Browse by Lectorate "Musculoskeletale Revalidatie"

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Work participation of patients with musculoskeletal disorders: is this addressed in physical therapy practice?
Oswald, W. ; Hutting, N. ; Engels, J.A. ; Staal, J.B. ; Nijhuis-van der Sanden, M.W.G. ; Heerkens, Y.F.
2017, Article / Letter to editor (Journal of Occupational Medicine and Toxicology, vol. 12, (2017), pp. 27)BACKGROUND: Musculoskeletal disorders are the main complaints for visiting a physical therapist (PT) in primary health care; they have a negative effect on an individual's quality of life and result in a major cost to society. Qualitative research has shown that physical therapists (PTs) treating patients with these disorders experience barriers in the integration of occupational factors within their practice, and also revealed a lack of cooperation between PTs and (other) occupational healthcare providers. The aim of this study is to quantitatively investigate how generalist PTs in the Netherlands, who treat patients with musculoskeletal disorders, currently integrate occupational factors within their practice, and to identify their opinions and needs with regard to enhancing the integration of the patient's work within physical therapy practice. METHODS: A cross-sectional survey was conducted among generalist PTs who treat working-age (18-67 years) patients with musculoskeletal disorders. Generalist PTs were contacted for participation via digital news-mails and asked to fill out an online survey which was developed based on the results of a recent qualitative study. The survey consisted of: i) demographics of the participants, ii) questions on how generalist PTs currently integrate occupational factors within their practice, and iii) asked their opinion about the integration of occupational factors within physical therapy. The PTs were also asked about their needs with regard to the integration of occupational factors and with regard to cooperation with other (occupational) health professionals. All answers (using Likert scales) are presented as the number and percentage of the respondents reporting those specific answers, whereas all other answers are presented as means and standard deviations. RESULTS: Of the 142 respondents, 64% indicated that occupational factors should be addressed to a greater extent within physical therapy. To have the possibility to bill for a workplace assessment (60.6%) and more knowledge about laws and regulations (50%) were identified as needs of the respondents. Only 14.8% of the respondents indicated that they communicate with or consult a PT specialized in occupational health. Only 12.7% of the participants who do not have a specialized PT within their practice sometimes/regularly refer patients to a specialized PT. CONCLUSIONS: Although generalist PTs address occupational factors within their practice, there is room for improvement. This study also identified a lack of cooperation between generalist PTs and PTs specialized in occupational health.
Which instruments can detect submaximal physical and functional capacity in patients with chronic nonspecific back pain? A systematic review.
Mooren - van der Meer, S ; Trippolini, M.A. ; Palen, J. van der ; Verhoeven, J. ; Reneman, M.F.
2013, Article / Letter to editor (Spine, vol. 38, iss. 25, (2013), pp. E1608-15)STUDY DESIGN: Systematic review. OBJECTIVE: To evaluate the validity of instruments that claim to detect submaximal capacity when maximal capacity is requested in patients with chronic nonspecific musculoskeletal pain. SUMMARY OF BACKGROUND DATA: Several instruments have been developed to measure capacity in patients with chronic pain. The detection of submaximal capacity can have major implications for patients. The validity of these instruments has never been systematically reviewed. METHODS: A systematic literature search was performed including the following databases: Web of Knowledge (including PubMed and Cinahl), Scopus, and Cochrane. Two reviewers independently selected the articles based on the title and abstract according to the study selection criteria. Studies were included when they contained original data and when they objectified submaximal physical or functional capacity when maximal physical or functional capacity was requested. Two authors independently extracted data and rated the quality of the articles. The included studies were scored according to the subscales "Criterion Validity" and "Hypothesis Testing" of the COSMIN checklist. A Best Evidence Synthesis was performed. RESULTS: Seven studies were included, 5 of which used a reference standard for submaximal capacity. Three studies were of good methodological quality and validly detected submaximal capacity with specificity rates between 75% and 100%. CONCLUSION: There is strong evidence that submaximal capacity can be detected in patients with chronic low back pain with a lumbar motion monitor or visual observations accompanying a functional capacity evaluation lifting test.
Which instruments can detect submaximal physical and functional capacity in patients with chronic nonspecific back pain? A systematic review.
Mooren - van der Meer, S ; Trippolini, M.A. ; Palen, J. van der ; Verhoeven, J. ; Reneman, M.F.
2013, Article / Letter to editor (Spine, vol. 38, iss. 25, (2013), pp. E1608-15)STUDY DESIGN: Systematic review. OBJECTIVE: To evaluate the validity of instruments that claim to detect submaximal capacity when maximal capacity is requested in patients with chronic nonspecific musculoskeletal pain. SUMMARY OF BACKGROUND DATA: Several instruments have been developed to measure capacity in patients with chronic pain. The detection of submaximal capacity can have major implications for patients. The validity of these instruments has never been systematically reviewed. METHODS: A systematic literature search was performed including the following databases: Web of Knowledge (including PubMed and Cinahl), Scopus, and Cochrane. Two reviewers independently selected the articles based on the title and abstract according to the study selection criteria. Studies were included when they contained original data and when they objectified submaximal physical or functional capacity when maximal physical or functional capacity was requested. Two authors independently extracted data and rated the quality of the articles. The included studies were scored according to the subscales "Criterion Validity" and "Hypothesis Testing" of the COSMIN checklist. A Best Evidence Synthesis was performed. RESULTS: Seven studies were included, 5 of which used a reference standard for submaximal capacity. Three studies were of good methodological quality and validly detected submaximal capacity with specificity rates between 75% and 100%. CONCLUSION: There is strong evidence that submaximal capacity can be detected in patients with chronic low back pain with a lumbar motion monitor or visual observations accompanying a functional capacity evaluation lifting test.
What moves the rheumatologist? Unravelling decision making in the referral of systemic sclerosis patients to health professionals: a qualitative study
Stöcker, J.K. ; Cup, E.H.C. ; Vonk, M.C. ; Hoogen, F.H.C. van den ; Nijhuis-van der Sanden, M.W.G. ; Staal, J.B. ; Ende, C.H.M.
2018, Article / Letter to editor (Rheumatology, vol. 2, iss. 2, (2018))
Use and perceived added value of patient-reported measurement instruments by physiotherapists treating acute low back pain: a survey study among Dutch physiotherapists
Knoop, J. ; Lankveld, W.G.J.M. van ; Geerdink, G. ; Soer, R ; Staal, J.B.
2020, Article / Letter to editor (BMC Musculoskeletal Disorders, (2020))
Treatment of metatarsalgia based on claw toe deformity through soft tissue release of the metatarsophalangeal joint and resection of the proximal interphalangeal joint: Evaluation based on foot kinematics and plantar pressure distribution.
Stolwijk, N.M. ; Keijsers, N.L.W. ; Pasma, J.H. ; Nanhoe-Mahabier, W. ; Duysens, J. ; Louwerens, J.W.
2020, Article / Letter to editor (Foot and Ankle Surgery, vol. 26, iss. 7, (2020), pp. 755-762)INTRODUCTION: This study investigated the effect of operative claw toe correction with release of the metatarsophalangeal (MTP) joint, repositioning of the plantar fat pad and resection of the proximal interphalangeal joint on foot kinematics, plantar pressure distribution and Foot Function Index (FFI). METHODS: Prospective experimental study with pretest-posttest design. The plantar pressure, 3D foot kinematics and the FFI of 15 patients with symptomatic claw toes were measured three months before and 12months after surgery. Mean pressure, peak pressure and pressure time integral per sensor and various foot angles were calculated for the pre- and posttest and compared to a control group (N=15). RESULTS: Claw toe patients have increased pressure under the distal part of the metatarsal head and less pressure under the proximal part of the metatarsal heads compared to healthy controls. After surgery, there was a redistribution of pressure, resulting in a significant decrease of pressure under the distal part and an increase under the proximal part of the metatarsal head, providing a more equal plantar pressure distribution. Except for some small areas under the forefoot, heel and toes, there were no significant differences in pressure distribution between the operated feet and controls. Small, but significant differences between the pre- and postoperative condition were found for the lateral arch angle, calcaneus/malleolus supination and tibio-talar flexion. The score on the FFI improved statistically significant. DISCUSSION: These findings imply that the present operative procedure results in a more equal distribution of the plantar pressure under the forefoot and decrease of pain and offers successful treatment of metatarsalgia based on claw toe deformity.
Translation, adaptation, validity and reliability of the Dutch version of the 'blue flags' questionnaire
Westerweel, A ; Heerkens, Y.F. ; Oswald, W. ; Sennehed, CP ; Stigmar, K. ; Hees, S.G.M. van ; Lankveld, W.G.J.M. van ; Hutting, N.
2021, Article / Letter to editor (European Journal of Physiotherapy, (2021))Purpose: To translate and culturally adapt the Swedish version of the 'Blue flags' questionnaire into Dutch and to examine the validity and reliability aspects of the Dutch version. Methods: The 'Blue flags' questionnaire was translated and culturally adapted to the Dutch situation. A total of 58 participants filled in the first questionnaire at baseline and 51 participants filled in the second questionnaire sent two weeks later. The data of the participants who filled in the first questionnaire was used to determine internal consistency, structural validity and concurrent validity. The data of the participants who filled in both questionnaires was used to determine test-retest reliability. Results: The internal consistency was good with a Cronbach's alpha of 0.83. The structural validity was satisfactory with a Kaiser-Meyer-Olkin (KMO) test of 0.75 and a significance of p < .001 for the Bartlett's test. Four factors were extracted using principal component analysis (PCA) with varimax rotation with an explained total variance of 70.8%. Spearman's rho for concurrent validity was 0.68 (p < .001). The intraclass correlation coefficient (ICC) for test-retest was 0.80 (p < .001) for the total score. Conclusions: The Dutch version of the 'Blue flags' questionnaire showed good internal consistency, satisfactory structural validity, strong concurrent validity (with mixed item representation results) and strong reliability.
Towards a consensus on communication skills required for physical therapist students.
Lankveld, W.G.J.M. van ; Lakke, S ; Oosterhaven, J. ; Kinds, E.
2020, Article in monograph or in proceedings (Communication with patients)
Three-dimensional kinematics of the cervical spine using an electromagnetic tracking device. Differences between healthy subjects and subjects with non-specific neck pain and the effect of age.
Lemmers, G.P.G. ; Heijmans, M.W.M. ; Scafoglieri, A. ; Buyl, R. ; Staal, J.B. ; Schmitt, M.A. ; Cattrysse, E.
2018, Article / Letter to editor (Clinical Biomechanics, vol. 54, (2018), pp. 111-117)
Therapists' experiences and needs with regard to providing work-focused care: a focus group study.
Oswald, W. ; Ummels, I. ; Raaijmakers, T. ; Baart, P. ; Staal, J.B. ; Bieleman, H.J. ; -van der Sanden, M.W.G. Nijhuis ; Heerkens, Y.F. ; Hutting, N.
2021, Article / Letter to editor (BMC Musculoskeletal Disorders, vol. 22, iss. 1, (2021), pp. 923)BACKGROUND: Musculoskeletal disorders (MSDs) can create a temporary or permanent disability that reduce a person's ability to work. Physiotherapists (PTs), occupational therapists (OTs) and exercise therapists (ETs) are often involved in the early management of MSDs. There is a need for additional insights into therapists' experiences, barriers and needs to work-focused care. Moreover, there is no evidence on how OTs and ETs address work participation. Therefore, the aim of this qualitative study was 1) to investigate how generalist PTs, OTs and ETs provide work-focused healthcare and 2) to obtain insight into their perceived barriers and needs that affect their ability to address occupational factors. METHODS: An exploratory qualitative study using three focus groups. Generalist PTs, OTs and ETs were eligible to participate if they treated working patients with MSDs. A semi-structured interview guide with open-ended questions was developed. Two moderators facilitated each focus group using the interview guide, and all the groups were audio recorded. Data were analysed using inductive thematic analysis. RESULTS: Sixteen therapists (mean age 44 years, range 25-59) participated in this study. Participants were aware of the importance of taking occupational factors into account. Whether they address occupational factors is largely dependent on the patient's request for help. However, ETs and OTs consider it normal to ask about occupational factors during the diagnostic process, while PTs often address this in later consultations. Almost all participants were unaware of the existence of PTs, OTs or ETs who are specialised in occupational health. Moreover, almost all participants struggled with when to refer a patient to other (occupational) healthcare professionals. This study identified several needs of therapists. These included knowledge about laws and legislation and skills for identifying and addressing work-related or work-relevant complaints. CONCLUSIONS: Participants in this qualitative study were aware of the importance of taking occupational factors into account. However, how PTs, OTs and ETs address work participation and the extent to which they do so can be improved. There was a lack of knowledge about and cooperation with occupational health professionals, including PTs, OTs or ETs specialised in occupational health.
Therapeut op onderzoek : Toekomstbestendige musculoskeletale fysiotherapie en revalidatie
Staal, J.B.
2016, Inaugural lecture Rede in verkorte vorm uitgesproken bij de aanvaarding van het ambt van lector Musculoskeletale Revalidatie aan de Faculteit Gezondheid, Gedrag en Maatschappij van de Hogeschool van Arnhem en Nijmegen op donderdag 26 mei 2016.
The IASP pain curriculum for undergraduate allied health professionals: educators defining competence level using Dublin descriptors
Lankveld, W.G.J.M. van ; Afram, B ; Staal, J.B. ; Sande, W.M.M. van der
2020, Article / Letter to editor (BMC Medical Education, vol. 2020;20(1), (2020))
The effects of integrating work-related factors and improving cooperation in musculoskeletal physical therapy practice: protocol for the 'WORK TO BE DONE' cluster randomised controlled trial.
Hutting, N. ; Oswald, W. ; Nijhuis-van der Sanden, M.W.G. ; Filart, M. ; Raaijmakers, T. ; Bieleman, H.J. ; Staal, J.B. ; Heerkens, Y.F.
2020, Article / Letter to editor (BMC Musculoskeletal Disorders, vol. 21, iss. 1, (2020), pp. 360)BACKGROUND: Musculoskeletal disorders (MSDs) are the primary cause of disability worldwide and a major societal burden. Recent qualitative research found that although a patient's work is considered important, physical therapists take work participation insufficiently into account as a determining factor in the treatment of patients with MSDs. Therefore, the aim of this study is to improve the effectiveness of physical therapy (in primary healthcare) with respect to the work participation of employees with MSDs by increasing the knowledge and skills of generalist physical therapists and by improving the collaboration between generalist physical therapists and physical therapists specialised in occupational health. METHODS/DESIGN: This trial is a two-arm non-blinded cluster randomised controlled trial. Working patients with MSDs visiting a physical therapy practice are the target group. The control group will receive normal physical therapy treatment. The intervention group will receive treatment from a physical therapist with more knowledge about work-related factors and skills in terms of integrating work participation into the patients' care. Data are gathered at baseline (T0), at four months (T1) and eight months (T2) follow-up. Most outcomes will be assessed with validated patient-reported questionnaires. Primary outcomes are the limitations in specific work-related activities and pain during work. Secondary outcomes include limitations in general work-related activities, general pain, quality of life, presenteeism, sick leave (absenteeism), estimated risk for future work disability, work-related psychosocial risk factors, job performance, and work ability. Based on a sample size calculation we need to include 221 patients in each arm (442 in total). During data analysis, each outcome variable will be analysed independently at T1 and at T2 as a dependent variable using the study group as an independent variable. In addition to the quantitative evaluation, a process evaluation will be performed by interviewing physical therapists as well as patients. DISCUSSION: The trial is expected to result in a more effective physical therapy process for working patients with MSDs. This will lead to a substantial reduction of costs: lower costs thanks to a more effective physical therapy process and lower costs due to less or shorter sick leave and decreased presenteeism. TRIAL REGISTRATION: Netherlands Trial Register, registration number: NL8518, date of registration 9 April 2020, URL registration: https://www.trialregister.nl/trial/8518.
The decline in physical activity in aging people is not modified by gender or the presence of cardiovascular disease.
Achttien, R. ; Lieshout, J.V. ; Wensing, M. ; Nijhuis-van der Sanden, M.W.G. ; Staal, J.B.
2019, Article / Letter to editor (European Journal of Public Health, (2019))
Symptoms of depression are associated with physical inactivity but not modified by gender or the presence of a cardiovascular disease; a cross-sectional study.
Achttien, R. ; Lieshout, J. van ; Wensing, M. ; Sanden, M.N. van ; Staal, J.B.
2019, Article / Letter to editor (BMC Cardiovascular Disorders, vol. 19, iss. 1, (2019), pp. 95)
Subgrouping and TargetEd Exercise pRogrammes for knee and hip OsteoArthritis (STEER OA): a systematic review update and individual participant data meta-analysis protocol.
Holden, M.A. ; Burke, D.L. ; Runhaar, J. ; Windt, D. van Der ; Riley, R.D. ; Dziedzic, K. ; Legha, A. ; Evans, A.L. ; Abbott, J.H. ; Baker, K. ; Brown, J. ; Bennell, K.L. ; Bossen, D. ; Brosseau, L. ; Chaipinyo, K. ; Christensen, R. ; Cochrane, T. ; Rooij, M. de ; Doherty, M. ; French, H.P. ; Hickson, S. ; Hinman, R.S. ; Hopman-Rock, M. ; Hurley, M.V. ; Ingram, C. ; Knoop, J. ; Krauss, I. ; McCarthy, C. ; Messier, S.P. ; Patrick, D.L. ; Sahin, N. ; Talbot, L.A. ; Taylor, R. ; Teirlinck, C.H. ; Middelkoop, M. van ; Walker, C. ; Foster, N.E. et al. sine al.
2017, Article / Letter to editor (BMJ Open, vol. 7, iss. 12, (2017), pp. e018971)INTRODUCTION: Knee and hip osteoarthritis (OA) is a leading cause of disability worldwide. Therapeutic exercise is a recommended core treatment for people with knee and hip OA, however, the observed effect sizes for reducing pain and improving physical function are small to moderate. This may be due to insufficient targeting of exercise to subgroups of people who are most likely to respond and/or suboptimal content of exercise programmes. This study aims to identify: (1) subgroups of people with knee and hip OA that do/donnot respond to therapeutic exercise and to different types of exercise and (2) mediators of the effect of therapeutic exercise for reducing pain and improving physical function. This will enable optimal targeting and refining the content of future exercise interventions. METHODS AND ANALYSIS: Systematic review and individual participant data meta-analyses. A previous comprehensive systematic review will be updated to identify randomised controlled trials that compare the effects of therapeutic exercise for people with knee and hip OA on pain and physical function to a non-exercise control. Lead authors of eligible trials will be invited to share individual participant data. Trial-level and participant-level characteristics (for baseline variables and outcomes) of included studies will be summarised. Meta-analyses will use a two-stage approach, where effect estimates are obtained for each trial and then synthesised using a random effects model (to account for heterogeneity). All analyses will be on an intention-to-treat principle and all summary meta-analysis estimates will be reported as standardised mean differences with 95% CI. ETHICS AND DISSEMINATION: Research ethical or governance approval is exempt as no new data are being collected and no identifiable participant information will be shared. Findings will be disseminated via national and international conferences, publication in peer-reviewed journals and summaries posted on websites accessed by the public and clinicians. PROSPERO REGISTRATION NUMBER: CRD42017054049.
Stratified exercise therapy does not improve outcomes compared with usual exercise therapy in people with knee osteoarthritis (OCTOPuS study): a cluster randomised trial.
Knoop, J. ; Dekker, J ; Dongen, J.M. van ; Leeden, M van der ; Rooij, M. de ; Peter, W.F. ; Joode, W. de ; Bodegom-Vos, L. van ; Lopuhaä, N. ; Bennell, K.L. ; Lems, W.F. ; Esch, M. van der ; Vliet Vlieland, T.P. ; Ostelo, R.W.J.G. et al. sine al.
2022, Article / Letter to editor (Journal of Physiotherapy, vol. 68, iss. 3, (2022), pp. 182-190)QUESTION: In people with knee osteoarthritis, how much more effective is stratified exercise therapy that distinguishes three subgroups (high muscle strength subgroup, low muscle strength subgroup, obesity subgroup) in reducing knee pain and improving physical function than usual exercise therapy? DESIGN: Pragmatic cluster randomised controlled trial in a primary care setting. PARTICIPANTS: A total of 335 people with knee osteoarthritis: 153 in an experimental arm and 182 in a control arm. INTERVENTION: Physiotherapy practices were randomised into an experimental arm providing stratified exercise therapy (supplemented by a dietary intervention from a dietician for the obesity subgroup) or a control arm providing usual, non-stratified exercise therapy. OUTCOME MEASURES: Primary outcomes were knee pain severity (numerical rating scale for pain, 0 to 10) and physical function (Knee Injury and Osteoarthritis Outcome Score subscale activities of daily living, 0 to 100). Measurements were performed at baseline, 3 months (primary endpoint) and 6 and 12 months (follow-up). Intention-to-treat, multilevel, regression analysis was performed. RESULTS: Negligible differences were found between the experimental and control groups in knee pain (mean adjusted difference 0.2, 95% CI -0.4 to 0.7) and physical function (-0.8, 95% CI -4.3 to 2.6) at 3 months. Similar effects between groups were also found for each subgroup separately, as well as at other time points and for nearly all secondary outcome measures. CONCLUSION: This pragmatic trial demonstrated no added value regarding clinical outcomes of the model of stratified exercise therapy compared with usual exercise therapy. This could be attributed to the experimental arm therapists facing difficulty in effectively applying the model (especially in the obesity subgroup) and to elements of stratified exercise therapy possibly being applied in the control arm. REGISTRATION: Netherlands National Trial Register NL7463.
Stratified exercise therapy compared with usual care by physical therapists in patients with knee osteoarthritis: A randomized controlled trial protocol (OCTOPuS study).
Knoop, J. ; Dekker, J ; Leeden, M van der ; Rooij, M. de ; Peter, W.F. ; Bodegom-Vos, L. van ; Dongen, J.M. van ; Lopuhäa, N. ; Bennell, K.L. ; Lems, W.F. ; Esch, M. van der ; Vliet Vlieland, T.P. ; Ostelo, R.W.J.G. et al. sine al.
2020, Article / Letter to editor (Physiotherapy Research International, vol. 25, iss. 2, (2020), pp. e1819)OBJECTIVES: Knee osteoarthritis (OA) is characterized by its heterogeneity, with large differences in clinical characteristics between patients. Therefore, a stratified approach to exercise therapy, whereby patients are allocated to homogeneous subgroups and receive a stratified, subgroup-specific intervention, can be expected to optimize current clinical effects. Recently, we developed and pilot tested a model of stratified exercise therapy based on clinically relevant subgroups of knee OA patients that we previously identified. Based on the promising results, it is timely to evaluate the (cost-)effectiveness of stratified exercise therapy compared with usual, "nonstratified" exercise therapy. METHODS: A pragmatic cluster randomized controlled trial including economic and process evaluation, comparing stratified exercise therapy with usual care by physical therapists (PTs) in primary care, in a total of 408 patients with clinically diagnosed knee OA. Eligible physical therapy practices are randomized in a 1:2 ratio to provide the experimental (in 204 patients) or control intervention (in 204 patients), respectively. The experimental intervention is a model of stratified exercise therapy consisting of (a) a stratification algorithm that allocates patients to a "high muscle strength subgroup," "low muscle strength subgroup," or "obesity subgroup" and (b) subgroup-specific, protocolized exercise therapy (with an additional dietary intervention from a dietician for the obesity subgroup only). The control intervention will be usual best practice by PTs (i.e., nonstratified exercise therapy). Our primary outcome measures are knee pain severity (Numeric Rating Scale) and physical functioning (Knee Injury and Osteoarthritis Outcome Score subscale daily living). Measurements will be performed at baseline, 3-month (primary endpoint), 6-month (questionnaires only), and 12-month follow-up, with an additional cost questionnaire at 9 months. Intention-to-treat, multilevel, regression analysis comparing stratified versus usual care will be performed. CONCLUSION: This study will demonstrate whether stratified care provided by primary care PTs is effective and cost-effective compared with usual best practice from PTs.
Stratified care integrated with eHealth versus usual primary care physiotherapy in patients with neck and/or shoulder complaints: protocol for a cluster randomized controlled trial.
TIlburg, M.L. van ; Kloek, C.J.J. ; Pisters, M.F. ; Staal, J.B. ; Dongen, J.M. van ; Weerd, M. de ; Ostelo, R.W.J.G. ; Foster, N.E. ; Veenhof, C.
2021, Article / Letter to editor (BMC Musculoskeletal Disorders, vol. 22, iss. 1, (2021), pp. 143)BACKGROUND: Neck and shoulder complaints are common in primary care physiotherapy. These patients experience pain and disability, resulting in high societal costs due to, for example, healthcare use and work absence. Content and intensity of physiotherapy care can be matched to a patient's risk of persistent disabling pain. Mode of care delivery can be matched to the patient's suitability for blended care (integrating eHealth with physiotherapy sessions). It is hypothesized that combining these two approaches to stratified care (referred to from this point as Stratified Blended Approach) will improve the effectiveness and cost-effectiveness of physiotherapy for patients with neck and/or shoulder complaints compared to usual physiotherapy. METHODS: This paper presents the protocol of a multicenter, pragmatic, two-arm, parallel-group, cluster randomized controlled trial. A total of 92 physiotherapists will be recruited from Dutch primary care physiotherapy practices. Physiotherapy practices will be randomized to the Stratified Blended Approach arm or usual physiotherapy arm by a computer-generated random sequence table using SPSS (1:1 allocation). Number of physiotherapists (1 or > 1) will be used as a stratification variable. A total of 238 adults consulting with neck and/or shoulder complaints will be recruited to the trial by the physiotherapy practices. In the Stratified Blended Approach arm, physiotherapists will match I) the content and intensity of physiotherapy care to the patient's risk of persistent disabling pain, categorized as low, medium or high (using the Keele STarT MSK Tool) and II) the mode of care delivery to the patient's suitability and willingness to receive blended care. The control arm will receive physiotherapy as usual. Neither physiotherapists nor patients in the control arm will be informed about the Stratified Blended Approach arm. The primary outcome is region-specific pain and disability (combined score of Shoulder Pain and Disability Index & Neck Pain and Disability Scale) over 9 months. Effectiveness will be compared using linear mixed models. An economic evaluation will be performed from the societal and healthcare perspective. DISCUSSION: The trial will be the first to provide evidence on the effectiveness and cost-effectiveness of the Stratified Blended Approach compared with usual physiotherapy in patients with neck and/or shoulder complaints. TRIAL REGISTRATION: Netherlands Trial Register: NL8249 . Officially registered since 27 December 2019. Date of first enrollment: 30 September 2020. Study status: ongoing, data collection.
Spinal manual therapy in infants, children and adolescents: A systematic review and meta-analysis on treatment indication, technique and outcomes.
Driehuis, F. ; Hoogeboom, T.J. ; Nijhuis-van der Sanden, M.W.G. ; Bie, R.A. de ; Staal, J.B.
2019, Article / Letter to editor (PLoS One, vol. 14, iss. 6, (2019))
Self-regulated learning in physical therapy education: a non-randomized experimental study comparing self-directed and instruction-based learning.
Lankveld, W. van ; Melick, N. van ; Wijchen, J. van ; Visser, V. ; Staal, J.B.
2019, Article / Letter to editor (BMC Medical Education, vol. 19, iss. 1, (2019), pp. 50)
Self-management support for people with non-specific low back pain: A qualitative survey among physiotherapists and exercise therapists.
Hutting, N. ; Oswald, W. ; Staal, J.B. ; Heerkens, Y.F.
2020, Article / Letter to editor (Musculoskeletal Science and Practice, vol. 50, (2020), pp. 102269)BACKGROUND: Low back pain (LBP) is a major problem across the globe and is the leading cause worldwide of years lost to disability. Self-management is considered an important component the treatment of people with non-specific LBP. However, it seems that the self-management support for people with non-specific LBP provided by physiotherapists can be improved. Moreover, the way exercise therapists (ET) address self-management in practice is unknown. The aim of this study was to investigate the ideas, opinions and methods used by physiotherapists and ET with regard to self-management and providing self-management support to patients with non-specific LBP. METHODS: This study was a qualitative survey. An online questionnaire with open-ended questions was developed. The survey was conducted among physiotherapists and ET working in the Netherlands. Data was analysed using thematic analysis. RESULTS: Respondents considered self-management support an important topic in physiotherapy and exercise therapy for people with non-specific LBP. In the self-management support provided by the respondents, providing information and advice were frequently mentioned. The topics included in the support given by the respondents covered a broad range of important factors. The topics frequently focused on biomechanical factors. The majority of respondents had a need with regard to self-management or providing self-management support. These needs include having more knowledge, skills and tools aimed at facilitating self-management. CONCLUSION: The way physiotherapists and ET address self-management in people with non-specific LBP is not optimal and should be improved.
A self-management program for employees with complaints of the arm, neck, or shoulder (CANS): study protocol for a randomized controlled trial.
Hutting, N. ; Staal, J.B. ; Heerkens, Y.F. ; Engels, J.A. ; Nijhuis-van der Sanden, M.W.G.
2013, Article / Letter to editor (Trials, vol. 14, (2013), pp. 258)BACKGROUND: Complaints of the arm, neck, or shoulder (CANS) have a multifactorial origin and cause considerable work problems, including decreased work productivity, sickness absence, and, ultimately, job loss. There is a need for intervention programs for people with CANS. Self-management is an approach used in chronic disease care to improve self-efficacy and wellness behaviors to facilitate participants to make informed choices and carry them out. This study will evaluate the effectiveness of a self-management program (including ehealth) and compare it to usual care among employees with chronic CANS (lasting >3 months). METHODS/DESIGN: This is a randomized controlled trial in which 142 participants will be recruited and randomized (with pre-stratification) to either the intervention group (IG) or control group (CG). The IG will participate in a self-management program consisting of six group sessions and an ehealth module. The CG is allowed to use all usual care available. The primary outcome of the study is the self-reported disability of arm, shoulder, and hand, measured with the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Secondary outcomes include: absenteeism, pain in the previous week, quality of life, catastrophizing pain, self-efficacy, workstyle, presenteeism, fatigue, the use of usual care, and limitations experienced on the job. Data are collected at baseline and at 3, 6, and 12 months follow-up. DISCUSSION: Following the process of intervention mapping we developed a self-management program to suit and alleviate the problems and needs of employees with CANS. A strength of the study is that our intervention is specifically tailored to match the needs of employees with CANS. The study also has some potential weaknesses (for example, use of co-interventions, combination of group sessions and ehealth, self-reporting of data and possible contamination, Hawthorne effect, and recall or information bias) which are discussed. TRIAL REGISTRATION: The trial is registered with the Dutch Trial Register (http://www.trialregister.nlNTR3816): (January 2013). The first participant was randomized in September 2012.
Self-management behaviour after a physiotherapist guided blended self-management intervention in patients with chronic low back pain: A qualitative study.
Achten, J.P.J. ; Mooren - van der Meer, S ; Pisters, M.F. ; Veenhof, C. ; Koppenaal, T. ; Kloek, C.J.J.
2022, Article / Letter to editor (Musculoskeletal Science and Practice, vol. 62, (2022), pp. 102675)BACKGROUND: Self-management support is considered an important component in the physiotherapeutic treatment of people with chronic low back pain. The stratified blended physiotherapy intervention e-Exercise Low Back Pain is an example of a self-management intervention. More insight may contribute to improving blended interventions to stimulate self-management after treatment and thus hopefully prevent chronicity and/or relapses in patients with chronic low back pain. OBJECTIVES: The aim of this study was to gain an in-depth understanding of the self-management behaviour after a physiotherapist guided blended self-management intervention in people with chronic low back pain. DESIGN: A qualitative study with semi-structured interviews nested within a randomized controlled trial on the (cost-)effectiveness of e-Exercise Low Back Pain was conducted. METHOD: Thematic analysis was used to analyse the transcriptions. A hybrid process of both deductive and inductive approaches was used. RESULTS: After 12 interviews, data saturation was reached. Analysis of the data yielded six themes related to self-management behaviour: illness beliefs, coping, cognitions, social support and resource utilization, physiotherapeutic involvement and motivation. CONCLUSIONS: In our study the majority of the participants seemed to show adequate self-management behaviour when experiencing low back pain. Most participants first try to gain control over their low back pain themselves when experiencing a relapse before contacting the physiotherapist. Participants struggle in continuing health behaviour in pain free periods between relapses of low back pain. Physiotherapists are recommended to encourage long-term behaviour change. Additionally, better facilitation by the physiotherapist or additional functionalities in the app to stimulate social support might have a useful contribution.
Room for improvement in non-pharmacological systemic sclerosis care?—a cross-sectional online survey of 650 patients
Stöcker, J.K. ; Vonk, M.C. ; Hoogen, F.H.C. van den ; Nijhuis-van der Sanden, M.W.G. ; Staal, J.B. ; Satink, T. ; Ende, C.H.M.
2020, Article / Letter to editor (Rheumatology, vol. 4, iss. 1, (2020), pp. 1-9)
Risk factors for musculoskeletal injuries in elite junior tennis players: a systematic review.
Oosterhoff, J.H.F. ; Gouttebarge, V. ; Moen, M. ; Staal, J.B. ; Kerkhoffs, G.M.M.J. ; Tol, J.L. ; Pluim, B.M.
2018, Article / Letter to editor (Journal of Sports Sciences, vol. 18, (2018), pp. 1-7)
Risk factors for musculoskeletal injuries in elite junior tennis players: a systematic review.
Oosterhoff, J.H.F. ; Gouttebarge, V. ; Moen, M. ; Staal, J.B. ; Kerkhoffs, G.M.M.J. ; Tol, J.L. ; Pluim, B.M.
2019, Article / Letter to editor (Journal of Sports Sciences, vol. 37, iss. 2, (2019), pp. 131-137)
Relationship between self-reported disability and functional capacity in patients with whiplash associated disorder.
Mooren - van der Meer, S ; Reneman, M.F. ; Verhoeven, J. ; Palen, J. van der
2014, Article / Letter to editor (Journal of Occupational Rehabilitation, vol. 24, iss. 3, (2014), pp. 419-424)PURPOSE: Patients with chronic Whiplash Associated Disorders (WAD) report symptoms and disability. Neither the relationship between self-reported disability and functional capacity, nor its predictors have been investigated in patients with WAD. This was the purpose of this study. METHOD: This was a cross-sectional study. Participants were patients with WAD on sick leave. Self-reported disability was assessed with the Neck Disability Index (NDI). Functional capacity was assessed with a six-item neck functional capacity evaluation (FCE). Correlation coefficients were used to express the relationship between NDI (total and items) and FCE. Multivariate linear regression analyses were performed to identify independent predictors of NDI and FCE. RESULTS: Forty patients were measured, of whom 18 (45 %) were male. Mean age was 33 years, median duration of complaints was 12 months, and 75 % had a pending insurance claim. Correlations between NDI and FCE tests varied from -0.39 to -0.70. Independent predictors of NDI were pain intensity and a pending claim, explaining 43 % of the variance. independent predictors of fce were ndi, gender, and pain intensity, explaining 20-55 % of the variance. CONCLUSIONS: Self-reported disability and functional capacity are related but different. Both can part be predicted by pain intensity. A pending claim can predict higher self-reported disability. Both constructs are complementary and are recommended to determine disability in patients with WAD comprehensively.
Recovery trajectories over six weeks in patients selected for a high-intensity physiotherapy program after Total knee Arthroplasty: a latent class analysis.
Harmelink, K.E.M. ; Dandis, R. ; Wees, P.J. van der ; Zeegers, A.V.C.M. ; Nijhuis-van der Sanden, M.W.G. ; Staal, J.B.
2021, Article / Letter to editor (BMC Musculoskeletal Disorders, vol. 22, iss. 1, (2021), pp. 179)BACKGROUND: Recovery trajectories differ between individual patients and it is hypothesizes that they can be used to predict if an individual patient is likely to recover earlier or later. Primary aim of this study was to determine if it is possible to identify recovery trajectories for physical functioning and pain during the first six weeks in patients after TKA. Secondary aim was to explore the association of these trajectories with one-year outcomes. METHODS: Prospective cohort study of 218 patients with the following measurement time points: preoperative, and at three days, two weeks, six weeks, and one year post-surgery (no missings). Outcome measures were performance-based physical functioning (Timed Up and Go [TUG]), self-reported physical functioning (Knee injury and Osteoarthritis Outcome Score-Activities of Daily Living [KOOS-ADL]), and pain (Visual Analogue Scale [VAS]). Latent Class Analysis was used to distinguish classes based on recovery trajectories over the first six weeks postoperatively. Multivariable regression analyses were used to identify associations between classes and one year outcomes. RESULTS: TUG showed three classes: "gain group" (n = 203), "moderate gain group" (n = 8) and "slow gain group" (n = 7), KOOS showed two classes: "gain group" (n = 86) and "moderate gain group" (n = 132), and VAS-pain three classes: "no/very little pain" (n = 151), "normal decrease of pain" (n = 48) and "sustained pain" (n = 19). The" low gain group" scored 3.31 [95% CI 1.52, 5.09] seconds less on the TUG than the "moderate gain group" and the KOOS "gain group" scored 11.97 [95% CI 8.62, 15.33] points better than the "moderate gain group" after one year. Patients who had an early trajectory of "sustained pain" had less chance to become free of pain at one year than those who reported "no or little pain" (odds ratio 0.11 [95% CI 0.03,0.42]. CONCLUSION: The findings of this study indicate that different recovery trajectories can be detected. These recovery trajectories can distinguish outcome after one year.
Quantification of gait in children with mitochondrial disease.
Koene, S. ; Stolwijk, N.M. ; Ramakers, R. ; Vries, M. de ; Boer, L. de ; Janssen, M.C.H. ; Groot, I. de ; Smeitink, J.
2018, Article / Letter to editor (Journal of Inherited Metabolic Disease, vol. 41, iss. 4, (2018), pp. 731-740)
Promoting the Use of Self-management Strategies for People With Persistent Musculoskeletal Disorders: The Role of Physical Therapists.
Hutting, N. ; Johnston, V. ; Staal, J.B. ; Heerkens, Y.F.
2019, Article / Letter to editor (Journal of Orthopaedic and Sports Physical Therapy, vol. 49, iss. 4, (2019), pp. 212-215)
Prognostic factors for outcome following lumbar spine fusion surgery: a systematic review and narrative synthesis.
Achttien, R.J. ; Powell, A. ; Zoulas, K. ; Staal, J.B. ; Rushton, A.
2022, Article / Letter to editor (European Spine Journal, vol. 31, iss. 3, (2022), pp. 623-668)PURPOSE: The objective of this study was to identify and evaluate the value of prognostic factors related to disability, pain and quality of life (QoL) for adult patients undergoing lumbar spine fusion surgery (LSFS). METHODS: Two reviewers independently searched the literature, assessed eligibility, extracted data and assessed risk of bias and certainty of evidence. Key electronic databases were searched [PubMed, CINAHL, EMBASE, MEDLINE, PEDro and ZETOC] using pre-defined terms [e.g. LSFS] to 20/9/2020; with additional searching of journals, reference lists and unpublished literature. Prospective cohort studies with≥12-month follow-up after LSFS were included. Narrative synthesis was based on recommendations by Cochrane Consumers and Communication Review Group. The GRADE tool enabled assessment of certainty of evidence. Prognostic factors and outcome were analysed and summarised when examined in≥2 studies and when results pointed in the same direction in≥75% of studies. RESULTS: Sixteen studies (nn=nn8388, 2 low and 14 high risk of bias) were included with 39 prognostic factors identified. There is low certainty evidence that higher pre-operative severity of leg pain predicts greater improvement of leg pain and that pre-operative working predicts less post-operative disability both at 1-2-year follow-up. Other found associations were of very low certainty evidence. CONCLUSION: No moderate to high certainty evidence exists. Use of leg pain and pre-operative working may be valuable predictors of outcome to inform clinical decision-making and advice regarding LSFS surgery. There is need for adequately powered low-risk-of-bias prospective observational studies to further investigate candidate prognostic factors.
Proactive and reactive mechanisms play a role in stepping on inverting surfaces during gait.
Nieuwenhuijzen, P.H.J.A. ; Duysens, J.
2007, Article / Letter to editor (Journal of Physiology, vol. 98, iss. 4, (2007), pp. 2266-2273)
Prediction of walking speed using single stance force or pressure measurements in healthy subjects.
Keijsers, N.L.W. ; Stolwijk, N.M. ; Renzenbrink, G.J. ; Duysens, J.
2016, Article / Letter to editor (Gait & Posture, vol. 43, (2016), pp. 93-95)Walking speed is one of the best measures of overall walking capacity. In plantar pressure measurements, walking speed can be assessed using contact time, but it is only moderately correlated with walking speed. The center of pressure might be of more value to indicate walking speed since walking speed alters foot loading. Therefore, the purpose of this study is to assess walking speed using the velocity of the center of pressure (VCOP). Thirty-three subjects walked over a Footscan pressure plate at three speed conditions; slow, preferred, and fast. Walking speed was measured by a motion analysis system. (Multiple) linear regression analysis was used to indicate the relation between walking speed and independent variables derived from the pressure plate such as mean VCOP and stance time for all walking conditions separately and together. The mean VCOP had the highest correlation coefficient value with walking speed for all walking conditions combined (0.94) and for the preferred walking condition (0.80). The multiple regression analysis, based on a number of additional parameters, revealed a small to modest increase in the performance of predicting walking speed (r=0.98 for combined and r=0.93 for preferred). The mean VCOP was the best predictor for walking speed when using a plantar pressure plate. The mean VCOP predicts the walking speed with a 95% accuracy of 0.20m/s when healthy subjects walk at their preferred walking speed.
Predicting readiness for return to sport and performance after anterior cruciate ligament reconstruction rehabilitation.
Haren, I.E.P.M. van ; Cingel, R.E.H. van ; Verbeek, A.L.M. ; Melick, N. van ; Stubbe, J.H. ; Bloo, H. ; Groenewoud, J.H.M.M. ; Wees, P.J. van der ; Staal, J.B.
2022, Article / Letter to editor (Annals of Physical and Rehabilitation Medicine, vol. 66, iss. 3, (2022), pp. 101689)BACKGROUND: Determining readiness to return to sport after anterior cruciate ligament (ACL) reconstruction is challenging. OBJECTIVES: To develop models to predict initial (directly after rehabilitation) and sustainable (one year after rehabilitation) return to sport and performance in individuals after ACL reconstruction. METHODS: We conducted a multicentre, prospective cohort study and included 208 participants. Potential predictors - demographics, pain, effusion, knee extension, muscle strength tests, jump tasks and three sport-specific questionnaires - were measured at the end of rehabilitation and 12 months post discharge from rehabilitation. Four prediction models were developed using backward logistic regression. All models were internally validated by bootstrapping. RESULTS: All 4 models shared 3 predictors: the participant's goal to return to their pre-injury level of sport, the participant's psychological readiness and ACL injury on the non-dominant leg. Another predictor for initial return to sport was no knee valgus, and, for sustainable return to sport, the single-leg side hop. Bootstrapping shrinkage factor was between 0.91 and 0.95, therefore the models' properties were similar before and after internal validation. The areas under the curve of the models ranged from 0.74 to 0.86. Nagelkerke's R2 varied from 0.23 to 0.43 and the Hosmer-Lemeshow test results varied from 2.7 (p = 0.95) to 8.2 (p = 0.41). CONCLUSION: Initial and sustainable return to sport and performance after anterior cruciate ligament reconstruction rehabilitation can be easily predicted by the sport goal formulated by the individual, the individual's psychological readiness, and whether the affected leg is the dominant or non-dominant leg.
‘Post-operative physiotherapy for low back pain: as systematic review’
Staal, J.B.
2019, Article in monograph or in proceedings ()
Plantar pressure with and without custom insoles in patients with common foot complaints.
Stolwijk, N.M. ; Louwerens, J.W. ; Nienhuis, B. ; Duysens, J. ; Keijsers, N.L.W.
2011, Article / Letter to editor (Foot & Ankle International, vol. 32, iss. 1, (2011), pp. 57-65)BACKGROUND: Although many patients with foot complaints receive customized insoles, the choice for an insole design can vary largely among foot experts. To investigate the variety of insole designs used in daily practice, the insole design and its effect on plantar pressure distribution were investigated in a large group of patients. MATERIALS AND METHODS: Mean, peak, and pressure-time-integral per sensor for 204 subjects with common foot complaints for walking with and without insoles was measured with the footscan® insole system (RSscan International). Each insole was scanned twice (precision3D), after which the insole height along the longitudinal and transversal cross section was calculated. Subjects were assigned to subgroups based on complaint and medial arch height. Data were analyzed for the total group and for the separate subgroups (forefoot or heel pain group and flat, normal or high medial arch group). RESULTS: The mean pressure significantly decreased under the metatarsal heads II-V and the calcaneus and significantly increased under the metatarsal bones and the lateral foot (p<0.0045) due to the insoles. However, similar redistribution patterns were found for the different foot complaints and arch heights. There was a slight difference in insole design between the subgroups; the heel cup was significantly higher and the midfoot support lower for the heel pain group compared to the forefoot pain group. The midfoot support was lowest in the flat arch group compared to the high and normal arch group (p<0.05). CONCLUSION: Although the insole shape was specific for the kind of foot complaint and arch height, the differences in shape were very small and the plantar pressure redistribution was similar for all groups. CLINICAL RELEVANCE: This study indicates that it might be sufficient to create basic insoles for particular patient groups.
Plantar pressure changes after long-distance walking.
Stolwijk, N.M. ; Duysens, J. ; Louwerens, J.W. ; Keijsers, N.L.W.
2010, Article / Letter to editor (Medicine and Science in Sports and Exercise, vol. 42, iss. 12, (2010), pp. 2264-2272)PURPOSE: The popularity of long-distance walking (LDW) has increased in the last decades. However, the effects of LDW on plantar pressure distribution and foot complaints, in particular, after several days of walking, have not been studied. METHODS: We obtained the plantar pressure data of 62 subjects who had no history of foot complaints and who walked a total distance of 199.8 km for men (n = 30) and 161.5 km for women (n = 32) during four consecutive days. Plantar pressure was measured each day after the finish (posttests I–IV) and compared with the baseline plantar pressure data, which was obtained 1 or 2 d before the march (pretest). Mean, peak, and pressure–time integral per pixel as well as the center of pressure (COP) trajectory of each foot per measurement day were calculated using the normalization method of Keijsers et al. A paired t-test with an adjusted P value was used to detect significant differences between pretest and posttest. RESULTS: Short-term adjustment to LDW resulted in a significant decreased loading on the toes accompanied with an increased loading on the metatarsal head III–V (P < 0.001). At all stages, particularly at later stages, there was significantly more heel loading (P < 0.001). Furthermore, the COP significantly displaced in the posterior direction but not in the mediolateral direction after marching. Contact time increased slightly from 638.5 +/- 24.2 to 675.4 +/- 22.5 ms (P < 0.001). CONCLUSIONS: The increased heel loading and decreased function of the toes found after marching indicate a change of walking pattern with less roll-off. It is argued that these changes reflect the effect of fatigue of the lower leg muscles and to avoid loading of the most vulnerable parts of the foot.
PHYSIOTHERAPY WORKS: RCT ON THE (COST-)EFFECTIVENESS OF A PHYSICAL THERAPIST-LED, WORK-ORIENTED INTERVENTION IN PEOPLE WITH AXIAL SPONDYLOARTHRITIS AND RHEUMATOID ARTHRITIS
Bakker, NF ; Knoop, J. ; Hutting, N. ; Heerkens, Y.F. ; Engels, J.A. ; Staal, J.B. ; Leeden, M van der ; Boonen, A ; Vlieland, TPMV ; Weely, SFE van
2021, Article / Letter to editor (Clinical and Experimental Rheumatology, vol. 39, iss. 5, (2021), pp. 1240)
Physiotherapy with integrated virtual reality for patients with complex chronic low back pain: protocol for a pragmatic cluster randomized controlled trial (VARIETY study).
Slatman, S. ; Ostelo, R. ; Goor, H. van ; Staal, J.B. ; Knoop, J.
2023, Article / Letter to editor (BMC Musculoskeletal Disorders, vol. 24, iss. 1, (2023), pp. 132)BACKGROUND: Chronic low back pain (CLBP) is the most common chronic pain condition worldwide. Currently, primary care physiotherapy is one of the main treatment options, but effects of this treatment are small. Virtual Reality (VR) could be an adjunct to physiotherapy care, due to its multimodal features. The primary aim of this study is to assess the (cost-)effectiveness of physiotherapy with integrated multimodal VR for patients with complex CLBP, compared to usual primary physiotherapy care. METHODS: A multicenter, two-arm, cluster randomized controlled trial (RCT) including 120 patients with CLBP from 20 physiotherapists will be conducted. Patients in the control group will receive 12nweeks of usual primary physiotherapy care for CLBP. Patients in the experimental group will receive treatment consisting of 12nweeks of physiotherapy with integrated, immersive, multimodal, therapeutic VR. The therapeutic VR consists of the following modules: pain education, activation, relaxation and distraction. The primary outcome measure is physical functioning. Secondary outcome measures include pain intensity, pain-related fears, pain self-efficacy and economic measures. Effectiveness of the experimental intervention compared to the control intervention on primary and secondary outcome measures will be analyzed on an intention-to-treat principle, using linear mixed-model analyses. DISCUSSION: This pragmatic, multicenter cluster randomized controlled trial, will determine the clinical and cost-effectiveness of physiotherapy with integrated, personalized, multimodal, immersive VR in favor of usual physiotherapy care for patients with CLBP. TRIAL REGISTRATION: This study is prospectively registered at ClinicalTrials.gov (identifier: NCT05701891).
Physical therapists and importance of work participation in patients with musculoskeletal disorders: a focus group study.
Hutting, N. ; Oswald, W. ; Staal, J.B. ; Engels, J.A. ; Nouwens, E ; Nijhuis-van der Sanden, M.W.G. ; Heerkens, Y.F.
2017, Article / Letter to editor (BMC Musculoskeletal Disorders, vol. 18, iss. 1, (2017), pp. 196)BACKGROUND: Musculoskeletal disorders are a major health problem resulting in negative effects on wellbeing and substantial costs to society. Work participation is associated with positive benefits for both mental and physical health. Potentially, generalist physical therapists (GPTs) can play an important role in reducing absenteeism, presenteeism and associated costs in patients with musculoskeletal disorders. However, work participation is often insufficiently addressed within generalist physical therapy practice (GPTP). Therefore, this study evaluates whether GPTs take work participation into account as a determining factor in patients with musculoskeletal disorders, and how this might be improved. METHODS: This qualitative study consisted of seven focus groups involving 30 participants: 21 GPTs and 9 occupational physical therapists (OPTs). Based on an interview guide, participants were asked how they integrate work participation within their practice, how they collaborate with other professionals, and how GPTs can improve integration of the patient's work within their practice. RESULTS: Although participants recognized the importance of work participation, they mentioned that the integration of this item in their GPTP could be improved. Generally, GPTs place insufficient priority on work participation. Moreover, there is a lack of cooperation between the generalist physical therapist and (other) occupational healthcare providers (including OPTs), and the borderlines/differences between generalist physcial therapy and occupational health physcial therapy were sometimes unclear. GPTs showed a lack of knowledge and a need for additional information about several important work-related factors (e.g. work content, physical and psychosocial working conditions, terms of employment). CONCLUSIONS: Although a patient's work is important, GPTs take insufficient account of work participation as a determining factor in the treatment of patients with musculoskeletal disorders. GPTs often lack specific knowledge about work-related factors, and there is insufficient cooperation between OPTs and other occupational healthcare providers. The integration of work participation within GPTP, and the cooperation between GPTs and other occupational healthcare providers, show room for improvement.
Physical prognostic factors predicting outcome following lumbar discectomy surgery: systematic review and narrative synthesis.
Rushton, A. ; Zoulas, K. ; Staal, J.B.
2018, Article / Letter to editor (BMC Musculoskeletal Disorders, vol. 19, (2018), pp. 326)
Physical exercise prior to hematopoietic stem cell transplantation: A feasibility study.
Haren, I.E.P.M. van ; Staal, J.B. ; Potting, C.M. ; Atsma, F. ; Hoogeboom, T.J. ; Blijlevens, N.M.A. ; Nijhuis-van der Sanden, M.W.G.
2018, Article / Letter to editor (Physiotherapy Theory and Practice, vol. 16, (2018), pp. 1-10)
Physical exercise prior to hematopoietic stem cell transplantation: A feasibility study.
Haren, I.E.P.M. van ; Staal, J.B. ; Potting, C.M. ; Atsma, F. ; Hoogeboom, T.J. ; Blijlevens, N.M.A. ; -van der Sanden, M.W.G. Nijhuis
2018, Article / Letter to editor (Physiotherapy Theory and Practice, vol. 34, iss. 10, (2018), pp. 747-756)PURPOSE: This study explores the feasibility and preliminary effectiveness of an exercise program in people scheduled for hematopoietic stem cell transplantation (HSCT). METHODS: In this controlled clinical trial, we compare pre-transplantation exercise to no exercise in the waiting period for an allogeneic of autologous HSCT. The supervised individually tailored exercise program (4-6 weeks) consisted of aerobic endurance, muscle strength, and relaxation exercises, administered twice a week in the period prior to HSCT. Feasibility was determined based on inclusion rate, attrition rate, adherence to intervention, safety, and satisfaction (0-10). Preliminary effectiveness was determined primarily by self-perceived physical functioning, quality of life (QOL), and fatigue. Secondary outcomes were global perceived effect (GPE), blood counts, hospital stay, and physical fitness. RESULTS: Forty-six patients were eligible, of whom 29 (69%) participated: 14 in the intervention group and 15 in the control group. The adherence rate to training was 69%. No adverse events or injuries occurred. Satisfaction of training conditions was high (mean 9.2 ±1.3). Positive (follow-up) trends in favor of the intervention group were found for self-perceived physical functioning, QOL, fatigue, GPE, blood counts, and hospital stay. CONCLUSION: Exercise prior to HSCT is safe and feasible, and positive trends suggest favorable preliminary effectiveness. Adherence to the exercise program needs to be optimized in a future trial.
Physical exercise for patients undergoing hematopoietic stem cell transplantation: systematic review and meta-analyses of randomized controlled trials.
Haren, I.E.P.M. van ; Timmerman, H. ; Potting, C.M. ; Blijlevens, N.M.A. ; Staal, J.B. ; -van der Sanden, M.W.G. Nijhuis
2013, Article / Letter to editor (Physical Therapy, vol. 93, iss. 4, (2013), pp. 514-528)BACKGROUND: The treatment-related burden for patients undergoing hematopoietic stem cell transplantation (HSCT) may be relieved by physical exercises. PURPOSE: The purpose of this study was to summarize and analyze the evidence provided by randomized controlled trials (RCTs) on physical exercise interventions among patients with cancer undergoing HSCT. DATA SOURCES: PubMed, CINAHL, EMBASE, the Cochrane Library, and PEDro were searched for relevant RCTs up to October 1, 2011. STUDY SELECTION: Two reviewers screened articles on inclusion criteria and indentified relevant RCTs. DATA EXTRACTION: Two authors assessed the selected articles for risk of bias. Data extraction was performed by 1 reviewer. Meta-analyses were undertaken to estimate the outcomes quality of life (QOL), psychological well-being and distress, and fatigue. DATA SYNTHESIS: Eleven studies were included, with study populations consisting of recipients undergoing either an allogeneic or autologous HSCT (n=734). Four studies had low risk of bias. The exercise interventions were performed before, during, and after hospitalization for the HSCT. Different exercise programs on endurance, resistance and/or activities of daily living training, progressive relaxation, and stretching were used. Meta-analyses showed that exercise during hospitalization led to a higher QOL (weighted mean difference=8.72, 95% confidence interval=3.13, 14.31) and less fatigue (standardized mean difference=0.53, 95% confidence interval=0.16, 0.91) in patients with an allogeneic HSCT at the moment of discharge from the hospital. No marked effects were found for psychological well-being and distress. Individual study results suggested significant positive effects on QOL, fatigue, psychological well-being and distress, and physical functioning. LIMITATIONS: Prevalent shortcomings in the included studies were the heterogeneity among studies and the lack of blinding of participants, personnel, and outcome assessment. CONCLUSIONS: The results suggest that recipients of HSCT may benefit from physical exercise.
Personal factors in systemic sclerosis and their coverage by patient-reported outcome measures: A multicentre European qualitative study and literature review
Mattsson, M. ; Boström, C. ; Mihai, C. ; Stöcker, J.K. ; Geyh, S. ; Stummvoll, G. ; Gard, G. ; Möller, B. ; Hesselstrand, R. ; Sandqvist, G. ; Draghicescu, O. ; Gherghe, A.M. ; Voicu, M. ; Distler, O. ; Smolen, J.S. ; Stamm, T.A. et al. sine al.
2015, Article / Letter to editor (European Journal of Physical and Rehabilitation Medicine, vol. 51, iss. 4, (2015), pp. 405-21)
Patients' and clinicians' experiences with stratified exercise therapy in knee osteoarthritis: a qualitative study.
Knoop, J. ; Joode, J.W. de ; Brandt, H. ; Dekker, J ; Ostelo, R.W.J.G.
2022, Article / Letter to editor (BMC Musculoskeletal Disorders, vol. 23, iss. 1, (2022), pp. 559)BACKGROUND: We have developed a model of stratified exercise therapy that distinguishes three knee osteoarthritis (OA) subgroups ('high muscle strength subgroup', 'low muscle strength subgroup', 'obesity subgroup'), which are provided subgroup-specific exercise therapy (supplemented by a dietary intervention for the 'obesity subgroup'). In a large clinical trial, this intervention was found to be no more effective than usual exercise therapy. The present qualitative study aimed to explore experiences from users of this intervention, in order to identify possible improvements. METHODS: Qualitative research design embedded within a cluster randomized controlled trial in a primary care setting. A random sample from the experimental arm (i.e., 15 patients, 11 physiotherapists and 5 dieticians) was interviewed on their experiences with receiving or applying the intervention. Qualitative data from these semi-structured interviews were thematically analysed. RESULTS: We identified four themes: one theme regarding the positive experiences with the intervention and three themes regarding perceived barriers. Although users from all 3 perspectives (patients, physiotherapists and dieticians) generally perceived the intervention as having added value, we also identified several barriers, especially for the 'obesity subgroup'. In this 'obesity subgroup', physiotherapists perceived obesity as difficult to address, dieticians reported that more consultations are needed to reach sustainable weight loss and both physiotherapists and dieticians reported a lack of interprofessional collaboration. In the 'high muscle strength subgroup', the low number of supervised sessions was perceived as a barrier by some patients and physiotherapists, but as a facilitator by others. A final theme addressed barriers to knee OA treatment in general, with lack of motivation as the most prominent of these. CONCLUSION: Our qualitative study revealed a number of barriers to effective application of the stratified exercise therapy, especially for the 'obesity subgroup'. Based on these barriers, the intervention and its implementation could possibly be improved. Moreover, these barriers are likely to account at least partly for the lack of superiority over usual exercise therapy. TRIAL REGISTRATION: The Netherlands National Trial Register (NTR): NL7463 (date of registration: 8 January 2019).
Patient views regarding the impact of hydrotherapy on critically ill ventilated patients: A qualitative exploration study.
Felten-Barentsz, K. ; Oorsouw, R. van ; Haans, A.J.C. ; Staal, J.B. ; Hoeven, J.G. van der ; Nijhuis-van der Sanden, M.W.G.
2018, Article / Letter to editor (Journal of Critical Care, vol. 48, (2018), pp. 321-327)
Patient journey following lumbar spinal fusion surgery (LSFS): protocol for a multicentre qualitative analysis of the patient rehabilitation experience (FuJourn).
Rushton, A. ; Staal, J.B. ; Verra, M. ; Emms, A. ; Reddington, M. ; Soundy, A. ; Cole, A. ; Willems, P. ; Benneker, L. ; Masson, A. ; Heneghan, N.R. et al. sine al.
2018, Article / Letter to editor (BMJ Open, vol. 8, iss. 1, (2018))
Patient journey following lumbar spinal fusion surgery (FuJourn): A multicentre exploration of the immediate post-operative period using qualitative patient diaries.
Rushton, A. ; Jadhakhan, F. ; Masson, A. ; Athey, V. ; Staal, J.B. ; Verra, M.L. ; Emms, A. ; Reddington, M. ; Cole, A. ; Willems, P.C. ; Benneker, L. ; Heneghan, N.R. ; Soundy, A. et al. sine al.
2020, Article / Letter to editor (PLoS One, vol. 15, iss. 12, (2020), pp. e0241931)The aim of this study was to capture and understand the immediate recovery journey of patients following lumbar spinal fusion surgery and explore the interacting constructs that shape their journey. A qualitative study using Interpretive Phenomenological Analysis (IPA) approach. A purposive sample of 43 adult patients (≥16 years) undergoing ≤4 level instrumented fusion for back and/or leg pain of degenerative cause, were recruited pre-surgery from 4 UK spinal surgery centres. Patients completed a weekly diary expressed in their own words for the first 4 weeks following surgery to capture their life as lived. Diary content was based on previous research findings and recorded progress, recovery, motivation, symptoms, medications, healthcare appointments, rehabilitation, positive/negative thoughts, and significant moments; comparing to the previous week. To maximise completion and data quality, diaries could be completed in paper form, word document, as online survey or as audio recording. Strategies to enhance diary adherence included a weekly prompt. A framework analysis for individual diaries and then across participants (deductive and inductive components) captured emergent themes. Trustworthiness was enhanced by strategies including reflexivity, attention to negative cases and use of critical co-investigators. Twenty-eight participants (15 female; n = 18 (64.3%) aged 45-64) contributed weekly diaries (12 withdrew post-surgery, 3 did not follow through with surgery). Adherence with diaries was 89.8%. Participants provided diverse and vivid descriptions of recovery experiences. Three distinct recovery trajectories were identified: meaningful recovery (engagement in physical and functional activities to return to functionality/mobility); progressive recovery (small but meaningful improvement in physical ability with increasing confidence); and disruptive recovery (limited purpose for meaningful recovery). Important interacting constructs shaped participants' recovery including their pain experience and self-efficacy. This is the first account of immediate recovery trajectories from patients' perspectives. Recognition of a patient's trajectory may inform patient-centred recovery, follow-up and rehabilitation to improve patient outcomes.

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