To compare the effectiveness of pain exposure physical therapy (PEPT) with conventional treatment in patients with complex regional pain syndrome type 1 (CRPS-1) in a randomised controlled trial with a blinded assessor. The study was... more
To compare the effectiveness of pain exposure physical therapy (PEPT) with conventional treatment in patients with complex regional pain syndrome type 1 (CRPS-1) in a randomised controlled trial with a blinded assessor. The study was conducted at a level 1 trauma centre in the Netherlands. 56 adult patients with CRPS-1 participated. Three patients were lost to follow-up. Patients received either PEPT in a maximum of five treatment sessions, or conventional treatment following the Dutch multidisciplinary guideline. Outcomes were assessed at baseline and at 3, 6 and 9 months after randomisation. The primary outcome measure was the Impairment level Sum Score-Restricted Version (ISS-RV), consisting of visual analogue scale for pain (VAS-pain), McGill Pain Questionnaire, active range of motion (AROM) and skin temperature. Secondary outcome measures included Pain Disability Index (PDI); muscle strength; Short Form 36 (SF-36); disability of arm, shoulder and hand; Lower Limb Tasks Questionnaire (LLTQ); 10 m walk test; timed up-and-go test (TUG) and EuroQol-5D. The intention-to-treat analysis showed a clinically relevant decrease in ISS-RV (6.7 points for PEPT and 6.2 points for conventional treatment), but the between-group difference was not significant (0.96, 95% CI -1.56 to 3.48). Participants allocated to PEPT experienced a greater improvement in AROM (between-group difference 0.51, 95% CI 0.07 to 0.94; p=0.02). The per protocol analysis showed larger and significant between-group effects on ISS-RV, VAS-pain, AROM, PDI, SF-36, LLTQ and TUG. We cannot conclude that PEPT is superior to conventional treatment for patients with CRPS-1. Further high-quality research on the effects of PEPT is warranted given the potential effects as indicated by the per protocol analysis. NCT00817128 and NTR 2090.
Research Interests: Quality of life, Risk, Muscle strength, Mobility, Gait, and 24 moreProspective studies, Humans, Muscle, Variability, Movement, Male, Exercise, Balance, Metaanalysis, Randomised Controlled Trial, Diabetic Foot, Group Intervention, Clinical Sciences, Intervention Studies, Aged, Middle Aged, Public health systems and services research, Joint, Physical Exercise, Joints, Indexation, Type 2 Diabetes Mellitus, Articulation, and Control Group
There is a body of literature that indicates that physical exercise interventions, with a primary focus on improvement of functioning instead of pain relief, might be effective to stimulate return to work and improve function in workers... more
There is a body of literature that indicates that physical exercise interventions, with a primary focus on improvement of functioning instead of pain relief, might be effective to stimulate return to work and improve function in workers who are absent from work due to low back pain (LBP). Successful application and implementation of these interventions however, depends on multiple factors that need to be addressed carefully in clinical practice as well as research. Descriptive literature review, to identify an overview of current knowledge with respect to the safety, content- and context-related aspects of physical exercise interventions, issues relating to timing, the influence of treatment confidence and patient expectations, and the process of changing provider and employer behavior. Physical exercises are not associated with an increased risk for recurrences. The effects of interventions may vary depending on content-related factors (i.e., type of exercises, dosage, frequency, skills of the healthcare providers, etc.) and contextual factors (i.e., treatment setting, compensation system, etc.). Treatment confidence and patients' expectations also significantly influence outcomes of physical exercise interventions. Timing is also important; interventions targeting return to work, applied during the acute phase of work absenteeism, compete with a high rate of spontaneous recovery and may therefore be inefficient. Despite numerous studies, more quantitative and qualitative investigations are needed to further clarify the requirements for a successful application and implementation of physical exercise interventions for disabled workers with low back pain.
Research Interests:
Research Interests: Psychometrics, Social Support, Social Security, Work Environment, Industrial Psychology, and 21 moreWorkplace, Computers, Humans, Female, Male, Exploratory Factor Analysis, Netherlands, Cross Validation, Risk factors, Psychometric Properties, Posture, SHOULDER PAIN, Clinical Sciences, Prevalence, Questionnaires, Longitudinal Studies, Risk Factors, Upper Extremity, Office Automation, Occupational Diseases, and Factor structure
Researchers from the Royal Netherlands Army are studying the potential of isolated lumbar extensor training in low back pain in their working population. Currently, a randomized controlled trial is carried out in five military health... more
Researchers from the Royal Netherlands Army are studying the potential of isolated lumbar extensor training in low back pain in their working population. Currently, a randomized controlled trial is carried out in five military health centers in The Netherlands and Germany, in which a 10-week program of not more than 2 training sessions (10-15 minutes) per week is studied in soldiers with nonspecific low back pain for more than 4 weeks. The purpose of the study is to investigate the efficacy of this 'minimal intervention program', compared to usual care. Moreover, attempts are made to identify subgroups of different responders to the intervention. Besides a baseline measurement, follow-up data are gathered at two short-term intervals (5 and 10 weeks after randomization) and two long-term intervals (6 months and one year after the end of the intervention), respectively. At every test moment, participants fill out a compound questionnaire on a stand-alone PC, and they undergo a...
Research Interests: Sports Medicine, Physical Activity, Exercise therapy, Low back pain, Germany, and 12 moreHumans, Back Pain, Follow-up studies, Netherlands, Patient Preference, Clinical Sciences, Intervention Studies, Randomized Controlled Trial, Prognosis, Chronic Low Back Pain, Military Personnel, and Physical Education and training
Clinical measurement. To translate and cross-culturally adapt the Hip disability and Osteoarthritis Outcome Score (HOOS) from English into German, and to study its psychometric properties in patients after hip surgery. There is no... more
Clinical measurement. To translate and cross-culturally adapt the Hip disability and Osteoarthritis Outcome Score (HOOS) from English into German, and to study its psychometric properties in patients after hip surgery. There is no specific hip questionnaire in German that not only measures symptoms and function but also contains items about hip-related quality of life. The translation and cross-cultural adaptation involved forward translation, harmonization, cognitive debriefing, back translation, and comparison to the original HOOS following international guidelines. The German version was tested in 51 Swiss inpatients 8 weeks after different types of hip surgery, mainly total hip replacement. The mean age of the participants was 62.5 years, and the age range was from 27 to 87 years. Thirty (58.8%) of the participants were women. Internal consistency and test-retest reliability were estimated using Cronbach alpha and intraclass correlation coefficients for agreement. For construct validity, total scores of the German HOOS were correlated with those of the Western Ontario and McMaster Universities Osteoarthritis Index. The HOOS was also compared to the Medical Outcomes Study 36-Item Short-Form Health Survey. Cronbach alpha values for all German HOOS subscales were between .87 and .93. For test-retest reliability, the intraclass correlation coefficient for agreement was 0.85 for the total scores of the German HOOS. The Spearman rho for the Medical Outcomes Study 36-Item Short-Form Health Survey physical functioning subscale compared to the sum of all HOOS subscales was 0.71, and that for the Medical Outcomes Study 36-Item Short-Form Health Survey physical component summary was 0.97. The German HOOS has demonstrated adequate reliability and validity. Use of the German HOOS is recommended for assessment of patients after hip surgery, with the proviso that additional psychometric testing should be done in future research.
Research Interests:
Despite the positive effects of physical activity on numerous aspects of health, many older adults remain sedentary even after participating in physical activity interventions. Standardized exercise programs do not necessarily bring about... more
Despite the positive effects of physical activity on numerous aspects of health, many older adults remain sedentary even after participating in physical activity interventions. Standardized exercise programs do not necessarily bring about the behavioral change that is necessary. Therefore, a patient-centered approach is needed. The purpose of this study was to develop and assess the acceptability and potential effectiveness of the Coach2Move strategy; a physical therapy (PT) approach aimed at improving the long-term level of physical activity in mobility-limited older adults. The Coach2Move strategy was developed on the basis of 2 systematic literature studies and expert consultations. Multiple focus group meetings and a Delphi procedure were organized to gain consensus on the Coach2Move strategy. Acceptability and potential effectiveness were studied in a pilot study with a pre-/postdesign in which 2 physical therapists and 12 patients participated. To assess acceptability, patient...
Research Interests:
Research Interests:
Research Interests:
ABSTRACT
Research Interests:
Research Interests:
Although motor problems in Prader-Willi syndrome (PWS) are prominent in infants, and continue into childhood and adulthood, there is little insight into the factors important for clinical management. The literature was reviewed to: (1)... more
Although motor problems in Prader-Willi syndrome (PWS) are prominent in infants, and continue into childhood and adulthood, there is little insight into the factors important for clinical management. The literature was reviewed to: (1) provide an overview of the characteristics and prevalence of motor problems and (2) evaluate the effects of growth hormone (GH) treatment and physical training on motor performance. A systematic search revealed 34 papers: 13 on motor performance; 12 on GH treatment; and nine on physical training. In infants, motor development is 30-57% of the normal reference values, and children and adults also have significant problems in skill acquisition, muscle force, cardiovascular fitness, and activity level. GH treatment positively influenced motor performance in infants, children, and adults, although not all studies demonstrated an effect. All studies on physical training demonstrated beneficial effects in PWS patients. We suggest a combination of GH treatment and physical training to be started as soon as possible, especially in infants, to improve motor development as this will positively influence general development.
Research Interests:
Research Interests:
Research Interests:
Research Interests: Occupational Health, Survival Analysis, Low back pain, Multivariate Analysis, Activities of Daily Living, and 13 moreHumans, Statistical Significance, Exercise, Netherlands, Recurrence, Clinical Sciences, Occupational, Randomized Controlled Trial, Return to Work, Occupational Diseases, Occupational Rehabilitation, Proportional Hazards Models, and Functional Status
Research Interests:
Research Interests:
Research Interests: Treatment Outcome, Exercise therapy, Linear models, Physical Therapy, Low back pain, and 13 moreMuscle strength, Humans, Back Pain, Male, Follow-up studies, Netherlands, Clinical Sciences, Middle Aged, Adult, Public health systems and services research, Randomized Controlled Trial, Prognosis, and Military Personnel
Low back pain is a common medical and social problem frequently associated with disability and absence from work. However, data on effective return to work after interventions for low back pain are scarce. To determine the effectiveness... more
Low back pain is a common medical and social problem frequently associated with disability and absence from work. However, data on effective return to work after interventions for low back pain are scarce. To determine the effectiveness of a behavior-oriented graded activity program compared with usual care. Randomized, controlled trial. Occupational health services department of an airline company in the Netherlands. 134 workers who were absent from work because of low back pain were randomly assigned to either graded activity (n = 67) or usual care (n = 67). Graded activity, a physical exercise program based on operant-conditioning behavioral principles, to stimulate a rapid return to work. Outcomes were the number of days of absence from work because of low back pain, functional status (Roland Disability Questionnaire), and severity of pain (11-point numerical scale). The median number of days of absence from work over 6 months of follow-up was 58 days in the graded activity group and 87 days in the usual care group. From randomization onward, graded activity was effective after 50 days of absence from work (hazard ratio, 1.9 [95% CI, 1.2 to 3.2]; P = 0.009). The graded activity group was more effective in improving functional status and pain than the usual care group. The effects, however, were small and not statistically significant. Graded activity was more effective than usual care in reducing the number of days of absence from work because of low back pain.