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Biomedical subjects

G J Lankhorst

Publications and source records attributed to G J Lankhorst.

At least 19 recordsLinked to original sources
PubMed1996

Quality of life in multiple sclerosis: the disability and impact profile (DIP).

Seventy-three Dutch and Flemish patients with definite multiple sclerosis (MS) were assessed by means of the Disability and Impact Profile (DIP), which is a 2 x 39 item, self-administered questionnaire with parallel questions about disabilities and their importance for or impact on the patient, resulting in a profile of weighted scores. It was designed as a tool for clinical assessment of quality of life (QoL) domains in MS patients. Group data showed more than 50% loss on weighted scores for "walk", "clean home", "work" and "worry about deterioration". In individual patients a median of 7 (range 0-23) major disruptions of quality of life (MD-QoL: loss on weighted score more than 50%) was found. Prevalence of MD-QoL in more than 10% of the patients was found for as many as 31 disabilities and > 50% for 3 ("clean home", "work" and "worry about deterioration"). Results in the MS group were compared with available data from 25 patients with rheumatoid arthritis (RA) and 25 patients with a spinal cord lesion (SCl). Weighted scores of "read", "memory" and "concentration" were significantly lower in the MS group than in the RA and SCl groups. Significantly lower weighted scores in both the MS and RA groups were found for "worry about deterioration", "physical endurance", "clean home", "work", "see" and "write". In conclusion, major disruptions in many domains of QoL were found in MS patients. Weighted score profiles for MS were in accordance with clinical manifestations. Unlike Kurtzke's Extended Disability Status Scale, DIP assesses a wide range of potentially MS-affected human activities, and also takes into account the subjective perception of disabilities.

Adult↗
PubMed1996

Computer-assisted hand-held dynamometer: low-cost instrument for muscle function assessment in rehabilitation medicine.

In rehabilitation medicine, muscle function is assessed during the physical examination of the patient. Although a simple hand-held instrument improves the assessment of static strength, it is rarely used in clinical practice, where dynamic measurements are preferred. A computer-assisted hand-held dynamometer (CAHNDY) has been developed that enables the clinician to measure dynamic muscle function in a standardised manner, using simple (i.e. portable and low-cost) apparatus. The CAHNDY comprises a force transducer and a movement transducer interfaced to a personal computer. In the study dynamic measurement protocols are used, based on a biomechanical analysis of daily activities. In this way, iso-functional profiles can be established, describing the kinematics of muscle function in its functional context. Using the iso-functional profiles as a basis for standardisation, the double feedback algorithm of the CAHNDY assists the tester in meeting this standard, during maximal muscle function testing. In a multi-centre trial, the CAHNDY is evaluated by physical therapists for knee extensor and flexor function. The CAHNDY enables iso-functional dynamic muscle function testing, although application is limited by the maximal strength of the tester. It is concluded that the CAHNDY is suitable for use in rehabilitation medicine.

Ambulatory Care↗
PubMed1996

Responsiveness of the rehabilitation activities profile and the Barthel index.

The goal of this study was to compare the responsiveness for clinically meaningful change over time of a newly designed functional status scale, the Rehabilitation Activities Profile (RAP), with more frequently used Barthel Index (BI). Four techniques for the quantification of responsiveness were utilized: effect sizes, p-values, t-statistics and ROC curves. The patient's return home was chosen as external criterion. An inception cohort of stroke patients was followed during 26 weeks. All patients still hospitalized on the 14th day after the stroke were included. The functional assessments took place at 2, 3, 4, 8, 12, and 26 weeks after stroke. The patients were visited at the hospital, home, nursing home, or rehabilitation center. Of the 125 patients included in the study, 18 patients died during the observation period, 2 patients were lost to follow-up, and 1 patient refused to cooperate after 12 weeks. After 26 weeks, 104 patients remained for analysis. Three time periods were discerned: 2 to 12 weeks (early response), 12 to 26 weeks (late response), and 2 to 26 weeks after stroke (overall response). The effect sizes of the RAP were consistently higher on all three time periods than those of the BI. The p-value of the overall response mean change score of the RAP appeared to discriminate between patients returning home and those not returning home, whereas the BI failed on this point (p = 0.004 vs. 0.496). Using t-statistics, the RAP showed a higher efficiency in expressing change on all time periods (relative efficiency = 1.42, 1.77, and 1.43, respectively). The receiver operating characteristic surface area of the RAP score was higher than the area of the BI score (0.74 and 0.59, respectively for the early response period). In conclusion, all results seemed to indicate that the RAP is more responsive than the BI when returning home is chosen as an external criterion.

Activities of Daily Living↗
PubMed1996

Measuring functional limitations in rising and sitting down: development of a questionnaire.

OBJECTIVE: Develop and test a self-administered questionnaire that measures perceived and actual functional limitations in rising and sitting down. SETTING: Private practices for physical therapy and outpatient clinics of hospitals and rehabilitation centers. PATIENTS: 345 outpatients (43% male, aged 14 to 92 years) with different grades of functional limitations and different types of lower extremity orthopedic or rheumatologic disorders. METHODS: The Questionnaire Rising and Sitting Down (QR&S) was developed on the basis of a literature review and careful operationalization of functional limitations. Five dimensions concerning different objects (high chair, low chair, toilet, bed, and car) and one global dimension were postulated to be contained in the instrument. Mokken scale analysis was used to test the postulated dimensions (scalability coefficient H). Furthermore, robustness with respect to patient characteristics was determined, as well as intratest reliability (reliability coefficient Rho), test-retest reliability (intraclass correlation coefficient [ICC]), content validity (coverage of operationalized aspects), and construct validity (testing of seven hypotheses). RESULTS: Mokken scale analysis confirmed the existence of 5 object dimensions (H = .53-.59). However, two global dimensions were found (H = .50-.54). The resulting hierarchical scales, consisting of subsets of the 32 final QR&S items, are robust and measure functional limitations in a reliable (Rho .77-.91; ICC .72-.90) and valid (3 out of 4 aspects covered, 2 hypotheses rejected for 3 out of 7 scales) manner. CONCLUSION: The QR&S is a reliable and valid self-administered questionnaire. It consists of hierarchical scales and measures perceived and actual functional limitations in rising and sitting down.

Activities of Daily Living↗
PubMed1996

Walking ability of stroke patients: efficacy of tibial nerve blocking and a polypropylene ankle-foot orthosis.

OBJECTIVE: To investigate the efficacy of tibial nerve blocking by percutaneous radiofrequency thermocoagulation and an ankle-foot orthosis on the walking ability of stroke patients with a spastic equinus or equinovarus foot. DESIGN: A placebo-controlled randomized clinical trial with a 2 x 2 factorial design and with a 3-month follow-up. SETTING: Outpatient clinic of a department of rehabilitation medicine. SUBJECTS: Sixty stroke patients (17 women, 43 men) with a median age of 58 years and a median period of 34 months poststroke were allocated to one of four treatment groups. MAIN OUTCOME MEASURES: Changes in walking ability (measured with the Sickness Impact Profile category "ambulation"; possible score range, 0% to 100%) and walking speed after 3 months. RESULTS: With respect to walking ability, the efficacy of thermocoagulation as compared with placebo thermocoagulation was .56% (95% confidence interval [CI] -3.01% to 4.13%), whereas the efficacy of the ankle-foot orthosis as compared with the placebo ankle-foot orthosis was 2.72% (95% CI -.94% to 6.38%). To study the potential synergistic effect of both treatments, a multivariate model was used; interaction between both treatments was small, .83% (95% CI -6.73% to 8.40%). Analysis restricted to the compliers (n = 30) showed an increased efficacy of thermocoagulation and a decreased efficacy of the ankle-foot orthosis. The changes in comfortable and maximal safe walking speed were less than .10m/sec and were neither clinically nor statistically significant (the median baseline values for the total group were .42m/sec and .56m/sec, respectively). CONCLUSION: No support was found for the beneficial effects of either thermocoagulation of the tibial nerve or a polypropylene ankle-foot orthosis in 5 degrees of dorsiflexion on the walking ability of stroke patients.

Adolescent↗
PubMed1996

Predicting disability in stroke--a critical review of the literature.

Research articles on the prognosis of stroke patients were analysed to identify studies that met sound methodological principles of prognostic research as well as to identify variables capable of predicting functional outcome (ADL) after stroke. Data sources comprised a computer-aided search of published prognostic studies and references to literature used in prognostic studies. Seventy-eight studies were tested for adherence to the following key methodological criteria: reliability and validity of measurement instruments used to assess dependent and independent variables; inclusion of an inception cohort; adequate and uniform end-point of observation; control for drop-outs during period of observation; statistical testing of presumed relationship between dependent and independent variables; sufficient sample size in relation to number of determinants; control for multicollinearity; specification of patient characteristics (i.e. age, type, recurrent stroke and localization of stroke); description of interfering treatment effects during the period of observation, and cross-validation of the prediction model in a second independent group of patients. Only three studies satisfied nine out 11 criteria and ten studies eight criteria for the determination of valid prognostic research. The results of these studies indicate that the following variables are valid predictors for functional recovery after stroke: age; previous stroke; urinary continence; consciousness at onset; disorientation in time and place; severity of paralysis; sitting balance; admission ADL score; level of social support and metabolic rate of glucose outside the infarct area in hypertensive patients. This study supports the general opinion that not only are differences in objectives and heterogeneity in stroke patients responsible for the lack of accuracy in predicting functional outcome, but also the methodological flaws in published prognostic research.

Activities of Daily Living↗
PubMed1996

Functional outcome of lower-limb amputees: a prospective descriptive study in a general hospital.

This paper describes functional outcome of a population of lower limb amputees five months after amputation compared with their preoperative functional abilities and studies the relationship between potential determinants and functional outcome. Twenty out of 26 patients who underwent a lower limb amputation between December 1993 and August 1994 in a general hospital in Amsterdam were included in the study. Their functional abilities before amputation were retrospectively assessed using an ICIDH (International Classification of Impairments, Disabilities and Handicaps)-based questionnaire. Functional outcome was assessed after amputation of the lower limb using ICIDH-based and SIP (Sickness Impact Profile)-questionnaires. The mean SIP scores were high (referring to a low functional outcome). Disabilities were spread over the five disability fields of the ICIDH. The functional outcome of the diabetic versus the non-diabetic group was lower on the physical, activities of daily living (ADL), psychological and communicative categories of the ICIDH. In most patients, functional outcome decreased. The diabetic patients compared to the non-diabetics showed more diversity in functional outcome, compared with their preoperative functional abilities. Increasing age is significantly associated with a low functional outcome on the SIP scores. Diabetes is age-related for this sample. Co-morbidity and motivation are strongly age-related for this sample. It was concluded that lower-limb amputees appear quite disabled in all disability categories of the ICIDH and as assessed by the SIP scores. In most patients, functional abilities decrease after lower limb amputation. Age seems to be a significant factor related to functional outcome.

Activities of Daily Living↗
PubMed1996

Introducing an innovative method in team conferences.

An innovative method to structure multidisciplinary team conferences in rehabilitation medicine was developed: Rehabilitation Activities Profile report system (RAP-TEAM). Experiences with introduction of RAP-TEAM and the study of its effects on the satisfaction of professionals are described. RAP-TEAM was introduced in three teams. RAP-TEAM did not influence the satisfaction of professionals in two teams; satisfaction in the third team even decreased. Nevertheless, professionals report more benefits than disadvantages of RAP-TEAM. Several possible explanations for these results and the methodological problems with this kind of evaluation study are discussed. The most important explanation is that introduction of an innovative method should be allowed sufficient time before it could become effective. Recommendations for a successful introduction of innovative changes are made. All people concerned must be aware that a process of change is not simple, and needs the full attention of all.

Congresses as Topic↗
PubMed1996

A criterion for stability of the motor function of the lower extremity in stroke patients using the Fugl-Meyer Assessment Scale.

A test-retest reproducibility study was performed to define a criterion for stability as opposed to change of motor function of the lower extremity in stroke patients. Forty-nine patients with stroke were examined twice by the same physiotherapist, using the Fugl-Meyer Assessment Scale. The interval between both measurements was three weeks. The mean differences between the first and the second measurement were small, with 0.04 points for the lower extremity scale and 0.92 points for the balance scale, respectively. Intraclass correlation coefficient for the lower extremity scale was 0.86, and 0.34 for the balance scale. The standard error of measurement for each scale was 1.76 and 1.17 points, respectively. The standard error of measurement can be transformed in an 'error threshold', which is a criterion to differentiate real changes from changes due to chance variation or measurement error. As the absence of real change is a parameter for stability, a change of less than 5 points for the lower extremity scale and of less than 4 points for balance confirms stability of motor function.

Adolescent↗
PubMed1995

Inter- and intra-rater agreement of the Rehabilitation Activities Profile.

The objective of the study was to determine the inter- and intra-rater agreement of the Rehabilitation Activities Profile (RAP). The RAP is an assessment method that covers the domains of communication, mobility, personal care, occupation and relationships. Each domain consists of items which are further divided in sub-items for in-depth analysis. The RAP allows quantification of the severity of disabilities, handicaps and perceived problems of a patient with regard to the items and sub-items. For this purpose ordinal 4-point Likert scales were constructed. The RAP can be used for goal setting and evaluation of rehabilitation. Because of the broad intended use of the RAP and its construction, a special design for the reliability study was needed. The study was carried out in 5 rehabilitation facilities with the participation of various professions. The items and sub-items of the RAP were divided over these professions according to their expertise. Pairs of interviewers were formed that questioned a patient. For the determination of inter- and intra-rater agreement each pair of interviewers was allowed to question a patient only once. To establish the intra-rater agreement, video recordings were made during the interviews. The median (weighted) kappa value and percentage of agreement about the severity grading of a disability or handicap for all items and sub-items exceeded 0.84 and 81%, respectively, with regard to the inter- and intra-rater agreement. For the severity grading of perceived problems these values were 0.91 and 86%. The interpretation of kappa was hindered by two paradoxes recently described in the literature. The paradox "high agreement but low kappa" manifested itself in particular. It is concluded that inter- and intra-rater agreement of the RAP can be considered to be good to very good.

Activities of Daily Living↗
PubMed1995

The Rehabilitation Activities Profile: a validation study of its use as a disability index with stroke patients.

OBJECTIVE: This study evaluates the criterion, content, and construct validity of the Rehabilitation Activities Profile (RAP) in patients with stroke. This instrument is constructed for screening, monitoring, and prognosis purposes to assist clinical rehabilitation. It consists of 21 activities, covering the domains communication, mobility, personal care, occupation, and relationships. Disabilities and perceived problems are assessed in parallel on two four-point severity scales. The disability sum scores of the first four RAP domains were used in the analyses presented in this article. DESIGN: An inception cohort of stroke patients was studied during 26 weeks. Patients that were still hospitalized on the 14th day after stroke were included. The functional assessments took place 2, 3, 4, 8, 12, and 26 weeks after stroke. SETTING: The patients were visited at the hospital, at home, nursing home, or rehabilitation center. PATIENTS: 125 patients were included in the study. After 26 weeks, 105 patients were still alive; 18 patients had died, and 2 patients were lost to follow-up. MAIN OUTCOME MEASURES: The RAP, Barthel Index (BI) and Frenchay Activities Index (FAI). RESULTS: The domain "mobility+personal care" correlated highly with the BI score (r: 0.87 to 0.90). The domain "occupation" correlated with the FAI score before the stroke and 26 weeks after stroke (r: 0.72, 0.73, respectively). The disability sum score of the domain "mobility+personal care" allowed a prediction of the living arrangement 26 weeks after stroke (receiver operator characteristic area surface: 0.90). The same domain showed significant differences (p < 0.05) in the 8-week disability sum score for most living arrangements. Exceptions were rehabilitation center versus intermediate care in a nursing home (p = 0.23) and acute care hospital versus chronic care in a nursing home (p = 0.45). Hypotheses on subgroup differences in mean scores in the domains "communication" and "mobility+personal care" could be confirmed (the discerned subgroups were: gender, having a partner, motor deficit of upper or lower extremity, urinary incontinence, higher cortical deficits, conjugate deviation of the eye, coma, hemianopsia). CONCLUSION: The disability sum scores of the RAP can be used as discriminative, evaluative, and predictive indexes.

Aged↗
PubMed1994

Two strategies of transferring from sit-to-stand; the activation of monoarticular and biarticular muscles.

In this study, two different strategies of rising from a chair were compared, using integrated biomechanical and electromyographic analyses. Nine healthy subjects were instructed to rise using two different strategies: natural sit-to-stand transfer (NSTS) and a sit-to-stand transfer with full flexion of the trunk (FSTS). Sagittal kinematics and ground reaction forces were registered. Muscle activity of nine muscles of the right leg were recorded by means of surface EMG. All signals were synchronized at seat-off. The results show that no differences occur between the kinematics of knee and ankle, whereas the hip flexion is, as expected, higher during FSTS. The higher moment about the knee during NSTS is shifted to proportionally higher moments about the hip and ankle during FSTS. It is mainly the differences in the EMG-levels of the biarticular hip and knee muscles which might explain the differences in net moment. These results are in accordance with a theory about a particular role of biarticular muscles. On the other hand, the shift from knee to ankle cannot be associated with a particular increase in activity of the biarticular m.gastrocnemius. It is hypothesized that about the ankle, control of stability is preferred over movement control. An important conclusion for rehabilitation medicine is that a lower net moment about the knee in FSTS does not automatically imply that this reduces the load on the knee extensors.

Adult↗
PubMed1993

The effectiveness of vibratory stimulation in anejaculatory men with spinal cord injury. Review article.

Most spinal cord injury (SCI) men have fertility problems caused by anejaculation and a decreased fertility of the ejaculate. There are several methods to induce ejaculation, such as vibratory stimulation and transrectal electrostimulation. In order to investigate the current state of knowledge about the effectiveness of vibratory stimulation and to prepare a controlled clinical trial we reviewed the available literature. Ten articles met our inclusion criteria. Articles were found by various strategies, such as computer searches and screening of relevant journals. We used a structured approach to evaluate these articles. In total 428 patients had been treated with vibration. Sixty percent (257) of the patients responded to treatment, ie produced ejaculate. Because of methodological shortcomings in most studies it remains unclear whether there is a relationship between injury type, such as level and completeness of the injury, and the response rate. Semen analyses showed a large intersubject variation. From the data available, it could be concluded that the semen volume is usually normal, whereas sperm motility and morphology of spermatozoa were in most cases far from normal. Side effects of vibratory stimulation were reported in 6% of the patients. Semen could be used for various (assisted) reproductive technologies, eg artificial insemination, in vitro fertilisation and microinsemination. Therefore, it is very important to know which stimulation method is most effective in treating anejaculatory SCI men. This review of the literature shows that the effectiveness of vibratory stimulation remains unclear. New, well designed clinical trials as well as basic research activities might clarify the effectiveness of vibratory stimulation and transrectal electrostimulation.

Ejaculation↗
PubMed1993

Factors related to the outcome of inpatient rehabilitation in patients with neoplastic epidural spinal cord compression.

In this study we have tried to develop a method to predict the survival and the functional outcome following neoplastic spinal cord injury (SCI), which can be helpful when selecting patients for an intensive inpatient rehabilitation programme. We reviewed the clinical records of all patients with neoplastic epidural spinal cord compression, admitted to any Dutch spinal cord unit (SCU) between 1-1-1985 and 1-1-1990 (n = 74). According to the outcome on 1-1-1991 the average stay at the SCU was 111 days, whereas the average survival after discharge was 423 days. Seven patients died during their stay. Of all of the factors analysed, six showed a positive relationship with prolonged survival (> one year after discharge) and improved functional level: tumour biology (lymphoma, myeloma, breast and kidney tumours); SCI as the presenting symptom of the malignancy; slow (> 1 week) progression rate of neurological symptoms; tumours treated with a combination of surgery and radiotherapy; (partial) bowel control at admission; and (partial) independence regarding transfer activities at admission. A sum score (range 0-6) of these indicators is introduced. A patient with a sum score of 0-1 has zero probability of living longer than one year after discharge and 0.19 of functional improvement during stay at the SCU. A score of 5-6 yields probabilities of 0.77 and 0.92 respectively. We conclude that the sum score can be helpful when selecting patients for an intensive inpatient rehabilitation programme or modifying such a programme. Validation for application in a general hospital is needed.

Adolescent↗
PubMed1993

The application of generalizability theory to reliability assessment: an illustration using isometric force measurements.

BACKGROUND AND PURPOSE: The objective of this study was to examine the potential use of the generalizability theory for assessing reliability of muscle force measurements in clinical applications. Reliability is expressed in terms of standard error of measurement (SEM) and the indexes derived from the SEM. Using generalizability theory, potential sources of measurement error can be recognized and estimated. SUBJECTS: Ten healthy women, aged 23 to 47 years (means = 29.5, SD = 7.1), participated in the study. METHODS: The method is illustrated by presenting a pilot study. Repeated measurements of maximal isometric knee extension force were carried out by two therapists. The time interval between measurement occasions was 1 week. A functional prototype of a hand-held dynamometer was used, and measurements were carried out according to standardized test protocols. RESULTS: Relatively important sources of measurement error were associated with interaction effects between subject and therapist as well as with interactions including the factor occasion. The SEM of the net knee moment was estimated for various hypothetical applications of the dynamometer. CONCLUSION AND DISCUSSION: It is concluded that the SEM, the corresponding confidence interval, and the smallest detectable difference are practical measures for expressing reliability of measurements on an individual. Generalizability theory is a powerful tool for estimating the magnitude of multiple sources of measurement error and for assessing the reliability of measurements tailored to specific clinical applications.

Adult↗
PubMed1991

Standardization of grip strength measurements. Effects on repeatability and peak force.

The aim of our study was to test grip strength and assess the effects of various degrees of standardization on repeatability and level of peak force. Sixteen healthy persons and eight subjects with an impaired hand function have been tested using a strain-gauge dynamometer. We compared four measurement protocols: (A) the subject is free to assume a comfortable arm position; (B) the subject is also free to assume a comfortable arm position but in addition a challenging stimulus to exceed a previous maximal effort, is given; (C) the arm was held in a predescribed and partly fixated position, as recommended by the American Society of Hand Therapists; (D) the position of the dynamometer is standardized using two reference points both on the hand and on the dynamometer. We found high test-retest reliabilities for each measurement protocol without any significant difference. There were, however, significant differences in strength level. With measurements according to protocol B the highest peak values were noted. Since the measurement protocol B combined good reliability with realistic peak forces, this procedure seems most suitable for grip strength measurements.

Adolescent↗