Op 8 januari 2020 verdedigde ik mijn proef - schrift bij de Rijksuniversiteit Groningen. Het proefschrift richt zich op het vergroten van inzicht in de aard en de omvang van potentiële complicaties na het toepassen van manueeltherapeutische handelingen aan de cervicale wervelkolom bij mensen met nekpijn en/of hoofdpijn. Zowel onder leken als onder zorgprofessionals bestaat de veronderstelling dat manueeltherapeutische handelingen die worden toegepast aan de cervicale wervelkolom, kunnen leiden tot complicaties. Er is tot nu toe geen duidelijk causaal verband gevonden tussen de handelingen en ernstige complicaties. Bovendien wordt slechts sporadisch gepubliceerd over casuïstiek met ernstige complicaties die tijdens of na manuele behandelingen van de cervicale wervelkolom ontstaan zijn. De schattingen van het voorkomen van complicaties variëren enorm. Daarnaast is niet duidelijk welke patiënten een hoger of lager risico lopen op dergelijke complicaties.
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Background: Health care practitioners' knowledge and attitudes influence patients’ beliefs and health outcomes in musculoskeletal (MSK) pain. It is unclear to what extent physiotherapists undertaking a postgraduate master in manual therapy (MT students) possess the knowledge and attitudes toward pain neuroscience to be able to apply the biopsychosocial model in patients with MSK pain. Objectives: The aim of this study was to assess the knowledge and attitudes toward pain neuroscience in MT students. Design: A cross-sectional study. Method: Self-reported knowledge and attitudes were measured among students (n = 662) at baseline and in all years of the MT postgraduate programs in the Netherlands. The Knowledge and Attitudes of Pain questionnaire (KNAP) was used as a primary measure. Difference in KNAP-scores between baseline (0), year 1, year 2 and year 3 was tested using a one-way ANOVA (hypothesis: 0 < 1
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Imagery Rehearsal Therapy (IRT) is effective for trauma-related nightmares and is also a challenge to patients in finding access to their traumatic memories, because these are saved in non-verbal, visual, or audiovisual language. Art therapy (AT) is an experiential treatment that addresses images rather than words. This study investigates the possibility of an IRT-AT combination. Systematic literature review and field research was conducted, and the integration of theoretical and practice-based knowledge resulted in a framework for Imagery Rehearsal-based Art Therapy (IR-AT). The added value of AT in IRT appears to be more readily gaining access to traumatic experiences, living through feelings, and breaking through avoidance. Exposure and re-scripting take place more indirectly, experientially and sometimes in a playlike manner using art assignments and materials. In the artwork, imagination, play and fantasy offer creative space to stop the vicious circle of nightmares by changing theme, story line, ending, or any part of the dream into a more positive and acceptable one. IR-AT emerges as a promising method for treatment, and could be especially useful for patients who benefit least from verbal exposure techniques. This description of IR-AT offers a base for further research.
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Background: Physical therapy is regarded an effective treatment for temporomandibular disorders (TMD). Patients with TMD often report concomitant headache. There is, however, no overview of the effect of physical therapy for TMD on concomitant headache complaints. Objectives: The aim of this study is to systematically evaluate the literature on the effectiveness of physical therapy on concomitant headache pain intensity in patients with TMD. Data sources: PubMed, Cochrane and PEDro were searched. Study eligibility criteria: Randomized or controlled clinical trials studying physical therapy interventions were included. Participants: Patients with TMD and headache. Appraisal: The Cochrane risk of bias tool was used to assess risk of bias. Synthesis methods: Individual and pooled between-group effect sizes were calculated according to the standardized mean difference (SMD) and the quality of the evidence was rated using the GRADE approach. Results: and manual therapy on both orofacial region and cervical spine. There is a very low level of certainty that TMD-treatment is effective on headache pain intensity, downgraded by high risk of bias, inconsistency and imprecision. Limitations: The methodological quality of most included articles was poor, and the interventions included were very different. Conclusions: Physical therapy interventions presented small effect on reducing headache pain intensity on subjects with TMD, with low level of certainty. More studies of higher methodological quality are needed so better conclusions could be taken.
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Depression is a highly prevalent and seriously impairing disorder. Evidence suggests that music therapy can decrease depression, though the music therapy that is offered is often not clearly described in studies. The purpose of this study was to develop an improvisational music therapy intervention based on insights from theory, evidence and clinical practice for young adults with depressive symptoms. The Intervention Mapping method was used and resulted in (1) a model to explain how emotion dysregulation may affect depressive symptoms using the Component Process Model (CPM) as a theoretical framework; (2) a model to clarify as to how improvisational music therapy may change depressive symptoms using synchronisation and emotional resonance; (3) a prototype Emotion-regulating Improvisational Music Therapy for Preventing Depressive symptoms (EIMT-PD); (4) a ten-session improvisational music therapy manual aimed at improving emotion regulation and reducing depressive symptoms; (5) a program implementation plan; and (6) a summary of a multiple baseline study protocol to evaluate the effectiveness and principles of EIMT-PD. EIMT-PD, using synchronisation and emotional resonance may be a promising music therapy to improve emotion regulation and, in line with our expectations, reduce depressive symptoms. More research is needed to assess its effectiveness and principles.
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Research showed that more than 30% of patients with Posttraumatic Stress Disorder (PTSD) do not benefit from evidence- based treatments: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) or Eye Movement Desensitization and Reprocessing (EMDR). These are patients with prolonged and multiple traumatization, with poor verbal memory, and patients with emotional over-modulation. Retelling traumatic experiences in detail is poorly tolerated by these patients and might be a reason for not starting or not completing the recommended treatments. Due to lack of evidence, no alternative treatments are recommended yet. Art therapy may offer an alternative and suitable treatment, because the nonverbal and experiential character of art therapy appears to be an appropriate approach to the often wordless and visual nature of traumatic memories. The objective of this pilot study was to test the acceptability, feasibility, and applicability of trauma-focused art therapy for adults with PTSD due to multiple and prolonged traumatization (patients with early childhood traumatization and refugees from different cultures). Another objective was to identify the preliminary effectiveness of art therapy. Results showed willingness to participate and adherence to treatment of patients. Therapists considered trauma-focused art therapy feasible and applicable and patients reported beneficial effects, such as more relaxation, externalization of memories and emotions into artwork, less intrusive thoughts of traumatic experiences and more confidence in the future. The preliminary findings on PTSD symptom severity showed a decrease of symptoms in some participants, and an increase of symptoms in other participants. Further research into the effectiveness of art therapy and PTSD is needed.
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Introduction: Depression can be a serious problem in young adult students. There is a need to implement and monitor prevention interventions for these students. Emotion-regulating improvisational music therapy (EIMT) was developed to prevent depression. The purpose of this study was to evaluate the feasibility of EIMT for use in practice for young adult students with depressive symptoms in a university context. Method: A process evaluation was conducted embedded in a larger research project. Eleven students, three music therapists and five referrers were interviewed. The music therapists also completed evaluation forms. Data were collected concerning client attendance, treatment integrity, musical components used to synchronise, and experiences with EIMT and referral. Results: Client attendance (90%) and treatment integrity were evaluated to be sufficient (therapist adherence 83%; competence 84%). The music therapists used mostly rhythm to synchronise (38 of 99 times). The students and music therapists reported that EIMT and its elements evoked changes in all emotion regulation components. The students reported that synchronisation elicited meaningful experiences of expressing joy, feeling heard, feeling joy and bodily responses of relaxation. The music therapists found the manual useful for applying EIMT. The student counsellors experienced EIMT as an appropriate way to support students due to its preventive character. Discussion: EIMT appears to be a feasible means of evoking changes in emotion regulation components in young adult students with depressive symptoms in a university context. More studies are needed to create a more nuanced and evidence-based understanding of the feasibility of EIMT, processes of change and treatment integrity.
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Art therapy is widely used and effective in the treatment of patients diagnosed with Personality Disorders (PDs). Current psychotherapeutic approaches may benefit from this additional therapy to improve their efficacy. But what is the patient perspective upon this therapy? This study explored perceived benefits of art therapy for patients with PDs to let the valuable perspective of patients be taken into account. Using a quantitative survey study over 3 months (N = 528), GLM repeated measures and overall hierarchical regression analyses showed that the majority of the patients reported quite a lot of benefit from art therapy (mean 3.70 on a 5-point Likert scale), primarily in emotional and social functioning. The improvements are concentrated in specific target goals of which the five highest scoring goals affected were: expression of emotions, improved (more stable/positive) self-image, making own choices/autonomy, recognition of, insight in, and changing of personal patterns of feelings, behaviors and thoughts and dealing with own limitations and/or vulnerability. Patients made it clear that they perceived these target areas as having been affected by art therapy and said so at both moments in time, with a higher score after 3 months. The extent of the perceived benefits is highly dependent for patients on factors such as a non-judgmental attitude on the part of the therapist, feeling that they are taken seriously, being given sufficient freedom of expression but at the same time being offered sufficient structure and an adequate basis. Age, gender, and diagnosis cluster did not predict the magnitude of perceived benefits. Art therapy provides equal advantages to a broad target group, and so this form of therapy can be broadly indicated. The experienced benefits and the increase over time was primarily associated with the degree to which patients perceive that they can give meaningful expression to feelings in their artwork. This provides an indication for the extent of the benefits a person can experience and can also serve as a clear guiding principle for interventions by the art therapist.
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