1
|
Liem SIE, Bergstra SA, Ciaffi J, van der Meulen C, Ueckert DA, Schriemer MR, Huizinga TWJ, Vliet Vlieland TPM, de Vries-Bouwstra JK. The long-term course of the Health Assessment Questionnaire in patients with systemic sclerosis. J Scleroderma Relat Disord 2023; 8:192-202. [PMID: 37744048 PMCID: PMC10515995 DOI: 10.1177/23971983231181719] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/27/2023] [Indexed: 09/26/2023]
Abstract
Objective The Health Assessment Questionnaire-Disability Index is an important outcome measure reflecting functional disability, but knowledge on its course over time in patients with systemic sclerosis is scarce. Therefore, we investigated the long-term course of the Health Assessment Questionnaire-Disability Index and its association with baseline characteristics in systemic sclerosis patients. Methods Systemic sclerosis patients, fulfilling the European League Against Rheumatism and the American College of Rheumatology 2013 criteria, were included from the Leiden Combined Care in Systemic Sclerosis cohort with annual assessments including the Scleroderma Health Assessment Questionnaire-Disability Index (range = 0-3). The course of the Health Assessment Questionnaire-Disability Index was evaluated over the total follow-up (baseline to last available Health Assessment Questionnaire-Disability Index) and between yearly visits. Based on a minimal clinical important difference of 0.22, courses were categorized into worsening, stable or improvement. The course of the Health Assessment Questionnaire-Disability Index over time was evaluated with linear mixed models. Baseline characteristics were compared between patients with a worsening or improvement of the Health Assessment Questionnaire-Disability Index over the total follow-up period with logistic regression analyses. Results A total of 517 systemic sclerosis patients were included, with a median follow-up of 7 years (interquartile range = 4-9; 2649 visits) and a baseline Health Assessment Questionnaire-Disability Index of 0.625 (interquartile range = 0.125-1.25). On group level, the Health Assessment Questionnaire-Disability Index is stable with an annual increase of 0.019 (95% confidence interval = 0.011 to 0.027). Looking at subgroups, patients >65 years or who died/were physically unable to come during follow-up had a worse mean Health Assessment Questionnaire-Disability Index. In individual courses from baseline to the last follow-up, the proportions of patients with a clinically meaningful worsening, stable or improved Health Assessment Questionnaire-Disability Index were 35%, 42% and 23%, respectively. Patients with immunosuppressants (odds ratio = 0.5, 95% confidence interval = 0.3 to 0.9) or gastrointestinal involvement (odds ratio = 0.6, 95% confidence interval = 0.4 to 0.9) at baseline showed a reduced chance of worsening of the Health Assessment Questionnaire-Disability Index over the total follow-up period. Conclusion Over time, the average course of the Health Assessment Questionnaire-Disability Index was stable in systemic sclerosis patients. However, individual courses vary, with worsening occurring in one-third. Worsening occurred less often in individuals using immunosuppressants or with gastrointestinal involvement at baseline.
Collapse
Affiliation(s)
- Sophie IE Liem
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sytske Anne Bergstra
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacopo Ciaffi
- Medicine and Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Coen van der Meulen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - David A Ueckert
- Department of Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Marisca R Schriemer
- NVLE, Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Tom WJ Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Theodora PM Vliet Vlieland
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | | |
Collapse
|
2
|
Liem SIE, Vliet Vlieland TPM, van de Ende CH, Dittmar S, Schriemer MR, Bodegom-Vos LV, Peter WFH, Vries-Bouwstra JKD. Consensus-based recommendations on communication and education regarding primary care physical therapy for patients with systemic sclerosis. Musculoskeletal Care 2023; 21:45-55. [PMID: 35689435 DOI: 10.1002/msc.1664] [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: 05/17/2022] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study aimed to develop recommendations for communication and postgraduate education regarding primary care physical therapy for systemic sclerosis (SSc) patients. METHODS A virtual Nominal Group Technique was used with tasks forces for communication (n = 18) and education (n = 21). Both included rheumatologists, physical therapists (PTs) in primary, secondary or tertiary care, rheumatology nurses, advanced nurse practictioners and patient representatives. Three online meetings were organised for each task force to discuss (1) current bottlenecks; (2) potential solutions; and (3) the resulting draft recommendations. After the final adjustments, participants rated their level of agreement with each recommendation on a scale from 0 (not at all agree) to 100 (totally agree), using an online questionnaire. RESULTS 19 and 34 recommendations were formulated for communication and education, respectively. For communication the main recommendations concerned the provision of an overview of primary care physical therapists with expertise in rheumatic and musculoskeletal diseases to patients and rheumatologists, the inclusion of the indication by the rheumatologist in the referral to the physical therapist and low-threshold communication with the rheumatologist in case of questions or concerns of the physical therapist. For postgraduate education three types of "on demand" educational offerings were recommended with varying levels of content and duration, to match the competencies and preferences of individual primary care physical therapists. CONCLUSION Using a systematic qualitative approach, two multi-stakeholder task forces developed practical recommendations for primary care physical therapists' communication with hospital-based care providers and postgraduate education regarding the treatment of SSc patients.
Collapse
Affiliation(s)
- Sophie I E Liem
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Theodora P M Vliet Vlieland
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Cornelia H van de Ende
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Sonja Dittmar
- NVLE, Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Marisca R Schriemer
- NVLE, Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Wilfred F H Peter
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | | |
Collapse
|
3
|
Liem SIE, van Leeuwen NM, Vliet Vlieland TPM, Boerrigter GMW, van den Ende CHM, de Pundert LAJ, Schriemer MR, Spierings J, Vonk MC, de Vries-Bouwstra JK. Physical Therapy in Systemic Sclerosis: The Patient Perspective. Arthritis Care Res (Hoboken) 2023; 75:145-151. [PMID: 34219404 DOI: 10.1002/acr.24741] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/31/2021] [Accepted: 07/01/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To assess the use, satisfaction, needs, and preferences regarding physical therapy (PT) in patients with systemic sclerosis (SSc). METHODS A total of 405 SSc patients, treated in the Leiden University Medical Center multidisciplinary care program and fulfilling American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) 2013 SSc criteria, received a questionnaire containing 37 questions on use and satisfaction regarding PT over a 2-year period, and their needs and preferences for future PT. RESULTS A total of 204 SSc patients (median age 63 years, 81% female) completed the questionnaire. One hundred twenty-eight patients (63%) had used or were using PT in a primary care setting. For 39% of patients not using PT, lack of referral or lack of knowledge was the reason for not using it. The most frequently reported active treatments were muscle-strengthening (n = 92 [72%]), range of motion (n = 77 [60%]), and aerobic exercises (n = 72 [56%]). Specific SSc hand- and mouth-opening exercises were reported by 20 (15%) and 7 (6%) patients, respectively. Manual treatment (massage or passive mobilization) was reported by 83 patients (65%). The mean ± SD satisfaction score (range 0-10) was 8.2 ± 1.6. Regarding patients' needs, 96 patients (47%) of the total group wanted to receive more information concerning PT, and 128 (63%) wanted to continue, start, or restart PT in the near future, with 56 of the 128 patients (44%) favoring individual treatment on a continuous basis. CONCLUSION We observed a significant variation in the use and content of PT for SSc patients in a primary care setting. Our results suggest potential underuse of PT care, in particular for hand and oral dysfunction, and underpin the need for initiatives to improve the quality and accessibility of PT care for SSc patients.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Marisca R Schriemer
- Radboud University Medical Center, Nijmegen, The Netherlands, and NVLE, Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | | | - Madelon C Vonk
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | |
Collapse
|
4
|
Liem S, van Leeuwen NM, Vliet Vlieland T, Boerrigter G, van den Ende C, de Pundert L, Schriemer MR, Spierings J, Vonk MC, de Vries-Bouwstra JK. Physical therapy in patients with systemic sclerosis: physical therapists' perspectives on current delivery and educational needs. Scand J Rheumatol 2021; 51:394-401. [PMID: 34263718 DOI: 10.1080/03009742.2021.1937306] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: To assess the perspectives of physical therapists treating patients with systemic sclerosis (SSc) on their current practice and educational needs.Method: In July 2019, 405 SSc patients attending a multidisciplinary SSc programme received a survey on physical therapy. Patients who indicated having received physical therapy in the past 2 years were asked to invite their treating physical therapist to complete a questionnaire including sociodemographic characteristics, referral process, content of treatment, perceived knowledge and skills, and educational needs (mostly yes/no answers).Results: Forty-eight of 80 possibly eligible physical therapists treating SSc patients returned the questionnaire [median age 44 years (interquartile range 35-58); 52% female; median number of SSc patients currently treated: 1 (range 1-4)]. Eighty-one per cent (n = 39) of physical therapists had received a referral, with 69% (n = 27/39) judging its content as insufficient. The most often provided types of exercises were range of motion (96%), muscle-strengthening (85%), and aerobic (71%) exercises, followed by hand (42%) and mouth (10%) exercises. Concerning manual treatment, 65% performed either massage or passive mobilization. Regarding competences, 65% indicated feeling capable of treating SSc patients. Nevertheless, 85% expressed the need for an information website on physical therapy in SSc, and 77% for postgraduate education on SSc.Conclusion: Primary care physical therapists treating patients with SSc used a wide range of treatment modalities. Although most stated that they treated very few patients, the majority felt capable of treating SSc patients. Nevertheless, the large majority expressed a need for additional information and educational activities concerning SSc.
Collapse
Affiliation(s)
- Sie Liem
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - N M van Leeuwen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tpm Vliet Vlieland
- Department of Orthopedics, Rehabilitation Medicine and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Gmw Boerrigter
- Department of Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Chm van den Ende
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Laj de Pundert
- Department of Physical Therapy, HagaZiekenhuis, The Hague, The Netherlands
| | - M R Schriemer
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands.,NVLE, Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - J Spierings
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M C Vonk
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J K de Vries-Bouwstra
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
5
|
Stöcker JK, Schouffoer AA, Spierings J, Schriemer MR, Potjewijd J, de Pundert L, van den Hoogen FHJ, Nijhuis-van der Sanden MWG, Staal JB, Satink T, Vonk MC, van den Ende CHM. Evidence and consensus-based recommendations for non-pharmacological treatment of fatigue, hand function loss, Raynaud's phenomenon, and digital ulcers in patients with systemic sclerosis. Rheumatology (Oxford) 2021; 61:1476-1486. [PMID: 34260723 PMCID: PMC8996778 DOI: 10.1093/rheumatology/keab537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/25/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Systemic sclerosis is a complex connective tissue disease affecting mental and physical health. Fatigue, hand function loss, and Raynaud's phenomenon are the most prevalent disease-specific symptoms of systemic sclerosis. This study aimed to develop consensus and evidence-based recommendations for non-pharmacological treatment of these symptoms. METHODS A multidisciplinary task force was installed comprising 20 Dutch experts. After agreeing on the method for formulating the recommendations, clinically relevant questions about patient education and treatments were inventoried. During a face-to-face task force meeting, draft recommendations were generated through a systematically structured discussion, following the nominal group technique. To support the recommendations, an extensive literature search was conducted in MEDLINE and six other databases until September 2020, and 20 key systematic reviews, randomized controlled trials, and published recommendations were selected. Moreover, 13 Dutch medical specialists were consulted on non-pharmacological advice regarding Raynaud's phenomenon and digital ulcers. For each recommendation the level of evidence and the level of agreement was determined. RESULTS Forty-one evidence and consensus-based recommendations were developed, and 34, concerning treatments and patient education of fatigue (12), hand function loss (8), and Raynaud's phenomenon/digital ulcers-related problems (14), were approved by the task force. CONCLUSIONS These 34 recommendations provide guidance on non-pharmacological treatment of three of the most frequently described symptoms in patients with systemic sclerosis. The proposed recommendations can guide referrals to health professionals, inform the content of non-pharmacological interventions, and can be used in the development of national and international postgraduate educational offerings.
Collapse
Affiliation(s)
- Juliane K Stöcker
- Sint Maartenskliniek, Department of Research, Nijmegen, The Netherlands.,HAN University of Applied Sciences, Musculoskeletal Rehabilitation Research group, Nijmegen, The Netherlands.,Radboud university medical center, Department of Rheumatic diseases, Nijmegen, The Netherlands
| | - Anne A Schouffoer
- Leiden University Medical Center, Department of Rheumatology, Leiden, The Netherlands.,Haga Teaching Hospital, Department of Rheumatology, The Hague, The Netherlands
| | - Julia Spierings
- University Medical Center Utrecht, Department of Rheumatology and Clinical Immunology, Utrecht, The Netherlands.,Royal Free and University College London, Department of Inflammation, Centre for Rheumatology and Connective Tissue Diseases, London, United Kingdom
| | - Marisca R Schriemer
- Sint Maartenskliniek, Department of Research, Nijmegen, The Netherlands.,National Association for people with Lupus, Systemic Sclerosis, Antiphospholipid syndrome, and Mixed Connective Tissue Disease, Utrecht, The Netherlands
| | - Judith Potjewijd
- Maastricht University Medical Center, Department of Clinical immunology, Maastricht, The Netherlands
| | - Lian de Pundert
- Haga Teaching Hospital, Department of physical therapy, The Hague, The Netherlands.,University Medical Center Utrecht, Department of Rehabilitation, Physical Therapy Science and Sport, UMC Utrecht Brain Center, Utrecht, The Netherlands
| | - Frank H J van den Hoogen
- Sint Maartenskliniek, Department of Research, Nijmegen, The Netherlands.,Radboud university medical center, Department of Rheumatic diseases, Nijmegen, The Netherlands
| | | | - J Bart Staal
- HAN University of Applied Sciences, Musculoskeletal Rehabilitation Research group, Nijmegen, The Netherlands.,Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Ton Satink
- HAN University of Applied Sciences, Research group Neuro Rehabilitation, Nijmegen, The Netherlands.,European Masters of Science in Occupational Therapy, Amsterdam, The Netherlands
| | - Madelon C Vonk
- Radboud university medical center, Department of Rheumatic diseases, Nijmegen, The Netherlands
| | - Cornelia H M van den Ende
- Sint Maartenskliniek, Department of Research, Nijmegen, The Netherlands.,Radboud university medical center, Department of Rheumatic diseases, Nijmegen, The Netherlands
| | | |
Collapse
|