Zoekresultaten

Effectiveness of rehabilitation for working-age patients after a total hip arthroplasty

Background: Postoperative rehabilitation after primary total hip arthroplasty (p-THA) differs between the Netherlands and Germany. Aim is to compare clinical effectiveness and to get a first impression of cost effectiveness of Dutch versus German usual care after p-THA. Methods: A transnational prospective controlled observational trial. Clinical effectiveness was assessed with self-reported questionnaires and functional tests. Measurements were taken preoperatively and 4 weeks, 12 weeks, and 6 months postoperatively. For cost effectiveness, long-term economic aspects were assessed from a societal perspective. Results: 124 working-age patients finished the measurements. German usual care leads to a significantly larger proportion (65.6% versus 47.5%) of satisfied patients 12 weeks postoperatively and significantly better self-reported function and Five Times Sit-to-Stand Test (FTSST) results. German usual care is generally 45% more expensive than Dutch usual care, and 20% more expensive for working-age patients. A scenario analysis assumed that German patients work the same number of hours as the Dutch, and that productivity costs are the same. This analysis revealed German care is still more expensive but the difference decreased to 8%. Conclusions: German rehabilitation is clinically advantageous yet more expensive, although comparisons are less straightforward as the socioeconomic context differs between the two countries. Trial registration: The study is registered in the German Registry of Clinical Trials (DRKS00011345, 18/11/2016).

Are chronic musculoskeletal pain and generalized joint hypermobility disabling contributors to physical functioning?

BACKGROUND: Chronic musculoskeletal pain (CMP), Generalized Joint Hypermobility (GJH) and pain-related fear have influence on physical functioning in adolescents.AIM: to evaluate differences in physical functioning between adolescents with CMP, GJH or the combination of both, and in addition evaluate the potential contribution of pain-related fear.DESIGN: The design of this study was observational and cross-sectional.SETTING: The adolescents with CMP were recruited by a physician in rehabilitation medicine and measured in the university outpatient rehabilitation clinic (Adelante/Maastricht University Medical Center+, the Netherlands). The adolescents without CMP were recruited in the Southern area of the Netherlands and measured in the university outpatient rehabilitation clinic (Adelante/Maastricht University Medical Center+, the Netherlands).POPULATION: Four subgroups of adolescents were included; 21 adolescents with CMP without GJH, 9 adolescents with CMP and GJH, 51 adolescents without CMP without GJH, and 11 adolescents without CMP with GJH.METHODS: Outcome measures were muscle strength and endurance, motor performance, physical activity level, and pain-related fear. Hierarchical regression analyses were used to study differences in physical functioning and the contribution of pain-related fear in adolescents with/without CMP as well as with/without GJH.RESULTS: Adolescents with CMP had decreased muscle strength (P=0.01), endurance (P=0.02), and lower motor performance (P<0.01) compared to adolescents without CMP. Higher levels of pain-related fear were related to decreased muscle strength (P=0.01), endurance (P<0.01), and motor performance (P<0.01). No differences in physical functioning and pain-related fear between hypermobile and non-hypermobile adolescents with CMP were found.CONCLUSIONS: Adolescents with CMP had decreased muscle strength and motor performance associated with increased levels of pain-related fear compared to adolescents without CMP. The association of being hypermobile with physical functioning is not more pronounced in adolescents with CMP.CLINICAL REHABILITATION IMPACT: No differences were found in physical functioning and pain-related fear between hypermobile adolescents with CMP compared to non-hypermobile adolescents with CMP. Future rehabilitation treatment in hypermobile adolescents with CMP should also focus on psychological components, such as pain-related fear.

"Treat people with human dignity"

Purpose The aim of this study was to gain insight into the perspectives of older adults on the quality of geriatric rehabilitation (GR) during the trajectory of GR from admission until six weeks after discharge.Methods We conducted a longitudinal qualitative study. Participants were interviewed three times: at the start of rehabilitation, at discharge, and six weeks after discharge. The data were analysed using a thematic analysis.Results In total, 50 interviews were conducted, with 18 participants being interviewed multiple times. The following themes emerged: 1. A bond of trust with health care professionals (HCPs), 2. Being prepared and informed at all stages of GR, 3. Participants emphasise physical and occupational therapy rather than other aspects of care as comprising GR 4. Changing needs regarding (the extent of) involvement in decision-making, 5. Contact with family and peers.Conclusion For older adults, preparation for and good organisation of rehabilitation and social interaction with HCPs and other older adults were found to be important for the perceived quality of GR. Social interaction is infuenced by how HCPs engage with older adults in all the phases of the rehabilitation process. Older adults have varying preferences about involvement in decision-making during GR. These perspectives should be acknowledged and acted upon in clinical practice to further improve the quality of care in GR.

Agreement between patient-generated subjective global assessment short form and short nutritional assessment questionnaire in a selected clinical population

Diagnostic accuracy of ESPEN Diagnostic Criteria for malnutrition in selected clinical populations

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