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Biomedical subjects

W H Eisma

Publications and source records attributed to W H Eisma.

At least 19 recordsLinked to original sources
PubMed1999

The Timed "up and go" test: reliability and validity in persons with unilateral lower limb amputation.

OBJECTIVE: To determine the interrater and intrarater reliability and the validity of the Timed "up and go" test as a measure for physical mobility in elderly patients with an amputation of the lower extremity. DESIGN: To test interrater reliability, the test was performed for two observers at different times of the same day in an alternating order. To test intrarater reliability, the patients performed the test for one observer on two consecutive visits with an interval of 2 weeks. To test validity, the results of the Timed "up and go" test were compared with the results on the Sickness Impact Profile, 68-item version (SIP68), and the Groningen Activity Restriction Scale (GARS). PATIENTS: Thirty-two patients, age 60 yrs or older, with unilateral transtibial or transfemoral amputation because of peripheral vascular disease. RESULTS: The Timed "up and go" test showed good intrarater and interrater reliability (r = .93 and .96, respectively). A moderate relationship exists between the Timed "up and go" test and the GARS, a good relationship exists with the "physical subscales" of the SIP68, and there is no relationship with the "mental subscales" of the SIP68. CONCLUSIONS: The Timed "up and go" test is a reliable instrument with adequate concurrent validity to measure the physical mobility of patients with an amputation of the lower extremity.

Activities of Daily Living↗
PubMed1999

Repeated passive stretching: acute effect on the passive muscle moment and extensibility of short hamstrings.

OBJECTIVE: To examine the response of short hamstring muscles to repeated passive stretching. DESIGN: A repeated measures design. SETTING: A university laboratory for human movement analysis in a department of rehabilitation. SUBJECTS: Students (7 men, 10 women) from the Department of Human Movement Sciences. MAIN OUTCOME MEASURES: The lift force, range of motion, pelvic-femoral angle, first sensation of pain, and electromyogram of the hamstrings were measured. RESULTS: Comparison of the data of the test group (n = 17) after five successive passive stretch tests by means of an instrumental straight-leg raising test showed no significant change of the variables passive muscle stiffness and extensibility (p>.05). CONCLUSION: The acute effect of repeated passive stretching of short hamstring muscles is negligible. With an instrumental straight-leg raising test, the relevant muscle variables can be examined noninvasively.

Adult↗
PubMed1999

Time off work due to scaphoid fractures and other carpal injuries in The Netherlands in the period 1990 to 1993.

This study assessed the epidemiology, treatment, disability and time off work due to carpal injuries in the Netherlands in the period from 1990 to 1993. Most injuries were scaphoid fractures and carpal instabilities were rare. The time off work was considerable (mean, 155 days; median, 105 days; range, 12-1708 days). Patients with non-scaphoid fractures had the shortest time off work, followed by those with scaphoid fractures; patients with carpal instabilities had the longest time off work. Despite the significant time off work, the prognosis for return to work was excellent.

Adult↗
PubMed1998

Long-term physical, psychological and social consequences of a fracture of the ankle.

The long-term physical, psychological and social outcomes of 68 patients with an ankle fracture were investigated by using a postal questionnaire 6 years after injury. Patients were treated at a level I Trauma Centre between January 1989 and December 1989. Where applicable, the outcomes were compared with the outcomes of severely injured patients who were investigated previously. Physically, the patients were suffering from problems in the extremities and the spine. Surprisingly, half of them (52 per cent) had psychological complaints due to the initial injury. Eighty-nine per cent of the patients returned to work. This result seems to be only slightly better than the return to work in severely injured patients (74 per cent). Those with an ankle fracture needed less time to return to work (3 months versus 13 months in the severely injured patients). Further social changes (marital status, leisure activities) were mostly found in the severely injured patients. Patients with an ankle fracture as well as severely injured patients are affected by long-term consequences. The differences between the two groups are not as pronounced as is generally assumed. Probably, the consequences of lesser injuries are frequently disregarded, whereas severely injured patients are doing better than expected.

Adolescent↗
PubMed1998

Long-term physical, psychological and social consequences of severe injuries.

This 6 year follow-up study was designed to evaluate the long-term physical, psychological and social outcomes of severely injured patients (Injury Severity Score of greater than or equal to 16). Patients were treated at the University Hospital Groningen, the Netherlands, between January 1989 and December 1989. Outcomes were assessed using a postal questionnaire. After injury, the 55 respondents had predominantly complaints of the extremities, the spine and the head. Psychological complaints were present in 84 per cent of patients and mainly concerned fatigue, slowness and memory impairments. Despite these physical and psychological complaints, 74 per cent of patients were able to return to work and the memory succeeded in complying with job requirements. Injuries of the extremities and the spine were risk factors for failing to return to work. Social consequences were also reflected in broken marriages (6/22) and changes of leisure activities (45 per cent). On the basis of the impairments and disabilities revealed, we conclude that further improvement of the long-term outcomes of severely injured patients may be achieved by advancements in the treatment of injuries to the head, spine or extremities, comprehensive psychological support and vocational rehabilitation.

Adolescent↗
PubMed1998

Variation in measurements of grip strength. A study in reflex sympathetic dystrophy patients.

The clinical picture of reflex sympathetic dystrophy (RSD) is characterized by a combination of the triad: autonomic, motor and sensory changes. In this study, the grip strength is measured in 29 upper extremity RSD patients. We used the generalizability theory to assess the extent of the disagreement or differences (errors in measurement) within or between observers and interactions between observer-session and repetition of the measurements. The aims of our study were to determine the different sources of variation in grip strength tests and the smallest detectable differences (SDD) as well as the reliability of upper extremity grip strength tests in RSD patients. The main sources of variation of measurement errors were observer, patient/observer interactions and patient/session/observer interaction and a random source. We found that the generalizability theory is useful for estimating the sources of measurement error. Clinical examinations for muscle strength measurements, as a part of a total clinical examination, for example for a disability payment or worker's compensation in case of RSD patients should be done by more than one observer in more than one session and more than once.

Analysis of Variance↗
PubMed1998

Variation in measurements of range of motion: a study in reflex sympathetic dystrophy patients.

OBJECTIVE: To quantify the amount of variation attributed to different sources of variation in measurement results of upper extremity range of motion, and to estimate the smallest detectable difference (SDD) between measurements in reflex sympathetic dystrophy (RSD) patients. DESIGN: Two observers each measured in two sessions the range of motion of several upper extremity joints of RSD patients participating in an outcome study. SETTING: Department of Rehabilitation of a university hospital. SUBJECTS: Twenty-nine upper extremity RSD patients. MAIN OUTCOME MEASURES: The range of motion of forward flexion and external rotation of the shoulder, extension, flexion and supination of the elbow, palmar, dorsiflexion and ulnar, radial deviation of the wrist of affected and nonaffected sides, using a two-armed goniometer and an inclinometer. The measurement results were analysed using an analysis of variance according to the generalizability theory. RESULTS: The results indicate that observer and patient-observer were important sources of variation. The random error was the most important source of variation. Averaged over all ranges of motion the observer contributed 3.9% to the total variation, patient-observer interactions contributed 5.2% and the random error 20.3%. The SDD was smallest for elbow flexion, 7.1 degrees and 9.6 degrees and was largest for external rotation of the shoulder, 24.8 degrees and 28.7 degrees. The SDD was smaller for the nonaffected side as compared to the affected side for the majority of ranges of motion except elbow extension, wrist dorsiflexion, and radial and ulnar deviation. CONCLUSION: Clinically, our results indicate that range-of-motion measurements in RSD patients are subject to considerable variation and indicate that results of medical examinations in order to assess disability on the basis of range-of-motion measurements are subject to the same variation.

Arm↗
PubMed1998

Relationship between impairments, disability and handicap in reflex sympathetic dystrophy patients: a long-term follow-up study.

OBJECTIVE: To determine the relationship between impairments, disability and handicap in reflex sympathetic dystrophy (RSD) patients. DESIGN: A long-term follow-up study of upper extremity RSD patients. SETTING: A university hospital. SUBJECTS: Sixty-five patients, 3-9 years (mean interval 5.5 years) after RSD of the upper extremity (mean age 50.2 years). MAIN OUTCOME MEASURES: Impairments: range of motion, moving two point discrimination, muscle strength of the hand and pain were measured. Disability was assessed with the Groningen Activity Restriction Scale (GARS) and handicap was assessed with three subscales (social functioning, role limitations due to physical problems and role limitations due to emotional problems) of the RAND-36. RESULTS: After RSD of the upper extremity, 62% of the patients are limited in activities of daily living (ADL) and/or instrumental ADL (IADL). Pain and restrictions in forward flexion of the shoulder, thumb opposition and grip strength are the most important impairments limiting ADL and IADL. Patients with limitations in ADL and IADL are significantly more handicapped than patients without limitations. Pain is the most important factor contributing to handicap. CONCLUSION: The relationship between impairments and disability and between disability and handicap in RSD patients is weak to moderate. Pain is the most important factor leading to disability and handicap.

Activities of Daily Living↗
PubMed1998

Effects of day-hospital rehabilitation in stroke patients: a review of randomized clinical trials.

The purpose of this study was to review the literature on the effects of day-hospital rehabilitation (DHR) in stroke patients. In The Netherlands DHR concerns a multidisciplinary approach to decrease disability and handicap and to optimize quality of life in an outpatient setting. Data were collected by a computer-aided search of published randomized trials. Fifteen articles reporting on seven randomized controlled trials were selected. Data extraction included a score for quality of the methods, based on four categories: "study population", "interventions", "effects" and "data presentation and analysis". To each criterion a weight was attached and the maximum score was set at 100 points. In judging the methodological quality of the selected studies, one study proved insufficient. Of the remaining studies the sum score varied from 34 to 67, with a mean of 50. Comparison of the results of the studies is complicated by different definitions of DHR, different natures of the control group and the study population, and the variety of measurement instruments applied. Often instruments were applied whose reliability and validity was not proven. As of now it is not possible to prove that DHR for stroke patients is effective. In future research a standardized definition of DHR, a uniform control group, and acceptable research methodology and adequate measurement instruments must be applied.

Aged↗
PubMed1998

Reflex sympathetic dystrophy of the upper extremity--a 5.5-year follow-up. Part I. Impairments and perceived disability.

The aim of this retrospective and long-term follow-up study was to identify impairments resulting from reflex sympathetic dystrophy (RSD) of the upper extremity and to analyze the relationship between impairment and disability in RSD patients. The study group consisted of a referred sample of 65 RSD patients, with clinical signs in the upper extremity. RSD developed after fractures of the wrist or hand in 29 patients or after a carpal tunnel release in 9 patients. The mean interval between the RSD diagnosis and our evaluation was 5.5 (3-9) years (SD = 0.8). The main outcome measurements were the impairments assessed by standard physical examination. ADL and pain were quantified with a visual analogue scale (VAS). Pain was evaluated immediately before and after the physical examination and the perceived pain was determined in the week before the examination. Significant differences in impairments were found between the affected and the unaffected sides (p < 0.05). According to the AMA-guides, the impairments did not lead to disabilities. Significant correlations were found between VAS-ADL and VAS-pain in the last week prior to evaluation and full fist grip-strength. Pain seems to be the most disabling effect.

Activities of Daily Living↗
PubMed1998

Reflex sympathetic dystrophy of the upper extremity--a 5.5-year follow-up. Part II. Social life events, general health and changes in occupation.

The aim of this retrospective long-term follow-up study was to describe the psychosocial aspects, such as social life events (SLE), around the causative event of reflex sympathetic dystrophy (RSD) and the psychological history of 65 patients, 3-9 years after RSD of the upper extremity. General health and long-term changes in occupation were assessed by means of a general health questionnaire (RAND-36) and a structured interview, respectively. SLE, with a life-change unit rate more than 35, was present in 32 patients. A psychological (or psychiatric) history was found in 22 patients. In total, 60% of the patients had a SLE and/or a psychological history. The pain scores of the RAND-36 among RSD patients differed significantly from those of the control group. 17 patients changed occupation after RSD. Nearly 30% of the patients had to stop work for more than one year. The results show a high coincidence between RSD and associated psychosocial disorders and this may play a role in intensifying and prolonging the symptomatology of RSD.

Adolescent↗
PubMed1997

External and internal hemipelvectomy for sarcomas of the pelvic girdle: consequences of limb-salvage treatment.

The outcome of different limb-saving treatment modalities for pelvic girdle sarcoma is controversial. The oncological and functional results after 11 external and 10 internal hemipelvectomies and the consequences of limb-salvage treatment were studied in 21 consecutive patients with primary bone (19 patients) or soft tissue sarcoma (two patients) of the pelvic girdle. Following external hemipelvectomy, 10 patients (91%) died after a median follow-up of 1.6 years (range: 0.3-7.1). Isolated local recurrences occurred in three patients (27%), with concomitant distant failure in one (9%), while isolated distant failure occurred in six patients (55%). The rate of flap necrosis and wound infection following external hemipelvectomy were both 25%. Following internal hemipelvectomy, nine patients (90%) were alive without evidence of disease after a median follow-up of 6.6 years (range: 2.3-16.0). Concomitant local and distant failures were found in one patient (10%). Reconstruction-related complications necessitated revisional procedures in five of seven patients (72%), leading to external hemipelvectomy in one. Patients with a locally advanced pelvic girdle sarcoma who are unable to undergo an internal hemipelvectomy have a worse prognosis than patients who undergo an internal hemipelvectomy. An internal hemipelvectomy is not attended by an increased risk of local failure, but is by long-term local complications, requiring extensive surgical procedures.

Adolescent↗
PubMed1997

Shoulder fusion for paralyzed upper limb.

Fusion of the shoulder joint after a brachial plexus injury is a well known procedure in cases of flail shoulder in combination with normal motor and sensory function in the band. However, in combination with modern orthoses to stabilize the elbow, fusion of the shoulder in cases of a totally flaccid and afunctional arm might be more beneficial. In a retrospective study the impact of shoulder fusion on daily abilities in a population with a completely flaccid arm caused by a brachial plexus injury was investigated. Compared with a similar population, consisting of 16 patients with an afunctional unstable shoulder, all 12 patients who underwent shoulder fusion proved to perform at a higher functional level. Shoulder fusion in combination with an elbow stabilizing orthosis for a completely flaccid upper limb is a beneficial procedure that leads to less disability and results in a better quality of life.

Brachial Plexus↗
PubMed1997

Pediatric polytrauma: short-term and long-term outcomes.

OBJECTIVE: To assess the short-term and long-term outcomes of pediatric polytrauma patients and to analyze the extent to which short-term outcomes can predict long-term outcomes. MATERIALS AND METHODS: All pediatric polytrauma patients (Injury Severity Score of > or = 16, < or = 15 years of age) who were treated at a Level I trauma center between 1985 and 1989 and who were 18 years or older at follow-up (1996) were included. Short-term outcomes were quantified using the Glasgow Outcome Scale. The Functional Independence Measure, the RAND-36, and questions on social outcome were used to assess long-term outcomes. MEASUREMENTS AND MAIN RESULTS: Fifty-nine of 74 patients survived (80%). At 1 year after injury, 22% were disabled, mainly due to severe brain injuries, and 32% had changed school. After 9 years of follow-up, the degree of physical disablement was low (12%). Cognitive impairments were found in 42% of the patients. Only 10% were in receipt of disablement allowances; 76% were employed or attended school. The quality of life enjoyed by the patients (RAND-36) did not differ from that enjoyed by a healthy reference population. The Glasgow Outcome Scale (from 6 weeks onward) was a good predictor of long-term disablement. CONCLUSIONS: Although the short-term impact of injuries is extensive, the long-term outcomes are satisfactory. Severe injuries sustained during childhood do not lead to a diminished quality of life during adulthood.

Adolescent↗
PubMed1997

Energy storage and release of prosthetic feet. Part 1: Biomechanical analysis related to user benefits.

The energy storing and releasing behaviour of 2 energy storing feet (ESF) and 2 conventional prosthetic feet (CF) were compared (ESF: Otto Bock Dynamic Pro and Hanger Quantum; CF: Otto Bock Multi Axial and Otto Bock Lager). Ten trans-tibial amputees were selected. The study was designed as a double-blind, randomised trial. For gait analysis a VICON motion analysis system was used with 2 AMTI force platforms. A special measuring device was used for measuring energy storage and release of the foot during a simulated step. The impulses of the anteroposterior component of the ground force showed small, statistically non-significant differences (deceleration phase: 22.7-23.4 Ns; acceleration phase: 17.0-18.4 Ns). The power storage and release phases as well as the net results also showed small differences (maximum difference in net result is 0.03 J kg-1). It was estimated that these differences lead to a maximum saving of 3% of metabolic energy during walking. It was considered unlikely that the subjects would notice this difference. It was concluded that during walking differences in mechanical energy expenditure of this magnitude are probably not of clinical relevance. Ankle power, as an indicator for energy storage and release gave different results to the energy storage and release as measured with the special test device, especially during landing response. In the biomechanical model (based on inverse dynamics) used in the gait analysis the deformation of the material is not taken into consideration and hence this method of gait analysis is probably not suitable for calculation of shock absorption.

Adult↗
PubMed1997

Energy storage and release of prosthetic feet. Part 2: Subjective ratings of 2 energy storing and 2 conventional feet, user choice of foot and deciding factor.

This paper is the second part of a study on biomechanical and functional properties of prosthetic feet. The first part dealt with a biomechanical analysis related to user benefits. This part deals with subjective ratings and deciding factors for trans-tibial amputees using 2 energy storing feet (ESF) and 2 conventional feet (CF). The Otto Bock Dynamic Pro and Hanger Quantum feet were used as ESF and the Otto Bock Multi Axial and Otto Bock Lager feet were used as CF. Ten trans-tibial amputees, active walkers, without stump problems, were selected (mean age: 49 years old). The study was designed as a double-blind, randomised trial and for each foot there was a habituation period of 2 weeks. Two questionnaires were designed. (A) concerned information about the preference of the subjects and (B) concerned the order of importance of difference aspects concerning a prosthesis. Results indicated that no clear preference for either the ESF or the CF existed and that the individual preference is not related to age. The items 'ability to walk fast' and 'no fatigue during walking', score statistically significantly worse for the CF2. With the small contrast between the ESF and CF, in relation to energy storing capacities, the subjects cannot distinguish between the ESF and CF. The 'absence of stump pain' and 'stability while walking' are ranked as most important aspects concerning a prosthesis. The perception of stability is likely to be related to the level and kind of activities the subject performs.

Adult↗
PubMed1997

Epidemiology of lower limb amputees in the north of The Netherlands: aetiology, discharge destination and prosthetic use.

The aim of this study was to give a retrospective review of all lower limb amputations performed in the 3 northern provinces of the Netherlands in 1991-1992. Assembled data were compared with the existing information in the National Medical Register (NMR) over the same period. With the participation of all regional hospitals, 473 lower limb amputations from transpelvic to transmetatarsal level were identified. Of the amputations 94% were performed for vascular pathology, 3% for trauma, and 3% for oncologic reasons. After surgery a prosthesis was provided to 48% of the amputees. The actual number of performed amputations exceeds the number of amputations registered by the NMR by 9%. Incidence rates of lower limb amputations in the Netherlands are 18-20/100,000 over the last 12 years. These numbers are lower than in other areas and no sharp decrease in frequency compared with other countries in Western Europe.

Adolescent↗