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Article ; Online: Patient education and health literacy.

Wittink, H / Oosterhaven, J

2018 Volume 38, Page(s) 120–127

Abstract: Introduction: Patient education is a relatively new science within the field of health care. In the past it consisted mainly of the transfer of knowledge and mostly biomedically based advice. Research has shown this to not be effective and sometimes ... ...

Abstract	Introduction: Patient education is a relatively new science within the field of health care. In the past it consisted mainly of the transfer of knowledge and mostly biomedically based advice. Research has shown this to not be effective and sometimes counterproductive. As health care has moved away from applying a traditional paternalistic approach of 'doctor knows best' to a patient-centred care approach, patient education must be tailored to meet persons' individual needs. Purpose: The purpose of this master paper is to increase awareness of patients' health literacy levels. Health literacy is linked to literacy and entails people's knowledge, motivation and competences to access, understand, appraise and apply health information in order to make judgements and take decisions in everyday life concerning health care, disease prevention and health promotion to maintain or improve quality of life during the life course. Many patients have low health literacy skills, and have difficulty with reading, writing, numeracy, communication, and, increasingly, the use of electronic technology, which impede access to and understanding of health care information. Implications: Multiple professional organizations recommend using universal health literacy precautions to provide understandable and accessible information to all patients, regardless of their literacy or education levels. This includes avoiding medical jargon, breaking down information or instructions into small concrete steps, limiting the focus of a visit to three key points or tasks, and assessing for comprehension by using the teach back cycle. Printed information should be written at or below sixth-grade reading level. Visual aids can enhance patient understanding.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Female ; Health Knowledge, Attitudes, Practice ; Health Literacy ; Humans ; Male ; Middle Aged ; Patient Education as Topic/methods ; Patient-Centered Care/methods
Language	English
Publishing date	2018-06-27
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2888772-4
ISSN	2468-7812
ISSN (online)	2468-7812
DOI	10.1016/j.msksp.2018.06.004
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Article ; Online: Limited predictive value of illness perceptions for short-term poor recovery in musculoskeletal pain. A multi-center longitudinal study.

de Raaij, E J / Wittink, H / Maissan, J F / Westers, P / Ostelo, R W J G

BMC musculoskeletal disorders

2021 Volume 22, Issue 1, Page(s) 522

Abstract: Background: Musculoskeletal pain (MSP) is recognized worldwide as a major cause of increased years lived with disability. In addition to known generic prognostic factors, illness perceptions (IPs) may have predictive value for poor recovery in MSP. We ... ...

Abstract	Background: Musculoskeletal pain (MSP) is recognized worldwide as a major cause of increased years lived with disability. In addition to known generic prognostic factors, illness perceptions (IPs) may have predictive value for poor recovery in MSP. We were interested in the added predictive value of baseline IPs, over and above the known generic prognostic factors, on clinical recovery from MSP. Also, it is hypothesized there may be overlap between IPs and domains covered by the Four-Dimensional Symptom Questionnaire (4DSQ), measuring distress, depression, anxiety and somatization. The aim of this study is twofold; 1) to assess the added predictive value of IPs for poor recovery and 2) to assess differences in predictive value for poor recovery between the Brief Illness Perception Questionnaire - Dutch Language Version (Brief IPQ-DLV) and the 4DSQ. Methods: An eligible sample of 251 patients with musculoskeletal pain attending outpatient physical therapy were included in a multi-center longitudinal cohort study. Pain intensity, physical functioning and Global Perceived Effect were the primary outcomes. Hierarchical logistic regression models were used to assess the added value of baseline IPs for predicting poor recovery. To investigate the performance of the models, the levels of calibration (Hosmer-Lemeshov test) and discrimination (Area under the Curve (AUC)) were assessed. Results: Baseline 'Treatment Control' added little predictive value for poor recovery in pain intensity [Odds Ratio (OR) 0.80 (Confidence Interval (CI) 0.66-0.97), increase in AUC 2%] and global perceived effect [OR 0.78 (CI 0.65-0.93), increase in AUC 3%]. Baseline 'Timeline' added little predictive value for poor recovery in physical functioning [OR 1.16 (CI 1.03-1.30), increase in AUC 2%]. There was a non-significant difference between AUCs in predictive value for poor recovery between the Brief IPQ-DLV and the 4DSQ. Conclusions: Based on the findings of this explorative study, assessing baseline IPs, over and above the known generic prognostic factors, does not result in a substantial improvement in the prediction of poor recovery. Also, no recommendations can be given for preferring either the 4DSQ or the Brief IPQ-DLV to assess psychological factors.
MeSH term(s)	Anxiety ; Humans ; Longitudinal Studies ; Musculoskeletal Pain/diagnosis ; Musculoskeletal Pain/therapy ; Perception ; Surveys and Questionnaires
Language	English
Publishing date	2021-06-07
Publishing country	England
Document type	Journal Article
ISSN	1471-2474
ISSN (online)	1471-2474
DOI	10.1186/s12891-021-04366-7
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Article ; Online: Living systematic reviews in rehabilitation science can improve evidence-based healthcare.

Elbers, S / Wittink, H / Kaiser, U / Kleijnen, J / Pool, J / Köke, A / Smeets, R

Systematic reviews

2021 Volume 10, Issue 1, Page(s) 309

Abstract: Although systematic reviews are considered as central components in evidence-based practice, they currently face an important challenge to keep up with the exponential publication rate of clinical trials. After initial publication, only a minority of the ...

Abstract	Although systematic reviews are considered as central components in evidence-based practice, they currently face an important challenge to keep up with the exponential publication rate of clinical trials. After initial publication, only a minority of the systematic reviews are updated, and it often takes multiple years before these results become accessible. Consequently, many systematic reviews are not up to date, thereby increasing the time-gap between research findings and clinical practice. A potential solution is offered by a living systematic reviews approach. These types of studies are characterized by a workflow of continuous updates which decreases the time it takes to disseminate new findings. Although living systematic reviews are specifically designed to continuously synthesize new evidence in rapidly emerging topics, they have also considerable potential in slower developing domains, such as rehabilitation science. In this commentary, we outline the rationale and required steps to transition a regular systematic review into a living systematic review. We also propose a workflow that is designed for rehabilitation science.
MeSH term(s)	Evidence-Based Medicine ; Evidence-Based Practice ; Humans ; Systematic Reviews as Topic
Language	English
Publishing date	2021-12-07
Publishing country	England
Document type	Journal Article
ZDB-ID	2662257-9
ISSN	2046-4053 ; 2046-4053
ISSN (online)	2046-4053
ISSN	2046-4053
DOI	10.1186/s13643-021-01857-5
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Article ; Online: Physiotherapists' knowledge, attitude and practice behavior to prevent chronification in patients with non-specific, non-traumatic, acute- and subacute neck pain: A qualitative study.

Verwoerd, M J / Wittink, H / Goossens, M E J B / Maissan, F / Smeets, R J E M

Musculoskeletal science & practice

2021 Volume 57, Page(s) 102493

Abstract: Background: The purpose of this study was to explore physiotherapists' knowledge, attitude, and practice behavior in assessing and managing patients with non-specific, non-traumatic, acute- and subacute neck pain, with a focus on prognostic factors for ... ...

Abstract	Background: The purpose of this study was to explore physiotherapists' knowledge, attitude, and practice behavior in assessing and managing patients with non-specific, non-traumatic, acute- and subacute neck pain, with a focus on prognostic factors for chronification. Method: A qualitative study using in-depth semi-structured interviews was conducted with 13 physiotherapists working in primary care. A purposive sampling method served to seek the broadest perspectives. The knowledge-attitude and practice framework was used as an analytic lens throughout the process. Textual data were analyzed using qualitative content analysis with an inductive approach and constant comparison. Results: Seven main themes emerged from the data; physiotherapists self-estimated knowledge and attitude, role clarity, therapeutic relationship, internal- and external barriers to practice behavior, physiotherapists' practice behaviors, and self-reflection. These findings are presented in an adjusted knowledge-attitude and practice behavior framework. Conclusion: A complex relationship was found between a physiotherapist's knowledge about, attitude, and practice behavior concerning the diagnostic process and interventions for non-specific, non-traumatic, acute, and subacute neck pain. Overall, physiotherapists used a biopsychosocial view of patients with non-specific neck pain. Physiotherapists' practice behaviors was influenced by individual attitudes towards their professional role and therapeutic relationship with the patient, and individual knowledge and skills, personal routines and habits, the feeling of powerlessness to modify patients' external factors, and patients' lack of willingness to a biopsychosocial approach influenced physiotherapists' clinical decisions. In addition, we found self-reflection to have an essential role in developing self-estimated knowledge and change in attitude towards their therapeutic role and therapist-patient relationship.
MeSH term(s)	Attitude of Health Personnel ; Health Knowledge, Attitudes, Practice ; Humans ; Low Back Pain/therapy ; Neck Pain/therapy ; Physical Therapists/psychology ; Professional-Patient Relations
Language	English
Publishing date	2021-12-11
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2888772-4
ISSN	2468-7812
ISSN (online)	2468-7812
DOI	10.1016/j.msksp.2021.102493
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Article ; Online: Illness perceptions; exploring mediators and/or moderators in disabling persistent low back pain. Multiple baseline single-case experimental design.

Edwin de Raaij, E J / Harriet Wittink, H / Francois Maissan, J F / Jos Twisk, J / Raymond Ostelo, R W J G

BMC musculoskeletal disorders

2022 Volume 23, Issue 1, Page(s) 140

Abstract: Introduction: Illness Perceptions (IPs) may play a role in the management of persistent low back pain. The mediation and/or moderation effect of IPs on primary outcomes in physiotherapy treatment is unknown.: Methods: A multiple single-case ... ...

Abstract	Introduction: Illness Perceptions (IPs) may play a role in the management of persistent low back pain. The mediation and/or moderation effect of IPs on primary outcomes in physiotherapy treatment is unknown. Methods: A multiple single-case experimental design, using a matched care physiotherapy intervention, with three phases (phases A-B-A') was used including a 3 month follow up (phase A'). Primary outcomes: pain intensity, physical functioning and pain interference in daily life. Analyzes: linear mixed models, adjusted for fear of movement, catastrophizing, avoidance, sombreness and sleep. Results: Nine patients were included by six different primary care physiotherapists. Repeated measures on 196 data points showed that IPs Consequences, Personal control, Identity, Concern and Emotional response had a mediation effect on all three primary outcomes. The IP Personal control acted as a moderator for all primary outcomes, with clinically relevant improvements at 3 month follow up. Conclusion: Our study might indicate that some IPs have a mediating or a moderating effect on the outcome of a matched care physiotherapy treatment. Assessing Personal control at baseline, as a relevant moderator for the outcome prognosis of successful physiotherapy management of persistent low back pain, should be further eplored.
Language	English
Publishing date	2022-02-11
Publishing country	England
Document type	Journal Article
ZDB-ID	2041355-5
ISSN	1471-2474 ; 1471-2474
ISSN (online)	1471-2474
ISSN	1471-2474
DOI	10.1186/s12891-022-05031-3
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Article ; Online: A study protocol for the validation of a prognostic model with an emphasis on modifiable factors to predict chronic pain after a new episode of acute- or subacute nonspecific idiopathic, non-traumatic neck pain presenting in primary care.

Verwoerd, Martine J / Wittink, Harriet / Maissan, Francois / van Kuijk, Sander M J / Smeets, Rob J E M

PloS one

2023 Volume 18, Issue 1, Page(s) e0280278

Abstract: Background: The primary objective of this study is to identify which modifiable and non-modifiable factors are independent predictors of the development of chronic pain in patients with acute- or subacute nonspecific idiopathic, non-traumatic neck pain, ...

Abstract	Background: The primary objective of this study is to identify which modifiable and non-modifiable factors are independent predictors of the development of chronic pain in patients with acute- or subacute nonspecific idiopathic, non-traumatic neck pain, and secondly, to combine these to develop and internally validate a prognostic prediction model. Methods: A prospective cohort study will be conducted by physiotherapists in 30 primary physiotherapy practices between January 26, 2020, and August 31, 2022, with a 6-month follow-up until March 17, 2023. Patients who consult a physiotherapist with a new episode of acute- (0 to 3 weeks) or subacute neck pain (4 to 12 weeks) will complete a baseline questionnaire. After their first appointment, candidate prognostic variables will be collected from participants regarding their neck pain symptoms, prior conditions, work-related factors, general factors, psychological and behavioral factors. Follow-up assessments will be conducted at six weeks, three months, and six months after the initial assessment. The primary outcome measure is the Numeric Pain Rating Scale (NPRS) to examine the presence of chronic pain. If the pain is present at six weeks, three months, and six months with a score of NPRS ≥3, it is classified as chronic pain. An initial exploratory analysis will use univariate logistic regression to assess the relationship between candidate prognostic factors at baseline and outcome. Multiple logistic regression analyses will be conducted. The discriminative ability of the prognostic model will be determined based on the Area Under the receiver operating characteristic Curve (AUC), calibration will be assessed using a calibration plot and formally tested using the Hosmer and Lemeshow goodness-of-fit test, and model fit will be quantified as Nagelkerke's R2. Internal validation will be performed using bootstrapping-resampling to yield a measure of overfitting and the optimism-corrected AUC. Discussion: The results of this study will improve the understanding of prognostic and potential protective factors, which will help clinicians guide their clinical decision making, develop an individualized treatment approach, and predict chronic neck pain more accurately.
MeSH term(s)	Humans ; Prognosis ; Chronic Pain/diagnosis ; Neck Pain/diagnosis ; Neck Pain/etiology ; Neck Pain/psychology ; Prospective Studies ; Primary Health Care
Language	English
Publishing date	2023-01-17
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0280278
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Article ; Online: Answer to the editor: "Treatment based classification systems for patients with nonspecific neck pain. A systematic review".

Maissan, Francois / Pool, Jan / de Raaij, Edwin / Wittink, Harriet / Ostelo, Raymond

Musculoskeletal science & practice

2023 Volume 65, Page(s) 102753

MeSH term(s)	Humans ; Neck Pain/therapy ; Neck ; Patients
Language	English
Publishing date	2023-04-07
Publishing country	Netherlands
Document type	Systematic Review ; Letter ; Comment
ZDB-ID	2888772-4
ISSN	2468-7812
ISSN (online)	2468-7812
DOI	10.1016/j.msksp.2023.102753
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Article ; Online: Consensus of potential modifiable prognostic factors for persistent pain after a first episode of nonspecific idiopathic, non-traumatic neck pain: results of nominal group and Delphi technique approach.

Verwoerd, Martine / Wittink, Harriet / Maissan, Francois / Smeets, Rob

BMC musculoskeletal disorders

2020 Volume 21, Issue 1, Page(s) 656

Abstract: Background: Identify and establish consensus regarding potential prognostic factors for the development of chronic pain after a first episode of idiopathic, non-traumatic neck pain.: Design: This study used two consensus group methods: a modified ... ...

Abstract	Background: Identify and establish consensus regarding potential prognostic factors for the development of chronic pain after a first episode of idiopathic, non-traumatic neck pain. Design: This study used two consensus group methods: a modified Nominal Group (m-NGT) and a Delphi Technique. Methods: The goal of the m-NGT was to obtain and categorize a list of potential modifiable prognostic factors. These factors were presented to a multidisciplinary panel in a two-round Delphi survey, which was conducted between November 2018 and January 2020. The participants were asked whether factors identified are of prognostic value, whether these factors are modifiable, and how to measure these factors in clinical practice. Consensus was a priori defined as 70% agreement among participants. Results: Eighty-four factors were identified and grouped into seven categories during the expert meeting using the modified NGT. A workgroup reduced the list to 47 factors and grouped them into 12 categories. Of these factors, 26 were found to be potentially prognostic for chronification of neck pain (> 70% agreement). Twenty-one out of these 26 factors were found to be potentially modifiable by physiotherapists based on a two-round Delphi survey. Conclusion: Based on an expert meeting (m-NGT) and a two-round Delphi survey, our study documents consensus (> 70%) on 26 prognostic factors. Twenty-one out of these 26 factors were found to be modifiable, and most factors were psychological in nature.
MeSH term(s)	Consensus ; Delphi Technique ; Humans ; Neck ; Neck Pain/diagnosis ; Neck Pain/epidemiology ; Neck Pain/therapy ; Prognosis
Language	English
Publishing date	2020-10-07
Publishing country	England
Document type	Journal Article
ISSN	1471-2474
ISSN (online)	1471-2474
DOI	10.1186/s12891-020-03682-8
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Article ; Online: Reproducibility of Different Methodologies to Calculate Oxygen Consumption and Oxygen Cost During Walking in Chronic Stroke Survivors.

Blatter, Tim / Outermans, Jacqueline / Punt, Michiel / Wittink, Harriet

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

2020 Volume 29, Issue 4, Page(s) 104637

Abstract: Objective: The most common methods to calculate energy costs are based on measured oxygen uptake during walking a standardized distance or time. Unfortunately, it is unclear which method is most reliable to determine energy cost of walking in stroke ... ...

Abstract	Objective: The most common methods to calculate energy costs are based on measured oxygen uptake during walking a standardized distance or time. Unfortunately, it is unclear which method is most reliable to determine energy cost of walking in stroke survivors. The objective of this study was to evaluate the 3 most commonly used methods for calculating oxygen consumption and -cost by assessing test-retest reliability and measurement error in community dwelling chronic stroke survivors during a 6 Minute Walk Test. Methods: In this secondary analysis of a longitudinal study, reproducibility of the outcome of walking distance, walking speed, oxygen consumption and oxygen cost from 3 methods (Kendall's tau, assumed steady-state and total walking time oxygen consumption) were determined using Intraclass Correlation Coefficient, Standard Error of Measurement and Smallest Detectable Change. Results: 20 from the 31 participants successfully performed the 6 minute walk test-retest within a timeframe of 1 month. Within the 2 tests the reproducibility of walking distance and walking speed was high. The 3 methods to determine reproducibility for oxygen cost and oxygen consumption were considered good (Kendall's tau), good (assumed steady-state) and excellent (total walking time). Conclusions: The method using oxygen consumption and -cost over the total walking time resulted in the highest reproducibility considering the Intraclass Correlation Coefficient, its 95% Confidence Interval, and smaller absolute differences.
MeSH term(s)	Adult ; Aged ; Chronic Disease ; Energy Metabolism ; Exercise Tolerance ; Female ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Models, Biological ; Oxygen Consumption ; Predictive Value of Tests ; Reproducibility of Results ; Stroke/diagnosis ; Stroke/metabolism ; Stroke/physiopathology ; Time Factors ; Walk Test ; Walking
Language	English
Publishing date	2020-01-30
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	1131675-5
ISSN	1532-8511 ; 1052-3057
ISSN (online)	1532-8511
ISSN	1052-3057
DOI	10.1016/j.jstrokecerebrovasdis.2020.104637
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Article ; Online: Extended steep ramp test normative values for 19-24-year-old healthy active young adults.

Werkman, M S / Bongers, B C / Blatter, T / Takken, T / Wittink, H

European journal of applied physiology

2019 Volume 120, Issue 1, Page(s) 107–115

Abstract: Purpose: To extend currently available sex and age-specific normative values in children and adolescents for the peak work rate (WR: Methods: Healthy male and female participants aged between 19 and 24 years were recruited. After screening and ... ...

Abstract	Purpose: To extend currently available sex and age-specific normative values in children and adolescents for the peak work rate (WR Methods: Healthy male and female participants aged between 19 and 24 years were recruited. After screening and anthropometric measurements, participants performed a SRT on a cycle ergometer (increments of 25 W/10 s), monitoring and recording SRT-WR Results: Fifty-seven participants (31 males and 26 females; median age of 21.3 years) volunteered and were tested. Anthropometrics, resting BP and lung function were all within normal ranges. Ninety-three percent of the participants attained a peak HR (HR Conclusions: The present study provides sex-, age-, body height-, and body mass-related normative values (presented as reference centiles) for absolute and relative SRT performance throughout childhood and early adulthood.
MeSH term(s)	Biological Variation, Population ; Blood Pressure ; Body Weight ; Female ; Heart Rate ; Humans ; Male ; Reference Standards ; Sex Factors ; Walk Test/methods ; Walk Test/standards ; Walking/physiology ; Young Adult
Language	English
Publishing date	2019-11-08
Publishing country	Germany
Document type	Journal Article
ZDB-ID	124793-1
ISSN	1439-6327 ; 1432-1025 ; 0301-5548 ; 1439-6319
ISSN (online)	1439-6327 ; 1432-1025
ISSN	0301-5548 ; 1439-6319
DOI	10.1007/s00421-019-04255-x
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