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1.
BMC Psychol ; 9(1): 155, 2021 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-34627397

RESUMO

BACKGROUND: People with a recent spinal cord injury (SCI) often follow intensive rehabilitation. Learning appropriate self-care, deal with their impairments and prevent secondary health conditions (SHCs), is highly important during rehabilitation. To date it is not clear how self-care skills are taught to people with SCI. The objective of this study was to understand how people with SCI experienced the learning of appropriate self-care skills during inpatient rehabilitation, including the role of the rehabilitation team. METHODS: Individual semi-structured interviews were conducted with 15 people with SCI, recently discharged from initial inpatient rehabilitation. Interviews were audio-taped, transcribed and analyzed thematically. RESULTS: Two main themes and seven sub-themes were identified. Participants stated that the contribution of the rehabilitation team to learning self-care, including prevention of SHCs, was mostly made by optimizing opportunities to learn through experience. For preventing SHCs, education and lessons learned from the professionals during therapy and the formal educational program, was experienced as especially important. Further, the motivational attitude of the professionals which participants found stimulating and was based on respect, combined with their positive contribution as one team, were seen as essentials elements for learning appropriate self-care. However participants did not recognize the contribution of the nursing staff as part of their rehabilitation, although it was seen as very important. An important aspect of the participants' own contribution was challenging oneself to learn self-care. This was done in different ways by the participants. Further, their own mental adjustment was considered important in the learning process. The gaining of confidence was by most participants seen as personal characteristic, although they also recognized the importance of the team effort and the experiences they underwent. CONCLUSIONS: Learning appropriate self-care was mostly done through experience, by challenging themselves, and making use of the opportunities given by the members of the rehabilitation team. The same strategies used by the rehabilitation team to teach people with SCI to perform appropriate self-care, were also helpful for the participants to gain confidence. Explicit attention for self-care training as an important goal in SCI rehabilitation may strengthen the nursing staff's role and stimulate interdisciplinary working.


Assuntos
Autocuidado , Traumatismos da Medula Espinal , Humanos , Pacientes Internados , Pesquisa Qualitativa
2.
Phys Ther ; 2021 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-34636920

RESUMO

OBJECTIVE: To gain insight into the changes in psychological factors during rehabilitation after Achilles tendon rupture (ATR) and to explore the association between psychological factors during rehabilitation and functional outcome 12 months after ATR. METHODS: Fifty patients clinically diagnosed with ATR were invited to visit the hospital 3, 6, and 12 months after injury for data collection. They completed questionnaires assessing psychological factors: psychological readiness to return to sport (Injury Psychological Readiness to Return to Sport Questionnaire), kinesiophobia (Tampa Scale for Kinesiophobia), expectations, motivation, and outcome measures related to symptoms and physical activity (Achilles Tendon Total Rupture Score), and sports participation and performance (Oslo Sports Trauma Research Centre Overuse Injury Questionnaire). To determine whether psychological factors changed over time, generalized estimating equation analyses were performed. Multivariate regression analyses were used to study the association between psychological factors at 3, 6, and 12 months and outcome measures at 12 months after ATR. RESULTS: Psychological readiness to return to sport improved, and kinesiophobia decreased significantly during rehabilitation. Psychological readiness at 6 and 12 months showed significant associations with sports participation and performance. Kinesiophobia at 6 months was significantly associated with symptoms and physical activity. Motivation remained high during rehabilitation and was highly associated with symptoms and physical activity, sports participation and performance. CONCLUSION: Psychological factors change during rehabilitation after ATR. Patients with lower motivation levels during rehabilitation, low psychological readiness to return to sports, and/or high levels of kinesiophobia at 6 months after ATR need to be identified. IMPACT: According to these results, psychological factors can affect the rehabilitation of patients with ATR. Physical therapists can play an important role in recognizing patients with low motivation levels and low psychological readiness for return to sport and patients with high levels of kinesiophobia at 6 months post-ATR. Physical therapist interventions to enhance motivation and psychological readiness to return to sport and to reduce kinesiophobia need to be developed and studied in the post-ATR population. LAY SUMMARY: If you have Achilles tendon rupture, your level of motivation, psychological readiness for return to sport, and fear of movement can affect your rehabilitation outcome. Your physical therapist can help you recognize these factors.

3.
BMC Musculoskelet Disord ; 22(1): 769, 2021 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-34503484

RESUMO

BACKGROUND: Obesity is common in persons with a lower limb amputation, an amputation can also lead to further weight gain. Data regarding the prevalence of obesity in the Dutch population with a lower limb amputation are lacking. Furthermore, the impact of obesity on skin problems of the residual limb and the need of prosthetic repairs is unknown. The aim of this study was to determine the prevalence of obesity in Dutch persons with a lower limb amputation and to investigate the relationship between body weight, body mass index and skin problems of the residual limb and the frequency of prosthetic repairs. METHODS: A survey was performed among adults with a unilateral lower limb amputation due to any cause, and who are user of a prosthesis. The survey consisted of measurement of the subjects' body height and weight, a questionnaire which assessed self-reported skin problems in the previous month and factors potentially associated with these skin problems, and assessment of the frequency of visits to the orthopedic workshop. RESULTS: In total, 413 persons were enrolled. Of them, 39% (95 % confidence interval 35;44) were overweight and 28% (95% confidence interval 24;33) were obese. A total of 77% (95% confidence interval 73;81) reported one or more skin problems in the past month. Body weight and body mass index were neither associated with the presence of skin problems in general nor with the number of prosthetic repairs. Persons with severe skin problems had a slightly lower body mass index (26.6 kg/m2 vs. 28.0 kg/m2, p = 0.012). Persons with skin problems were younger than those without (difference in means 6.0 years (95% confidence interval 3.0;8.9)). CONCLUSIONS: Our findings show that obesity is common in the Dutch ambulant population with a lower limb amputation, with a prevalence being higher than in the general Dutch adult population. However, its negative impact on the presence of skin problems and the frequency of prosthetic repairs may be limited.


Assuntos
Amputação , Membros Artificiais , Índice de Massa Corporal , Pele/patologia , Adulto , Humanos , Extremidade Inferior/cirurgia , Países Baixos , Implantação de Prótese
4.
BMC Sports Sci Med Rehabil ; 13(1): 75, 2021 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-34246299

RESUMO

BACKGROUND: To evaluate cycling participation and identify barriers and facilitators related to cycling participation in people with a lower limb amputation (LLA) in the Netherlands. METHODS: A questionnaire was sent to adults with a LLA between March and August 2019 to obtain information regarding prosthesis, individual's characteristics, amputation, cycling barriers and facilitators, and prosthetic satisfaction. The questionnaires were distributed via 8 orthopedic workshops, post and were given directly. To find cycling predictors, variables associated with cycling (p < 0.1) were entered into a logistic regression analysis. Non-significant variables were removed manually. RESULTS: Participants (n = 207, 71% males) had a mean age of 62.0 ± 13.0 years. The most frequent level of amputation was transtibial (42%), and trauma was the most frequent cause of amputation (43%). After the LLA, 141 participants (68%) cycled for recreation (80%), physical fitness (74%), and transport (50%). In the past six months, cyclists cycled for recreation (79%) and transport (66%). Most cycled less than once a day. Recreational cyclists cycled alone (75%) for a median duration of 45 min or 14 km per ride. Cyclists with a transportation purpose usually cycled to go shopping (80%) or to visit friends (68%), with a median duration of 20 min or five kilometers per ride. Cyclists reported more facilitators (median (IQR) = 5 (3, 7) than non-cyclists 0 (0, 3). The majority of cyclists reported a positive attitude toward cycling (89%) and cycled because of health benefits (81%). A dynamic foot (odds ratio: 5.2, 95% CI 2.0, 13.3) and a higher number of facilitators (odds ratio: 1.3, 95% CI 1.2, 1.5) positively predicted cycling, whereas the presence of other underlying diseases (odds ratio: 0.4, 95% CI 0.2, 0.9) negatively predicted cycling (R2: 40.2%). CONCLUSION: In the Netherlands, the majority of adults cycled after a LLA, mainly for recreational purposes. A dynamic foot, a higher number of facilitators, and no other underlying diseases increases the likelihood of cycling after a LLA. The results suggest that personal motivation and a higher mobility level could be the key to increasing cycling participation. Future research should determine the association between motivation, mobility levels, and cycling with a LLA.

5.
Phys Ther Sport ; 50: 145-152, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34015607

RESUMO

OBJECTIVE: to examine psychological factors during rehabilitation of patients with Achilles or patellar tendinopathy as well as the association between psychological factors and tendinopathy severity, sport participation, and satisfaction with activity level and tendon function. DESIGN: cross-sectional study. SETTING: online survey platform. PARTICIPANTS: 119 patients (mean age: 44 years (SD 14)) diagnosed with Achilles or patellar tendinopathy. MAIN OUTCOME MEASURES: A range of patient-reported psychological and outcome measures were recorded. Multivariate regression analyses were performed to establish the association between each psychological factor and outcome measures, adjusted for relevant confounders. RESULTS: Psychological readiness and confidence to return to sports (I-PRRS) and pain catastrophizing (PCS) were significantly associated with tendinopathy severity (modified VISA), sport participation(OSTRC-O), and satisfaction. Kinesiophobia (TSK) and the importance to patients of returning to pre-injury activity level were significantly associated with sports participation and satisfaction. CONCLUSION: The current study provides evidence of impairments in psychological factors during rehabilitation of patients with Achilles and patellar tendinopathy. Most investigated psychological factors were associated with tendinopathy severity, function, participation, and satisfaction. Physical therapists should recognize patients with lack of psychological readiness to return to sports and also patients with kinesiophobia or catastrophizing thoughts when experiencing pain.


Assuntos
Tendão do Calcâneo/lesões , Ligamento Patelar/lesões , Tendinopatia/psicologia , Tendinopatia/reabilitação , Tendão do Calcâneo/fisiopatologia , Adulto , Traumatismos em Atletas/fisiopatologia , Traumatismos em Atletas/psicologia , Traumatismos em Atletas/reabilitação , Catastrofização , Estudos Transversais , Medo , Feminino , Humanos , Controle Interno-Externo , Masculino , Pessoa de Meia-Idade , Ligamento Patelar/fisiopatologia , Medidas de Resultados Relatados pelo Paciente , Volta ao Esporte/psicologia , Tendinopatia/fisiopatologia
6.
Disabil Rehabil ; : 1-11, 2021 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-33970736

RESUMO

PURPOSE: This study aimed to explore factors that influence participants' perceptions of the therapeutic alliance with healthcare professionals; their participation in the alliance; and their commitment to treatment in a multidisciplinary pain rehabilitation setting. MATERIALS AND METHODS: A qualitative research-design was used and 26 participants in a multidisciplinary pain rehabilitation program were interviewed in-depth. RESULTS: Initially, participants reported to be satisfied with their healthcare professionals. After deeper reflection on the therapeutic alliance, several unspoken thoughts and feelings and relational ruptures emerged. Almost all participants mentioned a history of disappointing and fragmented healthcare, and they reported on how this affected their cognitions, perceptions, and beliefs about the current program. Participants felt insufficiently empowered to voice their concerns and regularly chose to avoid confrontation by not discussing their feelings. They felt a lack of ownership of their problems and did not experience the program as person-centered. CONCLUSIONS: Several factors were found that negatively influence the quality of therapeutic alliance (agreement on bond) and efficacy of the treatment plan (agreement on goals and tasks). To improve outcomes of pain rehabilitation, healthcare professionals should systematically take into account the perceptions and needs of participants, and focus more on personalized collaboration throughout the program offered.Implications for rehabilitationDifferences in perceptions and experiences of pain, together with differences in beliefs about the causes of pain, negatively influence the therapeutic alliance.When participants and healthcare professionals operate from different paradigms, it is important that they negotiate these differences.From the perspective of participants, a clear-cut organization of healthcare that encourages collaboration is required.It is important to focus on personalized collaboration from the start and during treatment, and to recognize and discuss disagreement on diagnosis and treatment plans.During this collaboration, healthcare professionals should systematically take into account the perceptions and needs of the participants.

7.
Disabil Rehabil ; : 1-11, 2021 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-33683989

RESUMO

PURPOSE: In persons with a hip or knee flexion contracture ≥25°, fitting a prosthesis is said to be difficult. This systematic review aims to assess the evidence for fitting of a prosthesis in persons with a severe contracture (≥25°) after a lower limb amputation. METHOD: PubMed, Embase, Scopus, CINAHL, and Orthotics & Prosthetics Virtual Library databases were searched from inception to December 2019, using database specific search terms related to amputation, prosthesis, and contracture. Reference lists of included studies were checked for relevant studies. Quality of the included studies was assessed using the critical appraisal checklist for case reports (Joanna Briggs Institute). RESULTS: In total, 13 case studies provided evidence for fitting of a prosthesis in more than 63 persons with a transtibial amputation and three with a transfemoral amputation, all of whom had a hip or knee flexion contracture ≥25°. Some studies found a reduction in contractures after prosthesis use. CONCLUSIONS: Several techniques for fitting a prosthesis in case of a flexion contracture ≥25° were found. Contracture reduction occurred in some cases and was possibly related to prosthesis use. Fitting a transtibial or transfemoral prosthesis in persons with a lower limb amputation with a severe flexion contracture is possible.IMPLICATIONS FOR REHABILITATIONThis study provides information on prosthesis prescriptions and adaptations for persons with a transfemoral and transtibial amputation with a flexion contracture ≥25°.The fitting of bent prostheses is not limited by prosthetic components and techniques.Parallel to the use of bent prostheses, it is also important to treat the contracture.

8.
BMC Psychol ; 8(1): 108, 2020 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-33076995

RESUMO

BACKGROUND: Self-efficacy is an important determinant of adjustment following spinal cord injury. Self-efficacy is defined as the belief that one can successfully execute behavior required to produce the desired outcomes. In its original conceptualization, self-efficacy refers to the confidence that people have in their ability to accomplish specific tasks and behaviors within a specific context. Over the years these situation specific aspects have been unconfined and multiple constructs of self-efficacy have been proposed. The most common is a division in trait and state self-efficacy. Another used division that is utilized is between general, domain-specific and task-specific self-efficacy. The scientific support for these constructs is to date still unclear. The objective of this study was to enhance the understanding of the self-efficacy construct by comparing four self-efficacy scales designed to measure three aspects of self-efficacy (general versus domain-specific versus task-specific) in people with spinal cord injury. METHODS: Dutch and Australian adults with spinal cord injury (N = 140) completed four frequently used self-efficacy scales; the Moorong Self-efficacy Scale, General Self-efficacy Scale, University of Washington Self-efficacy Scale and a Self-care Self-efficacy Scale approximately 6 months after their inpatient rehabilitation. Pearson correlations examined inter-relationships between the scales. RESULTS: Hypothesized strong correlations between scales measuring similar aspects of self-efficacy were found (correlations 0.50-0.65). However, the hypothesized weak to moderate correlations between scales measuring diverging aspects of self-efficacy were only partly found (correlations 0.31-0.74), with 7 out of 12 correlations being strong instead of moderate. CONCLUSIONS: The expected distinctions between the three aspects of self-efficacy was not demonstrated. All four scales measure a common latent construct, most likely general self-efficacy aspects. Further research is necessary to find ways to improve the measurement of domain-specific and task-specific aspects of SE, so that they are sensitive enough to capture change over time, and thus enhance clinical outcomes of people with SCI as they adjust to their disability.


Assuntos
Autoeficácia , Traumatismos da Medula Espinal/psicologia , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Psicometria , Reprodutibilidade dos Testes
9.
Med Hypotheses ; 143: 110134, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33017911

RESUMO

Major lower-limb amputation (LLA) is a life-changing event associated with poor post-operative physical and psychological functioning and decreased quality of life. The general physical condition of most LLA patients prior to surgery is already significantly deteriorated due to chronic peripheral vascular disease often in combination with diabetes. Pre-operative rehabilitation (also called 'pre-rehabilitation') is an increasingly common strategy used in multiple patient populations to improve patients' physical and mental condition prior to surgery, thus aiming at improving the post-operative patient outcomes. Given the positive effects of post-surgical outcomes in many patient populations, we hypothesize that pre-operative rehabilitation will improve post-operative outcomes after LLA. To test this hypothesis, a literature search of PubMed, EMBASE, EBSCOhost, Web of Science and ScienceDirect was performed to identify studies that investigated the impact of a pre-operative rehabilitation therapy on post-operative outcomes such as length of hospital stay, mobility, physical functioning, and health related quality of life. No time restrictions were applied to the search. Only articles published in English were included in the selection. Two studies satisfied the eligibility criteria for inclusion in the review, one qualitative and one quantitative study. The quantitative study reported a beneficial effect of pre-rehabilitation, resulting in post-operative mobility (at least indoor ambulation) in 63% of the included LLA patients. There is a need for prospective clinical studies examining the effect of pre-rehabilitation on post-operative outcomes to be able to confirm or reject our hypothesis. Although the hypothesis seems plausible, evidence is lacking to support our hypothesis that pre-operative rehabilitation will improve post-operative outcomes in patients with LLA. The qualitative study indicated that integrating pre-rehabilitation in the care for LLA patients seems to be limited to a selected group of dysvascular patients, but at this stage cannot be advised based on current evidence even in this subgroup. Further research is needed to clarify whether such an intervention prior to amputation would be a useful and effective tool for optimizing post-operative outcomes in LLA patients.


Assuntos
Extremidade Inferior , Qualidade de Vida , Amputação , Humanos , Extremidade Inferior/cirurgia , Exercício Pré-Operatório , Estudos Prospectivos
10.
J Rehabil Med ; 52(8): jrm00087, 2020 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-32735019

RESUMO

OBJECTIVE: To assess long-term outcomes of amputation in patients with long-standing therapy-resistant complex regional pain syndrome type I (CRPS-I). DESIGN: Partly cross-sectional, partly longitudinal study. SUBJECTS: Patients who had amputation of a limb due to long-standing, therapy-resistant CRPS-I, at the University Medical Centre Groningen, The Netherlands, between May 2000 and September 2015 (n = 53) were invited to participate. METHODS: Participants were interviewed in a semi-structured way regarding mobility, pain, recurrence of CRPS-I, quality of life, and prosthesis use. Those who reported recurrence of CRPS-I underwent physical examination. RESULTS: A total of 47 patients (median age at time of amputation, 41.0 years; 40 women) participated. Longitudinal evaluation was possible in 17 participants. Thirty-seven participants (77%) reported an important improvement in mobility (95% confidence interval (95% CI) 63; 87%). An important reduction in pain was reported by 35 participants (73%; 95% CI 59; 83%). CRPS-I recurred in 4 of 47 participants (9%; 95% CI 3; 20%), once in the residual limb and 3 times in another limb. At the end of the study of the 35 participants fitted with a lower limb prosthesis, 24 were still using the prosthesis. Longitudinal evaluation showed no significant deteriorations. CONCLUSION: Amputation can be considered as a treatment for patients with long-standing, therapy-resistant CRPS-I. Amputation can increase mobility and reduce pain, thereby improving the quality of patients' lives. However, approximately one-quarter of participants reported deteriorations in intimacy and self-confidence after the amputation.


Assuntos
Amputação/efeitos adversos , Síndromes da Dor Regional Complexa/cirurgia , Dor/etiologia , Qualidade de Vida/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Resultado do Tratamento
11.
Pediatr Transplant ; 24(7): e13803, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32860738

RESUMO

To determine prospectively gross and fine motor development of children <2 years of age, who undergo LTX. In this prospective study, children aged <2 years who undergo LTX were tested using the motor scale of the Bayley Scales of infant and toddler development, 3rd edition Dutch version. Testing was done during screening pre- and post-LTX: at the time of hospital discharge (2-6 weeks), at 3 months, 6 months, and 1 year. Z-scores were calculated. Twenty-nine children participated in this study, 14 boys, median age 6 months, at screening for LTX. Gross motor skills were delayed pre-LTX (Z-score -1.3). Fine motor skills were normal (Z-score 0.3). Immediately post-LTX, both skills reduced, and at 1 year post-LTX, gross motor skills Z-score was -1.0 and fine motor skills Z-score 0.0. Both gross and fine motor skills Z-scores decline post-LTX and tend to recover after 1 year, gross motor skills to low normal and fine motor skills to normal levels. Monitoring of gross motor development and attention on stimulating gross motor development post-LTX remains important, to enable participation in physical activity and sport for health benefits later in life.


Assuntos
Desenvolvimento Infantil/fisiologia , Hepatopatias/cirurgia , Transplante de Fígado , Destreza Motora/fisiologia , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos
12.
Disabil Rehabil ; : 1-21, 2020 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-32603198

RESUMO

Purpose: The aim of this study is to systematically review and critically assess the methodological quality of literature regarding prevalence, characteristics and factors influencing pain, other than phantom limb pain (PLP) in persons with lower limb amputation (LLA).Materials and methods: A systematic review was performed (PROSPERO CRD42019138018). Literature was searched using PubMed, EMBASE, PsycINFO, and PEDro. Studies were included if describing pain other than PLP at least three months after amputation. For residual limb pain (RLP) and back pain, a meta-regression was performed.Results: Fifty-one studies were included in which predominantly young males with a unilateral traumatic amputation using a prosthesis were investigated. Pooled prevalence of RLP was 0.51 (95% CI 0.40-0.62) with a positive association with presence of back pain (p = 0.044) in the univariate meta-regression. Pooled prevalence of back pain was 0.55 (95% CI 0.45-0.64), with a positive association of time since amputation (p < 0.001) and co-occurrence of RLP (p = 0.050).Conclusions: Back pain and RLP are common after LLA. The prevalence of back pain was positively associated with the presence of RLP, and vice versa. Future studies should give more attention to other chronic pain types, to persons with a diabetic or vascular cause of amputation, and to pain-related interference.Implications for RehabilitationBoth back pain and residual limb pain occur in more than 50% of persons with lower limb amputation (LLA), and both pain types are positively associated.Clinicians should be aware that chronic pain is common after LLA and can have a significant impact on the functioning of persons with LLA.Future research on this topic should give more attention to other chronic pain types, to persons with a diabetic or vascular cause of amputation, and to pain-related interference.

13.
PLoS One ; 15(4): e0230862, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32236117

RESUMO

INTRODUCTION: The way strength recovers after reduction of pediatric fractures of the upper extremity has not previously been the specific scope of research. This is remarkable, since strength measurements are often used as an outcome measure in studies on trauma of the upper extremity. The aim of this study was to evaluate how strength recovers after sustainment of fractures of the forearm, wrist or hand treated by closed or open reduction in children and adolescents in the first 6 months after trauma. How much strength is lost at 6 weeks, 3 months and 6 months after trauma, and is this loss significant? Are there differences in the pattern of recovery between children who underwent a different treatment? And finally, which of the following factors are associated with an increase in the ratio between affected grip strength and expected strength: type of fracture, cast immobilization, occurrence of complications, and degree of pain? DESIGN: Prospective observational study. PARTICIPANTS: Children and adolescents aged 4-18 years with a reduced fracture of the forearm, wrist or hand. METHODS: Grip strength, key grip and three-jaw chuck grip were measured twice in each hand 6 weeks, 3 months and 6 months after trauma. Details on fracture type and location, treatment received, cast immobilization and complications were obtained. Hand-dominance and pain were verbally confirmed. RESULTS: Loss of strength was more prominent and prolonged the more invasive the treatment, hence most extensive in the group receiving open reduction with internal fixation (ORIF), intermediate in the group receiving closed reduction with percutaneous pinning (CRIF), and least extensive in the group undergoing closed reduction without internal fixation (CR). Besides time passed, gender and age were of significant influence on strength, although there was no difference in pattern of recovery over time between children who received a different treatment. In the period of 6 weeks to 3 months after trauma, female gender, type of fracture sustained and occurrence of an unwanted event were associated with an increased ratio between affected and expected grip strength. For the later phase of recovery, between 3 and 6 months, this was only true for the occurrence of an unwanted event.


Assuntos
Traumatismos do Antebraço/reabilitação , Força da Mão , Recuperação de Função Fisiológica/fisiologia , Adolescente , Criança , Pré-Escolar , Redução Fechada , Feminino , Antebraço , Traumatismos do Antebraço/cirurgia , Fixação Interna de Fraturas , Mãos , Humanos , Masculino , Redução Aberta , Estudos Prospectivos , Fraturas do Rádio/cirurgia , Punho
14.
Int J Rehabil Res ; 43(1): 82-89, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31913184

RESUMO

The aim of this study is to determine the 15 most important daily activities according to persons with lower limb amputation (LLA) and healthcare professionals. Persons with LLA (n = 125) and healthcare professionals (n = 44) filled in a questionnaire. Participants had to select 10 items out of a list of 40 items on the domains activity and/or participation. Selection criterion was what they considered to be most important to perform independently and order the selected 10 items from most to least important. Mean rank scores of the 15 highest scored items according to participants with LLA were compared with the mean rank scores given by professionals, using the Mann-Whitney U test with a Hochberg adjustment for multiple testing. Participants with LLA rated five activities as significantly more important compared to professionals: 'driving a car', 'bicycling', 'ascending/descending stairs', 'heavy exercise', and 'preparing meals'. Healthcare professionals rated four activities as significantly more important compared to persons with LLA: 'going to the toilet', 'getting in and out bed', 'walking around outdoors', and 'walking around indoors'. A significant difference in rating importance was present in 9 out of 15 activities between persons with LLA and healthcare professionals. This result makes it all the more clear how complex shared decision making can be and how important it is for healthcare professionals to communicate with the person with LLA.


Assuntos
Atividades Cotidianas , Amputados , Terapeutas Ocupacionais , Fisioterapeutas , Atitude Frente a Saúde , Feminino , Humanos , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
15.
J Rehabil Med ; 52(1): jrm00008, 2020 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-31754724

RESUMO

OBJECTIVE: To report the rates of persons returning home within one year following dysvascular major amputation of the lower limb in the Netherlands, and to identify factors associated with returning home directly after hospital admission and after discharge to care facilities. DESIGN: Retrospective cohort study. PATIENTS: Dysvascular major amputation of the lower limb, n = 382, mean age 71.9 years (standard deviation (SD) 12.5 years), 65% male. METHODS: Medical records of all persons undergoing major amputation of the lower limb in 2012-2013 in 12 hospitals in Northern Netherlands were reviewed. Odds ratios (OR) were calculated using multivariate logistic regression. RESULTS: Among persons admitted from home and surviving the hospital admission, 21% returned home, with higher odds of returning home being associated with living with a partner (OR = 2.8, p = 0.006) and younger age (< 65 years). Among those discharged to care and surviving the first year, 77% returned home within one year after amputation, with higher odds being associated with younger age (<75 years) and admission to inpatient rehabilitation (OR = 10.6, p = 0.004) or geriatric rehabilitation in skilled nursing facilities (OR = 3.5, p = 0.030). CONCLUSION: Four out of 5 persons surviving dysvascular major amputation of the lower limb return home within one year, although a majority requires care in either inpatient rehabilitation or a skilled nursing facilities setting.


Assuntos
Amputação/reabilitação , Extremidade Inferior/cirurgia , Idoso , Feminino , Humanos , Masculino , Países Baixos , Estudos Retrospectivos
16.
Ann Vasc Surg ; 64: 228-238, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31629839

RESUMO

BACKGROUND: Historically, mortality rates after major lower limb amputations (LLAs) have been very high. However, there are inconsistencies regarding the risk factors. The reamputation rate after major LLAs is largely unknown. The aim of this study is to report the 30-day and 1-year mortality and 1-year reamputation rates after major LLA and to identify potential risk factors. METHODS: An observational cohort study in which all patients undergoing dysvascular major LLA in 2012-2013 in 12 hospitals in the northern region of the Netherlands is included. RESULTS: Of total 382 patients, who underwent major LLA, 65% were male and the mean age (standard deviation [SD]) was 71.9 ± 12.5 years. Peripheral arterial disease was observed in 88% and diabetes mellitus (DM), in 56% of patients. No revascularization or prior LLA on the amputated side was observed among 26%, whereas 56% had no minor or major LLA on either limb before the study period. The 30-day and 1-year mortality rates were 14% and 34%, respectively. Patients aged 75-84 and >85 years had 3-4 times higher odds of dying within 1 year. Transfemoral amputations (odds ratio [OR], 2.2), history of heart failure (OR, 2.3), myocardial infarction (OR, 1.7), hemodialysis (OR, 5.7), immunosuppressive medication (OR, 2.8), and guillotine amputations (OR, 5.1) were independently associated with 1-year mortality. Twenty-six percent underwent ipsilateral reamputation within 1 year, for which no risk factors were identified. CONCLUSIONS: The mortality rate in the first year after major LLA is high, particularly among those undergoing transfemoral amputations, which is likely to be indicative of more severe vascular disease. Higher mortality among the most elderly patients, those with more severe cardiac disease and who underwent hemodialysis reflects the frailty of this population. Interestingly, DM, revascularization history, and prior minor or major LLA were not associated with mortality rates.


Assuntos
Amputação/mortalidade , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Amputação/efeitos adversos , Criança , Pré-Escolar , Comorbidade , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/mortalidade , Reoperação , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
17.
Disabil Rehabil ; 42(26): 3752-3761, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-31079510

RESUMO

Purpose: Evidence for efficacy of early intervention in infants at high risk of cerebral palsy (CP) is limited. We compared outcome of infants at very high risk of CP after receiving the family centered program COPing with and CAring for infants with special needs (COPCA) or typical infant physiotherapy.Materials and methods: Forty-three infants were randomly assigned before the corrected age of 9 months to 1 year of COPCA (n = 23) or typical infant physiotherapy (n = 20). Neuromotor development, cognition, and behavior was assessed until 21 months corrected age. Video-recorded physiotherapy sessions were quantitatively analyzed for further process analyses. Outcome was evaluated with nonparametric tests and linear mixed effect models.Results: During and after the interventions, infant outcome in both intervention groups was similar [primary outcome Infant Motor Profile: COPCA 82 (69-94), typical infant physiotherapy 81 (69-89); Hodges Lehman estimate of the difference 0 (confidence interval -5;4)]. Outcome was not associated with contents of intervention.Conclusions: One year of COPCA and 1 year of typical infant physiotherapy in infants at high risk of CP resulted in similar neurodevelopmental outcomes. It is conceivable that combinations of active ingredients from different approaches are needed for effective early intervention.IMPLICATIONS FOR REHABILITATIONFor infants at very high risk of cerebral palsy, 1 year of intervention with the family-centred programme Coping with and Caring for infants with special needs resulted in similar infant outcome as 1 year of typical infant physiotherapy.Infant's neuromotor, cognitive, and behavioural outcome was not associated with specific interventional elements, implying that the various elements may have a similar effect on developmental outcome.We suggest that a specific mix of ingredients of different approaches may work best, resulting in comprehensive care including both infant and family needs.


Assuntos
Paralisia Cerebral , Desenvolvimento Infantil , Cognição , Intervenção Educacional Precoce , Humanos , Lactente , Modalidades de Fisioterapia
18.
Disabil Rehabil ; 42(26): 3762-3770, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-31141410

RESUMO

Purpose: To compare family and functional outcome in infants at very high risk of cerebral palsy, after receiving the family centred programme "Coping with and Caring for infants with special needs (COPCA)" or typical infant physiotherapy.Materials and methods: Forty-three infants at very high risk were included before 9 months corrected age and randomly assigned to one year COPCA (n = 23) or typical infant physiotherapy (n = 20). Family and infant outcome were assessed before and during the intervention. Physiotherapy intervention sessions were analysed quantitatively for process analysis. Outcome was evaluated with non-parametric tests and linear mixed-effect models.Results: Between-group comparisons revealed no differences in family and infant outcomes. Within-group analysis showed that family's quality of life improved over time in the COPCA-group. Family empowerment was positively associated with intervention elements, including "caregiver coaching."Conclusions: One year of COPCA or typical infant physiotherapy resulted in similar family and functional outcomes. Yet, specific intervention elements, e.g., coaching, may increase empowerment of families of very high risk infants and may influence quality of life, which emphasizes the importance of family centred services.Implications for rehabilitationOne year of the family centred programme "Coping with and a Caring for infants with special needs" compared with typical infant physiotherapy resulted in similar family outcome and similar functional outcome for the infants at very high risk for cerebral palsy.Specific contents of intervention, such as caregiver coaching, are associated with more family empowerment and increased quality of life.Emphasis on family needs is important in early intervention for infants at very high risk for cerebral palsy.


Assuntos
Paralisia Cerebral , Desenvolvimento Infantil , Intervenção Educacional Precoce , Humanos , Lactente , Modalidades de Fisioterapia , Qualidade de Vida
19.
Disabil Rehabil ; 42(6): 814-821, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-30563365

RESUMO

Purpose: To analyse the effects of interdisciplinary pain rehabilitation programmes with different dosages; care as usual versus short form.Methods: A single blinded, two armed, randomised controlled trial, with non-inferiority design was performed. All patients with chronic musculoskeletal pain referred to an outpatient multidisciplinary pain rehabilitation programme were eligible for this study. Only dosage differed, content was similar. The difference on Pain Disability Index was the primary outcome measure. Four points difference on Pain Disability Index was applied as a non-inferiority margin. Treatment effects within groups were expressed in standardised mean difference and effect sizes were calculated between the groups.Results: Because care as usual was frequently extended, the difference in dosage between groups was limited. The study was stopped prematurely because of an a-priori stopping rule. Interim analyses are presented. Both groups (care as usual n = 58, short form n = 54) improved significantly (mean Pain Disability Index change care as usual: -10.8; short form: -8.3). Mean difference between groups was 2.5 points (95% confidence interval was -2.2 to 7.3). Effect size between groups was 0.2.Conclusions: The 95% confidence interval for the difference in mean pain disability reduction exceeded the upper limit of the non-inferiority margin. The results of the primary analyses of this trial are, therefore, inconclusive. Ancillary analyses revealed that programme dosage was not associated with differences in the disability outcomes. Implications for rehabilitationOptimum dosage of interdisciplinary pain rehabilitation programs is unknown and scarcely studied. This study is the first to analyse dosage as primary aim.Although results are inconclusive, they also suggest that differences in dosage may not automatically lead to differences in effects.Further research is needed to analyse what dosage works for whom; to detect optimum effective and cost-effective dosage of pain rehabilitation programmes.


Assuntos
Dor Crônica/reabilitação , Dor Musculoesquelética/reabilitação , Manejo da Dor , Análise Custo-Benefício , Humanos
20.
Lymphat Res Biol ; 18(2): 110-115, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31429626

RESUMO

Background: The L-Dex U400 is a recently developed measurement device to aid in the clinical assessment of unilateral lymphedema. Until now, little is known about variation in measurement results of the L-Dex U400. The aim of this study was to determine variation in measurement results in determining extracellular fluid of the arm with the L-Dex U400 under different measurement conditions on 2 days and to determine the reliability of these measurements in healthy subjects. Methods and Results: Thirty participants were included. Participants were measured on 2 days, 2 weeks apart. Each day they were measured six times, 1st basic measurement, 2nd after a 10-minute rest period, 3rd second observer, 4th after drinking 200 mL of coffee and rest for 30 minutes on the examination couch, 5th after 30 minutes of cycling on an exercise bike at 50 W and 50-60 rounds per minute, and 6th after a 10-minute rest period. The variance due to participants was 68% of the total variance and 32% was error variance. Lin's concordance coefficient (CCC), a reliability measure, ranged from 0.935 (first day, 1st and 2nd measurement of observer 1) to 0.517 (first and second day after a 10-minute rest period after cycling). In two CCCs, the lower limits of the 95% confidence interval were higher than 0.750. Repeatability coefficient was smallest for the basic observations on day 2 (4.6) and largest after cycling (8.0). Conclusions: Clinical decision-making based on L-Dex U400 measurements should be regarded with caution because of moderate reliability.


Assuntos
Impedância Elétrica , Líquido Extracelular , Linfedema , Extremidade Superior/patologia , Humanos , Linfedema/diagnóstico , Reprodutibilidade dos Testes , Análise Espectral
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