Zicht op zorgprocessen

Oratie uitgesproken door Prof.dr. T.P.M. Vliet Vlieland bij de aanvaarding van het ambt van bijzonder hoogleraar op het gebied van Doelmatigheid van Revalidatieprocessen, in het bijzonder Fysiotherapie aan de Universiteit Leiden vanwege het Koninklijk Nederlands Genootschap voor Fysiotherapie op vrijdag 21 maart 2014LUMC / Geneeskund

EDAQ : DLV. Vragenlijst Evaluatie Dagelijkse Activiteit (Dutch language version of the Evaluation of Daily Activity Questionnaire)

The Dutch language version of the Evaluation of Daily Activity Questionnaire (EDAQ) is a self-report outcome measure, which people complete at home in their own time and then return to the clinician/ researcher. It has been validated for use with people with arthritis and musculoskeletal conditions in the UK, and with people with rheumatoid arthritis in the Netherlands. It can be used for clinical, audit and research purposes. It includes three parts. Part 1 consists of 10 numeric rating scales evaluating aspects of body functions (e.g. pain, fatigue, movement limitations). Part 2 consists of 14 domains assessing activity and participation abilities/ restrictions with and without the use of ergonomic approaches. Part 3 (optional) is about assistive device use. It is available in two forms: parts 1 to 3 and parts 1 and 2 only. Usually, the EDAQ parts 1 and 2 is used for most clinical and research purposes. The updated EDAQ Manual v3 (2018) explains how to use and score the EDAQ, with scoring examples (http://usir.salford.ac.uk/30752/). Rasch Transformation Tables are available in the EDAQ Manual v2 Supplement 1 and Supplement 2. An explanatory leaflet for clients is also available in USIR here under Monographs

Effect of adaptive abilities on utilities, direct or mediated by mental health?

<p>Abstract</p> <p>Background</p> <p>In cost-utility analyses gain in health can be measured using health state utilities. Health state utilities can be elicited from members of the public or from patients. Utilities given by patients tend to be higher than utilities given by members of the public. This difference is often suggested to be explained by adaptation, but this has not yet been investigated in patients. Here, we investigate if, besides health related quality of life (HRQL), persons' ability to adapt can explain health state utilities. Both the direct effect of persons' adaptive abilities on health state utilities and the indirect effect, where HRQL mediates the effect of ability to adapt, are examined.</p> <p>Methods</p> <p>In total 125 patients with Rheumatoid Arthritis were interviewed. Participants gave valuations of their own health on a visual analogue scale (VAS) and time trade-off (TTO). To estimate persons' ability to adapt, patients filled in questionnaires measuring Self-esteem, Mastery, and Optimism. Finally they completed the SF-36 measuring HRQL. Regression analyses were used to investigate the direct and mediated effect of ability to adapt on health state utilities.</p> <p>Results</p> <p>Persons' ability to adapt did not add considerably to the explanation of health state utilities above HRQL. In the TTO no additional variance was explained by adaptive abilities (Δ R²= .00, β = .02), in the VAS a minor proportion of the variance was explained by adaptive abilities (Δ R²= .05, β = .33). The effect of adaptation on health state utilities seems to be mediated by the mental health domain of quality of life.</p> <p>Conclusions</p> <p>Patients with stronger adaptive abilities, based on their optimism, mastery and self-esteem, may more easily enhance their mental health after being diagnosed with a chronic illness, which leads to higher health state utilities.</p

The perspective of people with axial spondyloarthritis regarding physiotherapy : room for the implementation of a more active approach

Objectives. Physiotherapy is recommended in the management of people with axial spondyloarthritis (axSpA), with new insights into its preferred content and dosage evolving. The aim of this study was to describe the use and preferences regarding individual and group physiotherapy among people with axSpA. Methods. A cross-sectional survey was conducted among people with axSpA living in The Netherlands (NL) and Switzerland (CH). Results. Seven hundred and thirteen people with axSpA participated (56.7% male, median age 55 years, median Assessment of Spondyloarthritis International Society Health Index score 4.2). Response rates were 45% (n¼206) in NL and 29% in CH (n¼507). Of these participants, 83.3% were using or had been using physiotherapy. Individual therapy only was used or had been used by 36.7%, a combination of individual plus land- and water-based group therapy by 29.1% and group therapy by only 5.3%. Fewer than half of the participants attending individual therapy reported active therapy (such as aerobic, muscle strength and flexibility exercises). Although the majority (75.9%) were not aware of the increased cardiovascular risk, participants showed an interest in cardiovascular training, either individually or in a supervised setting. If supervised, a majority, in CH (75.0%) more than in NL (55.7%), preferred supervision by a specialized physiotherapist. Conclusion. The majority of people with axSpA use or have used physiotherapy, more often in an individual setting than in a group setting. The content of individual therapy should be more active; in both therapy settings, aerobic exercises should be promoted. In particular, enabling people with axSpA to perform exercises independently would meet their needs and might enhance their daily physical activity

Are Aspects of a Motivational Interview Related to Subsequent Changes in Physical Activity and Regulatory Style? Examining Relationships among Patients with Rheumatoid Arthritis

Objectives: To determine whether the integrity of motivational interviewing (MI) delivery relates to short-term changes in physical activity (PA) and regulatory style within a sample of patients with rheumatoid arthritis, and to examine whether therapist proficiency in MI improves over time. Methods: During a randomized controlled trial to promote PA, 27 patients received a MI from one of three trained physical therapists, which was coded with the Motivational Interviewing Treatment Integrity scales (MITI). Pearson correlations examined associations between MITI scores and changes in PA and regulatory style.  Linear regression examined therapist proficiency over time. Results: MIs with greater reflection-to-question ratios and higher MI proficiency scores were related to increases in PA. MIs higher in global spirit and with a greater percentage of MI-adherent behaviors were associated with decreases in introjected regulation. Therapist proficiency in MI delivery tended to improve over time. Conclusions: Characteristics of motivational interviews are related to favorable shifts in regulatory style and PA behavior.  Although MI proficiency increases over time and with feedback, a 15-hour training course seems insufficient for physical therapists to obtain basic MI proficiency. Practice Implications:  Providing feedback to therapists new to delivering MI seems to improve MI proficiency and should help therapists to avoid using MI-non-adherent techniques

Cross-cultural adaptation and psychometric testing of the Dutch and German versions of the Evaluation of Daily Activity Questionnaire in people with rheumatoid arthritis

The Evaluation of Daily Activity Questionnaire (EDAQ) is a detailed patient-reported outcome measure of activity ability. The objective of this research was to assess the linguistic and cross-cultural validity and psychometric properties of the EDAQ in rheumatoid arthritis for Dutch and German speakers. The EDAQ was translated into Dutch and German using standard methods. A total of 415 participants (Dutch n = 252; German n = 163) completed two questionnaires about four weeks apart. The first included the EDAQ, Health Assessment Questionnaire (HAQ) and 36-item Short-Form v2 (SF-36v2) and the second, the EDAQ only. We examined construct validity using Rasch analysis for the two components (Self-Care and Mobility) of the Dutch and German EDAQ. Language invariance was also tested from the English version. We examined internal consistency, concurrent and discriminant validity and test–retest reliability in the 14 EDAQ domains. The Self-Care and Mobility components satisfied Rasch model requirements for fit, unidimensionality and invariance by language. Internal consistency for all 14 domains was mostly good to excellent (Cronbach’s alpha ≥ 0.80). Concurrent validity was mostly strong: HAQ rs = 0.65–0.87; SF36v2 rs = − 0.61 to − 0.87. Test–retest reliability was excellent [ICC (2,1) = 0.77–0.97]. The EDAQ has good reliability and validity in both languages. The Dutch and German versions of the EDAQ can be used as a measure of daily activity in practice and research in the Netherlands and German- speaking countries

Development of a framework for reporting health service models for managing rheumatoid arthritis

The purpose of this study was to develop a framework for reporting health service models for managing rheumatoid arthritis (RA). We conducted a search of the health sciences literature for primary studies that described interventions which aimed to improve the implementation of health services in adults with RA. Thereafter, a nominal group consensus process was used to synthesize the evidence for the development of the reporting framework. Of the 2,033 citations screened, 68 primary studies were included which described 93 health service models for RA. The origin and meaning of the labels given to these health service delivery models varied widely and, in general, the reporting of their components lacked detail or was absent. The six dimensions underlying the framework for reporting RA health service delivery models are: (1) Why was it founded? (2) Who was involved? (3) What were the roles of those participating? (4) When were the services provided? (5) Where were the services provided/received? (6) How were the services/interventions accessed and implemented, how long was the intervention, how did individuals involved communicate, and how was the model supported/sustained? The proposed framework has the potential to facilitate knowledge exchange among clinicians, researchers, and decision makers in the area of health service delivery. Future work includes the validation of the framework with national and international stakeholders such as clinicians, health care administrators, and health services researchers