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van der Schoot GGF, Ormel HL, Westerink NDL, Wempe JB, Lefrandt JD, May AM, Vrieling AH, Meijer C, Gietema JA, Walenkamp AME. Physical exercise in patients with testicular cancer treated with bleomycin, etoposide and cisplatin chemotherapy: pulmonary and vascular endothelial function-an exploratory analysis. J Cancer Res Clin Oncol 2023; 149:17467-17478. [PMID: 37889308 PMCID: PMC10657310 DOI: 10.1007/s00432-023-05469-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Bleomycin, etoposide, and cisplatin combination chemotherapy (BEP) improves the survival of patients with testicular cancer, but is associated with potentially life-threatening toxicities like pneumonitis and thromboembolic events. This study explored the effects of physical exercise in patients with testicular cancer during or after BEP-chemotherapy on pulmonary and vascular endothelial toxicity. METHODS In this post hoc analysis of a multicenter randomized clinical trial (NCT01642680), patients with metastatic testicular cancer scheduled to receive BEP-chemotherapy were randomized to a 24-week exercise intervention, initiated during (group A) or after BEP-chemotherapy (group B). Endpoints were pulmonary function (forced vital capacity (FVC), forced expiratory volume in one second (FEV1), lung transfer-coefficient and transfer factor for carbon monoxide (KCO, DLCO) and markers of vascular endothelial dysfunction (von Willebrand factor (vWF) and factor VIII). RESULTS Thirty patients were included. Post-chemotherapy, patients declined less in FVC, FEV1 and DLCO in group A compared to group B. Post-chemotherapy, vWF and factor VIII were significantly lower in group A compared to group B. After completion of exercise, started either during BEP-chemotherapy or thereafter, no between-group differences were found. At 1-year post-intervention, significant between-group differences were found in favour of group A in DLCO and KCO. CONCLUSIONS Patients who exercised during BEP-chemotherapy better preserved FVC, FEV1 and DLCO, measured directly post-chemotherapy and 1-year post-intervention (DLCO, KCO). This coincided with less increase in vWF and factor VIII measured directly post-chemotherapy. These data support a beneficial role of a physical exercise intervention during BEP-chemotherapy on pulmonary and vascular damage in patients with testicular cancer. TRIAL REGISTRY Optimal Timing of Physical Activity in Cancer Treatment (ACT) Registry URL: https://clinicaltrials.gov/ct2/show/NCT01642680 . TRIAL REGISTRATION NUMBER NCT01642680.
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Affiliation(s)
- Gabriela G F van der Schoot
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Harm L Ormel
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Nico-Derk L Westerink
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Johan B Wempe
- Department of Pulmonary Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joop D Lefrandt
- Department of Vascular Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Aline H Vrieling
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Coby Meijer
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Jourik A Gietema
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Annemiek M E Walenkamp
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
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Bosman CE, van der Sluis CK, Geertzen JHB, Kerver N, Vrieling AH. User-relevant factors influencing the prosthesis use of persons with a transfemoral amputation or knee-disarticulation: A meta-synthesis of qualitative literature and focus group results. PLoS One 2023; 18:e0276874. [PMID: 36649233 PMCID: PMC9844830 DOI: 10.1371/journal.pone.0276874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/17/2022] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Persons with a transfemoral amputation or knee-disarticulation are heavily reliant on an adequate set of components for their prosthesis. To improve the process of adjusting the specific prosthetic properties to the expectations of the prosthesis users, it is of importance to first identify which factors have an influence on prosthesis use. Therefore, we aimed to identify factors that influence prosthesis use in adults with a transfemoral amputation or knee-disarticulation. METHODS A qualitative meta-synthesis was conducted by searching five databases (last update January 20th 2022). Studies were considered eligible if they contained qualitative data about adult persons with a transfemoral amputation or knee-disarticulation with experience in using a prosthesis and focused on the users' opinions. All eligible studies were independently screened by two reviewers. The results sections of the included studies were entered in Atlas.ti software (v8) and coded using the framework approach. The quality of the included studies was assessed using the Critical Appraisal Skills Program (CASP) qualitative research checklist. Results of the meta-synthesis were validated with prosthesis users (n = 8) in a focus group. RESULTS Out of 5757 articles, 14 studies were included. An overview of seven themes ('prosthesis related'; 'rehabilitation, costs and prosthetist'; 'mental'; 'physical'; 'social'; 'activities and participation' and 'walking') containing 84 factors was created. Ten factors were added during the focus group, resulting in an overview of 94 factors that may influence the prosthesis use of lower-limb prosthesis users. Participants would like more user-involvement from the rehabilitation team. The development of a patient decision aid could help this process in the future. CONCLUSION The large number of factors demonstrates that there is a great variety between prosthesis users and the factors that influence their prosthesis use. Therefore, it is important to take individual preferences into account for the selection of a new prosthesis.
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Affiliation(s)
- Charlotte E. Bosman
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Corry K. van der Sluis
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan H. B. Geertzen
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nienke Kerver
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Aline H. Vrieling
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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van der Schoot GG, Ormel HL, Westerink NDL, May AM, Elias SG, Hummel YM, Lefrandt JD, van der Meer P, van Melle JP, Poppema BJ, Stel JM, van der Velden AW, Vrieling AH, Wempe JB, ten Wolde MG, Nijland M, de Vries EG, Gietema JA, Walenkamp AM. Optimal Timing of a Physical Exercise Intervention to Improve Cardiorespiratory Fitness. JACC CardioOncol 2022; 4:491-503. [DOI: 10.1016/j.jaccao.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
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Ormel HL, Schröder CP, van der Schoot GGF, Westerink NDL, van der Velden AWG, Poppema B, Vrieling AH, Gietema JA, Walenkamp AME, Reyners AKL. Effects of supervised exercise during adjuvant endocrine therapy in overweight or obese patients with breast cancer: The I-MOVE study. Breast 2021; 58:138-146. [PMID: 34023558 PMCID: PMC8165430 DOI: 10.1016/j.breast.2021.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/12/2021] [Accepted: 05/11/2021] [Indexed: 12/16/2022] Open
Abstract
Background Adjuvant endocrine therapy (ET) in patients with breast cancer (BC) increases the risk of becoming less physically active. Physical inactivity is associated with a higher risk of treatment-related side effects and mortality. This study investigated whether supervised exercise increased the proportion of patients adhering to the national physical activity (PA) guideline during adjuvant ET in overweight or obese BC patients. Methods This multicentre single-arm clinical trial included patients with BC participating in a 12-week supervised exercise intervention. An accelerometer measured moderate to vigorous PA (MVPA) at baseline (T0), after 12 (T1) and 26 weeks (T2). The primary endpoint was change in the proportion of patients with weekly ≥150 min of MVPA at T1 compared to T0. Secondary endpoints were adherence to PA guideline at T2, metabolic syndrome (MetS), body composition, health-related quality of life (HRQoL) and BC-specific functioning and symptoms, self-reported PA, self-efficacy, exercise motivation and satisfaction with life. Results 141 patients with a median age of 61 years and a mean BMI of 31.3 participated. Adherence to the PA guideline increased from 38.3% at T0, to 40.4% at T1 (p = .112) and 44.7% at T2 (p = .003). MetS, body composition, HRQoL, BC-specific functioning and symptoms (i.e. fatigue, dyspnoea), self-reported PA, self-efficacy, exercise motivation and satisfaction with life improved significantly over time. Conclusions Supervised exercise increased the proportion of BC patients adhering to the PA guideline over time. Furthermore, MetS, body composition, HRQoL and symptoms improved. Our findings highlight the clinical relevance of supervised exercise during ET in overweight BC patients. Clinical trial information (NCT02424292). Overweight breast cancer patients on endocrine therapy can be motivated for supervised exercise. Supervised exercise increases adherence to the physical activity guideline. Metabolic syndrome and quality of life improved due to our intervention. Participation in supervised exercise induces persistent clinical improvements.
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Affiliation(s)
- Harm L Ormel
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Carolina P Schröder
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Gabriela G F van der Schoot
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Nico-Derk L Westerink
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Boelo Poppema
- Department of Internal Medicine, Ommelander Hospital Group, Scheemda, the Netherlands
| | - Aline H Vrieling
- Department of Rehabilitation Medicine, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Jourik A Gietema
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Annemiek M E Walenkamp
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Anna K L Reyners
- Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
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van der Schoot GGGF, Ormel HL, Westerink NDL, Velden AVD, Poppema BJ, Fehrmann RSN, Lefrandt JD, van Roon AM, van Melle J, Van der Meer P, Wempe JB, ten Wolde M, Stel J, Vrieling AH, de Boer N, May AM, Elias SG, Gietema JA, Walenkamp AME. Effect of a tailored exercise intervention during or after chemotherapy on cardiovascular morbidity in cancer patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.12018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12018 Background: Cancer treatment outcome may be impaired due to treatment-related adverse effects like decreased cardiorespiratory fitness. Evidence on exercise during or after chemotherapy shows positive effects on cardiorespiratory fitness, fatigue and quality of life (QoL) in cancer patients. However, optimal timing of starting exercise is unknown. This study aimed to investigate if an exercise intervention that starts during chemotherapy (early group) is superior to a program starting after completion of chemotherapy (late group) to reduce cardiovascular morbidity. Methods: In this multicenter randomized controlled trial, 266 patients (testicular-, (n = 95), breast-, (n = 139), and colon cancer (n = 30) or non-Hodgkin lymphoma (NHL) (n = 2)), treated with curative chemotherapy were randomized to a 24 week aerobic and resistance exercise intervention starting either early, i.e. during chemotherapy (n = 131) or late, i.e. at completion of chemotherapy (n = 135) (NCT01642680). Effect on VO2 peak was evaluated with intention-to-treat linear mixed-effect models, adjusted for baseline values (T0) and diagnosis at post-chemotherapy (T1), post-exercise intervention (T2) and 1-year post-exercise intervention (T3, i.e., primary endpoint). Here we report T0, T1 and T2 data. Secondary endpoints were QoL (EORTC-QLQ-C30) and fatigue (MFI-20), with higher scores indicating more fatigue. Results: Median age was 33 yrs for testicular-, 52 yrs for breast- and 64 yrs for colon cancer and NHL patients. Patients in the early group declined significantly less in VO2 peak and QoL at T1 compared to the late group (adjusted between-group differences were 3.2 ml/min/kg (95% confidence interval CI 2.3 to 4.1, P < 0.0001) and 5.8 (95% CI 0.6 to 10.9, P = 0.028). Patients in the early group experienced reduced general and physical fatigue at T1 (adjusted between-group differences were -2.0 (95% CI -3.3 to -0.8, P = 0.002) and -2.9 (95% CI -4.3 to -1.5, P < 0.0001). At T2, VO2 peak, QoL, general and physical fatigue were comparable and regained baseline levels (adjusted between-group differences - 0.08 ml/min/kg (P = 0.9), -1.4 (P = 0.7), 0.7 (P = 0.3) and 0.2 (P = 0.7), respectively. Conclusions: A supervised exercise program for patients with testicular-, breast- and colon cancer that is initiated at start of curative chemotherapy effectively reduces a decline in VO2 peak and QoL and reduces fatigue. After completion of the exercise intervention, initiated both during and after chemotherapy, patients regained their baseline VO2 peak, levels of fatigue and QoL. Clinical trial information: NCT01642680 .
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Affiliation(s)
| | - Harm Laurens Ormel
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Nico-Derk L. Westerink
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Annette Van Der Velden
- Department of Internal Medicine, Martini Hospital Groningen, Groningen, Groningen, Netherlands
| | - Boelo Jan Poppema
- Department of Internal Medicine, Ommelander Hospital Group, Winschoten, Winschoten, Netherlands
| | | | - Joop D. Lefrandt
- Department of Vascular Medicine, University Medical Center Groningen, Groningen, Netherlands
| | - Arie M. van Roon
- Department of Vascular Medicine, University Medical Center Groningen, Groningen, Netherlands
| | - Joost van Melle
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Peter Van der Meer
- Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Johan B. Wempe
- Department of Pulmonary Medicine University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Marcel ten Wolde
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Joyce Stel
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Aline H. Vrieling
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Niek de Boer
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Anne Maria May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Sjoerd G. Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Jourik A. Gietema
- Department of Medical Oncology, University Medical Center Groningen, Groningen, Netherlands
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Spaan MH, Vrieling AH, van de Berg P, Dijkstra PU, van Keeken HG. Predicting mobility outcome in lower limb amputees with motor ability tests used in early rehabilitation. Prosthet Orthot Int 2017; 41:171-177. [PMID: 27770064 DOI: 10.1177/0309364616670397] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Retrospective cohort study. BACKGROUND Persons with a lower limb amputation can regain mobility using a prosthetic device. For fast and adequate prescription of prosthetic components, it is necessary to predict the mobility outcome early in rehabilitation. Currently, prosthetic prescription is primarily based on empirical knowledge of rehabilitation professionals. OBJECTIVE In this study, we explored motor ability tests, to be completed without a prosthetic device, which have predictive value for mobility outcome at the end of rehabilitation. METHODS For this study, data of 82 patients with a lower limb amputation were included. The Single-limb standing balance test (Balance test), the Lower-Extremity Motor Coordination Test and the Amputee Mobility Predictor Assessment Tool (AMPnoPRO) were used as measures for motor ability. Mobility outcome was measured using the Timed Up and Go Test, the Two-Minute Walking Test and K levels were used. RESULTS The explained variance of the Balance test, the Lower-Extremity Motor Coordination Test and the AMPnoPRO was, respectively, 0.603, 0.534 and 0.649 on the Two-Minute Walking Test (linear regression); 0.597, 0.431 and 0.624 on the Timed Up and Go Test (linear regression); and 0.432, 0.420 and 0.526 on the K levels (logistic regression). CONCLUSION The AMPnoPRO predicted mobility outcome statistically (largest amount of explained variance). Clinical relevance This study explored the possibility of statistically predicting mobility outcome in lower limb amputees at the end of rehabilitation, using motor ability tests conducted in early rehabilitation. This study suggests the use of the AMPnoPRO to predict mobility outcome in lower limb amputees.
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Affiliation(s)
- Matthijs H Spaan
- 1 University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Aline H Vrieling
- 2 University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - Pim van de Berg
- 1 University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
| | - Pieter U Dijkstra
- 2 University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - Helco G van Keeken
- 1 University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
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Westerink NL, Nuver J, Lefrandt JD, Vrieling AH, Gietema JA, Walenkamp AME. Cancer treatment induced metabolic syndrome: Improving outcome with lifestyle. Crit Rev Oncol Hematol 2016; 108:128-136. [PMID: 27931830 DOI: 10.1016/j.critrevonc.2016.10.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 08/26/2016] [Accepted: 10/26/2016] [Indexed: 12/19/2022] Open
Abstract
Increasing numbers of long-term cancer survivors face important treatment related adverse effects. Cancer treatment induced metabolic syndrome (CTIMetS) is an especially prevalent and harmful condition. The aetiology of CTIMetS likely differs from metabolic syndrome in the general population, but effective treatment and prevention methods are probably similar. In this review, we summarize the potential mechanisms leading to the development of CTIMetS after various types of cancer treatment. Furthermore, we propose a safe and accessible method to treat or prevent CTIMetS through lifestyle change. In particular, we suggest that a lifestyle intervention and optimization of energy balance can prevent or mitigate the development of CTIMetS, which may contribute to optimal survivorship care.
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Affiliation(s)
- N L Westerink
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - J Nuver
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - J D Lefrandt
- Department of Vascular Medicine, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - A H Vrieling
- Department of Rehabilitation Medicine, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - J A Gietema
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - A M E Walenkamp
- Department of Medical Oncology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
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Vrieling AH. Abstracts of meeting DCRM 5-7 November 2015. Clin Rehabil 2016. [DOI: 10.1177/0269215516634816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Netherlands Society of Physical and Rehabilitation Medicine (NSPRM) represents about 600 members. Scientific meetings are held twice a year. The next international meeting will be held on 10-11 November 2016 (see announcement on our website www.rehabilitationmedicinecongress.nl ). Abstracts for oral and poster presentations are peer reviewed before selection. These ten abstracts are presented and selected for publication during the scientific meeting DCRM on 5-7 November 2015 in the Netherlands. Selection was done by the jury, consisting of members of the scientific committee of the NSPRM.
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van Keeken HG, Vrieling AH, Hof AL, Postema K, Otten B. Controlling horizontal deceleration during gait termination in transfemoral amputees: Measurements and simulations. Med Eng Phys 2013; 35:583-90. [DOI: 10.1016/j.medengphy.2012.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 07/05/2012] [Accepted: 07/05/2012] [Indexed: 10/28/2022]
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van Keeken HG, Vrieling AH, Hof AL, Postema K, Otten B. Principles of obstacle avoidance with a transfemoral prosthetic limb. Med Eng Phys 2011; 34:1109-16. [PMID: 22197358 DOI: 10.1016/j.medengphy.2011.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 11/17/2011] [Accepted: 11/20/2011] [Indexed: 11/24/2022]
Abstract
In this study, conditions that enable a prosthetic knee flexion strategy in transfemoral amputee subjects during obstacle avoidance were investigated. This study explored the hip torque principle and the static ground principle as object avoidance strategies. A prosthetic limb simulator device was used to study the influence of applied hip torques and static ground friction on the prosthetic foot trajectory. Inverse dynamics were used to calculate the energy produced by the hip joint. A two-dimensional forward dynamics model was used to investigate the relation between obstacle-foot distance and the necessary hip torques utilized during obstacle avoidance. The study showed that a prosthetic knee flexion strategy was facilitated by the use of ground friction and by larger active hip torques. This strategy required more energy produced by the hip compared to a knee extension strategy. We conclude that when an amputee maintains enough distance between the distal tip of the foot and the obstacle during stance, he or she produces sufficiently high, yet feasible, hip torques and uses static ground friction, the amputee satisfies the conditions for enable stepping over an obstacle using a knee flexion strategy.
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Affiliation(s)
- Helco G van Keeken
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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van Keeken HG, Vrieling AH, Hof AL, Postema K, Otten B. Stabilizing moments of force on a prosthetic knee during stance in the first steps after gait initiation. Med Eng Phys 2011; 34:733-9. [PMID: 21996358 DOI: 10.1016/j.medengphy.2011.09.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 09/14/2011] [Accepted: 09/17/2011] [Indexed: 10/16/2022]
Abstract
In this study, the occurrences of stabilizing and destabilizing external moments of force on a prosthetic knee during stance, in the first steps after gait initiation, in inexperienced users were investigated. Primary aim was to identify the differences in the external moments during gait initiation with the sound leg leading and the prosthetic leg leading. A prosthetic leg simulator device, with a flexible knee, was used to test able-bodied subject, with no walking aid experience. Inverse dynamics calculations were preformed to calculate the external moments. The subjects learned to control the prosthetic leg within 100 steps, without walking aids, evoking similar patterns of external moments of force during the steps after the gait initiation, either with their sound leg loading or prosthetic leg leading. Critical phases in which a sudden flexion of the knee can occur were found just after heelstrike and just before toe off, in which the external moment of force was close to the internal moment produced by a knee extension aiding spring in the opposite direction.
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Affiliation(s)
- Helco G van Keeken
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Vrieling AH, van Keeken HG, Schoppen T, Hof AL, Otten B, Halbertsma JPK, Postema K. Gait adjustments in obstacle crossing, gait initiation and gait termination after a recent lower limb amputation. Clin Rehabil 2009; 23:659-71. [PMID: 19470553 DOI: 10.1177/0269215509102947] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the adjustments in gait characteristics of obstacle crossing, gait initiation and gait termination that occur in subjects with a recent lower limb amputation during the rehabilitation process. DESIGN Prospective and descriptive study. SUBJECTS Fourteen subjects with a recent transfemoral, knee disarticulation or transtibial amputation. METHODS Subjects stepped over an obstacle and initiated and terminated gait at four different times during the rehabilitation process. OUTCOME MEASURES Success rate, gait velocity and lower limb joint angles in obstacle crossing, centre of pressure shift and peak anteroposterior ground reaction force in gait initiation and termination. RESULTS In obstacle crossing amputees increased success rate, gait velocity and swing knee flexion of the prosthetic limb. Knee flexion in transfemoral and knee disarticulation amputees was not sufficient for safe obstacle crossing, which resulted in a circumduction strategy. In gait initiation and termination amputees increased the anteroposterior ground reaction force and the centre of pressure shift in the mediolateral direction in both tasks. Throughout the rehabilitation process the centre of pressure was shifted anteriorly before single-limb stance on the trailing prosthetic limb in gait initiation, whereas in gait termination the centre of pressure in single-limb stance remained posterior when leading with the prosthetic limb. CONCLUSION Subjects with a recent amputation develop adjustment strategies to improve obstacle crossing, gait initiation and gait termination. Innovations in prosthetic design or training methods may ease the learning process of these tasks.
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Affiliation(s)
- Aline H Vrieling
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, PO Box 30002, Haren 9750 RA, The Netherlands.
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Vrieling AH, van Keeken HG, Schoppen T, Otten E, Halbertsma JPK, Hof AL, Postema K. Uphill and downhill walking in unilateral lower limb amputees. Gait Posture 2008; 28:235-42. [PMID: 18242995 DOI: 10.1016/j.gaitpost.2007.12.006] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Revised: 11/26/2007] [Accepted: 12/06/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study adjustment strategies in unilateral amputees in uphill and downhill walking. DESIGN Observational cohort study. SUBJECTS Seven transfemoral, 12 transtibial unilateral amputees and 10 able-bodied subjects. METHODS In a motion analysis laboratory the subjects walked over a level surface and an uphill and downhill slope. Gait velocity and lower limb joint angles were measured. RESULTS In uphill walking hip and knee flexion at initial contact and hip flexion in swing were increased in the prosthetic limb of transtibial amputees. In downhill walking transtibial amputees showed more knee flexion on the prosthetic side in late stance and swing. Transfemoral amputees were not able to increase prosthetic knee flexion in uphill and downhill walking. An important adjustment strategy in both amputee groups was a smaller hip extension in late stance in uphill and downhill walking, probably related with a shorter step length. In addition, amputees increased knee flexion in early stance in the non-affected limb in uphill walking to compensate for the shorter prosthetic limb length. In downhill walking fewer adjustments were necessary, since the shorter prosthetic limb already resulted in lowering of the body. CONCLUSION Uphill and downhill walking can be trained in rehabilitation, which may improve safety and confidence of amputees. Prosthetic design should focus on better control of prosthetic knee flexion abilities without reducing stability.
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Affiliation(s)
- A H Vrieling
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Vrieling AH, van Keeken HG, Schoppen T, Otten E, Hof AL, Halbertsma JPK, Postema K. Balance control on a moving platform in unilateral lower limb amputees. Gait Posture 2008; 28:222-8. [PMID: 18207407 DOI: 10.1016/j.gaitpost.2007.12.002] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Revised: 11/26/2007] [Accepted: 12/02/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study balance control on a moving platform in lower limb amputees. DESIGN Observational cohort study. PARTICIPANTS Unilateral transfemoral and transtibial amputees and able-bodied control subjects. INTERVENTIONS Balance control on a platform that moved in the anteroposterior direction was tested with eyes open, blindfolded and while performing a dual task. MAIN OUTCOME MEASURES Weight bearing symmetry, anteroposterior ground reaction force and centre of pressure shift. RESULTS Compared to able-bodied subjects, in amputees the anteroposterior ground reaction force was larger in the prosthetic and non-affected limb, and the centre of pressure displacement was increased in the non-affected limb and decreased in the prosthetic limb. In amputees body weight was loaded more on the non-affected limb. Blindfolding or adding a dual task did not influence the outcome measures importantly. CONCLUSION The results of this study indicate that experienced unilateral amputees with a high activity level compensate for the loss of ankle strategy by increasing movements and loading in the non-affected limb. The ability to cope with balance perturbations is limited in the prosthetic limb. To enable amputees to manage all possible balance disturbances in real life in a safe manner, we recommend to improve muscle strength and control in the non-affected limb and to train complex balance tasks in challenging environments during rehabilitation.
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Affiliation(s)
- A H Vrieling
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Vrieling AH, van Keeken HG, Schoppen T, Otten E, Halbertsma JPK, Hof AL, Postema K. Gait initiation in lower limb amputees. Gait Posture 2008; 27:423-30. [PMID: 17624782 DOI: 10.1016/j.gaitpost.2007.05.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Revised: 05/23/2007] [Accepted: 05/25/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study limitations in function and adjustment strategies in lower limb amputees during gait initiation. DESIGN Observational cohort study. SETTING University Medical Center. PARTICIPANTS Amputees with a unilateral transfemoral or transtibial amputation, and able-bodied subjects. MAIN OUTCOME MEASURES Leading limb preference, temporal variables, ground reaction forces, and centre of pressure shift. RESULTS Amputees demonstrated a decrease in peak anterior ground reaction force, a smaller or absent posterior centre of pressure shift, and a lower gait initiation velocity. The main adjustments strategies in amputees were more limb-loading on the non-affected limb, prolonging the period of propulsive force production in the non-affected limb and initiating gait preferably with the prosthetic limb. CONCLUSION Since an intact ankle joint and musculature is of major importance in gait initiation, functional limitations and adjustment strategies in transfemoral and transtibial amputees were similar. Improving prosthetic ankle properties and initiating gait with the prosthetic limb may facilitate the gait initiation process in amputees.
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Affiliation(s)
- A H Vrieling
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, The Netherlands.
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van Keeken HG, Vrieling AH, Hof AL, Halbertsma JPK, Schoppen T, Postema K, Otten B. Controlling Propulsive Forces in Gait Initiation in Transfemoral Amputees. J Biomech Eng 2008; 130:011002. [DOI: 10.1115/1.2838028] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
During prosthetic gait initiation, transfemoral (TF) amputees control the spatial and temporal parameters that modulate the propulsive forces, the positions of the center of pressure (CoP), and the center of mass (CoM). Whether their sound leg or the prosthetic leg is leading, the TF amputees reach the same end velocity. We wondered how the CoM velocity build up is influenced by the differences in propulsive components in the legs and how the trajectory of the CoP differs from the CoP trajectory in able bodied (AB) subjects. Seven TF subjects and eight AB subjects were tested on a force plate and on an 8m long walkway. On the force plate, they initiated gait two times with their sound leg and two times with their prosthetic leg. Force measurement data were used to calculate the CoM velocity curves in horizontal and vertical directions. Gait initiated on the walkway was used to determine the leg preference. We hypothesized that because of the differences in propulsive components, the motions of the CoP and the CoM have to be different, as ankle muscles are used to help generate horizontal ground reaction force components. Also, due to the absence of an active ankle function in the prosthetic leg, the vertical CoM velocity during gait initiation may be different when leading with the prosthetic leg compared to when leading with the sound leg. The data showed that whether the TF subjects initiated a gait with their prosthetic leg or with their sound leg, their horizontal end velocity was equal. The subjects compensated the loss of propulsive force under the prosthesis with the sound leg, both when the prosthetic leg was leading and when the sound leg was leading. In the vertical CoM velocity, a tendency for differences between the two conditions was found. When initiating gait with the sound leg, the downward vertical CoM velocity at the end of the gait initiation was higher compared to when leading with the prosthetic leg. Our subjects used a gait initiation strategy that depended mainly on the active ankle function of the sound leg; therefore, they changed the relative durations of the gait initiation anticipatory postural adjustment phase and the step execution phase. Both legs were controlled in one single system of gait propulsion. The shape of the CoP trajectories, the applied forces, and the CoM velocity curves are described in this paper.
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Affiliation(s)
- Helco G. van Keeken
- Center for Human Movement Sciences, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Aline H. Vrieling
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - At L. Hof
- Center for Human Movement Sciences, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands; Center for Rehabilitation, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Jan P. K. Halbertsma
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Tanneke Schoppen
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Klaas Postema
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Bert Otten
- Center for Human Movement Sciences, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands
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Vrieling AH, van Keeken HG, Schoppen T, Otten E, Halbertsma JPK, Hof AL, Postema K. Gait termination in lower limb amputees. Gait Posture 2008; 27:82-90. [PMID: 17376689 DOI: 10.1016/j.gaitpost.2007.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Revised: 02/14/2007] [Accepted: 02/17/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study the limitations in function and adjustment strategies of lower limb amputees in gait termination. DESIGN Observational cohort study. SETTING University Medical Centre. PARTICIPANTS Unilateral transfemoral and transtibial amputees, and able-bodied control subjects. MAIN OUTCOME MEASURES Leading limb preference, temporal variables, lower limb joint angles, ground reaction forces, and centre of pressure shift. RESULTS Compared to able-bodied subjects, amputees showed a decreased peak braking ground reaction force in the prosthetic limb, no anterior centre of pressure shift during leading with the prosthetic limb and an increased mediolateral centre of pressure shift. Amputees used several adjustment strategies to compensate for the limitations in function; leading limb preference for the non-affected limb, longer production of braking force in the non-affected limb, decreased gait termination velocity and more weight-bearing on the non-affected limb. CONCLUSION Limitations in function and adjustment strategies were mainly similar in transfemoral and transtibial amputees. Due to the lack of active ankle function, amputees were not able to increase the braking force and to shift the centre of pressure anteriorly. Leading with the non-affected limb is favourable for adequate deceleration and balance control, but in daily life not always applicable. It is important that amputees are trained in gait termination during rehabilitation and prosthetic design should focus on a more active role of the prosthetic foot and knee.
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Affiliation(s)
- A H Vrieling
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, The Netherlands.
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Vrieling AH, van Keeken HG, Schoppen T, Otten E, Halbertsma JPK, Hof AL, Postema K. Obstacle crossing in lower limb amputees. Gait Posture 2007; 26:587-94. [PMID: 17275306 DOI: 10.1016/j.gaitpost.2006.12.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Revised: 11/24/2006] [Accepted: 12/09/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study limitations in function and adjustment strategies in lower limb amputees during obstacle crossing. DESIGN Observational cohort study. SUBJECTS Transfemoral and transtibial amputees and able-bodied control subjects. METHODS In a motion analysis laboratory unimpeded and obstacle crossing runs were performed. The subjects stepped over an obstacle of 0.1m height and thickness and 1m width. Outcome measures were gait velocity, hip, knee and ankle joint angles and leading limb preference. RESULTS Whereas able-bodied and transtibial subjects demonstrated an increase in knee flexion during obstacle crossing compared to unimpeded walking, in transfemoral amputees the opposite was seen, namely a decrease in knee flexion. The lack of knee strategy in transfemoral amputees was compensated by circumduction at the hip on the prosthetic side and plantar flexion of the non-affected ankle. Transtibial amputees preferred to cross the obstacle with the prosthetic limb first, while transfemoral amputees preferred the non-affected limb. CONCLUSION The different leading limb strategy in transfemoral and transtibial amputees could be explained by the restricted flexion and propulsion properties of the prosthetic knee. Training of obstacle crossing tasks during rehabilitation and improvement of prosthetic design may contribute to safe obstacle crossing.
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Affiliation(s)
- A H Vrieling
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
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