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Biomedical subjects

Pieter U Dijkstra

Publications and source records attributed to Pieter U Dijkstra.

At least 19 recordsLinked to original sources
PubMed2006

Skin problems in lower limb amputees: a systematic review.

PURPOSE: Skin problems of the stump in lower limb amputees are relative common in daily rehabilitation practice, possibly impeding prosthetic use. This impediment may have great impact in daily life. Our objective was to review literature systematically concerning incidence and prevalence of skin disorders of the stump in lower limb amputees. METHOD: A literature search was performed in several medical databases (MEDLINE, CINAHL, EMBASE, RECAL) using database specific search strategies. Reference lists in the identified publications were used as threads for retrieving more publications missed in the searches. Only clinical studies and patient surveys were eligible for further assessment. RESULTS: 545 publications were initially found. After selection, 28 publications were assessed for research methodology. Only one publication fulfilled the selection criteria. The prevalence of skin problems in a series of 45 lower leg amputees of 65 years and older was 16%. CONCLUSIONS: Prevalence and incidence of skin problems of the stump in lower limb amputees are mainly unknown.

Amputation Stumps↗
PubMed2006

A systematic review of the effects of shoes and other ankle or foot appliances on balance in older people and people with peripheral nervous system disorders.

The objective of this paper is to identify and review all publications on effects ankle and/or foot appliances (AFA) on balance in older people (>or=60 years) and patients with peripheral nervous system disorders (PNSD). These two groups account for the majority of the population with deteriorated balance due to peripheral somatosensory feedback problems. To provide a context for understanding and interpreting the studies that have been published to date, we will briefly summarize current theories on the role of somatosensory mechanisms in control of balance and how balance can be affected by AFA. A systematic literature review is presented in which publications were searched in Medline, Embase and Recal. In total 146 papers were identified and 18 were selected based on title and abstract for qualitative assessment by two independent reviewers. Based on assessment of the total articles, seven of the 18 papers fulfilled predetermined qualitative criteria and were selected for detailed review. No definitive conclusions can be drawn concerning the effects of AFA on balance in older people or in patients with PNSD because of the small number of studies and the weak level of evidence. The available literature seems to indicate that a training program may be helpful in ensuring the effectiveness of an appliance. Insoles with tubing or vibrating elements may improve balance, whereas thick or soft soles may deteriorate balance. The effects of these different types of insoles or soles are consistent with theories about somatosensory mechanisms that play a role in control of balance. More and better quality research is needed to support the prevalent use of appliances in these populations.

Aged↗
PubMed2006

Phantom breast sensations and phantom breast pain: a 2-year prospective study and a methodological analysis of literature.

The first aim of this study was to assess prospectively the incidence of phantom breast sensations (PB sensations) and phantom breast pain (PB pain) in a sample of patients treated for breast cancer (n=204) by means of a modified radical mastectomy (n=82). Patients were assessed 6 weeks, 6, 12 and 24 months after mastectomy, by means of a questionnaire. After 24 months, assessments of 74 (90%) patients were available. Two years after mastectomy, PB sensations were present in 19% (n=14) of the patients and PB pain was present in 1% (n=1) of the patients. Over time the percentage of patients with PB sensations remained relatively stable (around 20%) but for PB pain the percentage reduced from 7% to 1%. The amount of suffering as a result of PB sensations or PB pain was very limited. PB sensations and PB pain are of little clinical relevance in the 24 months following mastectomy. The second aim of this paper was to analyse the influence of research methodology on the prevalences of PB sensations and PB pain previously reported. Research design, assessment method and publication date were recorded. Data were weighted according to the number of women investigated. Linear regression analysis was performed to analyse the influences of methodology on the prevalences of PB sensations and PB pain. Of the 29 studies identified, 23 were cross-sectional and 6 were prospective. In 17 studies patients were interviewed and in 12 studies a questionnaire was used. A prospective design resulted in prevalences of PB sensations and PB pain averagely 8% lower respectively 9% higher than in cross-sectional studies. The use of an interview resulted in prevalences of PB sensations and PB pain averagely 13% lower respectively 5% lower than questionnaire use. Prevalences of PB sensations and PB pain reduce averagely with 0.08% respectively 0.13% per year since 1950. It is concluded that research design and assessment method have a significant influence on reported prevalence of PB sensations and PB pain.

Adult↗
PubMed2006

Safe lifting in patients with chronic low back pain: comparing FCE lifting task and Niosh lifting guideline.

INTRODUCTION: Both the floor-to-waist lifting task of the Isernhagen Work Systems Functional Capacity Evaluation (IWS FCE) and recommended weight limit (RWL) of the NIOSH produce safe lifting weights and are used world-wide nowadays. It is unknown whether they produce similar safe lifting weights. Aim of this study was to compare FCE performance on the floor-to-waist lifting task and RWL of the NIOSH lifting guideline for this task, in patients with chronic low back pain (CLBP). METHODS: Ninety-two patients performed the FCE lifting task. RWL was calculated for this task. Performance was compared with RWL. A lifting index was calculated by dividing performance by RWL. Differences between groups with a lifting index < or =1, 1-3, and >3 were calculated for pain intensity, scores on the Roland Morris Disability Questionnaire (RMDQ) and work status. RESULTS: Men lifted on average 32.5 kg (SD 15.4) and women 18.8 kg (SD 7.8). RWL for this task was 12.8 kg. Mean difference between performance and RWL was 15.0 kg (SD 14.7; range -8.8 to 59.2). The Roland Morris Disability score of patients with a lifting index < or =1 was significantly lower than patients with a lifting index 1-3 and >3. No difference in pain intensity and work status was found between groups. CONCLUSION: It was concluded that performance on the FCE floor-to-waist lifting task and RWL of the NIOSH for this task produce different safe lifting weights in individual patients with CLBP, which may result in contradictory recommendations about need for rehabilitation and return to work.

Adolescent↗
PubMed2006

Prediction of sickness absence in patients with chronic low back pain: a systematic review.

OBJECTIVES: To provide evidence of predictors for sickness absence in patients with non-specific chronic low back pain (CLBP), distinguishing predictors aimed at the decision to report sick (absence threshold) and decision to return to work (return to work threshold). METHODS: Medical and psychological databases were searched, as well as citations from relevant reviews. In- and exclusion criteria were applied. Two reviewers assessed the methodological quality of the papers independently. RESULTS: Many different predictors were studied, and few factors were studied more than once. Consistent evidence was found for own expectations of recovery only as predictor for the decision to return to work. Patients with higher expectations had less sickness absence at the moment of follow-up measurement. As expected, different predictors were found aiming at the absence threshold or the return to work threshold. Furthermore, predictors varied also with the measurement instruments used, timing of follow-up measurements, and definition of outcomes. Until now, too few studies are available to overcome several potential sources of heterogeneity. CONCLUSIONS: No core set of predictors exists for sickness absence in general. The characteristics of the study including the decision to report sick or to return to work determined the influence of several predictors on sickness absence in patients with CLBP. Further research and use of a core set of measurements and uniform definitions are needed to predict sickness absence and return to work in patients with CLBP.

Absenteeism↗
PubMed2006

Symptom increase following a functional capacity evaluation in patients with chronic low back pain: an explorative study of safety.

INTRODUCTION: This study was performed to study intensity and duration of symptom increase following an FCE and to explore safety of an FCE. METHODS: Included were 92 patients with chronic low back pain (CLBP), mean age 38.5 years, mean self-reported disability 12.5 (Roland Morris Disability Questionnaire). All patients underwent an FCE. Symptom increase was measured with a 2-item questionnaire. Operational definition for safety: no formal complaint filed and symptom increase to occur only temporarily. RESULTS: No formal complaints were filed (n=92). In total, 54 patients returned the questionnaire (59%; 'responders'). Of the responders, 76% reported increased symptom intensity after an FCE, ranging from 'little increase' to 'severe increase'. Symptoms of all responders returned to pre-FCE level. Duration of symptom increase of the responders ranged from 1 day to 3 weeks. Symptom increase resided to pre-FCE level within 1 week in 93% of the responders. Symptom increase was weakly related to self-reported disability (r=0.38, p<0.05). Except for gender, differences between responders and non-responders were non-significant. CONCLUSION: A temporary increase in symptom intensity following an FCE is common. Within the operational definitions of safety used in this study, assessment of functional capacity of patients with CLBP appears safe.

Adult↗
PubMed2006

Reliability of linear measurements on a virtual bilateral cleft lip and palate model.

OBJECTIVE: To assess the reliability and validity of measurements performed on three-dimensional virtual models of neonatal bilateral cleft lip and palate patients, compared with measurements performed on plaster cast models. MATERIALS AND METHODS: Ten high-quality plaster cast models of bilateral cleft lip and palate patients were scanned with an LDI-scanner to obtain a three-dimensional virtual model. Linear measurements were performed on the plaster cast models using a digital caliper and also on the three-dimensional virtual model using Viscam RP version 2.1 software. The measurements were performed by two observers on two occasions. RESULTS: Intraclass correlations ranging from .81 to .96 were found for all measurements except the measurement between the constructed reference point pr and reference point i (intraclass correlation = .40). A post hoc procedure in which top-view screen prints of the three-dimensional virtual model were used to perform the measurement between reference points pr and i demonstrated an intraclass coefficient of .90. CONCLUSIONS: Three-dimensional virtual models obtained by laser scanning neonatal cast models of bilateral cleft lip and palate patients can be used reliably and validly to perform linear measurements between existing reference points on the surface of the model using Viscam RP version 2.1 software. Measurements between reference points constructed outside the surface of the model cannot be validly performed on the three-dimensional virtual model with the software used in this study. For these measurements, top-view screen prints of the three-dimensional virtual model can be used.

Cephalometry↗
PubMed2005

Variation in the cervical range of motion over time measured by the "flock of birds" electromagnetic tracking system.

STUDY DESIGN: Observational longitudinal study. OBJECTIVE: To establish the normal variation over time for active and passive cervical range of motion (ROM) measured with the Flock of Birds electromagnetic tracking system (FOB). SUMMARY OF BACKGROUND DATA: Data about normal variation of cervical ROM over time are scarce but important for the interpretation of study results. METHODS: Forty-eight subjects without a manifest dysfunction in neck and shoulder region (asymptomatic group) and 58 subjects with a dysfunction in the neck and shoulder region (symptomatic group) participated in this study. Cervical active and passive ROM was assessed in three different sessions 6 weeks apart. The following movements were measured: flexion-extension, lateral bending, and axial rotation in neutral, flexed, and extended position. RESULTS: A wide range of variation of active and passive cervical ROM was found at the 6- and 12-week measurement in the asymptomatic group as well as in the symptomatic group. Highest variation was found during passive ROM testing as compared with active ROM testing. The symptomatic group showed larger variation than the asymptomatic group. CONCLUSIONS: Cervical range of motion varies considerably over time. This variation should be taken into account when results of therapeutic trials with respect to cervical ROM are interpreted.

Adult↗
PubMed2005

Claimed walking distance of lower limb amputees.

PURPOSE: Walking ability in general and specifically for lower limb amputees is of major importance for social mobility and ADL independence. Walking determines prosthesis prescription. The aim of this study was to mathematically analyse factors influencing claimed walking distance of lower limb amputees of 500 m or more. METHOD: A total of 437 patients returned two questionnaires: the Groningen Questionnaire Problems after Leg Amputation, in which walking distance was assessed, and the RAND 36. RESULTS: The chance of walking 500 m or more reduced when a transfemoral amputation was performed. The chance reduced even more when phantom pain or stump pains were present. If the amputation was performed because of vascular disease or because of vascular problems because of diabetes the chance reduced again. Independently of these factors, age reduced the chance of walking 500 m or more. CONCLUSION: The chance of walking 500 m or more reduces with increase in age and a more proximal amputation. The chance reduces even further when the amputation is performed because of diabetes or vascular disease and also if phantom pain and or stump pain is present.

Age Factors↗
PubMed2005

Testing lifting capacity: validity of determining effort level by means of observation.

STUDY DESIGN: Video observation study. OBJECTIVES: To establish the validity of determining effort level by visual observation of a lifting test. SUMMARY OF BACKGROUND DATA: Determining effort level during a lifting test is critical for interpretation of test performance, yet the validity of these determinations has not been established in patients with chronic nonspecific low back pain. METHODS: Fifteen healthy subjects and 16 patients with chronic nonspecific low back pain performed a standardized lifting test as outlined in the Isernhagen Work System Functional Capacity Evaluation. The lifts were videotaped and independently observed by 9 trained observers, who rated effort levels using an Isernhagen Work System categorical scale and a Borg Category Ratio scale. External effort indexes were established to control for effort at group level. Validity of the observer ratings was analyzed by means of a sensitivity and specificity analysis and correlations between performances and observer ratings. Interrater reliability was analyzed by means of intraclass correlation coefficients and Cohen kappa. RESULTS: External indexes differ significantly between patients with chronic low back pain and healthy subjects, indicating that at group level, patients did not perform maximally. Submaximal performances were correctly rated in 85% to 90% (healthy subjects) and in 100% (patients with chronic nonspecific low back pain) of the cases. "Maximal" performances were correctly rated in 46% to 53% (healthy subjects) and in 5% to 7% (patients with chronic nonspecific low back pain) of the cases. Correlations between performances and observer ratings were r = 0.90 to r = 0.92 (healthy subjects) and r = 0.82 (patients with chronic nonspecific low back pain). Reliability: intraclass correlation coefficient, r = 0.76 (patients with chronic nonspecific low back pain) to r = 0.87 (healthy), Kappa K = 0.50 (patients with chronic nonspecific low back pain) to r = 0.58 (healthy subjects). CONCLUSIONS: Effort level can be determined validly by means of visual observation.

Adolescent↗
PubMed2005

Distribution of Buruli ulcer lesions over body surface area in a large case series in Ghana: uncovering clues for mode of transmission.

We studied hospital records of 750 consecutive Buruli ulcer patients in a highly endemic area in Amansie West, Ghana. Although more Buruli ulcer lesions were found on the right side of the body, comparison of lesions on arms and legs showed a bilaterally symmetrical distribution. Upper and lower extremities were affected equally by Buruli ulcers, if correction was made for differences in body surface area. Patients from outside the Amansie West district presented significantly more often with ulcerated lesions, which were more often located on a joint, than patients who lived in Amansie West, suggesting that longer travel distance might have caused delay. Our observations of a bilaterally symmetrical distribution of lesions on extremities and equal upper and lower extremity involvement are compatible with a mode of transmission that involves passive exposure of exposed body parts. An asymmetrical distribution of lesions was found in an earlier study, suggesting transmission by vegetation near the ground, through activities like farming or play. Perhaps, transmission in or near water, e.g. by bites of infected aquatic insects, might favour the pattern of distribution of lesions that we found.

Adolescent↗
PubMed2005

Factors associated with functional limitations and subsequent employment or schooling in Buruli ulcer patients.

OBJECTIVES: To evaluate former Buruli ulcer disease (BUD) patients to assess the factors associated with functional limitations and subsequent employment or schooling. METHODS: The previously validated Buruli ulcer functional limitation score (BUFLS) questionnaire and interviews about educational and professional consequences incurred by BUD. RESULTS: Of 638 participants, 362 (57%) had a functional limitation after a median period of almost 4 years after treatment for BUD. A lesion on a joint, older age, female gender, a lesion on a distal part of an extremity and a persistent wound were found to be independent risk factors for stopping work or education. The same risk factors applied to the development of a functional limitation. Both functional limitations and financial difficulties due to BUD disease often led to job loss and school dropout. CONCLUSIONS: Rehabilitation programmes are urgently needed to diminish the suffering from the functional limitations and employment or schooling problems caused by BUD.

Adolescent↗
PubMed2005

Effect of an intraoral retrusion plate on maxillary arch dimensions in complete bilateral cleft lip and palate patients.

OBJECTIVE: The aim of this study was to analyze maxillary arch dimensions in patients with complete bilateral cleft lip and palate treated with an intraoral retrusion plate prior to lip closure. PATIENTS: The effects of the intraoral retrusion plate were evaluated on serially obtained maxillary casts of 14 patients with complete bilateral cleft lip and palate. RESULTS: The Student's t test for dependent observations showed a significant decrease in distance between the premaxilla and the cleft lateral segments during active treatment. This decrease correlated with an increase in deviation of the premaxilla in relation to the vomer. For each millimeter decrease in distance between the premaxilla and the cleft lateral segments, an average increase in deviation of 4.0 degrees was found. Left and right cleft widths decreased significantly, premaxillary width increased significantly, and transverse dimensions did not change significantly. CONCLUSION: From this study it can be concluded that active presurgical treatment with an intraoral retrusion plate induces a significant decrease in distance between the premaxilla and the lateral segments. This decrease is frequently accompanied by an increase in deviation of the premaxilla relative to the vomer.

Cephalometry↗
PubMed2005

Reliability and validity of the Buruli ulcer functional limitation score questionnaire.

The reliability and validity of the earlier developed Buruli ulcer functional limitation score (BUFLS) questionnaire was assessed. Of 638 former Buruli ulcer patients (of 678 individuals examined), sufficient items on daily activities (>or= 13 of the 19) were applicable to calculate a score. To determine the validity, the functional limitation scores of the 638 individuals were compared with the global impression of the limitations, range of motion (ROM), and the social impact (change of occupation or education) of Buruli ulcer. To determine inter-observer reliability, the functional limitation score was reassessed in 107 participants within one and three weeks after the first interview by another interviewer and interpreter. Both global impression and ROM correlated well with the functional limitation scores (rho = 0.66 and rho = 0.61). The inter-observer reliability of 107 participants as measured by an intra-class correlation coefficient of 0.86 was very good. The functional limitation scores measured in the second assessment were significantly higher than in the first assessment. This should be taken into account when the functional limitation score is used for the individual patient. The BUFLS can be used as for between group comparisons of endpoints in clinical trials and in the planning of resources.

Humans↗
PubMed2004

Impairments, disabilities and health related quality of life after treatment for breast cancer: a follow-up study 2.7 years after surgery.

PURPOSE: The aim of this study was to assess impairments, disabilities and health related Quality of Life (QOL) after treatment of breast cancer and to analyse the relationship between treatment modalities, impairments, disabilities and health related QOL. METHOD: Fifty-five patients who underwent a modified radical mastectomy or a segmental mastectomy with axillary lymph node dissection were retrospectively assessed with a mean follow up of 2.7 years after treatment. Impairments were assessed by means of measuring active shoulder range of motion, grip strength, arm volume and pain. Disabilities were assessed by means of the Shoulder Disability Questionnaire (SDQ) and health related QOL was assessed by means of the RAND 36-item Health Survey (RAND-36). SETTING: University Hospital Groningen (The Netherlands). RESULTS: Pain (60%) and reduction of grip-strength (40%) were the most frequent impairments found. The prevalence of impaired range of motion and oedema was 9 - 16% respectively 15%. Mean group score of the SDQ was 33.7 (sd: 32.1) and mean scores of the RAND-36 differed significantly for physical functioning, vitality and health perception to that of a female norm group. Radiotherapy and chemotherapy were significant factors in the prediction of impaired range of motion. Pain and restricted range of motion explained 61% respectively 12% of the variance in disability (SDQ). In the prediction of health related QOL, pain, grip strength and arm volume were significant factors respectively in six, three and two domains. CONCLUSIONS: Pain is the most frequent assessed impairment after breast cancer treatment with strong relationship to perceived disability and health related QOL. Disability is mild and health related QOL (RAND-36) differed in three of the nine domains with a female norm group.

Activities of Daily Living↗
PubMed2004

Morbidity of the neck after head and neck cancer therapy.

BACKGROUND: Studies on morbidity of the neck after head and neck cancer therapy are scarcely described. METHODS: Patients who underwent surgery, including neck dissection, with and without radiation therapy at least 1 year before the study were asked to participate. We assessed neck pain, loss of sensation, range of motion of the cervical spine, and shoulder pain. RESULTS: Of the 220 patients who were invited, 153 (70%) participated in the study. Neck pain was present in 33% of the patients (n = 51), and shoulder pain was present in 37% of the patients (n = 57). Neuropathic pain of the neck was present in 32% (n = 49); myofascial pain, in 46% (n = 70); and joint pain, in 24% (n = 37). Loss of sensation of the neck was present in 65% (n = 99) and was related to type of neck dissection and radiation therapy. Range of motion of the neck was significantly decreased because of the neck dissection and/or radiation therapy in lateral flexion away from the operated side. CONCLUSIONS: The occurrences of morbidity of the neck after cancer therapy were considerable and consisted of neck pain, loss of sensation, and decreased range of motion.

Adult↗