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VRA-Lustrumcongres
Pearls & Diamonds 17 april 2015
Krasnapolsky Amsterdam
Algemene informatie Hoofdsponsoren
Het VRA Lustrumcongres 2015 wordt mede mogelijk gemaakt door:
Algemene sponsoren • Otto Bock • Freedom Innovations Europe • Allergan • Focal Meditech • Basko Health Care • Ambroise Congreslocatie NH Krasnapolsky Amsterdam Dam 9 1012 JS Amsterdam Organisatie Nederlandse Vereniging van Revalidatieartsen Postbus 9696, 3506 GR Utrecht T. 030-2739685 E.
[email protected] Website www.rehabilitationmedicinecongress.nl Accreditatie Accreditatie is aangevraagd bij de VRA en NAPA. Deelname aan dit congres levert u vier accreditatiepunten op. Accreditatiepunten worden per dagdeel toegekend. Indien u niet de hele dag aanwezig bent ontvangt u niet alle punten. Om uw accreditatiepunten te ontvangen dient u bij vertrek uw badge te scannen bij de registratiebalie.
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OIM Orthopedie stimuleert onderzoek Elke orthopedische innovatie kan bij onze klanten zorgen voor bijvoorbeeld meer bewegingsvrijheid, een beter evenwichtsgevoel en minder compensatiebewegingen. Continu wil OIM Orthopedie daarom weten hoe het beter kan. Hoe we dat doen? Samen met andere partijen werken wij aan wetenschappelijk onderzoek, zoals: prototype onderbeenprothese ter verbetering van de zijwaartse balans knieorthese voor herstel van het kraakbeen verbeteren enkel-voetorthese bij kinderen met CP flexibele prothesepols voor mensen met een myo-elektrische onderarmprothese
Bezoek onze stand of lees meer over deze en andere onderzoeken die wij steunen op www.oim.nl/onderzoek
www.oim.nl
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Volg ons ook op
Voorwoord
Pearls & Diamonds: de VRA zestig jaar jong! Dit jaar viert de Nederlandse Vereniging van Revalidatieartsen haar diamanten jubileum. Ter ere van het 60-jarige bestaan wordt op 17 april het VRA-Lustrumcongres georganiseerd in het Krasnapolsky te Amsterdam. In deze passende locatie staan gedurende de hele dag de Parels en Diamanten van de revalidatiegeneeskunde centraal.
In de ochtend is Lucille Werner bij ons te gast; zij zal ingaan op onderwerpen als participatie en eigen regie. Aansluitend zullen prof. dr. Anne Visser- Meily en dr. Imelda de Groot parels binnen de revalidatiegeneeskunde presenteren.
In de middag wordt een paneldiscussie gehouden onder leiding van Frenk van der Linden, met als titel: VERLEDEN, HEDEN, nee … VOORAL TOEKOMST: Wat is de rol van de revalidatiearts over 60 jaar? Onderwerpen als neuromodulatie, osseo-integratie, robotica en transitie naar de eerstelijn komen hier aan bod. Aan de hand van stellingen zullen we met u in gesprek gaan over de toekomst.
De dag zal op een bijzondere wijze worden samengevat en afgerond door cabaretier Michiel Peereboom, waarna iedereen de mogelijkheid heeft om deel te nemen aan één van de sociale activiteiten.Vervolgens vindt het diner en een fonkelende feestavond plaats in de Wintertuin.
Vrijdag 17 april wordt een bijzondere dag, waar we samen mogen vieren dat de VRA zestig jaar jong is en springlevend! De Lustrumcommissie heeft met veel plezier en in goede samenwerking met de Wetenschappelijke Commissie deze dag voor u vorm gegeven. Wij hopen van harte dat u zult genieten van dit feestelijke lustrum congres! Namens De lustrumcommissie
Suzanne Lambregts Voorzitter Lustrumcommissie
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Ipsen revalidatie jaarprijs 2015 voor innovatieve patiëntenzorg
€ 20.000,Voor een projectvoorstel waarvan patiënten direct en meetbaar gaan profiteren in de dagelijkse revalidatiezorg
Sociaal programma Tussen 17.00 en 19.00 uur bieden wij u de mogelijkheid deel te nemen aan een van de onderstaande activiteiten. Activiteit: ‘Alternatief revalideren in Amsterdam’ Een rondleiding door het oudste stukje van Amsterdam: De BurghWallen.Tijdens de rondleiding is er een borrel en worden er hapjes geserveerd. De rondleiding duurt anderhalf uur en vertrekt vanuit het Krasnapolsky. Activiteit: Borrelboot door Amsterdam Na de lustrum ALV vertrekt de borrelboot achter het Krasnapolsky (op de hoek van de Oudezijds Voorburgwal en Damstraat) voor een prachtige vaartocht door hartje Amsterdam. Tijdens de vaartocht worden hapjes en drankjes geserveerd. De vaartocht duurt +/- anderhalf uur. Feestavond en diner Om 19.30 uur start de feestavond met diner in de Wintertuin van NH Krasnapolsky.
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Programma Ochtend
9.00 – 9.30
Ontvangst en registratie
9.30 – 10.00
Start ochtendprogramma
10.00 – 10.40
Gastspreker: Lucille Werner Durf te dromen!
10.40 – 11.10
Prof. dr. Anne Visser-Meily Van parel naar groeidiamanten; verbeteren van de CVA zorg vraagt om slim innoveren
11.10 – 11.40
Dr. Imelda de Groot Progressie in de kinderrevalidatie van neuromusculaire aandoeningen
11.40 – 12.00
Plenaire posterpresentaties
12.00 – 13.30
Posterbezichtigingen, expositie en lunch
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Programma Middag en Avond
13.30 – 15.00
Paneldiscussie: VERLEDEN, HEDEN, nee … VOORAL TOEKOMST: Wat is de rol van de revalidatiearts over 60 jaar? Discussieleider: Frenk van der Linden
15.00 – 15.40
Expositie en pauze
15.40 – 16.10
Cabaretier: Michiel Peereboom Lachen was nog nooit zo gezond
16.10 – 16.45
Lustrum ALV
17.00 – 19.00
Activiteit:
19.30 – 00.00
Diner en feestavond Locatie: NH Krasnapolsky:Wintertuin
Rondvaart of Rondwandeling
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Gastspreker Lucille Werner Durf te dromen!
Lucille Werner is presentatrice, programmamaakster en motivator. Naast haar televisiewerkzaamheden zet zij zich actief in voor haar stichting de Lucille Werner Foundation (LWF). Met haar stichting focust ze zich op positieve beeldvorming voor mensen met een lichamelijke handicap, door middel van mediaprojecten. Een lichamelijk handicap hoeft je niet in de weg te staan. Maar nog steeds blijven veel mensen met een handicap te ver op de achtergrond of zij plaatsen zichzelf daar. Onnodig! Integratie van mensen met een handicap in de samenleving is waar Lucille zich sterk voor maakt. Bekende initiatieven die Lucille heeft genomen om een bijdrage te leveren aan positieve beeldvorming over mensen met een handicap zijn de Mis(s) verkiezing en de CAPawards, waarin awards worden uitgereikt aan bijzondere talenten met een handicap. Zij heeft ook een boek geschreven over haar persoonlijke ervaringen met haar handicap: ‘Het leven op rolletjes’.
Tijdens haar lezing staat participatie van en eigen regie voor mensen met een handicap centraal. Aan de hand van haar eigen persoonlijke ervaringen en projecten van de Lucille Werner Foundation zal zij haar visie geven hoe mensen met een handicap een sterkere positie in de samenleving kunnen veroveren en eigen regie kunnen verkrijgen of behouden. De rol die de revalidatiearts hierin kan spelen zal door Lucille worden geschetst. Communicatie over de mogelijkheden van de revalidatiegeneeskunde speelt hierbij ook een belangrijke rol.
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Keynote Speaker Prof. dr. Anne Visser-Meily Van parel naar groeidiamanten; verbeteren van de CVA zorg vraagt om slim innoveren Anne Visser-Meily is revalidatiearts, hoogleraar revalidatiegeneeskunde, medisch hoofd van de Neurorevalidatie in het UMC Utrecht en is hoofd van het Kenniscentrum Revalidatiegeneeskunde Utrecht.Visser-Meily is voorzitter van de Werkgroep Scholing en Opleiding van Kennisnetwerk CVA NL, lid van de raad van advies van de patiëntenvereniging Hersenletsel.nl, ze is vaste columnist in het Hersenletsel Magazine, redactielid van het Nederlands Tijdschrift Revalidatiegeneeskunde en ambassadeur van www.jmzpro.nl.
De zorg voor CVA patiënten is sterk aan het veranderen; enerzijds op basis van nieuwe kennis anderzijds omdat het zorglandschap verandert. Snel mobiliseren, intensiever oefenen, inactiviteit voorkomen, eigen regie van patiënt met zijn naasten en steeds minder geld zijn sleutel woorden. Het is een uitdaging om patiënten, die allemaal anders zijn met andere ideeën en wensen, de eerste dagen tot weken op een doelmatige manier meer te activeren en gerichter te behandelen en om partners hierbij te betrekken.
De laatste jaren heeft het Kenniscentrum Revalidatiegeneeskunde Utrecht een aantal projecten uitgevoerd gericht op verhogen van de intensiteit van het oefenen en op het stimuleren om blijvend actiever te zijn. Dit startte met het ontwikkelen van de Oefengids waarvoor in 2011 de ZonMw Parel werd verkregen. Om het zelf oefenen verder te stimuleren en grip op eigen herstel te vergroten zijn de ‘Oefen app beroerte’ en gebruik van ‘de Activiteiten monitor’ toegevoegd. Dit zijn relatief simpele, goedkope hulpmiddelen, die vaak een andere groep patiënten aanspreken. Want elke patiënt is anders, dus je toolkit om mensen in beweging te krijgen moet verschillende gereedschappen bevatten. Hiermee kunnen we zorg pas echt verbeteren en op maat aan bieden. Implementatie en door ontwikkeling van deze hulpmiddelen vraagt blijvende aandacht. In de wereld om ons heen groeien pareltjes, het is aan revalidatieprofessionals om ze te zien en ze te gebruiken.
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Keynote Speaker Dr. Imelda de Groot Progressie in de kinderrevalidatie van neuromusculaire aandoeningen Imelda is kinderrevalidatiearts in het RadboudUMC. Momenteel is zij voorzitter van de werkgroep Neuromusculaire aandoeningen van de VRA, in samenwerking met de patiëntenorganisatie Spierziekten Nederland. Zij is senior researcher en projectleider van meerdere promotie-onderzoeken, student-onderzoeken en aiosonderzoek en neemt deel aan internationale onderzoeken en medicatie trials als Nederlands centrum. Zij is opleider revalidatiegeneeskunde en docent bij geneeskunde en paramedische opleidingen. Zij is cursusleider van PAOG en NPi cursussen Neuromusculaire aandoeningen
Een vorm van gecoördineerde kinderrevalidatie bestaat in Nederland reeds vanaf 1900 met de oprichting van de Johanna Stichting en een huis voor gebrekkige en mismaakte kinderen. Gebeurtenissen in de tijd, zoals polio-epidemieen, slachtoffers van wereldoorlogen (met bijvoorbeeld amputaties) en geneesmiddelen bijwerkingen (zoals softenon), bepaalden vaak welke diagnose groepen zorg kregen via de kinderrevalidatie. Pas in de jaren zeventig van de vorige eeuw kwam er aandacht voor progressieve aandoeningen als neuromusculaire aandoeningen op kinderleeftijd. Aanvankelijk is dit vooral symptomatisch gericht geweest, later ook meer anticiperend om secundaire problemen te beperken of te voorkomen. In de 21e eeuw komt er geleidelijk meer wetenschappelijke interesse in de mechanismen achter de symptomatologie, zoals bijvoorbeeld in het kauw/slikonderzoek en bewegingsonderzoek vanuit de kinderrevalidatie van het Radboudumc. Gerichte therapieën worden hierop gebaseerd. De toenemende levensverwachting maakt ook dat ondersteunende technische hulpmiddelen een steeds belangrijker rol gaan spelen, die specifiek ontwikkeld moeten worden op de problematiek van een neuromusculaire aandoening. Onderzoek naar zeldzame aandoeningen als neuromusculaire aandoeningen op kinderleeftijd kan niet gedaan worden door één centrum, maar vraagt om samenwerkingsverband tussen meerdere (inter)nationale centra. Gezamenlijke data-verzameling voor natuurlijk beloop (die veranderend is door betere zorg afgelopen decennia) en ontwikkeling van nieuwe onderzoeksmethoden krijgt snel en goed vorm bij intensieve samenwerking. De weerslag hiervan op de kwaliteit van patiëntenzorg is hierbij ook evident: expertise in de patiëntenzorg is in uitwisseling met wetenschap. Dit is zoals het Spierziektenteam in Radboudumc werkt, waarbij ook de link naar de volwassen zorg onderdeel is.
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Paneldiscussie VERLEDEN, HEDEN, nee … VOORAL TOEKOMST: Wat is de rol van de revalidatiearts over 60 jaar? Discussieleider: Frenk van der Linden
Panelleden
• • • •
Dr. Sander Dijkstra, orthopedisch chirurg Prof. dr. Henriëtte van der Horst, huisarts Prof. dr. Hans Rietman, revalidatiearts Dr. Jeroen Vermeulen, kinderneuroloog
Het specialisme revalidatiegeneeskunde heeft zich de afgelopen 60 jaar sterk ontwikkeld. Deze ontwikkeling ging regelmatig gepaard met stevige maar constructieve discussies over de grenzen van het vak. Door allerlei veranderingen die we op dit moment al dan niet kunnen voorzien, zal dat de komende 60 jaar niet anders zijn.
Technologische en maatschappelijke veranderingen staan ons ook in de toekomst te wachten. Te denken valt aan meer behandelmogelijkheden op het niveau van functie(stoornissen), zoals bv. neuromodulatie, nieuwe medicatie en stamceltherapie, waardoor de functionele prognose verandert. Meer geavanceerde hulpmiddelen, waaronder osseo-integratie, robotica en domotica, zullen moeten leiden tot het beter kunnen uitvoeren van activiteiten en daarmee de participatie verbeteren. Belangrijke maatschappelijke veranderingen die zich al aankondigen zijn het veranderende zorglandschap en de toenemende eigen regie van patiënten. Deze ontwikkelingen bieden kansen voor de verdere ontwikkeling van ons vak en verbetering van onze behandeluitkomsten. Het voeren van een dialoog binnen ons eigen vak en met andere vakgebieden helpt om de belangrijke veranderingen in de revalidatiegeneeskundige zorg te identificeren, en om hierop in te spelen.
Voor deze paneldiscussie zijn collegae van verschillende specialismen uitgenodigd: huisartsengeneeskunde, kinderneurologie, orthopedische chirurgie en vanzelfsprekend revalidatiegeneeskunde. De sprekers zullen toekomstige ontwikkelingen in hun eigen vakgebied en hun visie op de rol van de revalidatiearts bespreken. Daarna volgt een levendige discussie onder leiding van de ervaren discussieleider Frenk van der Linden.
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LIVIT ORTHOPEDIE PRESENTEERT U:
Vrijheid in bewegen op eigentijdse maatschoenen Livit streeft ernaar dat iedereen klachtenvrij kan lopen. Daarom introduceren wij met trots een eigen lijn maatschoenen: Ambulo®. Ambulo® is een nieuw concept maatschoenen geproduceerd op een verzameling unieke indicatieleesten waarin veel voorkomende voetklachten volledig verwerkt zijn. Ambulo® kenmerkt zich door: • een uitstekende pasvorm die optimale ondersteuning biedt • modieuze modellen die makkelijk aan- en uit te trekken zijn • binnen vier weken en met slechts één passessie aan te meten • ingebouwde sensor die het gebruik kan registreren
Maak kennis met Ambulo® tijdens de VRA Wij vertellen u graag meer over onze unieke maatschoenen en laten u onze actuele collectie zien. Wilt u zelf ervaren hoe het is om op maat gemaakte schoenen te lopen? Onze standbezoekers maken kans op een paar unieke maatschoenen die wij speciaal voor u naar uw wensen of ontwerp aanmeten en maken. Powered by
livit.nl
Wij zien u graag op de Livit stand, nr. 10.
Cabaret Lachen was nog nooit zo gezond
Michiel Peereboom heeft zich na zijn artsenopleiding gespecialiseerd tot cabaretier en presentator. Hij zal deze feestdag op een geestige manier afsluiten.
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Overzicht posterpresentaties
1.
Quality of life and burden of caregivers of SCI-patients during active rehabilitation – Annemiek Backx
2.
Measurement properties and usability of four CAD/CAM systems for measuring trans-tibial stump volume, using models – Maritza Beekman
3. 4. 5. 6.
Impact of Intensive Care Unit - acquired weakness on functional outcome in survivors after critical illness – Daniela Dettling-Ihnenfeldt
Pain Catastrophizing in patients with Painful Diabetic Peripheral Polyneuropathy: associations with Physical Activity, Disability and Quality of Life – Charlotte Geelen
Practice variation in stroke rehabilitation: Exploring differences in structure, process, outcomes and patient population characteristics – Iris Groeneveld Orthotics for thumb carpometacarpal osteoarthritis: which orthosis reduces pain the most? – Rinske Grond
7.
Outcome of secondary shoulder surgery in children with Neonatal Brachial Plexus Palsy with and without nerve surgery treatment history; a retrospective long-term follow-up study – Menno van der Holst
8.
Outcomes of pulmonary rehabilitation after treatment for Non-small Cell Lung Cancer (NSCLC) stage I-IIIa: an observational study – Steffi Janssen
9. 10.
The effect of rocker profile shoes on pain and range of motion (ROM) in patients with posttraumatic ankle arthritis (PTAA) – Irene Jetten
Association between cardiovascular diseases and mobility in persons with a lower limb amputation: a systematic review – Sara Kaptein
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11. 12. 13.
Gait parameters used in botulinum toxin A effect studies on patients with cerebral palsy; a systematic review – Annelies Mantje Muscle endurance of adolescents with cerebral palsy in relation to subjectively reported fatigue and mobility – Francisca Meuzelaar-Kiezebrink
Reliability and agreement of Neck-FCE in patients with chronic nonspecific neck pain – Monique Roelofs
14.
Physiotherapy in the Intensive Care Unit: an evidence-based, expert driven, practical statement – Marike van der Schaaf
15.
Changes in arm-hand function and skill performance in highly functional stroke patients three months after discharge from rehabilitation – Mieke Smolders
16. 17. 18.
19.
20.
Association of pain with posttraumatic stress disorder (PTSD) and other psychological factors in patients with spinal cord injury (SCI) – Lucinda van de Ven
Effects Of Robot-aided Gait Training On Stable Spinal Cord Injury Patients' Individual Goals And Psychological Well-being; A Pilot Study – Ester Vrij Postoperative weight-bearing in tibia plateau fracture healing – Marc van der Vusse
Employment in persons with spinal cord injury in the Netherlands in 2012: participation, satisfaction, work stress and quality of life – Annemiek van Wisselingh
The effect of handcycle interval training on physical capacity in persons with recent spinal cord injury – Ilse van der Brand
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Quality of life and burden of caregivers of SCI-patients during active rehabilitation A.P.M. Backx MD1, H.M.H. Bongers-Janssen MD1, H. Bouwsema PhD2 1
Adelante Rehabilitation Centre, Hoensbroek,The Netherlands Adelante Centre of Expertise and Rehabilitation, Hoensbroek,The Netherlands
2
Introduction: Caregivers of chronic ill patients, like spinal cord injured (SCI) patients, often experience high levels of burden. However, little is known about caregiver burden and quality of life of caregivers of SCI-patients during active rehabilitation. Objective: What is the burden and quality of life of caregivers of SCI-patient during active rehabilitation? Participants: Caregivers of 18 years and older, taking care of patients with a newly acquired SCI. Method: Quality of life and burden were measured during active rehabilitation by the SF-36 and the Caregiver Strain Index (CSI). Results: Of the 37 caregivers a total of 21 experienced a high level of burden on the CSI. The caregivers scored their quality of life the highest on physical functioning (Mean = 84.9, SD 18.9) and bodily pain (81.6, SD 24.1). Low scores were given to social role functioning (53.0, SD 28.5), emotional role functioning (50, SD 46.1), mental health (58, SD 23.5) and vitality (49.0, SD 20.1).
Abstracts
Conclusions: 57% of the caregivers experience a high level of burden. Caregivers report their quality of life the lowest on social role functioning, emotional role functioning, mental health and vitality.
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Clinical message: Every clinician working with SCI-patients and their caregivers should know about the high level of burden and the low quality of life of the caregivers (on social, emotional, mental and vitality aspects).There should be more alertness and support for the caregivers during the active phase of rehabilitation.
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A.P.M. Backx
[email protected]
Measurement properties and usability of four CAD/CAM systems for measuring trans-tibial stump volume, using models A.M. Beekman MD1,2,, C.H. Emmelot MD PhD2, prof. J.H.B. Geertzen MD PhD3, prof. P.U. Dijkstra PhD3 1 2 3
Center for Rehabilitation Vogellanden, Zwolle,The Netherlands
Department of Rehabilitation Medicine, Isala, Zwolle,The Netherlands
Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen,The Netherlands
Introduction: Non-contact scanners may have good potential for the measurement of stump volume and might easily be implemented in clinical practice. Last decades different non-contact scanners have been introduced. Before determining the clinical relevance of these systems, reliability and usability of each system should be assessed. Objectives: To analyze the measurement properties and usability of four different non-contact scanners (TT Design, Omega Scanner, BioSculptor Bioscanner and Rodin4D Scanner), using models. Methods: Nine models were measured on two occasions, each consisting of two sessions. In each session, four observers used the four systems for volume measurement. Grand mean for each model, variance components and their two-way interactions of the measurement conditions and repeatability coefficients for each system were calculated. User satisfaction was evaluated with the Post-Study System Usability Questionnaire (PSSUQ).
Abstracts
Results: Systematic differences between the systems were found in volume measurements. Most of the variance was explained by the model (97%), while error variance was 3%. Measurement system and the interaction between system and model explained 44% of the error variance. Repeatability coefficient of the systems ranged from 0.101 L (Omega Scanner) to 0.131 L (Rodin4D). The differences in usability between the systems were small. Discussion and conclusion: The systems were reliable in determining stump volume. The differences in repeatability coefficient and usability were small between the four CAD/CAM systems. Clinical message: These results should be verified in vivo.
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A.M. Beekman
[email protected]
Impact of Intensive Care Unit - acquired weakness on functional outcome in survivors after critical illness D.S. Dettling-Ihnenfeldt MSc*1, L. Wieske MD PhD*2,3, C. Verhamme MD PhD3, prof. F. Nollet MD PhD1, prof. I.N. van Schaik MD PhD3, prof. M.J. Schultz MD PhD2, J. Horn MD PhD*2, M. van der Schaaf PhD*1 * equally contributing authors Rehabilitation, Academic Medical Center, University of Amsterdam,The Netherlands Intensive Care Medicine, Academic Medical Center, University of Amsterdam,The Netherlands 3 Neurology, Academic Medical Center, University of Amsterdam,The Netherlands 1 2
Introduction: Intensive Care Unit-acquired weakness (ICU-AW) is a frequent complication of critical illness and is thought to mediate physical impairments in ICU-survivors. Objective: To investigate differences in physical functioning and post-ICU mortality between patients with and without ICU-AW at 6 months after ICU discharge. Patients: 133 ICU survivors who were mechanically ventilated for
2 days (60 with ICU-AW).
Abstracts
Methods: Single centre prospective observational study. Physical functioning was assessed at 6 months post-ICU discharge using the physical functioning (PF) domain score of the Short-Form Health Survey (SF-36), and post-ICU mortality was registered during the follow-up period. Multivariable linear regression and Cox proportional Hazards model were used to analyse the independent effect of ICU-AW on physical functioning and post-ICU mortality.
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Results: Six months after ICU discharge physical functioning (PF) domain scores were available for 98 survivors (39 patients with ICU-AW). ICU-AW was associated with a decrease of 16.7 points on the PF domain score (95% CI: -30.1 to -3.3; p=0.02). Post-ICU mortality was significantly higher in patients with ICU-AW compared to patients without ICU-AW (17 vs. 8; HR 3.5 (95% CI: 1.3 to 9.4); p=0.01). Discussion and Conclusions: ICU-AW is independently associated with clinically relevant lower physical functioning and with higher post-ICU mortality in critically ill patients, 6 months after ICU discharge. Future studies should investigate whether early rehabilitation interventions on the ICU can prevent ICU-AW and improve physical functioning in ICU survivors. Clinical message: ICU-survivors with ICU-AW are at higher risk for impaired physical recovery.
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D.S. Dettling-Ihnenfeldt
[email protected]
Pain Catastrophizing in patients with Painful Diabetic Peripheral Polyneuropathy: associations with Physical Activity, Disability and Quality of Life C.C.M. Geelen MD1, H.P.J. Kindermans PhD2, prof. J.P.W. van den Bergh MD PhD3,4, prof. J.A. Verbunt MD PhD1,2 1 2 3 4
Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek,The Netherlands
Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht,The Netherlands Department of Internal Medicine,VieCuri Medical Centre,Venlo,The Netherlands
Department of Internal Medicine, Research School NUTRIM, Maastricht University, Maastricht,The Netherlands
Objective: To investigate the impact of pain catastrophizing on a patient’s level of disability and quality of life in patients with painful diabetic peripheral polyneuropathy (DPNP).Also, to study the mediating role of physical activity and/or a decline in physical activity. Patients and Methods: This questionnaire-based cross-sectional study included 154 patients with painful DPNP. Linear regression analyses adjusted for age, gender, duration of neuropathy, pain intensity and insulin treatment were performed to assess the association of pain catastrophizing (PCS) with the outcome variables disability (PDI) and quality of life (QOL).The mediating role of actual physical activity (PARS) and perceived physical activity decline (PAD) was analysed using mediation analyses (Baron & Kenny).
Abstracts
Results: This study included 154 patients (96 male, 62%). Mean age was 65.7 years (SD=6.6). PCS (M=20.3, SD=13.1) was significantly associated with PDI (M=32.4, SD=17.0; R2=0.356, p<0.001), QOL (M=52.6, SD=26.1; R2=0.437, p<0.001) and PAD (M=7.4, SD=5.7; R2=0.087, p=0.045). PAD acted as a partial mediator in the associations of PCS with PDI and QOL respectively. There was no association of PCS with PARS. Conclusion: Pain catastrophizing was associated with increased disability and decreased quality of life in patients with painful DPNP. Also, it was associated with a perceived decline in physical activity, which had a mediating role in the association between catastrophizing and disability and between catastrophizing and quality of life. The present study underscores the role of catastrophic thinking about pain and the experienced loss in daily activities due to pain, in order to fully understand the burden of painful DPNP.
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C.C.M. Geelen
[email protected]
Practice variation in stroke rehabilitation: Exploring differences in structure, process, outcomes and patient population characteristics I.F. Groeneveld PhD1,2, H.J. Arwert MD2,3, J.J.L. Meesters PhD2,4, prof.T.P.M. Vliet Vlieland MD1,2,4, P.H. Goossens PhD MD1,2,4 Rijnlands Revalidatie Centrum, Leiden,The Netherlands Sophia Revalidatie,The Hague,The Netherlands 3 Medisch Centrum Haaglanden ,The Hague,The Netherlands 4 Leids Universitair Medisch Centrum, Leiden,The Netherlands 1
2
Introduction: Despite guidelines there seems to be practice variation between Dutch rehabilitation centres in stroke rehabilitation. Exploring practice variation will provide insight into differences in quality and quantity of care. Objective: To investigate the practice variation in structure, process, and outcomes of stroke rehabilitation and to analyse differences in patient population characteristics.
Abstracts
Patients and methods: Differences in structure (e.g. facilities, assessments) are evaluated in four centres by comparing their treatment protocols. Differences in process (e.g. length of stay) and outcomes (e.g. self-reported functioning) will be determined in a longitudinal study among approximately 300 consecutive stroke patients in two different rehabilitation centres, using regression analyses. Baseline characteristics are analysed using parametric and nonparametric tests.
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Results: A preliminary analysis shows practice variation in structure, i.e. in frequency and timing of team meetings, timing of assessments, and differentiation in patient subgroups and corresponding treatment schedules. Differences in process and outcomes are currently under investigation. By February 2015, no significant baseline differences between the two centers (N=100) were observed in age (mean 62.2 vs. 61.6 years), proportion higher educated (43% vs. 39%), comorbidities (median 2 vs 2), pre-stroke fulfilment of Dutch physical activity norms (54% vs. 60%), and smoking (23% vs. 31%). Discussion and conclusions: A preliminary analysis demonstrated practice variation in the structure of rehabilitation. The definite analysis of structure, process and outcomes may provide input for the optimization of stroke rehabilitation. Clinical message: Exploration of practice variation is the first step to reduce unwanted differences in quality and quantity of stroke rehabilitation.
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I.F. Groeneveld
[email protected]
Orthotics for thumb carpometacarpal osteoarthritis: which orthosis reduces pain the most? R. Grond MSc1,A.E. van der Vegt MSc2, J.S. Grüschke MSc2,3, prof. P.U. Dijkstra PhD2, C.H. Emmelot PhD1, M.F. Boomsma PhD1, prof. C.K. van der Sluis MD PhD2 1 2 3
Department of Rehabilitation Medicine, Isala, Zwolle,The Netherlands
Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen,The Netherlands Department of Rehabilitation Medicine, Medical Center Leeuwarden, Leeuwarden,The Netherlands
Introduction: Thumb carpometacarpal osteoarthritis (CMC-1) occurs in up to 21% of the population above the age of 40, resulting in pain and loss of function. A new off-the-shelf orthosis (push orthosis) has been developed to reduce pain, but it is unknown if pain reduction is larger than by using a custom made orthosis. Objective: To analyse whether using an orthosis results in pain reduction in patients with CMC-1 osteoarthritis and to analyse differences in pain reduction after using a custom made orthosis or an off-the-shelf orthosis. Patients: Patients with primary osteoarthritis of the CMC 1-joint, without any disease-related upper limb surgery. Methods: A cross-over randomised controlled trial was performed in which patients used both orthoses for two weeks in random order, with a two week washout period. Patients were asked to fill out questionnaires and to keep a diary during the trial in which pain was measured on a 10 cm visual analogue scale.
Abstracts
Results: Interim analysis of 34 participants indicated that mean (sd) pain reduced after wearing the push orthosis with 0.38 (1.48) (p=0.141) and after wearing the custom made orthosis with 0.37 (1.49) (p=0.148). The mean difference in change in pain between the orthoses was 0.01 (1.87) (p= 0.977). Discussion: Contrary to previous studies, using an orthosis did not appear to cause clinically relevant or significant pain reduction. No significant differences in pain reduction were observed between the two orthoses. Clinical message: Treatment of CMC-1 osteoarthritis with either orthosis provides pain relief only to a limited extent.
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R. Grond
[email protected]
Outcome of secondary shoulder surgery in children with Neonatal Brachial Plexus Palsy with and without nerve surgery treatment history; a retrospective long-term follow-up study M. van der Holst PT1,2, C.W.P.G. van der Wal1, R. Wolterbeek MSc3, W. Pondaag MD PhD4, prof.T.P.M. Vliet Vlieland MD PhD1,2, prof. R.G.H.H. Nelissen MD PhD1 1 2 3 4
Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands Rijnlands Rehabilitation Center, Leiden, the Netherlands
Department of Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
Introduction: Shoulder dysfunction may occur in children with Neonatal Brachial Plexus Palsy (NBPP) irrespective of treatment history. Following internal contracture release and/or muscle tendon transfer (ICR/MTT) shoulderfunction gain is possible.
Objective/Patients: This study describes long-term outcomes of ICR/MTT in children with NBPP, with/without nerve surgery treatment history (nerve surgery/conservative group).
Abstracts
Methods: Active and passive Range of Motion (aROM/pROM) and Mallet-scores were extracted from the medical records (pre-operatively, 6 months, 1, 3, 5, 10 years after surgery). Analyses included comparisons of pre-operative characteristics and changes over time within groups by using a mixed-linear-model.
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Results: 115 children (60 boys) were included, 83 with nerve surgery history, mean age 3.4 years (SD 3.0), mean follow-up 5.9 years (SD 3.2). Pre-operatively active external rotation, abduction and forward flexion were significantly better in the conservative group (p<0.05). AROM, pROM as well as Mallet-scores improved significantly at all time points in both groups.The course/magnitude of improvements of aROM, pROM and Mallet-scores were largely similar in both groups. On the long term, effects decreased but remained significantly different from baseline. Discussion/Conclusion: This study showed that in children with NBPP shoulder function improved after ICR/MTT. However, this study also showed that pre-operative and postoperative shoulder function was better in the conservative group compared to the nerve surgery group indicating that these concern different subgroups.
Clinical message: When evaluating outcomes of secondary surgery in children with NBPP adjustment for nerve surgery treatment history to prevent an over- or underestimation of results is necessary.
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M. van der Holst
[email protected]
Outcomes of pulmonary rehabilitation after treatment for Non-small Cell Lung Cancer (NSCLC) stage I-IIIa: an observational study S.M.J. Janssen MSc1, J.J. Abbink MD PhD1, R. Lindeboom PhD2, prof.T.P.M. Vliet Vlieland MD PhD1,3 Rijnlands Rehabilitation Center, Leiden, the Netherlands University of Amsterdam, Amsterdam, the Netherlands 3 Dept. of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands 1
2
Introduction: Although rehabilitation after treatment for non-small cell lung cancer (NSCLC) was found to have a beneficial effect on exercise capacity in a number of studies, knowledge of its effect on quality of life and fatigue is scarce. Objective: To analyze the changes over time in fatigue, quality of life and exercise capacity after multidisciplinary pulmonary rehabilitation.
Abstracts
Patients: Adult patients curatively treated for NSCLC stage I-IIIa. Methods: Analysis of data which were prospectively and routinely gathered in daily practice. in patients after treatment for NSCLC stage I-IIIa taking part in an outpatient pulmonary rehabilitation program, which consisted of 12 weeks of supervised exercise three times a week, supplemented with scheduled visits to members of a multidisciplinary team. Data were gathered at initial assessment and discharge. Outcome measures were fatigue, measured with the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) and the domain fatigue of the Chronic Respiratory Disease Questionnaire (CRDQ); quality of life measured with the total score the CRDQ, Functional Assessment of Cancer Therapy-Lung (FACT-L) and the Short Form 36 (SF-36); and exercise capacity measured with a cycle ergometer test (CET) and the incremental- and endurance shuttle walk test (ISWT and ESWT). Results: eventy patients were included, of whom 43 completed the program. Significant (p0.01) and clinically relevant improvements were seen for all outcome measures. Discussion and conclusion: Rehabilitation shows promising improvements on the patients’ complaints of fatigue, quality of life, and the patients exercise capacity.
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Clinical message: Pulmonary rehabilitation should be considered for patients after treatment for NSCLC I-IIIa.
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S.M.J. Janssen
[email protected]
The effect of rocker profile shoes on pain and range of motion (ROM) in patients with posttraumatic ankle arthritis (PTAA) I.V. Jetten MD MSc1, J. M. Hijmans PhD1, A.H. Hansen PhD2, L. van Kouwenhove MSc1, Prof. K. Postema MD PhD1 1 2
University Medical Center Groningen,The Netherlands University of Minnesota, Minneapolis, USA
Introduction: PTAA is a complication of ankle fractures. Shoes with proximal rocker profiles are commonly prescribed for patients with PTAA. It is assumed that proximal rocker profiles reduce the motion in and the loading of the ankle joint. However, to the authors’ knowledge, this has never been supported by scientific evidence. Objective: To assess whether proximal rocker profiles significantly reduce pain, ROM and moments in the ankle in patients with PTAA. Patients: 14 patients with painful PTAA. Methods: Standard shoes are compared to the same shoes with proximal rocker profiles. Size and shape of the rocker profile were as regularly used.Total duration was 6 weeks: 2 weeks walking on rocker profile shoes, 2 weeks on standard shoes with a 2-week wash-out period in between. Order of intervention was randomized. After completion, patients were allowed to keep one pair of shoes of their choice.Visual analogue scale scoring was used for pain recording. ROM and moments at the ankle joint in sagittal plane during stance phase was measured.
Abstracts
Results: No effect on pain and a non-significant reduction in ROM and ankle moments was found.
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Discussion, conclusion and clinical message: After completion, thirteen patients chose to keep the rocker shoes as they judged them to walk more comfortably. The rocker profile was less pronounced that we thought it should be. The profile was as often used in daily practice. The lack of effect might be contributed to insufficient rocker profile. Probably we should use in daily practice a more pronounced profile.
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I.V. Jetten
[email protected]
Association between cardiovascular diseases and mobility in persons with a lower limb amputation: a systematic review S. Kaptein MD1, prof. J.H.B. Geertzen MD PhD1, prof. P.U. Dijkstra PT PhD1,2 1 2
Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen,The Netherlands Department of Oral and Maxillofacial Surgery, University Medical Center Groningen,The Netherlands Objective: Persons requiring a lower limb amputation (LLA) are often elderly people with a high prevalence of co-morbidities including cardiovascular diseases (CVD). CVD reduces cardiac function which may complicate recovery and rehabilitation after LLA. Insight in effects of CVD on rehabilitation in persons with a LLA may enhance individualized rehabilitation programs.This systematic review analyses the association between CVD and mobility in persons with a LLA. Search strategy: Pubmed, Embase, Cochrane and EBSCO (including Cinahl and PsycINFO) were systematically searched for studies published before January 2015 using database-specific keywords and synonyms for amputation, cardiovascular diseases and mobility.
Abstracts
Selection of articles: The assessment of the publications was performed by 2 independent observers based on predefined criteria in 2 stages; first title and abstract of 1353 publications, second full text assessment of 51 studies. Ten studies were included. Evaluation of articles and results: The cardiac outcomes and mobility outcomes were different and difficult to compare meaningfully. CVD was associated with more cardiac complications during rehabilitation. Prosthetic training improved cardiac function. Seven studies showed that CVD was associated with a smaller chance of becoming a prosthetic walker and with poorer functional and mobility outcomes (Volpicelli, Walking ability Index, Locomotor Capability Index-5). Conclusion: Currently data about effects of CVD on mobility in persons with LLA is limited. More research about CVD in persons requiring a LLA is needed, to enable informed choices in the pre- and post- amputation rehabilitation. Current knowledge about CVD in prosthetic rehabilitation enables individualized rehabilitation programs to a limited extent.
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S. Kaptein
[email protected]
Gait parameters used in botulinum toxin A effect studies on patients with cerebral palsy; a systematic review A. Mantje MD1, S. Severijnen MD2, prof.T.P.M. Vliet Vlieland MD1,2,3, J.W. Schoones MA4, R.D. Rambaran Mishre MD1, J.H. de Groot PhD3,5 1 2 3 4 5
Sophia Rehabilitation,The Hague,The Netherlands
Rijnlands Rehabilitation Center, Leiden,The Netherlands
Department of Orthopaedics and Rehabilitation Medicine and Physical Therapy, Leiden University Medical Center, Leiden,The Netherlands Walaeus Library, Leiden University Medical Center, Leiden,The Netherlands
Laboratory for Kinematics and Neuromechanics, Leiden University Medical Center, Leiden,The Netherlands
Objective: The aim of this systematic review was to identify gait parameters that are used to quantify the effect of botulinum toxin A (BTX-A) treatment in patients with cerebral palsy (CP). Search strategy: A systematic search was carried out in seven databases between January 2003 and January 2013.
Abstracts
Selection of articles: Titles, abstracts and potentially eligible full-text articles were screened by two researchers independently for clinical studies on CP evaluating the effect of BTX-A treatment using quantitative gait analysis as an outcome measure. Data extraction included: study characteristics, aim of BTX-A treatment concerning gait and gait parameters, categorized into: kinematics, kinetics, EMG, energy-cost and miscellaneous.
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Evaluation of articles and results: 32 full-text papers were selected, concerning 19 observational studies and 13 randomized controlled studies. The number of patients varied from 2 to 110 and 28 papers only included children. In total 111 unique gait parameters were identified. Most frequently used parameters (number of papers) were: velocity (n=15), cadence (n=11), ankle angle at initial contact (n=10), stride length (n=9), step length (n=8), ankle maximal dorsal flexion at stance (n=8). Aims of BTX-A treatment were poorly described and could not be linked to the use of specific gait parameters. Conclusion: Many different gait analysis parameters are used to evaluate the effectiveness of BTX-A in CP, which could not be related to specific relevant treatment goals. The most frequently used parameters concerned the category kinematics.The large variety of outcome parameters warrants the need for standardization both in research and clinical practice.
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A. Mantje
[email protected]
Muscle endurance of adolescents with cerebral palsy in relation to subjectively reported fatigue and mobility F.E.M. Meuzelaar-Kiezebrink MD1, M.M. Eken MSc1,2, H. Dekkers MD1, H. Houdijk PhD1,3, A.J. Dallmeijer PhD2 Heliomare Rehabilitation, Research and Development,Wijk-aan-Zee,The Netherlands Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam,VU University Medical Center, Amsterdam,The Netherlands 3 Faculty of Human Movement Sciences, MOVE Research Institute Amsterdam,VU University, Amsterdam,The Netherlands 1
2
Introduction: Recent research using a submaximal repetition to fatigue protocol showed that adolescents with cerebral palsy (CP) have lower muscle endurance than typically developing (TD) peers. Whether reduced muscle endurance relates to subjectively reported fatigue and mobility in CP is unclear. Objective: To determine whether muscle endurance of adolescents with CP is related to subjectively reported fatigue and mobility and how this differs between unilateral or bilateral involvement of CP. Patients: Seventeen adolescents with unilateral (n=7) or bilateral (n=10) CP (age: 12-19y; GMFCS I/II) and eighteen TD peers (age: 12-19y).
Abstracts
Methods: Muscle endurance was quantified as the maximal resistance that could be overcome during 15 subsequent knee extensions on an isotonic dynamometer (i.e. 15 RM in Nm/kg). Fatigue was measured using the PedsQl questionnaire. Mobility was described by walking capacity (6-minutes walk test). Lineair regression was used to describe the relationship between muscle endurance and fatigue and mobility, separately for unilateral and bilateral involvement. Results: Muscle endurance was significantly related to subjectively reported fatigue in adolescents with bilateral CP (R2=0,53; p=0,02) but not for unilateral CP (R2=0,10; p=0,49). Also a significant relation for muscle endurance with walking capacity for bilateral CP (R2=0,48; p=0,03) was found but not for unilateral CP (R2=0,02; p=0,77). Discussion and conclusions: These results suggest that subjectively reported fatigue and reduced mobility in adolescents with bilateral CP might partly be due to lower muscle endurance.
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Clinical message: Training of muscle endurance in adolescents with bilateral CP might lead to less experienced fatigue and improvement of walking capacity.
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F.E.M. Meuzelaar-Kiezenbrink
[email protected]
Reliability and agreement of Neck FCE in patients with chronic nonspecific neck pain M. Roelofs MD1, H.R. Schiphorst Preuper MD PhD1, prof. M.F. Reneman MD PhD1 1
Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen,The Netherlands
Introduction/Objective: The aim of this study was to analyze test-retest reliability and to explore safety of Neck Functional Capacity Evaluation tests (Neck FCE) in patients with chronic non-specific neck pain. Patients: The study sample consisted of 18 participants, 14 females with mean age of 34 years. Methods: The Neck FCE protocol consists of 6 tests: lifting waist to overhead, two-handed carrying, overhead working, bending and overhead reaching, and repetitive side reaching (left and right). Two FCE sessions were held with a 2 week interval. Means, 95% confidence intervals (CI), Intraclass Correlation Coefficients (ICCs) and limits of agreement (LoA) were calculated. ICC point estimates between 0.75 and 0.90 was considered as good and >0.90 was considered as excellent reliability. Results: ICC point estimates ranged between 0.39 and 0.96. Ratios of the LoA ranged between 32.0% and 56.5%. Mean NRS pain scores in neck and shoulder 24-hours after the test were respectively 6.7 (SD2.6) and 6.3 (SD 3.0). Conclusion: Based on ICC point estimates and 95% CI, it was concluded that that 3 tests had excellent reliability and 3 had poor reliability. LoA were substantial in all 6 tests. Safety was confirmed.
Abstracts
Clinical message: After removal of repetitive side reaching test, the Neck FCE is suitable for use in research in patient groups with neck pain. Substantial natural variance should be considered when used in individual patient care.
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M. Roelofs
[email protected]
Physiotherapy in the Intensive Care Unit: an evidence-based, expert driven, practical statement J. Sommers MSc PT1, prof. R.H.H. Engelbert PhD PT1,2, D.S. Dettling-Ihnenfeldt MSc1, prof. R. Gosselink PhD PT3, P.E. Spronk MD PhD1,4, prof. F. Nollet MD PhD1, M. van der Schaaf PhD PT1,2 Academic Medical Center,The Netherlands Amsterdam School of Health Professions, University of Applied Sciences, Amsterdam,The Netherlands 3 KU Leuven, Leuven, Belgium 4 Gelre Hospitals, Apeldoorn,The Netherlands 1
2
Introduction: Evidence-based, expert driven statements improve quality and effectiveness of the diagnostic and therapeutic process of patient care. Although the effectiveness of physiotherapy treatment in intensive care unit (ICU) patients has been described in the literature, statements or guidelines of physiotherapy regarding ICU patients are not available. Objective: To develop evidence-based recommendations for effective and safe diagnostic assessment and intervention strategies for the physiotherapy treatment of patients in the ICU. Methods: We used the EBRO method to develop an ‘evidence statement for physiotherapy in the ICU’.1 This method consists of the identification of clinically relevant questions, followed by a systematic literature search, and summary of the evidence with final recommendations being moderated by feedback from experts.
Abstracts
Results: Three expert based clinical questions were formulated. In a systematic literature search, 129 studies were identified and assessed for methodological quality. The final Evidence Statement consisted of recommendations for physiotherapy for patients in the ICU.2 Discussion and conclusion: These recommendations form a protocol for treating people in an ICU, based on best available evidence in mid-2014. Further research is recommended to determine the ideal dose and timing of exercise and the effect of exercise in specific conditions. Clinical messages: This evidence statement led to: • A set of criteria determining when it is safe to mobilize patients. • A set of clinical parameters and standard assessments for use in the ICU. • Recommendations on passive and active treatments.
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References Burgers J. Ned Tijdschr Geneeskd. 2004;148(42):2057-9. 2 Sommers J, Engelbert RHH, Dettling-Ihnenfeldt D, Gosselink R, Spronk PE, Nollet F, Schaaf M van der Physiotherapy in the intensive care unit: an evidence-based, expert driven, practical statement and rehabilitation recommendations. Clinical Rehabilitation 2015 DOI: 10.1177/0269215514567156 (in press). 1
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M. van der Schaaf
[email protected]
Changes in arm-hand function and skill performance in highly functional stroke patients three months after discharge from rehabilitation A.J.J. Smolders MD1, J.A. Franck MSc1,2, H.A.M. Seelen PhD2 1 2
Adelante Rehabilitation Centre, Hoensbroek,The Netherlands
Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek,The Netherlands
Introduction/objective: It is not clear to what extent highly functional stroke patients may further improve their level of competency regarding AHF and arm-hand skill performance (AHSP) once discharged from rehabilitation, as it highly depends on the extent patients continue to use their affected arm-hand at home. Aim has been to assess to what extent AHF and AHSP in highly functional stroke patients (UAT score 4-7) changes within three months post-discharge. Methods: This study included a sample of 30 patients (UAT score: 4-7), taken from a larger prospective cohort study at Adelante (AMUSE-study), involving 90 adult stroke patients who were monitored during rehabilitation and up to 12 months post-discharge. Measurement times reported: time of discharge (Tcd) and 3 months later (T3m). Outcome measures reported: Fugl-Meyer Upper Extremity test (FM-UE), Jamar hand grip test, Action-ResearchArm-Test (ARAT), Stroke Impact Scale (SIS). Results: Median scores and Inter_Quartile_Ranges at both measuring times, and delta scores (T3m-Tcd) are displayed in table 1.
Abstracts
Table 1
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FM-UE Jamar (kg) ARAT SIS_domain_5
Tcd 62 [55.50;65] 25 [18;36.5] 54 [41.75;56.25] 71 [66;76]
T3m 63 [57;65] 30 [22.5;40.5] 54 [48.75;56.25] 74 [67.5;80]
T3m - Tcd 0.0 [-1; 2.5] 4.0 [0;8.5] 0.5 [-1;2.25] 2 [-2;4.5]
p-value 0.17 0.005 0.210 0.04
Discussion/conclusion: Participants’ performance either improved (grip strength, SIS_domain_5) or remained constant (FM-UE, ARAT) over three months post-discharge. No deterioration in AHF or AHSP was observed. Clinical message: Stroke patients with an UAT score of 4-7 at rehabilitation discharge seems to retain their level of arm-hand proficiency during the first three months post-discharge.
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A.J.J. Smolders
[email protected]
Association of pain with posttraumatic stress disorder (PTSD) and other psychological factors in patients with spinal cord injury (SCI) L.N.M. van de Ven MD1,2,3, D.J. Kopsky MD3,6, J. Stolwijk-Swuste MD PhD4, C.A.J. Smit MD3, prof. J. Dekker PhD5, M. van der Leeden PhD3,5 Department of rehabilitation medicine, Isala, Zwolle,The Netherlands Rehabilitation Center de Vogellanden, Zwolle,The Netherlands 3 Rehabilitation Center Reade, Amsterdam,The Netherlands 4 Meander Medical Center, Amersfoort,The Netherlands 5 VU University Medical Center, Amsterdam,The Netherlands 6 Institute for Neuropathic Pain, Soest,The Netherlands 1
2
Introduction and objective: Prevalence of pain in SCI patients is high, varying from 65 - 85%. PTSD and other psychological factors can influence pain intensity and all have a considerable impact on quality of life. Therefore the aim of this study was to investigate the association between pain intensity, PTSD and other psychological factors in SCI patients. Patients and Methods: SCI patients who underwent treatment between 2005 - 2010 in Reade, a rehabilitation centre specialized with a SCI ward, were invited to participate. 186 patients filled in a questionnaire which assessed pain characteristics, PTSD, anxiety, depression, helplessness and hostility, using validated questionnaires. Univariate regression analyses were performed to determine associations.Associations were controlled for possible confounders. Results: Analyses were performed on 175 patients of which 114 (65%) were male, 51 (29%) had a complete lesion (ASIA A), 87 (50%) had a traumatic lesion, 151 (86%) suffered from pain, of which 138 (79%) suffered from chronic pain (>6 months). After adjustment for education as a confounding factor, pain intensity turned out to be associated with severity of PTSD symptoms (β=0.28; P=0.001), depression and anxiety (β=0.35; P=0.001), hostility (β=0.27; P<0.001) and helplessness (β=0.35; P<0.001). Conclusion and clinical message: In this study pain intensity is associated with psychological factors. Thus, detection of PTSD and negative psychological symptoms might rise to effective psychological and pharmacological treatments with concurrent reduction of pain.
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L.N.M. van der Ven
[email protected]
Effects Of Robot-aided Gait Training On Stable Spinal Cord Injury Patients' Individual Goals And Psychological Well-being; A Pilot Study E. Vrij MD MSc1, B.E. Groen PhD2, H. Rijken BSc1,2, I. van Nes MD PhD1 1 2
Department of Rehabilitation, Sint Maartenskliniek, Nijmegen,The Netherlands Sint Maartenskliniek Research, Nijmegen,The Netherlands
Introduction: Evidence on the effectiveness of robotic-assisted gait training (RAGT) after spinal cord injury (SCI) is limited. Up to now, research is mainly focused on the objective effect on walking ability.The aim of this pilot study is to compare objective effects with subjectively experienced effects of RAGT on patients’ individual goals and mental health state. Methods: Seven stable (> 1 year post injury) patients with SCI (Th9 –C3, AIS C and D) received two 30-minute sessions RAGT (Lokomat) during 8 weeks. Measurements were performed at baseline and after finishing RAGT. The RAGT was evaluated on 3 individual pre-set training goals (e.g. quality of walking, standing balance, pain reduction) using objective (e.g. 10 meter walking test) and subjective measurements (e.g.Likert scale). In addition the effects on mental health state (e.g. coping, depression and anxiety) were evaluated.
Abstracts
Results: Primary training goal was in all patients, except one who had no walking ability, improving functional walking ability. Five of seven patients showed objective improvements exceeding the minimal clinically important difference (MCID) on their primary goal (p=0,062) and six patients showed a clinical significant improvement on at least one of their pre-set goals (p=0,031). When measured subjectively, 5 of 6 patients experienced improvements on one of their pre-set goals (p=0,063). No significant correlation between subjective and objective effects was found. Changes in mental health state were limited and diffuse.
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Conclusions: The majority of patients showed objective and subjective improvements on individual pre-set training goals. Further research in a larger group is needed to evaluate the correlation between objective and subjective results and the effects on changes in mental health.
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E.Vrij
[email protected]
Postoperative weight-bearing in tibia plateau fracture healing M. van der Vusse MD1, C.H.G. Bastiaenen-Heuts PhD2, Y.Y. van Horn MD1, prof. P.R.G. Brink MD PhD3, H.A.M. Seelen PhD4,5 Adelante Rehabilitation Centre, Hoensbroek,The Netherlands Maastricht university, Research School CAPHRI, dept. of Epidemiology, Maastricht, the Netherlands 3 Maastricht University Medical Centre, dept of Trauma Surgery, Maastricht, the Netherlands 4 Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands 5 Maastricht university, Research School CAPHRI, dept. of Rehabilitation Medicine, Maastricht, the Netherlands 1
2
Introduction/objective: In postoperative rehabilitation after tibia plateau fractures (TPF) uncertainty exists about the safe dosage of weight-bearing. Research questions were: Q1) When should post-operative weight-bearing start post-TPF? Q2) Which definition of ‘100% weight-bearing’ is used most by surgeons? Q3) Which criteria do surgeons use to determine if postoperative weight-bearing may be intensified earlier (Q3A) or should be delayed (Q3B)?
Abstracts
Methods: A questionnaire was distributed among 1293 Dutch orthopaedic surgeons (OS) and trauma surgeons (TS). Also respondents’ level of proficiency (LoP) with operating on TPF (=number of operations/year* years of specialist experience) was quantified (low=1-10 LoP; intermediate=11-25 LoP; high=25+ LoP). Results: 111 (12%) questionnaires were returned (TS=50, OS=61). LoP distribution was: low_LoP=54; intermediate_LoP=35; high_LoP=22. Q1: 59 responders (=53%) suggest starting weight-bearing after 6 weeks. Q2:‘walking without crutches’ was mentioned 45x, followed by ‘full weight-bearing on the affected side’ (35x)’,‘walking with crutches and full weight-bearing on the affected side’(18x) and ‘stair walking, jumping, running’ (12x). Q3A: ‘fracture type’ was mentioned 87x, followed by ‘type of osteosynthesis material/fixation technique’ (66x), ‘age’ (46x), ‘callus deposits visible on X-ray’ (38x) and ‘patients having borne full weight during daily pursuits (despite cautious clinical advice) without adverse effects’ (29x). Q3B: ‘fracture type’ was mentioned 83x, followed by ‘uncertainty about fixation quality’ (74x), ‘additional traumata’(50x) and ‘osteoporosis’(40x). Discussion/conclusion: Consensus regarding the definition of ‘100% weight-bearing’ was low. Regarding build-up (over time) towards full weight-bearing, experts’ opinion was diverse, as were criteria used to start early or delayed weight-bearing.
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Clinical message: More transparent criteria and predictors for designing optimal weight-bearing regimes are needed.
35
M. van der Vusse
[email protected]
Employment in persons with spinal cord injury in the Netherlands in 2012: participation, satisfaction, work stress and quality of life A.J.C van Wisselingh MD¹, M.W.M Post PhD1,², F.W.A van Asbeck MD PhD¹ ¹ De Hoogstraat Rehabilitation Centre, Utrecht,The Netherlands
² University Medical Center Utrecht, Rudolf Magnus Institute of Neuroscience and Center of Excellence for Rehabilitation Medicine,The Netherlands
Introduction: Research has been done on employment after spinal cord injury (SCI) and related factors. However, there is hardly any data about employment satisfaction and work stress in this group. Objective: To describe satisfaction with employment and work stress in Dutch people with SCI and the relationship between work stress and quality of life. Patients: Members of the Dutch SCI Association, aged 18-65 (N=396). Methods: Questionnaire on vocational outcome, employment satisfaction, the Effort-Reward Imbalance scale and 5 items of the World Health Organization Quality of Life.
Abstracts
Results: 48% of the participants had paid work and 90% of them was very satisfied or satisfied with their work situation. Of the participants with paid work, 41% had a effort-reward ratio above 1 (as much or more stress than reward). Only marital status (being alone) was found to be significantly correlated with higher work stress. Of the participants with paid work, 73% were generally positive about their quality of life, in contrast to 44% of those without paid work (p<0.001). Work stress was only weakly related to quality of life.
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Discussion and conclusions: Less than half of people with SCI have paid work, but those who have, seem to be satisfied with their work situation and experience a better quality of life than those without paid work. Levels of work stress were similar to those found in people with SCI in other countries and other populations. Clinical message: The results of this study underscore the importance of paid work for people with SCI.
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A.J.C.Wisselingh
[email protected]
The effect of handcycle interval training on physical capacity in persons with recent spinal cord injury I.L.J. van den Brand MD1, C.F.J. Nooijen MSc2, M. Bergen MD PhD1, Prof. H.J. Stam MD PhD2, R.J.G. van den Berg-Emons PhD2, Act-Active research group 1 2
Rijndam Rehabilitation Center, Rotterdam,The Netherlands Department of Rehabilitation Medicine, Erasmus University Medical Center Rotterdam,The Netherlands Introduction: Hand cycling is a suitable training method because it’s easy for daily mobility and risk of overuse injuries of the shoulder is relatively low. However, evidence for the effects of hand cycle training on physical capacity in persons with recent SCI is limited.Therefore, the goal of this study was to evaluate effects of a handcycle training program on physical capacity in persons with recent SCI and compare subgroups based on lesion characteristics. Methods: Twenty-three persons with subacute SCI (on average 4,7 months post injury; 61% motor complete, 43% tetraplegia) performed a structured handcycle training program (3x/week; intensity 60-80% HRR or 4-7/10 on a Borg scale) during the last eight weeks of inpatient rehabilitation. Before and after training they performed a graded maximal exercise test on a handcycle placed in a Tacx flow ergotrainer. Outcome measures were peak power output (POpeak) and peak oxygen uptake (VO2peak).
Abstracts
Results: After training POpeak was 39% (p<0,01) and VO2peak 12% (p<0,01) higher than before training. Compared to persons with paraplegia, persons with tetraplegia increased 11% less in POpeak (p=0,04), but similar in VO2peak (p=0,55). Persons with complete and incomplete lesions showed comparable results. Conclusions: Physical capacity in persons with subacute SCI improved after hand cycle training combined with regular rehabilitation. Since the improvements were larger than those known to occur in persons with paraplegia receiving regular rehabilitation (improvements of about 10%; Haisma et al. 2006), the results suggest that this combination may result in larger increases in physical capacity compared to regular rehabilitation only.
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I.L.J. van den Brand
[email protected]
Plattegrond
1. 2. 3. 4. 5. 6.
VIR e-Care Solutions Allergan Freedom Innovations Europe Basko Healthcare Focal Meditech ChipSoft
7. 8. 9. 10. 11.
Ipsen Farmaceutica Otto Bock Ambroise Livit Orthopedie OIM Orthopedie
Posters
Garderobe Ingang Wintertuin
Ingang Wintertuin
2
1
9
10
38
3 8
4
podium
7
5
6 11
Ingang zaal plenaire sessies
VIR
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