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Maastricht, Netherlands

Hoogeboom T.J.,Sint Maartenskliniek | Hoogeboom T.J.,Maastricht University | Oosting E.,Gelderse Vallei Hospital | Vriezekolk J.E.,Sint Maartenskliniek | And 6 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. Source

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. Source

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. Source

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. Source

Van Der Sluis G.,Nij Smellinghe Hospital | Goldbohm R.A.,TNO | Bimmel R.,Nij Smellinghe Hospital Drachten | Galindo Garre F.,VU University Amsterdam | And 5 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. Source

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