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Hacquebord S, Kiers H, van der Wees P, Hoogeboom TJ. Towards a better understanding of our patients. A qualitative study about how patients and their physiotherapists perceive the recovery of shoulder problems. Musculoskelet Sci Pract 2024; 71:102931. [PMID: 38520875 DOI: 10.1016/j.msksp.2024.102931] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/28/2024] [Accepted: 03/08/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE To investigate how people with shoulder problems and their physiotherapists perceive the recovery of shoulder problems. METHOD We performed a qualitative study using semi-structured interviews with patients and their physiotherapists. Nine pairs of patients and physiotherapists (n = 18) were recruited. The transcribed interviews were analyzed in a consecutive multistep iterative process using a conventional content analysis. RESULTS Analysis of the interviews resulted in three major themes: 'What do I expect from my recovery?', 'Am I recovering?' and 'When do I consider myself recovered?' The patients and physiotherapists talked similarly about the importance of and interdependency between these themes. Central to these three themes are the analysis of the cause of shoulder problems and the experience of uncertainty. Our analyses suggest that there are conceptual differences in how patients and physiotherapists formulate their expectations about recovery, observe the recovering process, and conceptualize when someone may be considered recovered. Different interpretations by the patients of the information provided by the physical therapists appeared to fuel these differences. CONCLUSION Our results show that the concept of recovery is defined by patients and physiotherapists in three distinct themes. Within these themes the patients and physiotherapists differ substantially in their conceptualization of the recovery. IMPACT STATEMENT This insight in the concept of recovery can help patients and physiotherapists better understand each other, enhance the alignment of ideas about the care process, and support making decisions together. Physiotherapists should be aware that patients might interpret their words, explanations, and expectations substantially different.
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Affiliation(s)
- Sijmen Hacquebord
- University of Applied Sciences Utrecht, Institute for Human Movement Studies, Utrecht, Netherlands; Radboud University Medical Center, IQ Healthcare, Nijmegen, Netherlands.
| | - Henri Kiers
- University of Applied Sciences Utrecht, Institute for Human Movement Studies, Utrecht, Netherlands
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Wildenbeest MH, Kiers H, Tuijt M, Prins MR, van Dieën JH. Corrigendum to "Trunk resistance to mechanical perturbations, associations with low back pain, pain-related cognitions and movement precision" [Human Movement Science Volume 92 (2023) 103159]. Hum Mov Sci 2024; 94:103173. [PMID: 38430730 DOI: 10.1016/j.humov.2023.103173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Affiliation(s)
- Meta H Wildenbeest
- HU University of Applied Sciences, Institute for Human Movement Studies, Postbus 12011, Utrecht 3501 AA, the Netherlands; Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam 1081 BT, the Netherlands.
| | - Henri Kiers
- HU University of Applied Sciences, Institute for Human Movement Studies, Postbus 12011, Utrecht 3501 AA, the Netherlands; Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam 1081 BT, the Netherlands
| | - Matthijs Tuijt
- HU University of Applied Sciences, Institute for Human Movement Studies, Postbus 12011, Utrecht 3501 AA, the Netherlands; Department of Movement and Education, Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Maarten R Prins
- HU University of Applied Sciences, Institute for Human Movement Studies, Postbus 12011, Utrecht 3501 AA, the Netherlands; Research and Development, Military Rehabilitation Centre 'Aardenburg', Doorn, the Netherlands
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam 1081 BT, the Netherlands
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van Benten E, de Kruif A, Kiers H, Coppieters MW, Pool-Goudzwaard AL. Exploring health and illness perceptions to identify the perceived cause of pregnancy-related pelvic girdle pain. A mixed-methods study among primiparous women in The Netherlands. Midwifery 2024; 129:103892. [PMID: 38043479 DOI: 10.1016/j.midw.2023.103892] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 11/09/2023] [Accepted: 11/23/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Pregnancy-related pelvic girdle pain (PPGP) is common and considered a multifactorial condition with biomechanical and psychosocial contributions. The patient's perceived cause is an important aspect of illness perceptions, and a strong predictor of self-management and healthcare utilization. It is unknown what causal beliefs primiparae hold regarding PPGP. OBJECTIVE To explore and describe health and illness perceptions among primiparae towards PPGP and its cause. DESIGN Exploratory, convergent parallel mixed-methods. SETTING At the participants' homes. PARTICIPANTS Sixteen primiparae with and without PPGP. FINDINGS Primiparae with and without PPGP held comparable causal beliefs about PPGP. PPGP was described as the result of hormonal softening and loosening of the pelvis, and failure of the muscular system to compensate for that. Women who experienced similar physical symptoms attributed them differently, leading to different coping strategies. Interestingly, maternal healthcare providers reinforced the unidimensional- and predominantly biomechanical view when women sought healthcare. CONCLUSION The causal mechanism of PPGP held by the women was not determined by their lived experience. It was primarily based on the concept of inevitable hormonal softening of the pelvis. This biomechanical belief is based on theories that are not in line with current knowledge of PPGP and contemporary pain science, yet they were reinforced by maternity healthcare providers. IMPLICATIONS FOR PRACTICE Healthcare seeking behavior is influenced by illness beliefs. Maternity healthcare providers may play a key role in providing reassurance and addressing the multifactorial nature of PPGP when providing care and support to pregnant women.
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Affiliation(s)
- Esther van Benten
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Institute for Movement Studies, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands.
| | - Anja de Kruif
- Department of Epidemiology and Data Science, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands; Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Henri Kiers
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Institute for Movement Studies, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Michel W Coppieters
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Menzies Health Institute Queensland, Griffith University, Brisbane, Gold Coast, Australia; School of Health Sciences and Social Work, Griffith University, Brisbane, Gold Coast, Australia
| | - Annelies L Pool-Goudzwaard
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; SOMT University of Physiotherapy, Amersfoort, the Netherlands
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el Hadouchi M, Kiers H, Boerstra BA, Veenhof C, van Dieën J. Therapeutic validity and replicability of power training interventions in older adults: A review using the TIDieR checklist and CONTENT scale. Heliyon 2024; 10:e24362. [PMID: 38298697 PMCID: PMC10827759 DOI: 10.1016/j.heliyon.2024.e24362] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 02/02/2024] Open
Abstract
Background Randomized controlled trials (RCTs) indicate that power training has the ability to improve muscle power and physical performance in older adults. However, power training definitions are broad and previously-established criteria are vague, making the validity and replicability of power training interventions used in RCTs uncertain. Objective The aim of this review was to assess whether the power training interventions identified in a previous systematic review (el Hadouchi 2022) are fully described, therapeutically valid, and meet our proposed criteria for power training. Design Review. Methods Power training interventions used in older adults, previously-identified in a systematic review, were assessed. The completeness of intervention descriptions was evaluated using the Template for Intervention Description and Replication (TIDieR), and therapeutic validity was evaluated using the CONTENT scale in combination with a set of criteria specific for power training. Results None of the power training interventions were fully described or met the CONTENT scale's criteria for therapeutic validity. Five out of 14 interventions (35.7 %) met all specific power training criteria. Conclusions Power training interventions used in RCTs comparing power training to strength training are poor to moderately described, may not be therapeutically valid, and may not reflect the construct of power training. This makes it difficult for clinicians or researchers to apply or replicate power training interventions reported in RCTs, and begs the question whether the true effects of power training have been estimated.
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Affiliation(s)
- Mohamed el Hadouchi
- Institute for Human Movement Studies, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
- HRC, Sports & Science Health, Hoeflingweg 20, 7241, CH, Lochem, the Netherlands
- Research Group Innovation of Movement Care, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands
| | - Henri Kiers
- Institute for Human Movement Studies, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands
| | | | - Cindy Veenhof
- Research Group Innovation of Movement Care, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands
| | - Jaap van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
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Wildenbeest MH, Kiers H, Tuijt M, Prins MR, van Dieën JH. Trunk resistance to mechanical perturbations, associations with low back pain, pain-related cognitions and movement precision. Hum Mov Sci 2023; 92:103159. [PMID: 37979472 DOI: 10.1016/j.humov.2023.103159] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/25/2023] [Accepted: 11/09/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Pain-related cognitions are associated with motor control changes in people with chronic low-back pain (CLBP). The mechanism underlying this association is unclear. We propose that perceived threat increases muscle-spindle-reflex-gains, which reduces the effect of mechanical perturbations, and simultaneously decreases movement precision. AIM To evaluate effects of CLBP and pain-related cognitions on the impact of mechanical perturbations on trunk movement, and associations between these perturbation effects and movement precision. METHODS 30 participants with CLBP and 30 healthy controls, performed two consecutive trials of a seated repetitive reaching task. During both trials participants were warned for mechanical perturbations, which were only administered during the second trial. The perturbation effect was characterized by the deviation of the trajectory of the T8 vertebra relative to the sacrum. Trunk movement precision was expressed as tracking error during a trunk movement target tracking task. We assessed pain-related cognitions with the task-specific 'Expected Back Strain'-scale (EBS). We used a two-way-Anova to assess the effect of Group (CLBP vs back-healthy) and dichotomized EBS (higher vs lower) on the perturbation effect, and a Pearson's correlation to assess associations between perturbation effects and movement precision. FINDINGS Higher EBS was associated with smaller perturbation effects (p ≤ 0.011). A negative correlation was found between the perturbation effect and the tracking error, in the higher EBS-group (r = -0.5, p = 0.013). INTERPRETATION These results demonstrate that pain-related cognitions influence trunk movement control and support the idea that more negative pain-related cognitions lead to an increased resistance against perturbations, at the expense of movement precision.
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Affiliation(s)
- Meta H Wildenbeest
- HU University of Applied Sciences, Institute for Human Movement Studies, Postbus 12011, Utrecht 3501 AA, the Netherlands; Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam 1081 BT, the Netherlands.
| | - Henri Kiers
- HU University of Applied Sciences, Institute for Human Movement Studies, Postbus 12011, Utrecht 3501 AA, the Netherlands; Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam 1081 BT, the Netherlands
| | - Matthijs Tuijt
- HU University of Applied Sciences, Institute for Human Movement Studies, Postbus 12011, Utrecht 3501 AA, the Netherlands; Department of Movement and Education, Windesheim University of Applied Sciences, Zwolle, the Netherlands
| | - Maarten R Prins
- HU University of Applied Sciences, Institute for Human Movement Studies, Postbus 12011, Utrecht 3501 AA, the Netherlands; Research and Development, Military Rehabilitation Centre 'Aardenburg', Doorn, the Netherlands
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam 1081 BT, the Netherlands
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van Dijk MJH, van der Wal AM, Mollema J, Visser B, Kiers H, Heerkens Y, van der Sanden MWGN. The Observable Movement Quality scale for patients with low back pain (OMQ-LBP): validity and reliability in a primary care setting of physical therapy. BMC Musculoskelet Disord 2023; 24:705. [PMID: 37667238 PMCID: PMC10476334 DOI: 10.1186/s12891-023-06784-1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 08/06/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND The Observable Movement Quality scale for patients with low back pain (OMQ-LBP) is a newly developed measurement instrument for use in primary care settings of physical and exercise therapists to assess movement quality (MQ) of patients with low back pain (LBP). OBJECTIVE This study aims to determine validity, reliability and feasibility of the OMQ-LBP. The OMQ-LBP consists of a standardized movement circuit (performed twice) consisting of five daily activities problematic for LBP patients, which are scored with an 11-item observation list. METHODS Construct validity was determined by testing seven hypotheses on associations between constructs (n = 85 patients with LBP) and four hypotheses on known group differences (n = 85 patients with LBP and n = 63 healthy controls; n = 35 matched participant-patients having VAS-pain ≥ 20 mm during and/or after both circuits and healthy controls). Internal consistency was analyzed with Cronbach's alpha (n = 85 patients with LBP). For inter- and intra-rater reliability Intraclass Correlation Coefficient (ICC) values were examined (n = 14 therapists: seven primary care physical therapists and seven exercise therapists). Additionally, content validity and feasibility were determined using thematic analysis of a brief interview with participants, patients (n = 38) and therapists (n = 14). RESULTS After Bonferroni correction 2/7 associations between constructs and 2/4 significant group differences were confirmed. Cronbach's alpha was 0,79. The ICC-values of interrater reliability of the OMQ-LBP total score and the duration score were 0.56 and 0.99 and intra-rater reliability 0.82 and 0,93, respectively. Thematic analysis revealed five themes. Three themes elucidate that both patients and therapists perceived the content of the OMQ-LBP as valid. The fourth theme exhibits that OMQ-LBP provides a clear and unambiguous language for MQ in patients with LBP. Theme 5 depicts that the OMQ-LBP seems feasible, but video recording is time-consuming. CONCLUSIONS The OMQ-LBP is a promising standardized observational assessment of MQ during the five most problematic daily activities in patients with LBP. It is expected that uniform and objective description and evaluation of MQ add value to clinical reasoning and facilitate uniform communication with patients and colleagues.
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Affiliation(s)
- M J H van Dijk
- Utrecht University of Applied Sciences, Institute of Human Movement Studies, Utrecht, the Netherlands.
- Radboud University Medical CenterRadboud Institute for Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.
| | - A M van der Wal
- Utrecht University of Applied Sciences, Institute of Human Movement Studies, Utrecht, the Netherlands
| | - J Mollema
- Utrecht University of Applied Sciences, Institute of Human Movement Studies, Utrecht, the Netherlands
| | - B Visser
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - H Kiers
- Utrecht University of Applied Sciences, Institute of Human Movement Studies, Utrecht, the Netherlands
| | - Y Heerkens
- Department Occupation & Health, HAN University of Applied Sciences, Nijmegen, the Netherlands
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Klerx SP, Mokkink LB, Coppieters MW, Pool-Goudzwaard AL, Kiers H. Reliability of two lumbar motor control tests for people with low back pain that are feasible in clinical practice. Musculoskelet Sci Pract 2023; 66:102775. [PMID: 37269589 DOI: 10.1016/j.msksp.2023.102775] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Clinically feasible and reliable methods to measure motor control in people with low back pain (LBP) are lacking. This reliability and measurement error study design (i.e. repeated measurements in stable patients) aimed to determine the intra- and interrater reliability, and measurement errors of several parameters for two clinical lumbar motor control tests. METHOD Participants 18-65 years of age, with current or a history of LBP performed a spiral tracking task (n = 33; i.e., tracing a spiral on a computer monitor by making spinal movements) or a repositioning task (n = 34; i.e., returning the trunk to a predefined position). Accelerometers were used to measure trunk positions. To explore the potential of these tests, we evaluated a broad range of parameters. To assess intra- and interrater reliability, we calculated the intraclass correlation coefficient (ICC(2,1) for absolute agreement), standard error of measurement and smallest detectable change for each parameter. FINDINGS Overall, the interrater reliability of the spiral tracking test was good (ICC>0.75). The reliability of the second and third trial revealed higher ICC values compared to the reliability of the first two trials. The intra- and interrater reliability of the repositioning test was overall poor (ICC <0.5, with the exception of trunk inclination: ICC: 0.5 to 0.75). CONCLUSION The reliability and set-up of the spiral tracking test supports its feasibility for clinical use. Considering the poor reliability of the repositioning test, it is doubtful whether further development of this measurement protocol is indicated. Only for the direction trunk inclination further standardisation might be warranted.
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Affiliation(s)
- Sabrine P Klerx
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Research Group Lifestyle and Health, Section Movement Adaptation and Prognosis, HU University of Applied Sciences, Utrecht, the Netherlands.
| | - Lidwine B Mokkink
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Michel W Coppieters
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia; School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, Australia.
| | - Annelies L Pool-Goudzwaard
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; SOMT University of Physiotherapy, Amersfoort, the Netherlands.
| | - Henri Kiers
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Research Group Lifestyle and Health, Section Movement Adaptation and Prognosis, HU University of Applied Sciences, Utrecht, the Netherlands.
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Wildenbeest MH, Kiers H, Tuijt M, van Dieën JH. Effect of postural threat on motor control in people with and without low back pain. PLoS One 2023; 18:e0280607. [PMID: 36972228 PMCID: PMC10042370 DOI: 10.1371/journal.pone.0280607] [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] [Received: 09/15/2022] [Accepted: 01/04/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Negative pain-related cognitions are associated with persistence of low-back pain (LBP), but the mechanism underlying this association is not well understood. We propose that negative pain-related cognitions determine how threatening a motor task will be perceived, which in turn will affect how lumbar movements are performed, possibly with negative long-term effects on pain. OBJECTIVE To assess the effect of postural threat on lumbar movement patterns in people with and without LBP, and to investigate whether this effect is associated with task-specific pain-related cognitions. METHODS 30 back-healthy participants and 30 participants with LBP performed consecutive two trials of a seated repetitive reaching movement (45 times). During the first trial participants were threatened with mechanical perturbations, during the second trial participants were informed that the trial would be unperturbed. Movement patterns were characterized by temporal variability (CyclSD), local dynamic stability (LDE) and spatial variability (meanSD) of the relative lumbar Euler angles. Pain-related cognition was assessed with the task-specific 'Expected Back Strain'-scale (EBS). A three-way mixed Manova was used to assess the effect of Threat, Group (LBP vs control) and EBS (above vs below median) on lumbar movement patterns. RESULTS We found a main effect of threat on lumbar movement patterns. In the threat-condition, participants showed increased variability (MeanSDflexion-extension, p<0.000, η2 = 0.26; CyclSD, p = 0.003, η2 = 0.14) and decreased stability (LDE, p = 0.004, η2 = 0.14), indicating large effects of postural threat. CONCLUSION Postural threat increased variability and decreased stability of lumbar movements, regardless of group or EBS. These results suggest that perceived postural threat may underlie changes in motor behavior in patients with LBP. Since LBP is likely to impose such a threat, this could be a driver of changes in motor behavior in patients with LBP, as also supported by the higher spatial variability in the group with LBP and higher EBS in the reference condition.
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Affiliation(s)
- Meta H Wildenbeest
- Institute for Human Movement Studies, HU University of Applied Sciences, Utrecht, The Netherlands
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Henri Kiers
- Institute for Human Movement Studies, HU University of Applied Sciences, Utrecht, The Netherlands
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Matthijs Tuijt
- Institute for Human Movement Studies, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Verburg AC, Zincken J, Kiers H, van Dulmen SA, van der Wees PJ. Experiences of physiotherapists regarding a standard set of measurement instruments to improve quality of care for patients with chronic obstructive pulmonary disease: a mixed methods study. J Patient Rep Outcomes 2022; 6:79. [PMID: 35852671 PMCID: PMC9296726 DOI: 10.1186/s41687-022-00487-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/05/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Rationale
The quality of physiotherapy care for patients with chronic obstructive pulmonary disease (COPD) can be improved by comparing outcomes of care in practice.
Aim
To evaluate the experiences of physiotherapists implementing a standard set of measurement instruments to measure outcomes and improve the quality of care for patients with COPD.
Methods
This sequential explanatory mixed methods study was performed in two parts. In the quantitative part, a survey of 199 physiotherapists was conducted to evaluate their attitudes and knowledge, as well as the influence of contextual factors (i.e., practice policy and support from colleagues), in the implementation of the standard measurement set. In the qualitative part, 11 physiotherapists participated in individual interviews to elucidate their experiences using a thematical framework.
Results
The survey showed that, on average, 68.4% of the physiotherapists reported having a positive attitude about using the standard set, 85.0% felt they had sufficient knowledge of the measurement instruments, and 84.7% felt supported by practice policy and colleagues. In total, 80.3% of physiotherapists thought the standard set had added value in clinical practice, and 90.3% indicated that the measurement instruments can be valuable for evaluating treatment outcomes. The physiotherapists mentioned several barriers, such as lack of time and the unavailability of the entire standard set of measurement instruments in their practice. Moreover, the physiotherapists indicated that the measurement instruments have added value in providing transparency to policymakers through the anonymized publication of outcomes.
Conclusion
Physiotherapists support the use of the standard set of measurement instruments to improve the quality of physiotherapy treatment for patients with COPD.
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El Hadouchi M, Kiers H, de Vries R, Veenhof C, van Dieën J. Effectiveness of power training compared to strength training in older adults: a systematic review and meta-analysis. Eur Rev Aging Phys Act 2022; 19:18. [PMID: 35953775 PMCID: PMC9367108 DOI: 10.1186/s11556-022-00297-x] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research suggests that muscle power is a more critical determinant of physical functioning in older adults than muscle strength. The objective of this study was to systematically review the literature on the effect of power training compared to strength training in older adults on tests for muscle power, two groups of activity-based tests under controlled conditions: generic tests and tests with an emphasis on movement speed, and finally, physical activity level in daily life. METHODS A systematic search for randomized controlled trials comparing effects of power training to strength training in older adults was performed in PubMed, Embase, Ebsco/CINAHL, Ebsco/SPORTDiscus, Wiley/Cochrane Library and Scopus. Risk of bias was assessed using the Cochrane Collaboration Tool, and quality of evidence was evaluated using GRADEpro Guideline Development Tool. Standardized mean differenences (SMD) and 95% confidence intervals (CI) were calculated for outcomes separately using a random effects model. RESULTS Fifteen trials and 583 participants were included in the meta-analysis. Results indicated a statistically significant benefit of power training on all reported outcomes (muscle power SMD: 0.99, 95% CI: 0.54 to 1.44, p < 0.001; generic activity-based tests SMD: 0.37, 95% CI 0.06 to 0.68; p = 0.02, activity-based tests emphasizing movement speed SMD: 0.43, 95% CI 0.23 to 0.62, p < 0.001). None of the included studies used physical activity level in daily life as outcome. CONCLUSIONS Power training offers more potential for improving muscle power and performance on activity tests in older adults compared to strength training. Future research should assess exercise parameters for power training in older adults. In addition, the validity and reliability of the tests used must be evaluated to establish a standardized test protocol. This protocol should also include measurements of physical activity in daily life.
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Affiliation(s)
- Mohamed El Hadouchi
- Institute for Human Movement Studies, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS, Utrecht, The Netherlands. .,Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.
| | - Henri Kiers
- Institute for Human Movement Studies, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS, Utrecht, The Netherlands.,Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
| | - Ralph de Vries
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
| | - Cindy Veenhof
- Research Group Innovation of Movement Care, University of Applied Sciences Utrecht, Heidelberglaan 7, 3584 CS, Utrecht, the Netherlands.,Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Jaap van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
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Verburg AC, van Dulmen SA, Kiers H, Nijhuis-van der Sanden MWG, van der Wees PJ. A practice test and selection of a core set of outcome-based quality indicators in Dutch primary care physical therapy for patients with COPD: a cohort study. ERJ Open Res 2022; 8:00008-2022. [PMID: 35983539 PMCID: PMC9379355 DOI: 10.1183/23120541.00008-2022] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/06/2022] [Indexed: 12/02/2022] Open
Abstract
Aim To estimate the comparability and discriminability of outcome-based quality indicators by performing a practice test in Dutch physical therapy primary care, and to select a core set of outcome-based quality indicators that are well accepted by physical therapists based on their perceived added value as a quality improvement tool. Methods First, a list of potential quality indicators was defined, followed by determination of the comparability (case-mix adjusted multilevel analysis) and discriminability (intraclass correlation coefficient (ICC)). Second, focus group meetings were conducted with stakeholders (physical therapists and senior researchers) to select a core set of quality indicators. Results Overall, 229 physical therapists from 137 practices provided 2651 treatment episodes. Comparability: in 10 of the 11 case-mix adjusted models, the ICC increased compared with the intercept-only model. Discriminability: the ICC ranged between 0.01 and 0.34, with five of the 11 ICCs being >0.10. The majority of physical therapists in each focus group preferred the inclusion of seven quality indicators in the core set, including three process and four outcome indicators based upon the 6-min walk test (6MWT), the Clinical COPD Questionnaire (CCQ), and the determination of quadriceps strength using a hand-held dynamometer. Conclusion This is the first study to describe the comparability and discriminability of the outcome-based quality indicators selected for patients with COPD treated in primary care physical therapy practices. Future research should focus on increasing data collection in daily practice and on the development of tangible methods to use as the core set of a quality improvement tool. The major finding of this study is that all participants in the focus groups accepted the quality indicators as a quality improvement tool based on their perceived added value and selected a core set of seven outcome-based quality indicators for COPD.https://bit.ly/3NJuQtq
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12
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Wildenbeest MH, Kiers H, Tuijt M, van Dieën JH. Associations of low-back pain and pain-related cognitions with lumbar movement patterns during repetitive seated reaching. Gait Posture 2022; 91:216-222. [PMID: 34740059 DOI: 10.1016/j.gaitpost.2021.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 07/12/2021] [Revised: 09/23/2021] [Accepted: 10/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Development of more effective interventions for nonspecific chronic low back pain (LBP), requires a robust theoretical framework regarding mechanisms underlying the persistence of LBP. Altered movement patterns, possibly driven by pain-related cognitions, are assumed to drive pain persistence, but cogent evidence is missing. AIM To assess variability and stability of lumbar movement patterns, during repetitive seated reaching, in people with and without LBP, and to investigate whether these movement characteristics are associated with pain-related cognitions. METHODS 60 participants were recruited, matched by age and sex (30 back-healthy and 30 with LBP). Mean age was 32.1 years (SD13.4). Mean Oswestry Disability Index-score in LBP-group was 15.7 (SD12.7). Pain-related cognitions were assessed by the 'Pain Catastrophizing Scale' (PCS), 'Pain Anxiety Symptoms Scale' (PASS) and the task-specific 'Expected Back Strain' scale(EBS). Participants performed a seated repetitive reaching movement (45 times), at self-selected speed. Lumbar movement patterns were assessed by an optical motion capture system recording positions of cluster markers, located on the spinous processes of S1 and T8. Movement patterns were characterized by the spatial variability (meanSD) of the lumbar Euler angles: flexion-extension, lateral-bending, axial-rotation, temporal variability (CyclSD) and local dynamic stability (LDE). Differences in movement patterns, between people with and without LBP and with high and low levels of pain-related cognitions, were assessed with factorial MANOVA. RESULTS We found no main effect of LBP on variability and stability, but there was a significant interaction effect of group and EBS. In the LBP-group, participants with high levels of EBS, showed increased MeanSDlateral-bending (p = 0.004, η2 = 0.14), indicating a large effect. MeanSDaxial-rotation approached significance (p = 0.06). SIGNIFICANCE In people with LBP, spatial variability was predicted by the task-specific EBS, but not by the general measures of pain-related cognitions. These results suggest that a high level of EBS is a driver of increased spatial variability, in participants with LBP.
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Affiliation(s)
- Meta H Wildenbeest
- HU University of Applied Sciences, Institute for Human Movement Studies, Postbus 12011, 3501 AA Utrecht, The Netherlands; Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 BT Amsterdam, The Netherlands.
| | - Henri Kiers
- HU University of Applied Sciences, Institute for Human Movement Studies, Postbus 12011, 3501 AA Utrecht, The Netherlands
| | - Matthijs Tuijt
- HU University of Applied Sciences, Institute for Human Movement Studies, Postbus 12011, 3501 AA Utrecht, The Netherlands
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 BT Amsterdam, The Netherlands
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Hofste A, Soer R, Groen GJ, van der Palen J, Geerdink FJB, Oosterveld FGJ, Kiers H, Wolff AP, Hermens H. Functional and morphological lumbar multifidus characteristics in subgroups with low back pain in primary care. Musculoskelet Sci Pract 2021; 55:102429. [PMID: 34271415 DOI: 10.1016/j.msksp.2021.102429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 07/05/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since the contribution of the lumbar multifidus(LM) is not well understood in relation to non-specific low back pain(LBP), this may limit physiotherapists in choosing the most appropriate treatment strategy. OBJECTIVES This study aims to compare clinical characteristics, in terms of LM function and morphology, between subacute and chronic LBP patients from a large clinical practice cohort compared to healthy controls. DESIGN Multicenter case control study. METHOD Subacute and chronic LBP patients and healthy controls between 18 and 65 years of age were included. Several clinical tests were performed: primary outcomes were the LM thickness from ultrasound measurements, trunk range of motion(ROM) from 3D kinematic tests, and median frequency and root mean square values of LM by electromyography measurements. The secondary outcomes Numeric Rating Scale for Pain(NRS) and the Oswestry Disability Index(ODI) were administered. Comparisons between groups were made with ANOVA, p-values<0.05, with Tukey's HSD post-hoc test were considered significant. RESULTS A total of 161 participants were included, 50 healthy controls, 59 chronic LBP patients, and 52 subacute LBP patients. Trunk ROM and LM thickness were significantly larger in healthy controls compared to all LBP patients(p < 0.01). A lower LM thickness was found between subacute and chronic LBP patients although not significant(p = 0.11-0.97). All between-group comparisons showed no statistically significant differences in electromyography outcomes (p = 0.10-0.32). NRS showed no significant differences between LBP subgroups(p = 0.21). Chronic LBP patients showed a significant higher ODI score compared to subacute LBP patients(p = 0.03). CONCLUSIONS Trunk ROM and LM thickness show differences between LBP patients and healthy controls.
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Affiliation(s)
- Anke Hofste
- University of Groningen, University Medical Center Groningen, Anesthesiology Pain Center, the Netherlands; Saxion University of Applied Sciences, Faculty Physical Activity and Health, Enschede, the Netherlands.
| | - Remko Soer
- Saxion University of Applied Sciences, Faculty Physical Activity and Health, Enschede, the Netherlands; University of Groningen, University Medical Center Groningen, Pain Center, the Netherlands
| | - Gerbrand J Groen
- University of Groningen, University Medical Center Groningen, Anesthesiology Pain Center, the Netherlands; University of Groningen, University Medical Center Groningen, Pain Center, the Netherlands
| | - Job van der Palen
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, Netherlands; Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - Frank J B Geerdink
- Saxion University of Applied Sciences, Faculty Physical Activity and Health, Enschede, the Netherlands
| | - Frits G J Oosterveld
- Saxion University of Applied Sciences, Faculty Physical Activity and Health, Enschede, the Netherlands
| | - Henri Kiers
- Institute for Human Movement Studies, University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - André P Wolff
- University of Groningen, University Medical Center Groningen, Anesthesiology Pain Center, the Netherlands; University of Groningen, University Medical Center Groningen, Pain Center, the Netherlands
| | - Hermie Hermens
- Department of Biomedical Signals & Systems, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, Netherlands; Telemedicine Group, Roessingh Research and Development Enschede, the Netherlands
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Verburg AC, van Dulmen SA, Kiers H, Nijhuis-van der Sanden MWG, van der Wees PJ. Patient-Reported Outcome-Based Quality Indicators in Dutch Primary Care Physical Therapy for Patients With Nonspecific Low Back Pain: A Cohort Study. Phys Ther 2021; 101:6258995. [PMID: 33929546 PMCID: PMC8336590 DOI: 10.1093/ptj/pzab118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/13/2021] [Accepted: 04/07/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The purpose of this study was to define and select a core set of outcome-based quality indicators, accepted by stakeholders on usability and perceived added value as a quality improvement tool, and to formulate recommendations for the next implementation step. METHODS In phase 1, 15 potential quality indicators were defined for patient-reported outcome measures and associated domains, namely the Numeric Pain Rating Scale (NPRS) for pain intensity, the Patient Specific Functioning Scale (PSFS) for physical activity, the Quebec Back Pain Disability Scale for physical functioning, and the Global Perceived Effect-Dutch Version for perceived effect. Their comparability and discriminatory characteristics were described using cohort data. In phase 2, a core set of quality indicators was selected based on consensus among stakeholders in focus group meetings. RESULTS In total, 65,815 completed treatment episodes for patients with nonspecific low back pain were provided by 1009 physical therapists from 219 physical therapist practices. The discriminability between physical therapists of all potential 15 quality indicators was adequate, with intraclass correlation coefficients between 0.08 and 0.30. Stakeholders selected a final core set of 6 quality indicators: 2 process indicators (the routine measurement of NPRS and the PSFS) and 4 outcome indicators (pretreatment and posttreatment change scores for the NPRS, PSFS, Quebec Back Pain Disability Scale, and the minimal clinically important difference of the Global Perceived Effect-Dutch Version). CONCLUSION This study described and selected a core set of outcome-based quality indicators for physical therapy in patients with nonspecific low back pain. The set was accepted by stakeholders for having added value for daily practice in physical therapy primary care and was found useful for quality improvement initiatives. Further studies need to focus on improvement of using the core set of outcome-based quality indicators as a quality monitoring and evaluation instrument. IMPACT Patient-reported outcome-based quality indicators developed from routinely collected clinical data are promising for use in quality improvement in daily practice.
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Affiliation(s)
- Arie C Verburg
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, 6500 HB, Nijmegen, The Netherlands,Address all correspondence to Dr Verburg at:
| | - Simone A van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Henri Kiers
- Institute of Human Movement Studies, Utrecht University of Applied Sciences, Utrecht, The Netherlands,Association for Quality in Physical Therapy (SKF), Zwolle, The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Philip J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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Wildenbeest MH, Kiers H, Tuijt M, van Dieën JH. Reliability of measures to characterize lumbar movement patterns, in repeated seated reaching, in a mixed group of participants with and without low-back pain: A test-retest, within- and between session. J Biomech 2021; 121:110435. [PMID: 33894470 DOI: 10.1016/j.jbiomech.2021.110435] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/26/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
Literature highlights the need for research on changes in lumbar movement patterns, as potential mechanisms underlying the persistence of low-back pain. Variability and local dynamic stability are frequently used to characterize movement patterns. In view of a lack of information on reliability of these measures, we determined their within- and between-session reliability in repeated seated reaching. Thirty-six participants (21 healthy, 15 LBP) executed three trials of repeated seated reaching on two days. An optical motion capture system recorded positions of cluster markers, located on the spinous processes of S1 and T8. Movement patterns were characterized by the spatial variability (meanSD) of the lumbar Euler angles: flexion-extension, lateral bending, axial rotation, temporal variability (CyclSD) and local dynamic stability (LDE). Reliability was evaluated using intraclass correlation coefficients (ICC), coefficients of variation (CV) and Bland-Altman plots. Sufficient reliability was defined as an ICC ≥ 0.5 and a CV < 20%. To determine the effect of number of repetitions on reliability, analyses were performed for the first 10, 20, 30, and 40 repetitions of each time series. MeanSD, CyclSD, and the LDE had moderate within-session reliability; meanSD: ICC = 0.60-0.73 (CV = 14-17%); CyclSD: ICC = 0.68 (CV = 17%); LDE: ICC = 0.62 (CV = 5%). Between-session reliability was somewhat lower; meanSD: ICC = 0.44-0.73 (CV = 17-19%); CyclSD: ICC = 0.45-0.56 (CV = 19-22%); LDE: ICC = 0.25-0.54 (CV = 5-6%). MeanSD, CyclSD and the LDE are sufficiently reliable to assess lumbar movement patterns in single-session experiments, and at best sufficiently reliable in multi-session experiments. Within-session, a plateau in reliability appears to be reached at 40 repetitions for meanSD (flexion-extension), meanSD (axial-rotation) and CyclSD.
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Affiliation(s)
- Meta H Wildenbeest
- HU University of Applied Sciences, Institute for Human Movement Studies, Postbus 12011, 3501 AA Utrecht, the Netherlands; Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 BT Amsterdam, the Netherlands.
| | - Henri Kiers
- HU University of Applied Sciences, Institute for Human Movement Studies, Postbus 12011, 3501 AA Utrecht, the Netherlands
| | - Matthijs Tuijt
- HU University of Applied Sciences, Institute for Human Movement Studies, Postbus 12011, 3501 AA Utrecht, the Netherlands
| | - Jaap H van Dieën
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 BT Amsterdam, the Netherlands
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16
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van Dijk MJH, Smorenburg NTA, Heerkens YF, Mollema J, Kiers H, Nijhuis-van der Sanden MWG, Visser B. Assessment instruments of movement quality in patients with non-specific low back pain: A systematic review and selection of instruments. Gait Posture 2020; 76:346-357. [PMID: 31901525 DOI: 10.1016/j.gaitpost.2019.12.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 08/05/2019] [Revised: 11/29/2019] [Accepted: 12/21/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Observing and analyzing movement quality (MQ) in patients with non-specific low back pain (NS-LBP) is important in the clinical reasoning of primary care physiotherapists and exercise therapists. However, there is no standardized form of assessment. RESEARCH QUESTION which MQ domains are measured with which instruments, and which activities are relevant, appropriate and methodologically sound for assessing MQ in patients with NS-LBP? METHODS The study had three phases. In phase 1 we conducted a systematic review in PubMed, CINAHL and SPORTDiscus of literature published until October 2018. The selected studies measured MQ domains with instruments that enabled us to 1) compare MQ in self-paced dynamic activities of patients with NS-LBP and healthy controls, and/or 2) determine change over time of MQ in patients with NS-LBP. In phase 2 we established relevant dynamic activities to assess in patients with NS-LBP. In phase 3 we determined appropriateness and methodological qualities of the selected instruments. RESULTS Thirty cross-sectional and three pre-post-test studies were eligible. The instruments consisted of complex (n = 19) and simple (n = 7) instrumented motion analysis systems and standardized observational tests (n = 7). We identified three domains representative for MQ: range of motion (ROM), inter-segmental coordination, and whole-body movements. In these domains, patients with NS-LBP significantly differed from healthy controls, respectively 7/12, 12/13 and 13/20 studies. Moreover, ROM and whole-body movements significantly improved over time in patients with NS-LBP (3/3 studies). Based on phase 3, we concluded that none of the instruments are appropriate to assess MQ in patients with NS-LBP in primary care. SIGNIFICANCE Forward bending, lifting, and walking seem the most relevant activities to evaluate in patients with NS-LBP. However, we found no suitable instruments to measure ROM, inter-segmental coordination, or whole-body movements as determinants of MQ in these activities in daily practice. We therefore recommend such an instrument be developed.
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Affiliation(s)
- Margriet J H van Dijk
- HU University of Applied Sciences, Institute for Human Movement Studies, Utrecht, the Netherlands.
| | - Nienke T A Smorenburg
- HU University of Applied Sciences, Institute for Human Movement Studies, Utrecht, the Netherlands
| | - Yvonne F Heerkens
- HAN University of Applied Sciences, Research Group Occupation & Health, Nijmegen & Dutch Institute of Allied Health Care, Amersfoort, the Netherlands
| | - Jurgen Mollema
- HU University of Applied Sciences, Institute for Human Movement Studies, Utrecht, the Netherlands
| | - Henri Kiers
- HU University of Applied Sciences, Institute for Human Movement Studies, Utrecht, the Netherlands
| | | | - Bart Visser
- Amsterdam University of Applied Sciences, ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam, the Netherlands
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Verburg AC, van Dulmen SA, Kiers H, Ypinga JH, Nijhuis-van der Sanden MW, van der Wees PJ. Development of a Standard Set of Outcome Domains and Proposed Measures for Chronic Obstructive Pulmonary Disease in Primary Care Physical Therapy Practice in the Netherlands: a Modified RAND/UCLA Appropriateness Method. Int J Chron Obstruct Pulmon Dis 2019; 14:2649-2661. [PMID: 31819398 PMCID: PMC6886541 DOI: 10.2147/copd.s219851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/11/2019] [Indexed: 11/23/2022] Open
Abstract
Background Standardization of measures in a common set opens the opportunity to learn from differences in treatment outcomes which can be used for improving the quality of care. Furthermore, a standard set can provide the basis for development of quality indicators and is therefore useful for quality improvement and public reporting purposes. The aim of this study was to develop a standard set of outcome domains and proposed measures for patients with COPD in Dutch primary care physical therapy practice, including a proposal to stratify patients in subgroups. Material and methods A consensus-driven modified RAND-UCLA appropriateness method was conducted with relevant stakeholders (patients, physical therapists, researchers, policy makers and health insurers) in Dutch primary physical therapy care in eight steps: (1) literature search, (2) first online survey, (3) patient interviews, (4) expert meeting, resulting in a concept standard set and methods to identify subgroups' (5) consensus meeting, (6) expert meeting (7) second online survey and (8) final approval of an advisory board resulting of the approved standard set. Results Five outcome domains were selected for COPD: physical capacity, muscle strength, physical activity, dyspnea and quality of life. A total of 21 measures were rated and discussed. Finally, eight measures were included, of which four mandatory measures: Characteristics of practices and physical therapists, Clinical COPD Questionnaire (CCQ) for quality of life, Global Perceived Effect (GPE) for experience, 6-mins Walk Test (6-MWT) for physical capacity; two conditional measures: Hand-Held Dynamometer (HHD) (with Microfet™) for Quadriceps strength, Medical Research Council Dyspnea (MRC) for monitoring dyspnea; and two exploratory measures: Accelerometry for physical activity, and the Assessment of Burden of COPD tool (ABC). To identify subgroups, a method described in the Dutch standard of care from the Lung Alliance was included. Conclusion This study described the development of a standard set of outcome domains and proposed measures for patients with COPD in primary care physical therapy. Each measure was accepted for relevance and feasibility by the involved stakeholders. The set is currently used in daily practice and tested on validity and reliability in a pilot for the development of quality indicators.
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Affiliation(s)
- Arie C Verburg
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands
| | - Simone A van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands
| | - Henri Kiers
- Utrecht University of Applied Sciences, Institute of Human Movement Studies, Utrecht, Netherlands.,Association for Quality in Physical Therapy (SKF), Zwolle, Netherlands
| | | | | | - Philip J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, Netherlands
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18
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Verburg AC, van Dulmen SA, Kiers H, Nijhuis-van der Sanden MWG, van der Wees PJ. Development of a standard set of outcome measures for non-specific low back pain in Dutch primary care physiotherapy practices: a Delphi study. Eur Spine J 2019; 28:1550-1564. [PMID: 31004195 DOI: 10.1007/s00586-019-05962-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/22/2019] [Accepted: 03/24/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To develop a clinical standard set of outcome measures that are accepted for relevance and feasibility by stakeholders and useful for (a) interaction between patient and the professional, e.g. shared decision-making in goal-setting, monitoring and feedback based on outcomes, (b) internal quality improvement, and (c) external transparency in patients with non-specific low back pain (NSLBP) in primary care physical therapy. METHODS We used a consensus-driven modified RAND-UCLA Delphi method in seven steps with panellists (patients, representatives of patient and physiotherapy associations, researchers, policy makers, health insurers): (1) literature search, (2) first online survey, (3) patient interviews, (4) an experts meeting, (5) a consensus meeting, (6) second online survey, and (7) final approval of an advisory board. Steps 1-4 resulted in potential outcome measures. In the consensus meeting after discussion panellists voted for inclusion per measure. In the second online survey the final standard set was rated on relevance and feasibility on a 9-point Likert scale; when the median score was ≥ 7, the standard set was accepted and finally approved. RESULTS Thirteen draft outcome measures were rated and discussed, and finally, six outcome measures were accepted. The standard set includes the Quebec Back Pain Disability Scale, Oswestry Disability Index, Patient-Specific Functional Scale, Numeric Pain Rating Scale, Global Perceived Effect (GPE-DV), and the STarT Back Screening Tool (SBT). CONCLUSION This study presents a standard set of outcome measures for patients with NSLBP in primary care physiotherapy accepted for relevance and feasibility by stakeholders. The standard set is currently used in daily practice and tested on validity and reliability in a pilot study. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- A C Verburg
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.
| | - S A van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - H Kiers
- Institute for Human Movement Studies, Utrecht University of Applied Sciences, Utrecht, The Netherlands
- Association for Quality in Physical Therapy (SKF), Zwolle, The Netherlands
| | - M W G Nijhuis-van der Sanden
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - P J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
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Prins MR, Griffioen M, Veeger TTJ, Kiers H, Meijer OG, van der Wurff P, Bruijn SM, van Dieën JH. Evidence of splinting in low back pain? A systematic review of perturbation studies. Eur Spine J 2017; 27:40-59. [PMID: 28900711 DOI: 10.1007/s00586-017-5287-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/26/2017] [Accepted: 08/19/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE The purpose of this systematic review was to assess whether LBP patients demonstrate signs of splinting by evaluating the reactions to unexpected mechanical perturbations in terms of (1) trunk muscle activity, (2) kinetic and (3) kinematic trunk responses and (4) estimated mechanical properties of the trunk. METHODS The literature was systematically reviewed to identify studies that compared responses to mechanical trunk perturbations between LBP patients and healthy controls in terms of muscle activation, kinematics, kinetics, and/or mechanical properties. If more than four studies reported an outcome, the results of these studies were pooled. RESULTS Nineteen studies were included, of which sixteen reported muscle activation, five kinematic responses, two kinetic responses, and two estimated mechanical trunk properties. We found evidence of a longer response time of muscle activation, which would be in line with splinting behaviour in LBP. No signs of splinting behaviour were found in any of the other outcome measures. CONCLUSIONS We conclude that there is currently no convincing evidence for the presence of splinting behaviour in LBP patients, because we found no indications for splinting in terms of kinetic and kinematic responses to perturbation and derived mechanical properties of the trunk. Consistent evidence on delayed onsets of muscle activation in response to perturbations was found, but this may have other causes than splinting behaviour.
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Affiliation(s)
- Maarten R Prins
- Research and Development, Military Rehabilitation Centre 'Aardenburg', Doorn, The Netherlands. .,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,Institute for Human Movement Studies, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands.
| | - Mariëtte Griffioen
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Thom T J Veeger
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Henri Kiers
- Institute for Human Movement Studies, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Onno G Meijer
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Orthopaedic Biomechanics Laboratory, Fujian Medical University, Quanzhou, Fujian, People's Republic of China
| | - Peter van der Wurff
- Research and Development, Military Rehabilitation Centre 'Aardenburg', Doorn, The Netherlands.,Institute for Human Movement Studies, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Sjoerd M Bruijn
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Orthopaedic Biomechanics Laboratory, Fujian Medical University, Quanzhou, Fujian, People's Republic of China
| | - Jaap H van Dieën
- Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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van Dulmen S, Maas M, Staal J, Rutten G, Kiers H, Nijhuis-Van der Sanden M, van der Wees P. Peer assessment as an effective strategy for implementing a physical therapy low back pain guideline. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1576] [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] [Indexed: 10/23/2022]
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Tong M, Mousavi S, Kiers H, Ferreira P, Refshauge K, van Dieën J. Is there a relationship between lumbar spine proprioception and non-specific low back pain? A systematic review with meta-analysis. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1512] [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] [Indexed: 10/23/2022]
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D’hondt N, Pool J, Hacquebord S, Terwee C, Kiers H, Veeger H. Cosmin-based systematic review on the reliability of measurements with clinical tests to assess shoulder girdle function. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.516] [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] [Indexed: 11/25/2022]
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Ginsel D, D’hondt N, Kiers H. Improving knowledge translation, communication and patient flow in multidisciplinary health care by creating a ‘centre of expertise shoulder disorders’. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.3239] [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] [Indexed: 10/23/2022]
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Kiers H, Brumagne S, van Dieën J, Vanhees L. Test-retest reliability of muscle vibration effects on postural sway. Gait Posture 2014; 40:166-71. [PMID: 24794420 DOI: 10.1016/j.gaitpost.2014.03.184] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [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] [Received: 04/09/2013] [Revised: 03/13/2014] [Accepted: 03/21/2014] [Indexed: 02/02/2023]
Abstract
The effect of alterations in the processing of proprioceptive signals, on postural control, has been studied using muscle vibration effects. However, reliability and agreement of muscle vibration have still to be addressed. This study aimed to assess intra- and interday reliability and agreement of vibration effects of lumbar paraspinal and triceps surae muscles in a non-selected sample of 20 subjects, standing on solid surface and on foam. We used mean position and velocity of Centre of Pressure (CoP), during and after vibration to quantify the effect of muscle vibration. We also calculated the ratio of vibration effects on the lumbar paraspinal and triceps surae muscles (proprioceptive weighting). Displacement of the CoP during vibration showed good reliability (ICCs>0.6), and proprioceptive weighting of displacement fair to good reliability (0.52-0.73). Agreement measures were poor, with most CV's ranging between 18% and 36%. Change in CoP velocity appeared not to be reliable. Balance recovery, when based on CoP position and calculated a short period after cessation of vibration, showed good reliability. According to this study, displacement during vibration, proprioceptive weighting and selected recovery variables are the most reliable indicators of the response to muscle vibration.
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Affiliation(s)
- Henri Kiers
- Research Group Lifestyle and Health, Faculty of Health Care, University of Applied Sciences, Utrecht, The Netherlands.
| | - Simon Brumagne
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
| | - Jaap van Dieën
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University, Amsterdam, The Netherlands.
| | - Luc Vanhees
- Research Group Lifestyle and Health, Faculty of Health Care, University of Applied Sciences, Utrecht, The Netherlands; Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
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Mazaheri M, Coenen P, Parnianpour M, Kiers H, van Dieën JH. Low back pain and postural sway during quiet standing with and without sensory manipulation: a systematic review. Gait Posture 2013; 37:12-22. [PMID: 22796243 DOI: 10.1016/j.gaitpost.2012.06.013] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [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: 09/25/2011] [Revised: 05/08/2012] [Accepted: 06/17/2012] [Indexed: 02/02/2023]
Abstract
A previous review concluded that postural sway is increased in patients with low back pain (LBP). However, more detailed analysis of the literature shows that postural deficit may be dependent on experimental conditions in which patients with LBP have been assessed. The research question to be answered in this review was: "Is there any difference in postural sway between subjects with and without LBP across several sensory manipulation conditions?". A literature search in Pubmed, Scopus, Embase and PsychInfo was performed followed by hand search and contact with authors. Studies investigating postural sway during bipedal stance without applying external forces in patients with specific and non-specific LBP compared to healthy controls were included. Twenty three articles fulfilled the eligibility criteria. Most studies reported an increased postural sway in LBP, or no effect of LBP on postural sway. In a minority of studies, a decreased sway was found in LBP patients. There were no systematic differences between studies finding an effect and those reporting no effect of LBP. The proportion of studies finding between-group differences did not increase with increased complexity of sensory manipulations. Potential factors that may have caused inconsistencies in the literature are discussed in this systematic review.
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Affiliation(s)
- Masood Mazaheri
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Fortuin MF, Schilperoort J, Evans BJW, Edgar DF, Manon HMT, Kiers H. Randomised controlled study comparing comfort-related outcomes between two rigid gas permeable (RGP) lenses with different sessile drop contact angles. Ophthalmic Physiol Opt 2011; 31:190-9. [DOI: 10.1111/j.1475-1313.2010.00812.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sassen B, Kok G, Schaalma H, Kiers H, Vanhees L. Cardiovascular risk profile: cross-sectional analysis of motivational determinants, physical fitness and physical activity. BMC Public Health 2010; 10:592. [PMID: 20929529 PMCID: PMC3091554 DOI: 10.1186/1471-2458-10-592] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Accepted: 10/07/2010] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cardiovascular risk factors are associated with physical fitness and, to a lesser extent, physical activity. Lifestyle interventions directed at enhancing physical fitness in order to decrease the risk of cardiovascular diseases should be extended. To enable the development of effective lifestyle interventions for people with cardiovascular risk factors, we investigated motivational, social-cognitive determinants derived from the Theory of Planned Behavior (TPB) and other relevant social psychological theories, next to physical activity and physical fitness. METHODS In the cross-sectional Utrecht Police Lifestyle Intervention Fitness and Training (UP-LIFT) study, 1298 employees (aged 18 to 62) were asked to complete online questionnaires regarding social-cognitive variables and physical activity. Cardiovascular risk factors and physical fitness (peak VO2) were measured. RESULTS For people with one or more cardiovascular risk factors (78.7% of the total population), social-cognitive variables accounted for 39% (p < .001) of the variance in the intention to engage in physical activity for 60 minutes every day. Important correlates of intention to engage in physical activity were attitude (beta = .225, p < .001), self-efficacy (beta = .271, p < .001), descriptive norm (beta = .172, p < .001) and barriers (beta = -.169, p < .01). Social-cognitive variables accounted for 52% (p < .001) of the variance in physical active behaviour (being physical active for 60 minutes every day). The intention to engage in physical activity (beta = .469, p < .001) and self-efficacy (beta = .243, p < .001) were, in turn, important correlates of physical active behavior.In addition to the prediction of intention to engage in physical activity and physical active behavior, we explored the impact of the intensity of physical activity. The intensity of physical activity was only significantly related to physical active behavior (beta = .253, p < .01, R2 = .06, p < .001). An important goal of our study was to investigate the relationship between physical fitness, the intensity of physical activity and social-cognitive variables. Physical fitness (R2 = .23, p < .001) was positively associated with physical active behavior (beta = .180, p < .01), self-efficacy (beta = .180, p < .01) and the intensity of physical activity (beta = .238, p < .01).For people with one or more cardiovascular risk factors, 39.9% had positive intentions to engage in physical activity and were also physically active, and 10.5% had a low intentions but were physically active. 37.7% had low intentions and were physically inactive, and about 11.9% had high intentions but were physically inactive. CONCLUSIONS This study contributes to our ability to optimize cardiovascular risk profiles by demonstrating an important association between physical fitness and social-cognitive variables. Physical fitness can be predicted by physical active behavior as well as by self-efficacy and the intensity of physical activity, and the latter by physical active behavior.Physical active behavior can be predicted by intention, self-efficacy, descriptive norms and barriers. Intention to engage in physical activity by attitude, self-efficacy, descriptive norms and barriers. An important input for lifestyle changes for people with one or more cardiovascular risk factors was that for ca. 40% of the population the intention to engage in physical activity was in line with their actual physical active behavior.
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Affiliation(s)
- Barbara Sassen
- Department of Health and Lifestyle, University of Applied Sciences, Utrecht, the Netherlands.
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Claeys K, Brumagne S, Dankaerts W, Kiers H, Janssens L. Decreased variability in postural control strategies in young people with non-specific low back pain is associated with altered proprioceptive reweighting. Eur J Appl Physiol 2010; 111:115-23. [DOI: 10.1007/s00421-010-1637-x] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2010] [Indexed: 11/29/2022]
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Fortuin MF, Schilperoort J, Evans BJW, Edgar DF, van den Berg TJTP, Kiers H. Randomised controlled trial of the effects of two rigid gas permeable (RGP) contact lens materials and two surface cleaners on straylight values. Ophthalmic Physiol Opt 2009; 29:497-508. [DOI: 10.1111/j.1475-1313.2009.00660.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Heneweer H, Aufdemkampe G, van Tulder MW, Kiers H, Stappaerts KH, Vanhees L. Psychosocial variables in patients with (sub)acute low back pain: an inception cohort in primary care physical therapy in The Netherlands. Spine (Phila Pa 1976) 2007; 32:586-92. [PMID: 17334295 DOI: 10.1097/01.brs.0000256447.72623.56] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [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] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective cohort study of patients with episodes of acute or subacute low back pain, seeking physical therapy in primary care, with follow-up at weeks 2, 4, 8, and 12. OBJECTIVES To evaluate the association between psychosocial factors and the transition from acute or subacute low back pain to chronicity. SUMMARY OF BACKGROUND DATA Psychosocial factors have long been thought to be associated with chronic pain only. Recent prospective studies, however, suggest that these factors may also be important in acute or subacute low back pain. METHODS Demographic, psychosocial, and psychological baseline data were collected and analyzed from a sample of 66 acute or subacute patients with low back pain in order to predict the 3-month outcome. RESULTS After 3 months, response rate was 85% (56 patients). Forty-five percent rated their current status as "not recovered." Twelve percent reported work absenteeism. Using multiple regression analyses, baseline scores on the Acute Low Back Pain Screening Questionnaire, Pain Coping Inventory, Fear-Avoidance Beliefs Questionnaire, and Tampa Scale for Kinesiophobia were not significantly associated with non-recovery at 3 months. The only significant predictor at baseline was the subscale pain of the ALBPSQ, correctly classifying 80% of the patients. The relative risk for not being recovered was 3.72 (95% confidence interval, 1.63-8.52) for the subjects with high scores on the subscale for pain. Pain scores and scores on psychosocial variables at 12 weeks were not associated. CONCLUSIONS The study strongly revealed pain-related items to be essential factors in the development of chronicity and long-term disability in primary care physical therapy. Health status at 8 weeks seems crucial in developing chronicity.
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Affiliation(s)
- Hans Heneweer
- Research Department Lifestyle and Health, University of Professional Education, Utrecht, The Netherlands.
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