Rationale: The PG-SGA is a validated instrument to assess malnutrition and its risk factors. Its patient component, i.e. the PG-SGA Short Form (SF), can be used as screening instrument. In this multicenter study, we aimed to assess diagnostic accuracy of the PG-SGA SF and NRS 2002, in patients at the Internal Medicine ward.Methods: In 192 patients (76.0±13.5 years; 53% female) in 9 Portuguese internal medicine wards, malnutrition risk was assessed by PG-SGA SF and NRS 2002. PG-SGA SF ≤8 was defined as low/medium malnutrition risk and NRS 2002 ≤2 as low risk. PG-SGA SF ≥9 and NRS 2002 ≥3 were defined as high malnutrition risk. Nutritional status was assessed by the full PG-SGA (reference method). Malnutrition was defined as PG-SGA Stage B (moderate/suspected malnutrition) or Stage C (severely malnourished). Diagnostic accuracy was tested by sensitivity, specificity, positive and negative predictive value, and receiver operating curve. Agreement between PG-SGA and NRS-2002 was tested by McNemar’s test and Cohen’s kappa (κ).Results: Forty-six % and 53% were categorized as at risk of malnutrition by PG-SGA SF and NRS 2002, respectively. In total, 55% were malnourished. Sensitivity, specificity, positive and negative predictive value of PG-SGA SF and NRS 2002 were 0.84, 1.00, 1.00, 0.83 and 0.74, 0.74, 0.77 and 0.70, respectively. Area under curve of PG-SGA SF and NRS 2002 was 0.987 and 0.778 respectively. McNemar’s test showed no significant disagreement (p=0.86) between PG-SGA SF and NRS 2002. Cohen’s kappa showed weak agreement (κ=0.492; p<0.001) (Table 1).Conclusion: Our findings indicate that in patients at the internal medicine ward, PG-SGA SF shows better diagnostic accuracy than NRS 2002, i.e. better sensitivity and specificity.
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Objective: To compare the effects of traditional mirror therapy (MT), a patient-centred teletreatment (PACT) and sensomotor exercises without a mirror on phantom limb pain (PLP). Design: Three-arm multicentre randomized controlled trial. Setting: Rehabilitation centres, hospital and private practices. Subjects: Adult patients with unilateral lower limb amputation and average PLP intensity of at least 3 on the 0–10 Numeric Rating Scale (NRS). Interventions: Subjects randomly received either four weeks of traditional MT followed by a teletreatment using augmented reality MT, traditional MT followed by self-delivered MT or sensomotor exercises of the intact limb without a mirror followed by self-delivered exercises. Main measures: Intensity, frequency and duration of PLP and patient-reported outcomes assessing limitations in daily life at baseline, 4 weeks, 10 weeks and 6 months. Results: In total, 75 patients received traditional MT (n = 25), teletreatment (n = 26) or sensomotor exercises (n = 24). Mean (SD) age was 61.1 (14.2) years and mean (SD) pain intensity was 5.7 (2.1) on the NRS. Effects of MT at four weeks on PLP were not significant. MT significantly reduced the duration of PLP at six months compared to the teletreatment (P = 0.050) and control group (P = 0.019). Subgroup analyses suggested significant effects on PLP in women, patients with telescoping and patients with a motor component in PLP. The teletreatment had no additional effects compared to self-delivered MT at 10 weeks and 6 months. Conclusion: Traditional MT over four weeks was not more effective than sensomotor exercises without a mirror in reducing PLP, although significant effects were suggested in some subgroups.
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Background: In postoperative pain treatment patients are asked to rate their pain experience on a single uni-dimensional pain scale. Such pain scores are also used as indicator to assess the quality of pain treatment. However, patients may differ in how they interpret the Numeric Rating Scale (NRS) score. Objectives: This study examines how patients assign a number to their currently experienced postoperative pain and which considerations influence this process. Methods: A qualitative approach according to grounded theory was used. Twenty-seven patients were interviewed one day after surgery. Results: Three main themes emerged that influenced the Numeric Rating Scale scores (0–10) that patients actually reported to professionals: score-related factors, intrapersonal factors, and the anticipated consequences of a given pain score. Anticipated consequences were analgesic administration—which could be desired or undesired—and possible judgements by professionals. We also propose a conceptual model for the relationship between factors that influence the pain rating process. Based on patients’ score-related and intrapersonal factors, a preliminary pain score was ‘‘internally’’ set. Before reporting the pain score to the healthcare professional, patients considered the anticipated consequences (i.e., expected judgements by professionals and anticipation of analgesic administration) of current Numeric Rating Scale scores. Conclusions: This study provides insight into the process of how patients translate their current postoperative pain into a numeric rating score. The proposed model may help professionals to understand the factors that influence a given Numeric Rating Scale score and suggest the most appropriate questions for clarification. In this way, patients and professionals may arrive at a shared understanding of the pain score, resulting in a tailored decision regarding the most appropriate treatment of current postoperative pain, particularly the dosing and timing of opioid administration.
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Purpose: This research aimed to explore factors associated with patient-reported breast and abdominal scar quality after deep inferior epigastric perforator (DIEP) flap breast reconstruction (BR). Material and Methods: This study was designed as a descriptive cross-sectional survey in which women after DIEP flap BR were invited to complete an online survey on breast and abdominal scarring. The online survey was distributed in the Netherlands in several ways in order to reach a diverse population of women. Outcomes were assessed with the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS). Additional items were assessed with a numeric rating scale (NRS). Results: A total of 248 women completed the survey. There was a statistically significant worse POSAS scar appraisal for the abdominal scar compared with the breast scar. The vast majority of women reported high scores on at least one scar characteristic of their breast scar or ab- dominal scar. Overall, color, stiffness, thickness, and irregularity scored higher than pain and itching. Women were only moderately positive about the size, noticeability, location, and the information provided regarding scarring. Conclusion: It is crucial to address the inevitability of scars in patient education before a DIEP flap BR, with a particular focus on the abdominal scar, as women experience abdominal scars significantly worse than their breast scars. Providing more information on the experience of other women and the expected appearance will contribute to having realistic expectations while allowing them to make well-informed decisions.
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In dit artikel wordt beknopt beschreven wat de aanleiding was van dit project en hoe de wenselijke multidisciplinaire behandeling er uit zou kunnen zien. Vervolgens wordt de uitvoering van het project beschreven en welke meetinstrumenten hierbij worden gehanteerd. Tot slot wordt in het kort ingegaan op het uiteindelijke multidisciplinaire pijnprotocol zoals dat momenteel wordt gebruikt.
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INLEIDING In deze module worden behandeladviezen gegeven voor de Post-COVID-19 ambulante behandeling in de geriatrische revalidatie gericht op somatische-, functionele- en psychische status. Deze module is een onderdeel van het behandeladvies post-COVID-19 (geriatrische) revalidatie-Verenso. Deze module is in een zeer korte tijd tot stand gekomen en heeft de status van groeidocument. Zorgvuldigheid is betracht om zowel de (beperkte) ervaringskennis, als de actuele stand van de wetenschappelijke literatuur hierin te betrekken. Voor dit behandeladvies is gebruik gemaakt van het door GRZPLUS ontwikkeld ambulant revalidatieprogramma CO FIT+. Bij GRZPLUS is een doorontwikkeling gemaakt op basis van de update behandeladvies post-COVID-19 geriatrische revalidatie van Verenso (Verenso, 19-05-2020) welke is gebaseerd op de principes van longrevalidatie zoals vertaald in het Behandelprogramma geriatrische COPD-revalidatie (van Damvan Isselt et al.) en het Behandelprogramma COVID-19 Post IC, van Revalidatiecentrum de Hoogstraat (Brouwers, de Graaf). Dit is aangevuld met behandeladviezen en leidraden vanuit de beroepsverenigingen en kennis uit wetenschappelijk onderzoek (long-revalidatie) en vanuit het REACH netwerk (REhabilitation After Critical illness and Hospital discharge). De komende maanden zullen zowel de nieuwe wetenschappelijke literatuur als de ervaringen uit de praktijk gebruikt worden om de handreiking te verbeteren en zo nodig aan te vullen. Dat zullen wij doen met specialisten ouderengeneeskunde, revalidatieartsen, klinisch-geriaters, paramedici, longartsen, verpleegkundigen, infectie deskundigen, en andere betrokken beroepsgroepen. De revalidatie van ambulante post-COVID-19 patiënten vereist vooral afstemming binnen de multidisciplinaire zorg. De complexiteit en ernst van de problematiek en de interactie van beperkingen op diverse domeinen maakt dat interdisciplinaire behandeling essentieel is.
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CC-BY 4.0 Background: Since the contribution of the lumbar multifidus(LM) is not well understood in relation to nonspecific low back pain(LBP), this may limit physiotherapists in choosing the most appropriate treatment strategy.Objectives: This study aims to compare clinical characteristics, in terms of LM function and morphology, between subacute and chronic LBP patients from a large clinical practice cohort compared to healthy controls.Design: Multicenter case control study.Method: Subacute and chronic LBP patients and healthy controls between 18 and 65 years of age were included.Several clinical tests were performed: primary outcomes were the LM thickness from ultrasound measurements, trunk range of motion(ROM) from 3D kinematic tests, and median frequency and root mean square values of LM by electromyography measurements. The secondary outcomes Numeric Rating Scale for Pain(NRS) and the Oswestry Disability Index(ODI) were administered. Comparisons between groups were made with ANOVA, pvalues< 0.05, with Tukey’s HSD post-hoc test were considered significant.Results: A total of 161 participants were included, 50 healthy controls, 59 chronic LBP patients, and 52 subacute LBP patients. Trunk ROM and LM thickness were significantly larger in healthy controls compared to all LBP patients(p < 0.01). A lower LM thickness was found between subacute and chronic LBP patients although not significant(p = 0.11–0.97). All between-group comparisons showed no statistically significant differences in electromyography outcomes (p = 0.10–0.32). NRS showed no significant differences between LBP subgroups(p = 0.21). Chronic LBP patients showed a significant higher ODI score compared to subacute LBP patients(p = 0.03).Conclusions: Trunk ROM and LM thickness show differences between LBP patients and healthy controls.
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De reconstructie van rituelen rondom dood en begraven in Roermond tussen 1870 en 1940. Promotieartikel.
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Introduction Physical activity is suggested to be important for low back pain (LBP) but a major problem is the limited validity of the measurement of physical activities, which is usually based on questionnaires. Physical fitness can be viewed as a more objective measurement and our question was how physical activity based on self-reports and objective measured levels of physical fitness were associated with LBP. Materials and methods We analyzed cross-sectional data of 1,723 police employees. Physical activity was assessed by questionnaire (SQUASH) measuring type of activity, intensity, and time spent on these activities. Physical fitness was based on muscular dynamic endurance capacity and peak oxygen uptake (VO2 peak). Severe LBP, interfering with functioning, was defined by pain ratings C4 on a scale of 0–10. Results Higher levels of physical fitness, both muscularand aerobic, were associated with less LBP (OR: 0.54; 95%CI: 0.34–0.86, respectively, 0.59: 95%CI: 0.35–0.99). For self-reported physical activity, both a low and a high level of the total physical activity pattern were associated with an increase of LBP (OR: 1.52; 95%CI: 1.00–2.31, respectively, 1.60; 95%CI: 1.05–2.44). Conclusion These findings suggest that physical activity of an intensity that improves physical fitness may be important in the prevention of LBP
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