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Hacquebord S, Kiers H, van der Wees P, Hoogeboom TJ. Towards a better understanding of our patients. A qualitative study about how patients and their physiotherapists perceive the recovery of shoulder problems. Musculoskelet Sci Pract 2024; 71:102931. [PMID: 38520875 DOI: 10.1016/j.msksp.2024.102931] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/28/2024] [Accepted: 03/08/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To investigate how people with shoulder problems and their physiotherapists perceive the recovery of shoulder problems. METHOD We performed a qualitative study using semi-structured interviews with patients and their physiotherapists. Nine pairs of patients and physiotherapists (n = 18) were recruited. The transcribed interviews were analyzed in a consecutive multistep iterative process using a conventional content analysis. RESULTS Analysis of the interviews resulted in three major themes: 'What do I expect from my recovery?', 'Am I recovering?' and 'When do I consider myself recovered?' The patients and physiotherapists talked similarly about the importance of and interdependency between these themes. Central to these three themes are the analysis of the cause of shoulder problems and the experience of uncertainty. Our analyses suggest that there are conceptual differences in how patients and physiotherapists formulate their expectations about recovery, observe the recovering process, and conceptualize when someone may be considered recovered. Different interpretations by the patients of the information provided by the physical therapists appeared to fuel these differences. CONCLUSION Our results show that the concept of recovery is defined by patients and physiotherapists in three distinct themes. Within these themes the patients and physiotherapists differ substantially in their conceptualization of the recovery. IMPACT STATEMENT This insight in the concept of recovery can help patients and physiotherapists better understand each other, enhance the alignment of ideas about the care process, and support making decisions together. Physiotherapists should be aware that patients might interpret their words, explanations, and expectations substantially different.
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Affiliation(s)
- Sijmen Hacquebord
- University of Applied Sciences Utrecht, Institute for Human Movement Studies, Utrecht, Netherlands; Radboud University Medical Center, IQ Healthcare, Nijmegen, Netherlands.
| | - Henri Kiers
- University of Applied Sciences Utrecht, Institute for Human Movement Studies, Utrecht, Netherlands
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Marcellis LHM, Sinnige A, Rutgers KM, Kittelson A, Spruijt S, Teijink JAW, van der Wees PJ, Hoogeboom TJ. Evaluating the implementation of personalised outcomes forecasts to optimise supervised exercise therapy in patients with intermittent claudication in the Netherlands: a multimethods study. BMJ Open Qual 2024; 13:e002594. [PMID: 38378615 PMCID: PMC10882410 DOI: 10.1136/bmjoq-2023-002594] [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] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/31/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND To support the optimisation of supervised exercise therapy (SET) in patients with intermittent claudication, we developed personalised outcomes forecasts (POFs), which visualise estimated walking distance and quality of life for individual patients. The POFs may enable healthcare professionals, such as physical and exercise therapists, to improve shared decision-making and patient outcomes. OBJECTIVES To assess differences in patient outcomes (functional walking distance, maximal walking distance and health-related quality of life) and the level of shared decision-making before and after the implementation of POFs in the conservative treatment of patients with intermittent claudication. METHODS An interrupted time series design was used to compare preimplementation and postimplementation differences on patient outcomes. Using routinely collected data, differences from baseline to 6 months were compared between patients before and patients after the implementation. To compare levels of shared decision-making, we conducted observations of initial consults within a sample of physical or exercise therapists both before and after the implementation. Audiorecords of observations were scored on shared decision-making using the OPTION-5 instrument. RESULTS Differences in improvements between patients with whom POFs were discussed (n=317) and patients before the implementation of POFs (n=721) did not reach statistical significance for both functional walking distance (experimental vs. control=+23%, p=0.11) and maximal walking distance (experimental vs. control=+21%, p=0.08). For health-related quality of life, the POFs-informed patients showed a statistically significant greater improvement of 4% (p=0.04). Increased levels of shared decision-making were observed in postimplementation consults (n=20) when compared with preimplementation consults (n=36), as the median OPTION-5 total score showed a statistically significant increase from 45 to 55 points (p=0.01). CONCLUSIONS Integrating POFs into daily practice of SET for patients with intermittent claudication could assist in improving health-related quality of life and enhancing patient involvement. Using POFs did not result in statistically significant different improvements between groups on walking distances. TRIAL REGISTRATION NUMBER NL8838.
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Affiliation(s)
- Laura H M Marcellis
- Radboud university medical center, IQ Health science department, Nijmegen, The Netherlands
- Chronisch ZorgNet, Eindhoven, The Netherlands
| | - Anneroos Sinnige
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Katrien M Rutgers
- Physique Preventiecentrum B.V, Arnhem, The Netherlands
- Physical Therapy Sciences, Program in Clinical Health Sciences, Utrecht University, Utrecht, The Netherlands
| | - Andrew Kittelson
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA
| | | | - Joep A W Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands
- CAPHRI Research School, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Philip J van der Wees
- Radboud university medical center, IQ Health science department, Nijmegen, The Netherlands
- Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Thomas J Hoogeboom
- Radboud university medical center, IQ Health science department, Nijmegen, The Netherlands
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Slotegraaf AI, de Kruif AJTCM, Agasi-Idenburg CS, van Oers SMD, Ronteltap A, Veenhof C, Gerards MHG, Verburg AC, Hoogeboom TJ, de van der Schueren MAE. Understanding recovery of people recovering from COVID-19 receiving treatment from primary care allied health professionals: a mixed-methods study. Disabil Rehabil 2024:1-10. [PMID: 38318773 DOI: 10.1080/09638288.2024.2311330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE To quantitatively assess changes in recovery of people recovering from COVID-19 treated by a primary care allied health professional, and to qualitatively describe how they dealt with persistent complaints. MATERIALS AND METHODS This mixed-methods study is part of a Dutch prospective cohort study, from which thirty participants were selected through purposive sampling. Quantitative data on recovery were collected at start of treatment and 6 months. Additionally, by use of semi-structured interviews participants were asked on how persistent complaints influenced their lives, and how they experienced received primary care allied health treatment. RESULTS Despite reported improvements, most participants still experienced limitations at 6 months. Hospital participants reported a higher severity of complaints, but home participants reported more diverse complaints and a longer recovery. Most participants were satisfied with the primary care allied healthcare. Tender loving care and a listening ear, learning to manage limits, and support and acceptance of building up in small steps were perceived as contributing most to participants' recovery. CONCLUSION Although improvements were reported on almost all outcomes, most participants suffered from persistent complaints. Despite these persistent complaints, many participants reported being better able to cope with persistent complaints because they had decreased substantially in their intensity. TRIAL REGISTRATION Clinicaltrials.gov registry (NCT04735744).
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Affiliation(s)
- Anne I Slotegraaf
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Anja J Th C M de Kruif
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Carla S Agasi-Idenburg
- Research Group Innovation of Movement Care, University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Sonja M D van Oers
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Amber Ronteltap
- Research Group Innovation of Movement Care, University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Cindy Veenhof
- Research Group Innovation of Movement Care, University of Applied Sciences Utrecht, Utrecht, the Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Marissa H G Gerards
- Department of Epidemiology, Care and Public Health Institute (CAPHRI), Faculty of Health, Medicine and Life sciences, Maastricht University, Maastricht, the Netherlands
- Department of Physiotherapy, Maastricht university medical centre, Maastricht, the Netherlands
| | - Arie C Verburg
- IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thomas J Hoogeboom
- IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marian A E de van der Schueren
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, the Netherlands
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Strijker D, Hoogeboom TJ, Meijerink JWJH, Taveirne A, Schreurs WH, van Laarhoven CJHM, van den Heuvel B. Multimodal rehabilitation (Fit4Chemo) before and during adjuvant chemotherapy in patients with colonic cancer. Br J Surg 2024; 111:znad354. [PMID: 37941132 PMCID: PMC10771254 DOI: 10.1093/bjs/znad354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Dieuwke Strijker
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Thomas J Hoogeboom
- Radboud University Medical Centre, IQ Healthcare, Nijmegen, the Netherlands
| | - Jeroen W J H Meijerink
- Department of Operating Rooms, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Ann Taveirne
- Physiotherapy, Centre for Physiotherapy and Rehabilitation, Heerhugowaard, the Netherlands
| | | | | | - Baukje van den Heuvel
- Department of Operating Rooms, Radboud University Medical Centre, Nijmegen, the Netherlands
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Slotegraaf AI, Gerards MHG, Verburg AC, de van der Schueren MAE, Kruizenga HM, Graff MJL, Cup EHC, Kalf JG, Lenssen AF, Meijer WM, Kool RA, de Bie RA, van der Wees PJ, Hoogeboom TJ. Evaluation of Primary Allied Health Care in Patients Recovering From COVID-19 at 6-Month Follow-up: Dutch Nationwide Prospective Cohort Study. JMIR Public Health Surveill 2023; 9:e44155. [PMID: 37862083 PMCID: PMC10592721 DOI: 10.2196/44155] [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: 11/08/2022] [Revised: 07/10/2023] [Accepted: 07/31/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Patients recovering from COVID-19 often experience persistent problems in their daily activities related to limitations in physical, nutritional, cognitive, and mental functioning. To date, it is unknown what treatment is needed to support patients in their recovery from COVID-19. OBJECTIVE This study aimed to evaluate the primary allied health care of patients recovering from COVID-19 at 6-month follow-up and to explore which baseline characteristics are associated with changes in the scores of outcomes between baseline and 6-month follow-up. METHODS This Dutch nationwide prospective cohort study evaluated the recovery of patients receiving primary allied health care (ie, dietitians, exercise therapists, occupational therapists, physical therapists, and speech and language therapists) after COVID-19. All treatments offered by primary allied health professionals in daily practice were part of usual care. Patient-reported outcome measures on participation, health-related quality of life, fatigue, physical functioning, and psychological well-being were assessed at baseline and at 3- and 6-month follow-up. Linear mixed model analyses were used to evaluate recovery over time, and uni- and multivariable linear regression analyses were used to examine the association between baseline characteristics and recovery. RESULTS A total of 1451 adult patients recovering from COVID-19 and receiving treatment from 1 or more primary allied health professionals were included. For participation (Utrecht Scale for Evaluation of Rehabilitation-Participation range 0-100), estimated mean differences of at least 2.3 points were observed at all time points. For the health-related quality of life (EuroQol Visual Analog Scale, range 0-100), the mean increase was 12.3 (95% CI 11.1-13.6) points at 6 months. Significant improvements were found for fatigue (Fatigue Severity Scale, range 1-7): the mean decrease was -0.7 (95% CI -0.8 to -0.6) points at 6 months. However, severe fatigue was reported by 742/929 (79.9%) patients after 6 months. For physical functioning (Patient-Reported Outcomes Measurement Information System-Physical Function Short Form 10b, range 13.8-61.3), the mean increase was 5.9 (95% CI 5.9-6.4) points at 6 months. Mean differences of -0.8 (95% CI -1.0 to -0.5) points for anxiety (Hospital Anxiety and Depression Scale range 0-21) and -1.6 (95% CI -1.8 to -1.3) points for depression were found after 6 months. A worse baseline score, hospital admission, and male sex were associated with greater improvement between baseline and 6-month follow-up, whereas age, the BMI, comorbidities, and smoking status were not associated with mean changes in any outcome measures. CONCLUSIONS Patients recovering from COVID-19 who receive primary allied health care make progress in recovery but still experience many limitations in their daily activities after 6 months. Our findings provide reference values to health care providers and health care policy makers regarding what to expect from the recovery of patients who receive health care from 1 or more primary allied health professionals. TRIAL REGISTRATION ClinicalTrials.gov NCT04735744; https://tinyurl.com/3vf337pn. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2340/jrm.v54.2506.
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Affiliation(s)
- Anne I Slotegraaf
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Marissa H G Gerards
- Department of Epidemiology, Care and Public Health Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Department of Physical Therapy, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Arie C Verburg
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Marian A E de van der Schueren
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, Netherlands
| | - Hinke M Kruizenga
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Maud J L Graff
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Edith H C Cup
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Johanna G Kalf
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Antoine F Lenssen
- Department of Physical Therapy, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Willemijn M Meijer
- Netherlands Institute for Health Services Research, Nivel, Utrecht, Netherlands
| | - Renée A Kool
- Lung Foundation Netherlands, Amersfoort, Netherlands
| | - Rob A de Bie
- Department of Epidemiology, Care and Public Health Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Philip J van der Wees
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Thomas J Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
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Sinnige A, Kittelson A, Rutgers KM, Marcellis LHM, van der Wees PJ, Teijink JAW, Hoogeboom TJ. Nationwide implementation of personalized outcomes forecasts to support physical therapists in treating patients with intermittent claudication: Protocol for an interrupted time series study. PLoS One 2023; 18:e0288511. [PMID: 37523366 PMCID: PMC10389723 DOI: 10.1371/journal.pone.0288511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 06/27/2023] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION Shared decision-making is the cornerstone of patient-centered care. However, evidence suggests that the application of shared decision-making in physical therapy practice is limited. To elicit shared decision-making and thereby potentially improve patient outcomes for patients with intermittent claudication, we developed a decision support system. This decision support system provides personalized outcomes forecasts that visualize the estimated walking distance of an individual patient. We hypothesize that personalized outcomes forecasts can support physical therapists in personalizing care to the needs and priorities of the individual patient to improve therapy outcomes. RESEARCH OBJECTIVES The primary aim is to evaluate the impact of personalized outcomes forecasts for patients with intermittent claudication to optimize personalized treatment. Second, this study aims to evaluate the process of implementation. METHODS This study uses a prospective interrupted time series (ITS) design. Participating physical therapists are divided into four clusters. Every month of the study period, a new cluster will be invited to begin using the decision support system. We aim to include data of 11,250 newly referred patients for physical therapy treatment. All therapists associated with a network of specialized therapists (Chronic CareNet) and patients treated by these therapists are eligible to participate. The decision support system, called the KomPas, makes use of personalized outcomes forecasts, which visualize the estimated outcome of supervised exercise therapy for an individual patient with intermittent claudication. Personalized outcomes forecasts are developed using a neighbors-based approach that selects patients similar to the index patient (a.k.a. neighbors) from a large database. Outcomes to evaluate impact of implementation are patients' functional and maximal walking distance, quality of life and shared decision-making. Process evaluation will be measured in terms of utilization efficacy, including the outcomes dropout rate and reasons to (not) use the personalized outcomes forecasts. Data will be routinely collected through two online systems: the Chronic CareNet Quality system, and the website logs of the decision support system. Additionally, observations and semi-structured interviews will be conducted with a small subset of therapists. ETHICS Formal medical ethical approval by the Medical Research Ethics Committees United 'MEC-U' was not required for this study under Dutch law (reference number 2020-6250).
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Affiliation(s)
- Anneroos Sinnige
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands
- CAPHRI Research School, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Andrew Kittelson
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT, United States of America
| | - Katrien M Rutgers
- Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Laura H M Marcellis
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Philip J van der Wees
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joep A W Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands
- CAPHRI Research School, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Thomas J Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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de Zwart L, Koenders N, Steenbruggen R, Nijhuis-van der Sanden R, Hoogeboom TJ. What is complexity of hospital-based physiotherapy from the perspective of physiotherapists themselves? A grounded theory study. BMJ Open 2023; 13:e069368. [PMID: 37076163 PMCID: PMC10124244 DOI: 10.1136/bmjopen-2022-069368] [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] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND The concept of 'complexity' is widely used by healthcare professionals in patient care. However, it is not completely understood. The inappropriate use and incorrect understanding of complexity lead to ambiguity for hospital-based physiotherapists in dealing with complex patients and work situations. OBJECTIVES To develop an understanding of complexity for hospital-based physiotherapy from the perspective of physiotherapists themselves. DESIGN A grounded theory study was conducted using data from face-to-face, semi-structured interviews with purposive sampled hospital-based physiotherapists. The sampling was used to incorporate variety in hospital work experience, field of expertise and gender. The interviews were conducted in three different types of Dutch hospitals. A conceptual model and grounded theory were constructed after open, axial and selective coding. RESULTS Twenty-four hospital-based physiotherapists were interviewed. Two core themes emerged from the data: 'puzzle-solving' and 'reflecting on decisions'. The third theme-'relationship between learning, adapting and complexity'-describes how hospital-based physiotherapists' perceptions of complexity change over time. Complexity as a construct was interpreted as the balance between context and patient-related factors on the one hand and therapist-related factors on the other. CONCLUSIONS Hospital-based physiotherapists encounter complexity during performing job-related activities and decision-making. Complexity depends on balancing context and patient-related factors and therapist-related factors. In hospital-based physiotherapy, it was perceived as challenging yet meaningful. Complexity contributes to becoming more competent and, as such, a balance between complex and non-complex activities should be sought for hospital-based physiotherapists.
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Affiliation(s)
- Lieven de Zwart
- Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Niek Koenders
- Department of Rehabilitation-Physical Therapy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rudi Steenbruggen
- IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
- Physiotherapy, Saxion University of Applied Sciences, Enschede, The Netherlands
| | | | - Thomas J Hoogeboom
- IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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Felten-Barentsz KM, Sommers J, Oorsouw R, Klooster E, Koenders N, Heusden-Scholtalbers L, Ormel HL, Werkman MS, Hulzebos EHJ, van der Wees PJ, Schaaf M, Hoogeboom TJ. On, "Recommendations for Hospital-Based Physical Therapists Managing Patients with COVID-19." Felten-Barentsz K, Van Oorsouw R, Klooster E, Et al. Phys Ther. 2020;100:1444-1457. https://doi.org/10.1093/ptj/pzaa114. Phys Ther 2023:7114828. [PMID: 37040337 DOI: 10.1093/ptj/pzad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/04/2023] [Indexed: 04/12/2023]
Affiliation(s)
| | - Juultje Sommers
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Roel Oorsouw
- Radboud university medical center, Department of Rehabilitation, Nijmegen, the Netherlands
| | - Emily Klooster
- Deventer Hospital, Department of Rehabilitation, Deventer, the Netherlands
- Radboud university medical center, IQ healthcare, Nijmegen, the Netherlands
| | - Niek Koenders
- Radboud university medical center, Department of Rehabilitation, Nijmegen, the Netherlands
| | - Linda Heusden-Scholtalbers
- Radboud university medical center, Department of Rehabilitation, Nijmegen, the Netherlands
- Royal Dutch Society for Physical Therapy (KNGF), Quality Policy, Amersfoort, the Netherlands
| | - Harm L Ormel
- Royal Dutch Society for Physical Therapy (KNGF), Quality Policy, Amersfoort, the Netherlands
| | - Maarten S Werkman
- Leiden University Medical Centre, Department of Physical Therapy, the Netherlands
| | - Erik H J Hulzebos
- University Medical Centre Utrecht, Child Development and Exercise Centre, the Netherlands
| | - Philip J van der Wees
- Radboud university medical center, Department of Rehabilitation, Nijmegen, the Netherlands
- Radboud university medical center, IQ healthcare, Nijmegen, the Netherlands
| | - Marike Schaaf
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam University of Applied Sciences, Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam, the Netherlands
| | - Thomas J Hoogeboom
- Radboud university medical center, Department of Rehabilitation, Nijmegen, the Netherlands
- Radboud university medical center, IQ healthcare, Nijmegen, the Netherlands
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Driehuis F, Bakker-Jacobs A, Staal JB, de Bie RA, Nijhuis-van der Sanden MWG, Hoogeboom TJ. Parents' and healthcare professionals' perspectives on manual therapy in infants: A mixed-methods study. PLoS One 2023; 18:e0283646. [PMID: 37023071 PMCID: PMC10079100 DOI: 10.1371/journal.pone.0283646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/14/2023] [Indexed: 04/07/2023] Open
Abstract
OBJECTIVES Manual therapy in infants is embedded in Dutch healthcare despite inconsistent evidence and ongoing debate about its safety and merits. This study examines decision-making in manual therapy in infants and explores parents' and healthcare professionals' perspectives on this treatment approach. METHODS This mixed-methods study consisted of an online survey among manual physiotherapists and paediatric physiotherapists exploring decision-making on manual therapy in infants and interprofessional collaboration. These data prompted further exploration and were combined with data collected with semi-structured interviews exploring parents' and healthcare professionals' perspectives. Interviews were analysed using an inductive content analysis approach. RESULTS 607 manual physiotherapists and 388 paediatric physiotherapists completed the online survey; 45% and 95% indicated they treat infants, respectively. Collaboration was reported by 46% of manual physiotherapists and 64% of paediatric physiotherapists for postural asymmetry, positional preference, upper cervical dysfunction, excessive crying, anxiety or restlessness. Reasons to not treat or collaborate were: limited professional competence, practice policy, not perceiving added value, lack of evidence and fear of complications. Analysis of interviews with 7 parents, 9 manual physiotherapists, 7 paediatric physiotherapists, 5 paediatricians and 2 maternity nurses revealed that knowledge and beliefs, professional norms, interpersonal relation, treatment experiences and emotions of parents influenced attitudes and decision-making towards choosing for manual therapy in infants. CONCLUSION Parents' and healthcare professionals' attitudes towards manual therapy in infants can be divided as 'in favour' or 'against'. Those who experienced a good interpersonal relation with a manual physiotherapist and positive treatment outcomes reported positive attitudes. Lack of evidence, treatment experience and related knowledge, safety issues due to publications on adverse events and professional norms led to negative attitudes. Despite lacking evidence, positive treatment experiences, good interpersonal relation and parents feeling frustrated and despaired can overrule negative attitudes and directly influence the decision-making process and choosing for manual therapy treatment.
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Affiliation(s)
- Femke Driehuis
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Annick Bakker-Jacobs
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J. Bart Staal
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Rob A. de Bie
- Caphri Research School, Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | | | - Thomas J. Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Voorn MJJ, Franssen RFW, Hoogeboom TJ, van Kampen-van den Boogaart VEM, Bootsma GP, Bongers BC, Janssen-Heijnen MLG. Evidence base for exercise prehabilitation suggests favourable outcomes for patients undergoing surgery for non-small cell lung cancer despite being of low therapeutic quality: a systematic review and meta-analysis. Eur J Surg Oncol 2023; 49:879-894. [PMID: 36788040 DOI: 10.1016/j.ejso.2023.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/12/2023] [Accepted: 01/23/2023] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this systematic review was to evaluate whether exercise prehabilitation programs reduce postoperative complications, postoperative mortality, and length of hospital stay (LoS) in patients undergoing surgery for non-small cell lung cancer (NSCLC), thereby accounting for the quality of the physical exercise program. METHODS Two reviewers independently selected randomized controlled trials (RCTs) and observational studies and assessed them for methodological quality and therapeutic quality of the exercise prehabilitation program (i-CONTENT tool). Eligible studies included patients with NSCLC performing exercise prehabilitation and reported the occurrence of 90-day postoperative complications, postoperative mortality, and LoS. Meta-analyses were performed and the certainty of the evidence was graded (Grading of Recommendations Assessment, Development and Evaluation (GRADE)) for each outcome. RESULTS Sixteen studies, comprising 2,096 patients, were included. Pooled analyses of RCTs and observational studies showed that prehabilitation reduces postoperative pulmonary complications (OR 0.45), postoperative severe complications (OR 0.51), and LoS (mean difference -2.46 days), but not postoperative mortality (OR 1.11). The certainty of evidence was very low to moderate for all outcomes. Risk of ineffectiveness of the prehabilitation program was high in half of the studies due to an inadequate reporting of the dosage of the exercise program, inadequate type and timing of the outcome assessment, and low adherence. CONCLUSION Although risk of ineffectiveness was high for half of the prehabilitation programs and certainty of evidence was very low to moderate, prehabilitation seems to result in a reduction of postoperative pulmonary and severe complications, as well as LoS in patients undergoing surgery for NSCLC.
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Affiliation(s)
- M J J Voorn
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands; Adelante Rehabilitation Centre, Venlo, the Netherlands; Department of Epidemiology, GROW School for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
| | - R F W Franssen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Epidemiology, GROW School for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Clinical Physical Therapy, VieCuri Medical Centre, Venlo, the Netherlands
| | - T J Hoogeboom
- Radboud Institute for Health Sciences, IQ Healthcare, Radboudumc, Nijmegen, the Netherlands
| | | | - G P Bootsma
- Department of Pulmonology, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - B C Bongers
- Department of Nutrition and Movement Sciences, School for Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; Department of Surgery, School for Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - M L G Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Epidemiology, GROW School for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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11
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Sweerts L, Dekkers PW, van der Wees PJ, van Susante JLC, de Jong LD, Hoogeboom TJ, van de Groes SAW. External Validation of Prediction Models for Surgical Complications in People Considering Total Hip or Knee Arthroplasty Was Successful for Delirium but Not for Surgical Site Infection, Postoperative Bleeding, and Nerve Damage: A Retrospective Cohort Study. J Pers Med 2023; 13:jpm13020277. [PMID: 36836512 PMCID: PMC9964485 DOI: 10.3390/jpm13020277] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
Although several models for the prediction of surgical complications after primary total hip or total knee replacement (THA and TKA, respectively) are available, only a few models have been externally validated. The aim of this study was to externally validate four previously developed models for the prediction of surgical complications in people considering primary THA or TKA. We included 2614 patients who underwent primary THA or TKA in secondary care between 2017 and 2020. Individual predicted probabilities of the risk for surgical complication per outcome (i.e., surgical site infection, postoperative bleeding, delirium, and nerve damage) were calculated for each model. The discriminative performance of patients with and without the outcome was assessed with the area under the receiver operating characteristic curve (AUC), and predictive performance was assessed with calibration plots. The predicted risk for all models varied between <0.01 and 33.5%. Good discriminative performance was found for the model for delirium with an AUC of 84% (95% CI of 0.82-0.87). For all other outcomes, poor discriminative performance was found; 55% (95% CI of 0.52-0.58) for the model for surgical site infection, 61% (95% CI of 0.59-0.64) for the model for postoperative bleeding, and 57% (95% CI of 0.53-0.61) for the model for nerve damage. Calibration of the model for delirium was moderate, resulting in an underestimation of the actual probability between 2 and 6%, and exceeding 8%. Calibration of all other models was poor. Our external validation of four internally validated prediction models for surgical complications after THA and TKA demonstrated a lack of predictive accuracy when applied in another Dutch hospital population, with the exception of the model for delirium. This model included age, the presence of a heart disease, and the presence of a disease of the central nervous system as predictor variables. We recommend that clinicians use this simple and straightforward delirium model during preoperative counselling, shared decision-making, and early delirium precautionary interventions.
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Affiliation(s)
- Lieke Sweerts
- Department of Orthopaedics, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
- Correspondence:
| | - Pepijn W. Dekkers
- Department of Orthopaedics, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Philip J. van der Wees
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
- Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | | | - Lex D. de Jong
- Department of Orthopedics, Rijnstate Hospital, 6800 TA Arnhem, The Netherlands
| | - Thomas J. Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Sebastiaan A. W. van de Groes
- Department of Orthopaedics, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
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12
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Steenbruggen RA, Maas MJM, Hoogeboom TJ, Brand PLP, van der Wees PJ. A framework to improve quality of hospital-based physiotherapy: a design-based research study. BMC Health Serv Res 2023; 23:34. [PMID: 36641465 PMCID: PMC9840522 DOI: 10.1186/s12913-023-09062-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 01/11/2023] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND A quality framework for hospital-based physiotherapy is lacking. This study aims to design a framework, building on the currently available literature, to improve the quality of hospital-based physiotherapy. METHODS A multidisciplinary panel of six representatives of hospital-based physiotherapy and their key stakeholders (patients, medical specialists, hospital management and professional association) was set up. We used brainwriting to sample ideas and the 'decision-matrix' to select the best ideas. RESULTS The first round of brainwriting with an online panel of six experienced participants yielded consensus on seven possible methods for quality improvement of hospital-based physiotherapy [1]: continuing education [2] ,feedback on patient reported experience measures and patient reported outcome measures [3] ,a quality portfolio [4] ,peer observation and feedback [5] ,360 degree feedback [6] ,a management information system, and [7] intervision with intercollegiate evaluation. Placing these methods in a decision matrix against four criteria (measurability, acceptability, impact, accessibility) resulted in a slight preference for a management information system, with almost equal preference for five other methods immediately thereafter. The least preference was given to a 360-degree feedback. CONCLUSIONS In the design of a framework for improving the quality of hospital-based physiotherapy, all seven suggested methods were perceived as relevant but differed in terms of advantages and disadvantages. This suggests that, within the framework, a mixture of these methods may be desirable to even out respective advantages and disadvantages.
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Affiliation(s)
- Rudi A. Steenbruggen
- grid.5477.10000000120346234School of Health, Physiotherapy, Saxion University of Applied Sciences, Enschede, the Netherlands, Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, the Netherlands, p/a Saxion, University of Applied Sciences, Postbus 70.000, 7500 KB Enschede, the Netherlands
| | - Marjo J. M. Maas
- grid.10417.330000 0004 0444 9382Institute of Allied Health Studies, HAN University of Applied Sciences, Nijmegen, the Netherlands Nijmegen, the Netherlands, Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, the Netherlands
| | - Thomas J. Hoogeboom
- grid.10417.330000 0004 0444 9382Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, the Netherlands
| | - Paul L. P. Brand
- grid.4494.d0000 0000 9558 4598Isala Hospital, Zwolle, the Netherlands, University of Groningen and University Medical Centre, Groningen, the Netherlands
| | - Philip J. van der Wees
- grid.10417.330000 0004 0444 9382Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, the Netherlands
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13
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Heij W, Sweerts L, Staal JB, Teerenstra S, Adang E, van der Wees PJ, Nijhuis-van der Sanden MWG, Hoogeboom TJ. Implementing a Personalized Physical Therapy Approach (Coach2Move) Is Effective in Increasing Physical Activity and Improving Functional Mobility in Older Adults: A Cluster-Randomized, Stepped Wedge Trial. Phys Ther 2022; 102:pzac138. [PMID: 36200397 PMCID: PMC10071485 DOI: 10.1093/ptj/pzac138] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 05/06/2022] [Accepted: 08/22/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to assess whether the superior cost-effectiveness of a personalized physical therapy approach (Coach2Move)-which was demonstrated in a previous trial compared with usual care physical therapy (UCP)-can be replicated in daily clinical practice. METHODS A multicenter, cluster-randomized, stepped wedge trial with 4 clusters consisting of 4 physical therapist practices in the Netherlands was used to compare a personalized physical therapy approach to elicit physical activity (Coach2Move) versus care as usual. Multilevel analyses for effectiveness were conducted for the amount of physical activity (Longitudinal Aging Study Amsterdam Physical Activity Questionnaire) and functional mobility (Timed "Up & Go" Test) at 3, 6 (primary outcome), and 12 months' follow-up. Secondary outcomes were level of frailty (Evaluative Frailty Index for Physical Activity), perceived effect (Global Perceived Effect and Patient-Specific Complaints Questionnaires), quality of life (Euro Quality of Life-5 Dimensions-5 Levels [EQ-5D-5L]), and health care expenditures. RESULTS The 292 community-dwelling older adults with mobility problems visiting physical therapists were included in either the Coach2Move (n = 112; mean [SD] age = 82 [5] years; 60% female) or UCP (n = 180; mean [SD] age = 81 (6) years; 62% female) section of the trial. At baseline, Coach2Move participants were less physically active compared with UCP participants (mean difference = -198; 95% CI = -90 to -306 active minutes). At 6 months, between-group mean differences [95% CI] favored Coach2Move participants on physical activity levels (297 [83 to 512] active minutes), functional mobility (-14.2 [-21 to -8]) seconds), and frailty levels (-5 [-8 to -1] points). At 12 months, the physical activity levels of Coach2Move participants further increased, and frailty levels and secondary outcomes remained stable, whereas outcomes of UCP participants decreased. After the Coach2Move implementation strategy, physical therapists utilized significantly fewer treatment sessions compared with before the implementation (15 vs 22). Anticipated cost savings were not observed. CONCLUSION This study replicated the results of an earlier trial and shows that Coach2Move leads to better mid- and long-term outcomes (physical activity, functional mobility, level of frailty) in fewer therapy sessions compared with UCP. Based on these and earlier findings, the implementation of Coach2Move in physical therapist practice is recommended. IMPACT This article describes the implementation of the Coach2Move approach, a treatment strategy that has proven to be cost-effective in a previously conducted randomized controlled trial. Implementation of Coach2Move in a real-life setting allowed an evaluation of the effects in a clinically relevant population. Coach2Move has been shown to increase physical activity, improve functional mobility, and reduce frailty more effectively compared with UCP therapy and therefore has application for physical therapists working with older adults in daily clinical practice. LAY SUMMARY Coach2Move is a new physical therapy approach for older adults. Implementation of Coach2Move in daily clinical practice can help people better outcomes over a longer period of time against similar costs compared with regular physical therapy.
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Affiliation(s)
- Ward Heij
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Health Care Nijmegen, the Netherlands
| | - Lieke Sweerts
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Health Care Nijmegen, the Netherlands
| | - J Bart Staal
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Health Care Nijmegen, the Netherlands
- Musculoskeletal Rehabilitation Research Group, School for Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Steven Teerenstra
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Health Evidence, Section Biostatistics, Nijmegen, the Netherlands
| | - Eddy Adang
- Radboud University Medical Center, Department of Health Evidence, Nijmegen, the Netherlands
| | - Philip J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Health Care Nijmegen, the Netherlands
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Rehabilitation, Nijmegen, the Netherlands
| | | | - Thomas J Hoogeboom
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Health Care Nijmegen, the Netherlands
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14
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Knoop J, van Lankveld W, Beijer L, Geerdink FJB, Heymans MW, Hoogeboom TJ, Hoppenbrouwers S, van Overmeeren E, Soer R, Veenhof C, Vissers KCP, van der Wees PJ, Sappelli M, Staal JB. Development and internal validation of a machine learning prediction model for low back pain non-recovery in patients with an acute episode consulting a physiotherapist in primary care. BMC Musculoskelet Disord 2022; 23:834. [PMID: 36057717 PMCID: PMC9440317 DOI: 10.1186/s12891-022-05718-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background While low back pain occurs in nearly everybody and is the leading cause of disability worldwide, we lack instruments to accurately predict persistence of acute low back pain. We aimed to develop and internally validate a machine learning model predicting non-recovery in acute low back pain and to compare this with current practice and ‘traditional’ prediction modeling. Methods Prognostic cohort-study in primary care physiotherapy. Patients (n = 247) with acute low back pain (≤ one month) consulting physiotherapists were included. Candidate predictors were assessed by questionnaire at baseline and (to capture early recovery) after one and two weeks. Primary outcome was non-recovery after three months, defined as at least mild pain (Numeric Rating Scale > 2/10). Machine learning models to predict non-recovery were developed and internally validated, and compared with two current practices in physiotherapy (STarT Back tool and physiotherapists’ expectation) and ‘traditional’ logistic regression analysis. Results Forty-seven percent of the participants did not recover at three months. The best performing machine learning model showed acceptable predictive performance (area under the curve: 0.66). Although this was no better than a’traditional’ logistic regression model, it outperformed current practice. Conclusions We developed two prognostic models containing partially different predictors, with acceptable performance for predicting (non-)recovery in patients with acute LBP, which was better than current practice. Our prognostic models have the potential of integration in a clinical decision support system to facilitate data-driven, personalized treatment of acute low back pain, but needs external validation first. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05718-7.
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Affiliation(s)
- J Knoop
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, Netherlands.
| | - W van Lankveld
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, Netherlands
| | - L Beijer
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, Netherlands.,Research and Innovation Department, Sint Maartenskliniek, Nijmegen, Netherlands
| | - F J B Geerdink
- Research Group Smart Health, Saxion University of Applied Sciences, Enschede, Netherlands
| | - M W Heymans
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, Netherlands
| | - T J Hoogeboom
- Radboud Institute for Health Sciences, Radboud University Medical Centre, IQ Healthcare, Nijmegen, Netherlands
| | - S Hoppenbrouwers
- Academy of IT and Mediadesign, Data and Knowledge Engineering Research Group, HAN University of Applied Sciences, Nijmegen, Netherlands.,Institute for Computing and Information Sciences, Radboud University, Nijmegen, Netherlands
| | - E van Overmeeren
- Royal Dutch Society for Physical Therapy, Amersfoort, Netherlands
| | - R Soer
- Research Group Smart Health, Saxion University of Applied Sciences, Enschede, Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Pain Center, Groningen, Netherlands
| | - C Veenhof
- Department of Rehabilitation, Physiotherapy Science and Sport, University Medical Center Utrecht, Utrecht, Netherlands
| | - K C P Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - P J van der Wees
- Radboud Institute for Health Sciences, Radboud University Medical Centre, IQ Healthcare, Nijmegen, Netherlands
| | - M Sappelli
- Academy of IT and Mediadesign, Data and Knowledge Engineering Research Group, HAN University of Applied Sciences, Nijmegen, Netherlands
| | - J B Staal
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, Netherlands.,Radboud Institute for Health Sciences, Radboud University Medical Centre, IQ Healthcare, Nijmegen, Netherlands
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15
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Sweerts L, Hoogeboom TJ, van Wessel T, van der Wees PJ, van de Groes SAW. Development of prediction models for complications after primary total hip and knee arthroplasty: a single-centre retrospective cohort study in the Netherlands. BMJ Open 2022; 12:e062065. [PMID: 36002218 PMCID: PMC9413190 DOI: 10.1136/bmjopen-2022-062065] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to develop prediction models for patients with total hip arthroplasty (THA) and total knee arthroplasty (TKA) to predict the risk for surgical complications based on personal factors, comorbidities and medication use. DESIGN Retrospective cohort study. SETTING Tertiary care in outpatient clinic of university medical centre. PARTICIPANTS 3776 patients with a primary THA or TKA between 2004 and 2018. PRIMARY AND SECONDARY OUTCOME MEASURES Multivariable logistic regression models were developed for primary outcome surgical site infection (SSI), and secondary outcomes venous thromboembolism (VTE), postoperative bleeding (POB), luxation, delirium and nerve damage (NER). RESULTS For SSI, age, smoking status, body mass index, presence of immunological disorder, diabetes mellitus, liver disease and use of non-steroidal anti-inflammatory drugs were included. An area under the receiver operating characteristic curve (AUC) of 71.9% (95% CI=69.4% to 74.4%) was found. For this model, liver disease showed to be the strongest predictor with an OR of 10.7 (95% CI=2.4 to 46.6). The models for POB and NER showed AUCs of 73.0% (95% CI=70.7% to 75.4%) and 76.6% (95% CI=73.2% to 80.0%), respectively. For delirium an AUC of 85.9% (95% CI=83.8% to 87.9%) was found, and for the predictive algorithms for luxation and VTE we found least favourable results (AUC=58.4% (95% CI=55.0% to 61.8%) and AUC=66.3% (95% CI=62.7% to 69.9%)). CONCLUSIONS Discriminative ability was reasonable for SSI and predicted probabilities ranged from 0.01% to 51.0%. We expect this to enhance shared decision-making in considering THA or TKA since current counselling is predicated on population-based probability of risk, rather than using personalised prediction. We consider our models for SSI, delirium and NER appropriate for clinical use when taking underestimation and overestimation of predicted risk into account. For VTE and POB, caution concerning overestimation exceeding a predicted probability of 0.08 for VTE and 0.05 for POB should be taken into account. Furthermore, future studies should evaluate clinical impact and whether the models are feasible in an external population.
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Affiliation(s)
- Lieke Sweerts
- Radboud Institute of Health Sciences, Department of Orthopaedics, Radboud university medical center, Nijmegen, The Netherlands
- Radboud Institute of Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, The Netherlands
| | - Thomas J Hoogeboom
- Radboud Institute of Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, The Netherlands
| | - Thierry van Wessel
- Radboud Institute of Health Sciences, Department of Orthopaedics, Radboud university medical center, Nijmegen, The Netherlands
| | - Philip J van der Wees
- Radboud Institute of Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Department of Rehabilitation, Radboud university medical center, Nijmegen, The Netherlands
| | - Sebastiaan A W van de Groes
- Radboud Institute of Health Sciences, Department of Orthopaedics, Radboud university medical center, Nijmegen, The Netherlands
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16
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Klooster E, Koenders N, Vermeulen-Holsen J, Vos L, van der Wees PJ, Hoogeboom TJ. Healthcare professionals feel empowered by implementing a hospital-based multifaceted intervention: a qualitative study using inductive thematic analysis. BMC Health Serv Res 2022; 22:903. [PMID: 35820839 PMCID: PMC9277783 DOI: 10.1186/s12913-022-08310-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 07/04/2022] [Indexed: 12/02/2022] Open
Abstract
Background Most patients are insufficiently physically active during their hospital stay, and this is associated with poor health and delayed recovery. Hospital-based multifaceted interventions aim to encourage patients to engage in physical activity. Ban Bedcentricity is one such intervention. Its value – and that of others similar to it – for healthcare professionals has not been studied yet. Whether an intervention looks and feels right, and whether it does the job well, is important for healthcare professionals and thus its use. Understanding value for healthcare professionals seems crucial for the long-term adoption and implementation of interventions. Therefore, we studied healthcare professionals’ perceptions of value in terms of the implementation of a multifaceted intervention that aimed at improving physically active behaviour in patients during their hospital stay. Methods Using Ban Bedcentricity as a case study to focus on healthcare professionals’ perceptions about multifaceted interventions, we conducted a qualitative study between November 2019 and September 2020. Semi-structured interviews were conducted with purposefully selected physicians, physiotherapists, and nurses (assistants) until theoretical data saturation was reached. Inductive thematic analysis was used to identify key themes and develop a conceptual model. Results We interviewed 15 healthcare professionals and formulated six key themes from these interviews. The participants said that Ban Bedcentricity empowered them in their beliefs about the importance of physical activity for hospitalized patients (theme 1). They also indicated that it made them more aware of the value of physical activity (theme 2) and skilled to promote physical activity as part of their professional role (theme 3). Similarly, they noted that it enabled them to shift from providing hands-on support to verbal coaching (theme 4). Other aspects that the participants valued were the increased possibilities for teamwork (theme 5) and the routinized physical activity promotion in usual care (theme 6). The challenges discussed by the participants were prioritizing activities that promoted physical activity, especially because of a high workload, and avoiding relapses of new routinized work practices related to physical activity promotion if insufficient long-term support and training were provided. Conclusions Our conceptual model shows that the implementation of a hospital-based multifaceted intervention by healthcare professionals empowers their beliefs, and improves their awareness, skills, professional roles, teamwork, and work routinization. These values are typically overlooked, despite potentially being important facilitators for long-term implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08310-w.
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Affiliation(s)
- E Klooster
- Department of Rehabilitation, Deventer Hospital, Deventer, the Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - N Koenders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Rehabilitation, Nijmegen, the Netherlands.
| | - J Vermeulen-Holsen
- Erasmus Medical Center, Cardiovascular Institute, Rotterdam, the Netherlands
| | - L Vos
- Department of Psychology and Geriatrics, Deventer Hospital, Deventer, the Netherlands
| | - P J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Rehabilitation, Nijmegen, the Netherlands
| | - T J Hoogeboom
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
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17
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Thackeray A, Waring J, Hoogeboom TJ, Nijhuis-van Der Sanden MWG, Hess R, Fritz JM, Conroy MB, Fernandez ME. Implementing a Dutch Physical Therapy Intervention Into a U.S. Health System: Selecting Strategies Using Implementation Mapping. Front Public Health 2022; 10:908484. [PMID: 35899163 PMCID: PMC9309571 DOI: 10.3389/fpubh.2022.908484] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCoach2Move is a person-centered physical therapy intervention that has demonstrated success in changing physical activity behaviors among older adults in the Netherlands. In this manuscript, we describe how we developed an implementation plan for Coach2move in a U.S. population and healthcare system using Implementation Mapping.MethodsWe established an implementation planning team of researchers, patients, and clinicians. The Consolidated Framework for Implementation Research provided an overall structure for consideration of the context for implementation. Implementation Mapping guided the planning process. The implementation planning team worked sequentially through the five tasks of Implementation Mapping (1) Identify needs, program adopters and implementers; (2) Identify adoption and implementation outcomes, performance objectives, determinants, and matrices of change; (3) Choose theoretical models and implementation strategies; (4) Produce implementation protocols; (5) Evaluate implementation outcomes. In this manuscript, we identify our evaluation plan but not results as data collection is ongoing.ResultsClinic managers and physical therapists were identified as program adopters and implementors. Performance objectives necessary steps to achieving implementation outcomes were linked to Coach2Move fidelity indicators with implementation by the physical therapist. These included delivery of person-centered care, motivational interviewing, meaningful goal setting, shared decision-making in planning, and systematic monitoring and follow-up. Determinants linked to these performance objectives included knowledge, outcome expectations, skills and self-efficacy, and perceived norms. Implementation strategies were selected based on a review of methods effective for influencing these determinants. This resulted in four primary strategies (1) educational meetings and dynamic training, (2) peer-assessment meetings, (3) changing the electronic health record template, and (4) reminders and prompts. Measures of intervention acceptability, appropriateness, and feasibility will be collected after training and early in implementation. Fidelity and effectiveness measures will be collected over the next 12-months.ConclusionImplementation mapping provided a systematic process for identifying what physical therapists would need to implement Coach2Move with fidelity. The result was a matrix linking behavioral determinants and performance objectives. These matrices of change allowed for systematic identification and tailoring of implementation strategies to the needs of our population and setting. The process was acceptable to diverse stakeholders, facilitated communication across stakeholders.
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Affiliation(s)
- Anne Thackeray
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
- *Correspondence: Anne Thackeray
| | - Jackie Waring
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Thomas J. Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Rachel Hess
- Division of Health System Innovation and Research, Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Julie M. Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Molly B. Conroy
- Department of General Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Maria E. Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
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Sinnige A, Teijink JAW, Spruijt S, Kittelson AJ, Oude Bos A, Van der Wees PJ, Hoogeboom TJ. Impact of Personalized Outcomes Forecasts on Clinical Reasoning of Physical Therapists in Intermittent Claudication: A Vignette Study. Phys Ther 2022; 102:6619486. [PMID: 35778937 DOI: 10.1093/ptj/pzac051] [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: 02/25/2021] [Revised: 12/23/2021] [Accepted: 02/26/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Guidelines recommend supervised exercise therapy and lifestyle counseling by a physical therapist as initial treatment for patients with intermittent claudication. However, guidelines provide only a crude estimate of the outcomes that therapists and patients might expect from treatment. The purpose of this study was to explore the impact of personalized outcomes forecasts (POFs) on the decision-making process of physical therapists and to learn lessons on facilitating the use of forecasts in daily practice. METHODS A vignette-based, think-aloud interview study design was used. The participants were physical therapists trained in treating patients with intermittent claudication. Vignettes described fictitious patients diagnosed with intermittent claudication and included POFs. A directed approach was used to code, organize, and describe the data. Transcripts were analyzed using a thematic approach. RESULTS Sixteen therapists participated in the study. Three themes were identified: (1) setting and contextualizing treatment expectations, (2) setting (shared) goals and (de)motivating the patient, and (3) establishing and monitoring the treatment plan. Therapists mentioned that POFs could be useful for setting expectations and realistic treatment goals, contextualizing expected treatment response, stimulating patients to achieve their goals, and deciding on treatment frequency and treatment timing. Therapists thought POFs would be of less use for changing treatment goals during follow-up visits or for establishing intensity or type of training. CONCLUSION To overcome challenges that may arise when adopting POFs in daily practice, adequate training of physical therapists should be conducted. Potential areas to address with training include statistical and data literacy as well as guidance on integrating POFs with existing treatment protocols. IMPACT The use of POFs by physical therapists might contribute to a more person-centered care approach. The insights provided by this study on the first use of POFs by physical therapists can serve as an example and lesson on how to optimally implement such supporting tools into daily practice.
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Affiliation(s)
- Anneroos Sinnige
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands.,CAPHRI Research School, Maastricht University Medical Centre, Maastricht, the Netherlands.,Chronisch ZorgNet, Eindhoven, the Netherlands
| | - Joep A W Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands.,CAPHRI Research School, Maastricht University Medical Centre, Maastricht, the Netherlands.,Chronisch ZorgNet, Eindhoven, the Netherlands
| | | | - Andrew J Kittelson
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA
| | - Anita Oude Bos
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands
| | - Philip J Van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands
| | - Thomas J Hoogeboom
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands
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19
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De Bie RA, Verburg K, Agasi-Idenburg C, Cup EHC, Dekker C, Van Dongen JM, Geleijn E, Gerards MHG, Graff M, Van Heerde R, Kalf H, Kammerer M, De Kruif A, Kruizenga HM, Van der Leeden M, Lenssen TAF, Meijer WM, Ostelo R, Ronteltap A, Van der Schaaf M, Van Oers S, De van der Schueren MAE, Slotegraaf AI, Veenhof C, Hoogeboom TJ, Van der Wees P. Evaluation of Allied Healthcare in Patients Recovering from Covid-19: Study Protocol and Baseline Data of a National Prospective Cohort Study. J Rehabil Med 2022; 54:jrm00309. [PMID: 35735900 PMCID: PMC9422882 DOI: 10.2340/jrm.v54.2506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/25/2022] Open
Abstract
Objective To report the study protocol and baseline characteristics of a prospective cohort study to evaluate longitudinal recovery trajectories of patients recovering from COVID-19 who have visited a primary care allied health professional. Design Report of the protocol and baseline characteristics for a prospective cohort study with a mixed-methods approach. Patients Patients recovering from COVID-19 treated by primary care dietitians, exercise therapists, occupational therapists, physical therapists and/or speech and language therapists in the Netherlands. Methods The prospective study will measure primary outcome domains: participation, health-related quality of life, fatigue, physical functioning, and costs, at baseline, 3, 6, 9 and 12 months. Interviews, on the patients’ experiences with allied healthcare, will be held with a subsample of patients and allied health professionals. Results The cohort comprises 1,451 patients (57% female, mean age 49 (standard deviation 13) years). Preliminary results for the study cohort show that 974 (67%) of the participants reported mild/moderate severity symptoms during the infection period and patients reported severe restrictions in activities of daily living compared with previous research in other patient populations. Both quantitative and qualitative, will provide insight into the recovery of patients who are treated by allied health professionals. Conclusion In conclusion, this will be the first comprehensive study to longitudinally evaluate the recovery trajectories and related costs of patients recovering from COVID-19 who are treated by allied health professionals in the Netherlands. This study will provide evidence for the optimal strategy to treat patients recovering from COVID-19 infection, including which patients benefit, and to what extent, from treatment, and which factors might impact their recovery course over time. The preliminary results of this study demonstrated the severity of restrictions and complaints at the start of therapy are substantial.
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Affiliation(s)
| | - Koen Verburg
- Radboud Institute for Health Sciences, IQ healthcare, Radboud university medical center, Nijmegen, the Netherlands.
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20
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Steenbruggen RA, Dolleman G, van Heusden-Scholtalbers LA, Maas M, Hoogeboom TJ, Brand P, Wees PVD. Quality aspects of hospital-based physiotherapy from the perspective of key stakeholders: a qualitative study. BMJ Open Qual 2022; 11:e001843. [PMID: 35589276 PMCID: PMC9121497 DOI: 10.1136/bmjoq-2022-001843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/08/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND For the design of a robust quality system for hospital-based physiotherapy, it is important to know what key stakeholders consider quality to be. OBJECTIVE To explore key stakeholders' views on quality of hospital-based physiotherapy. METHODS We conducted 53 semi-structured interviews with 62 representatives of five key stakeholder groups of hospital-based physiotherapy: medical specialists, hospital managers, boards of directors, multidisciplinary colleagues and patients. Audio recordings of these interviews were transcribed verbatim and analysed with thematic analysis. RESULTS According to the interviewees, quality of hospital-based physiotherapy is characterised by: (1) a human approach, (2) context-specific and up-to-date applicable knowledge and expertise, (3) providing the right care in the right place at the right time, (4) a proactive departmental policy in which added value for the hospital is transparent, (5) professional development and innovation based on a vision on science and developments in healthcare, (6) easy access and awareness of one's own and others' position within the interdisciplinary cooperation and (7) ensuring a continuum of care with the inclusion of preclinical and postclinical care of patients. CONCLUSIONS Important quality aspects in the perspective of all stakeholders were an expertise that matches the specific pathology of the patient, the hospital-based physiotherapist being a part of the care team, and the support and supervision of all patients concerning physical functioning during the hospitalisation period. Whereas patients mainly mentioned the personal qualities of the physiotherapist, the other stakeholders mainly focused on professional and organisational factors. The results of this study offer opportunities for hospital-based physiotherapy to improve the quality of provided care seen from the perspective of key stakeholders.
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Affiliation(s)
- Rudi A Steenbruggen
- IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
- School of Health, Saxion Hogescholen, Enschede, Overijssel, The Netherlands
| | - Guido Dolleman
- Physiotherapy, Isala Hospitals, Zwolle, Overijssel, The Netherlands
| | | | - Marjo Maas
- IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
- Institute of Allied Health Studies, Hogeschool van Arnhem en Nijmegen Instituut Sport en Bewegingsstudies, Nijmegen, Gelderland, The Netherlands
| | - Thomas J Hoogeboom
- IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
| | - Paul Brand
- Medical Education, Isala Hospitals, Zwolle, Overijssel, The Netherlands
- Clinical Education, UMCG, Groningen, Groningen, The Netherlands
| | - Philip van der Wees
- IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
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21
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Steenbruggen RA, Maas MJM, Hoogeboom TJ, Brand PLP, van der Wees PJ. The application of the tracer method with peer observation and formative feedback for professional development in clinical practice: a scoping review. Perspect Med Educ 2022; 11:15-21. [PMID: 34762266 PMCID: PMC8733089 DOI: 10.1007/s40037-021-00693-6] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The tracer method, commonly used for quality assessment, can also be used as a tool for peer observation and formative feedback on professional development. This scoping review describes how, by whom, and with what effect the tracer method is applied as a formative professional development instrument between healthcare professionals of equal status and aims to identify the types of scientific evidence for this use of the tracer method. METHODS The authors searched four electronic databases for eligible articles, which were screened and assessed for eligibility by two independent researchers. From eligible studies, data were extracted to summarize, collate, and make a narrative account of the findings. RESULTS The electronic search yielded 1757 unique studies, eight of which were included as valid and relevant to our aim: five qualitative, two mixed methods, and one quantitative study. Seven studies took place in hospitals and one in general practice. The tracer method was used mainly as a form of peer observation and formative feedback. Most studies evaluated the tracer method's feasibility and its impact on professional development. All but one study reported positive effects: participants described the tracer method generally as being valuable and worth continuing. DISCUSSION Although the body of evidence is small and largely limited to the hospital setting, using the tracer method for peer observation and formative feedback between healthcare professionals of equal status appears sufficiently useful to merit further rigorous evaluation and implementation in continuous professional development in healthcare.
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Affiliation(s)
- Rudi A Steenbruggen
- School of Health, Physiotherapy, Saxion University of Applied Sciences, Enschede, The Netherlands.
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Marjo J M Maas
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute of Allied Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Thomas J Hoogeboom
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul L P Brand
- Isala Hospital, Zwolle, The Netherlands
- University of Groningen and University Medical Centre, Groningen, The Netherlands
| | - Philip J van der Wees
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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22
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Kittelson AJ, Loyd BJ, Graber J, Himawan MA, Waugh D, Davenport J, Hoogeboom TJ, Stevens-Lapsley J. Examination of exclusion criteria in total knee arthroplasty rehabilitation trials: influence on the application of evidence in day-to-day practice. J Eval Clin Pract 2021; 27:1335-1342. [PMID: 33763961 PMCID: PMC8627122 DOI: 10.1111/jep.13564] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/03/2021] [Accepted: 03/08/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Total knee arthroplasty (TKA) rehabilitation trials use exclusion criteria, which may limit their generalizability in practice. We investigated whether patients seen in routine practice who meet common exclusion criteria recover differently from TKA compared to research-eligible patients. We hypothesized that research-ineligible patients would demonstrate poorer average postoperative function and slower rate of functional recovery compared to research-eligible patients. METHODS Patient characteristics and exclusion criteria were extracted and summarized from trials included in the three most recent systematic reviews of TKA rehabilitation. Trial participant characteristics were compared to a clinical dataset of patient outcomes collected in routine TKA rehabilitation. Where possible, individual exclusion criterion from the trials were applied to the clinical dataset to determine "eligible" and "ineligible" groups for research participation. Postoperative functional outcomes including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Timed Up and Go (TUG) were compared between "eligible" and "ineligible" groups using mixed effects models. RESULTS 2,528 participants from 27 trials were compared to 474 patients from the clinical dataset. Research participants were older, with lower Body Mass Index than patients in the clinical dataset. Many patients in the clinical dataset would be "ineligible" for research participation based upon common exclusion criteria from the trials. Differences were observed in average postoperative functioning between some "eligible" and "ineligible" groups in the clinical dataset. However, no differences were observed in functional recovery rate between groups, except for patients with diabetes whose TUG recovered more slowly than their "eligible" counterparts. CONCLUSIONS Many patients in the clinical dataset were "ineligible" for research participation based upon common TKA rehabilitation trial exclusion criteria. However, the postoperative recovery rate did not differ between "eligible" and "ineligible" groups based on individual exclusion criterion-except for individuals with diabetes. This suggests that both clinical and research populations may recover similarly from TKA.
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Affiliation(s)
- Andrew J Kittelson
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA
| | - Brian J Loyd
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA.,Department of Physical Therapy and Athletic Training, College of Health, University of Utah, Salt Lake City, Utah, USA
| | - Jeremy Graber
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Michael A Himawan
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Dawn Waugh
- ATI Physical Therapy, Greenville, South Carolina, USA
| | | | - Thomas J Hoogeboom
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Jennifer Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA.,Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, Colorado, USA
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Affiliation(s)
- Thomas J Hoogeboom
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University medical center, Nijmegen, the Netherlands
| | - Alan M Jette
- A.M. Jette, PT, PhD, FAPTA, is editor in chief of PTJ and is based in Boston, Massachusetts
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Sinnige A, Spruijt S, Saes M, Van der Wees PJ, Hoogeboom TJ, Teijink JAW. Using a Learning Health System to Improve Physical Therapy Care for Patients With Intermittent Claudication: Lessons Learned From the ClaudicatioNet Quality System. Phys Ther 2021; 102:6408933. [PMID: 34723323 PMCID: PMC8802141 DOI: 10.1093/ptj/pzab249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 06/28/2021] [Accepted: 08/30/2021] [Indexed: 11/14/2022]
Abstract
UNLABELLED Routinely collected outcomes data can be used to improve physical therapy care through benchmarking, personalization, continued education, and treatment optimization. This article describes how a nationwide infrastructure to routinely collect data from daily practice was created and how these data were used through a support system (called the ClaudicatioNet Quality system) to improve physical therapy care for patients with intermittent claudication in the Netherlands. ClaudicatioNet is a nationwide network of 2100 specialized physical therapists, providing high-quality supervised exercise therapy in combination with lifestyle counseling. The ClaudicatioNet Quality system uses a large national registry in which specific relevant health outcomes have been routinely collected since 2015. These data have then been used in turn to assess quality of care and provide transparency to therapists and other stakeholders. The Quality system is intended to serve as a learning health system, to support continuous learning at the therapist, practice, and network level. In this approach, individual patients and physical therapists are provided with opportunities to personalize, benchmark, and evaluate (and possibly alter) a treatment plan using routinely collected data from historical patients. The Quality system is described based on the essential elements of a learning health system. The challenges and lessons learned in developing the Quality system also are described. IMPACT The use of routinely collected health outcomes can, if implemented correctly, facilitate continuous learning among physical therapists and contribute to person-centered care. This example of a learning health system might serve as a blueprint for physical therapists on how to optimally implement and distill meaning from routinely collected clinical data.
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Affiliation(s)
- Anneroos Sinnige
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands,ClaudicatioNet, Eindhoven, the Netherlands
| | | | | | - Philip J Van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - Thomas J Hoogeboom
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
| | - Joep A W Teijink
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands,ClaudicatioNet, Eindhoven, the Netherlands,CAPHRI Research School, Maastricht University Medical Centre+, Maastricht, the Netherlands
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Scholz K, van Oorsouw R, Hermsen S, Hoogeboom TJ. Development and pilot-testing of a behavioural intervention to enhance physical activity in patients admitted to the cardiology ward: a proof-of-concept study. European Journal of Physiotherapy 2021. [DOI: 10.1080/21679169.2021.1949038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kathrin Scholz
- Department of Social Psychology – Behaviour Change/Work – and Organizational Psychology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Roel van Oorsouw
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | | | - Thomas J. Hoogeboom
- IQ healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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26
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Felten-Barentsz KM, van de Wetering-van Dongen VA, Vloet L, Koenders N, Nijhuis-van der Sanden MWG, Hoogeboom TJ. Family participation during physical activity in the intensive care unit: A longitudinal qualitative study. J Crit Care 2021; 65:42-48. [PMID: 34082254 DOI: 10.1016/j.jcrc.2021.05.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Family-centered care has been implemented in the ICU to meet relatives' needs concerning information, support, participation and shared decision making. This study explores the needs, beliefs, feelings and behaviors of relatives of patients admitted to the ICU regarding participation during physical activity. METHODS Longitudinal qualitative study design following a grounded theory approach. Relatives were interviewed at 4, 8 and 12 days after the patient's ICU-admission. Data were analyzed using constant comparison. RESULTS Twenty-five interviews were conducted in ten relatives. Relatives believed that physical activity in the ICU improves recovery. Participating in physical activity decreased their feelings of powerlessness and uselessness. Relatives mentioned that they would be stimulated to participate if they were invited, guided and informed by healthcare providers. The perceived reticence of healthcare providers, patient's health-changing capacity and the inability to communicate led to a more passive attitude towards participation. CONCLUSIONS The conceptual model shows how family participation during physical activity changes from a passive role, with negative beliefs and feelings of uselessness and powerlessness, to a more proactive participatory role. Relatives felt more useful and like they were part of the team. Providing relatives with additional information might be a viable strategy to help and stimulate participation.
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Affiliation(s)
- Karin M Felten-Barentsz
- Department of Rehabilitation - Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, the Netherlands.
| | - Veerle A van de Wetering-van Dongen
- Department of Rehabilitation - Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lilian Vloet
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Niek Koenders
- Department of Rehabilitation - Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Department of Rehabilitation - Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thomas J Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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27
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Hendriks MAL, van Wanroij JWM, Laros-van Gorkom BAP, Nijhuis-van der Sanden MWG, Hoogeboom TJ. The SLIM study-Shared medical appointments to change lifestyles of overweight people with haemophilia: A randomized multiple baseline (n-of-1) design. Haemophilia 2021; 27:606-617. [PMID: 33942447 PMCID: PMC8360008 DOI: 10.1111/hae.14306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/22/2021] [Accepted: 03/17/2021] [Indexed: 01/06/2023]
Abstract
INTRODUCTION People with haemophilia suffer from haemophilic joint disease that may result in physical inactivity and overweight. Shared medical appointments (SMAs) might help limit the consequences of haemophilic arthropathy. SMAs are group meetings supervised by one or more healthcare professionals that can be utilized to improve lifestyle. AIM To evaluate the feasibility and efficacy of SMAs in people with haemophilia to improve physical activity and eating habits. METHODS A multiple baseline single-case design was used. Overweight people with haemophilia were eligible to participate. Seven weekly SMAs were conducted using multiple behavioural change techniques to improve physical activity and eating habits. Feasibility of SMAs was evaluated using (a) dropout rate, (b) occurrence of adverse events (AEs), (c) adherence rate and (d) patient satisfaction. During 13 weeks, physical activity was measured daily and eating habits were measured three times per week. The efficacy of SMAs was determined using randomization tests and visual data inspection. RESULTS Out of the six men participating in the study, one participant dropped out. No study-related AEs occurred. The adherence rate of SMAs was 80%, and participants reported to be 'very satisfied' with the SMAs. Randomization tests and visual analyses demonstrated (statistical) improvements in physical activity (p = .03). No effect was found in self-reported eating habits (p = .55). CONCLUSION Shared medical appointments are feasible in people with haemophilia and appear to improve physical activity. The effect on improving eating habits could not be established. Scientific replication of our approach is warranted to confirm or refute the merit of SMAs in people with haemophilia.
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Affiliation(s)
- Marcel A L Hendriks
- Department of Health Innovations and Technology, Research Group Empowering Healthy Behaviour, Fontys University of Applied Sciences, Eindhoven, the Netherlands.,Radboud Institute for Health Sciences, IQ Healthcare, Radboud university medical center, Nijmegen, the Netherlands
| | | | | | | | - Thomas J Hoogeboom
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud university medical center, Nijmegen, the Netherlands
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Steenbruggen RA, van Heusden-Scholtalbers LA, Hoogeboom TJ, Maas M, Brand P, Wees PVD. Impact and feasibility of a tailor-made patient communication quality improvement programme for hospital-based physiotherapists: a mixed-methods study. BMJ Open Qual 2021; 10:bmjoq-2020-001286. [PMID: 33888470 PMCID: PMC8070875 DOI: 10.1136/bmjoq-2020-001286] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 03/23/2021] [Accepted: 04/11/2021] [Indexed: 11/30/2022] Open
Abstract
Background In tailoring a quality improvement programme for hospital-based physiotherapy, the original use of video recordings was replaced by using the tracer methodology. Objective To examine the impact of a tailor-made quality improvement programme addressing patient communication on the professional development of hospital-based physiotherapists, and to evaluate barriers and facilitators as determinants of feasibility of the programme. Methods A mixed-methods study was conducted. Participants were clustered in groups per hospital and linked with an equally sized group in a nearby hospital. Within the groups, fixed couples carried out a 2-hour tracer by directly observing each other’s daily work routine. This procedure was repeated 6 months later. Data from feedback forms were analysed quantitatively, and a thematic analysis of transcripts from group interviews was conducted. Results Fifty hospital-based physiotherapists from 16 hospitals participated. They rated the impact of the programme on professional development, on a scale from 1 (much improvement needed) to 5 (no improvement needed), as 3.99 (SD 0.64) after the first tracer and 4.32 (SD 0.63) 6 months later; a mean improvement of 0.33 (95% CI 0.16 to 0.50). Participants scored, on a scale ranging from 1 to 5 on barriers and facilitators (feasibility), a mean of 3.45 (SD 0.95) on determinants of innovation, 3.47 (SD 0.86) on probability to use and 2.63 (SD 1.07) on the user feedback list. All participants emphasised the added value of the tracer methodology and mentioned effects on self-reflection and awareness most. Conclusions The tailor-made quality improvement programme, based on principles of the tracer methodology, was associated with a significant impact on professional development. Barriers and facilitators as determinants of feasibility of the programme showed the programme being feasible.
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Affiliation(s)
- Rudi A Steenbruggen
- IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands .,School of Health, Saxion University of Applied Sciences, Enschede, The Netherlands
| | | | - Thomas J Hoogeboom
- IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Marjo Maas
- IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Institute of Allied Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Paul Brand
- Medical Education, Isala Hospitals, Zwolle, The Netherlands.,Clinical Education, UMCG, Groningen, The Netherlands
| | - Philip van der Wees
- IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Koenders N, Marcellis L, Nijhuis-van der Sanden MW, Satink T, Hoogeboom TJ. Multifaceted interventions are required to improve physical activity behaviour in hospital care: a meta-ethnographic synthesis of qualitative research. J Physiother 2021; 67:115-123. [PMID: 33753014 DOI: 10.1016/j.jphys.2021.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 02/10/2020] [Revised: 02/04/2021] [Accepted: 02/23/2021] [Indexed: 12/17/2022] Open
Abstract
QUESTION What are the views of patients, close relatives and healthcare professionals on physical activity behaviour in hospital care? METHODS A meta-ethnographic synthesis of qualitative studies was conducted with a lines-of-argument analysis. The methodological quality of included studies was evaluated using the Critical Appraisal Skills Programme (CASP) checklist. The lines of argument were synthesised and mapped in an existing theoretical model. The confidence of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach. RESULTS Eleven studies were included and provided data from 290 participants (145 patients, 0 close relatives and 145 healthcare professionals). We have synthesised six lines of argument that explained the (intention of) physical activity behaviour of patients during their hospital stay: patients and healthcare professionals perceive benefits and risks of physical activity for patients' health (high confidence); physical activity gives a sense of freedom, confidence in recovery and mental wellbeing (high confidence); all healthcare professionals should offer timely and tailored physical activity promotion (high confidence); patient motivation to be physically active may be contingent upon encouragement (moderate confidence); family members can influence physical activity behaviour favourably or unfavourably (low confidence); and hospital culture has a negative influence on physical activity behaviour of patients (high confidence). CONCLUSIONS Physical activity behaviour of patients during their hospital stay is a complex phenomenon with multiple interactions at the level of patients, healthcare professionals and hospital culture. Considering the results of this synthesis, multifaceted implementation strategies are needed to improve physical activity intention and behaviour of patients during their hospital stay.
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Affiliation(s)
- Niek Koenders
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.
| | - Laura Marcellis
- Department of Rehabilitation, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Maria Wg Nijhuis-van der Sanden
- Department of Allied Healthcare Sciences of IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Ton Satink
- Neurorehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Thomas J Hoogeboom
- Department of Allied Healthcare Sciences of IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
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Klein IL, van de Loo KFE, Hoogeboom TJ, Janssen MCH, Smeitink JAM, van der Veer E, Verhaak CM, Custers JAE. Blended cognitive behaviour therapy for children and adolescents with mitochondrial disease targeting fatigue (PowerMe): study protocol for a multiple baseline single case experiment. Trials 2021; 22:177. [PMID: 33648576 PMCID: PMC7923335 DOI: 10.1186/s13063-021-05126-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background Mitochondrial disease is a rare, hereditary disease with a heterogeneous clinical presentation. However, fatigue is a common and burdensome complaint in children and adolescents with mitochondrial disease. No psychological intervention targeting fatigue exists for paediatric patients with a mitochondrial disease. We designed the PowerMe intervention, a blended cognitive behaviour therapy targeting fatigue in children and adolescents with mitochondrial disease. The aim of the intervention is to reduce perceived fatigue by targeting fatigue-related cognitions and behaviours. Methods A multiple baseline single case experiment will be conducted in five children (8–12 years old) and 5 adolescents (12–18 years old) with mitochondrial disease and severe fatigue. Patients will be included in the study for 33 weeks, answering weekly questions about the fatigue. Patients will be randomly assigned a baseline period of 5 to 9 weeks before starting the PowerMe intervention. The intervention consists of face-to-face and online sessions with a therapist and a website with information and assignments. The treatment will be tailored to the individual. Each patient will work on their personalized treatment plan focusing on personally relevant goals. The primary outcome is perceived fatigue. Secondary outcomes are quality of life, school presence and physical functioning. Discussion The results of the PowerMe study will provide information on the efficacy of a blended cognitive behaviour therapy on reducing perceived fatigue and its impact on daily life in children and adolescents with mitochondrial disease. Strengths and limitations of the study design are discussed. Trial registration Dutch Trial Register NTR 7675. Registered on 17 December 2018. Identifier https://www.trialregister.nl/trial/7433
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Affiliation(s)
- I L Klein
- Radboud university medical center, Radboud Institute for Health Sciences, Radboud Center for Mitochondrial Medicine, Department of Medical Psychology, PO Box 9101, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands.
| | - K F E van de Loo
- Radboud university medical center, Radboud Institute for Health Sciences, Radboud Center for Mitochondrial Medicine, Department of Medical Psychology, PO Box 9101, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands
| | - T J Hoogeboom
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands
| | - M C H Janssen
- Radboud university medical center, Radboud Institute for Molecular Life Sciences, Radboud Center for Mitochondrial Medicine, Department of Internal Medicine, PO Box 9101, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands
| | - J A M Smeitink
- Radboud university medical center, Radboud Institute for Molecular Life Sciences, Radboud Center for Mitochondrial Medicine, Department of Pediatrics, PO Box 9101, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands
| | - E van der Veer
- International Mito Patients Association, Bergambacht, The Netherlands
| | - C M Verhaak
- Radboud university medical center, Radboud Institute for Health Sciences, Radboud Center for Mitochondrial Medicine, Department of Medical Psychology, PO Box 9101, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands
| | - J A E Custers
- Radboud university medical center, Radboud Institute for Health Sciences, Radboud Center for Mitochondrial Medicine, Department of Medical Psychology, PO Box 9101, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands
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Koenders N, Potkamp-Kloppers S, Geurts Y, Akkermans R, Nijhuis-van der Sanden MWG, Hoogeboom TJ. Ban Bedcentricity: A Multifaceted Innovation to Reduce Sedentary Behavior of Patients During the Hospital Stay. Phys Ther 2021; 101:6131759. [PMID: 33564890 PMCID: PMC8280922 DOI: 10.1093/ptj/pzab054] [Citation(s) in RCA: 6] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 12/03/2020] [Accepted: 01/20/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this study was to explore differences in sedentary behavior, length of hospital stay, and discharge destination of patients before and after the Ban Bedcentricity implementation at ward level. METHODS The Ban Bedcentricity innovation and implementation procedure were implemented at the cardiothoracic surgery, cardiology, and orthopedics-traumatology wards. Sedentary behavior data were collected 2 weeks before and after the implementation using behavioral observations and analyzed with Pearson chi-square. Length of hospital stay and discharge destination data were collected from all admitted patients and analyzed with multiple and logistic regression analyses. RESULTS Behavioral observations showed that in 52% of the observations, patients were lying in bed before implementation and 40% after implementation at the cardiothoracic surgery, 64% and 46% at the cardiology, and 53% and 57% at the orthopedics-traumatology wards, respectively. The mean length of hospital stay after implementation (compared with implementation before) was 5.1 days at the cardiothoracic surgery (n = 1923; mean = +0.13 days, 95% CI = -0.32 to 0.60), 2.6 days at the cardiology (n = 2646; mean = -0.22 days, 95% CI = -0.29 to -0.14), and 2.4 days at the orthopedics-traumatology wards (n = 1598; mean = +0.28 days, 95% CI = 0.06 to 0.50). After the implementation, more patients were discharged home from the cardiothoracic surgery (odds ratio [OR = 1.23], 95% CI = 1.07 to 1.37) and cardiology wards (OR = 1.37, 95% CI = 1.22 to 1.49), and no statistically significant difference was found at the orthopedics-traumatology ward (OR = 1.09, 95% CI = 0.88 to 1.27). CONCLUSION The results indicate beneficial outcomes after the implementation with less sedentary behavior and proportionately more patients being discharged home compared with before the implementation. However, little information is available about the adoption and fidelity of Ban Bedcentricity; therefore, outcomes should be interpreted with caution. IMPACT This multifaceted innovation to reduce sedentary behavior of patients during the hospital stay seems to be promising, with outcomes indicating less sedentary behavior in patients and more patients being discharged home after the implementation. LAY SUMMARY We introduced Ban Bedcentricity, an intervention to reduce the amount of time patients lie in the hospital bed during their hospitalization. This study shows that after the introduction of Ban Bedcentricity, patients lie in bed less and are more often discharged home.
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Affiliation(s)
- Niek Koenders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Rehabilitation, Nijmegen, the Netherlands,Address all correspondence to Mr Koenders at:
| | | | - Yvonne Geurts
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Rehabilitation, Nijmegen, the Netherlands
| | - Reinier Akkermans
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Allied Healthcare Sciences of IQ Healthcare, Nijmegen, the Netherlands,Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Allied Healthcare Sciences of IQ Healthcare, Nijmegen, the Netherlands
| | - Thomas J Hoogeboom
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Allied Healthcare Sciences of IQ Healthcare, Nijmegen, the Netherlands
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van der Sluis G, Jager J, Punt I, Goldbohm A, Meinders MJ, Bimmel R, van Meeteren NL, Nijhuis-van Der Sanden MWG, Hoogeboom TJ. Current Status and Future Prospects for Shared Decision Making Before and After Total Knee Replacement Surgery-A Scoping Review. Int J Environ Res Public Health 2021; 18:ijerph18020668. [PMID: 33466879 PMCID: PMC7829744 DOI: 10.3390/ijerph18020668] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/08/2021] [Accepted: 01/10/2021] [Indexed: 12/27/2022]
Abstract
Background. To gain insight into the current state-of-the-art of shared decision making (SDM) during decisions related to pre and postoperative care process regarding primary total knee replacement (TKR). Methods. A scoping review was performed to synthesize existing scientific research regarding (1) decisional needs and preferences of patients preparing for, undergoing and recovering from TKR surgery, (2) the relation between TKR decision-support interventions and SDM elements (i.e., team talk, option talk, and decision talk), (3) the extent to which TKR decision-support interventions address patients' decisional needs and preferences. Results. 2526 articles were identified, of which 17 articles met the inclusion criteria. Of the 17 articles, ten had a qualitative study design and seven had a quantitative study design. All included articles focused on the decision whether to undergo TKR surgery or not. Ten articles (all qualitative) examined patients' decisional needs and preferences. From these, we identified four domains that affected the patients' decision to undergo TKR: (1) personal factors, (2) external factors, (3) information sources and (4) preferences towards outcome prediction. Seven studies (5) randomized controlled trials and 2 cohort studies) used quantitative analyses to probe the effect of decision aids on SDM and/or clinical outcomes. In general, existing decision aids did not appear to be tailored to patient needs and preferences, nor were the principles of SDM well-articulated in the design of decision aids. Conclusions. SDM in TKR care is understudied; existing research appears to be narrow in scope with limited relevance to established SDM principles and the decisional needs of patients undertaking TKR surgery.
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Affiliation(s)
- Geert van der Sluis
- Department of Health Strategy and Innovation, Nij Smellinghe Hospital Drachten, Compagnonsplein 1, 9202 NN Drachten, The Netherlands
- Correspondence: ; Tel.: +31-512-588-245; Fax: +31-512-588-347
| | - Jelmer Jager
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), School for Public Health and Primary Care, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands;
- Department of Physical Therapy, Onze Lieve Vrouwe Gasthuis (OLVG), Hospital Amsterdam, Oosterpark 9, 1091 AC Amsterdam, The Netherlands
- Faculty of Health, University of Applied Sciences Leiden, Zernikedreef 11, 2333 CK Leiden, The Netherlands
| | - Ilona Punt
- Department of Orthopaedics, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands;
- Department of Surgery and Trauma Surgery and Research School NUTRIM, Maastricht University and Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
| | | | - Marjan J. Meinders
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Geert Grooteplein 21, 6525 EZ Nijmegen, The Netherlands; (M.J.M.); (M.W.G.N.-v.D.S.); (T.J.H.)
| | - Richard Bimmel
- Department of Orthopedics and Traumatology, Nij Smellinghe Hospital Drachten, Compagnonsplein 1, 9202 NN Drachten, The Netherlands;
| | - Nico L.U. van Meeteren
- Topsector Life Sciences and Health (Health~Holland), Laan van Nieuw Oost-Indie 334, 2693 CE the Hague, The Netherlands;
- Department of Anesthesiology, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Maria W. G. Nijhuis-van Der Sanden
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Geert Grooteplein 21, 6525 EZ Nijmegen, The Netherlands; (M.J.M.); (M.W.G.N.-v.D.S.); (T.J.H.)
| | - Thomas J. Hoogeboom
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Geert Grooteplein 21, 6525 EZ Nijmegen, The Netherlands; (M.J.M.); (M.W.G.N.-v.D.S.); (T.J.H.)
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Hoogeboom TJ, Kousemaker MC, van Meeteren NL, Howe T, Bo K, Tugwell P, Ferreira M, de Bie RA, van den Ende CH, Stevens-Lapsley JE. i-CONTENT tool for assessing therapeutic quality of exercise programs employed in randomised clinical trials. Br J Sports Med 2020; 55:1153-1160. [PMID: 33144350 PMCID: PMC8479742 DOI: 10.1136/bjsports-2019-101630] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE When appraising the quality of randomised clinical trial (RCTs) on the merits of exercise therapy, we typically limit our assessment to the quality of the methods. However, heterogeneity across studies can also be caused by differences in the quality of the exercise interventions (ie, 'the potential effectiveness of a specific intervention given the potential target group of patients')-a challenging concept to assess. We propose an internationally developed, consensus-based tool that aims to assess the quality of exercise therapy programmes studied in RCTs: the international Consensus on Therapeutic Exercise aNd Training (i-CONTENT) tool. METHODS Forty-nine experts (from 12 different countries) in the field of physical and exercise therapy participated in a four-stage Delphi approach to develop the i-CONTENT tool: (1) item generation (Delphi round 1), (2) item selection (Delphi rounds 2 and 3), (3) item specification (focus group discussion) and (4) tool development and refinement (working group discussion and piloting). RESULTS Out of the 61 items generated in the first Delphi round, consensus was reached on 17 items, resulting in seven final items that form the i-CONTENT tool: (1) patient selection; (2) qualified supervisor; (3) type and timing of outcome assessment; (4) dosage parameters (frequency, intensity, time); (5) type of exercise; (6) safety of the exercise programme and (7) adherence to the exercise programme. CONCLUSION The i-CONTENT-tool is a step towards transparent assessment of the quality of exercise therapy programmes studied in RCTs, and ultimately, towards the development of future, higher quality, exercise interventions.
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Affiliation(s)
- Thomas J Hoogeboom
- Radboud Institute for Health Sciences, IQ healthcare, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | | | - Nico Lu van Meeteren
- Executive Director, Top Sector Life Sciences & Health (Health~Holland), The Hague; Professor, Dept Anesthesiology, Erasmus MC, Rotterdam; CEO, Topcare, The Netherlands
| | - Tracey Howe
- Global Aging, Cochrane Collaboration, London, Oxfordshire, UK
| | - Kari Bo
- Department of Sports Medicine, Norwegian School of Sports Sciences, Oslo, Akershus, Norway.,Department of Obstetrics and Gynecology, Akershus University Hospital, Lorenskog, Norway
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Manuela Ferreira
- Institute of Bone and Joint Research, The Kolling Institute, University of Sydney Sydney Medical School, Sydney, New South Wales, Australia
| | - Rob A de Bie
- Department of Epidemiology, Maastricht University, Maastricht, Limburg, The Netherlands
| | | | - Jennifer E Stevens-Lapsley
- Department of Physical Medicine and Rehabilitation, University of Colorado Denver School of Medicine, Aurora, Colorado, USA.,Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, Colorado, USA
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Felten-Barentsz KM, van Oorsouw R, Klooster E, Koenders N, Driehuis F, Hulzebos EHJ, van der Schaaf M, Hoogeboom TJ, van der Wees PJ. Recommendations for Hospital-Based Physical Therapists Managing Patients With COVID-19. Phys Ther 2020; 100:1444-1457. [PMID: 32556323 PMCID: PMC7337861 DOI: 10.1093/ptj/pzaa114] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/05/2020] [Accepted: 06/07/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The COVID-19 pandemic is rapidly evolving and has led to increased numbers of hospitalizations worldwide. Hospitalized patients with COVID-19 experience a variety of symptoms, including fever, muscle pain, tiredness, cough, and difficulty breathing. Elderly people and those with underlying health conditions are considered to be more at risk of developing severe symptoms and have a higher risk of physical deconditioning during their hospital stay. Physical therapists have an important role in supporting hospitalized patients with COVID-19 but also need to be aware of challenges when treating these patients. In line with international initiatives, this article aims to provide guidance and detailed recommendations for hospital-based physical therapists managing patients hospitalized with COVID-19 through a national approach in the Netherlands. METHODS A pragmatic approach was used. A working group conducted a purposive scan of the literature and drafted initial recommendations based on the knowledge of symptoms in patients with COVID-19 and current practice for physical therapist management for patients hospitalized with lung disease and patients admitted to the intensive care unit. An expert group of hospital-based physical therapists in the Netherlands provided feedback on the recommendations, which were finalized when consensus was reached among the members of the working group. RESULTS The recommendations include safety recommendations, treatment recommendations, discharge recommendations, and staffing recommendations. Treatment recommendations address 2 phases of hospitalization: when patients are critically ill and admitted to the intensive care unit, and when patients are severely ill and admitted to the COVID ward. Physical therapist management for patients hospitalized with COVID-19 comprises elements of respiratory support and active mobilization. Respiratory support includes breathing control, thoracic expansion exercises, airway clearance techniques, and respiratory muscle strength training. Recommendations toward active mobilization include bed mobility activities, active range-of-motion exercises, active (assisted) limb exercises, activities-of-daily-living training, transfer training, cycle ergometer, pre-gait exercises, and ambulation.
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Affiliation(s)
- Karin M Felten-Barentsz
- Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 21, Nijmegen 6500 HB, the Netherlands
| | - Roel van Oorsouw
- Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center
| | - Emily Klooster
- Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center and Department of Rehabilitation, Deventer Ziekenhuis, Deventer, the Netherlands
| | - Niek Koenders
- Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center
| | - Femke Driehuis
- Department of Guideline Development, Royal Dutch Society for Physical Therapy (KNGF), Amersfoort, the Netherlands
| | - Erik H J Hulzebos
- Child Development and Exercise Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Marike van der Schaaf
- Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands, and Faculty of Health, ACHIEVE-Centre of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Thomas J Hoogeboom
- Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center and IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center
| | - Philip J van der Wees
- Department of Rehabilitation, Radboud Institute for Health Sciences, Radboud University Medical Center and IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center
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Kittelson AJ, Elings J, Colborn K, Hoogeboom TJ, Christensen JC, van Meeteren NLU, van Buuren S, Stevens-Lapsley JE. Reference chart for knee flexion following total knee arthroplasty: a novel tool for monitoring postoperative recovery. BMC Musculoskelet Disord 2020; 21:482. [PMID: 32698900 PMCID: PMC7376933 DOI: 10.1186/s12891-020-03493-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 07/08/2020] [Indexed: 11/15/2022] Open
Abstract
Background Clinicians and patients lack an evidence-based framework by which to judge individual-level recovery following total knee arthroplasty (TKA) surgery, thus impeding personalized treatment approaches for this elective surgery. Our study aimed to develop and validate a reference chart for monitoring recovery of knee flexion following TKA surgery. Methods Retrospective analysis of data collected in routine rehabilitation practice for patients following TKA surgery. Reference charts were constructed using Generalized Additive Models for Location Scale and Shape. Various models were compared using the Schwarz Bayesian Criterion, Mean Squared Error in 5-fold cross validation, and centile coverage (i.e. the percent of observed data represented below specified centiles). The performance of the reference chart was then validated against a test set of patients with later surgical dates, by examining the centile coverage and average bias (i.e. difference between observed and predicted values) in the test dataset. Results A total of 1173 observations from 327 patients were used to develop a reference chart for knee flexion over the first 120 days following TKA. The best fitting model utilized a non-linear time trend, with smoothing splines for median and variance parameters. Additionally, optimization of the number of knots in smoothing splines and power transformation of time improved model fit. The reference chart performed adequately in a test set of 171 patients (377 observations), with accurate centile coverage and minimal average bias (< 3 degrees). Conclusion A reference chart developed with clinically collected data offers a new approach to monitoring knee flexion following TKA.
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Affiliation(s)
- Andrew J Kittelson
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA. .,School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT, USA.
| | - Jordi Elings
- Department of Physiotherapy, University of Maastricht, Maastricht, The Netherlands
| | - Kathryn Colborn
- Department of Biostatistics and Informatics, University of Colorado, Aurora, CO, USA
| | - Thomas J Hoogeboom
- Radboud university medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Jesse C Christensen
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA.,VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Nico L U van Meeteren
- Department of Physiotherapy, University of Maastricht, Maastricht, The Netherlands.,Health~Holland (Topsector Life Sciences and Health), The Hague, The Netherlands
| | - Stef van Buuren
- Netherlands Organization for Applied Scientific Research TNO, Leiden, The Netherlands.,Department of Methodology and Statistics, University of Utrecht, Utrecht, The Netherlands
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA.,Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, CO, USA
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Steenbruggen RA, van Oorsouw R, Maas M, Hoogeboom TJ, Brand P, Wees PVD. Development of quality indicators for departments of hospital-based physiotherapy: a modified Delphi study. BMJ Open Qual 2020; 9:bmjoq-2019-000812. [PMID: 32576577 PMCID: PMC7312452 DOI: 10.1136/bmjoq-2019-000812] [Citation(s) in RCA: 4] [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: 08/30/2019] [Revised: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 12/17/2022] Open
Abstract
Background International hospital accreditation instruments, such as Joint Commission International (JCI) and Qmentum, focus mainly on hospital policy and procedures and do not specifically cover a profession such as hospital-based physiotherapy. This justifies the need for a quality system to which hospital-based physiotherapy can better identify, based on a common framework of quality indicators for effective quality management. Objective This study aimed to identify the most important quality indicators of a hospital-based physiotherapy department in the eyes of hospital-based physiotherapists and their managers. Methods Based on input from three focus groups and a structured literature review, a first set of quality indicators for hospital physiotherapy was assembled. After checking this set for duplicates and for overlap with JCI and Qmentum, it formed the starting point of a modified Delphi procedure. In two rounds, 17 hospital-based physiotherapy experts rated the quality indicators on relevance through online surveys. In a final consensus meeting, quality indicators were established, classified in quality themes and operationalised by describing for each theme the rationale, specifications, domain and type of indicator. Results Three focus groups provided 120 potential indicators, which were complemented with 18 potential indicators based on literature. After duplicate and overlap check and the Delphi procedure, these 138 potential indicators were reduced to a set of 56 quality indicators for hospital-based physiotherapy. Finally, these 56 indicators were condensed into 7 composite indicators, each representing a quality theme based on definitions of the European Foundation for Quality Management. Conclusion A set of 56 quality indicators, condensed into 7 composite indicators each representing a quality theme, was developed to assess the quality of a hospital-based physiotherapy department.
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Affiliation(s)
- Rudi A Steenbruggen
- IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- School of Health, Saxion University of Applied Sciences, Enschede, The Netherlands
| | | | - Marjo Maas
- IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Institute of Allied Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Thomas J Hoogeboom
- IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Paul Brand
- Medical Education, Isala Hospitals, Zwolle, The Netherlands
- Clinical Education, UMCG, Groningen, The Netherlands
| | - Philip van der Wees
- IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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van de Sant AJW, de Vries NM, Hoogeboom TJ, Nijhuis-van der Sanden MWG. Implementation of a Personalized, Cost-Effective Physical Therapy Approach (Coach2Move) for Older Adults: Barriers and Facilitators. J Geriatr Phys Ther 2020; 42:E1-E16. [PMID: 28753136 PMCID: PMC6687416 DOI: 10.1519/jpt.0000000000000140] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background and Purpose: This article reports on a recent randomized clinical trial that showed a personalized approach to physical therapy (Coach2Move) by a physical therapist specialized in geriatrics (PTG) to be more cost-effective than usual physical therapy care in people with mobility problems (n = 130, mean age = 78 years). Methods: We used an explanatory mixed-methods sequential design alongside the randomized clinical trial to gain insight into (a) the contrast between the 2 interventions, (b) the fidelity of the Coach2Move delivery; (c) PTGs' experiences of Coach2Move; and (d) possible barriers and facilitators for future implementation. The study included 13 PTGs educated in the strategy and 13 physical therapists with expertise in geriatrics delivering the usual care. In total, 106 medical records were available for assessment: 57 (85%) Coach2Move, 49 (75%) usual care. Quantitative process indicators were used to analyze electronic medical records to determine contrasts in the phases of clinical reasoning. The fidelity of the delivery was tested using indicator scores focusing on 4 key elements of Coach2Move. In-depth interviews with Coach2Move therapists were thematically analyzed to explore experiences and facilitators/barriers related to implementation. Results and Discussion: Indicator scores showed significant and clinically relevant contrasts in all phases of clinical reasoning, with consistently higher scores among PTGs, except for the treatment plan. Moreover, the fidelity of Coach2Move delivery was more than 70% in all phases, except the evaluation phase (53%). Experiences of Coach2Move were positive. In particular, extended intake allowing motivational interviewing, physical examination and an in-depth problem analysis, and shared goal setting were considered valuable. Facilitators for implementation were the addition of a Coach2Move medical record, frequent coaching by the researcher, and readiness to change in the therapist. Barriers were (1) having to use 2 parallel electronic medical record systems, (2) having to clear the calendar to schedule an intake of 90 minutes, (3) fear of losing income, (4) the sense that patients do not want to change their lifestyle, and (5) not acknowledging that increasing physical activity is an important goal for older adults with mobility problems. Conclusions: Physical therapy based on the Coach2Move strategy is substantially different from usual care. Future implementation should focus on increasing regular evaluation and feedback, taking into account individuals' contextual factors, and improving organizational facilities while mitigating income loss.
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Affiliation(s)
| | - Nienke M de Vries
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thomas J Hoogeboom
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands
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Driehuis F, Keijsers NLW, Nijhuis-van der Sanden MWG, De Bie RA, Staal JB, Hoogeboom TJ. Measurement of range-of-motion in infants with indications of upper cervical dysfunction using the Flexion-Rotation-Test and Lateral-Flexion-Test: a blinded inter-rater reliability study in a clinical practice setting. J Man Manip Ther 2020; 29:40-50. [PMID: 32282288 PMCID: PMC7889092 DOI: 10.1080/10669817.2020.1746896] [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] [Indexed: 11/07/2022] Open
Abstract
Background: In infants with indications of upper cervical dysfunction, the Flexion-Rotation-Test and Lateral-Flexion-Test are used to indicate reduced upper cervical range-of-motion (ROM). In infants, the inter-rater reliability of these tests is unknown. Objective: To assess the inter-rater reliability of subjectively and objectively measured ROM by using the Flexion-Rotation-Test and Lateral-Flexion-Test. Methods: 36 infants (<6 months) and three manual therapists participated in this cross-sectional observational study. Pairs of two manual therapists independently assessed infants’ upper cervical ROM using the Flexion-Rotation-Test and Lateral-Flexion-Test, blinded for each other’s outcomes. Two inertial motion sensors objectively measured cervical ROM. Inter-rater reliability was determined between each pair of manual therapists. For subjective outcomes, Cohen’s kappa (ĸ) and the proportion of agreement (Pra) were calculated. For objectively measured ROM, Bland Altman plots were conducted and Limits of Agreement and Intraclass Correlation Coefficients (ICC) were calculated. Results: The inter-rater reliability of the Flexion-Rotation-Test and Lateral-Flexion-Test for subjective (ĸ: 0.077–0.727; Pra: 0.46–0.86) and objective outcomes (ICC: 0.019–0.496) varied between pairs of manual therapists. Conclusion: Assessed ROM largely depends on the performance of the assessment and its interpretation by manual therapists, leading to high variation in outcomes. Therefore, the Flexion-Rotation-Test and Lateral-Flexion-Test cannot be used solely as a reliable outcome measure in clinical practice and research context.
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Affiliation(s)
- Femke Driehuis
- IQ Healthcare, Radboud Institute of Health Sciences, Radboud University Medical Center , Nijmegen, The Netherlands
| | - Noël L W Keijsers
- Institute Research, Development & Education, Sint Maartenskliniek , Ubbergen, The Netherlands.,Department of Rehabilitation, Cognition and Behavior, Donders Institute for Brain, Radboud University Medical Center , Nijmegen, The Netherlands
| | | | - Rob A De Bie
- CAPHRI Research School, Department of Epidemiology, Maastricht University , Maastricht, The Netherlands
| | - J Bart Staal
- IQ Healthcare, Radboud Institute of Health Sciences, Radboud University Medical Center , Nijmegen, The Netherlands.,Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences , Nijmegen, The Netherlands
| | - Thomas J Hoogeboom
- IQ Healthcare, Radboud Institute of Health Sciences, Radboud University Medical Center , Nijmegen, The Netherlands
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Heij W, Teerenstra S, Sweerts L, Staal JB, Nijhuis-van der Sanden MWG, Hoogeboom TJ. Implementation of a Cost-Effective Physical Therapy Approach (Coach2Move) to Improve Physical Activity in Community-Dwelling Older Adults With Mobility Problems: Protocol for a Cluster-Randomized, Stepped Wedge Trial. Phys Ther 2019; 100:653-661. [PMID: 31846501 PMCID: PMC7297439 DOI: 10.1093/ptj/pzz183] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/08/2019] [Accepted: 08/23/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Coach2Move is a personalized treatment strategy by physical therapists to elicit physical activity in community-dwelling older adults with mobility problems. OBJECTIVE The primary objective of this study is to assess the effectiveness and cost-effectiveness of the implementation of Coach2Move compared with regular care physical therapy in daily clinical practice. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTION A multicenter cluster-randomized stepped wedge trial is being implemented in 16 physical therapist practices (4 clusters of 4 practices in 4 steps) in the Netherlands. The study aims to include 400 older adults (≥70 years) living independently with mobility problems and/or physically inactive lifestyles. The intervention group receives physical therapy conforming to the Coach2Move strategy; the usual care group receives typical physical therapist care. MEASUREMENTS Measurements are taken at baseline and 3, 6, and 12 months after the start of treatment. The primary outcomes for effectiveness are the amount of physical activity (LASA Physical Activity Questionnaire) and functional mobility (Timed Up and Go test). Trial success can be declared if at least 1 parameter improves while another does not deteriorate. Secondary outcomes are level of frailty (Evaluative Frailty Index for Physical Activity), perceived effect (Global Perceived Effect and Patient Specific Complaints questionnaire), quality of life (EQ-5D-5 L), and health care expenditures. Multilevel linear regression analyses are used to compare the outcomes between treatment groups according to an intention-to-treat approach. Alongside the trial, a mixed-methods process evaluation is performed to understand the outcomes, evaluate therapist fidelity to the strategy, and detect barriers and facilitators in implementation. LIMITATIONS An important limitation of the study design is the inability to blind treating therapists to study allocation. DISCUSSION The trial provides insight into the effectiveness and cost-effectiveness of the Coach2Move strategy compared with usual care. The process evaluation provides insight into influencing factors related to outcomes and implementation.
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Affiliation(s)
- Ward Heij
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, PO Box 9101, 6500 HB, Nijmegen, the Netherlands,Address all correspondence to Mr Heij at:
| | - Steven Teerenstra
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Health Evidence, Section Biostatistics
| | - Lieke Sweerts
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare; Radboud university medical center, Radboud Institute for Health Sciences, Department of Orthopaedics
| | - J Bart Staal
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare; and HAN University of Applied Sciences, Research Group Musculoskeletal Rehabilitation, Nijmegen, the Netherlands
| | | | - Thomas J Hoogeboom
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare
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Koenders N, van den Heuvel S, Bloemen S, van der Wees PJ, Hoogeboom TJ. Development of a longlist of healthcare quality indicators for physical activity of patients during hospital stay: a modified RAND Delphi study. BMJ Open 2019; 9:e032208. [PMID: 31712346 PMCID: PMC6858236 DOI: 10.1136/bmjopen-2019-032208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To develop a longlist of healthcare quality indicators for the care of hospitalised adults of all ages with (or at risk of) low physical activity during the hospital stay. DESIGN A modified RAND/UCLA Appropriateness Method Delphi study. SETTING AND PARTICIPANTS Participants were physical therapists, nurses and managers working in Dutch university medical centres. METHODS The current study consisted of three phases. Phase I was a systematic literature search for quality indicators and relevant domains. Phase II was a survey among healthcare professionals to collect additional data. Phase III consisted of three consensus rounds. In round 1, experts rated the relevance of the potential indicators online (Delphi). The second round was a face-to-face expert panel meeting managed by an experienced moderator. Acceptability, feasibility and validity of the quality indicators were discussed by the panel members. In round 3, the panel members rated the relevance of the potential indicators that were still under discussion. RESULTS The search retrieved 1556 studies of which 53 studies were assessed full text. Data from 17 studies were included in a first draft longlist of indicators. Eighteen nurses and one physical therapist responded to the survey and added data for a second draft of the longlist. Experts constructed the final longlist of 23 indicators in three consensus rounds. Seven domains were identified: 'Policy', 'Attitude and education', 'Equipment and support', 'Evaluation', 'Information', 'Patient-tailored physical activity plan' and 'Outcome measure'. CONCLUSION AND IMPLICATIONS The healthcare quality indicators developed in this study could help to grade, monitor and improve healthcare for hospitalised adults of all ages with (or at risk of) low physical activity during the hospital stay. Future research will focus on the psychometric quality of the indicators and selection of key performance indicators.
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Affiliation(s)
- Niek Koenders
- Department of Rehabilitation-Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stein van den Heuvel
- Department of Rehabilitation-Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Shanna Bloemen
- Department of Rehabilitation-Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Philip J van der Wees
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Thomas J Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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Koenders N, Weenk M, van de Belt TH, van Goor H, Hoogeboom TJ, Bredie SJH. Exploring barriers to physical activity of patients at the internal medicine and surgical wards: a retrospective analysis of continuously collected data. Disabil Rehabil 2019; 43:1883-1889. [PMID: 31691603 DOI: 10.1080/09638288.2019.1685013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To analyse physical activity of patients during their hospital stay and to explore the relationship between physical activity and barriers to physical activity. METHODS This was a secondary analysis of physical activity data for patients admitted to the internal medicine and surgical wards. Physical activity data, collected with a wireless patch sensor, was operationalized as time spent lying, sitting/standing, and walking. Barriers to physical activity included patients' pain levels, the use of urinary catheters, intravenous tubing, oxygen lines, drains, and level of dependence. Regression analysis explored the relationship between physical activity and barriers to physical activity. RESULTS Physical activity data were collected in 39 patients (aged 27-88, mean 54 years) during hospital stay. Patients were admitted for a median of 10 d (interquartile range [IQR]: 7-15 d). These patients were lying for a median of 12.1 h (7.6-17.7), sitting/standing 11.8 h (6.3-15.7), and walking 0.1 h (0-0.3) per day. Time lying during the day related to pain levels (β = 0.4 h per unit increase in pain, p < 0.01) and drain use (β = 3.1 h, p < 0.01). CONCLUSIONS Patients spent the most time during the hospital stay lying in bed. Improved pain management and decreased drain use may be worth exploring to increase inpatient physical activity.Implications for rehabilitationContinuous monitoring of physical activity in patients during hospital stay is an important tool for health care professionals to improve multidisciplinary care and rehabilitation.Health care professionals should be aware of the necessity of adequate pain management and critically review the use of drains in order to improve physical activity of patients during hospital stay.Patients need extra support of health care professionals to increase physical activity during consecutive days of their hospital stay.
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Affiliation(s)
- Niek Koenders
- Department of Rehabilitation - Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mariska Weenk
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom H van de Belt
- Radboud Reshape Innovation Centre, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas J Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sebastian J H Bredie
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Kittelson AJ, Hoogeboom TJ, Schenkman M, Stevens-Lapsley JE, van Meeteren NLU. Person-Centered Care and Physical Therapy: A "People-Like-Me" Approach. Phys Ther 2019; 100:99-106. [PMID: 31608928 PMCID: PMC8204876 DOI: 10.1093/ptj/pzz139] [Citation(s) in RCA: 15] [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] [Received: 10/14/2019] [Accepted: 06/09/2019] [Indexed: 01/18/2023]
Abstract
In health care, "person centeredness" is a valued (though nebulous) concept. In physical therapy, clinical interactions often strive to be person-centered, for example, by focusing on participation and valuing patient empowerment. However, the available evidence has mostly been constructed around populations (or study samples) rather than individuals. In this perspective, an alternative evidence framework is described, constructed around measurements in routine practice. Specifically, the authors propose developing "people-like-me" reference charts, generated with historical outcomes data, to provide real-time information on an individual's status relative to similar people. The authors present an example of how this could work using their experience with people rehabilitating after total knee arthroplasty. They also describe several challenges that must be addressed to bring this innovation into practice. First, the most important outcome measures for stakeholders (eg, patients, clinicians) need to be identified and monitored longitudinally to ensure that "people-like-me" estimates are useful and support the goals of person-centered care. Statistical methods for selecting "people-like-me" need to be examined and refined. Finally, the "people-like-me" information needs to be packaged in such a way that it is accessible, intuitive, and helpful at the point of care. Ideally, the entire process should recognize from the outset that practice patterns evolve, so databases, statistical models, and decision tools should be dynamic by design. Ultimately, the authors propose this framework as a practical mechanism to advance person-centered decisions in physical therapy according to the ideals of evidence-based practice.
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Affiliation(s)
| | | | - Margaret Schenkman
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado; Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, Colorado
| | - Nico L U van Meeteren
- Department of Epidemiology and CAPHRI Research School, Maastricht University Medical Centre, Maastricht, the Netherlands; and Top Sector Life Sciences & Health, Health-Holland, the Hague, the Netherlands
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Driehuis F, Hoogeboom TJ, Nijhuis-van der Sanden MWG, de Bie RA, Staal JB. Spinal manual therapy in infants, children and adolescents: A systematic review and meta-analysis on treatment indication, technique and outcomes. PLoS One 2019; 14:e0218940. [PMID: 31237917 PMCID: PMC6592551 DOI: 10.1371/journal.pone.0218940] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/12/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Studies on effectiveness and safety of specific spinal manual therapy (SMT) techniques in children, which distinguish between age groups, are lacking. OBJECTIVE To conduct a systematic review of the evidence for effectiveness and harms of specific SMT techniques for infants, children and adolescents. METHODS PubMed, Index to Chiropractic Literature, Embase, CINAHL and Cochrane Library were searched up to December 2017. Controlled studies, describing primary SMT treatment in infants (<1 year) and children/adolescents (1-18 years), were included to determine effectiveness. Controlled and observational studies and case reports were included to examine harms. One author screened titles and abstracts and two authors independently screened the full text of potentially eligible studies for inclusion. Two authors assessed risk of bias of included studies and quality of the body of evidence using the GRADE methodology. Data were described according to PRISMA guidelines and CONSORT and TIDieR checklists. If appropriate, random-effects meta-analysis was performed. RESULTS Of the 1,236 identified studies, 26 studies were eligible. Infants and children/adolescents were treated for various (non-)musculoskeletal indications, hypothesized to be related to spinal joint dysfunction. Studies examining the same population, indication and treatment comparison were scarce. Due to very low quality evidence, it is uncertain whether gentle, low-velocity mobilizations reduce complaints in infants with colic or torticollis, and whether high-velocity, low-amplitude manipulations reduce complaints in children/adolescents with autism, asthma, nocturnal enuresis, headache or idiopathic scoliosis. Five case reports described severe harms after HVLA manipulations in four infants and one child. Mild, transient harms were reported after gentle spinal mobilizations in infants and children, and could be interpreted as side effect of treatment. CONCLUSIONS Based on GRADE methodology, we found the evidence was of very low quality; this prevented us from drawing conclusions about the effectiveness of specific SMT techniques in infants, children and adolescents. Outcomes in the included studies were mostly parent or patient-reported; studies did not report on intermediate outcomes to assess the effectiveness of SMT techniques in relation to the hypothesized spinal dysfunction. Severe harms were relatively scarce, poorly described and likely to be associated with underlying missed pathology. Gentle, low-velocity spinal mobilizations seem to be a safe treatment technique in infants, children and adolescents. We encourage future research to describe effectiveness and safety of specific SMT techniques instead of SMT as a general treatment approach.
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Affiliation(s)
- Femke Driehuis
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- * E-mail:
| | - Thomas J. Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Rob A. de Bie
- Caphri Research School, Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - J. Bart Staal
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, the Netherlands
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Leijendekkers RA, Hoogeboom TJ, van Hinte G, Didden L, Anijs T, Nijhuis-van der Sanden MWG, Verdonschot N. Reproducibility and discriminant validity of two clinically feasible measurement methods to obtain coronal plane gait kinematics in participants with a lower extremity amputation. PLoS One 2019; 14:e0217046. [PMID: 31112589 PMCID: PMC6528991 DOI: 10.1371/journal.pone.0217046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/23/2018] [Accepted: 05/03/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction Measuring coronal plane gait kinematics of the pelvis and trunk during rehabilitation of participants with a lower extremity amputation is important to detect asymmetries in gait which are hypothesised as associated with secondary complaints. The aim of this study was to test the reproducibility and discriminant validity of a three-dimensional (3-D; inertial measurement units) and a two-dimensional (2-D; video-based) system. Methods We tested the test-retest and inter-rater reproducibility of both systems and the 2-D system, respectively, in participants with a lower extremity amputation (group 1) and healthy subjects (group 2). The discriminant validity was determined with a within-group comparison for the 3-D system and with a between-group comparison for both systems. Results Both system showed to be test-retest reliable, both in group 1 (2-D system: ICC3.1agreement 0.52–0.83; 3-D system: ICC3.1agreement 0.81–0.95) and in group 2 (3-D system: ICC3.1agreement 0.33–0.92; 2-D system: ICC3.1agreement 0.54–0.95). The 2-D system was also inter-rater reliable (group 1: ICC2.1agreement 0.80–0.92; group 2: ICC2.1agreement 0.39–0.90). The within-group comparison of the 3-D system revealed a statistically significant asymmetry of 0.4°-0.5° in group 1 and no statistically significant asymmetry in group 2. The between-group comparison revealed that the maximum amplitude towards the residual limb (MARL) in the low back (3-D system) and the (residual) limb—trunk angle (2-D system) were significantly larger with a mean difference of 1.2° and 6.4°, respectively, than the maximum amplitude of healthy subjects. However, these average differences were smaller than the smallest detectable change (SDC) of group 1 for both the MARL (SDCagreement: 1.5°) and the residual limb—trunk angle (SDCagreement: 6.7°-7.6°). Conclusion The 3-D and 2-D systems tested in this study were not sensitive enough to detect real differences within and between participants with a lower extremity amputation and healthy subjects although promising reproducibility parameters for some of the outcome measures.
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Affiliation(s)
- Ruud A. Leijendekkers
- Department of Orthopaedics, Physical Therapy, Radboud University Medical Centre, Nijmegen, the Netherlands
- * E-mail:
| | - Thomas J. Hoogeboom
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Gerben van Hinte
- Department of Orthopaedics, Physical Therapy, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Lars Didden
- Radboud Institute for Health Sciences, Orthopaedic Research Laboratory, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Thomas Anijs
- Radboud Institute for Health Sciences, Orthopaedic Research Laboratory, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Maria W. G. Nijhuis-van der Sanden
- Department of Orthopaedics, Physical Therapy, Radboud University Medical Centre, Nijmegen, the Netherlands
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Nico Verdonschot
- Radboud Institute for Health Sciences, Orthopaedic Research Laboratory, Radboud University Medical Centre, Nijmegen, the Netherlands
- Laboratory for Biomechanical Engineering, University of Twente, Enschede, the Netherlands
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Leijendekkers RA, van Hinte G, Frölke JP, van de Meent H, Atsma F, Nijhuis-van der Sanden MWG, Hoogeboom TJ. Functional performance and safety of bone-anchored prostheses in persons with a transfemoral or transtibial amputation: a prospective one-year follow-up cohort study. Clin Rehabil 2019; 33:450-464. [PMID: 30537856 PMCID: PMC6416705 DOI: 10.1177/0269215518815215] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 06/05/2018] [Accepted: 11/01/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVES: (1) To compare level of function, activity, health-related quality of life (HRQoL) and satisfaction in persons with a lower extremity amputation before surgery and 6- and 12-months after implantation of an osseointegration implant and (2) to report adverse events. DESIGN: Prospective cohort study. SETTING: University medical centre. SUBJECTS: A total of 40 consecutive persons (median age: 56 years) who received a transfemoral (31) or transtibial (9) osseointegration implant, between April 2014 and March 2016. INTERVENTION: Osseointegration implant surgery followed by a predefined rehabilitation programme. MAIN MEASURES: Hip abductor strength, prosthetic use, back pain frequency, postoperative pain, mobility level (Timed-Up and Go (TUG) and wheelchair-boundedness), walking ability (6 minute walking test (6MWT) and walking distance in daily life), HRQoL, satisfaction regarding the prosthesis, and adverse events. RESULTS: Strength, prosthetic use, walking distance, HRQoL, and satisfaction level increased significantly at 6- and 12-month follow-up compared to baseline ( P ⩽ 0.002). The TUG showed no change at 6-month follow-up ( P = 0.420) but improved significantly at 12-month follow-up compared to baseline ( P = 0.005). Wheelchair-boundedness decreased from 12/40 participants at baseline to 0 at follow-ups. The 6MWT ( P ⩾ 0.038) and back pain ( P ⩾ 0.437) did not change over time. Stump pain was present in 28/39 and 22/40 of the participants at 6-and 12-month follow-up, respectively. The major adverse events were managed successfully and included three dual-cone breakages and four bone fractures. An uneventful course was completed by 19/31 transfemoral and 4/9 transtibial bone-anchored prostheses users. CONCLUSION: Bone-anchored prostheses lead to improved performance and appear to be safe, so they might be considered for persons with socket-related problems.
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Affiliation(s)
- Ruud A Leijendekkers
- Department of Orthopaedics, Physical
Therapy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gerben van Hinte
- Department of Orthopaedics, Physical
Therapy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Paul Frölke
- Department of Surgery, Radboud
University Medical Center, Nijmegen, The Netherlands
| | - Hendrik van de Meent
- Department of Rehabilitation, Radboud
University Medical Center, Nijmegen, The Netherlands
| | - Femke Atsma
- Department of IQ Healthcare, Radboud
Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The
Netherlands
| | - Maria WG Nijhuis-van der Sanden
- Department of Orthopaedics, Physical
Therapy, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Rehabilitation, Radboud
University Medical Center, Nijmegen, The Netherlands
- Department of IQ Healthcare, Radboud
Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The
Netherlands
| | - Thomas J Hoogeboom
- Department of IQ Healthcare, Radboud
Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The
Netherlands
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Kuijlaars IA, Sweerts L, Nijhuis-van der Sanden MW, van Balen R, Staal JB, van Meeteren NL, Hoogeboom TJ. Effectiveness of Supervised Home-Based Exercise Therapy Compared to a Control Intervention on Functions, Activities, and Participation in Older Patients After Hip Fracture: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2019; 100:101-114.e6. [DOI: 10.1016/j.apmr.2018.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/29/2018] [Accepted: 05/01/2018] [Indexed: 10/14/2022]
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Koenders N, Seeger JPH, van der Giessen T, van den Hurk TJ, Smits IGM, Tankink AM, Nijhuis - van der Sanden MWG, Hoogeboom TJ. Validation of a wireless patch sensor to monitor mobility tested in both an experimental and a hospital setup: A cross-sectional study. PLoS One 2018; 13:e0206304. [PMID: 30359448 PMCID: PMC6201929 DOI: 10.1371/journal.pone.0206304] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/10/2018] [Indexed: 11/26/2022] Open
Abstract
Purpose To assess the concurrent validity of a wireless patch sensor to monitor time lying, sitting/standing, and walking in an experimental and a hospital setup. Methods Healthy adults participated in two testing sessions: an experimental and real-world hospital setup. Data on time lying, sitting/standing, and walking was collected with the HealthPatch and concurrent video recordings. Validity was assessed in three ways: 1. test for mean differences between HealthPatch data and reference values; 2. Intraclass Correlation Coefficient analysis (ICC 3.1 agreement); and 3. test for mean differences between posture detection accuracies. Results Thirty-one males were included. Significant mean differences were found between HealthPatch data and reference values for sitting/standing (mean 14.4 minutes, reference: 12.0 minutes, p<0.01) and walking (mean 6.4 minutes, reference: 9.0 minutes, p<0.01) in the experimental setup. Good correlations were found between the HealthPatch data and video data for lying (ICC: 0.824) and sitting/standing (ICC: 0.715) in the hospital setup. Posture detection accuracies of the HealthPatch were significantly higher for lying and sitting/standing in the experimental setup. Conclusions Overall, the results show a good validity of the HealthPatch to monitor lying and poor validity to monitor sitting/standing or walking. In addition, the validity outcomes were less favourable in the hospital setup.
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Affiliation(s)
- Niek Koenders
- Department of Physiotherapy, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Gelderland, the Netherlands
- * E-mail:
| | - Joost P. H. Seeger
- Research group Musculoskeletal Rehabilitation, HAN university of applied sciences, Nijmegen, Gelderland, the Netherlands
| | - Teun van der Giessen
- Research group Musculoskeletal Rehabilitation, HAN university of applied sciences, Nijmegen, Gelderland, the Netherlands
| | - Ties J. van den Hurk
- Research group Musculoskeletal Rehabilitation, HAN university of applied sciences, Nijmegen, Gelderland, the Netherlands
| | - Indy G. M. Smits
- Research group Musculoskeletal Rehabilitation, HAN university of applied sciences, Nijmegen, Gelderland, the Netherlands
| | - Anne M. Tankink
- Research group Musculoskeletal Rehabilitation, HAN university of applied sciences, Nijmegen, Gelderland, the Netherlands
| | | | - Thomas J. Hoogeboom
- IQ healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, Gelderland, the Netherlands
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Koenders N, van Oorsouw R, Seeger JPH, Nijhuis – van der Sanden MWG, van de Glind I, Hoogeboom TJ. “I’m not going to walk, just for the sake of walking…”: a qualitative, phenomenological study on physical activity during hospital stay. Disabil Rehabil 2018; 42:78-85. [DOI: 10.1080/09638288.2018.1492636] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Niek Koenders
- Orthopaedics Department – Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Roel van Oorsouw
- Orthopaedics Department – Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joost P. H. Seeger
- Research Group Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | | | - Irene van de Glind
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thomas J. Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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Koenders N, Rushton A, Verra ML, Willems PC, Hoogeboom TJ, Staal JB. Pain and disability after first-time spinal fusion for lumbar degenerative disorders: a systematic review and meta-analysis. Eur Spine J 2018; 28:696-709. [DOI: 10.1007/s00586-018-5680-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 06/21/2018] [Indexed: 01/29/2023]
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Leijendekkers RA, Marra MA, Ploegmakers MJM, Van Hinte G, Frölke JP, Van De Meent H, Staal JB, Hoogeboom TJ, Verdonschot N. Magnetic-resonance-imaging-based three-dimensional muscle reconstruction of hip abductor muscle volume in a person with a transfemoral bone-anchored prosthesis: A feasibility study. Physiother Theory Pract 2018; 35:495-504. [PMID: 29589767 DOI: 10.1080/09593985.2018.1453902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Persons with transfemoral amputation typically have severe muscle atrophy of the residual limb. The effect of bone-anchored prosthesis use on existing muscle atrophy is unknown. A potentially feasible method to evaluate this is magnetic resonance imaging (MRI)-based three-dimensional (3D) muscle reconstruction. We aimed to (1) examine the feasibility of MRI-based 3D muscle reconstruction technique in a person with a cobalt-chrome-molybdenum transfemoral bone-anchored prosthesis; and (2) describe the change of hip abductor muscle volume over time. METHODS In this single case, 1-year follow-up study we reconstructed the 3D hip abductor muscle volumes semiautomatically from MRI scans at baseline, 6- and 12-month follow-up. The number of adverse events, difficulties in data analysis, time investment and participants' burden determined the level of feasibility. RESULTS We included a man (70 years) with a transfemoral amputation who received a bone-anchored prosthesis after 52 years of socket prosthesis use. No adverse events occurred. The accuracy of the 3D reconstruction was potentially reduced by severe adipose tissue interposition. Data analysis was time-intensive (115 h). Participants' burden was limited to 3-h time investment. Compared to baseline, the total hip abductor volume of both the residual limb (6 month: 5.5%; 12 month: 7.4%) and sound limb (6 month: 7.8%; 12 month: 5.5%) increased. CONCLUSION The presented technique appears feasible to follow muscle volume changes over time in a person with a cobalt-chrome-molybdenum transfemoral bone-anchored prosthesis in an experimental setting. Future research should focus on analysis of muscle tissue composition and the feasibility in bone-anchored prostheses of other alloys.
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Affiliation(s)
- Ruud A Leijendekkers
- a Department of Orthopaedics , Physical Therapy, Radboud University Medical Centre , Nijmegen , Netherlands
| | - Marco A Marra
- b Radboud Institute for Health Sciences, Orthopaedic Research Laboratory , Radboud University Medical Centre , Nijmegen , Netherlands
| | - Marieke J M Ploegmakers
- c Department of Radiology and Nuclear Medicine , Radboud University Medical Centre , Nijmegen , Netherlands
| | - Gerben Van Hinte
- a Department of Orthopaedics , Physical Therapy, Radboud University Medical Centre , Nijmegen , Netherlands
| | - Jan Paul Frölke
- d Department of Surgery , Radboud University Medical Centre , Nijmegen , Netherlands
| | - Hendrik Van De Meent
- e Department of Rehabilitation , Radboud University Medical Centre , Nijmegen , Netherlands
| | - J Bart Staal
- f Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre , Nijmegen , Netherlands.,g Research group Musculoskeletal Rehabilitation, HAN University of Applied Sciences , Nijmegen , Netherlands
| | - Thomas J Hoogeboom
- f Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre , Nijmegen , Netherlands
| | - Nico Verdonschot
- b Radboud Institute for Health Sciences, Orthopaedic Research Laboratory , Radboud University Medical Centre , Nijmegen , Netherlands.,h Laboratory for Biomechanical Engineering, University of Twente , Enschede , Netherlands
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