Purpose: Head and neck cancer (HNC) treatment often leads to physical and psychosocial impairments. Rehabilitation can overcome these limitations and improve quality of life. The aim of this study is to obtain an overview of rehabilitation care for HNC, and to investigate factors influencing rehabilitation provision, in Dutch HNC centers, and to some extent compare it to other countries. Methods: An online survey, covering five themes: organizational structure; rehabilitation interventions; financing; barriers and facilitators; satisfaction and future improvements, among HNC healthcare- and financial professionals of Dutch HNC centers. Results: Most centers (86%) applied some type of rehabilitation care, with variations in organizational structure. A speech language therapist, physiotherapist and dietitian were available in all centers, but other rehabilitation healthcare professionals in less than 60%. Facilitators for providing rehabilitation services included availability of a contact person, and positive attitude, motivation, and expertise of healthcare professionals. Barriers were lack of reimbursement, and patient related barriers including comorbidity, travel (time), low health literacy, limited financial capacity, and poor motivation. Conclusion: Although all HNC centers included offer rehabilitation services, there is substantial practice variation, both nationally and internationally. Factors influencing rehabilitation are related to the motivation and expertise of the treatment team, but also to reimbursement aspects and patient related factors. More research is needed to investigate the extent to which practice variation impacts individual patient outcomes and how to integrate HNC rehabilitation into routine clinical pathways.
Background: Neck and shoulder complaints are common in primary care physiotherapy. These patients experience pain and disability, resulting in high societal costs due to, for example, healthcare use and work absence. Content and intensity of physiotherapy care can be matched to a patient’s risk of persistent disabling pain. Mode of care delivery can be matched to the patient’s suitability for blended care (integrating eHealth with physiotherapy sessions). It is hypothesized that combining these two approaches to stratified care (referred to from this point as Stratified Blended Approach) will improve the effectiveness and cost-effectiveness of physiotherapy for patients with neck and/or shoulder complaints compared to usual physiotherapy. Methods: This paper presents the protocol of a multicenter, pragmatic, two-arm, parallel-group, cluster randomized controlled trial. A total of 92 physiotherapists will be recruited from Dutch primary care physiotherapy practices. Physiotherapy practices will be randomized to the Stratified Blended Approach arm or usual physiotherapy arm by a computer-generated random sequence table using SPSS (1:1 allocation). Number of physiotherapists (1 or > 1) will be used as a stratification variable. A total of 238 adults consulting with neck and/or shoulder complaints will be recruited to the trial by the physiotherapy practices. In the Stratified Blended Approach arm, physiotherapists will match I) the content and intensity of physiotherapy care to the patient’s risk of persistent disabling pain, categorized as low, medium or high (using the Keele STarT MSK Tool) and II) the mode of care delivery to the patient’s suitability and willingness to receive blended care. The control arm will receive physiotherapy as usual. Neither physiotherapists nor patients in the control arm will be informed about the Stratified Blended Approach arm. The primary outcome is region-specific pain and disability (combined score of Shoulder Pain and Disability Index & Neck Pain and Disability Scale) over 9 months. Effectiveness will be compared using linear mixed models. An economic evaluation will be performed from the societal and healthcare perspective. Discussion: The trial will be the first to provide evidence on the effectiveness and cost-effectiveness of the Stratified Blended Approach compared with usual physiotherapy in patients with neck and/or shoulder complaints.
Background Identify and establish consensus regarding potential prognostic factors for the development of chronic pain after a first episode of idiopathic, non-traumatic neck pain. Design This study used two consensus group methods: a modified Nominal Group (m-NGT) and a Delphi Technique. Methods The goal of the m-NGT was to obtain and categorize a list of potential modifiable prognostic factors. These factors were presented to a multidisciplinary panel in a two-round Delphi survey, which was conducted between November 2018 and January 2020. The participants were asked whether factors identified are of prognostic value, whether these factors are modifiable, and how to measure these factors in clinical practice. Consensus was a priori defined as 70% agreement among participants. Results Eighty-four factors were identified and grouped into seven categories during the expert meeting using the modified NGT. A workgroup reduced the list to 47 factors and grouped them into 12 categories. Of these factors, 26 were found to be potentially prognostic for chronification of neck pain (> 70% agreement). Twenty-one out of these 26 factors were found to be potentially modifiable by physiotherapists based on a two-round Delphi survey. Conclusion Based on an expert meeting (m-NGT) and a two-round Delphi survey, our study documents consensus (> 70%) on 26 prognostic factors. Twenty-one out of these 26 factors were found to be modifiable, and most factors were psychological in nature.
Meestal is er geen specifieke oorzaak te vinden voor nekpijn. Fysiotherapie richt zich daarom op algemene zaken, zoals spierkracht en beweeglijkheid. We onderzoeken of er effectieve behandelingen zijn voor subgroepen met niet-specifieke nekpijn. Met deze inzichten kunnen we fysiotherapie verbeteren.Doel We willen inzicht krijgen in effectieve behandelingen bij subgroepen patiënten met niet-specifieke nekpijn. Dit leidt uiteindelijk tot kostenvermindering voor de maatschappij en een sneller en beter herstel van de patiënten. Resultaten Dit onderzoek loopt nog. Na afronding vind je hier een samenvatting van alle resultaten. Tot nu toe is duidelijk geworden dat de volgende behandelingen effectief kunnen zijn bij patiënten met niet-specifieke nekpijn: Behandelingen gericht op kracht en uithoudingsvermogen. Behandelingen gericht op coördinatie met gebruik van visuele feedback. Een voorbeeld hiervan is patiënten met een laserlamp een parcours laten uitvoeren op een scherm. De resultaten van het onderzoek worden verwerkt in het bachelor- en masteronderwijs en cursussen binnen het werkveld. Looptijd 01 december 2015 - 01 december 2020 Aanpak Dit onderzoek bestaat uit verschillende delen: We onderzoeken wat er vanuit wetenschappelijk onderzoek al bekend is over de relatie tussen beperking in activiteit en een passende behandeling. We voeren een Delphi-studie uit onder deskundigen naar het behandelen van mensen met niet-specifieke nekpijn. We vragen ze naar een overeenstemming over de relatie tussen beperking in activiteit en een algemene behandeling, zoals het trainen van spierkracht. We onderzoeken of beweegoefeningen en/of manipulaties, als meest onderzochte behandelingen bij mensen met nekpijn, zo zijn beschreven dat we het kunnen hergebruiken. In de laatste studie onderzoeken we of beweegoefeningen en/of manipulaties effectief zijn in het herstellen van de beweeglijkheid. Het gaat hierbij om een subgroep van mensen met nekpijn die ook beperkt zijn in hun beweeglijkheid. Rapporten tot nu toe: The clinical reasoning process in randomized clinical trials with patients with non-specific neck pain is incomplete: A systematic review. Maissan F, Pool J, de Raaij E, Mollema J, Ostelo R, Wittink H. Musculoskelet Sci Pract. 2018 Jun;35:8-17 Clinical reasoning in unimodal interventions in patients with non-specific neck pain in daily physiotherapy practice, a Delphi study. Maissan F, Pool J, Stutterheim E, Wittink H, Ostelo R., Musculoskelet Sci Pract. 2018 Oct;37:8-16
