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Van Leeuwen C.M.,University Utrecht | Van Leeuwen C.M.,Swiss Paraplegic Research | Post M.W.,University Utrecht | Post M.W.,Swiss Paraplegic Research | And 7 more authors.
Archives of Physical Medicine and Rehabilitation | Year: 2012

Objective: To clarify relationships between activities, participation, mental health, and life satisfaction in persons with spinal cord injury (SCI) and specify how personal factors (self-efficacy, neuroticism, appraisals) interact with these components. We hypothesized that (1) activities are related directly to participation, participation is related directly to mental health and life satisfaction, and mental health and life satisfaction are 2 interrelated outcome variables; and (2) appraisals are mediators between participation and mental health and life satisfaction, and self-efficacy and neuroticism are related directly to mental health and life satisfaction and indirectly through appraisals. Design: Follow-up measurement of a multicenter prospective cohort study 5 years after discharge from inpatient rehabilitation. Setting: Eight Dutch rehabilitation centers with specialized SCI units. Participants: Persons (N=143) aged 18 to 65 years at the onset of SCI. Interventions: Not applicable. Main Outcome Measures: Mental health was measured by using the Mental Health subscale of the 36-Item Short Form Health Survey and life satisfaction with the sum score of "current life satisfaction" and "current life satisfaction compared with life satisfaction before SCI." Results: Structural equation modeling showed that activities and neuroticism were related to participation and explained 49% of the variance in participation. Self-efficacy, neuroticism, and 2 appraisals were related to mental health and explained 35% of the variance in mental health. Participation, 3 appraisals, and mental health were related to life satisfaction and together explained 50% of the total variance in life satisfaction. Conclusions: Mental health and life satisfaction can be seen as 2 separate but interrelated outcome variables. Self-efficacy and neuroticism are related directly to mental health and indirectly to life satisfaction through the mediating role of appraisals. © 2012 by the American Congress of Rehabilitation Medicine.

Sloots M.,Center for Rehabilitation and Rheumatology | Bartels E.A.C.,VU University | Angenot E.L.D.,Reade Center for Rehabilitation and Rheumatology | Geertzen J.H.B.,University of Groningen | Dekker J.,VU University Amsterdam
Journal of Clinical Nursing | Year: 2012

Aim. To explore the treatment experiences in patients of Moroccan and Turkish origin and their rehabilitation therapists regarding an adapted outpatient cardiac rehabilitation programme. Background. Non-native patients who participated in a cardiac rehabilitation programme at a Dutch rehabilitation centre had more difficulties to achieve the treatment aims than native Dutch patients. Therefore, an adapted programme for non-native patients, lacking proficiency in Dutch, has been instigated. The programme contains six adapted treatment modules and additional strategies: adapted education regarding (1) the heart and the vascular system and (2) the use of healthy food, with use the of (audio) visual educational materials, (3) adapted physical exercise module with explicit involvement of the patients' relatives, (4) standard use of professional interpreters, (5) increase in the number and length of consultations and (6) individual treatment instead of a group programme. Design. Qualitative study. Method. Semi-structured, face-to-face interviews were conducted with eight patients of Moroccan and Turkish origin and five native Dutch rehabilitation therapists. By comparison, three native Dutch patients were interviewed regarding the regular programme. Results. The results indicate that the patients' disease symptoms reduced and that patients adopted lifestyle changes. Therapists experienced that the number and length of the consultations, the structural use of interpreters and (audio) visual educational materials contributed to the achievement of the treatment aims. Conclusion. An adapted cardiac rehabilitation programme with separate modules and additional strategies for non-native patients appears to lead to satisfied patients who adopted lifestyle changes. Relevance to clinical practice. The findings of this study are important as the study highlights the practical actions that may be taken by physicians and healthworkers to adjust rehabilitation treatment to the needs of patients of non-native origin. © 2011 Blackwell Publishing Ltd.

Veerbeek J.M.,VU University Amsterdam | Van Wegen E.,VU University Amsterdam | Van Peppen R.,University Utrecht | Van Der Wees P.J.,Radboud University Nijmegen | And 4 more authors.
PLoS ONE | Year: 2014

Background: Physical therapy (PT) is one of the key disciplines in interdisciplinary stroke rehabilitation. The aim of this systematic review was to provide an update of the evidence for stroke rehabilitation interventions in the domain of PT. Methods and Findings: Randomized controlled trials (RCTs) regarding PT in stroke rehabilitation were retrieved through a systematic search. Outcomes were classified according to the ICF. RCTs with a low risk of bias were quantitatively analyzed. Differences between phases poststroke were explored in subgroup analyses. A best evidence synthesis was performed for neurological treatment approaches. The search yielded 467 RCTs (N = 25373; median PEDro score 6 [IQR 5-7]), identifying 53 interventions. No adverse events were reported. Strong evidence was found for significant positive effects of 13 interventions related to gait, 11 interventions related to arm-hand activities, 1 intervention for ADL, and 3 interventions for physical fitness. Summary Effect Sizes (SESs) ranged from 0.17 (95%CI 0.03-0.70; I2 = 0%) for therapeutic positioning of the paretic arm to 2.47 (95%CI 0.84-4.11; I 2 = 77%) for training of sitting balance. There is strong evidence that a higher dose of practice is better, with SESs ranging from 0.21 (95%CI 0.02-0.39; I2 = 6%) for motor function of the paretic arm to 0.61 (95%CI 0.41-0.82; I2 = 41%) for muscle strength of the paretic leg. Subgroup analyses yielded significant differences with respect to timing poststroke for 10 interventions. Neurological treatment approaches to training of body functions and activities showed equal or unfavorable effects when compared to other training interventions. Main limitations of the present review are not using individual patient data for meta-analyses and absence of correction for multiple testing. Conclusions: There is strong evidence for PT interventions favoring intensive high repetitive task-oriented and task-specific training in all phases poststroke. Effects are mostly restricted to the actually trained functions and activities. Suggestions for prioritizing PT stroke research are given. © 2014 Veerbeek et al.

Van Den Noort J.,VU University Amsterdam | Van Der Esch M.,Reade Center for Rehabilitation and Rheumatology | Steultjens M.P.,VU University Amsterdam | Steultjens M.P.,Glasgow Caledonian University | And 5 more authors.
Medical and Biological Engineering and Computing | Year: 2011

Osteoarthritis (OA) of the knee is associated with alterations in gait. As an alternative to force plates, instrumented force shoes (IFSs) can be used to measure ground reaction forces. This study evaluated the influence of IFS on gait pattern in patients with knee OA. Twenty patients with knee OA walked in a gait laboratory on IFS and control shoes (CSs). An optoelectronic system and force plate were used to perform 3D gait analyses. A comparison of temporal-spatial gait parameters, kinematics, and kinetics was made between IFS and CS. Patients wearing IFS showed a decrease in walking velocity and cadence (8%), unchanged stride length, an increase in stance time (13%), stride time (11%) and step width (14%). No differences were found in knee adduction moment or knee kinematics. Small differences were found in foot and ankle kinematics (2-5°), knee transverse moments (5%), ankle frontal (3%) and sagittal moments (1%) and ground reaction force (1-6%). The gait of patients with knee OA was only mildly influenced by the IFS, due to increased shoe height and weight and a change in sole stiffness. The changes were small compared to normal variation and clinically relevant differences. Importantly, in OA patients no effect was found on the knee adduction moment. © 2011 International Federation for Medical and Biological Engineering.

van den Noort J.C.,VU University Amsterdam | van der Esch M.,Reade Center for Rehabilitation and Rheumatology | Steultjens M.P.M.,VU University Amsterdam | Steultjens M.P.M.,Glasgow Caledonian University | And 5 more authors.
Journal of Biomechanics | Year: 2012

The external knee adduction moment (KAdM) during gait is an important parameter in patients with knee osteoarthritis (OA). KAdM measurement is currently restricted to instruments only available in gait laboratories. However, ambulatory movement analysis technology, including instrumented force shoes (IFS) and inertial and magnetic measurement systems (IMMS), can measure kinetics and kinematics of human gait free of laboratory restrictions.The objective of this study was a quantitative validation of the accuracy of the KAdM in patients with knee OA, when estimated with an ambulatory-based method (AmbBM) versus a laboratory-based method (LabBM). AmbBM is employing the IFS and a linked-segment model, while LabBM is based on a force plate and optoelectronic marker system. Effects of ground reaction force (GRF), centre of pressure (CoP), and knee joint position measurement are evaluated separately. Twenty patients with knee OA were measured.The GRFs showed differences up to 0.22. N/kg, the CoPs showed differences up to 4. mm, and the medio-lateral and vertical knee position showed differences to 9. mm, between AmbBM and LabBM. The GRF caused an under-estimation in KAdM in early stance. However, this effect was counteracted by differences in CoP and joint position, resulting in a net 5% over-estimation. In midstance and late stance the accuracy of the KAdM was mainly limited by use of the linked-segment model for joint position estimation, resulting in an under-estimation (midstance 6% and late stance 22%). Further improvements are needed in the estimation of joint position from segment orientation. © 2011 Elsevier Ltd.

van den Noort J.,VU University Amsterdam | van der Esch M.,Reade Center for Rehabilitation and Rheumatology | Steultjens M.P.M.,VU University Amsterdam | Steultjens M.P.M.,Glasgow Caledonian University | And 5 more authors.
Journal of Biomechanics | Year: 2013

High knee joint-loading increases the risk and progression of knee osteoarthritis (OA). Mechanical loading on the knee is reflected in the external knee adduction moment (KAdM) that can be measured during gait with laboratory-based measurement systems. However, clinical application of these systems is limited. Ambulatory movement analysis systems, including instrumented force shoes (IFS) and an inertial and magnetic measurement system (IMMS), could potentially be used to determine the KAdM in a laboratory-free setting. Promising results have been reported concerning the use of the IFS in KAdM measurements; however its application in combination with IMMS has not been studied. The objective of this study was to compare the KAdM measured with an ambulatory movement analysis system with a laboratory-based system in patients with knee OA. Gait analyses of 14 knee OA patients were performed in a gait laboratory. The KAdM was concurrently determined with two the systems: (i) Ambulatory: IFS and IMMS in combination with a linked-segment model (to obtain joint positions); (ii) Laboratory: force plate and optoelectronic marker system. Mean differences in KAdM between the ambulatory and laboratory system were not significant (maximal difference 0.20. %BW*H in late stance, i.e. 5.6% of KAdM range, P>0.05) and below clinical relevant and hypothesized differences, showing no systematic differences at group level. Absolute differences were on average 24% of KAdM range, i.e. 0.83. %BW*H, particularly in early and late stance. To achieve greater accuracy for clinical use, estimation of joint position via a more advanced calibrated linked-segment model should be investigated. © 2012 Elsevier Ltd.

PubMed | University of Calgary, Reade Center for Rehabilitation and Rheumatology, Private Practice, University of Southern Denmark and 8 more.
Type: Review | Journal: Best practice & research. Clinical rheumatology | Year: 2016

Osteoarthritis (OA) is a leading cause of pain and disability worldwide. Despite the existence of evidence-based treatments and guidelines, substantial gaps remain in the quality of OA management. There is underutilization of behavioral and rehabilitative strategies to prevent and treat OA as well as a lack of processes to tailor treatment selection according to patient characteristics and preferences. There are emerging efforts in multiple countries to implement models of OA care, particularly focused on improving nonsurgical management. Although these programs vary in content and setting, key lessons learned include the importance of support from all stakeholders, consistent program delivery and tools, a coherent team to run the program, and a defined plan for outcome assessment. Efforts are still needed to develop, deliver, and evaluate models of care across the spectrum of OA, from prevention through end-stage disease, in order to improve care for this highly prevalent global condition.

van den Heuvel M.R.C.,VU University Amsterdam | Kwakkel G.,VU University Amsterdam | Kwakkel G.,Reade Center for Rehabilitation and Rheumatology | Beek P.J.,VU University Amsterdam | And 4 more authors.
Parkinsonism and Related Disorders | Year: 2014

Balance training has been demonstrated to improve postural control in patients with Parkinson's disease (PD). The objective of this pilot randomized clinical trial was to investigate whether a balance training program using augmented visual feedback is feasible, safe, and more effective than conventional balance training in improving postural control in patients with PD. Methods: Thirty-three patients with idiopathic PD participated in a five-week training program consisting of ten group treatment sessions of 60min. Participants were randomly allocated to (1) an experimental group who trained on workstations consisting of interactive balance games with explicit augmented visual feedback (VFT), or (2) a control group receiving conventional training. Standing balance, gait, and health status were assessed at entry, at six weeks, and at twelve weeks follow-up. Results: Sixteen patients were allocated to the control group and seventeen to the experimental group. The program was feasible to apply and took place without adverse events. Change scores for all balance measures favored VFT, but the change in the primary outcome measure, i.e. the Functional Reach test, did not differ between groups (t(28)=-0.116, p =908). No other differences between groups were statistically significant. Conclusions: VFT proved to be a feasible and safe approach to balance therapy for patients with PD. In this proof-of-concept study VFT was not superior over conventional balance training although observed trends mostly favored VFT. These trends approached clinical relevance only in few cases: increasing the training load and further optimization of VFT may strengthen this effect. Trial registration: Controlled Trials, ISRCTN47046299. © 2014 Elsevier Ltd.

Winters C.,VU University Amsterdam | Van Wegen E.E.H.,VU University Amsterdam | Daffertshofer A.,VU University Amsterdam | Kwakkel G.,VU University Amsterdam | Kwakkel G.,Reade Center for Rehabilitation and Rheumatology
Neurorehabilitation and Neural Repair | Year: 2015

Background and objective. Spontaneous neurological recovery after stroke is a poorly understood process. The aim of the present article was to test the proportional recovery model for the upper extremity poststroke and to identify clinical characteristics of patients who do not fit this model. Methods. A change in the Fugl-Meyer Assessment Upper Extremity score (FMA-UE) measured within 72 hours and at 6 months poststroke served to define motor recovery. Recovery on FMA-UE was predicted using the proportional recovery model: ΔFMA-UEpredicted = 0.7·(66 - FMA-UEinitial) + 0.4. Hierarchical cluster analysis on 211 patients was used to separate nonfitters (outliers) from fitters, and differences between these groups were studied using clinical determinants measured within 72 hours poststroke. Subsequent logistic regression analysis served to predict patients who may not fit the model. Results. The majority of patients (∼70%; n = 146) showed a fixed proportional upper extremity motor recovery of about 78%; 65 patients had infstantially less improvement than predicted. These nonfitters had more severe neurological impairments within 72 hours poststroke (P values <.01). Logistic regression analysis revealed that absence of finger extension, presence of facial palsy, more severe lower extremity paresis, and more severe type of stroke as defined by the Bamford classification were significant predictors of not fitting the proportional recovery model. Conclusions. These results confirm in an independent sample that stroke patients with mild to moderate initial impairments show an almost fixed proportional upper extremity motor recovery. Patients who will most likely not achieve the predicted amount of recovery were identified using clinical determinants measured within 72 hours poststroke. © American Society of Neurorehabilitation.

Van Delden A.E.Q.,VU University Amsterdam | Beek P.J.,VU University Amsterdam | Beek P.J.,Brunel University | Roerdink M.,VU University Amsterdam | And 3 more authors.
Neurorehabilitation and Neural Repair | Year: 2015

Background. Bilateral training in poststroke upper-limb rehabilitation is based on the premise that simultaneous movements of the nonparetic upper limb facilitate performance and recovery of paretic upper-limb function through neural coupling effects. Objective. To determine whether the degree of coupling between both hands is higher after bilateral than after unilateral training and control treatment. Methods. In a single-blinded randomized controlled trial, we investigated rhythmic interlimb coordination after unilateral (mCIMT) and bilateral (mBATRAC) upper-limb training and a dose-matched control treatment (DMCT) in 60 patients suffering from stroke. To this end, we used a series of tasks to discern intended and unintended coupling effects between the hands. In addition, we investigated the control over the paretic hand as reflected by movement harmonicity and amplitude. All tasks were performed before and after a 6-week intervention period and at follow-up 6 weeks later. Results. There were no significant between-group differences in change scores from baseline to postintervention and from postintervention to follow-up with regard to interlimb coupling. However, the mBATRAC group showed greater movement harmonicity and larger amplitudes with the paretic hand after training than the mCIMT and DMCT groups. Conclusions. The degree of coupling between both hands was not significantly higher after bilateral than after unilateral training and control treatment. Although improvements in movement harmonicity and amplitude following mBATRAC may indicate a beneficial influence of the interlimb coupling, those effects were more likely due to the particular type of limb movements employed during this training protocol. © The Author(s) 2014.

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