i-CONTENT tool for assessing therapeutic quality of exercise programs employed in randomised clinical trials.

OBJECTIVE: When appraising the quality of randomised clinical trial (RCTs) on the merits of exercise therapy, we typically limit our assessment to the quality of the methods. However, heterogeneity across studies can also be caused by differences in the quality of the exercise interventions (ie, 'the potential effectiveness of a specific intervention given the potential target group of patients')-a challenging concept to assess. We propose an internationally developed, consensus-based tool that aims to assess the quality of exercise therapy programmes studied in RCTs: the international Consensus on Therapeutic Exercise aNd Training (i-CONTENT) tool. METHODS: Forty-nine experts (from 12 different countries) in the field of physical and exercise therapy participated in a four-stage Delphi approach to develop the i-CONTENT tool: (1) item generation (Delphi round 1), (2) item selection (Delphi rounds 2 and 3), (3) item specification (focus group discussion) and (4) tool development and refinement (working group discussion and piloting). RESULTS: Out of the 61 items generated in the first Delphi round, consensus was reached on 17 items, resulting in seven final items that form the i-CONTENT tool: (1) patient selection; (2) qualified supervisor; (3) type and timing of outcome assessment; (4) dosage parameters (frequency, intensity, time); (5) type of exercise; (6) safety of the exercise programme and (7) adherence to the exercise programme. CONCLUSION: The i-CONTENT-tool is a step towards transparent assessment of the quality of exercise therapy programmes studied in RCTs, and ultimately, towards the development of future, higher quality, exercise interventions.

Preoperative psychosocial factors predicting patient's functional recovery after total knee or total hip arthroplasty: a systematic review.

OBJECTIVE: To evaluate the predictive value of preoperative psychosocial factors on the perceived and observed postoperative patient's functional recovery during the post-hospital phase and up to 12 months after hospital discharge of patients who underwent total knee or total hip arthroplasty. METHODS: A systematic review was performed. MEDLINE, CINAHL, EMBASE and PsychINFO were systematically screened in order to find prospective longitudinal studies. Risk of bias was assessed using a modified version of a 27-item checklist for prognostic studies, as previously used by Veerbeek. A qualitative analysis was performed using the method of Zwikker. RESULTS: A total of 26 studies, with a total of 11,020 patients, were included. In total, 22 studies were judged as having a high risk of bias. Overall, no longitudinal association with perceived or observed functional recovery was found in all of the seven preoperative psychosocial categories: A: mental well-being, B: cognitions, C: beliefs, D: expectations, E: coping, F: social support or G: personality traits in total joint arthroplasty. Mental well-being seems to be the exception in one time period (>6 weeks through ≤3 months) and change score in observed functional recovery, but only in patients awaiting total knee arthroplasty (100% and 75% of the variables were significantly and consistently associated, respectively). CONCLUSION: Overall, the results of this systematic review suggest that there is no longitudinal association between preoperative psychosocial factors and perceived or observed patient's postoperative functional recovery after total joint arthroplasty. The psychological category mental well-being is related to observed postoperative recovery >6 weeks through ≤3 months and to change score after total knee arthroplasty.

Therapeutic validity and effectiveness of supervised physical exercise training on exercise capacity in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis.

OBJECTIVE: Our aim was to determine the effectiveness of supervised physical exercise training on exercise capacity in patients with chronic obstructive pulmonary disease taken into consideration indices such as therapeutic validity of interventions, methodological quality of studies, and exercise volume. DATA RESOURCES: MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, and PEDro databases were searched from inception until 17 July 2015 for randomized controlled trials comparing the effect of supervised exercise training vs. usual care in patients with chronic obstructive pulmonary disease. The references of included studies and review articles were hand searched for additional references and key authors of included trials were crosschecked in PubMed for any missed references. REVIEW METHODS: Two reviewers independently assessed therapeutic validity of exercise training and methodological quality of included studies. Overall effects were calculated using a random effects model. RESULTS: A total of 13 studies involving 756 patients with chronic obstructive pulmonary disease were included. Significant differences in maximal exercise capacity (standardized mean difference 0.52, 95% CI 0.31 to 0.74) and endurance exercise capacity (standardized mean difference 0.73, 95% CI 0.50 to 0.96) in favor of physical exercise training were found. The volume of physical exercise per week, the total volume of physical exercise, or their associations did not significantly influence the effect of training. CONCLUSION: Effects of supervised physical exercise was not significantly altered by therapeutic validity. A combination of aerobic exercise and strength training was found to be more effective than strength training or endurance training alone in increasing the 6-minute walking distance.

Functional health status in subjects after a motor vehicle accident, with emphasis on whiplash associated disorders: design of a descriptive, prospective inception cohort study.

BACKGROUND: The clinical consequences of whiplash injuries resulting from a motor vehicle accident (MVA) are poorly understood. Thereby, there is general lack of research on the development of disability in patients with acute and chronic Whiplash Associated Disorders. METHODS/DESIGN: The objective is to describe the design of an inception cohort study with a 1-year follow-up to determine risk factors for the development of symptoms after a low-impact motor vehicle accident, the prognosis of chronic disability, and costs. Victims of a low-impact motor vehicle accident will be eligible for participation. Participants with a Neck Disability Index (NDI) score of 7 or more will be classified as experiencing post-traumatic neck pain and will enter the experimental group. Participants without complaints (a NDI score less than 7) will enter the reference group. The cohort will be followed up by means of postal questionnaires and physical examinations at baseline, 3 months, 6 months, and 12 months. Recovery from whiplash-associated disorders will be measured in terms of perceived functional health, and employment status (return to work). Life tables will be generated to determine the 1-year prognosis of whiplash-associated disorders, and risk factors and prognostic factors will be assessed using multiple logistic regression analysis. DISCUSSION: Little is known about the development of symptoms and chronic disability after a whiplash injury. In the clinical setting, it is important to identify those people who are at risk of developing chronic symptoms.This inception prospective cohort study will provide insight in the influence of risk factors, of the development of functional health problems, and costs in people with whiplash-associated disorders.