Feasibility and acceptability of aquatic exercise therapy in burn patients – A pilot study

Background: As the assistive and resistive properties of water can facilitate the performance of exercise, aquatic exercise therapy might be a promising rehabilitation modality for burn patients. This study aimed to investigate the feasibility and acceptability of aquatic exercise therapy in adult burn patients with an indication for supervised exercise therapy. Methods: Eligible for this observational pilot study were all competent adult burn patients with an indication for supervised exercise therapy who had been admitted to the burn centre of the Maasstad Hospital between June 2016 and February 2017. Patients were asked to participate in an in-hospital aquatic exercise therapy program for a minimum of 2 weeks, 2 times per week, or otherwise serve as control by having land-based exercise therapy (regular care). Feasibility of aquatic exercise therapy was assessed by comparing the number of eligible patients to the number of patients that could actually participate, monitoring attendance rates, monitoring complications, and evaluating early experiences. Acceptability was assessed using the Water Exercise Acceptability Questionnaire. Results: Eleven patients were invited and ten of them agreed to participate. All chose aquatic instead of land-based exercise therapy. Participants were aged between 19 and 64 years and their burns affected 18–53% of total body surface area (TBSA). Aquatic exercise therapy appeared feasible in nine of 13 eligible patients (69%). Attendance rates were high (42–100%) and the majority of participants (n = 9) continued with aquatic exercise therapy beyond the initial two weeks. No serious complications (e.g. infections) occurred. Adverse symptoms (wound healing issues) were reported in five participants, but in four of them these were not likely to be due to the aquatic exercise therapy. Enjoyment was high and adherence to the aquatic exercise therapy was further facilitated by support from staff, a sense of achievement, noticeable improvements, personal motivation, and support from other participants. Peer support was reported as a positive side effect. Conclusions: These preliminary results indicate that aquatic exercise therapy is both feasible and acceptable for the majority of adult burn patients with an indication for supervised exercise therapy. No indications were found for an increased risk of infection or other serious complications.</p

Feasibility and acceptability of aquatic exercise therapy in burn patients – A pilot study

Background: As the assistive and resistive properties of water can facilitate the performance of exercise, aquatic exercise therapy might be a promising rehabilitation modality for burn patients. This study aimed to investigate the feasibility and acceptability of aquatic exercise therapy in adult burn patients with an indication for supervised exercise therapy. Methods: Eligible for this observational pilot study were all competent adult burn patients with an indication for supervised exercise therapy who had been admitted to the burn centre of the Maasstad Hospital between June 2016 and February 2017. Patients were asked to participate in an in-hospital aquatic exercise therapy program for a minimum of 2 weeks, 2 times per week, or otherwise serve as control by having land-based exercise therapy (regular care). Feasibility of aquatic exercise therapy was assessed by comparing the number of eligible patients to the number of patients that could actually participate, monitoring attendance rates, monitoring complications, and evaluating early experiences. Acceptability was assessed using the Water Exercise Acceptability Questionnaire. Results: Eleven patients were invited and ten of them agreed to participate. All chose aquatic instead of land-based exercise therapy. Participants were aged between 19 and 64 years and their burns affected 18–53% of total body surface area (TBSA). Aquatic exercise therapy appeared feasible in nine of 13 eligible patients (69%). Attendance rates were high (42–100%) and the majority of participants (n = 9) continued with aquatic exercise therapy beyond the initial two weeks. No serious complications (e.g. infections) occurred. Adverse symptoms (wound healing issues) were reported in five participants, but in four of them these were not likely to be due to the aquatic exercise therapy. Enjoyment was high and adherence to the aquatic exercise therapy was further facilitated by support from staff, a sense of achievement, noticeable improvements, personal motivation, and support from other participants. Peer support was reported as a positive side effect. Conclusions: These preliminary results indicate that aquatic exercise therapy is both feasible and acceptable for the majority of adult burn patients with an indication for supervised exercise therapy. No indications were found for an increased risk of infection or other serious complications.</p

Feasibility and acceptability of aquatic exercise therapy in burn patients – A pilot study

Background: As the assistive and resistive properties of water can facilitate the performance of exercise, aquatic exercise therapy might be a promising rehabilitation modality for burn patients. This study aimed to investigate the feasibility and acceptability of aquatic exercise therapy in adult burn patients with an indication for supervised exercise therapy. Methods: Eligible for this observational pilot study were all competent adult burn patients with an indication for supervised exercise therapy who had been admitted to the burn centre of the Maasstad Hospital between June 2016 and February 2017. Patients were asked to participate in an in-hospital aquatic exercise therapy program for a minimum of 2 weeks, 2 times per week, or otherwise serve as control by having land-based exercise therapy (regular care). Feasibility of aquatic exercise therapy was assessed by comparing the number of eligible patients to the number of patients that could actually participate, monitoring attendance rates, monitoring complications, and evaluating early experiences. Acceptability was assessed using the Water Exercise Acceptability Questionnaire. Results: Eleven patients were invited and ten of them agreed to participate. All chose aquatic instead of land-based exercise therapy. Participants were aged between 19 and 64 years and their burns affected 18–53% of total body surface area (TBSA). Aquatic exercise therapy appeared feasible in nine of 13 eligible patients (69%). Attendance rates were high (42–100%) and the majority of participants (n = 9) continued with aquatic exercise therapy beyond the initial two weeks. No serious complications (e.g. infections) occurred. Adverse symptoms (wound healing issues) were reported in five participants, but in four of them these were not likely to be due to the aquatic exercise therapy. Enjoyment was high and adherence to the aquatic exercise therapy was further facilitated by support from staff, a sense of achievement, noticeable improvements, personal motivation, and support from other participants. Peer support was reported as a positive side effect. Conclusions: These preliminary results indicate that aquatic exercise therapy is both feasible and acceptable for the majority of adult burn patients with an indication for supervised exercise therapy. No indications were found for an increased risk of infection or other serious complications.</p

Feasibility and acceptability of aquatic exercise therapy in burn patients – A pilot study

Background: As the assistive and resistive properties of water can facilitate the performance of exercise, aquatic exercise therapy might be a promising rehabilitation modality for burn patients. This study aimed to investigate the feasibility and acceptability of aquatic exercise therapy in adult burn patients with an indication for supervised exercise therapy. Methods: Eligible for this observational pilot study were all competent adult burn patients with an indication for supervised exercise therapy who had been admitted to the burn centre of the Maasstad Hospital between June 2016 and February 2017. Patients were asked to participate in an in-hospital aquatic exercise therapy program for a minimum of 2 weeks, 2 times per week, or otherwise serve as control by having land-based exercise therapy (regular care). Feasibility of aquatic exercise therapy was assessed by comparing the number of eligible patients to the number of patients that could actually participate, monitoring attendance rates, monitoring complications, and evaluating early experiences. Acceptability was assessed using the Water Exercise Acceptability Questionnaire. Results: Eleven patients were invited and ten of them agreed to participate. All chose aquatic instead of land-based exercise therapy. Participants were aged between 19 and 64 years and their burns affected 18–53% of total body surface area (TBSA). Aquatic exercise therapy appeared feasible in nine of 13 eligible patients (69%). Attendance rates were high (42–100%) and the majority of participants (n = 9) continued with aquatic exercise therapy beyond the initial two weeks. No serious complications (e.g. infections) occurred. Adverse symptoms (wound healing issues) were reported in five participants, but in four of them these were not likely to be due to the aquatic exercise therapy. Enjoyment was high and adherence to the aquatic exercise therapy was further facilitated by support from staff, a sense of achievement, noticeable improvements, personal motivation, and support from other participants. Peer support was reported as a positive side effect. Conclusions: These preliminary results indicate that aquatic exercise therapy is both feasible and acceptable for the majority of adult burn patients with an indication for supervised exercise therapy. No indications were found for an increased risk of infection or other serious complications.</p

Feasibility and acceptability of aquatic exercise therapy in burn patients – A pilot study

Background: As the assistive and resistive properties of water can facilitate the performance of exercise, aquatic exercise therapy might be a promising rehabilitation modality for burn patients. This study aimed to investigate the feasibility and acceptability of aquatic exercise therapy in adult burn patients with an indication for supervised exercise therapy. Methods: Eligible for this observational pilot study were all competent adult burn patients with an indication for supervised exercise therapy who had been admitted to the burn centre of the Maasstad Hospital between June 2016 and February 2017. Patients were asked to participate in an in-hospital aquatic exercise therapy program for a minimum of 2 weeks, 2 times per week, or otherwise serve as control by having land-based exercise therapy (regular care). Feasibility of aquatic exercise therapy was assessed by comparing the number of eligible patients to the number of patients that could actually participate, monitoring attendance rates, monitoring complications, and evaluating early experiences. Acceptability was assessed using the Water Exercise Acceptability Questionnaire. Results: Eleven patients were invited and ten of them agreed to participate. All chose aquatic instead of land-based exercise therapy. Participants were aged between 19 and 64 years and their burns affected 18–53% of total body surface area (TBSA). Aquatic exercise therapy appeared feasible in nine of 13 eligible patients (69%). Attendance rates were high (42–100%) and the majority of participants (n = 9) continued with aquatic exercise therapy beyond the initial two weeks. No serious complications (e.g. infections) occurred. Adverse symptoms (wound healing issues) were reported in five participants, but in four of them these were not likely to be due to the aquatic exercise therapy. Enjoyment was high and adherence to the aquatic exercise therapy was further facilitated by support from staff, a sense of achievement, noticeable improvements, personal motivation, and support from other participants. Peer support was reported as a positive side effect. Conclusions: These preliminary results indicate that aquatic exercise therapy is both feasible and acceptable for the majority of adult burn patients with an indication for supervised exercise therapy. No indications were found for an increased risk of infection or other serious complications.</p

Feasibility and acceptability of aquatic exercise therapy in burn patients – A pilot study

Background: As the assistive and resistive properties of water can facilitate the performance of exercise, aquatic exercise therapy might be a promising rehabilitation modality for burn patients. This study aimed to investigate the feasibility and acceptability of aquatic exercise therapy in adult burn patients with an indication for supervised exercise therapy. Methods: Eligible for this observational pilot study were all competent adult burn patients with an indication for supervised exercise therapy who had been admitted to the burn centre of the Maasstad Hospital between June 2016 and February 2017. Patients were asked to participate in an in-hospital aquatic exercise therapy program for a minimum of 2 weeks, 2 times per week, or otherwise serve as control by having land-based exercise therapy (regular care). Feasibility of aquatic exercise therapy was assessed by comparing the number of eligible patients to the number of patients that could actually participate, monitoring attendance rates, monitoring complications, and evaluating early experiences. Acceptability was assessed using the Water Exercise Acceptability Questionnaire. Results: Eleven patients were invited and ten of them agreed to participate. All chose aquatic instead of land-based exercise therapy. Participants were aged between 19 and 64 years and their burns affected 18–53% of total body surface area (TBSA). Aquatic exercise therapy appeared feasible in nine of 13 eligible patients (69%). Attendance rates were high (42–100%) and the majority of participants (n = 9) continued with aquatic exercise therapy beyond the initial two weeks. No serious complications (e.g. infections) occurred. Adverse symptoms (wound healing issues) were reported in five participants, but in four of them these were not likely to be due to the aquatic exercise therapy. Enjoyment was high and adherence to the aquatic exercise therapy was further facilitated by support from staff, a sense of achievement, noticeable improvements, personal motivation, and support from other participants. Peer support was reported as a positive side effect. Conclusions: These preliminary results indicate that aquatic exercise therapy is both feasible and acceptable for the majority of adult burn patients with an indication for supervised exercise therapy. No indications were found for an increased risk of infection or other serious complications.</p

A transcriptionally distinct CXCL13+CD103+CD8+ T-cell population is associated with B-cell recruitment and neoantigen load in human cancer

The chemokine CXCL13 mediates recruitment of B cells to tumors and is essential for the formation of tertiary lymphoid structures (TLSs). TLSs are thought to support antitumor immunity and are associated with improved prognosis. However, it remains unknown whether TLSs are formed in response to the general inflammatory character of the tumor microenvironment, or rather, are induced by (neo)antigen-specific adaptive immunity. We here report on the finding that the transforming growth factor beta (TGFβ)-dependent CD103+CD8+ tumor-infiltrating T-cell (TIL) subpopulation expressed and produced CXCL13. Accordingly, CD8+ T cells from peripheral blood activated in the presence of TGFβ upregulated CD103 and secreted CXCL13. Conversely, inhibition of TGFβ receptor signaling abrogated CXCL13 production. CXCL13+CD103+CD8+ TILs correlated with B-cell recruitment, TLSs, and neoantigen burden in six cohorts of human tumors. Altogether, our findings indicated that TGFβ plays a non-canonical role in coordinating immune responses against human tumors and suggest a potential role for CXCL13+CD103+CD8+ TILs in mediating B-cell recruitment and TLS formation in human tumors

Health status and psychological outcomes after trauma: A prospective multicenter cohort study

Introduction Survival after trauma has considerably improved. This warrants research on non-fatal outcome. We aimed to identify characteristics associated with both short and long-term health status (HS) after trauma and to describe the recovery patterns of HS and psychological outcomes during 24 months of follow-up. Methods Hospitalized patients with all types of injuries were included. Data were collected at 1 week 1, 3, 6, 12, and 24 months post-trauma. HS was assessed with the EuroQol-5D-3L (EQ-5D3L) and the Health Utilities Index Mark 2 and 3 (HUI2/3). For the screening of symptoms of post-traumatic stress, anxiety and depression, the Impact of Event Scale (IES) and the Hospital Anxiety and Depression Scale (HADS) subscale anxiety (HADSA) and subscale depression (HADSD) were used. Recovery patterns of HS and psychological outcomes were examined with linear mixed model analyses. Results A total of 4,883 patients participated (median age 68 (Interquartile range 53–80); 50% response rate). The mean (Standard Deviation (SD)) pre-injury EQ-5D-3L score was 0.85 (0.23). One week post-trauma, mean (SD) EQ-5D-3L, HUI2 and HUI3 scores were 0.49 (0.32), 0.61 (0.22) and 0.38 (0.31), respectively. These scores significantly improved to 0.77 (0.26), 0.77 (0.21) and 0.62 (0.35), respectively, at 24 months. Most recovery occurred up until 3 months. At long-term follow-up, patients of higher age, with comorbidities, longer hospital stay, lower extremity fracture and spine injury showed lower HS. The mean (SD) scores of the IES, HADSA and HADSD were respectively 14.80 (15.80), 4.92 (3.98) and 5.00 (4.28), respectively, at 1 week post-trauma and slightly improved over 24 months post-trauma to 10.35 (14.72), 4.31 (3.76) and 3.62 (3.87), respectively. Discussion HS and psychological symptoms improved over time and most improvements occurred within 3 months post-trauma. The effects of severity and type of injury faded out over time. Patients frequently reported symptoms of post-traumatic stress. Trial registration ClinicalTrials.gov identifier: NCT02508675

Development of a value-based healthcare burns core set for adult burn care

Background: Value-based healthcare (VBHC) is increasingly implemented in healthcare worldwide. Transparent measurement of the outcomes most important and relevant to patients is essential in VBHC, which is supported by a core set of most important quality indicators and outcomes. Therefore, the aim of this study was to develop a VBHC-burns core set for adult burn patients. Methods: A three-round modified national Delphi study, including 44 outcomes and 24 quality indicators, was conducted to reach consensus among Dutch patients, burn care professionals and researchers. Items were rated on a nine-point Likert scale and selected if ≥ 70% in each group considered an item ‘important’. Subsequently, instruments quantifying selected outcomes were identified based on a literature review and were chosen in a consensus meeting using recommendations from the Dutch consensus-based standard set and the Dutch Centre of Expertise on Health Disparities. Time assessment points were chosen to reflect the burn care and patient recovery process. Finally, the initial core set was evaluated in practice, leading to the adapted VBHC-burns core set. Results: Twenty-seven patients, 63 burn care professionals and 23 researchers participated. Ten outcomes and four quality indicators were selected in the Delphi study, including the outcomes pain, wound healing, physical activity, self-care, independence, return to work, depression, itching, scar flexibility and return to school. Quality indicators included shared decision-making (SDM), the number of patients receiving aftercare, determination of burn depth, and assessment of active range of motion. After evaluation of its use in clinical practice, the core set included all items except SDM, which are assessed by 9 patient-reported outcome instruments or measured in clinical care. Assessment time points included are at discharge, 2 weeks, 3 months, 12 months after discharge and annually afterwards. Conclusion: A VBHC-burns core set was developed, consisting of outcomes and quality indicators that are important to burn patients and burn care professionals. The VBHC-burns core set is now systemically monitored and analysed in Dutch burn care to improve care and patient relevant outcomes. As improving burn care and patient relevant outcomes is important worldwide, the developed VBHC-burns core set could be inspiring for other countries.</p

Impact of Splenic Artery Embolization on the Success Rate of Nonoperative Management for Blunt Splenic Injury

Introduction Nonoperative management (NOM) has become the treatment of choice for hemodynamically stable patients with blunt splenic injury. Results of outcome after NOM are predominantly based on large-volume studies from level 1 trauma centers in the United States. This study was designed to assess the results of NOM in a relatively low-volume Dutch level 1 trauma center. Methods An analysis of a prospective trauma registry was performed for a 6-year period before (period 1) and after the introduction and implementation of splenic artery embolization (SAE) (period 2). Primary outcome was the failure rate of initial treatment. Results A total of 151 patients were reviewed. An increased use of SAE and a reduction of splenic operations during the second period was observed. Compared with period 1, the failure rate after observation in period 2 decreased from 25% to 10%. The failure rate after SAE in period 2 was 18%. The splenic salvage rate (SSR) after observation increased from 79% in the first period to 100% in the second period. During the second period, all patients with failure after observation were successfully treated with SAE. The SSR after SAE in periods 1 and 2 was respectively 100% and 86%. Conclusions SAE of patients with blunt splenic injuries is associated with a reduction in splenic operations. The failure and splenic salvage rates in this current study were comparable with the results from large-volume studies of level 1 trauma centers. Nonoperative management also is feasible in a relatively low-volume level 1 trauma center outside the United State