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Previous research on self‐informant reports in assessing personality disorders (PDs) has been mainly focused on adults, leaving older adults under‐studied. We examined self‐informant agreement in PD screening among older adults (≥60 years) using the Gerontological Personality disorders Scale (GPS). Potential differences such as who reports more personality pathology on a PD screener (i.e., GPS), item accessibility and the effect of relational aspects were studied as well. Data of 326 older adult‐informant dyads, of which the older adults were sampled from five general practices in the Netherlands, were used. Results indicate that self‐informant agreement ranged from r = 0.26–0.73, with lower concordance on the GPS‐subscale measuring intrapersonal aspects of personality pathology. Informants were more sensitive to habitual pathological personality features than older adults. Two GPS items showed differential item functioning across self‐ and informant‐report. Of relational aspects, only congeniality affected the GPS‐iv scores; lower ratings on congeniality were associated with higher GPS‐iv scores (i.e., higher reporting of personality problems). [ABSTRACT FROM AUTHOR]

Objective Clinicians are recommended to use the clinical reasoning framework developed by the International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) to provide guidance regarding assessment of the cervical spine and potential for cervical artery dysfunction prior to manual therapy and exercise. However, the interexaminer agreement and reliability of this framework is unknown. This study aimed to estimate the interexaminer agreement and reliability of the IFOMPT framework among physical therapists in primary care. Methods Ninety-six patients who consulted a physical therapist for neck pain or headache were included in the study. Each patient was tested independently by 2 physical therapists, from a group of 17 physical therapists (10 pairs) across The Netherlands. Patients and examiners were blinded to the test results. The overall interexaminer agreement, specific agreement per risk category (high-, intermediate-, and low-risk), and interexaminer reliability (weighted κ) were calculated. Results Overall agreement was 71% (specific agreement in high-risk category = 63%; specific agreement in intermediate-risk category = 38%; specific agreement in low-risk category = 84%). Overall reliability was moderate (weighted κ = 0.39; 95% CI = 0.21–0.57) and varied considerably between pairs of physical therapists (κ = 0.14–1.00). Conclusion The IFOMPT framework showed an insufficient interexaminer agreement and fair interexaminer reliability among physical therapists when screening the increased risks for vascular complications following manual therapy and exercise prior to treatment. Impact The IFOMPT framework contributes to the safety of manual therapy and exercise. It is widely adopted in clinical practice and educational programs, but the measurement properties are unknown. This project describes the agreement and reliability of the IFOMPT framework. [ABSTRACT FROM AUTHOR]

The Royal Dutch Society for Physical Therapy (KNGF) issued a clinical practice guideline for physical therapists that addresses the assessment and treatment of patients with nonspecific neck pain, including cervical radiculopathy, in Dutch primary care. Recommendations were based on a review of published systematic reviews. During the intake, the patient is screened for serious pathologies and corresponding patterns. Patients with cervical radiculopathy can be included or excluded through corresponding signs and symptoms and possibly diagnostic tests (Spurling test, traction/ distraction test, and Upper Limb Tension Test). History taking is done to gather information about patients' limitations, course of pain, and prognostic factors (eg, coping style) and answers to health-related questions. In case of a normal recovery (treatment profile A), management should be hands-off, and patients should receive advice from the physical therapist and possibly some simple exercises to supplement "acting as usual." In case of a delayed/deviant recovery (treatment profile B), the physical therapist is advised to use, in addition to the recommendations for treatment profile A, forms of mobilization and/or manipulation in combination with exercise therapy. Other interventions may also be considered. The physical therapist is advised not to use dry needling, low-level laser, electrotherapy, ultrasound, traction, and/or a cervical collar. In case of a delayed/deviant recovery with clear and/or dominant psychosocial prognostic factors (treatment profile C), these factors should first be addressed by the physical therapist, when possible, or the patient should be referred to a specialist, when necessary. In case of neck pain grade 111 (treatment profile D), the therapy resembles that for profile B, but the use of a cervical collar for pain reduction may be considered. The advice is to use it sparingly: only for a short period per day and only for a few weeks. [ABSTRACT FROM AUTHOR]

Introduction: Although experienced raters show good reproducibility1 of Pressure Pain Thresholds (PPT) in most body locations2, it is unknown if inexperienced physiotherapy students perform comparably. Recruiting students as raters would increase opportunities for the student's development and the design of studies. Methods: A total of 175 participants were measured by ten undergraduate students using either a Wagner (n = 87) or Somedic (n = 88) digital algometer on four body locations; the lower leg, upper leg, arm and neck. Each student measured a subsample of ~9 participants. Agreement (reported as a coefficient of variance; standard error of measurement divided by the average threshold) and reliability (intraclass correlation (ICC)) were measured for both the individual rater and the total group. Results: Agreement ranged from 9-17% per body location, whereas individual raters differed from the group result from -7.9% up to +6.6%. Reliability was good to excellent, ICCs (1,1) ranging from 0.88 to 0.95. Individual ICCs (2,1) were between 0.00 to 0.99. Discussion: Reproducibility of the total group was good; however, it varies per student. Even though reliability is affected by group variance differences, agreement parameters also show individual differences. PPTs seem rater dependent, which may explain different findings in the literature. Consequently, using reproducibility values of other studies/raters should be done cautiously. Students may be recruited as research assistants to perform PPTs. Process evaluation: Organising raters and participants together is challenging. Using parallel rooms with observational tools helped. Dependency on raters was a threat, resulting in an excluded rater due to sickness. [ABSTRACT FROM AUTHOR]

Introduction: 'Psychologically informed' care is a recommended physiotherapeutic treatment for people with non-specific spinal pain1. However, we lack information about patient experiences with this approach. The aim of this qualitative study is to explore how thoughts, feelings and behaviour are influenced through a blended e-Health intervention in people with non-specific spinal pain. Methods: This is an interpretative qualitative study using semi-structured interviews. Twelve participants who followed (parts of) a blended e-Health intervention2 were interviewed. Two researchers analysed the interviews using thematic analyses3, which was an inductive process, whereby all codes were formed and analyzed systematic, repetitive and recursive. A third researcher was invoked during the whole process. Results: Three themes emerged answering how thoughts, feelings and behaviour are influenced through a blended e-Health intervention in people with non-specific spinal pain: (1) patients' stimulators to do the intervention (physiotherapists plays a key role; complaints are driver; online modules provide depth), (2) increasing awareness (own role in pain; importance of activity; pain is not the same as damage; online modules play major role) and (3) inducing changes in life (next step). Discussion: Patients that were motivated to participate in the intervention for variable reasons increased awareness and made steps to change life. Process evaluation: To evaluate the quality of this study (1) a qualitative data expert was actively involved, (2) data triangulation was performed in each phase of the coding process, and (3) deviant cases were included to enrich the data. [ABSTRACT FROM AUTHOR]

Background. Health care providers need prognostic factors to distinguish between patients who are likely to recover and those who are not likely to recover. Objective. The aim of this study was to: (1) describe the clinical course of recovery and (2) identify prognostic factors of recovery in patients with shoulder pain at the 26-week follow-up. Design. A prospective cohort study was carried out in the Netherlands and included 389 patients who consulted a physical therapist for a new episode of shoulder pain. Method. Participants were followed for 26 weeks. Potential predictors of recovery were selected from the literature and, with the addition of 2 new variables (ie, use of diagnostic ultrasound and working alliance), evaluated in the multivariable regression analysis. Multiple imputation was used to handle missing data, and bootstrap methods were used for internal validation. Results. The recovery rate was 60% for the total population and 65% for the working population after 26 weeks. Short duration of complaints, lower disability scores, having a paid job, better working alliance, and no feelings of anxiety or depression were associated with recovery. In the working population, only duration of complaints and disability remained in the final model. The area under the receiver operating characteristic curve (AUC) for the final model was 0.67 for the total population and 0.63 for the working population. After internal validation, the AUC was corrected to 0.66 and 0.63, respectively. Limitations. External validation of the prognostic model should be done prior to its use in clinical practice. Conclusion. The results of this study indicate that several factors can predict recovery. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Recent health care reforms in the Netherlands have led to the introduction of intermediate health care. Intermediate health care combines features of primary care and secondary (hospital) care. It is characterized by a task shift from hospital care to primary care. The initial experiences of medical specialists and general practitioners with intermediate health care are positive. However, the patients' perspectives regarding this reform are unknown. This study aimed to evaluate the level of support from patients with back and/or neck pain for intermediate health care services and to provide insight into their preferences how this care should be organized. Methods A cross-sectional survey was conducted in which members of the patient association for spinal pain in the Netherlands completed electronic questionnaires to measure the level of support and preferred organization of intermediate health care services. Results Questionnaires were returned by 367 patients (response rate: 51%). Respondents supported the concept of intermediate health care (numeric rating scale: 7/10). Aspects considered important for intermediate health care included knowledge and expertise of staff, multidisciplinary cooperation, patient contact time, reimbursement via health insurance, quality control of care, evidence-based treatments and electronic medical records. Although intermediate care is a health care reform, patients continued to think according to traditional primary and secondary care constitutions. Conclusions Patients with neck and/or back pain support the introduction of intermediate health care services and have explicit preferences regarding its organization, but may need to be better informed when intermediate care is introduced. [ABSTRACT FROM AUTHOR]

To determine risk factors for running injuries during the Lage Landen Marathon Eindhoven 2012. Prospective cohort study. Population-based study. This study included 943 runners. Running injuries after the Lage Landen Marathon. Sociodemographic and training-related factors as well as lifestyle factors were considered as potential risk factors and assessed in a questionnaire 1 month before the running event. The association between potential risk factors and injuries was determined, per running distance separately, using univariate and multivariate logistic regression analysis. In total, 154 respondents sustained a running injury. Among the marathon runners, in the univariate model, body mass index ≥ 26 kg/m2, ≤ 5 years of running experience, and often performing interval training, were significantly associated with running injuries, whereas in the multivariate model only ≤ 5 years of running experience and not performing interval training on a regular basis were significantly associated with running injuries. Among marathon runners, no multivariate model could be created because of the low number of injuries and participants. This study indicates that interval training on a regular basis may be recommended to marathon runners to reduce the risk of injury. [ABSTRACT FROM AUTHOR]

Introduction: Targeting psychosocial factors in patients with persistent spinal pain is recommended for more favourable outcomes in physiotherapy. However, some clinical challenges hinder a biopsychosocial treatment. Hence, Back2Action was developed. This study aims to gain insight into the experiences of physiotherapists using this blended treatment for patients with persistent spinal pain. Methods: The design of this study is mixed methods; The qualitative component is a thematic content analysis of semi-structured interviews with physiotherapists (N = 15) from the RCT 'Back2Action'. The quantitative component used digital questionnaires assessing user-friendliness. Results: Five themes emerged from the interviews; (1) Back2Action is an unexpected shift in treatment. The added eHealth intervention provides quality of information and structure. (2) Physiotherapists report becoming aware of their own biases and capabilities. (3) Their expectations towards patients with persistent pain and perceived patient expectations of a 'quick fix', could lead to a resistance of this new approach. (4) A surprising strengthening of the therapeutic relationship is reported due to growing experience and confidence. (5) Successful implementation requires supervision, intervision and means. The quantitative analyses showed that the overall intervention is perceived as user-friendly with a mean score of 74 (range 0-100) and a net promotor score of 7.9 (range 0-10). Discussion: Back2Action is considered a valuable treatment tool for physiotherapists. Process evaluation: A limitation of this study is the expert level of the physiotherapists and the generalisation of these results. [ABSTRACT FROM AUTHOR]

Introduction: Psychosocial factors predict recovery in patients with spinal pain. Several of these factors are modifiable. However, physiotherapists indicate that they do not feel sufficiently equipped to address these factors. We developed an eHealth intervention to support physiotherapists in managing psychosocial factors in patients with spinal pain. This paper describes the protocol for a pragmatic randomised clinical trial which evaluates the effectiveness of this eHealth intervention blended with physiotherapy compared to physiotherapy alone. Methods: Participants with non-specific low back pain and/or neck pain for at least six weeks who also experience psychosocial symptoms will be recruited in a pragmatic multi-centre cluster randomised clinical trial. The experimental intervention consists of physiotherapy blended with six online modules of pain education and behavioural activation. The control intervention consists of usual care physiotherapy. The primary outcomes are disability and perceived effect. Outcomes will be assessed at baseline, and at 2, 6 and 12 months after baseline. The results will be analysed using linear mixed models. Results: At this moment, 357 patients were assessed for eligibility and 140 patients are included. Our hypothesis is that the blended intervention is more effective than usual physiotherapy at 12 month follow-up. Process evaluation: Inclusion of participants has proven challenging, we have extended the inclusion phase with 1.5 years and recruited more physiotherapy practices. [ABSTRACT FROM AUTHOR]

Although communication failures between professionals in acute care delivery occur, explanations for these failures remain unclear. We aim to gain a deeper understanding of interprofessional communication failures by assessing two different explanations for them. A multiple case study containing six cases (i.e. acute care chains) was carried out in which semi-structured interviews, physical artifacts and archival records were used for data collection. Data were entered into matrices and the pattern-matching technique was used to examine the two complementary propositions. Based on the level of standardization and integration present in the acute care chains, the six acute care chains could be divided into two categories of care processes, with the care chains equally distributed among the categories. Failures in communication occurred in both groups. Communication routines were embedded within organizations and descriptions of communication routines in the entire acute care chain could not be found. Based on the results, failures in communication could not exclusively be explained by literature on process typology. Literature on organizational routines was useful to explain the occurrence of communication failures in the acute care chains. Organizational routines can be seen as repetitive action patterns and play an important role in organizations, as most processes are carried out by means of routines. The results of this study imply that it is useful to further explore the role of organizational routines on interprofessional communication in acute care chains to develop a solution for failures in handover practices. [ABSTRACT FROM AUTHOR]

Study Design: Diagnostic accuracy study. Objective: To evaluate the diagnostic accuracy of the Thessaly test compared with an arthroscopic examination in patients with suspected meniscal tears. Background: The Thessaly test was introduced to improve the diagnostic accuracy of the clinical examination in detecting meniscal tears. This test appears to be a valuable alternative to other meniscal clinical tests usually performed, but additional diagnostic accuracy data are required. Methods: Patients with suspected meniscal tears, referred to a hospital for arthroscopic surgery, were eligible. The Thessaly test alone and the combination of the Thessaly and McMurray tests were considered as index tests, and arthroscopy was used as the reference test. Experienced physical therapists performed the Thessaly test at 20° of flexion and the McMurray test for both knees. The physical therapist was blinded to patient information, the affected knee, and the results from possible earlier diagnostic imaging. An orthopaedic surgeon blinded to the clinical test results from the physical therapist performed the arthroscopic examination. Results: A total of 593 patients were included, of whom 493 (83%) had a meniscal tear, as determined by the arthroscopic examination. The Thessaly test had a sensitivity of 64% (95% confidence interval [CI]: 60%, 68%), specificity of 53% (95% CI: 43%, 63%), positive predictive value of 87% (95% CI: 83%, 90%), negative predictive value of 23% (95% CI: 18%, 29%), and positive and negative likelihood ratios of 1.37 (95% CI: 1.10, 1.70) and 0.68 (95% CI: 0.59, 0.78), respectively. The combination of positive Thessaly and McMurray tests showed a sensitivity of 53% and specificity of 62%. Conclusion: The results of the Thessaly test alone or combined with the McMurray test do not seem useful to determine the presence or absence of meniscal tears. [ABSTRACT FROM AUTHOR]

This article deals with the questions what the benefits and limitations are of the instruments and strategies that patient organisations use to influence quality of care. The advocacy of patients' interests has become more important for patient organisations in recent years, which is partly due to Dutch health care policy reform. Thirty state funded quality improvement projects run by patient organisations between 2009 and 2012 have been analysed. The quality improvement instruments developed and used in these projects are concerned with: standardization and standard setting (What is good care?); consultation, comparison and checking (What is the state of the care given?); and negotiating and advising (How can quality of care be improved?). The choice for these instruments is partly based on patient organisations' strategies of scientization, valuing institutionalized methods and valuing good relationships. We see that the development and use of these quality improvement instruments do strengthen patient organisation and therefore have internal identity and organisational effects. However, the external effects patient organisations can have by using these instruments and strategies is limited or at least insecure by lack of economic capital after the development phase and lack of negotiating power. The external effects of these instruments and strategies depend largely on a patient organisation's network and the willingness, degree of openness and policy of other stakeholders to cooperate. Therefore, these forms of patient participation remain vulnerable. [ABSTRACT FROM AUTHOR]

Background Accurate information transfer is an important element of continuity of care and patient safety. Despite the demonstrated urge for improvement of communication in acute care, there is a lack of data on improvements of communication. This study aims to describe the barriers to implementation of a redesign of the existing model for information transfer and feedback. Methods A case study with six cases (i.e. acute care chains), using mixed methods was carried out in the Netherlands. The redesign was implemented in one acute care chain while the five other acute care chains served as control groups. Focus group interviews were held with members of the acute care chains and questionnaires were sent to care providers working in the acute care chains. Results Respondents reported three sets of barriers for implementation of the model: (a) existing routines for information transfer and feedback in organizations within the acute care chain; (b) barriers related to the implementation method and time period; and (c) the absence of a high 'sense of urgency' amongst providers in the acute care chain which would aid in improving the communication process. Conclusions This study shows that organizational factors play an important role in the success or failure of redesigning a communication process. Organizational routines can hamper implementation of a redesign if it differs too much from the routines of care providers involved. Besides focussing on provider characteristics in the implementation of a redesigned process, specific attention should be paid to unlearning existing organizational routines. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Evidence-based medicine (EBM) has gained widespread acceptance in physical therapy. However, because little is known about the attitudes, knowledge and behaviour of physical therapists towards EBM, and their participation in research to generate EBM, we explored these aspects among physical therapy students, teachers, supervisors and practising physical therapists. Methods This is a cross-sectional survey in which participants completed a web-based questionnaire to determine their attitudes, knowledge and behaviour regarding EBM, and their participation in research. Results Questionnaires were sent to 814 participants of which 165 were returned. The overall mean score for attitude was 4.3 [standard deviation (SD) 1.0; range 1-7], which indicates a weak positive attitude. Teachers scored the highest (4.9, SD 1.2) and students the lowest (4.1, SD 0.8). Although most participants had some understanding of the technical terms used in EBM, only teachers felt able to explain these terms to others. Of the students, 45% rated their perceived EBM knowledge as bad and 45% as average, whereas 78% of the teachers considered that they had good knowledge. To answer clinical questions, most students generally use textbooks (96%) and the opinion of their supervisors (87.7%). Conclusions There is a weak positive attitude of physical therapists, teachers, supervisors and students towards participating in research in general practice, but there is a lack of knowledge and active behaviour regarding EBM, especially among physical therapy students. [ABSTRACT FROM AUTHOR]