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Mol TI, van Bennekom CAM, Scholten EWM, Visser-Meily JMA, Reneman MF, Riedstra A, de Groot V, Meijer JWG, Bult MK, Post MWM. Self-regulation as rehabilitation outcome: what is important according to former patients? Disabil Rehabil 2022; 44:7484-7490. [PMID: 34747280 DOI: 10.1080/09638288.2021.1998663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE Self-regulation refers to self-management and self-control, with or without disability. Outcomes of rehabilitation with respect to self-regulation are unclear. This study aims to identify elements of self-regulation that former patients consider important in the context of medical rehabilitation. MATERIALS AND METHODS Qualitative exploration based on focus group discussions (FGDs). Transcripts were analysed using thematic analysis as well as open coding. Forty individuals participated in seven diagnosis-related FGDs. RESULTS Six subthemes were raised in the FGDs which could be merged into three main themes. Two main themes are conditional for regaining self-regulation: 1) having insight into one's condition and abilities (i.e., insight into impairments. consequences of impairments. abilities); 2) to know how to cope with the consequences of the condition (be able to communicate limitations; have to trust in body and functioning). The subject of the last theme 3) is how to apply self-regulation in one's own life (to make use of abilities and optimize functioning). CONCLUSIONS Three main themes of self-regulation in the context of medical rehabilitation were identified by former patients, partly relating to the ability to self-regulate and partly to the execution of self-regulation. This knowledge can be used to define specific rehabilitation goals and further develop rehabilitation outcome measurement.IMPLICATIONS FOR REHABILITATIONAwareness of the fundamental subthemes of self-regulation in rehabilitation will positively contribute to theory building and improve clinical practice (e.g., goal setting).Paying explicit attention to the six subthemes as standard elements of rehabilitation will help to provide a comprehensive view concerning self-regulation.The conceptual model of self-regulation, based on patient perspectives, can contribute to the measurement of rehabilitation outcomes.
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Affiliation(s)
- T I Mol
- Centre of Excellence for Rehabilitation Medicine, University Medical Centre Utrecht, UMC Utrecht Brain Centre, Utrecht, the Netherlands.,Department of Rehabilitation Medicine, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - C A M van Bennekom
- Research and Development Division, Heliomare Rehabilitation Centre, Wijk aan Zee, the Netherlands.,Coronel Institute of Occupational Health, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - E W M Scholten
- Centre of Excellence for Rehabilitation Medicine, University Medical Centre Utrecht, UMC Utrecht Brain Centre, Utrecht, the Netherlands
| | - J M A Visser-Meily
- Centre of Excellence for Rehabilitation Medicine, University Medical Centre Utrecht, UMC Utrecht Brain Centre, Utrecht, the Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Centre Utrecht, UMC Utrecht Brain Centre, Utrecht, the Netherlands
| | - M F Reneman
- Department of Rehabilitation Medicine, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - A Riedstra
- Research Committee Dutch Spinal Cord Association, Utrecht, the Netherlands
| | - V de Groot
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - J W G Meijer
- Centre of Excellence for Rehabilitation Medicine, University Medical Centre Utrecht, UMC Utrecht Brain Centre, Utrecht, the Netherlands.,De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - M K Bult
- Cerebral Palsy Netherlands/Spina Bifida & Hydrocephalus Netherlands, Utrecht, The Netherlands
| | - M W M Post
- Centre of Excellence for Rehabilitation Medicine, University Medical Centre Utrecht, UMC Utrecht Brain Centre, Utrecht, the Netherlands.,Department of Rehabilitation Medicine, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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2
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Lam KH, van Oirschot P, den Teuling B, Hulst HE, de Jong BA, Uitdehaag BMJ, de Groot V, Killestein J. Reliability, construct and concurrent validity of a smartphone-based cognition test in multiple sclerosis. Mult Scler 2021; 28:300-308. [PMID: 34037472 PMCID: PMC8795217 DOI: 10.1177/13524585211018103] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Early detection and monitoring of cognitive dysfunction in multiple sclerosis (MS) may be enabled with smartphone-adapted tests that allow frequent measurements in the everyday environment. Objectives: The aim of this study was to determine the reliability, construct and concurrent validity of a smartphone-adapted Symbol Digit Modalities Test (sSDMT). Methods: During a 28-day follow-up, 102 patients with MS and 24 healthy controls (HC) used the MS sherpa® app to perform the sSDMT every 3 days on their own smartphone. Patients performed the Brief International Cognitive Assessment for MS at baseline. Test–retest reliability (intraclass correlation coefficients, ICC), construct validity (group analyses between cognitively impaired (CI), cognitively preserved (CP) and HC for differences) and concurrent validity (correlation coefficients) were assessed. Results: Patients with MS and HC completed an average of 23.2 (SD = 10.0) and 18.3 (SD = 10.2) sSDMT, respectively. sSDMT demonstrated high test–retest reliability (ICCs > 0.8) with a smallest detectable change of 7 points. sSDMT scores were different between CI patients, CP patients and HC (all ps < 0.05). sSDMT correlated modestly with the clinical SDMT (highest r = 0.690), verbal (highest r= 0.516) and visuospatial memory (highest r= 0.599). Conclusion: Self-administered smartphone-adapted SDMT scores were reliable and different between patients who were CI, CP and HC and demonstrated concurrent validity in assessing information processing speed.
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Affiliation(s)
- KH Lam
- KH Lam Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, De Boelelaan, 1117 Amsterdam, The Netherlands.
| | - P van Oirschot
- Orikami Digital Health Products, Nijmegen, The Netherlands
| | - B den Teuling
- Orikami Digital Health Products, Nijmegen, The Netherlands
| | - HE Hulst
- Department of Anatomy and Neurosciences, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - BA de Jong
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - BMJ Uitdehaag
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - V de Groot
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - J Killestein
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
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3
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Lam KH, Meijer KA, Loonstra FC, Coerver E, Twose J, Redeman E, Moraal B, Barkhof F, de Groot V, Uitdehaag B, Killestein J. Real-world keystroke dynamics are a potentially valid biomarker for clinical disability in multiple sclerosis. Mult Scler 2020; 27:1421-1431. [PMID: 33150823 PMCID: PMC8358561 DOI: 10.1177/1352458520968797] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Clinical measures in multiple sclerosis (MS) face limitations that may be overcome by utilising smartphone keyboard interactions acquired continuously and remotely during regular typing. Objective: The aim of this study was to determine the reliability and validity of keystroke dynamics to assess clinical aspects of MS. Methods: In total, 102 MS patients and 24 controls were included in this observational study. Keyboard interactions were obtained with the Neurokeys keyboard app. Eight timing-related keystroke features were assessed for reliability with intraclass correlation coefficients (ICCs); construct validity by analysing group differences (in fatigue, gadolinium-enhancing lesions on magnetic resonance imaging (MRI), and patients vs controls); and concurrent validity by correlating with disability measures. Results: Reliability was moderate in two (ICC = 0.601 and 0.742) and good to excellent in the remaining six features (ICC = 0.760–0.965). Patients had significantly higher keystroke latencies than controls. Latency between key presses correlated the highest with Expanded Disability Status Scale (r = 0.407) and latency between key releases with Nine-Hole Peg Test and Symbol Digit Modalities Test (ρ = 0.503 and r = −0.553, respectively), ps < 0.001. Conclusion: Keystroke dynamics were reliable, distinguished patients and controls, and were associated with clinical disability measures. Consequently, keystroke dynamics are a promising valid surrogate marker for clinical disability in MS.
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Affiliation(s)
- K H Lam
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam, The Netherlands
| | - K A Meijer
- Neurocast B.V., Amsterdam, The Netherlands
| | - F C Loonstra
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam, The Netherlands
| | - Eme Coerver
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam, The Netherlands
| | - J Twose
- Neurocast B.V., Amsterdam, The Netherlands
| | - E Redeman
- Neurocast B.V., Amsterdam, The Netherlands
| | - B Moraal
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam, The Netherlands
| | - F Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam, The Netherlands/Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, UK
| | - V de Groot
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Bmj Uitdehaag
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam, The Netherlands
| | - J Killestein
- Department of Neurology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, MS Center Amsterdam, Amsterdam, The Netherlands
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4
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Gravesteijn AS, Beckerman H, de Jong BA, Hulst HE, de Groot V. Neuroprotective effects of exercise in people with progressive multiple sclerosis (Exercise PRO-MS): study protocol of a phase II trial. BMC Neurol 2020; 20:177. [PMID: 32393193 PMCID: PMC7212565 DOI: 10.1186/s12883-020-01765-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/04/2020] [Indexed: 12/31/2022] Open
Abstract
Background Neurodegeneration, rather than inflammation, plays a key role in the progressive phase of multiple sclerosis (MS). Current disease modifying treatment options for people with progressive MS (PMS) do not specifically target neurodegeneration. Preliminary evidence suggests that exercise therapy might have neuroprotective effects. However, neuroprotective effect studies of exercise interventions in PMS are scarce and the possible mode of action underlying neuroprotective effects of exercise are unknown and need to be elucidated. The main aim of this phase II trial is to assess whether progressive resistance training (PRT) and high intensity interval training (HIIT), can slow down neurodegeneration in people with PMS. Methods In a single-blinded phase II clinical trial with an extended baseline period, 60 people with PMS will be randomly assigned to PRT or HIIT. The participants should have had a relapse onset of MS with confirmed disease progression, however still ambulatory. The duration of the study is 48 weeks, consisting of 16 weeks baseline period (no intervention), 16 weeks intervention and 16 weeks follow-up. Patient-tailored training will be performed 3 times per week for one hour in groups, led by an experienced physiotherapist. The primary outcome measure is neurodegeneration, measured as whole brain atrophy on magnetic resonance imaging (MRI). Secondary outcome parameters will include other biomarkers associated with neurodegeneration (i.e. regional brain atrophy, lesion load, white matter integrity, resting state functional connectivity, blood biomarkers (brain derived neurotrophic factor (BDNF) and serum neurofilament light (sNFL)), patient functioning (physical and cognitive) and cardiovascular risk factors. Discussion Besides the primary outcome measures, this study will examine a large variety of biomarkers associated with neurodegeneration after an exercise intervention. Combining outcome parameters may help to elucidate the mode of action underlying neuroprotective effects of exercise. Trial registration This trial is prospectively registered at the Dutch Trial Registry (number NL8265, date 06-01-2020).
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Affiliation(s)
- A S Gravesteijn
- Department of Rehabilitation Medicine, MS Center Amsterdam, Amsterdam Neuroscience research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, PO Box 7057, 1007, MB, Amsterdam, the Netherlands.
| | - H Beckerman
- Department of Rehabilitation Medicine, MS Center Amsterdam, Amsterdam Neuroscience research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, PO Box 7057, 1007, MB, Amsterdam, the Netherlands
| | - B A de Jong
- Department of Neurology, MS Center Amsterdam, Amsterdam Neuroscience research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, PO Box 7057, 1007, MB, Amsterdam, the Netherlands
| | - H E Hulst
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, PO Box 7057, 1007, MB, Amsterdam, the Netherlands
| | - V de Groot
- Department of Rehabilitation Medicine, MS Center Amsterdam, Amsterdam Neuroscience research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, PO Box 7057, 1007, MB, Amsterdam, the Netherlands
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5
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Schmidt AK, van Gorp M, van Wely L, Ketelaar M, Hilberink SR, Roebroeck ME, van Meeteren J, van der Slot W, Stam H, Dallmeijer AJ, de Groot V, Voorman JM, Smits DW, Wintels SC, Reinders‐Messelink HA, Gorter JW, Verheijden J. Autonomy in participation in cerebral palsy from childhood to adulthood. Dev Med Child Neurol 2020; 62:363-371. [PMID: 31578717 DOI: 10.1111/dmcn.14366] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2019] [Indexed: 11/30/2022]
Abstract
AIM To determine the long-term development of autonomy in participation of individuals with cerebral palsy (CP) without intellectual disability. METHOD Individuals with CP (n=189, 117 males, 72 females; mean age [SD] 21y 11mo [4y 11mo], range 12-34y); were assessed cross-sectionally (46%) or up to four times (54%), between the ages of 12 and 34 years. Autonomy in participation was classified using phase 3 of the Rotterdam Transition Profile. A logistic generalized estimating equation regression model was used to analyse autonomy in six domains (independent variables: age, Gross Motor Function Classification System [GMFCS] level, and interaction between age and GMFCS level). Proportions of autonomy were compared to references using binomial tests (p<0.05). RESULTS In most domains, over 90% of participants (n=189, 400 observations, 80% in GMFCS levels I and II) reached autonomy in participation in their late twenties, except for intimate/sexual relationships. Those in GMFCS levels III to V compared to those in GMFCS levels I and II had less favourable development of autonomy in the transportation, intimate relationships, employment, and housing domains, and more favourable development in the finances domain. Compared to references, fewer individuals with CP were autonomous in participation. INTERPRETATION This knowledge of autonomy may guide the expectations of young people with CP and their caregivers. Furthermore, rehabilitation professionals should address autonomy development in intimate relationships, employment, and housing, especially in individuals with lower gross motor function. WHAT THIS PAPER ADDS Individuals with cerebral palsy without intellectual disability achieved autonomy in most participation domains. Regarding intimate relationships, they continued to have less experience compared to age-matched references. Development of autonomy was less favourable for individuals in Gross Motor Function Classification System levels III to V.
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Affiliation(s)
- Ann Katrin Schmidt
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Rijndam Rehabilitation, Rotterdam, the Netherlands
| | - Marloes van Gorp
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Leontien van Wely
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Sander R Hilberink
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Marij E Roebroeck
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.,Rijndam Rehabilitation, Rotterdam, the Netherlands
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6
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Braakhuis HEM, Berger MAM, van der Stok GA, van Meeteren J, de Groot V, Beckerman H, Bussmann JBJ. Three distinct physical behavior types in fatigued patients with multiple sclerosis. J Neuroeng Rehabil 2019; 16:105. [PMID: 31443714 PMCID: PMC6708224 DOI: 10.1186/s12984-019-0573-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/29/2019] [Indexed: 01/16/2023] Open
Abstract
Background Multiple sclerosis often leads to fatigue and changes in physical behavior (PB). Changes in PB are often assumed as a consequence of fatigue, but effects of interventions that aim to reduce fatigue by improving PB are not sufficient. Since the heterogeneous nature of MS related symptoms, levels of PB of fatigued patients at the start of interventions might vary substantially. Better understanding of the variability by identification of PB subtypes in fatigued patients may help to develop more effective personalized rehabilitation programs in the future. This study aimed to identify PB subtypes in fatigued patients with multiple sclerosis based on multidimensional PB outcome measures. Methods Baseline accelerometer (Actigraph) data, demographics and clinical characteristics of the TREFAMS-ACE participants (n = 212) were used for secondary analysis. All patients were ambulatory and diagnosed with severe fatigue based on a score of ≥35 on the fatigue subscale of the Checklist Individual Strength (CIS20r). Fifteen PB measures were used derived from 7 day measurements with an accelerometer. Principal component analysis was performed to define key outcome measures for PB and two-step cluster analysis was used to identify PB types. Results Analysis revealed five key outcome measures: percentage sedentary behavior, total time in prolonged moderate-to-vigorous physical activity, number of sedentary bouts, and two types of change scores between day parts (morning, afternoon and evening). Based on these outcomes three valid PB clusters were derived. Conclusions Patients with severe MS-related fatigue show three distinct and homogeneous PB subtypes. These PB subtypes, based on a unique set of PB outcome measures, may offer an opportunity to design more individually-tailored interventions in rehabilitation. Trial registration Clinical trial registration no ISRCTN 82353628, ISRCTN 69520623 and ISRCTN 58583714. Electronic supplementary material The online version of this article (10.1186/s12984-019-0573-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- H E M Braakhuis
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands. .,Faculty of Health Nutrition and Sport, The Hague University of Applied Sciences, The Hague, The Netherlands.
| | - M A M Berger
- Faculty of Health Nutrition and Sport, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - G A van der Stok
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J van Meeteren
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - V de Groot
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,MS Center Amsterdam, Amsterdam, The Netherlands
| | - H Beckerman
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,MS Center Amsterdam, Amsterdam, The Netherlands
| | - J B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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7
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van Gorp M, van Wely L, Dallmeijer, de Groot V, Ketelaar M, Roebroeck M. Difficulty and independence in participation of emerging adults with cerebral palsy. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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van Gorp M, Roebroeck M, van Wely L, de Groot V, Gorter J, Smits D, Schmidt A, Dallmeijer A. Development curves of motor and daily activity performance of individuals with cerebral palsy from childhood into adulthood. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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9
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van den Akker LE, Beckerman H, Collette EH, Knoop H, Bleijenberg G, Twisk JW, Dekker J, de Groot V. Cognitive behavioural therapy for MS-related fatigue explained: A longitudinal mediation analysis. J Psychosom Res 2018; 106:13-24. [PMID: 29455894 DOI: 10.1016/j.jpsychores.2017.12.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 12/08/2017] [Accepted: 12/26/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) effectively reduces fatigue directly following treatment in patients with Multiple Sclerosis (MS), but little is known about the process of change during and after CBT. DESIGN Additional analysis of a randomized clinical trial. OBJECTIVE To investigate which psychological factors mediate change in fatigue during and after CBT. METHODS TREFAMS-CBT studied the effectiveness of a 16-week CBT treatment for MS-related fatigue. Ninety-one patients were randomized (44 to CBT, 47 to the MS-nurse consultations). Mediation during CBT treatment was studied using assessments at baseline, 8 and 16weeks. Mediation of the change in fatigue from post-treatment to follow-up was studied separately using assessments at 16, 26 and 52weeks. Proposed mediators were: changes in illness cognitions, general self-efficacy, coping styles, daytime sleepiness, concentration and physical activity, fear of disease progression, fatigue perceptions, depression and physical functioning. Mediators were separately analysed according to the product-of-coefficients approach. Confidence intervals were calculated with a bootstrap procedure. RESULTS During treatment the decrease in fatigue brought on by CBT was mediated by improved fatigue perceptions, increased physical activity, less sleepiness, less helplessness, and improved physical functioning. Post-treatment increases in fatigue levels were mediated by reduced physical activity, reduced concentration, and increased sleepiness. CONCLUSION These results suggests that focusing on improving fatigue perceptions, perceived physical activity, daytime sleepiness, helplessness, and physical functioning may further improve the effectiveness of CBT for fatigue in patients with MS. Maintenance of treatment effects may be obtained by focusing on improving physical activity, concentration and sleepiness.
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Affiliation(s)
- L E van den Akker
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; MS Center Amsterdam, Amsterdam, The Netherlands.
| | - H Beckerman
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; MS Center Amsterdam, Amsterdam, The Netherlands
| | - E H Collette
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - H Knoop
- Expert Centre for Chronic Fatigue, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Medical Psychology, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - G Bleijenberg
- Expert Centre for Chronic Fatigue, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J W Twisk
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - J Dekker
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - V de Groot
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; MS Center Amsterdam, Amsterdam, The Netherlands
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de Groot V, Beckerman H, Lankhorst GJ, Polman CH, Bouter LM. The initial course of daily functioning in multiple sclerosis: a three-year follow-up study. Mult Scler 2016; 11:713-8. [PMID: 16320733 DOI: 10.1191/1352458505ms1238oa] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We studied the initial course of daily functioning in multiple sclerosis (MS). A cohort of 156 recently diagnosed patients was prospectively followed for three years (five measurements). Domains of interest were neurological deficits, physical functioning, mental health, social functioning and general health. An a priori distinction was made between a relapse onset group (n=128) and a non-relapse onset group (n=28). At baseline, neurological deficits are relatively minor for most patients, 26.3% have aberrant physical functioning scores, 38.5% have aberrant social functioning scores, 9% have aberrant mental health scores and 25% have aberrant general health scores. The neurological deficits and physical functioning deteriorated significantly over time. This deterioration was more pronounced and clinically relevant in the non-relapse onset group only. Mental health showed a significant, but not clinically relevant deterioration over time. Social functioning and general health showed non-significant effects for time. It is concluded that in the initial stage of MS, when neurological deficits are relatively minor and mental health is relatively unaffected, patients in both groups experience limitations in daily functioning. Patients in the non-relapse onset group have progressive neurological symptoms that are accompanied by progressive limitations in physical functioning, but not by progressive limitations in the other domains.
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Affiliation(s)
- V de Groot
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.
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11
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Bregman DJJ, Harlaar J, Meskers CGM, de Groot V. Spring-like Ankle Foot Orthoses reduce the energy cost of walking by taking over ankle work. Gait Posture 2012; 35:148-53. [PMID: 22050974 DOI: 10.1016/j.gaitpost.2011.08.026] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 08/21/2011] [Accepted: 08/28/2011] [Indexed: 02/02/2023]
Abstract
In patients with central neurological disorders, gait is often limited by a reduced ability to push off with the ankle. To overcome this reduced ankle push-off, energy-storing, spring-like carbon-composite Ankle Foot Orthoses (AFO) can be prescribed. It is expected that the energy returned by the AFO in late stance will support ankle push-off, and reduce the energy cost of walking. In 10 patients with multiple sclerosis and stroke the energy cost of walking, 3D kinematics, joint power, and joint work were measured during gait, with and without the AFO. The mechanical characteristics of the AFO were measured separately, and used to calculate the contribution of the AFO to the ankle kinetics. We found a significant decrease of 9.8% in energy cost of walking when walking with the AFO. With the AFO, the range of motion of the ankle was reduced by 12.3°, and the net work around the ankle was reduced by 29%. The total net work in the affected leg remained unchanged. The AFO accounted for 60% of the positive ankle work, which reduced the total amount of work performed by the leg by 11.1% when walking with the AFO. The decrease in energy cost when walking with a spring-like energy-storing AFO in central neurological patients is not induced by an augmented net ankle push-off, but by the AFO partially taking over ankle work.
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Affiliation(s)
- D J J Bregman
- MOVE Institute for Human Movement Research, Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.
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Bregman DJJ, van der Krogt MM, de Groot V, Harlaar J, Wisse M, Collins SH. The effect of ankle foot orthosis stiffness on the energy cost of walking: a simulation study. Clin Biomech (Bristol, Avon) 2011; 26:955-61. [PMID: 21723012 DOI: 10.1016/j.clinbiomech.2011.05.007] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 05/16/2011] [Accepted: 05/18/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND In stroke and multiple sclerosis patients, gait is frequently hampered by a reduced ability to push-off with the ankle caused by weakness of the plantar-flexor muscles. To enhance ankle push-off and to decrease the high energy cost of walking, spring-like carbon-composite Ankle Foot Orthoses are frequently prescribed. However, it is unknown what Ankle Foot Orthoses stiffness should be used to obtain the most efficient gait. The aim of this simulation study was to gain insights into the effect of variation in Ankle Foot Orthosis stiffness on the amount of energy stored in the Ankle Foot Orthosis and the energy cost of walking. METHODS We developed a two-dimensional forward-dynamic walking model with a passive spring at the ankle representing the Ankle Foot Orthosis and two constant torques at the hip for propulsion. We varied Ankle Foot Orthosis stiffness while keeping speed and step length constant. FINDINGS We found an optimal stiffness, at which the energy delivered at the hip joint was minimal. Energy cost decreased with increasing energy storage in the ankle foot orthosis, but the most efficient gait did not occur with maximal energy storage. With maximum storage, push-off occurred too late to reduce the impact of the contralateral leg with the floor. Maximum return prior to foot strike was also suboptimal, as push-off occurred too early and its effects were subsequently counteracted by gravity. The optimal Ankle Foot Orthosis stiffness resulted in significant push-off timed just prior to foot strike and led to greater ankle plantar-flexion velocity just before contralateral foot strike. INTERPRETATION Our results suggest that patient energy cost might be reduced by the proper choice of Ankle Foot Orthosis stiffness.
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Affiliation(s)
- D J J Bregman
- MOVE Institute for Human Movement Research, Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.
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Feys P, Gijbels D, Romberg A, Santoyo C, Gebara B, de Noordhout BM, Knuts K, Béthoux F, de Groot V, Vaney C, Dalgas U. Effect of time of day on walking capacity and self-reported fatigue in persons with multiple sclerosis: a multi-center trial. Mult Scler 2011; 18:351-7. [PMID: 21969239 DOI: 10.1177/1352458511419881] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many persons with multiple sclerosis (PwMS) report increased fatigue in the afternoon and evening compared with the morning. It is commonly accepted that physical capacity also decreases as time of day progresses, potentially influencing the outcomes of testing. OBJECTIVE The objective of this article was to determine whether self-reported fatigue level and walking capacity are influenced by time of day in PwMS. METHODS A total of 102 PwMS from 8 centers in 5 countries, with a diverse level of ambulatory dysfunction (Expanded Disability Status Scale [EDSS] <6.5), participated. Patients performed walking capacity tests and reported fatigue level at three different time points (morning, noon, afternoon) during 1 day. Walking capacity was measured with the 6-Minute Walk Test (6MWT) and the 10-m walk test performed at usual and fastest speed. Self-reported fatigue was measured by the Rochester Fatigue Diary (RFD). Subgroups with mild (EDSS 1.5-4.0, n = 53) and moderate (EDSS 4.5-6.5, n = 49) ambulatory dysfunction were formed, as changes during the day were hypothesized to depend on disability status. RESULTS Subgroups had different degree of ambulatory dysfunction (p < 0.001) but reported similar fatigue levels. Although RFD scores were affected by time of day with significant differences between morning and noon/afternoon (p < 0.0001), no changes in walking capacity were found in any subgroup. Additional analyses on subgroups distinguished by diurnal change in self-reported fatigue failed to reveal analogous changes in walking capacity. CONCLUSIONS Testing of walking capacity is unaffected by time of day, despite changes in subjective fatigue.
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Affiliation(s)
- P Feys
- BIOMED, Hasselt University, Diepenbeek and REVAL Research Institute, PHL University College, Hasselt, Belgium.
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Abstract
Background: A decline in mobility is a common feature of multiple sclerosis (MS). Community walking scales are used to categorize patients in their ability to move independently. The first purpose of this study was to determine which specific gait speed corresponded with the categories of the Modified Functional Walking Categories (MFWC). The second purpose was to determine the Minimally Important Change (MIC) in absolute gait speed using the MFWC and Expanded Disability Status Scale (EDSS) as external criteria. Method: MS patients were measured six times in 6 years. Gait velocity was measured with the 10-metre timed walk test (10-m TWT), the severity of MS was determined with the EDSS, and community walking was assessed with the MFWC. For each category of the MFWC, Receiver Operating Characteristic (ROC) curves were used to find the best possible cut-off point on the 10-m TWT. The MIC in absolute gait speed was determined using a change of one category on the MFWC or one point on the EDSS. Results: A strong relationship was found between gait speed and the MFWC; all areas under the ROC curves (AUCs) were between 0.74 and 0.86. The MIC in absolute gait speed could not be determined, because the AUCs were below the threshold of 0.70 and changes in gait speed were small. Conclusions: Gait speed is related to community walking, but an MIC in absolute gait speed could not be determined using a minimally important change on the MFWC or the EDSS as external criteria.
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Affiliation(s)
- JCE Kempen
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, VU University and VU University Medical Center, Amsterdam, The Netherlands
- MS Center Amsterdam, The Netherlands
| | - V de Groot
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, VU University and VU University Medical Center, Amsterdam, The Netherlands
- MS Center Amsterdam, The Netherlands
| | - DL Knol
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - CH Polman
- MS Center Amsterdam, The Netherlands
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - GJ Lankhorst
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - H Beckerman
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
- EMGO Institute for Health and Care Research, VU University and VU University Medical Center, Amsterdam, The Netherlands
- MS Center Amsterdam, The Netherlands
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Bregman DJJ, Rozumalski A, Koops D, de Groot V, Schwartz M, Harlaar J. A new method for evaluating ankle foot orthosis characteristics: BRUCE. Gait Posture 2009; 30:144-9. [PMID: 19520576 DOI: 10.1016/j.gaitpost.2009.05.012] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Revised: 04/28/2009] [Accepted: 05/18/2009] [Indexed: 02/02/2023]
Abstract
The mechanical characteristics of ankle foot orthoses (AFOs), such as the stiffness and neutral angle around the ankle and metatarsal-phalangeal (MTP) joints, are rarely quantified. Paradoxically, it is expected that these characteristics determine the function of the AFO in pathological gait. Therefore a device to determine these AFO characteristics named BRUCE was designed based on multidisciplinary consensus. The design is based on a replicated human leg that is manually driven and continuously registers joint configuration and force exerted by the AFO onto the device. From this information, neutral angles and stiffnesses around the ankle and MTP joints are determined using a linear fit. The reliability of the stiffnesses and neutral angles was studied by repeatedly measuring the mechanical characteristics of four different AFOs, and evaluating the inter-session, intra-session, and inter-observer errors. The reliability study revealed that ankle and MTP stiffness could be measured with very high reliability (ICC=0.98-1.00). Ankle and MTP neutral angles showed reasonable reliability (ICC=0.79-0.92). Measurement error in the neutral angles could mainly be attributed to the difference in testers. With a fixed tester excellent reliability was obtained (ICC=0.99-0.99). The results derived using BRUCE can help to gain insight into the role of the mechanical characteristics of AFOs in correcting pathological gait. Objective information of AFO characteristics is expected to lead to a better founded prescription of AFOs, resulting in optimal functional benefit for the patient.
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Affiliation(s)
- D J J Bregman
- MOVE Institute for Human Movement Research, VU University Medical Center, Amsterdam, The Netherlands.
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Minneboo A, Jasperse B, Barkhof F, Uitdehaag BMJ, Knol DL, de Groot V, Polman CH, Castelijns JA. Predicting short-term disability progression in early multiple sclerosis: added value of MRI parameters. J Neurol Neurosurg Psychiatry 2008; 79:917-23. [PMID: 18077480 DOI: 10.1136/jnnp.2007.124123] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) and clinical parameters are associated with disease progression in multiple sclerosis (MS). The aim of this study was to investigate whether adding MRI parameters to a model with only clinical parameters could improve these associations. METHODS 89 patients (55 women) with recently diagnosed MS had clinical and MRI evaluation at baseline (time of diagnosis) and at follow-up after 2.2 years. Detailed clinical data were available, including disease type (relapse-onset or progressive-onset) and disability, as measured by the Expanded Disability Status Scale (EDSS). MRI parameters included Normalised Brain Volume (NBV) at baseline, percentage brain volume change (PBVC/year), T2- and T1-lesion loads and spinal cord abnormalities. Progression of disability (increase in EDSS of at least 1 point at follow-up) was the main outcome measure. For a model containing only clinical parameters, the added value of MRI parameters was tested using logistic regression. RESULTS PBVC/year and lesion loads at follow-up were significantly higher in the group with progression. Adding PBVC/year to a clinical model improved the model, indicating that MRI parameters added independent information (p<0.001). CONCLUSION The rate of cerebral atrophy conveys added information for the progression of disability in patients with early MS, suggesting that clinical disability is determined by neurodegenerative changes as depicted by MRI.
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Affiliation(s)
- A Minneboo
- MS Center of the VU University Medical Center, Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.
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Beckerman H, van Zee IE, de Groot V, van den Bos GAM, Lankhorst GJ, Dekker J. Utilization of health care by patients with multiple sclerosis is based on professional and patient-defined health needs. Mult Scler 2008; 14:1269-79. [PMID: 18653735 DOI: 10.1177/1352458508094884] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This cross-sectional study investigates healthcare utilization, and determines which predisposing, enabling, and health factors are associated with healthcare utilization among 121 patients with multiple sclerosis (MS). METHODS Data on patient-related predisposing, enabling, and health factors were collected by means of written questionnaires and a home visit from a well-trained physiotherapist. RESULTS Of the 121 patients with MS (mean age 43 years, mean score on the Expanded Disability Status Scale 3.5, disease duration 6 years), 16% were hospitalized in the previous year; 62% consulted their general practitioner, and 69% consulted their neurologist in the previous 6 months. Other medical specialists were consulted in the 6-month period by 50% of the study population. In a 4-week period preceding the home visit, 41% of the patients were treated by an allied healthcare professional. Multivariate logistic regression analyses showed that consulting the general practitioner, the neurologist, other medical specialists, and allied healthcare professionals, and the use of equipment/aids by MS patients is primarily related to their health, either as perceived by the patients themselves or defined by the professional. CONCLUSIONS MS patients in the Netherlands make appropriate use of healthcare facilities, because their utilization can predominantly be explained by health-related factors, and not by predisposing or enabling factors.
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Affiliation(s)
- H Beckerman
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.
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de Groot V, Beckerman H, Twisk JW, Uitdehaag BM, Hintzen RQ, Minneboo A, Lankhorst GJ, Polman CH, Bouter LM. Vitality, perceived social support and disease activity determine the performance of social roles in recently diagnosed multiple sclerosis: A longitudinal analysis. J Rehabil Med 2008; 40:151-7. [DOI: 10.2340/16501977-0145] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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de Groot V, Beckerman H, Uitdehaag BMJ, de Vet HCW, Lankhorst GJ, Polman CH, Bouter LM. The usefulness of evaluative outcome measures in patients with multiple sclerosis. Brain 2006; 129:2648-59. [PMID: 16956906 DOI: 10.1093/brain/awl223] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To select the most useful evaluative outcome measures for early multiple sclerosis, we included 156 recently diagnosed patients in a 3-year follow-up study, and assessed them on 23 outcome measures in the domains of disease-specific outcomes, physical functioning, mental health, social functioning and general health. A global rating scale (GRS) and the Expanded Disability Status Scale (EDSS) were used as external criteria to determine the minimally important change (MIC) for each outcome measure. Subsequently, we determined whether the outcome measures could detect their MIC reliably. From these, per domain the outcome measure that was found to be most sensitive to changes (responsive) was identified. At group level, 11 outcomes of the domains of physical functioning, mental health, social functioning and general health could reliably detect the MIC. Of these 11, the most responsive measures per domain were the Medical Outcome Study 36 Short Form sub-scale physical functioning (SF36pf), the Disability and Impact Profile (DIP) sub-scale psychological, the Rehabilitation Activities Profile sub-scale occupation (RAPocc) and the SF36 sub-scale health, respectively. Overall, the most responsive measures were the SF36pf and the RAPocc. In individual patients, none of the measures could reliably detect the MIC. In sum, in the early stages of multiple sclerosis the most useful evaluative outcome measures for research are the SF36pf (physical functioning) and the RAPocc (social functioning).
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Affiliation(s)
- V de Groot
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.
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Dallmeijer AJ, Dekker J, Knol DL, Kalmijn S, Schepers VPM, de Groot V, Lindeman E, Beelen A, Lankhorst GJ. Dimensional structure of the SF-36 in neurological patients. J Clin Epidemiol 2006; 59:541-3. [PMID: 16632144 DOI: 10.1016/j.jclinepi.2005.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Revised: 10/16/2005] [Accepted: 10/16/2005] [Indexed: 11/18/2022]
Affiliation(s)
- A J Dallmeijer
- Department of Rehabilitation Medicine, VU University Medical Center, P.O. Box 7057, Amsterdam 1007 MB, The Netherlands.
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Huijbregts SCJ, Kalkers NF, de Sonneville LMJ, de Groot V, Reuling IEW, Polman CH. Differences in cognitive impairment of relapsing remitting, secondary, and primary progressive MS. Neurology 2005; 63:335-9. [PMID: 15277630 DOI: 10.1212/01.wnl.0000129828.03714.90] [Citation(s) in RCA: 174] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the cognitive skills of patients with relapsing remitting multiple sclerosis (RRMS), secondary progressive MS (SPMS), and primary progressive MS (PPMS) relative to healthy control subjects and to assess whether there is heterogeneity in the type of cognitive disabilities demonstrated by patients with different MS phenotypes. METHODS RRMS patients (n = 108), SPMS patients (n = 71), PPMS patients (n = 55), and healthy control subjects (n = 67) underwent neuropsychological assessment with the Brief Repeatable Battery of Neuropsychological Tests. RESULTS Relative to controls, cognitive performance of RRMS patients was deficient when tasks required higher-order working memory (WM) processes (Word List Generation, 10/36 Spatial Recall Test, Symbol Digit Modalities Test). PPMS and SPMS patients performed poorer than control subjects on all tasks. SPMS patients performed more poorly than PPMS patients when tasks required higher-order WM processes, except when speed of information processing played a relatively important role (Symbol Digit Modalities Test, Paced Auditory Serial Addition Test). Whereas RRMS patients generally performed better than the progressive subtypes, they showed relatively poor verbal fluency. CONCLUSION MS patients with different disease courses have different cognitive profiles.
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Affiliation(s)
- S C J Huijbregts
- Department of Clinical Neuropsychology, Vrije Universiteit, Amsterdam, The Netherlands
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Bot JCJ, Barkhof F, Polman CH, Lycklama à Nijeholt GJ, de Groot V, Bergers E, Ader HJ, Castelijns JA. Spinal cord abnormalities in recently diagnosed MS patients: added value of spinal MRI examination. Neurology 2004; 62:226-33. [PMID: 14745058 DOI: 10.1212/wnl.62.2.226] [Citation(s) in RCA: 222] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The most recent diagnostic criteria for multiple sclerosis (MS) ascertain that findings from spinal cord MRI can be used to demonstrate dissemination in space. Because little is known about the prevalence and characteristics of cord lesions early in the disease, the authors studied the prevalence of spinal cord abnormalities in patients with early-stage MS and assessed their impact on diagnostic classification. METHODS The brains and spinal cords of 104 recently diagnosed patients with MS were examined. Median interval between first symptom and diagnosis was 18.4 months. The brain MRI protocol included before and after gadolinium axial T1-weighted conventional spin-echo sequences and dual-echo spin-echo images. For spinal cord MRI, sagittal cardiac-triggered dual-echo T2-weighted and sagittal T1-weighted spin-echo images were included. Clinical assessment for each patient included age, sex, clinical signs for spinal cord involvement, and Expanded Disability Status Scale. RESULTS Abnormal cord MRIs were found in 83% of patients, usually with only focal lesions. Diffuse cord abnormalities were found in 13% of patients, although in isolation they were found in only three patients. Focal cord lesions were often multiple (median number, 3.0), small (median, 0.8 vertebral segments), and primarily (56.4%) situated in the cervical spinal cord. In 68 of 104 patients (65.4%), two or more focal lesions were visible on spinal cord images. The criteria for dissemination in space, as defined in the McDonald criteria for the brain, were met in only 66.3% of the patients. This percentage increased to 84.6% when spinal cord MRI abnormalities were also included. CONCLUSION Spinal cord abnormalities are prevalent in patients with early-stage MS, have distinct morphologic characteristics, and help to determine dissemination in space at time of diagnosis.
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Affiliation(s)
- J C J Bot
- MR Center for MS Research, Departments of Radiology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
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Uitdehaag BMJ, Adèr HJ, Roosma TJA, de Groot V, Kalkers NF, Polman CH. Multiple sclerosis functional composite: impact of reference population and interpretation of changes. Mult Scler 2002; 8:366-71. [PMID: 12356201 DOI: 10.1191/1352458502ms835oa] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Multiple sclerosis functional composite (MSFC) has been recommended as a clinical outcome measure to be used in future MS trials. A specific characteristic of the MSFC is that it is defined as a measure of impairment relative to a reference population. Using different reference populations affects actual MSFC scores. If the selection of a reference population also has an effect on sensitivity to change of the MSFC, comparison of data from clinical trials will be almost impossible when different reference populations are used We studied the effect of the selection of a reference population on the outcome of a trial by simulating 343 intervention trials and comparing results obtained by using three different reference populations: two previously published MS patient populations and a healthy population. Scores of the healthy population were collected in the first part of the study. The effects of sex, age and education level on test scores of healthy subjects were studied as well. In the healthy controls, sex, age and education level had a different impact on individual test scores of MSFC components and overall MSFC score. Our study shows that, with the use of the MSFC, the selection of different reference populations does not affect the trial statistics and significance, but it does affect comparability of results between different trials, and complicates the dinical interpretation of any observed change.
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Affiliation(s)
- B M J Uitdehaag
- Department of Neurology, VU Medical Centre, Amsterdam, The Netherlands.
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Kalkers NF, Bergers L, de Groot V, Lazeron RH, van Walderveen MA, Uitdehaag BM, Polman CH, Barkhof F. Concurrent validity of the MS Functional Composite using MRI as a biological disease marker. Neurology 2001; 56:215-9. [PMID: 11160958 DOI: 10.1212/wnl.56.2.215] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The MS Functional Composite (MSFC), a recently developed outcome measure for MS clinical trials measuring three dimensions (ambulation/leg function, arm/hand function, and cognition), was applied to 134 patients with MS to study the concurrent validity, using MRI measurements as a biological disease marker. The results were compared to correlations between the traditionally applied Expanded Disability Status Scale (EDSS) and MRI measurements in the same patients. METHODS The assessments of MSFC and EDSS were performed in combination with brain MRI. MRI consisted of T1- and T2-weighted images, from which the hypointense and hyperintense lesion loads were quantified. RESULTS The MSFC score ranged from -2.54 to 0.99. The median EDSS was 3.0 (interquartile range [IQR] 1.5 to 6.0). The median T2-weighted lesion load was 8.4 cm(3) (IQR 3.4 to 19.8) and the median T1-weighted lesion load was 1.1 cm(3) (IQR 0.3 to 3.2). Correlations between the MSFC and both T1 (-0.24) and T2 (-0.25) lesion loads were demonstrated, but not between the EDSS and both MRI parameters. Significant correlations between MSFC components and T1 and T2 lesion loads existed for cognitive function and arm/hand function, but not for ambulation. If relapse-onset patients (relapsing-remitting and secondary progressive) were combined, the correlation between MSFC and MRI parameters became stronger for both T1 (-0.37) and T2 lesion loads (-0.35). CONCLUSIONS The authors present the concurrent validity of the MSFC with a biological disease marker by showing correlations with MRI. Specifically, they demonstrate significant correlations with cognition and arm/hand function assessments, domains that are not well represented in the EDSS.
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Affiliation(s)
- N F Kalkers
- MS-MRI Center, University Hospital "Vrije Universiteit," Amsterdam, The Netherlands.
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Kalkers NF, de Groot V, Lazeron RH, Killestein J, Adèr HJ, Barkhof F, Lankhorst GJ, Polman CH. MS functional composite: relation to disease phenotype and disability strata. Neurology 2000; 54:1233-9. [PMID: 10746590 DOI: 10.1212/wnl.54.6.1233] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The MS Functional Composite (MSFC), a recently developed outcome measure for clinical trials, was applied to 240 patients with MS to explore its utility in different subgroups of MS and for comparison with the Expanded Disability Status Scale (EDSS). METHOD Three clinical dimensions were examined: arm/hand function, leg function/ambulation, and cognition. Predictions of relative scores on the MSFC and its components in three major MS phenotypes (relapsing-remitting, primary progressive, and secondary progressive) and three strata of disability were developed and tested. Also, correlations with EDSS were calculated and the effect of an external reference population was assessed. RESULTS Mean MSFC score was positive in the relapsing-remitting (0.4) and mildly disabled (0.4) groups and negative in the secondary progressive (-0.3), primary progressive (-0.4), and moderately (-0.07) and severely disabled (-1.0) groups. The correlation between EDSS and MSFC was strong (-0.68). EDSS correlated strongly with ambulation in secondary and primary progressive patients and severely disabled patients, moderately with arm/hand function for all analyzed groups, and not at all with cognition. Comparison with an external reference population showed changes in MSFC- and Z-scores, but did not result in altered differences between the subgroups. CONCLUSION Our prospective study in subgroups of MS confirmed and extended the construct validity of the MSFC. The MSFC also showed good concurrent validity with the EDSS, and includes information about cognition.
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Affiliation(s)
- N F Kalkers
- Department of Neurology, Academisch Ziekenhuis Vrije Universiteit Amsterdam, The Netherlands.
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