Background To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with coronary heart disease (CHD) the CR guideline from the Dutch Royal Society for Physiotherapists (KNGF) has been updated. This guideline can be considered an addition to the 2011 Dutch Multidisciplinary CR guideline, as it includes several novel topics. Methods A systematic literature search was performed to formulate conclusions on the efficacy of exercise-based interventions during all CR phases in patients with CHD. Evidence was graded (1–4) according the Dutch evidence-based guideline development (EBRO) criteria. In case of insufficient scientific evidence, recommendations were based on expert opinion. This guideline comprised a structured approach including assessment, treatment and evaluation. Results Recommendations for exercise-based CR were formulated covering the following topics: preoperative physiotherapy, mobilisation during the clinical phase, aerobic exercise, strength training, and relaxation therapy during the outpatient rehabilitation phase, and adoption and monitoring of a physically active lifestyle after outpatient rehabilitation. Conclusions There is strong evidence for the effectiveness of exercise-based CR during all phases of CR. The implementation of this guideline in clinical practice needs further evaluation as well as the maintenance of an active lifestyle after supervised rehabilitation. LinkedIn: https://www.linkedin.com/in/tinusjongert/
AbstractObjective: Many older individuals receive rehabilitation in an out-of-hospital setting (OOHS) after acute hospitalization; however, its effect onmobility and unplanned hospital readmission is unclear. Therefore, a systematic review and meta-analysis were conducted on this topic.Data Sources: Medline OVID, Embase OVID, and CINAHL were searched from their inception until February 22, 2018.Study Selection: OOHS (ie, skilled nursing facilities, outpatient clinics, or community-based at home) randomized trials studying the effect ofmultidisciplinary rehabilitation were selected, including those assessing exercise in older patients (mean age 65y) after discharge from hospitalafter an acute illness.Data Extraction: Two reviewers independently selected the studies, performed independent data extraction, and assessed the risk of bias.Outcomes were pooled using fixed- or random-effect models as appropriate. The main outcomes were mobility at and unplanned hospitalreadmission within 3 months of discharge.Data Synthesis: A total of 15 studies (1255 patients) were included in the systematic review and 12 were included in the meta-analysis (7assessing mobility using the 6-minute walk distance [6MWD] test and 7 assessing unplanned hospital readmission). Based on the 6MWD, patientsreceiving rehabilitation walked an average of 23 m more than controls (95% confidence interval [CI]Z: 1.34 to 48.32; I2: 51%). Rehabilitationdid not lower the 3-month risk of unplanned hospital readmission (risk ratio: 0.93; 95% CI: 0.73-1.19; I2: 34%). The risk of bias was present,mainly due to the nonblinded outcome assessment in 3 studies, and 7 studies scored this unclearly.Conclusion: OOHS-based multidisciplinary rehabilitation leads to improved mobility in older patients 3 months after they are discharged fromhospital following an acute illness and is not associated with a lower risk of unplanned hospital readmission within 3 months of discharge.However, the wide 95% CIs indicate that the evidence is not robust.
Wanneer het nodig is om SB opnieuw of verder vorm te geven, bijvoorbeeld door het invoeren van formatief handelen binnen een nieuw curriculum, dan biedt de SB-scan:• een gestructureerd overzicht van de elementen die een rol spelen bij het vormgeven van studentbegeleiding binnen de opleiding. • handvatten voor het maken van beredeneerde keuzes voor het vormgeven van studentbegeleiding in de opleiding aan de hand van reflectievragen.
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SportDrenthe heeft twee sportseizoenen lang een proeftuin uitgevoerd waarbij de inzet was om 150 jongeren te bereiken die nu niet of minder maatschappelijk actief en/of betrokken zijn en waarbij de sportvereniging (of andere sportaanbieder) hen de nodige leerervaringen en sociale context kan bieden. Daarbij gaat het bijvoorbeeld om jongeren met een tussenjaar, (meerderjarige) jongeren zonder startkwalificatie en zonder baan, jongeren met een arbeidsbeperking, jongeren in armoede, jonge statushouders, vroegtijdige schoolverlaters en andere kwetsbare en/of moeilijk toegankelijke jongeren met een afstand tot deelname in een reguliere sociale (werk)context.In dit project wordt de monitoring uitgevoerd door het lectoraat Praktijkgerichte Sportwetenschap. In deze monitoring worden de opbrengsten van de proeftuin in beeld gebracht waarbij de volgende vraag centraal staat:Wat zijn de opbrengsten van de MDT proeftuin in Drenthe voor de jongeren en de betrokken stakeholders?