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Chang CW, Tzeng HY, Ma CY, Li ST, Chen KJ, Chiang HH. Effectiveness of exercise in improving quality of life in patients with traumatic brain injury: A systematic review and meta-analysis. Brain Inj 2023; 37:140-146. [PMID: 36625006 DOI: 10.1080/02699052.2023.2165155] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a major cause of disability and mortality worldwide. People with TBI exhibit poor quality of life (QOL). Exercise is considered a possible intervention for improving cognitive function and mood, helping improve QOL in patients with TBI. According to our review of the relevant literature, meta-analyses have yet to explore the effect of exercise on QOL in patients with TBI. OBJECTIVES To determine by meta-analysis of relevant studies whether physical exercise could promote QOL in patients with TBI. METHODS A systematic review and meta-analysis of intervention studies involving physical exercise for improving QOL outcomes in TBI populations were conducted according to the PRISMA guideline. Our inclusion criteria were as follows: being randomized or nonrandomized controlled trials with quantitative designs that included patients diagnosed with TBI. RESULTS Thus, six studies met the inclusion criteria. The interventions in four of the six studies had statistically significant effects on QOL improvement. Our meta-analysis revealed a moderate effect size of physical exercise on QOL promotion in patients with TBI. CONCLUSION For TBI, exercise seems to improve QOL. More research with long-term follow-up should be conducted to assess the effect of exercise on patients with TBI.
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Affiliation(s)
- Chia-Wen Chang
- Department of Nursing, Taoyuan Armed Forces, Taoyuan General Hospital, Taoyuan, Taiwan
| | - Hsin-Ya Tzeng
- School of Nursing, National Defense Medical Center, Taipei, Taiwan.,Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
| | - Ching-Yuan Ma
- School of Nursing, National Defense Medical Center, Taipei, Taiwan.,Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
| | - Shih-Ting Li
- School of Nursing, National Defense Medical Center, Taipei, Taiwan.,Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
| | - Kuan-Jung Chen
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
| | - Hui-Hsun Chiang
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
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Prediction of recovery in trauma patients using Latent Markov models. Eur J Trauma Emerg Surg 2021; 48:2059-2080. [PMID: 34779870 DOI: 10.1007/s00068-021-01798-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 09/26/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Patients' expectations during recovery after a trauma can affect the recovery. The aim of the present study was to identify different physical recovery trajectories based on Latent Markov Models (LMMs) and predict these recovery states based on individual patient characteristics. METHODS The data of a cohort of adult trauma patients until the age of 75 years with a length of hospital stay of 3 days and more were derived from the Brabant Injury Outcome Surveillance (BIOS) study. The EuroQol-5D 3-level version and the Health Utilities Index were used 1 week, and 1, 3, 6, 12, and 24 months after injury. Four prediction models, for mobility, pain, self-care, and daily activity, were developed using LMMs with ordinal latent states and patient characteristics as predictors for the latent states. RESULTS In total, 1107 patients were included. Four models with three ordinal latent states were developed, with different covariates in each model. The prediction of the (ordinal) latent states in the LMMs yielded pseudo-R2 values between 40 and 53% and between 21 and 41% (depending of the type R2 used) and classification errors between 24 and 40%. Most patients seem to recover fast as only about a quarter of the patients remain with severe problems after 1 month. CONCLUSION The use of LMMs to model the development of physical function post-injury is a promising way to obtain a prediction of the physical recovery. The step-by-step prediction fits well with the outpatient follow-up and it can be used to inform the patients more tailor-made to manage the expectations.
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Wiertsema SH, Donker MH, van Dongen JM, Geleijn E, Bloemers FW, Ostelo RW, de Groot V. The Transmural Trauma Care Model can be implemented well but some barriers and facilitators should be considered during implementation: a mixed methods study. J Physiother 2021; 67:298-307. [PMID: 34511380 DOI: 10.1016/j.jphys.2021.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/19/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022] Open
Abstract
QUESTIONS What is the reach, dose delivered, dose received and fidelity of the Transmural Trauma Care Model (TTCM)? What are the barriers and facilitators associated with the implementation of the TTCM? DESIGN Mixed-methods process evaluation with quantitative evaluation of the extent to which the TTCM was implemented as intended and qualitative evaluation of barriers and facilitators to its implementation. PARTICIPANTS Focus group participants included trauma patients, trauma surgeons, hospital-based physiotherapists and primary care network physiotherapists. OUTCOME MEASURES Implementation was assessed with reach, dose delivered, dose received and fidelity. DATA ANALYSIS A framework method was used to analyse the focus groups and the 'constellation approach' was used to categorise barriers and facilitators into three categories: structure, culture and practice. RESULTS The TTCM's reach was 81%, its dose delivered was 99% and 100%, and its dose received was 95% and 96% for the multidisciplinary TTCM consultation hours at the outpatient clinic for trauma patients and the primary care network physiotherapists, respectively. Various fidelity scores ranged from 66 to 93%. Numerous barriers and facilitators associated with the implementation of the TTCM were identified and categorised. CONCLUSION This process evaluation showed that the TTCM was largely implemented as intended. Furthermore, various facilitators and barriers were identified that need to be considered when implementing the TTCM more widely. Differences were found among stakeholders but they were generally of the opinion that if the barriers were overcome, the quality of care and patient satisfaction were likely to improve significantly after implementing the TTCM. REGISTRATION NTR5474.
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Affiliation(s)
- Suzanne H Wiertsema
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands.
| | - Marianne H Donker
- Vrije Universiteit Amsterdam, Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Johanna M van Dongen
- Vrije Universiteit Amsterdam, Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Edwin Geleijn
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Frank W Bloemers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Trauma Surgery, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Raymond Wjg Ostelo
- Vrije Universiteit Amsterdam, Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences, Amsterdam, Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Vincent de Groot
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands
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Ramnarain D, Aupers E, den Oudsten B, Oldenbeuving A, de Vries J, Pouwels S. Post Intensive Care Syndrome (PICS): an overview of the definition, etiology, risk factors, and possible counseling and treatment strategies. Expert Rev Neurother 2021; 21:1159-1177. [PMID: 34519235 DOI: 10.1080/14737175.2021.1981289] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Post-intensive care syndrome (PICS) has only recently been recognized as a new clinical entity in patients surviving their intensive care unit (ICU) stay due to critical illness. With increasing survival rates of ICU patients worldwide, there is a rising interest regarding post-ICU recovery. AREAS COVERED First, based on the current literature a definition is provided of PICS, including the domains of impairments that comprise PICS along with the etiology and risk factors. Second, preventive measures and possible treatment strategies integrated in the follow-up care are described. Third, the authors will discuss the current SARS-Cov-2 pandemic and the increased risk of PICS in these post-ICU patients and their families. EXPERT OPINION PICS is a relatively new entity, which not only encompasses various physical, cognitive, and psychological impairments but also impacts global health due to long-lasting detrimental socioeconomic burdens. Importantly, PICS also relates to caregivers of post-ICU patients. Strategies to reduce this burden will not only be needed within the ICU setting but will also have to take place in an interdisciplinary, multifaceted approach in primary care settings. Additionally, the SARS-Cov-2 pandemic has a high burden on post-ICU patients and their relatives.
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Affiliation(s)
- Dharmanand Ramnarain
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disease (Corps), Tilburg University, Tilburg, The Netherlands.,Department of Intensive Care Medicine, Saxenburg Medisch Centrum Hardenberg, The Netherlands
| | - Emily Aupers
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Brenda den Oudsten
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disease (Corps), Tilburg University, Tilburg, The Netherlands
| | - Annemarie Oldenbeuving
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Jolanda de Vries
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disease (Corps), Tilburg University, Tilburg, The Netherlands.,Board, ADRZ (Admiraal De Ruyter Ziekenhuis), Goes, The Netherlands
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
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Ratter J, Wiertsema S, van Dongen JM, Geleijn E, Ostelo RWJG, de Groot V, Bloemers FW. Effectiveness and cost-effectiveness of the Transmural Trauma Care Model investigated in a multicenter trial with a controlled before-and-after design: A study protocol. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2021; 26:e1894. [PMID: 33480123 PMCID: PMC8047890 DOI: 10.1002/pri.1894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 12/07/2020] [Accepted: 12/25/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The rehabilitation of trauma patients in primary care is challenging, and there are no guidelines for optimal treatment. Also, the organization of care is not well-structured. The Transmural Trauma Care Model (TTCM) has been developed in the Netherlands, aiming to improve patient outcomes by optimizing the organization and the quality of the rehabilitation process in primary care. A recent feasibility study showed that implementation of the TTCM at a Dutch Level 1 trauma center was feasible, patient outcomes were improved, and costs were reduced. This study aims to assess the effectiveness and cost-effectiveness of the TTCM compared to the usual care in a multicenter trial. METHODS A multicenter trial with a controlled before-and-after design will be performed at 10 hospitals in the Netherlands. First, participating hospitals will include 322 patients in the control group, receiving usual care as provided in these specific hospitals. Subsequently, the TTCM will be implemented in all participating hospitals, and hospitals will include an additional 322 patients in the intervention group. The TTCM consists of a multidisciplinary team at the outpatient clinic (trauma surgeon and hospital-based physical therapist), an educated and trained network of primary care trauma physical therapists, and structural communication between them. Co-primary outcomes will investigate generic and disease-specific, health-related quality of life. Secondary outcomes will include pain, patient satisfaction, perceived recovery, and patient-reported physical functioning. For the economic evaluation, societal and healthcare costs will be measured. Measurements will take place at baseline and after 6 weeks, 3, 6, and 9 months. Analyses will be based on the intention-to-treat principle. Missing data will be handled using longitudinal data analyses in the effect analyses and by multivariate imputation in the economic evaluation. CONCLUSION This trial with a controlled before-and-after design will give insight into the effectiveness and cost-effectiveness of the TTCM in a multicenter trial.
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Affiliation(s)
- Julia Ratter
- Department of Rehabilitation MedicineAmsterdam UMCVrije Universiteit Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands
| | - Suzanne Wiertsema
- Department of Rehabilitation MedicineAmsterdam UMCVrije Universiteit Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands
| | - Johanna M. van Dongen
- Department of Health Sciences, Faculty of ScienceVrije Universiteit AmsterdamVrije Universiteit Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands
| | - Edwin Geleijn
- Department of Rehabilitation MedicineAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Raymond W. J. G. Ostelo
- Department of Health Sciences, Faculty of ScienceAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands
- Department of Epidemiology and BiostatisticsAmsterdam UMClocatie VUmcAmsterdam Movement SciencesAmsterdamThe Netherlands
| | - Vincent de Groot
- Department of Rehabilitation MedicineAmsterdam UMCVrije Universiteit Amsterdam, Amsterdam Movement SciencesAmsterdamThe Netherlands
| | - Frank W. Bloemers
- Department of Trauma SurgeryAmsterdam UMCVrije Universiteit AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands
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Kruithof N, Haagsma JA, Karabatzakis M, Cnossen MC, de Munter L, van de Ree CLP, de Jongh MAC, Polinder S. Validation and reliability of the Abbreviated World Health Organization Quality of Life Instrument (WHOQOL-BREF) in the hospitalized trauma population. Injury 2018; 49:1796-1804. [PMID: 30154022 DOI: 10.1016/j.injury.2018.08.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/17/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION While the number of trauma patients surviving their injury increase, it is important to measure Quality of Life (QoL). The Abbreviated World Health Organization Quality of Life (WHOQOL-BREF) questionnaire can be used to assess QoL. However, its psychometric properties in trauma patients are unknown and therefore, we aimed to investigate the validity and reliability of the WHOQOL-BREF for the hospitalized trauma population. METHODS Data were derived from the Brabant Injury Outcome Surveillance. Floor and ceiling effects and missing values of the WHOQOL-BREF were examined. Confirmatory factor analysis (CFA) was performed to examine the underlying 4 dimensions (i.e. physical, psychological, social and environmental) of the questionnaire. Cronbach's alpha (CA) was calculated to determine internal consistency. In total, 42 hypotheses were formulated to determine construct validity and 6 hypotheses were created to determine discriminant validity. To determine construct validity, Spearman's correlations were calculated between the WHOQOL-BREF and the EuroQol-five-dimension-3-level questionnaire, the Health Utility Index Mark 2 and 3, the Hospital Anxiety and Depression Scale and the Impact of Event Scale. Discriminant validity between patients with minor injuries (i.e. Injury Severity Score (ISS)≤8) and moderate/severe injuries (i.e. ISS ≥ 9) was examined by conducting Mann-Whitney-U-tests. RESULTS In total, 202 patients (median 63y) participated in this study with a median of 32 days (interquartile range 29-37) post-trauma. The WHOQOL-BREF showed no problematic floor and ceiling effects. The CFA revealed a moderate model fit. The domains showed good internal consistency, with the exception of the social domain. All individual items and domain scores of the WHOQOL-BREF showed nearly symmetrical distributions since mean scores were close to median scores, except of the 'general health' item. The highest percentage of missing values was found on the 'sexual activity' item (i.e. 19.3%). The WHOQOL-BREF showed moderate construct and discriminant validity since in both cases, 67% of the hypotheses were confirmed. CONCLUSION The present study provides support for using the WHOQOL-BREF for the hospitalized trauma population since the questionnaire appears to be valid and reliable. The WHOQOL-BREF can be used to assess QoL in a heterogeneous group of hospitalized trauma patients accurately. TRAIL REGISTRATION ClinicalTrials.gov identifier: NCT02508675.
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Affiliation(s)
- N Kruithof
- ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Department Trauma TopCare, Tilburg, the Netherlands.
| | - J A Haagsma
- Erasmus MC University Medical Centre, Department of Public Health, Rotterdam, the Netherlands; Erasmus MC University Medical Centre, Department of Emergency Medicine, Rotterdam, the Netherlands
| | - M Karabatzakis
- ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Department Trauma TopCare, Tilburg, the Netherlands
| | - M C Cnossen
- Erasmus MC University Medical Centre, Department of Public Health, Rotterdam, the Netherlands
| | - L de Munter
- ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Department Trauma TopCare, Tilburg, the Netherlands
| | - C L P van de Ree
- ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Department Trauma TopCare, Tilburg, the Netherlands
| | - M A C de Jongh
- ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Department Trauma TopCare, Tilburg, the Netherlands; Brabant Trauma Registry, Network Emergency Care Brabant, Tilburg, the Netherlands
| | - S Polinder
- Erasmus MC University Medical Centre, Department of Public Health, Rotterdam, the Netherlands
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