Referral to and enrolment in cardiac rehabilitation after open-heart surgery in the Netherlands.

AIM: Although referral to phase 2 cardiac rehabilitation (CR) following open-heart surgery is recommended in professional guidelines, according to the literature, participation rates are suboptimal. This study investigates the referral and enrolment rates, as well as determinants for these rates, for phase 2 CR following open-heart surgery via sternotomy. METHODS: A cross-sectional survey study was conducted among patients who underwent open-heart surgery via sternotomy in a university hospital. Data on referral and enrolment rates and possible factors associated with these rates (age, sex, type of surgery, educational level, living status, employment, income, ethnicity) were collected by a questionnaire or from the patient's medical file. Univariate logistic regression analysis (odds ratio) was used to study associations of patient characteristics with referral and enrolment rates. RESULTS: Of the 717 eligible patients, 364 (51%) completed the questionnaire. Their median age was 68 years (interquartile range 61-74) and 82 (23%) were female. Rates for referral to and enrolment in phase 2 CR were 307 (84%) and 315 (87%), respectively. Female sex and older age were independently associated with both non-referral and non-enrolment. Additional factors for non-enrolment were surgery type (coronary artery bypass grafting with valve surgery and miscellaneous types of relatively rare surgery), living alone and below-average income. CONCLUSION: Phase 2 CR referral and enrolment rates for patients following open-heart surgery were well over 80%, suggesting adequate adherence to professional guidelines. During consultation, physicians and specialised nurses should pay more attention to certain patient groups (at risk of non-enrolment females and elderly). In addition, in-depth qualitative research to identify reasons for non-referral and/or non-enrolment is needed.

Parent-reported family impact in children and young adults with acquired brain injury in the outpatient rehabilitation setting.

Purpose: To increase knowledge/awareness on family impact (FI) after acquired brain injury (ABI) in rehabilitation settings, it is essential to investigate the associations between patient-functioning and impact on families. This has been explored in hospital-based cohorts, but not in rehabilitation settings.Methods: A cross-sectional, multi-center study among parents of children/young adults (aged 5-24 years) with ABI referred to rehabilitation was performed. Patient/injury/family-characteristics were noted, and parents completed the PedsQL™Family-Impact-Module and PedsQL™generic-core-4.0 to assess FI and health-related quality of life (HRQoL). Univariate- and multivariable-regression analyses were performed to investigate associations between HRQoL/patient/injury/family-related factors and FI.Results: 246 families participated; patients' median age was 14 year (IQR 11-16), 65 had non-traumatic-brain-injury (nTBI) (26%), 127 were female. FI was found to be considerable (median FIM-score 71.9, IQR:60-85). Especially referral to rehabilitation >6 months after onset, diminished patients' mental/emotional health and HRQoL (child/family factors), and premorbid problems were associated with higher FI.Conclusions: In this rehabilitation cohort, pediatric ABI caused considerably higher FI than in hospital-based studies with referral to rehabilitation >6 months, diminished child/family factors and presence of premorbid problems increasing FI. Assessing and monitoring FI and its associated factors enables professionals to individualize treatment, psychoeducation, support and follow-up.

How to improve eRehabilitation programs in stroke care? A focus group study to identify requirements of end-users.

BACKGROUND: A user-centered design approach for eHealth interventions improves their effectiveness in stroke rehabilitation. Nevertheless, insight into requirements of end-users (patients/informal caregivers and/or health professionals) for eRehabilitation is lacking. The aim of this study was to identify end-user requirements for a comprehensive eHealth program in stroke rehabilitation. METHODS: Eight focus groups were conducted to identify user requirements; six with patients/informal caregivers and two with health professionals involved in stroke rehabilitation (rehabilitation physicians, physiotherapists, occupational therapists, psychologists, team coordinators, speech therapist). The focus groups were audiotaped and transcribed in full. Direct content analysis was used to identify the end-user requirements for stroke eHealth interventions concerning three categories: accessibility, usability and content. RESULTS: In total, 45 requirements for the accessibility, usability and content of a stroke eRehabilitation program emerged from the focus groups. Most requirements concerned content (27 requirements), followed by usability (12 requirements) and accessibility (6 requirements). Patients/informal caregivers and health professionals each identified 37 requirements, respectively, with 29 of them overlapping. CONCLUSIONS: Requirements between stroke patients/informal caregivers and health professionals differed on several aspects. Therefore, involving the perspectives of all end users in the design process of stroke eRehabilitation programs is needed to achieve a user-centered design. TRIAL REGISTRATION: The study was approved by the Medical Ethical Review Board of the Leiden University Medical Center [P15.281].

Teachers' and students' perceptions on barriers and facilitators for eHealth education in the curriculum of functional exercise and physical therapy: a focus groups study.

BACKGROUND: Despite the growing importance of eHealth it is not consistently embedded in the curricula of functional exercise and physical therapy education. Insight in barriers and facilitators for embedding eHealth in education is required for the development of tailored strategies to implement eHealth in curricula. This study aims to identify barriers/facilitators perceived by teachers and students of functional exercise/physical therapy for uptake of eHealth in education. METHODS: A qualitative study including six focus groups (two with teachers/four with students) was conducted to identify barriers/facilitators. Focus groups were audiotaped and transcribed in full. Reported barriers and facilitators were identified, grouped and classified using a generally accepted framework for implementation including the following categories: innovation, individual teacher/student, social context, organizational context and political and economic factors. RESULTS: Teachers (n = 11) and students (n = 24) of functional exercise/physical therapy faculties of two universities of applied sciences in the Netherlands participated in the focus groups. A total of 109 barriers/facilitators were identified during the focus groups. Most related to the Innovation category (n = 26), followed by the individual teacher (n = 22) and the organization (n = 20). Teachers and students identified similar barriers/facilitators for uptake of eHealth in curricula: e.g. unclear concept of eHealth, lack of quality and evidence for eHealth, (lack of) capabilities of students/teachers on how to use eHealth, negative/positive attitude of students/teachers towards eHealth. CONCLUSION: The successful uptake of eHealth in the curriculum of functional exercise/physical therapists needs a systematic multi-facetted approach considering the barriers and facilitators for uptake identified from the perspective of teachers and students. A relatively large amount of the identified barriers and facilitators were overlapping between teachers and students. Starting points for developing effective implementation strategies can potentially be found in those overlapping barriers and facilitators. REGISTRATION: The study protocol was a non-medical research and no registration was required. Participants gave written informed consent.

Value-Based Stroke Rehabilitation: Feasibility and Results of Patient-Reported Outcome Measures in the First Year After Stroke.

PURPOSE: Structured application of patient-reported outcome measures (PROMs) is a key element in Value Based Healthcare. This study aimed to evaluate the feasibility of a broad set of PROMs reflecting similar patient reported health domains as proposed within the International Standard Set of Patient-Centered Outcome Measures After Stroke within the first year after stroke. METHODS: The study included consecutive stroke patients admitted to inpatient or outpatient specialized rehabilitation. PROMs were administered upon admission, discharge (inpatients only), and at 3, 6, and 12 months. PROMs included: EuroQol 5 Dimensions (EQ-5D), Stroke Impact Scale (SIS), Stroke and Aphasia Quality of Life Scale (SAQOL-39NL), Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P), Hospital Anxiety and Depression Scale (HADS), and Fatigue Severity Scale (FSS). Feasibility was defined as participation, retention, and response rates. Paired t tests were conducted to analyze their changes over time. RESULTS: Of 485 inpatients and 189 outpatients who were invited, 291 (60.0%) and 82 (43.3%) participated, of whom 45 (15.5%) and 7 (8.5%) dropped out before 12 months, respectively. Two hundred seven (71.1%) and 71 (86.6%) of the inpatients and outpatients returned the questionnaires on all or all but one time points, respectively. Between admission and 12 months statistically significant improvements of PROMs addressing general health and quality of life (EQ-5D), psychiatric functioning (HADS), motor functioning (SIS mobility), and social functioning (USER-P, SIS communication) were seen. The SIS memory scale, the SAQOL-39NL and the FSS did not show any changes. CONCLUSIONS: Participation, retention, and response rates for a comprehensive set of PROMS for stroke in patients in rehabilitation were moderate to good, with clinical improvements seen until 1 year post stroke. The SAQOL-39NL and FSS did not demonstrate changes over time and cannot be recommended for repetitive measurements in this setting. By simplifying the set of questionnaires, participation and response rates may be further enhanced.

Return to Work 2-5 Years After Stroke: A Cross Sectional Study in a Hospital-Based Population.

Purpose To describe factors associated with RTW in patients 2-5 years after stroke. Methods Cross sectional study, including patients 2-5 years after hospitalization for a first-ever stroke, who were <65 years and had been gainfully employed before stroke. Patients completed a set of questionnaires on working status and educational level, physical functioning (Frenchay Activities Index, FAI), mental functioning (Hospital Anxiety and Depression Scale, HADS), Coping Orientations to Problems Experienced, (COPE easy) and quality of life (Short-Form(SF)-36 and EQ(Euroqol)-5D). Caregivers completed the Caregiver Strain Index (CSI). Baseline stroke characteristics were gathered retrospectively. Baseline characteristics and current health status were compared between patients who did and did not RTW by means of logistic regression analysis with odds ratios (OR) and 95 % confidence intervals (CI), adjusted for age and gender. Results Forty-six patients were included, mean age of 47.7 years (SD 9.7), mean time since stroke of 36 months (SD 11.4); 18 (39 %) had RTW. After adjusting for age and gender a shorter length of hospitalization was associated with RTW (OR 0.87; CI 0.77-0.99). Of the current health status, a lower HADS depression score (0.76; 0.63-0.92), a less avoidant coping style (1.99; 0.80-5.00), better scores on the FAI (1.13; 1.03-1.25), the mental component summary score of the SF36 (1.07; 1.01-1.13), the EQ5D (349; 3.33-36687) and the CSI (0.68; 0.50-0.92) were associated with the chance of RTW. Conclusions A minority of working patients RTW after stroke; a shorter duration of the initial hospitalization was associated with a favorable work outcome. The significant association between work status and activities, mental aspects and quality of life underlines the need to develop effective interventions supporting RTW.

The effects of an 8-week computer-based brain training programme on cognitive functioning, QoL and self-efficacy after stroke.

Cognitive impairment after stroke has a direct impact on daily functioning and quality of life (QoL) of patients and is associated with higher mortality and healthcare costs. The aim of this study was to determine the effect of a computer-based brain training programme on cognitive functioning, QoL and self-efficacy compared to a control condition in stroke patients. Stroke patients with self-perceived cognitive impairment were randomly allocated to the intervention or control group. The intervention consisted of an 8-week brain training programme (Lumosity Inc.®). The control group received general information about the brain weekly. Assessments consisted of a set of neuropsychological tests and questionnaires. In addition, adherence with trained computer tasks was recorded. No effect of the training was found on cognitive functioning, QoL or self-efficacy when compared to the control condition, except for very limited effects on working memory and speed. This study found very limited effects on neuropsychological tests that were closely related to trained computer tasks, but no transfers to other tests or self-perceived cognitive failures, QoL or self-efficacy. These findings warrant the need for further research into the value of computer-based brain training to improve cognitive functioning in the chronic phase after stroke.

Measuring educational needs among patients with systemic lupus erythematosus (SLE) using the Dutch version of the Educational Needs Assessment Tool (D-ENAT).

OBJECTIVE: The Educational Needs Assessment Tool (ENAT) was developed in the United Kingdom (UK) to systematically assess the educational needs of patients with rheumatic diseases. The aim of the present study was to describe the educational needs of Dutch patients with systemic lupus erythematosus (SLE) by means of a Dutch version of the ENAT (D-ENAT). METHODS: The D-ENAT was sent to a random sample of 244 SLE patients registered at the outpatient clinic of a university hospital. D-ENAT consists of 39 items in seven domains. The D-ENAT domain scores range from 0-16 to 0-28 (higher scoring equals higher educational needs) depending of the number of items in the domain. A total D-ENAT score (0-156) is calculated by summing all 39 items. In addition, age, disease duration, gender, educational level, present information need (yes/no) and the extent of information need (1-4: nothing-everything) were recorded. Univariate regression analysis was used to examine the D-ENAT's potential determinants. RESULTS: The response rate was 122 out of 244 (50%). The mean (% of maximum score) educational needs scores were 56% for 'D-ENAT total score', 62% for 'Self-help measures', 60% for 'Disease process', 58% for 'Feelings', 56% for 'Treatments', 50% for 'Movement', 49% for 'Support systems' and 46% for 'Managing pain'. Being female was significantly associated with higher scoring on the D-ENAT total score (ß 23.0; 95% CI 5.9, 40.3). CONCLUSION: SLE patients demonstrated substantial educational needs, especially in the domains: 'Self-help measures', 'Disease process' and 'Feelings'. The validity and practical applicability of the D-ENAT to make an inventory of SLE patients' educational needs requires further investigation.

A multimedia model to estimate the environmental fate of microplastic particles.

Nano- and microplastic (NMP) is a diverse and challenging contaminant and data on NMP concentrations are therefore not fully available for all environmental compartments. For environmental assessments of NMP, screening-level multimedia models can fill this gap, but such models are not available. Here, we present SimpleBox4Plastic (SB4P) as the first multimedia 'unit world' model capable of addressing the full NMP continuum, explore its validity, and evaluate it based on a case study for microbeads and by comparisons with (limited) concentration data. SB4P links NMP transport and concentrations in and across air, surface water, sediment, and soil, taking into account processes such as attachment, aggregation, and fragmentation, by solving mass balance equations using matrix algebra. These link all concentrations and processes known to be relevant for NMP using first-order rate constants, which are obtained from the literature. The SB4P model, as applied to microbeads, provided mass or number concentrations of NMP as the total of 'free' particles, heteroaggregates with natural colloids, and larger natural particles in each compartment at steady state. Processes most relevant in explaining observed Predicted Exposure Concentrations (PECs) were determined using rank correlation analysis. Although the predicted PECs remained uncertain due to the propagating uncertainty, inferences regarding these processes and relative distribution across compartments can be considered robust.

Physical activity after mild traumatic brain injury: What are the relationships with fatigue and sleep quality?

OBJECTIVES: To determine self-reported physical activity (PA) levels and relationships with fatigue and sleep quality in adolescents and young adults after mild traumatic brain injury (mTBI). SETTING: Follow-up 6-18 months after visiting the emergency department of one of 2 general hospitals. PARTICIPANTS: Forty-nine adolescents and young adults aged 12-25 years (mean 18.4 years), 22 (45%) male with mTBI. DESIGN: Cross-sectional survey study. MAIN OUTCOME MEASURES: The Activity Questionnaire for Adults and Adolescents (AQuAA), with results dichotomized into meeting or not meeting Dutch Health Enhancing PA recommendations (D-HEPA), the Checklist Individual Strength (CIS, 4 subscores) and the Pittsburgh Sleep Quality Index (PSQI, total score) were administered. RESULTS: Twenty-five participants (51%) did not meet the D-HEPA recommendations. After adjusting for sex, BMI and age, not meeting the recommendations was associated with a higher CIS Total Score (OR 1.04 95%CI 1.01, 1.07) but not with PSQI Total Score (OR 0.99, 95%CI 0.80, 1.21). CONCLUSIONS: In adolescents and young adults with mTBI the level of reported PA is associated with fatigue but not with sleep quality. It remains to be established whether interventions aiming to promote PA should primarily be focused on PA or fatigue or both.

Illness perceptions of stroke survivors: Predictors and changes over time - A 1 year follow-up study.

OBJECTIVE: To describe the illness perceptions (IP) of stroke patients in the first year post stroke; to identify patient clusters with comparable IP trajectories and determine their associations with health. METHODS: This prospective study included consecutive stroke patients after medical rehabilitation. Three and 12 months post stroke they completed the Brief Illness Perception Questionnaire (B-IPQ) and questionnaires on physical and mental health. All eight IP and their changes over time were described. Clusters of patients with comparable IP trajectories were constructed by k-means clustering, with subsequent comparison of patient characteristics. Multivariable logistic regression analyses were conducted to determine the association between IP clusters and 12-month mental health. RESULTS: Hundred-and-eighty-four patients were included (men n = 107 [58.2%]; mean age 61.1 [SD 12.7] years). At 3 months, the scores of the IP coherence (mean 3.0, SD 2.3) and treatment control (mean 3.2, SD 2.5) were lowest (best), and consequences (mean 6.1, SD 2.8) and anticipated timeline (mean 6.0, SD 2.7) were highest (worst). At 12 months, the timeline and treatment control scores had significantly worsened. Three clusters of the trajectories of IP were identified, and designated as 'favourable', 'average', and 'unfavourable'. The unfavourable cluster was significantly associated with worse physical and mental health at 3 months (unadjusted) and depressive symptoms at 12 months. CONCLUSION: Stroke patients' IP partly changed between 3 and 12 months post stroke. Patients with an unfavourable IP trajectory had a higher chance of depressive symptoms at 12 months. Illness perceptions could be considered as an additional target of treatment.

The patient perspective on the use of information and communication technologies and e-health in rehabilitation.

INTRODUCTION: Success of e-health relies on the extent to which the related technology, such as the electronic device, is accepted by its users. However, there has been limited research on the patients' perspective on use of e-health-related technology in rehabilitation care. OBJECTIVE: To explore the usage of common electronic devices among rehabilitation patients with access to email and investigate their preferences regarding their usage in rehabilitation. METHODS: Adult patients who were admitted for inpatient and/or outpatient rehabilitation and were registered with an email address were invited to complete an electronic questionnaire regarding current and preferred use of information and communication technologies in rehabilitation care. RESULTS: 190 out of 714 invited patients completed the questionnaire, 94 (49%) female, mean age 49 years (SD 16). 149 patients (78%) used one or more devices every day, with the most frequently used devices were: PC/laptop (93%), smartphone (57%) and tablet (47%). Patients mostly preferred to use technology for contact with health professionals (mean 3.15, SD 0.79), followed by access to their personal record (mean 3.09, SD 0.78) and scheduling appointments with health professionals (mean 3.07, SD 0.85). CONCLUSION: Most patients in rehabilitation used one or more devices almost every day and wish to use these devices in rehabilitation. Implications for Rehabilitation In a sample of 190 patients in rehabilitation with access to email, almost all patients used one or more electronic devices almost every day of the week, with the most frequently used devices were: a PC/laptop, smartphone and tablet. Most of the patients wish to incorporate electronic devices in their rehabilitation process and prefer to use those devices to have insight in their health record, communication with peers and scheduling appointments with health professionals. To better assist patients with e-health in rehabilitation care in the future, preferences could be implemented in rehabilitation care by using the most commonly used devices.

Cytomegalovirus pleuropericarditis after orthotopic liver transplantation.

Cytomegalovirus (CMV) reactivation is a common complication after liver transplantation. In patients with CMV infection, indicated by a positive CMV DNA titer, the presence of any clinical symptom is termed CMV disease. The most common organ affected in CMV disease is the gastrointestinal tract, causing esophagitis, gastritis, enteritis or colitis. CMV infection of the pleura and pericard has been reported in immunocompromised patients, but is rarely seen following liver transplantation.We report a case of a 59-year-old male who developed CMV pleuropericarditis after liver transplantation. Initial ganciclovir treatment did not improve the patient's symptoms and therapy was switched to Foscarnet which ultimately resulted in resolution of infection. However, a few weeks after Foscarnet cessation, the patient again developed bilateral pleural effusion. Ultimate biochemical and clinical response was achieved with IV ganciclovir treatment. The patient was discharged from the hospital with oral Valganciclovir for 3 weeks and has since remained relapse free for >1 year.

Why the uptake of eRehabilitation programs in stroke care is so difficult-a focus group study in the Netherlands.

BACKGROUND: The uptake of eRehabilitation programs in stroke care is insufficient, despite the growing availability. The aim of this study was to explore which factors influence the uptake of eRehabilitation in stroke rehabilitation, among stroke patients, informal caregivers, and healthcare professionals. METHODS: A qualitative focus group study with eight focus groups (6-8 participants per group) was conducted: six with stroke patients/informal caregivers and two with healthcare professionals involved in stroke rehabilitation (rehabilitation physicians, physical therapists, occupational therapists, psychologists, managers). Focus group interviews were audiotaped, transcribed in full, and analyzed by direct content analysis using the implementation model of Grol. RESULTS: Thirty-two patients, 15 informal caregivers, and 13 healthcare professionals were included. A total of 14 influencing factors were found, grouped to 5 of the 6 levels of the implementation model of Grol (Innovation, Organizational context, Individual patient, Individual professional, and Economic and political context). Most quotes of patients, informal caregivers, and healthcare professionals were classified to factors at the level of the Innovation (e.g., content, attractiveness, and feasibility of eRehabilitation programs). In addition, for patients, relatively many quotes were classified to factors at the level of the individual patient (e.g., patients characteristics as fatigue and the inability to understand ICT-devices), and for healthcare professionals at the level of the organizational context (e.g., having sufficient time and the fit with existing processes of care). CONCLUSION: Although there was a considerable overlap in reported factors between patients/informal caregivers and healthcare professionals when it concerns eRehabilitation as innovation, its seems that patients/informal caregivers give more emphasis to factors related to the individual patient, whereas healthcare professionals emphasize the importance of factors related to the organizational context. This difference should be considered when developing an implementation strategy for patients and healthcare professionals separately.

Adherence of stroke patients with an online brain training program: the role of health professionals' support.

Background Computer-based cognitive rehabilitation is used to improve cognitive functioning after stroke. However, knowledge on adherence rates of stroke patients is limited. Objective To describe stroke patients' adherence with a brain training program using two frequencies of health professionals' supervision. Methods This study is part of a randomized controlled trial comparing the effect of the brain training program (600 min playtime with weekly supervision) with a passive intervention in patients with self-perceived cognitive impairments after stroke. Patients randomized to the control condition were offered the brain training after the trial and received supervision twice (vs weekly in intervention group). Adherence was determined using data from the study website. Logistic regression analyses were used to examine the impact of supervision on adherence. Results 53 patients allocated to the intervention group (group S8; 64% male, mean age 59) and 52 patients who were offered the intervention after the trial (group S2; 59% male, mean age 59) started the brain training. The median playtime was 562 min (range 63-1264) in group S8 vs. 193 min (range 27-2162) in group S2 (p < 0.001, Mann Whitney U). Conclusions The overall adherence of stroke patients with a brain training was low and there are some implications that systematic, regular interaction with a supervisor can increase training adherence of stroke patients with a restitution-focused intervention performed at home.

Environmental contamination due to shale gas development.

Shale gas development potentially contaminates both air and water compartments. To assist in governmental decision-making on future explorations, we reviewed scattered information on activities, emissions and concentrations related to shale gas development. We compared concentrations from monitoring programmes to quality standards as a first indication of environmental risks. Emissions could not be estimated accurately because of incomparable and insufficient data. Air and water concentrations range widely. Poor wastewater treatment posed the highest risk with concentrations exceeding both Natural Background Values (NBVs) by a factor 1000-10,000 and Lowest Quality Standards (LQSs) by a factor 10-100. Concentrations of salts, metals, volatile organic compounds (VOCs) and hydrocarbons exceeded aquatic ecotoxicological water standards. Future research must focus on measuring aerial and aquatic emissions of toxic chemicals, generalisation of experimental setups and measurement technics and further human and ecological risk assessment.

Do rehabilitation tools cover the perspective of patients with rheumatoid arthritis? A focus group study using the ICF as a reference.

BACKGROUND: Despite the advocated use of rehabilitation tools in clinical rehabilitation of with rheumatoid arthritis (RA) patients, little is known about the representation of the patient perspective in these tools. AIM: Aim of the study was to explore the experiences of RA patients with rehabilitation and the coverage by rehabilitation tools. DESIGN AND POPULATION: Qualitative focus group study with RA patients about experiences with rehabilitation. SETTING: Rheumatology rehabilitation clinic of a Dutch university hospital. METHODS: Focus groups were tape recorded and transcribed verbatim. From the meaningful units, concepts were extracted and linked to the International Classification of Functioning, Disability and Health (ICF). Rehabilitation tools validated for RA were identified using a structured literature search. Using the ICF as common framework, we determined for each concept identified in the focus groups the coverage by each rehabilitation tool. RESULTS: Nineteen patients participated in 4 focus groups. Fifty-one concepts were identified in 368 meaningful units derived from the transcribed data. From the literature the ICF Core Sets for RA, Canadian Occupational Performance Measure, Rehabilitation Activities Profile and WHO Disability Assessment Schedule II were elected. The concepts from the focus groups were best covered by the ICF Core Sets (44 out of 51; 86%), followed by the WHODAS II (39%), RAP (35%) and COPM (16%). CONCLUSION: With the exception of the ICF Core Sets for RA, current rehabilitation tools poorly cover the RA patients' perception on rehabilitation. CLINICAL REHABILITATION IMPACT: The ICF Core Sets can serve as a checklist to guide multidisciplinary assessment, goal-setting and evaluation in RA rehabilitation.