Publications by authors named "Roy E Stewart"

89 Publications

Therapists' perceptions and attitudes in facial palsy rehabilitation therapy: A mixed methods study.

Physiother Theory Pract 2021 Apr 23:1-11. Epub 2021 Apr 23.

Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, GZ, Groningen, Netherlands.

: Facial palsy rehabilitation therapy plays an essential role in treating facial palsy. This study aimed to gain insight into therapists' perceptions and attitudes toward facial palsy rehabilitation therapy and to examine whether therapists could be categorized into distinct groups based on these attitudes and perceptions. Thirteen semi-structured, in-depth interviews were conducted in a purposive sample of therapists. Interviews were analyzed using thematic analysis. Next, a questionnaire containing questions about therapists' characteristics and perceptions and attitudes toward facial palsy rehabilitation therapy was sent to all facial palsy rehabilitation therapists in the Netherlands and Flanders (n = 292). Latent class analysis (LCA) was performed to identify and analyze distinct groups of therapists. Seven themes were derived from the interviews: treatment goals, therapy content, indications, measurement instruments, factors influencing success, emotional support, and cooperation with colleagues. The questionnaire was filled out by 127 therapists. A 2-group structure consisting of a positive class and a negative class was found to fit the questionnaire data best. No distinction could be made regarding therapists' characteristics. Considerable variation in stated treatment practices was present among therapists. Therapists could be classified into 2 groups. This study raises several hypotheses that require further study.
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http://dx.doi.org/10.1080/09593985.2021.1920074DOI Listing
April 2021

Long-term follow-up of patients with chronic musculoskeletal pain attending interdisciplinary pain rehabilitation: outcomes and predictive factors.

Int J Rehabil Res 2021 06;44(2):110-117

Department of Rehabilitation, Center for Rehabilitation, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.

The long-term outcomes of interdisciplinary pain rehabilitation (IPR) in patients with chronic musculoskeletal pain (CMP) and its predictors has been studied to a limited extent. In this historical cohort study, functioning, satisfaction with life domains, and pain were assessed at baseline, discharge, and at 6-15 years follow-up. At follow-up, most patients (77%) rated the effects of the IPR as temporarily or persistently positive. The gains in functioning, satisfaction with life domains, and pain made during IPR remained for 6-15 years after the IPR. Patients who were single, retired, or not in work, and those having higher pain and lower functioning at baseline, had lower functioning at follow-up, while patients with traumatic pain disorders had higher functioning at follow-up. Gains made during IPR, particularly gains in social and mental functioning and in pain predicted functioning at follow-up. Treatments and events between discharge and follow-up also influenced the long-term outcome. In conclusion, on average, outcomes achieved during IPR persisted at long-term follow-up. Predictors of a better long-term outcome were mainly baseline characteristics.
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http://dx.doi.org/10.1097/MRR.0000000000000467DOI Listing
June 2021

Multi-domain cognitive impairments at school age in very preterm-born children compared to term-born peers.

BMC Pediatr 2021 Apr 13;21(1):169. Epub 2021 Apr 13.

Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.

Background: Preterm infants are at risk for functional impairments in motor, cognitive, and behavioral development that may persist into childhood. The aim of this study was to determine the co-occurrence of cognitive impairments in multiple cognitive domains at school age in very preterm born children compared to term-born children.

Methods: Comparative study including 60 very preterm-born children (gestational age ≤ 32 weeks) and 120 term-born controls. At school age, we assessed intelligence with the WISC-III, and visuomotor integration with the NEPSY-II, verbal memory with the AVLT, attention with the TEA-ch, and executive functioning with the BRIEF. We investigated co-occurrence of various abnormal (<5th percentile) and suspect-abnormal (<15th percentile, including both suspect and abnormal) cognitive functions.

Results: At mean age 8.8 years, 15% of preterm children had abnormal outcomes in multiple cognitive functions (≥2), versus 3% of the controls (odds ratio, OR 4.65, 95%-confidence interval, CI 1.33-16.35). For multiple suspect-abnormal cognitive outcomes, rates were 55% versus 25% (OR 3.02, 95%-CI 1.49-6.12). We found no pattern of co-occurrence of cognitive impairments among preterm children that deviated from term-born controls. However, low performance IQ was more frequently accompanied by additional cognitive impairments in preterms than in controls (OR 5.43, 95%-CI 1.75-16.81).

Conclusions: A majority of preterm children showed co-occurrence of impairments in multiple cognitive domains, but with no specific pattern of impairments. The occurrence of multi-domain cognitive impairments is higher in preterms but this seems to reflect a general increase, not one with a pattern specific for preterm-born children.
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http://dx.doi.org/10.1186/s12887-021-02641-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042721PMC
April 2021

Erythritol airpolishing in the non-surgical treatment of peri-implantitis: A randomized controlled trial.

Clin Oral Implants Res 2021 Apr 12. Epub 2021 Apr 12.

Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Objectives: To compare erythritol air polishing with piezoelectric ultrasonic scaling in the non-surgical treatment of peri-implantitis.

Material And Methods: Eighty patients (n = 139 implants) with peri-implantitis (probing pocket depth (PPD) ≥5 mm, marginal bone loss (MBL) ≥2 mm as compared to bone level at implant placement, bleeding, and/or suppuration on probing (BoP/SoP)) were randomly allocated to air polishing or ultrasonic treatment. The primary outcome was mean BoP (%) at 3 months after therapy (T3). Secondary outcomes were mean SoP (%), plaque score (Plq) (%), PPD (mm), MBL (mm), full mouth periodontal scores (FMPS) (%), levels of 8 classical periodontal pathogens, and treatment pain/discomfort (Visual Analog Scale, VAS). Patients who were considered successful at T3 were additionally assessed at 6, 9, and 12 months. Differences between both groups were analyzed using multilevel statistics.

Results: Three months after therapy, no significant difference in mean BoP (%) between the air polishing and ultrasonic therapy was found (crude analysis β (95% CI) -0.037 (-0.147; 0.073), p = .380). Neither secondary outcomes SoP (%), Plq (%), PPD (mm), MBL (mm), FMPS (%), and periodontal pathogens showed significant differences. Treatment pain/discomfort was low in both groups (VAS score airpolishing group 2.1 (±1.9), ultrasonic 2.6 (±1.9); p = .222). All successfully treated patients at T3 (18.4%) were still considered successful at 12-month follow-up.

Conclusions: Erythritol air polishing seems as effective as piezoelectric ultrasonic scaling in the non-surgical treatment of peri-implantitis, in terms of clinical, radiographical, and microbiological parameters. However, neither of the proposed therapies effectively resolved peri-implantitis. Hence, the majority of patients required further surgical treatment.
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http://dx.doi.org/10.1111/clr.13757DOI Listing
April 2021

Regional splanchnic oxygen saturation for preterm infants in the first week after birth: reference values.

Pediatr Res 2021 Jan 27. Epub 2021 Jan 27.

Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Background: Near-infrared spectroscopy is used in the assessment of regional splanchnic oxygen saturation (rSO), but solid reference values are scarce. We aimed to establish reference values of rSO for preterm infants during the first week after birth, both crude and modeled based on predictors.

Methods: We included infants with gestational age (GA) <32 weeks and/or birth weight <1200 g. We excluded infants who developed necrotizing enterocolitis or sepsis or who died. In the first week after birth, we determined a daily 2-h mean of rSO to assess its associations with sex, GA, postnatal age (PNA), small-for-gestational age (SGA) status, patent ductus arteriosus, hemoglobin, nutrition, and head circumference at birth and translated those into a prediction model.

Results: We included 220 infants. On day 1, the mean ± SD rSO value was 48.2% ± 16.6. The nadir of rSO was on day 4 (38.7% ± 16.6 smoothed line) to 5 (37.4%±17.3, actual data), after which rSO increased to 44.2% ± 16.6 on day 7. The final model of the reference values of rSO included the following coefficients: rSO = 3.2 - 7.0 × PNA + 0.8 × PNA - 4.0 × SGA + 1.8 × GA.

Conclusions: We established reference values of rSO for preterm infants during the first week after birth. GA, PNA, and SGA affect these values and need to be taken into account.

Impact: Regional splanchnic oxygen saturation is lower in infants with a lower gestational age and in small-for-gestational age infants. Regional splanchnic oxygen saturation decreases with a higher postnatal age until day 4 after birth and then increases until day 7 after birth. Gestational age, postnatal age, and small-for-gestational age status affect regional splanchnic oxygen saturation and need to be taken into account when interpreting regional splanchnic oxygen saturations using NIRS. Reference values for infant regional splanchnic oxygen saturation can be computed with a formula based on these variables, as provided by this study.
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http://dx.doi.org/10.1038/s41390-020-01323-3DOI Listing
January 2021

Trajectories of Disability and Low Back Pain Impact: 2-year Follow-up of the Groningen Spine Cohort.

Spine (Phila Pa 1976) 2020 Dec;45(23):1649-1660

University of Groningen, University Medical Center Groningen, Pain Center, The Netherlands.

Study Design: Prospective cohort study.

Objective: The aim of this study was to identify treatment response trajectories in patients with low back pain (LBP) during and after multidisciplinary care in a tertiary spine center, and to examine baseline patient characteristics that can distinguish trajectories.

Summary Of Background Data: Treatment response is often heterogeneous between patients with LBP. Knowledge on key characteristics that are associated with courses of disability could identify patients at risk for less favorable outcome. This knowledge will help improve shared decision-making.

Methods: Adult patients with LBP completed questionnaires on disability (Pain Disability Index) and LBP impact (Impact Stratification of the National Institutes of Health minimal dataset) at baseline, 6, 12, 18, and 24 months' follow-up. Latent class analyses were applied to identify trajectories of disability and LBP impact. Baseline sociodemographic and clinical patient characteristics were compared between trajectory subgroups.

Results: Follow-up was available for 996 patients on disability and 707 patients on LBP impact. Six trajectories were identified for both outcome measures. Three disability trajectories remained stable at distinct levels of severity (68% of patients) and three trajectories showed patterns of recovery (32%). For LBP impact there was one stable trajectory (17%), two slightly improving (59%), two recovering (15%), and one with a pattern of recovery and relapse (15%). Significant differences between trajectories were observed for almost all baseline patient characteristics.

Conclusion: On average, patients show moderate improvements in disability and LBP impact 2 years after visiting a multidisciplinary tertiary spine center. However, latent class analyses revealed that most patients belong to subgroups experiencing stable levels of disability and LBP impact. Differences in baseline patient characteristics were mostly associated with baseline levels of functioning, instead of (un)favorable outcome during follow-up.

Level Of Evidence: 2.
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http://dx.doi.org/10.1097/BRS.0000000000003647DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7647438PMC
December 2020

Two-year recovery courses of physical and mental impairments, activity limitations, and participation restrictions after total knee arthroplasty among working-age patients.

Disabil Rehabil 2020 May 22:1-10. Epub 2020 May 22.

Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Total knee arthroplasty is increasingly performed on working-age individuals, but little is known about their recovery process. Therefore this study examined recovery courses of physical and mental impairments, activity limitations and participation restrictions among working-age total knee arthroplasty recipients. Associated sociodemographic and health-related factors were also evaluated. A prospective study among working total knee arthroplasty patients (aged <65 years) ( = 146). Surveys were completed preoperatively and 6 weeks and 3, 6, 12, and 24 months postoperatively. Outcomes represented domains of the International Classification of Functioning, that is, physical impairments (pain, stiffness, vitality), mental impairments (mental health, depressive symptoms), activity limitations (physical functioning), and participation restrictions (social-, work functioning, working hours). Covariates included age, gender, education, home situation, body mass index, and comorbidity. Largest improvements in physical and mental impairments and activity limitations were observed until 3 months postoperatively. Participation in social roles improved early after surgery, and improvements in work participation occurred from 6 to 12 months. Older age, being male and fewer comorbidities were associated with better recovery courses. Working-age total knee arthroplasty patients recover soon from physical and mental impairments, activity limitations, and participation in social roles, but participation at work occurs later. Younger patients, females, and those with musculoskeletal comorbidities appear at risk for suboptimal recovery after total knee arthroplasty.Implications for rehabilitationAn increasing number of working-age patients are asking for total knee arthroplasty and have high expectations of total knee arthroplasty, in particular, to participate in the workforce again;Recovery after total knee arthroplasty (TKA) does not occur in the short term and is not limited to clinical improvements for working-age TKA recipients only, as an important part of recovery, that is, participation occurs in the long term (>6 months);Closer collaboration between occupational physicians and orthopedic surgeons might result in increased and earlier ability to work full contractual hours;Rehabilitation after TKA should focus on patients with multiple comorbidities, whereby musculoskeletal diseases may even need additional preoperative treatment to optimize outcomes and prevent work disability.
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http://dx.doi.org/10.1080/09638288.2020.1766583DOI Listing
May 2020

Which patients improve most after total hip arthroplasty? Influence of patient characteristics on patient-reported outcome measures of 22,357 total hip arthroplasties in the Dutch Arthroplasty Register.

Hip Int 2020 Apr 14:1120700020913208. Epub 2020 Apr 14.

Orthopaedic Surgery Department, Medical Center Leeuwarden, Leeuwarden, The Netherlands.

Background: Patient-reported outcome measures (PROMs) after total hip arthroplasty (THA), can be influenced by patient characteristics (case-mix factors). We used the Dutch Arthroplasty Register (LROI) to determine the effect of case-mix on improvement of PROMs after primary THA.

Methods: We included all primary THAs ( = 22,357) performed in the Netherlands between 2014 and 2018. The Hip disability and Osteoarthritis Outcome Score Physical function short form (HOOS-PS), Oxford Hip Score (OHS), EQ-5D index score and thermometer, and Numeric Rating Scales (NRS) measuring pain during activities and at rest, were recorded. The difference between preoperative and 3- and 12-month postoperative scores was calculated (delta-PROM) and used as primary outcome variable. Multivariable linear regression was used to examine the association between patient characteristics (age, sex, ASA score, body mass index (BMI), Charnley class, smoking, and previous operations to the affected hip) and PROMs. Cohens' d was used to measure effect size.

Results: Postoperative improvement (delta-PROM) on HOOS-PS, OHS, EQ-5D, and pain relief were significantly higher in patients <60 years, in patients with female gender, a high ASA score (III-IV), a BMI >30 kg/m, and patients without a previous operation to the hip. Cohen's d indicated clinically small differences (0.2).

Conclusions: Patients benefiting most in terms of postoperative improvement of self-reported physical functioning, pain relief and quality of life after primary THA were young, female, with a high ASA or BMI score, and without previous operations to the hip.
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http://dx.doi.org/10.1177/1120700020913208DOI Listing
April 2020

Patient Characteristics Influence Revision Rate of Total Hip Arthroplasty: American Society of Anesthesiologists Score and Body Mass Index Were the Strongest Predictors for Short-Term Revision After Primary Total Hip Arthroplasty.

J Arthroplasty 2020 01 14;35(1):188-192.e2. Epub 2019 Aug 14.

Department of Orthopedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands.

Background: Outcome and survival after primary total hip arthroplasty (THA) can be affected by patient characteristics. We examined the effect of case-mix on revision after primary THA using the Dutch Arthroplasty Register.

Methods: Our cohort included all primary THAs (n = 218,214) performed in patients with osteoarthritis in the Netherlands between 2007 and 2018. Multivariable logistic regression analysis was used to calculate the difference in survivorship in patients with different patient characteristics (age, gender, American Society of Anesthesiologists [ASA] score, body mass index [BMI], Charnley score, smoking, and previous operations to the hip).

Results: Case-mix factors associated with an increased risk for revision 1 year after THA were the following: a high ASA score (II and III-IV) (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1-2.0 and OR 3.0, 95% CI 1.7-5.3), a higher BMI (30-40 and >40) (OR 1.4, 95% CI 1.2-1.5 and OR 2.0, 95% CI 1.4-1.7), age ≥75 years (OR 1.5, 95% CI 1.1-2.0), and male gender (OR 1.3, 95% CI 1.2-1.4). A similar model for 3-year revision showed comparable results. High BMI (OR 1.9, 95% CI 1.3-2.9), a previous hip operation (OR 1.8, 95% CI 1.3-2.5), ASA III-IV (OR 1.2, 95% CI 1-1.6), and Charnley score C (OR 1.5, 95% CI 1.1-2.2) were associated with increased risk for revision. Main reasons for revision in obese and ASA II-IV patients were infection, dislocation, and periprosthetic fracture. Patients with femoral neck fracture and late post-traumatic pathology were more likely to be revised within 3 years, compared to osteoarthritis patients (OR 1.5, 95% CI 1.3-1.7 and OR 1.5, 95% CI 1.2-1.7).

Conclusion: The short-term risk for revision after primary THA is influenced by case-mix factors. ASA score and BMI (especially >40) were the strongest predictors for 1-year revision after primary THA. After 3 years, BMI and previous hip surgery were independent risk factors for revision. This will help surgeons to identify and counsel high-risk patients and take appropriate preventive measures.
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http://dx.doi.org/10.1016/j.arth.2019.08.024DOI Listing
January 2020

Effects of Dementia Care Mapping on job satisfaction and caring skills of staff caring for older people with intellectual disabilities: A quasi-experimental study.

J Appl Res Intellect Disabil 2019 Sep 13;32(5):1228-1240. Epub 2019 May 13.

Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Background: The ageing of people with intellectual disabilities, involving consequences like dementia, creates a need for methods to support care staff. One promising method is Dementia Care Mapping (DCM). This study examined the effect of DCM on job satisfaction and care skills of ID-care staff.

Methods: We performed a quasi-experimental study in 23 group homes for older people with intellectual disabilities in the Netherlands. Among staff, we assessed job satisfaction and care skills as primary outcomes and work experience measures as secondary outcomes (N = 227).

Results: Dementia Care Mapping achieved no significantly better effect than care as usual (CAU) for primary outcomes on job satisfaction (MWSS-HC) and working skills (P-CAT). Effect sizes varied from -0.18 to -0.66. We also found no differences for any of the secondary outcomes.

Conclusion: Dementia Care Mapping does not increase job satisfaction and care skills of staff caring for older people with intellectual disabilities. This result differs from previous findings and deserves further study.
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http://dx.doi.org/10.1111/jar.12615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6851587PMC
September 2019

Patellar tendon structure responds to load over a 7-week preseason in elite male volleyball players.

Scand J Med Sci Sports 2019 Jul 14;29(7):992-999. Epub 2019 Apr 14.

Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

The purpose of this study was to investigate the relation between external and internal load and the response of the patellar tendon structure assessed with ultrasound tissue characterization (UTC) in elite male volleyball players during preseason. Eighteen players were followed over 7 weeks, measuring four load parameters during every training and match: volume (minutes played), rating of perceived exertion (RPE) (ranging from 6 to 20), weekly load (RPE*volume), and jump frequency (number of jumps). Patellar tendon structure was measured biweekly using UTC, which quantifies tendon matrix stability resulting in four different echo types (I-IV). On average, players spent 615 min/wk on training and matches with an RPE of 13.9 and a jump frequency of 269. Load evaluation shows significant changes over the 7 weeks: Volume and weekly load parameters were significantly higher in week 3 than week 7 and in week 4 than week 2. Weekly load performed in week 4 was significantly higher than week 7. No significant changes were observed in tendon structure. On the non-dominant side, no significant correlations were found between changes in load parameters and echo types. At the dominant side, a higher weekly volume and weekly load resulted in a decrease of echo type I and a higher mean RPE in an increase of echo type II. The results of this study show that both external and internal load influence changes in patellar tendon structure of elite male volleyball players. Monitoring load and the effect on patellar tendon structure may play an important role in injury prevention.
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http://dx.doi.org/10.1111/sms.13428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850050PMC
July 2019

Measurement properties and implications of the Brief Resilience Scale in healthy workers.

J Occup Health 2019 May 22;61(3):242-250. Epub 2019 Mar 22.

Centre for eHealth and Wellbeing, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands.

Objectives: The aim of this study was to study measurement properties of the Dutch Language Version of the Brief Resilience Scale (BRS-DLV) in blue and white collar workers employed at multiple companies and to compare the validity and factor structure to other language versions.

Methods: Workers (n = 1023) were assessed during a cross-sectional health surveillance. Construct validity was tested with exploratory and confirmatory factor analyses (EFA and CFA) and hypothesis testing. Reliability was tested with Cronbach's alpha.

Results: A two-factor structure of the BRS-DLV had good model fit in both EFA and CFA, which could be explained by difficulties of workers with reversed order items. After excluding these inconsistent answering patterns, a one-factor structure showed good model fit resembling the original BRS (χ = 16.5; CFI & TLI = 0.99; SRMR = 0.02;RMSEA = 0.04). Internal consistency is sufficient (Cronbach's α = 0.78). All five hypotheses were confirmed, suggesting construct validity.

Conclusions: Reliability of the BRS-DLV is sufficient and there is evidence of construct validity. Inconsistent answering, however, caused problems in interpretation and factor structure of the BRS-DLV. This can be easily detected and handled because item 2, 4 and 6 are in reversed order. Other language versions differ in factor structure, most likely because systematic errors are not corrected for. To collect valid data, it is advised to be aware of inconsistent answering of respondents.
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http://dx.doi.org/10.1002/1348-9585.12041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6499349PMC
May 2019

Effects of Dementia Care Mapping on well-being and quality of life of older people with intellectual disability: A quasi-experimental study.

J Appl Res Intellect Disabil 2019 Jul 13;32(4):849-860. Epub 2019 Mar 13.

Department of Health Sciences, Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Background: The ageing of people with intellectual disability, accompanied with consequences like dementia, challenges intellectual disability-care staff and creates a need for supporting methods, with Dementia Care Mapping (DCM) as a promising possibility. This study examined the effect of DCM on the quality of life of older people with intellectual disability.

Methods: We performed a quasi-experimental study in 23 group homes for older people with intellectual disability in the Netherlands, comparing DCM (n = 113) with care-as-usual (CAU; n = 111). Using three measures, we assessed the staff-reported quality of life of older people with intellectual disability.

Results: DCM achieved no significantly better or worse quality of life than CAU. Effect sizes varied from 0.01 to -0.22. Adjustments for covariates and restriction of analyses to people with dementia yielded similar results.

Conclusion: The finding that DCM does not increase quality of life of older people with intellectual disability contradicts previous findings and deserves further study.
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http://dx.doi.org/10.1111/jar.12576DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6849613PMC
July 2019

Variable Interpretation of the Dystonia Consensus Classification Items Compromises Its Solidity.

Mov Disord 2019 03 6;34(3):317-320. Epub 2019 Feb 6.

University of Groningen, University Medical Centre Groningen, Department of Neurology, Groningen, the Netherlands.

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http://dx.doi.org/10.1002/mds.27627DOI Listing
March 2019

Pace and determinants of implementation of the self-management of well-being group intervention: a multilevel observational study.

BMC Health Serv Res 2019 Jan 25;19(1):67. Epub 2019 Jan 25.

Department of Health Psychology, University Medical Center Groningen, University of Groningen, P.O. Box 196, FA12, 9700 AD, Groningen, The Netherlands.

Background: When implementing an empirically supported intervention (ESI) arrays of influencing factors operate on the professional and organizational level, but so far dependency between these levels has often been ignored. The aim of this study is to describe the pace and identify determinants of implementation of the Self-Management of Well-being (SMW) group intervention while taking the dependency between professionals and organizations into account.

Methods: Pace of implementation was measured as the time between training of professionals and first use of the SMW intervention in months. Determinants of first use were derived from the Fleuren framework and assessed using web-based questionnaires and telephone interviews. First, univariate analyses, Fisher's exact tests and t-tests, were performed to identify determinants of first use of the SMW intervention on the individual professional and the organizational level independently. Second, multilevel analyses were performed to correct for the dependency between professionals and organizations. Simple multilevel logistic regression analyses were performed with determinants found significant in the univariate analyses as independent variables, first use as dependent variable, professionals entered in the first level, and organizations in the second level.

Results: Forty-eight professionals from 18 organizations were trained to execute the SMW intervention. Thirty-two professionals achieved first use, at a mean pace of 7.5 months ± 4.2. Determinants on the professional level were 'ownership', 'relative advantage', 'support from colleagues' and 'compatibility'. Determinants on the organizational level were 'organizational size' and 'innovation-task orientation fit'. Multilevel analysis showed that 'compatibility', a factor on the professional level, was the only significant determinant contributing to first use in the multilevel model.

Conclusions: This implementation study revealed a strong dependency between professionals and organizations. Results showed that a majority of professionals used the SMW intervention in about 8 months. When the dependency between professionals and organization was taken into account, the professionals' perception of compatibility was the only remaining determinant of implementation on the professional level. Organizational size and managers' perception of 'innovation-task orientation fit' were determinants of implementation on the organizational level. It is advisable to discuss the compatibility between new and current tasks among managers and professionals before adopting a new intervention.
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http://dx.doi.org/10.1186/s12913-019-3891-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6346574PMC
January 2019

Incidence rates of dysvascular lower extremity amputation changes in Northern Netherlands: A comparison of three cohorts of 1991-1992, 2003-2004 and 2012-2013.

PLoS One 2018 24;13(9):e0204623. Epub 2018 Sep 24.

Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

Objective: To analyze the incidence rates of dysvascular major lower extremity amputations (LEA) in Northern Netherlands in 2012-2013 compared to previous cohorts in 1991-1992 and 2003-2004.

Design: Retrospective cohort study.

Participants: Adults (N = 343) with first ever dysvascular LEA at ankle disarticulation or more proximal levels. The median age (interquartile range) was 74.2 years (64.5-81.9), 64% were male and 55% had been diagnosed with diabetes mellitus (DM).

Main Outcome Measures: Crude and age-standardized incidence rates of major LEA per 100.000 person-years.

Results: Crude incidence rate (IR) of first ever major LEA in 2012-2013 was 9.9 per 100.000 person-years, while the age-standardized IR was 7.7 per 100.000 person-years. A Poisson regression analysis showed that amputation rates among men were 2.3 times higher compared to women (95%CI 1.9-2.6), while in 2012-2013 the population aged >63 years had decreased amputation rates compared to 1991-1992. In the DM population the crude IR decreased from 142.6 per 100.000 person-years in 2003-2004 to 89.2 per 100.000 person-years in 2012-2013 (p<0.001).

Conclusions: In 2012-2013 a decrease in age-standardized IR for the general population and a decrease in crude IR for the DM population were observed compared to cohorts from the previous two decades, despite considerable shifts in the age distribution of the Dutch population towards more elderly people and increased prevalence of DM. These findings might suggest that improved treatment of patients at risk of dysvascular amputations is associated with reduced incidence rates of major LEA at the population level.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0204623PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6152988PMC
March 2019

Incidence rates of dysvascular lower extremity amputation changes in Northern Netherlands: A comparison of three cohorts of 1991-1992, 2003-2004 and 2012-2013.

PLoS One 2018 24;13(9):e0204623. Epub 2018 Sep 24.

Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

Objective: To analyze the incidence rates of dysvascular major lower extremity amputations (LEA) in Northern Netherlands in 2012-2013 compared to previous cohorts in 1991-1992 and 2003-2004.

Design: Retrospective cohort study.

Participants: Adults (N = 343) with first ever dysvascular LEA at ankle disarticulation or more proximal levels. The median age (interquartile range) was 74.2 years (64.5-81.9), 64% were male and 55% had been diagnosed with diabetes mellitus (DM).

Main Outcome Measures: Crude and age-standardized incidence rates of major LEA per 100.000 person-years.

Results: Crude incidence rate (IR) of first ever major LEA in 2012-2013 was 9.9 per 100.000 person-years, while the age-standardized IR was 7.7 per 100.000 person-years. A Poisson regression analysis showed that amputation rates among men were 2.3 times higher compared to women (95%CI 1.9-2.6), while in 2012-2013 the population aged >63 years had decreased amputation rates compared to 1991-1992. In the DM population the crude IR decreased from 142.6 per 100.000 person-years in 2003-2004 to 89.2 per 100.000 person-years in 2012-2013 (p<0.001).

Conclusions: In 2012-2013 a decrease in age-standardized IR for the general population and a decrease in crude IR for the DM population were observed compared to cohorts from the previous two decades, despite considerable shifts in the age distribution of the Dutch population towards more elderly people and increased prevalence of DM. These findings might suggest that improved treatment of patients at risk of dysvascular amputations is associated with reduced incidence rates of major LEA at the population level.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0204623PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6152988PMC
March 2019

The added value of a family-centered approach to optimize infants' social-emotional development: A quasi-experimental study.

PLoS One 2017;12(12):e0187750. Epub 2017 Dec 21.

Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

Objective: Family-centered care (FCC) has been related to positive healthcare outcomes in pediatric care. Our aim was to assess whether an FCC approach also leads to better and earlier identification of social-emotional problems and less child psychosocial problems at age 18 months.

Methods: In a quasi-experimental study within routine well-child care in the Netherlands, we compared those regions in which an FCC approach was implemented (FCC-JointStart) to those regions with "care-as-usual" (CAU), including all children. In all regions, professionals performed well-child visits (2-18 months) and assessed social-emotional problems, or risks developing these, by rating outcomes of assessments as "not optimal" or as "a problem." We compared FCC-JointStart and CAU regarding the rates of newly identified (risks for) social-emotional problems, the pace of identification over time, and the child's psychosocial wellbeing at eighteen months as measured by the Child Behavior Checklist (CBCL). For participants that received extra care, we compared FCC-JointStart and CAU regarding the severity of parent-reported problems. Parents were blinded, professionals were not.

Results: 5658 parents (68%) agreed to participate in the study. In the FCC-JointStart group, risks were identified more frequently, though differences were small (24.7% versus 22.0%, odds ratio (95%-confidence interval) adjusted for confounders: 1.44 (0.96; 2.18), Phi = .03). Risks were also identified earlier (p = .008), and additional care was provided to more severe cases than in CAU. Effect sizes r ranged from 0.17 (PSBC) to 0.22 (FAD). CBCL scores at 18 months did not differ between groups.

Conclusions: FFC-JointStart may contribute to more and earlier identification of risks for social-emotional problems and of families that need additional care, but not to fewer child psychosocial problems at age 18 months.

Trial Registration: Netherlands Trial Register NTR2681.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0187750PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5739404PMC
January 2018

Benefit finding trajectories in cancer patients receiving psychological care: Predictors and relations to depressive and anxiety symptoms.

Br J Health Psychol 2018 05 15;23(2):238-252. Epub 2017 Nov 15.

Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.

Objectives: This study aimed to (1) identify benefit finding trajectories in cancer patients receiving psychological care; (2) examine associations of benefit finding trajectories with levels of and changes in psychological symptoms; and (3) examine whether socio-demographic and medical characteristics distinguished trajectories.

Design: Naturalistic longitudinal study design.

Methods: Participants were 241 cancer patients receiving psychological care at specialized psycho-oncological institutions in the Netherlands. Data were collected before starting psychological care, and three and 9 months thereafter. Latent class growth analysis was performed to identify benefit finding trajectories.

Results: Five benefit finding trajectories were identified: 'high level-stable' (8%), 'very low level-small increase' (16%), 'low level-small increase' (39%), 'low level-large increase' (9%), and 'moderate level-stable' (28%). People in distinct benefit finding trajectories reported significant differential courses of depression but not of anxiety symptoms. Compared with the other four trajectories, people in the 'low level-large increase' trajectory reported the largest decreases in depression over time. Perceptions of cancer prognosis distinguished these trajectories, such that people with a favourable prognosis were more likely to belong to the 'high level-stable' trajectory, while people perceiving an uncertain prognosis were more likely to belong to the 'low level-large increase' trajectory of benefit finding.

Conclusions: Cancer patients showed distinct benefit finding trajectories during psychological care. A small proportion reporting a large increase in benefit finding were also most likely to show decreases in depressive symptoms over time. These findings suggest a relation between perceiving benefits from cancer experience and improved psychological functioning in cancer patients receiving psychological care. Statement of contribution What is already known on this subject? People vary in course of benefit finding (BF) after trauma, with some experiencing enhanced BF and others decreased BF. Empirical studies have identified subgroups of cancer patients with distinct BF trajectories. What does this study add? This is the first study showing that cancer patients followed different BF trajectories during psychological care. Only a small proportion experienced clinically meaningful increases in BF over time. More attention is needed for cancer patients with decreased BF, as they are at a higher risk of remaining depressed.
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http://dx.doi.org/10.1111/bjhp.12283DOI Listing
May 2018

Trajectories of Anxiety and Depression After Liver Transplantation as Related to Outcomes During 2-Year Follow-Up: A Prospective Cohort Study.

Psychosom Med 2018 Feb/Mar;80(2):174-183

From the Departments of Nursing Research (Annema, Roodbol) Health Psychology, (Ranchor), Gastroenterology and Hepatology (Drent), Public Health (Stewart), and Surgery (Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation) (Porte), University Medical Center Groningen, University of Groningen; Department of Gastroenterology and Hepatology (Metselaar), Erasmus Medical Center, Rotterdam; and Department of Gastroenterology and Hepatology (Hoek), Leiden University Medical Center, the Netherlands.

Objective: The aims of the study were to examine whether distinct trajectories of anxious and depressive symptoms are present among liver transplant recipients from before transplantation to 2 years afterward, to identify associated demographic, clinical, and individual characteristics, and to examine the influence of distinct trajectories on outcomes.

Methods: A prospective, multicenter cohort study was performed among 153 liver transplant recipients. Data were retrieved using questionnaires administered before transplantation and at 3, 6, 12, and 24 months after transplantation. Clinical data were retrieved by medical record review. Latent class growth analysis was used to identify distinct trajectories. χ test, analyses of variance, and multinomial logistic regression were used to identify associated variables and the impact of the distinct trajectories on outcomes.

Results: Three distinct trajectories for symptoms of anxiety (State-Trait Anxiety Inventory-short form) as well as depression (Center for Epidemiological Studies Depression Scale) were identified: "no symptoms," "resolved symptoms," and "persistent symptoms." The trajectories of persistent anxiety and depression comprised, respectively, 23% and 29% of the transplant recipients. Several clinical and individual variables were associated with the trajectories of persistent anxiety and/or depression: experiencing more adverse effects of the immunosuppressive medication, lower level of personal control, more use of emotion-focused coping, less disclosure about the transplant, and more stressful life events. The trajectories of persistent symptoms were associated with worse outcomes regarding medication adherence and health-related quality of life, but not with mortality.

Conclusions: A significant subset of transplant recipients showed persistent symptoms of anxiety and depression from before to 2 years after transplantation. These results emphasize the importance of psychosocial care in the transplant population.
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http://dx.doi.org/10.1097/PSY.0000000000000539DOI Listing
March 2019

Work functioning trajectories in cancer patients: Results from the longitudinal Work Life after Cancer (WOLICA) study.

Int J Cancer 2017 11 19;141(9):1751-1762. Epub 2017 Jul 19.

Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.

More than 60% of cancer patients are able to work after cancer diagnosis. However, little is known about their functioning at work. Therefore, the aims of this study were to (1) identify work functioning trajectories in the year following return to work (RTW) in cancer patients and (2) examine baseline sociodemographic, health-related and work-related variables associated with work functioning trajectories. This longitudinal cohort study included 384 cancer patients who have returned to work after cancer diagnosis. Work functioning was measured at baseline, 3, 6, 9 and 12 months follow-up. Latent class growth modeling (LCGM) was used to identify work functioning trajectories. Associations of baseline variables with work functioning trajectories were examined using univariate and multivariate analyses. LCGM analyses with cancer patients who completed on at least three time points the Work Role Functioning Questionnaire (n = 324) identified three work functioning trajectories: "persistently high" (16% of the sample), "moderate to high" (54%) and "persistently low" work functioning (32%). Cancer patients with persistently high work functioning had less time between diagnosis and RTW and had less often a changed meaning of work, while cancer patients with persistently low work functioning reported more baseline cognitive symptoms compared to cancer patients in the other trajectories. This knowledge has implications for cancer care and guidance of cancer patients at work.
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http://dx.doi.org/10.1002/ijc.30876DOI Listing
November 2017

Physician job satisfaction related to actual and preferred job size.

BMC Med Educ 2017 May 11;17(1):86. Epub 2017 May 11.

University Medical Center Groningen and University of Groningen, A. Deusinglaan 1, 9713, AV, Groningen, The Netherlands.

Background: Job satisfaction is essential for physicians' well-being and patient care. The work ethic of long days and hard work that has been advocated for decades is acknowledged as a threat for physicians' job satisfaction, well-being, and patient safety. Our aim was to determine the actual and preferred job size of physicians and to investigate how these and the differences between them influence physicians' job satisfaction.

Method: Data were retrieved from a larger, longitudinal study among physicians starting medical training at Groningen University in 1982/83/92/93 (N = 597). Data from 506 participants (85%) were available for this study. We used regression analysis to investigate the influence of job size on physicians' job satisfaction (13 aspects) and ANOVA to examine differences in job satisfaction between physicians wishing to retain, reduce or increase job size.

Results: The majority of the respondents (57%) had an actual job size less than 1.0 FTE. More than 80% of all respondents preferred not to work full-time in the future. Respondents' average actual and preferred job sizes were .85 FTE and .81 FTE, respectively. On average, respondents who wished to work less (35% of respondents) preferred a job size reduction of 0.18 FTE and those who wished to work more (12%) preferred an increase in job size of 0.16 FTE. Job size influenced satisfaction with balance work-private hours most (β = -.351). Physicians who preferred larger job sizes were - compared to the other groups of physicians - least satisfied with professional accomplishments.

Conclusions: A considerable group of physicians reported a gap between actual and preferred job size. Realizing physicians' preferences as to job size will hardly affect total workforce, but may greatly benefit individual physicians as well as their patients and society. Therefore, it seems time for a shift in work ethic.
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http://dx.doi.org/10.1186/s12909-017-0911-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5425993PMC
May 2017

How reliable and valid is the teacher version of the Strengths and Difficulties Questionnaire in primary school children?

PLoS One 2017 28;12(4):e0176605. Epub 2017 Apr 28.

Department of Pediatrics, University Medical Center Groningen, Beatrix Children's Hospital, University of Groningen, Groningen, the Netherlands.

Introduction: The Strengths and Difficulties Questionnaire (SDQ) is validated for parents, but not yet for teachers in a broad age range of children. We conducted a cross-sectional study with 4-10 years old school children to investigate if the SDQ-T can be used instead of the validated but lengthy Teacher's Report Form (TRF) to acquire information about emotional and behavioral problems in the school community.

Methods: Teachers of 453 children from primary schools were approached. Teachers of 394 children (response rate 86.9%) with a mean age of 7.1 years filled in the SDQ-T (n = 387), the TRF (n = 349) or both (n = 342). We assessed reliability by calculating internal consistency and concurrent validity (using correlation coefficients, sensitivity, specificity) of the SDQ-T compared with the TRF.

Results: Internal consistency of the SDQ-T Total Difficulties Score (SDQ-T TDS; Cronbach α = 0.80), hyperactivity/ inattention- (α = 0.86) and prosocial behavior (α = 0.81) was very good. Concurrent validity demonstrated a strong correlation of all subscales of the SDQ-T with the corresponding scale on the TRF (range 0.54-0.73), except for peer problems (0.46). Using a SDQ-T TDS cut-off score > 14, the SDQ-T had a good sensitivity (90%) and specificity (94%).

Discussion: The good reliability, validity and brevity of the SDQ-T make it an easily applicable questionnaire for obtaining information about emotional and behavioral problems from teachers in primary school children.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0176605PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409073PMC
September 2017

Measurement Properties of the NIH-Minimal Dataset Dutch Language Version in Patients With Chronic Low Back Pain.

Spine (Phila Pa 1976) 2017 Oct;42(19):1472-1477

Groningen Spine Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Study Design: Validation study with cross-sectional and longitudinal measurements.

Objective: To translate the US National Institutes of Health (NIH)-minimal dataset for clinical research on chronic low back pain into the Dutch language and to test its validity and reliability among people with chronic low back pain.

Summary Of Background Data: The NIH developed a minimal dataset to encourage more complete and consistent reporting of clinical research and to be able to compare studies across countries in patients with low back pain. In the Netherlands, the NIH-minimal dataset has not been translated before and measurement properties are unknown.

Methods: Cross-cultural validity was tested by a formal forward-backward translation. Structural validity was tested with exploratory factor analyses (comparative fit index, Tucker-Lewis index, and root mean square error of approximation). Hypothesis testing was performed to compare subscales of the NIH dataset with the Pain Disability Index and the EurQol-5D (Pearson correlation coefficients). Internal consistency was tested with Cronbach α and test-retest reliability at 2 weeks was calculated in a subsample of patients with Intraclass Correlation Coefficients and weighted Kappa (κω).

Results: In total, 452 patients were included of which 52 were included for the test-retest study.

Validity: factor analysis for structural validity pointed into the direction of a seven-factor model (Cronbach α = 0.78). Factors and total score of the NIH-minimal dataset showed fair to good correlations with Pain Disability Index (r = 0.43-0.70) and EuroQol-5D (r = -0.41 to -0.64). Reliability: test-retest reliability per item showed substantial agreement (κω=0.65). Test-retest reliability per factor was moderate to good (Intraclass Correlation Coefficient = 0.71).

Conclusion: The Dutch language version measurement properties of the NIH-minimal were satisfactory.

Level Of Evidence: N/A.
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http://dx.doi.org/10.1097/BRS.0000000000002134DOI Listing
October 2017

Content of conventional therapy for the severely affected arm during subacute rehabilitation after stroke: An analysis of physiotherapy and occupational therapy practice.

Physiother Res Int 2018 Jan 16;23(1). Epub 2017 Jan 16.

Department of Rehabilitation Medicine, and Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, The Netherlands.

Background And Purpose: Physiotherapy (PT) and occupational therapy (OT) are key professions providing treatment for the arm after stroke; however, knowledge about the content of these treatments is scant. Detailed data are needed to replicate interventions, evaluate their effective components, and evaluate PT and OT practice. This paper describes PT and OT treatment for the severely affected arm in terms of duration, content according to components and categories of the International Classification of Human Functioning, Disability and Health, and to analyze differences between professions.

Methods: Design: This is a retrospective analysis of randomized trial data.

Participants: 46 patients after stroke with poor arm motor control recruited from inpatient neurological units from three rehabilitation centers in the Netherlands.

Procedure: PTs and OTs recorded duration and content of arm treatment interventions for 8 weeks using a bespoke treatment schedule with 15 International Classification of Human Functioning, Disability and Health categories.

Results: PTs and OTs spent on average 4-7 min per treatment session (30 min) on arm treatment. OTs spent significantly more time providing arm treatment and treatment at the activities level than PTs. PTs spent 79% of their arm treatment time on body functions, OTs 41%. OTs spent significantly more time on "moving around using transportation," "self care," and "household tasks" categories.

Conclusions: Patients after stroke with a severely affected arm and an unfavorable prognosis for arm motor recovery receive little arm-oriented PT and OT. Therapists spent most arm treatment time on body functions. There was a considerable overlap in the content of PT and OT in 12 of the 15 categories. Results can be generalized only to patients with poor arm motor control and may not represent practice in other countries.
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http://dx.doi.org/10.1002/pri.1683DOI Listing
January 2018

Fatigue, Sleep Disturbances, and Their Influence on Quality of Life in Cervical Dystonia Patients.

Mov Disord Clin Pract 2017 Jul-Aug;4(4):517-523. Epub 2016 Dec 5.

Department of Neurology University Medical Center Groningen University of Groningen Groningen the Netherlands.

Background: Nonmotor symptoms (NMS) are highly prevalent in cervical dystonia (CD). In general, fatigue and sleep are important NMS that determine a decreased health-related quality of life (HR-QoL), but their influence in CD is unknown. The authors systematically investigated fatigue, excessive daytime sleepiness (EDS), and sleep quality in patients with CD and controls and assessed the influence of psychiatric comorbidity, pain, and dystonia motor severity. They also examined the predictors of HR-QoL.

Methods: The study included 44 patients with CD and 43 matched controls. Fatigue, EDS, and sleep quality were assessed with quantitative questionnaires and corrected for depression and anxiety using analysis of covariance. The Toronto Western Spasmodic Torticollis Rating Scale and the Clinical Global Impression Scale-jerks/tremor subscale were used to score motor severity and to assess whether motor characteristics could explain an additional part of the variation in fatigue and sleep-related measures. HR-QoL was determined with the RAND-36 item Health Survey, and predictors of HR-QoL were assessed using multiple regression.

Results: Fatigue scores were increased independently from psychiatric comorbidity (4.0 vs. 2.7; <0.01), whereas EDS (7.3 vs. 7.4; =0.95) and sleep quality (6.5 vs. 6.1; =0.73) were highly associated with depression and anxiety. In patients with CD, motor severity did not explain the variations in fatigue (change in the correlation coefficient [ΔR] = 0.06; =0.15), EDS (ΔR = 0.00; =0.96), or sleep quality (ΔR = 0.04; =0.38) scores. Fatigue, EDS, psychiatric comorbidity, and pain predicted a decreased QoL.

Conclusion: Independent from psychiatric comorbidity and motor severity, fatigue appeared to be a primary NMS. Sleep-related measures were highly associated with psychiatric comorbidity, but not with motor severity. Only NMS predicted HR-QoL, which emphasizes the importance of attention to NMS in patients with CD.
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http://dx.doi.org/10.1002/mdc3.12459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174405PMC
December 2016

Cut-Off Points for Mild, Moderate, and Severe Pain on the Numeric Rating Scale for Pain in Patients with Chronic Musculoskeletal Pain: Variability and Influence of Sex and Catastrophizing.

Front Psychol 2016 30;7:1466. Epub 2016 Sep 30.

Department of Rehabilitation, Centre for Rehabilitation, University Medical Centre Groningen, University of Groningen Groningen, Netherlands.

The 0-10 Numeric Rating Scale (NRS) is often used in pain management. The aims of our study were to determine the cut-off points for mild, moderate, and severe pain in terms of pain-related interference with functioning in patients with chronic musculoskeletal pain, to measure the variability of the optimal cut-off points, and to determine the influence of patients' catastrophizing and their sex on these cut-off points. 2854 patients were included. Pain was assessed by the NRS, functioning by the Pain Disability Index (PDI) and catastrophizing by the Pain Catastrophizing Scale (PCS). Cut-off point schemes were tested using ANOVAs with and without using the PSC scores or sex as co-variates and with the interaction between CP scheme and PCS score and sex, respectively. The variability of the optimal cut-off point schemes was quantified using bootstrapping procedure. The study showed that NRS scores ≤ 5 correspond to mild, scores of 6-7 to moderate and scores ≥8 to severe pain in terms of pain-related interference with functioning. Bootstrapping analysis identified this optimal NRS cut-off point scheme in 90% of the bootstrapping samples. The interpretation of the NRS is independent of sex, but seems to depend on catastrophizing. In patients with high catastrophizing tendency, the optimal cut-off point scheme equals that for the total study sample, but in patients with a low catastrophizing tendency, NRS scores ≤ 3 correspond to mild, scores of 4-6 to moderate and scores ≥7 to severe pain in terms of interference with functioning. In these optimal cut-off schemes, NRS scores of 4 and 5 correspond to moderate interference with functioning for patients with low catastrophizing tendency and to mild interference for patients with high catastrophizing tendency. Theoretically one would therefore expect that among the patients with NRS scores 4 and 5 there would be a higher average PDI score for those with low catastrophizing than for those with high catastrophizing. However, we found the opposite. The fact that we did not find the same optimal CP scheme in the subgroups with lower and higher catastrophizing tendency may be due to chance variability.
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http://dx.doi.org/10.3389/fpsyg.2016.01466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5043012PMC
September 2016

Nationwide review of mixed and non-mixed components from different manufacturers in total hip arthroplasty.

Acta Orthop 2016 Aug 27;87(4):356-62. Epub 2016 Jun 27.

c University Medical Center Groningen, University of Groningen , Groningen ;

Background and purpose - Combining components from different manufacturers in total hip arthroplasty (THA) is common practice worldwide. We determined the proportion of THAs used in the Netherlands that consist of components from different manufacturers, and compared the revision rates of these mixed THAs with those of non-mixed THAs. Patients and methods - Data on primary and revision hip arthroplasty are recorded in the LROI, the nationwide population-based arthroplasty register in the Netherlands. We selected all 163,360 primary THAs that were performed in the period 2007-2014. Based on the manufacturers of the components, 4 groups were discerned: non-mixed THAs with components from the same manufacturer (n = 142,964); mixed stem-head THAs with different manufacturers for the femoral stem and head (n = 3,663); mixed head-cup THAs with different head and cup manufacturers (n = 12,960), and mixed stem-head-cup THAs with different femoral stem, head, and cup manufacturers (n = 1,773). Mixed prostheses were defined as THAs (stem, head, and cup) composed of components made by different manufacturers. Results - 11% of THAs had mixed components (n = 18,396). The 6-year revision rates were similar for mixed and non-mixed THAs: 3.4% (95% CI: 3.1w-3.7) for mixed THAs and 3.5% (95% CI: 3.4-3.7) for non-mixed THAs. Revision of primary THAs due to loosening of the acetabulum was more common in mixed THAs (16% vs. 12%). Interpretation - Over an 8-year period in the Netherlands, 11% of THAs had mixed components-with similar medium-term revision rates to those of non-mixed THAs.
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http://dx.doi.org/10.1080/17453674.2016.1194128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967277PMC
August 2016

Is Poor Sleep Quality Associated With Greater Disability in Patients With Multiple Sclerosis?

Behav Sleep Med 2018 Mar-Apr;16(2):106-116. Epub 2016 May 18.

b Graduate School Kosice Institute for Society and Health, Safarik University , Kosice , Slovakia.

Poor sleep is a serious burden for patients with multiple sclerosis (MS). The aim of this study is to assess whether the association between sleep quality and disability in MS patients is direct or mediated by depression, pain, and fatigue. We collected data from 152 patients with MS who filled out the Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale, the Multidimensional Fatigue Inventory and one item of the Short Form-36 regarding pain. The relationship between poor sleep and disability was found to be indirect, mediated by depression (p < 0.05), pain (p < 0.001) and physical fatigue (p < 0.01). Treatment of sleep disturbances may have beneficial effects beyond improving sleep. It may reduce depression, pain, and physical fatigue, which in turn may lessen disability.
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http://dx.doi.org/10.1080/15402002.2016.1173555DOI Listing
December 2017

Implications of a clinical medication review and a pharmaceutical care plan of polypharmacy patients with a cardiovascular disorder.

Int J Clin Pharm 2016 Aug 6;38(4):808-15. Epub 2016 Apr 6.

Department Pharmacotherapy and Pharmaceutical Care, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands.

Background A clinical medication review, including patient involvement, is expected to improve pharmaceutical care. Objective To determine whether a clinical medication review followed by a pharmaceutical care plan decreases the number of potential drug-related problems (DRPs) and pharmaceutical care issues (PCIs) and leads to a positive effect on relevant clinical and laboratory parameters for elderly cardiovascular patients with multiple drug use. Setting Randomized controlled trial in eight primary care settings in the Netherlands. Method Elderly polypharmacy patients with a cardiovascular disorder were randomized into two groups. Intervention patients received a clinical medication review, followed by a pharmaceutical care plan developed in cooperation between these patients' pharmacists and general practitioners (GPs), and agreed to by the patients. Control patients received care as usual. Patient data were collected at the start of the study (t = 0) and after 1-year follow-up (t = 1). Main outcome measure Decrease in potential DRPs and pharmaceutical PCIs, improvement of clinical and laboratory parameters. Results 512 patients were included. An average of 2.2 potential DRPs and pharmaceutical PCIs were defined per patient in the intervention group. After 1-year follow-up, 47.2 % of potential DRPs and PCIs were resolved. In total, 156 care interventions were proposed (0.9/patient), 108 of which were implemented after 1 year (69.2 %). For control-group patients, a total of 47 proposed care interventions were documented for 255 patients (0.2/patient); after 1 year, 43 had been implemented (91.5 %). The study intervention (p < 0.001) and the number of medicines used (p = 0.030) had a significant effect on the number of interventions proposed. Small biochemical changes in cardiovascular risk factors did occur, but the differences were small and not considered clinically relevant. Conclusion The integrated use of a clinical medication review with a pharmaceutical care plan in a primary care setting supports the detection of and decrease in DRPs and pharmaceutical PCIs in almost half of the patients. Its benefit in terms of control of cardiovascular risk factors and safety parameters was relatively low. Risk stratification might be necessary to decide which patients might benefit most from this type of intervention.
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http://dx.doi.org/10.1007/s11096-016-0281-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4929171PMC
August 2016