Parallel Session C
C1. Mini-symposium: Physical fitness in amputation of the lower limb (in Dutch)
C2. Workshop: From CP guideline to CP proven practice: the road to implementation and innovation
C3. Mini-symposium: Actief binnen en buiten de spreekkamer – generieke activiteiten in de opleiding
C4. Mini-symposium: Enhancing the evidence base of rehabilitation: from clinical studies to clinical registries with real-world data
C5. Workshop: Over rouw en veerkracht in de revalidatie
C6. Mini-symposium: The person behind the patient: to be taken for granted?
C7. Mini-symposium: Stiff knee gait: the role of rectus femoris in stroke. The science, the daily clinical practice and a special case study (in Dutch)
C8. Mini-symposium: Developing and evaluating complex interventions in rehabilitation research; the MRC framework illustrated with examples from clinical studies
C1. Mini-symposium: Physical fitness in amputation of the lower limb (in Dutch)
An active lifestyle is important for good physical and mental health. Patients with amputation of the lower limb have a decreased physical activity compared to the 'average' Dutch person. But what does an active lifestyle really mean? And what is the guideline for physical activity? In this minisymposium we want to provide insight into the physical fitness of patients with amputation of the lower limb due to peripheral arterial disease and how many extra energy it costs them to be physically active. A physical profile has been developed to improve physical fitness of patients in rehabilitation settings and is already in use at various locations in the Netherlands. What are the results so far and what is the practical experience with the use of the physical profile?
There are several obstacles for patients with an amputation of the lower limb to be sufficiently physical active: search for a new sport, the application process for the right sports aids. The Ministry of Health, Welfare and Sport recently presented a new guideline for sports aids, which Hans Leutscher will discuss with us. And how can you, as a rehabilitation physician, contribute to this?
By changing the physical possibilities, the occurrence of an injury is lurking. What can you do to prevent this in patients with a prosthetic leg? What training principles should you take into account when improving physical fitness? What advice do you give and what role do you have as a rehabilitation or sports physician?
Speakers and outline session:
- Han Houdijk, professor Human Movement Sciences UMCG, will discuss the balance between physical fitness and physical strain in persons with an amputation of the lower limb. He will demonstrate how an imbalance will influence walking ability and how walking ability can be improved by an optimised physical fitness.
- Liesbeth Simmelink, PhD and rehabilitation physician UMCG, will tell us about her PhD thesis "Met één been kun je nu wél testen" (Now it ís possible to perform a cardiopulmonary exercise test (CPET) with one leg). She will also discuss important factors for measuring and improving physical fitness during rehabilitation after amputation of the lower limb.
- Floor Groot, sports physician Sport- en Beweegkliniek (Haarlem) and Heliomare, and Roy Appel, movement therapist Heliomare, will guide us through the translation of CPET into practice, the actual training to maximize strength in a short time.
- Hans Leutscher, specialist Kenniscentrum Sport & Bewegen, will discuss the exercise guidelines for physically disabled persons and will also discuss the guideline for sports aids (2022) which should ensure that (potential) athletes who are physically disabled can apply for a sports aids more easily.
Learning objective(s):
Come to this minisymposium to learn, apply and promote physical fitness among persons with an amputation of the lower limb, to learn about the (im)possibilities of CPET (even with one limb), to share your experiences and to increase your network.
C2. Workshop: From CP guideline to CP proven practice: the road to implementation and innovation
Since 2006, a multidisciplinary guideline for the diagnosis and treatment of children with Cerebral Palsy (CP) is available. The guideline has been updated, with the most recent update starting this year. Providing a guideline is the first step, but it does not change clinical practice at once.
Three initiatives that are are paving the road to implementation will be presented:
- Implementation projects were started by development of a network of Knowledge Brokers. By developing implementation strategies and practical tools, efficiency in implementation increased highly. In 2013 CP-Net was founded (www.CP-Net.nl), a collaboration of health care providers, researchers, and the client organisation for CP.
- Besides scientific knowledge, the use of knowledge of people with lived experience of CP is crucial. The Dutch client organisation, CP-Nederland (www.CP-Nederland.nl ) participated in the development of the CP-guidelines and developed a research agenda.
- The Netherlands CP-register (www.CPregister.nl) started in 2016, and has developed into a combined screening/follow up ánd treatment registry, with nationwide coverage. It includes tools for shared decision making. Data collection will enable research promoting personalized treatment for children with CP.
Presenters:
- Annemieke Buizer: CP guideline and process of updates
- Marieke van Driel: involvement of CP-Nederland in guideline development and implementation
- Jeanine Voorman: organization of CP Net
- Maaike de Kleijn: Knowledge Broker-system, practising steps for implementation
- Annemieke Buizer: the role of the Netherlands CP-register
Outline of the session:
In the workshop, CP-Nederland, CP-Net and the Netherlands CP-register will explain what they have done in the last years to achieve successfully the translation of scientific knowledge to innovation in daily rehabilitation practice. Typical for the efforts is the collaboration of scientists, healthcare providers and experts with lived experience of CP. The desired innovation and translation in daily practice is a leading motive. Which factors are related with success or failure? Based on the several phases of implementation and change of behaviour, the participants learn about implementation of a guideline, combining theoretical knowledge with experience from practice.
Discussion with the audience.
Learning objective(s):
1. Systematic approach to implementation of a guideline into daily practice.
2. Which factors are related with success or failure in implementing a guideline.
C3. Mini-symposium: Actief binnen en buiten de spreekkamer – generieke activiteiten in de opleiding
Welke revalidatieartsen hebben we in de toekomst nodig en hoe geven we dit vorm in de opleiding? Naast medisch inhoudelijke kennis, vaardigheden, klinisch redeneren en goede communicatie wordt van alle aiossen verwacht dat zij op basisniveau bekwaam worden in de drie generieke competenties ‘Leidinggeven en organiseren’, ‘Onderwijs en supervisie verzorgen’ en ‘Actief bijdragen aan de wetenschap’. Van oudsher heeft deze laatste competentie een grote rol in de opleiding vanwege de wetenschapseis uit het kaderbesluit. Hierbij doen de aiossen tijdens hun opleiding een (poster)voordracht op een wetenschappelijk congres of schrijven ze een wetenschappelijk artikel. In dit mini symposium geven we handvatten hoe aiossen ook met activiteiten die binnen de andere generieke competenties vallen aan deze wetenschapseis kunnen voldoen. Tot slot tonen we voorbeelden van verdiepingsmogelijkheden van de generieke activiteiten ‘Leidinggeven en organiseren’ en ‘Onderwijs en supervisie verzorgen’.
Programma:
In dit mini-symposium bespreken en onderbouwen we het belang van differentiatie binnen de opleiding en ons vak, waarbij aiossen breed opgeleid worden door verschillende collega’s en ieders talenten benut worden.
De volgende presentaties zullen onderdeel zijn van het mini symposium:
- Eindtermen van de verschillende generieke activiteiten en handvatten hoe die te toetsen - Vincent de Groot
- Ontwikkelingen in diverse OORs ten aanzien van de generieke activiteiten - Ilse van Nes en Clemens Rommers
- Praktische voorbeelden van stages gericht op de generieke activiteit ‘Onderwijs en supervisie verzorgen’ en ‘Leiding geven en organiseren’ - Vera van Reuler en Annique Priesterbach
- Discussie over de revalidatiearts van de toekomst - Vincent de Groot
Clinical registries with real-world data has attracted increasing attention in health research to address effectiveness of treatment and form the basis of precision medicine. In rehabilitation medicine, with heterogeneous samples and complex interventions, robust evidence for treatment effectiveness is currently lacking. Large, comprehensive data registries with longitudinal data on real-world functioning may form the solution for building the evidence base. Technological advances in the last decade, with electronic health records, ehealth applications for blended-care, new technologies for remote-monitoring of functioning and advances in data analytics, make this the right time to build and make use of clinical registries, thereby accelerating precision rehabilitation. Important prerequisites for building clinical registries is standardization of data collection using core sets of functional measures that can be used in clinical practice as well as valid, precise and frequent longitudinal measurement of real-world functioning.
In this mini-symposium experiences with clinical registries and registry-based research will be shared and the national initiative CumuluZ will be presented that can unlock all patient healthcare data in care networks for optimal use in care and research. The opportunities and challenges in developing and implementing clinical registries in rehabilitation medicine will be interactively discussed.
Chairs: Esther Kruitwagen MD PhD and Anita Beelen, PhD
Outline session:
1. Welcome and introduction - Dr. Anita Beelen, PhD, assistant professor at the Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht (10 min)
2. Getting consensus in clinical measures on stroke recovery and rehabilitation studies post stroke: The ISRRA initiative - Gert Kwakkel, PhD, Professor in Neurorehabilitation Head Department Acquired Brain Injury, Rehabilitation centre Reade, Amsterdam & Department Rehabilitation Medicine, Amsterdam University Medical Centre, Amsterdam (20 min)
3. The importance of clinical registry data in drug development for Amyotrophic Lateral Sclerosis - Ruben van Eijk, MD PhD, assistant professor and medical statistician, department of Neurology, University Medical Center Utrecht (20 min)
4. CumuluZ: let’s put health-data to work! Ruud Bongers, IT-Architect, Directorate Information Technology, University Medical Center Utrecht, Utrecht (20 min)
CumuluZ will provide a futureproof healthcare platform based on an open common data model and open API’s. It will unlock all patient healthcare data via a transmural longitudinal record and will put clinicians and patients back in the driver’s seat of clinical innovation.
5. Panel discussion on opportunities and challenges of clinical registries in rehabilitation (20 min)
Learning oblectives:
1. To create awareness of the importance of clinical registries and synergistic use of different data sources for evidence building in rehabilitation medicine
2. To obtain insight in the advances in care and research obtained from existing clinical registries in and outside the field of rehabilitation
3. To provide a platform to discuss the opportunities and challenges in generating, implementing an maintaining registries in rehabilitation medicine.
In ons werk als revalidatiearts zien we dagelijks mensen die te maken hebben met verlies zoals (letterlijk) een deel van hun lichaam, moeiteloos kunnen bewegen, makkelijk kunnen denken of verlies van gezondheid in algemene zin. Verlies van functie en taken in het leven leidt vaak ook tot een veranderingsproces in identiteit, zingeving en (toekomst)perspectief.
Verlies geeft rouw en een goed doorlopen “rouwcyclus” draagt bij aan herstel van veerkracht. Veerkracht die nodig is om het leven weer op te pakken. Dit rouwproces begint vaak al tijdens de revalidatie maar kan heel verschillend en SOMS grillig verlopen. Maar hoe doe je dat dan, goed rouwen? En wat kunnen wij als revalidatiearts doen om dat proces te ondersteunen?
Met rouw hebben we dus dagelijks te maken in de revalidatie maar in onze opleiding hebben we hier eigenlijk zo goed als niks over geleerd.
Moderators/chairs:
- Véronique Moulaert, revalidatiearts UMCG centrum voor revalidatie (locatie Beatrixoord), werkt nu 10 jaar in de neurorevalidatie en begeleidt daar mensen met NAH en MS. Zij had zelf op jonge leeftijd al te maken met ingrijpend verlies. Véronique won in 2014 de VRA PhD award met haar proefschrift ‘Life after survival of a cardiac arrest. The brain is the heart of the matter’.
- Casper van Koppenhagen, revalidatiearts Rijndam RC (locatie Erasmus MC), sportarts np, auteur, blogger, podcastmaker van ‘KopCast’ ‘van geluk spreken’van Medisch Contact. Auteur “Ik had je gedacht mijn kind” over het verlies van zijn zoons Lennard en Simon, alsmede het opgeven van kinderwens. Promoveerde in 2013 op “Life satisfaction and wheelchair exercise capacity in persons with spinal cord injury”.
Sprekers:
- Ervaringsdeskundige en rouwcoach Annemarieke Driessen, partner "Wakker". Je kunt meer dan je denkt!
Annemarieke spreekt, weet waar ze het over heeft en raakt met een lach en een traan. Positieve gezondheid, omgaan met verandering en inspirerend leiderschap. Een inspirerend verhaal, dat prikkelt, door pakkende persoonlijke metaforen te linken aan een organisatie. Hierdoor raakt zij en zet ze mensen in beweging. Soms voor even en vaak voor heel het leven. - Tanja van Roosmalen van Lef Verliesbegeleiding, tevens trainer en rouw- en verliesbegeleider bij Expertisecentrum Omgaan met Verlies.
Doel workshop:
Deelnemers krijgen inzicht in rouw binnen de revalidatie, praktische adviezen over omgang met rouw in spreekkamer, op de afdeling, bij zichzelf en bij collegae.
C6. Mini-symposium: The person behind the patient: to be taken for granted?
Rehabilitation aims to optimize body functions and functional abilities, with the ultimate aim to optimize independence, participation and quality of life. Rehabilitation is person-centered, meaning that the interventions and approach selected for each individual depends on their goals and preferences. Nevertheless, rehabilitation is generally characterized by a strong focus on treatment of impairments and functional disabilities. Although varying across diagnoses, attention for psychological factors is relatively sparse in rehabilitation.
In this mini-symposium we want to address the following learning objectives:
1. To provide knowledge on the impact of psychological factors, such as self-efficacy, illness perceptions, resilience etc., on rehabilitation outcomes at various levels (independence, secondary health conditions, participation) in multiple diagnostic groups;
2. To provide knowledge on examples of psychological interventions as part of multidisciplinary rehabilitation, such as ACT, Mindfulness, self-management training, CBT, CFT and other;
3. To discuss and explore the commonalities and differences in the impact of psychological factors across diagnoses.
Chair: Marcel Post
Speakers:
- Marcel Post: Introduction
- Jeanine Verbunt: The person behind the patient with chronic pain
- Marion Sommers: The person behind the patient with amyotrophic lateral sclerosis
- Christel van Leeuwen: The person behind the patient with spinal cord injury
- Anne Visser-Meily: The person behind the patient with stroke
Outline of the session:
- Marcel Post will introduce the topic by presenting evidence from multiple recent studies on the predictive value of psychological factors measured early after injury for long-term outcomes (10 minutes).
- After that, four speakers will present evidence on the relevance of psychological factors and present psychological interventions in various diagnostic groups (15 minutes each):
- Jeanine Verbunt on chronic pain and multiple psychological therapies
- Marion Sommers on amyotrophic lateral sclerosis and self-compassion therapy
- Christel van Leeuwen on spinal cord injury, mindfulness and self-regulation groups
- Anne Visser-Meily on stroke. - The session will be closed by a discussion with the audience (15 minutes)
Learning objective(s):
Discover the latest advances in gait diagnostics using instrumented treadmill technology, learn about their theoretical background and recent research findings, and find out how to apply the developed protocols in your own clinical practice.
Stiff knee gait is characterized by a decreased peak knee flexion during swing and is a common deviation in the gait pattern observed after stroke. Overactivity of the rectus femoris muscle is often related to this reduced peak knee flexion, and stiff knee gait is linked to limited walking speed, stumbling and falls. This symposium will include basic scientific research on the treatment options for stiff knee gait post-stroke with implementation of results into clinical practice.
The symposium will start with scientific research performed at Roessingh Research and Development and includes the results of a randomized controlled trial on botulinum toxin injections in the rectus femoris in stroke patients, as a treatment option for patients walking with a stiff knee gait. Patient examples and clinical recommendations from this randomized controlled trial will be discussed.
Second, we will continue with an example of a stroke patient presenting stiff knee gait from the clinical practice from Roessingh, Centre for Rehabilitation. The gait pattern, physical examination and outcomes of the (3D) clinical gait analysis will be discussed with the audience. Treatment options will be explained and effects be shown. Finally, the end results of the treatment, including rectus femoris transfer will be discussed.
To conclude the symposium, we will present a special case study of the Roessingh Diagnostic Centre, concerning a young stroke patient that experienced stiffness around the knee and decreased peak knee flexion in swing during normal walking and running. Before stroke, the subject exercised at high level (triathlons) and her goal was to participate in running-competitions again. The subject requested for a rectus femoris transfer to improve running. We will demonstrate the clinical decision making process within the clinical team related to this request, including results of multiple 3D gait analyses pre- and post-intervention with botulinum toxin during normal walking and running. End results of the treatment will be shown and the discussion will include the importance of including other situations than straight line walking in clinical decision making, related to the ambitions of the patient.
Chair: C. Nikamp, PhD
Outline of the session:
- Introduction symposium: Chair: C. Nikamp, PhD (5 min)
- 'The effect of Botulinum toxin injections in the rectus femoris in stroke patients with a stiff knee gait'- M. Tenniglo, PT, PhD-candidate (20 min + 5 min questions)
- 'An example of clinical decision making and treatment options in multilevel gait problems after stroke'- J. Fleuren, MD, PhD (20 min + 5 min questions)
- 'Rectus femoris transfer to improve running after stroke: a case study'- R. Huurneman, PT (20 min + 5 min questions)
- General discussion and questions: Chair: C. Nikamp, PhD (10 min)
Learning objectives:
1. To acquire knowledge about the scientific evidence of treatment options of stiff knee gait after stroke
2. To understand how scientific research on the role of the rectus femoris in stiff knee gait is incorporated in clinical decision making of stroke patients presenting stiff knee gait
3. To get insight in the process of clinical decision making for treatment of overactivity of the rectus femoris
Complex interventions are common in rehabilitation and provide challenges in research since the treatment programs are multidisciplinary and patients have personalized goals. The Medical Research Council (MRC) and National Institute of Health Research in the UK has published guidance on developing and evaluating these complex interventions, the so called MRC framework. This framework describes the different steps in scientific research into complex interventions. To be successful, a health innovation has to be implemented within daily (rehabilitation) care. Implementation of these complex interventions is included in the framework, however implementation research and strategies for an effective implementation is often inferior within a research proposal.
In this mini-symposium we will present this MRC framework illustrated with recent examples from clinical practice within the multidisciplinary outpatient clinic and primary care setting. The objectives are to learn about the MRC framework as a tool for developing and evaluating complex multidisciplinary rehabilitation interventions, and to have relevant clinical examples on how to use this tool within rehabilitation research. With specific attention on effectively implementing a complex intervention within rehabilitation care.
Chair: Dr J.T. Groothuis, MD PhD, consultant rehabilitation medicine
Presenters:
- Prof dr M.J.L. Graff, PhD, professor of occupational therapy
- T. Hoogeboom, PhD, assistant-professor, senior researcher
- Dr Y. Veenhuizen, PhD, head of occupational therapy
Department of Rehabilitation and Scientific Institute for Quality of Heathcare, Radboud university medical center, Nijmegen, the Netherlands.
Session outline:
- Welcome - Jan Groothuis
- Context and setting of complex interventions in rehabilitation (5 min) - Jan Groothuis
- The MRC framework, an introduction. Illustrated by the clinical example of the evaluation of feasibility, efficacy and cost-effectiveness of two 10-week home based occupational therapy interventions for people with Dementia (COTiD) and for people with Parkinson's disease (OTiP) and their caregivers (20 min) - Maud Graff
- Clinical example of Energetic, Effectiveness and cost-effectiveness of a self-management group program to improve social participation in patients with neuromuscular disease and chronic fatigue (15 min) - Yvonne Veenhuizen
- Implementation of complex interventions. Illustrated by the clinical example of Coach-2-move, a personalized treatment strategy by physical therapists to elicit physical activity in community-dwelling older adults with mobility problems. (20 min) - Thomas Hoogeboom
- Energetic, clinical example of an implementation plan (10 min) - Yvonne Veenhuizen
- Discussion and experiences from the audience (20 min)
- Concluding remarks - Jan Groothuis