Ilse Stuive

Cognitive Treatment of Illness Perceptions in Patients With Chronic Low Back Pain: A Randomized Controlled Trial

Background Illness perceptions have been shown to predict patient activities. Therefore, studies of the effectiveness of a targeted illness-perception intervention on chronic nonspecific low back pain (CLBP) are needed. Objective The purpose of this study was to compare the effectiveness of treatment of illness perceptions against a waiting list for patients with CLBP. Design This was a prospectively registered randomized controlled trial with an assessor blinded for group allocation. Setting The study was conducted in an outpatient rehabilitation clinic. Participants The participants were 156 patients (18–70 years of age) with CLBP (>3 months). Intervention Patients were randomly assigned to either a treatment group or to a waiting list (control) group. Trained physical therapists and occupational therapists delivered 10 to 14 one-hour treatment sessions according to the treatment protocol. Measurements The primary outcome measure was change in patient-relevant physical activities (Patient-Specific Complaints questionnaire). The secondary outcome measures were changes in illness perceptions (Illness Perceptions Questionnaire) and generic physical activity level (Quebec Back Pain Disability Scale). Measurements were taken at baseline (0 weeks) and after treatment (18 weeks). Results A baseline-adjusted analysis of covariance showed that there were statistically significant differences between intervention and control groups at 18 weeks for the change in patient-relevant physical activities. This was a clinically relevant change (19.1 mm) for the intervention group. Statistically significant differences were found for the majority of illness perception scales. There were no significant differences in generic physical activity levels. Limitations Longer-term effectiveness was not studied. Conclusions This first trial evaluating cognitive treatment of illness perceptions concerning CLBP showed statistically significant and clinically relevant improvements in patient-relevant physical activities at 18 weeks.

The Empirical Verification of an Assignment of Items to Subtests: The Oblique Multiple Group Method Versus the Confirmatory Common Factor Method

This study compares two confirmatory factor analysis methods on their ability to verify whether correct assignments of items to subtests are supported by the data. The confirmatory common factor (CCF) method is used most often and defines nonzero loadings so that they correspond to the assignment of items to subtests. Another method is the oblique multiple group (OMG) method, which defines subtests as unweighted sums of the scores on all items assigned to the subtest, and (corrected) correlations are used to verify the assignment. A simulation study compares both methods, accounting for the influence of model error and the amount of unique variance. The CCF and OMG methods show similar behavior with relatively small amounts of unique variance and low interfactor correlations. However, at high amounts of unique variance and high interfactor correlations, the CCF detected correct assignments more often, whereas the OMG was better at detecting incorrect assignments.

Comparison of Methods for Adjusting Incorrect Assignments of Items to Subtests Oblique Multiple Group Method Versus Confirmatory Common Factor Method

A common question in test evaluation is whether an a priori assignment of items to subtests is supported by empirical data. If the analysis results indicate the assignment of items to subtests under study is not supported by data, the assignment is often adjusted. In this study the authors compare two methods on the quality of their suggestions to adjust incorrect assignments of items to subtests. The confirmatory common factor (CCF) method is often used in practice. However, previous research reported rather poor quality of the suggested adjustments. Therefore, the CCF method is compared with a less often used but promising method, the oblique multiple group (OMG) method. The authors compared both methods with a simulation study taken under various conditions. For each method, several adjustment procedures were studied. The best adjustment procedure within the OMG method performed better than or highly comparable to the procedures within the CCF method.

Health-Related Physical Fitness in Dutch Children With Developmental Coordination Disorder

Objective: To compare components of health-related physical fitness between Dutch children with clinically diagnosed developmental coordination disorder (DCD) and typically developing children (TDC), and to examine associations between motor performance problems and components of health-related fitness in children with DCD. Methods: A multicenter case-control study was used to compare health-related physical fitness in children with DCD (N = 38; age, 7–12 years; 10 girls and 28 boys) with that in age- and gender-matched TDC. Motor coordination problems (manual dexterity, ball and balance skills) were assessed using the Movement Assessment Battery for Children. Health-related physical fitness was indicated by (1) cardiorespiratory fitness, (2) muscle strength, and (3) body mass index. Results: Significantly lower values of cardiorespiratory fitness (6.7% lower maximal cardiorespiratory fitness) were found in children with DCD compared with TDC. Extension and flexion of the elbow and flexion of the knee were also significantly lower (by 15.3%, 16.7%, and 18.4%, respectively) in DCD children compared with TDC. A significant negative and large association was found between cardiorespiratory fitness and balance performance. Conclusion: Lower cardiorespiratory fitness and muscle strength in children with clinically diagnosed DCD compared with TDC support the importance of examining and training cardiorespiratory fitness and muscle strength, besides the regular attention for motor coordination problems.

Adherence to a Maintenance Exercise Program 1 Year After Pulmonary Rehabilitation WHAT ARE THE PREDICTORS OF DROPOUT

PURPOSE: To evaluate adherence to a maintenance exercise program in patients with chronic obstructive pulmonary disease (COPD) and explore predictors for adherence. METHODS: Seventy patients with COPD were referred to a home-care maintenance exercise program after completing pulmonary rehabilitation (PR) in the rehabilitation center. Adherence (yes/no) to the maintenance program was assessed by a self-reported questionnaire, where adherence was defined as attending the maintenance program 1 year after PR. Early dropouts received a self-reported questionnaire after 6 months and the remaining patients after 12 months. Lung function, exercise capacity, exercise self-efficacy, illness perceptions, health-related quality of life, levels of anxiety and depression, duration of PR, and the number of exacerbations were studied as possible predictors of adherence. RESULTS: Ten patients died or were lost to followup. Of the remaining 60 patients, 73.3% and 63.3% were adherent to the maintenance exercise program after 6 and 12 months, respectively. Forced expiratory volume in 1 second (FEV1) (P = .021), Hospital Anxiety and Depression Scale depression score (P = .025), and duration of PR (P = .018) were significant predictors of adherence to the maintenance program. CONCLUSION: Adherence to the maintenance exercise program included a 36.7% drop-out rate during the first year after completing PR. Experiencing exacerbations was the most reported reason for dropout. Poorer lung function, shorter initial PR course measured by reviewing patient records, and higher level of depressive symptoms were predictive of drop-out to the maintenance program. Adherence to the maintenance program needs to be improved for patients with lower FEV1, with signs of depression, or with a shorter initial PR course.

Arm Motor Control as Predictor for Hypertonia After Stroke: A Prospective Cohort Study

OBJECTIVES To analyze the development of hypertonia in the hemiparetic elbow flexors, and to explore the predictive value of arm motor control on hypertonia in a cohort of first-ever stroke survivors in the first 6 months poststroke. DESIGN A prospective cohort study. SETTING A cohort of stroke survivors from a large, university-affilliated hospital in The Netherlands. PARTICIPANTS Patients (N=50) with first-time ischemic strokes and initial arm paralysis who were admitted to a stroke unit. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES At 48 hours, 10 to 12 days, 3 and 6 months poststroke, hypertonia and arm motor control were assessed using the Modified Ashworth Scale and the Fugl-Meyer Assessment arm score. RESULTS The incidence rate of hypertonia reached its maximum before the third month poststroke (30%). Prevalence was 42% at 3 and 6 months. Participants with poor arm motor control at 48 hours poststroke were 13 times more likely to develop hypertonia in the first 6 months poststroke than those with moderate to good arm motor control. These results were not confounded by the amount of arm function training received. CONCLUSIONS Hypertonia develops in a large proportion of patients with stroke, predominantly within the first 3 months poststroke. Poor arm motor control is a risk factor for the development of hypertonia.

Recovery of mouth-opening after closed treatment of a fracture of the mandibular condyle: a longitudinal study.

The aim of this retrospective study was to assess recovery of mouth opening after closed treatment of fractures of the mandibular condyle, and analyse which characteristics might influence recovery. We measured mouth opening in 142 patients (mean (SD) age 30 (14) years, 96 of whom were male) during follow-up at 3, 6, 13, 26, and 52 weeks after the injury. Fractures were assessed on radiographs. Data were analysed using a multilevel analysis. Half the fractures were of the low condylar neck (n=71). Thirty-seven patients had bilateral condylar fractures, 29 had dislocated fractures, and in 80 the fracture was displaced. One or more additional mandibular fractures were present in 68. During follow-up mean (SD) mouth opening increased to: 33.6 (9.6) at 3 weeks, 40.1 (10.0) at 6 weeks, 45.1 (9.6) at 13 weeks, 49.8 (9.5) at 26 weeks, and 52.6 (7.5) at 52 weeks. Older age, female sex, displaced fracture, bilateral fractures, additional mandibular fractures, and the interaction between follow-up time and additional mandibular fractures, were predictors of a less favourable recovery of mouth opening. Clinicians can use the results of this study to predict recovery of mouth opening after closed treatment of fractures of the mandibular condyle at first consultation.

Relationship Between Participation in Leisure Time Physical Activities and Aerobic Fitness in Children With DCD

Purpose: (1) To explore participation in leisure time physical activities (LTPAs) in children with developmental coordination disorder (DCD) compared with children developing typically. (2) To examine the association between participation in LTPA and aerobic fitness. Methods: Thirty-eight children with DCD (aged 7–12 years) were age and gender matched with 38 children developing typically. Participation in LTPA was self-administered by using an activity questionnaire, and aerobic fitness was estimated using a Shuttle Run Test. Results: Children with DCD spent significantly less time in overall, nonorganized, and vigorous LTPA compared with children developing typically. Aerobic fitness was significantly lower for children with DCD. The best model, including age, group, and overall LTPA, explained 46.2% of the variance in aerobic fitness. Conclusions: Suitable physical activities should be fostered in children with DCD, who have a low participation rate and aerobic fitness level.

Perceived athletic competence and physical activity in children with developmental coordination disorder who are clinically referred, and control children

The relationship between perceived athletic competence (PAC) and physical activity (PA) in children with developmental coordination disorder (DCD) is still unclear. This study investigated differences in PAC and PA between, and within, a group of children with DCD that were clinically referred (n = 31) and a group of control children (n = 38), aged 7-12 years. All children were categorized in four groups: (1) children with DCD/low PAC, (2) children with DCD/normal to high PAC, (3) control children/low PAC, and (4) control children/normal to high PAC. PAC was assessed with the Self-Perception Profile for Children, and PA was assessed with the Modifiable Activity Questionnaire. Children with DCD participated less in unorganized PA, but not in organized PA, compared with control children. Normal to high PAC was found in more than half of the children (64.5%) with DCD. Children with DCD/low PAC and children with DCD/normal to high PAC participated significantly less in unorganized physical activity compared with control children/normal to high PAC, but not compared with control children/low PAC. The results indicate that there are large individual differences in PAC in children with DCD.

Best candidates for cognitive treatment of illness perceptions in chronic low back pain: results of a theory-driven predictor study.

OBJECTIVE The aim of this study was to identify treatment-specific predictors of the effectiveness of a method of evidence-based treatment: cognitive treatment of illness perceptions. This study focuses on what treatment works for whom, whereas most prognostic studies focusing on chronic non-specific low back pain rehabilitation aim to reduce the heterogeneity of the population of patients who are suitable for rehabilitation treatment in general. DESIGN Three treatment-specific predictors were studied in patients with chronic non-specific low back pain receiving cognitive treatment of illness perceptions: a rational approach to problem-solving, discussion skills and verbal skills. Hierarchical linear regression analysis was used to assess their predictive value. Short-term changes in physical activity, measured with the Patient-Specific Functioning List, were the outcome measure for cognitive treatment of illness perceptions effect. RESULTS A total of 156 patients with chronic non-specific low back pain participated in the study. Rational problem-solving was found to be a significant predictor for the change in physical activity. Discussion skills and verbal skills were non-significant. Rational problem-solving explained 3.9% of the total variance. CONCLUSION The rational problem-solving scale results are encouraging, because chronic non-specific low back pain problems are complex by nature and can be influenced by a variety of factors. A minimum score of 44 points on the rational problem-solving scale may assist clinicians in selecting the most appropriate candidates for cognitive treatment of illness perceptions.