The objective of this study was to evaluate the effectiveness of an activity pacing self-manageme... more The objective of this study was to evaluate the effectiveness of an activity pacing self-management (APSM) intervention in improving performance of daily life activities in women with chronic fatigue syndrome (CFS). A total of 33 women with CFS (age 41.1 ± 11.2 yr) were randomly allocated to APSM (experimental group; n = 16) or relaxation (control group; n = 17). Main outcome measures included the Canadian Occupational Performance Measure (COPM; primary) and Checklist Individual Strength (CIS). COPM scores changed significantly over time in both groups (p = .03). The change in Satisfaction scores showed a significant difference in favor only of APSM (effect size = 0.74 [0.11, 1.4]). CIS scores decreased significantly in the experimental group only (p < .01). APSM was found to be feasible and effective in optimizing participation in desired daily life activities in women with CFS. Replication in a larger sample with long-term follow-up is required.
Journal of back and musculoskeletal rehabilitation, Jan 11, 2014
Hospital workers with physically demanding jobs are at risk for developing recurrent LBP. There i... more Hospital workers with physically demanding jobs are at risk for developing recurrent LBP. There is a lack of studies evaluating multidisciplinary prevention of low back pain (LBP) in hospital workers.OBJECTIVE: This randomized controlled trial evaluates the effect of a multidisciplinary prevention program, focusing on a client-centred approach, on hospital workers at risk for developing LBP. Caregiving hospital workers were allocated to an experimental (12-week lasting multidisciplinary prevention program) or control group (no intervention). They were evaluated prior to the intervention and after a 6 months follow-up period. Primary outcome measures included incidence of LBP, work absenteeism and general health. Secondary outcomes included daily physical activity, job satisfaction and coping strategies. A significant improvement was seen for passive coping after 6 months follow-up, but no significant differences were observed between groups in primary or other secondary outcome meas...
The aim of this study is to evaluate the reliability, validity and responsiveness of the Dutch ve... more The aim of this study is to evaluate the reliability, validity and responsiveness of the Dutch version of the Modified Fatigue Impact Scale. Fifty-one randomly selected subjects with definite multiple sclerosis (MS) (mean age 51.9 +/- 10.5 years, 25 women) and 20 healthy controls (mean age 50.6 +/- 14.0 years, 13 women) filled in the Modified Fatigue Impact Scale (MFIS), the Fatigue Severity Scale (FSS) and the fatigue subscale of Guy's Neurological Disability Scale (GNDS). All tests were repeated with an interval of maximum three days. The hospitalised individuals with MS (n = 20) were assessed at intake and discharge. No significant difference was found between first and second administration of MFIS (z = -.519, p = .603, Wilcoxon signed ranks test), with a good correlation (.729). MFIS was able to distinguish individuals with MS from controls, and subjects with fatigue from the non-fatigued group. MFIS showed no floor or ceiling effect. MFIS correlated moderately with Fatigue...
Delayed recovery of muscle function following exercise has been demonstrated in the lower limbs o... more Delayed recovery of muscle function following exercise has been demonstrated in the lower limbs of patients with multiple sclerosis (MS). However, studies examining this in the upper limbs are currently lacking. This study compared physical activity level (PAL) and recovery of upper limb muscle function following exercise between MS patients and healthy inactive controls. Furthermore, the relationship between PAL and muscle recovery was examined. PAL of 19 MS patients and 32 controls was measured using an accelerometer for 7 consecutive days. Afterwards, recovery of muscle function was assessed by performing a fatiguing upper limb exercise test with subsequent recovery measures. Muscle recovery of the upper limb muscles was similar in both groups. Average activity counts were significantly lower in MS patients than in the control group. MS patients spent significantly more time being sedentary and less time on activities of moderate intensity compared with the control group. No significant correlation between PAL and recovery of muscle function was found in MS patients. Recovery of upper limb muscle function following exercise is normal in MS patients. MS patients are less physically active than healthy inactive controls. PAL and recovery of upper limb muscle function appear unrelated in MS patients.
SUMMARY Fatigue is among the most common and disabling symptoms of multiple sclerosis. Clinicians... more SUMMARY Fatigue is among the most common and disabling symptoms of multiple sclerosis. Clinicians usually assess fatigue by asking people to describe and rate their fatigue in a self-report instrument. This paper evaluates the clinical usefulness and the scientific properties of a selection of various self-report instruments for fatigue. To be selected, instruments had to assess fatigue or a related concept, have some published information on reliability and validity, be used in at least one clinical trial of fatigue with people with multiple sclerosis, and demonstrate validity in people with MS. Five fatigue specific scales and four subscales of quality of life instruments were selected and evaluated. In occupational therapy, the fatigue subscales or items of quality of life measurements give limited information about the quality of fatigue. The selection of an instrument may depend on the clinical setting or trial design.
To establish the efficacy of a multidisciplinary fatigue management programme (MFMP) in MS. Metho... more To establish the efficacy of a multidisciplinary fatigue management programme (MFMP) in MS. Method Fifty-one subjects with MS were randomly allocated to group A, who only received the four weeks MFMP, or group B receiving a placebo intervention programme first and the MFMP after 6 months. In both groups, assessment was performed at baseline, 3 weeks and 6 months after the programmes and included Modified Fatigue Impact Scale (MFIS), Fatigue Severity Scale (FSS), MS Self-Efficacy scale (MSSE), Mental Health Inventory (MHI) and Impact on Participation and Autonomy (IPA). The MFIS showed a significant change over time (F(4,152) = 3.346, P = 0.012), which was similar in both groups (time*group interaction: F(4,152) = 1.094, P = 0.361). A clinically relevant reduction of MFIS score of 10 points or more was found in 17% of individuals following the MFMP, compared to 44% after the placebo intervention programme (P = 0.06). Compared to no intervention, a significant effect of the MFMP after 6 months (P = 0.003) was found in five participants (31%). No significant changes in FSS, MSSE, MHI and IPA, in both groups, were found. Although an additional effect was found, the multidisciplinary fatigue management programme showed no efficacy in reducing the impact of fatigue compared to a placebo intervention programme.
To evaluate the psychometric properties of the Modified Fatigue Impact Scale (MFIS) in four diffe... more To evaluate the psychometric properties of the Modified Fatigue Impact Scale (MFIS) in four different European countries. Individuals with definite multiple sclerosis (MS) were selected from centres in Italy (n =50), Spain (n =30), Slovenia (n =50) and Belgium (n =51) and completed the MFIS and the Fatigue Severity Scale (FSS) twice (interval < or =3 days). In all four samples, the MFIS demonstrated a good reproducibility (intraclass correlation coefficient > or = 0.84), with no significant differences between countries (P =0.77). Moderate correlations were found between the MFIS and FSS. No significant correlations were found between the MFIS and age, gender, type of MS, duration of the disease or EDSS score. Factor analysis of all samples (n = 181) could not completely confirm the original assumptions concerning the physical, cognitive and psychosocial component The total score, the physical and the cognitive subscale of the scale were homogeneous (Cronbach's alpha 0.92, 0.88 and 0.92, respectively), but the psychosocial subscale had a Cronbach's alpha of 0.65. No cultural or linguistic differences were found in the psychometric properties of the Belgian, Italian, Slovenian or Spanish version of the MFIS. We recommend this scale for research purposes and in clinical practice. Due to the limited value of the psychosocial subscale, we recommend interpreting this subscale with caution.
The paced auditory serial addition test (PASAT) is increasingly used in multiple sclerosis (MS) s... more The paced auditory serial addition test (PASAT) is increasingly used in multiple sclerosis (MS) studies. Since these studies rely on repeated assessments with relatively short inter-test intervals, practice effects can be a confounding factor. We examined intra-session PASAT practice effects in 70 relapsing remitting (RR) and 40 secondary progressive (SP) patients. The average number of correct answers increased from 39.6+/-11.7 in the first PASAT run to 43.8+/-11.4 in the second run for the RR group, and from 39.1+/-11.6 to 41.8+/-13.3 in the SP group. PASAT scores showed a consistent decrease when comparing the second half of each test to the first half for both patient groups, and for both runs. Items for which the answer was a number greater than 9 had the same discrimination ability as other test items, but were significantly more difficult. A simulation of ;single-button' responses supported the use of the simplified scoring method which is currently used in fMRI studies. Our results demonstrate a within-session PASAT practice effect in MS, as well as a fatigability effect for both patient groups.
The real-life relevance of frequently applied clinical arm tests is not well known in multiple sc... more The real-life relevance of frequently applied clinical arm tests is not well known in multiple sclerosis (MS). This study aimed to determine the relation between real-life arm performance and clinical tests in MS. Thirty wheelchair-bound MS patients and 30 healthy controls were included. Actual and perceived real-life arm performance was measured by using accelerometry and a self-reported measure (Motor Activity Log). Clinical tests on 'body functions & structures' (JAMAR handgrip strength, Motricity Index (MI), Fugl Meyer (FM)) and 'activity' level (Nine Hole Peg Test (NHPT), Action Research Arm test) of the International Classification of Functioning were conducted. Statistical analyses were performed separately for current dominant and non-dominant arm. For all outcome measures, MS patients scored with both arms significantly lower than the control group. Higher correlations between actual arm performance and clinical tests were found for the non-dominant arm (0.63-0.80). The FM (55%) was a good predictor of actual arm performance, while the MI (46%) and NHPT (55%) were good predictors of perceived arm performance. Real-life arm performance is decreased in wheelchair-bound MS patients and can be best predicted by measures on 'body functions & structures' level and fine motor control. Hand dominance influenced the magnitude of relationships.
The objective of this study was to evaluate the effectiveness of an activity pacing self-manageme... more The objective of this study was to evaluate the effectiveness of an activity pacing self-management (APSM) intervention in improving performance of daily life activities in women with chronic fatigue syndrome (CFS). A total of 33 women with CFS (age 41.1 ± 11.2 yr) were randomly allocated to APSM (experimental group; n = 16) or relaxation (control group; n = 17). Main outcome measures included the Canadian Occupational Performance Measure (COPM; primary) and Checklist Individual Strength (CIS). COPM scores changed significantly over time in both groups (p = .03). The change in Satisfaction scores showed a significant difference in favor only of APSM (effect size = 0.74 [0.11, 1.4]). CIS scores decreased significantly in the experimental group only (p < .01). APSM was found to be feasible and effective in optimizing participation in desired daily life activities in women with CFS. Replication in a larger sample with long-term follow-up is required.
Journal of back and musculoskeletal rehabilitation, Jan 11, 2014
Hospital workers with physically demanding jobs are at risk for developing recurrent LBP. There i... more Hospital workers with physically demanding jobs are at risk for developing recurrent LBP. There is a lack of studies evaluating multidisciplinary prevention of low back pain (LBP) in hospital workers.OBJECTIVE: This randomized controlled trial evaluates the effect of a multidisciplinary prevention program, focusing on a client-centred approach, on hospital workers at risk for developing LBP. Caregiving hospital workers were allocated to an experimental (12-week lasting multidisciplinary prevention program) or control group (no intervention). They were evaluated prior to the intervention and after a 6 months follow-up period. Primary outcome measures included incidence of LBP, work absenteeism and general health. Secondary outcomes included daily physical activity, job satisfaction and coping strategies. A significant improvement was seen for passive coping after 6 months follow-up, but no significant differences were observed between groups in primary or other secondary outcome meas...
The aim of this study is to evaluate the reliability, validity and responsiveness of the Dutch ve... more The aim of this study is to evaluate the reliability, validity and responsiveness of the Dutch version of the Modified Fatigue Impact Scale. Fifty-one randomly selected subjects with definite multiple sclerosis (MS) (mean age 51.9 +/- 10.5 years, 25 women) and 20 healthy controls (mean age 50.6 +/- 14.0 years, 13 women) filled in the Modified Fatigue Impact Scale (MFIS), the Fatigue Severity Scale (FSS) and the fatigue subscale of Guy's Neurological Disability Scale (GNDS). All tests were repeated with an interval of maximum three days. The hospitalised individuals with MS (n = 20) were assessed at intake and discharge. No significant difference was found between first and second administration of MFIS (z = -.519, p = .603, Wilcoxon signed ranks test), with a good correlation (.729). MFIS was able to distinguish individuals with MS from controls, and subjects with fatigue from the non-fatigued group. MFIS showed no floor or ceiling effect. MFIS correlated moderately with Fatigue...
Delayed recovery of muscle function following exercise has been demonstrated in the lower limbs o... more Delayed recovery of muscle function following exercise has been demonstrated in the lower limbs of patients with multiple sclerosis (MS). However, studies examining this in the upper limbs are currently lacking. This study compared physical activity level (PAL) and recovery of upper limb muscle function following exercise between MS patients and healthy inactive controls. Furthermore, the relationship between PAL and muscle recovery was examined. PAL of 19 MS patients and 32 controls was measured using an accelerometer for 7 consecutive days. Afterwards, recovery of muscle function was assessed by performing a fatiguing upper limb exercise test with subsequent recovery measures. Muscle recovery of the upper limb muscles was similar in both groups. Average activity counts were significantly lower in MS patients than in the control group. MS patients spent significantly more time being sedentary and less time on activities of moderate intensity compared with the control group. No significant correlation between PAL and recovery of muscle function was found in MS patients. Recovery of upper limb muscle function following exercise is normal in MS patients. MS patients are less physically active than healthy inactive controls. PAL and recovery of upper limb muscle function appear unrelated in MS patients.
SUMMARY Fatigue is among the most common and disabling symptoms of multiple sclerosis. Clinicians... more SUMMARY Fatigue is among the most common and disabling symptoms of multiple sclerosis. Clinicians usually assess fatigue by asking people to describe and rate their fatigue in a self-report instrument. This paper evaluates the clinical usefulness and the scientific properties of a selection of various self-report instruments for fatigue. To be selected, instruments had to assess fatigue or a related concept, have some published information on reliability and validity, be used in at least one clinical trial of fatigue with people with multiple sclerosis, and demonstrate validity in people with MS. Five fatigue specific scales and four subscales of quality of life instruments were selected and evaluated. In occupational therapy, the fatigue subscales or items of quality of life measurements give limited information about the quality of fatigue. The selection of an instrument may depend on the clinical setting or trial design.
To establish the efficacy of a multidisciplinary fatigue management programme (MFMP) in MS. Metho... more To establish the efficacy of a multidisciplinary fatigue management programme (MFMP) in MS. Method Fifty-one subjects with MS were randomly allocated to group A, who only received the four weeks MFMP, or group B receiving a placebo intervention programme first and the MFMP after 6 months. In both groups, assessment was performed at baseline, 3 weeks and 6 months after the programmes and included Modified Fatigue Impact Scale (MFIS), Fatigue Severity Scale (FSS), MS Self-Efficacy scale (MSSE), Mental Health Inventory (MHI) and Impact on Participation and Autonomy (IPA). The MFIS showed a significant change over time (F(4,152) = 3.346, P = 0.012), which was similar in both groups (time*group interaction: F(4,152) = 1.094, P = 0.361). A clinically relevant reduction of MFIS score of 10 points or more was found in 17% of individuals following the MFMP, compared to 44% after the placebo intervention programme (P = 0.06). Compared to no intervention, a significant effect of the MFMP after 6 months (P = 0.003) was found in five participants (31%). No significant changes in FSS, MSSE, MHI and IPA, in both groups, were found. Although an additional effect was found, the multidisciplinary fatigue management programme showed no efficacy in reducing the impact of fatigue compared to a placebo intervention programme.
To evaluate the psychometric properties of the Modified Fatigue Impact Scale (MFIS) in four diffe... more To evaluate the psychometric properties of the Modified Fatigue Impact Scale (MFIS) in four different European countries. Individuals with definite multiple sclerosis (MS) were selected from centres in Italy (n =50), Spain (n =30), Slovenia (n =50) and Belgium (n =51) and completed the MFIS and the Fatigue Severity Scale (FSS) twice (interval < or =3 days). In all four samples, the MFIS demonstrated a good reproducibility (intraclass correlation coefficient > or = 0.84), with no significant differences between countries (P =0.77). Moderate correlations were found between the MFIS and FSS. No significant correlations were found between the MFIS and age, gender, type of MS, duration of the disease or EDSS score. Factor analysis of all samples (n = 181) could not completely confirm the original assumptions concerning the physical, cognitive and psychosocial component The total score, the physical and the cognitive subscale of the scale were homogeneous (Cronbach's alpha 0.92, 0.88 and 0.92, respectively), but the psychosocial subscale had a Cronbach's alpha of 0.65. No cultural or linguistic differences were found in the psychometric properties of the Belgian, Italian, Slovenian or Spanish version of the MFIS. We recommend this scale for research purposes and in clinical practice. Due to the limited value of the psychosocial subscale, we recommend interpreting this subscale with caution.
The paced auditory serial addition test (PASAT) is increasingly used in multiple sclerosis (MS) s... more The paced auditory serial addition test (PASAT) is increasingly used in multiple sclerosis (MS) studies. Since these studies rely on repeated assessments with relatively short inter-test intervals, practice effects can be a confounding factor. We examined intra-session PASAT practice effects in 70 relapsing remitting (RR) and 40 secondary progressive (SP) patients. The average number of correct answers increased from 39.6+/-11.7 in the first PASAT run to 43.8+/-11.4 in the second run for the RR group, and from 39.1+/-11.6 to 41.8+/-13.3 in the SP group. PASAT scores showed a consistent decrease when comparing the second half of each test to the first half for both patient groups, and for both runs. Items for which the answer was a number greater than 9 had the same discrimination ability as other test items, but were significantly more difficult. A simulation of ;single-button' responses supported the use of the simplified scoring method which is currently used in fMRI studies. Our results demonstrate a within-session PASAT practice effect in MS, as well as a fatigability effect for both patient groups.
The real-life relevance of frequently applied clinical arm tests is not well known in multiple sc... more The real-life relevance of frequently applied clinical arm tests is not well known in multiple sclerosis (MS). This study aimed to determine the relation between real-life arm performance and clinical tests in MS. Thirty wheelchair-bound MS patients and 30 healthy controls were included. Actual and perceived real-life arm performance was measured by using accelerometry and a self-reported measure (Motor Activity Log). Clinical tests on 'body functions & structures' (JAMAR handgrip strength, Motricity Index (MI), Fugl Meyer (FM)) and 'activity' level (Nine Hole Peg Test (NHPT), Action Research Arm test) of the International Classification of Functioning were conducted. Statistical analyses were performed separately for current dominant and non-dominant arm. For all outcome measures, MS patients scored with both arms significantly lower than the control group. Higher correlations between actual arm performance and clinical tests were found for the non-dominant arm (0.63-0.80). The FM (55%) was a good predictor of actual arm performance, while the MI (46%) and NHPT (55%) were good predictors of perceived arm performance. Real-life arm performance is decreased in wheelchair-bound MS patients and can be best predicted by measures on 'body functions & structures' level and fine motor control. Hand dominance influenced the magnitude of relationships.
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Papers by Daphne Kos