Verbetering van de kwaliteit van CVA-zorg; registratie kwaliteitsindicatoren is gezamenlijke verantwoordelijkheid

We streven voortdurend naar een betere zorgkwaliteit. Door routinematig een standaardset van uitkomsten te verzamelen (‘routine outcome measurements’) kunnen we bijvoorbeeld de kwaliteit van zorg van verschillende ziekenhuizen vergelijken om zo de zorg te kunnen verbeteren.1 Op basis van de overweging dat de uitkomsten van zorg uiteindelijk moeten worden afgemeten aan wat deze zorg de patiënt heeft gebracht, wordt daarbij tegenwoordig veel waarde gehecht aan patiëntgerapporteerde uitkomstmaten (‘patient-reported outcome measures’, PROM’s). Dit geldt ook binnen de zorg voor patiënten die een cerebrovasculair accident (CVA) hebben doorgemaakt. Wij hebben gezamenlijk kwaliteitsindicatoren vastgesteld, maar registratie hiervan in de CVA-ketens moet meer aandacht krijgen. Vanuit het buitenland worden interessante veranderingen voorgesteld, zoals onder andere beschreven in een recent artikel in Stroke.2 Maar in Nederland heeft het verbeteren van onze registratiediscipline prioriteit

Improving the quality of stroke care in the Netherlands; registration of quality indicators is a joint responsibility

We streven voortdurend naar een betere zorgkwaliteit. Door routinematig een standaardset van uitkomsten te verzamelen (‘routine outcome measurements’) kunnen we bijvoorbeeld de kwaliteit van zorg van verschillende ziekenhuizen vergelijken om zo de zorg te kunnen verbeteren.1 Op basis van de overweging dat de uitkomsten van zorg uiteindelijk moeten worden afgemeten aan wat deze zorg de patiënt heeft gebracht, wordt daarbij tegenwoordig veel waarde gehecht aan patiëntgerapporteerde uitkomstmaten (‘patient-reported outcome measures’, PROM’s).Dit geldt ook binnen de zorg voor patiënten die een cerebrovasculair accident (CVA) hebben doorgemaakt. Wij hebben gezamenlijk kwaliteitsindicatoren vastgesteld, maar registratie hiervan in de CVA-ketens moet meer aandacht krijgen. Vanuit het buitenland worden interessante veranderingen voorgesteld, zoals onder andere beschreven in een recent artikel in Stroke.2 Maar in Nederland heeft het verbeteren van onze registratiediscipline prioriteit.An article by the International Consortium of Health Outcomes Measurement, with the title 'An international standard set of patient-centered outcome measures after stroke', was published recently in the journal Stroke. In this article we reflect on this paper and its significance for the Netherlands. The authors report on an international consensus conference to establish recommendations for outcome measurement in stroke care. Indicators, measurement moments and measures were proposed, with a strong focus on patient-reported outcomes. The core measure advocated is use of the recently developed Patient Reported Outcomes Measurement Information System 10-Question Short Form (PROMIS SF v1.1 Global Health; or PROMIS-10). We can appreciate this paper as support for current developments towards benchmarking in stroke rehabilitation in the Netherlands; however, we also have concerns about the administrative burden and the proposed time points and measures. Joining forces to strengthen the current efforts to establish benchmarking should be given priority in the Netherlands.</p

Life Satisfaction and Return to Work After Aneurysmal Subarachnoid Hemorrhage

This study was conducted to investigate life satisfaction and employment status after aneurysmal subarachnoid hemorrhage (SAH) and to explain the associations between life satisfaction and demographic, disease-related, psychological, and personality characteristics. Subjects with SAH (n = 141) living at home 2-4 years after the SAH responded to a mailed questionnaire. Outcomes were life satisfaction, as measured with the Life Satisfaction Questionnaire 9 (LiSat-9), and employment status. Determinants in multiple regression analysis were demographic and SAH characteristics, subjective complaints (eg, mood disorder, fatigue, cognitive complaints), and personality characteristics (eg, neuroticism, passive coping style). Of the 141 subjects, 64 (46.7%) had a Glasgow Outcome Scale score of V (good outcome) at discharge. Mean subject age was 51.4 +/- 12.3 years, and mean time after SAH was 36.1 +/- 7.9 months. Of the 88 subjects who were working at the time of the SAH, 54 (61.4%) returned to work, but only 31(35.2%) resumed their work completely. The subjects were least satisfied with their vocational situation (51.9% satisfied) and sexual life (51.7%) and were most satisfied with their relationships (75.2%-88.7%) and self-care ability (88.6%). Age (beta value = 0.17), return to work after SAH (0.19), disability at hospital discharge (0.25), worsened mood (-0.37), and passive coping (-0.25) together accounted for 47.2% of the life satisfaction scores. Our data indicate that return to work is a major issue for individuals who survive an SAH. Not returning to work, disability, depression, and passive coping are associated with reduced life satisfaction. Thus, vocational reintegration after SAH merits more attention during rehabilitation

Child-focused and context-focused behaviors of physical and occupational therapists during treatment of young children with cerebral palsy

Aims: To (1) describe the child- and context-focused behaviors of physical and occupational therapists, and (2) compare the behaviors of therapists in a standard therapy session with those of therapists trained to deliver child- and context-focused services. Method: Videos of 49 therapy sessions provided by 36 therapists were analyzed using the intervention domains of the Paediatric Rehabilitation Observational measure of Fidelity (PROF) to examine the therapeutic behaviors of physical and occupational therapists with young children with cerebral palsy (CP) (24 to 48 months) in a Dutch rehabilitation setting. The PROF ratings of 18 standard therapy sessions were compared with the ratings of 16 child- and 15 context-focused therapy sessions. Results: Therapists who provided standard therapy demonstrated a mix of child- and context-focused behaviors. PROF ratings indicated fewer child- and context-focused behaviors during standard therapy sessions compared with sessions where therapists were instructed to use either child- or context-focused behaviors. Conclusions: A sample of Dutch physical and occupational therapists of young children with CP demonstrated a mix of child- and context-focused therapy behaviors during standard therapy. Further research is recommended on clinical reasoning and the effect of setting to better understand therapists’ use of child- and context-focused behaviors during therapy sessions

Child-Focused and Context-Focused Behaviors of Physical and Occupational Therapists during Treatment of Young Children with Cerebral Palsy

AIMS: To (1) describe the child- and context-focused behaviors of physical and occupational therapists, and (2) compare the behaviors of therapists in a standard therapy session with those of therapists trained to deliver child- and context-focused services. METHOD: Videos of 49 therapy sessions provided by 36 therapists were analyzed using the intervention domains of the Paediatric Rehabilitation Observational measure of Fidelity (PROF) to examine the therapeutic behaviors of physical and occupational therapists with young children with cerebral palsy (CP) (24 to 48 months) in a Dutch rehabilitation setting. The PROF ratings of 18 standard therapy sessions were compared with the ratings of 16 child- and 15 context-focused therapy sessions. RESULTS: Therapists who provided standard therapy demonstrated a mix of child- and context-focused behaviors. PROF ratings indicated fewer child- and context-focused behaviors during standard therapy sessions compared with sessions where therapists were instructed to use either child- or context-focused behaviors. CONCLUSIONS: A sample of Dutch physical and occupational therapists of young children with CP demonstrated a mix of child- and context-focused therapy behaviors during standard therapy. Further research is recommended on clinical reasoning and the effect of setting to better understand therapists' use of child- and context-focused behaviors during therapy sessions

Child-focused and context-focused behaviors of physical and occupational therapists during treatment of young children with cerebral palsy

Aims: To (1) describe the child- and context-focused behaviors of physical and occupational therapists, and (2) compare the behaviors of therapists in a standard therapy session with those of therapists trained to deliver child- and context-focused services. Method: Videos of 49 therapy sessions provided by 36 therapists were analyzed using the intervention domains of the Paediatric Rehabilitation Observational measure of Fidelity (PROF) to examine the therapeutic behaviors of physical and occupational therapists with young children with cerebral palsy (CP) (24 to 48 months) in a Dutch rehabilitation setting. The PROF ratings of 18 standard therapy sessions were compared with the ratings of 16 child- and 15 context-focused therapy sessions. Results: Therapists who provided standard therapy demonstrated a mix of child- and context-focused behaviors. PROF ratings indicated fewer child- and context-focused behaviors during standard therapy sessions compared with sessions where therapists were instructed to use either child- or context-focused behaviors. Conclusions: A sample of Dutch physical and occupational therapists of young children with CP demonstrated a mix of child- and context-focused therapy behaviors during standard therapy. Further research is recommended on clinical reasoning and the effect of setting to better understand therapists’ use of child- and context-focused behaviors during therapy sessions