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Vints WAJ, Gökçe E, Šeikinaitė J, Kušleikienė S, Česnaitienė VJ, Verbunt J, Levin O, Masiulis N. Resistance training's impact on blood biomarkers and cognitive function in older adults with low and high risk of mild cognitive impairment: a randomized controlled trial. Eur Rev Aging Phys Act 2024; 21:9. [PMID: 38600451 PMCID: PMC11005144 DOI: 10.1186/s11556-024-00344-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 03/30/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND The aging brain exhibits a neuroinflammatory state, driven partly by peripheral pro-inflammatory stimuli, that accelerates cognitive deterioration. A growing body of evidence clearly indicates that physical exercise partly alleviates neuroinflammation and positively affects the aging process and cognition. In this randomized controlled trial, we aimed to observe the effect of 12 weeks of resistance training (RT) on peripheral biomarker levels, cognitive function changes and their interrelationship, and explore differences in those exercise-induced changes in older adults with high risk of mild cognitive impairment (MCI) compared to older adults with low risk of MCI. METHODS Fifty-two participants (aged 60-85 years old, 28 female) were randomly allocated to a 12 week lower limb RT program consisting of two training sessions per week or waiting list control group. The Montreal Cognitive Assessment (MoCA) was used to stratify participants screened as high (< 26/30) or low risk (≥ 26/30) of MCI. We assessed serum Interleukin 6 (IL-6), Insulin-like Growth Factor-1 (IGF-1), and Kynurenine (KYN) levels. Cognitive measurement consisted of and four subtests of Automated Neuropsychological Assessment Metrics (ANAM), the two-choice reaction time, go/no-go, mathematical processing, and memory search test. RESULTS Twelve weeks of RT improved Go/No-go test results in older adults with high MCI risk. RT did not significantly affect blood biomarkers. However, IGF-1 level increases were associated with improvements in response time on the mathematical processing test in the exercise group, and IL-6 level increases were associated with improvements in response time on the memory search test in the total group of participants. Finally, KYN levels significantly differed between older adults with low and high MCI risk but no significant associations with performance were found. CONCLUSION Our study results suggest a different effect of RT on inhibitory control between older adults with low compared to high MCI risk. IGF-1 may play a role in the mechanism behind the cognitive benefit of RT and KYN may be a surrogate biomarker for neurodegeneration and cognitive decline.
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Affiliation(s)
- Wouter A J Vints
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, Sporto Str. 6, 44221, Kaunas, Lithuania.
- Department of Rehabilitation Medicine Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.
- Centre of Expertise in Rehabilitation and Audiology, Adelante Zorggroep, Hoensbroek, The Netherlands.
| | - Evrim Gökçe
- Sports Rehabilitation Laboratory, Ankara City Hospital, 06800, Ankara, Turkey
| | - Julija Šeikinaitė
- Department of Rehabilitation, Physical and Sports Medicine, Institute of Health Science, Vilnius University, Vilnius, Lithuania
| | - Simona Kušleikienė
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, Sporto Str. 6, 44221, Kaunas, Lithuania
| | - Vida J Česnaitienė
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, Sporto Str. 6, 44221, Kaunas, Lithuania
| | - Jeanine Verbunt
- Department of Rehabilitation Medicine Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Adelante Zorggroep, Hoensbroek, The Netherlands
| | - Oron Levin
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, Sporto Str. 6, 44221, Kaunas, Lithuania
- Department of Imaging and Pathology, Group Biomedical Sciences, Biomedical MRI Unit, Catholic University Leuven, Leuven, Belgium
| | - Nerijus Masiulis
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, Sporto Str. 6, 44221, Kaunas, Lithuania
- Department of Rehabilitation, Physical and Sports Medicine, Institute of Health Science, Vilnius University, Vilnius, Lithuania
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Verbrugghe J, Agten A, Stevens S, Vandenabeele F, Roussel N, Verbunt J, Goossens N, Timmermans A. High intensity training improves symptoms of central sensitization at six-month follow-up in persons with chronic nonspecific low back pain: Secondary analysis of a randomized controlled trial. Braz J Phys Ther 2023; 27:100496. [PMID: 36963161 PMCID: PMC10060179 DOI: 10.1016/j.bjpt.2023.100496] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 09/22/2022] [Accepted: 02/22/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND High intensity training (HIT) improves disability and physical fitness in persons with chronic nonspecific low back pain (CNSLBP). However, it remains unclear if HIT affects pain processing and psychosocial factors. OBJECTIVE To evaluate 1) the effects of HIT on symptoms of central sensitization and perceived stress and 2) the relationship of symptoms of central sensitization and perceived stress with therapy success, at six-month follow-up, in persons with CNSLBP. METHODS This is a secondary analysis of a previously published randomized controlled trial. Persons with CNSLBP (n = 51, age=43.6y) completed the Central Sensitization Inventory (CSI) and Perceived Stress Scale (PSS) at baseline (PRE) and six months after 12-week of HIT consisting of concurrent exercise therapy (FU). Two groups were formed based on CSI scores (low-CSI/high-CSI). First, linear mixed models were fitted for each outcome, with time and groups as covariates. Multiple comparisons were executed to evaluate group (baseline), time (within-group), and interaction (between-group) effects. Second, correlation and regression analyses were performed to evaluate if baseline and changes in CSI/PSS scores were related to therapy success, operationalized as improvements on disability (Modified Oswestry Disability Index), and pain intensity (Numeric Pain Rating Scale). RESULTS Total sample analyses showed a decrease in both CSI and PSS. Within-group analyses showed a decrease of CSI only in the high-CSI group and a decrease of PSS only in the low-CSI group. Between-group analyses showed a pronounced decrease favouring high-CSI (mean difference: 7.9; 95%CI: 2.1, 12.7) and no differences in PSS (mean difference: 0.1; 95%CI: -3.0, 3.2). CSI, but not PSS, was weakly related to therapy success. CONCLUSION HIT improves symptoms of central sensitization in persons with CNSLBP. This effect is the largest in persons with clinically relevant baseline CSI scores. HIT also decreases perceived stress.
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Affiliation(s)
- Jonas Verbrugghe
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.
| | - Anouk Agten
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Sjoerd Stevens
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Frank Vandenabeele
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Nathalie Roussel
- Faculty of Medicine and Health Sciences (MOVANT), University of Antwerp, Antwerp, Belgium
| | - Jeanine Verbunt
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands; Department of Rehabilitation Medicine, Maastricht University, Maastricht, Netherlands
| | - Nina Goossens
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Annick Timmermans
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
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Elmanowski J, Seelen H, Geers R, Kleynen M, Verbunt J. Effects of a remote-handling-concept-based task-oriented arm training (ReHab-TOAT) on arm-hand skill performance in chronic stroke: a study protocol for a two-armed randomized controlled trial. Trials 2023; 24:189. [PMID: 36918922 PMCID: PMC10012705 DOI: 10.1186/s13063-023-07139-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/18/2022] [Accepted: 02/07/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Improving arm-hand skill performance is a major therapeutic target in stroke rehabilitation and needs intensive and varied training. However, guided treatment time is limited. Technology can assist in the training of patients, offering a higher intensity and more variety in content. A new task-oriented arm training approach was developed, using a 'Remote Handling concept based' device to provide haptic feedback during the performance of daily living activities (ReHab-TOAT). This study aims to investigate the effects of ReHab-TOAT on patients' arm-hand function and arm-hand skill performance, quality of life of both patients in the chronic phase after stroke and their caregivers and the patients' perception regarding the usability of the intervention. METHODS A randomized clinical trial was designed. Adult chronic stroke patients suffering from hemiparesis and arm-hand problems, with an Utrechtse Arm-hand Test score of 1-3, will be invited to participate. Participants in the experimental group receive ReHab-TOAT additional to care as usual. ReHab-TOAT contains task-oriented arm training for stroke patients in combination with haptic feedback, generated by a remote handling device. They will train for 4 weeks, 3× per week, 1.5h per day. Participants in the control group will receive no additional therapy apart from care as usual. The Fugl-Meyer Assessment (FMA), measuring participants' motor performance of the affected arm, is used as the primary outcome measure. Secondary outcome measures are arm-hand capacity of the patient (ARAT), perceived arm-hand skill performance (MAL), actual arm-hand skill performance (accelerometry), patients' quality of life (EuoQol-5D) and caregivers' quality of life (CarerQoL). Participants' perception regarding the usability of the intervention, including both the developed approach and technology used, will be evaluated by the System Usability Scale and a questionnaire on the user experience of technology. Measurements will be performed at 1, 2, 3 and 4 weeks pre-intervention (baseline); immediately post-intervention; and 3, 6 and 9 months post-intervention. Statistical analysis includes linear mixed model analysis. DISCUSSION This study is designed to investigate the evidence regarding the effects of ReHab-TOAT on patients' performance at different levels of the International Classification of Functioning, disability and health (ICF) model, i.e. a framework measuring functioning and disability in relation to a health condition, and to provide insights on a successful development and research process regarding technology-assisted training in co-creation. TRIAL REGISTRATION Netherlands Trial Register NL9541. Registered on June 22, 2021.
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Affiliation(s)
- Jule Elmanowski
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands. .,Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands. .,Adelante Rehabilitation Centre, Hoensbroek, the Netherlands.
| | - Henk Seelen
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Richard Geers
- Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Melanie Kleynen
- Research Centre for Nutrition, Lifestyle and Exercise, Faculty of Health, Zuyd University of Applied Sciences, Heerlen, the Netherlands
| | - Jeanine Verbunt
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
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Vints WA, Kušleikienė S, Sheoran S, Valatkevičienė K, Gleiznienė R, Himmelreich U, Pääsuke M, Česnaitienė VJ, Levin O, Verbunt J, Masiulis N. Body fat and components of sarcopenia relate to inflammation, brain volume and neurometabolism in older adults. Neurobiol Aging 2023; 127:1-11. [PMID: 37004309 DOI: 10.1016/j.neurobiolaging.2023.02.011] [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] [Received: 08/10/2022] [Revised: 12/27/2022] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
Abstract
Obesity and sarcopenia are associated with cognitive impairments at older age. Current research suggests that blood biomarkers may mediate this body-brain crosstalk, altering neurometabolism and brain structure eventually resulting in cognitive performance changes. Seventy-four older adults (60-85 years old) underwent bio-impedance body composition analysis, handgrip strength measurements, 8-Foot Up-and-Go (8UG) test, Montreal Cognitive Assessment (MoCA), blood analysis of interleukin-6 (IL-6), kynurenine, and insulin-like growth factor-1 (IGF-1), as well as brain magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (1H-MRS), estimating neurodegeneration and neuroinflammation. Normal fat% or overweight was associated with larger total gray matter volume compared to underweight or obesity in older adults and obesity was associated with higher N-acetylaspartate/Creatine levels in the sensorimotor and dorsolateral prefrontal cortex. Muscle strength, not muscle mass/physical performance, corresponded to lower kynurenine and higher N-acetylaspartate/Creatine levels in the dorsal posterior cingulate and dorsolateral prefrontal cortex. The inflammatory and neurotrophic blood biomarkers did not significantly mediate these body-brain associations. This study used a multimodal approach to comprehensively assess the proposed mechanism of body-brain crosstalk.
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van Gils P, van Heugten C, Sep S, Moulaert V, Hofmeijer J, Verbunt J. A change of perspective? An explorative study on why patients may not subjectively report cognitive impairments after a cardiac arrest. Resuscitation 2022; 180:59-63. [PMID: 36185035 DOI: 10.1016/j.resuscitation.2022.09.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/20/2022]
Abstract
AIM Cardiac arrest survivors are at risk of long-term cognitive impairment. Patients with cognitive impairments do not always have cognitive complaints and vice versa. Not reporting cognitive complaints could be caused by a lack of awareness. We hypothesized that caregivers report more cognitive failures than patients, indicating patients' lack of insight into cognitive functioning. METHODS This is a secondary analysis of the Activity and Life After Survival of Cardiac Arrest study on survivors of cardiac arrest and their caregivers. They were assessed at two weeks, three months, and one year after cardiac arrest. At each time point, the patient and the caregiver filled out the cognitive failure questionnaire (CFQ) regarding the patient. We analysed the correlation, intraclass correlation, and self-proxy discrepancy between patients and caregivers on the CFQ over time. RESULTS One-hundred-and-nineteen cardiac arrest survivors (mean age = 60, 85 % male) and their caregivers were included. The CFQ scores of the patients and caregivers were equally low. The correlation (T1 r = 0.31; T2 r = 0.40; T3 r = 0.55) and intraclass correlation (T1 r = 0.48; T2 r = 0.56; T3 r = 0.71) between patient and caregiver increased over time. CONCLUSION This study does not support a lack of awareness of cognitive impairments by long-term cardiac arrest survivors. Future research may focus on alternative explanations for why patients have less cognitive complaints than expected based on the frequency of cognitive impairments. Possible explanations include a response shift.
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Affiliation(s)
- Pauline van Gils
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Clinical Neurophysiology (CNPH), TechMed Centre, University of Twente, Enschede, the Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands.
| | - Caroline van Heugten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands; Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Simone Sep
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands; Department of Rehabilitation Medicine, Maastricht University Medical Centre, Maastricht, the Netherland; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Véronique Moulaert
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Jeannette Hofmeijer
- Clinical Neurophysiology (CNPH), TechMed Centre, University of Twente, Enschede, the Netherlands; Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Jeanine Verbunt
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands; Department of Rehabilitation Medicine, Maastricht University Medical Centre, Maastricht, the Netherland; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
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Armand S, Wagner MK, Ozenne B, Verbunt J, Sep SJS, Berg SK, Knudsen GM, Stenbæk DS. Acute Traumatic Stress Screening Can Identify Patients and Their Partners at Risk for Posttraumatic Stress Disorder Symptoms After a Cardiac Arrest: A Multicenter Prospective Cohort Study. J Cardiovasc Nurs 2022; 37:394-401. [PMID: 37707973 DOI: 10.1097/jcn.0000000000000829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is prevalent in patients who have had a cardiac arrest and their partners. Accordingly, acute traumatic stress screening is recommended, but its association with later PTSD symptoms has never been addressed in postresuscitation settings. OBJECTIVE The aim of this study was to examine whether acute traumatic stress is associated with PTSD symptoms in patients who have had a cardiac arrest and their partners. METHODS This multicenter longitudinal study of 141 patients and 97 partners measures acute traumatic stress at 3 weeks and PTSD symptoms at 3 months and 1 year after resuscitation, using the Impact of Event Scale. Linear regression models were used to evaluate the association between severity of acute traumatic stress and PTSD symptoms and post hoc to explore effects of group (patients/partners), age, and sex on acute traumatic stress severity. We categorized Impact of Event Scale scores higher than 26 at 3 months and 1 year as clinical severe PTSD symptoms . RESULTS Higher acute traumatic stress severity is significantly positively associated with higher PTSD symptom severity at 3 months (patients and partners: P < .001) and 1 year (patients and partners: P < .001) postresuscitation, with the strongest association for women compared with men ( P = .03). Acute traumatic stress was higher in women compared with men across groups ( P = .02). Clinical severe PTSD symptoms were present in 26% to 28% of patients and 45% to 48% of partners. CONCLUSION Experiencing a cardiac arrest may elicit clinical severe PTSD symptoms in patients, but particularly in their partners. Screening patients and partners for acute traumatic stress postresuscitation is warranted to identify those at increased risk of long-term PTSD symptoms.
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Vints WAJ, Levin O, Fujiyama H, Verbunt J, Masiulis N. Exerkines and long-term synaptic potentiation: Mechanisms of exercise-induced neuroplasticity. Front Neuroendocrinol 2022; 66:100993. [PMID: 35283168 DOI: 10.1016/j.yfrne.2022.100993] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 06/16/2021] [Revised: 03/03/2022] [Accepted: 03/06/2022] [Indexed: 01/30/2023]
Abstract
Physical exercise may improve cognitive function by modulating molecular and cellular mechanisms within the brain. We propose that the facilitation of long-term synaptic potentiation (LTP)-related pathways, by products induced by physical exercise (i.e., exerkines), is a crucial aspect of the exercise-effect on the brain. This review summarizes synaptic pathways that are activated by exerkines and may potentiate LTP. For a total of 16 exerkines, we indicated how blood and brain exerkine levels are altered depending on the type of physical exercise (i.e., cardiovascular or resistance exercise) and how they respond to a single bout (i.e., acute exercise) or multiple bouts of physical exercise (i.e., chronic exercise). This information may be used for designing individualized physical exercise programs. Finally, this review may serve to direct future research towards fundamental gaps in our current knowledge regarding the biophysical interactions between muscle activity and the brain at both cellular and system levels.
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Affiliation(s)
- Wouter A J Vints
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, Sporto str. 6, LT-44221 Kaunas, Lithuania; Department of Rehabilitation Medicine Research School CAPHRI, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands; Centre of Expertise in Rehabilitation and Audiology, Adelante Zorggroep, P.O. Box 88, 6430 AB Hoensbroek, the Netherlands.
| | - Oron Levin
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, Sporto str. 6, LT-44221 Kaunas, Lithuania; Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, Catholic University Leuven, Tervuursevest 101, 3001 Heverlee, Belgium.
| | - Hakuei Fujiyama
- Department of Psychology, Murdoch University, 90 South St., WA 6150 Perth, Australia; Centre for Healthy Ageing, Health Futures Institute, Murdoch University, 90 South St., WA 6150 Perth, Australia; Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, 90 South St., WA 6150 Perth, Australia.
| | - Jeanine Verbunt
- Department of Rehabilitation Medicine Research School CAPHRI, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands; Centre of Expertise in Rehabilitation and Audiology, Adelante Zorggroep, P.O. Box 88, 6430 AB Hoensbroek, the Netherlands.
| | - Nerijus Masiulis
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, Sporto str. 6, LT-44221 Kaunas, Lithuania; Department of Rehabilitation, Physical and Sports Medicine, Institute of Health Science, Faculty of Medicine, Vilnius University, M. K. Čiurlionio Str. 21, LT-03101 Vilnius, Lithuania.
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Klaps S, Haesevoets S, Verbunt J, Köke A, Janssens L, Timmermans A, Verbrugghe J. The Influence of Exercise Intensity on Psychosocial Outcomes in Musculoskeletal Disorders: A Systematic Review. Sports Health 2022; 14:859-874. [PMID: 35243924 PMCID: PMC9631039 DOI: 10.1177/19417381221075354] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT Psychosocial parameters play an important role in the onset and persistence of chronic musculoskeletal disorders (CMSDs). Exercise therapy is a valuable therapeutic modality as part of CMSD rehabilitation. Hereby, exercise intensity is an important factor regarding changes in pain and disability in multiple CMSDs. However, the impact of exercise intensity on psychosocial outcomes remains poorly explored. OBJECTIVE To identify the effects of different modes of exercise intensity on psychosocial outcomes in persons with CMSDs. DATA SOURCES A systematic search was conducted up to November 2020 using the following databases: PubMed/MEDline, PEDro, Cochrane Library, and Web of Science. STUDY SELECTION Studies reporting exercise therapy in CMSDs with a predefined display of exercise intensity and an evaluation of at least 1 psychosocial outcome were included. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 2a. DATA EXTRACTION Data regarding demographics, exercise intensity, and psychosocial outcomes were included in a descriptive analysis. Methodological quality was assessed using the PEDro scale and Critical Appraisal Skills Programme (CASP) checklist. RESULTS A total of 22 studies, involving 985 participants (with fibromyalgia, chronic low back pain, knee osteoarthritis, psoriatic arthritis, and axial spondyloarthritis) were included (mean PEDro score = 5.77/10). The most common psychosocial outcomes were quality of life (QoL) (n = 15), depression (n = 10), and anxiety (n = 9). QoL improved at any exercise intensity in persons with fibromyalgia. However, persons with fibromyalgia benefit more from exercising at low to moderate intensity regarding anxiety and depression. In contrast, persons with chronic low back pain benefit more from exercising at a higher intensity regarding QoL, anxiety, and depression. Other CMSDs only showed limited or conflicting results regarding the value of certain exercise intensities. CONCLUSION Psychosocial outcomes are influenced by the intensity of exercise therapy in fibromyalgia and chronic low back pain, but effects differ across other CMSDs. Future research is necessary to determine the exercise intensity that yields optimal exercise therapy outcomes in specific CMSDs.
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Affiliation(s)
- Sim Klaps
- REVAL–Rehabilitation Research Centre,
Hasselt University, Hasselt, Belgium
| | - Sarah Haesevoets
- REVAL–Rehabilitation Research Centre,
Hasselt University, Hasselt, Belgium
| | - Jeanine Verbunt
- Adelante Centre of Expertise in
Rehabilitation and Audiology, Hoensbroek, the Netherlands,Department of Rehabilitation Medicine,
Maastricht University, Maastricht, the Netherlands
| | - Albère Köke
- Adelante Centre of Expertise in
Rehabilitation and Audiology, Hoensbroek, the Netherlands,Department of Rehabilitation Medicine,
Maastricht University, Maastricht, the Netherlands
| | - Lotte Janssens
- REVAL–Rehabilitation Research Centre,
Hasselt University, Hasselt, Belgium,Adelante Centre of Expertise in
Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Annick Timmermans
- REVAL–Rehabilitation Research Centre,
Hasselt University, Hasselt, Belgium,Adelante Centre of Expertise in
Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Jonas Verbrugghe
- REVAL–Rehabilitation Research Centre,
Hasselt University, Hasselt, Belgium,Adelante Centre of Expertise in
Rehabilitation and Audiology, Hoensbroek, the Netherlands,Jonas Verbrugghe, PhD, PT,
Faculty of Rehabilitation Sciences, Hasselt University, REVAL, Gebouw A,
Agoralaan 5, 3590, Diepenbeek, Belgium (
) (Twitter: @VerbruggheJonas)
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van Die-de Vries J, Verbunt J, Ramaekers S, Calders P, Engelbert R. Generalized Joint Hypermobility and Anxiety Are Serious Risk Factors for Dysfunctioning in Dance Students: A One-Year Follow-Up Study. Int J Environ Res Public Health 2022; 19:ijerph19052662. [PMID: 35270355 PMCID: PMC8910411 DOI: 10.3390/ijerph19052662] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/14/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022]
Abstract
Young professional dancers find themselves in a demanding environment. GJH within dancers is often seen as aesthetically beneficial and a sign of talent but was found to be potentially disabling. Moreover, high-performing adolescents and young adults (HPAA), in this specific lifespan, might be even more vulnerable to anxiety-related disability. Therefore, we examined the development of the association between the presence of Generalized Joint Hypermobility (GJH) and anxiety within HPAA with a one-year follow-up. In 52.3% of the HPAA, anxiety did not change significantly over time, whereas GJH was present in 28.7%. Fatigue increased significantly in all HPAA at one year follow-up (respectively, females MD (SD) 18(19), p < 0.001 and males MD (SD) 9(19), p < 0.05). A significantly lower odds ratio (ß (95% CI) 0.4 (0.2−0.9); p-value 0.039) for participating in the second assessment was present in HPAA with GJH and anxiety with a 55% dropout rate after one year. This confirms the segregation between GJH combined with anxiety and GJH alone. The fatigue levels of all HPAA increased significantly over time to a serious risk for sick leave and work disability. This study confirms the association between GJH and anxiety but especially emphasizes the disabling role of anxiety. Screening for anxiety is relevant in HPAA with GJH and might influence tailored interventions.
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Affiliation(s)
- Janneke van Die-de Vries
- School of Physiotherapie, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands;
- Department of Rehabilitation, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam Movement Sciences, 1105 AZ Amsterdam, The Netherlands;
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands
- Correspondence: ; Tel.: +31-6-1320-89-96
| | - Jeanine Verbunt
- Department of Rehabilitation Medicine, CAPHRI, Functioning and Rehabilitation, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands;
- Adelante Center of Expertise in Rehabilitation and Audiology, 6432 CC Hoensbroek, The Netherlands
| | - Stephan Ramaekers
- School of Physiotherapie, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands;
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands
| | - Patrick Calders
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium;
| | - Raoul Engelbert
- Department of Rehabilitation, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam Movement Sciences, 1105 AZ Amsterdam, The Netherlands;
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands
- Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Emma Children’s Hospital, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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10
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Vints WAJ, Kušleikiene S, Sheoran S, Šarkinaite M, Valatkevičiene K, Gleizniene R, Kvedaras M, Pukenas K, Himmelreich U, Cesnaitiene VJ, Levin O, Verbunt J, Masiulis N. Inflammatory Blood Biomarker Kynurenine Is Linked With Elevated Neuroinflammation and Neurodegeneration in Older Adults: Evidence From Two 1H-MRS Post-Processing Analysis Methods. Front Psychiatry 2022; 13:859772. [PMID: 35479493 PMCID: PMC9035828 DOI: 10.3389/fpsyt.2022.859772] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 01/21/2022] [Accepted: 03/11/2022] [Indexed: 12/21/2022] Open
Abstract
RATIONALE AND OBJECTIVES Pro-inflammatory processes have been argued to play a role in conditions associated with cognitive decline and neurodegeneration, like aging and obesity. Only a limited number of studies have tried to measure both peripheral and central biomarkers of inflammation and examined their interrelationship. The primary aim of this study was to examine the hypothesis that chronic peripheral inflammation would be associated with neurometabolic changes that indicate neuroinflammation (the combined elevation of myoinositol and choline), brain gray matter volume decrease, and lower cognitive functioning in older adults. MATERIALS AND METHODS Seventy-four older adults underwent bio-impedance body composition analysis, cognitive testing with the Montreal Cognitive Assessment (MoCA), blood serum analysis of inflammatory markers interleukin-6 (IL-6) and kynurenine, magnetic resonance imaging (MRI), and proton magnetic resonance spectroscopy (1H-MRS) of the brain. Neurometabolic findings from both Tarquin and LCModel 1H-MRS post-processing software packages were compared. The regions of interest for MRI and 1H-MRS measurements were dorsal posterior cingulate cortex (DPCC), left hippocampal cortex (HPC), left medial temporal cortex (MTC), left primary sensorimotor cortex (SM1), and right dorsolateral prefrontal cortex (DLPFC). RESULTS Elevated serum kynurenine levels were associated with signs of neuroinflammation, specifically in the DPCC, left SM1 and right DLPFC, and signs of neurodegeneration, specifically in the left HPC, left MTC and left SM1, after adjusting for age, sex and fat percentage (fat%). Elevated serum IL-6 levels were associated with increased Glx levels in left HPC, left MTC, and right DLPFC, after processing the 1H-MRS data with Tarquin. Overall, the agreement between Tarquin and LCModel results was moderate-to-strong for tNAA, tCho, mIns, and tCr, but weak to very weak for Glx. Peripheral inflammatory markers (IL-6 and kynurenine) were not associated with older age, higher fat%, decreased brain gray matter volume loss or decreased cognitive functioning within a cohort of older adults. CONCLUSION Our results suggest that serum kynurenine may be used as a peripheral inflammatory marker that is associated with neuroinflammation and neurodegeneration, although not linked to cognition. Future studies should consider longitudinal analysis to assess the causal inferences between chronic peripheral and neuroinflammation, brain structural and neurometabolic changes, and cognitive decline in aging.
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Affiliation(s)
- Wouter A J Vints
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, Kaunas, Lithuania.,Department of Rehabilitation Medicine Research School Caphri, Maastricht University, Maastricht, Netherlands.,Centre of Expertise in Rehabilitation and Audiology, Adelante Zorggroep, Hoensbroek, Netherlands
| | - Simona Kušleikiene
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, Kaunas, Lithuania
| | - Samrat Sheoran
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, Kaunas, Lithuania
| | - Milda Šarkinaite
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kristina Valatkevičiene
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rymante Gleizniene
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mindaugas Kvedaras
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, Kaunas, Lithuania
| | - Kazimieras Pukenas
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, Kaunas, Lithuania
| | - Uwe Himmelreich
- Biomedical MRI Unit, Department of Imaging and Pathology, Group Biomedical Sciences, Catholic University Leuven, Leuven, Belgium
| | - Vida J Cesnaitiene
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, Kaunas, Lithuania
| | - Oron Levin
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, Kaunas, Lithuania.,Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, Catholic University Leuven, Heverlee, Belgium
| | - Jeanine Verbunt
- Department of Rehabilitation Medicine Research School Caphri, Maastricht University, Maastricht, Netherlands.,Centre of Expertise in Rehabilitation and Audiology, Adelante Zorggroep, Hoensbroek, Netherlands
| | - Nerijus Masiulis
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, Kaunas, Lithuania.,Department of Rehabilitation, Physical and Sports Medicine, Institute of Health Science, Vilnius University, Vilnius, Lithuania
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11
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Verbrugghe J, Hansen D, Demoulin C, Verbunt J, Roussel NA, Timmermans A. High Intensity Training Is an Effective Modality to Improve Long-Term Disability and Exercise Capacity in Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial. Int J Environ Res Public Health 2021; 18:ijerph182010779. [PMID: 34682522 PMCID: PMC8535878 DOI: 10.3390/ijerph182010779] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 12/13/2022]
Abstract
Previous research indicates that high intensity training (HIT) is a more effective exercise modality, as opposed to moderate intensity training (MIT), to improve disability and physical performance in persons with chronic nonspecific low back pain (CNSLBP). However, it is unclear how well benefits are maintained after intervention cessation. This study aimed to evaluate the long-term effectiveness of HIT on disability, pain intensity, patient-specific functioning, exercise capacity, and trunk muscle strength, and to compare the long-term effectiveness of HIT with MIT in persons with CNSLBP. Persons with CNSLBP (n = 35) who participated in a randomized controlled trial comparing effects of an HIT versus MIT intervention (24 sessions/12 weeks) were included for evaluation at baseline (PRE), directly after (POST), and six months after program finalization (FU) on disability, pain intensity, exercise capacity, patient-specific functioning, and trunk muscle strength. A general linear model was used to evaluate PRE-FU and POST-FU deltas of these outcome measures in each group (time effects) and differences between HIT and MIT (interaction effects). Ultimately, twenty-nine participants (mean age = 44.1 year) were analysed (HIT:16; MIT:13). Six participants were lost to follow-up. At FU, pain intensity, disability, and patient-specific functioning were maintained at the level of POST (which was significant from PRE, p < 0.05) in both groups. However, HIT led to a greater conservation of lowered disability and improved exercise capacity when compared with MIT (p < 0.05). HIT leads to a greater maintenance of lowered disability and improved exercise capacity when compared to MIT six months after cessation of a 12-week supervised exercise therapy intervention, in persons with CNSLBP.
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Affiliation(s)
- Jonas Verbrugghe
- REVAL—Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (D.H.); (A.T.)
- Correspondence: ; Tel.: +32-11269224
| | - Dominique Hansen
- REVAL—Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (D.H.); (A.T.)
- Heart Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium
| | - Christophe Demoulin
- Department of Sport and Rehabilitation Sciences, University of Liege, 4000 Liege, Belgium;
| | - Jeanine Verbunt
- Adelante Centre of Expertise in Rehabilitation and Audiology, 6432CC Hoensbroek, The Netherlands;
- Department of Rehabilitation Medicine, Maastricht University, 6211LK Maastricht, The Netherlands
| | - Nathalie Anne Roussel
- Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerp, Belgium;
| | - Annick Timmermans
- REVAL—Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (D.H.); (A.T.)
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12
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van Gassel RJJ, Bels J, Remij L, van Bussel BCT, Posthuma R, Gietema HA, Verbunt J, van der Horst ICC, Olde Damink SWM, van Santen S, van de Poll MCG. Functional Outcomes and Their Association With Physical Performance in Mechanically Ventilated Coronavirus Disease 2019 Survivors at 3 Months Following Hospital Discharge: A Cohort Study. Crit Care Med 2021; 49:1726-1738. [PMID: 33967204 PMCID: PMC8439632 DOI: 10.1097/ccm.0000000000005089] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We performed a comprehensive health assessment in mechanically ventilated coronavirus disease 2019 survivors to assess the impact of respiratory and skeletal muscle injury sustained during ICU stay on physical performance at 3 months following hospital discharge. DESIGN Preregistered prospective observational cohort study. SETTING University hospital ICU. PATIENTS All mechanically ventilated coronavirus disease 2019 patients admitted to our ICU during the first European pandemic wave. MEASUREMENTS AND MAIN RESULTS At 3 months after hospital discharge, 46 survivors underwent a comprehensive physical assessment (6-min walking distance, Medical Research Council sum score and handgrip strength), a full pulmonary function test, and a chest CT scan which was used to analyze skeletal muscle architecture. In addition, patient-reported outcomes measures were collected. Physical performance assessed by 6-minute walking distance was below 80% of predicted in 48% of patients. Patients with impaired physical performance had more muscle weakness (Medical Research Council sum score 53 [51-56] vs 59 [56-60]; p < 0.001), lower lung diffusing capacity (54% [44-66%] vs 68% of predicted [61-72% of predicted]; p = 0.002), and higher intermuscular adipose tissue area (p = 0.037). Reduced lung diffusing capacity and increased intermuscular adipose tissue were independently associated with physical performance. CONCLUSIONS Physical disability is common at 3 months in severe coronavirus disease 2019 survivors. Lung diffusing capacity and intermuscular adipose tissue assessed on CT were independently associated with walking distance, suggesting a key role for pulmonary function and muscle quality in functional disability.
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Affiliation(s)
- Rob J J van Gassel
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of rehabilitation, Maastricht University, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Julia Bels
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Loes Remij
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bas C T van Bussel
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Rein Posthuma
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of rehabilitation, Maastricht University, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Hester A Gietema
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Jeanine Verbunt
- Department of rehabilitation, Maastricht University, Maastricht, The Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Steven W M Olde Damink
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Susanne van Santen
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marcel C G van de Poll
- Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- GROW School of Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of rehabilitation, Maastricht University, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
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13
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Baumgartner-Dupuits M, Sep SJS, Verbunt J, Bosma H, van Eijk J. Peer Support to Enhance Social and Emotional Self-Management Following Acquired Brain Injury Rehabilitation: Design of a Pre-post Study With Process Evaluation. Front Neurol 2021; 12:647773. [PMID: 34393968 PMCID: PMC8360636 DOI: 10.3389/fneur.2021.647773] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Specialized rehabilitation following acquired brain injury provides intensive multidisciplinary treatment to individuals with complex disabilities for optimizing recovery and supporting a safe transition to the community. Post-specialist rehabilitation, patients and caregivers have reported a need for support. We present the design of an implementation study to evaluate a new self-management support service for individuals with acquired brain injury and their caregivers. Methods: This is a pre–post intervention study with a mixed-method design. The study population comprises individuals aged ≥18 years with acquired brain injury living independently following specialized rehabilitation in the Southern part of the Netherlands. All participants receive a post-rehabilitation support service. The support service consists of several house visits by a peer support volunteer in the first weeks after specialized rehabilitation treatment. The peer support volunteers are trained according to an adapted version of the previously developed Self-Management Support (SMS) program. The SMS program is directed at improving social and emotional self-management. Patient outcomes are assessed by questionnaire pre-, directly post-, and 6 months post-intervention. The primary patient outcome measure is self-efficacy. Secondary outcomes are perceived autonomy, quality of life, and psychological well-being. A process evaluation will be performed to gain insight into barriers and facilitators for the implementation of peer-led SMS by combining both quantitative, questionnaire data and qualitative data derived from focus groups with peer supporters and patients. In a workshop with relevant stakeholders, possibilities for dissemination and sustainability will be explored. Discussion: This paper describes the design of a practice-based study on feasibility, barriers, and facilitators to the implementation of a home-based, peer-led self-management support intervention for patients with acquired brain injury. We will quantitatively and qualitatively evaluate the change in relevant patient outcomes pre- and post-intervention and the barriers and facilitators related to the implementation of the intervention. Following a positive evaluation, the final stage of the study aims to facilitate deployment and utilization of the intervention.
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Affiliation(s)
- Milou Baumgartner-Dupuits
- Care and Public Health Research Institute (Caphri), Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Department of Rehabilitation Medicine, Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Netherlands
| | - Simone J S Sep
- Care and Public Health Research Institute (Caphri), Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Department of Rehabilitation Medicine, Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Netherlands
| | - Jeanine Verbunt
- Care and Public Health Research Institute (Caphri), Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Department of Rehabilitation Medicine, Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Netherlands
| | - Hans Bosma
- Care and Public Health Research Institute (Caphri), Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands
| | - Jacques van Eijk
- Care and Public Health Research Institute (Caphri), Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands.,Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, University Maastricht, Maastricht, Netherlands
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14
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Molenaar B, Willems C, Verbunt J, Goossens M. Achievement Goals, Fear of Failure and Self-Handicapping in Young Elite Athletes with and without Chronic Pain. Children (Basel) 2021; 8:children8070591. [PMID: 34356570 PMCID: PMC8305616 DOI: 10.3390/children8070591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 12/05/2022]
Abstract
Background: Pain is a common problem in elite athletes. This exploratory study compares goal orientations towards sport, fear of failure, self-handicapping and pain catastrophizing between active young elite athletes with and without chronic pain (CP) complaints (longer than three months). It examines the associations between chronic pain, fear of failure, goal orientations, self-handicapping and pain catastrophizing in young elite athletes. We explore how far goal orientation can be explained by these factors. Methods: Young elite athletes completed an online questionnaire. Data analysis: Independent samples t-test, correlational analyses and multivariate regression analyses. Results: Participants were 132 young elite athletes (mean 16 years); data for 126 were analyzed. A total of 47% reported current pain, of which 60% had CP. Adolescents with CP showed significantly more pain intensity, fear of failure, self-handicapping and mastery–avoidance goals than those without. Pain intensity was significantly related to fear of failure, self-handicapping, pain catastrophizing and mastery–avoidance. Self-handicapping and fear of failure contributed significantly to mastery–avoidance variance. Performance–avoidance and –approach goals were explained by fear of failure. Conclusion: CP was common, with sufferers showing more fear of failure and self-handicapping strategies, and being motivated to avoid performing worse (mastery–avoidance). Self-handicapping and fear of failure influenced mastery–avoidance orientation, and fear of failure explained part of performance–avoidance and –approach orientations. Longitudinal studies should explore the role of these factors in the trajectory of CP in these athletes.
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Affiliation(s)
- Bodile Molenaar
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (B.M.); (C.W.); (J.V.)
| | - Charlotte Willems
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (B.M.); (C.W.); (J.V.)
- Adelante Center of Expertise in Rehabilitation and Audiology, Zandbergsweg 111, 6432 CC Hoensbroek, The Netherlands
| | - Jeanine Verbunt
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (B.M.); (C.W.); (J.V.)
- Adelante Center of Expertise in Rehabilitation and Audiology, Zandbergsweg 111, 6432 CC Hoensbroek, The Netherlands
| | - Mariëlle Goossens
- Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (B.M.); (C.W.); (J.V.)
- Department of Clinical Psychological Sciences, Experimental Psychology, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
- Correspondence: ; Tel.: +31-43-388-2160
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15
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de Vries J, Verbunt J, Stubbe J, Visser B, Ramaekers S, Calders P, Engelbert R. Generalized Joint Hypermobility and Anxiety in Adolescents and Young Adults, the Impact on Physical and Psychosocial Functioning. Healthcare (Basel) 2021; 9:525. [PMID: 33946940 PMCID: PMC8146775 DOI: 10.3390/healthcare9050525] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/18/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to study the association between the presence of generalized joint hypermobility (GJH) and anxiety within a non-clinical high performing group of adolescents and young adults. Second, to study the impact of GJH and/or anxiety on physical and psychosocial functioning, 168 adolescents and young adults (mean (SD) age 20 (2.9)) were screened. Joint (hyper)mobility, anxiety, and physical and psychosocial functioning were measured. In 48.8% of all high performing adolescents and young adults, GJH was present, whereas 60% had symptoms of anxiety. Linear models controlled for confounders showed that adolescents and young adults with GJH and anxiety had decreased workload (ß (95%CI) -0.43 (-0.8 to -0.08), p-value 0.02), increased fatigue (ß (95%CI) 12.97 (6.3-19.5), p-value < 0.01), and a higher level of pain catastrophizing (ß (95%CI) 4.5 (0.5-8.6), p-value 0.03). Adolescents and young adults with only anxiety had increased fatigue (ß (95%CI) 11 (4.9-19.5). In adolescents and young adults with GJH alone, no impact on physical and psychosocial functioning was found. Adolescents and young adults with the combination of GJH and anxiety were significantly more impaired, showing decreased physical and psychosocial functioning with decreased workload, increased fatigue, and pain catastrophizing. Presence of GJH alone had no negative impact on physical and psychosocial functioning. This study confirms the association between GJH and anxiety, but especially emphasizes the disabling role of anxiety. Screening for anxiety is relevant in adolescents and young adults with GJH and might influence tailored interventions.
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Affiliation(s)
- Janneke de Vries
- School of Physiotherapie, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands;
- Amsterdam UMC, Department of Rehabilitation, Amsterdam Movement Sciences, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands;
| | - Jeanine Verbunt
- Department of Rehabilitation Medicine, CAPHRI, Functioning and Rehabilitation, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands;
- Adelante Center of Expertise in Rehabilitationand Audiology, 6432 CC Hoensbroek, The Netherlands
| | - Janine Stubbe
- Codarts, University of the Arts, 3012 CC Rotterdam, The Netherlands;
- PErforming Artist and Athlete Research Lab (PEARL), 3012 CC Rotterdam, The Netherlands
- Department of General Practice, Erasmus MC University Medical Center, 3015 GD Rotterdam, The Netherlands
- Rotterdam Arts and Science Lab (RASL), 3012 CC Rotterdam, The Netherlands
| | - Bart Visser
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands;
| | - Stephan Ramaekers
- School of Physiotherapie, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands;
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands;
| | - Patrick Calders
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium;
| | - Raoul Engelbert
- Amsterdam UMC, Department of Rehabilitation, Amsterdam Movement Sciences, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands;
- Amsterdam UMC, Department of Pediatrics, Emma Children’s Hospital, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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16
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Wijenberg M, Rauwenhoff J, Stapert S, Verbunt J, van Heugten C. Do fear and catastrophizing about mental activities relate to fear-avoidance behavior in a community sample? An experimental study. J Clin Exp Neuropsychol 2021; 43:66-77. [PMID: 33567961 DOI: 10.1080/13803395.2021.1874881] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Healthy people often experience headache, cognitive failures, or mental fatigue. Some people even experience these symptoms on a level comparable to patients with mild spectrum brain injuries. In these individuals, the fear-avoidance model explains symptoms as a consequence of catastrophizing and fear-avoidance toward mental activities. This experimental study investigated in healthy adults whether fear-avoidance and catastrophizing about mental activities are related to fear-avoidance behavior (i.e., behavioral avoidance of mental activities) according to the fear-avoidance model.Method: A randomized crossover within-subject design was used with two measurements and 80 participants. Participants were exposed to three demanding cognitive tasks and their simplified counterparts. Post-concussion symptoms, catastrophizing, fear-avoidance, behavioral avoidance (time spent working on cognitive tasks), exposure to mental activity, depression, heart rate, and state-trait anxiety were assessed.Results: Significant correlations between the variables of the fear-avoidance model were found. Furthermore, catastrophizers spent less time on difficult tasks compared to easy tasks. Both catastrophizing and female sex predicted time spent on difficult tasks, whereas only female sex predicted time spent on easy tasks.Conclusions: This study found that, according to the fear-avoidance model, catastrophizing is related to behavioral avoidance of cognitively challenging tasks in a community sample.
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Affiliation(s)
- Melloney Wijenberg
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Limburg Brain Injury Centre, The Netherlands
| | - Johanne Rauwenhoff
- Limburg Brain Injury Centre, The Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Sven Stapert
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Clinical and Medical Psychology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Jeanine Verbunt
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Caroline van Heugten
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Limburg Brain Injury Centre, The Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Baadjou V, Vints W, Erens T, van Horn Y, Verbunt J. Ervaringen in de COVID-19 revalidatiezorg. TBV - Tijdschr Bedrijfs- en Verzekeringsgeneeskd 2021; 29:22-25. [PMID: 33398215 PMCID: PMC7773801 DOI: 10.1007/s12498-020-1314-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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Van Meulenbroek T, Huijnen I, Stappers N, Engelbert R, Verbunt J. Generalized joint hypermobility and perceived harmfulness in healthy adolescents; impact on muscle strength, motor performance and physical activity level. Physiother Theory Pract 2020; 37:1438-1447. [PMID: 31908174 DOI: 10.1080/09593985.2019.1709231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: The first aim of this study was to determine whether adolescents with asymptomatic Generalized Joint Hypermobility (GJH) have a lower level of physical functioning (physical activity level, muscle strength and performance) compared to non-hypermobile controls. Secondly, to evaluate whether the negative impact of perceived harmfulness on physical functioning was more pronounced in adolescents with asymptomatic GJH.Methods: Cross-sectional study. Sixty-two healthy adolescents (mean age 16.8, range 12-21) participated. Hypermobility (Beighton score), perceived harmfulness (PHODA-youth) and muscle strength (dynamometry), motor performance (Single-Leg-Hop-for-Distance) and physical activity level (PAL) (accelerometry) were measured. Hierarchical regression analyses were used to study differences in physical functioning and perceived harmfulness between asymptomatic GJH and non-hypermobile controls.Results: Asymptomatic GJH was associated with increased knee extensor muscle strength (peak torque/body weight; PT/BW), controlled for age and gender (dominant leg; ß = 0.29; p = .02). No other associations between asymptomatic GJH and muscle strength, motor performance and PAL were found. Perceived harmfulness was not more pronounced in adolescents with asymptomatic GJH.Conclusions: Adolescents with asymptomatic GJH had increased knee extensor muscle strength compared to non-hypermobile controls. No other differences in the level of physical functioning was found and the negative impact of perceived harmfulness was not more pronounced in adolescents with asymptomatic GJH.
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Affiliation(s)
- Thijs Van Meulenbroek
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Netherlands
| | - Ivan Huijnen
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Netherlands
| | - Nicole Stappers
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, Netherlands
| | - Raoul Engelbert
- ACHIEVE, Center for Applied Research, Faculty of Health, University of Applied Sciences Amsterdam, Amsterdam, Netherlands.,Department of Rehabilitation, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Department of Pediatrics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Jeanine Verbunt
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, Netherlands.,Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Netherlands
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Abstract
INTRODUCTION Patients having chronic musculoskeletal pain (CMP) face challenges as mismatches often exist between the complexity of patient's pain problem and the rehabilitation treatment offered. This can result in less efficient care for the patient and increased medical shopping. The Network Pain Rehabilitation Limburg (NPRL), a transmural integrated healthcare network, will be designed to improve daily care for patients with CMP. NPRL focusses on improving patient's level of functioning despite pain by stimulating a biopsychosocial approach given by all involved healthcare professionals. A feasibility study will be performed which will give insight into the barriers and facilitators, perceived value, acceptability and implementation strategies for NPRL. METHODS AND ANALYSIS This study has a three-phase iterative and incremental design, based on key principles of a user-centred design. Mixed methods will be used in which healthcare professionals and patients involved in NPRL will participate. In phase 1, NPRL will be developed and healthcare professionals educated. Phase 2 focusses on the implementation and phase 3 on the transferability of NPRL. In addition, preliminary data on patient's work status, general health and participation level will be collected. The qualitative results of each phase will be analysed following the Consolidated Framework for Implementation Research (CFIR) and will be used to refine NPRL in daily practise. ETHICS AND DISSEMINATION Informed consent will be obtained from all participants. The results of this feasibility study will form the basis for refinement of NPRL and planning of a large-scale process and effect evaluation of the Quadruple Aim outcomes. Dissemination will include publications and presentations at national and international conferences. Ethical approval for this study was granted by the Medical Ethics Committee Z, the Netherlands, METC 17 N-133.
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Affiliation(s)
- Cynthia Lamper
- Department of Rehabilitation Medicine, Maastricht University CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
| | - Mariëlle Kroese
- Department of Health Services Research, Maastricht University CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
| | - Albère Köke
- Department of Rehabilitation Medicine, Maastricht University CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
- Kenniscentrum, Adelante, Hoensbroek, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Maastricht University CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
| | - Jeanine Verbunt
- Department of Rehabilitation Medicine, Maastricht University CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
- Kenniscentrum, Adelante, Hoensbroek, The Netherlands
| | - Ivan Huijnen
- Department of Rehabilitation Medicine, Maastricht University CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
- Kenniscentrum, Adelante, Hoensbroek, The Netherlands
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Van't Wout Hofland J, Moulaert V, van Heugten C, Verbunt J. Long-term quality of life of caregivers of cardiac arrest survivors and the impact of witnessing a cardiac event of a close relative. Resuscitation 2018; 128:198-203. [PMID: 29567463 DOI: 10.1016/j.resuscitation.2018.03.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 03/06/2018] [Accepted: 03/09/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The incidence of cardiac arrest is high, with a poor survival rate of 8-14%. Currently, only limited evidence is available about long-term consequences of cardiac arrest on quality of life of caregivers. AIMS First, to determine the level of daily functioning and quality of life in caregivers of cardiac arrest survivors two years after the cardiac arrest. Second, to study the long-term impact of witnessing the event of a cardiac arrest. METHODS A longitudinal cohort study including caregivers of cardiac arrest survivors. Participants received a questionnaire at home. Outcome variables were instrumental daily activities(FAI), emotional functioning(HADS), fatigue(FSS), caregiver strain(CSI), impact of event(IES), and quality of life(SF36). RESULTS 57 caregivers (89% female, age 56,9 ± 12 years) participated. Two years after the cardiac arrest, quality of life of caregivers equals that of the general population, although almost 30% still scored high on the Impact of Events Scale. Mean IES-, FSS-, CSI and FAI-scores were increased as compared to the general population (P < 0.001). Two years after the cardiac arrest, caregivers that witnessed the resuscitation (IES = 23.6 ± 14.9) still experienced significantly more trauma related stress than caregivers that did not witness the resuscitation (11.9 ± 12.5; p < 0.01). CONCLUSIONS Two years after the cardiac arrest, quality of life of caregivers is quite good, but almost one third of the caregivers still experience a high level of trauma-related stress, especially in those that witnessed the resuscitation. Future research will have to focus on the effectiveness of support programs for caregivers of survivors of cardiac arrest.
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Affiliation(s)
- Janine Van't Wout Hofland
- CAPHRI School for Public Health and Primary Care, Department of Rehabilitation Medicine, Maastricht University, PO box 616, 6200 MD, Maastricht, the Netherlands; CAPHRI School for Public Health and Primary Care, Department of Family Medicine, Maastricht University, PO box 616, 6200 MD, Maastricht, the Netherlands
| | - Veronique Moulaert
- Adelante, Centre of Expertise in Rehabilitation and Audiology, 6432 CC Hoensbroek, the Netherlands; University of Groningen, University Medical Center Groningen, Hanzeplein 1 (9713 GZ) Groningen, the Netherlands
| | - Caroline van Heugten
- Maastricht University Medical Center, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School for Mental Health and Neuroscience (MHeNS), P.O. Box 616 6200 MD, Maastricht, The Netherlands,; Maastricht University, Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, P.O. Box 616 6200 MD, Maastricht, The Netherlands,; Limburg Brain Injury Center, P.O. Box 616 6200 MD, Maastricht, The Netherlands
| | - Jeanine Verbunt
- CAPHRI School for Public Health and Primary Care, Department of Rehabilitation Medicine, Maastricht University, PO box 616, 6200 MD, Maastricht, the Netherlands; CAPHRI School for Public Health and Primary Care, Department of Family Medicine, Maastricht University, PO box 616, 6200 MD, Maastricht, the Netherlands,.
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Verberne D, Moulaert V, Verbunt J, van Heugten C. Factors predicting quality of life and societal participation after survival of a cardiac arrest: A prognostic longitudinal cohort study. Resuscitation 2018; 123:51-57. [DOI: 10.1016/j.resuscitation.2017.11.069] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/09/2017] [Accepted: 11/30/2017] [Indexed: 11/28/2022]
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Mertens VC, Moser A, Verbunt J, Smeets R, Goossens M. Content Validity of the Credibility and Expectancy Questionnaire in a Pain Rehabilitation Setting. Pain Pract 2016; 17:902-913. [PMID: 27911035 DOI: 10.1111/papr.12543] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 04/01/2016] [Revised: 09/22/2016] [Accepted: 10/16/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Content validity, the proper reflection of the concept to be measured, is yet unknown for the Credibility and Expectancy Questionnaire (CEQ). It is frequently used in pain rehabilitation because treatment expectancy is influential on the outcome. OBJECTIVE To test and improve the content validity of the CEQ in a sample of patients with chronic pain in different phases of their treatment. METHODS A qualitative observational study design using the Three-Step Test-Interview method was used. Therein, data collection, analyses, and adaptations occur iteratively. RESULTS Seventeen patients with chronic pain in different stages of treatment participated through convenience sampling from the mother sample of a randomized controlled trial. The main study parameter is content validity, which is defined as (1) interpretations and responses of the participants and (2) the identification of response problems operationalized, and resulting in changes in the CEQ. For patients waiting for treatment, the written instruction of the CEQ allowed different interpretations. After changing the instructions, the CEQ became an easy-to-understand and content-valid questionnaire. For patients who had already undergone treatment, changes regarding time frame and recall period were necessary to overcome interpretation and response problems to the CEQ. DISCUSSION After small changes, the CEQ appeared to be a content-valid measurement instrument for patients waiting for treatment. However, for patients who had already undergone treatment, the content validity of the CEQ was less, and considerable changes were necessary.
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Affiliation(s)
- Vera-Christina Mertens
- Research Unit INSIDE, Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg.,Department of Rehabilitation Medicine, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Albine Moser
- Department of Family Practice, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Faculty of Healthcare, Research Programme Autonomy and Participation of Chronically Ill People, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Jeanine Verbunt
- Department of Rehabilitation Medicine, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Department of Rehabilitation Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rob Smeets
- Department of Rehabilitation Medicine, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Libra Rehabilitation and Audiology, Eindhoven/Weert, Maastricht, The Netherlands
| | - Mariëlle Goossens
- Department of Rehabilitation Medicine, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Department of Clinical Psychological Sciences, Faculty of Psychology and Neurosciences, Maastricht University, Maastricht, The Netherlands
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Scheper MC, Juul-Kristensen B, Rombaut L, Rameckers EA, Verbunt J, Engelbert RH. Disability in Adolescents and Adults Diagnosed With Hypermobility-Related Disorders: A Meta-Analysis. Arch Phys Med Rehabil 2016; 97:2174-2187. [PMID: 26976801 DOI: 10.1016/j.apmr.2016.02.015] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [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: 01/08/2016] [Accepted: 02/05/2016] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To (1) establish the association of the most common reported symptoms on disability; and (2) study the effectiveness of treatment on disability in patients with Ehlers-Danlos syndrome-hypermobility type (EDS-HT)/hypermobility syndrome (HMS). DATA SOURCES An electronic search (Medical Subject Headings and free-text terms) was conducted in bibliographic databases CENTRAL/MEDLINE. STUDY SELECTION Comparative, cross-sectional, longitudinal cohort studies and (randomized) controlled trials including patients with HMS/EDS-HT aged ≥17 years were considered for inclusion. A class of symptoms was included when 5 publications were available. In regards to treatment (physical, cognitive interventions), only (randomized) controlled trials were considered. Surgical and medicinal interventions were excluded. DATA EXTRACTION Bias was assessed according to the methodological scoring tools of the Cochrane collaboration. Z-score transformations were applied to classify the extent of disability in comparison with healthy controls and to ensure comparability between studies. DATA SYNTHESIS Initially, the electronic search yielded 714 publications, and 21 articles remained for analysis after selection. The following symptoms were included for meta-analysis: pain (n=12), fatigue (n=6), and psychological distress (n=7). Pain (r=.64, P=.021), fatigue (r=.91, P=.011), and psychological distress (r=.86, P=.018) had a significant impact on disability. Regarding treatment, a significant pain reduction was achieved by a variety of physical and cognitive approaches. Treatment effectiveness on disability was not established. CONCLUSIONS Disability can affect patients with HMS/EDS-HT significantly and is highly correlated with both physical and psychological factors. Although evidence is available that physical and psychological treatment modalities can induce significant pain reduction, the evidence regarding disability reduction is lacking.
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Affiliation(s)
- Mark C Scheper
- Amsterdam Center for Innovative Health Practice, Center for Applied Research, Faculty of Health, University of Applied Sciences Amsterdam, Amsterdam, The Netherlands; Department of Rehabilitation, Academic Medical Center, Amsterdam, The Netherlands.
| | - Birgit Juul-Kristensen
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark; Institute of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
| | - Lies Rombaut
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Eugene A Rameckers
- Department of Rehabilitation Medicine, Maastricht University Medical Center, CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands; Adelante Center of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands; Master of Pediatric Physical Therapy, University of Applied Sciences, AVANS+, Breda, The Netherlands
| | - Jeanine Verbunt
- Department of Rehabilitation Medicine, Maastricht University Medical Center, CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands; Adelante Center of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Raoul H Engelbert
- Amsterdam Center for Innovative Health Practice, Center for Applied Research, Faculty of Health, University of Applied Sciences Amsterdam, Amsterdam, The Netherlands; Department of Rehabilitation, Academic Medical Center, Amsterdam, The Netherlands
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Scheper MC, de Vries JE, Verbunt J, Engelbert RH. Chronic pain in hypermobility syndrome and Ehlers-Danlos syndrome (hypermobility type): it is a challenge. J Pain Res 2015; 8:591-601. [PMID: 26316810 PMCID: PMC4548768 DOI: 10.2147/jpr.s64251] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [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] [Indexed: 12/20/2022] Open
Abstract
Generalized joint hypermobility (GJH) is highly prevalent among patients diagnosed with chronic pain. When GJH is accompanied by pain in ≥4 joints over a period ≥3 months in the absence of other conditions that cause chronic pain, the hypermobility syndrome (HMS) may be diagnosed. In addition, GJH is also a clinical sign that is frequently present in hereditary diseases of the connective tissue, such as the Marfan syndrome, osteogenesis imperfecta, and the Ehlers-Danlos syndrome. However, within the Ehlers-Danlos spectrum, a similar subcategory of patients having similar clinical features as HMS but lacking a specific genetic profile was identified: Ehlers-Danlos syndrome hypermobility type (EDS-HT). Researchers and clinicians have struggled for decades with the highly diverse clinical presentation within the HMS and EDS-HT phenotypes (Challenge 1) and the lack of understanding of the pathological mechanisms that underlie the development of pain and its persistence (Challenge 2). In addition, within the HMS/EDS-HT phenotype, there is a high prevalence of psychosocial factors, which again presents a difficult issue that needs to be addressed (Challenge 3). Despite recent scientific advances, many obstacles for clinical care and research still remain. To gain further insight into the phenotype of HMS/EDS-HT and its mechanisms, clearer descriptions of these populations should be made available. Future research and clinical care should revise and create consensus on the diagnostic criteria for HMS/EDS-HT (Solution 1), account for clinical heterogeneity by the classification of subtypes within the HMS/EDS-HT spectrum (Solution 2), and create a clinical core set (Solution 3).
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Affiliation(s)
- Mark C Scheper
- School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands ; Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Janneke E de Vries
- School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands ; Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands ; Department of Rehabilitation Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Jeanine Verbunt
- Department of Rehabilitation Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands ; Adelante, Center of expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Raoul Hh Engelbert
- School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands ; Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Moulaert V, van Heugten C, Winkens B, Bakx W, de Krom M, Gorgels A, Wade D, Verbunt J. New psychosocial intervention improves quality of life after cardiac arrest: Results of a randomised controlled trial. Resuscitation 2013. [DOI: 10.1016/j.resuscitation.2013.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Engelbert R, Scheper M, Rameckers E, Verbunt J, Remvig L, Juul-Kristensen B. AB0800 Children with generalized joint hypermobility and musculoskeletal complaints: state of the art on diagnostics, clinical characteristics and treatment. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.3122] [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: 11/03/2022]
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Scheper M, de Vries J, Verbunt J, Nollet F, Engelbert R. FRI0455 Is the presence of generalized joint hypermobility in young adult female dancers beneficial? Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2912] [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: 11/03/2022]
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Scheper MC, de Vries JE, de Vos R, Verbunt J, Nollet F, Engelbert RHH. Generalized joint hypermobility in professional dancers: a sign of talent or vulnerability? Rheumatology (Oxford) 2012; 52:651-8. [DOI: 10.1093/rheumatology/kes220] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Nijland R, van Wegen E, Verbunt J, van Wijk R, van Kordelaar J, Kwakkel G. A comparison of two validated tests for upper limb function after stroke: The Wolf Motor Function Test and the Action Research Arm Test. J Rehabil Med 2010; 42:694-6. [PMID: 20603702 DOI: 10.2340/16501977-0560] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To investigate the concurrent validity between the Action Research Arm Test (ARAT) and the Wolf Motor Function Test (WMFT) and to compare their reproducibility, internal consistency and floor and ceiling effects in the same sample of stroke patients. METHODS Forty patients participated in this study. Concurrent validity was determined with Spearman's rank correlation coefficients. Reproducibility was assessed with intraclass correlation coefficients (ICCs) and Bland-Altman plots, internal consistency by means of Cronbach's alphas, and floor and ceiling effects were considered to be present if more than 20% of patients fell outside a preliminary set lower and upper boundary. RESULTS Spearman's rank correlation coefficients ranged from 0.70 to 0.86. ICCs for inter-rater and intra-rater reliability ranged from 0.92 to 0.97. Bland-Altman plots showed a less stable way of scoring for the WMFT, compared with the ARAT. Cronbach's alpha was > 0.98 for both scales. No floor and ceiling effects were found. CONCLUSION The present study showed good clinimetric properties for both assessments. The high concurrent validity suggests that ARAT and WMFT have significant overlap with regard to the underlying construct that is being measured.
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Affiliation(s)
- Rinske Nijland
- Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Centre Amsterdam, The Netherlands
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Smeets R, Verbunt J, Hasenbring M. 42 Topical Seminar Summary: DISUSE AND OVERUSE: TWO OPPOSITE PATHWAYS INTO CHRONIC BACK PAIN? Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60045-8] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- R. Smeets
- Rehabilitation Foundation Limburg, CC Hoensbroek, Netherlands
- Maastricht University Medical Centre, Department of Rehabilitation, Maastricht, Netherlands
| | - J. Verbunt
- Rehabilitation Foundation Limburg, CC Hoensbroek, Netherlands
| | - M. Hasenbring
- Dept. of Medical Psychology and Medical Sociology Ruhr‐University of Bochum, Bochum, Germany
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Kindermans H, Huijnen I, Goossens M, Roelofs J, Verbunt J, Vlaeyen J. 953 THE ROLE OF SELF‐DISCREPANCIES IN THE ACTIVITY PATTERNS OF PATIENTS WITH CHRONIC LOW BACK PAIN. Eur J Pain 2009. [DOI: 10.1016/s1090-3801(09)60956-3] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- H. Kindermans
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
| | - I. Huijnen
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, Netherlands
| | - M. Goossens
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
| | - J. Roelofs
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
| | - J. Verbunt
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, Netherlands
| | - J. Vlaeyen
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
- Research Center for Health Psychology, University of Leuven, Leuven, Belgium
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Bosboom JLW, Stoffers D, Stam CJ, van Dijk BW, Verbunt J, Berendse HW, Wolters EC. Resting state oscillatory brain dynamics in Parkinson’s disease: An MEG study. Clin Neurophysiol 2006; 117:2521-31. [PMID: 16997626 DOI: 10.1016/j.clinph.2006.06.720] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Revised: 06/22/2006] [Accepted: 06/29/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The pathophysiological mechanisms of cognitive dysfunction and dementia in Parkinson's disease (PD) are still poorly understood. Altered resting state oscillatory brain activity may reflect underlying neuropathological changes. The present study using magneto encephalography (MEG) was set up to study differences in the pattern of resting state oscillatory brain activity in groups of demented and non-demented PD patients and healthy, elderly controls. METHODS The pattern of MEG background oscillatory activity was studied in 13 demented PD patients, 13 non-demented PD patients and 13 healthy controls. Whole head MEG recordings were obtained in the morning in an eyes closed and an eyes open, resting state condition. Relative spectral power was calculated using Fast Fourier Transformation in delta, theta, alpha, beta and gamma frequency bands. RESULTS In the non-demented PD patients, relative theta power was diffusely increased and beta power concomitantly decreased relative to controls. gamma Power was decreased in central and parietal channels. In the demented PD patients, a diffuse increase in relative delta and to lesser extent theta power and a decrease in relative alpha, beta and to lesser extent gamma power were found in comparison to the non-demented PD group. In addition, reactivity to eye opening was much reduced in the demented PD group. CONCLUSIONS Parkinson's disease is characterized by a slowing of resting state brain activity involving theta, beta and gamma frequency bands. Dementia in PD is associated with a further slowing of resting state brain activity, additionally involving delta and alpha bands, as well as a reduction in reactivity to eye-opening. SIGNIFICANCE The differential patterns of slowing of resting state brain activity in demented and non-demented PD patients suggests that, in conjunction with a progression of the pathological changes already present in non-demented patients, additional mechanisms are involved in the development of dementia in PD.
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Affiliation(s)
- J L W Bosboom
- Department of Neurology, Institute for Clinical and Experimental Neurosciences, VU University Medical Center, Amsterdam, The Netherlands.
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Stam C, Bosboom J, Stoffers D, van Dijk B, Verbunt J, Berendse H, Wolters E. V.10 The neurophysiology of dementia in Parkinson's Disease: does connectivity count? Parkinsonism Relat Disord 2006. [DOI: 10.1016/s1353-8020(07)70064-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Boonstra TW, Clairbois HE, Daffertshofer A, Verbunt J, van Dijk BW, Beek PJ. MEG-compatible force sensor. J Neurosci Methods 2005; 144:193-6. [PMID: 15910977 DOI: 10.1016/j.jneumeth.2004.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2004] [Revised: 10/26/2004] [Accepted: 11/04/2004] [Indexed: 11/27/2022]
Abstract
By use of an insulating material we constructed a strain gauge based sensor to measure isometric forces in parallel with magneto-encephalographic recordings (i.e. without interference). The sensor can be used in different geometries to measure force production in different dimensions. Furthermore, it can easily be adapted or modified for specific experimental applications. Finally, on-line processing of the recorded forces, e.g., for the purpose of feedback, can be realized using standard MEG equipment.
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Affiliation(s)
- T W Boonstra
- Faculty of Human Movement Sciences, Vrije Universiteit, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands.
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van der Kraan PM, Vitters EL, Postma NS, Verbunt J, van den Berg WB. Maintenance of the synthesis of large proteoglycans in anatomically intact murine articular cartilage by steroids and insulin-like growth factor I. Ann Rheum Dis 1993; 52:734-41. [PMID: 8257210 PMCID: PMC1005171 DOI: 10.1136/ard.52.10.734] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The exact regulation of the synthesis of cartilage specific molecules, such as collagen type II and aggrecan, by articular chondrocytes is unknown, but growth factors and hormones probably play an important part. The effects of glucocorticosteroids (prednisolone and triamcinolone), in combination with insulin-like growth factor I (IGF-I), on the synthesis and hydrodynamic volume of proteoglycans from murine patellar cartilage were investigated. METHODS The in vitro effect of IGF-I and steroids on proteoglycan synthesis in murine patellar cartilage was evaluated by [35S]sulphate incorporation in combination with dissociative gel chromatography using a Sephacryl S-1000 column. The impact of in vivo prednisolone (0-5 mg/kg) on proteoglycan synthesis in murine patellar cartilage was analysed by [35S]sulphate incorporation immediately after dissection from the knee joint. RESULTS Prednisolone stimulated proteoglycan synthesis in murine patellar cartilage from normal knees and in cartilage from knees injected with papain in vitro in the absence and presence of IGF-I. Moreover, oral administration of prednisolone for seven days to C57Bl10 mice resulted in enhanced proteoglycan synthesis in patellar cartilage. The incubation of patellar cartilage for 48 hours without serum or growth factors led to the synthesis of proteoglycans with a smaller hydrodynamic volume than those synthesised immediately after dissection of the patellae. This could either be circumvented by the addition of IGF-I or by the addition of glucocorticosteroids (prednisolone or triamcinolone) to the culture medium. CONCLUSIONS These results show that in a dose range of 0.0003-0.3 mmol/l, glucocorticosteroids, like IGF-I, stimulate proteoglycan synthesis and maintain the synthesis of hydrodynamically large proteoglycans by chondrocytes from murine articular cartilage. This indicates that glucocorticosteroids might play a part in the preservation of matrix integrity in articular cartilage.
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Affiliation(s)
- P M van der Kraan
- Department of Rheumatology, University Hospital, Nijmegen, The Netherlands
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