Carolien H. G. Bastiaenen

A tailored exercise program versus general exercise for a subgroup of patients with low back pain and movement control impairment: A randomised controlled trial with one-year follow-up

BACKGROUND Exercise is an effective treatment for patients with sub-acute and chronic non-specific low back pain (NSLBP). Previous studies have shown that a subgroup of patients with NSLBP and movement control impairment (MCI) can be diagnosed with substantial reliability. However, which type of exercises are most beneficial to this subgroup is still unknown. OBJECTIVES The effectiveness of a specific exercise treatment to improve movement control was tested in this study. METHODS Using a multicentre randomised controlled trial (RCT), we compared exercises that targeted MCI (MC) with a general exercise (GE) treatment. After randomisation, patients in both groups n(MC = 52; GE = 54) were treated in eight private physiotherapy practices and five hospital outpatient physiotherapy centres. Follow-up measurements were taken at post-treatment, six months and 12 months. The primary outcome measurement was the Patient Specific Function Scale (PSFS). RESULTS PSFS showed no difference between groups after treatment, or at six months and 12 months. Secondary outcome analysis for pain and disability, measured with the Graded Chronic Pain scale and the Roland Morris Disability Questionnaire respectively, showed that a small improvement post-treatment levelled off over the long term. Both groups improved significantly (p < 0.001) over the course of one year. CONCLUSION This study found no additional benefit of specific exercises targeting MCI.

Assisting Hand Assessment and Children's Hand-use Experience Questionnaire – Observed Versus Perceived Bimanual Performance in Children with Unilateral Cerebral Palsy

ABSTRACT Aims: To explore the differences, relationship, and extent of agreement between the Assisting Hand Assessment (AHA), measuring observed ability to perform bimanual tasks, and the Childrens Hand-Use Experience Questionnaire (CHEQ), assessing experienced bimanual performance. Methods: This study investigates a convenience sample of 34 children (16 girls) with unilateral cerebral palsy aged 6–18 years (mean 12.1, SD 3.9) in a cross-sectional design. Results: The AHA and CHEQ subscales share 8–25% of their variance (R2). Bland–Altman plots for AHA and all three CHEQ subscales indicate good average agreement, with a mean difference approaching zero but large 95% confidence intervals. Limits of agreement were extremely wide, indicating considerable disagreement between AHA and CHEQ subscales. Conclusion: AHA and CHEQ seem to measure different though somewhat related constructs of bimanual performance. Results of this investigation reinforce the recommendation to use both instruments to obtain complementary information about bimanual performance including observed and perceived performance of children with unilateral cerebral palsy.

Reliability, agreement, and responsiveness of a 6-minute walk/run test in patients with heart disease

Background: The 6-minute walk test (6MWT) is widely used to assess exercise tolerance in cardiac rehabilitation (CR). However, previous research shows it to be insufficiently responsive, especially for patients with a relatively high maximal exercise tolerance at baseline. We therefore designed a 6-minute walk/run test (6MWRT), which has the same duration as the 6MWT but allows running. The objective of this study was to determine the test–retest reproducibility and responsiveness of this 6MWRT. Design: Responsiveness was investigated in a prospective cohort study among a group of patients entering CR at Maastricht University Medical Center, with a cross-sectional part to assess the test–retest reproducibility. Methods: Test–retest reproducibility (reliability and agreement) was investigated using the intraclass correlation (ICC) and a Bland–Altman plot of two measurements implemented in the first week of rehabilitation. Responsiveness of the 6MWT and the 6MWRT was calculated using the standard response mean (SRM) over a 6-week period. Results: The first reproducibility analysis included 34 patients, the second 22 patients. The ICCs were 0.935 and 0.906, respectively, with limits of agreement of ±79 and ±61 m. The responsiveness analysis included 27 patients. The SRM values were 0.83 for the 6MWT and 0.71 for the 6MWRT. Conclusions: Although the 6MWRT is a reproducible test in CR, its responsiveness is not superior to that of the 6MWT. We therefore prefer the conventional 6MWT as an evaluative measurement in CR and advise against using the 6MWRT as (evaluative) measurement in CR for this purpose.

To Explore the Validity of Change Scores of the Children's Hand-use Experience Questionnaire (CHEQ) in Children with Unilateral Cerebral Palsy

ABSTRACT Aims: To explore the validity of change scores of the Childrens Hand-use Experience Questionnaire (CHEQ). Methods: Analysis of the CHEQ included 44 children (15 girls) between 6–16 years (median 9.0; IQR 8–11) with unilateral cerebral palsy, with baseline and post- (two-week intensive) intervention assessments using the Goal Attainment Scale (GAS) as external anchor for change. Hypotheses on the magnitude of expected change were formulated and correlation coefficients and effect sizes calculated. Receiver operating curve analysis was performed and the area under the curve (AUC) calculated to investigate the ability of CHEQ to discriminate between improvement and non-improvement according to GAS. Results: All hypotheses about the magnitude of change were confirmed supporting longitudinal validity of CHEQ scales to measure change in the perception of bimanual performance. AUCs for the Grasp efficacy and the Time utilization were slightly below, and for the Feeling bothered slightly above the threshold. The latter one accurately discriminating between children that improved and did not improve according to the GAS. Conclusions: Evidence was found that CHEQ scales capture change in bimanual performance but with limited accuracy for two out of three scales. The validity of CHEQ change scores needs to be further explored in a wider population.

Onderzoek naar graded exposure voor jongeren

Wetenschappelijk onderzoek naar verschillende nieuwe revalidatiebehandelingen kan helpen bij het verbeteren van revalidatiezorg. Door onderzoek neemt onze kennis van multidisciplinaire behandelstrategieen toe en kan patienten steeds meer evidence-based zorg worden aangeboden. Wetenschappelijk onderzoek maakt het mogelijk antwoord te geven op verschillende wetenschappelijke vragen. In dit hoofdstuk wordt beschreven hoe onderzoek naar de effectiviteit van een (nieuwe) revalidatiebehandeling er in de praktijk uit kan zien. Het onderzoek 2B Active naar graded-exposurebehandeling bij jongeren met chronische pijn wordt hierbij als voorbeeld gebruikt.

The Dutch version of the self-report Child Activity and Limitations Interview in adolescents with chronic pain

Abstract Purpose: To assess the factor structure, related constructs and internal consistency of the Child Activity Limitation Interview 21-Child version for use in Dutch-language countries. Methods: Cross-sectional validation study: After forward and back translation of the Dutch version of the Child Activity Limitation Interview 21-Child adolescents (11–21 years old) with chronic musculoskeletal pain completed an assessment. The assessment contained the Dutch Child Activity Limitation Interview, and questionnaires about demographics, pain intensity, functional disability, anxiety and depression. Internal consistency and construct validity were evaluated through exploratory factor analysis (principal axis factoring with oblique rotation) and hypotheses testing using pain intensity, activity limitations, anxiety and depression as comparative constructs. Results: Seventy-four adolescents completed the assessment. Exploratory factor analysis resulted in a two-factor structure, explaining 50% of the variance. Internal consistency was good (Cronbach’s α = 0.91 total scale, α = 0.90 Factor 1, α = 0.80 Factor 2). All nine hypotheses were confirmed. Conclusion: The Dutch version can be used to assess pain-related disability in Dutch-speaking adolescents comparable to the study sample. Scores on both subscales provide insight into the severity of the pain-related disability in both daily routine and more physically vigorous activities. Implications for Rehabilitation Chronic pain is a disabling disorder which not only impacts physically but restricts quality of life. This study provides clinicians a questionnaire to measure pain-related disability and quantify the impact of pain on the daily living of adolescents. The advantage of the Dutch version of the Child Activity and Limitations Interview over other measurements is that it can distinguish limitations in daily activities from more physically vigorous activities.