Are persons with rheumatoid arthritis deconditioned? A review of physical activity and aerobic capacity

BACKGROUND: Although the general assumption is that patients with rheumatoid arthritis (RA) have decreased levels of physical activity, no review has addressed whether this assumption is correct. METHODS: Our objective was to systematically review the literature for physical activity levels and aerobic capacity (VO(2max)). in patients with (RA), compared to healthy controls and a reference population. Studies investigating physical activity, energy expenditure or aerobic capacity in patients with RA were included. Twelve studies met our inclusion criteria. RESULTS: In one study that used doubly labeled water, the gold standard measure, physical activity energy expenditure of patients with RA was significantly decreased. Five studies examined aerobic capacity. Contradictory evidence was found that patients with RA have lower VO(2max) than controls, but when compared to normative values, patients scored below the 10(th) percentile. In general, it appears that patients with RA spend more time in light and moderate activities and less in vigorous activities than controls. CONCLUSION: Patients with RA appear to have significantly decreased energy expenditure, very low aerobic capacity compared to normative values and spend less time in vigorous activities than controls

Treatment based classification systems for patients with non-specific neck pain:A systematic review

Objective: We aimed to identify published classification systems with a targeted treatment approach (treatment-based classification systems (TBCSs)) for patients with non-specific neck pain, and assess their quality and effectiveness. Design: Systematic review. Data sources: MEDLINE, CINAHL, EMBASE, PEDro and the grey literature were systematically searched from inception to December 2019. Study appraisal and synthesis: The main selection criterium was a TBCS for patients with non-specific neck pain with physiotherapeutic interventions. For data extraction of descriptive data and quality assessment we used the framework developed by Buchbinder et al. We considered as score of ≤3 as low quality, a score between 3 and 5 as moderate quality and a score ≥5 as good quality. To assess the risk of bias of studies concerning the effectiveness of TBCSs (only randomized clinical trials (RCTs) were included) we used the PEDro scale. We considered a score of ≥ six points on this scale as low risk of bias. Results: Out of 7664 initial references we included 13 studies. The overall quality of the TBCSs ranged from low to moderate. We found two RCTs, both with low risk of bias, evaluating the effectiveness of two TBCSs compared to alternative treatments. The results showed that both TBCSs were not superior to alternative treatments. Conclusion: Existing TBCSs are, at best, of moderate quality. In addition, TBCSs were not shown to be more effective than alternatives. Therefore using these TBCSs in daily practice is not recommended

Completeness of the description of manipulation and mobilisation techniques in randomized controlled trials in neck pain:A review using the TiDieR checklist

Study design: A secondary analysis of a systematic review. Background: Manipulations or mobilizations are commonly used interventions in patients with mechanical neck pain. The treatment effects have often been studied in randomized controlled trials (RCT) which are generally considered the gold standard in evaluating the treatment effects, mainly due to its high internal validity. External validity is defined as the extent to which the effects can be generalised to clinical practice. An important prerequisite for this is that interventions used in clinical trials can be replicated in clinical practice. It can be questioned if interventions utilized in randomized controlled trials can be translated into clinical practice. Objectives: The overall aim of this study is to examine whether the quality of the description of manipulation and mobilization interventions is sufficient for to replication of these interventions in clinical practice. Methods: A comprehensive literature search was performed. Two independent researchers used the Template for Intervention Description and Replication (TIDieR) which is a 12-item checklist for describing the completeness of the interventions. Results: Sixty-seven articles were included that used manipulation and/or mobilization interventions for patients with mechanical neck pain. None of the articles describe the intervention e.g. all the items on the TIDieR list. Considering item 8 (a-f) of the TIDieR checklist only one article described the used techniques completely. Conclusion: Manipulation or a mobilization interventions are poorly reported in RCTs, which jeopardize the external validity of RCTs, making it difficult for clinicians and researchers to replicate these interventions

Микротопонимика воинской части. Часть 1.

Целью же данной статьи является выяснение места и значения микротопонимики воинской части в структуре военной субкультуры

Research Centre for Healthy and Sustainable Living

[EN] The Research Centre for Healthy and Sustainable Living of the University of Applied Sciences Utrecht aims to enable healthy urban living. According to the latest concept, health entails the capacity to respond resiliently to stressors that disturb homeostasis. In addition, an individual’s health benefits from the ability to self-manage and is determined by personalized conditions. One of the derived research challenges is to obtain know-how (biomarkers) and tools (e.g. point-of-care, wearables) to monitor an individual’s health condition in daily life. The well-known quotes “you are what you eat” and “sitting is the new smoking” indicate that condition of the oro-gastrointestinal tract and physical activity are pivotal to health. With this popular knowledge, we set out to identify biomarkers to monitor health benefits from nutrition and physical activity. Our first studies with human volunteers indicated that immune and intestinal parameters are responsive to physical stress (performed on a bicycle ergometer) in a clear kinetic manner, related to extent of physical activity and influenced by an unhealthy condition (deprivation of water intake during exercise). Our next research goals are to: -evaluate the initial selection of biomarkers in specific patient-groups and; -how these biomarkers are influenced by the condition of the oro-gastrointestinal tract, e.g. via nutrition.Pieters, R.; Bleijenberg, N.; Jerkovic, K.; Krul, C.; Veenhof, C.; Wittink, H. (2020). Research Centre for Healthy and Sustainable Living. Editorial Universitat Politècnica de València. http://hdl.handle.net/10251/156433OC

Musculoskeletal Pain:Current and Future Directions of Physical Therapy Practice

Musculoskeletal (MSK) pain is 1 of the most common problems managed by clinicians in MSK care. This article reviews current frameworks for the assessment and management of MSK pain within evidence-based physical therapy practice. Key considerations related to the biopsychosocial model of pain, evidence-based practice, assessment, treatment, physical activity/movement behavior, risk stratification, communication as well as patient education and self-management skills within physical therapy and physical and rehabilitation medicine are addressed. The future direction of MSK pain management is also discussed, including strategies to promote evidence-based practice, behavior change, social prescribing, and the use of technologies.status: Published onlin

Virtual obstacle crossing:Reliability and differences in stroke survivors who prospectively experienced falls or no falls

Introduction Stroke survivors often fall during walking. To reduce fall risk, gait testing and training with avoidance of virtual obstacles is gaining popularity. However, it is unknown whether and how virtual obstacle crossing is associated with fall risk. Aim The present study assessed whether obstacle crossing characteristics are reliable and assessed differences in stroke survivors who prospectively experienced falls or no falls. Method We recruited twenty-nine community dwelling chronic stroke survivors. Participants crossed five virtual obstacles with increasing lengths. After a break, the test was repeated to assess test-retest reliability. For each obstacle length and trial, we determined; success rate, leading limb preference, pre and post obstacle distance, margins of stability, toe clearance, and crossing step length and speed. Subsequently, fall incidence was monitored using a fall calendar and monthly phone calls over a six-month period. Results Test-retest reliability was poor, but improved with increasing obstacle-length. Twelve participants reported at least one fall. No association of fall incidence with any of the obstacle crossing characteristics was found. Discussion Given the absence of height of the virtual obstacles, obstacle avoidance may have been relatively easy, allowing participants to cross obstacles in multiple ways, increasing variability of crossing characteristics and reducing the association with fall risk. Conclusion These finding cast some doubt on current protocols for testing and training of obstacle avoidance in stroke rehabilitation

Does a Perturbation Based Gait Intervention Enhance Gait Stability in Fall Prone Stroke Survivors?:A Pilot Study

A recent review indicated that perturbation based training (PBT) interventions are effective in reducing falls in older adults and patients with Parkinson's disease. It is unknown whether this type of intervention is effective in stroke survivors. We determined whether PBT can enhance gait stability in stroke survivors. Ten chronic stroke survivors who experienced falls in the past six months participated in the PBT. Participants performed 10 training sessions over a six-week period. The gait training protocol was progressive and each training contained, unexpected gait perturbations and expected gait perturbations. Evaluation of gait stability was performed by determining steady-state gait characteristics and daily-life gait characteristics. We previously developed fall prediction models for both gait assessment methods. We evaluated whether predicted fall risk was reduced after PBT according to both models. Steady-state gait characteristics significantly improved and consequently predicted fall risk was reduced after the PBT. Daily-life gait characteristics, however, did not change and thus predicted fall risk based on daily-life gait remained unchanged after the PBT. A PBT resulted in more stable gait on a treadmill and thus lower predicted fall risk. However, the more stable gait on the treadmill did not transfer to a more stable gait in daily life

An Exploratory Practice-Oriented Pilot Study into Matched Treatments in Patients with Non-Specific Neck Pain

Background: Even though physiotherapists attempt to match care to the patient’s needs, there is little knowledge about which treatments are applied in daily practice and which treatments have the most potential to improve ROM in patients with non-specific neck pain with a limited ROM. The objective of this study was 1) to establish the measurement error of the Sensamove cervical training accelerometer (SCT); 2) to describe the applied treatments for patients with non-specific neck pain with an identified restriction in cervical Range of Motion (ROM) in primary care physiotherapy clinics; 3) to explore if the cervical ROM, pain, (perceived) disability and motor control improved after one manual therapy treatment. Methods: The standard error of measurement (SEM) and the smallest detectable difference (SDD) were calculated based on a test-retest study. Second, an explorative, longitudinal study design (follow-up one week) was performed. Inclusion criterion: nonspecific neck pain with an identified restriction in cervical ROM. Measurements: pre- (T0) and post-treatment (T1), and one-week post-treatment (T2). Outcomes: ROM, motor control movement task, Numerical Pain Rating Scale (NPRS), and Patient Specific Function Scale (PSFS). Results: The SEM varied from 1.62° (lateral flexion right) to 3.46° (extension). The SDD varied from 4.49° (lateral flexion right) to 9.58° (extension). Four physiotherapists included 24 patients and used eight different treatments. The T0-T2 improvement in cervical ROM ranged from 2.95° (SD 6.09) (right lateral flexion) to 11.00° (SD11.87) (left rotation). The movement task was performed 3.96 (SD 4.24) seconds faster. The NPRS decreased by 3.08 (SD 1.82) points, and PSFS improved by 7.71 (SD 5.34) points. Conclusion: The measurement error has been established. Moreover, this study illustrates that matched treatments, as applied in daily practice, have the potential to induce short-term improvements