Early termination in interdisciplinary pain rehabilitation: numbers, timing, and reasons. A mixed method study.

PURPOSE: To analyse the number of, timing of, and reasons for early termination of interdisciplinary pain rehabilitation (IPR). METHODS: A multicentre study in two Dutch rehabilitation centres with a mixed method design. Quantitative part: retrospective patient file review of all IPR patients. Qualitative part: 20 semi-structured patient interviews with early IPR terminators. RESULTS: One hundred and thirty-seven of 428 participants (31.3%) had terminated IPR early, of which almost 30% had a positive reason. Of a planned treatment duration of 12 weeks, the median (interquartile range (IQR)) reduction was 5.3 week (3.0; 8.0). Over 80% of the early terminators with negative reasons stopped in the first half of IPR, whereas approximately 55% of the early terminators with positive reasons stopped in the final quarter of IPR. A discrepancy between patient expectations of the aim and content and the actual IPR was mentioned as a negative reason for early termination. Many of the positive early terminators were able to self-manage. CONCLUSIONS: Previously reported figures on early termination were confirmed. Early termination of IPR should not be considered negative per se, because a substantial proportion of early terminations have a positive reason. Negative early terminators tend to stop earlier during IPR, compared to positive terminators.Implications for rehabilitationSubstantial rates of patients (31%) terminate interdisciplinary pain rehabilitation (IPR) earlier than planned.Early IPR termination should not be considered negative per se, because a substantial proportion of early terminations have a positive reason (i.e. goals achieved early).Although patients receive extensive personalised information about aim and content of IPR before starting, early terminators with a negative reason often have different expectations about the aim and content of treatment.Clinicians and researchers should be focused on how to explain IPR to the patient and check whether the patient has understood it well and is convinced of its credibility.

Effects of ankle foot orthoses on body functions and activities in people with floppy paretic ankle muscles: a systematic review.

BACKGROUND: People with floppy ankle muscles paresis use ankle foot orthoses to improve their walking ability. Ankle foot orthoses also limit ankle range of motion thereby introducing additional problems. Insight in effects of ankle foot orthoses on body functions and activities in people with floppy paretic ankle muscles aids in clinical decision making and may improve adherence. METHODS: Studies published before October 27th, 2014, were searched in Pubmed, Embase, Cinahl, and Cochrane Library. Studies evaluating effects of ankle foot orthoses on body functions and/or activities in people with floppy paretic ankle muscles were included. Studies solely focusing on people with spastic paretic ankle muscles were excluded. Study quality was assessed using a custom-made scale. Body functions and activities were defined according to the International Classification of Functioning, Disability and Health. FINDINGS: Twenty-four studies were included, evaluating 394 participants. Participants were grouped according to paresis type (i) dorsiflexor paresis, (ii) plantar flexor paresis, (iii) both dorsiflexor and plantar flexor paresis. Dorsal, circular, and elastic ankle foot orthoses increased dorsiflexion during swing (by 4-6°, group i). Physical comfort with dorsal ankle foot orthoses was lower than that with circular ankle foot orthoses (groups i and iii). Dorsal ankle foot orthoses increased push-off moment (by 0.2-0.5 Nm/kg), increased walking efficiency, and decreased ankle range of motion (by 12-30°, groups ii and iii). INTERPRETATION: People with dorsiflexor paresis benefit more from circular and elastic ankle foot orthoses while people with plantar flexor paresis (and dorsiflexor paresis) benefit more from dorsal ankle foot orthoses.

Methodological quality of a systematic review on physical therapy for temporomandibular disorders: influence of hand search and quality scales.

The validity of a systematic review depends on completeness of identifying randomised clinical trials (RCTs) and the quality of the included RCTs. The aim of this study was to analyse the effects of hand search on the number of identified RCTs and of four quality lists on the outcome of quality assessment of RCTs evaluating the effect of physical therapy on temporomandibular disorders. In addition, we investigated the association between publication year and the methodological quality of these RCTs. Cochrane, Medline and Embase databases were searched electronically. The references of the included studies were checked for additional trials. Studies not electronically identified were labelled as "obtained by means of hand search". The included RCTs (69) concerning physical therapy for temporomandibular disorders were assessed using four different quality lists: the Delphi list, the Jadad list, the Megens & Harris list and the Risk of Bias list. The association between the quality scores and the year of publication were calculated. After electronic database search, hand search resulted in an additional 17 RCTs (25%). The mean quality score of the RCTs, expressed as a percentage of the maximum score, was low to moderate and varied from 35.1% for the Delphi list to 54.3% for the Risk of Bias list. The agreement among the four quality assessment lists, calculated by the Interclass Correlation Coefficient, was 0.603 (95% CI, 0.389; 0.749). The Delphi list scored significantly lower than the other lists. The Risk of Bias list scored significantly higher than the Jadad list. A moderate association was found between year of publication and scores on the Delphi list (r = 0.50), the Jadad list (r = 0.33) and the Megens & Harris list (r = 0.43).

Dose-response relationship between periodontal inflamed surface area and HbA1c in type 2 diabetics.

BACKGROUND: A dose-response relationship between the amount of inflamed periodontal tissue and HbA1c level, might be indicative for a causal association between periodontitis and type 2 diabetes. AIM: To assess a dose-response relationship between the periodontal inflamed surface area (PISA), as a measure of the amount of inflamed periodontal tissue, and HbA1c levels in type 2 diabetics. MATERIAL AND METHODS: Forty consecutive dentate type 2 diabetics attending their general practitioner for regular check-up, underwent full-mouth probing pocket depth and bleeding on probing assessment. From these data PISA was calculated. HbA1c levels were retrieved from patients' medical files. The dose-response relationship between PISA and HbA1c levels was assessed using multiple linear regression analyses, controlling for factors that might influence PISA or HbA1c levels. RESULTS: The higher the PISA of type 2 diabetics was, the higher their HbA1c levels were. On a group level, an increase of PISA with 333 mm(2) was associated with a 1.0 percentage point increase of HbA1c, independent of the influence of other factors. CONCLUSION: On a group level, there is a dose-response relationship between PISA and HbA1c in type 2 diabetics. This might be an indication of a causal relationship between type 2 diabetes and periodontitis.

Periodontal inflamed surface area: quantifying inflammatory burden.

BACKGROUND: Currently, a large variety of classifications is used for periodontitis as a risk factor for other diseases. None of these classifications quantifies the amount of inflamed periodontal tissue, while this information is needed to assess the inflammatory burden posed by periodontitis. AIM: To develop a classification of periodontitis that quantifies the amount of inflamed periodontal tissue, which can be easily and broadly applied. MATERIAL AND METHODS: A literature search was conducted to look for a classification of periodontitis that quantified the amount of inflamed periodontal tissue. A classification that quantified the root surface area affected by attachment loss was found. This classification did not quantify the surface area of inflamed periodontal tissue, however. Therefore, an Excel spreadsheet was developed in which the periodontal inflamed surface area (PISA) is calculated using clinical Attachment Level (CAL), recessions and bleeding on probing (BOP). RESULTS: The PISA reflects the surface area of bleeding pocket epithelium in square millimetres. The surface area of bleeding pocket epithelium quantifies the amount of inflamed periodontal tissue. A freely downloadable spreadsheet is available to calculate the PISA. CONCLUSION: PISA quantifies the inflammatory burden posed by periodontitis and can be easily and broadly applied.