The current implementation status of the integration of sports and physical activity into Dutch rehabilitation care

Purpose: To describe the current status of the nationwide implementation process of a sports and physical activity stimulation programme to gain insight into how sports and physical activity were integrated into Dutch rehabilitation care. Methods: The current implementation status of a sports and physical activity stimulation programme in 12 rehabilitation centres and 5 hospitals with a rehabilitation department was described by scoring fidelity and satisfaction. Seventy-one rehabilitation professionals filled out a questionnaire on how sports and physical activity, including stimulation activities, were implemented into rehabilitation care. Total fidelity scores (in %) were calculated for each organization. Professionals’ satisfaction was rated on a scale from 1 to 10. Results: In most organizations sports and physical activity were to some extent integrated during and after rehabilitation (fidelity scores: median = 54%, IQR = 23%). Physical activity stimulation was not always embedded as standard component of a rehabilitation treatment. Professionals’ satisfaction rated a median value of 8.0 (IQR = 0.0) indicating high satisfaction rates. Conclusions: The fidelity outcome showed that activities to stimulate sports and physical activity during and after rehabilitation were integrated into rehabilitation care, but not always delivered as standardized component. These findings have emphasized the importance to focus on integrating these activities into routines of organizations.Implications for Rehabilitation Components of an evidence-based programme to stimulate sports and physical activity during and after rehabilitation can be used to measure the current status of the integration of sports and physical activity in rehabilitation care in a structural and effective way. The method described in the current study can be used to compare the content of the rehabilitation care regarding the integration of sports and physical activity among organizations both on a national and international level. Sports and physical activity are seen as important ingredients for successful rehabilitation care in The Netherlands

Implementing Individually Tailored Prescription of Physical Activity in Routine Clinical Care:Protocol of the Physicians Implement Exercise = Medicine (PIE=M) Development and Implementation Project

BACKGROUND: The prescription of physical activity (PA) in clinical care has been advocated worldwide. This "exercise is medicine" (E=M) concept can be used to prevent, manage, and cure various lifestyle-related chronic diseases. Due to several challenges, E=M is not yet routinely implemented in clinical care. OBJECTIVE: This paper describes the rationale and design of the Physicians Implement Exercise = Medicine (PIE=M) study, which aims to facilitate the implementation of E=M in hospital care. METHODS: PIE=M consists of 3 interrelated work packages. First, levels and determinants of PA in different patient and healthy populations will be investigated using existing cohort data. The current implementation status, facilitators, and barriers of E=M will also be investigated using a mixed-methods approach among clinicians of participating departments from 2 diverse university medical centers (both located in a city, but one serving an urban population and one serving a more rural population). Implementation strategies will be connected to these barriers and facilitators using a systematic implementation mapping approach. Second, a generic E=M tool will be developed that will provide tailored PA prescription and referral. Requirements for this tool will be investigated among clinicians and department managers. The tool will be developed using an iterative design process in which all stakeholders reflect on the design of the E=M tool. Third, we will pilot-implement the set of implementation strategies, including the E=M tool, to test its feasibility in routine care of clinicians in these 2 university medical centers. An extensive learning process evaluation will be performed among clinicians, department managers, lifestyle coaches, and patients using a mixed-methods design based on the RE-AIM framework. RESULTS: This project was approved and funded by the Dutch grant provider ZonMW in April 2018. The project started in September 2018 and continues until December 2020 (depending on the course of the COVID-19 crisis). All data from the first work package have been collected and analyzed and are expected to be published in 2021. Results of the second work package are described. The manuscript is expected to be published in 2021. The third work package is currently being conducted in clinical practice in 4 departments of 2 university medical hospitals among clinicians, lifestyle coaches, hospital managers, and patients. Results are expected to be published in 2021. CONCLUSIONS: The PIE=M project addresses the potential of providing patients with PA advice to prevent and manage chronic disease, improve recovery, and enable healthy ageing by developing E=M implementation strategies, including an E=M tool, in routine clinical care. The PIE=M project will result in a blueprint of implementation strategies, including an E=M screening and referral tool, which aims to improve E=M referral by clinicians to improve patients' health, while minimizing the burden on clinicians

Test of Wheeled Mobility (TOWM) and a short wheelie test:a feasibility and validity study

<p>Objective: To assess the feasibility and validity of both the Test of Wheeled Mobility (TOWM) and a wheelie test.</p><p>Design: Cross-sectional study.</p><p>Setting: KU Leuven gymnasium.</p><p>Subjects: Thirty male manual wheelchair users (age range 23-53 years) with spinal cord injury.</p><p>Interventions: Participants preformed both tests after completing a personal information form and a 'Perceived self-efficacy in WM' scale. The TOWM consists of 30 tasks reflecting functional wheeled mobility. The wheelie test consists of eight tasks measuring the ability to perform a 'wheelie' in challenging situations.</p><p>Main measure: Ability, performance time, qualitative and anxiety scores were assessed. Convergent validity was tested by correlating the TOWM and the wheelie test scores. Construct validity was assessed by testing whether the four scores of both tests are significantly related to perceived self-efficacy in wheeled mobility, time since injury and sport participation.</p><p>Results: TOWM average total testing time was 24.7 minutes (+/- 5.93) and the wheelie test was 12.62 minutes (+/- 5.08). Convergent validity was confirmed by the positive correlation between the TOWM and wheelie test total ability scores (r = 0.84; P <0.001), quality scores (r = 0.88) and anxiety scores (r = 0.66). Moderate correlations were found between the total time scores of the TOWM and wheelie test (r = 0.47). Construct validity was confirmed by fair to moderate correlations between both test's scores with time since injury, self-efficacy and sport participation after injury.</p><p>Conclusion: The TOWM and the wheelie tests are feasible and valid instruments for assessing manual wheelchair mobility in persons with spinal cord injury.</p>

Skill acquisition of manual wheelchair propulsion: initial motor learning

Changes in propulsion technique due to motor learning might account for a higher mechanical efficiency (ME, the ratio of internal power over external power). The changes in ME and propulsion technique were studied in a learning experiment, three times a week for eight minutes, with nine able-bodied subjects, simulating early rehabilitation. Instrumented wheels measured three-dimensional forces and torques on the handrim. During practice peak torques were reduced, work per cycle increased, while push frequency decreased, at a stable power output and speed of the treadmill. Over the three weeks of practice propulsion technique kept changing in combination with an increase of ME. Results suggest skill acquisition because of motor learning. The rise in ME seems logically related to propulsion technique, but is not yet fully understood. More insight in motor learning and skill acquisition will contribute to understanding and optimizing rehabilitation strategies in the light of wheelchair provision in early rehabilitation

Development of a portable low-cost system for the metrological verification of wheelchair roller ergometers

Wheelchair ergometers are widely used in research, clinical practice, and sports environments. The majority of wheelchair ergometers are roller systems that allow for wheelchair propulsion in the personal wheelchair on one or two (instrumented) rollers. Oftentimes these systems are only statically calibrated. However, wheelchair propulsion is dynamic by nature, requiring a dynamic validation process. The aim of the current project was to present a low-cost portable system for the dynamic metrological verification of wheelchair roller ergometers, based on an instrumented reference wheel. The tangential force on the roller is determined, along with its uncertainty, from the reference wheel properties, and compared with the force measured by the ergometer. Uncertainty of this reference wheel system was found to be lower than the one of the ergometer used, indicating that this novel approach can be used for the metrological verification of ergometers.</p

Gross mechanical efficiency of the combined arm–leg (Cruiser) ergometer

The combined arm-leg (Cruiser) ergometer is assumed to be a relevant testing and training instrument in the rehabilitation of patients with a lower limb amputation. The efficiency and submaximal strain have not been established and thus cannot be compared with alternative common modes of exercise. A total of 22 healthy able-bodied men (n=10) and women (n=12) were enrolled in four discontinuous submaximal graded exercise tests. Each test consisted of seven bouts of 3 min exercise ranging from 20 to 45 W and was performed on, respectively, the Cruiser ergometer, a bicycle ergometer, a handbike, and again the Cruiser ergometer. Cardiorespiratory parameters were measured and rate of perceived exertion was determined. Gross mechanical efficiency (GE) was determined from power output and submaximal steady-state energy cost. Repeated-measures analysis of variance (P<0.05) was used to evaluate the effects of exercise mode, exercise intensity, and sex. No differences in GE and cardiorespiratory strain were found between both Cruiser tests (GE 45 W: men 13.0%, women 15%) and the bicycle test (GE 45 W: men 13.2%, women 14.6%). GEs of handbiking (45 W: men 11.2%, women 12.2%) were lower compared with the Cruiser and bicycle test results, whereas cardiorespiratory strain in handbiking was consistently higher. Apart from a lower rate of perceived exertion at the second Cruiser test, no differences were found between the repeated Cruiser tests. It can be concluded that GE and cardiorespiratory strain in submaximal Cruiser exercise are comparable with leg cycling, the repeatability was good, and no obvious learning effects were observed. The results of this study form a base for further research in patients with a lower limb amputation

Dataset for manuscript entitled 'Steering does affect biophysical responses in asynchronous, but not synchronous submaximal handcycle ergometry in able-bodied men': Biophysical effects of steering on asynchronous and synchronous submaximal handcycle ergometry in able-bodied men

The aim of the study was to evaluate the effects of combining propulsion and steering requirements on synchronous and asynchronous submaximal handcycle ergometry. A biophysical approach was taken, combining physiological and biomechanical measures. Location of data collection: Department of Movement Science, Institute for Sport and Exercise Sciences, University of Münster, Horstmarer Landweg 62b, 48149 Münster, German

Design of a cross-sectional study on physical fitness and physical activity in children and adolescents after burn injury

BACKGROUND: Burn injuries have a major impact on the patient’s physical and psychological functioning. The consequences can, especially in pediatric burns, persist long after the injury. A decrease in physical fitness seems logical as people survive burn injuries after an often extensive period of decreased activity and an increased demand of proteins leading to catabolism, especially of muscle mass. However, knowledge on the possibly affected levels of physical fitness in children and adolescents after burn injury is limited and pertains only to children with major burns. The current multidimensional study aims to determine the level of physical fitness, the level of physical activity, health-related quality of life and perceived fatigue in children after a burn injury. Furthermore, interrelations between those levels will be explored, as well as associations with burn characteristics. METHODS/DESIGN: Children and adolescents in the age range of 6 up to and including 18 years are invited to participate in this cross-sectional descriptive study if they have been admitted to one of the three Dutch burn centers between 6 months and 5 years ago with a burn injury involving at least 10% of the total body surface area and/or were hospitalized ≥ 6 weeks. Physical fitness assessments will take place in a mobile exercise lab. Quantitative measures of cardiorespiratory endurance, muscular strength, body composition and flexibility will be obtained. Outcomes will be compared with Dutch reference values. Physical activity, health-related quality of life and fatigue will be assessed using accelerometry and age-specific questionnaires. DISCUSSION: The findings of the current study will contribute to a better understanding of the long-term consequences of burn injury in children and adolescents after burns. The results can guide rehabilitation to facilitate a timely and optimal physical recovery. TRIAL REGISTRATION: The study is registered in the National Academic Research and Collaborations Information System of the Netherlands (OND1348800)

Design of a cross-sectional study on physical fitness and physical activity in children and adolescents after burn injury

BACKGROUND: Burn injuries have a major impact on the patient's physical and psychological functioning. The consequences can, especially in pediatric burns, persist long after the injury. A decrease in physical fitness seems logical as people survive burn injuries after an often extensive period of decreased activity and an increased demand of proteins leading to catabolism, especially of muscle mass. However, knowledge on the possibly affected levels of physical fitness in children and adolescents after burn injury is limited and pertains only to children with major burns. The current multidimensional study aims to determine the level of physical fitness, the level of physical activity, health-related quality of life and perceived fatigue in children after a burn injury. Furthermore, interrelations between those levels will be explored, as well as associations with burn characteristics. METHODS/DESIGN: Children and adolescents in the age range of 6 up to and including 18 years are invited to participate in this cross-sectional descriptive study if they have been admitted to one of the three Dutch burn centers between 6 months and 5 years ago with a burn injury involving at least 10% of the total body surface area and/or were hospitalized ≥ 6 weeks. Physical fitness assessments will take place in a mobile exercise lab. Quantitative measures of cardiorespiratory endurance, muscular strength, body composition and flexibility will be obtained. Outcomes will be compared with Dutch reference values. Physical activity, health-related quality of life and fatigue will be assessed using accelerometry and age-specific questionnaires. DISCUSSION: The findings of the current study will contribute to a better understanding of the long-term consequences of burn injury in children and adolescents after burns. The results can guide rehabilitation to facilitate a timely and optimal physical recovery. TRIAL REGISTRATION: The study is registered in the National Academic Research and Collaborations Information System of the Netherlands (OND1348800)

Handrim wheelchair propulsion technique in individuals with spinal cord injury with and without shoulder pain - a cross-sectional comparison.

OBJECTIVE: To compare handrim wheelchair propulsion technique between individuals with spinal cord injury (SCI) with and without shoulder pain. DESIGN: A cross-sectional study including 38 experienced handrim wheelchair users with SCI. Participants were divided in a 'shoulder pain' (n = 15) and 'no-shoulder pain' (n = 23) group using the Local Musculoskeletal Discomfort scale. Kinetic and spatiotemporal aspects of handrim wheelchair propulsion during submaximal exercise on a motor-driven treadmill were analyzed. Data were collected using a measurement wheel instrumented with 3D force sensors. RESULTS: After correction for confounders (time since injury and body height), linear regression analyses showed the pain group had a 0.30 s (95% CI, -0.5 to -0.1) shorter cycle time, 0.22 s (95% CI, -0.4 to -0.1) shorter recovery time, 15.6° (95% CI, -27.4 to -3.8) smaller contact angle and 8% (95% CI, -15 to 0) lower variability in the work per push compared to the no-pain group. Other parameters did not differ between groups. CONCLUSIONS: This study indicates that individuals with SCI who experience shoulder pain propel their handrim wheelchair kinematically different from individuals with SCI without shoulder pain. This difference in propulsion technique might be a pain-avoiding mechanism aimed at decreasing shoulder range of motion