Dienst van SURF
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BACKGROUND: Early mobilization has been proven effective for patients in intensive care units (ICUs) to improve functional recovery. However, early mobilization of critically ill, often mechanically ventilated, patients is cumbersome because of the attachment to tubes, drains, monitoring devices and muscle weakness. A mobile treadmill with bodyweight support may help to initiate mobilization earlier and more effectively. The aim of this study is to assess the effectiveness of weight-supported treadmill training in critically ill patients during and after ICU stay on time to independent functional ambulation. METHODS: In this randomized controlled trial, a custom-built bedside body weight-supported treadmill will be used and evaluated. Patients are included if they have been mechanically ventilated for at least 48 hours, are able to follow instructions, have quadriceps muscle strength of Medical Research Council sum-score 2 (MRC 2) or higher, can sit unsupported and meet the safety criteria for physical exercise. Exclusion criteria are language barriers, no prior walking ability, contraindications for physiotherapy or a neurological condition as reason for ICU admission. We aim to include 88 patients and randomize them into either the intervention or the control group. The intervention group will receive usual care plus bodyweight-supported treadmill training (BWSTT) daily. The BWSSTT consists of walking on a mobile treadmill while supported by a harness. The control group will receive usual care physiotherapy treatment daily consisting of progressive activities such as bed-cycling and active functional training exercises. In both groups, we will aim for a total of 40 minutes of physiotherapy treatment time every day in one or two sessions, as tolerated by the patient. The primary outcome is time to functional ambulation as measured in days, secondary outcomes include walking distance, muscle strength, status of functional mobility and symptoms of post-traumatic stress. All measurements will be done by assessors who are blinded to the intervention on the regular wards until hospital discharge. DISCUSSION: This will be the first study comparing the effects of BWSTT and conventional physiotherapy for critically ill patients during and after ICU stay. The results of this study contribute to a better understanding of the effectiveness of early physiotherapy interventions for critically ill patients. TRIAL REGISTRATION: Dutch Trial Register (NTR) ID: NL6766. Registered at 1 December 2017.
Many children aged 9–12 appear to have low levels of fundamental movement skills (FMS). Physical education (PE) is important because PE-teachers can teach children a variety of FMS and can influence PE-motivation. However, declined levels of PE-motivation are reported in the final grades of elementary school. Therefore, more insight in the relations between PE-motivation and FMS is needed.Purposes: In the first phase, instruments to measure the satisfaction of basic psychological needs (competence, autonomy, classmate relatedness and teacher relatedness) and PE-motivation (autonomous and controlled) in 9–12-year-old children were developed and validated. The purpose of the second phase was to examine the influence of basic psychological needs on PE-motivation, the influence of PE-motivation on locomotor skills, object control skills and balance skills, and the direct influence of basic psychological needs on FMS for boys and girls aged 9–12.Participants and data collection: In the first phase, 172 children (82 boys, 90 girls, M = 10.72 years ± 0.77) filled out questionnaires assessing the satisfaction of their basic psychological needs and motivation for PE. Forty-eight children completed the questionnaires again 4 weeks later. In the second phase, a total of 138 children (66 boys, 72 girls, 10.8 years ± .79) (three schools from phase 1 and one new school) participated. Children from the new school also completed the questionnaires and all children conducted the subtest for speed and agility, upper limb coordination and balance of the Bruininks-Oseretsky Test of Motor Proficiency 2.Data analysis: In phase 1, linear weighted Kappa's and the Mokken Scale Program for polychotomous items were used to test reliability and validity. In phase 2, Pearson's correlations and multiple linear regression analyses were performed to examine the relations.Findings: Regarding phase 1, all subscales were reliable and the validity was considered moderate to strong except for the autonomy subscale, which was not reliable and valid. With respect to phase 2, all basic psychological needs, except autonomy among girls, had moderate to strong correlations with autonomous PE-motivation. Teacher relatedness was the most important predictor for boys and girls, while the second predictor was classmate relatedness for boys and competence for girls. No positive significant relations between basic psychological needs and FMS and between PE-motivation and FMS were found. In contrary, moderate but negative relations between teacher relatedness and balance skills and between autonomous PE-motivation and balance skills were found for boys.Conclusions: The results confirmed the importance of the basic psychological needs in the prediction of autonomous PE-motivation in 9–12-year-old children. Although all needs should be supported by the PE-teacher, it is important to be aware of the different impact of the needs on autonomous PE-motivation for boys and girls. Despite the missing relations with FMS, PE-teachers seem to be able to autonomously motivate children for PE regardless of their FMS proficiency.