Browsing by Author "Wees, P.J. van der"

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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.
Healthcare needs, expectations, utilization, and experienced treatment effects in patients with hereditary spastic paraplegia: a web-based survey in the Netherlands
Kerstens, H.C.J.W. ; Lith, B.J.H. van ; Nijkrake, M.J. ; Swart, B.J.M. de ; Bemd, LAC van den ; Smeets, RJEM ; Klemens, F ; Warrenburg, BPC van de ; Wees, P.J. van der ; Geurts, A.C.H.
2021, Article / Letter to editor (Orphanet Journal of Rare Diseases, vol. 16, iss. 1, (2021))Background We aimed to identify healthcare needs, expectations, utilization, and the experienced treatment effects in a population of Dutch patients with hereditary spastic paraplegia (HSP). Methods We distributed an online questionnaire among 194 adult persons with HSP in the Netherlands, of which 166 returned a fully completed version. After applying predefined exclusion criteria, 109 questionnaires from persons with pure HSP were analysed. Results Healthcare needs and expectations were primarily focused on the relief of muscle stiffness and reduction of balance and gait impairments (65-80%), but many participants also expressed needs regarding relief of non-motor symptoms (e.g. pain, fatigue), emotional problems, impaired sleep and self-care capacity, and participation problems (> 60%). Remarkably, despite these frequent needs, relatively few participants (< 33%) expected to be able to improve in these additional domains. Rehabilitation physicians and physiotherapists were more frequently consulted than neurologists and occupational therapists, respectively. Physiotherapy was the most often proposed non-pharmacological intervention (85%), followed by orthopedic footwear (55%) and splints (28%). Approximately one third of the participants was never offered any pharmacological (spasmolytic) treatment. Spasmolytic oral drugs, injections, and intrathecal baclofen were given to 41%, 26%, and 5% of the participants, respectively. Independent of the type of pharmacological intervention, 35-46% of these participants experienced decreased spastiticy and improved general fitness. Other experienced effects differed per type of intervention. Conclusions Based on this web-based survey in the Netherlands, there seems to be ample room for improvement to meet and attune the healthcare needs and expectations of people with HSP concerning both their motor and non-motor symptoms and functional limitations. In addition, the provision of adequate information about non-pharmacological and pharmacological interventions seems to be insufficient for many patients to allow shared decision making. These conclusions warrant a more pro-active attitude of healthcare providers as well as an interdisciplinary approach for a substantial proportion of the HSP population, also involving professionals with a primary occupational and/or psychosocial orientation.

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