 10.1186/s13047-021-00463-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- E J Huijbrechts
- Amsterdam Rehabilitation Research Centre
- Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040, HG, Amsterdam, The Netherlands. .,Fontys University of applied sciences
- Department of allied health professionals, Fontys Paramedische Hogeschool, Eindhoven, The Netherlands.
| | - J Dekker
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - M Tenten-Diepenmaat
- Amsterdam Rehabilitation Research Centre
- Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040, HG, Amsterdam, The Netherlands.,Saxion University of Applied Sciences
- Department of Healthcare, Saxion, Enschede, The Netherlands
| | - M Gerritsen
- Amsterdam Rehabilitation Research Centre
- Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040, HG, Amsterdam, The Netherlands
| | - M van der Leeden
- Amsterdam Rehabilitation Research Centre
- Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040, HG, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit van Amsterdam, Amsterdam, The Netherlands
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Barakat A, Cornelis J, Blankers M, Beekman A, Dekker J. Intensive home treatment in comparison with care as usual: Cost-utility analysis from a pre-randomized controlled trial in the netherlands. Eur Psychiatry 2021. [PMCID: PMC9470436 DOI: 10.1192/j.eurpsy.2021.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionThe implementation of Intensive Home Treatment (IHT) aims to decrease the pressure on acute inpatient services that could lead to prevent hospitalization and reduce the number of hospitalization days and, ultimately, reduce cost in the mental health services. Although there are studies assessing the effectiveness of IHT, there is a shortage of research studying the cost-effectiveness.ObjectivesThe aim of this study is to present an cost-utility analysis of IHT compared to care as usual (CAU)MethodsPatients between 18 and 65 years of age whose mental health professionals considered hospitalization were included. These patients were pre-randomized in either IHT or CAU and followed up for 12-months. For this study, the base case analysis was performed from the societal and healthcare perspective. For the cost-utility analyses the Euroqol 5D was used to calculate quality adjusted life years (QALYs) as a generic measure of health gains.ResultsData of 198 patients were used. From a sociatal perspective, the cost-utility analysis resulted in an incremental cost-effectiveness ratios (ICERs) of €58 730, and a 37% likelihood that IHT leads to higher QALYs at lower costs. The probability of IHT being cost-effective was >50% if there was no willingness to pay more for extra QALY than in the current situation under CAU.ConclusionsProfessionals working in crisis care are able to offer IHT with the same effect as other crisis care interventions at lower costs. IHT seem to be cost-effective compared with CAU over 52 weeks follow-up for patients who experience psychiatric crises.DisclosureNo significant relationships.
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Ryman V, van der Esch M, Dekker J, Roorda L, van Dieën J, Twisk J, Verberne S, Huijbrechts E, Lems W, van der Leeden M. Determinants of pain and activity limitations in foot osteoarthritis: An exploratory cross-sectional study in the Amsterdam-foot cohort. Osteoarthritis and Cartilage Open 2021; 3:100134. [DOI: 10.1016/j.ocarto.2020.100134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/22/2020] [Accepted: 12/31/2020] [Indexed: 11/29/2022] Open
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Huijbrechts EJ, Dekker J, Tenten-Diepenmaat M, Gerritsen M, van der Leeden M. Clinical guidance for podiatrists in the management of foot problems in rheumatic disorders: evaluation of an educational programme for podiatrists using a mixed methods design. J Foot Ankle Res 2021; 14:15. [PMID: 33632287 PMCID: PMC7908782 DOI: 10.1186/s13047-020-00435-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/16/2020] [Indexed: 01/18/2023] Open
Abstract
Background Foot and ankle problems are common in rheumatic disorders and often lead to pain and limitations in functioning, affecting quality of life. There appears to be large variability in the management of foot problems in rheumatic disorders across podiatrists. To increase uniformity and quality of podiatry care for rheumatoid arthritis (RA), osteoarthritis (OA), spondyloarthritis (SpA), and gout a clinical protocol has been developed. Research objectives [1] to evaluate an educational programme to train podiatrists in the use of the protocol and [2] to explore barriers and facilitators for the use of the protocol in daily practice. Method This study used a mixed method design and included 32 podiatrists in the Netherlands. An educational programme was developed and provided to train the podiatrists in the use of the protocol. They thereafter received a digital questionnaire to evaluate the educational programme. Subsequently, podiatrists used the protocol for three months in their practice. Facilitators and barriers that they experienced in the use of the protocol were determined by a questionnaire. Semi-structured interviews were held to get more in-depth understanding. Results The mean satisfaction with the educational programme was 7.6 (SD 1.11), on a 11 point scale. Practical knowledge on joint palpation, programme variation and the use of practice cases were valued most. The protocol appeared to provide support in the diagnosis, treatment and evaluation of foot problems in rheumatic disorders and the treatment recommendations were clear and understandable. The main barrier for use of the protocol was time. The protocol has not yet been implemented in the electronic patient file, which makes it more time consuming. Other experienced barriers were the reimbursement for the treatment and financial compensation. Conclusions The educational programme concerning the clinical protocol for foot problems in rheumatic disorders appears to be helpful for podiatrists. Podiatrists perceived the protocol as being supportive during patient management. Barriers for use of the protocol were identified and should be addressed prior to large scale implementation. Whether the protocol is also beneficial for patients, needs to be determined in future research.
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Affiliation(s)
- E J Huijbrechts
- Amsterdam Rehabilitation Research Centre
- Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040, HG, Amsterdam, The Netherlands. .,Fontys University of applied sciences
- Department of allied health professionals, Fontys Paramedische Hogeschool, Eindhoven, The Netherlands.
| | - J Dekker
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - M Tenten-Diepenmaat
- Amsterdam Rehabilitation Research Centre
- Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040, HG, Amsterdam, The Netherlands.,Saxion University of applied sciences
- department of healthcare, Saxion, Enschede, The Netherlands
| | - M Gerritsen
- Amsterdam Rehabilitation Research Centre
- Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040, HG, Amsterdam, The Netherlands
| | - M van der Leeden
- Amsterdam Rehabilitation Research Centre
- Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040, HG, Amsterdam, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit van Amsterdam, Amsterdam, The Netherlands
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Moore H, Corning W, van der Esch M, Roorda L, Dekker J, Groot J, Wijbenga M, Lems W, van der Leeden M. Evaluation of treatment outcome using the Patient Specific Functional Scale in knee osteoarthritis patients undergoing multidisciplinary rehabilitation. Osteoarthritis and Cartilage Open 2020; 2:100098. [DOI: 10.1016/j.ocarto.2020.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022] Open
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Buffart LM, Schreurs MAC, Abrahams HJG, Kalter J, Aaronson NK, Jacobsen PB, Newton RU, Courneya KS, Armes J, Arving C, Braamse AM, Brandberg Y, Dekker J, Ferguson RJ, Gielissen MF, Glimelius B, Goedendorp MM, Graves KD, Heiney SP, Horne R, Hunter MS, Johansson B, Northouse LL, Oldenburg HS, Prins JB, Savard J, van Beurden M, van den Berg SW, Brug J, Knoop H, Verdonck-de Leeuw IM. Effects and moderators of coping skills training on symptoms of depression and anxiety in patients with cancer: Aggregate data and individual patient data meta-analyses. Clin Psychol Rev 2020; 80:101882. [PMID: 32640368 DOI: 10.1016/j.cpr.2020.101882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/21/2020] [Accepted: 06/11/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE This study evaluated the effects of coping skills training (CST) on symptoms of depression and anxiety in cancer patients, and investigated moderators of the effects. METHODS Overall effects and intervention-related moderators were studied in meta-analyses of pooled aggregate data from 38 randomized controlled trials (RCTs). Patient-related moderators were examined using linear mixed-effect models with interaction tests on pooled individual patient data (n = 1953) from 15 of the RCTs. RESULTS CST had a statistically significant but small effect on depression (g = -0.31,95% confidence interval (CI) = -0.40;-0.22) and anxiety (g = -0.32,95%CI = -0.41;-0.24) symptoms. Effects on depression symptoms were significantly larger for interventions delivered face-to-face (p = .003), led by a psychologist (p = .02) and targeted to patients with psychological distress (p = .002). Significantly larger reductions in anxiety symptoms were found in younger patients (pinteraction < 0.025), with the largest reductions in patients <50 years (β = -0.31,95%CI = -0.44;-0.18) and no significant effects in patients ≥70 years. Effects of CST on depression (β = -0.16,95%CI = -0.25;-0.07) and anxiety (β = -0.24,95%CI = -0.33;-0.14) symptoms were significant in patients who received chemotherapy but not in patients who did not (pinteraction < 0.05). CONCLUSIONS CST significantly reduced symptoms of depression and anxiety in cancer patients, and particularly when delivered face-to-face, provided by a psychologist, targeted to patients with psychological distress, and given to patients who were younger and received chemotherapy.
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Affiliation(s)
- L M Buffart
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands; Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
| | - M A C Schreurs
- Department of Medical Oncology, Family Cancer Clinic, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - H J G Abrahams
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - J Kalter
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands.
| | - N K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - P B Jacobsen
- Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD, Florida, USA.
| | - R U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
| | - K S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada.
| | - J Armes
- School of Health Science, University of Surrey, Surrey, UK.
| | - C Arving
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
| | - A M Braamse
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Y Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
| | - J Dekker
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - R J Ferguson
- Division of Hematology-Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
| | | | - B Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
| | - M M Goedendorp
- Department of Health Science, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - K D Graves
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
| | - S P Heiney
- College of Nursing, University of South Carolina, Columbia, SC, USA.
| | - R Horne
- UCL School of Pharmacy, University College London, London, UK.
| | - M S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - B Johansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
| | - L L Northouse
- University of Michigan School of Nursing, Ann Arbor, MI, USA.
| | - H S Oldenburg
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
| | - J B Prins
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, the Netherlands.
| | - J Savard
- School of Psychology, Université Laval and Laval University Cancer Research Center, Québec, QC, Canada.
| | - M van Beurden
- Department of Gynecology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
| | - S W van den Berg
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, the Netherlands.
| | - J Brug
- National Institute of Public Health and the Environment, Bilthoven, the Netherlands.
| | - H Knoop
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - I M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery and Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Vrije Universiteit Amsterdam, Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, the Netherlands.
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Satam A, Van der Leeden M, De Zwart A, Verberne S, Schrijvers J, Dekker J, Lems W, Haarlaar J, Van der Esch M. THU0634-HPR KNEE EXTENSOR MUSCLE STEADINESS IN RELATION TO MAXIMAL TORQUE AND PHYSICAL FUNCTIONING IN PATIENTS WITH KNEE OSTEOARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Osteoarthritis (OA) of the knee is characterized by knee pain and limitations in daily activities. Muscle weakness is associated with these characteristics, quantified as maximal voluntary muscle torque (MVT). The quality of muscle contraction is presented by fluctuations observed on a torque-time curve and the extent of these fluctuations is referred to as muscle steadiness. Whether muscle steadiness is associated with maximal muscle torque and consequently with pain and activity limitations is unknown.Objectives:To determine the association of knee extensor muscle steadiness with MVT and to explore the association of muscle steadiness with physical functioning in subjects with knee OA.Methods:Baseline data of 172 patients out of 177 patients with knee OA, who participated in the VIDEX trial (trial registration number, NL47786.048.14), were used for this study. Maximal voluntary knee extension torque (MVT) was assessed using an isokinetic dynamometer. Torque-time curve data were processed into (i) coefficient of magnitude of torque variance (CV) in percentage (%), (ii) frequency of torque variance as peak power frequency (PPF) in Hertz (Hz) and (iii) MVT in Newton meters (Nm). Physical functioning was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, the Get-Up & Go (GUG) test, the 6-minute walk test (6MWT) and the Stair climb up & down test. Correlation and Regression analyses were performed to determine associations. Sex, age, BMI, KL-grade, knee alignment and pain were considered as potential confounders.Results:Lower CV and PPF, reflecting better muscle steadiness, were significantly associated (p< 0.01 and p<0.05, respectively) with higher MVT, but associations were weak. Regression analyses showed a significant association of lower CV with better physical functioning on the WOMAC (p<0.05), also after correction for relevant confounders. The association with WOMAC was confounded by pain, but not by sex, age and BMI. No associations of CV with the GUG test, the 6MWT and the Stair climb up & down test were found. PPF was not significantly associated with physical functioning.Conclusion:This is the first explorative study of muscle steadiness in relation to physical functioning in knee OA patients. Muscle steadiness is, to some extent, related to better physical functioning, but this is not consistent across all measures of physical functioning in this study. There seems to be some relationship, but it is weak and needs further exploration. No previous studies comparing clinical scores to muscle steadiness in knee OA were found to compare our results. Studies on muscle steadiness are needed to improve our understanding on this aspect of muscle torque.References:N/ADisclosure of Interests:Anuja Satam: None declared, Marike van der Leeden: None declared, Arjan de Zwart: None declared, Simon Verberne: None declared, Jim Schrijvers: None declared, Joost Dekker: None declared, WIllem Lems Grant/research support from: Pfizer, Consultant of: Lilly, Pfizer, Jaap Haarlaar: None declared, Martin van der Esch: None declared
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de Zwart A, van der Leeden M, Roorda L, van der Esch M, Twisk J, Lems W, Dekker J. Course and predictors of upper leg muscle strength over 48 months in subjects with knee osteoarthritis: Data from the osteoarthritis initiative. Osteoarthritis and Cartilage Open 2020; 2:100038. [DOI: 10.1016/j.ocarto.2020.100038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/03/2020] [Indexed: 11/25/2022] Open
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Wouters RM, Slijper HP, Esteban Lopez L, Hovius SE, Selles RW, Blomme R, Sluijter B, van der Avoort D, Kroeze A, Smit J, Debeij J, Walbeehm E, van Couwelaar G, Vermeulen G, de Schipper J, Temming J, van Uchelen J, de Boer H, de Haas K, Zöphel O, Feitz R, Souer J, Hovius S, Moojen T, Smit X, van Huis R, Pennehouat P, Schoneveld K, van Kooij Y, Wouters R, Zagt P, van Ewijk F, Moussault F, Veltkamp J, Fink A, de Ridder W, Slijper H, Selles R, Porsius J, Spekreijse K, Zhou C, Tsehaie J, Poelstra R, Janssen M, van der Oest M, Evers S, Sun P, Schrier V, Dekker J, Jansen-Landheer M, ter Stege M. Beneficial Effects of Nonsurgical Treatment for Symptomatic Thumb Carpometacarpal Instability in Clinical Practice: A Cohort Study. Arch Phys Med Rehabil 2020; 101:434-441. [DOI: 10.1016/j.apmr.2019.08.485] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/23/2019] [Accepted: 08/31/2019] [Indexed: 11/24/2022]
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de Beurs E, Thomaes K, Kronemeijer H, Dekker J. [The PTSD Checklist for DSM-5 (PCL-5): comparing responsivity with the Outcome Questionnaire (OQ-45) and practical utility]. Tijdschr Psychiatr 2020; 62:448-456. [PMID: 32583865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The PTSD Checklist for the DSM-5 (PCL-5) may be a suitable addition for routine outcome monitoring (ROM) for patients with PTSD.<br/> AIM: To determine whether the PCL-5 is worth the extra effort that administration requires from the patient.<br/> METHOD: Pretest and retest measurement results of the PCL-5 and the OQ-45 were compared head-to-head in 464 patients from the Sinai Center of Arkin.<br/> RESULTS: The correlations between scores on the instruments were high and analysis of variance for repeated measurements revealed no difference in responsiveness. Comparison of Cohen's d (0.49 vs. 0.43) and Delta T (5.0 vs. 4.4), indicated a slightly better responsiveness of the PCL-5 and also the proportion of recovered patients was greater according to the PCL-5 compared to the OQ-SD.<br/> CONCLUSION: At first glance, the PCL-5 and the OQ-SD were equally sensitive to detect change during treatment. However, the PCL-5 provided more detailed information about the nature and severity of symptomatology in an individual patient and with the PCL-5 we were slightly better able to demonstrate clinical significant change than with the OQ-SD. We recommend to add the PCL-5 to ROM for patients with PTSD.
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Nusselder KJ, Zoeteman J, Buis B, Hoeve N, Peen J, van Grasstek L, Dekker J. [Trends in emergency admissions in Amsterdam. Fifteen years of emergency psychiatry in an increasingly crowded city]. Tijdschr Psychiatr 2020; 62:530-540. [PMID: 32700298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The Temporary Holding Department (toa) is a link between the 7/24 service and the admissions departments. We examined the make-up of the admission cohorts and the use of isolation between 2001 and 2017 in the context of demographic developments and changes in the mental healthcare sector.<br/> METHOD: Comparison of patient data in four cohorts who came in during four consecutive periods.<br/> RESULTS: The number of admissions rose from 408 a year in the period 2001-2003 to 728 in the period 2013-2016. The proportion of voluntary admissions increased from 4 to 33%, while emergency compulsory admissions (ibs) fell from 83 to 54%. The proportion of admissions of Dutch people from outside Amsterdam and of people from other countries rose from 11 to 23%. The percentage of patients with schizophrenic disorder rose from 25 to 32%, the percentage with mood disorder from 14 to 20% and the percentage with drug-related disorders from 3 to 7%. Assessment at a police station and the classification psychotic disorder were predictors of compulsory admissions (under the terms of the Dutch bopz act). Men under the age of 45 who were admitted compulsorily were more likely to be isolated. The percentage of patients isolated during admission fell from 37% to 20%, and the length of the periods of isolation also declined. CONCLUSIONS The increase in the annual number of admissions to the toa indicates, in the context of population growth and the rise in tourism, that there is a shortage of available beds in regular admissions departments in Amsterdam. Over the course of fifteen years, the number of Dutch nationals from outside Amsterdam and foreigners doubled. Due to policy and/or as a result of the increased proportion of patients admitted voluntarily, the use of isolation decreased.
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Vondeling A, Hazen J, Van Huis Tanja L, Schiphorst A, Dekker J, Hamaker M. FACTORS ASSOCIATED WITH SURVIVAL IN ELDERLY PATIENTS WITH STAGE I–III COLORECTAL CARCINOMA IN THE NETHERLANDS MANAGED WITH NON-CURATIVE INTENT. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31168-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dekker J. The minimal clinically important difference re-considered. Osteoarthritis Cartilage 2019; 27:1403-1404. [PMID: 31153985 DOI: 10.1016/j.joca.2019.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 02/02/2023]
Affiliation(s)
- J Dekker
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers (location VUmc), PO Box 7057, 1007 MB Amsterdam, the Netherlands.
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Garcia M, Dekker J. EP-1955 Increased accuracy in setup position by using surface scanning. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32375-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sovran B, Hugenholtz F, Elderman M, Van Beek AA, Graversen K, Huijskes M, Boekschoten MV, Savelkoul HFJ, De Vos P, Dekker J, Wells JM. Age-associated Impairment of the Mucus Barrier Function is Associated with Profound Changes in Microbiota and Immunity. Sci Rep 2019; 9:1437. [PMID: 30723224 PMCID: PMC6363726 DOI: 10.1038/s41598-018-35228-3] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 10/16/2018] [Indexed: 02/07/2023] Open
Abstract
Aging significantly increases the vulnerability to gastrointestinal (GI) disorders but there are few studies investigating the key factors in aging that affect the GI tract. To address this knowledge gap, we used 10-week- and 19-month-old litter-mate mice to investigate microbiota and host gene expression changes in association with ageing. In aged mice the thickness of the colonic mucus layer was reduced about 6-fold relative to young mice, and more easily penetrable by luminal bacteria. This was linked to increased apoptosis of goblet cells in the upper part of the crypts. The barrier function of the small intestinal mucus was also compromised and the microbiota were frequently observed in contact with the villus epithelium. Antimicrobial Paneth cell factors Ang4 and lysozyme were expressed in significantly reduced amounts. These barrier defects were accompanied by major changes in the faecal microbiota and significantly decreased abundance of Akkermansia muciniphila which is strongly and negatively affected by old age in humans. Transcriptomics revealed age-associated decreases in the expression of immunity and other genes in intestinal mucosal tissue, including decreased T cell-specific transcripts and T cell signalling pathways. The physiological and immunological changes we observed in the intestine in old age, could have major consequences beyond the gut.
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Affiliation(s)
- Bruno Sovran
- Top Institute Food and Nutrition, Wageningen, The Netherlands.,Cell Biology and Immunology Group, Wageningen University and Research Center, Wageningen, The Netherlands
| | - Floor Hugenholtz
- Laboratory of Microbiology, Wageningen University and Research Center, Wageningen, The Netherlands
| | - Marlies Elderman
- Top Institute Food and Nutrition, Wageningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adriaan A Van Beek
- Top Institute Food and Nutrition, Wageningen, The Netherlands.,Cell Biology and Immunology Group, Wageningen University and Research Center, Wageningen, The Netherlands
| | - Katrine Graversen
- Host-Microbe Interactomics Group, Wageningen University and Research Center, Wageningen, The Netherlands
| | - Myrte Huijskes
- Host-Microbe Interactomics Group, Wageningen University and Research Center, Wageningen, The Netherlands
| | - Mark V Boekschoten
- Top Institute Food and Nutrition, Wageningen, The Netherlands.,Division of Human Nutrition, Wageningen University and Research Center, Wageningen, The Netherlands
| | - Huub F J Savelkoul
- Top Institute Food and Nutrition, Wageningen, The Netherlands.,Cell Biology and Immunology Group, Wageningen University and Research Center, Wageningen, The Netherlands
| | - Paul De Vos
- Top Institute Food and Nutrition, Wageningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan Dekker
- Top Institute Food and Nutrition, Wageningen, The Netherlands.,Host-Microbe Interactomics Group, Wageningen University and Research Center, Wageningen, The Netherlands
| | - Jerry M Wells
- Top Institute Food and Nutrition, Wageningen, The Netherlands. .,Host-Microbe Interactomics Group, Wageningen University and Research Center, Wageningen, The Netherlands.
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Konings-Pijnappels APM, Tenten-Diepenmaat M, Dahmen R, Verberne SK, Dekker J, Twisk JWR, Roorda LD, van der Leeden M. Forefoot pathology in relation to plantar pressure distribution in patients with rheumatoid arthritis: A cross-sectional study in the Amsterdam Foot cohort. Gait Posture 2019; 68:317-322. [PMID: 30566899 DOI: 10.1016/j.gaitpost.2018.12.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/27/2018] [Accepted: 12/10/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND In patients with rheumatoid arthritis (RA), both high and low forefoot plantar pressures have been reported. Better understanding of pathology in the forefoot associated with altered pressure distribution in patients with RA could help to better formulate and specify goals for treatment with foot orthoses or therapeutic footwear. OBJECTIVES To investigate the association of plantar pressure with disease activity and deformity in the forefoot in patients with rheumatoid arthritis and forefoot symptoms. METHODS A cross sectional study, using data of 172 patients with rheumatoid arthritis and forefoot symptoms, was conducted. Peak pressure (PP) and pressure time integral (PTI) in the forefoot were measured with a pressure platform. Forefoot deformity was assessed using the Platto score. Forefoot disease activity was defined as swelling and/or pain assessed by palpation of the metatarsophalangeal joints. The forefoot was divided in a medial, central and lateral region, in which the following conditions could be present: 1) no pathology, 2) disease activity, 3) deformity or 4) disease activity and deformity. A multilevel analysis was performed using condition per forefoot region as independent variable and PP or PTI in the corresponding region as dependent variable. RESULTS Statistically significant higher plantar pressures were found in forefoot regions with deformities (RR 1.2, CI 1.1-1.3, P<0.0001), compared to forefoot regions without forefoot pathology. No significant differences in plantar pressures were found when solely forefoot disease activity was present in forefoot regions. SIGNIFICANCE Forefoot deformities are related to higher plantar pressures measured in the corresponding forefoot regions. The absence of an association between local disease activity and plantar pressure might be explained by the low prevalence of metatarsophalangeal joint pain or swelling. Future research with sensitive imaging measures to detect disease activity is recommended to reveal the effect of forefoot disease activity on plantar pressure.
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Affiliation(s)
- A P M Konings-Pijnappels
- Amsterdam Rehabilitation Research Center, Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040 HG, Amsterdam, the Netherlands.
| | - M Tenten-Diepenmaat
- Amsterdam Rehabilitation Research Center, Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040 HG, Amsterdam, the Netherlands.
| | - R Dahmen
- Amsterdam Rehabilitation Research Center, Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040 HG, Amsterdam, the Netherlands.
| | - S K Verberne
- Amsterdam Rehabilitation Research Center, Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040 HG, Amsterdam, the Netherlands.
| | - J Dekker
- VU University Medical Center, Department of Rehabilitation Medicine, PO 7057, 1007 MB, Amsterdam, the Netherlands; Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.
| | - J W R Twisk
- Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, VU University Medical Center, De Boelelaan 1089a, 1081 HV Amsterdam, the Netherlands.
| | - L D Roorda
- Amsterdam Rehabilitation Research Center, Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040 HG, Amsterdam, the Netherlands.
| | - M van der Leeden
- Amsterdam Rehabilitation Research Center, Reade, Dr. Jan van Breemenstraat 2, PO 58271, 1040 HG, Amsterdam, the Netherlands; VU University Medical Center, Department of Rehabilitation Medicine, PO 7057, 1007 MB, Amsterdam, the Netherlands; Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.
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Dekker J, Stenning FJ, Willms LJFB, Martherus T, Hooper SB, Te Pas AB. Time to achieve desired fraction of inspired oxygen using a T-piece ventilator during resuscitation of preterm infants at birth. Resuscitation 2019; 136:100-104. [PMID: 30708072 DOI: 10.1016/j.resuscitation.2019.01.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/03/2018] [Accepted: 01/20/2019] [Indexed: 11/17/2022]
Abstract
AIM To determine the time between adjustment of FiO2 at the oxygen blender and the desired FiO2 reaching the preterm infant during respiratory support at birth. METHODS This observational study was performed using a Neopuff™ T-piece Resuscitator attached to either a test lung (during initial bench tests) or a face mask during the stabilization of infants at birth. FiO2 was titrated following resuscitation guidelines. The duration for the desired FiO2 to reach either the test lung or face mask was recorded, both with and without leakage. A respiratory function monitor was used to record FiO2 and amount of leak. RESULTS In bench tests, the median (IQR) time taken to achieve a desired FiO2 was 34.2 (21.8-69.1) s. This duration was positively associated with the desired FiO2 difference, the direction of titration (upwards) and the occurrence of no leak (R2 0.863, F 65.016, p < 0.001). During stabilization of infants (median (IQR) gestational age 29+0 (28+2-30+0) weeks, birthweight 1290 (1240-1488) g), the duration (19.0 (0.0-57.0) s) required to reach a desired FiO2 was less, but still evident. In 27/55 (49%) titrations, the desired FiO2 was not achieved before the FiO2 levels were again changed. CONCLUSION There is a clear delay before a desired FiO2 is achieved at the distal end of the T-piece resuscitator. This delay is clinically relevant as this delay could easily lead to over- and under titration of oxygen, which might result in an increased risk for both hypoxia and hyperoxia.
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Affiliation(s)
- J Dekker
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
| | - F J Stenning
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, Melbourne, Australia
| | - L J F B Willms
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - T Martherus
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - S B Hooper
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, Melbourne, Australia
| | - A B Te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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Knoop J, van der Leeden M, van der Esch M, de Rooij M, Peter WF, Bennell KL, Steultjens MPM, Hakkinen A, Roorda LD, Lems WF, Dekker J. Is a model of stratified exercise therapy by physical therapists in primary care feasible in patients with knee osteoarthritis? : a mixed methods study. Physiotherapy 2019; 106:101-110. [PMID: 30981515 DOI: 10.1016/j.physio.2019.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/01/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To explore the feasibility of a newly developed model of stratified exercise therapy in primary care for patients with knee osteoarthritis (OA). DESIGN Mixed method design (process, outcome and qualitative evaluation). SETTING Six physical therapy practices in primary care around Amsterdam. PARTICIPANTS Fifty eligible patients with knee OA, visiting one of the participating physical therapists (PTs). INTERVENTION Patients were allocated to a subgroup based on a simple stratification tool and received subgroup-specific, protocolized, 4-month, exercise therapy. MAIN OUTCOME MEASURES Feasibility of this model of stratified exercise therapy was explored by multiple process parameters, outcome measures (physical functioning and knee pain; at baseline and 4-months follow-up) and experiences from patients and PTs. RESULTS From 97 potentially eligible patients, fifty patients were included and allocated to the 'high muscle strength subgroup' (n=17), 'depression subgroup' (n=4), 'obesity subgroup' (n=6) or 'low muscle strength subgroup' (n=23). Three patients dropped out during the study period. PTs provided relatively low numbers of sessions (on average 10 sessions), although exceedance of the recommended maximum number of sessions did occur frequently. We found clinically relevant improvements on physical functioning and knee pain (P<0.001 for both) for the total group. In general, the model of stratified exercise therapy was considered to be easily applicable and of added value for daily practice. CONCLUSIONS Our model of stratified exercise therapy seems to be feasible in primary care, although a number of limitations were reported. Future research should determine the (cost-)effectiveness of an adapted model, compared to usual, non-stratified exercise therapy.
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Affiliation(s)
- J Knoop
- Reade, Amsterdam Rehabilitation Research Institute, Amsterdam, Netherlands; Vrije Universiteit Amsterdam, Department of Health Sciences, Amsterdam, Netherlands.
| | - M van der Leeden
- Reade, Amsterdam Rehabilitation Research Institute, Amsterdam, Netherlands; VUmc, Department of Rehabilitation Medicine, Amsterdam, Netherlands.
| | - M van der Esch
- Reade, Amsterdam Rehabilitation Research Institute, Amsterdam, Netherlands.
| | - M de Rooij
- Reade, Amsterdam Rehabilitation Research Institute, Amsterdam, Netherlands.
| | - W F Peter
- Reade, Amsterdam Rehabilitation Research Institute, Amsterdam, Netherlands.
| | - K L Bennell
- University of Melbourne, School of Health Sciences, Melbourne, Australia.
| | - M P M Steultjens
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, UK.
| | - A Hakkinen
- University of Jyväskylä, Faculty of Sports and Health Sciences, Jyväskylä, Finland.
| | - L D Roorda
- Reade, Amsterdam Rehabilitation Research Institute, Amsterdam, Netherlands.
| | - W F Lems
- Reade, Jan van Breemen Research Institute, Amsterdam, Netherlands; VUmc, Department of Rheumatology, Amsterdam, Netherlands.
| | - J Dekker
- VUmc, Department of Rehabilitation Medicine, Amsterdam, Netherlands.
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30
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de Zwart AH, van der Leeden M, Roorda LD, Visser M, van der Esch M, Lems WF, Dekker J. Dietary protein intake and upper leg muscle strength in subjects with knee osteoarthritis: data from the osteoarthritis initiative. Rheumatol Int 2019; 39:277-284. [DOI: 10.1007/s00296-018-4223-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/04/2018] [Indexed: 01/01/2023]
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31
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Oosterhaven J, Wittink H, Dekker J, Kruitwagen C, Devillé W. Pain catastrophizing predicts dropout of patients from an interdisciplinary chronic pain management programme: A prospective cohort study. J Rehabil Med 2019; 51:761-769. [DOI: 10.2340/16501977-2609] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Leermakers L, Döking S, Thewes B, Braamse AMJ, Gielissen MFM, de Wilt JHW, Collette EH, Dekker J, Prins JB. Study protocol of the CORRECT multicenter trial: the efficacy of blended cognitive behavioral therapy for reducing psychological distress in colorectal cancer survivors. BMC Cancer 2018; 18:748. [PMID: 30021555 PMCID: PMC6052704 DOI: 10.1186/s12885-018-4645-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 06/28/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Approximately one third of the colorectal cancer survivors (CRCS) experience high levels of psychological distress. Common concerns experienced by CRCS include distress related to physical problems, anxiety, fear of cancer recurrence (FCR) and depressive symptoms. However, psychological interventions for distressed CRCS are scarce. Therefore, a blended therapy was developed, combining face-to-face cognitive behavioral therapy (CBT) with online self-management activities and telephone consultations. The aim of the study is to evaluate the efficacy and cost-effectiveness of this blended therapy in reducing psychological distress in CRCS. METHODS/DESIGN The CORRECT study is a two-arm multicenter randomized controlled trial (RCT). A sample of 160 highly distressed CRCS (a score on the Distress Thermometer of 5 or higher) will be recruited from several hospitals in the Netherlands. CRCS will be randomized to either the intervention condition (blended CBT) or the control condition (care as usual). The blended therapy covers approximately 14 weeks and combines five face-to-face sessions and three telephone consultations with a psychologist, with access to an interactive self-management website. It includes three modules which are individually-tailored to patient concerns and aimed at decreasing: 1) distress caused by physical consequences of CRC, 2) anxiety and FCR, 3) depressive symptoms. Patients can choose between the optional modules. The primary outcome is general distress (Brief Symptom Inventory-18). Secondary outcomes are quality of life and general psychological wellbeing. Assessments will take place at baseline prior to randomization, after 4 and 7 months. DISCUSSION Blended CBT is an innovative and promising approach for providing tailored supportive care to reduce high distress in CRCS. If the intervention proves to be effective, an evidence-based intervention will become available for implementation in clinical practice. TRIAL REGISTRATION This trial is registered in the Netherlands Trial Register ( NTR6025 ) on August 3, 2016.
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Affiliation(s)
- L. Leermakers
- Radboud Institute for Health Sciences, Department of Medical Psychology Radboud University Medical Center, (840), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - S. Döking
- Radboud Institute for Health Sciences, Department of Medical Psychology Radboud University Medical Center, (840), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - B. Thewes
- Radboud Institute for Health Sciences, Department of Medical Psychology Radboud University Medical Center, (840), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - A. M. J. Braamse
- Department of Medical Psychology, Amsterdam UMC, location AMC, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - M. F. M. Gielissen
- Radboud Institute for Health Sciences, Department of primary and community care, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Siza (disability service) Arnhem, P.O. Box 532, 6800 AM Arnhem, The Netherlands
| | - J. H. W. de Wilt
- Radboud Institute for Health Sciences, Department of Surgery, Radboud university medical center, (725), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - E. H. Collette
- Department of Medical Psychology, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - J. Dekker
- Department of Rehabilitation Medicine, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location VUmc, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - J. B. Prins
- Radboud Institute for Health Sciences, Department of Medical Psychology Radboud University Medical Center, (840), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Carlier IVE, Andree Wiltens DH, van Rood YR, van Veen T, Dekker J, van Hemert AM. Treatment course and its predictors in patients with somatoform disorders: A routine outcome monitoring study in secondary psychiatric care. Clin Psychol Psychother 2018; 25:550-564. [PMID: 29573030 DOI: 10.1002/cpp.2191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 02/14/2018] [Accepted: 02/14/2018] [Indexed: 12/27/2022]
Abstract
AIM Somatoform disorders are common and often chronic. It would be helpful to distinguish those patients who are likely to have a positive treatment course from those who are likely to follow a negative course. Such studies of different somatoform disorders are scarce, especially in secondary psychiatric care. This study examined the 6-month treatment course of psychological, physical symptoms, and functioning, and its predictors in a naturalistic sample of secondary psychiatric care outpatients with somatoform disorders. METHOD The present study used routine outcome monitoring data of patients with somatoform disorders regarding their 6-month treatment course of psychological and physical symptoms as well as functioning. The following patient groups were included: total group of somatoform disorders (N = 435), and undifferentiated somatoform disorder (N = 242), pain disorder (N = 102), body dysmorphic disorder (N = 51), and hypochondriasis (N = 40). Measures were Mini-International Neuropsychiatric Interview plus, Brief Symptom Inventory, Montgomery-Ǻsberg Depression Rating Scale, Brief Anxiety Scale, Short Form Health Survey 36, and Physical Symptom Checklist (PSC). RESULTS The study population generally showed high co-morbidity, especially with anxiety and mood disorders. The PSC total score, body dysmorphic disorder, and hypochondriasis were significant predictors for the treatment course of symptoms (Brief Symptom Inventory), whereas the PSC total score was the only significant predictor for the course of functioning (Short Form Health Survey 36). CONCLUSION Secondary psychiatric care outpatients with somatoform disorders showed high co-morbidity with anxiety and mood disorders, and an unfavourable 6-month course of both symptoms and functioning. Clinical implications are discussed, such as additional treatment of co-morbidity in somatoform disorders.
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Affiliation(s)
- I V E Carlier
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Y R van Rood
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - T van Veen
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - J Dekker
- Department of Psychiatry and Department of Rehabilitation Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - A M van Hemert
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
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Kalter J, Verdonck-de Leeuw IM, Sweegers MG, Aaronson NK, Jacobsen PB, Newton RU, Courneya KS, Aitken JF, Armes J, Arving C, Boersma LJ, Braamse AMJ, Brandberg Y, Chambers SK, Dekker J, Ell K, Ferguson RJ, Gielissen MFM, Glimelius B, Goedendorp MM, Graves KD, Heiney SP, Horne R, Hunter MS, Johansson B, Kimman ML, Knoop H, Meneses K, Northouse LL, Oldenburg HS, Prins JB, Savard J, van Beurden M, van den Berg SW, Brug J, Buffart LM. Effects and moderators of psychosocial interventions on quality of life, and emotional and social function in patients with cancer: An individual patient data meta-analysis of 22 RCTs. Psychooncology 2018; 27:1150-1161. [PMID: 29361206 PMCID: PMC5947559 DOI: 10.1002/pon.4648] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 01/02/2018] [Accepted: 01/10/2018] [Indexed: 01/25/2023]
Abstract
Objective This individual patient data (IPD) meta‐analysis aimed to evaluate the effects of psychosocial interventions (PSI) on quality of life (QoL), emotional function (EF), and social function (SF) in patients with cancer, and to study moderator effects of demographic, clinical, personal, and intervention‐related characteristics. Methods Relevant studies were identified via literature searches in 4 databases. We pooled IPD from 22 (n = 4217) of 61 eligible randomized controlled trials. Linear mixed‐effect model analyses were used to study intervention effects on the post‐intervention values of QoL, EF, and SF (z‐scores), adjusting for baseline values, age, and cancer type. We studied moderator effects by testing interactions with the intervention for demographic, clinical, personal, and intervention‐related characteristics, and conducted subsequent stratified analyses for significant moderator variables.Results: PSI significantly improved QoL (β = 0.14,95%CI = 0.06;0.21), EF (β = 0.13,95%CI = 0.05;0.20), and SF (β = 0.10,95%CI = 0.03;0.18). Significant differences in effects of different types of PSI were found, with largest effects of psychotherapy. The effects of coping skills training were moderated by age, treatment type, and targeted interventions. Effects of psychotherapy on EF may be moderated by cancer type, but these analyses were based on 2 randomized controlled trials with small sample sizes of some cancer types. Conclusions PSI significantly improved QoL, EF, and SF, with small overall effects. However, the effects differed by several demographic, clinical, personal, and intervention‐related characteristics. Our study highlights the beneficial effects of coping skills training in patients treated with chemotherapy, the importance of targeted interventions, and the need of developing interventions tailored to the specific needs of elderly patients.
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Affiliation(s)
- J Kalter
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - I M Verdonck-de Leeuw
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands.,Department of Otolaryngology-Head and Neck Surgery, Amsterdam Public Health research institute and Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - M G Sweegers
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - N K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - P B Jacobsen
- Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, Maryland, FL, USA
| | - R U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - K S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - J F Aitken
- Menzies Health Institute Queensland, Griffith University, Southport, Australia.,Cancer Council Queensland, Brisbane, Australia.,Institute for Resilient Regions, University of Southern Queensland, Brisbane, Australia
| | - J Armes
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - C Arving
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - L J Boersma
- Department of Radiation Oncology, Maastricht University Medical Center (MAASTRO clinic), Maastricht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A M J Braamse
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - Y Brandberg
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - S K Chambers
- Menzies Health Institute Queensland, Griffith University, Southport, Australia.,Cancer Council Queensland, Brisbane, Australia.,Prostate Cancer Foundation of Australia, Sydney, NSW, Australia
| | - J Dekker
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - K Ell
- Department of Adults and Healthy Aging, University of Southern California, Los Angeles, CA, USA
| | - R J Ferguson
- Division of Hematology-Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - M F M Gielissen
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - B Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - M M Goedendorp
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - K D Graves
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - S P Heiney
- College of Nursing, University of South Carolina, Columbia, SC, USA
| | - R Horne
- UCL School of Pharmacy, University College London, London, UK
| | - M S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - B Johansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - M L Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - H Knoop
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - K Meneses
- University of Alabama at Birmingham, School of Nursing, Birmingham, AL, USA
| | - L L Northouse
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - H S Oldenburg
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - J B Prins
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Savard
- School of Psychology, Université Laval and Laval University Cancer Research Center, Québec, QC, Canada
| | - M van Beurden
- Department of Gynecology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - S W van den Berg
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Brug
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - L M Buffart
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,Department of Medical Oncology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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van den Akker LE, Beckerman H, Collette EH, Knoop H, Bleijenberg G, Twisk JW, Dekker J, de Groot V. Cognitive behavioural therapy for MS-related fatigue explained: A longitudinal mediation analysis. J Psychosom Res 2018; 106:13-24. [PMID: 29455894 DOI: 10.1016/j.jpsychores.2017.12.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 12/08/2017] [Accepted: 12/26/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) effectively reduces fatigue directly following treatment in patients with Multiple Sclerosis (MS), but little is known about the process of change during and after CBT. DESIGN Additional analysis of a randomized clinical trial. OBJECTIVE To investigate which psychological factors mediate change in fatigue during and after CBT. METHODS TREFAMS-CBT studied the effectiveness of a 16-week CBT treatment for MS-related fatigue. Ninety-one patients were randomized (44 to CBT, 47 to the MS-nurse consultations). Mediation during CBT treatment was studied using assessments at baseline, 8 and 16weeks. Mediation of the change in fatigue from post-treatment to follow-up was studied separately using assessments at 16, 26 and 52weeks. Proposed mediators were: changes in illness cognitions, general self-efficacy, coping styles, daytime sleepiness, concentration and physical activity, fear of disease progression, fatigue perceptions, depression and physical functioning. Mediators were separately analysed according to the product-of-coefficients approach. Confidence intervals were calculated with a bootstrap procedure. RESULTS During treatment the decrease in fatigue brought on by CBT was mediated by improved fatigue perceptions, increased physical activity, less sleepiness, less helplessness, and improved physical functioning. Post-treatment increases in fatigue levels were mediated by reduced physical activity, reduced concentration, and increased sleepiness. CONCLUSION These results suggests that focusing on improving fatigue perceptions, perceived physical activity, daytime sleepiness, helplessness, and physical functioning may further improve the effectiveness of CBT for fatigue in patients with MS. Maintenance of treatment effects may be obtained by focusing on improving physical activity, concentration and sleepiness.
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Affiliation(s)
- L E van den Akker
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; MS Center Amsterdam, Amsterdam, The Netherlands.
| | - H Beckerman
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; MS Center Amsterdam, Amsterdam, The Netherlands
| | - E H Collette
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - H Knoop
- Expert Centre for Chronic Fatigue, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Medical Psychology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - G Bleijenberg
- Expert Centre for Chronic Fatigue, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J W Twisk
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - J Dekker
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - V de Groot
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; MS Center Amsterdam, Amsterdam, The Netherlands
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Schuurhuizen CSEW, Braamse AMJ, Konings IRHM, Sprangers MAG, Ket JCF, Dekker J, Verheul HMW. Reply to the letter to the editor 'Specific QOL scales that reflect toxicity-induced impairment are needed in RCTs'. Ann Oncol 2018; 28:2033-2034. [PMID: 28838215 DOI: 10.1093/annonc/mdx234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C S E W Schuurhuizen
- Department of Medical Oncology, Cancer Center Amsterdam.,Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam
| | - A M J Braamse
- Department of Medical Psychology, Academic Medical Center, Amsterdam
| | | | - M A G Sprangers
- Department of Medical Psychology, Academic Medical Center, Amsterdam
| | - J C F Ket
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam
| | - J Dekker
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam.,Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - H M W Verheul
- Department of Medical Oncology, Cancer Center Amsterdam
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Zwart A, Dekker J, Lems W, Roorda L, Esch M, Leeden M. Factors associated with upper leg muscle strength in knee osteoarthritis: A scoping review. J Rehabil Med 2018; 50:140-150. [DOI: 10.2340/16501977-2284] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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38
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Driessen MJ, Dekker J, Lankhorst G, Van Der Zee J. Factors Affecting the Choice of Treatment in Occupational Therapy Practice in Hospital-based Care. Scand J Occup Ther 2017; 3:163-171. [DOI: 10.1080/11038128.1996.11933203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - J. Dekker
- Netherlands Institute of Primary Health Care, Utrecht
| | - G. Lankhorst
- Free University Hospital, Amsterdam, The Netherlands
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Elderman M, Sovran B, Hugenholtz F, Graversen K, Huijskes M, Houtsma E, Belzer C, Boekschoten M, de Vos P, Dekker J, Wells J, Faas M. The effect of age on the intestinal mucus thickness, microbiota composition and immunity in relation to sex in mice. PLoS One 2017; 12:e0184274. [PMID: 28898292 PMCID: PMC5595324 DOI: 10.1371/journal.pone.0184274] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 08/21/2017] [Indexed: 01/14/2023] Open
Abstract
A mucus layer covers and protects the intestinal epithelial cells from direct contact with microbes. This mucus layer not only prevents inflammation but also plays an essential role in microbiota colonization, indicating the complex interplay between mucus composition-microbiota and intestinal health. However, it is unknown whether the mucus layer is influenced by age or sex and whether this contributes to reported differences in intestinal diseases in males and females or with ageing. Therefore, in this study we investigated the effect of age on mucus thickness, intestinal microbiota composition and immune composition in relation to sex. The ageing induced shrinkage of the colonic mucus layer was associated with bacterial penetration and direct contact of bacteria with the epithelium in both sexes. Additionally, several genes involved in the biosynthesis of mucus were downregulated in old mice, especially in males, and this was accompanied by a decrease in abundances of various Lactobacillus species and unclassified Clostridiales type IV and XIV and increase in abundance of the potential pathobiont Bacteroides vulgatus. The changes in mucus and microbiota in old mice were associated with enhanced activation of the immune system as illustrated by a higher percentage of effector T cells in old mice. Our data contribute to a better understanding of the interplay between mucus-microbiota-and immune responses and ultimately may lead to more tailored design of strategies to modulate mucus production in targeted groups.
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Affiliation(s)
- Marlies Elderman
- Top Institute Food and Nutrition, Wageningen, the Netherlands
- Division of Medical Biology, department of Pathology and Medical Biology, University of Groningen, Groningen, the Netherlands
- * E-mail:
| | - Bruno Sovran
- Top Institute Food and Nutrition, Wageningen, the Netherlands
- Host-Microbe Interactomics Group, Wageningen University, Wageningen, the Netherlands
| | - Floor Hugenholtz
- Top Institute Food and Nutrition, Wageningen, the Netherlands
- Laboratory of Microbiology, Wageningen University and Research, Wageningen, the Netherlands
| | - Katrine Graversen
- Host-Microbe Interactomics Group, Wageningen University, Wageningen, the Netherlands
| | - Myrte Huijskes
- Host-Microbe Interactomics Group, Wageningen University, Wageningen, the Netherlands
| | - Eva Houtsma
- Division of Medical Biology, department of Pathology and Medical Biology, University of Groningen, Groningen, the Netherlands
| | - Clara Belzer
- Top Institute Food and Nutrition, Wageningen, the Netherlands
- Laboratory of Microbiology, Wageningen University and Research, Wageningen, the Netherlands
| | - Mark Boekschoten
- Top Institute Food and Nutrition, Wageningen, the Netherlands
- Nutrition, Metabolism and Genomics group, Wageningen University, Wageningen, the Netherlands
| | - Paul de Vos
- Top Institute Food and Nutrition, Wageningen, the Netherlands
- Division of Medical Biology, department of Pathology and Medical Biology, University of Groningen, Groningen, the Netherlands
| | - Jan Dekker
- Top Institute Food and Nutrition, Wageningen, the Netherlands
- Host-Microbe Interactomics Group, Wageningen University, Wageningen, the Netherlands
| | - Jerry Wells
- Top Institute Food and Nutrition, Wageningen, the Netherlands
- Host-Microbe Interactomics Group, Wageningen University, Wageningen, the Netherlands
| | - Marijke Faas
- Division of Medical Biology, department of Pathology and Medical Biology, University of Groningen, Groningen, the Netherlands
- Department of Obstetrics and Gynaecology, University of Groningen and University Medical Centre Groningen, Groningen, the Netherlands
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40
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van den Hoek J, Boshuizen HC, Roorda LD, Tijhuis GJ, Nurmohamed MT, Dekker J, van den Bos GAM. Association of Somatic Comorbidities and Comorbid Depression With Mortality in Patients With Rheumatoid Arthritis: A 14-Year Prospective Cohort Study. Arthritis Care Res (Hoboken) 2017; 68:1055-60. [PMID: 26663143 DOI: 10.1002/acr.22812] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 11/19/2015] [Accepted: 12/01/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Patients with rheumatoid arthritis (RA) have a significantly increased risk of mortality compared with the general population. One of the most important predictors for mortality is somatic comorbidity. Moreover, studies have demonstrated that comorbid depression is associated with mortality. Which specific comorbidities are associated with mortality is less investigated. The purpose of this study was to investigate the association of a wide range of comorbidities with mortality in patients with RA. METHODS Longitudinal data over a 14-year period were collected from 882 patients with RA. Data were assessed with questionnaires. The mortality status was obtained from the Statistics Netherlands for the period 1996-2011 for 99% of the patients. Somatic comorbidity was assessed in 1997, 1998, 1999, and 2008 and measured by a national population-based questionnaire including 20 chronic diseases. Comorbid depression was assessed in 1997, 1998, and 1999 and measured with the Center for Epidemiologic Studies Depression Scale. Cox regression was used to study the relationship between comorbidity and mortality. RESULTS At baseline, 72% of the patients were women. The mean ± SD age was 59.3 ± 14.8 years, and the median (interquartile range) disease duration was 5.0 (2.0-14.0) years. A total of 345 patients died during the study period. Comorbidities that were associated with mortality were circulatory conditions (hazard ratio [HR] 1.60 [95% confidence interval (95% CI) 1.15-2.22]), respiratory conditions (HR 1.43 [95% CI 1.09-1.89]), cancer (HR 2.00 [95% CI 1.28-3.12]), and depression (HR 1.35 [95% CI 1.06-1.72]). CONCLUSION Comorbid circulatory conditions, respiratory conditions, cancer, and depression are associated with mortality among patients with RA. Careful monitoring of these comorbidities during the course of the disease and adequate referral may improve health outcomes and chances of surviving.
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Affiliation(s)
- J van den Hoek
- Amsterdam Rehabilitation Research Center, Reade, and Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - H C Boshuizen
- National Institute of Public Health and the Environment, Bilthoven, Utrecht, and Wageningen University and Research Centre, Wageningen, The Netherlands
| | - L D Roorda
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
| | - G J Tijhuis
- Jan van Breeman Research Institute, Reade, Amsterdam, The Netherlands
| | - M T Nurmohamed
- Jan van Breeman Research Institute, Reade, Amsterdam, The Netherlands
| | - J Dekker
- Amsterdam Rehabilitation Research Center, Reade, and EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - G A M van den Bos
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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41
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Schuurhuizen C, Braamse A, Konings I, Sprangers M, Ket J, Dekker J, Verheul H. Does severe toxicity affect global quality of life in patients with metastatic colorectal cancer during palliative systemic treatment? A systematic review. Ann Oncol 2017; 28:478-486. [DOI: 10.1093/annonc/mdw617] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Wells JM, Brummer RJ, Derrien M, MacDonald TT, Troost F, Cani PD, Theodorou V, Dekker J, Méheust A, de Vos WM, Mercenier A, Nauta A, Garcia-Rodenas CL. Homeostasis of the gut barrier and potential biomarkers. Am J Physiol Gastrointest Liver Physiol 2017; 312:G171-G193. [PMID: 27908847 PMCID: PMC5440615 DOI: 10.1152/ajpgi.00048.2015] [Citation(s) in RCA: 342] [Impact Index Per Article: 48.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 11/09/2016] [Accepted: 11/19/2016] [Indexed: 02/07/2023]
Abstract
The gut barrier plays a crucial role by spatially compartmentalizing bacteria to the lumen through the production of secreted mucus and is fortified by the production of secretory IgA (sIgA) and antimicrobial peptides and proteins. With the exception of sIgA, expression of these protective barrier factors is largely controlled by innate immune recognition of microbial molecular ligands. Several specialized adaptations and checkpoints are operating in the mucosa to scale the immune response according to the threat and prevent overreaction to the trillions of symbionts inhabiting the human intestine. A healthy microbiota plays a key role influencing epithelial barrier functions through the production of short-chain fatty acids (SCFAs) and interactions with innate pattern recognition receptors in the mucosa, driving the steady-state expression of mucus and antimicrobial factors. However, perturbation of gut barrier homeostasis can lead to increased inflammatory signaling, increased epithelial permeability, and dysbiosis of the microbiota, which are recognized to play a role in the pathophysiology of a variety of gastrointestinal disorders. Additionally, gut-brain signaling may be affected by prolonged mucosal immune activation, leading to increased afferent sensory signaling and abdominal symptoms. In turn, neuronal mechanisms can affect the intestinal barrier partly by activation of the hypothalamus-pituitary-adrenal axis and both mast cell-dependent and mast cell-independent mechanisms. The modulation of gut barrier function through nutritional interventions, including strategies to manipulate the microbiota, is considered a relevant target for novel therapeutic and preventive treatments against a range of diseases. Several biomarkers have been used to measure gut permeability and loss of barrier integrity in intestinal diseases, but there remains a need to explore their use in assessing the effect of nutritional factors on gut barrier function. Future studies should aim to establish normal ranges of available biomarkers and their predictive value for gut health in human cohorts.
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Affiliation(s)
- Jerry M. Wells
- 1Host-Microbe Interactomics, Animal Sciences, Wageningen University, Wageningen, The Netherlands;
| | - Robert J. Brummer
- 2Nutrition-Gut-Brain Interactions Research Centre, School of Medicine and Health, Örebro University, Örebro, Sweden;
| | - Muriel Derrien
- 3Centre Daniel Carasso, Danone Research, Palaiseau, France;
| | - Thomas T. MacDonald
- 4Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Whitechapel, London, United Kingdom;
| | - Freddy Troost
- 5Division of Gastroenterology-Hepatology, Department of Internal Medicine, University Hospital Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands;
| | - Patrice D. Cani
- 6Louvain Drug Research Institute, WELBIO (Walloon Excellence in Life Sciences and BIOtechnology), Metabolism and Nutrition Research Group, Université Catholique de Louvain, Brussels, Belgium;
| | - Vassilia Theodorou
- 7Neuro-Gastroenterology and Nutrition Group, Institut National de la Recherche Agronomique, Toulouse, France;
| | - Jan Dekker
- 1Host-Microbe Interactomics, Animal Sciences, Wageningen University, Wageningen, The Netherlands;
| | | | - Willem M. de Vos
- 9Laboratory of Microbiology, Wageningen UR, Wageningen, The Netherlands;
| | - Annick Mercenier
- 10Institute of Nutritional Science, Nestlé Research Center, Lausanne, Switzerland; and
| | - Arjen Nauta
- 11FrieslandCampina, Amersfoort, The Netherlands
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Gottsäter M, Balkau B, Hatunic M, Gabriel R, Anderwald CH, Dekker J, Lalic N, Nilsson PM. Insulin resistance and β-cell function in smokers: results from the EGIR-RISC European multicentre study. Diabet Med 2017; 34:223-228. [PMID: 27334352 DOI: 10.1111/dme.13172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 01/08/2023]
Abstract
AIMS Tobacco smoking is known to increase the long-term risk of developing Type 2 diabetes mellitus, but the mechanisms involved are poorly understood. This observational, cross-sectional study aims to compare measures of insulin sensitivity and β-cell function in current, ex- and never-smokers. METHODS The study population included 1246 people without diabetes (mean age 44 years, 55% women) from the EGIR-RISC population, a large European multicentre cohort. Insulin sensitivity was measured using a hyperinsulinaemic, euglycaemic clamp and the homeostatic model assessment - insulin resistance (HOMA-IR) index. Two β-cell function parameters were derived from measures during an oral glucose tolerance test: the early insulin response index and β-cell glucose sensitivity. Additionally, the areas under the curve during the oral glucose tolerance test were calculated for glucose, insulin and C-peptide. RESULTS According to smoking habits, there were differences in insulin sensitivity, which was lower in women who smoked, and in β-cell glucose sensitivity, which was lower in men who smoked, but these associations lost significance after adjustment. However, after adjustment, the areas under the glucose and the C-peptide curves during the oral glucose tolerance test were significantly higher in men who smoked. CONCLUSIONS Smoking habits were not independently associated with insulin sensitivity or β-cell function in a healthy middle-aged European population. Health-selection bias, methodological shortcomings or a true lack of causal links between smoking and impaired insulin sensitivity/secretion are possible explanations. The mechanisms behind the observed increased glucose and C-peptide areas under the curve during the oral glucose tolerance test in male smokers need to be further evaluated.
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Affiliation(s)
- M Gottsäter
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - B Balkau
- INSERM U-1018, CESP, Team5 (EpReC, Renal and Cardiovascular Epidemiology), Villejuif, France
| | - M Hatunic
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - R Gabriel
- Instituto de Investigación Princesa IP, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - C-H Anderwald
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
- Metabolic Unit, Institute of Biomedical Engineering, Padua, Italy
- Mariahilf Community Pharmacy, Arnoldstein, Austria
| | - J Dekker
- Department of Epidemiology and Biostatistics, VU Medical Centre, Amsterdam, The Netherlands
- EMGO+ Institute for Health and Care Research, VU Medical Centre, Amsterdam, The Netherlands
| | - N Lalic
- University of Belgrade, Clinic for Endocrinology, Diabetes and Metabolic Diseases, Belgrade, Serbia
| | - P M Nilsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
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Fassaert T, Heijnen H, de Wit MAS, Peen J, Beekman ATF, Dekker J. The association between ethnic background and characteristics of first mental health treatment for psychotic disorders in the Netherlands between 2001 and 2005. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1591-1601. [PMID: 27333981 DOI: 10.1007/s00127-016-1248-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To test the hypothesis that ethnic minority status of patients is associated with specific psychotic disorder treatment characteristics. METHODS Longitudinal data (2001-2005) were extracted from a nationwide psychiatric case register in the Netherlands. The sample consisted of 30,655 episodes of mental health treatment for 23,122 patients with psychotic disorders. Information was available about waiting time and treatment duration, source of referral, occurrence of crisis contacts, admittance to clinical care and compulsory admissions. In addition, information was available about ethnicity (based on country of birth), gender, age and marital status. Results were calculated for ethnic and gender groups separately. In addition, a number of multivariate regression analyses were conducted to correct for differences in age and marital status. RESULTS There was substantial variation between ethnic minority and gender groups in relation to the treatment characteristics. Compared with a Dutch ethnic background, ethnic minority background was generally associated with less waiting time, and more police referrals, crisis contacts, admittance to clinical care and compulsory admission, but shorter treatment duration. Characteristics appeared to be least favorable in episodes that involved male patients with Antillean and Surinamese backgrounds, whereas episodes were quite similar for ethnic Dutch and Turkish patients. CONCLUSIONS Characteristics of mental health treatment for psychosis in the Netherlands are different for ethnic minority patient groups than for patients with an ethnic Dutch background. However, there were substantial differences between ethnic minority groups.
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Affiliation(s)
- T Fassaert
- Department of Community Mental Health Care (MGGZ), Public Health Service Amsterdam, Nieuwe Achtergracht 100, P.O. Box 2200, 1000 CE, Amsterdam, The Netherlands.
| | - H Heijnen
- Heijnen Organisatieadviseurs, Amsterdam, The Netherlands
| | - M A S de Wit
- Department of Epidemiology and Health Promotion, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - J Peen
- Arkin, Amsterdam, The Netherlands
| | - A T F Beekman
- Department of Psychiatry, VU University, Amsterdam, The Netherlands.,GGZ inGeest, Amsterdam, The Netherlands
| | - J Dekker
- Arkin, Amsterdam, The Netherlands.,Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
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Kloek C, Bossen D, de Bakker D, Dekker J, Veenhof C. Blended intervention with reduced face-to-face contact and usual physiotherapy show similar effectiveness in patients with osteoarthritis: a randomized controlled trial. Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Poerbodipoero S, Steultjens M, Van Der Beek A, Dekker J. Pain, Disability in Daily Activities and Work Participation in Patients with Traumatic Hand Injury. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/175899830701200201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Traumatic hand injuries are represented in a large proportion of the patients treated at the out-patient department of occupational therapy in the VU University Medical Centre, Amsterdam. Most of the patients are referred to occupational therapy by specialists in the hospital. Information about the course of traumatic hand injuries regarding performance of daily activities is still limited. Research, focused on problems experienced by patients with hand injuries, may contribute to a better understanding of the course and rehabilitation of traumatic hand injuries. This article is a report of a cross-sectional observational study with the objective to: 1) describe the impact of traumatic injuries of the hand on daily activities and work participation six months after injury 2) to analyse the impact of demographic characteristics and type and severity of the injury on pain and ability to perform daily activities, and 3) to analyse the impact of demographic characteristics and type and severity of the injury on work participation and time off work (TOW). Fifty-eight patients completed a questionnaire six months after injury. The Disability of Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate disability in daily activities. A Numeric Rating Scale (NRS) was used to evaluate pain. Patients showed a mean DASH score of 22.5 (±19.3). The experience of pain and ethnicity were predictors of disability (p<0.001). The average TOW was 10.3 weeks (± 8.3). There was a significant difference (p=0.005) in TOW between Dutch patients (7.6 ± 5.8) and patients of another ethnicity (20.0 ± 8.9). Despite the reported disabilities in performing daily activities, almost all patients (91%) returned to their occupations within six months after hand injury. It is suggested that, for optimal rehabilitation, it may be necessary to focus more attention on the cultural background of the patients and the problems experienced in daily activities. Integration of evaluative instruments in hand therapy practice is advocated to guide therapy sessions, to measure outcome and to anticipate long-term problems in daily activities in an early stage of treatment.
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Affiliation(s)
- Sj Poerbodipoero
- Department of Rehabilitation Medicine, Department of Occupational Therapy, VU University Medical Centre, Amsterdam, The Netherlands
| | - Mpm Steultjens
- Department of Rehabilitation Medicine, EMGO Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - Aj Van Der Beek
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands, Body@Work, Research Center Physical Activity, Work and Health, TNO VUmc Amsterdam, The Netherlands
| | - J Dekker
- Department of Rehabilitation Medicine, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
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47
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van Heugten C, Dekker J, Deelman B, Stehmann-Saris J, Kinebanian A. Assessment of Disabilities in Stroke Patients with Apraxia: Internal Consistency and Inter-Observer Reliability. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153944929901900104] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In this paper the internal consistency and inter-observer reliability of the assessment of disabilities in stroke patients with apraxia is presented. Disabilities were assessed by means of observation of activities of daily living (ADL). The study was conducted at occupational therapy departments in general hospitals, rehabilitation centers and nursing homes in the Netherlands. Patients (n=42) diagnosed to have had a stroke in the left hemisphere and to have apraxia as well, participated in the study (48% male, aged 39–91). Guidelines were offered for the ADL-observation and the assessment of disabilities in these activities. The internal consistency of the scales is expressed by means of Cronbach's alpha and Mokken-scale analysis. The inter-observer reliability is expressed by means of percentage of agreement between two observers, Cohen's kappa and the intra-class correlation coefficient (ICC). The internal consistency of the observations is good: alpha is high (0.94). The Mokken-analysis confirms this finding: an H-coefficient of 0.58 and corresponding rho of 0.94 indicate a strong and reliable scale composed of the set of all ADL-observations. Results indicate that the inter-observer reliability can be considered fair to good: all kappa values were higher than 0.44; the maximum kappa was 0.95. Percentages of agreement vary between 60% and 96%. The ICC range from 0.62 to 0.98. The results of this study imply that the ADL-observations can be considered an internally consistent and reliable instrument for the assessment of disabilities in stroke patients with apraxia.
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Abstract
Objective: To assess the reproducibility (reliability and inter-rater agreement) of the client-centred Canadian Occupational Performance Measure (COPM). Design: The COPM was administered twice, with a mean interval of seven days (SD 1.6, range 4-14), by two different occupational therapists. Data analysis was based on intraclass correlation coefficients, the Bland and Altman method and Cohen's weighted kappas. Setting: Occupational therapy departments of two university medical centres. Subjects: Consecutive clients, with various diagnoses, newly referred to the outpatient clinic of two occupational therapy departments, were included. They were all over 18 years of age and perceived limitations in more than one activity of daily life. Complete data on 95 clients were obtained: 31 men and 64 women. Results: Sixty-six per cent of the activities prioritized at the first assessment were also prioritized at the second assessment. The intraclass correlation coefficients were 0.67 (95% confidence interval (CI) 0.54-0.78) for the mean performance score and 0.69 (95% CI 0.56-0.79) for the mean satisfaction score. The limits of agreement were-2.5 to 2.4 for the mean performance score and-2.3 to 2.7 for the mean satisfaction score. For the separate prioritized problems, the weighted kappas ranged from 0.37 to 0.49. Conclusions: Inter-rater agreement of the prioritized problems was moderate. The reproducibility of the mean performance and satisfaction scores was moderate, but it was poor for the scores of the separate problems. Therefore, the mean scores should be used for individual assessment.
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Affiliation(s)
- I C J M Eyssen
- Department of Occupational Therapy, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
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Kloek C, Bossen D, de Bakker D, Dekker J, Veenhof C. SAT0432 Blended Physical Activity Intervention with Reduced Face-To-Face Contact and Usual Physical Therapy Show Similar Effectiveness in Patients with Knee and Hip Osteoarthritis: A Randomized Controlled Trial. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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50
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De Rooij M, van der Leeden M, Cheung J, van der Esch M, Arja Häkkinen A, Haverkamp D, Roorda L, Twisk J, Vollebregt J, Lems W, Dekker J. OP0062-HPR Efficacy of Tailored Exercise Therapy in Patients with Knee Osteoarthritis and Comorbidity: A Randomized Controlled Trial. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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