1
|
Larsen KSR, Lisby M, Kirkegaard H, Petersen AK. Functional decline in emergency department patients with dyspnea: a register-based cohort. Int J Qual Health Care 2021; 33:6174034. [PMID: 33724379 DOI: 10.1093/intqhc/mzab047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/03/2020] [Revised: 01/29/2021] [Accepted: 03/15/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Functional decline is associated with frequent hospital admissions and elevated risk of death. Presumably, patients acutely admitted to hospital with dyspnea have a high risk of functional decline. OBJECTIVE The aim of this study was to describe patient characteristics, hospital trajectory and use of physiotherapy services by dyspneic patients in an emergency department. The study also wanted to compare readmission and death among patients with and without a functional decline and to identify predictors of functional decline. METHODS Data originated from a historic cohort of patients admitted to a Danish Emergency Department using prospectively collected electronic patient record data from a Business Intelligence Registry of the Central Denmark Region. The study included adult patients who were treated at the emergency department (ED) for dyspnea in 2015. The main outcome measures were readmission, death and functional decline. RESULTS In total, 2048 dyspneic emergency treatments were registered. Within 30 days after discharge, 20% was readmitted and 3.9% had died. Patients with functional decline had a higher rate of 30-day readmission (31.2% vs. 19.1%, P < 0.001) and mortality (9.3% vs. 3.6%, P = 0.009) as well as mortality within 1 year (36.1% vs. 13.4%, P < 0.001). Predictors of functional decline were age ≥60 years and hospital stay ≥6 days. CONCLUSION Patients suffering from acute dyspnea are seen at the ED at all hours. In total, one in five patients were readmitted and 3.9% died within 30 days. Patients with a functional decline at discharge seem to be particularly vulnerable.
Collapse
Affiliation(s)
- Karoline Stentoft Rybjerg Larsen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 69, Aarhus 8200, Central Denmark Region, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus 8200, Central Denmark Region, Denmark
| | - Marianne Lisby
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus 8200, Central Denmark Region, Denmark.,Emergency Department, Aarhus University Hospital, Palle Juul-Jensens Boulevard 161, Aarhus 8200, Central Denmark Region, Denmark
| | - Hans Kirkegaard
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus 8200, Central Denmark Region, Denmark.,Emergency Department, Aarhus University Hospital, Palle Juul-Jensens Boulevard 161, Aarhus 8200, Central Denmark Region, Denmark
| | - Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 69, Aarhus 8200, Central Denmark Region, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus 8200, Central Denmark Region, Denmark
| |
Collapse
|
2
|
Sørensen L, Oestergaard LG, van Tulder M, Petersen AK. Measurement properties of handheld dynamometry for assessment of shoulder muscle strength: A systematic review. Scand J Med Sci Sports 2021; 30:2305-2328. [PMID: 33463791 DOI: 10.1111/sms.13805] [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: 02/17/2020] [Revised: 07/15/2020] [Accepted: 08/03/2020] [Indexed: 12/11/2022]
Abstract
Like any assessment tool, handheld dynamometry (HHD) must be valid and reliable in order to be meaningful in clinical practice and research. To summarize the evidence of measurement properties of HHD for the assessment of shoulder muscle strength. Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, and PEDro were searched up to February 2020. Inclusion criteria were studies (a) evaluating HHD used on the glenohumeral joint, (b) evaluating measurement properties, and (c) included individuals ≥ 18 years old with or without shoulder symptoms. Exclusion criteria were studies (a) including patients with neurologic, neuromuscular, systemic diseases, or critical illness or bed-side patients and (b) that did not report the results separately for each movement. In total, 28 studies with 963 participants were included. The reliability results showed that 98% of the intraclass correlation coefficient (ICC) values were ≥0.70. The measurement error showed that the minimal detectable change in percent varied from 0% to 51.0%. The quality of evidence was high or moderate for the majority of movements and type of reliability examined. Based on the evidence of low or very low quality of evidence, the convergent validity and discriminative validity of HHD were either sufficient, indeterminate, or insufficient. The reliability of HHD was overall sufficient, and HHD can be used to distinguish between individuals on the group level. The measurement error was not sufficient, and evaluation of treatment effect on the individual level should be interpreted with caution.
Collapse
Affiliation(s)
- Lotte Sørensen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Maurits van Tulder
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Department of Health Sciences, Amsterdam Movement Sciences research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
3
|
Petersen AK, Jacobsen JS, Hansen MG, Rasmussen RG, Blaabjerg B, Lind M, Oestergaard LG. Translation, reproducibility, and responsiveness of a Danish version of the International Knee Documentation Committee Subjective Knee Form. Transl Sports Med 2020. [DOI: 10.1002/tsm2.208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy Aarhus University Hospital Aarhus Denmark
- Institute of Clinical Medicine Aarhus University Aarhus Denmark
- Centre of Research in Rehabilitation (CORIR) Institute of Clinical Medicine Aarhus University Aarhus Denmark
| | - Julie Sandell Jacobsen
- Department of Physiotherapy and Research Centre for Health and Welfare Technology Programme for Rehabilitation VIA University College Horsens Denmark
| | | | - Randi G. Rasmussen
- Department of Physiotherapy and Occupational Therapy Aarhus University Hospital Aarhus Denmark
| | - Birgitte Blaabjerg
- Department of Physiotherapy and Occupational Therapy Aarhus University Hospital Aarhus Denmark
| | - Martin Lind
- Institute of Clinical Medicine Aarhus University Aarhus Denmark
- Department of Orthopaedic Surgery Aarhus University Hospital Aarhus Denmark
| | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy Aarhus University Hospital Aarhus Denmark
- Institute of Clinical Medicine Aarhus University Aarhus Denmark
- Centre of Research in Rehabilitation (CORIR) Institute of Clinical Medicine Aarhus University Aarhus Denmark
| |
Collapse
|
4
|
Sørensen L, Oestergaard LG, van Tulder M, Petersen AK. Measurement Properties of Isokinetic Dynamometry for Assessment of Shoulder Muscle Strength: A Systematic Review. Arch Phys Med Rehabil 2020; 102:510-520. [PMID: 32619417 DOI: 10.1016/j.apmr.2020.06.005] [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] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the evidence of measurement properties of isokinetic dynamometry (ID) for assessment of shoulder muscle strength in healthy individuals and patients with nonneurologic shoulder pathology. DATA SOURCES Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and Physiotherapy Evidence Database were searched up to February 2020 without restrictions. Reference lists and citations were hand-searched. STUDY SELECTION Two review authors independently included studies that met the following criteria: (1) evaluated measurement properties of ID when used on the glenohumeral joint and (2) included individuals 18 years and older. Studies including patients with neurologic, neuromuscular, or systemic diseases or critical illness were excluded. DATA EXTRACTION The quality assessment and data synthesis were performed according to the COnsensus-based Standards for the selection of health Measurement INstruments methodology. DATA SYNTHESIS Twenty-one studies with a total of 597 participants were included. The results were combined separately for isometric, concentric, and eccentric test mode; for the velocities 30°/s-60°/s, 90°/s, 120°/s, and 240°/s; for the seated, supine, and standing position; and for internal rotation (IR), external rotation (ER), and the ER/IR ratio. The reliability of ID was overall sufficient with the majority of intraclass correlation coefficients ≥0.70. The quality of evidence was moderate or low for 20 of 30 strata examined. The measurement error results were rated as insufficient for all strata. The SEM ranged from 4%-28%. The quality of evidence varied depending of strata examined. CONCLUSIONS The reliability of ID for measurement of shoulder strength was overall sufficient for all positions, velocities, and modes of strength. The measurement error was not sufficient. Because most studies used the seated position, the velocities 30°/s-60°/s or 120°/s, and the concentric test mode, the quality of evidence was highest for these conditions.
Collapse
Affiliation(s)
- Lotte Sørensen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark; DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Maurits van Tulder
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Health Sciences, Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
5
|
Muren MA, Kristensen LQ, Petersen AK, van Tulder MW, Oestergaard LG. Measurement properties of instruments to assess mental function during activity and participation in individuals surviving traumatic brain injury: A systematic review protocol. Scand J Occup Ther 2020; 27:163-167. [PMID: 30757936 DOI: 10.1080/11038128.2018.1563630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 12/17/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
Abstract
Background: Most studies assessing mental function in individuals with traumatic brain injury (TBI) assess the impairments through pen and paper tests. However, weak correlation has been found between the results from pen and paper tests and the results from performance-based tests during activity and participation. Objective: To investigate measurement properties of performance-based instruments that are used to assess mental function during activity and participation in individuals with a TBI. Material and methods: PubMed, EMBASE, CINAHL, PsycINFO, and OTseeker will be searched for relevant studies reporting on measurement properties of performance-based instruments to assess mental function in individuals with a TBI. The COnsensus-based Standards for selection of Health Measurement Instruments (COSMIN) checklist will be used to evaluate the methodological quality of the included studies. The Terwee quality criteria will be applied to evaluate the study findings for each measurement property. To summarize all the evidence, a best evidence synthesis will be performed. Results: Results will be presented in text and tables. Conclusions: Conclusion will be drawn up-on the overall evidence Significance: It is expected that the findings of the review will provide evidence to guide clinicians in the selection of instruments to use in occupational therapy practice and research.
Collapse
Affiliation(s)
- Marie Almkvist Muren
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Lola Qvist Kristensen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Neurorehabilitation Skive, Hammel Neurorehabilitation Centre and University Research Clinic, Skive, Denmark
| | - Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital and Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Maurits W van Tulder
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Health Sciences and Amsterdam Movement Institute, Faculty of Science, Vrije Universiteit Amsterdam, the Netherlands
| | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital and Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| |
Collapse
|
6
|
Kristensen LQ, Muren MA, Petersen AK, van Tulder MW, Gregersen Oestergaard L. Measurement properties of performance-based instruments to assess mental function during activity and participation in traumatic brain injury: A systematic review. Scand J Occup Ther 2019; 27:168-183. [PMID: 31725339 DOI: 10.1080/11038128.2019.1689291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Performance-based measures that focus primarily on the ability to engage in ADL are routinely used by occupational therapists to assess a client's cognitive abilities.Objective: To perform a systematic review to investigate measurement properties of performance-based instruments to assess mental function during activity and participation in individuals with traumatic brain injury.Material and methods: Pubmed, EMBASE, CINAHL, PsycINFO and OTseeker were searched. The Consensus-based Standards for the selection of health measurement instruments checklist was used to evaluate methodological quality of each included study. The quality criteria adapted by Terwee were applied to extract the results of each measurement property followed by a best evidence synthesis.Results: Twenty-eight articles, including 40 ratings of measurement properties, were included. The combination of the Functional Independence Measure and the Functional Assessment Measure showed moderate evidence of good internal consistency (Cronbach's alpha 0.99), but conflicting evidence of reliability (ICC 0.83) and poor evidence of construct validity. All other instruments showed limited or unknown evidence.Conclusions: This review provides an overview of measurement properties of performance-based instruments and contributes to such methodological considerations before choosing an instrument. Though, the results reveal a lack of high-quality evidence for any of the measurement properties, it is recommended to use tools with the highest possible evidence for positive ratings.Significance: This review contributes with psychometric evidence on instruments to use in occupational therapy practice and research.
Collapse
Affiliation(s)
- Lola Qvist Kristensen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Neurorehabilitation Skive, Hammel Neurorehabilitation Centre and University Research Clinic, Skive, Denmark
| | - Marie Almkvist Muren
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital and Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maurits W van Tulder
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Department of Health Sciences and the EMGO + Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, the Netherlands
| | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital and Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark.,Department of Public Health, The Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
7
|
Abstract
PURPOSE Patients are referred to exercise-based cardiac rehabilitation (ECR) to increase exercise capacity and health-related quality of life (HRQOL) and thereby reduce risk of morbidity and mortality. The purpose of this study was to examine the correlation between exercise capacity and HRQOL. Furthermore, this study examined whether improvements in HRQOL were directly related to improvements in exercise capacity. METHODS The study included 277 patients participating in ECR. HRQOL was assessed using the Medical Outcomes Study 36-item Short Form Health Survey (SF-36), and exercise capacity was measured as peak oxygen uptake ((Equation is included in full-text article.)O2peak) and oxygen uptake ((Equation is included in full-text article.)O2) at the ventilatory threshold (VTh). Patients were examined before and after completion of an 8-wk ECR program. RESULTS Analyses at baseline showed a significant correlation between (Equation is included in full-text article.)O2peak and VTh and physical functioning (PF), role limitations because of physical problems (RP), general health perceptions (GH), vitality (VT), and physical component summary (PCS) on the SF-36; PF was the only dimension showing a moderate correlation (>0.40 Spearman ρ) with (Equation is included in full-text article.)O2peak. The follow-up analyses demonstrated a significant correlation between changes in (Equation is included in full-text article.)O2peak and changes in PF, RP, VT, and MH. Changes in (Equation is included in full-text article.)O2 peak explained 4% of the changes in the PF and VT scores. CONCLUSION The correlations between exercise capacity and HRQOL were weak and varied considerably among patients. The ECR program improved both exercise capacity and HRQOL, but it was not necessarily the same patients who improved both parameters. Therefore, it is recommended to use separate objective measures and patient-reported outcomes when evaluating the effect of ECR.
Collapse
Affiliation(s)
- Karoline Stentoft Andersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark (Ms Andersen and Drs Laustsen and Petersen); Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark (Dr Laustsen); Centre of Research in Rehabilitation, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Ms Andersen and Drs Laustsen and Petersen)
| | | | | |
Collapse
|
8
|
Petersen AK, Oestergaard LG, van Tulder M, Laustsen S. A comparison of high versus low dose of exercise training in exercise-based cardiac rehabilitation: a randomized controlled trial with 12-months follow-up. Clin Rehabil 2019; 34:69-81. [PMID: 31642352 DOI: 10.1177/0269215519883411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/02/2023]
Abstract
OBJECTIVE To assess if a higher dose of exercise training in exercise-based cardiac rehabilitation could affect improvements in aerobic capacity and muscle strength. DESIGN Assessor-blinded randomized controlled trial with 12-months follow-up. SETTING Aarhus University Hospital, Aarhus, Denmark. SUBJECTS A total of 164 cardiac patients referred to exercise-based cardiac rehabilitation were recruited. INTERVENTIONS Patients were randomized to 1-hour exercise sessions either three times weekly for 12 weeks (36 sessions, high-dose group) or twice weekly for 8 weeks (16 sessions, low-dose group). The same standardized exercise and intensity protocol including aerobic and muscle strength training was used in all participants. MAIN MEASURES Primary outcome was changes in VO2peak. Secondary outcomes were changes in maximal workload, muscle strength and power. Measures were obtained at baseline, after termination of the rehabilitation programme and at follow-up after 6 and 12 months. RESULTS After the end of intervention, statistically significant between-group differences were seen in favour of the high-dose group in all outcomes: VO2peak 2.6 (mL kg-1 min-1) (95% confidence interval (CI): 0.4-4.8), maximal workload 0.3 W kg-1 (95%CI: 0.02-0.5), isometric muscle strength 0.7 N m kg-1 (95%CI: 0.1-1.2) and muscle power 0.3 W kg-1 (95%CI: 0.04-0.6). After 12 months, a significant between-group difference only persisted in VO2peak and maximal workload. CONCLUSION A higher dose of exercise training had a small effect on all outcomes at termination of intervention. A long-term effect persisted in VO2peak and maximal workload. Although the effect was small, it is an important finding because VO2peak is the most important predictor of all-cause mortality in cardiac patients.
Collapse
Affiliation(s)
- Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital, Aarhus, Denmark
| | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital, Aarhus, Denmark.,Research Initiative of Activity Studies and Occupational Therapy, Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Maurits van Tulder
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Health Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Sussie Laustsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
9
|
Abstract
INTRODUCTION Research suggests the need for further studies of patients' experiences of cardiac tele-rehabilitation to understand how they adapt to life with heart disease in a program with long-distance contact, remote supervision and monitoring of health behavior. Therefore, the aim of this study was to explore patients' experiences of tele-rehabilitation and the perceived gains of taking part in the program. MATERIALS AND METHODS Seven patients were interviewed using a phenomenological-hermeneutic approach. Interview transcripts were analyzed as narratives using the interpretation theory of the French philosopher Paul Ricoeur. This involves three levels of textual analysis: a naïve reading as the first interpretation followed by a structural analysis, where the text is explored in detail, before identifying the most significant interpretation through critical interpretation. RESULTS Patients valued cardiac tele-rehabilitation because it was not restricted to the hospital setting. They felt that the program's flexibility was an advantage because the program could be adjusted to their daily lives. The patients showed greater acknowledgement of and commitment towards the rehabilitation interventions if they were consistent with the patients' self-image, and if the activities were already part of their daily lives. If they were not, they were experienced as an extra challenge. CONCLUSIONS Understanding patients' self-image and prior lifestyle may better inform clinicians about why it can be difficult for patients to follow rehabilitation recommendations. Therefore, clinicians may need to focus more on these two factors to help patients adapt to life with heart disease. IMPLICATIONS FOR REHABILITATION Patients' self-image and prior lifestyle may be important factors for how patients adapt to their new life situation with heart disease within a cardiac tele-rehabilitation program. Patients' commitment to selected rehabilitation interventions may be either too high or too low if it fails to take into consideration their self-image and prior lifestyle. Understanding patients' self-image and prior lifestyle may better inform clinicians and their understanding of why it can be difficult for patients to follow the rehabilitation recommendations.
Collapse
Affiliation(s)
- Marie Veje Knudsen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Centre of Research in Rehabilitation, Aarhus University, Aarhus, Denmark
| | - Sussie Laustsen
- Department of Clinical Medicine, Centre of Research in Rehabilitation, Aarhus University, Aarhus, Denmark.,Faculty of Health Sciences (Nursing), VIA University College, Aarhus, Denmark
| | - Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Centre of Research in Rehabilitation, Aarhus University, Aarhus, Denmark
| | | | - Sanne Angel
- Section for Nursing, Department of Public Health, Aarhus University, Aarhus, Denmark
| |
Collapse
|
10
|
Larsen KS, Skoffer B, Gregersen Oestergaard L, Van Tulder M, Petersen AK. The effects of various respiratory physiotherapies after lung resection: a systematic review. Physiother Theory Pract 2019; 36:1201-1219. [DOI: 10.1080/09593985.2018.1564095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Karoline Stentoft Larsen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital (AUH), Aarhus N., Denmark
- Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University and AUH, Aarhus N., Denmark
| | - Birgit Skoffer
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital (AUH), Aarhus N., Denmark
- Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University and AUH, Aarhus N., Denmark
| | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital (AUH), Aarhus N., Denmark
- Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University and AUH, Aarhus N., Denmark
- Department of Public Health, Aarhus University, Aarhus N., Denmark
| | - Maurits Van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital (AUH), Aarhus N., Denmark
- Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University and AUH, Aarhus N., Denmark
- Institute of Clinical Medicine, Aarhus University, Aarhus N., Denmark
| |
Collapse
|
11
|
Lindman A, Krintel Petersen A, Olesen G, Handberg C. Patients´ experiences and perspectives of challenges and needs related to nonmyeloablative stem cell transplantation: Involving patients in developing a targeted rehabilitation programme. J Clin Nurs 2019; 28:1260-1272. [PMID: 30552726 DOI: 10.1111/jocn.14739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/07/2018] [Revised: 10/22/2018] [Accepted: 12/05/2018] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To explore patients' experiences and perspectives of their challenges and needs regarding their return to everyday life after allogeneic nonmyeloablative haematopoietic stem cell transplantation (NMA-HSCT). BACKGROUND NMA-HSCT can cure patients with malignant blood diseases, but during the following years, the majority of patients suffer from serious side effects and complications. Hence, it is a major challenge for patients treated with NMA-HSCT to rehabilitate, maintain physical and psychosocial functioning and return to a life in restored balance. DESIGN The design was qualitative using the interpretive description methodology, and the theoretical framework symbolic interactionism inspired the interview guide and analysis. METHODS Between April to May 2017, five focus group interviews were conducted with 15 outpatients in a haematological ward in Denmark. The patients were treated with NMA-HSCT 8-30 months prior to the interviews. The study adheres to the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS The impaired functioning was the overarching theme and seemed to be the trigger entailing rehabilitation needs related to the following main themes: realising decline, adapting to changes, the meaning of motivation and reliance on relations. These findings seemed to affect and influence the patients' struggle for a return to an everyday life like before being diagnosed or just before undergoing NMA-HSCT. CONCLUSION This study adds to our understanding of important elements to consider when developing a targeted rehabilitation programme. RELEVANCE TO CLINICAL PRACTICE Based on our findings, the rehabilitation programme should encompass: extensive variation regarding how to address the impaired functioning through individualised approaches, multimodal interventions, interventions through several months with varying intensity, an interdisciplinary team approach supporting motivation and visualisation of every progress by tangible goal setting, communication regarding hope and support, extended supportive care for patients living alone and finally increased adherence through social sessions with relatives and fellow patients.
Collapse
Affiliation(s)
- Astrid Lindman
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Annemette Krintel Petersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Physiotherapy and Occupational Therapy, Aarhus University, Aarhus, Denmark.,Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital & Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Gitte Olesen
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Charlotte Handberg
- Department of Public Health, Faculty of Health, Aarhus University, Denmark.,DEFACTUM, Central Denmark Region, Denmark
| |
Collapse
|
12
|
Astrup K, Corner EJ, Hansen MG, Petersen AK. Translation and cross-cultural adaptation of the Chelsea Critical Care Physical Assessment tool into Danish. Physiother Theory Pract 2018; 36:1027-1034. [PMID: 30499357 DOI: 10.1080/09593985.2018.1548048] [Citation(s) in RCA: 4] [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] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim of the study was to validate the Chelsea Critical Care Physical Assessment Tool (CPAx) in Danish, including translation, cross-cultural adaptation and evaluation of clinemetric properties. METHOD International recommendations for translation and cross-cultural adaptation of outcome measures were followed. Physiotherapists with ICU experience investigated the clinemetric properties of the Danish CPAx version among 30 critically ill patients at three different ICUs. Furthermore, a focus group interview was carried out to examine cross-cultural adaptation of the CPAx tool. RESULTS Translation and pre-test of the Danish version of CPAx resulted in a measurement tool with good clinemetric properties. Few adaptations were made with consideration of comparability between the Danish and the English version. The author of the original version of CPAx, Eve Corner, approved the Danish translation. CONCLUSION The Danish version of the CPAx seems to be an appropriate measurement instrument for evaluation of physical function in ICU patients. This study is the first step toward a validation of a Danish version of the CPAx tool. However, further research is needed to investigate reliability and responsiveness among patients in the ICU.
Collapse
Affiliation(s)
- Katrine Astrup
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital , Aarhus, Denmark.,Centre of Research in Rehabilitation (CORIR), Department of Clinical Medicine, Aarhus University Hospital and Aarhus University , Aarhus, Denmark
| | - Evelyn J Corner
- Department of Clinical Sciences, Centre for Human Performance Exercise and Rehabilitation, Brunel University London , London, England.,Department of Surgery and Cancer, Imperial College London , London, England.,Chelsea and Westminster NHS Foundation Trust , London, England
| | | | - Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital , Aarhus, Denmark.,Centre of Research in Rehabilitation (CORIR), Department of Clinical Medicine, Aarhus University Hospital and Aarhus University , Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University , Aarhus, Denmark
| |
Collapse
|
13
|
Larsen KSR, Petersen AK, Lisby M, Knudsen MV. Dyspnoea and self-management strategies in patients admitted to the emergency department: A study of patients' experiences. J Clin Nurs 2018; 27:4112-4118. [PMID: 29893435 DOI: 10.1111/jocn.14560] [Citation(s) in RCA: 4] [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: 09/20/2017] [Revised: 04/24/2018] [Accepted: 06/03/2018] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVE To explore patients' experiences of acute dyspnoea, physical functioning and perspectives on course of illness prior to admission to the emergency department. BACKGROUND Many emergency admissions are considered unnecessary and avoidable. In this perspective, it seems relevant to gain insight into the patients' perspective on acute dyspnoea and the need for emergency admission. However, only few studies have investigated reasons for emergency admission from a patient perspective. DESIGN A qualitative study was conducted with semi-structured interviews among six patients previously admitted to the emergency department due to dyspnoea. Data collection and analysis were carried out according to Kvale & Brinkmann using meaning condensation. FINDINGS Dyspnoea was experienced as an unpleasant breathlessness in the form of pain or suffocation, which limited usual physical activities, negatively impacting on quality of life. Self-management strategies such as medication, breathing exercises, distraction from breathing, and mental and physical relaxation in general were used to avoid hospital admission. The chronically ill patients saw the following ways to alternate course of disease to avoid admissions to the emergency department: easier access to specialised emergency medical care, medical supplies in the patient's home and making existing physical exercise programmes more accessible and interesting. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE It would be relevant to further investigate whether prehospital interventions may remedy acute dyspnoea among chronically ill patients, and whether such interventions are cost-effective.
Collapse
Affiliation(s)
- Karoline Stentoft Rybjerg Larsen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Centre of Research in Rehabilitation (CORIR), Aarhus University, Aarhus N, Denmark
| | - Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Centre of Research in Rehabilitation (CORIR), Aarhus University, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Marianne Lisby
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Emergency Department, Aarhus University Hospital, Aarhus N, Denmark
| | - Marie Veje Knudsen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Centre of Research in Rehabilitation (CORIR), Aarhus University, Aarhus N, Denmark
| |
Collapse
|
14
|
Sørensen L, Oestergaard LG, van Tulder M, Petersen AK. Measurement properties of objective methods to assess shoulder muscle strength (a systematic review protocol). Physical Therapy Reviews 2017. [DOI: 10.1080/10833196.2017.1392673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Lotte Sørensen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Lisa Gregersen Oestergaard
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital and Aarhus University, Aarhus, Denmark
- Department of Public Health, Institute of Public Health, Aarhus University, Aarhus, Denmark
| | - Maurits van Tulder
- Department of Health Sciences and EMGO, Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, Amsterdam, Netherlands
| | - Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital and Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
15
|
Pryds K, Nielsen RR, Jorsal A, Hansen MS, Ringgaard S, Refsgaard J, Kim WY, Petersen AK, Bøtker HE, Schmidt MR. Effect of long-term remote ischemic conditioning in patients with chronic ischemic heart failure. Basic Res Cardiol 2017; 112:67. [PMID: 29071437 DOI: 10.1007/s00395-017-0658-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [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: 08/21/2017] [Accepted: 10/18/2017] [Indexed: 12/17/2022]
Abstract
Remote ischemic conditioning (RIC) protects against acute ischemia-reperfusion injury and may also have beneficial effects in patients with stable cardiovascular disease. We investigated the effect of long-term RIC treatment in patients with chronic ischaemic heart failure (CIHF). In a parallel group study, 22 patients with compensated CIHF and 21 matched control subjects without heart failure or ischemic heart disease were evaluated by cardiac magnetic resonance imaging, cardiopulmonary exercise testing, skeletal muscle function testing, blood pressure measurement and blood sampling before and after 28 ± 4 days of once daily RIC treatment. RIC was conducted as four cycles of 5 min upper arm ischemia followed by 5 min of reperfusion. RIC did not affect left ventricular ejection fraction (LVEF) or global longitudinal strain (GLS) in patients with CIHF (p = 0.63 and p = 0.11) or matched controls (p = 0.32 and p = 0.20). RIC improved GLS in the subgroup of patients with CIHF and with NT-proBNP plasma levels above the geometric mean of 372 ng/l (p = 0.04). RIC did not affect peak workload or oxygen uptake in either patients with CIHF (p = 0.26 and p = 0.59) or matched controls (p = 0.61 and p = 0.10). However, RIC improved skeletal muscle power in both groups (p = 0.02 for both). In patients with CIHF, RIC lowered systolic blood pressure (p < 0.01) and reduced NT-proBNP plasma levels (p = 0.02). Our findings suggest that long-term RIC treatment does not improve LVEF but increases skeletal muscle function and reduces blood pressure and NT-proBNP in patients with compensated CIHF. This should be investigated in a randomized sham-controlled trial.
Collapse
Affiliation(s)
- Kasper Pryds
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Aarhus, Denmark.
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Roni Ranghøj Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Aarhus, Denmark
- Department of Cardiology, Viborg Region Hospital, Viborg, Denmark
| | - Anders Jorsal
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Aarhus, Denmark
| | - Mona Sahlholdt Hansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Aarhus, Denmark
| | | | - Jens Refsgaard
- Department of Cardiology, Viborg Region Hospital, Viborg, Denmark
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Aarhus, Denmark
- MR Centre, Aarhus University, Aarhus, Denmark
| | - Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine and Centre of Research in Rehabilitation (CORIR), Aarhus University Hospital, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Aarhus, Denmark
| | - Michael Rahbek Schmidt
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Aarhus, Denmark
| |
Collapse
|
16
|
Besse A, Petersen AK, Hunter JV, Appadurai V, Lalani SR, Bonnen PE. Personalized medicine approach confirms a milder case of ABAT deficiency. Mol Brain 2016; 9:93. [PMID: 27903293 PMCID: PMC5131463 DOI: 10.1186/s13041-016-0273-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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] [Received: 08/31/2016] [Accepted: 11/09/2016] [Indexed: 01/09/2023] Open
Abstract
ABAT deficiency (OMIM 613163) is a rare inborn error of metabolism caused by recessive variants in the gene 4-aminobutyric acid transaminase (ABAT), which is responsible for both the catalysis of GABA and maintenance of nucleoside pools in the mitochondria. To date, only a few patients have been reported worldwide. Their clinical presentation has been remarkably consistent with primary features of severe psychomotor retardation, encephalopathy, hypotonia, and infantile-onset refractory epilepsy. We report a new case of ABAT deficiency that marks an important departure from previous clinical findings. The patient presented at age 6 months with global developmental delay, hypotonia, hypersomnolence and mild choreiform movements. At age 18 months, the subject’s clinical presentation was still milder than all previously reported patients and, most notably, did not include seizures. Clinical whole exome sequencing revealed two heterozygous ABAT missense variants that are rare and predicted damaging, but never before reported in a patient and were reported as variants of unknown significance. To test the potential pathogenicity of the variants identified in this patient we developed a cell-based system to test both functions of the ABAT protein via GABA transaminase enzyme activity and mtDNA copy number assays. This systematic approach was validated using vigabatrin, the irreversible inhibitor of ABAT, and leveraged to test the functionality of all ABAT variants in previously reported patients plus the variants in this new case. This work confirmed the novel variants compromised ABAT function to similar levels as variants in previously characterized cases with more severe clinical presentation, thereby confirming the molecular diagnosis of this patient. Additionally, functional studies conducted in cells from both mild and severe patient fibroblasts showed similar levels of compromise in mitochondrial membrane potential, respiratory capacity, ATP production and mtDNA depletion. These results illustrate how cell-based functional studies can aid in the diagnosis of a rare, neurological disorder. Importantly, this patient marks an expansion in the clinical phenotype for ABAT deficiency to a milder presentation that is more commonly seen in pediatric genetics and neurology clinics.
Collapse
Affiliation(s)
- A Besse
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - A K Petersen
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - J V Hunter
- Department of Radiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - V Appadurai
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - S R Lalani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - P E Bonnen
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.
| |
Collapse
|
17
|
Bohn MB, Petersen AK, Nielsen DB, Sørensen H, Lind M. Three-dimensional kinematic and kinetic analysis of knee rotational stability in ACL-deficient patients during walking, running and pivoting. J Exp Orthop 2016; 3:27. [PMID: 27730595 PMCID: PMC5059229 DOI: 10.1186/s40634-016-0062-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/30/2016] [Indexed: 12/01/2022] Open
Abstract
Background Anterior cruciate ligament (ACL) deficiency leads to altered stability of the knee. The purpose of this study was to compare the dynamic, rotational stability of the knee, expressed as rotational stiffness, between anterior cruciate ligament-deficient (ACLD) knees, their contralateral intact knees (ACLI) and a knee healthy control group during walking, running and 90° pivoting. We hypothesized a larger tibial internal rotation, a smaller knee joint external moment and a lower rotational stiffness in the ACLD group compared to the ACLI and the control group. Methods Kinematic and kinetic data were collected from both legs of 44 ACLD patients and 16 healthy controls during walking, running and a pivoting maneuver (descending a staircase and immediately pivoting 90° on the landing leg). Motion data were captured using 8 high-speed cameras and a force-plate. Reflective markers were attached to bony landmarks of the lower limb and rigid clusters on the shank and thigh (CASH model). Maximum internal tibial rotation and the corresponding rotational moment were identified for all tasks and groups and used to calculate rotational stiffness (= Δmoment /Δrotation) of the knee. Results The tibial internal rotation of the ACLD knee was not significantly different from the ACLI knee during all three tasks. During walking and running, the tibial rotation of the control group was significantly different from both legs of the ACL-injured patient. For pivoting, no difference in tibial rotation between knees of the ACLD, ACLI and the control group was found. Knee joint external moments were not significantly different between the three groups during walking and pivoting. During running, the moments of the ACLI group were significantly higher than both the knees of the ACLD and the control group. Rotational stiffness did not differ significantly between groups in any of the three tasks. Conclusion A high-intensity activity combining stair descent and pivoting produces similar angular rotations, knee joint external moments and rotational stiffness in ACLD knees compared to ACLI knees and the control group. During running, the ACLI knee displayed a higher external moment than the ACLD and the healthy control group. This could indicate some type of protective strategy or muscular adaptation in the ACL-injured patients.
Collapse
Affiliation(s)
- Marie Bagger Bohn
- Division of Sportstrauma, Department of Orthopedics, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Aarhus C, Denmark.
| | - Annemette Krintel Petersen
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Dennis Brandborg Nielsen
- Department of Public Health - Sport, Aarhus University, Dalgas Avenue 4, 8000, Aarhus C, Denmark
| | - Henrik Sørensen
- Department of Public Health - Sport, Aarhus University, Dalgas Avenue 4, 8000, Aarhus C, Denmark
| | - Martin Lind
- Division of Sportstrauma, Department of Orthopedics, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Aarhus C, Denmark
| |
Collapse
|
18
|
Jensen BT, Laustsen S, Jensen JB, Borre M, Petersen AK. PD27-08 EXERCISE-BASED PREHABILITATION IS FEASIBLE AND EFFECTIVE IN RADICAL CYSTECTOMY PATHWAYS - SECONDARY RESULTS FROM A RANDOMIZED CONTROLLED TRIAL. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.382] [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: 10/22/2022]
|
19
|
Jensen BT, Laustsen S, Jensen JB, Borre M, Petersen AK. Exercise-based pre-habilitation is feasible and effective in radical cystectomy pathways-secondary results from a randomized controlled trial. Support Care Cancer 2016; 24:3325-31. [PMID: 26961741 DOI: 10.1007/s00520-016-3140-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [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: 10/22/2015] [Accepted: 02/22/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Physical exercises offer a variety of health benefits to cancer survivors during and post-treatment. However, exercise-based pre-habilitation is not well reported in major uro-oncology surgery. The aim of this study was to investigate the feasibility, the adherence, and the efficacy of a short-term physical pre-habilitation program to patients with invasive bladder cancer awaiting radical cystectomy (RC). METHODS A parent prospective randomized controlled clinical trial investigated efficacy of a multidisciplinary rehabilitation program on length of stay following RC. A total of 107 patients were included in the intension-to-treat population revealing 50 patients in the intervention group and 57 patients in the standard group. Pre-operatively, the intervention group was instructed to a standardized exercise program consisting of both muscle strength exercises and endurance training. The number of training sessions and exercise repetitions was patient-reported. Feasibility was expressed as adherence to the program and efficacy as the differences in muscle power within and between treatment groups at time for surgery. RESULTS A total of 66 % (95 % confidence interval (CI) 51; 78) adhered more than 75 % of the recommended progressive standardized exercise program. In the intervention group, a significant improvement in muscle power of 18 % (p < 0.002) was found at time for surgery. Moreover, muscle power was significantly improved compared to that in the standard group with 0.3 W/kg (95 % CI 0.08; 0.5 %) (p < 0.006). Adherence was not associated with pre-operative BMI, nutritional risk, comorbidity, pain, gender, or age. CONCLUSION In patients awaiting RC, a short-term exercise-based pre-habilitation intervention is feasible and effective and should be considered in future survivorship strategies.
Collapse
Affiliation(s)
- Bente Thoft Jensen
- Department of Urology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark. .,Department of Urology, Aarhus University Hospital, Aarhus, Denmark.
| | - Sussie Laustsen
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark.,Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Annemette Krintel Petersen
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark.,Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
20
|
Mikkelsen LR, Mechlenburg I, Søballe K, Jørgensen LB, Mikkelsen S, Bandholm T, Petersen AK. Effect of early supervised progressive resistance training compared to unsupervised home-based exercise after fast-track total hip replacement applied to patients with preoperative functional limitations. A single-blinded randomised controlled trial. Osteoarthritis Cartilage 2014; 22:2051-8. [PMID: 25305374 DOI: 10.1016/j.joca.2014.09.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [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: 04/24/2014] [Revised: 08/26/2014] [Accepted: 09/30/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine if 2 weekly sessions of supervised progressive resistance training (PRT) in combination with 5 weekly sessions of unsupervised home-based exercise is more effective than 7 weekly sessions of unsupervised home-based exercise in improving leg-extension power of the operated leg 10 weeks after total hip replacement (THR) in patients with lower pre-operative function. METHOD A total of 73 patients scheduled for THR were randomised (1:1) to intervention group (IG, home based exercise 5 days/week and PRT 2 days/week) or control group (CG, home based exercise 7 days/week). The primary endpoint was change in leg extension power at 10 week follow up. Secondary outcomes were isometric hip muscle strength, sit-to-stand test, stair climb test, 20 m walking speed and patient-reported outcome (HOOS). RESULTS Sixty-two completed the trial (85%). Leg extension power increased from baseline to the 10 week follow up in both groups; mean [95% CI] IG: 0.29 [0.13; 0.45] and CG: 0.26 [0.10; 0.42] W/kg, with no between-group difference (primary outcome) (P = 0.79). Maximal walking speed (P = 0.008) and stair climb performance (P = 0.04) improved more in the IG compared to CG, no other between-group differences existed. CONCLUSIONS In this trial, supervised PRT twice a week in addition to 5 weekly sessions of unsupervised exercise for 10 weeks was not superior to 7 weekly sessions of unsupervised home-based exercise for 10 weeks in improving the primary outcome, leg-extension power of the operated leg, at the primary endpoint 10 weeks after surgery in THR patients with lower pre-operative function. TRIAL REGISTRATION NCT01214954.
Collapse
Affiliation(s)
- L R Mikkelsen
- Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Denmark; Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Denmark.
| | - I Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark.
| | - K Søballe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark.
| | - L B Jørgensen
- Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Denmark; Institute of Clinical Medicine, Aarhus University, Denmark.
| | - S Mikkelsen
- Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Denmark.
| | - T Bandholm
- Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Physiotherapy, Copenhagen University Hospital, Hvidovre, Denmark; Department of Orthopaedic Surgery and Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark.
| | - A K Petersen
- Department of Physiotherapy- and Occupational Therapy, Aarhus University Hospital, Denmark; Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University, Denmark.
| |
Collapse
|
21
|
Jensen BT, Petersen AK, Jensen JB, Laustsen S, Borre M. Efficacy of a multiprofessional rehabilitation programme in radical cystectomy pathways: A prospective randomized controlled trial. Scand J Urol 2014; 49:133-41. [DOI: 10.3109/21681805.2014.967810] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
22
|
Jensen BT, Jensen JB, Laustsen S, Petersen AK, Søndergaard I, Borre M. Multidisciplinary rehabilitation can impact on health-related quality of life outcome in radical cystectomy: secondary reported outcome of a randomized controlled trial. J Multidiscip Healthc 2014; 7:301-11. [PMID: 25075194 PMCID: PMC4106955 DOI: 10.2147/jmdh.s62172] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [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: 12/15/2022] Open
Abstract
Purpose Health related quality of life (HRQoL) is an important outcome in cancer care, although it is not well reported in surgical uro-oncology. Radical cystectomy (RC) with lymph-node dissection is the standard treatment of muscle-invasive bladder cancer and high-risk noninvasive bladder cancer. A wide range of impairments are reported postsurgery. The aims were to evaluate whether a standardized pre- and postoperative physical exercise program and enhanced mobilization can impact on HRQoL and inpatient satisfaction in RC, as defined by the European Organisation for Research and Treatment of Cancer (EORTC). Materials and methods Patients were randomized to fast-track RC and intervention (nI=50) or fast-track standard treatment (nS=57). HRQoL and inpatient satisfaction was measured using valid questionnaires: EORTC Quality of Life Questionnaire Core 30 (QLQ-C30) combined with the disease-specific EORTC BLS24 (baseline), and EORTC BLM30 (follow-up), and IN-PATSAT32 inpatient-satisfaction survey at discharge. Efficacy was defined as the differences in HRQoL-scores between treatment groups at the 4-month follow-up. Results The intervention group significantly improved HRQoL scores in dyspnea (P≤0.05), constipation (P<0.02), and abdominal flatulence (P≤0.05) compared to the standard group. In contrast, the standard group reported significantly reduced symptoms in sleeping pattern (P≤0.04) and clinically relevant differences in role function, body function, and fatigue. The intervention did not compromise inpatient satisfaction. Conclusion We found no overall impact on global HRQoL due to a physical rehabilitation program. However, pre- and postoperative physical rehabilitation can significantly and positively impact on HRQoL aspects related to bowel management and respiratory function (dyspnea) without compromising inpatient satisfaction. These results highlight the role of multimodal rehabilitation, including physical exercises in fast-track RC.
Collapse
Affiliation(s)
- Bente Thoft Jensen
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark ; Department of Clinical Medicine, Centre of Research in Rehabilitation, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Bjerggaard Jensen
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark ; Department of Clinical Medicine, Centre of Research in Rehabilitation, Aarhus University Hospital, Aarhus, Denmark
| | - Sussie Laustsen
- Department of Clinical Medicine, Centre of Research in Rehabilitation, Aarhus University Hospital, Aarhus, Denmark ; Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Annemette Krintel Petersen
- Department of Clinical Medicine, Centre of Research in Rehabilitation, Aarhus University Hospital, Aarhus, Denmark ; Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Ingrid Søndergaard
- Department of Clinical Medicine, Centre of Research in Rehabilitation, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark ; Department of Clinical Medicine, Centre of Research in Rehabilitation, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
23
|
Mikkelsen LR, Mikkelsen S, Søballe K, Mechlenburg I, Petersen AK. A study of the inter-rater reliability of a test battery for use in patients after total hip replacement. Clin Rehabil 2014; 29:165-74. [DOI: 10.1177/0269215514534088] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objective: To assess the within-day inter-rater reliability of a test battery of functional performance, muscle strength and leg extension power on total hip replacement patients. Design: A test–retest design was used. Setting: Orthopaedic department at a Regional Hospital in Denmark. Subjects: Two convenience samples of 20 total hip replacement patients were included. Intervention: The tests were performed three months after total hip replacement. Two raters performed test and re-test, with two hours rest in-between. Main measures: The test battery included: sit-to-stand performance, 20-metre maximum walking speed, stair climb performance, isometric muscle strength (hip abduction/flexion), and leg extension power. Absolute reliability was assessed with Bland Altman plots, standard error of measurement (SEM), and minimal detectable change. Relative reliability was assessed with intra-class correlation coefficient. Results: Systematic differences between testers were seen in tests of walking speed (0.32 seconds p = 0.03) and stair climb performance (0.18 seconds p = 0.003). In per cent of the grand mean, the standard error of measurement was 3%–10%, indicating the measurement error on a group level, and the minimal detectable change was 10%–27%, indicating the measurement error on an individual level. The intra-class correlation coefficients were above 0.80 in all tests (range 0.83–0.95). Conclusions: The tests showed acceptable relative and absolute inter-rater reliability on a group level, but not on an individual level (except from test of walking speed and stair climb performance). Systematic differences between testers were considered clinically irrelevant (0.3 and 0.2 seconds).
Collapse
Affiliation(s)
- Lone Ramer Mikkelsen
- Interdisciplinary Research Unit, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Søren Mikkelsen
- Interdisciplinary Research Unit, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Kjeld Søballe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark
| | | |
Collapse
|
24
|
Knudsen MV, Laustsen S, Petersen AK, Angel S. Lifestyle after Cardiac Rehabilitation: Did the Message Come across, and Was It Feasible? An Analysis of Patients’ Narratives. Health (London) 2014. [DOI: 10.4236/health.2014.619303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
25
|
|
26
|
|
27
|
Frydenberg J, Poulsen K, Petersen AK, Lund A, Olesen OF. Isolation and characterization of the gene encoding EF-1 alpha O, an elongation factor 1-alpha expressed during early development of Xenopus laevis. Gene X 1991; 109:185-92. [PMID: 1765266 DOI: 10.1016/0378-1119(91)90608-e] [Citation(s) in RCA: 11] [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: 12/28/2022] Open
Abstract
In Xenopus laevis, the gene encoding the elongation factor 1-alpha variant EF-1 alpha O, where O stands for oocyte, is expressed in oocytes and early embryos. A genomic library from X. laevis was screened with a cDNA probe coding for EF-1 alpha O. Two recombinant phages were isolated, one of which carries an entire EF-1 alpha O gene. This clone was characterized by restriction enzyme mapping and sequencing. Comparison of cDNA and genomic sequences revealed that EF-1 alpha O consists of seven exons spanning about 6.5 kb. The structure of the gene is very homologous to the human EF-1 alpha gene, as all locations of the splice junctions are conserved between the two genes. The sequence immediately upstream from the transcription start point (tsp) contains a CCAAT box, but does not contain either a TATA box or a Sp1-binding site. Interestingly, this sequence has a sequence homologous to the negative regulatory element from the TFIIIA promoter. A region located about 400 bp upstream from the tsp contains an additional number of possible regulatory sequence elements. The first intron contains G + C-rich elements which exist both isolated and as part of longer inverted repeats. Furthermore, one octamer and four Sp1-binding sites are found in this intron.
Collapse
Affiliation(s)
- J Frydenberg
- Division of Biostructural Chemistry, Aarhus University, Denmark
| | | | | | | | | |
Collapse
|
28
|
Paulsen JE, Reichelt KL, Petersen AK. Purification and characterization of a growth inhibitory hepatic peptide. A preliminary note. Virchows Arch B Cell Pathol Incl Mol Pathol 1987; 54:152-4. [PMID: 2894089 DOI: 10.1007/bf02899207] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A pentapeptide isolated from normal mouse liver seems to inhibit DNA synthesis (3H-thymidine incorporation into liver DNA and labeling indices) and the mitotic rate (G2-M cell flux) in regenerating mouse liver. The inhibitor is somewhat similar to the growth inhibitory pentapeptides previously reported for granulocytes and epidermis. It is active at very low dose levels, showing a bell-shaped dose-response curve.
Collapse
Affiliation(s)
- J E Paulsen
- Institute of Pathology, Rikshospitalet, Oslo, Norway
| | | | | |
Collapse
|