Lectorale rede
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Objectives: The primary objective was to determine the responsiveness of the Dutch version of the 13-item Tampa Scale for Kinesiophobia for cardiac patients (TSK-NL Heart). The secondary objective was to assess changes in kinesiophobia during cardiac rehabilitation.Methods: Kinesiophobia was measured pre- and post-cardiac rehabilitation using the TSK-NL Heart questionnaire in 109 cardiac patients (61 years; 76% men). The effect size of kinesiophobia score changes was calculated for the full population. A measure that is responsive to change should produce higher effects sizes in patients in whom kinesiophobia improves. Therefore, effect sizes were also calculated for patients who did or did not improve on selected external measures. For this step, the Cardiac Anxiety Questionnaire (CAQ) and the Hospital Anxiety and Depression Scale (HADS) were completed as external measures in a subsample of 58 patients.Results: The effect size of the TSK-NL Heart for the full study population was small (0.29). In line with the study hypothesis the effect size was higher (moderate) for patients with improved CAQ (0.52) and HADS scores (0.54). Prevalence of high kinesiophobia levels decreased from 40% pre-cardiac rehabilitation to 26% post-cardiac rehabilitation (p = 0.004).Conclusion: The TSK-NL Heart has moderate responsiveness and can be used to measure changes in kinesiophobia. Improvements in kinesiophobia were observed during cardiac rehabilitation. Nevertheless, high levels of kinesiophobia were still highly prevalent post-cardiac rehabilitation.
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Background: Follow-up of stroke survivors is important to objectify activity limitations and/or participations restrictions. Responsive measurement tools are needed with a low burden for professional and patient. Aim: To examine the concurrent validity, floor and ceiling effects and responsiveness of both domains of the Late-Life Function and Disability Index Computerized Adaptive Test (LLFDI-CAT) in first-ever stroke survivors discharged to their home setting. Design: Longitudinal study. Setting: Community. Population: First ever stroke survivors. Methods: Participants were visited within three weeks after discharge and six months later. Stroke Impact Scale (SIS 3.0) and Five-Meter Walk Test (5MWT) outcomes were used to investigate concurrent validity of both domains, activity limitations, and participation restriction, of the LLFDI-CAT. Scores at three weeks and six months were used to examine floor and ceiling effects and change scores were used for responsiveness. Responsiveness was assessed using predefined hypotheses. Hypotheses regarding the correlations with change scores of related measures, unrelated measures, and differences between groups were formulated. Results: The study included 105 participants. Concurrent validity (R) of the LLFDI-CAT activity limitations domain compared with the physical function domain of the SIS 3.0 and with the 5MWT was 0.79 and -0.46 respectively. R of the LLFDI-CAT participation restriction domain compared with the participation domain of the SIS 3.0 and with the 5MWT was 0.79 and -0.41 respectively. A ceiling effect (15%) for the participation restriction domain was found at six months. Both domains, activity limitations and participation restrictions, of the LLFDI-CAT, scored well on responsiveness: 100% (12/12) and 91% (12/11) respectively of the predefined hypotheses were confirmed. Conclusions: The LLFDI-CAT seems to be a valid instrument and both domains are able to detect change over time. Therefore, the LLFDI-CAT is a promising tool to use both in practice and in research. Clinical rehabilitation impact: The LLFDI-CAT can be used in research and clinical practice.
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Funding Acknowledgements Type of funding sources: None. Background An important factor related to low physical activity in cardiac patients is fear of movement (kinesiophobia). The setting of cardiac rehabilitation (CR) seems suitable for targeting kinesiophobia. Nevertheless, the impact of CR on kinesiophobia is currently unknown, partly due to the absence of information on the responsiveness of instruments to measure kinesiophobia. Purpose To determine the responsiveness of the Dutch version of the Tampa Scale for Kinesiophobia questionnaire (TSK-NL Heart), to asses changes in kinesiophobia during participation in CR and to assess predictors of high levels of kinesiophobia at completion of CR. Methods This study was performed among 109 patients (mean age: 61 years; 76% men) who participated in a 6- till 12-week CR program. Kinesiophobia was measured using the TSK-NL Heart questionnaire. To determine the responsiveness of the TSK-NL Heart, the Cardiac Anxiety Questionnaire (CAQ) and the general anxiety scale of the Hospital Anxiety and Depression Scale (HADS-A) were used as external measures. All questionnaires were completed pre- and post-CR. Internal responsiveness was estimated by calculating the effect size (ES) and standardized response mean (SRM). External responsiveness was determined by calculating the correlation between change scores on the TSK-NL heart and on the external measures. Furthermore, univariate logistic regression analysis was performed with the dichotomized TSK-NL Heart score post-CR as dependent variable (high vs low scores) and baseline characteristics (age, sex, reason for referral and pre-CR scores on the TSK-NL Heart, CAQ and HADS) as predictor variables. Results Prevalence of a high levels of kinesiophobia improved from 40.4% pre-CR to 25.7% at completion of CR (p = 0.05). Both the ES and the SRM of the TSK change score were moderate for patients with an improved CAQ and HADS-A score (respectively ES = 0.52; SRM = 0.57 and ES = 0.54; SRM = 0.60) and small for patients with a stable score (ES = 0; SRM = 0 and ES = 0.26; SRM = 0.36). There was a moderate correlation between the TSK-NL Heart change score and the CAQ (Rs = 0.30, p = 0.023) and a small correlation between the TSK-NL Heart change score and the HADS-A (Rs =0.21, p = 0.107). The odds of having high kinesiophobia levels post-CR were increased by having a high level of kinesiophobia pre-CR (OR= 9.83, 95%CI: 3.52-27.46), a higher baseline score on the CAQ (OR = 1.12, 95%CI: 1.06-1.19), and a higher baseline score on the HADS-A (OR = 1.26, 95% CI: 1.11-1.42). Conclusion The TSK-NL Heart has moderate responsiveness. In addition, this study shows that there are reductions in kinesiophobia during the course of CR. Nevertheless, a large number of patients (26%) still had high levels of kinesiophobia at completion of CR. Interventions targeting kinesiophobia should focus on patients that enter CR with high levels of kinesiophobia, cardiac anxiety and generic anxiety.
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OBJECTIVE: Juvenile dermatomyositis (DM) is an inflammatory myopathy in which the immune system targets the microvasculature of the skeletal muscle and skin, leading to significant muscle weakness and exercise intolerance, although the precise etiology is unknown. The goal of this study was to investigate the changes in exercise capacity in children with myositis during active and inactive disease periods and to study the responsiveness of exercise parameters.METHODS: Thirteen children with juvenile DM (mean+/-SD age 11.2+/-2.6 years) participated in this study. Patients performed a maximal exercise test using an electronically braked cycle ergometer and respiratory gas analysis system. Exercise parameters were analyzed, including peak oxygen uptake (VO2peak), peak work rate (Wpeak), and ventilatory anaerobic threshold (VAT). All children were tested during an active period of the disease and during a remission period. From these data, 4 different response statistics were calculated.RESULTS: The children performed significantly better during a remission period compared with a period of active disease. Most exercise parameters showed a very large response. The 5 most responsive parameters were Wpeak, Wpeak (percent predicted), oxygen pulse, VO2peak, and power at the VAT.CONCLUSION: We found in our longitudinal study that children with active juvenile DM had significantly reduced exercise parameters compared with a remission period. Moreover, we found that several parameters had very good responsiveness. With previously established validity and reliability, exercise testing has been demonstrated to be an excellent noninvasive instrument for the longitudinal followup of children with myositis.
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CC-BY-NC-NDSTUDY DESIGN:prospective cohort study.OBJECTIVE:To analyze responsiveness and minimal clinically important change (MCIC) of the US National Institutes of Health (NIH) minimal dataset for chronic low back pain (CLBP).SUMMARY OF BACKGROUND DATA:The NIH minimal dataset is a 40-item questionnaire developed to increase use of standardized definitions and measures for CLBP. Longitudinal validity of the total minimal dataset and the subscale Impact Stratification are unknown.METHODS:Total outcome scores on the NIH minimal dataset, Dutch Language Version, were calculated ranging from 0-100 points with higher scores representing worse functioning. Responsiveness and MCIC were determined with an anchor based method, calculating the area under the receiver operating characteristics (ROC) curve (AUC) and by determining the optimal cut-off point. Smallest detectable change (SDC) was calculated as a parameter of measurement error.RESULTS:In total 223 patients with CLBP were included. Mean total score on the NIH minimal dataset was 44 ± 14 points at baseline. The total outcome score was responsive to change with an AUC of 0.84. MCIC was 14 points with a sensitivity of 72% and specificity 82%, and SDC was 23 points. Mean total score on Impact Stratification (scale 8-50) was 34.4 ± 7.4 points at baseline, with an AUC of 0.91, an MCIC of 7.5 with a sensitivity 96% of and specificity of 78%, and an SDC of 14 points.CONCLUSION:The longitudinal validity of the NIH minimal dataset is adequate. An improvement of 14 points in total outcome score and 7.5 points in Impact Stratification can be interpreted as clinically important in individual patients. However, MCIC depends on baseline values and the method that is chosen to determine the optimal cut-off point. Furthermore, measurement error is larger than the MCIC. This means that individual change scores should be interpreted with caution.LEVEL OF EVIDENCE:4This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal
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Due to fast and unpredictable developments, professional education is challenged with being responsive, which demands a rethinking of conventional curriculum development approaches. Yet, literature on curriculum development falls short in terms of recognising how to react rapidly and adequately to these new developments. This study focuses on curriculum development initiatives at the school level in a Dutch university of applied sciences. Open interviews were held with 29 curriculum developers to explore how they define and give substance to developing curricula for new, changing or unpredictable professions. These 29 participants were involved in seven curriculum development trajectories. Four themes were detected: (1) curriculum developers are in favour of open, flexible and authentic curricula; (2) the context in which the curriculum development takes place and the different roles and responsibilities of curriculum developers are challenging; (3) curriculum developers feel insufficiently equipped to carry out their tasks; and (4) involving stakeholders is necessary but results in a “viscous” social–political process. Responsive curriculum development requires a great deal of flexibility and adaptability from curriculum developers. Yet, in our study, “institutional concrete” is found to severely hinder responsive curriculum development processes. To be responsive, such processes need to be supported and institutional barriers need to be removed.
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In recent decades the trend of public accountability, transparency and governance has become a priority in many public sectors, but in de media sector and the public broadcasting sector in particular there have only very recently been attempts to address the public in terms of accountability and responsiveness
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