Miriam Marie Rosé Vollenbroek-Hutten

Mobile patient monitoring: The MobiHealth system

The emergence of high bandwidth public wireless networks and miniaturized personal mobile devices give rise to new mobile healthcare services. To this end, the MobiHealth system provides highly customizable vital signs tele-monitoring and tele-treatment system based on a body area network (BAN) and a mobile health care (m-health) service platform utilizing next generation public wireless networks. The developed system allows the incorporation of diverse medical sensors via wireless connections, and the live transmission of the measured vital signs to healthcare providers as well as real-time feedback to the patient. Since 2002 the system has undergone substantial development in consecutive EU and national research projects. Diverse trials with different healthcare scenarios and patient groups in different European countries have been conducted in all projects. These have been performed to test the service and the network infrastructure including its suitability for m-health applications.

A Systematic Review of Sociodemographic, Physical, and Psychological Predictors of Multidisciplinary Rehabilitation—or, Back School Treatment Outcome in Patients With Chronic Low Back Pain

Study Design. A systematic review. Objective. To determine predictors of outcome of multidisciplinary rehabilitation–or back school treatment for patients with chronic low back pain. Summary of Background Data. Numerous reviews have been performed to gain insight into which patients benefit from which treatment. However, no review has systematically focused on predictors from multiple domains (i.e., sociodemographic, physical, and psychological), or on treatment outcome measured as activity limitation or participation restriction. Methods. Studies were found by searching medical and psychological databases, and screening references. Two reviewers independently assessed the methodological quality using standard criteria. Studies were only included if they met a predefined level of internal validity. A qualitative analysis was performed. Results. Heterogeneity among studies in patient characteristics, predictors, treatment, and outcomes limited evidence. All reviewed studies were descriptive or exploratory in nature. Consistent evidence was found for the predictive value of pain intensity (more pain→ worse outcome), several work-related parameters (e.g., high satisfaction→ better outcome), and coping style (less active coping→ better outcome). Other sociodemographic and physical variables consistently lacked predictive value. No consistent evidence was found for other psychological variables. Conclusions. It is impossible to define a generic set of predictors of outcome of multidisciplinary rehabilitation and back schools for patients with chronic low back pain because the reviewed studies were descriptive or exploratory in nature, and most predictors were only studied once. Nevertheless, for several predictors, consistent evidence was found. Large confirmatory studies are needed to test the value of these predictors.

Daily physical activities in chronic lower back pain patients assessed with accelerometry

Background: Normalization of activities in daily living is an important goal in rehabilitation treatment of chronic lower back pain (CLBP) patients. Clinicians indicate that CLBP patients often show deconditioning but also CLBP patients who seem to be too active are seen. The objective of the present cross‐sectional study was to gain more insight into the daily activity pattern of CLBP patients compared to controls, using accelerometry.

Feasibility of a home-based telerehabilitation system compared to usual care: arm/hand function in patients with stroke, traumatic brain injury and multiple sclerosis

We conducted a randomized controlled multicentre trial to investigate the feasibility of a telerehabilitation intervention for arm/hand function (the Home Care Activity Desk [HCAD] training) in a home setting. Usual care was compared to HCAD training. The hypothesis was that the clinical outcomes of the HCAD intervention would be at least the same as those measured after a period of usual care for patients with stroke, traumatic brain injury (TBI) and multiple sclerosis (MS) with respect to their arm/hand function. Eighty-one patients with affected arm/hand function resulting from either stroke, MS or TBI were recruited in Italy, Spain and Belgium; 11 were lost during follow-up (14%). The outcome measures were the Action Research Arm Test (ARAT) and the Nine Hole Peg Test (NHPT). There were no significant differences between the two groups on the outcome measures (ARAT and NHPT); in both groups, patients maintained or even improved their arm/hand function. The HCAD training was found to be as feasible as usual care in terms of clinical outcomes, and both therapists and patients were satisfied with the HCAD intervention. A telerehabilitation intervention using HCAD may increase the efficiency of care.

Effects of ambulant myofeedback training and ergonomic counselling in female computer workers with work-related neck-shoulder complaints: A randomized controlled trial

Objective: To investigate the effects of ambulant myofeedback training including ergonomic counselling (Mfb) and ergonomic counselling alone (EC), on work-related neck-shoulder pain and disability. Methods: Seventy-nine female computer workers reporting neck-shoulder complaints were randomly assigned to Mfb or EC and received four weeks of intervention. Pain intensity in neck, shoulders, and upper back, and pain disability, were measured at baseline, immediately after intervention, and at three and six months follow-up. Results: Pain intensity and disability had significantly decreased immediately after four weeks Mfb or EC, and the effects remained at follow up. No differences were observed between the Mfb and EC group for outcome and subjects in both intervention groups showed comparable chances for improvement in pain intensity and disability. Conclusions: Pain intensity and disability significantly reduced after both interventions and this effect remained at follow-up. No differences were observed between the two intervention groups.

Differences in outcome of a multidisciplinary treatment between subgroups of chronic low back pain patients defined using two multiaxial assessment instruments: the Multidimensional Pain Inventory and lumbar dynamometry

Objective: To investigate the effects of a multidisciplinary back school programme (Roessingh Back Rehabilitation Programme, RRP) compared with usual care, as well as differences in treatment outcome between subgroups defined using two multiaxial assessment instruments: the Multidimensional Pain Inventory (MPI-DLV) and lumbar dynamometry. Design: Randomized controlled trial. Setting: Rehabilitation. Subjects: One hundred and sixty-three patients with chronic, aspecific low back pain. Intervention: All subjects were randomly assigned either to a multidisciplinary, physically oriented group treatment or to their usual care. Main outcome measures: The Roland Disability Questionnaire and health-related quality of life (EuroQol, EQ5-D) were measured as primary outcomes before randomization and after eight weeks and six months follow-up. Result: Only 30-50% of the patients in the RRP group showed improvement and this number is not significantly different from the control group. Subgroup analyses give some first indications that multiaxial measurement instruments can be used to identify subgroups with differences in treatment effects. Conclusion: The overall effect of a multidisciplinary treatment is disappointing, however multiaxial assessment before admission might be valuable in clinical practice, resulting in more effective treatments for patients with chronic low back pain.

A Staged Approach Evaluation of Remotely Supervised Myofeedback Treatment (RSMT) in Women with Neck—Shoulder Pain Due to Computer Work

Remotely supervised myofeedback treatment (RSMT) is a relatively new intervention aimed at reducing neck-shoulder pain and disabilities. Subjects are equipped with a garment that can be worn under the clothes during daily work. Dry surface electrodes incorporated in this garment measure muscle activation (sEMG) of the trapezius muscle. The garment is connected to an ambulant device that provides feedback to the subject when muscle relaxation is insufficient. sEMG data are also sent to a secured server that is accessible by therapists for remote counseling purposes. In conformance with the evaluation stages of DeChant, RSMT was evaluated on technical feasibility, patient satisfaction, and changes in clinical outcomes. In addition, subjects were asked about their willingness to pay. The study population consisted of 10 female workers suffering from neck-shoulder pain related to computer work. Results show that in 78% of the remote counseling sessions, sufficient amounts of data were available at the server for the therapist to make an assessment of muscle tension needed for the remote counseling sessions. Subjects were highly satisfied about the usefulness and ease of use of the remote counseling. However, they were less satisfied with the technical functioning of the myofeedback system. Eighty percent of the subjects reported a reduction in pain intensity and disability directly after RSMT. Subjects were willing to contribute a maximum of 200 euro for RSMT. Based on this study, it can be concluded that RSMT is technically feasible and induces changes in clinical outcomes. However, further improvements to technical functioning and research into the clinical effectiveness are needed before this treatment can go into real deployment.

Daily physical activities of patients with chronic pain or fatigue versus asymptomatic controls. A systematic review

Objective: To gain an insight into the daily physical activity levels of patients with chronic pain or fatigue compared with asymptomatic controls. Data sources: MEDLINE, EMBASE, PsycINFO, Picarta, Cochrane Database of Systematic Reviews, reference tracking and a manual search of relevant journals. Review methods: A systematic, computerized database search of the medical databases up to September 2006 was performed. In addition, a hand search of relevant journals was carried out. Appropriate studies reported on the daily physical activities of adult patients with chronic pain or fatigue and included an asymptomatic control group. Two reviewers independently carried out methodological quality assessment and data extraction. A qualitative analysis was performed. Results: Twelve studies were included, involving five different syndromes. Results show large heterogeneity in methods used and syndromes investigated, which limited evidence. Eleven different methods were used to assess daily physical activities resulting in 16 different outcome parameters. There seem to be differences between the different syndromes, but results are not conclusive. Eight studies reported a lower physical activity level in patients compared with controls. There seems to be a difference in results between studies using objective versus those using subjective methods. Conclusions: Results reported in the literature with respect to the activity level of patients with chronic pain or fatigue compared with controls were too heterogeneous to give sufficient evidence and were not conclusive.

Counselling increases physical activity behaviour nine weeks after rehabilitation

Background: For people with disabilities, a physically active lifestyle can reduce the risk of secondary health problems and improve overall functioning. Objectives: To determine the effects of the sport stimulation programme “rehabilitation and sports” (R&S) and R&S combined with the daily physical activity promotion programme “active after rehabilitation” (AaR) on sport participation and daily physical activity behaviour nine weeks after inpatient or outpatient rehabilitation. Methods: Subjects in four intervention rehabilitation centres were randomised to a group receiving R&S only (n  =  315) or a group receiving R&S and AaR (n  =  284). Subjects in six control rehabilitation centres (n  =  603) received the usual care. Most common diagnoses were stroke, neurological disorders, and back disorders. Two sport and two daily physical activity outcomes were assessed with questionnaires seven weeks before and nine weeks after the end of rehabilitation. Data were analysed by intention to treat and on treatment multilevel analyses, comparing both intervention groups with the control group. Results: The R&S group showed no significant change. Intention to treat analyses of the R&S+AaR group showed significant improvements in one sport (p  =  0.02) and one physical activity outcome (p  =  0.03). On treatment analyses in the R&S+AaR group showed significant improvements in both sport outcomes (p<0.01 and p  =  0.02) and one physical activity outcome (p<0.01). Conclusions: Only the combination of R&S and AaR had increased sports participation and daily physical activity behaviour nine weeks after the end of inpatient or outpatient rehabilitation.

An exploration of chronic pain patients perceptions of home telerehabilitation services

Objectives  To explore patients’ perceptions regarding prospective telerehabilitation services and the factors that facilitate or impede patients’ intentions to use these services.