Center for Care Technology Research

Maastricht, Netherlands

Center for Care Technology Research

Maastricht, Netherlands
Time filter
Source Type

Elings J.,Diakonessenhuis Hospital | Elings J.,Maastricht University | Van Der Sluis G.,Maastricht University | Van Der Sluis G.,Nij Smellinghe Hospital | And 7 more authors.
Journal of Orthopaedic and Sports Physical Therapy | Year: 2016

TTSTUDY DESIGN: Prospective cohort design using data derived from usual care. TTBACKGROUND: It is important that patients are able to function independently as soon as possible after total hip replacement. However, the speed of regaining activities differs significantly. TTOBJECTIVES: To develop a risk stratification model (RSM) to predict delayed inpatient recovery of physical activities in people who underwent total hip replacement surgery. TTMETHODS: This study was performed in 2 routine orthopaedic settings: Diakonessenhuis Hospital (setting A) and Nij Smellinghe Hospital (setting B). Preoperative screening was performed for all consecutive patients. In-hospital recovery of activities was assessed with the Modified Iowa Level of Assistance Scale. Delayed inpatient recovery of activities was defined as greater than 5 days. The RSM, developed using logistic regression analysis and bootstrapping, was based on data from setting A (n = 154). External validation was performed on the data set from setting B (n = 271). TTRESULTS: Twenty-one percent of the patients in setting A had a delayed recovery of activities during their hospital stay. Multivariable logistic regression modeling yielded a preliminary RSM that included the following factors: male sex (odds ratio [OR] = 0.8; 95% confidence interval [CI]: 0.2, 2.6), 70 or more years of age (OR = 1.2; 95% CI: 0.4, 3.4), body mass index of 25 kg/m2 or greater (OR = 2.2; 95% CI: 0.7, 7.4), an American Society of Anesthesiologists score of 3 (OR = 1.2; 95% CI: 0.3, 4.4), a Charnley score of B or C (OR = 6.1; 95% CI: 2.2, 17.4), and a timed up-and-go score of 12.5 seconds or greater (OR = 3.1; 95% CI: 1.1, 9.0). The area under the receiver operating characteristic (ROC) curve was 0.82 (95% CI: 0.74, 0.90) and the Hosmer-Lemeshow test score was 3.57 (P>.05). External validation yielded an area under the ROC curve of 0.71 (95% CI: 0.61, 0.81). TTCONCLUSION: We demonstrated that the risk for delayed recovery of activities during the hospital stay can be predicted by using preoperative data. Copyright © 2016 Journal of Orthopaedic & Sports Physical Therapy. All rights reserved.

Schmitt M.A.,Institute for Master Education in Manual Therapy | Schroder C.D.,Institute for Master Education in Manual Therapy | Stenneberg M.S.,Institute for Master Education in Manual Therapy | van Meeteren N.L.U.,TNO | And 4 more authors.
Manual Therapy | Year: 2013

Objective: Mechanical neck pain is a common human phenomenon. In most cases, no patho-anatomical lesion can be identified with the limitations of current radiological imaging. Therefore it is preferable to assess patients with neck pain with a focus on functioning and health, within a biopsychosocial model. The Neck Bournemouth Questionnaire aims to assess biopsychosocial aspects of neck pain. However, the content validity of the Neck Bournemouth Questionnaire Dutch language version (NBQ-NL) in relation to the International Classification of Functioning, Disability and Health (ICF) is unknown. The purpose of the study was to examine the content validity of the NBQ-NL in relation to the health components of the ICF. Method: Content validity was assessed in relation to the ICF, by means of Discriminant Content Validity (DCV). Results: The results indicate that the NBQ-NL measures four components of the five ICF (impairment, activity, participation and personal factors). Conclusion: The NBQ is a multidimensional questionnaire, representing four of the five components of the ICF. © 2013 Elsevier Ltd.

Schmitt M.A.,Institute for Master Education in Musculoskeletal Therapy | Stenneberg M.S.,Institute for Master Education in Musculoskeletal Therapy | Schrama P.P.M.,Institute for Master Education in Musculoskeletal Therapy | Van Meeteren N.L.U.,TNO | And 4 more authors.
European Spine Journal | Year: 2013

Purpose: The International Classification of Human Functioning Disability and Health (ICF) provides insight into functional health status in patients with whiplash-associated disorders (WAD). In the assessment of functional limitations in patients with WAD, there are several condition-specific questionnaires available. Estimation of the true relationship between the separate constructs of the ICF is only possible if the items of the salient questionnaires measure exactly the constructs of interest, while not simultaneously measuring other constructs of the model. This study aimed to develop a condition specific and clinically relevant and usable instrument for patients with WAD that measures activity limitations and participation restrictions, as defined by the ICF framework. Methods: Item generation consisted of (1) a semi-structured interview which was conducted among 69 WAD patients; (2) a Delphi study involving 13 health professionals experienced in the assessment of patients with WAD; (3) a literature search for items from self-assessment questionnaires for neck pain. Results: A 35-item condition-specific self-assessment questionnaire for patients with WAD was developed. This new questionnaire measures purely activity limitations and participation restrictions according to the ICF and is based on patients' opinions and expert opinions. Conclusion: The whiplash activity and participation list tends to measure clinically relevant activity limitations and participation restrictions in WAD patients. © 2013 Springer-Verlag Berlin Heidelberg.

Hoogeboom T.J.,Maastricht University | Oosting E.,Gelderse Vallei Hospital | Siemonsma P.C.,TNO | de Bie R.A.,Maastricht University | And 2 more authors.
PLoS ONE | Year: 2012

Background: Our aim was to develop a rating scale to assess the therapeutic validity of therapeutic exercise programmes. By use of this rating scale we investigated the therapeutic validity of therapeutic exercise in patients awaiting primary total joint replacement (TJR). Finally, we studied the association between therapeutic validity of preoperative therapeutic exercise and its effectiveness in terms of postoperative functional recovery. Methods: (Quasi) randomised clinical trials on preoperative therapeutic exercise in adults awaiting TJR on postoperative recovery of functioning within three months after surgery were identified through database and reference screening. Two reviewers extracted data and assessed the risk of bias and therapeutic validity. Therapeutic validity of the interventions was assessed with a nine-itemed, expert-based rating scale (scores range from 0 to 9; score ≥6 reflecting therapeutic validity), developed in a four-round Delphi study. Effects were pooled using a random-effects model and meta-regression was used to study the influence of therapeutic validity. Results: Of the 7,492 articles retrieved, 12 studies (737 patients) were included. None of the included studies demonstrated therapeutic validity and two demonstrated low risk of bias. Therapeutic exercise was not associated with 1) observed functional recovery during the hospital stay (Standardised Mean Difference [SMD]: -1.19; 95%-confidence interval [CI], -2.46 to 0.08); 2) observed recovery within three months of surgery (SMD: -0.15; 95%-CI, -0.42 to 0.12); and 3) self-reported recovery within three months of surgery (SMD -0.07; 95%-CI, -0.35 to 0.21) compared with control participants. Meta-regression showed no statistically significant relationship between therapeutic validity and pooled-effects. Conclusion: Preoperative therapeutic exercise for TJR did not demonstrate beneficial effects on postoperative functional recovery. However, poor therapeutic validity of the therapeutic exercise programmes may have hampered potentially beneficial effects, since none of the studies met the predetermined quality criteria. Future review studies on therapeutic exercise should address therapeutic validity. © 2012 Hoogeboom et al.

Snoek J.A.,Isala | Van Berkel S.,Isala | Van Meeteren N.,TNO | Van Meeteren N.,Center for Care Technology Research | And 3 more authors.
PLoS ONE | Year: 2013

Background: Although a delayed decrease in heart rate during the first minute after graded exercise has been identified as a powerful predictor of overall mortality in cardiac patients, the potential to influence this risk factor by aerobic training remains to be proven. Objective: The aim was to study the relationship between aerobic training and Heart Rate Recovery (HRR) in patients with established heart disease. Methods: (Quasi) randomized clinical trials on aerobic exercise training in adults with established heart disease were identified through electronic database and reference screening. Two reviewers extracted data and assessed the risk of bias and therapeutic validity. Methodological validity was evaluated using an adapted version of the Cochrane Collaboration's tool for assessing risk of bias and the therapeutic validity of the interventions was assessed with a nine-itemed, expert-based rating scale (CONTENT). Scores range from 0 to 9 (score ≥ 6 reflecting therapeutic validity). Results: Of the 384 articles retrieved, 8 studies (449 patients) were included. Three of the included studies demonstrated adequate therapeutic validity and five demonstrated low risk of bias. Two studies showed both adequate therapeutic validity and a low risk of bias. For cardiac patients aerobic exercise training was associated with more improvement in HRR compared to usual care. Conclusion: The present systematic review shows a level 1A evidence that aerobic training increases HRR in patients with established heart disease. © 2013 Snoek et al.

Hettinga F.J.,University of Essex | Hettinga F.J.,University of Groningen | Monden P.G.,University of Groningen | Van Meeteren N.L.U.,TNO | And 3 more authors.
Sports Medicine | Year: 2014

There is a need for easy-to-use methods to assess training progress in sports and rehabilitation research. The present review investigated whether cardiac acceleration at the onset of physical exercise (HRonset) can be used as a monitoring variable. The digital databases of Scopus and PubMed were searched to retrieve studies investigating HRonset. In total 652 studies were retrieved. These articles were then classified as having emphasis on HRonset in a sports or rehabilitation setting, which resulted in 8 of 112 studies with a sports application and 6 of 68 studies with a rehabilitation application that met inclusion criteria. Two co-existing mechanisms underlie HRonset: feedforward (central command) and feedback (mechanoreflex, metaboreflex, baroreflex) control. A number of studies investigated HRonset during the first few seconds of exercise (HRonsetshort), in which central command and the mechanoreflex determine vagal withdrawal, the major mechanism by which heart rate (HR) increases. In subsequent sports and rehabilitation studies, interest focused on HRonset during dynamic exercise over a longer period of time (HR onsetlong). Central command, mechanoreflexes, baroreflexes, and possibly metaboreflexes contribute to HRonset during the first seconds and minutes of exercise, which in turn leads to further vagal withdrawal and an increase in sympathetic activity. HRonset has been described as the increase in HR compared with resting state (delta HR) or by exponential modeling, with measurement intervals ranging from 0-4 s up to 2 min. Delta HR was used to evaluate HRonsetshort over the first 4 s of exercise, as well as for analyzing HRonsetlong. In exponential modeling, the HR response to dynamic exercise is biphasic, consisting of fast (parasympathetic, 0-10 s) and slow (sympathetic, 1-4 min) components. Although available studies differed largely in measurement protocols, crosssectional and longitudinal training studies showed that studies analyzing HRonset in relation to physical training primarily incorporated HRonsetlong. HR onsetlong slowed in athletes as well as in patients with a coronary disease, who have a relatively fast HRonsetlong. It is advised to include both HRonsetlong and HRonsetshort in further studies. The findings of this review suggest that HRonset is a potential tool for monitoring and titrating training in sports as well as in rehabilitation settings, particularly in patients with ventricular fibrillation. Monitoring HRonset in the early phase of training can help optimize the effectiveness of training and therapy. More research is needed to gain a better understanding of the mechanisms underlying HRonset in relation to their application in sports and rehabilitation settings. © 2014 Springer International Publishing Switzerland.

Elings J.,Diakonessenhuis Hospital | Elings J.,Maastricht University | Hoogeboom T.J.,Maastricht University | Hoogeboom T.J.,Center for Care Technology Research | And 4 more authors.
Clinical Rehabilitation | Year: 2015

Objective: To identify the preoperative patient-related characteristics predicting inpatient recovery of functioning and/or length of hospital stay after elective primary total hip arthroplasty. Design: A search was conducted of the electronic databases MEDLINE, EMBASE and CINAHL from inception through April 2014. Observational studies were selected for systematic review if they identified clinically relevant preoperative prognostic factors and reported an association between inpatient recovery of physical functioning and/or length of hospital stay. Study participants were adults undergoing an elective primary total hip arthroplasty. Results: Fourteen studies were included, a total of 199,410 individual total hip arthroplasty procedures. Two studies investigated inpatient recovery of physical functioning, no strong level of evidence was found for a relationship between functional recovery and any of the preoperative predictors. Twelve studies investigated the length of hospital stay and reported 19 preoperative prognostic factors. A strong level of evidence suggested that higher scores on the American Society of Anaesthesiologists assessment (OR 3.34 to 6.22, +0.20 days), increased number of comorbidities (RR of 1.10, +0.59 to 1.61 days), presence of heart disease, (RR of 1.59, +0.26 days), and presence of lung disease (RR of 1.30, +0.34 days) were associated with longer lengths of hospital stay following total hip arthroplasty. Conclusion: For the prediction of inpatient recovery of physical functioning no factors with a strong level of evidence were found. For length of stay there was a strong level of evidence for the American Society of Anaesthesiologists score, number of comorbidities, and presence of heart or lung disease.

Van Der Sluis G.,Nij Smellinghe Hospital | Goldbohm R.A.,TNO | Bimmel R.,Nij Smellinghe Hospital Drachten | Galindo Garre F.,VU University Amsterdam | And 6 more authors.
BioMed Research International | Year: 2015

Background. In the routine setting of the 20-bed orthopaedic ward of a regional hospital in Netherlands, we developed, implemented, and evaluated a new, function-tailored perioperative care pathway for patients receiving total knee replacement (TKR), aimed at faster functional recovery by reduction of inactivity and stimulation of self-efficacy of the patients. Methods. To assess effectiveness, we compared, using prospectively collected data from medical files, patient groups before n = 127 and after n = 108 introduction of the new care pathway with respect to time to recovery of physical functioning during hospitalisation (five milestones), length of hospital stay (LoS), referrals to an inpatient rehabilitation facility, and readmissions. Multivariable regression was used to adjust results for differences between the two groups in preoperatively assessed risk factors for delayed recovery. Results. Comparison of patient groups before n = 127 and after n = 108 introduction of the tailored care pathway showed that the tailored rehabilitation pathway decreased the time to recovery of physical functioning (from 4.5 to 4.1 days, P < 0.05), the mean LoS (from 5.2 days to 4.2 days, P < 0.01). Conclusion. We demonstrated that the introduction of a function-tailored care pathway shortens the hospital stay and accelerates the recovery of physical functioning. © 2015 G. van der Sluis et al.

Oosting E.,Gelderse Vallei Hospital | Jans M.P.,University Utrecht | Dronkers J.J.,Gelderse Vallei Hospital | Naber R.H.,Gelderse Vallei Hospital | And 4 more authors.
Archives of Physical Medicine and Rehabilitation | Year: 2012

Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: a pilot randomized controlled trial. Objective: To investigate the feasibility and preliminary effectiveness of a home-based intensive exercise program to improve physical health of frail elderly patients scheduled for elective total hip arthroplasty (THA). Design: Single-blind pilot randomized controlled trial. Setting: Patients' homes and a general hospital in The Netherlands. Participants: Frail patients (N=30) older than 65 years. Intervention: A preoperative, home-based program supervised by an experienced physical therapist to train functional activities and walking capacity. The control group received usual care consisting of 1 session of instructions. Main Outcome Measures: Feasibility was determined on the basis of adherence to treatment, patient satisfaction, adverse events, walking distance (measured with a pedometer), and intensity of exercise (evaluated with the Borg scale). Preliminary pre- and postoperative effectiveness was determined by the Timed Up & Go (TUG) test, 6-minute walk test (6MWT), Chair Rise Time, and self-reported measures of functions, activities, and participation. Results: Patient satisfaction and adherence to the training were good (median=5 on a 5-point Likert scale) and no serious adverse events occurred. The Borg score during training was 14 (range, 1316). Preoperative clinical relevant differences on the TUG test (2.9s; 95% confidence interval [CI], -0.9 to 6.6) and significant differences on the 6MWT (41m; 95% CI, 8 to 74) were found between groups. Conclusions: Intensive preoperative training at home is feasible for frail elderly patients waiting for THA and produces relevant changes in functional health. A larger multicenter randomized controlled trial is in progress to investigate the (cost-)effectiveness of preoperative training. © 2012 by the American Congress of Rehabilitation Medicine.

Dronkers J.J.,Gelderse Vallei Hospital | Chorus A.M.J.,Applied Scientific Research | Van Meeteren N.L.U.,Applied Scientific Research | Van Meeteren N.L.U.,Center for Care Technology Research | And 2 more authors.
Anaesthesia | Year: 2013

We studied whether reported physical activity and measurements of fitness (hand, leg and inspiration) were associated with postoperative in-hospital mortality, length of stay and discharge destination in 169 patients after major oncological abdominal surgery. In multivariate analysis, adequate activity level (OR 5.5, 95% CI 1.4-21.9) and inspiratory muscle endurance (OR 5.2, 95% CI 1.4-19.1) were independently associated with short-term mortality, whereas conventional factors, such as age and heart disease, were not. Adequate activity level (OR 6.7, 95% CI 1.4-3.0) was also independently associated with discharge destination. The factors that were independently associated with a shorter length of hospital stay were as follows: absence of chronic obstructive pulmonary disease (HR 0.6, 95% CI 0.3-1.1); adequate activity level (HR 0.6, 95% CI 0.4-0.8); and inspiratory muscle strength (HR 0.6, 95% CI 0.5-0.9). For all postoperative outcomes physical activity and fitness significantly improved the predictive value compared with known risk factors, such as age and comorbidities. We conclude that pre-operative questionnaires of physical activity and measurements of fitness contribute to the prediction of postoperative outcomes. © Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland.

Loading Center for Care Technology Research collaborators
Loading Center for Care Technology Research collaborators