Rationale To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) a practice guideline from the Dutch Royal Society for Physiotherapy (KNGF) has been developed. Guideline development A systematic literature search was performed to formulate conclusions on the efficacy of exercise-based intervention during all CR phases in patients with CHF. Evidence was graded (1–4) according the Dutch evidence-based guideline development criteria. Clinical and research recommendations Recommendations for exercise-based CR were formulated covering the following topics: mobilisation and treatment of pulmonary symptoms (if necessary) during the clinical phase, aerobic exercise, strength training (inspiratory muscle training and peripheral muscle training) and relaxation therapy during the outpatient CR phase, and adoption and monitoring training after outpatient CR. Applicability and implementation issues This guideline provides the physiotherapist with an evidence-based instrument to assist in clinical decision-making regarding patients with CHF. The implementation of the guideline in clinical practice needs further evaluation. Conclusion This guideline outlines best practice standards for physiotherapists concerning exercise-based CR in CHF patients. Research is needed on strategies to improve monitoring and follow-up of the maintenance of a physical active lifestyle after supervised CR.
Background To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with coronary heart disease (CHD) the CR guideline from the Dutch Royal Society for Physiotherapists (KNGF) has been updated. This guideline can be considered an addition to the 2011 Dutch Multidisciplinary CR guideline, as it includes several novel topics. Methods A systematic literature search was performed to formulate conclusions on the efficacy of exercise-based interventions during all CR phases in patients with CHD. Evidence was graded (1–4) according the Dutch evidence-based guideline development (EBRO) criteria. In case of insufficient scientific evidence, recommendations were based on expert opinion. This guideline comprised a structured approach including assessment, treatment and evaluation. Results Recommendations for exercise-based CR were formulated covering the following topics: preoperative physiotherapy, mobilisation during the clinical phase, aerobic exercise, strength training, and relaxation therapy during the outpatient rehabilitation phase, and adoption and monitoring of a physically active lifestyle after outpatient rehabilitation. Conclusions There is strong evidence for the effectiveness of exercise-based CR during all phases of CR. The implementation of this guideline in clinical practice needs further evaluation as well as the maintenance of an active lifestyle after supervised rehabilitation. LinkedIn: https://www.linkedin.com/in/tinusjongert/
We developed an evidence-based practice guideline to support occupational safety and health (OSH) professionals in assessing the risk due to lifting and in selecting effective preventive measures for low back pain (LBP) in the Netherlands. The guideline was developed at the request of the Dutch government by a project team of experts and OSH professionals in lifting and work-related LBP. The recommendations for risk assessment were based on the quality of instruments to assess the risk on LBP due to lifting. Recommendations for interventions were based on a systematic review of the effects of worker- and work directed interventions to reduce back load due to lifting. The quality of the evidence was rated as strong (A), moderate (B), limited (C) or based on consensus (D). Finally, eight experts and twenty-four OSH professionals commented on and evaluated the content and the feasibility of the preliminary guideline. For risk assessment we recommend loads heavier than 25 kg always to be considered a risk for LBP while loads less than 3 kg do not pose a risk. For loads between 3-25 kg, risk assessment shall be performed using the Manual handling Assessment Charts (MAC)-Tool or National Institute for Occupational Safety and Health (NIOSH) lifting equation. Effective work oriented interventions are patient lifting devices (Level A) and lifting devices for goods (Level C), optimizing working height (Level A) and reducing load mass (Level C). Ineffective work oriented preventive measures are regulations to ban lifting without proper alternatives (Level D). We do not recommend worker-oriented interventions but consider personal lift assist devices as promising (Level C). Ineffective worker-oriented preventive measures are training in lifting technique (Level A), use of back-belts (Level A) and pre-employment medical examinations (Level A). This multidisciplinary evidence-based practice guideline gives clear criteria whether an employee is at risk for LBP while lifting and provides an easy-reference for (in)effective risk reduction measures based on scientific evidence, experience, and consensus among OSH experts and practitioners.
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Designing cities that are socially sustainable has been a significant challenge until today. Lately, European Commission’s research agenda of Industy 5.0 has prioritised a sustainable, human-centric and resilient development over merely pursuing efficiency and productivity in societal transitions. The focus has been on searching for sustainable solutions to societal challenges, engaging part of the design industry. In architecture and urban design, whose common goal is to create a condition for human life, much effort was put into elevating the engineering process of physical space, making it more efficient. However, the natural process of social evolution has not been given priority in urban and architectural research on sustainable design. STEPS stems from the common interest of the project partners in accessible, diverse, and progressive public spaces, which is vital to socially sustainable urban development. The primary challenge lies in how to synthesise the standardised sustainable design techniques with unique social values of public space, propelling a transition from technical sustainability to social sustainability. Although a large number of social-oriented studies in urban design have been published in the academic domain, principles and guidelines that can be applied to practice are large missing. How can we generate operative principles guiding public space analysis and design to explore and achieve the social condition of sustainability, developing transferable ways of utilising research knowledge in design? STEPS will develop a design catalogue with operative principles guiding public space analysis and design. This will help designers apply cross-domain knowledge of social sustainability in practice.
The pressure on the European health care system is increasing considerably: more elderly people and patients with chronic diseases in need of (rehabilitation) care, a diminishing work force and health care costs continuing to rise. Several measures to counteract this are proposed, such as reduction of the length of stay in hospitals or rehabilitation centres by improving interprofessional and person-centred collaboration between health and social care professionals. Although there is a lot of attention for interprofessional education and collaborative practice (IPECP), the consortium senses a gap between competence levels of future professionals and the levels needed in rehabilitation practice. Therefore, the transfer from tertiary education to practice concerning IPECP in rehabilitation is the central theme of the project. Regional bonds between higher education institutions and rehabilitation centres will be strengthened in order to align IPECP. On the one hand we deliver a set of basic and advanced modules on functioning according to the WHO’s International Classification of Functioning, Disability and Health and a set of (assessment) tools on interprofessional skills training. Also, applications of this theory in promising approaches, both in education and in rehabilitation practice, are regionally being piloted and adapted for use in other regions. Field visits by professionals from practice to exchange experiences is included in this work package. We aim to deliver a range of learning materials, from modules on theory to guidelines on how to set up and run a student-run interprofessional learning ward in a rehabilitation centre. All tested outputs will be published on the INPRO-website and made available to be implemented in the core curricula in tertiary education and for lifelong learning in health care practice. This will ultimately contribute to improve functioning and health outcomes and quality of life of patients in rehabilitation centres and beyond.
The pace of technology advancements continues to accelerate, and impacts the nature of systems solutions along with significant effects on involved stakeholders and society. Design and engineering practices with tools and perspectives, need therefore to evolve in accordance to the developments that complex, sociotechnical innovation challenges pose. There is a need for engineers and designers that can utilize fitting methods and tools to fulfill the role of a changemaker. Recognized successful practices include interdisciplinary methods that allow for effective and better contextualized participatory design approaches. However, preliminary research identified challenges in understanding what makes a specific method effective and successfully contextualized in practice, and what key competences are needed for involved designers and engineers to understand and adopt these interdisciplinary methods. In this proposal, case study research is proposed with practitioners to gain insight into what are the key enabling factors for effective interdisciplinary participatory design methods and tools in the specific context of sociotechnical innovation. The involved companies are operating at the intersection between design, technology and societal impact, employing experts who can be considered changemakers, since they are in the lead of creative processes that bring together diverse groups of stakeholders in the process of sociotechnical innovation. A methodology will be developed to capture best practices and understand what makes the deployed methods effective. This methodology and a set of design guidelines for effective interdisciplinary participatory design will be delivered. In turn this will serve as a starting point for a larger design science research project, in which an educational toolkit for effective participatory design for socio-technical innovation will be designed.
