A pilot randomized controlled trial of exercise to improve cognitive performance in patients with stable glioma:A proof of concept

BACKGROUND: Patients with glioma often suffer from cognitive deficits. Physical exercise has been effective in ameliorating cognitive deficits in older adults and neurological patients. This pilot randomized controlled trial (RCT) explored the possible impact of an exercise intervention, designed to improve cognitive functioning in glioma patients, regarding cognitive test performance and patient-reported outcomes (PROs). METHODS: Thirty-four clinically stable patients with World Health Organization grades II/III glioma were randomized to a home-based remotely coached exercise group or an active control group. Patients exercised 3 times per week for 20-45 minutes, with moderate to vigorous intensity, during 6 months. At baseline and immediate follow-up, cognitive performance and PROs were assessed with neuropsychological tests and questionnaires, respectively. Linear regression analyses were used to estimate effect sizes of potential between-group differences in cognitive performance and PROs at 6 months. RESULTS: The exercise group (n = 21) had small- to medium-sized better follow-up scores than the control group (n = 11) on several measures of attention and information processing speed, verbal memory, and executive function, whereas the control group showed a slightly better score on a measure of sustained selective attention. The exercise group also demonstrated small- to medium-sized better outcomes on measures of self-reported cognitive symptoms, fatigue, sleep, mood, and mental health-related quality of life. CONCLUSIONS: This small exploratory RCT in glioma patients provides a proof of concept with respect to improvement of cognitive functioning and PROs after aerobic exercise, and warrants larger exercise trials in brain tumor patients

e-Exercise: The integration of face-to-face physiotherapy with a web-application for patients with osteoarthritis of hip and knee

e-Exercise zorgt voor vergelijkbare vooruitgang bij artrose met minder bezoeken aan de fysiotherapeut Patiënten met artrose aan de heup, knie of beiden die e-Exercise volgen gaan ongeveer evenveel vooruit als patiënten die reguliere fysiotherapie volgen, terwijl ze veel minder vaak bij de fysiotherapeut komen. Dit blijkt uit onderzoek van Nivel en Hogeschool Utrecht-onderzoeker Corelien Kloek, die hierop 4 april promoveert aan Tilburg University. Binnen e-Exercise worden reguliere fysiotherapiebehandelingen gecombineerd met een web-applicatie waarmee de patiënt thuis toegang heeft tot beweegopdrachten, oefeningen en informatie. Herinneringsmailtjes, video’s, monitoring door de fysiotherapeut en gepersonaliseerde feedback stimuleren de patiënt om met de opdrachten aan de slag te gaan. Lagere kosten Uit het onderzoek van Kloek blijkt dat patiënten met e-Exercise in vergelijkbare mate vooruitgaan in fysiek functioneren, pijn, vermoeidheid, zelf-effectiviteit en kwaliteit van leven, als mensen die reguliere fysiotherapiesessies volgen. De kosten van de interventie e-Exercise vielen significant lager uit dan die van reguliere fysiotherapie. Dit komt doordat het behandelgemiddelde bij e-Exercise op 5 sessies lag en bij reguliere fysiotherapie op 12. e-Exercise bleek voor de maatschappij echter niet significant kosteneffectiever dan reguliere fysiotherapie. Stimulans om aan de slag te gaan Patiënten die meededen aan het onderzoek hebben gemiddeld 10 van de 12 online modules gevolgd en gaven aan dat e-Exercise stimuleerde om thuis actief met de informatie en opdrachten aan de slag te gaan. Het gebruik van e-Exercise door fysiotherapeuten na afloop van het onderzoek viel tegen en behoeft nog aandacht. Zo gaven fysiotherapeuten aan behoefte te hebben aan een platform dat inzetbaar is voor meerdere doelgroepen, maar ook aan businessmodellen die aansluiten bij deze nieuwe manier van werken. Beschikbaar vanaf april 2018 Sinds het begin van het project is er in een werkgroep nagedacht over de implementatie van e-Exercise. Als resultaat hiervan worden er momenteel gesprekken gevoerd met zorgverzekeraars, wordt e-Exercise vanuit de Hogeschool Utrecht, het UMC Utrecht en Fontys Paramedische Hogeschool uitgebreid naar andere doelgroepen en wordt er scholing gegeven over e-Exercise. Vanaf april 2018 komt e-Exercise beschikbaar in de HWO-Afsprakenapp, een bestaande applicatie waarmee fysiotherapeuten hun patiënt kunnen herinneren aan opdrachten, oefeningen en afspraken. Artrose toenemend probleem Artrose is een chronische aandoening die zich kenmerkt door pijn en stijfheid in de gewrichten. Fysiotherapie, bestaande uit voorlichting, oefeningen en beweegopdrachten, is effectief in het verbeteren van het dagelijks functioneren en het verminderen van pijn bij mensen met artrose aan de heup en/of knie. Gezien het toenemende aantal mensen met artrose, is er behoefte aan interventies die die enerzijds stimuleren dat mensen in hun eigen omgeving actief met hun aandoening aan de slag gaan, en anderzijds ook nog eens goedkoper zijn. Onderzoek Binnen het e-Exercise project is door onderzoekers van het onderzoeksinstituut Nivel en Tilburg University (Tranzo) onderzocht of de integratie van een web-applicatie binnen reguliere fysiotherapie, ook wel blended care, een potentiële oplossing is. Tijdens het e-Exercise project is in samenwerking met patiënten, fysiotherapeuten en experts de interventie e-Exercise ontwikkeld. Na een pilot-fase is e-Exercise in 143 praktijken onderzocht op (kosten-)effectiviteit in vergelijking met reguliere face-to-face therapie. De 208 patiënten die mee hebben gedaan zijn door de onderzoekers 12 maanden gevolgd. Dit onderzoek is gefinancierd vanuit ZonMw Onderzoeksprogramma Sport, het Reumafonds en het Koninklijk Genootschap voor Fysiotherapie. Hoe werkt e-Exercise? https://www.youtube.com/watch?v=4l9GoQWWy5

e-Exercise geeft vergelijkbare resultaten tegen lagere kosten

Intramed Magazine, September 2017:pg5-

Development of a Checklist to Assist Physiotherapists in Determination of Patients’ Suitability for a Blended Treatment

Background: The integration of digital applications within health care is called blended care. Introduction: Despite its potential, physiotherapists experience difficulty in determining which patients are suitable for blended care. This study aimed to develop a checklist to support physiotherapists while setting up a blended treatment. Therefore, we aimed to investigate which patient characteristics predict patients’ suitability for blended physiotherapy and which patient characteristics need to be taken into account while determining the ratio between therapeutic guidance and a digital application. Methods: A scoping review was conducted consisting of (1) literature search in PubMed and PEDro up to December 2017: studies were eligible if they focused on blended physiotherapy consisting of contact at least twice with a physiotherapist complemented by a digital application, and characteristics related to patients’ suitability for blended physiotherapy were extracted and categorized in themes; (2) a checklist item for each theme formulated by the authors, which resulted in a first version of the Dutch Blended Physiotherapy Checklist; and (3) expert opinion and feedback on clinical relevance by six experts. The checklist was adapted accordingly. Results: The final Dutch Blended Physiotherapy Checklist consists of eight items: motivation, safety, equipment, digital skills, health literacy, self-management, time, and financial factors. Discussion: The next step is to investigate the feasibility and predictive validity of the checklist, that is, whether this checklist is actually able to predict patients’ suitability for blended physiotherapy. Conclusions: This study provides the final version of the Dutch Blended Physiotherapy Checklist, which is supposed to guide physiotherapists in their clinical reasoning process while setting up a personalized, blended physiotherapy treatment

Blended interventions to change behavior in patients with Chronic somatic disorders : Systematic review

Background: Blended behavior change interventions combine therapeutic guidance with online care. This new way of delivering health care is supposed to stimulate patients with chronic somatic disorders in taking an active role in their disease management. However, knowledge about the effectiveness of blended behavior change interventions and how they should be composed is scattered. Objective: This comprehensive systematic review aimed to provide an overview of characteristics and effectiveness of blended behavior change interventions for patients with chronic somatic disorders. Methods: We searched for randomized controlled trials published from 2000 to April 2017 in PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials. Risk of bias was assessed using the Cochrane Collaboration tool. Study characteristics, intervention characteristics, and outcome data were extracted. Studies were sorted based on their comparison group. A best-evidence synthesis was conducted to summarize the effectiveness. Results: A total of 25 out of the 29 included studies were of high quality. Most studies (n=21; 72%) compared a blended intervention with no intervention. The majority of interventions focused on changing pain behavior (n=17; 59%), and the other interventions focused on lifestyle change (n=12; 41%). In addition, 26 studies (90%) focused on one type of behavior, whereas 3 studies (10%) focused on multiple behaviors. A total of 23 studies (79%) mentioned a theory as basis for the intervention. The therapeutic guidance in most studies (n=18; 62%) was non face-to-face by using email, phone, or videoconferencing, and in the other studies (partly), it was face-to-face (n=11; 38%). In 26 studies (90%), the online care was provided via a website, and in 3 studies (10%) via an app. In 22 studies (76%), the therapeutic guidance and online care were integrated instead of two separate aspects. A total of 26 outcome measures were included in the evidence synthesis comparing blended interventions with no intervention: For the coping strategy catastrophizing, we found strong evidence for a significant effect. In addition, 1 outcome measure was included in the evidence synthesis comparing blended interventions with face-to-face interventions, but no evidence for a significant effect was found. A total of 6 outcome measures were included in the evidence synthesis comparing blended interventions with online interventions, but no evidence for a significant effect was found. Conclusions: Blended behavior change interventions for patients with chronic somatic disorders show variety in the type of therapeutic guidance, the type of online care, and how these two delivery modes are integrated. The evidence of the effectiveness of blended interventions is inconsistent and nonsignificant for most outcome measures. Future research should focus on which type of blended intervention works for whom

Movement behaviour patterns in patients with hip and/or knee osteoarthritis in the physical therapy setting: a cross-sectional study

Background: Osteoarthritis is one of the most common chronic joint diseases, mostly affecting the knee or hip through pain, joint stiffness and decreased physical functioning in daily life. Regular physical activity (PA) can help preserve and improve physical functioning and reduce pain in patients with osteoarthritis. Interventions aiming to improve movement behaviour can be optimized by tailoring them to a patients' starting point; their current movement behaviour. Movement behaviour needs to be assessed in its full complexity, and therefore a multidimensional description is needed. Objectives: The aim of this study was to identify subgroups based on movement behaviour patterns in patients with hip and/or knee osteoarthritis who are eligible for a PA intervention. Second, differences between subgroups regarding Body Mass Index, sex, age, physical functioning, comorbidities, fatigue and pain were determined between subgroups. Methods: Baseline data of the clinical trial 'e-Exercise Osteoarthritis', collected in Dutch primary care physical therapy practices were analysed. Movement behaviour was assessed with ActiGraph GT3X and GT3X+ accelerometers. Groups with similar patterns were identified using a hierarchical cluster analysis, including six clustering variables indicating total time in and distribution of PA and sedentary behaviours. Differences in clinical characteristics between groups were assessed via Kruskall Wallis and Chi2 tests. Results: Accelerometer data, including all daily activities during 3 to 5 subsequent days, of 182 patients (average age 63 years) with hip and/or knee osteoarthritis were analysed. Four patterns were identified: inactive & sedentary, prolonged sedentary, light active and active. Physical functioning was less impaired in the group with the active pattern compared to the inactive & sedentary pattern. The group with the prolonged sedentary pattern experienced lower levels of pain and fatigue and higher levels of physical functioning compared to the light active and compared to the inactive & sedentary. Conclusions: Four subgroups with substantially different movement behaviour patterns and clinical characteristics can be identified in patients with osteoarthritis of the hip and/or knee. Knowledge about these subgroups can be used to personalize future movement behaviour interventions for this population

Feasibility of a stratified blended physiotherapy intervention for patients with non-specific low back pain: a mixed methods study

Introduction: Integrating web-based or mobile components and face-to-face components within a treatment process is called blended care. As part of the participatory development of a blended physiotherapeutic intervention for patients with low back pain (e-Exercise LBP), a proof of concept study was carried out and showed promising results. Objective: To investigate the feasibility of the e-Exercise LBP prototype for patients and physiotherapists to improve the intervention. Methods: A mixed methods study was executed, embedded in the development phase of e-Exercise LBP. 21 physiotherapists treated 41 patients with e-Exercise LBP. Quantitative data consisted of: patients' satisfaction on a five-point Likert Scale; patients' and physiotherapists' experienced usability of the web-based application (System Usability Scale) and; patients' experiences with e-Exercise LBP (closed-ended questions and statements related to the elements and goals of e-Exercise LBP). Semi-structured interviews about experiences with e-Exercise LBP were conducted with seven patients and seven physiotherapists. Qualitative data were analyzed by a phenomenological approach. Quantitative data were analyzed with descriptive statistics. Results: Patients were satisfied with e-Exercise LBP (mean: 4.0; SD:0.8; range: extreme dissatisfaction (1)-extreme satisfaction (5)). Usability of the web-based application was acceptable (patients: mean: 73.2 (SD:16.3); physiotherapists: mean: 63.3 (SD:12.0); range: 0-100). Interviews revealed that physiotherapists' training is essential to successfully integrate the web-based application and face-to-face sessions within physiotherapy treatment. Also, patients addressed the need of reminder messages to support long-term (exercise) adherence. Conclusion: e-Exercise LBP appeared to be feasible. However, various prerequisites and points of improvement were mentioned to improve physiotherapists' training and the prototype

Videoconsulten binnen de fysiotherapie: Gebruik tijdens coronacrisis en implicaties voor de toekomst

Digitalisering is al sinds de jaren ‘90 een trend om zorg efficiënter en dicht bij de patiënt aan te aanbieden. COVID-19 heeft de digitalisering in een stroomversnelling gebracht. Ook binnen de fysiotherapie werd geëxperimenteerd met de inzet van videoconsulten. Het overgrote deel van patiënten was (zeer) tevreden over videoconsulten. Fysiotherapeuten waren wat gematigder enthousiast, mede omdat ze bepaalde diagnostische- en behandelelementen niet konden uitvoeren, die vaak onderdeel zijn van een behandeling