Search

Item does not contain fulltext The purposes of this prospective cohort study were (1) to assess if second anterior cruciate ligament (ACL) injury rate 2 years after ACL reconstruction (ACLR) in those who returned to pivoting sport was associated with meeting (a) quantitative return to sport (RTS) criteria, (b) qualitative RTS criteria, and (c) combined quantitative and qualitative RTS criteria, and (2) to determine why athletes did not return to their preinjury (level of) sport. Athletes after ACLR performed RTS tests immediately before RTS: seven movement quantity (strength and hop test battery) and two movement quality (countermovement jump with LESS score and hop-and-hold test) tests. A 2-year postoperative questionnaire asked for RTS, reasons for not returning to the same (level of) sport and second ACL injuries. One hundred and forty-four athletes (82%) completed the questionnaire and 97 of them returned to a pivoting sport. Seven of these athletes had a second ACL injury. Meeting the hop test battery RTS criterion (absolute risk reduction 11%; p = .047) and hop-and-hold test RTS criterion (absolute risk reduction 15%; p = .031) were both significantly associated with a reduced second ACL injury rate. Meeting combined RTS criteria were not significantly associated with second ACL injury rate. Therefore, RTS tests after ACLR should at least comprise a hop test battery or the hop-and-hold test to reduce second ACL injury risk after return to pivoting sport. Also, one-third of all athletes mentioned fear of reinjury as the main reason for not returning to their preinjury (level of) sport. This psychological component should be taken seriously and discussed during rehabilitation.

Contains fulltext : 249012.pdf (Publisher’s version ) (Open Access) Background: The optimal treatment for a distal radius fracture (DRF) remains an ongoing discussion. This study observed whether early activity postinjury can lead to the prevention of type 1 complex regional pain syndrome (CRPS-1). Method: Patients who underwent nonoperative treatment for a DRF were invited to participate in this study. Patients followed an exercise program with progressive loading exercises at home immediately after cast removal. After a minimum of 3 months, patients were interviewed by telephone to determine the presence of disproportionate pain. If present, the patients were seen during a clinical consultation to determine whether they had CRPS-1, using the Budapest Diagnostic Criteria. Results: Of the 129 patients included in this study, 12 reported disproportionate pain, and none were diagnosed with CRPS-1. The incidence of CRPS-1 was zero in this study. Conclusion: A more active treatment approach seems to lower the incidence of CRPS-1. A larger randomized study is necessary to strengthen the evidence.

INTRODUCTION: Apalutamide and darolutamide are next-generation androgen receptor inhibitors that have demonstrated superior efficacy compared to placebo in men with non-metastatic castration-resistant prostate cancer (nmCRPC) receiving androgen deprivation therapy (ADT). In the absence of head-to-head studies, the present study sought to indirectly compare the efficacy and tolerability between these two treatments. METHODS: This anchored matching-adjusted indirect comparison (MAIC) used patient-level data from the phase 3, randomized, controlled SPARTAN study (apalutamide + ADT), weighted to match aggregate published data from the ARAMIS study (darolutamide + ADT) for clinically relevant baseline measures. Hazard ratios (HR) and 95% credible intervals (CrI) were estimated for efficacy endpoints: metastasis-free survival (MFS), prostate-specific antigen (PSA) progression, progression-free survival (PFS), and overall survival (OS). Odds ratios were estimated for tolerability outcomes: adverse events and serious adverse events. RESULTS: Before weighting, baseline characteristics from SPARTAN versus ARAMIS were different for median PSA (7.8 vs. 9.2 ng/mL), Eastern Cooperative Oncology Group performance status of 1 (23% vs. 31%), use of bone-targeted agents (10% vs. 4%), median time from initial diagnosis (94.9 vs. 85.4 months), and proportion of patients from North America (35% vs. 12%) and Europe (50% vs. 64%). After matching (n = 455), our analysis demonstrated that apalutamide + ADT had a Bayesian probability of being more effective than darolutamide + ADT for MFS [98.3%; HR 0.70 (95% CrI 0.51, 0.98)], PSA progression [~ 100%; HR 0.46 (95% CrI 0.33, 0.64)], and PFS [93.2%; HR 0.79 (95% CrI 0.59, 1.08)]. Results for OS and tolerability were similar between apalutamide + ADT and darolutamide + ADT. CONCLUSION: This anchored MAIC analysis of pivotal phase 3 studies in patients with nmCRPC suggests that apalutamide + ADT is more effective than darolutamide + ADT for MFS, progression-free survival (PFS), and prostate-specific antigen (PSA) progression, with a similar OS benefit and tolerability profile. TRIAL REGISTRATION: ARAMIS ClinicalTrials.gov number: NCT02200614; SPARTAN ClinicalTrials.gov number: NCT01946204. ispartof: ADVANCES IN THERAPY vol:39 issue:1 pages:518-531 ispartof: location:United States status: published

OBJECTIVE This study estimated the comparative efficacy of ciltacabtagene autoleucel (cilta-cel) versus the approved idecabtagene vicleucel (ide-cel) dose range of 300-460 × 106 CAR-positive T-cells for the treatment of patients with relapsed or refractory multiple myeloma (RRMM) who were previously treated with a proteasome inhibitor, an immunomodulatory drug, and an anti-CD38 monoclonal antibody (i.e. triple-class exposed) using matching-adjusted indirect treatment comparisons (MAICs). METHODS MAICs were performed with individual patient data for cilta-cel (CARTITUDE-1; NCT03548207) and published summary-level data for ide-cel (KarMMa; NCT03361748). Treated patients from CARTITUDE-1 who satisfied the eligibility criteria for KarMMa were included in the analyses. The MAIC adjusted for unbalanced baseline covariates of prognostic significance identified in the literature and by clinical expertise. Comparative efficacy was estimated for overall response rate (ORR), complete response or better (≥CR) rate, duration of response (DoR), progression-free survival (PFS), and overall survival (OS). RESULTS Cilta-cel was associated with statistically significantly improved ORR (odds ratio [OR]: 94.93 [95% confidence interval [CI]: 21.86, 412.25; p

Item does not contain fulltext OBJECTIVE: To (1) classify patients who are recovering from total knee arthroplasty (TKA) based on walking speed during an early physical therapy program, and (2) assess whether walking-speed trajectory predicts performance on the timed up-and-go (TUG) test. DESIGN: Cohort study. METHODS: We included 218 patients from a 10-day physical therapy program after TKA. A latent class mixed model was used to classify patients according to their walking-speed trajectory during the program. We assessed the change in TUG test score from pre-TKA to 6 weeks and 1 year after TKA. The association between change in TUG test score and walking-speed trajectory was assessed using multivariable regression. RESULTS: There were 2 groups with distinct walking-speed trajectories: a high-gain group (46%) and a low-gain group (54%). There was no significant association between change in TUG test score and walking-speed trajectory after TKA and physical therapy. Function (based on TUG test performance) improved for all patients 1 year after TKA, irrespective of walking-speed trajectory (ie, high or low gain) early in postoperative physical therapy. CONCLUSION: Although we distinguished different groups based on functional outcomes during physical therapy, the clinical relevance of classifying patients based on walking speed remains unclear, as it did not predict short- and long-term functional outcomes. J Orthop Sports Phys Ther 2021;51(7):362-371. Epub 10 May 2021. doi:10.2519/jospt.2021.10299.

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. (C) 2021 Australian Physiotherapy Association. Published by Elsevier B.V.

Contains fulltext : 248597.pdf (Publisher’s version ) (Open Access) Introduction: Movement observation is a core aspect in physical therapists' diagnosis to determine which interventions are adequate to improve functional abilities. The aim of this study was to derive design principles for an educational program for the development of observational skills.Methods: We used a qualitative approach within a design-based research methodology. In four rounds, 8 physical therapy students, 16 teachers, and 9 practitioners participated in five Nominal Group Technique meetings and six interviews. Meetings and interviews were transcribed verbatim and analyzed using thematic analysis.Results: We identified three themes, each with several design principles: (1) didactics; (2) professional content; and (3) conditions for optimal learning. We developed a proto-theory underpinned with underlying educational theories.Conclusions: To learn observational skills, students, facilitated by an experienced teacher, need to take the lead in their own learning process. This might imply a need for additional training for teachers. A realistic context is a precondition for learning; it might be necessary to increase possibilities for observations in clinical contexts or to invest in training for (simulated) patients as participants in education. Further research is needed to test the applicability of the design principles and a proto-theory for other professionals with a focus on observation and analysis of movements.

Contains fulltext : 248675.pdf (Publisher’s version ) (Open Access) BACKGROUND: Children with Developmental Coordination Disorder (DCD) have motor coordination deficits leading to difficulties in sports and play that require adaptations of the walking pattern. Children with DCD indeed demonstrate poorer walking adaptability (WA) compared to typically developing children, but it remains elusive whether WA can be improved by training. RESEARCH QUESTION: Does augmented-reality treadmill training lead to improvements in WA in children with DCD? METHODS: Seventeen children with DCD were included in this proof-of-concept intervention study. They received a six-session training on the C-mill, a treadmill on which gait adjustments can be evoked by projected visual context. The effect of the training was evaluated before (M1), directly after training (M2) and after 6 months follow-up (M3) using the WAL-K (single and double run) and WA-tasks on the C-mill (as a single and with concurrent visuo-motor and cognitive task). In addition, parents completed a questionnaire on their perception of the training. Linear Mixed Model analyses were performed to assess the differences in WAL-K scores and success rates on the WA-tasks between M1-M2 and M1-M3. RESULTS: Children significantly improved on the WAL-K double run and on all three WA-tasks between M1-M2 and M1-M3. Children did not improve on the WAL-K single run. Parents found the training useful and fun for their child and indicated that their child fell less frequently. SIGNIFICANCE: The results show that C-mill training had positive and task-specific effects on WA in children with DCD, which effects generalized to an overground task and were retained at 6 months follow-up. This may help children with DCD to better participate in daily activities. Future research should include a control group to examine the effectiveness of the training program compared to receiving no training and may also examine the effect of the training on participation in daily life.

Objective SSc is a complex CTD affecting mental and physical health. Fatigue, hand function loss, and RP are the most prevalent disease-specific symptoms of systemic sclerosis. This study aimed to develop consensus and evidence-based recommendations for non-pharmacological treatment of these symptoms. Methods A multidisciplinary task force was installed comprising 20 Dutch experts. After agreeing on the method for formulating the recommendations, clinically relevant questions about patient education and treatments were inventoried. During a face-to-face task force meeting, draft recommendations were generated through a systematically structured discussion, following the nominal group technique. To support the recommendations, an extensive literature search was conducted in MEDLINE and six other databases until September 2020, and 20 key systematic reviews, randomized controlled trials, and published recommendations were selected. Moreover, 13 Dutch medical specialists were consulted on non-pharmacological advice regarding RP and digital ulcers. For each recommendation, the level of evidence and the level of agreement was determined. Results Forty-one evidence and consensus-based recommendations were developed, and 34, concerning treatments and patient education of fatigue, hand function loss, and RP/digital ulcers-related problems, were approved by the task force. Conclusions These 34 recommendations provide guidance on non-pharmacological treatment of three of the most frequently described symptoms in patients with systemic sclerosis. The proposed recommendations can guide referrals to health professionals, inform the content of non-pharmacological interventions, and can be used in the development of national and international postgraduate educational offerings.

Treatment of temporomandibular disorder (TMD) currently consists of a combination of noninvasive therapies and may be supported by e-Health. It is, however, unclear if physical therapists and patients are positive towards the use of e-Health. To assess the needs, facilitators and barriers of the use of an e-Health application from the perspective of both orofacial physical therapists and patients with TMD. A descriptive qualitative study was performed. Eleven physical therapists and nine patients with TMD were interviewed using a topic guide. Thematic analysis was applied, and findings were ordered according to four themes: acceptance of e-Health, expected utility, usability and convenience. Physical therapists identified the need for e-Health as a supporting application to send questionnaires, animated exercises and evaluation tools. Key facilitators for both physical therapists and patients for implementing e-Health included the increase in self-efficacy, support of data collection and personalization of the application. Key barriers are the increase of screen time, the loss of personal contact, not up-to-date information and poor design of the application. Physical therapists and patients with TMD are positive towards the use of e-Health, in a blended form with the usual rehabilitation care process for TMD complaints.Implications for rehabilitationThe rehabilitation process of temporomandibular complaints may be supported by the use of e-Health applications.Physical therapists and patients with temporomandibular disorders are positive towards the use of e-Health as an addition to the usual care.Especially during the treatment process, there is a need for clear animated videos and reminders for the patients. The rehabilitation process of temporomandibular complaints may be supported by the use of e-Health applications. Physical therapists and patients with temporomandibular disorders are positive towards the use of e-Health as an addition to the usual care. Especially during the treatment process, there is a need for clear animated videos and reminders for the patients.

Objective This observational study explores advanced practice nurses’ (APN) performance in secondary prevention and self-management support in patients with cardiovascular disease. Methods Real-life consultations in three outpatient clinics were recorded on audio and analysed. First, discussed (sub)categories were determined using five categories of self-management: symptom management, treatment, biomedical cardiovascular risk factors, psychosocial consequences, and lifestyle changes. Second, the extent in which motivational interviewing aspects were applied was determined using the Behaviour Change Counselling Index (BECCI). Results In total, 49 consultations performed by five female APNs were analysed. Physical topics were discussed in 98% and psychological subthemes in 41% of the consultations. Although not all components of motivational interviewing were applied, talking about current behaviour and behaviours that should change were discussed, and information was provided. Especially setting targets and exchanging ideas on how to reach behavioural goals were applied to a small extent. Conclusion Well-trained APNs in the current study do not carry out motivational interviewing in a structural and complete manner according to BECCI and do not discuss all self-management categories. Practice implications Psychological topics should be more integrated in providing self-management support by APNs and the application of motivational interviewing should be enhanced by regularly and repeated training.

Background LATITUDE was the first phase 3 trial examining the survival benefit of adding abiraterone acetate (AA) + prednisone (P) to androgen-deprivation therapy (ADT) in newly diagnosed metastatic, castration-sensitive prostate cancer (mCSPC). Due to significant improvement in overall survival after the first interim analysis, patients in the placebos + ADT arm could switch to AA + P + ADT during an open-label extension. As in other studies where switching is allowed, statistical adjustments are needed to assess the real benefit of new drugs. Patients and Methods This was a post hoc analysis to estimate the true survival benefit of AA + P + ADT in patients with newly diagnosed mCSPC by applying statistical adjustments commonly used to adjust for treatment switching. Results Of 112 patients still receiving placebos + ADT at the first interim analysis, 72 switched to AA + P + ADT during the open-label extension. Final analysis was conducted after median follow-up of 51.8 months. Compared to the placebos + ADT arm, the risk of death in the AA + P + ADT arm was 34% lower [hazard ratio (HR) = 0.663 (95% confidence interval 0.566–0.778)] by unadjusted intent-to-treat analysis, 37% lower [HR = 0.629 (95% confidence interval 0.526–0.753)] by rank preserving structure failure time modeling, and 38% lower [HR = 0.616 (95% confidence interval 0.524–0.724)] by inverse probability of censoring weights. Conclusions Analyses adjusting for treatment switching using two different statistical approaches confirm the improved survival benefit of adding AA + P to ADT in patients with newly diagnosed mCSPC. Trial Registration ClinicalTrials.gov identifier NCT01715285. Electronic supplementary material The online version of this article (10.1007/s11523-019-00685-x) contains supplementary material, which is available to authorized users.

PURPOSE: Taste alterations (TA) and oral discomfort in cancer patients are neglected side effects of the disease and treatments. They contribute to poor appetite, decrease food intake and affect quality of life, leading to adverse outcomes such as malnutrition and depression. The study aimed to explore TAs in relation to other oral conditions causing discomfort in cancer patients. Additionally, the correlation between patients' acidity of saliva and experienced TAs and oral discomfort was evaluated.METHODS: A case study including 100 patients diagnosed with cancer receiving chemotherapy or immunotherapy. Data were collected using two questionnaire forms: the Chemotherapy-induced Taste Alteration Scale (CiTAS) and an additional information questionnaire. Saliva samples were collected for each patient and measured with a pocket pH meter. Data were analysed using descriptive statistics, and comparisons were performed using the Kruskal-Wallis H test, Mann-Whitney U test and Fisher's exact test.RESULTS: The prevalence of reported TAs was 93%. Patient age, oral discomfort and swallowing difficulty were found to be significant factors for experienced TAs (p CONCLUSION: CiTAS proved to be a convenient tool to collect information about TAs in cancer patients. Using the CiTAS tool, a high prevalence (93%) of reported TAs in cancer patients receiving chemo- or immunotherapy was found. CiTAS provides a fast and cheap recognition of symptoms and causes of TAs that can be addressed.

Migraine, tension-type headache (TTH) and headaches attributed to temporomandibular disorders (TMD) are prevalent in patients with TMD-pain. The objective was to describe the course of headache complaints as compared to the course of TMD complaints in TMD-pain patients with headache during usual care multidisciplinary treatment for TMD. This was a 12-week longitudinal observational study following adults with TMD-pain and headache during a usual-care multidisciplinary TMD-treatment. The Graded Chronic Pain Scale was used for both TMD and headache to measure pain-related disability (primary outcome measure), pain intensity, days with pain and days experiencing disability (secondary outcome measures). Stratified for the headache type, general linear modelling for repeated measures was used to analyze changes over time in the TMD complaints and the headache complaints. TMD-pain patients with migraine (n = 22) showed significant decrease of pain-related disability for both TMD and headache complaints over time. No difference in the effect over time was found between the two complaints. Patients with TMD-pain and TTH (n = 21) or headache attributed to TMD (n = 17) did not improve in disability over time. For the secondary outcome measures, the results were equivocal. In conclusion, TMD-pain patients with migraine, improvement in TMD-related disability was comparable to headache-related disability for TMD-pain patients with TTH or with headache attributed to TMD, no improvements in disability were found.

Contains fulltext : 235057.pdf (Publisher’s version ) (Closed access) 01 juni 2021

Aim To systematically review the available literature on the diagnostic accuracy of questionnaires and measurement instruments for headaches associated with musculoskeletal symptoms. Design Articles were eligible for inclusion when the diagnostic accuracy (sensitivity/specificity) was established for measurement instruments for headaches associated with musculoskeletal symptoms in an adult population. The databases searched were PubMed (1966–2018), Cochrane (1898–2018) and Cinahl (1988–2018). Methodological quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist for criterion validity. When possible, a meta-analysis was performed. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) recommendations were applied to establish the level of evidence per measurement instrument. Results From 3450 articles identified, 31 articles were included in this review. Eleven measurement instruments for migraine were identified, of which the ID-Migraine is recommended with a moderate level of evidence and a pooled sensitivity of 0.87 (95% CI: 0.85–0.89) and specificity of 0.75 (95% CI: 0.72–0.78). Six measurement instruments examined both migraine and tension-type headache and only the Headache Screening Questionnaire – Dutch version has a moderate level of evidence with a sensitivity of 0.69 (95% CI 0.55–0.80) and specificity of 0.90 (95% CI 0.77–0.96) for migraine, and a sensitivity of 0.36 (95% CI 0.21–0.54) and specificity of 0.86 (95% CI 0.74–0.92) for tension-type headache. For cervicogenic headache, only the cervical flexion rotation test was identified and had a very low level of evidence with a pooled sensitivity of 0.83 (95% CI 0.72–0.94) and specificity of 0.82 (95% CI 0.73–0.91). Discussion The current review is the first to establish an overview of the diagnostic accuracy of measurement instruments for headaches associated with musculoskeletal factors. However, as most measurement instruments were validated in one study, pooling was not always possible. Risk of bias was a serious problem for most studies, decreasing the level of evidence. More research is needed to enhance the level of evidence for existing measurement instruments for multiple headaches.

Contains fulltext : 205409.pdf (Publisher’s version ) (Open Access) Caries progression seems to follow universal, predictable rates, depending largely on the caries severity in populations: the higher the caries severity, the higher the progression rates. Quantification of these rates would allow prediction of future caries increments. Our aim was to describe caries progression rates in the primary and permanent dentition in Western populations (not in lesions) of children and adolescents. Therefore, we systematically searched MEDLINE-PubMed, Embase, CINAHL, and the Cochrane library for studies reporting caries progression data. Eligibility criteria were reporting empirical data from at least 2 full-mouth dental caries examinations in a closed cohort during a follow-up of at least 3 y, a first examination after 1974, a second examination before the age of 22 y, caries assessed as dentine caries (d3/D3), and caries reported in dmfs/DMFS (decayed, missing, and filled surfaces), dmft/DMFT (decayed, missing, and filled teeth), or caries-free participants. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we described the results for the primary and permanent dentition in a systematic review, performed a meta-analysis for the caries incidence rate in the permanent dentition, and conducted multivariate, hierarchical meta-regression analyses for the caries incidence rate and the increments in DMFS and DMFT. Of the 6,343 unique studies retrieved, 43 studies (56,376 participants) were included for systematic review and 32 for meta-analyses (39,429 participants). The annual decline in caries-free children in the permanent dentition ranged from 0.8% to 10.2%. The annual increment ranged from 0.07 to 1.77 in DMFS and from 0.06 to 0.73 in DMFT. The pooled caries incidence rate was 0.11 (0.09-0.13) per person-year at risk. Meta-regression analyses showed that the methods of individual studies influenced pooled caries incidence rates and increments in DMFS and DMFT. This should be taken into account in planning and evaluation of oral health care services. However, the caries incidence rate is promising for prediction of future caries increments in populations.

Elevated levels of chlorpyrifos‑methyl have been detected in plant-based Atlantic salmon feeds. To evaluate the potential negative effects of long-term and continuous dietary exposure to chlorpyrifos‑methyl in fish, we fed juvenile Atlantic salmon three concentrations (0.1, 1.0 and 8.0 mg/kg) of the pesticide for about two months. Brain and liver tissues were collected after 30 and 67 days of exposure. Homogenized brain tissue was examined for effects on acetylcholinesterase, and brain and liver tissue from fish exposed to 8.0 mg/kg were used for transcriptional analysis (RNA-seq). The results showed a transient accumulation of chlorpyrifos‑methyl in the brain with lower levels after 67 days of exposure compared to after 30 days of exposure. In contrast, the liver showed a time-dependent accumulation pattern. No effect on acetylcholinesterase activity, the primary target of chlorpyrifos‑methyl, was seen in the brain. However, after 30 days of exposure, 98 significantly differentially expressed genes (DEGs) were found in brain tissue and 239 DEGs in liver tissue. After 67 days of exposure, two and 258 DEGs were found in brain and liver tissue, respectively. Continuous dietary exposure of chlorpyrifos‑methyl most profoundly affected mechanisms associated with protein degradation and lipid metabolism in both brain and liver. Specific for the brain, many of the significant DEGs encode proteins involved in neuron function. In conclusion, this study shows that chlorpyrifos‑methyl affects the transcription of genes involved in neurological function in Atlantic salmon brain, even at exposure concentrations below the threshold for systemic toxicity as seen from brain acetylcholinesterase inhibition.

Objective This study aims to explain the earlier findings of a Randomized Controlled Trial (RCT), which showed that rheumatoid arthritis (RA) patients did not benefit from an online self-management program. Moreover, less patients than expected used the program. Methods As part of an explorative RCT, patients were interviewed to explore their (non) usage of the program. Purposive sampling (n = 21) was used to select patients from four groups of patients (n = 49): 1) non-users; 2) low users; 3) high users basic; 4) high users plus. Results The program supported only a small group of patients because: 1) not all patients were motivated to use the program, 2) patients had no clear expectation or had differing expectations of the program, 3) there was a mismatch between individual patients’ support needs and the needs included in the program, 4) reminders were only sent to fill in the diaries for pain and fatigue, not to use the program modules. Conclusion This study offers insights in the (non-) usage of online programs and how usage could be increased in practice. Practical implications Health professionals should be involved in the implementation of this online programs and should inform patients what the program could bring them.

Introduction Sleep disruption is a characteristic of Alzheimer's disease (AD) that may exacerbate disease progression. This study tested whether a dual orexin receptor antagonist (DORA) would enhance sleep and attenuate neuropathology, neuroinflammation, and cognitive deficits in an AD-relevant mouse model, 5XFAD. Methods Wild-type (C57Bl6/SJL) and 5XFAD mice received chronic treatment with vehicle or DORA-22. Piezoelectric recordings monitored sleep and spatial memory was assessed via spontaneous Y-maze alternations. Aβ plaques, Aβ levels, and neuroinflammatory markers were measured by immunohistochemistry, enzyme-linked immunosorbent assay, and real-time polymerase chain reaction, respectively. Results In 5XFAD mice, DORA-22 significantly increased light-phase sleep without reducing Aβ levels, plaque density, or neuroinflammation. Effects of DORA-22 on cognitive deficits could not be determined because the 5XFAD mice did not exhibit deficits. Discussion These findings suggest that DORAs may improve sleep in AD patients. Further investigations should optimize the dose and duration of DORA-22 treatment and explore additional AD-relevant animal models and cognitive tests., Highlights • Daily DORA-22 treatment at light onset for 5 weeks increased sleep in 5XFAD mice. • DORA-22 mainly increased sleep during the light (inactive) phase. • Chronic DORA-22 treatment did not affect cortical amyloid β levels or plaques. • Chronic DORA-22 treatment did not alter cortical neuroinflammation.

Purpose Athletes who meet return to play (RTP) criteria after anterior cruciate ligament reconstruction (ACLR) rehabilitation still have a substantially increased risk of second ACL injury. One of the contributing factors to this increased risk could be that the RTP criteria are often not tested in an ecologically valid environment and in a fatigued state. The purpose of this cross-sectional case-control study was to investigate the influence of neuromuscular fatigue on both movement quantity and quality in fully-rehabilitated soccer players after ACLR and to compare them with healthy soccer players. Methods ACL-reconstructed soccer players (n = 14) and healthy soccer players (n = 19) participated in the study and were matched by playing level and training hours. RTP measurements were performed on the soccer field, in both a non-fatigued and fatigued state. The RTP measurements focussed on both movement quantity (hop tests) and quality [countermovement jump with a Landing Error Scoring System (LESS) score]. Results Movement quantity did not differ between ACL-reconstructed and healthy soccer players, both expressed in absolute values and the LSI-D/ND (calculated as dominant/non-dominant*100%). However, movement quality decreased more in the ACL-reconstructed soccer players in the fatigued state compared to the non-fatigued state. Conclusions Ideally, RTP measurements should focus on movement quality and should be conducted on the soccer field in a fatigued state, creating an ecologically valid environment. The LSI-D/ND can be used as an outcome parameter for RTP measurements of movement quantity and should be at least 95%. Level of evidence Therapeutic, Level III. Electronic supplementary material The online version of this article (10.1007/s00167-018-5149-2) contains supplementary material, which is available to authorized users.

Late in 2015 the Royal Dutch Dental Association (KNMT) conducted a study of the therapeutic prescription of antibiotics and NSAIDs by dentists in general practice in the Netherlands and the factors influencing their decisions. Of the 1,087 dentists contacted 367 (34%) completed the online questionnaire. In the 4 weeks preceding the study they had prescribed an antibiotic to 1.3% of their patients on average. A fifth (20%) found it difficult to decide whether an anti-inflammatory drug is indicated and/or whether this should be an antibiotic or a NSAID. Questioned about medication decisions (whether or not antibiotics are indicated) in 11 fictional cases, 11% of respondents judged every case correctly. 39% undertreated, 24% overtreated and 26% both undertreated and overtreated. In the last two categories, dentists with non-Dutch degrees are overrepresented. More than half (55%) of the respondents say they need a guideline for prescribing antibiotics in dental treatment and 28% (also) need postgraduate education on this matter.Eind 2015 onderzocht de KNMT de indicatie voor het therapeutisch voorschrijven van antibiotica en NSAID’s door tandarts-algemeen practici in Nederland en factoren die daarbij een rol spelen. Van de 1.087 benaderde tandartsen vulden er 367 (34%) de webenquête in. Zij schreven in de 4 aan het onderzoek voorgaande weken aan gemiddeld 1,3% van hun patiënten een antibioticum voor. Een vijfde (20%) had moeite met de afweging of een ontstekingsremmer is geïndiceerd en/of met de keuze tussen antibioticum of NSAID. Gevraagd om medicatiebeslissingen (al of geen antibioticum geïndiceerd) bij 11 vignetten (fictieve casussen) beoordeelde 11% van de respondenten elk daarvan juist. Bij 39% was sprake van onderbehandeling, bij 24% overbehandeling en bij 26% van zowel overals onderbehandeling. Buitenslands gediplomeerde respondenten waren oververtegenwoordigd in de laatste 2 categorieën. Ruim de helft (55%) van de deelnemers bleek behoefte te hebben aan een richtlijn voor het voorschrijven van antibioticum bij tandheelkundige behandelingen en 28% (ook) aan bij- en nascholing op dit gebied.

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.

Background: Investigating disease mechanisms and treatment responses in obstructive airway diseases with invasive sampling are hampered by the small size and mechanical artefacts that conventional forceps biopsies suffer from. Endoscopic cryobiopsies are larger and more intact and are being increasingly used. However, the technique has not yet been explored for obtaining mucosa biopsies. Objective: To investigate differences in size and quality of endobronchial mucosal biopsies obtained with cryotechnique and forceps. Further, to check for eligibility of cryobiopsies to be evaluated with immunohistochemistry and in situ hybridization and to investigate tolerability and safety of the technique. Methods: Endobronchial mucosal biopsies were obtained with cryotechnique and forceps from patients with haemoptysis undergoing bronchoscopy and evaluated by quantitative morphometry, automated immunohistochemistry and in situ hybridization. Results: A total of 40 biopsies were obtained from 10 patients. Cross-sectional areas were threefold larger in cryobiopsies (median: 3.08 mm2 (IQR: 1.79) vs 1.03 mm2 (IQR: 1.10), P < 0.001). Stretches of intact epithelium were 8-fold longer (median: 4.61 mm (IQR: 4.50) vs 0.55 mm (IQR: 1.23), P = 0.001). Content of glands (median: 0.095 mm2 (IQR: 0.30) vs 0.00 mm2 (IQR: 0.01), P = 0.002) and airway smooth muscle (median: 0.25 mm2 (IQR: 0.30) vs 0.060 mm2 (IQR: 0.11), P = 0.02) was higher in the cryobiopsies compared with forceps biopsies. Further, the cryobiopsies had well-preserved protein antigens and mRNA. Mild to moderate bleeding was the only complication observed. Conclusion and clinical relevance: By yielding significantly larger and more intact biopsies, the cryotechnique represents a valuable new research tool to explore the bronchi in airway disease. Ultimately with the potential to create better understanding of underlying disease mechanisms and improvement of treatments. (Less)

Long-read sequencing (LRS) has the potential to comprehensively identify all medically relevant genome variation, including variation commonly missed by short-read sequencing (SRS) approaches. To determine this potential, we performed LRS around 15×-40× genome coverage using the Pacific Biosciences Sequel I System for five trios. The respective probands were diagnosed with intellectual disability (ID) whose etiology remained unresolved after SRS exomes and genomes. Systematic assessment of LRS coverage showed that ~35 Mb of the human reference genome was only accessible by LRS and not SRS. Genome-wide structural variant (SV) calling yielded on average 28,292 SV calls per individual, totaling 12.9 Mb of sequence. Trio-based analyses which allowed to study segregation, showed concordance for up to 95% of these SV calls across the genome, and 80% of the LRS SV calls were not identified by SRS. De novo mutation analysis did not identify any de novo SVs, confirming that these are rare events. Because of high sequence coverage, we were also able to call single nucleotide substitutions. On average, we identified 3 million substitutions per genome, with a Mendelian inheritance concordance of up to 97%. Of these, ~100,000 were located in the ~35 Mb of the genome that was only captured by LRS. Moreover, these variants affected the coding sequence of 64 genes, including 32 known Mendelian disease genes. Our data show the potential added value of LRS compared to SRS for identifying medically relevant genome variation.

Contains fulltext : 232495.pdf (Publisher’s version ) (Closed access) INTRODUCTION: Risk factors for pelvic floor disorders are often related to pregnancy and delivery. Consistent evidence is needed to develop prevention strategies targeting risk factors. The objective of this study is to identify which pregnancy- and/or obstetric-related risk factors can predict urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life by means of a systematic review and meta-analysis. MATERIAL AND METHODS: Systematic review Prospero number: CRD42019131758. Literature searches of PubMed, EMBASE, CINAHL, and Cochrane Library were conducted according to PRISMA guidelines (April 2020). Prospective cohort studies describing more than two pregnancy- and/or obstetric-related risk factors on urinary incontinence, fecal incontinence (including flatal incontinence), or pelvic organ prolapse were eligible. Risk of bias was assessed (using Quality In Prognosis Studies [QUIPS]). Studies with high risk of bias were excluded. Data were extracted and checked for accuracy with the CHARMS checklist. Sub-groups were used to distinguish between a short- and long-term follow-up period: 18 months (long-term) postpartum. Odds ratios were calculated from reported prevalence rates. Log odds ratios were calculated using SPSS v.24. Variables were pooled using RevMan5. RESULTS: Data were extracted from nineteen studies for urinary incontinence, nine for fecal incontinence, and two for pelvic organ prolapse. Multivariate analysis was not possible because of the heterogeneity of the population and outcome measures. Pooled univariate risk factors for urinary incontinence were: urinary incontinence during pregnancy, instrumental vaginal delivery, episiotomy, tears, and constipation. Pooled univariate risk factors for fecal incontinence were: fecal incontinence during pregnancy, maternal age over 35 years, prenatal body mass index over 30 kg/m(2) , instrumental vaginal delivery, a spontaneous vaginal delivery, oxytocin augmentation, and when the weight of the newborn was more than 4000 g. Both studies for pelvic organ prolapse had a short-term follow-up period and cesarean section was the only risk factor that could be pooled. CONCLUSIONS: Pregnancy- and obstetric-related risk factors predicting pelvic floor disorders postpartum are multifactorial and differ between pelvic floor disorders. The strongest risk factor for incontinence later in life was incontinence during pregnancy. Better quality research with long-term follow up is needed on this topic.

Item does not contain fulltext Background: Patients after total knee arthroplasty treated with a 10-day high-intensity physiotherapy program in a resort were expected to recover fast without need for a longer physiotherapy treatment period.Objective: To explore the expectations and experiences of patients with total knee arthroplasty following the high-intensity physiotherapy program, including the perceived recovery level at discharge, and reasons for (not) adhering to the given advice at discharge (being either continuing with or refraining from further physiotherapy treatment).Design: A mixed-methods approach: semi-structured interviews were held and were then used to develop items and answer categories for a survey.Methods: Fifteen patients participated in semi-structured interviews, which focused on expectations and experiences related to the total knee arthroplasty and physiotherapy program, the perceived recovery level at the moment of discharge, and the reasons for the advice at discharge (continuing with or refraining from physiotherapy treatment) being followed. A deductive thematic analysis of those interviews was used to develop a survey, which was sent to the total cohort of 60 patients. Logistic regression models were estimated to determine which factors were associated with the continuation of physiotherapy treatment and (not) following the advice. Results: Four themes were identified: (1) confidence of independent recovery; (2) experiencing residual complaints; (3) expecting further improvement of physical fitness; and (4) preferring to be supervised by a healthcare professional. These themes were covered by 14 items in the survey. In total, 55 out of 60 patients completed the survey. Out of 36 patients, 23 continued with physiotherapy treatment despite an adequate level of recovery. Five out of 19 patients, who were advised to continue with physiotherapy treatment, decided to refrain. Advice to continue with physiotherapy treatment was followed more often than advice to refrain from physiotherapy treatment (OR 0.09; 95%CI 0.01-0.85). Reasons for continuing with physiotherapy treatment were residual complaints, the expectation that their physical fitness could be improved and preferring to be supervised by a healthcare professional. In contrast, patients who refrained from physiotherapy, despite being advised to continue, were self-confident that they could do exercises by themselves.Conclusions: A substantial proportion of patients continued with physiotherapy treatment because they expected that a higher level of recovery could be reached. The level of self-confidence to recover on their own seemed to be an important factor in deciding to continue with or refrain from physiotherapy treatment. It would be helpful to focus on self-management skills during the high-intensity physiotherapy program following total knee arthroplasty.

Contains fulltext : 237742.pdf (Publisher’s version ) (Open Access) OBJECTIVE: To gain insight into the level of unmet needs and limitations in physical health experienced by survivors of head and neck cancer, and to evaluate whether unmet needs in physical health and limitations in physical performance are associated. MATERIALS AND METHODS: In this cross-sectional study, unmet needs were measured with Supportive Care Needs Surveys (SCNS-SF34, SCNS-HNC). Limitations in physical health were measured for maximal mouth opening, neck and shoulder function, hand grip strength and lower body strength, level of mobility and walking ability. RESULTS: The SCNSs showed that 48% had a cancer generic unmet need and 46% had at least one HNC-specific unmet need. In total, 76% of sHNC had a cancer generic limitation in physical health and that 58% had an HNC-specific limitation in the mobility of neck and shoulders or maximum mouth opening. The domain of physical and daily living needs showed a weak association with lateral flexion of the neck to the left (R = -0.319; p = 0.024). CONCLUSION: Survivors of HNC might benefit from the use of both SCNSs and physical performance measurements during usual care follow-up for early and optimal identification of unmet needs and limitations in physical health.

Objective The purpose of this study was to define and select a core set of outcome-based quality indicators, accepted by stakeholders on usability and perceived added value as a quality improvement tool, and to formulate recommendations for the next implementation step. Methods In phase 1, 15 potential quality indicators were defined for patient-reported outcome measures and associated domains, namely the Numeric Pain Rating Scale (NPRS) for pain intensity, the Patient Specific Functioning Scale (PSFS) for physical activity, the Quebec Back Pain Disability Scale for physical functioning, and the Global Perceived Effect—Dutch Version for perceived effect. Their comparability and discriminatory characteristics were described using cohort data. In phase 2, a core set of quality indicators was selected based on consensus among stakeholders in focus group meetings. Results In total, 65,815 completed treatment episodes for patients with nonspecific low back pain were provided by 1009 physical therapists from 219 physical therapist practices. The discriminability between physical therapists of all potential 15 quality indicators was adequate, with intraclass correlation coefficients between 0.08 and 0.30. Stakeholders selected a final core set of 6 quality indicators: 2 process indicators (the routine measurement of NPRS and the PSFS) and 4 outcome indicators (pretreatment and posttreatment change scores for the NPRS, PSFS, Quebec Back Pain Disability Scale, and the minimal clinically important difference of the Global Perceived Effect—Dutch Version). Conclusion This study described and selected a core set of outcome-based quality indicators for physical therapy in patients with nonspecific low back pain. The set was accepted by stakeholders for having added value for daily practice in physical therapy primary care and was found useful for quality improvement initiatives. Further studies need to focus on improvement of using the core set of outcome-based quality indicators as a quality monitoring and evaluation instrument. Impact Patient-reported outcome–based quality indicators developed from routinely collected clinical data are promising for use in quality improvement in daily practice.

Background Musculoskeletal disorders (MSDs) can create a temporary or permanent disability that reduce a person’s ability to work. Physiotherapists (PTs), occupational therapists (OTs) and exercise therapists (ETs) are often involved in the early management of MSDs. There is a need for additional insights into therapists’ experiences, barriers and needs to work-focused care. Moreover, there is no evidence on how OTs and ETs address work participation. Therefore, the aim of this qualitative study was 1) to investigate how generalist PTs, OTs and ETs provide work-focused healthcare and 2) to obtain insight into their perceived barriers and needs that affect their ability to address occupational factors. Methods An exploratory qualitative study using three focus groups. Generalist PTs, OTs and ETs were eligible to participate if they treated working patients with MSDs. A semi-structured interview guide with open-ended questions was developed. Two moderators facilitated each focus group using the interview guide, and all the groups were audio recorded. Data were analysed using inductive thematic analysis. Results Sixteen therapists (mean age 44 years, range 25-59) participated in this study. Participants were aware of the importance of taking occupational factors into account. Whether they address occupational factors is largely dependent on the patient’s request for help. However, ETs and OTs consider it normal to ask about occupational factors during the diagnostic process, while PTs often address this in later consultations. Almost all participants were unaware of the existence of PTs, OTs or ETs who are specialised in occupational health. Moreover, almost all participants struggled with when to refer a patient to other (occupational) healthcare professionals. This study identified several needs of therapists. These included knowledge about laws and legislation and skills for identifying and addressing work-related or work-relevant complaints. Conclusions Participants in this qualitative study were aware of the importance of taking occupational factors into account. However, how PTs, OTs and ETs address work participation and the extent to which they do so can be improved. There was a lack of knowledge about and cooperation with occupational health professionals, including PTs, OTs or ETs specialised in occupational health.

Background: The Society for Vascular Surgery (SVS)-reporting standards for neurogenic thoracic outlet syndrome (NTOS) were published in 2016 to produce more consistency in the diagnosis and treatment of NTOS, but outcomes after following these standards are not yet available. We report the results of a standardized multidisciplinary care pathway for NTOS based on the SVS-reporting standards TOS. Methods: Patients referred between August 2016 and December 2019 suspected of TOS were evaluated. Diagnosis and treatment were performed according to a care pathway based on the SVS-reporting standards. Outcome of surgically treated patients was determined by the Derkash score, the TOS disability scale (TDS), CBSQ, DASH Dutch language version (DASH-DLV) and SF-12 at 3, 6, 12, and 24 months. Findings: Of 856 referred patients, 476 (56%) patients were diagnosed with NTOS. Dedicated physical therapy was successful in 186 patients (39%). Surgical treatment was performed in 290 (61%) patients of which 274 were included in final follow up. At a mean follow-up of 16·9 months, significant improvement (P

Contains fulltext : 243544.pdf (Publisher’s version ) (Open Access) PURPOSE: To understand how the social network of patients with acquired brain injury facilitates or hinders resumption of their activities, such as social and leisure activities, and how this affects patients' well-being and quality of life. METHODS: Thematic analysis was applied to 70 narratives about family members, friends, neighbors and colleagues helping or hindering patients in resuming their activities. The narratives were derived from social workers with extensive experience with brain-injured patients and their social networks. RESULTS: The narratives show that an available, understanding and well-informed network enhances activity resumption by being inclusive and encouraging patients to develop their skills. This is in line with earlier studies based on patients' experiences. Whereas the patient-based studies emphasize that being unsupportive or overprotective hinders patients from resuming their activities, this study also shows that preventing patients from meeting others or placing too-high demands results in activity loss, social isolation and reduced well-being and quality of life. CONCLUSIONS: Several social network factors play a role in activity resumption, well-being, and quality of life of after brain injury. Early after the brain injury, rehabilitation professionals should work with patients' family members, friends, and others and educate them about how to provide adequate support.IMPLICATIONS FOR REHABILITATIONSince the patient's social network is an important determinant of activity resumption, rehabilitation professionals should analyze its features soon after brain injury, such as whether patients have an understanding network that encourages them and includes them in their activities.Since especially close network members tend to be protective of or place high demands on the patient, rehabilitation professionals should explain to them the importance of activity resumption for the patient's wellbeing and the adverse effects of being overprotective or over-demanding.Rehabilitation professionals should include other network members, such as friends or colleagues, in the rehabilitation process and educate them about how to support patients in resuming their activities.

Contains fulltext : 237762.pdf (Publisher’s version ) (Open Access) 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.

Background A national clinical registry was established in the Netherlands containing data directly sampled from electronic health record systems of physical therapists (PTs). This registry aims to evaluate the potential of patient reported outcome measures (PROMs) to develop quality indicators (QIs) in physical therapy care. Purpose To test to what extent the collected PROM data are reliable, valid and discriminatory between practices in measuring outcomes of patients with non-specific low back pain (NSLBP). Methods In this retrospective cohort study 865 PT practices with 6,560 PTs voluntarily collected PROM data of patients with NSLBP, using the Quebec Back Pain Disability Scale (QBPDS), the Numeric Pain Rating Scale (NPRS) and the Patient Specific Functioning Scale (PSFS). Reliability was determined by analysing the completeness of the dataset, the comparability by using national reference data, and through checking selection bias in the included patients. Validity was tested using the known-groups contrast between patients with (sub)acute vs. chronic NSLBP. To determine discriminative ability of outcomes between PT practices, case-mix corrected hierarchical multilevel analyses were performed. Results Reliability was sufficient by confirming fifteen of the sixteen hypotheses: 59% of all patients opted in for data analysis, 42% of these included patients showed repeated measurement, comparing with reference data and potential selection bias showed < 5% between group differences, while differences between (sub)acute and chronic NSLB-groups were significantly larger than 5% (less treatment sessions, lager differences in outcomes in (sub)acute NSLB patients). In addition, all nine adjusted hierarchical multilevel models confirm that the collected dataset on outcomes in PT care is able to discriminate between practices using PROM results of patients with NSLBP (ICC-scores range 0.11–0.21). Limitations Although we have shown the reliability, validity and discriminative ability of the dataset in the quest to develop QIs, we are aware that reducing missing values in patient records and the selective participation of PTs that belong to the innovators needs attention in the next stages of implementation to avoid bias in the results. Conclusion PROMs of patients with NSLBP collected in the national clinical registry of KNGF are reliable, valid and able to discriminate between primary care PT practices.

ObjectiveTo obtain insight into experiences of patients with a neuromuscular disease and chronic fatigue and their healthcare professionals regarding content and delivery of a multidisciplinary outpatient self-management group programme to improve social participation. This will inform future implementation.DesignA mixed method study alongside a randomised controlled trial.SettingUniversity hospital, rehabilitation centre and community health centre.Participants29 patients with a neuromuscular disease and chronic fatigue and 13 healthcare professionals participated in this mixed methods study.InterventionMultidisciplinary group programme, called Energetic, consisted of a 4 months intervention with weekly meetings and covered four modules: (1) individually tailored aerobic exercise training; (2) education about aerobic exercise; (3) self-management training in applying energy conservation strategies and (4) implementation and relapse prevention in daily life.Main measuresQuantitative data were collected by a questionnaire measuring patients’ (n=25, all completed the programme) satisfaction with the perceived results, content and delivery of the programme. Qualitative data were collected by individual and focus group interviews to gain insight in the experiences of patients (n=18), next of kin (n=2) and healthcare professionals (n=13) with facilitators and barriers to programme implementation.ResultsPatients were satisfied with the number and length of the sessions, the different modules and the therapists. Analysis of the interviews led to five themes: (1) the combination of modules makes a complete picture, (2) the programme is physically and mentally intensive, (3) the group setting is valuable, (4) small variations in delivery occur in different settings, (5) therapists are coaches. Suggestions for programme improvement include a combination of face to face and e-health, enhancement of therapists’ skills in guiding group interventions and inclusion of more booster sessions to evaluate and maintain self-management competencies.ConclusionsThe Energetic programme could be implemented in different healthcare settings and group settings, and a combination of modules proved to be a facilitator for improving self-management.Trial registration numberNCT02208687.

Purpose Complementary interventions for persons with severe mental illness (SMI) focus on both personal recovery and illness self-management. This paper aimed to identify the patient-reported outcome measures (PROMs) associated with the most relevant and meaningful change in persons with SMI who attended the Illness Management and Recovery Programme (IMR). Methods The effect of the IMR was measured with PROMs concerning recovery, illness self-management, burden of symptoms and quality of life (QoL). From the QoL measures, an anchor was chosen based on the most statistically significant correlations with the PROMs. Then, we estimated the minimal important difference (MID) for all PROMs using an anchor-based method supported by distribution-based methods. The PROM with the highest outcome for effect score divided by MID (the effect/MID index) was considered to be a measure of the most relevant and meaningful change. Results All PROMs showed significant pre–post-effects. The QoL measure ‘General Health Perception (Rand-GHP)’ was identified as the anchor. Based on the anchor method, the Mental Health Recovery Measure (MHRM) showed the highest effect/MID index, which was supported by the distribution-based methods. Because of the modifying gender covariate, we stratified the MID calculations. In most MIDs, the MHRM showed the highest effect/MID indexes. Conclusion Taking into account the low sample size and the gender covariate, we conclude that the MHRM was capable of showing the most relevant and meaningful change as a result of the IMR in persons with SMI.

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 (

Background Recovery trajectories differ between individual patients and it is hypothesizes that they can be used to predict if an individual patient is likely to recover earlier or later. Primary aim of this study was to determine if it is possible to identify recovery trajectories for physical functioning and pain during the first six weeks in patients after TKA. Secondary aim was to explore the association of these trajectories with one-year outcomes. Methods Prospective cohort study of 218 patients with the following measurement time points: preoperative, and at three days, two weeks, six weeks, and one year post-surgery (no missings). Outcome measures were performance-based physical functioning (Timed Up and Go [TUG]), self-reported physical functioning (Knee injury and Osteoarthritis Outcome Score-Activities of Daily Living [KOOS-ADL]), and pain (Visual Analogue Scale [VAS]). Latent Class Analysis was used to distinguish classes based on recovery trajectories over the first six weeks postoperatively. Multivariable regression analyses were used to identify associations between classes and one year outcomes. Results TUG showed three classes: “gain group” (n = 203), “moderate gain group” (n = 8) and “slow gain group” (n = 7), KOOS showed two classes: “gain group” (n = 86) and “moderate gain group” (n = 132), and VAS-pain three classes: “no/very little pain” (n = 151), “normal decrease of pain” (n = 48) and “sustained pain” (n = 19). The” low gain group” scored 3.31 [95% CI 1.52, 5.09] seconds less on the TUG than the “moderate gain group” and the KOOS “gain group” scored 11.97 [95% CI 8.62, 15.33] points better than the “moderate gain group” after one year. Patients who had an early trajectory of “sustained pain” had less chance to become free of pain at one year than those who reported “no or little pain” (odds ratio 0.11 [95% CI 0.03,0.42]. Conclusion The findings of this study indicate that different recovery trajectories can be detected. These recovery trajectories can distinguish outcome after one year.

Background A recently published Dutch practice guideline emphasizes criterion-based rehabilitation after anterior cruciate ligament reconstruction (ACLR) instead of time-based. As a consequence of this criterion-based rehabilitation, return to play is only suggested when athletes meet specific return to play (RTP) criteria. Purpose The goal of this prospective observational study was to analyze if physical therapists adhere to ACLR practice guideline RTP criteria for testing and return to sport decisions, and to explore whether there is a difference in adherence between physical therapists specialized in sports versus those who are not. Methods When the treating physical therapist cleared an athlete for RTP after ACLR, the primary researcher performed RTP measurements according to the ACLR practice guideline to investigate if all nine quantitative and qualitative RTP criteria were met. Results Of the 158 athletes (54 females and 104 males, mean age 24 ± 6 years, 12 ± 3 months after surgery), 69 (44%) had performed the RTP measurements with their primary physical therapist. Of the athletes tested by their primary physical therapist 23% met all RTP criteria compared to 10% of the athletes who were not tested at all by their primary physical therapist (p = 0.026). Of the athletes rehabilitating with a sports physical therapist, 52% had been tested by their primary physical therapist compared to 34% of the athletes rehabilitating with a non-sports physical therapist (p = 0.024). Conclusion Only 44% of the athletes were tested according to the guideline RTP criteria and only 23% of them were given an RTP advice consistent with the ACLR guideline. Although sports physical therapists adhered to the guideline more often than non-sports physical therapists, the adherence is still alarmingly low. More attention for the implementation of ACLR guidelines and RTP criteria is needed. Level of evidence Therapy, level 2b.

Contains fulltext : 238555.pdf (Publisher’s version ) (Open Access) The objective is to describe the spectrum of the health professional (HP) treatment approach for systemic sclerosis (SSc) from the perspective of Dutch HPs, including alignment of treatment goals set by HPs with self-reported referral reasons, coverage of patient-reported unmet care needs, and quality of communication between HPs and rheumatologists. Dutch HPs were invited through their patients with SSc to complete an anonymous online survey. The survey covered referral reasons, treatment goals, and interventions of the last patient treated, as well as the perceived quality of communication between HPs and rheumatologists. Referral reasons and treatment targets were linked to the International Classification of Functioning, Disability and Health following the refined ICF Linking Rules. Seventy-nine HPs from 8 professions (including 58 physiotherapists, 73%) completed the survey. One hundred and thirty-three different referral reasons were reported, yielding 58 different ICF codes, with 41 (70.7%) being linked to the ICF domain "body structures and functions." The reported interventions focused on body functions/structures (27.9%), training of daily activities (25.6%), education and advice (26.3%), and psychosocial interventions (20.2%). The quality of communication between HPs and rheumatologists was perceived as low. Our findings revealed numerous treatment options offered by Dutch HPs addressing the unmet care needs of patients with SSc. There is an overlap in the content of the various HP disciplines, and HP treatment goals are not sufficiently aligned with referrals of rheumatologists. HP treatment offer seemed inefficiently organized, possibly precluding rheumatologists from making targeted referrals. Communication between rheumatologists and HPs should be improved.

Background: The effect of inhaled corticosteroids (ICS) in patients with type 2 low (T2-low) asthma is unpredictable. Biomarkers are lacking to identify patients likely to benefit from ICS. We speculate that airway hyperresponsiveness (AHR) to mannitol, an indirect bronchial provocation test reflecting mast cell activation, predicts response to ICS in T2-low asthma. Aims and Objectives: To compare the response in AHR to mannitol in patients with T2-high and T2-low asthma after treatment with ICS. Methods: The RECONSTRUCT-study was a prospective intervention study with 50 steroid-free patients with asthma and AHR to mannitol. All patients were assessed before and after 6 weeks of daily treatment with 1600 µg budesonide. Patients were stratified into T2-high (FeNO≥25 ppb) and T2-low asthma (FeNO Results: In total, 46 patients, 25 with T2-high and 21 with T2-low asthma completed the study. AHR to mannitol was comparable at baseline: Gmean PD15: 126mg (95% CI:73-215) and 134mg (95% CI:77-232), P=0.87 and increased after treatment corresponding to a doubling dose of: 3.98 (95% CI:2.49-6.38, P Conclusion: Patients with T2-high and T2-low asthma and AHR to mannitol improve in AHR and ACQ after treatment with inhaled corticosteroids. Mannitol challenge may be a useful physiological marker to identify patients with T2-low asthma who benefit from inhaled corticosteroids.

Background: The Na+/K+ ATPase may play a role in bronchoconstriction in asthma: Through active building of ion gradients across cell membranes, the Na+/K+ ATPase contributes to regulation of intracellular Ca2+ in airway smooth muscle via the Na+/Ca2+ exchanger. Corticosteroids increase Na+/K+ ATPase content in striated muscle but the effect has not been investigated in human airways. Aims and Objectives: To investigate the effect of inhaled corticosteroids (ICS) on the airway Na+/K+ ATPase content in patients with type 2 high (T2-high) and T2-low asthma. Methods: The RECONSTRUCT-study was a prospective intervention study with 50 steroid-free patients with asthma and 10 healthy controls. Airway Na+/K+ ATPase content was determined by the vanadate-facilitated [H3]-ouabain method in mucosal cryobiopsies before and after 6 weeks of daily treatment with 1600 µg budesonide. Patients were stratified into T2-high (FeNO≥25 ppb) and T2-low asthma (FeNO Results: Airway Na+/K+ ATPase content was comparable in healthy controls: Mean: 148ρmol/g (95% CI: 120-177), patients with T2-high asthma: 177ρmol/g (95% CI: 157-198) and patients with T2-low asthma: 189ρmol/g (95% CI: 156-222), P=0.20. After treatment with ICS, Na+/K+ ATPase content increased by 14% in patients with T2-high asthma to: 205ρmol/g (95% CI: 178-228), P=0.017, but not in patients with T2-low asthma: 201ρmol/g (95% CI: 174-228), P=0.54. Conclusion: Treatment with ICS increases airway Na+/K+ ATPase content in patients with T2-high asthma but not in patients with T2-low asthma. This effect could be protective against bronchoconstriction, but needs to be verified in further studies.

Contains fulltext : 220936.pdf (Publisher’s version ) (Closed access) Introduction: Shoulder abnormalities on imaging are increasingly common with advancing age.We tested the difference in the accuracy of diagnosing the injured shoulder between surgeons who reviewed MRI reports and who did and did not receive information about the patients. METHODS: Thirty people aged 40 or older that experienced new shoulder symptoms after an event at work had MRI of both shoulders. Members of the Science of Variation Group (SOVG) were invited to review the radiologist's reports and diagnose the symptomatic side. Ninety-seven surgeons participated. RESULTS: Surgeon observers provided with patient information were not more accurate in diagnosing the symptomatic shoulder (Odds Ratio: 0.90; 95% CI: 0.75 to 1.1; P = 0.29). There was slight agreement between surgeons (kappa = 0.10). The sensitivity and specificity for diagnosing the symptomatic side were 51% (CI: 48%-54%) and 67% (CI: 64%-70%) respectively. A binomial test showed that surgeons indicated the injured shoulder slightly more frequently than expected by random chance (59%; P

Background Musculoskeletal disorders (MSDs) are the primary cause of disability worldwide and a major societal burden. Recent qualitative research found that although a patient’s work is considered important, physical therapists take work participation insufficiently into account as a determining factor in the treatment of patients with MSDs. Therefore, the aim of this study is to improve the effectiveness of physical therapy (in primary healthcare) with respect to the work participation of employees with MSDs by increasing the knowledge and skills of generalist physical therapists and by improving the collaboration between generalist physical therapists and physical therapists specialised in occupational health. Methods/design This trial is a two-arm non-blinded cluster randomised controlled trial. Working patients with MSDs visiting a physical therapy practice are the target group. The control group will receive normal physical therapy treatment. The intervention group will receive treatment from a physical therapist with more knowledge about work-related factors and skills in terms of integrating work participation into the patients’ care. Data are gathered at baseline (T0), at four months (T1) and eight months (T2) follow-up. Most outcomes will be assessed with validated patient-reported questionnaires. Primary outcomes are the limitations in specific work-related activities and pain during work. Secondary outcomes include limitations in general work-related activities, general pain, quality of life, presenteeism, sick leave (absenteeism), estimated risk for future work disability, work-related psychosocial risk factors, job performance, and work ability. Based on a sample size calculation we need to include 221 patients in each arm (442 in total). During data analysis, each outcome variable will be analysed independently at T1 and at T2 as a dependent variable using the study group as an independent variable. In addition to the quantitative evaluation, a process evaluation will be performed by interviewing physical therapists as well as patients. Discussion The trial is expected to result in a more effective physical therapy process for working patients with MSDs. This will lead to a substantial reduction of costs: lower costs thanks to a more effective physical therapy process and lower costs due to less or shorter sick leave and decreased presenteeism. Trial registration Netherlands Trial Register, registration number: NL8518, date of registration 9 April 2020, URL registration: https://www.trialregister.nl/trial/8518

Background: Complementary interventions for persons with severe mental illness (SMI) provide broad strategies for recovery and illness self-management. It is not known which outcome measure can be considered to be relevant for persons with SMI. This knowledge can motivate a professional to offer and stimulate a person to participate in that intervention. This paper aimed to identify the outcome measures that determine the most relevant and meaningful change and capture the benefits of a complementary intervention. Methods: By using anchor-based and distribution-based methods, we estimated the minimal important difference (MID) to determine which outcome measure persons improved in beyond the MID to reflect a relevant change in pre-post effect of a complementary intervention, in casu the Illness Management and Recovery programme (IMR).Results: The anchor MID was based on the results of the measure Rand General Health Perception (Rand-GHP). On all MIDs, the Mental Health Recovery Measure (MHRM) had the highest score on the effect compared to its MIDs, and also on all MIDs the MHRM had the highest percentages of participants that scored above the MID. Conclusion: The Rand-GHP is considered to be an excellent measure for investigating the MID as a result of an intervention. The results of our study can be used in shared decision-making processes to determine which intervention is suitable for a person with SMI. A person who desires a recovery outcome, as measured by the MHRM, can be recommended to do the IMR programme.

To compare the relative efficacy of ustekinumab (UST) vs. other therapies for 1-year response and remission rates in patients with moderate-severe UC. Randomized controlled trials reporting induction and maintenance efficacy of anti-TNFs (infliximab [IFX], adalimumab [ADA], golimumab [GOL]), vedolizumab (VDZ), tofacitinib (TOF) or UST were identified through a systematic literature review (SLR). Analyses were conducted for clinical response, clinical remission and endoscopic-mucosal healing for populations with and without failure of prior biologics (non-biologic failure [NBF]; biologic failure [BF]). Maintenance data from trials with re-randomized response designs were re-calculated to correspond to treat-through arms. Bayesian network meta-analyses (NMA) were conducted to obtain posterior distribution probabilities for UST to perform better than comparators. Six trials included NBF patients and four included BF patients. In NBF patients, UST as a 1-year regimen showed higher probabilities of clinical response, remission and endoscopic-mucosal healing vs. all treatments: Bayesian probabilities of UST being better than active therapies ranged from 91% (VDZ) to 100% (ADA) for response; 82% (VDZ) to 99% (ADA) for remission and 82% (IFX) to 100% (ADA and GOL) for endoscopic-mucosal healing. In BF patients, UST was the most effective treatment (Q8W dose); however, effect sizes were smaller than in the NBF population. Results indicate a higher likelihood of response, remission and endoscopic-mucosal healing at 1 year with UST vs. comparators in the NBF population. In BF patients, a higher likelihood of response to UST vs. the most comparators was also observed, although results were more uncertain.

Background Hereditary spastic paraplegia (HSP) is a group of inherited disorders characterized by progressive spastic paresis of the lower limbs. Treatment is often focused on reducing spasticity and its physical consequences. To better address individual patients’ needs, we investigated a broad range of experienced complaints, activity limitations, and loss of motor capacities in pure HSP. In addition, we aimed to identify patient characteristics that are associated with increased fall risk and/or reduced walking capacity. Methods We developed and distributed an HSP-specific online questionnaire in the Netherlands. A total of 109 out of 166 questionnaires returned by participants with pure HSP were analyzed. Results Participants experienced the greatest burden from muscle stiffness and limited standing and walking activities, while 72% reported leg and/or back pain. Thirty-five and 46% reported to use walking aids (e.g. crutches) indoors and outdoors, respectively; 57% reported a fall incidence of at least twice a year (‘fallers’); in 51% a fall had led to an injury at least once; and 73% reported fear of falling. Duration of spasticity and incapacity to rise from the floor were positively associated with being a ‘faller’, whereas non-neurological comorbidity and wheelchair use were negatively associated. Higher age, experienced gait problems, not being able to stand for 10 min, and incapacity to open a heavy door showed a negative association with being a ‘walker without aids’ (> 500 m). Conclusions Our results emphasize the large impact of spastic paraparesis on the lives of people with pure HSP and contribute to a better understanding of possible targets for rehabilitation.

Engagement for children with mitochondrial disorder is not self evident. To develop personalised and value-based care for this population, we require knowledge about their perspectives and values with regards to everyday activities. To gain insight into children’s perspective on activities by (1) asking what activities they perform, (2) how they perform them, (3) how they experience these activities and (4) their wants and needs. Seven semi-structured content analyzed interviews. The interviews identified a variety of activities. The overarching themes on wants/needs were ‘I want to meet up with others whenever I want to’,‘I want to be able to…’, ‘I don’t want to…’ and ‘Dream’. These themes were interconnected to thirteen other themes that captured how children experience and perform activities, for example, ‘Because I can decide by myself’, ‘Because I can do it on my own’ and ‘It is more fun to do things with other people’. The activities children performed represent regular childhood activities. The identified themes fit with the three aspects of the self-determination theory: autonomy, competence and relatedness. This study exposed the broad child perspective and should provide better understanding of children’s choices in their participation in everyday activities.