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Warnink-Kavelaars J, de Koning LE, van der Hulst AE, Buizer AI, Poissonnier N, Wijninga LE, Menke LA, Mosquera LM, Rombaut L, Engelbert RHH. Physical fitness in children with Marfan and Loeys-Dietz syndrome: associations between cardiovascular parameters, systemic manifestations, fatigue, and pain. Eur J Pediatr 2024; 183:2421-2429. [PMID: 38466415 PMCID: PMC11035467 DOI: 10.1007/s00431-024-05456-z] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/17/2024] [Accepted: 01/26/2024] [Indexed: 03/13/2024]
Abstract
Children with Marfan (MFS) and Loeys-Dietz syndrome (LDS) report limitations in physical activities, sports, school, leisure, and work participation in daily life. This observational, cross-sectional, multicenter study explores associations between physical fitness and cardiovascular parameters, systemic manifestations, fatigue, and pain in children with MFS and LDS. Forty-two participants, aged 6-18 years (mean (SD) 11.5(3.7)), diagnosed with MFS (n = 36) or LDS (n = 6), were enrolled. Physical fitness was evaluated using the Fitkids Treadmill Test's time to exhaustion (TTE) outcome measure. Cardiovascular parameters (e.g., echocardiographic parameters, aortic surgery, cardiovascular medication) and systemic manifestations (systemic score of the revised Ghent criteria) were collected. Pain was obtained by visual analog scale. Fatigue was evaluated by PROMIS® Fatigue-10a-Pediatric-v2.0-short-form and PROMIS® Fatigue-10a-Parent-Proxy-v2.0-short-form. Multivariate linear regression analyses explored associations between physical fitness (dependent variable) and independent variables that emerged from the univariate linear regression analyses (criterion p < .05). The total group (MFS and LDS) and the MFS subgroup scored below norms on physical fitness TTE Z-score (mean (SD) -3.1 (2.9); -3.0 (3.0), respectively). Univariate analyses showed associations between TTE Z-score aortic surgery, fatigue, and pain (criterion p < .05). Multivariate analyses showed an association between physical fitness and pediatric self-reported fatigue that explained 48%; 49%, respectively, of TTE Z-score variance (F (1,18) = 18.6, p ≤ .001, r2 = .48; F (1,15) = 16,3, p = .01, r2 = .49, respectively). Conclusions: Physical fitness is low in children with MFS or LDS and associated with self-reported fatigue. Our findings emphasize the potential of standardized and tailored exercise programs to improve physical fitness and reduce fatigue, ultimately enhancing the physical activity and sports, school, leisure, and work participation of children with MFS and LDS. What is Known: • Marfan and Loeys-Dietz syndrome are heritable connective tissue disorders and share cardiovascular and systemic manifestations. • Children with Marfan and Loeys-Dietz syndrome report increased levels of disability, fatigue and pain, as well as reduced levels of physical activity, overall health and health-related quality of life. What is New: • Physical fitness is low in children with Marfan and Loeys-Dietz syndrome and associated with self-reported fatigue. • Our findings emphasize the potential of standardized and tailored exercise programs to improve physical fitness and reduce fatigue, ultimately enhancing the physical activity and sports, school, leisure, and work participation of children with Marfan and Loeys-Dietz syndrome.
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Affiliation(s)
- Jessica Warnink-Kavelaars
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, PO box 22660, 1100 DD, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands.
| | - Lisanne E de Koning
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, PO box 22660, 1100 DD, Amsterdam, The Netherlands
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Tafelbergweg 51, Amsterdam, The Netherlands
| | - Annelies E van der Hulst
- Department of Pediatric Cardiology, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, PO box 22660, 1100 DD, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Nicole Poissonnier
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, PO box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Laura E Wijninga
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, PO box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Leonie A Menke
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Laura Muiño Mosquera
- Department of Pediatrics, Division of Pediatric Cardiology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium
- Center for Medical Genetics, Ghent University Hospital, Ghent University, Corneel Heymanslaan 10, Ghent, Belgium
| | - Lies Rombaut
- Center for Medical Genetics, Ghent University Hospital, Ghent University, Corneel Heymanslaan 10, Ghent, Belgium
| | - Raoul H H Engelbert
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, PO box 22660, 1100 DD, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Tafelbergweg 51, Amsterdam, The Netherlands
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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Kwakman RCH, Voorn EL, Sommers J, Gerrits K, Nollet F, Engelbert RHH, van der Schaaf M. Metabolic load during morning care and active bed exercises in critically ill patients: An explorative study. Aust Crit Care 2024; 37:441-447. [PMID: 37286446 DOI: 10.1016/j.aucc.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND To avoid overexertion in critically ill patients, information on the physical demand, i.e., metabolic load, of daily care and active exercises is warranted. OBJECTIVE The objective of this study was toassess the metabolic load during morning care activities and active bed exercises in mechanically ventilated critically ill patients. METHODS This study incorporated an explorative observational study executed in a university hospital intensive care unit. Oxygen consumption (VO2) was measured in mechanically ventilated (≥48 h) critically ill patients during rest, routine morning care, and active bed exercises. We aimed to describe and compare VO2 in terms of absolute VO2 (mL) defined as the VO2 attributable to the activity and relative VO2 in mL per kilogram bodyweight, per minute (mL/kg/min). Additional outcomes achieved during the activity were perceived exertion, respiratory variables, and the highest VO2 values. Changes in VO2 and activity duration were tested using paired tests. RESULTS Twenty-one patients were included with a mean (standard deviation) age of 59 y (12). Median (interquartile range [IQR]) durations of morning care and active bed exercises were 26 min (21-29) and 7 min (5-12), respectively. Absolute VO2 of morning care was significantly higher than that of active bed exercises (p = 0,009). Median (IQR) relative VO2 was 2.9 (2.6-3.8) mL/kg/min during rest; 3.1 (2.8-3.7) mL/kg/min during morning care; and 3.2 (2.7-4) mL/kg/min during active bed exercises. The highest VO2 value was 4.9 (4.2-5.7) mL/kg/min during morning care and 3.7 (3.2-5.3) mL/kg/min during active bed exercises. Median (IQR) perceived exertion on the 6-20 Borg scale was 12 (10.3-14.5) during morning care (n = 8) and 13.5 (11-15) during active bed exercises (n = 6). CONCLUSION Absolute VO2 in mechanically ventilated patients may be higher during morning care than during active bed exercises due to the longer duration of the activity. Intensive care unit clinicians should be aware that daily-care activities may cause intervals of high metabolic load and high ratings of perceived exertion.
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Affiliation(s)
- Robin C H Kwakman
- Department of Rehabilitation Medicine, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, Amsterdam, the Netherlands; Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands.
| | - Eric L Voorn
- Department of Rehabilitation Medicine, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands
| | - Juultje Sommers
- Department of Rehabilitation Medicine, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands
| | - Karin Gerrits
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands; Merem Medical Rehabilitation, Hilversum, the Netherlands; Department of Human Movement Sciences, Vrije Universiteit, Faculty of Behavioural and Movement Sciences, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands
| | - Raoul H H Engelbert
- Department of Rehabilitation Medicine, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, Amsterdam, the Netherlands; Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation Medicine, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, Amsterdam, the Netherlands; Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Ageing and Vitality, Amsterdam, the Netherlands
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van der Meer HA, Doomen A, Visscher CM, Engelbert RHH, Nijhuis-van der Sanden MWG, Speksnijder CM. The additional value of e-Health for patients with a temporomandibular disorder: a mixed methods study on the perspectives of orofacial physical therapists and patients. Disabil Rehabil Assist Technol 2024; 19:433-445. [PMID: 35960692 DOI: 10.1080/17483107.2022.2094000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 06/17/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE To assess the experience and perceived added value of an e-Health application during the physical therapy treatment of patients with temporomandibular disorders (TMD). MATERIALS AND METHODS A mixed-methods study including semi-structured interviews was performed with orofacial physical therapists (OPTs) and with TMD patients regarding their experience using an e-Health application, Physitrack. The modified telemedicine satisfaction and usefulness questionnaire and pain intensity score before and after treatment were collected from the patients. RESULTS Ten OPTs, of which nine actively used Physitrack, described that the e-Health application can help to provide personalised care to patients with TMD, due to the satisfying content, user-friendliness, accessibility, efficiency, and ability to motivate patients. Ten patients, of which nine ended up using Physitrack, felt that shared decision-making was very important. These patients were positive towards the application as it was clear, convenient, and efficient, it helped with reassurance and adherence to the exercises and overall increased self-efficacy. This was mostly built on their experience with exercise videos, as this feature was most used. None of the OPTs or patients used all features of Physitrack. The overall satisfaction of Physitrack based on the telemedicine satisfaction and usefulness questionnaire (TSUQ) was 20.5 ± 4.0 and all patients (100%) showed a clinically relevant reduction of TMD pain (more than 2 points and minimally 30% difference). CONCLUSION OPTs and patients with TMD shared the idea that exercise videos are of added value on top of usual physical therapy care for TMD complaints, which could be delivered through e-Health.Implications for RehabilitationPhysical therapists and patients with temporomandibular disorders do not use all features of the e-Health application Physitrack in a clinical setting.Exercise videos were the most often used feature and seen as most valuable by physical therapists and patients.Based on a small number of participants, e-Health applications such as Physitrack may be perceived as a valuable addition to the usual care, though this would need verification by a study designed to evaluate the therapeutic effect (e.g., a randomised clinical trial).
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Affiliation(s)
- Hedwig A van der Meer
- University Medical Center Utrecht, Department of Oral-Maxillofacial Surgery and Special Dental Care, Utrecht University, Utrecht, The Netherlands
- Department of Orofacial Pain and Disfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit (VU) University Amsterdam, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation, Amsterdam, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Location Meibergdreef 9, The Netherlands
- Radboud University Medical Center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Annet Doomen
- Physiotherapy Private Practice 'De Molen', Houten, The Netherlands
- Institute of Movement Studies, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Corine M Visscher
- Department of Orofacial Pain and Disfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit (VU) University Amsterdam, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation, Amsterdam, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Location Meibergdreef 9, The Netherlands
| | | | - Caroline M Speksnijder
- University Medical Center Utrecht, Department of Oral-Maxillofacial Surgery and Special Dental Care, Utrecht University, Utrecht, The Netherlands
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Flierman M, Vriend E, Leemhuis AG, Engelbert RHH, Jeukens-Visser M. Development and evaluation of a fidelity tool in a post-discharge responsive parenting intervention program for very preterm born children. Eval Program Plann 2023; 99:102299. [PMID: 37187117 DOI: 10.1016/j.evalprogplan.2023.102299] [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] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/17/2023] [Accepted: 04/29/2023] [Indexed: 05/17/2023]
Abstract
The TOP program is a fully implemented responsive parenting intervention for very preterm born infants. Fidelity monitoring of interventions is important for preserving program adherence, impact outcomes and to make evidence-based adaptations. The aim of this study was to develop a fidelity tool for the TOP program following an iterative and co-creative process and subsequently evaluate the reliability of the tool. Three consecutive phases were carried out. Phase I: Initial development and pilot testing two methods namely self-report and video based observation. Phase II: Adaptations and refinements. Phase III: Evaluation of the psychometric properties of the tool based on 20 intervention videos rated by three experts.The interrater reliability of the adherence and competence subscales was good (ICC.81 to .84) and varied from moderate to excellent for specific items (ICC between .51 and .98). The FITT displayed a high correlation (Spearman's rho.79 to.82) between the subscales and total impression item. The co-creative and iterative process resulted in a clinical useful and reliable tool for evaluating fidelity in the TOP program. This study offers insights in the practical steps in the development of a fidelity assessment tool which can be used by other intervention developers.
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Affiliation(s)
- Monique Flierman
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Reproduction and development, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Eline Vriend
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Reproduction and development, Meibergdreef 9, Amsterdam, the Netherlands
| | - Aleid G Leemhuis
- Emma Children's Hospital, Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Raoul H H Engelbert
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Reproduction and development, Meibergdreef 9, Amsterdam, the Netherlands; Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Emma Children's Hospital, Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Martine Jeukens-Visser
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Reproduction and development, Meibergdreef 9, Amsterdam, the Netherlands
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de Koning LE, Warnink-Kavelaars J, van Rossum MA, Bosman D, Menke LA, Malfait F, de Boer R, Oosterlaan J, Engelbert RHH, Rombaut L. Somatic symptoms, pain, catastrophizing and the association with disability among children with heritable connective tissue disorders. Am J Med Genet A 2023. [PMID: 37186039 DOI: 10.1002/ajmg.a.63204] [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: 09/21/2022] [Revised: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 05/17/2023]
Abstract
The aim of the present study was to investigate the nature and prevalence of nonspecific somatic symptoms, pain and catastrophizing in children with Heritable Connective Tissue Disorders (HCTD), and to determine their association with disability. This observational, multicenter study included 127 children, aged 4-18 years, with Marfan syndrome (MFS) (59%), Loeys-Dietz syndrome (LDS) (8%), Ehlers-Danlos syndromes (EDS) (12%) and hypermobile Ehlers-Danlos syndrome (hEDS) (23%). The assessments included the Children's Somatization Inventory or parent proxy (CSI, PCSI), pain visual-analogue scale (VAS), SUPERKIDZ body diagram, Pain Catastrophizing Scale Child or parent proxy (PCS-C, PCS-P) and Childhood Health Assessment Questionnaire (CHAQ-30). Data from children aged ≥8 years were compared to normative data. In children ≥ 8 years (n = 90), pain was present in 59%, with a median of 4 (IQR = 3-9) pain areas. Compared to normative data, the HCTD group reported significantly higher on the CSI (p ≤ 0.001, d = 0.85), VAS pain intensity (p ≤ 0.001, d = 1.22) and CHAQ-30 (p ≤ 0.001, d = 1.16) and lower on the PCS-C (p = 0.017, d = -0.82) and PCS-P (p ≤ 0.001, d = -0.49). The intensity of nonspecific somatic symptoms and pain explained 45% of the variance in disability (r2 = 0.45 F(2,48) = 19.70, p ≤ 0.001). In children ≤ 7 years (n = 37), pain was present in 35% with a median of 5(IQR = 1-13) pain areas. The mean(SD) VAS scores for pain intensity was 1.5(2.9). Functional disability was moderately correlated to the number of pain areas (r = 0.56, p ≤ 0.001), intensity of nonspecific somatic symptoms (r = 0.63, p ≤ 0.001) and pain (r = 0.83, p ≤ 0.001). In conclusion, this study supports the need for comprehensive assessment of nonspecific somatic symptoms, pain, and disability in children with HCTD to allow tailored treatment.
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Affiliation(s)
- Lisanne E de Koning
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Jessica Warnink-Kavelaars
- Department of Rehabilitation Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
| | - Marion A van Rossum
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Diederik Bosman
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Leonie A Menke
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Fransiska Malfait
- Center for Medical Genetics, Ghent University Hospital/Ghent University, Ghent, Belgium
| | - Rosa de Boer
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow-Me Program & Emma Neuroscience Group, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Lies Rombaut
- Center for Medical Genetics, Ghent University Hospital/Ghent University, Ghent, Belgium
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de Koning LE, Scheper MC, Ploeger HE, Warnink-Kavelaars J, Oosterlaan J, Bus SA, Engelbert RHH. An exploratory study of clinical characteristics and gait features of adolescents with hypermobility disorders. Gait Posture 2023; 100:222-229. [PMID: 36638668 DOI: 10.1016/j.gaitpost.2023.01.001] [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: 12/02/2021] [Revised: 12/21/2022] [Accepted: 01/04/2023] [Indexed: 01/06/2023]
Abstract
BACKGROUND In adolescents with non-pathological and pathological joint hypermobility, gait deviations have been associated with pain and fatigue. It remains unclear what distinguishes the non-pathological form of joint hypermobility (JH) from pathological forms (i.e. hypermobile Ehlers-Danlos syndrome (hEDS) or hypermobility spectrum disorders (HSD). Our objective was to identify discriminative clinical characteristics and biomechanical gait features between adolescents with hEDS/HSD, JH, and healthy controls (HC). METHODS Thirty-two adolescents were classified into three subgroups (hEDS/HSD=12, JH=5, HC=15). Clinical characteristics (e.g. pain intensity and surface, fatigue, functional disability) were inventoried. The gait pattern was assessed using a three-dimensional, eight-camera VICON MX1.3 motion capture system, operating at a sample rate of 100 Hz (VICON, Oxford, UK). Spatiotemporal parameters, joint angles (sagittal plane), joint work, joint impulse, ground reaction force and gait variability expressed as percentage using Principal Component Analysis (PCA) were assessed and analysed using multivariate analysis. Multivariate analysis data is expressed in mean differences(MD), standard error(SE) and P-values. RESULTS The hEDS/HSD-group had significantly higher fatigue score (+51.5 points, p = <0.001) and functional disability (+1.6, p < .001) than the HC-group. Pain intensity was significantly higher in the hEDS/HSD-group than the other subgroups (JH; +37 mm p = .004, HC; +38 mm, p = .001). The hEDS/HSD-group showed significantly more gait variability (JH; +7.2(2.0)% p = .003, HC; + 7.8(1.4)%, p = <0.001) and lower joint work (JH; -0.07(0.03)J/kg, p = .007, HC; - 0.06(0.03)J/kg, p = .013) than the other subgroups. The JH-group showed significantly increased ankle dorsiflexion during terminal stance (+5.0(1.5)degree, p = .001) compared to hEDS/HSD-group and knee flexion during loading response compared to HC-group (+5.7(1.8) degree, p = .011). SIGNIFICANCE A distinctive difference in gait pattern between adolescents with non-pathological and pathological joint hypermobility is found in gait variability, rather than in the biomechanical features of gait. This suggests that a specific gait variability metric is more appropriate than biomechanical individual joint patterns for assessing gait in adolescents with hEDS/HSD.
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Affiliation(s)
- Lisanne E de Koning
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Mark C Scheper
- Rotterdam University of Applied Sciences, Institute for Health, (pediatric) Physical Therapy, Rochussenstraat 198, 3015 Rotterdam, the Netherlands; Research Center Innovations In Care, Transitions in Care / Data-supported Healthcare, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 Rotterdam, the Netherlands; Department of Health Professions, Faculty of Medicine and Health, Macquarie University, Macquarie Park, Sydney, NSW 2109, Australia.
| | - Hilde E Ploeger
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands.
| | - Jessica Warnink-Kavelaars
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands.
| | - Jaap Oosterlaan
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow-Me Program & Emma Neuroscience Group, Amsterdam Reproduction & Development, Amsterdam, the Netherlands.
| | - Sicco A Bus
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands.
| | - Raoul H H Engelbert
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands.
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Aarden JJ, Major ME, Aghina CMW, Esch MVD, Buurman BM, Engelbert RHH, Schaaf MVD. Recommendations for an exercise intervention and core outcome set for older patients after hospital discharge: Results of an international Delphi study. PLoS One 2023; 18:e0283545. [PMID: 36961843 PMCID: PMC10038288 DOI: 10.1371/journal.pone.0283545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/10/2023] [Indexed: 03/25/2023] Open
Abstract
For older adults, acute hospitalization is a high-risk event with poor health outcomes, including functional decline. In absence of practical guidelines and high quality randomized controlled trials, this Delphi study was conducted. The aim of this study was to obtain consensus on an exercise intervention program, a core outcome set (COS) and handover information to prevent functional decline or restore physical function in acutely hospitalized older patients transitioning from hospital to home. An internal panel of experts in the field of exercise interventions for acutely hospitalized older adults were invited to join the study. In the Delphi study, relevant topics were recognized, statements were formulated and ranked on a 9-point Likert scale in two additional rounds. To reaching consensus, a score of 7-9 was classified as essential. Results were expressed as median and semi-interquartile range (SIQR), and consensus threshold was set at SIQR≤0.5. Fifteen international experts from eight countries participated in the panel. The response rate was 93%, 93% and 80% for the three rounds respectively. After three rounds, consensus was reached on 167 of the 185 (90.3%) statements, of which ninety-five (51.4%) were ranked as essential (median Likert-score ≥7.0, SIQR ≤0.5). This Delphi study provides starting points for developing an exercise intervention, a COS and handover information. The results of this Delphi study can assist physical therapists to provide a tailored exercise intervention for older patients with complex care needs after hospital discharge, to prevent functional decline and/or restore physical function.
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Affiliation(s)
- Jesse J Aarden
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- ESP-European School of Physiotherapy, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Mel E Major
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- ESP-European School of Physiotherapy, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Claartje M W Aghina
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Martin van der Esch
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands
| | - Bianca M Buurman
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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8
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Geelen SJG, Giele BM, Veenhof C, Nollet F, Engelbert RHH, van der Schaaf M. Physical dependence and urinary catheters both strongly relate to physical inactivity in adults during hospital stay: a cross-sectional, observational study. Disabil Rehabil 2022; 44:6684-6691. [PMID: 34528861 DOI: 10.1080/09638288.2021.1970257] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To determine which factors are associated with physical inactivity in hospitalized adults of all ages. METHODS A cross-sectional sample of 114 adults admitted to a gastrointestinal surgery, internal medicine or cardiology hospital ward (median age 60, length of stay 13 days) were observed during one random day from 8 am to 8 pm using wireless accelerometers and behavioral mapping protocols. Factors (e.g., comorbidities, self-efficacy, independence in mobility, functional restraints) were collected from medical records, surveys, and observations. RESULTS Patients were physically active for median(IQR) 26 (13-52.3) min and were observed to lie in bed for 67.3%, sit for 25.2%, stand for 2.5%, and walk for 5.0% of the time. Multivariable regression analysis revealed that physical inactivity was 159.87% (CI = 89.84; 255.73) higher in patients dependent in basic mobility, and 58.88% (CI = 10.08; 129.33) higher in patients with a urinary catheter (adjusted R2 = 0.52). The fit of our multivariable regression analysis did not improve after adding hospital ward to the analysis (p > 0.05). CONCLUSIONS Independence in mobility and urine catheter presence are two important factors associated with physical inactivity in hospitalized adults of all ages, and these associations do not differ between hospital wards. Routine assessments of both factors may therefore help to identify physically inactive patients throughout the hospital.IMPLICATIONS FOR REHABILITATIONHealthcare professionals should be aware that physical inactivity during hospital stay may result into functional decline.Regardless of which hospital ward patients are admitted to, once patients require assistance in basic mobility or have a urinary catheter they are at risk of physical inactivity during hospital stay.Implementing routine assessments on the independence of basic mobility and urine catheter presence may therefore assist healthcare professionals in identifying physically inactive patients before they experience functional decline.
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Affiliation(s)
- Sven J G Geelen
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Boukje M Giele
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Cindy Veenhof
- Physical Therapy Research, Department of Rehabilitation, Physical Therapy Sciences and Sports, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.,Expertise Centre Healthy Urban Living, Research Group Innovation of Human Movement Care, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
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9
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van den Helder J, Verreijen AM, van Dronkelaar C, Memelink RG, Engberink MF, Engelbert RHH, Weijs PJM, Tieland M. Bio-Electrical Impedance Analysis: A Valid Assessment Tool for Diagnosis of Low Appendicular Lean Mass in Older Adults? Front Nutr 2022; 9:874980. [PMID: 35719168 PMCID: PMC9201397 DOI: 10.3389/fnut.2022.874980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/29/2022] [Indexed: 12/16/2022] Open
Abstract
Background The diagnosis of sarcopenia is essential for early treatment of sarcopenia in older adults, for which assessment of appendicular lean mass (ALM) is needed. Multi-frequency bio-electrical impedance analysis (MF-BIA) may be a valid assessment tool to assess ALM in older adults, but the evidences are limited. Therefore, we validated the BIA to diagnose low ALM in older adults. Methods ALM was assessed by a standing-posture 8 electrode MF-BIA (Tanita MC-780) in 202 community-dwelling older adults (age ≥ 55 years), and compared with dual-energy X-ray absorptiometry (DXA) (Hologic Inc., Marlborough, MA, United States; DXA). The validity for assessing the absolute values of ALM was evaluated by: (1) bias (mean difference), (2) percentage of accurate predictions (within 5% of DXA values), (3) the mean absolute error (MAE), and (4) limits of agreement (Bland–Altman analysis). The lowest quintile of ALM by DXA was used as proxy for low ALM (< 22.8 kg for men, < 16.1 kg for women). Sensitivity and specificity of diagnosing low ALM by BIA were assessed. Results The mean age of the subjects was 72.1 ± 6.4 years, with a BMI of 25.4 ± 3.6 kg/m2, and 71% were women. BIA slightly underestimated ALM compared to DXA with a mean bias of −0.6 ± 1.2 kg. The percentage of accurate predictions was 54% with a MAE of 1.1 kg, and limits of agreement were −3.0 to + 1.8 kg. The sensitivity for ALM was 80%, indicating that 80% of subjects who were diagnosed as low ALM according to DXA were also diagnosed low ALM by BIA. The specificity was 90%, indicating that 90% of subjects who were diagnosed as normal ALM by DXA were also diagnosed as normal ALM by the BIA. Conclusion This comparison showed a poor validity of MF-BIA to assess the absolute values of ALM, but a reasonable sensitivity and specificity to recognize the community-dwelling older adults with the lowest muscle mass.
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Affiliation(s)
- Jantine van den Helder
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Department of Nutrition and Dietetics, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- *Correspondence: Jantine van den Helder,
| | - Amely M. Verreijen
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Carliene van Dronkelaar
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Robert G. Memelink
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Mariëlle F. Engberink
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Raoul H. H. Engelbert
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Peter J. M. Weijs
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Department of Nutrition and Dietetics, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Michael Tieland
- Faculty of Sports and Nutrition, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
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10
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Warnink-Kavelaars J, de Koning LE, Rombaut L, Menke LA, Alsem MW, van Oers HA, Buizer AI, Engelbert RHH, Oosterlaan J. Heritable connective tissue disorders in childhood: Decreased health-related quality of life and mental health. Am J Med Genet A 2022; 188:2096-2109. [PMID: 35393672 PMCID: PMC9321696 DOI: 10.1002/ajmg.a.62750] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/23/2022] [Accepted: 03/22/2022] [Indexed: 11/28/2022]
Abstract
The psychosocial consequences of growing up with Heritable Connective Tissue Disorders (HCTD) are largely unknown. We aimed to assess Health‐Related Quality of Life (HRQoL) and mental health of children and adolescents with HCTD. This observational multicenter study included 126 children, aged 4–18 years, with Marfan syndrome (MFS, n = 74), Loeys–Dietz syndrome (n = 8), molecular confirmed Ehlers–Danlos syndromes (n = 15), and hypermobile Ehlers–Danlos syndrome (hEDS, n = 29). HRQoL and mental health were assessed through the parent and child‐reported Child Health Questionnaires (CHQ‐PF50 and CHQ‐CF45, respectively) and the parent‐reported Strengths and Difficulties Questionnaire. Compared with a representative general population sample, parent‐reported HRQoL of the HCTD‐group showed significantly decreased Physical sum scores (p < 0.001, d = 0.9) and Psychosocial sum scores (p = 0.024, d = 0.2), indicating decreased HRQoL. Similar findings were obtained for child‐reported HRQoL. The parent‐reported mental health of the HCTD‐group showed significantly increased Total difficulties sum scores (p = 0.01, d = 0.3), indicating decreased mental health. While the male and female MFS‐ and hEDS‐subgroups both reported decreased HRQoL, only the hEDS‐subgroup reported decreased mental health. In conclusion, children and adolescents with HCTD report decreased HRQoL and mental health, with most adverse outcomes reported in children with hEDS and least in those with MFS. These findings call for systematic monitoring and tailored interventions.
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Affiliation(s)
- Jessica Warnink-Kavelaars
- Amsterdam UMC location University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam, The Netherlands.,Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
| | - Lisanne E de Koning
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, The Netherlands
| | - Lies Rombaut
- Ghent University Hospital, Ghent University, Center for Medical Genetics, Ghent, Belgium
| | - Leonie A Menke
- Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Department of Pediatrics, Amsterdam, The Netherlands
| | - Mattijs W Alsem
- Amsterdam UMC location University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam, The Netherlands.,Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
| | - Hedy A van Oers
- Amsterdam UMC, location University of Amsterdam, Emma Children's Hospital, Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Annemieke I Buizer
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands.,Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam, The Netherlands.,Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Amsterdam UMC location University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam, The Netherlands.,Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands.,Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, The Netherlands.,Emma Children's Hospital, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow-Me program & Emma Neuroscience Group, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development research institute, Amsterdam, The Netherlands
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11
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Gmelig Meyling C, Verschuren O, Rentinck IR, Engelbert RHH, Gorter JW. Physical rehabilitation interventions in children with acquired brain injury: a scoping review. Dev Med Child Neurol 2022; 64:40-48. [PMID: 34309829 PMCID: PMC9292549 DOI: 10.1111/dmcn.14997] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 12/14/2022]
Abstract
AIM To synthesize the evidence about the characteristics (frequency, intensity, time, type) and effects of physical rehabilitation interventions on functional recovery and performance in daily functioning in children and young people with acquired brain injury (ABI), including traumatic brain injuries (TBI) and non-TBI, during the subacute rehabilitation phase. METHOD Using scoping review methodology, a systematic literature search was performed using four databases. Articles were screened by title and abstract and data from eligible studies were extracted for synthesis. RESULTS Nine of 3009 studies were included. The results demonstrated a variety of intervention characteristics: frequency varied between 1 and 7 days per week; time of intervention varied between 25 minutes and 6 hours a day; intervention types were specified in seven studies; and none of the included studies reported details of intensity of intervention. All studies reported positive results on the International Classification of Functioning, Disability and Health: Children and Youth (ICF-CY) levels of body function and activities after the intervention period, with study designs of included studies being cohort studies without concurrent controls (n=7) or case reports (n=2). INTERPRETATION Inconsistency in results hampers generalizability to guide clinical practice. Physical interventions during subacute rehabilitation have potential to improve functional recovery with intervention characteristics as an important factor influencing its effectiveness. Future well-designed studies are indicated to gain knowledge and optimize rehabilitation practice in paediatric ABI and high-quality research including outcomes across all ICF-CY domains is needed.
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Affiliation(s)
- Christiaan Gmelig Meyling
- UMC Utrecht Brain Center and Center of Excellence for Rehabilitation MedicineUtrecht UniversityUtrechtthe Netherlands,Department of Pediatric RehabilitationDe Hoogstraat RehabilitationUtrechtthe Netherlands
| | - Olaf Verschuren
- UMC Utrecht Brain Center and Center of Excellence for Rehabilitation MedicineUtrecht UniversityUtrechtthe Netherlands
| | - Ingrid R Rentinck
- Department of Pediatric RehabilitationDe Hoogstraat RehabilitationUtrechtthe Netherlands
| | - Raoul H H Engelbert
- Department of RehabilitationAmsterdam Movement SciencesAmsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands,Faculty of HealthCentre of Expertise Urban VitalityAmsterdam University of Applied SciencesAmsterdamthe Netherlands,Department of PediatricsAmsterdam UMCEmma Children’s HospitalUniversity of AmsterdamAmsterdamthe Netherlands
| | - Jan Willem Gorter
- UMC Utrecht Brain Center and Center of Excellence for Rehabilitation MedicineUtrecht UniversityUtrechtthe Netherlands,Department of PediatricsCanChild Centre for Childhood Disability ResearchMcMaster UniversityHamiltonONCanada
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12
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Major ME, Dettling-Ihnenfeldt D, Ramaekers SPJ, Engelbert RHH, van der Schaaf M. Feasibility of a home-based interdisciplinary rehabilitation program for patients with Post-Intensive Care Syndrome: the REACH study. Crit Care 2021; 25:279. [PMID: 34353341 PMCID: PMC8339801 DOI: 10.1186/s13054-021-03709-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Survivors of critical illness experience long-term functional challenges, which are complex, heterogeneous, and multifactorial in nature. Although the importance of rehabilitation interventions after intensive care unit (ICU) discharge is universally recognized, evidence on feasibility and effectiveness of home-based rehabilitation programs is scarce and ambiguous. This study investigates the feasibility of an interdisciplinary rehabilitation program designed for patients with Post-Intensive Care Syndrome (PICS) who are discharged home. METHODS A mixed method, non-randomized, prospective pilot feasibility study was performed with a 6-month follow-up, comparing the intervention (REACH) with usual care. REACH was provided by trained professionals and included a patient-centered, interdisciplinary approach starting directly after hospital discharge. Primary outcomes were patient safety, satisfaction, adherence, referral need and health care usage. Secondary outcomes, measured at 3 timepoints, were functional exercise capacity, self-perceived health status, health-related quality of life (HRQoL), return to work and psychotrauma. Risk of undernutrition was assessed at baseline. RESULTS 43 patients with a median mechanical ventilation duration of 8 (IQR:10) days, were included in the study and 79.1% completed 6-month follow-up. 19 patients received the intervention, 23 received usual care. Groups were similar for gender distribution and ICU length of stay. No adverse events occurred. REACH participants showed higher satisfaction with treatment and reported more allied health professional visits, while the usual care group reported more visits to medical specialists. Qualitative analysis identified positive experiences among REACH-professionals related to providing state-of-the-art interventions and sharing knowledge and expertise within an interprofessional network. Similar recovery was seen between groups on all secondary outcomes, but neither group reached reference values for HRQoL at 6 months. Larger return to work rates were seen in the REACH group. Prevalence of undernutrition at hospital discharge was high in both groups (> 80%), warranting the need for careful tuning of physical therapy and nutritional interventions. CONCLUSIONS This study shows that providing early, home-based rehabilitation interventions for patients with PICS-related symptoms is feasible and perceived positively by patients and professionals. When provided in an interdisciplinary collaborative network state of the art, person-centered interventions can be tailored to individual needs potentially increasing patient satisfaction, adherence, and efficacy. Registered in the Dutch Trial register: NL7792: https://www.trialregister.nl/trial/7792 , registered 7-06-2019.
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Affiliation(s)
- Mel E Major
- European School of Physiotherapy, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Daniela Dettling-Ihnenfeldt
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Stephan P J Ramaekers
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marike van der Schaaf
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
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13
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van der Meer HA, Calixtre LB, Engelbert RHH, Visscher CM, Nijhuis-van der Sanden MW, Speksnijder CM. Corrigendum to "Effects of physical therapy for temporomandibular disorders on headache pain intensity: A systematic review" [Musculoskeletal science and practice 50 (2020) 102277]. Musculoskelet Sci Pract 2021; 53:102344. [PMID: 33622659 DOI: 10.1016/j.msksp.2021.102344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Hedwig A van der Meer
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Department of Orofacial Pain and Dysfunction, Amsterdam, the Netherlands; University Medical Center Utrecht, Utrecht University, Department of Oral-Maxillofacial Surgery and Special Dental Care, Utrecht, the Netherlands; Amsterdam University of Applied Sciences, Education of Physiotherapy, Faculty of Health, Amsterdam, the Netherlands; Radboud University Medical Center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands; University of Amsterdam, Amsterdam University Medical Centers (AUMC), Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, Meibergdreef 9, the Netherlands.
| | - Leticia B Calixtre
- Federal University of São Carlos (UFSCar), Physiotherapy Department, São Carlos, Brazil
| | - Raoul H H Engelbert
- Amsterdam University of Applied Sciences, Education of Physiotherapy, Faculty of Health, Amsterdam, the Netherlands; University of Amsterdam, Amsterdam University Medical Centers (AUMC), Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, Meibergdreef 9, the Netherlands
| | - Corine M Visscher
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Department of Orofacial Pain and Dysfunction, Amsterdam, the Netherlands
| | | | - Caroline M Speksnijder
- University Medical Center Utrecht, Utrecht University, Department of Oral-Maxillofacial Surgery and Special Dental Care, Utrecht, the Netherlands
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14
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Warnink-Kavelaars J, de Koning LE, Rombaut L, Alsem MW, Menke LA, Oosterlaan J, Buizer AI, Engelbert RHH. Heritable Connective Tissue Disorders in Childhood: Increased Fatigue, Pain, Disability and Decreased General Health. Genes (Basel) 2021; 12:genes12060831. [PMID: 34071423 PMCID: PMC8229209 DOI: 10.3390/genes12060831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 05/01/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022] Open
Abstract
Heritable Connective Tissue Disorders (HCTD) show an overlap in the physical features that can evolve in childhood. It is unclear to what extent children with HCTD experience burden of disease. This study aims to quantify fatigue, pain, disability and general health with standardized validated questionnaires. METHODS This observational, multicenter study included 107 children, aged 4-18 years, with Marfan syndrome (MFS), 58%; Loeys-Dietz syndrome (LDS), 7%; Ehlers-Danlos syndromes (EDS), 8%; and hypermobile Ehlers-Danlos syndrome (hEDS), 27%. The assessments included PROMIS Fatigue Parent-Proxy and Pediatric self-report, pain and general health Visual-Analogue-Scales (VAS) and a Childhood Health Assessment Questionnaire (CHAQ). RESULTS Compared to normative data, the total HCTD-group showed significantly higher parent-rated fatigue T-scores (M = 53 (SD = 12), p = 0.004, d = 0.3), pain VAS scores (M = 2.8 (SD = 3.1), p < 0.001, d = 1.27), general health VAS scores (M = 2.5 (SD = 1.8), p < 0.001, d = 2.04) and CHAQ disability index scores (M = 0.9 (SD = 0.7), p < 0.001, d = 1.23). HCTD-subgroups showed similar results. The most adverse sequels were reported in children with hEDS, whereas the least were reported in those with MFS. Disability showed significant relationships with fatigue (p < 0.001, rs = 0.68), pain (p < 0.001, rs = 0.64) and general health (p < 0.001, rs = 0.59). CONCLUSIONS Compared to normative data, children and adolescents with HCTD reported increased fatigue, pain, disability and decreased general health, with most differences translating into very large-sized effects. This new knowledge calls for systematic monitoring with standardized validated questionnaires, physical assessments and tailored interventions in clinical care.
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Affiliation(s)
- Jessica Warnink-Kavelaars
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.W.A.); (A.I.B.); (R.H.H.E.)
- Correspondence: ; Tel.: +31(0)2-0566-3345
| | - Lisanne E. de Koning
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD Amsterdam, The Netherlands;
| | - Lies Rombaut
- Center of Medical Genetics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium;
| | - Mattijs W. Alsem
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.W.A.); (A.I.B.); (R.H.H.E.)
| | - Leonie A. Menke
- Department of Pediatrics, Emma Children’s Hospital, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
| | - Jaap Oosterlaan
- Emma Neuroscience Group, Amsterdam Reproduction & Development, Department of Pediatrics, Emma Children’s Hospital, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
| | - Annemieke I. Buizer
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.W.A.); (A.I.B.); (R.H.H.E.)
- Department of Pediatrics, Emma Children’s Hospital, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
- Department of Rehabilitation Medicine, Rehabilitation and Development, Amsterdam Movement Sciences Institute, Amsterdam UMC, Vrije University of Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Raoul H. H. Engelbert
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.W.A.); (A.I.B.); (R.H.H.E.)
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD Amsterdam, The Netherlands;
- Department of Pediatrics, Emma Children’s Hospital, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
| | - on behalf of the Pediatric Heritable Connective Tissue Disorders Study Group
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.W.A.); (A.I.B.); (R.H.H.E.)
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD Amsterdam, The Netherlands;
- Center of Medical Genetics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium;
- Department of Pediatrics, Emma Children’s Hospital, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
- Emma Neuroscience Group, Amsterdam Reproduction & Development, Department of Pediatrics, Emma Children’s Hospital, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
- Department of Rehabilitation Medicine, Rehabilitation and Development, Amsterdam Movement Sciences Institute, Amsterdam UMC, Vrije University of Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Genetics, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- Center for Human and Clinical Genetics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Department of Human Genetics, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Centre of Medical Genetics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium
- Department of Physical and Rehabilitation Medicine, Child Rehabilitation, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium
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15
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Geelen SJG, Giele BM, Engelbert RHH, de Moree S, Veenhof C, Nollet F, van Nes F, van der Schaaf M. Barriers to and solutions for improving physical activity in adults during hospital stay: a mixed-methods study among healthcare professionals. Disabil Rehabil 2021; 44:4004-4013. [PMID: 33605171 DOI: 10.1080/09638288.2021.1879946] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 10/22/2022]
Abstract
PURPOSE To identify healthcare professionals' perspectives on key barriers to improving physical activity in hospitalized adult patients, and to identify solutions to overcome these barriers. Methods: We used an explanatory sequential mixed-methods study design in a Dutch university hospital. A survey exploring 39 potential barriers was completed by 15 physicians/physician assistants, 106 nurses, four nursing assistants, and four physical therapists working on surgery, internal medicine, and cardiology wards. Next, three in-depth semi-structured focus groups - comprising 30 healthcare professionals - discussed the survey findings to identify key barriers and solutions. Focus group discussions were analyzed using thematic analysis. Results: Five themes were identified that described both the key barriers and the solutions to overcome these barriers. Healthcare professionals proposed several solutions, including clarifying the definition of physical activity, empowering patients to take responsibility for physical activity, giving physical therapists or physicians a prominent role in encouraging physical activity, and changing the hospital ward to entice patients to become physically active. Conclusions: Healthcare professionals need clear guidelines, roles, and responsibilities when it comes to physical activity. They also need personalized interventions that empower patients in physical activity. Finally, hospital wards should be designed and furnished so that patients are encouraged to be active.IMPLICATIONS FOR REHABILITATIONMany healthcare professionals want to sustainably improve physical activity in hospitalized adults.For this they need clear guidelines that not only define physical activity, but also describe the roles and responsibilities of all members of the medical team.Healthcare professionals need interventions that help to empower patients to take an active role in physical activity during hospital stay.Hospital wards should be designed and furnished so that patients are encouraged to be physically active.
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Affiliation(s)
- Sven J G Geelen
- Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Boukje M Giele
- Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Sandra de Moree
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Cindy Veenhof
- Physical Therapy Research, Department of Rehabilitation, Physical Therapy Sciences & Sports, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Expertise Center Healthy Urban Living, Research Group Innovation of Human Movement Care, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Fenna van Nes
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation Medicine, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
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16
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van Seben R, Covinsky KE, Reichardt LA, Aarden JJ, van der Schaaf M, van der Esch M, Engelbert RHH, Twisk JWR, Bosch JA, Buurman BM. Insight Into the Posthospital Syndrome: A 3-Month Longitudinal Follow up on Geriatric Syndromes and Their Association With Functional Decline, Readmission, and Mortality. J Gerontol A Biol Sci Med Sci 2021; 75:1403-1410. [PMID: 32072168 PMCID: PMC7302165 DOI: 10.1093/gerona/glaa039] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Indexed: 11/29/2022] Open
Abstract
Background Acute hospitalization may lead to posthospital syndrome, but no studies have investigated how this syndrome manifests and geriatric syndromes are often used as synonym. However, studies on longitudinal associations between syndromes and adverse outcomes are scarce. We aimed to analyze longitudinal associations between geriatric syndromes and functional decline (FD), readmission, and mortality. Methods Prospective cohort study, including 401 acutely hospitalized patients (aged ≥ 70). We performed: (i) logistic regression analyses to assess associations between patterns of geriatric syndromes as they develop over time (between admission and 1 month postdischarge), and FD and readmission; (ii) generalized estimating equations to assess longitudinal associations between geriatric syndromes over five time points (admission, discharge, 1, 2, and 3 months postdischarge) and FD, mortality, and readmission at 3 months postdischarge. Results After syndrome absent, syndrome present at both admission and 1 month postdischarge was most prevalent. Persistent patterns of apathy (odds ratio [OR] = 4.35, 95% confidence interval [CI] = 1.54–12.30), pain (OR = 3.26, 95% CI = 1.21–8.8), malnutrition (OR = 3.4, 95% CI = 1.35–8.56), mobility impairment (OR = 6.65, 95% CI = 1.98–22.38), and fear of falling (OR = 3.17, 95% CI = 1.25–8.02) were associated with FD. Developing cognitive impairment (OR = 6.40, 95% CI = 1.52–26.84), fatigue (OR = 4.71, 95% CI = 1.03–21.60), and fall risk (OR = 4.30, 95% CI = 1.21–16.57) postdischarge, was associated with readmission; however, only 4%–6% developed these syndromes. Over the course of five time points, mobility impairment, apathy, and incontinence were longitudinally associated with FD; apathy, malnutrition, fatigue, and fall risk with mortality; malnutrition with readmission. Conclusion Most geriatric syndromes are present at admission and patients are likely to retain them postdischarge. Several geriatric syndromes are longitudinally associated with mortality and, particularly, persistently present syndromes place persons are at risk of FD. Although few persons develop syndromes postdischarge, those developing cognitive impairment, fatigue, and fall risk were at increased readmission risk.
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Affiliation(s)
- Rosanne van Seben
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, The Netherlands
| | | | - Lucienne A Reichardt
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Jesse J Aarden
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, The Netherlands.,ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, The Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, The Netherlands.,ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, The Netherlands
| | - Martin van der Esch
- Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, The Netherlands
| | - Raoul H H Engelbert
- ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, The Netherlands.,Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, The Netherlands.,ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, The Netherlands
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17
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van den Helder J, Verlaan S, Tieland M, Scholten J, Mehra S, Visser B, Kröse BJA, Engelbert RHH, Weijs PJM. Digitally Supported Dietary Protein Counseling Changes Dietary Protein Intake, Sources and Distribution in Community-Dwelling Older Adults. Nutrients 2021; 13:nu13020502. [PMID: 33546451 PMCID: PMC7913661 DOI: 10.3390/nu13020502] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 12/17/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 01/14/2023] Open
Abstract
Digitally supported dietary counselling may be helpful in increasing the protein intake in combined exercise and nutritional interventions in community-dwelling older adults. To study the effect of this approach, 212 older adults (72.2 ± 6.3 years) were randomised in three groups: control, exercise, or exercise plus dietary counselling. The dietary counselling during the 6-month intervention was a blended approach of face-to-face contacts and videoconferencing, and it was discontinued for a 6-month follow-up. Dietary protein intake, sources, product groups, resulting amino acid intake, and intake per eating occasion were assessed by a 3-day dietary record. The dietary counselling group was able to increase the protein intake by 32% at 6 months, and the intake remained 16% increased at 12 months. Protein intake mainly consisted of animal protein sources: dairy products, followed by fish and meat. This resulted in significantly more intake of essential amino acids, including leucine. The protein intake was distributed evenly over the day, resulting in more meals that reached the protein and leucine targets. Digitally supported dietary counselling was effective in increasing protein intake both per meal and per day in a lifestyle intervention in community-dwelling older adults. This was predominantly achieved by consuming more animal protein sources, particularly dairy products, and especially during breakfast and lunch.
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Affiliation(s)
- Jantine van den Helder
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (J.S.); (S.M.); (B.V.); (B.J.A.K.); (R.H.H.E.)
- Correspondence: (J.v.d.H.); (P.J.M.W.); Tel.: +31-(62)-1155919 (J.v.d.H.)
| | - Sjors Verlaan
- FrieslandCampina, 3818 LE Amersfoort, The Netherlands; or
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
| | - Michael Tieland
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (J.S.); (S.M.); (B.V.); (B.J.A.K.); (R.H.H.E.)
| | - Jorinde Scholten
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (J.S.); (S.M.); (B.V.); (B.J.A.K.); (R.H.H.E.)
| | - Sumit Mehra
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (J.S.); (S.M.); (B.V.); (B.J.A.K.); (R.H.H.E.)
- CREATE-IT Applied Research, Amsterdam University of Applied Sciences, 1091 GC Amsterdam, The Netherlands
| | - Bart Visser
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (J.S.); (S.M.); (B.V.); (B.J.A.K.); (R.H.H.E.)
| | - Ben J. A. Kröse
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (J.S.); (S.M.); (B.V.); (B.J.A.K.); (R.H.H.E.)
- Informatics Institute, University of Amsterdam, 1090 GH Amsterdam, The Netherlands
| | - Raoul H. H. Engelbert
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (J.S.); (S.M.); (B.V.); (B.J.A.K.); (R.H.H.E.)
- Department of Rehabilitation, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Peter J. M. Weijs
- Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (J.S.); (S.M.); (B.V.); (B.J.A.K.); (R.H.H.E.)
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, VU University, 1081 HV Amsterdam, The Netherlands
- Correspondence: (J.v.d.H.); (P.J.M.W.); Tel.: +31-(62)-1155919 (J.v.d.H.)
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18
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Aarden JJ, Reijnierse EM, van der Schaaf M, van der Esch M, Reichardt LA, van Seben R, Bosch JA, Twisk JWR, Maier AB, Engelbert RHH, Buurman BM. Longitudinal Changes in Muscle Mass, Muscle Strength, and Physical Performance in Acutely Hospitalized Older Adults. J Am Med Dir Assoc 2021; 22:839-845.e1. [PMID: 33428891 DOI: 10.1016/j.jamda.2020.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/30/2020] [Accepted: 12/05/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Acute hospitalization may lead to a decrease in muscle measures, but limited studies are reporting on the changes after discharge. The aim of this study was to determine longitudinal changes in muscle mass, muscle strength, and physical performance in acutely hospitalized older adults from admission up to 3 months post-discharge. DESIGN A prospective observational cohort study was conducted. SETTING AND PARTICIPANTS This study included 401 participants aged ≥70 years who were acutely hospitalized in 6 hospitals. All variables were assessed at hospital admission, discharge, and 1 and 3 months post-discharge. METHODS Muscle mass in kilograms was assessed by multifrequency Bio-electrical Impedance Analysis (MF-BIA) (Bodystat; Quadscan 4000) and muscle strength by handgrip strength (JAMAR). Chair stand and gait speed test were assessed as part of the Short Physical Performance Battery (SPPB). Norm values were based on the consensus statement of the European Working Group on Sarcopenia in Older People. RESULTS A total of 343 acute hospitalized older adults were included in the analyses with a mean (SD) age of 79.3 (6.6) years, 49.3% were women. From admission up to 3 months post-discharge, muscle mass (-0.1 kg/m2; P = .03) decreased significantly and muscle strength (-0.5 kg; P = .08) decreased nonsignificantly. The chair stand (+0.7 points; P < .001) and gait speed test (+0.9 points; P < .001) improved significantly up to 3 months post-discharge. At 3 months post-discharge, 80%, 18%, and 43% of the older adults scored below the cutoff points for muscle mass, muscle strength, and physical performance, respectively. CONCLUSIONS AND IMPLICATIONS Physical performance improved during and after acute hospitalization, although muscle mass decreased, and muscle strength did not change. At 3 months post-discharge, muscle mass, muscle strength, and physical performance did not reach normative levels on a population level. Further research is needed to examine the role of exercise interventions for improving muscle measures and physical performance after hospitalization.
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Affiliation(s)
- Jesse J Aarden
- Amsterdam UMC, Department of Rehabilitation, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands; European School of Physiotherapy, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
| | - Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Marike van der Schaaf
- Amsterdam UMC, Department of Rehabilitation, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Martin van der Esch
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands; Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands
| | - Lucienne A Reichardt
- Amsterdam UMC, Department of Internal Medicine, Section of Geriatric Medicine, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Rosanne van Seben
- Amsterdam UMC, Department of Internal Medicine, Section of Geriatric Medicine, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Amsterdam UMC, Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia; Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Amsterdam UMC, Department of Rehabilitation, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Bianca M Buurman
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands; Amsterdam UMC, Department of Internal Medicine, Section of Geriatric Medicine, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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19
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van den Helder J, Mehra S, van Dronkelaar C, Ter Riet G, Tieland M, Visser B, Kröse BJA, Engelbert RHH, Weijs PJM. Blended home-based exercise and dietary protein in community-dwelling older adults: a cluster randomized controlled trial. J Cachexia Sarcopenia Muscle 2020; 11:1590-1602. [PMID: 33103379 PMCID: PMC7749597 DOI: 10.1002/jcsm.12634] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 08/07/2020] [Accepted: 09/16/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Effective and sustainable interventions are needed to counteract the decline in physical function and sarcopenia in the growing aging population. The aim of this study was to determine the 6 and 12 month effectiveness of blended (e-health + coaching) home-based exercise and a dietary protein intervention on physical performance in community-dwelling older adults. METHODS This cluster randomized controlled trial allocated 45 clusters of older adults already engaged in a weekly community-based exercise programme. The clusters were randomized to three groups with ratio of 16:15:14; (i) no intervention, control (CON); (ii) blended home-based exercise intervention (HBex); and (iii) HBex with dietary protein counselling (HBex-Pro). Both interventions used a tablet PC with app and personalized coaching and were targeting on behaviour change. The study comprised coached 6 month interventions with a 6 month follow-up. The primary outcome physical performance was assessed by modified Physical Performance Test (m-PPT). Secondary outcomes were gait speed, physical activity level (PAL), handgrip muscle strength, protein intake, skeletal muscle mass, health status, and executive functioning. Linear mixed models of repeated measured were used to assess intervention effects at 6 and 12 months. RESULTS The population included 245 older adults (mean age 72 ± 6.5 (SD) years), 71% female, and 54% co-morbidities observed. Dropout of the intervention was 18% at 6 months and 26% at 12 months. Participants were well functioning, based on an m-PPT score of 33.9 (2.8) out of 36. For the primary outcome m-PPT, no significant intervention effects (HBex, +0.03, P = 0.933; HBex-Pro, -0.13, P = 0.730) were found. Gait speed (+0.20 m/s, P = 0.001), PAL (+0.06, P = 0.008), muscle strength (+2.32 kg, P = 0.001), protein intake (+0.32 g/kg/day, P < 0.001), and muscle mass (+0.33 kg, P = 0.017) improved significantly in the HBex-Pro group compared with control group after 6 month intervention. The protein intake, muscle mass, and strength remained significantly improved after 12 months as compared with those of control. Health change and executive functioning improved significantly in both intervention groups after 6 months. CONCLUSIONS This HBex and dietary protein interventions did not change the physical performance (m-PPT) in community-dwelling older adults. Changes were observed in gait speed, PAL, muscle mass, strength, and dietary protein intake, in response to this combined intervention.
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Affiliation(s)
- Jantine van den Helder
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition (room B1.28), Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Sumit Mehra
- CREATE-IT Applied Research, Faculty of Digital Media and Creative Industries, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Applied Psychology, Faculty of Applied Social Sciences and Law, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Carliene van Dronkelaar
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition (room B1.28), Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Gerben Ter Riet
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition (room B1.28), Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael Tieland
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition (room B1.28), Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Bart Visser
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Amsterdam Movement Sciences, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands
| | - Ben J A Kröse
- CREATE-IT Applied Research, Faculty of Digital Media and Creative Industries, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Amsterdam Movement Sciences, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands.,Department of Rehabilitation, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter J M Weijs
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition (room B1.28), Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Amsterdam Movement Sciences, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands.,Department of Nutrition and Dietetics, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands
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20
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van der Meer HA, Calixtre LB, Engelbert RHH, Visscher CM, Nijhuis-van der Sanden MW, Speksnijder CM. Effects of physical therapy for temporomandibular disorders on headache pain intensity: A systematic review. Musculoskelet Sci Pract 2020; 50:102277. [PMID: 33126108 DOI: 10.1016/j.msksp.2020.102277] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 03/11/2020] [Revised: 10/02/2020] [Accepted: 10/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Physical therapy is regarded an effective treatment for temporomandibular disorders (TMD). Patients with TMD often report concomitant headache. There is, however, no overview of the effect of physical therapy for TMD on concomitant headache complaints. OBJECTIVES The aim of this study is to systematically evaluate the literature on the effectiveness of physical therapy on concomitant headache pain intensity in patients with TMD. DATA SOURCES PubMed, Cochrane and PEDro were searched. STUDY ELIGIBILITY CRITERIA Randomized or controlled clinical trials studying physical therapy interventions were included. PARTICIPANTS Patients with TMD and headache. APPRAISAL The Cochrane risk of bias tool was used to assess risk of bias. SYNTHESIS METHODS Individual and pooled between-group effect sizes were calculated according to the standardized mean difference (SMD) and the quality of the evidence was rated using the GRADE approach. RESULTS and manual therapy on both orofacial region and cervical spine. There is a very low level of certainty that TMD-treatment is effective on headache pain intensity, downgraded by high risk of bias, inconsistency and imprecision. LIMITATIONS The methodological quality of most included articles was poor, and the interventions included were very different. CONCLUSIONS Physical therapy interventions presented small effect on reducing headache pain intensity on subjects with TMD, with low level of certainty. More studies of higher methodological quality are needed so better conclusions could be taken.
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Affiliation(s)
- Hedwig A van der Meer
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Department of Orofacial Pain and Dysfunction, Amsterdam, the Netherlands; University Medical Center Utrecht, Utrecht University, Department of Oral-Maxillofacial Surgery and Special Dental Care, Utrecht, the Netherlands; Amsterdam University of Applied Sciences, Education of Physiotherapy, Faculty of Health, Amsterdam, the Netherlands; Radboud University Medical Center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands; University of Amsterdam, Amsterdam University Medical Centers (AUMC), Department of Rehabilitation, Amsterdam, Meibergdreef 9, Amsterdam Movement Sciences, the Netherlands.
| | - Leticia B Calixtre
- Federal University of São Carlos (UFSCar), Physiotherapy Department, São Carlos, Brazil
| | - Raoul H H Engelbert
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Department of Orofacial Pain and Dysfunction, Amsterdam, the Netherlands; Amsterdam University of Applied Sciences, Education of Physiotherapy, Faculty of Health, Amsterdam, the Netherlands
| | - Corine M Visscher
- University of Amsterdam, Amsterdam University Medical Centers (AUMC), Department of Rehabilitation, Amsterdam, Meibergdreef 9, Amsterdam Movement Sciences, the Netherlands
| | - Maria Wg Nijhuis-van der Sanden
- University Medical Center Utrecht, Utrecht University, Department of Oral-Maxillofacial Surgery and Special Dental Care, Utrecht, the Netherlands
| | - Caroline M Speksnijder
- Radboud University Medical Center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
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Geelen SJG, Giele BM, Nollet F, Engelbert RHH, van der Schaaf M. Improving Physical Activity in Adults Admitted to a Hospital With Interventions Developed and Implemented Through Cocreation: Protocol for a Pre-Post Embedded Mixed Methods Study. JMIR Res Protoc 2020; 9:e19000. [PMID: 33185561 PMCID: PMC7695526 DOI: 10.2196/19000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/25/2020] [Accepted: 10/13/2020] [Indexed: 01/26/2023] Open
Abstract
Background Admission to a hospital is often related with hospital-associated disabilities. Improving physical activity during hospitalization is considered effective to counteract hospital-associated disabilities, whereas many studies report on very low physical activity levels. Gradually developing and implementing interventions in cocreation with patients and health care professionals rather than implementing predefined interventions may be more effective in creating sustainable changes in everyday clinical practice. However, no studies have reported on the use of cocreation in the development and implementation of interventions aimed at improving physical activity. Objective This protocol presents a study that aims to investigate if interventions, which will be developed and implemented in cocreation, improve physical activity among patients in surgery, internal medicine, and cardiology hospital wards. The secondary aims are to investigate effectiveness in terms of the reduction in the time patients spend in bed, the length of hospital stay, and the proportion of patients going home after discharge. Methods The Better By Moving study takes place for 12 months at the following five different wards of a university hospital: two gastrointestinal and oncology surgery wards, one internal medicine hematology ward, one internal medicine infectious diseases ward, and one cardiology ward. The step-by-step implementation model of Grol and Wensing is used, and all interventions are developed and implemented in cocreation with health care professionals and patients. Outcome evaluation is performed across the different hospital wards and for each hospital ward individually. The primary outcome is the amount of physical activity in minutes assessed with the Physical Activity Monitor AM400 accelerometer in two individual groups of patients (preimplementation [n=110], and 13 months after the start of the implementation [n=110]). The secondary outcomes are time spent in bed measured using behavioral mapping protocols, and length of stay and discharge destination assessed using organizational data. A process evaluation using semistructured interviews and surveys is adopted to evaluate the implementation, mechanisms of impact, context, and perceived barriers and enablers. Results This study is ongoing. The first participant was enrolled in January 2018. The last outcome evaluation and process evaluation are planned for May and June 2020, respectively. Results are expected in April 2021. Conclusions This study will provide information about the effectiveness of developing and implementing interventions in cocreation with regard to improving physical activity in different subgroups of hospitalized patients in a university hospital. By following step-by-step implementation and by performing process evaluation, we will identify the barriers and enablers for implementation and describe the effect of new interventions on improving physical activity among hospitalized patients. Trial Registration Netherlands Trial Register NL8480; https://www.trialregister.nl/trial/8480 International Registered Report Identifier (IRRID) DERR1-10.2196/19000
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Affiliation(s)
- Sven J G Geelen
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Boukje M Giele
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Raoul H H Engelbert
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
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Warnink-Kavelaars J, van Oers HA, Haverman L, Buizer AI, Alsem MW, Engelbert RHH, Menke LA. Parenting a child with Marfan syndrome: Distress and everyday problems. Am J Med Genet A 2020; 185:50-59. [PMID: 33034422 PMCID: PMC7756496 DOI: 10.1002/ajmg.a.61906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/06/2020] [Accepted: 09/20/2020] [Indexed: 12/25/2022]
Abstract
Marfan syndrome (MFS) is a multisystemic, autosomal dominant connective tissue disorder that occurs de novo in 25%. In many families, parent and child(ren) are affected, which may increase distress in parents. To assess distress, 42 mothers (29% MFS) and 25 fathers (60% MFS) of 43 affected children, completed the validated screening‐questionnaire Distress thermometer for parents of a chronically ill child, including questions on overall distress (score 0–10; ≥4 denoting “clinical distress”) and everyday problems (score 0–36). Data were compared to 1,134 control‐group‐parents of healthy children. Mothers reported significantly less overall distress (2, 1–4 vs. 3, 1–6; p = .049; r = −.07) and total everyday problems (3, 0–6 vs. 4, 1–8; p = .03; r = −.08) compared to control‐group‐mothers. Mothers without MFS reported significantly less overall distress compared to mothers with MFS, both of a child with MFS (1, 0–4 vs. 3.5, 2–5; p = .039; r = −.17). No significant differences were found between the father‐groups, nor between the group of healthy parents of an affected child living together with an affected partner compared to control‐group‐parents. No differences in percentages of clinical distress were reported between mothers and control‐group‐mothers (33 vs. 42%); fathers and control‐group‐fathers (28 vs. 32%); nor between the other groups. Distress was not associated with the children's MFS characteristics. Concluding, parents of a child with MFS did not show more clinical distress compared to parents of healthy children. However, clinical distress was reported in approximately one‐third and may increase in case of acute medical complications. We advise monitoring distress in parents of a child with MFS to provide targeted support.
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Affiliation(s)
- Jessica Warnink-Kavelaars
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Hedy A van Oers
- Psychosocial Department, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Lotte Haverman
- Psychosocial Department, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mattijs W Alsem
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Raoul H H Engelbert
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.,Center of Expertise Urban Vitality, University of Applied Sciences, Faculty of Health, Amsterdam, The Netherlands.,Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Leonie A Menke
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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van Meulenbroek T, Huijnen IPJ, Simons LE, Conijn AEA, Engelbert RHH, Verbunt JA. Exploring the underlying mechanism of pain-related disability in hypermobile adolescents with chronic musculoskeletal pain. Scand J Pain 2020; 21:22-31. [PMID: 32862151 DOI: 10.1515/sjpain-2020-0023] [Citation(s) in RCA: 8] [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: 02/05/2020] [Accepted: 07/12/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES A significant proportion of adolescents with chronic musculoskeletal pain (CMP) experience difficulties in physical functioning, mood and social functioning, contributing to diminished quality of life. Generalized joint hypermobility (GJH) is a risk factor for developing CMP with a striking 35-48% of patients with CMP reporting GJH. In case GJH occurs with one or more musculoskeletal manifestations such as chronic pain, trauma, disturbed proprioception and joint instability, it is referred to as generalized hypermobility spectrum disorder (G-HSD). Similar characteristics have been reported in children and adolescents with the hypermobile Ehlers-Danlos Syndrome (hEDS). In the management of CMP, a biopsychosocial approach is recommended as several studies have confirmed the impact of psychosocial factors in the development and maintenance of CMP. The fear-avoidance model (FAM) is a cognitive-behavioural framework that describes the role of pain-related fear as a determinant of CMP-related disability. CONTENT Pubmed was used to identify existing relevant literature focussing on chronic musculoskeletal pain, generalized joint hypermobility, pain-related fear and disability. Relevant articles were cross-referenced to identify articles possibly missed during the primary screening. In this paper the current state of scientific evidence is presented for each individual component of the FAM in hypermobile adolescents with and without CMP. Based on this overview, the FAM is proposed explaining a possible underlying mechanism in the relations between GJH, pain-related fear and disability. SUMMARY AND OUTLOOK It is assumed that GJH seems to make you more vulnerable for injury and experiencing more frequent musculoskeletal pain. But in addition, a vulnerability for heightened pain-related fear is proposed as an underlying mechanism explaining the relationship between GJH and disability. Further scientific confirmation of this applied FAM is warranted to further unravel the underlying mechanism.In explaining disability in individuals with G-HSD/hEDS, it is important to focus on both the physical components related to joint hypermobility, in tandem with the psychological components such as pain-related fear, catastrophizing thoughts and generalized anxiety.
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Affiliation(s)
- Thijs van Meulenbroek
- Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,and Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Maastricht, The Netherlands
| | - Ivan P J Huijnen
- Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,and Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Maastricht, The Netherlands
| | - Laura E Simons
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Arnoud E A Conijn
- Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Raoul H H Engelbert
- Department of Rehabilitation, Amsterdam University Medical Centers, University of Amsterdam, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Department of Pediatrics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; and ACHIEVE, Centre for Applied Research, Faculty of Health, University of Applied Sciences Amsterdam,The Netherlands
| | - Jeanine A Verbunt
- Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands.,and Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, Maastricht, The Netherlands
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24
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Reichardt LA, Aarden JJ, van Seben R, van der Schaaf M, Engelbert RHH, van der Esch M, Twisk JWR, Bosch JA, Buurman BM. Motivational factors mediate the association of general self-efficacy and performance outcomes in acutely hospitalised older patients. Age Ageing 2020; 49:837-842. [PMID: 32453822 PMCID: PMC7444668 DOI: 10.1093/ageing/afaa076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Indexed: 01/31/2023] Open
Abstract
Objectives To study (i) the association of general self-efficacy (GSE) on the course of subjective (i.e. basic and instrumental activities of daily living (ADLs and IADLs) and objective physical performance outcomes (short physical performance battery (SPPB)) among older persons from discharge up to 3 months post-discharge and (ii) the extent to whether motivational factors such as depressive symptoms, apathy and fatigue mediate this association. Methods Prospective multi-centre cohort of acutely hospitalised patients aged ≥70 (Hospital-ADL study). Structural equation modelling was used to analyse the structural relationships. Results The analytic sample included 236 acutely hospitalised patients. GSE had a significant total effect on the course of subjective and objective performance outcomes (ADLs: β = −0.21, P < 0.001, IADLs: β = −0.24, P < 0.001 and SPPB: β = 0.17, P < 0.001). However, when motivational factors as mediator were included into the same model, motivational factors (IADLs: β = 0.51, P < 0.001; SPPB: β = 0.49, P < 0.001) but not GSE remained significantly associated with IADLs (β = −0.06, P = 0.16) and SPPB (β = 0.002, P = 0.97). Motivational factors partially mediated the relationship between GSE and ADLs (β = −0.09, P = 0.04). The percentage of mediation was 55, 74 and 99% for ADLs, IADLs and SPPB, respectively. Conclusions Motivational factors and GSE are both associated with subjective and objective performance outcomes. However, the relationship between GSE and subjective and objective performance outcomes was highly mediated by motivational factors. Taken together, this suggests that GSE is important to being physically active but not sufficient to becoming more physical active in acutely hospitalised older patients; motivation is important to improving both subjective and objective performance.
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Affiliation(s)
- Lucienne A Reichardt
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Jesse J Aarden
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
- ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Rosanne van Seben
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Raoul H H Engelbert
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
- ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Martin van der Esch
- ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, the Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam University of Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
- Department of Psychology, Section of Psychology, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, the Netherlands
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25
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Reichardt LA, Nederveen FE, van Seben R, Aarden JJ, van der Schaaf M, Engelbert RHH, van der Esch M, Twisk JWR, Bosch JA, Buurman BM. The longitudinal association between depressive symptoms and functional abilities in older patients. J Psychosom Res 2020; 137:110195. [PMID: 32731046 DOI: 10.1016/j.jpsychores.2020.110195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/18/2020] [Accepted: 07/19/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To investigate the course of depressive symptoms, and basic and instrumental activities of daily living (collectively described as, (I)ADL functioning) from acute admission until one year post-discharge, the longitudinal association between depressive symptoms and (I)ADL functioning, and to disaggregate between- and within-person effects to examine whether changes in depressive symptoms are associated with changes in (I)ADL functioning. METHODS Prospective multicenter cohort of acutely hospitalized patients aged ≥70. Data gathered over a one-year period were assessed using validated measures of depressive symptoms (GDS-15) and physical functioning (Katz-ADL index). A Poisson mixed model analysis was used to examine the association between the courses and a hybrid model was used to disentangle between- and within-subject effects. RESULTS The analytic sample included 398 patients (mean age = 79.6 years, SD = 6.6). Results showed an improvement in depressive symptoms and physical functions over time, whereby changes in depressive symptoms were significantly associated with the course of ADL function (rate ratio (RR) = 0.91, p < .001) and IADL function (RR = 0.94, p < .001), even after adjustment for confounding variables. Finally, both between- and within-person effects of depressive symptoms were significantly associated with the course of ADL function (between-person: RR = 0.85, p < .001; within-person: RR = 0.94, p < .001) and IADL function (between-person: RR = 0.87, p < .001; within-person: RR = 0.97, p < .001). CONCLUSION The course of depressive symptoms and physical functions improved over time, whereby changes in depressive symptoms were significantly associated with changes in physical functions, both at group and individual level. These changes in (I)ADL functioning lie mostly above the estimated minimally important change for both scales, implying clinically relevant changes.
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Affiliation(s)
- Lucienne A Reichardt
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Floor E Nederveen
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Rosanne van Seben
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Jesse J Aarden
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Raoul H H Engelbert
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
| | - Martin van der Esch
- ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, the Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands; Department of Psychology, Section of Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands..
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
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26
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Mehra S, van den Helder J, Visser B, Engelbert RHH, Weijs PJM, Kröse BJA. Evaluation of a Blended Physical Activity Intervention for Older Adults: Mixed Methods Study. J Med Internet Res 2020; 22:e16380. [PMID: 32459652 PMCID: PMC7413279 DOI: 10.2196/16380] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/11/2020] [Accepted: 05/14/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Physical activity can prolong the ability of older adults to live independently. Home-based exercises can help achieve the recommended physical activity levels. A blended intervention was developed to support older adults in performing home-based exercises. A tablet and a personal coach were provided to facilitate the self-regulation of exercise behavior. OBJECTIVE In line with the Medical Research Council framework, this study aimed to carry out process evaluation of a blended intervention. The objectives were (1) to assess the long-term usability of the tablet adopted in the blended intervention and (2) to explore how the tablet, in conjunction with a personal coach, supported older adults in performing home-based exercises. METHODS The process evaluation was conducted with a mixed-methods approach. At baseline, older adults participating in the blended intervention were asked to fill out a questionnaire about their general experience with information and communication technology (ICT) devices and rate their own skill level. After 6 months, participants filled out the Usefulness, Satisfaction, and Ease of use (USE) questionnaire to assess the usefulness, satisfaction, and ease of use of the tablet. With a random selection of participants, in-depth interviews were held to explore how the tablet and coach supported the self-regulation. The interviews were double coded and analyzed with the directed content analysis method. RESULTS At baseline, 29% (65/224) of participants who started the intervention (mean age 72 years) filled out the ICT survey and 36% (37/103) of participants who used the tablet for 6 months (mean age 71 years) filled out the USE questionnaire. Furthermore, with 17% (18/103) of participants (mean age 73 years), follow-up interviews were held. The results of the baseline questionnaire showed that the large majority of participants already had experience with a tablet, used it regularly, and reported being skillful in operating ICT devices. After 6 months of use, the participants rated the usefulness, satisfaction, and ease of use of the tablet on average as 3.8, 4.2, and 4.1, respectively, on a 5-point scale. The analysis of the interviews showed that the participants felt that the tablet supported action planning, behavior execution, and self-monitoring. On the other hand, especially during the first few months, the personal coach added value during the goal setting, behavior execution, and evaluation phases of self-regulation. CONCLUSIONS The results of the process evaluation showed that older adults who participated in the study were positive about the blended intervention that was designed to support them in performing home-based exercises. Participants reported that the tablet helped them to perform the exercises better, more frequently, and safely. It supported them in various phases of self-regulation. The availability of a personal coach was nevertheless crucial. To support physical activity in older adults, a blended approach is promising.
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Affiliation(s)
- Sumit Mehra
- Applied Psychology, Faculty of Applied Social Sciences and Law, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- CREATE-IT Applied Research, Faculty of Digital Media and Creative Industries, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Informatics Institute, Faculty of Science, University of Amsterdam, Amsterdam, Netherlands
| | - Jantine van den Helder
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Bart Visser
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Raoul H H Engelbert
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Department of Rehabilitation, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Peter J M Weijs
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, VU University, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, VU University, Amsterdam, Netherlands
| | - Ben J A Kröse
- CREATE-IT Applied Research, Faculty of Digital Media and Creative Industries, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Informatics Institute, Faculty of Science, University of Amsterdam, Amsterdam, Netherlands
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van der Meer HA, de Pijper L, van Bruxvoort T, Visscher CM, Nijhuis-van der Sanden MWG, Engelbert RHH, Speksnijder CM. Using e-Health in the physical therapeutic care process for patients with temporomandibular disorders: a qualitative study on the perspective of physical therapists and patients. Disabil Rehabil 2020; 44:617-624. [PMID: 32543903 DOI: 10.1080/09638288.2020.1775900] [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: 10/24/2022]
Abstract
Background: Treatment of temporomandibular disorder (TMD) currently consists of a combination of noninvasive therapies and may be supported by e-Health. It is, however, unclear if physical therapists and patients are positive towards the use of e-Health.Purpose: To assess the needs, facilitators and barriers of the use of an e-Health application from the perspective of both orofacial physical therapists and patients with TMD.Methods: A descriptive qualitative study was performed. Eleven physical therapists and nine patients with TMD were interviewed using a topic guide. Thematic analysis was applied, and findings were ordered according to four themes: acceptance of e-Health, expected utility, usability and convenience.Results: Physical therapists identified the need for e-Health as a supporting application to send questionnaires, animated exercises and evaluation tools. Key facilitators for both physical therapists and patients for implementing e-Health included the increase in self-efficacy, support of data collection and personalization of the application. Key barriers are the increase of screen time, the loss of personal contact, not up-to-date information and poor design of the application.Conclusions: Physical therapists and patients with TMD are positive towards the use of e-Health, in a blended form with the usual rehabilitation care process for TMD complaints.Implications for rehabilitationThe rehabilitation process of temporomandibular complaints may be supported by the use of e-Health applications.Physical therapists and patients with temporomandibular disorders are positive towards the use of e-Health as an addition to the usual care.Especially during the treatment process, there is a need for clear animated videos and reminders for the patients.
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Affiliation(s)
- Hedwig A van der Meer
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.,Department of Oral-Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Education of Physiotherapy, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Research Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Rehabilitation, Amsterdam University Medical Centers (AUMC), University of Amsterdam, Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | | | | | - Corine M Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | | | - Raoul H H Engelbert
- Education of Physiotherapy, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Department of Rehabilitation, Amsterdam University Medical Centers (AUMC), University of Amsterdam, Amsterdam, Amsterdam Movement Sciences, The Netherlands
| | - Caroline M Speksnijder
- Department of Oral-Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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28
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van Egmond MA, Engelbert RHH, Klinkenbijl JHG, van Berge Henegouwen MI, van der Schaaf M. Physiotherapy With Telerehabilitation in Patients With Complicated Postoperative Recovery After Esophageal Cancer Surgery: Feasibility Study. J Med Internet Res 2020; 22:e16056. [PMID: 32515742 PMCID: PMC7312239 DOI: 10.2196/16056] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/22/2020] [Accepted: 02/07/2020] [Indexed: 12/14/2022] Open
Abstract
Background Improvement of functional status with physiotherapy is an important goal for patients with postoperative complications and an increased length of hospital stay (LoS) after esophagectomy. Supervised physiotherapy with telerehabilitation instead of conventional face-to-face care could be an alternative to treat these patients in their home environment after hospital discharge (T0), but its feasibility has not yet been investigated in detail. Objective The aim of this study was to investigate the feasibility of a 12-week supervised postoperative physiotherapy intervention with telerehabilitation for patients with esophageal cancer who underwent esophagectomy and had postoperative complications or who had an increased LoS. The secondary objective was to investigate the preliminary effectiveness of telerehabilitation on functional recovery compared with usual care. Methods A prospective feasibility study with a matched historical comparison group was performed. Feasibility outcomes included willingness and adherence to participate, refusal rate, treatment duration, occurrence of adverse events, and patient satisfaction. Secondary outcome measures were measurements of musculoskeletal and cardiovascular functions and activities according to the domains of the International Classification of Functioning, Disability and Health. Results A total of 22 patients with esophageal cancer who underwent esophagectomy and had postoperative complications or an increased LoS were included. The mean age at surgery was 64.55 (SD 6.72) years, and 77% (17/22) of patients were male. Moreover, 15 patients completed the intervention. Patient adherence was 99.8% in the first 6 weeks and dropped to 75.6% in the following 6 weeks, with a mean difference of −24.3% (95% CI 1.3 to 47.2; P=.04). At 3 months post operation, no differences in functional status were found between the intervention group and the matched historical comparison group. Conclusions This study showed that a postoperative physiotherapeutic intervention with telerehabilitation is feasible for patients with postoperative complications or an increased LoS after esophageal cancer surgery up to 6 weeks after T0.
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Affiliation(s)
- Maarten A van Egmond
- Department of Rehabiltation, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Faculty of Health, European School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Raoul H H Engelbert
- Department of Rehabiltation, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Jean H G Klinkenbijl
- Department of Surgery, Gelre Hospital Apeldoorn-Zutphen, Apeldoorn, Netherlands.,University of Amsterdam, Amsterdam, Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Marike van der Schaaf
- Department of Rehabiltation, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
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Kwakman RCH, Sommers J, Horn J, Nollet F, Engelbert RHH, van der Schaaf M. Steps to recovery: body weight-supported treadmill training for critically ill patients: a randomized controlled trial. Trials 2020; 21:409. [PMID: 32414411 PMCID: PMC7227333 DOI: 10.1186/s13063-020-04333-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/19/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Early mobilization has been proven effective for patients in intensive care units (ICUs) to improve functional recovery. However, early mobilization of critically ill, often mechanically ventilated, patients is cumbersome because of the attachment to tubes, drains, monitoring devices and muscle weakness. A mobile treadmill with bodyweight support may help to initiate mobilization earlier and more effectively. The aim of this study is to assess the effectiveness of weight-supported treadmill training in critically ill patients during and after ICU stay on time to independent functional ambulation. METHODS In this randomized controlled trial, a custom-built bedside body weight-supported treadmill will be used and evaluated. Patients are included if they have been mechanically ventilated for at least 48 hours, are able to follow instructions, have quadriceps muscle strength of Medical Research Council sum-score 2 (MRC 2) or higher, can sit unsupported and meet the safety criteria for physical exercise. Exclusion criteria are language barriers, no prior walking ability, contraindications for physiotherapy or a neurological condition as reason for ICU admission. We aim to include 88 patients and randomize them into either the intervention or the control group. The intervention group will receive usual care plus bodyweight-supported treadmill training (BWSTT) daily. The BWSSTT consists of walking on a mobile treadmill while supported by a harness. The control group will receive usual care physiotherapy treatment daily consisting of progressive activities such as bed-cycling and active functional training exercises. In both groups, we will aim for a total of 40 minutes of physiotherapy treatment time every day in one or two sessions, as tolerated by the patient. The primary outcome is time to functional ambulation as measured in days, secondary outcomes include walking distance, muscle strength, status of functional mobility and symptoms of post-traumatic stress. All measurements will be done by assessors who are blinded to the intervention on the regular wards until hospital discharge. DISCUSSION This will be the first study comparing the effects of BWSTT and conventional physiotherapy for critically ill patients during and after ICU stay. The results of this study contribute to a better understanding of the effectiveness of early physiotherapy interventions for critically ill patients. TRIAL REGISTRATION Dutch Trial Register (NTR) ID: NL6766. Registered at 1 December 2017.
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Affiliation(s)
- Robin C. H. Kwakman
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Education of Physiotherapy, University of Applied Sciences Amsterdam, Amsterdam, The Netherlands
| | - Juultje Sommers
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Janneke Horn
- Department of Intensive Care, Neurosciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Frans Nollet
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Raoul H. H. Engelbert
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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Van Meulenbroek T, Conijn AEA, Huijnen IPJ, Engelbert RHH, Verbunt JA. Multidisciplinary Treatment for Hypermobile Adolescents with Chronic Musculoskeletal Pain. J Rehabil Med Clin Commun 2020; 3:1000033. [PMID: 33884135 PMCID: PMC8008726 DOI: 10.2340/20030711-1000033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND To determine whether adolescents with generalized hypermobility spectrum disorder/ hypermobile Ehlers-Danlos syndrome (G-HSD/ hEDS) show changes in the level of disability, physical functioning, perceived harmfulness and pain intensity after completing multidisciplinary rehabilitation treatment. METHODS Pre-test post-test design. Fourteen adolescents with G-HSD/hEDS participated. The multidisciplinary rehabilitation treatment consisted of a combination of physical training and exposure in vivo. Physical training aims to improve aerobic capacity, muscle strength and propriocepsis for compensating hypermobility. Exposure in vivo aims to decrease disability and pain-related fear. Pre- and post-treatment assessments were conducted to assess the level of disability, physical functioning (motor performance, muscle strength and physical activity level), perceived harmfulness and pain intensity. RESULTS After completing multidisciplinary rehabilitation treatment, the adolescents showed a significant and clinically relevant improvement (improvement of 67%, p<0.01) in functional disability. Furthermore, significant improvements were found in motor performance (p < 0.01), muscle strength (p < 0.05), perceived harmfulness (p < 0.01) and pain intensity (p <0.01) after completing multidisciplinary rehabilitation treatment. CONCLUSION Multidisciplinary rehabilitation treatment leads to a significantly and clinically relevant improvement in the level of disability for adolescents with G-HSD/hEDS. Positive effects were also found in physical functioning, perceived harmfulness and pain intensity. Although the results of this multidisciplinary rehabilitation treatment for adolescents with G-HSD/hEDS are promising, further study is needed to confirm these findings in a randomized design.
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Affiliation(s)
- Thijs Van Meulenbroek
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Arnoud E A Conijn
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Ivan P J Huijnen
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Raoul H H Engelbert
- Centre of Expertise Urban Vitality, Faculty of Health, University of Applied Sciences Amsterdam, Amsterdam, The Netherlands
- Department of Rehabilitation, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Department of Pediatrics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeanine A Verbunt
- Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
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Major ME, Ramaekers SPJ, Engelbert RHH, Van der Schaaf M. Preparing undergraduate students for clinical work in a complex environment: evaluation of an e-learning module on physiotherapy in the intensive care unit. BMC Med Educ 2020; 20:130. [PMID: 32345330 PMCID: PMC7189528 DOI: 10.1186/s12909-020-02035-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Intensive Care Units (ICUs) are daunting environments for physiotherapy (PT) students performing clinical rotations. To prepare students for this environment, a newly developed, evidence-based e-learning module was designed and implemented in the undergraduate curriculum. The aim of this study was to investigate whether e-learning is a feasible method in preparing PT students for clinical work in complex ICU environments, as perceived by students and experts. METHODS A mixed methods proof of concept study was undertaken. Participants were final-year students of an international curriculum, and experts from didactic and clinical fields. An e-learning module consisting of 7 separate chapters based on the latest scientific evidence and clinical expertise was developed, piloted and incorporated into the undergraduate curriculum as a compulsory course to be completed prior to clinical ICU rotations. Data were collected through 3 focus group meetings and 5 semi-structured interviews; these meetings and interviews were audio recorded, transcribed verbatim and analyzed. RESULTS The study sample comprised of 14 students and 5 experts. Thematic analysis revealed three themes: expected competencies of PT students in ICU, feeling prepared for ICU clinical work and dealing with local variety. The e-learning module enabled students to anticipate clinical situations and PT tasks in the ICU. Higher level clinical reasoning skills, handling of lines and wires and dealing with out-of-textbook situations could not be achieved with the e-learning module alone. CONCLUSIONS An e-learning module can sufficiently prepare PT students for their clinical tasks in the ICU, as long as it is integrated with, or closely connected to, the students' clinical placement.
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Affiliation(s)
- Mel E. Major
- European School of Physiotherapy, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Stephan P. J. Ramaekers
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Raoul H. H. Engelbert
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Marike Van der Schaaf
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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van Egmond MA, van der Schaaf M, Hagens ERC, van Laarhoven HWM, van Berge Henegouwen MI, Haverkort EB, Engelbert RHH, Gisbertz SS. Muscle Strength Is Associated With Muscle Mass in Patients With Esophageal Cancer Awaiting Surgery. J Geriatr Phys Ther 2020; 43:82-88. [DOI: 10.1519/jpt.0000000000000200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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van Egmond MA, van der Schaaf M, Klinkenbijl JHG, Twisk JWR, Engelbert RHH, van Berge Henegouwen MI. The pre- and postoperative course of functional status in patients undergoing esophageal cancer surgery. Eur J Surg Oncol 2019; 46:173-179. [PMID: 31445767 DOI: 10.1016/j.ejso.2019.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/03/2019] [Accepted: 08/05/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To optimally target physiotherapy treatment, knowledge of the pre- and postoperative course of functional status in patients undergoing esophagectomy is required. The aim of this prospective longitudinal study was to investigate the course of functional status in patients with esophageal cancer before and after esophagectomy. MATERIALS AND METHODS Functional status outcome measures of patients with esophageal cancer who underwent surgery between March 2012 and June 2016 were prospectively measured at 3 months and at 1 day before surgery and at 1 week and at 3 months after surgery. Analysis of repeated measurements with the mixed model approach was used to study changes over time. RESULTS Hundred fifty-five patients were measured at 3 months and at 1 day before surgery, of which 109 (70.3%) at 1 week and 60 (38.7%) at 3 months after surgery. Mean (SD) age at surgery was 63.5 years (9.3), and 122 patients (78.7%) were male. The incidence of postoperative complications was 83 (53.5%). Three months postoperatively, functional status measures returned to baseline levels, except from handgrip strength (beta [95% CI] -6.2 [-11.3 to -1.1]; P = 0.02) and fatigue (4.7 [0.7to 8.7]; P = 0.02). No differences were observed in the course of functional status between patients with and without postoperative complications. CONCLUSION Functional status of patients undergoing esophagectomy returned to baseline values three months after surgery, despite the high incidence of postoperative complications. This requires rethinking the concept of prehabilitation, where clearly not all patients benefit from high functional status to prevent postoperative complications.
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Affiliation(s)
- Maarten A van Egmond
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam University of Applied Sciences, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam, Netherlands; Amsterdam University of Applied Sciences, European School of Physiotherapy, Faculty of Health, Amsterdam, Netherlands.
| | - Marike van der Schaaf
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam University of Applied Sciences, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam, Netherlands
| | - Jean H G Klinkenbijl
- Gelre Hospital Apeldoorn-Zutphen, Department of Surgery, Apeldoorn, Netherlands; University of Amsterdam, Amsterdam, Netherlands
| | - Jos W R Twisk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, De Boelelaan, 1117, Amsterdam, Netherlands
| | - Raoul H H Engelbert
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam University of Applied Sciences, Center of Expertise Urban Vitality, Faculty of Health, Amsterdam, Netherlands
| | - Mark I van Berge Henegouwen
- Amsterdam UMC, University of Amsterdam, Department of Surgery, Cancer Center Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
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Aarden JJ, van der Schaaf M, van der Esch M, Reichardt LA, van Seben R, Bosch JA, Twisk JWR, Buurman BM, Engelbert RHH. Muscle strength is longitudinally associated with mobility among older adults after acute hospitalization: The Hospital-ADL study. PLoS One 2019; 14:e0219041. [PMID: 31276471 PMCID: PMC6611658 DOI: 10.1371/journal.pone.0219041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/16/2019] [Indexed: 11/26/2022] Open
Abstract
Background 30 to 60% of the acute hospitalized older adults experience functional decline after hospitalization. The first signs of functional decline after discharge can often be observed in the inability to perform mobility tasks, such as raising from a chair or walking. Information how mobility develops over time is scarce. Insight in the course of mobility is needed to prevent and decrease mobility limitations. Objectives The objectives of this study were to determine (i) the course of mobility of acute hospitalized older adults and (ii) the association between muscle strength and the course of mobility over time controlled for influencing factors. Methods In a multicenter, prospective, observational cohort study, measurements were taken at admission, discharge, one- and three months post-discharge. Mobility was assessed by the De Morton Mobility Index (DEMMI) and muscle strength by the JAMAR. The longitudinal association between muscle strength and mobility was analysed with a Linear Mixed Model and controlled for potential confounders. Results 391 older adults were included in the analytic sample with a mean (SD) age of 79.6 (6.7) years. Mobility improved significantly from admission up to three months post-discharge but did not reach normative levels. Muscle strength was associated with the course of mobility (beta = 0.64; p<0.01), even after controlling for factors as age, cognitive impairment, fear of falling and depressive symptoms (beta = 0.35; p<0.01). Conclusion Muscle strength is longitudinally associated with mobility. Interventions to improve mobility including muscle strength are warranted, in acute hospitalized older adults.
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Affiliation(s)
- Jesse J. Aarden
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- European School of Physiotherapy, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- * E-mail:
| | - Marike van der Schaaf
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Martin van der Esch
- Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, Netherlands
| | - Lucienne A. Reichardt
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
| | - Rosanne van Seben
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
| | - Jos A. Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Jos W. R. Twisk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam, Netherlands
| | - Bianca M. Buurman
- Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam, Netherlands
| | - Raoul H. H. Engelbert
- Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
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Reichardt LA, van Seben R, Aarden JJ, van der Esch M, van der Schaaf M, Engelbert RHH, Twisk JWR, Bosch JA, Buurman BM. Trajectories of cognitive-affective depressive symptoms in acutely hospitalized older adults: The hospital-ADL study. J Psychosom Res 2019; 120:66-73. [PMID: 30929710 DOI: 10.1016/j.jpsychores.2019.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify trajectories of cognitive-affective depressive symptoms among acutely hospitalized older patients and whether trajectories are related to prognostic baseline factors and three-month outcomes such as functional decline, falls, unplanned readmissions, and mortality. METHODS Prospective multicenter cohort of acutely hospitalized patients aged ≥ 70. Depressive trajectories were based on Group Based Trajectory Modeling, using the Geriatric Depression Scale-15. Outcomes were functional decline, falls, unplanned readmission, and mortality within three months post-discharge. RESULTS The analytic sample included 398 patients (mean age = 79.6 years; SD = 6.6). Three distinct depressive symptoms trajectories were identified: minimal (63.6%), mild persistent (25.4%), and severe persistent (11.0%). Unadjusted results showed that, compared to the minimal symptoms group, the mild and severe persistent groups showed a significantly higher risk of functional decline (mild: OR = 3.9, p < .001; severe: OR = 3.0, p = .04), falls (mild: OR = 2.0, p = .02; severe: OR = 6.0, p < .001), and mortality (mild: OR = 2.2, p = .05; severe: OR = 3.4, p = .009). Patients with mild or severe persistent symptoms were more malnourished, anxious, and functionally limited and had more medical comorbidities at admission. CONCLUSION Nearly 40% of the acutely hospitalized older adults exhibited mild to severe levels of cognitive-affective depressive symptoms. In light of the substantially elevated risk of serious complications and the fact that elevated depressive symptoms was not a transient phenomenon identification of these patients is needed. This further emphasizes the need for acute care hospitals, as a point of engagement with older adults, to develop discharge or screening procedures for managing cognitive-affective depressive symptoms.
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Affiliation(s)
- Lucienne A Reichardt
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Rosanne van Seben
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Jesse J Aarden
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
| | - Martin van der Esch
- ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands; Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands.
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Raoul H H Engelbert
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands; Department of Psychology, Section of Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
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van Dronkelaar C, Tieland M, Aarden JJ, Reichardt LA, van Seben R, van der Schaaf M, van der Esch M, Engelbert RHH, Twisk JWR, Bosch JA, Buurman BM. Decreased Appetite is Associated with Sarcopenia-Related Outcomes in Acute Hospitalized Older Adults. Nutrients 2019; 11:nu11040932. [PMID: 31027202 PMCID: PMC6520962 DOI: 10.3390/nu11040932] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 12/31/2022] Open
Abstract
Decreased appetite is one of the main risk factors of malnutrition. Little is known on how appetite changes during hospitalization and after discharge and how it relates with sarcopenia-related outcomes. We analyzed data of the Hospital-ADL study, a multicenter prospective cohort study that followed 400 acutely hospitalized older adults (≥70 year). Appetite (SNAQ), handgrip strength (Jamar), muscle mass (BIA), mobility (DEMMI), and physical performance (SPPB) were assessed within 48 h of admission, at discharge, and at one and three months post-discharge. The course of decreased appetite was analysed by Generalised Estimating Equations. Linear Mixed Model was used to analyse the associations between decreased appetite and the sarcopenia-related outcomes. Decreased appetite was reported by 51% at hospital admission, 34% at discharge, 28% one month post-discharge, and 17% three months post-discharge. Overall, decreased appetite was associated with lower muscle strength (β = −1.089, p = 0.001), lower mobility skills (β = −3.893, p < 0.001), and lower physical performance (β = −0.706, p < 0.001) but not with muscle mass (β = −0.023, p = 0.920). In conclusion, decreased appetite was highly prevalent among acute hospitalized older adults and remained prevalent, although less, after discharge. Decreased appetite was significantly associated with negative sarcopenia-related outcomes, which underlines the need for assessment and monitoring of decreased appetite during and post hospitalization.
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Affiliation(s)
- Carliene van Dronkelaar
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, 1067SM Amsterdam, The Netherlands.
| | - Michael Tieland
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, 1067SM Amsterdam, The Netherlands.
| | - Jesse J Aarden
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
- Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Center of Applied Research, 1105 BD Amsterdam, The Netherlands.
| | - Lucienne A Reichardt
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Rosanne van Seben
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
- Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Center of Applied Research, 1105 BD Amsterdam, The Netherlands.
| | - Martin van der Esch
- Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Center of Applied Research, 1105 BD Amsterdam, The Netherlands.
- Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, 1056 AB Amsterdam, The Netherlands.
| | - Raoul H H Engelbert
- Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Center of Applied Research, 1105 BD Amsterdam, The Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands.
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, 1018 WS Amsterdam, The Netherlands.
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | - Bianca M Buurman
- Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Center of Applied Research, 1105 BD Amsterdam, The Netherlands.
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
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Kwakman RCH, Major ME, Dettling-Ihnenfeldt DS, Nollet F, Engelbert RHH, van der Schaaf M. Physiotherapy treatment approaches for survivors of critical illness: a proposal from a Delphi study. Physiother Theory Pract 2019; 36:1421-1431. [PMID: 30821565 DOI: 10.1080/09593985.2019.1579283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/30/2023]
Abstract
Purpose: The aim of this study was to develop practical recommendations for physiotherapy for survivors of critical illness after hospital discharge. Methods: A modified Delphi consensus study was performed. A scoping literature review formed the basis for three Delphi rounds. The first round was used to gather input from the panel to finalize the survey for the next two rounds in which the panel was asked to rank each of the statements on an ordinal scale with the objective to reach consensus. Consensus was defined as a SIQR of ≤ 0.5. Ten Dutch panelists participated in this study: three primary care physiotherapists, four intensive care physiotherapists, one occupational therapist, one ICU-nurse and one former ICU-patient. All involved professionals have treated survivors of critical illness. Our study was performed in parallel with an international Delphi study with hospital-based health-care professionals and researchers. Results: After three Delphi rounds, consensus was reached on 95.5% of the statements. This resulted in practical recommendations for physiotherapy for critical illness survivors in the primary care setting. The panel agreed that the handover should include information on 14 items. Physiotherapy treatment goals should be directed toward improvement of aerobic capacity, physical functioning, activities in daily living, muscle strength, respiratory and pulmonary function, fatigue, pain, and health-related quality of life. Physiotherapy measurements and interventions to improve these outcomes are suggested. Conclusion: This study adds to the knowledge on post-ICU physiotherapy with practical recommendations supporting clinical decision-making in the treatment of survivors of critical illness after hospital discharge.
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Affiliation(s)
- Robin C H Kwakman
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences , Amsterdam, Netherlands.,ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences , Amsterdam, Netherlands
| | - Mel E Major
- ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences , Amsterdam, Netherlands.,European School of Physiotherapy, Amsterdam University of Applied Sciences , Amsterdam, Netherlands
| | - Daniela S Dettling-Ihnenfeldt
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences , Amsterdam, Netherlands
| | - Frans Nollet
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences , Amsterdam, Netherlands
| | - Raoul H H Engelbert
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences , Amsterdam, Netherlands.,ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences , Amsterdam, Netherlands
| | - Marike van der Schaaf
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences , Amsterdam, Netherlands.,ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences , Amsterdam, Netherlands
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Warnink-Kavelaars J, Beelen A, Goedhart TMHJ, de Koning LE, Nollet F, Alsem MW, Menke LA, Engelbert RHH. Marfan syndrome in adolescence: adolescents' perspectives on (physical) functioning, disability, contextual factors and support needs. Eur J Pediatr 2019; 178:1883-1892. [PMID: 31620888 PMCID: PMC6881250 DOI: 10.1007/s00431-019-03469-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 04/12/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 12/11/2022]
Abstract
Although essential for providing optimal adolescent patient support, knowledge of the impact of Marfan syndrome in adolescence is limited. To explore adolescents' perceived impact of Marfan syndrome on (physical) functioning (activities, participation), disability (limitations, restrictions), contextual factors and support needs, we interviewed 19 adolescents with Marfan syndrome. Audio-recordings were transcribed, coded and analysed using thematic analysis. Identified themes were "difficulties in keeping up with peers" and "being and feeling different from peers". Furthermore, an adolescent Marfan syndrome-specific International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) model derived from the data describing the adolescent perceived impact of Marfan syndrome on functioning, disability and its contextual factors. Adolescents perceived problems in keeping up with peers in school, sports, leisure and friendships/relationships, and they could not meet work requirements. Moreover, participants perceived to differ from peers due to their appearance and disability. Contextual factors: coping with Marfan syndrome, self-esteem/image, knowledge about Marfan syndrome, support from family/friends/teachers, ability to express needs and peer-group acceptation acted individually as barrier or facilitator for identified themes.Conclusion: Adolescents with Marfan syndrome perceived limitations and restrictions in (physical) functioning. They perceived problems in keeping up with peers and perceived to differ from peers due to their appearance and disability. This warrants awareness and tailored physical, psychosocial, educational and environmental support programmes to improve (physical) functioning and empowerment of adolescents with Marfan syndrome.What is known:• Marfan syndrome is a hereditary connective tissue disorder.• Marfan syndrome affects multiple systems.What is new:• Adolescents with Marfan syndrome perceive (1) problems in keeping up with peers in school, sports, leisure, friendships/relationships and work (2) to differ from peers due to their appearance and disability.• An adolescent Marfan syndrome-specific International Classification of Functioning, Disability and Health for Children and Youth model derived from the data describing the adolescent perceived impact of Marfan syndrome on functioning, disability and contextual factors.
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Affiliation(s)
- Jessica Warnink-Kavelaars
- Amsterdam UMC, University of Amsterdam, Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, PO 22660, 1100 DD, Amsterdam, Netherlands.
| | - Anita Beelen
- grid.7177.60000000084992262Amsterdam UMC, University of Amsterdam, Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, PO 22660, 1100 DD Amsterdam, Netherlands ,grid.7692.a0000000090126352Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands ,grid.7692.a0000000090126352Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Tine M. H. J. Goedhart
- grid.7177.60000000084992262Amsterdam UMC, University of Amsterdam, Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, PO 22660, 1100 DD Amsterdam, Netherlands
| | - Lisanne E. de Koning
- grid.431204.0ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, the Netherlands
| | - Frans Nollet
- grid.7177.60000000084992262Amsterdam UMC, University of Amsterdam, Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, PO 22660, 1100 DD Amsterdam, Netherlands
| | - Mattijs W. Alsem
- grid.7177.60000000084992262Amsterdam UMC, University of Amsterdam, Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, PO 22660, 1100 DD Amsterdam, Netherlands
| | - Leonie A. Menke
- grid.7177.60000000084992262Amsterdam UMC, University of Amsterdam, Pediatrics, Meibergdreef 9, Amsterdam, Netherlands
| | - Raoul H. H. Engelbert
- grid.7177.60000000084992262Amsterdam UMC, University of Amsterdam, Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, PO 22660, 1100 DD Amsterdam, Netherlands ,grid.431204.0ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, the Netherlands ,grid.7177.60000000084992262Amsterdam UMC, University of Amsterdam, Pediatrics, Meibergdreef 9, Amsterdam, Netherlands
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Sommers J, Van Den Boorn M, Engelbert RHH, Nollet F, Van Der Schaaf M, Horn J. Feasibility of Muscle Activity Assessment With Surface Electromyography During Bed Cycling Exercise In Intensive Care Unit Patients. Muscle Nerve 2018; 58:688-693. [PMID: 30160070 PMCID: PMC6282956 DOI: 10.1002/mus.26330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 08/22/2018] [Accepted: 08/26/2018] [Indexed: 01/19/2023]
Abstract
Introduction: Intensive care unit (ICU) patients often develop weakness. Rehabilitation is initiated early to prevent physical deterioration, but knowledge of optimal training schedules is lacking. A reliable method to assess muscle activity during exercise is needed. In this study we explored the feasibility of electrical activity measurement by surface electromyography (sEMG) during bed cycling in ICU patients. Methods: SEMG was performed in 9 ICU patients and 6 healthy controls. A standardized 1‐minute incremental resistance bedside cycle ergometer protocol was used. Results: The median cycle time was 5.3 minutes in patients and 12.0 minutes in controls. The maximum sEMG increased in both groups; the minimal sEMG activity remained the same in patients, whereas an increase in the control group was found. Discussion: sEMG is feasible and can detect muscle activity during bed cycling in ICU patients. It may be a useful monitoring tool. Repeated measurements could possibly provide information on the effects of training. Muscle Nerve58: 688–693, 2018
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Affiliation(s)
- Juultje Sommers
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, P.O. Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Michelle Van Den Boorn
- Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, P.O. Box 22660, 1100DD, Amsterdam, The Netherlands.,ACHIEVE-Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, P.O. Box 22660, 1100DD, Amsterdam, The Netherlands
| | - Marike Van Der Schaaf
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, P.O. Box 22660, 1100DD, Amsterdam, The Netherlands.,ACHIEVE-Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Janneke Horn
- Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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van Seben R, Reichardt LA, Aarden JJ, van der Schaaf M, van der Esch M, Engelbert RHH, Twisk JWR, Bosch JA, Buurman BM. The Course of Geriatric Syndromes in Acutely Hospitalized Older Adults: The Hospital-ADL Study. J Am Med Dir Assoc 2018; 20:152-158.e2. [PMID: 30270027 DOI: 10.1016/j.jamda.2018.08.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 03/17/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To establish the prevalence and course of geriatric syndromes from hospital admission up to 3 months postdischarge and to determine the probability to retain geriatric syndromes over the period from discharge until 3 months postdischarge, once they are present at admission. DESIGN Prospective multicenter cohort study conducted between October 2015 and June 2017. SETTING AND PARTICIPANTS Acutely hospitalized patients aged 70 years and older recruited from internal, cardiology, and geriatric wards of 6 Dutch hospitals. MEASURES Cognitive impairment, depressive symptoms, apathy, pain, malnutrition, incontinence, dizziness, fatigue, mobility impairment, functional impairment, fall risk, and fear of falling were assessed at admission, discharge, and 1, 2, and 3 months postdischarge. Generalized estimating equations analysis were performed to analyze the course of syndromes and to determine the probability to retain syndromes. RESULTS A total of 401 participants [mean age (standard deviation) 79.7 (6.7)] were included. At admission, a median of 5 geriatric syndromes were present. Most prevalent were fatigue (77.2%), functional impairment (62.3%), apathy (57.5%), mobility impairment (54.6%), and fear of falling (40.6%). At 3 months postdischarge, an average of 3 syndromes were present, of which mobility impairment (52.7%), fatigue (48.1%), and functional impairment (42.5%) were most prevalent. Tracking analysis showed that geriatric syndromes that were present at admission were likely to be retained. The following 6 geriatric syndromes were most likely to stay present postdischarge: mobility impairment, incontinence, cognitive impairment, depressive symptoms, functional impairment, and fear of falling. IMPLICATIONS Acutely hospitalized older adults exhibit a broad spectrum of highly prevalent geriatric syndromes. Moreover, patients are likely to retain symptoms that are present at admission postdischarge. Our study underscores the need to address a wide range of syndromes at admission, the importance of communication on syndromes to the next care provider, and the need for adequate follow-up care and syndrome management postdischarge.
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Affiliation(s)
- Rosanne van Seben
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Lucienne A Reichardt
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jesse J Aarden
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Centre of Applied Research, Amsterdam, The Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Centre of Applied Research, Amsterdam, The Netherlands
| | - Martin van der Esch
- Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Centre of Applied Research, Amsterdam, The Netherlands; Reade, Center for Rehabilitation and Rheumatology/Amsterdam Rehabilitation Research Center, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Centre of Applied Research, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Faculty of Health, Amsterdam University of Applied Sciences, ACHIEVE-Centre of Applied Research, Amsterdam, The Netherlands
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van den Helder J, van Dronkelaar C, Tieland M, Mehra S, Dadema T, Visser B, Kröse BJA, Engelbert RHH, Weijs PJM. A digitally supported home-based exercise training program and dietary protein intervention for community dwelling older adults: protocol of the cluster randomised controlled VITAMIN trial. BMC Geriatr 2018; 18:183. [PMID: 30107787 PMCID: PMC6092847 DOI: 10.1186/s12877-018-0863-7] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 07/19/2018] [Indexed: 12/20/2022] Open
Abstract
Background Increased physical activity and dietary protein intake are promising interventions to prevent or treat the age-related decline in physical performance in older adults. There are well-controlled exercise as well as dietary intervention studies that show beneficial effects on physical performance in older adults. In practice, however, weekly group based exercise or nutritional programs may not be as effective. To optimise these exercise programs for community dwelling older adults, a digitally supported and personalised home-based exercise training program has been designed aiming to improve physical performance in older adults. In addition, a protein intervention in combination with the training program may further improve physical performance in older adults. Methods The VITAMIN study will be a cluster randomised controlled trial with three parallel arms. In total, 240 community dwelling older adults (≥ 55 years) participating in weekly group exercise are randomly allocated into: 1) regular weekly exercise program (Control group, n = 80), 2) digitally supported personalised home-based exercise training program group (VITA group, n = 80) and 3) digitally supported personalised home-based exercise training program group plus dietary protein counselling (VITA-Pro group, n = 80). The VITAMIN study aims to evaluate effectiveness of the digitally supported personalised home-based exercise training program as well as the additional value of dietary protein on physical performance after 6 months. In addition, a 12 month follow-up measurement will assess the retaining effect of the interventions. Primary outcome is physical performance measured by the Modified Physical Performance Test (M-PPT) and relevant secondary and observational outcomes include habitual physical activity and dietary intake, body composition, cognitive performance, quality of life, compliance and tablet usage. Data will be analysed by Linear Mixed Models. Discussion To our knowledge, the VITAMIN study is the first study that investigates the impact of home-based exercise, protein intake as well as use of persuasive technology in the population of community dwelling older adults. Trial registration NL56094.029.16 / NTR (TC = 5888; registered 03–06-2016).
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Affiliation(s)
- Jantine van den Helder
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Carliene van Dronkelaar
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Michael Tieland
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Sumit Mehra
- CREATE-IT Applied Research, Faculty of Digital Media and Creative Industries, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Applied Psychology, Faculty of Applied Social Sciences and Law, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Tessa Dadema
- Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Bart Visser
- Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Ben J A Kröse
- CREATE-IT Applied Research, Faculty of Digital Media and Creative Industries, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Amsterdam Center for Innovative Health Practice (ACHIEVE), Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Department of Rehabilitation, Academic Medical Center, Amsterdam, The Netherlands
| | - Peter J M Weijs
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands. .,Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands. .,Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, the Netherlands.
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Verweij L, Jepma P, Buurman BM, Latour CHM, Engelbert RHH, Ter Riet G, Karapinar-Çarkit F, Daliri S, Peters RJG, Scholte Op Reimer WJM. The cardiac care bridge program: design of a randomized trial of nurse-coordinated transitional care in older hospitalized cardiac patients at high risk of readmission and mortality. BMC Health Serv Res 2018; 18:508. [PMID: 29954403 PMCID: PMC6025727 DOI: 10.1186/s12913-018-3301-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND After hospitalization for cardiac disease, older patients are at high risk of readmission and death. Although geriatric conditions increase this risk, treatment of older cardiac patients is limited to the management of cardiac diseases. The aim of this study is to investigate if unplanned hospital readmission and mortality can be reduced by the Cardiac Care Bridge transitional care program (CCB program) that integrates case management, disease management and home-based cardiac rehabilitation. METHODS In a randomized trial on patient level, 500 eligible patients ≥ 70 years and at high risk of readmission and mortality will be enrolled in six hospitals in the Netherlands. Included patients will receive a Comprehensive Geriatric Assessment (CGA) at admission. Randomization with stratified blocks will be used with pre-stratification by study site and cognitive status based on the Mini-Mental State Examination (15-23 vs ≥ 24). Patients enrolled in the intervention group will receive a CGA-based integrated care plan, a face-to-face handover with the community care registered nurse (CCRN) before discharge and four home visits post-discharge. The CCRNs collaborate with physical therapists, who will perform home-based cardiac rehabilitation and with a pharmacist who advices the CCRNs in medication management The control group will receive care as usual. The primary outcome is the incidence of first all-cause unplanned readmission or mortality within 6 months post-randomization. Secondary outcomes at three, six and 12 months after randomization are physical functioning, functional capacity, depression, anxiety, medication adherence, health-related quality of life, healthcare utilization and care giver burden. DISCUSSION This study will provide new knowledge on the effectiveness of the integration of geriatric and cardiac care. TRIAL REGISTRATION NTR6316 . Date of registration: April 6, 2017.
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Affiliation(s)
- L Verweij
- ACHIEVE Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands. .,Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands.
| | - P Jepma
- ACHIEVE Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.,Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - B M Buurman
- ACHIEVE Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.,Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - C H M Latour
- ACHIEVE Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - R H H Engelbert
- ACHIEVE Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.,Department of Rehabilitation, Academic Medical Center, Amsterdam, the Netherlands
| | - G Ter Riet
- Department of General Practice, Academic Medical Center, Amsterdam, the Netherlands
| | - F Karapinar-Çarkit
- Department of Clinical Pharmacy, OLVG hospital, Amsterdam, the Netherlands
| | - S Daliri
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands.,Department of Clinical Pharmacy, OLVG hospital, Amsterdam, the Netherlands
| | - R J G Peters
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - W J M Scholte Op Reimer
- ACHIEVE Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.,Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
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Verweij L, van de Korput E, Daams JG, Ter Riet G, Peters RJG, Engelbert RHH, Scholte Op Reimer WJM, Buurman BM. Effects of Postacute Multidisciplinary Rehabilitation Including Exercise in Out-of-Hospital Settings in the Aged: Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2018; 100:530-550. [PMID: 29902471 DOI: 10.1016/j.apmr.2018.05.010] [Citation(s) in RCA: 12] [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: 01/19/2018] [Revised: 05/02/2018] [Accepted: 05/04/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Many older individuals receive rehabilitation in an out-of-hospital setting (OOHS) after acute hospitalization; however, its effect on mobility and unplanned hospital readmission is unclear. Therefore, a systematic review and meta-analysis were conducted on this topic. DATA SOURCES Medline OVID, Embase OVID, and CINAHL were searched from their inception until February 22, 2018. STUDY SELECTION OOHS (ie, skilled nursing facilities, outpatient clinics, or community-based at home) randomized trials studying the effect of multidisciplinary rehabilitation were selected, including those assessing exercise in older patients (mean age ≥65y) after discharge from hospital after an acute illness. DATA EXTRACTION Two reviewers independently selected the studies, performed independent data extraction, and assessed the risk of bias. Outcomes were pooled using fixed- or random-effect models as appropriate. The main outcomes were mobility at and unplanned hospital readmission within 3 months of discharge. DATA SYNTHESIS A total of 15 studies (1255 patients) were included in the systematic review and 12 were included in the meta-analysis (7 assessing mobility using the 6-minute walk distance [6MWD] test and 7 assessing unplanned hospital readmission). Based on the 6MWD, patients receiving rehabilitation walked an average of 23 m more than controls (95% confidence interval [CI]=: -1.34 to 48.32; I2: 51%). Rehabilitation did not lower the 3-month risk of unplanned hospital readmission (risk ratio: 0.93; 95% CI: 0.73-1.19; I2: 34%). The risk of bias was present, mainly due to the nonblinded outcome assessment in 3 studies, and 7 studies scored this unclearly. CONCLUSION OOHS-based multidisciplinary rehabilitation leads to improved mobility in older patients 3 months after they are discharged from hospital following an acute illness and is not associated with a lower risk of unplanned hospital readmission within 3 months of discharge. However, the wide 95% CIs indicate that the evidence is not robust.
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Affiliation(s)
- Lotte Verweij
- ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology and Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Eva van de Korput
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Joost G Daams
- Research Support, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Gerben Ter Riet
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Ron J G Peters
- Department of Cardiology and Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Raoul H H Engelbert
- ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Wilma J M Scholte Op Reimer
- ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Cardiology and Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Bianca M Buurman
- ACHIEVE, Center of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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de Vries JE, Dekker C, Bastiaenen CHG, Goossens MEJB, Engelbert RHH, Verbunt JAMCF. The Dutch version of the self-report Child Activity and Limitations Interview in adolescents with chronic pain. Disabil Rehabil 2017; 41:833-839. [PMID: 29185366 DOI: 10.1080/09638288.2017.1407969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/18/2022]
Abstract
PURPOSE To assess the factor structure, related constructs and internal consistency of the Child Activity Limitation Interview 21-Child version for use in Dutch-language countries. METHODS Cross-sectional validation study: After forward and back translation of the Dutch version of the Child Activity Limitation Interview 21-Child adolescents (11-21 years old) with chronic musculoskeletal pain completed an assessment. The assessment contained the Dutch Child Activity Limitation Interview, and questionnaires about demographics, pain intensity, functional disability, anxiety and depression. Internal consistency and construct validity were evaluated through exploratory factor analysis (principal axis factoring with oblique rotation) and hypotheses testing using pain intensity, activity limitations, anxiety and depression as comparative constructs. RESULTS Seventy-four adolescents completed the assessment. Exploratory factor analysis resulted in a two-factor structure, explaining 50% of the variance. Internal consistency was good (Cronbach's α = 0.91 total scale, α = 0.90 Factor 1, α = 0.80 Factor 2). All nine hypotheses were confirmed. CONCLUSION The Dutch version can be used to assess pain-related disability in Dutch-speaking adolescents comparable to the study sample. Scores on both subscales provide insight into the severity of the pain-related disability in both daily routine and more physically vigorous activities. Implications for Rehabilitation Chronic pain is a disabling disorder which not only impacts physically but restricts quality of life. This study provides clinicians a questionnaire to measure pain-related disability and quantify the impact of pain on the daily living of adolescents. The advantage of the Dutch version of the Child Activity and Limitations Interview over other measurements is that it can distinguish limitations in daily activities from more physically vigorous activities.
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Affiliation(s)
- Janneke E de Vries
- a School of Physiotherapy , Amsterdam University of Applied Sciences , Amsterdam , the Netherlands.,b Department of Rehabilitation , Academic Medical Center, University of Amsterdam , Amsterdam , the Netherlands.,c ACHIEVE, Center of Applied Research, Faculty of Health , Amsterdam University of Applied Sciences , Amsterdam , the Netherlands
| | - Carolien Dekker
- d Department of Rehabilitation Medicine, CAPHRI, Functioning and Rehabilitation , Maastricht University , Maastricht , the Netherlands
| | - Carolien H G Bastiaenen
- e Department of Epidemiology , Research Program Functioning and Rehabilitation CAPHRI, Maastricht University , Maastricht , the Netherlands
| | - Mariëlle E J B Goossens
- d Department of Rehabilitation Medicine, CAPHRI, Functioning and Rehabilitation , Maastricht University , Maastricht , the Netherlands.,f Department of Clinical Psychological Sciences , EPP, Maastricht University , Maastricht , the Netherlands
| | - Raoul H H Engelbert
- b Department of Rehabilitation , Academic Medical Center, University of Amsterdam , Amsterdam , the Netherlands.,c ACHIEVE, Center of Applied Research, Faculty of Health , Amsterdam University of Applied Sciences , Amsterdam , the Netherlands
| | - Jeanine A M C F Verbunt
- d Department of Rehabilitation Medicine, CAPHRI, Functioning and Rehabilitation , Maastricht University , Maastricht , the Netherlands.,g Maastricht University Medical Center (MUMC+) , Maastricht , the Netherlands.,h Adelante Center of Expertise in Rehabilitation and Audiology , Hoensbroek , the Netherlands
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Juul-Kristensen B, Schmedling K, Rombaut L, Lund H, Engelbert RHH. Measurement properties of clinical assessment methods for classifying generalized joint hypermobility-A systematic review. Am J Med Genet C Semin Med Genet 2017; 175:116-147. [PMID: 28306223 DOI: 10.1002/ajmg.c.31540] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose was to perform a systematic review of clinical assessment methods for classifying Generalized Joint Hypermobility (GJH), evaluate their clinimetric properties, and perform the best evidence synthesis of these methods. Four test assessment methods (Beighton Score [BS], Carter and Wilkinson, Hospital del Mar, Rotes-Querol) and two questionnaire assessment methods (Five-part questionnaire [5PQ], Beighton Score-self reported [BS-self]) were identified on children or adults. Using the Consensus-based Standards for selection of health Measurement Instrument (COSMIN) checklist for evaluating the methodological quality of the identified studies, all included studies were rated "fair" or "poor." Most studies were using BS, and for BS the reliability most of the studies showed limited positive to conflicting evidence, with some shortcomings on studies for the validity. The three other test assessment methods lack satisfactory information on both reliability and validity. For the questionnaire assessment methods, 5PQ was the most frequently used, and reliability showed conflicting evidence, while the validity had limited positive to conflicting evidence compared with test assessment methods. For BS-self, the validity showed unknown evidence compared with test assessment methods. In conclusion, following recommended uniformity of testing procedures, the recommendation for clinical use in adults is BS with cut-point of 5 of 9 including historical information, while in children it is BS with cut-point of at least 6 of 9. However, more studies are needed to conclude on the validity properties of these assessment methods, and before evidence-based recommendations can be made for clinical use on the "best" assessment method for classifying GJH. © 2017 Wiley Periodicals, Inc.
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Engelbert RHH, Juul-Kristensen B, Pacey V, de Wandele I, Smeenk S, Woinarosky N, Sabo S, Scheper MC, Russek L, Simmonds JV. The evidence-based rationale for physical therapy treatment of children, adolescents, and adults diagnosed with joint hypermobility syndrome/hypermobile Ehlers Danlos syndrome. Am J Med Genet C Semin Med Genet 2017; 175:158-167. [PMID: 28306230 DOI: 10.1002/ajmg.c.31545] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
New insights into the phenotype of Joint Hypermobility Syndrome (JHS) and Ehlers-Danlos Syndrome-hypermobile type (hEDS) have raised many issues in relation to classification, diagnosis, assessment, and treatment. Within the multidisciplinary team, physical therapy plays a central role in management of individuals with hypermobility related disorders. However, many physical therapists are not familiar with the diagnostic criteria, prevalence, common clinical presentation, and management. This guideline aims to provide practitioners with the state of the art regarding the assessment and management of children, adolescents, and adults with JHS/hEDS. Due to the complexity of the symptoms in the profile of JHS/hEDS, the International Classification of Functioning, Disability and Health (ICF) is adopted as a central framework whereby the umbrella term of disability is used to encompass functions, activities and participation, as well as environmental and personal factors. The current evidence-based literature regarding the management of JHS/hEDS is limited in size and quality and there is insufficient research exploring the clinical outcomes of a number of interventions. Multicenter randomized controlled trials are warranted to assess the clinical and cost-effectiveness of interventions for children and adults. Until further multicenter trials are conducted, clinical decision-making should be based on theoretical and the current limited research evidence. For all individuals diagnosed with JHS/hEDS, international consensus and combined efforts to identify risk profiles would create a better understanding of the pathological mechanisms and the potential for optimizing health care for affected individuals. © 2017 Wiley Periodicals, Inc.
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van der Meer HA, Visscher CM, Engelbert RHH, Mulleners WM, Nijhuis-van der Sanden MWG, Speksnijder CM. Development and psychometric validation of the headache screening questionnaire - Dutch Version. Musculoskelet Sci Pract 2017; 31:52-61. [PMID: 28734169 DOI: 10.1016/j.msksp.2017.07.001] [Citation(s) in RCA: 14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/14/2017] [Accepted: 07/01/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Headache is a common disorder which may lead to substantial socio-economic loss. Treatment options include self-management strategies, medication and physiotherapy. Physiotherapists need to be able to screen for the presence of migraine and tension-type headache (TTH), so they can adjust their treatment strategies to the type of headache. A quick screening questionnaire to recognize migraine and TTH in the physiotherapy practice is needed. OBJECTIVE The aim of this study was to create a headache screening questionnaire based on the ICHD-3 beta criteria for migraine and TTH, and to establish its content and criterion validity. DESIGN A cross-sectional design was used during the validation phase of the study. METHODS A screening questionnaire was developed for migraine and TTH. Content validity was checked by the research group and a headache research expert. For validation of this questionnaire, patients from the headache clinic of the Canisius Wilhelmina Hospital in Nijmegen were recruited. The outcome of the questionnaire was compared to the ICHD-3 beta diagnosis of the headache specialist. For criterion validity, sensitivity, specificity, likelihood ratios, and positive- and negative predictive values were calculated. RESULTS A 10-item questionnaire has been developed: the Headache Screening Questionnaire. For validation of the Dutch version (HSQ-DV), 105 patients were included in the study. The sensitivity and specificity were 0.89 and 0.54 respectively for probable migraine, and for probable TTH 0.92 and 0.48 respectively. CONCLUSION The HSQ-DV is a sensitive screening tool to detect patients with probable migraine and probable TTH.
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Affiliation(s)
- Hedwig A van der Meer
- Education of Physiotherapy, ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands; Radboud University Medical Center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Research Institute MOVE Amsterdam, Amsterdam, The Netherlands; Department of Oral-Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Corine M Visscher
- Department of Oral Health Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Research Institute MOVE Amsterdam, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Education of Physiotherapy, ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands; Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim M Mulleners
- Department of Neurology, Canisius Wilhemina Hospital, Nijmegen, The Netherlands
| | | | - Caroline M Speksnijder
- Radboud University Medical Center, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands; Department of Oral-Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Scheper MC, Pacey V, Rombaut L, Adams RD, Tofts L, Calders P, Nicholson LL, Engelbert RHH. Generalized Hyperalgesia in Children and Adults Diagnosed With Hypermobility Syndrome and Ehlers-Danlos Syndrome Hypermobility Type: A Discriminative Analysis. Arthritis Care Res (Hoboken) 2017; 69:421-429. [PMID: 27483212 DOI: 10.1002/acr.22998] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/22/2016] [Accepted: 07/19/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Lowered pressure-pain thresholds have been demonstrated in adults with Ehlers-Danlos syndrome hypermobility type (EDS-HT), but whether these findings are also present in children is unclear. Therefore, the objectives of the study were to determine whether generalized hyperalgesia is present in children with hypermobility syndrome (HMS)/EDS-HT, explore potential differences in pressure-pain thresholds between children and adults with HMS/EDS-HT, and determine the discriminative value of generalized hyperalgesia. METHODS Patients were classified in 1 of 3 groups: HMS/EDS-HT, hypermobile (Beighton score ≥4 of 9), and healthy controls. Descriptive data of age, sex, body mass index, Beighton score, skin laxity, and medication usage were collected. Generalized hyperalgesia was quantified by the average pressure-pain thresholds collected from 12 locations. Confounders collected were pain locations/intensity, fatigue, and psychological distress. Comparisons between children with HMS/EDS-HT and normative values, between children and adults with HMS/EDS-HT, and corrected confounders were analyzed with multivariate analysis of covariance. The discriminative value of generalized hyperalgesia employed to differentiate between HMS/EDS-HT, hypermobility, and controls was quantified with logistic regression. RESULTS Significantly lower pressure-pain thresholds were found in children with HMS/EDS-HT compared to normative values (range -22.0% to -59.0%; P ≤ 0.05). When applying a threshold of 30.8 N/cm2 for males and 29.0 N/cm2 for females, the presence of generalized hyperalgesia discriminated between individuals with HMS/EDS-HT, hypermobility, and healthy controls (odds ratio 6.0). CONCLUSION Children and adults with HMS/EDS-HT are characterized by hypermobility, chronic pain, and generalized hyperalgesia. The presence of generalized hyperalgesia may indicate involvement of the central nervous system in the development of chronic pain.
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Affiliation(s)
- M C Scheper
- University of Applied Sciences and Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - V Pacey
- The Children's Hospital at Westmead and Macquarie University, Sydney, New South Wales, Australia
| | - L Rombaut
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - R D Adams
- University of Sydney, Sydney, New South Wales, Australia
| | - L Tofts
- The Children's Hospital at Westmead and University of Sydney, Sydney, New South Wales, Australia
| | | | - L L Nicholson
- The Children's Hospital at Westmead and University of Sydney, Sydney, New South Wales, Australia
| | - R H H Engelbert
- University of Applied Sciences and Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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49
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Sommers J, Wieferink DC, Dongelmans DA, Nollet F, Engelbert RHH, van der Schaaf M. Body weight-supported bedside treadmill training facilitates ambulation in ICU patients: An interventional proof of concept study. J Crit Care 2017; 41:150-155. [PMID: 28549273 DOI: 10.1016/j.jcrc.2017.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 03/03/2017] [Revised: 05/02/2017] [Accepted: 05/10/2017] [Indexed: 01/03/2023]
Abstract
PURPOSE Early mobilisation is advocated to improve recovery of intensive care unit (ICU) survivors. However, severe weakness in combination with tubes, lines and machinery are practical barriers for the implementation of ambulation with critically ill patients. The aim of this study was to explore the feasibility of Body Weight-Supported Treadmill Training (BWSTT) in critically ill patients in the ICU. METHODS A custom build bedside Body Weight-Supported Treadmill was used and evaluated in medical and surgical patients in the ICU. Feasibility was evaluated according to eligibility, successful number of BWSTT, number of staff needed, adverse events, number of patients that could not have walked without BWSTT, patient satisfaction and anxiety. RESULTS Twenty participants, underwent 54 sessions BWSTT. Two staff members executed the BWSTT and no adverse events occurred. Medical equipment did not have to be disconnected during all treatment sessions. In 74% of the sessions, the participants would not have been able to walk without the BWSTT. Patient satisfaction with BWSTT was high and anxiety low. CONCLUSIONS This proof of concept study demonstrated that BWSTT is safe, reduces staff resource, and facilitates the first time to ambulation in critically ill patients with severe muscle weakness in the ICU.
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Affiliation(s)
- Juultje Sommers
- Department of Rehabilitation medicine, Academic Medical Center (AMC), University of Amsterdam, The Netherlands.
| | - Denise C Wieferink
- Department of Rehabilitation medicine, Academic Medical Center (AMC), University of Amsterdam, The Netherlands.
| | - Dave A Dongelmans
- Department of Intensive Care medicine, Academic Medical Center (AMC), University of Amsterdam, The Netherlands.
| | - Frans Nollet
- Department of Rehabilitation medicine, Academic Medical Center (AMC), University of Amsterdam, The Netherlands.
| | - Raoul H H Engelbert
- Department of Rehabilitation medicine, Academic Medical Center (AMC), University of Amsterdam, The Netherlands; Amsterdam School of Health Professions (ASHP), University of Applied Sciences, Amsterdam, The Netherlands.
| | - Marike van der Schaaf
- Department of Rehabilitation medicine, Academic Medical Center (AMC), University of Amsterdam, The Netherlands; Amsterdam School of Health Professions (ASHP), University of Applied Sciences, Amsterdam, The Netherlands.
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50
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Aarden JJ, van der Esch M, Engelbert RHH, van der Schaaf M, de Rooij SE, Buurman BM. Hip Fractures in Older Patients: Trajectories of Disability after Surgery. J Nutr Health Aging 2017; 21:837-842. [PMID: 28717815 DOI: 10.1007/s12603-016-0830-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Hip fracture in older patients often lead to permanent disabilities and can result in mortality. OBJECTIVE To identify distinct disability trajectories from admission to one-year post-discharge in acutely hospitalized older patients after hip fracture. DESIGN Prospective cohort study, with assessments at admission, three-months and one-year post-discharge. SETTING AND PARTICIPANTS Patients ≥ 65 years admitted to a 1024-bed tertiary teaching hospital in the Netherlands. METHODS Disability was the primary outcome and measured with the modified Katz ADL-index score. A secondary outcome was mortality. Latent class growth analysis was performed to detect distinct disability trajectories from admission and Cox regression was used to analyze the effect of the deceased patients to one-year after discharge. RESULTS The mean (SD) age of the 267 patients was 84.0 (6.9) years. We identified 3 disability trajectories based on the Katz ADL-index score from admission to one-year post-discharge: 'mild'- (n=54 (20.2%)), 'moderate'- (n=110 (41.2%)) and 'severe' disability (n=103 (38.6%)). Patients in all three trajectories showed an increase of disabilities at three months, in relation to baseline and 80% did not return to baseline one-year post-discharge. Seventy-three patients (27.3%) deceased within one-year post-discharge, particularly in the 'moderate'- (n=22 (8.2%)) and 'severe' disability trajectory (n=47 (17.6%)). CONCLUSIONS Three disability trajectories were identified from hospital admission until one-year follow-up in acutely hospitalized older patients after hip fracture. Most patients had substantial functional decline and 27% of the patient's deceased one-year post-discharge, mainly patients in the 'moderate'- 'and severe' disability trajectories.
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Affiliation(s)
- J J Aarden
- J.J. Aarden, Amsterdam University of Applied Sciences Amsterdam School of Physiotherapy, Tafelbergweg 51, 1105 BD, Amsterdam, the Netherlands, , Phone:+31 621158578
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