Marten Munneke

Evidence-based analysis of physical therapy in Parkinson's disease with recommendations for practice and research†

Physical therapy is often prescribed in Parkinsons disease. To facilitate the uniformity and efficacy of this intervention, we analyzed current evidence and developed practice recommendations. We carried out an evidence‐based literature review. The results were supplemented with clinical expertise and patient values and translated into practice recommendations, developed according to international standards for guideline development. A systematic literature search yielded 6 systematic reviews and 23 randomized controlled trials of moderate methodological quality with sufficient data. Six specific core areas for physical therapy were identified: transfers, posture, reaching and grasping, balance, gait, and physical capacity. We extracted four specific treatment recommendations that were based on evidence from more than two controlled trials: cueing strategies to improve gait; cognitive movement strategies to improve transfers; exercises to improve balance; and training of joint mobility and muscle power to improve physical capacity. These practice recommendations provide a basis for current physical therapy in Parkinsons disease in everyday clinical practice, as well as for future research in this field.

Continued disability and pain after lumbar disc surgery: the role of cognitive-behavioral factors.

Abstract Cognitive‐behavioral factors are considered important in the development of chronic disability and pain in patients with low back pain. In a prospective cohort study of 277 patients undergoing surgery for lumbosacral radicular syndrome, the predictive value of preoperatively measured cognitive‐behavioral factors (fear of movement/(re)injury, passive pain coping, and negative outcome expectancies) for disability and pain intensity at 6 weeks and 6 months after surgery was investigated, taking into account the effect of possible confounding variables. Higher levels of cognitive‐behavioral factors were found to be associated with a worse outcome at both 6 weeks and 6 months. These associations remained significant after controlling for possible confounding variables (preoperative disability and pain intensity, age, gender, educational level, duration of complaints, neurological deficits, and intake of analgesics) and pain intensity 3 days postoperatively. In multiple regression analyses, the cognitive‐behavioral factors independently predicted different outcomes. Fear of movement/(re)injury predicted more disability and more severe pain at 6 weeks and more severe pain at 6 months; passive pain‐coping strategies predicted more disability at 6 months; and negative outcome expectancies predicted more disability and more severe pain at both 6 weeks and 6 months. The findings support the potential utility of preoperative screening measures that include cognitive‐behavioral factors for predicting surgical outcome, as well as studies to examine the potential benefits of cognitive‐behavioral treatment to improve surgical outcome.

Reduced work capacity after lumbar disc surgery : The role of cognitive-behavioral and work-related risk factors

&NA; A significant number of patients who have had surgery for lumbosacral radicular syndrome still have a reduced work capacity several months later. In a prospective cohort study of 182 people who underwent lumbar disc surgery, we determined the predictive value of preoperatively measured cognitive‐behavioral and work‐related factors on work capacity 6 months after surgery. Logistic regression analyses indicated that these factors independently predicted work capacity 6 months after surgery. Specifically, fear of movement/(re)injury, more passive pain coping, and higher physical work‐load predicted reduced work capacity in multiple logistic regression analyses, taking into account the role of a wide range of control variables including demographic variables, preoperative disability and pain intensity, neurological deficits, intake of analgesics, duration of complaints, and pain intensity 3 days postoperatively. The study supports the need to develop and evaluate preoperative risk screening measures that include both cognitive‐behavioral and work‐related factors and to evaluate the effectiveness of cognitive‐behavioral and work‐related interventions in patients at risk of reduced work capacity after surgery for LRS.

Physical and occupational therapy

The graduate entry-level program in Physical Therapy is a professional entry level program designed to prepare students for licensure to practice as physical therapists. The program is accredited by the Commission on Accreditation in Physical Therapy Education of the American Physical Therapy Association. The Doctor of Physical Therapy program (DPT) was granted re-accreditation status by the Commission on Accreditation in Physical Therapy Education (CAPTE) in May 2016. Prospective students having questions about the programs accreditation status should contact: