IOF-functioneringskonijn uit de hoge hoed getoverd

Item does not contain fulltextReactie op 'Herbeschouwing van het ICF-schema, Focus op functioneren', FysioPraxis 3-2017 (april), pag. 36-37. ln het aprilnummer van Fysiopraxis 2017 wordt, in de rubriek met de naam Wetenschap-exploratief onderzoek, door Heerkens et al. een poging ondernomen om het schema van de lnternational ClassiÍication of Functioning, Disability and Health (lCF) te reanimeren. ln naam van de wetenschap toveren de auteurs een 'functioneringskonijn' uit de hoge hoed.4 p

Solution space: Monitoring the dynamics of motor rehabilitation

This article presents and discusses a perspective on the concept of "solution space" in physiotherapy. The model is illustrated with a subjective assessment of the way movements are performed and an objective quantification of the dynamics of the recovery process for a patient with a knee injury. Based on insights from the domain of human motor control, solution space is a key concept in our recovery model that explains the emergence of a variety of adaptive changes that may occur in the movement system recovering from an injury. The three dimensions that span the solution space are: (1) information and control processes; (2) time; and (3) degrees of freedom. Each dimension is discussed within the context of feasible physiotherapeutic assessments to identify and facilitate desirable behavioral patterns or bypass emerging but undesirable behavioral patterns that could impede both short- and long-term recovery. Central to this article is our view on the relationship between the recovery process and the three dimensions of the solution space, which determines the model's usefulness as a motor-rehabilitation monitoring tool

The effectiveness of the use of a digital activity coaching system in addition to a two-week home-based exercise program in patients after total knee arthroplasty: study protocol for a randomized controlled trial

Contains fulltext : 176937.pdf (publisher's version ) (Open Access)BACKGROUND: There is consistent evidence that supervised programs are not superior to home-based programs after total knee arthroplasty (TKA), especially in patients without complications. Home-based exercise programs are effective, but we hypothesize that their effectiveness can be improved by increasing the adherence to physical therapy advice to reach an adequate exercise level during the program and thereafter. Our hypothesis is that an activity coaching system (accelerometer-based activity sensor), alongside a home-based exercise program, will increase adherence to exercises and the activity level, thereby improving physical functioning and recovery. The objective of this study is to determine the effectiveness of an activity coaching system in addition to a home-based exercise program after a TKA compared to only the home-based exercise program with physical functioning as outcome. METHODS: This study is a single-blind randomized controlled trial. Both the intervention (n = 55) and the control group (n = 55) receive a two-week home-based exercise program, and the intervention group receives an additional activity coaching system. This is a hand-held electronic device together with an app on a smartphone providing information and advice on exercise behavior during the day. The primary outcome is physical functioning, measured with the Timed Up and Go test (TUG) after two weeks, six weeks and three months. Secondary outcomes are 1) adherence to the activity level (activity diary); 2) physical functioning, measured with the 2-Minute Walk Test (2MWT) and the Knee Osteoarthritis Outcome Score; 3) quality of life (SF-36); 4) healthcare use up to one year postoperatively and 5) cost-effectiveness. Data are collected preoperatively, three days, two and six weeks, three months and one year postoperatively. DISCUSSION: The strengths of the study are the use of both performance-based tests and self-reported questionnaires and the personalized tailored program after TKA given by specialized physical therapists. Its weakness is the lack of blinding of the participants to treatment allocation. Outcomes are generalizable to uncomplicated patients as defined in the inclusion criteria. TRIAL REGISTRATION: The trial is registered in the Dutch Trial Register ( www.trialregister.nl , NTR 5109) (March 22, 2015)

Oplossingsruimte als indicator voor de gezondheid van het bewegingsapparaat

In dit artikel wordt uitgebreid aandacht besteed aan een invulling van de concepten restcapaciteit en oplossingsruimte. Dit wordt gedaan aan de hand van een virtuele casus van een patiënt met een nieuwe knieprothese ten gevolge van een knie met Osteoartritis. De virtuele casus wordt gebruikt om aan te geven waarom het beschrijven van de kwaliteit van het looppatroon of beenbewegingen informatief kan zijn voor wijze waarop herstel processen bevorderd kunnen worden. Centraal in dit schrijven staat de relatie tussen de dimensies Tijd (adaptatie), Vrijheidsgraden (compensatie) en Processen (efficiëntie) en herstelprocessen, ofwel de oplossingsruimte als indicator van de gezondheid van het bewegingsapparaat. Afsluitend wordt een voorstel uitgewerkt voor een fysiotherapeutische interventie bij de virtuele casus waarin het specifieke deel van de oplossingsruimte dat nog benut kan worden als richtpunt voor ons therapeutisch handelen kan dienen

Oplossingsruimte, een nieuw fenomeen in fysiotherapie?

Item does not contain fulltextLineaire causale verbanden tussen aandoeningen, stoornissen en beperkingen zijn zwak of niet aanwezig bij klachten van het bewegingsapparaat. Tijdens het fysiotherapeutisch redeneerproces wordt de aanwezige aandoening van het bewegingsapparaat als een 'constraint' (inperking) voor het neuromotorisch systeem beschouwd. De ICF wordt gebruikt om de restcapaciteit van de patiënt te bepalen. De fysiotherapie richt zich daarbij niet alleen op de beperkingen die de patiënt als gevolg van de aandoening ondervindt, maar ook op de acties die de patiënt nog wel kan uitvoeren, oftewel welk specifiek deel van de oplossingsruimte gebruikt wordt. De rijkgevulde 'gereedschapskist' van de fysiotherapeut met interventies zoals geleid actief bewegen, massage en mobilisaties kan worden ingezet om de restcapaciteit te vergroten of te optimaliseren.7 p

Are There Prognostic Factors for One-Year Outcome After Total Knee Arthroplasty? A Systematic Review

BACKGROUND: Preoperative factors predicting outcome for pain, physical function and quality of life after total knee arthroplasty (TKA) have not been clearly identified. METHODS: Embase and MEDLINE were searched for relevant studies. A study was considered for inclusion if the study aimed to identify preoperative prognostic factors for pain, physical function, and/or quality of life after a follow-up period of at least 1 year; included at least 200 adults suffering from osteoarthritis and undergoing TKA; and analyzed data using multivariable modeling. The quality of the evidence per prognostic factor was determined using the Grading of Recommendations, Assessment, Development and Evaluation framework for prognosis studies. RESULTS: A total of 18 studies were included. There is very low-quality evidence that preoperative more pain, presence of social support, absence of anxiety, and presence of more radiographic damage are prognostic factors for lower pain levels after TKA. There is very low-quality evidence that low preoperative physical function, less comorbidity, absence of anxiety, presence of social support, higher income, normal body mass index, and more radiographic damage are prognostic factors for better physical function. There is very low-quality evidence that female sex and less comorbidity are prognostic factors for better quality of life. CONCLUSION: Only very low-quality evidence was found for a number of prognostic factors of long-term outcome after TKA. More studies that seek to generate understanding of the underlying process for the prognosis of outcome in TKA are needed to understand and test prognostic pathways, and it might be more valuable to look at recovery curves rather than at recovery points. Systematic review registration number: CRD42015026814

Lopen is meer dan bewegen: Stagnatie van herstel na knietrauma

Loopgedrag dat wordt gedigitaliseerd met draagbare accelerometers en geanalyseerd middels moderne proces-maten kan onderliggende processen van het lopen zichtbaar maken. Deze processen kunnen de fysiotherapeut ondersteunen bij het maken van keuzes tijdens een behandeltraject. Aan de hand van een specifieke casus van een knietrauma worden op basis van geavanceerde analyses de keuzes in de klinische praktijk besproken

Haptic feedback helps bipedal coordination

The present study investigated whether special haptic or visual feedback would facilitate the coordination of in-phase, cyclical feet movements of different amplitudes. Seventeen healthy participants sat with their feet on sliding panels that were moved externally over the same or different amplitudes. The participants were asked to generate simultaneous knee flexion-extension movements, or to let their feet be dragged, resulting in reference foot displacements of 150 mm and experimental foot displacements of 150, 120, or 90 mm. Four types of feedback were given: (1) special haptic feedback, involving actively following the motions of the sliders manipulated by two confederates, (2) haptic feedback resulting from passive motion, (3) veridical visual feedback, and (4) enhanced visual feedback. Both with respect to amplitude assimilation effects, correlations and standard deviation of relative phase, the results showed that enhanced visual feedback did not facilitate bipedal independence, but haptic feedback with active movement did. Implications of the findings for movement rehabilitation contexts are discussed

Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus

AIM: The Royal Dutch Society for Physical Therapy (KNGF) instructed a multidisciplinary group of Dutch anterior cruciate ligament (ACL) experts to develop an evidence statement for rehabilitation after ACL reconstruction. DESIGN: Clinical practice guideline underpinned by systematic review and expert consensus. DATA SOURCES: A multidisciplinary working group and steering group systematically reviewed the literature and wrote the guideline. MEDLINE and the Cochrane Library were searched for meta-analyses, systematic reviews, randomised controlled trials and prospective cohort studies published between January 1990 and June 2015. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Included literature must have addressed 1 of 9 predetermined clinical topics: (1) preoperative predictors for postoperative outcome, (2) effectiveness of physical therapy, (3) open and closed kinetic chain quadriceps exercises, (4) strength and neuromuscular training, (5) electrostimulation and electromyographic feedback, (6) cryotherapy, (7) measurements of functional performance, (8) return to play and (9) risk for reinjury. SUMMARY: Ninety studies were included as the basis for the evidence statement. Rehabilitation after ACL injury should include a prehabilitation phase and 3 criterion-based postoperative phases: (1) impairment-based, (2) sport-specific training and (3) return to play. A battery of strength and hop tests, quality of movement and psychological tests should be used to guide progression from one rehabilitation stage to the next. Postoperative rehabilitation should continue for 9-12 months. To assess readiness to return to play and the risk for reinjury, a test battery, including strength tests, hop tests and measurement of movement quality, should be used