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Maas MJM, van Dulmen SA, Sagasser MH, Heerkens YF, van der Vleuten CPM, Nijhuis-van der Sanden MWG, van der Wees PJ. Critical features of peer assessment of clinical performance to enhance adherence to a low back pain guideline for physical therapists: a mixed methods design. BMC MEDICAL EDUCATION 2015; 15:203. [PMID: 26563246 PMCID: PMC4643538 DOI: 10.1186/s12909-015-0484-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 11/03/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Clinical practice guidelines are intended to improve the process and outcomes of patient care. However, their implementation remains a challenge. We designed an implementation strategy, based on peer assessment (PA) focusing on barriers to change in physical therapy care. A previously published randomized controlled trial showed that PA was more effective than the usual strategy "case discussion" in improving adherence to a low back pain guideline. Peer assessment aims to enhance knowledge, communication, and hands-on clinical skills consistent with guideline recommendations. Participants observed and evaluated clinical performance on the spot in a role-play simulating clinical practice. Participants performed three roles: physical therapist, assessor, and patient. This study explored the critical features of the PA program that contributed to improved guideline adherence in the perception of participants. METHODS Dutch physical therapists working in primary care (n = 49) organized in communities of practice (n = 6) participated in the PA program. By unpacking the program we identified three main tasks and eleven subtasks. After the program was finished, a questionnaire was administered in which participants were asked to rank the program tasks from high to low learning value and to describe their impact on performance improvement. Overall ranking results were calculated. Additional semi-structured interviews were conducted to elaborate on the questionnaires results and were transcribed verbatim. Questionnaires comments and interview transcripts were analyzed using template analysis. RESULTS Program tasks related to performance in the therapist role were perceived to have the highest impact on learning, although task perceptions varied from challenging to threatening. Perceptions were affected by the role-play format and the time schedule. Learning outcomes were awareness of performance, improved attitudes towards the guideline, and increased self-efficacy beliefs in managing patients with low back pain. Learning was facilitated by psychological safety and the quality of feedback. CONCLUSION The effectiveness of PA can be attributed to the structured and performance-based design of the program. Participants showed a strong cognitive and emotional commitment to performing the physical therapist role. That might have contributed to an increased awareness of strength and weakness in clinical performance and a motivation to change routine practice.
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Hutting N, Staal JB, Engels JA, Heerkens YF, Detaille S, Nijhuis-van der Sanden MWG. Effect evaluation of a self-management programme for employees with complaints of the arm, neck or shoulder: a randomised controlled trial. Occup Environ Med 2015; 72:852-61. [DOI: 10.1136/oemed-2015-103089] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 08/11/2015] [Indexed: 11/04/2022]
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Viehoff PB, Pelzer L, Heerkens YF, van Ravensberg DC, Neumann M. Functioning in lymphoedema from the health professionals' perspective using the international classification of functioning, disability and health as a reference. Phlebology 2015; 31:554-63. [PMID: 26338844 DOI: 10.1177/0268355515603556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To capture the views of different health care providers involved in the treatment of patients with lymphoedema from various countries around the world on the functioning of lymphoedema patients and the factors influencing functioning of these patients using the international classification of functioning, disability and health (ICF). METHOD A worldwide e-mail survey with questions based on components of the ICF. RESULTS In total, 142 health professionals from seven different health professions and 20 different countries answered the questions. The aspects of functioning that were named by the health professionals could be linked to 359 different ICF categories. Of these categories, 109 belonged to body functions (30.4%), 55 to body structures (15.3%), 121 to activities and participation (33.7%) and 74 to environmental factors (20.6%). Overall, the most mentioned items were health services, systems and policies, immunological system functions, looking after one's health, products and technology for personal use in daily life and dressing. CONCLUSIONS The ICF provided a valuable reference for identifying concepts in statements from international health care professionals experienced in the treatment of lymphoedema patients. The results of this research will be used in the development of ICF core sets for lymphoedema.
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Hutting N, Detaille SI, Engels JA, Heerkens YF, Staal JB, Nijhuis-van der Sanden MW. Development of a self-management program for employees with complaints of the arm, neck, and/or shoulder: an intervention mapping approach. J Multidiscip Healthc 2015; 8:307-20. [PMID: 26170689 PMCID: PMC4492641 DOI: 10.2147/jmdh.s82809] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To develop a self-management program with an additional eHealth module, using the six steps of the intervention mapping (IM) protocol, to help employees with complaints of the arm, neck, and/or shoulder (CANS) cope with their problems. Methods In Step 1 of the IM protocol, a needs assessment was performed consisting of a review of the Dutch multidisciplinary guidelines on CANS, and of focus group sessions with employees with CANS (n=15) and with relevant experts (n=17). After the needs assessment, the objectives of the intervention and the determinants of self-management at work were formulated (Step 2). Furthermore, theory-based intervention methods and practical strategies were selected (Step 3), and an intervention program (including the eHealth module) was developed (Step 4). Finally, plans for implementation and evaluation of the program were developed (Steps 5 and 6). Results Step 1 of the IM protocol revealed that employees with CANS should be stimulated to search for information about the cause of their complaints, about how to deal with their complaints, and in which manner they can influence their complaints themselves. In Step 2, the overall goal of the intervention was defined as “self-management behavior at work” with the aim to alleviate the perceived disability of the participants. Step 3 described how the intervention methods were translated into practical strategies, and goal setting was introduced as an important method for increasing self-efficacy. The product of Step 4 was the final program plan, consisting of 6-weekly group sessions of 2.5 hours each and an eHealth module. In Step 5, a recruitment plan and course materials were developed, a steering committee was set up, trainers were recruited, and the final program was tested. In Step 6, an evaluation plan was developed, which consists of a randomized controlled trial with a 12-month follow-up period and a qualitative evaluation (interviews) with some of the participants. Conclusion This study resulted in a theory- and practice-based self-management program, based on behavioral change theories, guideline-related evidence, and practice-based knowledge that fits the needs of employees with CANS.
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Brouwers LAM, Engels JA, Heerkens YF, van der Beek AJ. Development of a Vitality Scan related to workers' sustainable employability: a study assessing its internal consistency and construct validity. BMC Public Health 2015; 15:551. [PMID: 26076659 PMCID: PMC4467054 DOI: 10.1186/s12889-015-1894-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 05/29/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most validated sustainable employability questionnaires are extensive and difficult to obtain. Our objective was to develop a usable and valid tool, a Vitality Scan, to determine possible signs of stagnation in one's functioning related to sustainable employability and to establish the instrument's internal consistency and construct validity. METHODS A literature review was performed and expert input was obtained to develop an online survey of 31 items. A sample of 1722 Dutch employees was recruited. Internal consistency was assessed by Cronbach's alpha. The underlying theoretical concepts were extracted by factor analysis using a principal component method. For construct validity, a priori hypotheses were defined for expected differences between known subgroups: 1) older workers would report more stagnation than younger workers, and 2) less educated workers would report more problems than the highly educated ones. Both hypotheses were statistically tested using ANOVA. RESULTS Internal consistency measures and factor analysis resulted in five subscales with acceptable to good reliability (Cronbach's alpha 0.72-0.87). These subscales included: balance and competence, motivation and involvement, resilience, mental and physical health, and social support at work. Three items were removed following these analyses. In accordance with our a priori hypothesis 1, the ANOVA showed that older workers reported the most problems, while younger workers reported the least problems. However, hypothesis 2 was not confirmed: no significant differences were found for education level. CONCLUSIONS The developed Vitality Scan - with the 28 remaining items - showed good measurement properties. It is applicable as a user-friendly, evaluative instrument for worker's sustainable employability. The scan's value for determining whether or not the employee is at risk for a decrease in functioning during present and future work, should be further tested.
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Hutting N, Engels JA, Staal JB, Heerkens YF, Nijhuis-van der Sanden MWG. Development of a self-management intervention for employees with complaints of the arm, neck and/or shoulder (CANS): a focus group study with experts. J Occup Med Toxicol 2015; 10:9. [PMID: 25745509 PMCID: PMC4349775 DOI: 10.1186/s12995-015-0051-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 02/18/2015] [Indexed: 11/20/2022] Open
Abstract
Background Many people suffer from complaints of the arm, neck and/or shoulder (CANS). The complaints are persistent and there is a need for intervention programs for those with longstanding CANS. Studies suggest that a behavioural change is needed in employees with CANS. A self-management program with an add-on eHealth module might be an effective option to achieve the behavioural change needed to manage the complaints in employees with CANS. The aim of this study was to determine the content and strategies of the intervention and to gain insight into possible barriers and facilitators for implementation. Therefore, we examined the views of experts on the problems and characteristics associated with employees with CANS as well as their opinion on a self-management program consisting of self-management sessions and an eHealth module. Methods A qualitative study was performed consisting of three focus groups involving a total of 17 experts (with experience with CANS, self-management and/or eHealth interventions). Experts were asked their opinion about the content and requirements of a self-management program for employees with CANS, including an eHealth module. Data were analysed using qualitative data analysis. After coding, the emergent themes were used to organise the data into main categories, expressing the ideas and opinions of experts on CANS, self-management and/or eHealth interventions. Results The experts pointed out that the intervention should focus on increasing employees’ self-efficacy and empowerment, and address topics related to the possible risk factors for CANS, symptoms, work environment, social environment and personal factors. The eHealth module should be self-explanatory and attractive, and the information provided should be brief, clear and concise. Conclusions Experts appeared to see a role for a self-management program for employees with CANS. They indicated that the combination of group sessions and eHealth can work well. Experts provided valuable information with regard to the content of the self-management intervention and the design of the eHealth module.
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Viehoff PB, Heerkens YF, Van Ravensberg CD, Hidding J, Damstra RJ, Ten Napel H, Neumann HAM. Development of consensus International Classification of Functioning, Disability and Health (ICF) core sets for lymphedema. Lymphology 2015; 48:38-50. [PMID: 26333213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
To understand the challenges of patients with lymphedema it is important to describe functioning and to measure the effectiveness of treatment in changing functioning. The International Classification of Functioning, Disability and Health (ICF) offers an international framework to classify functioning of persons in their personal environment. ICF Core Sets are lists of selected ICF categories concerning those important aspects of functioning that are most likely to be affected by a specific health problem or disease. These Core Sets make it easier and faster to describe and communicate the patient's problems and to define treatment goals. Furthermore, they are available to health care providers of all professions, researchers, health insurance companies and policy-makers. The objective of this document is to present the outcomes of a consensus conference held to determine the first versions of the ICF Core Sets for lymphedema. Frequency rankings were made of the ICF categories derived from four preparatory studies, being: a) a systematic review; b) a qualitative study; c) an expert survey; and d) a cross-sectional study. By means of working group discussions and plenary sessions, a final consensus on ICF categories was achieved and Comprehensive and Brief Core Sets for lymphedema for the upper limb, lower limb, and midline lymphedema were defined. These ICF Core Sets contain different items in each region. Future validation of these Core Sets for health professions and for countries is needed.
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Viehoff PB, Gielink PDC, Damstra RJ, Heerkens YF, van Ravensberg DC, Neumann MHA. Functioning in lymphedema from the patients' perspective using the International Classification of Functioning, Disability and health (ICF) as a reference. Acta Oncol 2015; 54:411-21. [PMID: 25152221 DOI: 10.3109/0284186x.2014.952389] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To identify and quantify meaningful concepts in lymphedema from the patients' perspectives using the International Classification of Functioning, Disability and Health (ICF). METHODS Six focus group interviews in five different centers were organized, audiotaped, transcribed verbatim and analyzed. RESULTS A total of 2681 relevant ICF linkings were performed with the focus group data, resulting in 130 different second-level categories. Of these 130 second-level categories, 41 (31.5%) categories were categorized as Body Functions, 20 (15.5%) as Body Structures, 41 (31.5%) as Activities and Participation, and 28 (21.5%) as Environmental Factors. Overall, the most important issues according to the patients were the use of hosiery and bandages, support and relationships, and the shape of structures related to movement. CONCLUSION Based on their experiences with lymphedema, patients reported activity limitations and participation restrictions combined with impaired body functioning. Anatomical changes (Body Structures) were also often mentioned as a problem in daily life. Environmental factors may act as a barrier or facilitator for patient functioning. The ICF provides a valuable reference to identify concepts in statements from lymphedema patients. The results of this research will be used in the development of ICF Core Sets for lymphedema.
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Viehoff PB, Potijk F, Damstra RJ, Heerkens YF, van Ravensberg CD, van Berkel DM, Neumann HAM. Identification of relevant ICF (International Classification of Functioning, Disability and Health) categories in lymphedema patients: A cross-sectional study. Acta Oncol 2015; 54:1218-24. [PMID: 25629588 DOI: 10.3109/0284186x.2014.1001873] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND To describe functioning and health of lymphedema patients and to identify their most common problems using the International Classification of Functioning, Disability and Health (ICF) as part of the preparatory studies for the development of ICF Core Sets for lymphedema. METHODS Cross-sectional study in a population of lymphedema patients (n = 200), undergoing treatment in a Dutch lymphedema-specialized hospital. The second-level categories of the ICF were used to collect information on patients' problems in daily functioning. RESULTS The mean age of the study group was 56 years (22-84). In total 78.5% of the patients were female. The most frequent mentioned items were: In the Body Functions component: muscle power and mobility of joints, in the Activities and Participation component: doing housework, and changing and maintaining a body position, in the Environmental Factors: Health professionals, who can act as both facilitators and barriers. Interestingly, patients assessed their health more positively than health professionals do. CONCLUSION By using the ICF, a considerable part of the broad spectrum of problems in functioning of lymphedema patients was reported.
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Koopman FS, Brehm MA, Heerkens YF, Nollet F, Beelen A. Measuring fatigue in polio survivors: content comparison and reliability of the Fatigue Severity Scale and the Checklist Individual Strength. J Rehabil Med 2014; 46:761-7. [PMID: 24941350 DOI: 10.2340/16501977-1838] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To compare the content of the Fatigue Severity Scale and the subscale "subjective experience of fatigue" of the Checklist Individual Strength, and (ii) to assess the reliability of both questionnaires in polio survivors. DESIGN Repeated-measures at a 3-week interval. SUBJECTS Consecutive series of 61 polio survivors. METHODS Concepts contained in the questionnaire items were linked to the International Classification of Functioning, Disability and Health (ICF), using standardized linking rules. Reliability analyses included tests of internal consistency, test-retest reliability and measurement error. RESULTS Questionnaires differed in the extent to which they measured other than fatigue-related aspects of functioning (represented ICF components: "Body functions": 50% and 80%, "Activities and Participation": 30% and 0%, for the Fatigue Severity Scale and Checklist Individual Strength, respectively). Internal consistency and test-retest reliability were considered acceptable, while measurement error was large (Cronbach's α: 0.90 and 0.93, intraclass correlation coefficient: 0.80 and 0.85, smallest detectable change: 28.7% and 29.4% for the Fatigue Severity Scale and Checklist Individual Strength, respectively). CONCLUSION Considering the acceptable clinimetric properties, we conclude that both the Fatigue Severity Scale and the Checklist Individual Strength can be applied in research on post-poliomyelitis syndrome when measuring fatigue. However, because the 2 questionnaires differ in content they cannot be used interchangeably.
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Maas MJM, Sluijsmans DMA, van der Wees PJ, Heerkens YF, Nijhuis-van der Sanden MWG, van der Vleuten CPM. Why peer assessment helps to improve clinical performance in undergraduate physical therapy education: a mixed methods design. BMC MEDICAL EDUCATION 2014; 14:117. [PMID: 24928420 PMCID: PMC4064265 DOI: 10.1186/1472-6920-14-117] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 06/02/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Peer Assessment (PA) in health professions education encourages students to develop a critical attitude towards their own and their peers' performance. We designed a PA task to assess students' clinical skills (including reasoning, communication, physical examination and treatment skills) in a role-play that simulated physical therapy (PT) practice. Students alternately performed in the role of PT, assessor, and patient. Oral face-to-face feedback was provided as well as written feedback and scores.This study aims to explore the impact of PA on the improvement of clinical performance of undergraduate PT students. METHODS The PA task was analyzed and decomposed into task elements. A qualitative approach was used to explore students' perceptions of the task and the task elements. Semi-structured interviews with second year students were conducted to explore the perceived impact of these task elements on performance improvement. Students were asked to select the elements perceived valuable, to rank them from highest to lowest learning value, and to motivate their choices. Interviews were transcribed verbatim and analyzed, using a phenomenographical approach and following template analysis guidelines. A quantitative approach was used to describe the ranking results. RESULTS Quantitative analyses showed that the perceived impact on learning varied widely. Performing the clinical task in the PT role, was assigned to the first place (1), followed by receiving expert feedback (2), and observing peer performance (3). Receiving peer feedback was not perceived the most powerful task element.Qualitative analyses resulted in three emerging themes: pre-performance, true-performance, and post-performance triggers for improvement. Each theme contained three categories: learning activities, outcomes, and conditions for learning.Intended learning activities were reported, such as transferring prior learning to a new application context and unintended learning activities, such as modelling a peer's performance. Outcomes related to increased self-confidence, insight in performance standards and awareness of improvement areas. Conditions for learning referred to the quality of peer feedback. CONCLUSIONS PA may be a powerful tool to improve clinical performance, although peer feedback is not perceived the most powerful element. Peer assessors in undergraduate PT education use idiosyncratic strategies to assess their peers' performance.
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Stallinga HA, Dijkstra PU, Bos I, Heerkens YF, Roodbol PF. The ambiguity of the concept of participation in measurement instruments: operationalization of participation influences research outcomes. Clin Rehabil 2014; 28:1225-36. [DOI: 10.1177/0269215514537092] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Objective: This study explores, based on the International Classification of Functioning, Disability and Health, the consequences of different operationalizations of participation in regression models predicting participation in one sample of patients. Design: Cross-sectional, comparative study. Setting: Department of Neurology of a University Hospital. Subjects: A total of 677 patients with a Neuromuscular Disease. Measures: Participation was measured using the Neuromuscular Disease Impact Profile questionnaire, the RAND-36 Item Health Survey (social functioning, role limitations—physical, role limitations—emotional) and the Impact on Participation and Autonomy questionnaire (autonomy outdoors, social relations). Potential predictors of participation included type of neuromuscular disease, body functions (measured with Neuromuscular Disease Impact Profile), activities (measured with Neuromuscular Disease Impact Profile), environmental factors (measured with Neuromuscular Disease Impact Profile), and personal factors (measured with the 13-item Sense of Coherence questionnaire). The results were controlled for patient characteristics. Results: Participation was statistically predicted by different determinants depending on the operationalization used for participation. Additionally, the regression coefficients differed significantly. Body functions and activities were predictors in five out of six operationalizations of participation. Sense of coherence predicted participation in all of the operationalizations. The explained variance of the different models ranged from 25% (RAND-36 role limitations—emotional) to 65% (Neuromuscular Disease Impact Profile). Conclusions: Different operationalizations of participation result in different prediction models. Lack of conceptual consensus makes participation an ambiguous concept in research, and this ambiguity makes evidence-based decisions directed at enhancing participation difficult. Participation needs to be operationalized in an unambiguous and standard way in order to improve the comparability of outcomes.
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Hutting N, Engels JA, Heerkens YF, Staal JB, Nijhuis-van der Sanden MWG. Development and measurement properties of the Dutch version of the Stanford Presenteeism Scale (SPS-6). JOURNAL OF OCCUPATIONAL REHABILITATION 2014; 24:268-277. [PMID: 23868673 DOI: 10.1007/s10926-013-9453-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To develop a Dutch version of the Stanford Presenteeism Scale (SPS-6) and examine the reliability and discriminant, discriminative and structural validity of the Dutch SPS-6 (DSPS-6). METHODS The original SPS-6 (English-language) was translated and adapted to the Dutch culture. Thirty participants filled in the DSPS-6 at baseline (T0) and after 5 days (T1). Internal consistency (Cronbach's alpha), test-retest reliability (Spearman's correlation coefficient, Spearman's rho), item-to-total correlations, discriminant validity (association with job stress and job satisfaction), discriminative validity (patients reporting a (work) disability compared with those indicating that they had no disability; Spearman's rho, t tests), structural validity (Varimax rotation with Kaiser Normalization) and floor and ceiling effects were examined. RESULTS Cronbach's alpha for the DSPS-6 was 0.89. Test-retest Spearman's rho was 0.82 (p < 0.01). Item-to-total correlations ranged from 0.60 to 0.82. Subjects reporting a work disability had significantly lower DSPS scores (discriminative validity). Spearman's rho for the DSPS-6 score and job satisfaction were 0.38 (p = 0.05; at T0) and 0.27 (at T1), respectively. Spearman's rho for the association between the DSPS-6 and job stress were -0.52 (p = 0.01; at T0) and -0.42 (p = 0.05; at T1), respectively (discriminant validity). The two factors derived from the principal components analysis account for 77.5 % of the variance of responses (structural validity). A ceiling effect was present. CONCLUSIONS The DSPS-6 showed good reliability and structural validity. The discriminative validity of the DSPS-6 is partly supported. The concept of presenteeism is not sufficiently distinct from the constructs of job stress and job satisfaction (discriminant validity). The results of the present study show that the adaptation of the SPS-6 into Dutch was successful. Further research on the reliability, validity and responsiveness of the DSPS-6 in a larger group of participants is recommended.
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Minis MAH, Satink T, Kinébanian A, Engels JA, Heerkens YF, van Engelen BGM, Nijhuis-van der Sanden MWG. How persons with a neuromuscular disease perceive employment participation: a qualitative study. JOURNAL OF OCCUPATIONAL REHABILITATION 2014; 24:52-67. [PMID: 23645359 DOI: 10.1007/s10926-013-9447-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION A qualitative study was carried out to understand how people with a slow progressive adult type neuromuscular disease (NMD) perceive employment participation. METHODS 16 paid employed persons with NMD were interviewed in open, in-depth interviews. Data were analyzed using the constant comparison method. RESULTS Four themes were identified in the analyses: (1) Experiences regarding the meaning of work; (2) Solving problems oneself; (3) Reaching a turning point; and (4) Taking into account environmental aspects. Persons with NMD highlighted benefits of staying at work as well as the tension they felt how to shape decisions to handle progressive physical hindrances in job retention. This study shows how participants at work with NMD were challenged to keep up appearances at work and at home, the tension felt around when and if to disclose, the effect of their condition on colleagues and work reorganisation challenges. Participants experienced that disclosure did not always make things better. With increasing disability participants' focus shifted from the importance of assistive products towards considerate colleague, in particular superior's willingness in supporting job retention. CONCLUSIONS Implications for health professionals might include awareness of the significant impact of changes in physical condition on employment. Timely communication and if appropriate referral to a health or occupational professional may empower employees with NMD to handle employment issues at a for themselves appropriate way. Assistive products and a supportive superior might enhance employment participation.
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Hutting N, Staal JB, Heerkens YF, Engels JA, Sanden MWGNVD. A self-management program for employees with complaints of the arm, neck, or shoulder (CANS): study protocol for a randomized controlled trial. Trials 2013; 14:258. [PMID: 23958154 PMCID: PMC3751728 DOI: 10.1186/1745-6215-14-258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 08/01/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Complaints of the arm, neck, or shoulder (CANS) have a multifactorial origin and cause considerable work problems, including decreased work productivity, sickness absence, and, ultimately, job loss. There is a need for intervention programs for people with CANS. Self-management is an approach used in chronic disease care to improve self-efficacy and wellness behaviors to facilitate participants to make informed choices and carry them out. This study will evaluate the effectiveness of a self-management program (including ehealth) and compare it to usual care among employees with chronic CANS (lasting >3 months). METHODS/DESIGN This is a randomized controlled trial in which 142 participants will be recruited and randomized (with pre-stratification) to either the intervention group (IG) or control group (CG). The IG will participate in a self-management program consisting of six group sessions and an ehealth module. The CG is allowed to use all usual care available. The primary outcome of the study is the self-reported disability of arm, shoulder, and hand, measured with the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Secondary outcomes include: absenteeism, pain in the previous week, quality of life, catastrophizing pain, self-efficacy, workstyle, presenteeism, fatigue, the use of usual care, and limitations experienced on the job. Data are collected at baseline and at 3, 6, and 12 months follow-up. DISCUSSION Following the process of intervention mapping we developed a self-management program to suit and alleviate the problems and needs of employees with CANS. A strength of the study is that our intervention is specifically tailored to match the needs of employees with CANS. The study also has some potential weaknesses (for example, use of co-interventions, combination of group sessions and ehealth, self-reporting of data and possible contamination, Hawthorne effect, and recall or information bias) which are discussed. TRIAL REGISTRATION The trial is registered with the Dutch Trial Register (http://www.trialregister.nlNTR3816): (January 2013). The first participant was randomized in September 2012.
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Detaille SI, Heerkens YF, Engels JA, van der Gulden JWJ, van Dijk FJH. Effect evaluation of a self-management program for dutch workers with a chronic somatic disease: a randomized controlled trial. JOURNAL OF OCCUPATIONAL REHABILITATION 2013; 23:189-99. [PMID: 23690087 DOI: 10.1007/s10926-013-9450-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE The objective of this study is to investigate the effect of a Self-Management Program for workers with a chronic disease. This program is based on the Chronic Disease Self-Management Program of Stanford University, modified for workers with a chronic somatic disease. METHODS In a randomized controlled trial, the effectiveness of a Self-Management Program was evaluated. Participants were randomly assigned to the experimental group (n = 57) and the control group (n = 47). The experimental group received an intervention, the control group received care as usual. Primary outcome measures were self-efficacy at work and the attitude towards self-management at work. Secondary outcomes were the SF-12 health survey questionnaire, job satisfaction and intention to change job. The results were measured at baseline, after the intervention and 8 months after the intervention. RESULTS The attitude towards self-management at work (enjoyment) improved after 8 months for the intervention group (p = 0.030). No other outcome variable differed significantly. As an interaction effect, it was found that low educated workers developed a better physical health quality (SF-12) in the intervention group compared with the control group. The attitude towards self-management at work (importance) improved in the intervention group for older and female workers and the attitude toward enjoying self-management at work improved for female workers only. CONCLUSION The results show that low educated workers, older workers and women benefit significantly more from the training than higher educated workers, younger workers and men.
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Wijlhuizen GJ, Perenboom RJM, Garre FG, Heerkens YF, van Meeteren N. Impact of multimorbidity on functioning: evaluating the ICF Core Set approach in an empirical study of people with rheumatic diseases. J Rehabil Med 2013; 44:664-8. [PMID: 22729794 DOI: 10.2340/16501977-1002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Chronic conditions can lead to considerable deterioration in functioning. Several condition-specific Core Sets, selections of categories from the International Classification of Functioning, Disability and Health (ICF), have been developed to facilitate the rehabilitation process. Considering the increase in patients with more than one specific condition, we evaluated the impact of multimorbidity on functioning and the implications for the Core Set approach. DESIGN Internet survey. SUBJECTS A total of 127 people with a rheumatic disease and 707 people with rheumatic disease and multimorbidity were included. METHODS Self-report information on chronic conditions and perceived functioning using the IMPACT-S (ICF Measure of Participitation and Activities Screener) questionnaire, measuring the ICF component activities and participation (32 items). RESULTS The mean number of reported serious limitations/restrictions was 5.6 (standard deviation (SD) 5.7) for respondents with rheumatic disease and 6.7 (SD 6.8) for respondents with rheumatic disease and multimorbidity (p < 0.05). Seventeen items were relevant (more than 20% of the respondents reported serious limitations/restrictions) for individuals with rheumatic disease and multimorbidity, and 12 items were relevant for individuals with rheumatic disease only. CONCLUSION Multimorbidity seriously aggravates the already existing functioning problems of people with rheumatic disease. We recommend that in the ICF Core Set approach more emphasis is given to systematic empirical analysis of the impact of multimorbidity on functioning.
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Minis MA, Cup EH, Heerkens YF, Engels JA, van Engelen BG, Oostendorp RA. Exploring employment in consultation reports of patients with neuromuscular diseases. Arch Phys Med Rehabil 2012; 93:2276-80. [PMID: 22543016 DOI: 10.1016/j.apmr.2012.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 04/12/2012] [Accepted: 04/15/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To explore consultation reports for patient and employment characteristics and recommendations on employment regarding patients with neuromuscular diseases (NMDs). DESIGN Retrospective study of multidisciplinary reports. SETTING An outpatient neuromuscular clinic at a university hospital. PARTICIPANTS Reports (N=102) of patients with NMDs. INTERVENTIONS Based on one-off consultations by occupational therapists, physical therapists, and speech therapists and a multidisciplinary meeting, recommendations were developed regarding therapy content and volume in primary care or rehabilitation settings. MAIN OUTCOME MEASURES A checklist has been developed to examine employment characteristics. A general questionnaire has been used including demographic variables and data on employment. RESULTS Of the 102 reports available, 86 were included for analysis. Sixty-nine reports contained information on employment. Thirty-seven patients (43%) with NMD were employed, most in white-collar or moderately strenuous jobs. Of the 37 employed patients, 28 (76%) worked using adaptations. Thirty-two (87%) had employment problems; of these, 15 (40%) needed improvement in 1 or more environmental factors. Twenty patients (54%) needed advice regarding participation in employment, of whom 19 were referred to primary care or rehabilitation settings for treatment to enhance employment participation. CONCLUSIONS Eighty percent of the included consultation reports contained information on employment. Less than half the patients with NMD were employed, most in office-related jobs, using some kind of adaptations. Nineteen of 20 patients who agreed to recommendations regarding therapy were adequately referred by occupational therapists and physical therapists for treatment of employment problems.
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Perenboom RJM, Wijlhuizen GJ, Garre FG, Heerkens YF, van Meeteren NLU. An empirical exploration of the relations between the health components of the International Classification of Functioning, Disability and Health (ICF). Disabil Rehabil 2012; 34:1556-61. [DOI: 10.3109/09638288.2011.647233] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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van der Mei SF, Dijkers MPJM, Heerkens YF. Participation as an outcome measure in psychosocial oncology: content of cancer-specific health-related quality of life instruments. Qual Life Res 2011; 20:1617-27. [PMID: 21479851 PMCID: PMC3220821 DOI: 10.1007/s11136-011-9900-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2011] [Indexed: 11/12/2022]
Abstract
PURPOSE To examine to what extent the concept and the domains of participation as defined in the International Classification of Functioning, Disability and Health (ICF) are represented in general cancer-specific health-related quality of life (HRQOL) instruments. METHODS Using the ICF linking rules, two coders independently extracted the meaningful concepts of ten instruments and linked these to ICF codes. RESULTS The proportion of concepts that could be linked to ICF codes ranged from 68 to 95%. Although all instruments contained concepts linked to Participation (Chapters d7-d9 of the classification of 'Activities and Participation'), the instruments covered only a small part of all available ICF codes. The proportion of ICF codes in the instruments that were participation related ranged from 3 to 35%. 'Major life areas' (d8) was the most frequently used Participation Chapter, with d850 'remunerative employment' as the most used ICF code. CONCLUSIONS The number of participation-related ICF codes covered in the instruments is limited. General cancer-specific HRQOL instruments only assess social life of cancer patients to a limited degree. This study's information on the content of these instruments may guide researchers in selecting the appropriate instrument for a specific research purpose.
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Detaille SI, Heerkens YF, Engels JA, van der Gulden JWJ, van Dijk FJH. Common prognostic factors of work disability among employees with a chronic somatic disease: a systematic review of cohort studies. Scand J Work Environ Health 2010; 35:261-81. [PMID: 19562236 DOI: 10.5271/sjweh.1337] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Based on prospective and retrospective disease cohort studies, the aim of this review was to determine common prognostic factors for work disability among employees with rheumatoid arthritis, asthma, chronic obstructive pulmonary disease, diabetes mellitus, and ischemic heart disease (IHD). METHODS A systematic literature search in Medline (1990-2008) and Embase (1990-2008) was carried out to identify relevant cohort studies using a well-defined list of inclusion and quality criteria. RESULTS We identified 43 relevant cohort studies with sufficient methodological quality (20 for rheumatoid arthritis, 3 for asthma and 20 for IHD). The common prognostic factors for work disability found in all the diseases were: perceived health complaints, limitation in daily physical activities caused by the disease (high versus low), heavy manual work, and female gender. The common positive prognostic factors for rheumatoid arthritis and IHD were age (high versus low) and sickness absence. The common negative factors for rheumatoid arthritis and IHD were education (high versus low) and ethnic origin (white versus non-white). CONCLUSIONS As many prognostic factors for work disability are similar for employees with various chronic diseases, it is possible to detect high risk groups. This information supports the development and implementation of a general disability management intervention for employees suffering from a chronic disease to overcome health-related limitations at work.
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Detaille SI, van der Gulden JWJ, Engels JA, Heerkens YF, van Dijk FJH. Using intervention mapping (IM) to develop a self-management programme for employees with a chronic disease in the Netherlands. BMC Public Health 2010; 10:353. [PMID: 20565925 PMCID: PMC2908090 DOI: 10.1186/1471-2458-10-353] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Accepted: 06/21/2010] [Indexed: 11/23/2022] Open
Abstract
Background Employees with a chronic disease often encounter problems at work because of their chronic disease. The current paper describes the development of a self-management programme based on the Chronic Disease Self-Management programme (CDSMP) of Stanford University to help employees with a chronic somatic disease cope with these problems at work. The objective of this article is to present the systematic development and content of this programme. Methods The method of intervention mapping (Bartholomew 2006) was used to tailor the original CDSMP for employees with a chronic somatic disease. This paper describes the process of adjusting the CDSMP for this target group. A needs assessment has been carried out by a literature review and qualitative focus groups with employees with a chronic disease and involved health professionals. On the basis of the needs assessment, the relevant determinants of self-management behaviour at work have been identified for the target population and the objectives of the training have been formulated. Furthermore, techniques have been chosen to influence self-management and the determinants of behaviour and a programme plan has been developed. Results The intervention was designed to address general personal factors such as lifestyle, disease-related factors (for example coping with the disease) and work-related personal factors (such as self-efficacy at work). The course consists of six sessions of each two and a half hour and intents to increase the self management and empowerment of employees with a chronic somatic disease. Conclusion Intervention mapping has been found to be a useful tool for tailoring in a systematic way the original CDSMP for employees with a chronic somatic disease. It might be valuable to use IM for the development or adjusting of interventions in occupational health care.
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Detaille SI, Heerkens YF, Engels JA, van der Gulden JWJ, van Dijk FJH. Author’s reply to Coggon commentary on epidemiological investigation of prognosis. Scand J Work Environ Health 2009; 35:479. [DOI: 10.5271/sjweh.1351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Halbertsma J, Heerkens YF, Hirs WM, de Kleijn-de Vrankrijker MW, Dorine Van Ravensberg CD, Napel HT. Towards a new ICIDH. International Classification of Impairments, Disabilities and Handicaps. Disabil Rehabil 2000; 22:144-56. [PMID: 10749037 DOI: 10.1080/096382800297006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In 1995 a special issue of Disability and Rehabilitation was published on the use of the International Classification of Impairments, Disabilities and Handicaps (ICIDH) which was issued by WHO in 1980. Since 1995 a lot of energy has been spent by WHO and other organizations aiming at the development of a new and improved ICIDH. In 1997, a draft ICIDH-2 (Beta-1 version) was circulated by WHO in order to be tested in the field. This paper informs the reader about the content of the draft ICIDH, the revision process planning and some Dutch comments relating to the actual draft.
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Hendriks EJ, Brandsma JW, Heerkens YF, Oostendorp RA, Nelson RM. Intraobserver and interobserver reliability of assessments of impairments and disabilities. Phys Ther 1997; 77:1097-106. [PMID: 9327824 DOI: 10.1093/ptj/77.10.1097] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to evaluate the interobserver and intraobserver reliability of assessments of impairments and disabilities. SUBJECTS AND METHODS One physical therapist's assessments were examined for intraobserver reliability. Judgments of two pairs of therapists were used to examine interobserver reliability. Reliability was assessed by Cohen's kappa. RESULTS Of the 42 impairments and disabilities assessed by the physical therapist in the intraobserver reliability study, kappa values could be calculated for 33 items. For 31 items (94%), kappa values ranged from .40 to .91, and 2 items (6%) had kappa values of less than .40. To determine interobserver reliability, 37 items were assessed in one practice. Kappa values could be calculated for 34 items, with 30 items (88%) having kappa values ranging from .41 to .80 and 4 items (12%) showing "poor" agreement. In the second practice, 47 items were assessed for interobserver reliability. Kappa values could be calculated for 40 items, with 11 items (27.5%) having kappa values ranging from .41 to .84. Poor agreement was shown for the remaining 29 items (72.5%). CONCLUSION AND DISCUSSION Assessments of impairments and disabilities are potentially reliable. The differences between practices of the interobserver reliability study can be explained by the fact that one of the therapists did not receive training in the use of the assessment form. More generalizable conclusions will require further study with more subjects and therapists.
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