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Stokman-Meiland DCM, Groeneveld IF, Arwert HJ, van der Pas SL, Meesters JJL, Rambaran Mishre RD, Vliet Vlieland TPM, Goossens PH. The course of depressive symptoms in the first 12 months post-stroke and its association with unmet needs. Disabil Rehabil 2022; 44:428-435. [PMID: 35130113 DOI: 10.1080/09638288.2020.1769746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIM To describe the course of depressive symptoms during the first 12 months post-stroke and its association with unmet needs. METHODS A prospective cohort study among stroke patients admitted to inpatient rehabilitation. Depressive symptoms were assessed 3, 6, and 12 months post-stroke using the Hospital Anxiety and Depression Scale, and categorized into three trajectories: no (all times <8), non-consistent (one or two times ≥8), or persistent (all times ≥8) depressive symptoms. Unmet needs were assessed using the Longer-Term Unmet Needs questionnaire. Multivariable logistic regression analyses were used to investigate the association between depressive symptoms and unmet needs. RESULTS One hundred and fifty-one patients were included, of whom 95 (62.9%), 38 (25.2%), and 18 (11.9%) had no, non-consistent, or persistent depressive symptoms, respectively. Depressive symptoms three months post-stroke persisted in 43.9% and recurred in 19.5% of patients during the first 12 months post-stroke. Depressive symptoms were significantly associated with the occurrence and number of unmet needs (odds ratio 6.49; p = 0.003 and odds ratio 1.28; p = 0.005, respectively). CONCLUSIONS Depressive symptoms three months post-stroke were likely to persist or recur during the first 12 months post-stroke. Depressive symptoms are associated with unmet needs. These results suggest that routine monitoring of depressive symptoms and unmet needs should be considered post-stroke.Implications for rehabilitationPatients with depressive symptoms three months post-stroke have a high risk of developing persistent or recurrent depressive symptoms during the first 12 months post-stroke.Unmet needs are associated with both non-consistent and persistent depressive symptoms post-stroke.These results suggest that health professionals should routinely screen for depressive symptoms and health care needs around three months post-stroke.In patients with depressive symptoms at three months post-stroke early treatment of depressive symptoms and addressing unmet needs should be considered and depressive symptoms should be routinely monitored during the first 12 months post-stroke.
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Affiliation(s)
| | | | - Henk J Arwert
- Basalt, The Hague, The Netherlands.,Department of Rehabilitation, Haaglanden Medical Center, The Hague, The Netherlands
| | - Stéphanie L van der Pas
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.,Mathematical Institute, Leiden University, Leiden, The Netherlands
| | - Jorit J L Meesters
- Basalt, The Hague, The Netherlands.,Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Radha D Rambaran Mishre
- Basalt, The Hague, The Netherlands.,Department of Rehabilitation, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - Thea P M Vliet Vlieland
- Basalt, The Hague, The Netherlands.,Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
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2
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van Meijeren-Pont W, Tamminga SJ, Goossens PH, Groeneveld IF, Arwert H, Meesters JJL, Mishre RR, Vlieland TPM, van den Hout WB. Societal burden of stroke rehabilitation: Costs and health outcomes after admission to stroke rehabilitation. J Rehabil Med 2021; 53:jrm00201. [PMID: 33856036 PMCID: PMC8814873 DOI: 10.2340/16501977-2829] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To estimate societal costs and changes in health-related quality of life in stroke patients, up to one year after start of medical specialist rehabilitation. Design Observational. Patients Consecutive patients who received medical specialist rehabilitation in the Stroke Cohort Out-comes of REhabilitation (SCORE) study. Methods Participants completed questionnaires on health-related quality of life (EuroQol EQ-5D-3L), absenteeism, out-of-pocket costs and healthcare use at start and end of rehabilitation and 6 and 12 months after start. Clinical characteristics and rehabilitation costs were extracted from the medical and financial records, respectively. Results From 2014 to 2016 a total of 313 stroke patients completed the study. Mean age was 59 (standard deviation (SD) 12) years, 185 (59%) were male, and 244 (78%) inpatients. Mean costs for inpatient and outpatient rehabilitation were US$70,601 and US$27,473, respectively. For inpatients, utility (an expression of quality of life) increased significantly between baseline and 6 months (EQ-5D-3L 0.66–0.73, p = 0.01; visual analogue scale 0.77–0.82, p < 0.001) and between baseline and 12 months (visual analogue scale 0.77–0.81, p < 0.001). Conclusion One-year societal costs from after the start of rehabilitation in stroke patients were considerable. Future research should also include costs prior to rehabilitation. For inpatients, health-related quality of life, expressed in terms of utility, improved significantly over time.
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Affiliation(s)
- Winke van Meijeren-Pont
- Basalt Rehabilitation/ Department of Orthopaedics, Rehabilitation, and Physical, Therapy, Leiden University Medical Center, AL Leiden, The Netherlands. E-mail:
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3
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Brouns B, van Bodegom-Vos L, de Kloet AJ, Tamminga SJ, Volker G, Berger MAM, Fiocco M, Goossens PH, Vliet Vlieland TPM, Meesters JJL. Effect of a comprehensive eRehabilitation intervention alongside conventional stroke rehabilitation on disability and health-related quality of life: A pre-post comparison. J Rehabil Med 2021; 53:jrm00161. [PMID: 33369683 PMCID: PMC8814840 DOI: 10.2340/16501977-2785] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective To compare the effect on disability and quality of life, of conventional rehabilitation (control group) with individualized, tailored eRehabilitation intervention alongside conventional rehabilitation (Fast@home; intervention group), for people with stroke. METHODS Pre–post design. The intervention comprised cognitive (Braingymmer®) and physical (Telerevalidatie®/Physitrack®) exercises, activity-tracking (Activ8®) and psycho-education. Assessments were made at admission (T0) and after 3 (T3) and 6 months (T6). The primary outcome concerned disability (Stroke Impact Scale; SIS). Secondary outcomes were: health-related quality of life, fatigue, self-management, participation and physical activity. Changes in scores between T0–T3, T3–T6, and T0–T6 were compared by analysis of variance and linear mixed models. Results The study included 153 and 165 people with stroke in the control and intervention groups, respectively. In the intervention group, 82 (50%) people received the intervention, of whom 54 (66%) used it. Between T3 and T6, the change in scores for the SIS subscales Communication (control group/intervention group –1.7/–0.3) and Physical strength (–5.7/3.3) were significantly greater in the total intervention group (all mean differences< minimally clinically important differences). No significant differences were found for other SIS subscales or secondary outcomes, or between T0–T3 and T0–T6. Conclusion eRehabilitation alongside conventional stroke rehabilitation had a small positive effect on communication and physical strength on the longer term, compared to conventional rehabilitation only.
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Affiliation(s)
- Berber Brouns
- Basalt Rehabilitation Centre, The Hague and Leiden, Department of Innovation, Quality + Research, Haag, The Netherlands. ,
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4
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Tamminga SJ, van Vree FM, Volker G, Roorda LD, Terwee CB, Goossens PH, Vliet Vlieland TPM. Changes in the ability to participate in and satisfaction with social roles and activities in patients in outpatient rehabilitation. J Patient Rep Outcomes 2020; 4:73. [PMID: 32870463 PMCID: PMC7462938 DOI: 10.1186/s41687-020-00236-3] [Citation(s) in RCA: 5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 08/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background One of the main aims of rehabilitation is to improve participation. Patient-Reported Outcomes Measurement Information System (PROMIS®) item banks ‘Ability to Participate in Social roles and Activities, (PROMIS-APS) and ‘Satisfaction with Social Roles and Activities’ (PROMIS-SPS) are promising options to measure participation, but the literature on PROMIS measures of (satisfaction with) participation across diagnoses in rehabilitation is limited. Therefore, the objective of this study was to describe levels of and changes in participation, as assessed with the PROMIS-APS and the PROMIS-SPS short forms, of patients in outpatient rehabilitation. Methods This study had quantitative, observational design with assessments at admission and discharge. Consecutive patients treated between April and August 2018 receiving outpatient multidisciplinary rehabilitation were the population of this study. The following diagnosis categories were included: brain injury (e.g. stroke), spinal cord and nerve injury, neuromuscular disorder (e.g. lateral sclerosis), amputation, musculoskeletal condition (e.g. osteoarthritis) or heart or lung disease (e.g. myocardial infarction, chronic obstructive pulmonary disease). The main patient-reported outcomes (PRO) of this study were the short form of the PROMIS-APS (8 items, Dutch general population reference score 50.6 [SD 9.5]), and PROMIS-SPS (8 items, Dutch general population reference score 47.5 [SD 8.3]. Results Of the 1279 patients invited, 777 (61%) completed the online forms at admission. Of those, 329 patients were invited at discharge, with 209 (64%) completing the forms. The mean (SD) T-scores of the PROMIS-APS and PROMIS-SPS were lower at admission (42.7 [SD 7.4]; (41.4 [SD 7.7]) and discharge (43.6 [SD 7.2]; (43.7 [SD 7.8]) than the Dutch general population. The change scores of the PROMIS-APS and PROMIS-SPS were 1.2 (95% CI 0.4–1.9; p = 0.004; effect size 0.16), and 2.4 (95% CI 1.6–3.2; p < 0.0001; effect size 0.31), respectively. In all diagnostic subgroups with > 30 paired measurements statistically significant improvements of PROMIS-APS, PROMIS-SPS or both were seen. Conclusions Patients undergoing outpatient rehabilitation had, both at admission and discharge, considerably lower PROMIS-APS and PROMIS-SPS T-scores short forms than the general Dutch population, and showed small T-score improvements at discharge.
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Affiliation(s)
- Sietske J Tamminga
- Basalt Rehabilitation, Leiden/The Hague, the Netherlands. .,Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands.
| | | | - Gerard Volker
- Basalt Rehabilitation, Leiden/The Hague, the Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Center, Amsterdam, the Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Thea P M Vliet Vlieland
- Basalt Rehabilitation, Leiden/The Hague, the Netherlands.,Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
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5
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Bij de Vaate E, Gerrits KHL, Goossens PH. Personalized recovery of severe COVID19: Rehabilitation from the perspective of patient needs. Eur J Clin Invest 2020; 50:e13325. [PMID: 32558922 PMCID: PMC7323030 DOI: 10.1111/eci.13325] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 12/27/2022]
Affiliation(s)
| | - Karin H L Gerrits
- Merem Medische Revalidatie, Hilversum, The Netherlands.,Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Physiology, VU Amsterdam, Amsterdam, The Netherlands
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Voogdt-Pruis HR, Ras T, van der Dussen L, Benjaminsen S, Goossens PH, Raats I, Boss G, van Hoef EFM, Lindhout M, Tjon-A-Tsien MRS, Vrijhoef HJM. Improvement of shared decision making in integrated stroke care: a before and after evaluation using a questionnaire survey. BMC Health Serv Res 2019; 19:936. [PMID: 31805927 PMCID: PMC6896582 DOI: 10.1186/s12913-019-4761-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 11/20/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Shared decision making (SDM) is at the core of policy measures for making healthcare person-centred. However, the context-sensitive nature of the challenges in integrated stroke care calls for research to facilitate its implementation. This before and after evaluation study identifies factors for implementation and concludes with key recommendations for adoption. METHODS Data were collected at the start and end of an implementation programme in five stroke services (December 2017 to July 2018). The SDM implementation programme consisted of training for healthcare professionals (HCPs), tailored support, development of decision aids and a social map of local stroke care. Participating HCPs were included in the evaluation study: A questionnaire was sent to 25 HCPs at baseline, followed by 11 in-depth interviews. Data analysis was based on theoretical models for implementation and 51 statements were formulated as a result. Finally, all HCPs were asked to validate and to quantify these statements and to formulate recommendations for further adoption. RESULTS The majority of respondents said that training of all HCPs is essential. Feedback on consultation and peer observation are considered to help improve performance. In addition, HCPs stated that SDM should also be embedded in multidisciplinary meetings, whereas implementation in the organisation could be facilitated by appointed ambassadors. Time was not seen as an inhibiting factor. According to HCPs, negotiating patients' treatment decisions improves adherence to therapy. Despite possible cognitive or communications issues, all are convinced patients with stroke can be involved in a SDM-process. Relatives play an important role too in the further adoption of SDM. HCPs provided eight recommendations for adoption of SDM in integrated stroke care. CONCLUSIONS HCPs in our study indicated it is feasible to implement SDM in integrated stroke care and several well-known implementation activities could improve SDM in stroke care. Special attention should be given to the following activities: (1) the appointment of knowledge brokers, (2) agreements between HCPs on roles and responsibilities for specific decision points in the integrated stroke care chain and (3) the timely investigation of patient's preferences in the care process - preferably before starting treatment through discussions in a multidisciplinary meeting.
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Affiliation(s)
- H R Voogdt-Pruis
- Stroke Knowledge Network Netherlands, Oudlaan 4, 3515, Utrecht, GA, Netherlands.
- EnCorps, Goudenregenlaan, 16 1214 ND, Hilversum, Netherlands.
| | - T Ras
- Stroke Knowledge Network Netherlands, Oudlaan 4, 3515, Utrecht, GA, Netherlands
| | - L van der Dussen
- Netherlands Society of Rehabilitation Medicine, Oudlaan 4, 3515, Utrecht, GA, Netherlands
| | - S Benjaminsen
- Stroke Knowledge Network Netherlands, Oudlaan 4, 3515, Utrecht, GA, Netherlands
- Maastricht University Medical Center, P. Debyelaan 25, 6229, Maastricht, HX, Netherlands
| | - P H Goossens
- Branch Organization of Rehabilitation in the Netherlands, Oudlaan 4, 3515, Utrecht, GA, Netherlands
| | - I Raats
- Stroke Knowledge Network Netherlands, Oudlaan 4, 3515, Utrecht, GA, Netherlands
| | - G Boss
- Stroke Knowledge Network Netherlands, Oudlaan 4, 3515, Utrecht, GA, Netherlands
| | - E F M van Hoef
- Stroke Knowledge Network Netherlands, Oudlaan 4, 3515, Utrecht, GA, Netherlands
- Maastricht University Medical Center, P. Debyelaan 25, 6229, Maastricht, HX, Netherlands
| | - M Lindhout
- Patient Association for Acquired Brain Injury, Den Heuvel 62, 6881, Velp, VE, Netherlands
| | - M R S Tjon-A-Tsien
- Dutch General Practitioners' Expert Group on Cardiovascular Diseases, Mercatorlaan, 1200 3528, Utrecht, BL, Netherlands
| | - H J M Vrijhoef
- Maastricht University Medical Center, P. Debyelaan 25, 6229, Maastricht, HX, Netherlands
- Panaxea, Science park 400, 1098 XH, Amsterdam, Netherlands
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7
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Groeneveld IF, van der Pas SL, Meesters JJL, Schuurman JM, van Meijeren-Pont W, Jagersma E, Goossens PH, Kaptein AA, Vliet Vlieland TPM. Illness perceptions of stroke survivors: Predictors and changes over time - A 1 year follow-up study. J Psychosom Res 2019; 116:54-61. [PMID: 30654994 DOI: 10.1016/j.jpsychores.2018.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/03/2018] [Revised: 10/11/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe the illness perceptions (IP) of stroke patients in the first year post stroke; to identify patient clusters with comparable IP trajectories and determine their associations with health. METHODS This prospective study included consecutive stroke patients after medical rehabilitation. Three and 12 months post stroke they completed the Brief Illness Perception Questionnaire (B-IPQ) and questionnaires on physical and mental health. All eight IP and their changes over time were described. Clusters of patients with comparable IP trajectories were constructed by k-means clustering, with subsequent comparison of patient characteristics. Multivariable logistic regression analyses were conducted to determine the association between IP clusters and 12-month mental health. RESULTS Hundred-and-eighty-four patients were included (men n = 107 [58.2%]; mean age 61.1 [SD 12.7] years). At 3 months, the scores of the IP coherence (mean 3.0, SD 2.3) and treatment control (mean 3.2, SD 2.5) were lowest (best), and consequences (mean 6.1, SD 2.8) and anticipated timeline (mean 6.0, SD 2.7) were highest (worst). At 12 months, the timeline and treatment control scores had significantly worsened. Three clusters of the trajectories of IP were identified, and designated as 'favourable', 'average', and 'unfavourable'. The unfavourable cluster was significantly associated with worse physical and mental health at 3 months (unadjusted) and depressive symptoms at 12 months. CONCLUSION Stroke patients' IP partly changed between 3 and 12 months post stroke. Patients with an unfavourable IP trajectory had a higher chance of depressive symptoms at 12 months. Illness perceptions could be considered as an additional target of treatment.
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Affiliation(s)
- I F Groeneveld
- Rijnlands Rehabilitation Centre, Leiden, the Netherlands; Sophia Rehabilitation, The Hague, the Netherlands; Department of Orthopaedics, Rehabilitation, and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands.
| | - S L van der Pas
- Medical Statistics, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; Mathematical Institute, Leiden University, the Netherlands
| | - J J L Meesters
- Sophia Rehabilitation, The Hague, the Netherlands; Department of Orthopaedics, Rehabilitation, and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | | | - W van Meijeren-Pont
- Rijnlands Rehabilitation Centre, Leiden, the Netherlands; Sophia Rehabilitation, The Hague, the Netherlands; Department of Orthopaedics, Rehabilitation, and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | - E Jagersma
- Sophia Rehabilitation, The Hague, the Netherlands
| | - P H Goossens
- Rijnlands Rehabilitation Centre, Leiden, the Netherlands; Sophia Rehabilitation, The Hague, the Netherlands; Department of Orthopaedics, Rehabilitation, and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
| | - A A Kaptein
- Department of Medical Psychology, Leiden University Medical Center, Leiden, the Netherlands
| | - T P M Vliet Vlieland
- Rijnlands Rehabilitation Centre, Leiden, the Netherlands; Sophia Rehabilitation, The Hague, the Netherlands; Department of Orthopaedics, Rehabilitation, and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands
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Groeneveld IF, Goossens PH, van Meijeren-Pont W, Arwert HJ, Meesters JJL, Rambaran Mishre AD, Van Vree F, Vliet Vlieland TPM. Value-Based Stroke Rehabilitation: Feasibility and Results of Patient-Reported Outcome Measures in the First Year After Stroke. J Stroke Cerebrovasc Dis 2018; 28:499-512. [PMID: 30503680 DOI: 10.1016/j.jstrokecerebrovasdis.2018.10.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 05/25/2018] [Revised: 09/23/2018] [Accepted: 10/26/2018] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Structured application of patient-reported outcome measures (PROMs) is a key element in Value Based Healthcare. This study aimed to evaluate the feasibility of a broad set of PROMs reflecting similar patient reported health domains as proposed within the International Standard Set of Patient-Centered Outcome Measures After Stroke within the first year after stroke. METHODS The study included consecutive stroke patients admitted to inpatient or outpatient specialized rehabilitation. PROMs were administered upon admission, discharge (inpatients only), and at 3, 6, and 12 months. PROMs included: EuroQol 5 Dimensions (EQ-5D), Stroke Impact Scale (SIS), Stroke and Aphasia Quality of Life Scale (SAQOL-39NL), Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P), Hospital Anxiety and Depression Scale (HADS), and Fatigue Severity Scale (FSS). Feasibility was defined as participation, retention, and response rates. Paired t tests were conducted to analyze their changes over time. RESULTS Of 485 inpatients and 189 outpatients who were invited, 291 (60.0%) and 82 (43.3%) participated, of whom 45 (15.5%) and 7 (8.5%) dropped out before 12 months, respectively. Two hundred seven (71.1%) and 71 (86.6%) of the inpatients and outpatients returned the questionnaires on all or all but one time points, respectively. Between admission and 12 months statistically significant improvements of PROMs addressing general health and quality of life (EQ-5D), psychiatric functioning (HADS), motor functioning (SIS mobility), and social functioning (USER-P, SIS communication) were seen. The SIS memory scale, the SAQOL-39NL and the FSS did not show any changes. CONCLUSIONS Participation, retention, and response rates for a comprehensive set of PROMS for stroke in patients in rehabilitation were moderate to good, with clinical improvements seen until 1 year post stroke. The SAQOL-39NL and FSS did not demonstrate changes over time and cannot be recommended for repetitive measurements in this setting. By simplifying the set of questionnaires, participation and response rates may be further enhanced.
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Affiliation(s)
- I F Groeneveld
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands; Sophia Rehabilitation Centre, The Hague, The Netherlands; Department of Orthopaedics, Leiden University Medical Center, Rehabilitation, and Physical Therapy, Leiden, The Netherlands.
| | - P H Goossens
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands; Sophia Rehabilitation Centre, The Hague, The Netherlands; Department of Orthopaedics, Leiden University Medical Center, Rehabilitation, and Physical Therapy, Leiden, The Netherlands
| | - W van Meijeren-Pont
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands; Sophia Rehabilitation Centre, The Hague, The Netherlands; Department of Orthopaedics, Leiden University Medical Center, Rehabilitation, and Physical Therapy, Leiden, The Netherlands
| | - H J Arwert
- Sophia Rehabilitation Centre, The Hague, The Netherlands; Department of Rehabilitation Medicine, Haaglanden Medical Center, The Hague, The Netherlands
| | - J J L Meesters
- Sophia Rehabilitation Centre, The Hague, The Netherlands; Department of Orthopaedics, Leiden University Medical Center, Rehabilitation, and Physical Therapy, Leiden, The Netherlands
| | - A D Rambaran Mishre
- Sophia Rehabilitation Centre, The Hague, The Netherlands; Department of Rehabilitation Medicine, Reinier de Graaf Groep, Delft, The Netherlands
| | - F Van Vree
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands; Sophia Rehabilitation Centre, The Hague, The Netherlands
| | - T P M Vliet Vlieland
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands; Sophia Rehabilitation Centre, The Hague, The Netherlands; Department of Orthopaedics, Leiden University Medical Center, Rehabilitation, and Physical Therapy, Leiden, The Netherlands
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9
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Boyce LW, Goossens PH, Volker G, van Exel HJ, Vliet Vlieland TPM, van Bodegom-Vos L. Attention needed for cognitive problems in patients after out-of-hospital cardiac arrest: an inventory about daily rehabilitation care. Neth Heart J 2018; 26:493-499. [PMID: 30215169 PMCID: PMC6150874 DOI: 10.1007/s12471-018-1151-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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] [Indexed: 11/30/2022] Open
Abstract
Aim Recent literature and Dutch guidelines for patients with out-of-hospital cardiac arrest (OHCA) recommend screening for cognitive impairments and referral to cognitive rehabilitation when needed. The aim of this study is to assess the uptake of these recommendations for OHCA patients. Method An internet-based questionnaire was sent to 74 cardiologists and 143 rehabilitation specialists involved in rehabilitation of OHCA patients in the Netherlands. The questionnaire covered: background characteristics, availability and content of cognitive screening and rehabilitation, organisation of care, experienced need for an integrated care pathway including physical and cognitive rehabilitation, barriers and facilitators for an integrated care pathway. Results Forty-five questionnaires were returned (16 cardiologists and 29 rehabilitation doctors). Thirty-nine percent (n = 17) prescribed cognitive screening. Eighty-nine percent underscores an added value of an integrated care pathway. Barriers for an integrated care pathway included lack of knowledge, logistic obstacles, and poor cooperation between medical specialties. Conclusions In the Netherlands, only a minority of cardiologists and rehabilitation specialists routinely prescribe some form of cognitive screening in OHCA patients, although the majority underscores the value of cognitive screening in OHCA patients in an integrated care pathway. The uptake of such a care pathway seems hindered by lack of knowledge and organisational barriers.
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Affiliation(s)
- L W Boyce
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands.
| | - P H Goossens
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands.,Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - G Volker
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands
| | - H J van Exel
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands.,Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - T P M Vliet Vlieland
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands.,Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - L van Bodegom-Vos
- Department of Biomedical Data Sciences, section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
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10
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van Dongen CH, Goossens PH, van Zee IE, Verpoort KN, Vliet Vlieland TPM, van Velzen JM. Short-Term and Long-Term Outcomes of a Vocational Rehabilitation Program for Patients with Acquired Brain Injury in The Netherlands. J Occup Rehabil 2018; 28:523-530. [PMID: 29139017 PMCID: PMC6096502 DOI: 10.1007/s10926-017-9738-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Purpose To describe short-term and long-term work status after a vocational rehabilitation (VR) program in patients with acquired brain injury (ABI) in the Netherlands. Methods Patients with ABI who participated in a VR program between 2007 and 2010 were included in this study. The 4-month VR program included a multidisciplinary assessment, three meetings with all stakeholders and reintegration with coaching on the job. Short-term results at the end of the VR program were based on data extracted from medical records. Long-term results were determined at 3-6 years (mean 4.4 years) after the program based on patient-reported data. Outcome measures included return to work, hours at work and task adjustments. Results Fifty-eight patients were included [mean age 48 (SD 9.4) years; n = 33 male; all working before ABI]. After the intervention, 50 patients (86%) had returned to work, working on average 60% of their former hours. Working tasks were adjusted in 48 patients. At long-term follow-up 28 patients had paid work, working on average 5.3 h more than immediately after the VR program. Conclusions Directly after the intervention 86% of the patients had returned to work. After 3-6 years, 64% of these patients were still working in a paid job.
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Affiliation(s)
| | - Paulien H Goossens
- Rijnlands Rehabilitation Centre, PO Box 176, 2300 AD, Leiden, The Netherlands
- Department of Orthopaedics, Physiotherapy and Rehabilitation, Leiden University Medical Center, Leiden, The Netherlands
| | - Inge E van Zee
- Rijnlands Rehabilitation Centre, PO Box 176, 2300 AD, Leiden, The Netherlands
| | - Kirsten N Verpoort
- Rijnlands Rehabilitation Centre, PO Box 176, 2300 AD, Leiden, The Netherlands
| | - Thea P M Vliet Vlieland
- Rijnlands Rehabilitation Centre, PO Box 176, 2300 AD, Leiden, The Netherlands
- Department of Orthopaedics, Physiotherapy and Rehabilitation, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith M van Velzen
- Department of Research and Development, Heliomare, Wijk aan Zee, The Netherlands
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11
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Groeneveld IF, Goossens PH, van Braak I, van der Pas S, Meesters JJL, Rambaran Mishre RD, Arwert HJ, Vliet Vlieland TPM. Patients' outcome expectations and their fulfilment in multidisciplinary stroke rehabilitation. Ann Phys Rehabil Med 2018; 62:21-27. [PMID: 30053628 DOI: 10.1016/j.rehab.2018.05.1321] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 01/20/2018] [Revised: 05/04/2018] [Accepted: 05/04/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients' expectations of the outcomes of rehabilitation may influence the outcomes and satisfaction with treatment. OBJECTIVES For stroke patients in multidisciplinary rehabilitation, we aimed to explore patients' outcome expectations and their fulfilment as well as determinants. METHODS The Stroke Cohort Outcomes of REhabilitation (SCORE) study included consecutive stroke patients admitted to an inpatient rehabilitation facility after hospitalisation. Outcome expectations were assessed at the start of rehabilitation (admission) by using the three-item Expectancy scale (sum score range 3-27) of the Credibility/Expectancy Questionnaire (CEQ). After rehabilitation, patients answered the same questions formulated in the past tense to assess fulfilment of expectations. Baseline patient characteristics were recorded and health-related quality of life (EQ-5D) was measured at baseline and after rehabilitation. The number of patients with expectations unfulfilled or fulfilled or exceeded was computed by subtracting the admission and discharge CEQ Expectancy scores. Multivariable regression analysis was used to determine the factors associated with outcome expectations and their fulfilment, estimating odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS We included 165 patients (96 males [58.2%], mean (SD) age 60.2 years [12.7]) who completed the CEQ Expectancy instrument at admission (median score 21.6, interquartile range [IQR] 17.0-24.0); 79 completed it both at admission (median score 20.6, IQR 16.6-24.4) and follow-up (median score 20.0, IQR 16.4-22.8). For 40 (50.6%) patients, expectations of therapy were fulfilled or exceeded. No patient characteristic at admission was associated with baseline CEQ Expectancy score. Odds of expectation fulfilment were associated with low expectations at admission (OR 0.70, 95% CI 0.60-0.83) and improved EQ-5D score (OR 1.35, 95% CI 1.04-0.75). CONCLUSIONS In half of the stroke patients in multidisciplinary rehabilitation, expectations were fulfilled or exceeded, most likely in patients with low expectations at admission and with improved health-related quality of life. More research into the role of health professionals regarding the measurement, shaping and management of outcome expectations is needed.
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Affiliation(s)
- Iris F Groeneveld
- Rijnlands Rehabilitation Centre, Wassenaarseweg 501, 2333 AL Leiden, The Netherlands; Sophia Rehabilitation, Vrederustlaan 180, 2543 SW The Hague, The Netherlands; Department of Orthopaedics, Rehabilitation, and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Paulien H Goossens
- Rijnlands Rehabilitation Centre, Wassenaarseweg 501, 2333 AL Leiden, The Netherlands; Department of Orthopaedics, Rehabilitation, and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Inke van Braak
- Rijnlands Rehabilitation Centre, Wassenaarseweg 501, 2333 AL Leiden, The Netherlands
| | - Stéphanie van der Pas
- Medical Statistics, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; Mathematical Institute, Leiden University, Niels Bohrweg 1, 2333 CA Leiden, The Netherlands
| | - Jorit J L Meesters
- Sophia Rehabilitation, Vrederustlaan 180, 2543 SW The Hague, The Netherlands; Department of Orthopaedics, Rehabilitation, and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Radha D Rambaran Mishre
- Sophia Rehabilitation, Vrederustlaan 180, 2543 SW The Hague, The Netherlands; Department of Rehabilitation Medicine, Reinier de Graaf Hospital, Reinier de Graafweg 5, 2625 AD Delft, The Netherlands
| | - Henk J Arwert
- Sophia Rehabilitation, Vrederustlaan 180, 2543 SW The Hague, The Netherlands; Department of Rehabilitation Medicine, Haaglanden Medical Centre, Lijnbaan 32, 2512 VA Den Haag, The Netherlands
| | - Thea P M Vliet Vlieland
- Rijnlands Rehabilitation Centre, Wassenaarseweg 501, 2333 AL Leiden, The Netherlands; Sophia Rehabilitation, Vrederustlaan 180, 2543 SW The Hague, The Netherlands; Department of Orthopaedics, Rehabilitation, and Physical Therapy, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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12
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Groeneveld IF, Arwert HJ, Goossens PH, Vliet Vlieland TPM. The Longer-term Unmet Needs after Stroke Questionnaire: Cross-Cultural Adaptation, Reliability, and Concurrent Validity in a Dutch Population. J Stroke Cerebrovasc Dis 2017; 27:267-275. [PMID: 28967592 DOI: 10.1016/j.jstrokecerebrovasdis.2017.08.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 05/15/2017] [Revised: 08/15/2017] [Accepted: 08/26/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Unmet needs are common after stroke. We aimed to translate the 22-item Longer-term Unmet Needs after Stroke (LUNS) Questionnaire and validate it in a Dutch stroke population. METHODS The LUNS was translated and cross-culturally adapted according to international guidelines. After field testing, the Dutch version was administered twice to a hospital-based cohort 5-8 years after stroke. Participants were also asked to complete the Frenchay Activity Index (FAI) and Short Form (SF)-12. To explore acceptability, the response and completion rates as well as number of missing items were computed. For concurrent validity, the differences in health status (FAI, SF-12) between groups who did and did not report an unmet need were calculated per item. To determine the 14-day test-retest reliability, the percentage of agreement between the first and the second administration was calculated for each item. RESULTS Seventy-eight of 145 patients (53.8%) returned the initial Dutch LUNS (average age 68.3 [standard deviation 14.0] years, 59.0% male); 66 of these patients (84.6%) fully completed it. Of all items, 3.3% were missing. Among completers, the median number of unmet needs was 3.5 (2.0-5.0; 1.0-14.0). For 15 of 22 items, there was a significant association with the FAI or SF-12 Mental or Physical Component Summary scales. The percentage of agreement ranged from 69.8% to 98.1% per item. CONCLUSIONS Among the 53.8% who completed the survey, the LUNS was concluded to be feasible, reliable, and valid; two-thirds of its items were related to activities and quality of life. Its usefulness and acceptability when administered in routine practice require further study.
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Affiliation(s)
- Iris F Groeneveld
- Sophia Rehabilitation, Den Haag, The Netherlands; Rijnlands Rehabilitation Center, Leiden, The Netherlands; Leiden University Medical Center, Leiden, The Netherlands.
| | - Henk J Arwert
- Sophia Rehabilitation, Den Haag, The Netherlands; Haaglanden Medical Center, Den Haag, The Netherlands
| | - Paulien H Goossens
- Rijnlands Rehabilitation Center, Leiden, The Netherlands; Leiden University Medical Center, Leiden, The Netherlands
| | - Thea P M Vliet Vlieland
- Sophia Rehabilitation, Den Haag, The Netherlands; Rijnlands Rehabilitation Center, Leiden, The Netherlands; Leiden University Medical Center, Leiden, The Netherlands
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13
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Boyce LW, Reinders CC, Volker G, Los E, van Exel HJ, Vliet Vlieland TPM, Goossens PH. Out-of-hospital cardiac arrest survivors with cognitive impairments have lower exercise capacity. Resuscitation 2017; 115:90-95. [PMID: 28392370 DOI: 10.1016/j.resuscitation.2017.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 11/15/2016] [Revised: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Hypoxic brain injury is described in up to 40% of survivors after out-of-hospital cardiac arrest (OHCA). Besides cognitive impairments, lack of circulation may also affect exercise capacity. It is not known if exercise capacity of patients with cognitive impairments differs from other OHCA survivors. METHODS This retrospective cohort study included patients ≥18 years with myocardial infarction (MI) as cause of OHCA admitted for cardiac rehabilitation between February 2011 and April 2014. Data in socio-demographic, OHCA and medical interventions were retrieved. Cognitive functioning was determined with the Mini-Mental State Examination, Cognitive Failures Questionnaire and the Informant Questionnaire on Cognitive Decline in the Elderly. Exercise capacity (VO2peak), workload (Watts) and blood pressure (mmHg) were measured at maximum cardiopulmonary exercise. Heart rate (bpm) was measured at rest and maximum exercise and Metabolic Equivalents of Tasks (MET) were calculated. RESULTS 65 patients after OHCA caused by MI were included (85% male, median age 60years). Of 53 patients Cardio Pulmonary Exercise Test data was available of which nine patients showed cognitive impairments. Significant differences (p<0.05) in exercise capacity were found between patients with and without cognitive impairments: VO2peak (median 14.5 vs 19.7ml/kg/min), workload (median 130.0 vs 143.5W) and MET's (median 4.1 vs 5.6). CONCLUSION Based on this small study, there seems to be a correlation between cognitive impairments and lower exercise capacity in patients referred for rehabilitation after OHCA caused by MI. It seems sensible for rehabilitation programs to take the lower exercise capacity of patients with cognitive impairments into account.
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Affiliation(s)
| | | | - Gerard Volker
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands
| | - Esther Los
- Sophia Rehabilitation, The Hague, The Netherlands
| | - Henk J van Exel
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands; Leiden University Medical Center, Leiden, The Netherlands
| | - Thea P M Vliet Vlieland
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands; Sophia Rehabilitation, The Hague, The Netherlands; Leiden University Medical Center, Leiden, The Netherlands
| | - Paulien H Goossens
- Rijnlands Rehabilitation Centre, Leiden, The Netherlands; Leiden University Medical Center, Leiden, The Netherlands
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14
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Abstract
Cognitive impairments are common after resuscitation. Severe cognitive impairments are easily recognized. Mild cognitive impairments are much more difficult to spot. Given the influence of cognitive problems in daily functioning, it is important to identify cognitive impairments at an early stage. Also, emotional problems, mainly depression and fear, are common in this group of patients. To optimize the care for patients after an out-of-hospital cardiac arrest, rehabilitation should focus on the physical approach through cardiac rehabilitation and on brain injury and associated cognitive impairments. The goal of rehabilitation after a cardiac arrest is to provide excellent patient-centered cardiac and cognitive rehabilitation to all patients and their spouses to achieve optimal participation in society, with minimal burden for spouses and society. To achieve this, cardiac and cognitive rehabilitation need to be coordinated in an integrated care path.
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15
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Boyce LW, Vliet Vlieland TPM, Bosch J, Wolterbeek R, Volker G, van Exel HJ, Heringhaus C, Schalij MJ, Goossens PH. High survival rate of 43% in out-of-hospital cardiac arrest patients in an optimised chain of survival. Neth Heart J 2014; 23:20-5. [PMID: 25326102 PMCID: PMC4268206 DOI: 10.1007/s12471-014-0617-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIMS Survival to hospital discharge after out-of-hospital cardiac arrest (OHCA) varies widely. This study describes short-term survival after OHCA in a region with an extensive care path and a follow-up of 1 year. METHODS Consecutive patients ≥16 years admitted to the emergency department between April 2011 and December 2012 were included. In July 2014 a follow-up took place. Socio-demographic data, characteristics of the OHCA and interventions were described and associations with survival were determined. RESULTS Two hundred forty-two patients were included (73 % male, median age 65 years). In 76 % the cardiac arrest was of cardiac origin and 52 % had a shockable rhythm. In 74 % the cardiac arrest was witnessed, 76 % received bystander cardiopulmonary resuscitation and in 39 % an automatic external defibrillator (AED) was used. Of the 168 hospitalised patients, 144 underwent therapeutic procedures. A total of 105 patients survived until hospital discharge. Younger age, cardiac arrest in public area, witnessed cardiac arrest, cardiac origin with a shockable rhythm, the use of an AED, shorter time until return of spontaneous circulation, Glasgow Coma Scale (GCS) ≥13 during transport and longer length of hospital stay were associated with survival. Of the 105 survivors 72 survived for at least 1 year after cardiac arrest and 6 patients died. CONCLUSION A survival rate of 43 % after OHCA is achievable. Witnessed cardiac arrest, cardiac cause of arrest, initial cardiac rhythm and GCS ≥13 were associated with higher survival.
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Affiliation(s)
- L W Boyce
- Rijnlands Rehabilitation Centre, Wassenaarseweg 501, 2333AL, Leiden, the Netherlands,
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16
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van Haaren MAC, Lawrence M, Goossens PH, van den Bossche B, Wermer MJH, Kaptein AA. Pirandello's analogy: a source for a better understanding of the social impact of stroke. Eur Neurol 2012; 67:92-7. [PMID: 22236661 DOI: 10.1159/000334846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 11/04/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Suffering a stroke has major implications for the patient. To understand human suffering, one should understand society. Pirandello described society as a higher entity than the individual, thereby justifying human adaptability to society. We explore a qualitative finding that suggests that social trends may influence how stroke patients prioritize aspects of their rehabilitation. METHODS We compare a contemporary patient's experience of stroke recovery with that of a fictional character from the works of Luigi Pirandello. Both patients had two main residual symptoms: hemiparesis and aphasia. RESULTS The rehabilitation priorities of the two patients differed, and appeared to reflect the contemporaneous demands of society. Mobility was prioritized in 1910; communication was prioritized in 2010. However, essential aspects of 'being a stroke patient' remained unchanged; both patients retained a sense of self and both coped emotionally by being hopeful. CONCLUSIONS We conclude that stroke patients respond to society's contemporaneous demands and expectations. Currently, society demands participation in a large social environment and this is reflected in stroke patients' priorities. This analogy could enable medical professionals to better understand the social impact of stroke, and consequently offer appropriate interventions to improve rehabilitation outcomes for individual patients.
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Affiliation(s)
- M A C van Haaren
- Department of Medical Psychology, Leiden University Medical Center, Leiden, The Netherlands.
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17
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Goossens PH, Huizinga TWJ. Adenoviral-mediated gene transfer to the synovial tissue. Clin Exp Rheumatol 2002; 20:415-9. [PMID: 12102483] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
In various animal models gene transfer to the synovial tissue has been shown after intraarticular injection of adenoviral vectors. Safety of the transfer of therapeutic genes to the synovial tissue depends on multiple factors, including the mode of administration, the vector and the gene used, and the immune system of the host. In this article, data on the biodistribution and induction of inflammation after the intraarticular administration of adenoviral vectors are summarized and discussed. The ultimate goal of gene therapy will be the injection of a vector that has a specific target cell. Such a goal will require major improvements in the currently available delivery systems or the development of novel vectors. In this article new strategies are proposed in which gene transfer efficiency to the synovial tissue increases, whereas simultaneously the effect of neutralization of the adenoviral vector by the synovial fluid is circumvented.
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Affiliation(s)
- P H Goossens
- Department of Rheumatology, Leiden University Medical Center, The Netherlands
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18
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Pieterman E, Goossens PH, van der Laan WH, Huidekoper AL, Rabelink MJM, Hoeben RC, Verheijen JH, Breedveld FC, Huizinga TWJ. Invasion of synoviocytes is inhibited by gene transfer of TNF-BP or IL10 in an in vitro invasion model. Arthritis Res Ther 2001. [PMCID: PMC3273259 DOI: 10.1186/ar212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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19
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Affiliation(s)
- P H Goossens
- Department of Rheumatology, Leiden University Medical Centre, The Netherlands
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20
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Goossens PH, Havenga MJ, Pieterman E, Lemckert AA, Breedveld FC, Bout A, Huizinga TW. Infection efficiency of type 5 adenoviral vectors in synovial tissue can be enhanced with a type 16 fiber. Arthritis Rheum 2001; 44:570-7. [PMID: 11263771 DOI: 10.1002/1529-0131(200103)44:3<570::aid-anr105>3.0.co;2-y] [Citation(s) in RCA: 33] [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] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To obtain an adenoviral vector with increased infection efficiency in the synovial tissue compared with conventional vectors based on adenovirus serotype 5 (Ad5), without compromising the specificity of infection. METHODS Coxsackie adenovirus receptor (CAR) expression was assessed in cultured synoviocytes. Chimeric adenoviruses based on Ad5 but carrying the DNA encoding the fiber of adenovirus from subgroup B (Adll, 16, 35) or D (Ad24, 28, 33, 45, or 47) were constructed and produced on PER.C6 cells. The gene transfer efficiency of these chimera was tested on cultured synoviocytes and peripheral blood mononuclear cells (PBMC). RESULTS No surface expression of CAR protein was observed on synoviocytes. CAR messenger RNA expression of synoviocytes was found to be low. Of all fiber chimeric vectors tested, vectors carrying the fiber of Ad16 (Ad5.fib16) were most potent, yielding approximately150 times increased transgene expression in cultured synoviocytes compared with those of Ad5. Flow cytometry showed that the increase in transgene expression was caused by the transduction of higher percentages of synoviocytes and higher gene expression per synoviocyte. Experiments with 500 virus particles/cell of Ad5.GFP or Ad5.fib16.GFP resulted in an infection efficiency of 0.6% and 1% in PBMC and 43% and 76% in synoviocytes, respectively. CONCLUSION Synoviocytes hardly express CAR, which hampers Ad5-mediated gene transfer. Ad5.fib16 is superior to Ad5 vectors for transducing synoviocytes, without compromising the specificity of infection. Our data suggest that Ad5.fib16-mediated gene transfer to synovial tissue improves the therapeutic window.
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Affiliation(s)
- P H Goossens
- Leiden University Medical Center, The Netherlands
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21
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Goossens PH, Vogels R, Pieterman E, Havenga MJ, Bout A, Breedveld FC, Valerio D, Huizinga TW. The influence of synovial fluid on adenovirus-mediated gene transfer to the synovial tissue. Arthritis Rheum 2001; 44:48-52. [PMID: 11212175 DOI: 10.1002/1529-0131(200101)44:1<48::aid-anr7>3.0.co;2-d] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine the effect of synovial fluid (SF) from rheumatoid arthritis (RA) patients on adenovirus type 5 (Ad5)-mediated gene transfer to synoviocytes, and to explore new strategies for vector development based on the neutralization data obtained. METHODS SF was derived from 63 randomly selected R4 patients. Ten samples were used to study the effect of SF on Ad5-mediated gene transfer in synoviocytes. IgG and <100-kd fractions were purified from these 10 SF, and their effect on gene transfer was determined. Neutralizing activity against wild-type Ad5 (wt-Ad5), wt-Ad26, wt-Ad34, wt-Ad35, and wt-Ad48 was tested in the SF from the remaining 53 patients. RESULTS Seven of 10 SF samples inhibited Ad5-mediated gene transfer. Purified antibodies exhibited inhibition patterns similar to those seen with unfractionated SF. In 5 of 10 SF samples, low molecular weight fractions inhibited gene transfer at low dilutions. Neutralization of wt-Ad35 by SF from RA patients was less frequent than neutralization of other wt-Ad tested (4% versus 42-72%; n = 53). CONCLUSION SF from 70% of the RA patients contained neutralizing antibodies that hamper Ad5-mediated gene transfer to synoviocytes. The activity of neutralizing antibodies may be circumvented in the majority of RA patients when vectors based on an Ad35 backbone are used.
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Affiliation(s)
- P H Goossens
- Leiden University Medical Center, The Netherlands
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22
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Goossens PH, Schouten GJ, Heemskerk B, 't Hart BA, Bout A, Kluin PM, Breedveld FC, Valerio D, Huizinga TW. The effect of promoter strength in adenoviral vectors in hyperplastic synovium. Clin Exp Rheumatol 2000; 18:547-52. [PMID: 11072592] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVES To compare the activity of the CytoMegaloVirus promoter (CMV) and the Major Late promoter (MLP) in synoviocytes in vitro and in vivo. To determine the phenotype of infected cells and the induction of inflammation. To investigate the effects of the cytomegalovirus (CMV) or major late (MLP) promoter on adenovirus-mediated reporter gene transduction of synoviocytes in vitro and in vivo. METHODS After infection with adenoviral vectors harboring CMV- and MLP-driven luciferase and lacZ genes, gene expression was examined in cultured synoviocytes and in the synovium of rhesus monkeys with collagen-induced arthritis. Immunohistochemical staining for the macrophage-marker CD68 and lacZ expression was performed. Inflammation was scored in the synovial membrane of injected and non-injected joints. RESULTS CMV-driven reporter gene expression was found to be 6 to 10 times higher than MLP-driven gene expression in both cultured synoviocytes and monkey synovium. Both CD68 positive and CD68 negative cells were lacZ positive. Inflammation in joints injected with CMV-driven adenoviral vectors was not higher than that in MLP-driven adenoviral vectors- or non-injected joints. CONCLUSION These experiments show that the CMV promoter induces higher gene expression in synoviocytes than the MLP promoter. Both fibroblast-like and macrophage-like synoviocytes can be infected with adenoviral vectors. No deleterious effects of the CMV-promoter driven adenoviral vectors were observed.
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Affiliation(s)
- P H Goossens
- Department of Rheumatology, Leiden University Medical Center, The Netherlands
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23
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Goossens PH, Heemskerk B, van Tongeren J, Zwinderman AH, Vliet Vlieland TP, Huizinga TW. Reliability and sensitivity to change of various measures of hand function in relation to treatment of synovitis of the metacarpophalangeal joint in rheumatoid arthritis. Rheumatology (Oxford) 2000; 39:909-13. [PMID: 10952748 DOI: 10.1093/rheumatology/39.8.909] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The reliability and discriminative capacity of hand function tests were studied in order to obtain tests suitable for the evaluation of local treatment of an arthritic metacarpophalangeal (MCP) joint. METHODS To assess reliability, hand function tests were measured twice without local treatment of the MCP in 25 patients with rheumatoid arthritis (RA). The discriminative capacity of the hand function tests with respect to the results of intra-articular corticosteroid injection was assessed in 28 RA patients with synovitis of an MCP joint. Thereafter, a randomized, observer-blind treatment study was performed in 21 RA patients with synovitis of an MCP joint; 10 of the patients were treated. Results/Conclusions. This study showed that the efficacy of treatment of an MCP joint can be measured by several reliable and discriminative parameters: passive flexion, the Ritchie pain score, swelling, the Arthritis Impact Measurements Scales question about buttoning clothes, and visual analogue scale questions about the activity of the disease and swelling of the joint.
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Affiliation(s)
- P H Goossens
- Department of Rheumatology and. Medical Statistics, Leiden University Medical Centre, The Netherlands
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24
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Goossens PH, Schouten GJ, 't Hart BA, Bout A, Brok HP, Kluin PM, Breedveld FC, Valerio D, Huizinga TW. Feasibility of adenovirus-mediated nonsurgical synovectomy in collagen-induced arthritis-affected rhesus monkeys. Hum Gene Ther 1999; 10:1139-49. [PMID: 10340546 DOI: 10.1089/10430349950018139] [Citation(s) in RCA: 53] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Gene transfer to synovial tissue by adenoviral vectors (Ad) was studied in vitro in cultured human synoviocytes and in vivo in seven primates with arthritis. Hyperplastic synovium was efficiently transduced with Ad.lacZ in vitro and in vivo in rhesus monkeys with collagen-induced arthritis, whereas chondrocytes were not transduced. Intraarticular injection of recombinant Ad harboring the luciferase gene showed the presence of reporter gene products only in Ad-injected joints. In addition, the feasibility of synovectomy by Ad harboring the herpes simplex virus thymidine kinase gene (tk) was studied. In vitro infection of synovium from rheumatoid arthritis patients with Ad.TK, followed by administration of ganciclovir, resulted in death of >90% of the synoviocytes. By mixing Ad.TK-infected with noninfected cells, it appeared that the presence of 10% infected synoviocytes resulted in the killing of more than 85% of the synoviocytes, demonstrating a substantial bystander effect. Intraarticular injection of Ad.TK in the knees of rhesus monkeys with arthritis, followed by treatment with ganciclovir for 14 days, resulted in increased apoptotic cell death in the synovium of Ad.TK-injected as compared with noninjected joints and ablation of the synovial lining layer. The procedure revealed no toxic side effects. These data suggest that nonsurgical synovectomy by tK gene therapy is feasible.
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Affiliation(s)
- P H Goossens
- Department of Rheumatology, Leiden University Medical Center, The Netherlands
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25
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van Laar T, van der Geest R, Danhof M, Boddé HE, Goossens PH, Roos RA. Stepwise intravenous infusion of apomorphine to determine the therapeutic window in patients with Parkinson's disease. Clin Neuropharmacol 1998; 21:152-8. [PMID: 9617506] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A new experimental strategy was applied to determine the concentration-effect relation and the therapeutic window of apomorphine in individual patients with Parkinson's disease. Apomorphine was administered by a stepwise intravenous infusion. The infusion rate was increased by 10 micrograms/kg/h every 20 minutes, up to 100 micrograms/kg/h or less when adverse effects occurred. Thereafter, the infusion rate was decreased in a stepwise fashion until zero. Plasma apomorphine concentrations were measured every 20 minutes. Clinical efficacy (tapping score and tremor), dyskinesia, and adverse effects were monitored at the same time. The mean clearance of apomorphine was 4.5 L/min (2.2 to 6.6 L/min). Of the 10 patients, 8 responded to apomorphine. The effects were quantal rather than continuous. Within each patient, the concentrations at onset and offset of effect generally were similar. Significant interpatient variability was observed with respect to minimal concentration for each of the effects. Clinical efficacy occurred at a mean minimal effective concentration (MEC) of 4.7 ng/mL (range 1.4 to 10.7 ng/mL). Dyskinesia was observed at a mean concentration of 8.5 ng/mL (range 2.7 to 20 ng/mL). This value was not significantly different from the MEC. The mean minimal toxic concentration was 16.7 ng/mL (8.5 to 24.5 ng/mL) and was significantly different from the mean MEC. In conclusion, the stepwise increase and decrease of the intravenous infusion rate is a suitable tool for the establishment of the concentration-effect relation of apomorphine in individual patients. The finding of a narrow therapeutic window, in which the onset concentrations vary from patient to patient, underlines the need for accurate and individualized dosing.
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Affiliation(s)
- T van Laar
- Department of Neurology, Leiden University Hospital, The Netherlands
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