I.G.L. van de Port

Is Fatigue an Independent Factor Associated with Activities of Daily Living, Instrumental Activities of Daily Living and Health-Related Quality of Life in Chronic Stroke?

Background: To determine the longitudinal association of poststroke fatigue with activities of daily living (ADL), instrumental ADL (IADL) and perceived health-related quality of life (HRQoL) and to establish whether this relationship is confounded by other determinants. Methods: A prospective cohort study of stroke patients consecutively admitted for inpatient rehabilitation was conducted. ADL, IADL and HRQoL were assessed in 223 patients at 6, 12 and 36 months after stroke. Fatigue was determined by the Fatigue Severity Scale. Random coefficient analysis was used to analyze the impact of fatigue on ADL, IADL and HRQoL. The association between fatigue and outcome was corrected for potential confounders, i.e. age, gender, comorbidity, executive function, severity of paresis and depression. The covariate was considered to be a confounder if the regression coefficient of fatigue on outcome changed by >15%. Results: Fatigue was significantly related to IADL and HRQoL but not to ADL. The relation between fatigue and IADL was confounded by depression and motor impairment. Depression biased the relation between fatigue and HRQoL, but fatigue remained independently related to HRQoL. Conclusions: Fatigue is longitudinally spuriously associated with IADL and independently with HRQoL. These findings suggest that in examining the impact of poststroke fatigue on outcome, one should control for confounders such as depression.

Comparing contents of functional outcome measures in stroke rehabilitation using the International Classification of Functioning, Disability and Health

Purpose. To examine the content of outcome measures that are frequently used in stroke rehabilitation and focus on activities and participation, by linking them to the International Classification of Functioning, Disability and Health (ICF). Method. Constructs of the following instruments were linked to the ICF: Barthel Index, Berg Balance Scale, Chedoke McMaster Stroke Assessment Scale, Euroqol-5D, Functional Independence Measure, Frenchay Activities Index, Nottingham Health Profile, Rankin Scale, Rivermead Motor Assessment, Rivermead Mobility Index, Stroke Adapted Sickness Impact Profile 30, Medical Outcomes Study Short Form 36, Stroke Impact Scale, Stroke Specific Quality of Life Scale and Timed Up and Go test. Results. It proved possible to link most constructs to the ICF. Most constructs fitted into the activities and participation component, with mobility being the category most frequently covered in the instruments. Although instruments were selected on the basis of their focus on activities and participation, 27% of the constructs addressed categories of body functions. Approximately 10% of the constructs could not be linked. Conclusions. The ICF is a useful tool to examine and compare contents of instruments in stroke rehabilitation. This content comparison should enable clinicians and researchers to choose the measure that best matches the area of their interest.

PREDICTING MOBILITY OUTCOME ONE YEAR AFTER STROKE: A PROSPECTIVE COHORT STUDY

OBJECTIVE To develop a prognostic model to predict mobility outcome one year post-stroke. DESIGN Prospective cohort study in patients with a first-ever stroke admitted for inpatient rehabilitation. PATIENTS A total of 217 patients with stroke (mean age 58 years) following inpatient rehabilitation in 4 rehabilitation centres across the Netherlands. METHODS Mobility was measured using the Rivermead Mobility Index at one year poststroke. Included independent variables were: patient and stroke characteristics, functional status, urinary incontinence, sitting balance, motor and cognitive function. Univariate and multivariate linear regression analyses were performed in a model-developing set (n=174) and the model was validated in cross-validation set (n=43). RESULTS Total Rivermead Mobility Index score at one year post-stroke was predicted by functional status, sitting balance, time between stroke onset and measurement, and age. The derived model predicted 48% of the variance, while validation in the cross-validation set resulted in an adjusted R(2) of 0.47. CONCLUSION The present prospective study shows that outcome of mobility one year after stroke can be predicted validly by including functional status, sitting balance, moment of admission to the rehabilitation centre after stroke onset and age.

Risk Factors for Hamstring Injuries in Male Soccer Players: A Systematic Review of Prospective Studies

Hamstring injuries are common injuries in soccer players. In view of the high incidence and the serious consequences, identifying risk factors related to hamstring injuries is essential. The aim of this systematic review was therefore to identify risk factors for hamstring injuries in male adult soccer players. PubMed, Embase/Medline, Cumulative Index to Nursing and Allied Health Literature, and SPORTDiscus were systematically searched, and prospective studies investigating risk factors for hamstring injuries in adult male soccer players were included. The methodological quality of the included articles was assessed using a standardized set of predefined criteria. Seven of the 11 studies identified, involving a total of 1775 players and 344 hamstring injuries, met the inclusion criteria. All but one of the included studies met at least five of nine methodological criteria, causing them to be qualified as ‘high quality’. The included studies used univariate as well as multivariate analyses to identify risk factors for hamstring injury. The results from the multivariate analyses suggest that previous hamstring injury is most strongly related to hamstring injury. Conflicting evidence is found for age and hamstring length or flexibility as risk factors for the occurrence of hamstring injuries.

Manual or exercise therapy for long-standing adductor-related groin pain: a randomised controlled clinical trial.

HYPOTHESIS A multi-modal treatment program (MMT) is more effective than exercise therapy (ET) for the treatment of long-standing adductor-related groin pain. STUDY DESIGN Single blinded, prospective, randomised controlled trial. METHODS PATIENTS Athletes with pain at the proximal insertion of the adductor muscles on palpation and resisted adduction for at least two months. INTERVENTIONS ET: a home-based ET and a structured return to running program with instruction on three occasions from a sports physical therapist. MMT: Heat, Van den Akker manual therapy followed by stretching and a return to running program. PRIMARY OUTCOME time to return to full sports participation. SECONDARY OUTCOME MEASURES objective outcome score and the visual analogue pain score during sports activities. Outcome was assessed at 0, 6, 16 and 24 weeks. RESULTS Athletes who received MMT returned to sports quicker (12.8 weeks, SD 6.0) than athletes in the ET group (17.3 weeks, SD 4.4. p = 0.043). Only 50-55% of athletes in both groups made a full return to sports. There was no difference between the groups in objective outcome (p = 0.72) or VAS during sports (p = 0.12). CONCLUSIONS The multi-modal program resulted in a significantly quicker return to sports than ET plus return to running but neither treatment was very effective.

Differences in injury risk and characteristics between Dutch amateur and professional soccer players

OBJECTIVES To compare the incidence and characteristics of injuries between Dutch amateur and professional male soccer players during one entire competition season. DESIGN A prospective two-cohort design. METHODS During the 2009-2010 season, 456 Dutch male amateur soccer players and 217 professional players were prospectively followed. Information on injuries and individual exposure to all soccer activities were recorded in both cohorts. Injuries were recorded using the time-loss definition. RESULTS In total, 424 injuries were recorded among 274 of the amateur players (60.1% injured players) and 286 injuries were sustained by 136 (62.7% injured players) of the professional players (p=0.52). Compared to the professionals, the injury incidence during training sessions was higher among amateurs (p=0.01), but the injury incidence among professionals was higher during matches (p<0.001). Professional players also had a higher incidence of minimal injuries (p<0.001), whereas the incidence of moderate and severe injuries was higher for amateurs (all p<0.001). Lastly, professional players sustained more overuse injuries (p=0.02), whereas amateurs reported more recurrent injuries (p<0.001). CONCLUSIONS The above-mentioned differences in injury rates between amateur and professional players in the Netherlands might be explained by the difference in the level at which they play, since factors like the availability of medical support and/or the team size may influence the injury risk and characteristics.

Identification of risk factors related to perceived unmet demands in patients with chronic stroke

Purpose. To investigate the prevalence of unmet demands concerning autonomy and participation and to identify risk factors related to these unmet demands in patients with chronic stroke. Method. A cross-sectional study of 147 patients three years after stroke. We assessed perceived unmet care demands in relation to problems of participation and autonomy measured by the Impact on Participation and Autonomy Questionnaire (IPAQ). Socio-demographic and health characteristics were analysed as potential risk factors for the prevalence of unmet demands, using multivariate regression analysis. Results. A total of 33% of the patients perceived at least one unmet demand in one of the IPAQ subdomains. Risk factors significantly related to the presence of unmet demands were younger age, motor impairment, fatigue and depressive symptoms. Findings indicate that the model including these factors was fairly accurate in identifying patients having unmet demands and those not having unmet demands. Conclusions. Unmet care demands were present in a substantial proportion of the stroke patients. The risk factors identified are helpful for clinicians and health care providers to recognize patients who are at risk of perceiving unmet care demands and to optimize care to patients with chronic stroke.

Ankle injuries in the Netherlands: Trends over 10–25 years

Ankle injuries are a common health problem; data on ankle injury rates and time trends in the population at large are scarce. Our aim was to investigate the incidence of and time trends in population‐based and emergency department‐treated ankle injuries related to sports activities and other activities related to daily living. Data were obtained from one national survey on accidents and injuries (2000–2010) and one based on emergency department data (1986–2010). Linear regression was used to determine linear trends in ankle injuries per 1000 person‐years. The number of ankle injuries related to sports activities and other activities of daily living increased from 19.0 to 26.6 per 1000 person‐years (P = 0.002). The number of sports‐related ankle injuries treated in emergency departments decreased from 4.2 to 1.5 per 1000 person‐years (P < 0.001), and from 3.2 to 2.1 per 1000 person‐years (P < 0.001) for other activities of daily living. According to our data, the incidence rates of all ankle injuries are around 5.5 times higher than those registered at emergency departments. The high incidence rates of ankle injuries highlight the need for proper ankle injury treatment and prevention.

Cost-effectiveness of an injury prevention program in dutch male amateur soccer

Background Approximately 16% of all sports injuries in the Netherlands are the result of playing outdoor soccer. Objective The aim of this intervention study is to investigate the cost-effectiveness of an injury prevention program (‘The11’ from FIFA) in male amateur soccer players. The hypothesis is that the ‘The11’ exercises have a beneficial effect on injury incidence, injury severity, medical costs and/or absenteeism. Design The study is a two-armed cluster randomised controlled trial. Randomisation has taken place on a cluster level: the regional competitions. Setting First class amateur teams, in two separated districts in the Netherlands, participate in this study. All participating teams have practice sessions 2–3 times a week. Participants Male players aged 18–40 years were eligible for inclusion in the study. 22 teams participated in this study, resulting in 460 players performing an intake at the start of the intervention season (intervention group 214 players, control group 246 players). Intervention The teams in the intervention group were instructed to perform ‘The11’, during each practice session throughout the 2009–2010 season (September–June). All teams of the control group were asked to continue their practice sessions as usual. Main outcome measurements The primary outcomes of the study include injury incidence, healthcare use and absenteeism. These outcomes were registered online during the competitive season 2009–2010. Results Preliminary results show that the proportion of injured players was almost equal for both groups (58.9% vs 57.7%). The injury risk for both research groups was the same (0.92). The sports absenteeism was on average 1 day longer in the intervention group (30.3 vs 29.3 days). Conclusions First impression is that there are no significant differences between the two research groups. However, more extensive results of this study, particularly focused on possible confounders and cost-effectiveness, are expected in January 2011 and can be presented in Monaco.