Purpose: The etiology of pain in osteoarthritis (OA) is complex andmultifactorial. A growing number of studies suggest that modificationof pain-transmission in the peripheral and central nervous system,leading to sensitization, plays a role in OA pain. Sensitization seems tobe associated with neuropathic pain-like symptoms and assessment ofthese symptoms can help to identify patients who could benefit fromadditional treatment options. Several questionnaires are available todistinguish neuropathic from nociceptive pain symptoms. The modifiedpainDETECT questionnaire (mPDQ) is a self-reported questionnairedeveloped to discriminate between nociceptive- and possible/likelyneuropathic pain in knee OA patients. Recently the mPDQ was translatedinto Dutch and adjusted to also fit hip OA patients. The aim of thisstudy was to assess the validity of the mPDQ-NL in patients with hip orknee OA.Methods: Primary hip and knee OA patients were recruited from threeDutch hospitals. Based on previous research, confirmatory factor analysisfor two principal components was performed to assess structuralvalidity. Construct validity (both convergent and divergent) wasassessed using hypothesis testing. Predefined hypotheses were formulatedconcerning the correlation between the mPDQ-NL and theSelf-reported Leeds Assessment of Neuropathic Symptoms and Signs (SLANSS),subscales of the Knee injury and Osteoarthritis Outcome score/Hip disability and Osteoarthritis Outcome Score (KOOS/HOOS), VisualAnalogue Scale for pain (VAS pain), and subscales of the RAND-36health survey (RAND-36). According to the COSMIN criteria, constructvalidity of a questionnaire is sufficient if 75% of predefined hypothesesare met. Additionally, convergent validity was assessed with blunt PainPressure Thresholds (PPTs) in a subsample of participants. A reducedPPT is a somatosensory abnormality that is considered an indication ofsensitization in OA. Therefore it was expected that reduction of PPTswas associated with higher mPDQ scores.Results: 168 participants were included. PPT measurements wereperformed in a sample of 46 participants. Factor analysis confirmed twoprincipal components. The items that loaded on the first componentcould be described as “evoked neuropathic sensations”, the items thatloaded on the second component as “spontaneous neuropathic sensations”.However there were two items that substantially loaded on bothcomponents. The item regarding pain pattern did not load on anycomponent. Considering construct analysis, 80% of the predefinedhypotheses concerning the correlation between mPDQ and self-reportedquestionnaires were met. Considering the correlation with PPTmeasurements, 50% of the predefined hypotheses were met.Conclusions: The mPDQ-NL seems to adequately reflect neuropathicpain-like symptoms experienced by hip and knee OA patients. Concerningstructural validity, two determinative components seem to bepresent, in line with previous research. However, one particular itemregarding pain pattern might not reflect the construct of neuropathicpain-like symptoms in hip or knee OA. Therefore, when using the mPDQin hip or knee OA patients, it might be considered to skip this particularitem. Construct validity can be considered sufficient, with over 75% ofthe predefined hypotheses regarding correlation between the mPDQNLand other questionnaires were met. However, only 50% of the hypotheses concerning PPT measurements were met, probably due toheterogeneity and limited sample size of this subgroup. To ourknowledge, this study is the first to assess the structural validity of themPDQ knee and hip by using factor analysis and to assess constructvalidity using elaborate hypothesis testing as proposed by the COSMINguidelines.
DOCUMENT
Background: The modified painDETECT questionnaire (PDQ) is a self-reported questionnaire to discriminatebetween nociceptive and neuropathic-like pain in patients with knee/hip osteoarthritis (OA). This studyaims to assess the structural and construct validity of this questionnaire.Methods: Confirmatory factor analysis and hypothesis-testing was used. For 168 patients, predefinedhypotheses were formulated on the correlation between the modified painDETECT and several otherquestionnaires, and in a subsample of 46 with pain pressure thresholds (PPTs).Results: Two principal components were confirmed. The pain pattern item did not load on any component.Eighty per cent of the hypotheses on the correlation between modified PDQ and the questionnaireswere met, as were 50% concerning PPTs measurements.Conclusions: This study is the first to assess structural and construct validity of the modified PDQ knee/hip by using factor analysis and hypothesis-testing. This questionnaire seems to reflect neuropathic-like pain symptoms experienced by hip/knee OA-patients with adequate validity. The item on pain patternmight not reflect the construct. More than 75% of the predefined hypotheses regarding the modified PDQ and the other questionnaires were met. Only 50% of the hypotheses on PPTs measurements were met, probably due to heterogeneity and limited size of this subsample.
DOCUMENT
Hoe snel evolueert de markt en wat zien we daarvan nu terug in organisaties? Kunnen en willen organisaties in Nederland zich aanpassen aan snel veranderende omstandigheden: tempo van de markt, nieuwe technologieën en klantvraag? Is reality-pull alleen het nieuwe buzz-word of voorwaarde om te overleven? Gelden de bestaande ideeën over marktsegmentatie nog wel? In dit artikel presenteren we de resultaten van een onderzoek dat we hiernaar gedaan hebben.
DOCUMENT
BACKGROUND: Whether hip range of motion (ROM) is a risk factor for groin pain in athletes is not known.OBJECTIVES: To systematically review the relationship between hip ROM and groin pain in athletes in cross-sectional/case-control and prospective studies.STUDY DESIGN: Systematic review, prospectively registered (PROSPERO) according to PRISMA guidelines.METHODS: Pubmed, Embase, CINAHL and SPORTDiscus were systematically searched up to December 2015. Two authors performed study selection, data extraction/analysis, quality assessment (Critical Appraisal Skills Programme) and strength of evidence synthesis.RESULTS: We identified seven prospective and four case-control studies. The total quality score ranged from 29% to 92%. Heterogeneity in groin pain classification, injury definitions and physical assessment precluded data pooling. There was strong evidence that total rotation of both hips below 85° measured at the pre-season screening was a risk factor for groin pain development. Strong evidence suggested that internal rotation, abduction and extension were not associated with the risk or presence of groin pain.CONCLUSION: Total hip ROM is the factor most consistently related to groin pain in athletes. Screening for hip ROM is unlikely to correctly identify an athlete at risk of developing groin pain because of the small ROM differences found and poor ROM measurement properties.
DOCUMENT
The present study examined differences in visual search and locomotor behavior among a group of skilled 10–12 year-old football players. The participants watched video clips of a 4-to-4 position game, presented on a large screen. The participants were asked to take part in the game by choosing the best position for the reception of the ball passed by one of the players in the clip. Participants’ visual search and locomotor behavior were collected continuously throughout the presentation of the clip. A within-group comparison was made based upon the participants’ interception score, i.e., more at the correct position. The findings show that the high-score group looked more to the ball area, while the players in the low-score group concentrated on the receiving player and on the hips/upper-body region of the passing player. The players in the high-score group covered a significantly greater distance compared to the low-score group. It was concluded that differences in visual search and locomotion behavior can be used as indicators for identifying talented junior football players.
DOCUMENT
Individuals after anterior cruciate ligament reconstruction (ACLR) have a high rate of reinjury upon return to competitive sports. Deficits in motor control may influence reinjury risk and can be addressed during rehabilitation with motor learning strategies. When instructing patients in performing motor tasks after ACLR, an external focus of attention directed to the intended movement effect has been shown to be more effective in reducing reinjury risk than an internal focus of attention on body movements. While this concept is mostly agreed upon, recent literature has made it clear that the interpretation and implementation of an external focus of attention within ACLR rehabilitation needs to be better described. The purpose of this commentary is to provide a clinical framework for the application of attentional focus strategies and guide clinicians towards effectively utilizing an external focus of attention in rehabilitation after ACLR.
DOCUMENT
OBJECTIVE: The prevalence of osteoarthritis (OA) increases, but the impact of the disorder on peoples' functional capacity is not known. Therefore, the objective of this study was to compare self-reported health status and functional capacity of subjects with early OA of hip and/or knee to reference data of healthy working subjects and to assess whether this capacity is sufficient to meet physical job demands.METHODS: Self-reported health status and functional capacity of 93 subjects from the Cohort Hip and Cohort Knee (CHECK) were measured using the Short-Form 36 Health Survey and 6 tests of the Work Well Systems Functional Capacity Evaluation. Results were compared with reference data from 275 healthy workers, using t-tests. To compare the functional capacity with job demands, the proportions of subjects with OA performing lower than the p(5) of reference data were calculated.RESULTS: Compared to healthy workers, the subjects (mean age 56) from CHECK at baseline reported a significantly worse physical health status, whereas the women (n = 78) also reported a worse mental health status. On the FCE female OA subjects performed significantly lower than their healthy working counterparts on all 6 tests. Male OA subjects performed lower than male workers on 3 tests. A substantial proportion of women demonstrated functional capacities that could be considered insufficient to perform jobs with low physical demands.CONCLUSIONS: Functional capacity and self-reported health of subjects with early OA of the hips and knees were worse compared to healthy ageing workers. A substantial proportion of female subjects did not meet physical job demands.
DOCUMENT
Powerful Ageing is a power training intervention offered by Dutch municipalities to improve the physical functioning of its older residents, thereby reducing their reliance on assistive living devices and social support services. This study aimed to investigate the effects of Powerful Ageing on muscle power, physical performance, and physical functioning in older adults immediately following the intervention and at 1-year follow-up. The study design was a prospective longitudinal case series. Eligible older adults requesting social support services from their municipality participated in a 14-week power training intervention. Primary outcomes were categorized according to ICF health domains: within the function domain, muscle power was measured with a Power Squat Test and a Lifting Test; within the activities domain, physical performance was assessed using the Star Agility Run and Timed Up-and-Go Test; and within the participation domain, physical functioning was assessed using a patient-specific complaints questionnaire. Participant motivation, a secondary outcome, was assessed using a short questionnaire.
MULTIFILE
Background: Improved preferred gait speed in older adults is associated with increased survival rates. There are inconsistent findings in clinical trials regarding effects of exercise on preferred gait speed, and heterogeneity in interventions in the current reviews and meta-analyses. Objective: to determine the meta-effects of different types or combinations of exercise interventions from randomized controlled trials on improvement in preferred gait speed. Methods: Data sources: A literature search was performed; the following databases were searched for studies from 1990 up to 9 December 2013: PubMed, EMBASE, EBSCO (AMED, CINAHL, ERIC, Medline, PsycInfo, and SocINDEX), and the Cochrane Library. Study eligibility criteria: Randomized controlled trials of exercise interventions for older adults ≥ 65 years, that provided quantitative data (mean/SD) on preferred gait speed at baseline and post-intervention, as a primary or secondary outcome measure in the published article were included. Studies were excluded when the PEDro score was ≤4, or if participants were selected for a specific neurological or neurodegenerative disease, Chronic Obstructive Pulmonary Disease, cardiovascular disease, recent lower limb fractures, lower limb joint replacements, or severe cognitive impairments. The meta-effect is presented in Forest plots with 95 % confidence Study appraisal and synthesis methods: intervals and random weights assigned to each trial. Homogeneity and risk of publication bias were assessed. Results: Twenty-five studies were analysed in this meta-analysis. Data from six types or combinations of exercise interventions were pooled into sub-analyses. First, there is a significant positive meta-effect of resistance training progressed to 70-80 % of 1RM on preferred gait speed of 0.13 [CI 95 % 0.09-0.16] m/s. The difference between intervention- and control groups shows a substantial meaningful change (>0.1 m/s). Secondly, a significant positive meta-effect of interventions with a rhythmic component on preferred gait speed of 0.07 [CI 95 % 0.03-0.10] m/s was found. Thirdly, there is a small significant positive meta-effect of progressive resistance training, combined with balance-, and endurance training of 0.05 [CI 95 % 0.00-0.09] m/s. The other sub-analyses show non-significant small positive meta-affects. Conclusions: Progressive resistance training with high intensities, is the most effective exercise modality for improving preferred gait speed. Sufficient muscle strength seems an important condition for improving preferred gait speed. The addition of balance-, and/or endurance training does not contribute to the significant positive effects of progressive resistance training. A promising component is exercise with a rhythmic component. Keeping time to music or rhythm possibly trains higher cognitive functions that are important for gait. Limitations: The focus of the present meta-analysis was at avoiding as much heterogeneity in exercise interventions. However heterogeneity in the research populations could not be completely avoided, there are probably differences in health status within different studies.
DOCUMENT
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).
DOCUMENT
