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Item does not contain fulltext, Objective(s): To interpret change in quality-of-life scores in facial palsy patients by calculating the smallest detectable change (SDC) and minimal important change (MIC) for the Facial Disability Index (FDI), Facial Clinimetric Evaluation (FaCE) scale, and Synkinesis Assessment Questionnaire (SAQ). Materials and Methods: The SDC, for individuals and groups, was calculated using previously collected test-retest data (2-week interval). The MIC (predictive modeling method) was calculated in a second similar facial palsy population using two measurements (1-1.5-year interval) and an anchor question assessing perceived change. Results: SDC(individual) of FaCE was 17.6 and SAQ was 28.2. SDC(group) of FaCE was 2.9 and SAQ was 4.6 (n = 62). Baseline FaCE and SAQ scores were 43.3 (interquartile range [IQR]: 35.8;55.0) and 51.1 (IQR: 32.2;60.0), respectively. MIC for important improvement of FDI physical/social function, FaCE total, and SAQ total were 4.4, 0.4, 0.7, and 2.8, respectively (n = 88). MIC for deterioration was 8.2, -1.8, -8.5, and 0.6, respectively. Baseline scores were 70.0 (IQR: 60.0;80.0), 76.0 (68.0;88.0), 55.0 (IQR: 40.0;61.7), and 26.7 (IQR: 22.2;35.6), respectively. Number of participants reporting important change for the different questionnaires ranged from 3 to 23 per subscale. Conclusion: Interpreting change scores of the FDI, FaCE, and SAQ is appropriate for groups, but for individual patients it is limited by a substantial SDC.

Item does not contain fulltext, INTRODUCTION: Dance can reduce motor symptoms in persons with Parkinson's disease (PD). However, the effect on psychosocial wellbeing, including self-esteem and quality of life is less clear. METHODS: Forty-nine persons with PD (Hoehn and Yahr stage 1-4) participated in weekly dance classes for a consecutive period of 22 weeks, 36 participants completed the classes. Two baseline measurements (T1a and T1b) were performed during a 2-week control period prior to the dance classes. Post-measurements (T2) were performed immediately after 22 weeks of dance classes. Primary outcome was self-esteem as measured with the Rosenberg Self-Esteem Score. RESULTS: Self-esteem scores were stable across the two baseline measurements and improved significantly after the dance classes (1.5 points improvement between T1b and T2, 95% CI 0.3, 2.7; p = 0.012). Additionally, quality of life as measured with the Parkinson's Disease Questionnaire 39 improved significantly (3.4 points reduction between T1b and T2, 95%CI - 5.7, - 1.2; p = 0.003) as did motor symptoms as measured with the Movement Disorders Society-Unified Parkinson's Disease Rating Scale-part III (6.2 points reduction between T1b and T2, 95%CI - 10.1, - 2.4; p = 0.002). Balance confidence as measured with the Activities-Specific Balance Confidence Scale did not change. DISCUSSION AND CONCLUSIONS: Dance classes seem to improve self-esteem, quality of life and motor symptoms in persons with PD. These effects should be investigated further in a randomized clinical trial. CLINICAL MESSAGE: Dance classes may be a valuable complementary treatment option in people with PD to improve not only motor symptoms, but also self-esteem and quality of life.

Introduction: The reorganisation of the structure of a Gastro-Intestinal Oncology Multidisciplinary Team Meeting (GIO-MDTM) in a tertiary centre with three care pathways is evaluated on added value. Methods: In a mixed method investigation, process indicators such as throughput times were analysed and stakeholders were interviewed regarding benefits and drawbacks of the reorganisation and current MDTM functioning. Results: For the hepatobiliary care pathway, the time to treatment plan increased, but the time to start treatment reduced significantly. The percentage of patients treated within the Dutch standard of 63 days increased for the three care pathways. From the interviews, three themes emerged: added value of MDTMs, focus on planning integrated care and awareness of possible improvements. Discussion: The importance of evaluating interventions in oncology care pathways is shown, including detecting unexpected drawbacks. The evaluation provides insight into complex dynamics of the care pathways and contributes with recommendations on functioning of an MDTM. Conclusions: Throughput times are only partly determined by oncology care pathway management, but have influence on the functioning of MDTMs. Process indicator information can help to reflect on integration of care in the region, resulting in an increase of patients treated within the Dutch standard.

Contains fulltext : 229876.pdf (publisher's version ) (Open Access), PURPOSE: Patient-reported outcome measures are essential in the evaluation of facial palsy. Aim of this study was to translate and validate the Facial Disability Index (FDI) for use in the Netherlands. METHODS: The FDI was translated into Dutch according to a forward-backward method. Construct validity was assessed by formulating 22 hypotheses regarding associations of FDI scores with the Facial Clinimetric Evaluation scale, the Synkinesis Assessment Questionnaire, the Short Form-12 and the Sunnybrook Facial Grading System. Validity was considered adequate if at least 75% (i.e. 17 out of 22) of the hypotheses were confirmed. Additionally, confirmatory factor analysis was performed. Cronbach's α was calculated as a measure of internal consistency. Participants were asked to fill out the FDI a second time after 2 weeks to analyse test-retest reliability. Lastly, smallest detectable change was calculated. RESULTS: In total, 19 hypotheses (86.4%) were confirmed. Confirmatory factor analysis showed acceptable fit for the two factor structure of the original FDI (root mean square error of approximation = 0.064, standardized root mean square residual = 0.081, comparative fit index = 0.925, Chi-square = 50.22 with 34 degrees of freedom). Internal consistency for the FDI physical function scale was good (α > 0.720). Internal consistency for the FDI social/well-being scale was slightly less (α > 0.574). Test-retest reliability for both scales was good (intraclass correlation coefficients > 0.786). Smallest detectable change at the level of the individual was 17.6 points for the physical function and 17.7 points for the social/well-being function, and at group level 1.9 points for both scales. CONCLUSION: The Dutch version FDI shows good psychometric properties. The relatively large values for individual smallest detectable change may limit clinical use. The translation and widespread use of the FDI in multiple languages can help to compare treatment results internationally.

Purpose: Existing physical activity interventions do not reach a considerable proportion of physically disabled people. This study assessed feasibility and short-term effects of Activity Coach+, a community-based intervention especially targeting this hard-to-reach population. Methods: Feasibility was determined by reach, dropouts, and compliance with the protocol. Physical activity was measured with the Activ8 accelerometer and the adapted SQUASH questionnaire. Health outcomes were assessed by body composition, blood pressure, hand grip force, 10-metre walk test, 6-minute walk test, and the Berg Balance Scale. The RAND-36, Exercise Self-Efficacy Scale, Fatigue Severity Scale, and IMPACT-S were administered. Measurements were performed at baseline and after 2 and 4 months. Changes over time were analysed by Friedman tests. Results: Twenty-nine participants enrolled during the first 4 months, of whom two dropped out. Intervention components were employed in 86–100% of the participants. Physical activity did not change after the implementation of Activity Coach+. Body mass index (p = 0.006), diastolic blood pressure (p = 0.032), walking ability (p = 0.002), exercise capacity (p = 0.013), balance (p = 0.014), and vitality (p = 0.049) changed over time. Conclusions: Activity Coach + is feasible in a community setting. Indications for effectivity of Activity Coach + in hard-to-reach people with a physical disability were found.Implications for rehabilitation Activity Coach + was able to reach physically disabled people living in community, a population that is assumed hard-to-reach. Activity Coach + was feasible in a population of persons with a physical disability that was heterogeneous with respect to age and (severity of) disability. The current study provides the first indications for the beneficial health effects of Activity Coach + in hard-to-reach people with a physical disability.

Background: Head and neck cancers are fast growing tumours that are complex to diagnose and treat. Multidisciplinary input into organization and logistics is critical to start treatment without delay. A multidisciplinary first-day consultation (MFDC) was introduced to reduce throughput times for patients suffering from head and neck cancer in the care pathway. In th

Introduction: The Working Alliance Inventory Rehabilitation Dutch Version (WAI-ReD) is a valid instrument for measuring therapeutic alliance within rehabilitation. A limitation of the WAI-ReD is its ceiling effects for all domains, in more than 15% of the patients. These effects affect the responsiveness of an instrument. Objective: Determine if modifying response scales, by changing labels and utilizing visual analogue scales of the WAI-ReD will reduce ceiling effects. Methods: The primary outcomes were the percentage of ceiling effects and the median scores on the total- and domain scores of the WAI-ReD and the two modified versions. As secondary outcomes, the construct validity and internal consistency of the modified versions were explored. The items of the original WAI-ReD are graded on a balanced Likert scale, the modified versions have a; (1) Likert scale with Positive-Packed labels (WAI-ReDPP); or (2) Visual Analogue Scale (WAI-ReDVAS). Adult patients from the Department of Rehabilitation of the University Medical Center Groningen and two physiotherapy practices were recruited. This study had a cross-sectional design. Participants randomly received one of the versions of the WAI-ReD. Results: No ceiling effects were present in the total- or domain scores of the modified WAI-ReDVAS. Significantly (p≤ 0.05) fewer ceiling effects were found in the domains “Bond” and “Goal” of the WAI-ReDVAS compared to the WAI-ReD and WAI-RedPP. Ceiling effects were still present on the domains “Bond” and “Goal” of the WAI-ReDPP. Median outcomes of the modified versions were higher than the median outcome of the original version, but not significantly. The correlations (Pearson’s r) between the WAI-ReDVAS and similar validated instruments were high (r ≥ 0.70) . The internal consistency of the total- and domain scores of both modified versions were high (0.70 ≤ r < 0.95). Conclusion: Utilizing visual analogue scales is an effective method to prevent ceiling effects o

Rationale: In therapy a positive patient-therapist relationship between client and therapist is an important prerequisite for reaching therapeutic goals. It is also known to be a key determinant for progress in therapy. In psychotherapy effects of this relationship have been studied extensively. Concerning pediatric physiotherapy, only studies are available how to collaborate in therapy with child and parent in a model of Family Centred Care. However, in pediatric physiotherapy no research has been conducted into the process and topics affecting the therapeutic relationship. To gain insight of the therapeutic relationship in pediatric physiotherapy, more knowledge is needed about perceptions, experiences and preferences of the therapeutic relationship according to child, parent and child therapist. Purpose: To explore the therapeutic relationship in pediatric physiotherapy from the perceptions, experiences and preferences of child, parent and therapist. Methods: In a qualitative study based on the Grounded Theory, five children, their parents and therapists from the department pediatric rehabilitation of a local hospital in The Netherlands, served as respondents during in-depth interviews. After the interviews, a treatment of each child was observed in order to collect additional data. Qualitative analysis was performed in a cyclic process. Results: Complementary and mutual reinforcement in the therapeutic relationship emerged as a central theme. This theme consisted of four common themes: (a) trust in the characteristics and in the attitude of the therapist, (b) trust in the quality of care, (c) collaboration between child, parent and therapist, and (d) sharing of information between child, parent and therapist. Trust in the characteristics and in the attitude of the therapist was the most important theme. The results indicate that it is important for therapists to know the needs and preferences of the children and their parents to strenghten the therapeutic relati

1 december 2013, Contains fulltext : 125557.pdf (publisher's version ) (Open Access), QUESTION: Does static stretch positioning combined with simultaneous neuromuscular electrical stimulation (NMES) in the subacute phase after stroke have beneficial effects on basic arm body functions and activities? DESIGN: Multicentre randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: Forty-six people in the subacute phase after stroke with severe arm motor deficits (initial Fugl-Meyer Assessment arm score

Contains fulltext : 80752.pdf (publisher's version ) (Closed access), Trismus is a common problem after treatment of head and neck cancer. The Therabite is an effective treatment for trismus. To explore the factors that may influence Therabite exercise adherence, how these interrelate and to provide aims for interventions to increase adherence, the authors conducted a multi-centre, formal-evaluative qualitative retrospective study. 21 patients treated for head-neck cancer were interviewed in semi-structured, in-depth interviews. Internal motivation to exercise, the perceived effect, self-discipline and having a clear exercise goal influenced Therabite exercise adherence positively. Perceiving no effect, limitation in Therabite opening range and reaching the exercise goal or a plateau in mouth opening were negative influences. Pain, anxiety and the physiotherapist could influence adherence both positively and negatively. Based on the results, a model for Therabite exercise adherence was proposed. It is important to signal and assess the factors negatively influencing Therabite adherence, specifically before there is a perceived effect. Research is needed to examine why some patients do not achieve results despite high exercise adherence, to identify effective exercise regimens and to assess proposed interventions aimed to increase Therabite exercise adherence.

Contains fulltext : 49589.pdf (publisher's version ) (Closed access), PURPOSE: This paper focuses on the construct validity of instruments measuring impairments in body structures and function in rheumatic disorders. The objective is: 1) to make an inventory of constructs, based on the domains of the International Classification of Functioning, Disabilities and Health problems (ICF), against which instruments measuring impairments in body structures and function were validated; 2) to analyse whether validation against a similar construct resulted in higher correlation coefficients than validation against a dissimilar construct. METHODS: In a systematic review papers were identified in which instruments measuring impairments in body structures and function for patients with rheumatic disorders were validated. The instruments identified were assessed on their methodological properties and the constructs against which they were validated. Subsequently, pooled (interclass) correlations of similar constructs and dissimilar constructs against which was validated were compared. An instrument was decided to have good construct validity, if the correlation coefficient was 0.50 or higher, and the measurement instrument in question is validated against similar constructs. RESULTS: In total 216 papers were identified analysing the validity of 42 different instruments. Only 16% of these instruments were validated against instruments that represent the most similar construct. In general, estimates of construct validity were lower when validated against dissimilar constructs, except for instruments measuring impairments in mental functions. CONCLUSION: There is a trend that validation against a similar construct yields higher correlation coefficients than validation against a dissimilar construct. If an instrument measuring impairments is validated against the most similar construct, and a criterion of r > 0.50 is applied, only 10 out of the 42 identified instruments turned out to be valid.

OBJECTIVES: The first aim was to make an inventory of available instruments and questionnaires for the assessment of disabilities in personal care in patients with rheumatic disorders. The second aim was to investigate which of these instruments have acceptable, methodological quality with regard to reliability, validity and responsiveness. The third aim was to investigate the assumption that convergent validity results in stronger correlations when validated against a more similar construct. METHODS: A computer-aided literature search (1982-2001) in several databases was performed to identify studies focusing on the clinimetric properties of instruments to assess impairments in function in patients with rheumatic disorders. Data were extracted in a standardised way and compared to a priori defined criteria. RESULTS: In total, 19 measurement instruments were included. Five out of these 19 were found to have acceptable reliability, while 12 had acceptable validity. Only three questionnaires met both criteria. Results concerning the responsiveness of these three questionnaires were conflicting. No difference was found in the strength of correlation between validation against the most similar construct versus validation against the least similar construct. CONCLUSION: It is concluded that the Arthritis Impact Measurement Scale (AIMS) is the most suitable instrument for the assessment of disabilities in personal care