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Authors would like to update the title of the Electronic Supplementary Material. The revised version of ESM files updated to the original publication. The original article has been corrected.

Introduction: After total knee arthroplasty (TKA) only 70% of patients return to work (RTW) and in general timely RTW is associated with successful RTW. This study aimed to examine whether patients who consulted an occupational physician (OP) RTWearlier than patients who did not consult an OP. Materials and methods: A multi-center prospective cohort study was performed among TKA patients between 18 to 65 years and having a paid job. Patients provided information on whether an OP was consulted or not within three months after TKA and were compared for time to RTW using Kaplan Meier curves (KM). Results: One hundred and eighty-two (182) patients were included with a median age of 59 years [IQR 54-62]; 95 patients were women (52%). Patient and work-related characteristics did not differ between patients who consulted an OP or not, except that self-employed patients consulted anOP less often than employed patients. TKA patients who consulted an OP did RTW later (median 84 days [IQR 61-115]) than those who did not (median 64 days [IQR 35-118] (KM p¼0.03). Conclusions: Consulting an OP was not associated with an earlier RTW. Additional analyses to adjust for confounding and effect modification are needed to confirm this result.

BACKGROUND: Long-term avoidance of painful activities has shown to be dysfunctional in chronic pain. Pain may elicit escape or avoidance responses automatically, particularly when pain-related fear is high. A conflict may arise between opposing short-term escape/avoidance goals to reduce pain and long-term approach goals to receive a reward. An inhibitory control system may resolve this conflict. It was hypothesized that reduced response inhibition would be associated with greater escape/avoidance during pain, particularly among subjects with higher pain-related fear. METHODS: Response inhibition was measured with the stop-signal task, and pain-related fear with the Fear of Pain Questionnaire. Participants completed a tone-detection task (TDT) in which they could earn money while being exposed to cold pressor pain. Escape/avoidance was operationalized as the hand immersion time during a cold pressor task (CPT) and the performance on the TDT. RESULTS: Poorer response inhibition was associated with shorter CPT immersion duration and with worse TDT performance. Pain after the CPT was associated with pain-related fear, but not with response inhibition. No supportive evidence was found for the hypothesis that the relation between inhibition and escape/avoidance would be most pronounced for those with higher pain-related fear. In contrast, the relation between response inhibition and number of hits on the TDT was most pronounced for those with lower pain-related fear. CONCLUSIONS: The findings suggest that individuals with a stronger ability to inhibit responses in a stop-signal task are better able to inhibit escape/avoidance responses elicited by pain, in the service of a conflicting approach goal.

Mostly, patients with peri-pancreatic cancer (including pancreatic, ampullary and distal bile duct tumors) are diagnosed in a stage in which curative resection is not possible. The median survival rate of patients with non resectable peri-pancreatic cancer varies between 6 and 12 months. During this period palliative treatment is necessary, which should focus on major symptoms as obstructive jaundice, duodenal obstruction and pain. Controversy exists about how to provide optimal palliative treatment. Both surgical and non surgical palliative procedures relief obstructive jaundice. From early retrospective and prospective randomized studies it is known that in the early phase after treatment, more complications are found after surgical palliation, whereas in the late phase more complications are seen after endoscopic palliation. Because more recent studies clearly showed improved results after surgical palliation, current recommendations probably should be that patients with a suspected poor short-term survival (

The aims of this thesis were to investigate activities after knee arthroplasty (KA) and realignment osteotomies, younger knee OA patients’ expectations and activity goals, and to search for individualized ways to -realistically- improve satisfaction for activities of daily life, work and leisure time after KA. Conclusions: 1. Younger patients expect different activities to perform better after KA, that varied most in leisure time activities. 2. Return to both low- and higher-impact sports is possible after both Total KA (TKA) and Unicondylar KA (UKA), but seemed more likely after UKA than after TKA. 3. We found better outcomes for KA in anteromedial osteoarthritis (AMOA), compared to more advanced OA and other wear patterns, and this was slightly more likely if treated with UKA than with KA. 4. Patients can also return to sports activities and work after realignment osteotomies, also when they are young and athletic, and more likely than after KA. 5. Concerning ‘usual care’ rehabilitation after KA broad agreement amongst physiotherapists exists about goals for rehabilitation, but they use a variety of strategies to achieve those goals. 6. We described the intervention group of our ACTION trial, that followed rehabilitation using Goal Attainment Scaling (GAS) after KA. We showed that patients wished to achieve many activity goals, but that following six months of rehabilitation with GAS, almost all activity goals (91%) were attained; 7. Moreover, GAS-based rehabilitation after KA led to significant improvement of satisfaction for activities to Visual Analogue Scales of 80/100 at six months after surgery.