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Reference values for isometric muscle force among workers for the Netherlands

BACKGROUND: Muscle force is important for daily life and sports and can be measured with a handheld dynamometer. Reference values are employed to quantify a subject's muscle force. It is not unambiguous whether reference values can be generalized to other populations. Objectives in this study were; first to confirm the reliability of the utilization of hand-held dynamometers for isometric strength measurement; second to determine reference values for a population of Dutch workers; third to compare these values with those of a USA population.METHODS: 462 Healthy working subjects (259 male, 203 female) were included in this study. Their age ranged from 20 to 60 years with a mean (sd) of 41 (11) years. Muscle force values from elbow flexion and extension, knee flexion and extension, and shoulder abduction were measured with the break method using a MicroFet 2 hand-held dynamometer. Reliability was analyzed by calculating ICC's and limits of agreement. Muscle force expressed in Newton, means, and confidence intervals were determined for males and females in age groups ranging from twenty to sixty years old. Regression equations and explained variances were calculated from weight, height, age, and gender. The mean values and 95% CI were compared to the results from other studies.RESULTS: Reliability was good; the ICC ranged between 0.83 to 0.94. The explained variance ranged from 0.25 to 0.51. Comparison of data for the Dutch population mean muscle force values with those from the USA revealed important differences between muscle force reference values for the American and Dutch populations.CONCLUSIONS: Muscle force measurements demonstrate a sound reliability. Reference values and regressions equations are made available for the Dutch population. Comparison with other studies indicates that reference values differ between countries.

Patients at risk of the progression of chronic venous disease

The objective of this thesis is to make a first step towards prevention of the progression of chronic venous disease and the development of a first venous leg ulcer in chronic venous disease patients. The aim is to identify chronic venous disease patients at risk of developing more severe clinical stages, provide insight in the lifestyle related risk factors, and provide an overview of current chronic venous disease care in the Netherlands.

The impact of scars on health-related quality of life after breast surgery: a qualitative exploration

Purpose The purpose of this research was to explore women’s experiences after breast surgery with scar characteristics and symptoms, and its impact on their health-related quality of life (HRQOL). Material andmethods A qualitative study using semi-structured face-to-face interviewswas conducted among women following prophylactic, oncologic, or reconstructive breast surgery in the Netherlands. A directed content analysis was performed using guiding themes. Themes were “physical and sensory symptoms,” “impact of scar symptoms,” “personal factors,” “impact of scar interventions,” and “change over time.” Results The study population consisted of 26 women after breast surgery. Women experienced a wide range of symptoms like adherence, stiffness, pain, and uncomfortable sensations. Scar characteristics as visibility, location, texture, and size, influenced satisfaction with their appearance. The impact of scar symptoms is reflected in physical, social, emotional, and cognitive functioning, thereby affecting HRQOL. The experienced impact on HRQOL depended on several factors, like personal factors as the degree of acceptance and environmental factors like social support. Conclusion Women can experience a diversity of scar characteristics and symptoms, which play a central role in the perceived impact on HRQOL. Since scarring can have a considerable impact on HRQOL, scarring after prophylactic, oncologic and reconstructive breast surgery should be given more attention in clinical practice and research. Implications for Cancer Survivors Considering scarring as a common late effect after breast surgery and understanding the variety of experiences, which could impact HRQOL of women, can be beneficial in sufficient information provision, expectation management, and informed decision making.

Providing in-between meals during dialysis treatment contributes to an adequate protein and energy intake in hemodialysis patients

Dementia in People with Severe/Profound Intellectual (and Multiple) Disabilities:

IntroductionObservable dementia symptoms are hardly studied in people with severe/profound intellectual (and multiple) disabilities (SPI(M)D). Insight in symptomatology is needed for timely signaling/diagnosis. This study aimed to identify practice-based observations of dementia symptoms in this population.MethodsCare professionals and family members were invited to complete a survey about symptoms. Quantitatively analyzed survey data were further deepened through semi-structured interviews with care professionals having vast experience in signaling/diagnosing dementia in this population. Symptoms were categorized using a symptom matrix.ResultsSurvey respondents and interviewees frequently observed a decline in activities of daily living (ADL) functioning and behavioral and psychological changes, like increased irritability, anxiety, apathy and decreased eating/drinking behavior. Cognitive symptoms were particularly recognized in persons with verbal communication and/or walking skills. To lesser extent motor changes and medical comorbidities were reported.ConclusionIncreased insight in dementia symptoms contributes to developing a dedicated screening instrument for dementia in people with SPI(M)D.

Cervical dystonia: Disability and the value of physical therapy

Cervical dystonia (CD) is a neurological movement disorder characterized by involuntary muscle contractions causing abnormal postures and/or twisting movements of the head and neck.Patients may also experience non-motor symptoms including pain, anxiety and depression. The main treatment option is botulinum toxin (BoNT) injections in affected muscles to improve head postures and reduce pain. In addition to BoNT treatment, patients are often referred for physical therapy (PT), but there is little evidence regarding the long-term effectiveness.Despite remarkable improvements during the last decades, there are still many unmet needs that remain open in the treatment of cervical dystonia (CD). The first goal of this thesis was to assess clinical issues in BoNT treatment that need further improvement and to define clinical recommendations for clinicians. The second goal was to explore which determinants play an important role in disability of CD patients and the third goal was to develop a specialized PT program and to evaluate its effects on disability.Results showed that BoNT treatment can be further improved despite all the evidence for its effectiveness. Further research is needed towards optimal treatment intervals, dose equivalence between different BoNT formulations, the use of supportive techniques like electromyography or ultrasound and managing side effects. Secondly, we found that psychological factors are important determinants of disability. Finally, we found that PT is a valuable addition to BoNT treatment to improve disability and pain. Based on these findings, a multidisciplinary treatment approach to further improve the treatment and quality of life for CD patients is recommended.