E-health nazorg counseling voor een fysiek actievere levensstijl: Kan een op maat gemaakte e-health interventie een fysiek actievere levensstijl bevorderen?

Introduction: Research shows that rehabilitants encounter difficulties to participate in a healthy and active lifestyle in their home situation after their rehabilitation period.2 Effective prevention of secondary health problems, as a result of an inactive lifestyle, should start at the end of the rehabilitation period.3 The question is whether a customized e-health intervention is effective starting after outpatient rehabilitation treatment? Methods: In a randomised longitudinal experiment the effects of a custom-made e-health aftercare intervention on ‘physical active behaviour’, ‘exercise self-efficacy’ and ‘behavioural intention’ was determined. Adult patients were included 1-12 months after their rehabilitation treatment. These ex-rehabilitants (n = 16) diagnosed with spinal core injury (n = 8), CVA (n = 5) or acquired brain injury (n = 3) from rehabilitation centre Adelante Hoensbroek were randomly divided into two groups. Group 1 received three counselling sessions based on motivational interviewing using a webcam in a time period of 3 months. They further received a schematic reflection report (prompt) one week after each counselling session. Group 2 (control group) received no intervention the first three months. The second period of 3 months, group 2 received the same intervention as group 1, while group 1 received no intervention. In all three variables, the effect of the intervention was measured by comparing the difference score between T0 - T1 for group 1 with the difference score between T0 - T1 of group 2. In addition, the difference score within group 2 between T1 - T2 and T0 - T1 were also compared on all 3 variables. In order to see if the possible effects of the intervention after T1 remained stable, T1 was compared to T2 in group 1. At the end of the study, participants were contacted by mail for written feedback regarding the intervention. Results: Statistically significant difference was found for ‘physically active behaviour’ in favour of group 1 as compared to group 2 between T0 and T1. Within group 2, there was no significant difference between T1 and T2. ‘Exercise selfefficacy’ and ‘behavioral intent’ did not significantly improve, both in comparison between both groups and over time within the groups. One exception was the ‘exercise self-efficacy’ within group 2 between T1 and T2. Here a significant difference was found. Over time the intervention had no significant effect on outcome when groups were pooled. Conclusions: The tailor-made e-health intervention applied in this study seems to have effect on the ‘physically active behavior’ of the participants. However, the effect doesn’t remain over time (three months). Continued research is desirable to determine how the effect of intervention can be increased and results can be maintained over time

Which patients with osteoarthritis of hip and/or knee benefit most from behavorial graded activity?

Our objective was to investigate whether behavioral graded activity (BGA) has particular benefit in specific subgroups of osteoarthritis (OA) patients. Two hundred participants with OA of hip or knee, or both (clinical American College of Rheumatology, ACR, criteria) participated in a randomized clinical trial on the efficacy of BGA compared to treatment according to the Dutch physiotherapy guideline (usual care; UC). Changes in pain (Visual Analog Scale, VAS), physical functioning (Western Ontario and McMaster Universities Osteoarthritis Index, WOMAC, and McMaster Toronto Arthritis Questionnaire, MACTAR), and patient global assessment were compared for specific subgroups. Subgroups were assigned by the median split method and were analyzed using analysis of covariance. Beneficial effects of BGA were found for patients with a relatively low level of physical functioning (p?0.03). Furthermore, beneficial effects of BGA in patients with a low level of internal locus of control were marginally significant (p = .05). Patients with a relatively low level of physical functioning benefit more from BGA compared to UC. Compared to UC, BGA is the preferred treatment option in patients with a low level of physical functioning. (aut. ref.

Factors influencing the success of behavioral graded activity in patients with OA of hip and /or knee: a qualitative study.

Background: Recently, a randomized controlled trial was conducted on the effectiveness of behavioral graded activity (BGA) in patients with OA of hip and/or knee. The BGA intervention is performed by physiotherapists, and aims to increase activity in the long term. It consists of an exercise program with boostersessions, using operant treatment principles. Objective – To investigate why certain patients treated with BGA successfully integrate activities in their daily lives and others do not. Method: A qualitative study was performed, based on interviews with 12 patients. Patients were selected according to the model of deliberate sampling for heterogeneity. Selection was based on their success of the treatment as assessed on the patient global assessment (PGA). The data were coded and analysed using the methods developed in grounded theory. Results: The findings from this study suggest that two factors influence the compliance of patients treated with BGA. First, patients' motivation for long-term goals seems to relate to a higher compliance of patients. Secondly, an active involvement of patients during the treatment-process seems to relate to a higher compliance. Conclusion: Although the involvement of patients in the treatment process is already part of the BGA protocol, it would be beneficial to emphasize the importance of an active involvement of patients right from the start of the treatment. Furthermore, to increase the success of treatment, physiotherapists should gain a clear understanding of the patients' motives for treatment and, subsequently, physiotherapists can make use of the knowledge of these motives when making a choice for a specific intervention.(aut. ref.

The effectiveness of behavioral graded activity in patients with osteoarthrits of hip and/or knee: a randomized clinical trial.

Objective: To determine the effectiveness of a behavioral graded activity program (BGA) compared to usual care (UC, mainly exercise therapy) according to the Dutch guideline physiotherapy in patients with osteoarthritis (OA) of hip and/or knee. The BGA intervention consisted of an exercise program with boostersessions, using operant treatment principles with the goal to increase activity levels in the long term. Method: A cluster randomised controlled trial involving 200 patients with hip and/or knee OA (ACR-criteria) was performed. Primary outcome measures were pain (VAS and WOMAC), physical function (WOMAC) and global patient assessment (GPA), assessed at week 0, 13, 39 and 65. Data were analysed according to intention-to-treat principle. Additional subgroup-analyses were performed. Results: Both treatments showed beneficial within-group effects both in the short term and long term. The mean differences between the two groups for the primary outcome measures pain and functional status were not statistically significant. Significant differences in favour of BGA were found for the functional scale MACTAR and 5 meter walking test at week 65. Furthermore, significant interaction effects were found for the subgroup of patients according to their baseline-level of physical function on the outcomes pain and physical function. This means that patients with a low level of physical function at baseline responded significantly better on BGA-treatment compared to UC. Conclusion: Since both interventions resulted in beneficial long term effects, the superiority of BGA over UC, in general, could not be demonstrated. However, evidence was found for the particular benefit of BGA in the subgroup of patients with a low level of physical function at baseline. Therefore, BGA is recommended for patients with OA of hip and/or knee with a low level of physical function at the start of treatment. (aut. ref.