D1. PhD thesis session: Presentations of the best PhD theses in the Netherlands
D2. Debate: Prove it or lose it? De noodzaak van wetenschappelijke onderbouwing van de revalidatiezorg (in Dutch)
D1. PhD thesis session: Presentations of the best PhD theses in the Netherlands
Chair: prof. Annemieke Buizer MD
During the DCRM 2022 in 's-Hertogenbosch the best PhD theses in the field of rehabilitation medicine in the academic year 2021-2022 are presented. Afterwards the jury will select the winner of the PhD Award Rehabilitation Medicine 2022.
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.
The three nominees for the prize are (in alphabetic order):
- Stefan Elbers - 'On maintaining successful treatment outcomes in interdisciplinary multimodal pain treatment'
Despite evidence that Interdisciplinary Multimodal Pain Treatment (IMPT) programmes have a positive effect on physical, mental and social health outcomes, there are indications that patients find it difficult to maintain positive treatment gains over time. This thesis is centred around this problem of relapse after successful treatment. The first part focuses on obtaining and maintaining an overview of the current state of evidence on longitudinal outcomes of IMPT programmes. In a systematic review, we identified that the majority of the 74 included cohorts of showed a favourable change over time from pre to post intervention. Importantly, this effect was largely maintained over time or even improved at final follow-up. We also developed a living systematic review workflow with planned yearly updates of the results.
The second aim was to develop an intervention that supports the maintenance of treatment gains over time. The core activity was a co-design project that included the perspectives of end-users, such as patients and healthcare providers, in each phase of the process. Over the course of 18 months, we organized design activities, were we developed an evidence base, tested ideas and developed two prototype interventions that we merged into one final prototype: a relapse prevention workbook.
Stefan Elbers obtained degrees in Physiotherapy and Psychology. From 2012 to 2022, he combined an appointment as teacher behavioural science with a research position at the University of Applied Sciences Utrecht. Stefan was a member of the Lifestyle and Health research group and collaborated with the Department of Rehabilitation Medicine at Maastricht University and Adelante Zorggroep on research projects that centred on preventing relapse after successful pain rehabilitation. From 2019 onwards, Stefan co-authored various awarded research grant applications, including the SIA RAAK Publiek PAIN project and participated in research projects that focused on behaviour change. In November 2021, Stefan obtained his PhD degree from the University of Maastricht, on a thesis titled 'On Maintaining Successful Treatment Outcomes in Interdisciplinary Multimodal Pain Treatment'. Currently, he works as client director behaviour change at Kantar Public where he helps to provide evidence and insights to the public sector on pressing societal challenges.
- Sven Geelen - 'Improving physical activity during hospital stay – towards bridging the research-practice gap'
Although the relationship between physical activity during hospital stay and positive health outcomes is well-documented, recent studies continue to report very low physical activity levels and the bed remains to be a centerpiece in hospital care. There is therefore a discrepancy between what is known and what actually happens in a hospital. To bridge this gap, this thesis aims to expand knowledge on how to improve physical activity in hospitalized patients.
In part I of this thesis, we explored and provide evidence for two easy-to-implement methods to identify physically inactive patients during routine hospital care.
In part II, we explored why patients are physically inactive during hospital stay. We provide a comprehensive overview of all published barriers and enablers to in-hospital physical activity. Additionally, we present the healthcare professionals’ perspectives on key barriers to improving physical activity, and on solutions to overcome these barriers.
In part III, we described the development, implementation and evaluation of a multifaceted intervention to improve physical activity in patients admitted to a tertiary hospital in the Netherlands. Although significant improvements in physical activity were not observed, the process evaluation yielded valuable information that may improve the effectiveness of implementing such multifaceted interventions in another context or setting.
After obtaining his degree, Sven Geelen worked as a physical therapist at the Meander Medisch Centrum while simultaneously completing his education as clinical health scientist. In July 2017, he started as a physical therapist at the gastrointestinal- and oncological surgery ward of the Amsterdam UMC and as project manager of a major quality-improvement project aiming to improve physical activity in hospitalized patients. In January 2018, this position was converted into a PhD. During the years that followed, he specialized himself as physical therapist and gained expertise in the science behind changing behavior and implementation. He was a board member of the Amsterdam UMC youth association and Amsterdam Movement Sciences research program ‘Ageing and Vitality’. He obtained the University Teaching Qualification by supervising and teaching numerous students. Currently, Sven is working as a postdoctoral researcher for the specialized Burn Center Martini Hospital, where he aims to optimize Dutch aftercare for patients with burns.
- Joris de Graaf - 'Participation after stroke: towards personalized care'
The findings of this thesis emphasize the need to pay more attention to individuals with stroke who experience restrictions in participation or who are at risk for restrictions in participation. Although recent developments in the acute treatment of stroke (such as intravenous thrombolysis and mechanical thrombectomy) have led to higher rates of 'favorable functional outcome' (often defined as modified Rankin Scale 0-2 in clinical stroke trials), a considerable number of these 'mildly affected'individuals with stroke (according to the clinician) still experiences long term restrictions in participation. We identified old age, mood problems, the absence of adaptive psychological factors, cognitive problems and a sedentary and inactive lifestyle to be determinants associated with worse participation after stroke. Early identification of individuals with stroke who are at risk for an unfavorable course of participation is important, as modifiable factors can be managed and follow-up assessments after stroke can be extended for those at risk for restrictions in participation. This shows the need for a paradigm shift in current stroke research and clinical practice, as the impact of stroke on the individual needs to be acknowledged in order to achieve 'favorable outcome' according to the individual as well.
After obtaining his medical degree, Joris de Graaf worked as a physician (ANIOS) at the Neurology department of the Zuwe Hofpoort Hospital and St. Antonius Hospital. In March 2017, he started as a resident (AIOS) in Rehabilitation Medicine at De Hoogstraat Rehabilitation. During this training he continued conducting research, which resulted in the work described in his Thesis. He followed the research educational program 'Clinical and Experimental Neuroscience' at the Graduate School of Life Sciences at University Utrecht. In April 2021, the final month of his training, Joris was awarded the Livit Orthopedie Award. Currently, he is attached to UMC Utrecht, with special interest in stroke and oncology.
D2. Debate (in Dutch)
This session will be held in Dutch.
Prove it or lose it? De noodzaak van wetenschappelijke onderbouwing van de revalidatiezorg
Wetenschappelijke onderbouwing van medisch specialistische revalidatie (MSR) behandelingen ligt steeds meer onder een vergrootglas, zo ook binnen de revalidatiegeneeskunde. Het is belangrijk om te laten zien dat de kostbare zorg die in de tweede lijn wordt aangeboden aantoonbaar beter is dan zorg zoals die in bijvoorbeeld de eerste lijn wordt geboden. Tegelijkertijd is het van belang om in samenwerking met de eerste lijn minder intensieve of monodisciplinaire behandelingen in de eerste lijn te organiseren. Kortom: de juiste zorg op de juiste plek.
Beroepsgroepen zijn zelf verantwoordelijk voor het wetenschappelijk onderzoeken van de huidige behandelingen. Maar hoe toon je als sector aan dat bepaalde MSR behandelingen kosteneffectief zijn? Welke typen onderzoek zijn hiervoor geschikt? En wat als een patiëntenpopulatie niet wil mee doen aan een controlegroep binnen een RCT onderzoek: zijn er andere manieren om behandelingen te vergelijken?
Naast de revalidatiesector zelf zijn ook andere partijen stakeholder op dit onderwerp. Op grond van welke criteria wordt de (kosten)effectiviteit van behandelingen bijvoorbeeld onderzocht door partijen zoals Zorginstituut Nederland (ZiN), Zorgevaluatie en Gepast Gebruik (ZE&GG) en Zorgverzekeraars Nederland (ZN)? Wat is hun standpunt en welke concrete handvaten kunnen ze bieden om bij te dragen aan toekomstbestendige effectieve (revalidatie)zorg?
Tot slot: op welke manier draagt u in uw rol als revalidatiearts, bestuurder, lid van een diagnose gebonden werkgroep, aios, etc. hieraan bij?
Doel van het debat is om een levendige en scherpe discussie te hebben met inbreng van ZiN, ZE&GG, VRA en RN en de deelnemers bewust te maken van hun rol bij toekomstbestendige effectieve zorg. Dus: bent u geïnteresseerd in dit onderwerp en gaat ons vak u aan het hart, schrijf dan in op de debatsessie en praat en denk zodoende mee over de toekomst van ons vak.
- Inzicht geven in het proces van onderzoek naar (kosten)effectiviteit vanuit ZiN/ZN
- Aanwezigen bewust maken van ieders rol bij het ontwikkelen en uitvoeren van toekomstbestendige effectieve zorg
- Aanwezigen handvatten bieden hoe ze kunnen bijdragen aan toekomstbestendige effectieve zorg
- Levendige discussie met aanwezigen
Panelleden zijn namens:
- ZE&GG, drs. Veronique van Dooren
- Zorginstituut Nederland, dr. Harald Miedema
- Revalidatie Nederland, prof. dr. Jan Geertzen
- VRA, dr. Annette van Kuijk
Debatleider is Hans Oosterkamp.