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Background: Grip strength is widely used as a surrogate parameter for functional status. The current gold standard, the JAMAR® Hydraulic Dynamometer (JAMAR® Hydraulic), presents challenges for individuals with painful finger joints or low grip strength. Therefore, the objective of this observational study was to assess comparability across the JAMAR® Smart, the Martin Vigorimeter and the gold standard. Additionally, the intrasubject and intersession reliability of all three devices were examined, which are essential for quality control before generating normative data. Methods: Forty healthy participants (aged 37.0 ± 11.3 years) were included, and a subset of 20 participants was randomly selected for retesting. Grip strength testing involved five attempts per measurement device. Results: Intrasubject reliability was excellent (ICC3,1: 0.91–0.97), and a strong correlation (ICC3,1: 0.90–0.98) was found between the first attempt and the best of five as well as between the best of two or three attempts and the best of five, demonstrating robust reliability across multiple measures. Intersession reliability was good to excellent (ICC3,1: 0.85–0.97) across all three devices, which was confirmed by Bland–Altman analysis. The PCC (r) revealed moderate to very strong agreement with the current gold standard JAMAR® Hydraulic (r = 0.68–0.98), with increased differences between the Martin Vigorimeter and the JAMAR® Hydraulic measurements, particularly at low and high values. Conclusions: The proposed devices are suitable for test-retest analysis with 2–3 attempts. Despite high correlations between all three devices, the diverging levels of agreement between the Martin Vigorimeter and the established gold standard warrant caution against using these devices interchangeably. [ABSTRACT FROM AUTHOR]

This study investigates the effectiveness of using Hospital Fit as part of usual care physiotherapy on the physical activity (PA) behavior of hospitalized patients compared to patients who received physiotherapy before implementation of Hospital Fit. In addition, a process evaluation is conducted. A prospective, multi-center, mixed-methods stepped wedge cluster randomized trial was performed at the cardiology and medical oncology departments of two Dutch university medical centers. Patients were included in the non-intervention or intervention phase. During the non-intervention phase, patients received usual care physiotherapy. During the intervention phase, Hospital Fit was additionally used. Mean time spent walking, standing, lying/sitting per day and the number of postural transitions from lying/sitting to standing/walking positions were measured using an accelerometer and analyzed using linear mixed models. A process evaluation was performed using questionnaires and semi-structured interviews with patients and focus-group interviews with healthcare professionals. A total of 77 patients were included, and data from 63 patients were used for data analysis. During the intervention phase, the average time spent walking per day was 20 min (95% confidence interval: −2 to 41 min) higher than during the non-intervention phase (p = 0.075). No significant differences were found for mean time spent standing per day, mean time spent lying/sitting per day, or the number of postural transitions per day either. During the intervention phase, 87% of patients used Hospital Fit at least once, with a median daily use of 2.5 to 4.0 times. Patients and healthcare professionals believed that Hospital Fit improved patients' PA behavior and recovery. Insufficient digital skills and technical issues were described as challenges. Although patients and healthcare professionals described Hospital Fit as an added value, no statistically significant effects were found. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess physiotherapists' clinical use and acceptance of a novel telemonitoring platform to facilitate the recording of measurements during rehabilitation of patients following anterior cruciate ligament reconstruction. Additionally, suggestions for platform improvement were explored. Physiotherapists from seven Dutch private physiotherapy practices participated in the study. Data were collected through log files, a technology acceptance questionnaire and focus group meetings using the "buy a feature" method. Data regarding platform use and acceptance (7-point/11-point numeric rating scale) were descriptively analysed. Total scores were calculated for the features suggested to improve the platform, based on the priority rating (1 = nice to have, 2 = should have, 3 = must have). Participating physiotherapists (N= 15, mean [SD] age 33.1 [9.1] years) together treated 52 patients during the study period. Platform use by the therapists was generally limited, with the number of log-ins per patient varying from 3 to 73. Overall, therapists' acceptance of the platform was low to moderate, with average (SD) scores ranging from 2.5 (1.1) to 4.9 (1.5) on the 7-point Likert scale. The three most important suggestions for platform improvement were: (1) development of a native app, (2) system interoperability, and (3) flexibility regarding type and frequency of measurements. Even though health care professionals were involved in the design of the telemonitoring platform, use in routine care was limited. Physiotherapists recognized the relevance of using health technology, but there are still barriers to overcome in order to successfully implement eHealth in routine care. The use and acceptance of the telemonitoring platform by physiotherapists for patients following anterior cruciate ligament reconstruction was limited. Suggestions made by therapists for platform improvement mainly related to user-friendliness and efficiency of workflow. Novel digital health technology needs to fit into daily routines, be easily accessible and easy to use for the end users. [ABSTRACT FROM AUTHOR]

Abstract Background Adequate and intensive rehabilitation is an important requirement for successful total knee arthroplasty. Although research suggests that Continuous Passive Motion (CPM) should be implemented in the first rehabilitation phase after surgery, there is substantial debate about the duration of each session and the total period of CPM application. A Cochrane review on this topic concluded that short-term use of CPM leads to greater short-term range of motion. It also suggested, however, that future research should concentrate on the treatment period during which CPM should be administered. Methods In a randomised controlled trial we investigated the effectiveness of prolonged CPM use in the home situation as an adjunct to standardised PT. Efficacy was assessed in terms of faster improvements in range of motion (RoM) and functional recovery, measured at the end of the active treatment period, 17 days after surgery. Sixty patients with knee osteoarthritis undergoing TKA and experiencing early postoperative flexion impairment were randomised over two treatment groups. The experimental group received CPM + PT for 17 consecutive days after surgery, whereas the usual care group received the same treatment during the in-hospital phase (i.e. about four days), followed by PT alone (usual care) in the first two weeks after hospital discharge. From 18 days to three months after surgery, both groups received standardised PT. The primary focus of rehabilitation was functional recovery (e.g. ambulation) and regaining RoM in the knee. Results Prolonged use of CPM slightly improved short-term RoM in patients with limited RoM at the time of discharge after total knee arthroplasty when added to a semi-standard PT programme. Assessment at 6 weeks and three months after surgery found no long-term effects of this intervention Neither did we detect functional benefits of the improved RoM at any of the outcome assessments. Conclusion Although results indicate that prolonged CPM use might have a small short-term effect on RoM, routine use of prolonged CPM in patients with limited RoM at hospital discharge should be reconsidered, since neither long-term effects nor transfer to better functional performance was detected. Trial Registration ISRCTN85759656

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Patients scheduled for cardiac surgery and procedures often present with modifiable risk factors for adverse perioperative outcomes. Prehabilitation has shown potential to enhance mental and physical fitness; however, its effect on clinical cardiovascular endpoints in this population has not been studied. The current trial was designed to evaluate the effect of a personalized multimodal teleprehabilitation on the incidence of composite endpoint on major adverse cardiovascular events in patients scheduled for elective cardiac surgery. In a multicenter randomized controlled trial, 394 patients awaiting elective cardiac surgery and procedures were enrolled. Of these, 197 patients were randomized to an online multimodal personalized teleprehabilitation program through shared decision-making by a multidisciplinary team, and 197 were assigned to a control group. The primary outcome was major adverse cardiovascular events (ie, cardiovascular death, myocardial infarction, stroke, hospitalization for heart failure or other life-threatening cardiac events, and earlier or repeated intervention), as measured from the randomization until 1-year postoperatively. All events were adjudicated by a blinded event committee. Secondary outcomes included length of hospital stay, postoperative complications, quality of life, adherence to the program, and effect on the incidence of modifiable risk factors. Sensitivity analyses of the primary outcome were conducted adjusting for baseline characteristics to evaluate the consistency of treatment effects. From randomization until 1 year postoperatively, the primary endpoint occurred in 33 patients (16.8%) in the teleprehabilitation group and 50 patients (25.5%) in the control group (difference 8.8%; 95% CI: 0.7%-16.8%; P = 0.032). This difference was primarily driven by a reduction in hospitalizations, and the sensitivity analyses showed that treatment effect was mainly in the patients undergoing a cardiac surgery rather than transcatheter procedures with adjusted OR of 0.54 (95% CI: 0.30-0.96; P = 0.035). Teleprehabilitation also reduced the incidence of active smokers, elevated pulmonary risk scores, and elevated depression scores. There was no significant difference in postoperative length of hospital stay, occurrence of postoperative complications, physical fitness, incidence of obesity, or malnutrition. Multimodal personalized teleprehabilitation resulted in a clinically relevant and statistically significant reduction of the primary endpoint in patients undergoing cardiac surgery. (Digital Cardiac Counseling Trial: DCC Trial [DCC]; NCT04393636) [Display omitted] [ABSTRACT FROM AUTHOR]

Aims: Previous research has shown the possibility to use the pre-operative period to improve a patient's tolerance for surgery. However, there is limited experience with prehabilitation in cardiac surgery. The aim of this study is to evaluate the effect of a comprehensive personalized teleprehabilitation programme on major adverse cardiac events (MACE) in patients scheduled for elective cardiac surgery. Secondary outcomes are post-operative complications, cardiovascular risk factors, quality of life, and cost-effectiveness., Methods and Results: In this single-centre randomized controlled trial, patients are eligible for inclusion when they are ≥18 years of age and cardiac surgery is scheduled at least 8 weeks from informed consent. Participants will be randomized to the teleprehabilitation group or the control group. After a digital baseline screening for perioperative risk factors, patients in the intervention arm can pre-operatively be referred to one or more of the prehabilitation modules (functional exercise training, inspiratory muscle training, psychological support, nutritional support, and/or smoking cessation). The programme is targeted at a duration of at least 6 weeks. It is executed by a multidisciplinary team using (video)calls and supported by a custom-made digital platform. During the pre-operative period, the platform is also used to inform patients about their upcoming surgery and for telemonitoring., Conclusion: Reducing perioperative risk factors might result in a reduction of MACE, post-operative complications, length of stay, and cardiovascular risk factors, as well as improved quality of life. Cost-effectiveness will be evaluated., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: The first aim of this study was to describe duration and relative timing of the phases of the maximal instep kick. The second aim was to describe the concurrence of maximal range of motion, maximal angular acceleration, maximal angular deceleration and maximal angular velocity of body segments with four key points., Methods: Twenty experienced football players performed three maximal instep kicks. The kicks were analysed using a full body, three-dimensional motion capture system. Camera recordings determined kicking leg events. The concurrence of peak kinematics of body segments with four key points was calculated., Results: Duration and timing of five phases were identified. Key point maximal hip extension (51.4±5.0%) concurred significantly with maximal range of motion (ROM) of shoulder extension. Key point maximal knee flexion (63.6±5.2%) concurred significantly with maximal angular acceleration of spine flexion and pelvis posterior tilt. Key point knee flexion 90 degrees (69.3±4.9%) concurred significantly with maximal angular velocity of shoulder flexion and spine flexion, maximal angular deceleration of hip flexion and maximal angular acceleration of knee extension. Key point ball impact (75.2±5.2%) concurred significantly with maximal ROM of hip deflexion and pelvis anterior rotation and with maximal angular deceleration of spine flexion and pelvis anterior rotation., Conclusions: This study demonstrated that eleven peak kinematics of upper body and kicking leg segments, significantly concurred with four kicking leg positions. These results provide Key points for kicking coordination and stress the importance of dynamical coupling as a kicking mechanism.

The purpose of this project was to summarise the available evidence on the effectiveness of exercise therapy for patients with disorders of the musculoskeletal, nervous, respiratory, and cardiovascular systems. Systematic reviews were identified by means of a comprehensive search strategy in 11 bibliographic databases (08/2002), in combination with reference tracking. Reviews that included (i) at least one randomised controlled trial investigating the effectiveness of exercise therapy, (ii) clinically relevant outcome measures, and (iii) full text written in English, German or Dutch, were selected by two reviewers. Thirteen independent and blinded reviewers participated in the selection, quality assessment and data-extraction of the systematic reviews. Conclusions about the effectiveness of exercise therapy were based on the results presented in reasonable or good quality systematic reviews (quality score > or = 60 out of 100 points). A total of 104 systematic reviews were selected, 45 of which were of reasonable or good quality. Exercise therapy is effective for patients with knee osteoarthritis, sub-acute (6 to 12 weeks) and chronic (> or = 12 weeks) low back pain, cystic fibrosis, chronic obstructive pulmonary disease, and intermittent claudication. Furthermore, there are indications that exercise therapy is effective for patients with ankylosing spondylitis, hip osteoarthritis, Parkinson's disease, and for patients who have suffered a stroke. There is insufficient evidence to support or refute the effectiveness of exercise therapy for patients with neck pain, shoulder pain, repetitive strain injury, rheumatoid arthritis, asthma, and bronchiectasis. Exercise therapy is not effective for patients with acute low back pain. It is concluded that exercise therapy is effective for a wide range of chronic disorders.