D1. PhD thesis session: Presentations of the best PhD theses in the Netherlands
D2. Debate: 'Healthy living for everyone! Really??'
D1. PhD thesis session: Presentations of the best PhD theses in the Netherlands
Chair: prof. Jeanine Verbunt MD PhD
During the DCRM 2018 in Groningen the best PhD theses in the field of rehabilitation medicine in the academic year 2017-2018 are presented. Afterwards the jury will select the winner of the PhD Award Rehabilitation Medicine 2018.
The four nominees for the prize are:
- Family needs and the role of information in paediatric rehabilitation care – Mattijs Alsem
- Optimizing Cardiac Rehabilitation – Nienke ter Hoeve
- Upper extremity function in Duchenne Muscular Dystrophy – Mariska Janssen
- Reactive neurobiological recovery after ischaemic stroke? – Caroline Winters
The PhD Award Rehabilitation Medicine is a prize awarded annually for the best and most appealing doctoral thesis in the field of rehabilitation medicine in The Netherlands. The aim of this prize is to value and further high-quality research and to put the researchers into the limelight.
Family needs and the role of information in paediatric rehabilitation care – Mattijs Alsem
Parents of children with physical disabilities play an important role in the functioning of the child and family. Because the needs for care and information differ between families and change in time, it is important to address these needs explicitly. Parents have a great need for information. This can be information about medical topics, but also experience-based knowledge. Parents often search for information on the internet, but find it difficult to find reliable information. To help parents identify their (family) needs, we compiled a list of 189 possible needs from the literature and from interviews with parents and professionals, forming the basis for a digital instrument, the WWW-roadmap. The WWW-roadmap aims to support parents in formulating their needs, looking up reliable information and asking questions to the appropriate professional. We studied whether using this instrument helped parents in the process of empowerment and self-management. In interviews, parents indicated that they value the WWW-roadmap as a reliable source of information, and that the WWW-roadmap helps to think of topics for which they want to look up information. This helps them in keeping comprehensive view of their situation. Yet we saw no difference in the empowerment of parents or changes in the consultation. In order to really help parents with taking a more equal role in the consultation, it is important to not only look at their information needs, but also at other conditions, such as facilitation by professionals.
Optimizing Cardiac Rehabilitation – Nienke ter Hoeve
Cardiac rehabilitation (CR) improves health (e.g. blood pressure) and risk of mortality. However, results of this thesis showed that only small improvements in moderate-to-vigorous intensity physical activity (MVPA) and sedentary behaviour are reached. We focused on the added value of two behavioural lifestyle interventions on top of standard CR. A total of 914 patients with an acute coronary syndrome were randomized to: 1)3 months of standard CR (CR-only); 2)3 months of standard CR with three pedometer-based, face-to-face physical activity group counseling sessions followed by 9 months of aftercare with three lifestyle, face-to-face group counseling sessions (CR+F); or 3)3 months of standard CR, followed by 9 months of aftercare with six lifestyle, telephonic counseling sessions (CR+T). Compared to standard CR, adding physical activity counselling sessions (initial phase CR+F) improved step count with an additional 500 steps/day. Furthermore, time spent in prolonged MVPA periods increased. There were no changes in total MVPA time or sedentary behaviour. At completion of the CR+F aftercare program, improvements in step count partly diminished. The additional improvements in prolonged MVPA were maintained. No additional benefits were found for CR+T. We recommend that face-to-face physical activity group counselling sessions be added to CR, although aftercare optimization is needed.
Upper extremity function in Duchenne Muscular Dystrophy – Mariska Janssen
Duchenne Muscular Dystrophy is a severe neuromuscular disorder, that weakens arm muscles among other muscles. In order to remain independent as long as possible, new aids are being developed to support arm function. To develop these aids, more information in needed on arm function. Therefore, this thesis examined arm function in boys and men with Duchenne Muscular Dystrophy, using questionnaires and motion analysis. The results showed that already at a young age arm function is reduced, and that during the course of the disease the amount of limitations increase. This coincides also with increased pain and stiffness levels. First limitations can be seen during activities with the shoulder (reaching), and later on movement with the elbow (drink) and hand (write) become more difficult. We also found that corticosteroid use and an active lifestyle positively influence arm function, and that pain, stiffness and the occurrence of scoliosis have a negative impact on arm function. Using these results new aids can be developed and clinicians can prescribe better treatments to preserve arm function.
Reactive neurobiological recovery after ischaemic stroke? – Caroline Winters
Stroke remains one of the leading causes of long-term disability worldwide. The challenge for neurorehabilitation and neurological research is to reduce impairments and to optimize activity and participation of patients. The main aims of this PhD thesis were to gain insight into early prediction of outcome after stoke and to investigate whether it is possible to influence neurobiological recovery with early applied interventions focused at the arm. The results show that the course of neurological recovery is predictable in the majority of patients and that the expected recovery is in proportion to the impairment within 72 hours after stroke. Recovery of activities seems to be accelerated by three weeks of modified Constraint Induced Movement Therapy, however the results show no effect of therapy on the recovery of arm functions. It is therefore still unclear whether we can influence neurobiological recovery. To gain more insight, future research should focus on the underlying mechanisms responsible for recovery. In order to find rehabilitation therapies that can influence the degree of reactive (i.e. spontaneous) neurobiological recovery, it is essential for future studies to include repeated measurements at fixed moments after the stroke and to divide patients into subgroups using early biomarkers for neurobiological recovery.
D2. Debate: Healthy living for everyone! Really??
Chair: Hans Oosterkamp
Active living and a healthy lifestyle are seen as important elements of modern life. It is almost unthinkable nowadays that we don’t have an idea of what type of activities are good for us and prolong our longevity. We walk, run, bike and are reading about living up to low-carb and high-protein diets, see the benefits of omega-3 proteins, vitamins and flavonoids. We are truly bombarded online and offline about these subjects. And how can one be against an active living or healthy lifestyle? Even more, nowadays it is thought that coaching by medical specialists on topics as active living and healthy lifestyle are seen as an important part of what should be talked about during consultation with patients. But is this what our jobs as medical specialists is about? Are we truly prepared to give this type of advice? What does this mean for our resident education? And should we then live by example and practice what we preach or do we allow adult people to make their own choices, and respect them even if we don’t agree, just as they might not agree with ours? Do you have a (strong) opinion on this subject and want to share this or do you want to encounter a lively debate on this topic? Please come and join us.