The movement towards proven best care: inspiration for rehabilitation physicians
All parties in the Dutch Healthcare system work together in the program ‘Zorgevaluatie en Gepast Gebruik'(ZE&GG) to make care increasingly evidence based. The intention is that healthcare evaluation and appropriate use will become part of all regular care processes. How will this be part of guideline revisions of the FMS and policy decisions of the Zorginstituut? How is it secured in the healthcare purchasing cycle between hospitals and insurance companies? And what adjustments to the system are needed? In his lecture, Sjoerd Repping talks about the latest developments as a source of inspiration for rehabilitation physicians.
Sjoerd Repping is professor of Appropriate Care at the Amsterdam University Medical Centers and chair of the Healthcare Evaluation and Appropriate Use program. Originally trained as a clinical embryologist and geneticist, Sjoerd has focused his career in the past decade on how to ensure that medical care is evidence based. He currently runs a national program in which patients, doctors, nurses, hospitals, insurers and the national government collaborate to make healthcare evaluation and appropriate use an integral part of medical care in the Netherlands.
More information will follow soon.
Knowledge translation and dissemination to impact health policy and implement evidence in clinical rehabilitation practice.
Evidence-Based Medicine (EBM) and evidence-based practice (EBP) in health combine three components: research-based evidence, clinician’s expertise, and patient’s values and preferences, making the effectiveness of interventions one of the primary drivers of good quality care. An essential role of EBM is to strengthen the importance of scientific data in making decisions in medicine for individual patients (by clinicians) and populations (by health policy-makers). Evidence is growing exponentially and keeping up-to-date has become a big challenge for the busy clinician. Therefore evidence synthesis is needed by means of systematic reviews and meta-analyses. However, high-quality evidence is still not consistently applied in clinical practice or in health policy-making: this is called the “know-do” gap. The WHO defined Knowledge Translation as “the synthesis, exchange, and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and improving people’s health”. The Knowledge to Action Framework comprises knowledge creation and an action cycle at all levels of health care to finally implement evidence. Cochrane is the scientific community producing the recognised best health evidence syntheses, and Cochrane Rehabilitation is the field of Cochrane focusing on Knowledge Translation in our field. Rehabilitation focuses on functioning and is based on conceptual models close to the complex bio-psycho-social paradigm, rendering evidence gathering complicated. Tools to facilitate evidence production and dissemination will be discussed, also in light of the pandemic and how this led to several global evidence reports by Cochrane, the WHO, and COVID-END.
Carlotte Kiekens is a Belgian Physical and Rehabilitation (PRM) physician, working in Italy since 2020, after 30 years at the University Hospitals Leuven – KU Leuven, as Head of Clinic of the Rehabilitation Centre UZ Leuven campus Pellenberg. She was Director of the Spinal Unit at the Montecatone Rehabilitation Institute in 2020-2021 and is currently head of the PRM unit at Ospedale San Giuseppe, IRCCS MultiMedica in Milano.
Carlotte is Co-Director of Cochrane Rehabilitation, which she co-founded in 2016. She is the chair of the International Society of PRM (ISPRM)-WHO Liaison committee, member of the European Academy of Rehabilitation Medicine, Senior Fellow of the European Board of PRM, and ISCoS Fellow. She chairs the Professional Practice Committee at the UEMS (European Union of Medical Specialists) PRM Section. She is Specialty Co-chief Editor of the Strengthening Rehabilitation in Health Systems section of the Journal Frontiers in Rehabilitation Sciences.Carlotte has been actively involved in teaching and research activities, published over 150 papers in PubMed, 20 book chapters, and given lectures at national and international conferences, including in low-and middle-income countries in Asia and Africa.
Small is beautiful: Single-case experimental designs in rehabilitation medicine
In a typical group-based RCT, participants are randomly assigned to either an experimental or a control group. The group means are then compared, and the size of the effect is calculated considering the spread of the data. This approach has so far led to numerous evidence-based pain treatments and guidelines at the population level. A critical question is whether this information provides valid information about the expected outcome of a single individual. The idea that group-based data can be generalized to the individual has been criticized. An viable alternative approach is the analysis of data at the individual level through single-case experimental designs (SCEDs). These are designs in which one case is observed repeatedly during a certain period of time before and after an intervention. SCEDs should not be confused with (narrative) case studies or observational time-series research. In this presentation, the history of the single-case experiential designs will be briefly reviewed, and their essential components will be highlighted. Data analytic methods will be brieflty introduced. These include visual analysis, effect size calculations, and inferential statistics (e.g. randomization tests), Lastly, the benefits and limitations of SCEDs will be discussed in the context of rehabilitation medicine.
Johan W.S. Vlaeyen is professor at the Universities of Maastricht (NL) and Leuven (B). His main research expertise is on the psychological mechanisms underlying the transition from common acute aversive sensations to chronic bodily symptoms. His experimental work includes research on the acquisition of pain-related fear and avoidance behavior. Johan highly values translational research, and he and his team have developed customized cognitive-behavioral management strategies for individuals suffering chronic bodily symptoms and utilized replicated single-case experimental designs to evaluate the effects of these interventions. Johan Vlaeyen has published more than 400 scientific papers in international journals. He is on the editorial board of the flagship journal Pain, Clinical Journal of Pain, Scandinavian Journal of Pain, Cognitive Behaviour Therapy, and Translational Behavioural Medicine. He received the Pain Award of the Dutch Chapter of IASP and has been awarded Distinguished International Affiliate of the American Psychological Association, for “unusual and outstanding contributions” to health psychology. He has an adjunct research professorship at the University of South Australia (Adelaide Australia) and obtained an honorary doctorate at the University of Örebro (Sweden) for his scientific contributions in the area of health psychology. He will serve as a Councilor of the International Association for the Study of Pain (IASP) from October 2022. Publications: https://orcid.org/0000-0003-0437-6665
Corry van der Sluis
Research results that made it into clinical practice
Research in the field of rehabilitation medicine mostly has the goal to improve patient outcomes. Such research results can be diverse: development of new assistive devices, training programs or improvement of treatments, and many more. The ultimate goals in our field are to increase the patients’ participation in society or improve their quality of life. A lot of research results however do not reach the clinicians’ daily practice. Several reasons can be identified to explain the lack of integration of research results into daily clinical practice, such as type of research design (for example generalizability of RCT results is mostly questionable), technology driven research instead of patient driven research, lack of patient involvement, too little attention for implementation from the start of a project, etc. Fortunately, there are also examples of research results that influence daily practice in a substantial way. In professor van der Sluis’ lecture she will try to provide some insights how research results can be integrated in daily practice. She will use examples of her own research activities focused on improving upper limb function or the quality of life of individuals with an amputation or stroke survivors to illustrate why and how these research results did reach daily clinical practice.
Corry K. van der Sluis (1964) is a professor and consultant for Rehabilitation Medicine at the University Medical Center Groningen, the Netherlands. Her field of interest is the rehabilitation of persons with upper limb disorders. Her professional activities comprise patient care, teaching and research. Her research focuses mainly on upper limb amputations and prostheses. A main research topic is the development of training programs for people who use upper limb prostheses. Innovative technology such as serious games are integrated in this research. A second main research topic is the decrease and prevention of musculoskeletal complaints in persons with upper limb disorders. She is author of over 130 internationally peer reviewed publications and she contributed as an author to 8 book chapters. She gave over 70 international presentations.