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A multidisciplinary lifestyle program for rheumatoid arthritis: the 'Plants for Joints' randomized controlled trial

ObjectiveTo determine the effect of a multidisciplinary lifestyle program in patients with RA with low–moderate disease activity.MethodsIn the ‘Plants for Joints’ (PFJ) parallel-arm, assessor-blind randomized controlled trial, patients with RA and 28-joint DAS (DAS28) ≥2.6 and ≤5.1 were randomized to the PFJ or control group. The PFJ group followed a 16-week lifestyle program based on a whole-food plant-based diet, physical activity and stress management. The control group received usual care. Medication was kept stable 3 months before and during the trial whenever possible. We hypothesized that PFJ would lower disease activity (DAS28). Secondary outcomes included anthropometric, metabolic and patient-reported measures. An intention-to-treat analysis with a linear mixed model adjusted for baseline values was used to analyse between-group differences.ResultsOf the 83 people randomized, 77 completed the study. Participants were 92% female with mean (S.D.) age of 55 (12) years, BMI of 26 (4) kg/m2 and mean DAS28 of 3.8 (0.7). After 16 weeks the PFJ group had a mean 0.9-point greater improvement of DAS28 vs the control group (95% CI 0.4, 1.3; P < 0.0001). The PFJ intervention led to greater decreases in body weight (difference –3.9 kg), fat mass (–2.8 kg), waist circumference (–3 cm), HbA1c (–1.3 mmol/mol) and low-density lipoprotein (–0.32 mmol/l), whereas patient-reported outcome measures, blood pressure, glucose and other lipids did not change.ConclusionThe 16-week PFJ multidisciplinary lifestyle program substantially decreased disease activity and improved metabolic status in people with RA with low–moderate disease activity.Trial RegistrationInternational Clinical Trials Registry Platform; https://www.who.int/clinical-trials-registry-platform; NL7800.

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A multidisciplinary lifestyle program for rheumatoid arthritis: the 'Plants for Joints' randomized controlled trial

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Are persons with rheumatoid arthritis deconditioned? A review of physical activity and aerobic capacity

Background: Although the general assumption is that patients with rheumatoid arthritis (RA) have decreased levels of physical activity, no review has addressed whether this assumption is correct. Methods: Our objective was to systematically review the literature for physical activity levels and aerobic capacity (VO2max). in patients with (RA), compared to healthy controls and a reference population. Studies investigating physical activity, energy expenditure or aerobic capacity in patients with RA were included. Twelve studies met our inclusion criteria. Results: In one study that used doubly labeled water, the gold standard measure, physical activity energy expenditure of patients with RA was significantly decreased. Five studies examined aerobic capacity. Contradictory evidence was found that patients with RA have lower VO2max than controls, but when compared to normative values, patients scored below the 10th percentile. In general, it appears that patients with RA spend more time in light and moderate activities and less in vigorous activities than controls. Conclusion: Patients with RA appear to have significantly decreased energy expenditure, very low aerobic capacity compared to normative values and spend less time in vigorous activities than controls

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Are persons with rheumatoid arthritis deconditioned? A review of physical activity and aerobic capacity

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Stukje bij beetje water bij de wijn

“Als je iets meekrijgt in de accountantsopleiding, dan is het dat je de uitspraken die je als accountant doet op een deugdelijke grondslag moet baseren. Op dit punt, heb ik, terwijl ik nog niet ben afgestudeerd als RA, voor mijn gevoel al water bij de wijn moeten doen. Dat moment, dat besef, dat wringt

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The effect of a multidisciplinary lifestyle program for patients with rheumatoid arthritis, an increased risk for rheumatoid arthritis or with metabolic syndrome-associated osteoarthritis

Low-grade inflammation and metabolic syndrome are seen in many chronic diseases, including rheumatoid arthritis (RA) and osteoarthritis (OA). Lifestyle interventions which combine different non-pharmacological therapies have shown synergizing effects in improving outcomes in patients with other chronic diseases or increased risk thereof, especially cardiovascular disease. For RA and metabolic syndrome-associated OA (MSOA), whole food plant-based diets (WFPDs) have shown promising results. A WFPD, however, had not yet been combined with other lifestyle interventions for RA and OA patients. In this protocol paper, we therefore present Plants for Joints, a multidisciplinary lifestyle program, based on a WFPD, exercise, and stress management. The objective is to study the effect of this program on disease activity in patients with RA (randomized controlled trial [RCT] 1), on a risk score for developing RA in patients with anti-citrullinated protein antibody (ACPA) positive arthralgia (RCT 2) and on pain, stiffness, and function in patients with MSOA (RCT 3), all in comparison with usual care.We designed three 16-week observer-blind RCTs with a waiting-list control group for patients with RA with low to moderate disease activity (2.6 ≤ Disease Activity Score [DAS28] ≤ 5.1, RCT 1, n = 80), for patients at risk for RA, defined by ACPA-positive arthralgia (RCT 2, n = 16) and for patients with metabolic syndrome and OA in the knee and/or hip (RCT 3, n = 80). After personal counseling on diet and exercise, participants join 10 group meetings with 6-12 other patients to receive theoretical and practical training on a WFPD, exercise, and stress management, while medication remains unchanged. The waiting-list control group receives usual care, while entering the program after the RCT. Primary outcomes are: difference in mean change between intervention and control groups within 16 weeks for the DAS28 in RA patients (RCT 1), the RA-risk score for ACPA positive arthralgia patients (RCT 2), and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score for MSOA patients (RCT 3). Continued adherence to the lifestyle program is measured in a two-year observational extension study.

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The effect of a multidisciplinary lifestyle program for patients with rheumatoid arthritis, an increased risk for rheumatoid arthritis or with metabolic syndrome-associated osteoarthritis

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Long-term effectiveness of a lifestyle intervention for rheumatoid arthritis and osteoarthritis

Objectives In two randomised controlled trials, the Plants for Joints (PFJ) multidisciplinary lifestyle intervention reduced signs and symptoms of rheumatoid arthritis (RA), or metabolic syndrome-associated hip or knee osteoarthritis (MSOA) compared with usual care. The current study investigated long-term outcomes.Methods After completion of two 16-week trials in people with (1) RA or (2) MSOA, control groups switched to the active PFJ intervention. At the end of the intervention, all participants were followed up in a 1-year observational extension study. Primary outcomes were 28-joint Disease Activity Score (DAS28) (RA) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (MSOA). Secondary outcomes included body composition, metabolic outcomes, medication changes and intervention adherence. An intention-to-treat analysis with a linear mixed model was used to analyse within-group changes.Results 65 (84%) of 77 RA participants and 49 (77%) of 64 MSOA participants completed the extension study. The effects of the PFJ intervention were replicated in the original control groups and sustained within the RA group a year after intervention completion (mean DAS28 –0.9 points; p<0.001), while in the MSOA group mean WOMAC increased towards but remained well under the starting value (–7.8 points, p<0.001). Improvements in C-reactive protein, waist circumference (RA and MSOA); low-density lipoprotein cholesterol (RA); and weight, haemoglobin A1c, blood pressure (MSOA) were also sustained. Participants had a net decrease of medication, and intervention adherence was largely sustained.Conclusions A year after the PFJ lifestyle intervention, improvements of disease activity and metabolic outcomes within RA and MSOA groups were largely sustained and related to sustained adherence, with a net decrease of medication.Trial registration numbers NL7800, NL7801.

MULTIFILE

Long-term effectiveness of a lifestyle intervention for rheumatoid arthritis and osteoarthritis

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The association between physical activity and cardiorespiratory fitness in patients with rheumatoid artahrtis and high cardiovascular risk

Background: Rheumatoid arthritis (RA) is associated with increased risk of cardiovascular disease (CVD) disease and CV mortality1. High values of cardiorespiratory fitness (CRF) are protective against CVD and CV mortality2. Physical activity levels in patients with RA are low. Knowledge on whether physical activity is associated with CRF in patients with RA and high CV risk is scarce. This knowledge is important because improving the level of physical activity could improve CRF and lower CV risk in this group of patients with RA and high CV risk. However, it is unclear whether physical activity is associated with CRF in this group of patients. This study presents the preliminary results at baseline of the association of physical activity with CRF from an ongoing pilot study aimed at improving CRF through exercise therapy in patients with RA and high CV risk.Objectives: To determine (i) the level of physical activity in patients with RA and high CV risk and (ii) whether physical activity is associated with CRF in patients with RA and high CV risk.Methods: Patients with RA and high CV risk participated in this pilot study. Increased 10-year risk of CV mortality was determined by using the Dutch SCORE-table. Anthropometrics and disease characteristics were collected. Physical activity was assessed with an Actigraph accelerometer to determine the number of steps and intensity of physical activity expressed in terms of sedentary, light, and moderate-to-vigorous time per day. Participants wore the accelerometer for seven days. A minimum of four measurement days with a wear time of at least 10 hours was required. The VO2 max measured with a graded maximal exercise test was used to determine the CRF. Pearson correlation coefficients were calculated for the associations between the different measures of physical activity and VO2max. For the variables that were associated, linear regression analysis was carried out, with pain and disease activity as possible confounders.Results: Thirteen females and five males were included in the study. The mean age was 66.5 (± 15.0) years. Only 22% of the patients met public health physical activity guidelines for the minimal amount of 150 minutes a week. The mean step count was 6237 (± 2297) steps per day and mean moderate-to-vigorous physical activity time was 16.50 (± 23.56) minutes per day. The median VO2max was 16.23 [4.63] ml·kg-1·min-1, which is under the standard. Pearson correlations showed a significant positive association for step count with VO2max. No associations were found for sedentary, light, and moderate-to-vigorous physical activity with VO2max. The significant association between step count and VO2max(p = 0.01) was not confounded by disease severity and pain.Discussion: Since better CRF protects against CVD, increasing daily step count may be a simple way to reduce the risk of CVD in patients with RA and high CV risk. However, these results need to be confirmed in a larger study group. Future research should investigate if improving daily step count will lead to better CRF levels and ultimately will lead to a reduction in CV risk in patients with RA and high CV risk.Conclusion: Physical activity levels of patients with RA and high CV risk do not meet public health requirements for physical activity criteria and the VO2max was under the standard. Step count is positively associated with CRF.

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The association between physical activity and cardiorespiratory fitness in patients with rheumatoid artahrtis and high cardiovascular risk

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Asynchronous mHealth interventions in rheumatoid arthritis

BACKGROUND: Mobile devices such as smartphones and tablets have surged in popularity in recent years, generating numerous possibilities for their use in health care as mobile health (mHealth) tools. One advantage of mHealth is that it can be provided asynchronously, signifying that health care providers and patients are not communicating in real time. The integration of asynchronous mHealth into daily clinical practice might therefore help to make health care more efficient for patients with rheumatoid arthritis (RA). The benefits have been reviewed in various medical conditions, such as diabetes and asthma, with promising results. However, to date, it is unclear what evidence exists for the use of asynchronous mHealth in the field of RA.OBJECTIVE: The objective of this study was to map the different asynchronous mHealth interventions tested in clinical trials in patients with RA and to summarize the effects of the interventions.METHODS: A systematic search of Pubmed, Scopus, Cochrane, and PsycINFO was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies were initially screened and later assessed by two independent researchers. Disagreements on inclusion or exclusion of studies were resolved by discussion.RESULTS: The literature search yielded 1752 abstracts. After deduplication and screening, 10 controlled intervention studies were included. All studies were assessed to be at risk for bias in at least one domain of the Cochrane risk-of-bias tool. In the 10 selected studies, 4 different types of mHealth interventions were used: SMS reminders (to increase medication adherence or physical activity; n=3), web apps (for disease monitoring and/or to provide medical information; n=5), smartphone apps (for disease monitoring; n=1), and pedometers (to increase and track steps; n=1). Measured outcomes varied widely between studies; improvements were seen in terms of medication compliance (SMS reminders), reaching rapid remission (web app), various domains of physical activity (pedometer, SMS reminders, and web apps), patient-physician interaction (web apps), and self-efficacy (smartphone app).CONCLUSIONS: SMS reminders, web apps, smartphone apps, and pedometers have been evaluated in intervention studies in patients with RA. These interventions have been used to monitor patients or to support them in their health behavior. The use of asynchronous mHealth led to desirable outcomes in nearly all studies. However, since all studies were at risk of bias and methods used were very heterogeneous, high-quality research is warranted to corroborate these promising results.

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Asynchronous mHealth interventions in rheumatoid arthritis

People 5.038

person

Ruben Walravens

person

Mayra Corona-Andrade

person

Te Hurinui Karaka-Clarkea

person

(Afra) Willems

Projects 5.249

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"Beats and Connections”: Building Transdisciplinary Collaborative Education to Innovate Interprofessional Approaches for Supporting Well-Being in Ageing Societies.

As the Dutch population is aging, the field of music-in-healthcare keeps expanding. Healthcare, institutionally and at home, is multiprofessional and demands interprofessional collaboration. Musicians are sought-after collaborators in social and healthcare fields, yet lesser-known agents of this multiprofessional group. Although live music supports social-emotional wellbeing and vitality, and nurtures compassionate care delivery, interprofessional collaboration between musicians, social work, and healthcare professionals remains marginal. This limits optimising and integrating music-making in the care. A significant part of this problem is a lack of collaborative transdisciplinary education for music, social, and healthcare students that deep-dives into the development of interprofessional skills. To meet the growing demand for musical collaborations by particularly elderly care organisations, and to innovate musical contributions to the quality of social and healthcare in Northern Netherlands, a transdisciplinary education for music, physiotherapy, and social work studies is needed. This project aims to equip multiprofessional student groups of Hanze with interprofessional skills through co-creative transdisciplinary learning aimed at innovating and improving musical collaborative approaches for working with vulnerable, often older people. The education builds upon experiential learning in Learning LABs, and collaborative project work in real-life care settings, supported by transdisciplinary community forming.The expected outcomes include a new concept of a transdisciplinary education for HBO-curricula, concrete building blocks for a transdisciplinary arts-in-health minor study, innovative student-led approaches for supporting the care and wellbeing of (older) vulnerable people, enhanced integration of musicians in interprofessional care teams, and new interprofessional structures for educational collaboration between music, social work and healthcare faculties.

To be started

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A “room” of their own – training cultural workers for facilitating rural youths culture

Erasmus project about training cultural workers for facilitating rural youths culture

Finished

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CIVITAS MUSE : Mobility for Urban Sustainability and the Environment CIVITAS 2030 Coordination and Support Action: Sustainable and Smart Mobility for All

MUSE supports the CIVITAS Community to increase its impact on urban mobility policy making and advance it to a higher level of knowledge, exchange, and sustainability.As the current Coordination and Support Action for the CIVITAS Initiative, MUSE primarily engages in support activities to boost the impact of CIVITAS Community activities on sustainable urban mobility policy. Its main objectives are to:- Act as a destination for knowledge developed by the CIVITAS Community over the past twenty years.- Expand and strengthen relationships between cities and stakeholders at all levels.- Support the enrichment of the wider urban mobility community by providing learning opportunities.Through these goals, the CIVITAS Initiative strives to support the mobility and transport goals of the European Commission, and in turn those in the European Green Deal.Breda University of Applied Sciences is the task leader of Task 7.3: Exploitation of the Mobility Educational Network and Task 7.4: Mobility Powered by Youth Facilitation.

Ongoing

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'Naar inclusief (gezondheids)onderzoek. Een toolbox voor begrijpelijke onderzoekscommunicatie'

Mensen die moeite hebben met lezen en schrijven (laaggeletterden) zijn ondervertegenwoordigd in onderzoek, waardoor een belangrijke onderzoekspopulatie ontbreekt. Dit is een probleem, omdat zorgbeleid dan onvoldoende op hun behoeften wordt aangepast. Laaggeletterden hebben vaak een lage sociaal economische positie (SEP). Mensen met een lage SEP leven gemiddeld 4 jaar korter en 15 jaar in minder goed ervaren gezondheid vergeleken met mensen met een hoge SEP. Om laaggeletterden te betrekken in onderzoek, is het o.a. nodig om onderzoek toegankelijker te maken. Dit project draagt hieraan bij door de ontwikkeling van een toolbox voor toegankelijke (proefpersonen)informatie (pif) en toestemmingsverklaringen. We ontwikkelen in co-creatie met de doelgroep toegankelijke audiovisuele materialen die breed ingezet kunnen worden door (gezondheids)onderzoekers van (zorggerelateerde) instanties/bedrijven én kennisinstellingen voor de werving voor en informatieverstrekking over onderzoek. In de multidisciplinaire samenwerking met onze partners YURR.studio, Pharos, Stichting ABC, Stichting Crowdience, de HAN-Sterkplaats en de Academische Werkplaats Sterker op eigen benen (AW-SOEB) van Radboudumc stellen we de behoeften van de doelgroep centraal. Middels creatieve sessies en gebruikerservaringen wordt in een iteratief ontwerpende onderzoeksaanpak toegewerkt naar diverse ontwerpen van informatiebrieven en toestemmingsverklaringen, waarbij de visuele communicatie dragend is. Het ontwikkelproces biedt kennisontwikkeling en hands-on praktijkvoorbeelden voor designers en grafisch vormgevers in het toegankelijk maken van informatie. Als laaggeletterden beter bereikt worden d.m.v. de pif-toolbox, kunnen de inzichten van deze groep worden meegenomen. Dit zorgt voor een minder scheef beeld in onderzoek, waardoor (gezondheids)beleid zich beter kan richten op kwetsbare doelgroepen. Hiermee wordt een bijdrage geleverd aan het verkleinen van gezondheidsverschillen.

Finished

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‘Datagedragen’ fysiotherapie: sluiten de technische mogelijkheden aan bij de wensen van fysiotherapeuten en hun patiënten?

Patiëntdata uit vragenlijsten, fysieke testen en ‘wearables’ hebben veel potentie om fysiotherapie-behandelingen te personaliseren (zogeheten ‘datagedragen’ zorg) en gedeelde besluitvorming tussen fysiotherapeut en patiënt te faciliteren. Hiermee kan fysiotherapie mogelijk doelmatiger en effectiever worden. Veel fysiotherapeuten en hun patiënten zien echter nauwelijks meerwaarde in het verzamelen van patiëntdata, maar vooral toegenomen administratieve last. In de bestaande landelijke databases krijgen fysiotherapeuten en hun patiënten de door hen zelf verzamelde patiëntdata via een online dashboard weliswaar teruggekoppeld, maar op een weinig betekenisvolle manier doordat het dashboard primair gericht is op wensen van externe partijen (zoals zorgverzekeraars). Door gebruik te maken van technologische innovaties zoals gepersonaliseerde datavisualisaties op basis van geavanceerde data science analyses kunnen patiëntdata betekenisvoller teruggekoppeld en ingezet worden. Wij zetten technologie dus in om ‘datagedragen’, gepersonaliseerde zorg, in dit geval binnen de fysiotherapie, een stap dichterbij te brengen. De kennis opgedaan in de project is tevens relevant voor andere zorgberoepen. In dit KIEM-project worden eerst wensen van eindgebruikers, bestaande succesvolle datavisualisaties en de hiervoor vereiste data science analyses geïnventariseerd (werkpakket 1: inventarisatie). Op basis hiervan worden meerdere prototypes van inzichtelijke datavisualisaties ontwikkeld (bijvoorbeeld visualisatie van patiëntscores in vergelijking met (beoogde) normscores, of van voorspelling van verwacht herstel op basis van data van vergelijkbare eerdere patiënten). Middels focusgroepinterviews met fysiotherapeuten en patiënten worden hieruit de meest kansrijke (maximaal 5) prototypes geselecteerd. Voor deze geselecteerde prototypes worden vervolgens de vereiste data-analyses ontwikkeld die de datavisualisaties op de dashboards van de landelijke databases mogelijk maken (werkpakket 2: prototypes en data-analyses). In kleine pilots worden deze datavisualisaties door eindgebruikers toegepast in de praktijk om te bepalen of ze daadwerkelijk aan hun wensen voldoen (werkpakket 3: pilots). Uit dit 1-jarige project kan een groot vervolgonderzoek ‘ontkiemen’ naar het effect van betekenisvolle datavisualisaties op de uitkomsten van zorg.

Finished

Parties 158

party

ACE Mobility, Automotive Centre of Expertise

Centre of Expertise, part of Hogeschool Rotterdam, Hogeschool van Arnhem en Nijmegen, Fontys

party

Aeres Hogeschool

University of Applied Sciences

party

AI for Society

Centre of Expertise, part of Fontys

party

Ambient Intelligence

Lectorate, part of Saxion

Editorials 96

editorial

Inclusief ontwerpen binnen onderzoeksproject Active Inclusive Design

editorial

Zorg met impact: Robbert Gobbens benoemd tot Medical Delta-lector

editorial

Samen Beter: over de circulaire potentie van bedrijventerreinen

Products 1.531

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A multidisciplinary lifestyle program for rheumatoid arthritis: the 'Plants for Joints' randomized controlled trial

DOCUMENT

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