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SYNOPSIS: Neck pain, headache, and/or orofacial symptoms are potentially the first (non-ischaemic) symptoms of an underlying vascular pathology or blood flow limitation. If an underlying vascular pathology or blood flow limitation is not recognized by the musculoskeletal rehabilitation clinician, it can subsequently be aggravated by treatment, raising the risk of serious adverse events. We argue that clinicians can make an important, and potentially lifesaving difference, by providing specific information and advice. This is especially the case in patients with an intermediate level of concern for example in patients who only show a few concerning features regarding a possible underlying serious condition, and for whom an initial vasculogenic hypothesis was rejected during the clinical reasoning process. We present background information to help the reader understand the context of the problem, and suggestions for how clinicians can provide appropriate information and advice to patients who present with neck pain, headache, and/or orofacial symptoms.

BACKGROUND: Access to pain education for healthcare professionals is an International Association for the Study of Pain's key recommendation to improve pain care. The content of preregistration and undergraduate physical therapy pain curricula, however, is highly variable.OBJECTIVE: This study aimed to develop a list, by consensus, of essential pain-related topics for the undergraduate physical therapy curriculum.METHODS: A modified Delphi study was conducted in four rounds, including a Delphi Panel ( N = 22) consisting of in pain experienced lecturers of preregistration undergraduate physical therapy of Universities of Applied Sciences in the Netherlands, and five Validation Panels. Round 1: topics were provided by the Delphi Panel, postgraduate pain educators, and a literature search. Rounds 2-4: the Delphi Panel rated the topics and commented. All topics were analyzed in terms of importance and degree of consensus. Validation Panels rated the outcome of Round 2. RESULTS: The Delphi Panel rated 257, 146, and 90 topics in Rounds 2, 3, and 4, respectively. This resulted in 71 topics judged as "not important," 97 as "important," and 89 as "highly important." In total, 63 topics were rated as "highly important" by the Delphi Panel and Validation Panels.CONCLUSION: A list was developed and can serve as a foundation for the development of comprehensive physical therapy pain curricula.

Met de toenemende vergrijzing in ons land zal er ook een toename plaatsvinden van het aantal ouderen met dementie. Dementie, met als voornaamste oorzaak de ziekte van Alzheimer, wordt in het algemeen vooral gezien als een ziekte waarbij cognitieve problemen optreden. Dat er ook al in een vroeg stadium motorische stoornissen optreden is veel minder bekend. Pas in een laat stadium worden de motorische problemen dusdanig groot dat de fysiotherapeut wordt ingeschakeld. Het is van belang om als fysiotherapeut kennis te hebben van de verschillende vormen van dementie en de daarmee gepaard gaande verschillen in motorische stoornissen. Daarnaast is het van belang om inzicht te krijgen in werkzame interventies en de juiste meetinstrumenten in te kunnen zetten. In deze masterclass wordt inzicht gegeven in de motorische problemen bij dementie (o.a. paratonie) en worden handvatten voor de praktijk gegeven.

Movement disorders in dementia are not well known yet they have a devastating effect on the quality of life and the abilities of a person with dementia. Paratonia is one of these movement disorders that are already present in 10% of the population with dementia in the early stages and increase up to 100% in the late stages. Paratonia is caused by central nervous system pathology, yet peripheral biomechanical changes due to Advanced Glycation Endproducts (AGEs) are also responsible for further deterioration of motor control in dementia. Physical activity can prevent the accumulation of AGEs.

Digitalisering is al sinds de jaren ‘90 een trend om zorg efficiënter en dicht bij de patiënt aan te aanbieden. COVID-19 heeft de digitalisering in een stroomversnelling gebracht. Ook binnen de fysiotherapie werd geëxperimenteerd met de inzet van videoconsulten. Het overgrote deel van patiënten was (zeer) tevreden over videoconsulten. Fysiotherapeuten waren wat gematigder enthousiast, mede omdat ze bepaalde diagnostische- en behandelelementen niet konden uitvoeren, die vaak onderdeel zijn van een behandeling.

Digitalisering is al sinds de jaren ‘90 een trend om zorg efficiënter en dicht bij de patiënt aan te aanbieden. COVID-19 heeft de digitalisering in een stroomversnelling gebracht. Ook binnen de fysiotherapie werd geëxperimenteerd met de inzet van videoconsulten. Het overgrote deel van patiënten was (zeer) tevreden over videoconsulten. Fysiotherapeuten waren wat gematigder enthousiast, mede omdat ze bepaalde diagnostische- en behandelelementen niet konden uitvoeren, die vaak onderdeel zijn van een behandeling.

Achtergrond: De Two-Minute Step Test (TMST) is een meetinstrument gericht op het beoordelen van uithoudingsvermogen. Verscheidene psychometrische eigenschappen van de TMST-NL (Nederlands vertaalde versie) zijn onderzocht bij intramuraal wonende ouderen. De gevoeligheid voor verandering en de responsiviteit is bij deze patiëntenpopulatie nog niet vastgesteld. Doel: Het vaststellen van de gevoeligheid voor verandering en de responsiviteit (Minimal Clinical Important Difference) van de TMST-NL bij intramuraal wonende ouderen. Design: Prospectief responsiviteitsonderzoek. Methode: De onderzoekspopulatie bestond uit intramuraal wonende ouderen. Deelnemers hebben twee meetmomenten (T0 en T1) ondergaan waartussen ze drie maanden fysiotherapie gericht op uithoudingsvermogen ontvingen. Om de gevoeligheid van verandering te meten werd de distributie methode gebruikt waarbij de correlatie met de 6-minuten wandeltest (6MWT) werd getoetst. Via de anker methode met de Receiver Operating Characteristic (ROC) curve werd de MCID bepaald. Metingen voor het aerobe uithoudingsvermogen werden verricht met de TMST-NL en de 6-minuten wandeltest (6MWT). De Global Rating of Change (GRC) en de Borg Category-Ratio10 (BORG-CR10) werden gebruikt als subjectieve vragenlijsten om verandering van de gezondheidssituatie en vermoeidheid te meten. Resultaten: Intramurale ouderen (N=50) met een gemiddelde (SD) leeftijd van 83,96 jaar (6,96) zijn geïncludeerd. De correlatie tussen de verschilscores van de TMST-NL en de 6MWT over de deelnemerspopulatie die T1 ook hebben afgerond (N= 36) kwam uit op r=0.51 (P

Tijdens de coronapandemie kwam de term 'kwetsbaarheid' of 'kwetsbare ouderen' regelmatig in het nieuws. Deze groep liep meer risico om het virus te krijgen en bovendien was het ziektebeloop bij deze groep vaak ernstiger. Maar wat is ‘kwetsbaarheid bij ouderen’, ook wel aangeduid met de Engelse term 'Frailty', nu precies en welke mechanismen liggen eraan ten grondslag? En waarom is het van belang dat u als fysiotherapeut kennis hebt van kwetsbaarheid. Deze cursus gaat daarop in. Oorspronkelijk is kwetsbaarheid een biomedisch concept. De definitie van Fried et al. is een voorbeeld van een dergelijke definitie. Zij definiëren kwetsbaarheid als: een biologisch syndroom waarbij sprake is van een verminderde reserve en weerstand tegen stressoren, dat het resultaat is van dalingen van diverse fysiologische systemen, en het risico verhoogt op negatieve gezondheidsuitkomsten. In meer recente definities wordt kwetsbaarheid integraal benaderd en als multidimensionaal gezien. Naast het fysieke domein is er ook oog voor psychische en sociale problemen die ouderen kunnen hebben. Deze holistische benadering (waarbij systeemdenken van belang is) is essentieel voor een efficiënte en effectieve fysiotherapeutische behandeling. Bovendien hebben fysiotherapeuten de preventieve taak om kwetsbaarheid vroegtijdig te signaleren om d.m.v. gerichte interventies kwetsbaarheid te verminderen of erger te voorkomen.

The ESCAPE trial is a randomized clinical trial comparing meniscus surgery with physical therapy in patients with a degenerative meniscal tear. This thesis is an in-depth analysis and continuation of the ESCAPE trial, aiming to advance evidence-based practice for patients with a degenerative meniscal tear. We investigated the responsiveness and minimal important change of the International Knee Documentation Committee Subjective Knee Form, the primary outcome of the ESCAPE trial. These measurement properties are important for assessing intervention effects in clinical practice and randomized controlled trials. This study showed that the IKDC is responsive to change among patients aged 45 to 70 years with meniscus tears, with an MIC of 10.9 points. This strengthens the value of the IKDC in quantifying treatment effects in this population. Patient-specific activities have not yet been considered as part of the evaluation of treatment effects in those with a meniscus tear. We compared meniscus surgery with physical therapy in patients with a degenerative meniscal tear using the Dutch equivalent of the patient-specific functioning score. measure over a period of 2 years. We also calculated the MIC for the PSFS using an anchor-based method to interpret the results. In our study population, we found a MIC of 2.5 points. The crude overall between-group difference showed a difference of 0.6 points (95% CI, –1.0 to –0.2; p = .004) between both groups. Although statistically significant, this difference between meniscus surgery and physical therapy in terms of patients’ specific activities is not clinically meaningful. In the current guidelines, exercise-based physical therapy is the recommended treatment in patients over 45 years old with a degenerative meniscus tear. However, between 1.9 and 36% of the patients randomized to physical therapy still opt for meniscus surgery. We developed and validated two multivariable prognostic models to identify those patients with a degenerative meniscal tear who will undergo surgery within 6 months and within 24 months following physical therapy. At 24 months, patients were more likely to opt for meniscus surgery when they had worse knee function and a lower level of education at baseline. Both models had a low explained variance (16% and 11%, respectively) and a poor discriminative ability. The non-responders to physical therapy could not accurately be predicted by our prognostic models. To select the best treatment (i.e. meniscus surgery or exercise-based physical therapy) for an individual patient it is important to quantify the expected benefit of one treatment over the other. We introduced a novel approach in musculoskeletal research, a marker-by-treatment analysis. We found that general physical health, pain during activities, knee function, BMI and age were potential treatment selection markers. While some marker-based thresholds could be identified at 3, 12 and 24 months follow-up, none of the baseline characteristics were consistent markers at all three follow-up times. This novel in-depth analysis did not result in clear clinical subgroups of patients who are substantially more likely to benefit from either surgery or physical therapy. Finally, we compared longer term effectiveness of meniscus surgery and exercise-based physical therapy on patient reported knee function and progression of knee osteoarthritis in patients with a degenerative meniscus tear. We assessed patient-reported knee function on the IKDC over 5 years follow-up based on the intention-to-treat principle, with a non-inferiority threshold of 11 points (based on the MIC determined in chapter 2 in our study population). The between-group difference was 2.8 points (95%CI: -0.9 to 6.5; p-value for non-inferiority

The ESCAPE trial is a randomized clinical trial comparing meniscus surgery with physical therapy in patients with a degenerative meniscal tear. This thesis is an in-depth analysis and continuation of the ESCAPE trial, aiming to advance evidence-based practice for patients with a degenerative meniscal tear. We investigated the responsiveness and minimal important change of the International Knee Documentation Committee Subjective Knee Form, the primary outcome of the ESCAPE trial. These measurement properties are important for assessing intervention effects in clinical practice and randomized controlled trials. This study showed that the IKDC is responsive to change among patients aged 45 to 70 years with meniscus tears, with an MIC of 10.9 points. This strengthens the value of the IKDC in quantifying treatment effects in this population. Patient-specific activities have not yet been considered as part of the evaluation of treatment effects in those with a meniscus tear. We compared meniscus surgery with physical therapy in patients with a degenerative meniscal tear using the Dutch equivalent of the patient-specific functioning score. measure over a period of 2 years. We also calculated the MIC for the PSFS using an anchor-based method to interpret the results. In our study population, we found a MIC of 2.5 points. The crude overall between-group difference showed a difference of 0.6 points (95% CI, –1.0 to –0.2; p = .004) between both groups. Although statistically significant, this difference between meniscus surgery and physical therapy in terms of patients’ specific activities is not clinically meaningful. In the current guidelines, exercise-based physical therapy is the recommended treatment in patients over 45 years old with a degenerative meniscus tear. However, between 1.9 and 36% of the patients randomized to physical therapy still opt for meniscus surgery. We developed and validated two multivariable prognostic models to identify those patients with a degenerative meniscal tear who will undergo surgery within 6 months and within 24 months following physical therapy. At 24 months, patients were more likely to opt for meniscus surgery when they had worse knee function and a lower level of education at baseline. Both models had a low explained variance (16% and 11%, respectively) and a poor discriminative ability. The non-responders to physical therapy could not accurately be predicted by our prognostic models. To select the best treatment (i.e. meniscus surgery or exercise-based physical therapy) for an individual patient it is important to quantify the expected benefit of one treatment over the other. We introduced a novel approach in musculoskeletal research, a marker-by-treatment analysis. We found that general physical health, pain during activities, knee function, BMI and age were potential treatment selection markers. While some marker-based thresholds could be identified at 3, 12 and 24 months follow-up, none of the baseline characteristics were consistent markers at all three follow-up times. This novel in-depth analysis did not result in clear clinical subgroups of patients who are substantially more likely to benefit from either surgery or physical therapy. Finally, we compared longer term effectiveness of meniscus surgery and exercise-based physical therapy on patient reported knee function and progression of knee osteoarthritis in patients with a degenerative meniscus tear. We assessed patient-reported knee function on the IKDC over 5 years follow-up based on the intention-to-treat principle, with a non-inferiority threshold of 11 points (based on the MIC determined in chapter 2 in our study population). The between-group difference was 2.8 points (95%CI: -0.9 to 6.5; p-value for non-inferiority

The ESCAPE trial is a randomized clinical trial comparing meniscus surgery with physical therapy in patients with a degenerative meniscal tear. This thesis is an in-depth analysis and continuation of the ESCAPE trial, aiming to advance evidence-based practice for patients with a degenerative meniscal tear. We investigated the responsiveness and minimal important change of the International Knee Documentation Committee Subjective Knee Form, the primary outcome of the ESCAPE trial. These measurement properties are important for assessing intervention effects in clinical practice and randomized controlled trials. This study showed that the IKDC is responsive to change among patients aged 45 to 70 years with meniscus tears, with an MIC of 10.9 points. This strengthens the value of the IKDC in quantifying treatment effects in this population. Patient-specific activities have not yet been considered as part of the evaluation of treatment effects in those with a meniscus tear. We compared meniscus surgery with physical therapy in patients with a degenerative meniscal tear using the Dutch equivalent of the patient-specific functioning score. measure over a period of 2 years. We also calculated the MIC for the PSFS using an anchor-based method to interpret the results. In our study population, we found a MIC of 2.5 points. The crude overall between-group difference showed a difference of 0.6 points (95% CI, –1.0 to –0.2; p = .004) between both groups. Although statistically significant, this difference between meniscus surgery and physical therapy in terms of patients’ specific activities is not clinically meaningful. In the current guidelines, exercise-based physical therapy is the recommended treatment in patients over 45 years old with a degenerative meniscus tear. However, between 1.9 and 36% of the patients randomized to physical therapy still opt for meniscus surgery. We developed and validated two multivariable prognostic models to identify those patients with a degenerative meniscal tear who will undergo surgery within 6 months and within 24 months following physical therapy. At 24 months, patients were more likely to opt for meniscus surgery when they had worse knee function and a lower level of education at baseline. Both models had a low explained variance (16% and 11%, respectively) and a poor discriminative ability. The non-responders to physical therapy could not accurately be predicted by our prognostic models. To select the best treatment (i.e. meniscus surgery or exercise-based physical therapy) for an individual patient it is important to quantify the expected benefit of one treatment over the other. We introduced a novel approach in musculoskeletal research, a marker-by-treatment analysis. We found that general physical health, pain during activities, knee function, BMI and age were potential treatment selection markers. While some marker-based thresholds could be identified at 3, 12 and 24 months follow-up, none of the baseline characteristics were consistent markers at all three follow-up times. This novel in-depth analysis did not result in clear clinical subgroups of patients who are substantially more likely to benefit from either surgery or physical therapy. Finally, we compared longer term effectiveness of meniscus surgery and exercise-based physical therapy on patient reported knee function and progression of knee osteoarthritis in patients with a degenerative meniscus tear. We assessed patient-reported knee function on the IKDC over 5 years follow-up based on the intention-to-treat principle, with a non-inferiority threshold of 11 points (based on the MIC determined in chapter 2 in our study population). The between-group difference was 2.8 points (95%CI: -0.9 to 6.5; p-value for non-inferiority

The ESCAPE trial is a randomized clinical trial comparing meniscus surgery with physical therapy in patients with a degenerative meniscal tear. This thesis is an in-depth analysis and continuation of the ESCAPE trial, aiming to advance evidence-based practice for patients with a degenerative meniscal tear. We investigated the responsiveness and minimal important change of the International Knee Documentation Committee Subjective Knee Form, the primary outcome of the ESCAPE trial. These measurement properties are important for assessing intervention effects in clinical practice and randomized controlled trials. This study showed that the IKDC is responsive to change among patients aged 45 to 70 years with meniscus tears, with an MIC of 10.9 points. This strengthens the value of the IKDC in quantifying treatment effects in this population. Patient-specific activities have not yet been considered as part of the evaluation of treatment effects in those with a meniscus tear. We compared meniscus surgery with physical therapy in patients with a degenerative meniscal tear using the Dutch equivalent of the patient-specific functioning score. measure over a period of 2 years. We also calculated the MIC for the PSFS using an anchor-based method to interpret the results. In our study population, we found a MIC of 2.5 points. The crude overall between-group difference showed a difference of 0.6 points (95% CI, –1.0 to –0.2; p = .004) between both groups. Although statistically significant, this difference between meniscus surgery and physical therapy in terms of patients’ specific activities is not clinically meaningful. In the current guidelines, exercise-based physical therapy is the recommended treatment in patients over 45 years old with a degenerative meniscus tear. However, between 1.9 and 36% of the patients randomized to physical therapy still opt for meniscus surgery. We developed and validated two multivariable prognostic models to identify those patients with a degenerative meniscal tear who will undergo surgery within 6 months and within 24 months following physical therapy. At 24 months, patients were more likely to opt for meniscus surgery when they had worse knee function and a lower level of education at baseline. Both models had a low explained variance (16% and 11%, respectively) and a poor discriminative ability. The non-responders to physical therapy could not accurately be predicted by our prognostic models. To select the best treatment (i.e. meniscus surgery or exercise-based physical therapy) for an individual patient it is important to quantify the expected benefit of one treatment over the other. We introduced a novel approach in musculoskeletal research, a marker-by-treatment analysis. We found that general physical health, pain during activities, knee function, BMI and age were potential treatment selection markers. While some marker-based thresholds could be identified at 3, 12 and 24 months follow-up, none of the baseline characteristics were consistent markers at all three follow-up times. This novel in-depth analysis did not result in clear clinical subgroups of patients who are substantially more likely to benefit from either surgery or physical therapy. Finally, we compared longer term effectiveness of meniscus surgery and exercise-based physical therapy on patient reported knee function and progression of knee osteoarthritis in patients with a degenerative meniscus tear. We assessed patient-reported knee function on the IKDC over 5 years follow-up based on the intention-to-treat principle, with a non-inferiority threshold of 11 points (based on the MIC determined in chapter 2 in our study population). The between-group difference was 2.8 points (95%CI: -0.9 to 6.5; p-value for non-inferiority

The general aim of this dissertation is to gain insight into the physiotherapeutic validity of physiotherapy research in subjects with non-specific neck pain. Chapter 1 describes the background of the research and the research questions and gives an overview of the studies performed. Chapter 2 presents the results of a systematic review (SR) of the completeness of the clinical reasoning process within the methodology of the RCT in patients with non-specific neck pain. For the SR analysis 122 studies were included. In the majority of studies (70%) the described clinical reasoning process was incomplete. There was scarcely any association between the degree of risk of bias and the completeness of the clinical reasoning process, indicating that better methodological quality does not necessarily imply a better description of clinical reasoning process. Chapter 3 presents the results of a SR in which we sought to identify published classification systems with a targeted treatment approach (treatment-based classification systems (TBCSs)) for patients with non-specific neck pain. Thirteen TBCSs were identified. In conclusion, existing treatment-based classification systems are of moderate quality at best. Moreover, these systems were not more effective than alternative treatments. Therefore, we do not recommend the use of these systems in daily physiotherapy practice. Chapter 4 describes a Delphi study of the clinical reasoning process of physiotherapy experts in unimodal interventions in patients with non-specific neck pain. This study had three goals. First, we aimed explore the expert opinions on the indication for physiotherapy when, other than neck pain, there are no positive signs and symptoms, no positive diagnostic tests or complaints of limitations in functioning or restrictions in participation. Second, we focused on the experts' use of measurement tools and when they are used to support and objectify the clinical reasoning process. Finally, we wanted to reach consensus among experts on the use of unimodal interventions in patients with non-specific neck pain. According to all experts, pain alone was not considered to be an indication for physiotherapy. Patient reported outcome measures were mainly used for evaluative purposes and physical tests for diagnostic and evaluative purposes. Only 6 of the 18 variants of sequential linear clinical reasoning reached a consensus of more than 50%. Chapter 5 describes a review that examined the completeness of the description of manipulation and mobilization interventions in randomized controlled trials of subjects with non-specific neck pain. In conclusion, mobilization or manipulation interventions are poorly reported in RCTs, compromising the external validity of RCTs, making it difficult for clinicians and researchers to replicate these interventions. Chapter 6 investigated the diagnostic physiotherapeutic process regarding limited ROM of the neck. It can be concluded that the overall diagnostic accuracy of physical examination is limited (compared to the CROM measurement). Therefore, a measurement device should be used in daily physical therapy practice to assess if a movement direction is restricted. Chapter 7 describes an exploratory, practice-oriented study into matched treatments in patients with non-specific neck pain. The objective of this study was 1) to establish the measurement error of the used accelerometer; 2) To determine which different treatments are used; 3) To explore if the cervical ROM, pain, (perceived) disability and motor control improved after one treatment. The SCT is a reliable accelerometer for measuring neck ROM, with a small measurement error. Eight different treatments were carried out. Pain, disability and left and right rotation showed a clinically relevant improvements (exceeded the measurement error). Chapter 8 comprises the general discussion. The general discussion presents an overview of this dissertation and discusses the strengths and limitations of the studies and possible implications of the results and recommendations for future research.

The general aim of this dissertation is to gain insight into the physiotherapeutic validity of physiotherapy research in subjects with non-specific neck pain. Chapter 1 describes the background of the research and the research questions and gives an overview of the studies performed. Chapter 2 presents the results of a systematic review (SR) of the completeness of the clinical reasoning process within the methodology of the RCT in patients with non-specific neck pain. For the SR analysis 122 studies were included. In the majority of studies (70%) the described clinical reasoning process was incomplete. There was scarcely any association between the degree of risk of bias and the completeness of the clinical reasoning process, indicating that better methodological quality does not necessarily imply a better description of clinical reasoning process. Chapter 3 presents the results of a SR in which we sought to identify published classification systems with a targeted treatment approach (treatment-based classification systems (TBCSs)) for patients with non-specific neck pain. Thirteen TBCSs were identified. In conclusion, existing treatment-based classification systems are of moderate quality at best. Moreover, these systems were not more effective than alternative treatments. Therefore, we do not recommend the use of these systems in daily physiotherapy practice. Chapter 4 describes a Delphi study of the clinical reasoning process of physiotherapy experts in unimodal interventions in patients with non-specific neck pain. This study had three goals. First, we aimed explore the expert opinions on the indication for physiotherapy when, other than neck pain, there are no positive signs and symptoms, no positive diagnostic tests or complaints of limitations in functioning or restrictions in participation. Second, we focused on the experts' use of measurement tools and when they are used to support and objectify the clinical reasoning process. Finally, we wanted to reach consensus among experts on the use of unimodal interventions in patients with non-specific neck pain. According to all experts, pain alone was not considered to be an indication for physiotherapy. Patient reported outcome measures were mainly used for evaluative purposes and physical tests for diagnostic and evaluative purposes. Only 6 of the 18 variants of sequential linear clinical reasoning reached a consensus of more than 50%. Chapter 5 describes a review that examined the completeness of the description of manipulation and mobilization interventions in randomized controlled trials of subjects with non-specific neck pain. In conclusion, mobilization or manipulation interventions are poorly reported in RCTs, compromising the external validity of RCTs, making it difficult for clinicians and researchers to replicate these interventions. Chapter 6 investigated the diagnostic physiotherapeutic process regarding limited ROM of the neck. It can be concluded that the overall diagnostic accuracy of physical examination is limited (compared to the CROM measurement). Therefore, a measurement device should be used in daily physical therapy practice to assess if a movement direction is restricted. Chapter 7 describes an exploratory, practice-oriented study into matched treatments in patients with non-specific neck pain. The objective of this study was 1) to establish the measurement error of the used accelerometer; 2) To determine which different treatments are used; 3) To explore if the cervical ROM, pain, (perceived) disability and motor control improved after one treatment. The SCT is a reliable accelerometer for measuring neck ROM, with a small measurement error. Eight different treatments were carried out. Pain, disability and left and right rotation showed a clinically relevant improvements (exceeded the measurement error). Chapter 8 comprises the general discussion. The general discussion presents an overview of this dissertation and discusses the strengths and limitations of the studies and possible implications of the results and recommendations for future research.

The European population is ageing rapidly and with age an increase in co-morbidites and a decline in abilities is seen. Frailty is an often-used term to indicate a higher risk to adverse health outcomes. This seems to be a simple concept however in daily practice it is awkward for physiotherapists to work with the term frailty. Frailty is complex and dynamic and is often not recognized by the patient themselves. In this lecture the multiple dimensions of frailty will be addressed and the usefulness in daily practice for physical therapists.

Dit boek geeft fysio- en kinesitherapeuten een actueel overzicht van kennis en vaardigheden om (kwetsbare) ouderen adequaat te onderzoeken en behandelen met oog voor de fysieke aspecten én voor de psychische, sociale en omgevingsfactoren. Deze tweede, geheel herziene editie van Geriatrie in de fysiotherapie en kinesitherapie bestaat uit twee delen: een boek en een online beschikbaar deel. In het eerste deel komt de kennis aan bod over de reguliere veroudering, de rol en kracht van de therapeut, en het klinisch redeneren. Ook worden de veranderingen in de grofmotorische eigenschappen beschreven (spierfunctie,­ mobiliteit, posturale controle en uithoudingsvermogen) en een twaalftal bijzondere aandachtsgebieden zoals onder andere dementie, vallen, hulpmiddelen en farmacotherapie. Online volgen in het tweede deel de vaardigheden op het gebied van onderzoek en behandeling. Daarin staat veelvoorkomende casuïstiek op cardiovasculair, respiratoir, orthopedisch, neurologisch en oncologisch vlak. Dit digitale deel is een heus ‘groeiboek’. Aan de basiscasuïstiek­ worden de komende jaren telkens nieuwe casussen toegevoegd. Het boek richt zich op fysio- en kinesitherapeuten, oefentherapeuten, ergotherapeuten en alle andere zorgprofessionals die betrokken zijn bij de zorg voor ouderen.

Met de toenemende vergrijzing in ons land zal er ook een toename plaatsvinden van het aantal ouderen met dementie. Dementie, met als voornaamste oorzaak de ziekte van Alzheimer, wordt in het algemeen vooral gezien als een ziekte waarbij cognitieve problemen optreden. Dat er ook al in een vroeg stadium motorische stoornissen optreden is veel minder bekend. Pas in een laat stadium worden de motorische problemen dusdanig groot dat de fysiotherapeut wordt ingeschakeld. Het is van belang om als fysiotherapeut kennis te hebben van de verschillende vormen van dementie en de daarmee gepaard gaande verschillen in motorische stoornissen. Daarnaast is het van belang om inzicht te krijgen in werkzame interventies en om de juiste meetinstrumenten te kunnen inzetten. In deze cursus wordt inzicht gegeven in de motorische problemen bij dementie, waarbij er in het bijzonder aandacht is voor paratonie. En er worden handvatten voor de praktijk gegeven.

Door de dubbele vergrijzing (meer ouderen leven langer) zal het aantal mensen met dementie de komende jaren sterk toenemen. Dementie is een overkoepelend verzamelbegrip met vele verschillende oorzaken. De meest voorkomende oorzaken zijn de ziekte van Alzheimer en vasculaire dementie. Daarnaast komen frontotemporale dementie, parkinsondementie, en de dementie met zogeheten lewylichaampjes (‘Lewy body’-dementie) voor. Bij elke vorm van dementie is de motoriek ook aangedaan, we bewegen immers met onze hersenen. Zelfs al in het prodromale stadium (GDS 2–3) zijn veranderingen waargenomen. Er is veelbelovend bewijs voor een positief effect van oefentherapie bij mensen met dementie op het verbeteren van ADL en cognitie. Bovendien is aangetoond dat de zorglast van mantelzorgers significant lager wordt als gevolg van deze oefentherapie, vooral als de mantelzorger zelf bij de oefentherapie wordt betrokken. Over het geheel genomen is het van belang in multidisciplinair verband samen met patiënt en familie creatief te zoeken naar mogelijkheden voor welzijn en comfort, die individueel heel verschillend zijn.

Door de dubbele vergrijzing (meer ouderen leven langer) zal het aantal mensen met dementie de komende jaren sterk toenemen. Dementie is een overkoepelend verzamelbegrip met vele verschillende oorzaken. De meest voorkomende oorzaken zijn de ziekte van Alzheimer en vasculaire dementie. Daarnaast komen frontotemporale dementie, parkinsondementie, en de dementie met zogeheten lewylichaampjes (‘Lewy body’-dementie) voor. Bij elke vorm van dementie is de motoriek ook aangedaan, we bewegen immers met onze hersenen. Zelfs al in het prodromale stadium (GDS 2–3) zijn veranderingen waargenomen. Er is veelbelovend bewijs voor een positief effect van oefentherapie bij mensen met dementie op het verbeteren van ADL en cognitie. Bovendien is aangetoond dat de zorglast van mantelzorgers significant lager wordt als gevolg van deze oefentherapie, vooral als de mantelzorger zelf bij de oefentherapie wordt betrokken. Over het geheel genomen is het van belang in multidisciplinair verband samen met patiënt en familie creatief te zoeken naar mogelijkheden voor welzijn en comfort, die individueel heel verschillend zijn.

De Two-Minute Step Test (TMST) is een praktisch meetinstrument om het uithoudingsvermogen te beoordelen en heeft als voordeel dat deze te gebruiken is wanneer weinig ruimte voorhanden is zoals in intramurale woonsettingen. Tot heden was er geen duidelijkheid over de betrouwbaarheid bij intramuraal wonende ouderen in Nederland. Dit artikel beschrijft een betrouwbaarheidsonderzoek naar de Nederlandse versie van de TMST (TMST-NL) welke is uitgevoerd bij 58 intramuraal wonende ouderen. Hierbij is geconcludeerd dat zowel de interbeoordelaarsbetrouwbaarheid als de intrabeoordelaarsbetrouwbaarheid goed is. Verzorgingshuisdeelnemers lieten hierbij betere resultaten (P

Achtergrond: De Two-Minute Step Test (TMST) is een meetinstrument gericht op het beoordelen van uithoudingsvermogen. Verscheidene psychometrische eigenschappen van de TMST-NL (Nederlands vertaalde versie) zijn onderzocht bij intramuraal wonende ouderen. De gevoeligheid voor verandering en de responsiviteit is bij deze patiëntenpopulatie nog niet vastgesteld. Doel: Het vaststellen van de gevoeligheid voor verandering en de responsiviteit (Minimal Clinical Important Difference) van de TMST-NL bij intramuraal wonende ouderen. Design: Prospectief responsiviteitsonderzoek. Methode: De onderzoekspopulatie bestond uit intramuraal wonende ouderen. Deelnemers hebben twee meetmomenten (T0 en T1) ondergaan waartussen ze drie maanden fysiotherapie gericht op uithoudingsvermogen ontvingen. Om de gevoeligheid van verandering te meten werd de distributie methode gebruikt waarbij de correlatie met de 6-minuten wandeltest (6MWT) werd getoetst. Via de anker methode met de Receiver Operating Characteristic (ROC) curve werd de MCID bepaald. Metingen voor het aerobe uithoudingsvermogen werden verricht met de TMST-NL en de 6-minuten wandeltest (6MWT). De Global Rating of Change (GRC) en de Borg Category-Ratio10 (BORG-CR10) werden gebruikt als subjectieve vragenlijsten om verandering van de gezondheidssituatie en vermoeidheid te meten. Resultaten: Intramurale ouderen (N=50) met een gemiddelde (SD) leeftijd van 83,96 jaar (6,96) zijn geïncludeerd. De correlatie tussen de verschilscores van de TMST-NL en de 6MWT over de deelnemerspopulatie die T1 ook hebben afgerond (N= 36) kwam uit op r=0.51 (P

Met de toenemende vergrijzing in ons land zal er ook een toename plaatsvinden van het aantal ouderen met dementie. Dementie, met als voornaamste oorzaak de ziekte van Alzheimer, wordt in het algemeen vooral gezien als een ziekte waarbij cognitieve problemen optreden. Dat er ook al in een vroeg stadium motorische stoornissen optreden is veel minder bekend. Pas in een laat stadium worden de motorische problemen dusdanig groot dat de fysiotherapeut wordt ingeschakeld. Het is van belang om als fysiotherapeut kennis te hebben van de verschillende vormen van dementie en de daarmee gepaard gaande verschillen in motorische stoornissen. Daarnaast is het van belang om inzicht te krijgen in werkzame interventies en de juiste meetinstrumenten in te kunnen zetten. In deze masterclass wordt inzicht gegeven in de motorische problemen bij dementie (o.a. paratonie) en worden handvatten voor de praktijk gegeven.DoelNa deze masterclass is de deelnemer in staat de verschillen in motorische stoornissen te herkennen en hier de passende meetinstrumenten op in te zetten. Daarnaast heeft de deelnemer handvatten voor de praktische consequenties gekregen.

Het proces waarmee de fysiotherapeut/kinesitherapeut tot een eigen diagnostiek komt, heet klinisch redeneren of in het Engels ‘clinical reasoning’ of ‘diagnostic reasoning’. Klinisch redeneren wordt gedefinieerd als het proces waarin de therapeut, in interactie met de patiënt en anderen (zoals familie en andere zorgprofessionals), tot een goed onderbouwde fysiotherapeutische/kinesitherapeutische diagnostiek komt waarin evidence-based of evidence-informed practice is geïntegreerd

Het proces waarmee de fysiotherapeut/kinesitherapeut tot een eigen diagnostiek komt, heet klinisch redeneren of in het Engels ‘clinical reasoning’ of ‘diagnostic reasoning’. Klinisch redeneren wordt gedefinieerd als het proces waarin de therapeut, in interactie met de patiënt en anderen (zoals familie en andere zorgprofessionals), tot een goed onderbouwde fysiotherapeutische/kinesitherapeutische diagnostiek komt waarin evidence-based of evidence-informed practice is geïntegreerd

10th International Lymphoedema Framework Conference

Latest inside into the screening, diagnosis, prevention and treatnment of sarcopenia and the importance of interprofessional collaboration

Physical activity monitoring with wearable technology has the potential to support stroke rehabilitation. Little is known about how physical therapists use and value the use of wearable activity monitors. This cross-sectional study explores the use, perspectives, and barriers to wearable activity monitoring in day-to-day stroke care routines amongst physical therapists. Over 300 physical therapists in primary and geriatric care and rehabilitation centers in the Netherlands were invited to fill in an online survey that was developed based on previous studies and interviews with experts. In total, 103 complete surveys were analyzed. Out of the 103 surveys, 27% of the respondents were already using activity monitoring. Of the suggested treatment purposes of activity monitoring, 86% were perceived as useful by more than 55% of the therapists. The most recognized barriers to clinical implementation were lack of skills and knowledge of patients (65%) and not knowing what brand and type of monitor to choose (54%). Of the non-users, 79% were willing to use it in the future. In conclusion, although the concept of remote activity monitoring was perceived as useful, it was not widely adopted by physical therapists involved in stroke care. To date, skills, beliefs, and attitudes of individual therapists determine the current use of wearable technology.

Physical activity monitoring with wearable technology has the potential to support stroke rehabilitation. Little is known about how physical therapists use and value the use of wearable activity monitors. This cross-sectional study explores the use, perspectives, and barriers to wearable activity monitoring in day-to-day stroke care routines amongst physical therapists. Over 300 physical therapists in primary and geriatric care and rehabilitation centers in the Netherlands were invited to fill in an online survey that was developed based on previous studies and interviews with experts. In total, 103 complete surveys were analyzed. Out of the 103 surveys, 27% of the respondents were already using activity monitoring. Of the suggested treatment purposes of activity monitoring, 86% were perceived as useful by more than 55% of the therapists. The most recognized barriers to clinical implementation were lack of skills and knowledge of patients (65%) and not knowing what brand and type of monitor to choose (54%). Of the non-users, 79% were willing to use it in the future. In conclusion, although the concept of remote activity monitoring was perceived as useful, it was not widely adopted by physical therapists involved in stroke care. To date, skills, beliefs, and attitudes of individual therapists determine the current use of wearable technology.

The Dynamic ArthroMyofascial Translation® Test

Op 8 januari 2020 verdedigde ik mijn proef - schrift bij de Rijksuniversiteit Groningen. Het proefschrift richt zich op het vergroten van inzicht in de aard en de omvang van potentiële complicaties na het toepassen van manueeltherapeutische handelingen aan de cervicale wervelkolom bij mensen met nekpijn en/of hoofdpijn. Zowel onder leken als onder zorgprofessionals bestaat de veronderstelling dat manueeltherapeutische handelingen die worden toegepast aan de cervicale wervelkolom, kunnen leiden tot complicaties. Er is tot nu toe geen duidelijk causaal verband gevonden tussen de handelingen en ernstige complicaties. Bovendien wordt slechts sporadisch gepubliceerd over casuïstiek met ernstige complicaties die tijdens of na manuele behandelingen van de cervicale wervelkolom ontstaan zijn. De schattingen van het voorkomen van complicaties variëren enorm. Daarnaast is niet duidelijk welke patiënten een hoger of lager risico lopen op dergelijke complicaties.

Op 8 januari 2020 verdedigde ik mijn proef - schrift bij de Rijksuniversiteit Groningen. Het proefschrift richt zich op het vergroten van inzicht in de aard en de omvang van potentiële complicaties na het toepassen van manueeltherapeutische handelingen aan de cervicale wervelkolom bij mensen met nekpijn en/of hoofdpijn. Zowel onder leken als onder zorgprofessionals bestaat de veronderstelling dat manueeltherapeutische handelingen die worden toegepast aan de cervicale wervelkolom, kunnen leiden tot complicaties. Er is tot nu toe geen duidelijk causaal verband gevonden tussen de handelingen en ernstige complicaties. Bovendien wordt slechts sporadisch gepubliceerd over casuïstiek met ernstige complicaties die tijdens of na manuele behandelingen van de cervicale wervelkolom ontstaan zijn. De schattingen van het voorkomen van complicaties variëren enorm. Daarnaast is niet duidelijk welke patiënten een hoger of lager risico lopen op dergelijke complicaties.

The goal of this thesis is to gain insight in the nature and scale of potential adverse events following manual therapy techniques applied to the cervical spine to patients with neck pain and/ or headache. This thesis describes that most of the patients visiting a manual therapist in a private setting in The Netherlands, does this with complaints of the neck. This research also shows that Dutch manual therapists experience treatments of the upper cervical spine as riskier compared to the rest of the cervical spine. In this thesis potential adverse events have been defined and linked to known classifications. Subsequently, these potential adverse events have been systematically reviewed in published literature. Therewith, it was tried to gain insight in characteristics of involved patients and clinicians. The most frequent described adverse event is a dissection of a cervical artery. Since no profile of patients with an increased or decreased risk could be established, a case control study between patients with a cervical dissection and neck patients without one. No clinically relevant significant differences were established. A systematic literature review has been performed to identify the effect of neck and head positions on cervical blood flow. The findings suggest that neck positions do not alter blood flow as much as previously expected. Finally, treatments and adverse events were nationally inventoried for 12 months. The incidence of major adverse events in The Netherlands is estimated at 1:2,869,020 cervical manipulations.

Achtergrond: Coxartrose wordt vaak in het eindstadium behandeld met een Totale Heup Artroplastiek (THA). In de postoperatieve fase na een THA varieert het fysiotherapeutische beleid. Mogelijk leidt een verhoogd BMI tot een trager functioneel herstel na een THA. Een aangepast revalidatietraject zou dan van belang zijn. Vraagstelling: Is er een verschil in mate van functioneel herstel na een THA, bij patiënten met normaal gewicht, overgewicht en obesitas 12 weken en 6 maanden postoperatief? Daarnaast wordt de mate van associatie bepaald tussen BMI en de mate van functioneel herstel. Methode: In dit longitudinaal, prospectief onderzoek werden patiënten geïncludeerd in het PIUS ziekenhuis in Oldenburg; ze kregen allen eenzelfde revalidatietraject na de THA. Indeling vond plaats in 3 subgroepen, met normaal gewicht (BMI 18,5- 25 kg/m²), overgewicht (BMI 25 - 30 kg/m²) en obesitas (BMI > 30kg/m²). Mate van functioneel herstel werd objectief gemeten met de Timed Up & Go test (TUG) en de 5 Times Sit-to-Stand Test (5TSST), en subjectief met de self-reported vragenlijsten: de Hip disability and Osteoarthritis Outcome Score (HOOS) en de Short Form 36 (SF-36). Metingen werden verricht preoperatief (T0), en 12 weken (T1) en 6 maanden (T2) postoperatief. Met behulp van de Kruskall-Wallis test werden de verschilscores van de uitkomstmaten in de 3 subgroepen tussen T0-T1 en T0-T2 geanalyseerd. De mate van associatie werd berekend met de Spearman correlatiecoëfficiënt (rS). Het significantieniveau was p

Achtergrond: Coxartrose wordt vaak in het eindstadium behandeld met een Totale Heup Artroplastiek (THA). In de postoperatieve fase na een THA varieert het fysiotherapeutische beleid. Mogelijk leidt een verhoogd BMI tot een trager functioneel herstel na een THA. Een aangepast revalidatietraject zou dan van belang zijn. Vraagstelling: Is er een verschil in mate van functioneel herstel na een THA, bij patiënten met normaal gewicht, overgewicht en obesitas 12 weken en 6 maanden postoperatief? Daarnaast wordt de mate van associatie bepaald tussen BMI en de mate van functioneel herstel. Methode: In dit longitudinaal, prospectief onderzoek werden patiënten geïncludeerd in het PIUS ziekenhuis in Oldenburg; ze kregen allen eenzelfde revalidatietraject na de THA. Indeling vond plaats in 3 subgroepen, met normaal gewicht (BMI 18,5- 25 kg/m²), overgewicht (BMI 25 - 30 kg/m²) en obesitas (BMI > 30kg/m²). Mate van functioneel herstel werd objectief gemeten met de Timed Up & Go test (TUG) en de 5 Times Sit-to-Stand Test (5TSST), en subjectief met de self-reported vragenlijsten: de Hip disability and Osteoarthritis Outcome Score (HOOS) en de Short Form 36 (SF-36). Metingen werden verricht preoperatief (T0), en 12 weken (T1) en 6 maanden (T2) postoperatief. Met behulp van de Kruskall-Wallis test werden de verschilscores van de uitkomstmaten in de 3 subgroepen tussen T0-T1 en T0-T2 geanalyseerd. De mate van associatie werd berekend met de Spearman correlatiecoëfficiënt (rS). Het significantieniveau was p

Physiotherapy and DementiaFysiotherapie bij mensen met dementieWe leven in een vergrijzende samenleving en ouderdom is de grootste risicofactor om dementie te ontwikkelen. De rol van de fysiotherapeut is bij mensen met dementie tot nu toe beperkt. Reactief wordt de fysiotherapeut ingezet voor revalidatie als een patiënt met dementie bijvoorbeeld is gevallen of als de dementie zover gevorderd is dat wassen en aankleden een probleem is geworden. Maar eigenlijk weten we als fysiotherapeut vaak niet goed wat onze mogelijkheden zijn en of we ook preventief iets kunnen betekenen in het tegengaan van de functionele achteruitgang. Deze lezing zal ingaan op de laatste, voor de geriatriefysiotherapeut belangrijke, wetenschappelijke inzichten op het terrein van diagnostiek, interventie en preventie van motorische problemen bij mensen met dementie.

Frailty and Physical Therapy講演要旨 （Abstract）The speed of ageing differs from country to country, but ageing is worldwide happening more quickly than in the past. We live in a dangerous world and all kinds of negative influences like stress or poor nutrition causes random molecular damage with an accumulation of cellular defects. And this will lead to age related frailty, disability and disease. Physiotherapist can have an important role in prevention and treatment of frailty. Frailty is a decrease of intrinsic or reserve capacity.Frailty consists of three domains; psychological-cognitive frailty, social frailty and physical frailty. Physiotherapist are often focused on the physical problems, However the cognitive and social domain influences the physical domain. In order to enable frail elderly to keep up the social contacts, strong cognition and physical condition we must maximize their functional ability. The golden opportunities of physiotherapy in frail elderly are: a Holistic view, focus on the health benefits of exercise and physical activity, to be aware of the fact that the muscles are a large endocrine organ, to be an advocate for a healthy and active lifestyle in the full life circle, to be a proactive health professional.

To evaluate the construct validity and the inter-rater reliability of the Dutch Activity Measure for Post-Acute Care “6-clicks” Basic Mobility short form measuring the patient’s mobility in Dutch hospital care. First, the “6-clicks” was translated by using a forward-backward translation protocol. Next, 64 patients were assessed by the physiotherapist to determine the validity while being admitted to the Internal Medicine wards of a university medical center. Six hypotheses were tested regarding the construct “mobility” which showed that: Better “6-clicks” scores were related to less restrictive pre-admission living situations (p = 0.011), less restrictive discharge locations (p = 0.001), more independence in activities of daily living (p = 0.001) and less physiotherapy visits (p r= −0.408, p = 0.001), but not between the “6-clicks” and age (r= −0.180, p = 0.528). To determine the inter-rater reliability, an additional 50 patients were assessed by pairs of physiotherapists who independently scored the patients. Intraclass Correlation Coefficients of 0.920 (95%CI: 0.828–0.964) were found. The Kappa Coefficients for the individual items ranged from 0.649 (walking stairs) to 0.841 (sit-to-stand). The Dutch “6-clicks” shows a good construct validity and moderate-to-excellent inter-rater reliability when used to assess the mobility of hospitalized patients.Implications for RehabilitationEven though various measurement tools have been developed, it appears the majority of physiotherapists working in a hospital currently do not use these tools as a standard part of their care.The Activity Measure for Post-Acute Care “6-clicks” Basic Mobility is the only tool which is designed to be short, easy to use within usual care and has been validated in the entire hospital population.This study shows that the Dutch version of the Activity Measure for Post-Acute Care “6-clicks” Basic Mobility form is a valid, easy to use, quick tool to assess the basic mobility of Dutch hospitalized patients. Even though various measurement tools have been developed, it appears the majority of physiotherapists working in a hospital currently do not use these tools as a standard part of their care. The Activity Measure for Post-Acute Care “6-clicks” Basic Mobility is the only tool which is designed to be short, easy to use within usual care and has been validated in the entire hospital population. This study shows that the Dutch version of the Activity Measure for Post-Acute Care “6-clicks” Basic Mobility form is a valid, easy to use, quick tool to assess the basic mobility of Dutch hospitalized patients.