Objectives: To determine the psychometric properties of a questionnaire to assess fear of movement (kinesiophobia): the Tampa Scale for Kinesiophobia (TSK-NL Heart), and to investigate the prevalence of kinesiophobia in patients attending cardiac rehabilitation.Methods: A total of 152 patients were evaluated with the TSK-NL Heart during intake and 7 days later. Internal consistency, test-retest reliability and construct validity were assessed. For construct validity, the Cardiac Anxiety Questionnaire (CAQ) and the Hospital Anxiety and Depression Scale (HADS) were used. The factor structure of the TSK-NL Heart was determined by a principal component analysis (PCA).Results: After removal of 4 items due to low internal consistency, the TSK-NL Heart showed substantial reliability (intraclass correlation coefficient; ICC: 0.80). A strong positive correlation was found between the TSK-NL Heart and the CAQ (rs: 0.61). Strong positive correlations were found between the TSK-NL Heart and de HADS (Anxiety) (rs: 0.60) and between the TSK-NL Heart and the CAQ (rs: 0.61). The PCA revealed a 3-factor structure as most suitable (fear of injury, avoidance of physical activity, perception of risk). High levels of kinesiophobia were found in 45.4% of patients.Conclusion: The 13-item TSK-NL Heart has good psychometric properties, and we recommend using this version to assess kinesiophobia, which is present in a substantial proportion of patients referred for cardiac rehabilitation.Keywords: Tampa Scale for Kinesiophobia; cardiac rehabilitation; exercise; fear of movement; physical activity; cardiovascular disease
Background. The Treatment Beliefs Questionnaire has been developed to measure patients’ beliefs of necessity of and concerns about rehabilitation. Preliminary evidence suggests that these beliefs may be associated with attendance of rehabilitation. The aim of this study was to translate and adapt the Treatment Beliefs Questionnaire for interdisciplinary pain rehabilitation and to examine the measurement properties of the Dutch translation including the predictive validity for dropout. Methods. The questionnaire was translated in 4 steps: forward translation from English into Dutch, achieving consensus, back translation into English, and pretesting on providers and patients. In order to establish structural validity, internal consistency, construct validity, and predictive validity of the questionnaire, 188 participants referred to a rehabilitation centre for outpatient interdisciplinary pain rehabilitation completed the questionnaire at the baseline. Dropout was measured as the number of patients starting, but not completing the programme. For reproducibility, 51 participants were recruited at another rehabilitation centre to complete the questionnaire at the baseline and one week later. Results. We confirmed the structural validity of the Treatment beliefs Questionnaire in the Dutch translation with three subscales, necessity, concerns, and perceived barriers. internal consistency was acceptable with ordinal alphas ranging from 0.66–0.87. Reproducibility was acceptable with ICC2,1 agreement ranging from 0.67–0.81. Hypotheses testing confirmed construct validity, similar to the original questionnaire. Predictive validity showed the questionnaire was unable to predict dropouts. Conclusion. Cross-cultural translation was successfully completed, and the Dutch Treatment Beliefs Questionnaire demonstrates similar psychometric properties as the original English version.
AbstractObjective: Many older individuals receive rehabilitation in an out-of-hospital setting (OOHS) after acute hospitalization; however, its effect onmobility and unplanned hospital readmission is unclear. Therefore, a systematic review and meta-analysis were conducted on this topic.Data Sources: Medline OVID, Embase OVID, and CINAHL were searched from their inception until February 22, 2018.Study Selection: OOHS (ie, skilled nursing facilities, outpatient clinics, or community-based at home) randomized trials studying the effect ofmultidisciplinary rehabilitation were selected, including those assessing exercise in older patients (mean age 65y) after discharge from hospitalafter an acute illness.Data Extraction: Two reviewers independently selected the studies, performed independent data extraction, and assessed the risk of bias.Outcomes were pooled using fixed- or random-effect models as appropriate. The main outcomes were mobility at and unplanned hospitalreadmission within 3 months of discharge.Data Synthesis: A total of 15 studies (1255 patients) were included in the systematic review and 12 were included in the meta-analysis (7assessing mobility using the 6-minute walk distance [6MWD] test and 7 assessing unplanned hospital readmission). Based on the 6MWD, patientsreceiving rehabilitation walked an average of 23 m more than controls (95% confidence interval [CI]Z: 1.34 to 48.32; I2: 51%). Rehabilitationdid not lower the 3-month risk of unplanned hospital readmission (risk ratio: 0.93; 95% CI: 0.73-1.19; I2: 34%). The risk of bias was present,mainly due to the nonblinded outcome assessment in 3 studies, and 7 studies scored this unclearly.Conclusion: OOHS-based multidisciplinary rehabilitation leads to improved mobility in older patients 3 months after they are discharged fromhospital following an acute illness and is not associated with a lower risk of unplanned hospital readmission within 3 months of discharge.However, the wide 95% CIs indicate that the evidence is not robust.
Longaandoeningen, zoals COPD, veroorzaken problemen in het dagelijks functioneren door een afgenomen uithoudingsvermogen, benauwdheid en (bewegings-) angst. Tijdens longrevalidatie vormen inspanningstraining en het leren omgaan met dagelijkse fysieke beperkingen (zoals benauwdheid bij inspanning) de hoeksteen van de behandeling. Het is voor patiënten moeilijk om een actieve leefstijl te behouden. Na deelname aan revalidatie gaan trainingseffecten verloren door een verminderd aanbod van trainingsprikkels (reversibiliteit). Daarnaast wordt, een jaar na de revalidatie, maar liefst 20% van de patiënten opnieuw opgenomen in het ziekenhuis met een longaanval (exacerbatie). Door de verschuiving van (dure) derdelijns naar eerstelijns zorg, hebben meer patiënten toegang tot de zorg die ze nodig hebben. Hierdoor kan verergering van klachten voorkomen worden. Naast fysieke inspanning is het voor oefen- en fysiotherapeuten belangrijk om patiënten een duurzame actieve leefstijl aan te leren en het zelfmanagement van patiënten te vergroten. Een blended beweeginterventie, om het zelfmanagement (omtrent beweging, benauwdheid en beweginsgangst) van COPD patiënten te stimuleren, zowel in de praktijk als in de thuissituatie middels een eHealth toepassing, biedt mogelijk uitkomst. Echter, missen therapeuten kennis en handvatten om blended care toe te passen in de praktijk. Het doel van dit project is om samen met fysiotherapeuten en oefentherapeuten een blended care programma in te richten voor patiënten met COPD. In werkpakket 1 inventariseren we de behoeften en belemmerende factoren van een blended beweeginterventie bij therapeuten en patiënten. Op basis van deze bevindingen worden de belangrijkste elementen van de interventie geselecteerd en wordt, in co-creatie met eindgebruikers de eerste versie van de interventie ontwikkeld (WP2). Om te bepalen wat de toegevoegde waarde van de interventie is, worden de voorlopige effectiviteit en haalbaarheid onderzocht waarbij 25 eerstelijns therapeuten de blended interventie gaan gebruiken (WP3). In WP4 worden scholingsmodules ontwikkeld voor studenten en therapeuten om kennis over zelfmanagement en technologie bij COPD te vergroten.
