Risk factors for pelvic girdle pain postpartum and pregnancy related low back pain postpartum:a systematic review and meta-analysis

Contains fulltext : 221001.pdf (Publisher’s version ) (Closed access)BACKGROUND: Although pelvic girdle pain postpartum and pregnancy related low back pain postpartum (combined and named PGPP in this study) have a natural favourable course, there is a subgroup of women who have persistent complaints. The objective of this study was to identify personal-, (pre)pregnancy-, obstetric-, and child related risk factors on PGPP by means of a systematic literature review and meta-analysis. METHODS: Literature searches of PubMed, EMBASE, CINAHL and Cochrane up to October 2018 were conducted. Prospective cohort studies in English or Dutch describing three or more risk factors for PGPP were included. We assessed articles for inclusion and risk of bias. Studies with high risk of bias were excluded from data extraction. Data was extracted and checked for accuracy confirming to the CHARMS-checklist. Homogeneous variables were pooled. RESULTS: Twelve full text studies were assessed. Seven studies were excluded due to high risk of bias. Data was extracted from five studies. Multivariate analysis was not possible due to heterogeneity in included risk factors as well as outcome measures on risk factor per study. Pooled univariate significant risk factors on PGPP were: a history of low back pain, pre-pregnancy body mass index >25, pelvic girdle pain in pregnancy, depression in pregnancy, and a heavy workload in pregnancy. No significant obstetric and child related risk factors were reported. CONCLUSIONS: Risk factors on PGPP have been identified. Since multivariate analysis was not possible the outcome should be treated with care, because interaction between risk factors could not be analysed

Identifying unmet needs and limitations in physical health in survivors of Head and Neck Cancer

Objective: To gain insight into the level of unmet needs and limitations in physical health experienced by survivors of head and neck cancer, and to evaluate whether unmet needs in physical health and limitations in physical performance are associated. Materials and methods: In this cross-sectional study, unmet needs were measured with Supportive Care Needs Surveys (SCNS-SF34, SCNS-HNC). Limitations in physical health were measured for maximal mouth opening, neck and shoulder function, hand grip strength and lower body strength, level of mobility and walking ability. Results: The SCNSs showed that 48% had a cancer generic unmet need and 46% had at least one HNC-specific unmet need. In total, 76% of sHNC had a cancer generic limitation in physical health and that 58% had an HNC-specific limitation in the mobility of neck and shoulders or maximum mouth opening. The domain of physical and daily living needs showed a weak association with lateral flexion of the neck to the left (R = −0.319; p = 0.024). Conclusion: Survivors of HNC might benefit from the use of both SCNSs and physical performance measurements during usual care follow-up for early and optimal identification of unmet needs and limitations in physical health

Effect of elective neck dissection versus sentinel lymph node biopsy on shoulder morbidity and health-related quality of life in patients with oral cavity cancer: A longitudinal comparative cohort study

Objective: To research the difference in shoulder morbidity and health-related quality of life between patients with cT1-2N0 oral cavity squamous cell carcinoma that undergo either elective neck dissection (END) or a sentinel lymph node biopsy (SLNB) based approach of the neck. Materials and methods: A longitudinal study with measurements before surgery, 6 weeks, 6 months, and 12 months after surgery. Shoulder morbidity were determined with measurements of active range of motion of the shoulder and patient-reported outcomes for shoulder morbidity (SDQ, SPADI) and health-related quality of life (HR-QoL) (EQ5D, EORTC-QLQ-HN35). Linear mixed model analyses were used to analyze differences over time between patients that had END, SLNB or SLNB followed by complementing neck dissection. Results: We included 69 patients. Thirty-three patients were treated with END. Twenty-seven patients had SLNB without complementing neck dissection (SLNB), and nine were diagnosed lymph node positive followed by completion neck dissection (SLNB + ND). Ipsilateral shoulder abduction (P = .031) and forward flexion (P = .039) were significantly better for the SLNB group at 6 weeks post-intervention compared to the END and SLNB + ND group. No significant differences for shoulder morbidity, or health-related quality of life were found at 6 weeks, 6 months, and 12 months between the three groups. Conclusion: With oncologic equivalence for the END and SLNB as strategies for the cN0 neck already demonstrated, and the SLNB being more cost-effective, our demonstrated benefit in short-term shoulder function strengthens the choice for the SLNB as a preferred treatment strategy

Measurement of fine-motor skills in young children with visual impairment

Insight into the typical motor development of children with visual impairment (VI) is necessary in order to recognise whether children with VI are at risk of motor developmental problems, and to evaluate the effectiveness of exercise interventions. In 2003 the ManuVis was published with reference values for children with VI of ages from 6 to 11 years. This paper reports on a follow-up study of the ManuVis focused on: a) comparison of fine motor skills between children with VI and normal sighted (NS) children; b) sampling norm-references for children with VI in the 4-11 years age range to increase validity; and c) test-retest and inter-rater reliability. In total 256 children with VI and 162 NS children were included in the study. The results demonstrated that children with VI needed significantly more time than NS children to perform all test items, especially at younger ages. Performance time decreased in both children with VI and NS children from the younger to the older age groups, but NS children reached their minimum at a younger age. Test-retest reliability on the items varied from moderate to excellent and inter-rater reliability was excellent. The results suggest that children with VI have slower and more prolonged motor learning than NS children. The ManuVis differentiates between typical and atypical fine-motor performance of children with VI between 4 and 9 years of age, and is useful for monitoring fine-motor skills in children with VI from 4 years to (at least) 11 years.<br/

The diagnostic accuracy of headache measurement instruments : A systematic review and meta-analysis focusing on headaches associated with musculoskeletal symptoms

Aim: To systematically review the available literature on the diagnostic accuracy of questionnaires and measurement instruments for headaches associated with musculoskeletal symptoms. Design: Articles were eligible for inclusion when the diagnostic accuracy (sensitivity/specificity) was established for measurement instruments for headaches associated with musculoskeletal symptoms in an adult population. The databases searched were PubMed (1966–2018), Cochrane (1898–2018) and Cinahl (1988–2018). Methodological quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist for criterion validity. When possible, a meta-analysis was performed. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) recommendations were applied to establish the level of evidence per measurement instrument. Results: From 3450 articles identified, 31 articles were included in this review. Eleven measurement instruments for migraine were identified, of which the ID-Migraine is recommended with a moderate level of evidence and a pooled sensitivity of 0.87 (95% CI: 0.85–0.89) and specificity of 0.75 (95% CI: 0.72–0.78). Six measurement instruments examined both migraine and tension-type headache and only the Headache Screening Questionnaire – Dutch version has a moderate level of evidence with a sensitivity of 0.69 (95% CI 0.55–0.80) and specificity of 0.90 (95% CI 0.77–0.96) for migraine, and a sensitivity of 0.36 (95% CI 0.21–0.54) and specificity of 0.86 (95% CI 0.74–0.92) for tension-type headache. For cervicogenic headache, only the cervical flexion rotation test was identified and had a very low level of evidence with a pooled sensitivity of 0.83 (95% CI 0.72–0.94) and specificity of 0.82 (95% CI 0.73–0.91). Discussion: The current review is the first to establish an overview of the diagnostic accuracy of measurement instruments for headaches associated with musculoskeletal factors. However, as most measurement instruments were validated in one study, pooling was not always possible. Risk of bias was a serious problem for most studies, decreasing the level of evidence. More research is needed to enhance the level of evidence for existing measurement instruments for multiple headaches

Using e-Health in the physical therapeutic care process for patients with temporomandibular disorders: a qualitative study on the perspective of physical therapists and patients

Background: Treatment of temporomandibular disorder (TMD) currently consists of a combination of noninvasive therapies and may be supported by e-Health. It is, however, unclear if physical therapists and patients are positive towards the use of e-Health. Purpose: To assess the needs, facilitators and barriers of the use of an e-Health application from the perspective of both orofacial physical therapists and patients with TMD. Methods: A descriptive qualitative study was performed. Eleven physical therapists and nine patients with TMD were interviewed using a topic guide. Thematic analysis was applied, and findings were ordered according to four themes: acceptance of e-Health, expected utility, usability and convenience. Results: Physical therapists identified the need for e-Health as a supporting application to send questionnaires, animated exercises and evaluation tools. Key facilitators for both physical therapists and patients for implementing e-Health included the increase in self-efficacy, support of data collection and personalization of the application. Key barriers are the increase of screen time, the loss of personal contact, not up-to-date information and poor design of the application. Conclusions: Physical therapists and patients with TMD are positive towards the use of e-Health, in a blended form with the usual rehabilitation care process for TMD complaints.Implications for rehabilitation The rehabilitation process of temporomandibular complaints may be supported by the use of e-Health applications. Physical therapists and patients with temporomandibular disorders are positive towards the use of e-Health as an addition to the usual care. Especially during the treatment process, there is a need for clear animated videos and reminders for the patients

Evaluation of a web-based self-management program for patients with cardiovascular disease: Explorative randomized controlled trial

Background: Web-based self-management programs have the potential to support patients with cardiovascular disease (CVD) in their self-management (eg, by focusing on behavior change and improving physical activity). The intervention mapping framework was used to develop a web-based program called Vascular View. The Vascular View program contained 6 modules (coping with CVD, setting boundaries, lifestyle, healthy nutrition, being physically active, interaction with health professionals) aiming to increase self-management behavior by tailoring to the perceived problems and (support) needs of patients after CVD. Objective: The aim was to test the effectiveness of Vascular View before embarking on a full-scale randomized clinical trial (RCT) by evaluating the potential effectiveness and effect sizes of the Vascular View program and identifying outcome measures most likely to capture the potential benefits. Methods: An explorative RCT was performed. Both control and intervention groups received care as usual and, in addition, the intervention group received 12 months of access to a web-based self-management program. Assessment occurred at baseline, 6 months, and 12 months. Outcome measures included general patient-reported outcome measurements: Illness Perception Questionnaire (IPQ), Rand-36, Patient Activation Measure, and patient self-efficacy. Module-specific patient-reported outcome measurements were Beliefs about Medicines Questionnaire, International Physical Activity Questionnaire, Dutch Healthy Diet Index, Fagerström Test for Nicotine Dependence (FTND), Alcohol Use Disorders Identification Test, and Perceived Efficacy in Patient-Physician Interaction. Linear mixed models for repeated measures using intention-to-treat and per-protocol analysis were applied to study differences between the patients in the intervention and control groups. Floor and ceiling effects were explored to give insight into the outcome measures most likely to capture the potential benefits. Results: A total of 105 patients in the control group and 103 patients in the intervention group participated in the study. A positive direction of change between baseline and 12 months was shown for most outcome measurements in favor of the intervention group, of which 2 out of 10 outcomes showed a significant effect: attribution of cause of the disease to risk factors and immunity factors (IPQ) and dependency of nicotine (FTND). Floor and ceiling effects were seen in the IPQ, Rand-36, and the self-efficacy questionnaire. Conclusions: No conclusion for the efficacy of the Vascular View program or selection of outcome measurements can be taken yet. A process evaluation will be conducted to gain thorough insight into the working elements of the program, patient needs in eHealth, and the use of the program by patients. This can determine for whom web-based self-management programs will work and help to adapt the program