Programmabrochure Colloquium 2014

C o ll o q u i u m
De Spiegel
Zwolle
11 april 2014
1
VRA Colloquium 2014
Algemene
informatie
Op 11 april vindt het Colloquium van de Nederlandse Vereniging
van Revalidatieartsen plaats in het theater De Spiegel in Zwolle.
In deze congresbrochure vindt u het programma en de abstracts van
de sprekers.
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THE NETHERLANDS
13.00 – 14.00 uur
Lunch en bezoek expositie
14.00 – 15.00 uur
Wetenschappelijk programma deel I
Voorzitter: dr. I.J.M. de Groot
Programma
Ochtend
08.30 – 09.30 uur
Ontvangst gasten, registratie en bezoek
expositie
09.30 – 09.35 uur
Welkomstwoord mevr. F. Eefting,
bestuurder RC De Vogellanden
09.35 – 10.35 uur
1. Wanneer past de prothese?
E.C.T. Baars
2. Wetenschappelijk onderzoek van
Revalidatie Zwolle: een overzicht
S.M. Brink
3. Osteogenesis Imperfecta (OI):
de multidisciplinaire benadering
A.M.V. Dommisse
10.35 – 11.00 uur
Pauze
11.00 – 13.00 uur
Algemene Ledenvergadering VRA
Middag
1. A new training prosthesis for transfemoral
amputees: results of the implementation
process – A.H.Vrieling
2. Functional hindrance due to spasticity in
persons with spinal cord injury during inpatient rehabilitation and 1 year thereafter –
I. van Cooten
3. Impaired cardiorespiratory fitness in patients
after SAH and its relationship to fatigue –
B. Zegers
4. Muscle stiffness in stroke patients compared to controls – M.Wuisman
15.00 – 15.45 uur
Pauze en bezoek expositie
15.45 – 16.45 uur
Wetenschappelijk programma deel II
Voorzitter: prof. dr. C.A.M. van Bennekom
5. Return to work after acquired brain injury
(ABI): long-term outcome of vocational
rehabilitation – K.Verpoort
6. Comparison of barefoot and in-shoe
pressure measurements in patients with
rheumatoid arthritis (RA) – S. Kerkhof
7. Multidisciplinary rehabilitation programmes
for chronic widespread musculoskeletal
pain: results from daily practice – R. Koele
8. Do out-of-hospital cardiac arrest patients
in a regular cardiac rehabilitation program
experience cognitive problems? – L. Boyce
Borrel
16.45 – 17.45
4
5
Erwin C.T. Baars
1.
Wanneer past
de prothese?
Revalidatiearts, opleider en medisch
manager, Centrum voor Revalidatie
De Vogellanden, Zwolle
Het bereiken van een goede prothesepassing is een van de voornaamste
doelen van het revalidatiebehandelteam. Echter ondanks alle inspanningen wordt dit niet bij elke amputatiepatiënt bereikt. Pijn, drukplekken
of wondjes treden regelmatig op aan de stomp bij het gebruik van de
prothese. Men kan in deze gevallen zeggen dat de biologische/biomechanische passing niet goed is in verband waarmee veelal het aanpassen
van de koker nodig is.
Maar ook zonder deze klachten kan de patiënt ontevreden zijn over de
passing. De prothese maakt veel geluid of de cosmetiek is niet naar wens.
Deze factoren betreffen de zogenaamde psychosociale fit van de prothese.
Kortom zowel biomedische als psychosociale factoren hebben invloed
op de gehele prothesepassing.
In de literatuur worden deze factoren fragmentarisch onderzocht.
Daarom hebben wij een Delphi-onderzoek verricht onder professionals
in prothesezorg om zo een goed overzicht te krijgen van alle factoren
die de prothesefit beïnvloeden.
6
2.
Wetenschappelijk
onderzoek van
Revalidatie
Zwolle:
een overzicht
Sander M. Brink
Bewegingswetenschapper,
Hand en polscentrum Isala, Zwolle
Researchcoördinator, Centrum voor
Revalidatie De Vogellanden, Zwolle
In het Centrum voor Revalidatie De Vogellanden en het Isala ziekenhuis
in Zwolle zijn diverse revalidatieartsen, aios revalidatie, wetenschappelijk
onderzoekers en therapeuten bezig met (eigen en/of betrokken bij)
wetenschappelijke onderzoek. Het over het algemeen klinisch onderzoek
vindt in De Vogellanden meestal plaats binnen één van de volgende twee
onderzoeksdomeinen:
1. Revalidatietechniek (o.a. prothesiologie)
2. Spasticiteit
Het derde speerpunt is de handrevalidatie en is onderdeel van het Hand- en
polscentrum. Dit centrum is een interdisciplinair samenwerkingsverband
tussen de maatschap Plastische chirurgie, afdeling Revalidatiegeneeskunde en
afdeling Handtherapie van het Isala ziekenhuis. Een verscheidenheid aan
hand- polspatiënten worden in dit centrum chirurgisch dan wel conservatief
(na)behandeld. Het onderzoek in dit centrum richt zich onder andere op de
volgende onderwerpen: 1. Artrose van het duimbasisgewricht en 2. Ontwikkeling van meetinstrumenten. Daarnaast is recent gestart met het afnemen
van standaard klinimetrie (op afgesproken momenten) bij alle handpatiënten.
In deze presentatie wordt een overzicht gegeven van alle (recent) afgeronde
en lopende wetenschappelijke studies van Revalidatie Zwolle.
7
3.
Osteogenesis
Imperfecta (OI):
de
multidisciplinaire
benadering
Anne Marieke Dommisse
Revalidatiearts, Isala, Zwolle en Centrum
voor Revalidatie De Vogellanden, Zwolle
In Nederland zijn er naar schatting 1100 patiënten met Osteogenesis
Imperfecta (OI). OI is een erfelijke collageenaandoening. Het is bekend
als de ‘broze botten ziekte’, maar dit is niet het enige probleem. In het
UMCU is al jaren een multidisciplinair team werkzaam voor kinderen
met OI. Binnen patiëntenvereniging OI bleek er behoefte te bestaan
voor een check-up ronde specifiek voor volwassenen. Aan deze
behoefte is in 2007 invulling gegeven door in Isala te Zwolle een breed
multidisciplinair team op te richten. Het team bekijkt onder meer
specifieke hulpvragen, botdichtheid en longfunctie. Ook wordt een
cardiale status bepaald. Daarnaast wordt het participatieniveau in kaart
gebracht en wordt het (eventuele) hulpmiddelen/voorzieningenpakket
geëvalueerd.
Tot slot wordt de genmutatie bepaald. De teamdoelstelling is tweeledig:
enerzijds leveren van directe patiëntenzorg, anderzijds het opzetten
van onderzoekslijnen ter kennisvergroting. Dit verloopt in samenwerking met UMCU en VUMC.
8
THE NETHERLANDS
1.
Patients
22 patients with a recent unilateral transfemoral amputation were included (mean age 59 years, 81% men).
A new training prosthesis for
transfemoral amputees: results of
the implementation process
Methods
Patients and their physiotherapist filled out a questionnaire to evaluate
usability, safety, comfort and functionality.
Results
In 7 patients the BOP could not be used due to fitting problems.
Main reason was an excessive stump volume. Of the 15 patients who
walked with the BOP in 5 patients the fitting was good, in 9 moderate
and in 1 poor. Eleven patients only used the free-moveable knee function,
4 patients trained both functions. All patients used the knee flexion ability
while walking. Serious skin problems, falling incidents and wounds did
not occur. Five patients documented pain complaints while walking
(mean VAS 5.5). VAS for patient satisfaction on walking was 7.4, on fitting
5.9. Physiotherapists reported that the BOP in some cases changed their
estimation of the K-level and their choice of the prosthetic knee in the
definitive prosthesis.
A.H.Vrieling MD PhD, J.M. Hijmans PhD, T.J. Oosting PT,
H. Zijlstra CPO, G.M. Rommers MD PhD
Medicine, Center for Rehabilitation, University Medical Center Groningen,
The Netherlands
Introduction and objective
A new interim prosthesis that allows knee flexion in the early rehabilitation
period, the Beatrixoord Training Prosthesis (BOP), was implemented in
seven rehabilitation centers in the Netherlands.The prosthetic knee unit
of the BOP can be used as a free-moveable or locked knee joint.
This to give a prognosis about the use of a free-movable knee function
in the definitive prosthesis and to train walking with knee flexion early
in rehabilitation.
10
Discussion and conclusions
Walking with the BOP is safe and patients are satisfied. The fitting
can be improved by another socket to allow larger stump volumes.
The BOP was mainly used to train knee flexion during walking in early
rehabilitation.
Correspondentie
Clinical message
The BOP is a valuable extension of the current interim prosthesis for
transfemoral amputees.
A.H.Vrieling
[email protected]
11
2.
Patients
203 patients with recent SCI from 8 specialized rehabilitation centers.
Functional hindrance due to
spasticity in persons with spinal
cord injury during inpatient
rehabilitation and one year
thereafter
Methods
Patients rated the functional hindrance due to spasticity at start of
active rehabilitation (t1), 3 months later (t2), at discharge (t3) and one
year thereafter (t4). Hindrance was dichotomized into absent/negligible
and present. Multilevel regression analyses were performed determining
the course of functional hindrance due to spasticity and associations
with possible determinants.
Results
Percentage of persons that indicated functional hindrance due to
spasticity ranged from 54% to 62% over time and did not change
significantly over time (∆t3t1 Odds Ratio (OR)=0.85 p=0.44,
∆t3t2 OR=1.20 p=0.41, ∆t3t4 OR=0.91 p=0.67). Percentages of
persons with a lot of hindrance due to spasticity during specific activities ranged from 4-27%. Odds for experiencing functional hindrance
due to spasticity were significantly higher for persons with tetraplegia
(OR=2.17, p=0.0001), more severe spasticity (OR=5.51, p<0.0001) and
those using anti-spasticity medication (OR=4.18, p<0.0001).
I.P. van Cooten MD1, G.J. Snoek MD PhD1,
A.V. Nene MD PhD1, S. de Groot PhD2,3, M.W.M. Post PhD4
1
Rehabilitation Center Roessingh, Enschede,The Netherlands
Amsterdam Rehabilitation Research Center | Reade, Amsterdam,The Netherlands
3
University of Groningen, University Medical Center Groningen, Center for Human
Movement Sciences, Groningen,The Netherlands
4
Rudolf Magnus Institute of Neuroscience and Center of Excellence for Rehabilitation
Medicine, University Medical Center Utrecht and De Hoogstraat, Utrecht,The Netherlands
2
Introduction
Persons with spinal cord injury (SCI) can be hindered by spasticity
during activities of daily living. There are no studies about functional
hindrance due to spasticity in early phase after SCI.
Objective
To assess the occurrence and risk factors for functional hindrance due
to spasticity during and after inpatient rehabilitation.
12
Discussion and conclusion
Functional hindrance due to spasticity occurred in majority of persons
with SCI and did not change significantly during inpatient rehabilitation
and one year thereafter. Factors that influence hindrance were determined.
Correspondentie
I.P. van Cooten
[email protected]
Clinical message
It is important to focus on activities during which patients experience
most hindrance due to spasticity.
13
3.
Aims
To evaluate whether cardiorespiratory fitness is impaired in patients
after SAH and if cardiorespiratory fitness is related to fatigue in these
patients.
Impaired cardiorespiratory fitness
in patients after SAH and its
relationship to fatigue
Methods
A cross-sectional observational study. Study sample consisted of patients 6 months after SAH, aged 27-70 years. Outcomes were compared with a control sample consisting of matched healthy Dutch
individuals. The main study endpoint was peak oxygen uptake (VO2peak,
in ml/min and ml/kg/min), as determined by a maximal progressive cycle
ergometer test. Subjects were included if the peak respiratory exchange ratio (RER) was ≥ 1. Fatigue was assessed with the Fatigue
Severity Scale.
I.P. B. Zegers MD 1,2, R. van den Berg-Emons PhD1, W.J. Harmsen MSC1,2,
E. Sneekes MSc1, S. Neggers MD PhD3, L. Kahjeh MD4,
F. van Kooten MD PhD4, M. Heijenbrok-Kal PhD1,2,
prof. G.M. Ribbers MD PhD1,2
Results
28 patients (24 females) were included and compared with 28 matched
controls.VO2peak (ml/kg/min) was significantly (p<0.0001) reduced with
on average 30% in patients compared to controls. Mean FSS-score was
significantly higher in the patient group (3.5±1.5 vs. 2.5±1.00, p=0.005).
After correction for confounders (age, gender),VO2peak was related to
fatigue (β=-0.34 for VO 2peak in ml/kg/min, p=0.09; (β=-0.54) for
VO2peak in ml/min, p=0.015).
1
Erasmus MC, dept. of Rehabilitation Medicine, Rotterdam,The Netherlands
Rijndam Rehabilitation Center, Rotterdam,The Netherlands
3
Erasmus MC, dept. of Endocrinology, Rotterdam,The Netherlands
4
Erasmus MC, dept. of Neurology, Rotterdam,The Netherlands
2
Background
Patients after subarachnoid haemorrhage (SAH) have a reduced
health-related quality of life with fatigue as the most frequently reported
complaint.To date no research has been performed on cardiorespiratory
fitness and its relation with fatigue. The focus of the current study is to
assess the role of cardiorespiratory fitness in fatigue after SAH.
14
Conclusion
Cardiorespiratory fitness is considerably impaired in patients 6 months
after SAH and cardiorespiratory fitness seems to play a role in fatigue
complaints that are frequently reported by patients after SAH.
Correspondentie
B. Zegers
[email protected]
15
4.
Objective
The aim of this study was to determine muscle activation during
isometric wrist flexion and extension through short range stiffness.
Muscle stiffness in stroke
patients compared to controls
Patients
15 Stroke patients and 11 controls.
Methods
A cross-sectional case-control study design was applied.
Muscle activation was determined during isometric wrist flexion and
extension by measuring the short range stiffness, initial muscle
stiffness due to elastic stiffness of connected cross-bridges. Additional
determinants (Modified Ashworth, Tardieu, Fugl-Meyer motor score
and grip strength) were measured during a clinical assessment. The
groups were compared by a student t-test (p=0.05).
M.C.Wuisman MD1, J.H. de Groot PhD2, D.S. Spelt MD1,
E. de Vlugt PhD3, C.G.M. Meskers MD PhD2, A.D. Rambaran MD1
Results
At group level we did not observe differences in Short Range Stiffness
between patients and controls.
1
Sophia Rehabilitation,The Hague, Netherlands
Dept. Rehabilitation, Laboratory for Kinematics and Neuromechanics, Leiden University
Medical Center, Leiden, Netherlands
3
Dept. of Mechanical Engineering, Laboratory of Neuromusclular Control, Delft University of
Technology, Delft, Netherlands
2
Introduction
Stroke patients experience increased joint stiffness which may originate
from involuntary increased muscle contraction. It is possible to quantify
the muscle contribution at the wrist by measuring the Short Range
Stiffness. Our hypothesis is that patients show increased muscle
activation compared to controls.
16
Conclusion & discussion
Short Range Stiffness did not differ between patients and controls.
Some patients however showed increased Short Range Stiffness, which
may indicate that some individual patients did show increased muscle
activation.
Correspondentie
Clinical message
The joint stiffness experienced by patients and physicians seems in
general not to be caused by increased muscle activation measured
in isometric tasks. In individual cases this may however differ.
M.C.Wuisman
[email protected]
17
5.
Objective
To evaluate the long-term outcome of VR-IPS for ABI.
Return to work after acquired
brain injury (ABI):
long-term outcome of
vocational rehabilitation
Patients
58 employed patients with ABI taking part in a 4-month VR-IPS
programme between 2007-2010 in a Dutch rehabilitation center.
Methods
In 2013, eligible patients received a questionnaire on their current
working status. Comparisons of working hours before, immediately
after VR-IPS and at follow-up were done with the Wilcoxon-signed-ranktest.
Results
Fifty patients (86%) responded, 6 were irretrievable and 2 died.
Responders were 54 (SD 8.5) years old, 26 (52%) were male, 32 (64%)
had stroke. Twenty-two patients were not working, of whom 14
were fully work-disabled. Twenty-eight patients (56%) were working,
of whom 10 were partially work-disabled. These 28 patients worked
on average 5.9 hours per week less than before ABI (p<0.01), and
5.3 hours more than immediately after VR-IPS (p<0.01). Change of
tasks occurred in 15 patients.
K.N.Verpoort MD PhD1, I.E. van Zee MD1, D.M.J. van den Heuvel PhD1,
C.H. van Dongen1, V.V. Valkenburg MD1, Prof. T.M.P. Vliet Vlieland MD PhD1,2,3 ,
P.H. Goossens MD PhD1,2
1
Rijnlands Rehabilitation Center (RRC), Leiden,The Netherlands
Dept. of Orthopaedic surgery, physiotherapy and rehabilitation, Leiden University Medical
Center, Leiden,The Netherlands
3
Sophia Rehabilitation Center,The Hague,The Netherlands
2
Introduction
With vocational rehabilitation based on “individual placement of supported employment” (VR-IPS) patient, partner, employer, co-workers, the
occupational physician and the rehabilitation team work together
on reintegration.The literature on the effectiveness of VR-IPS is scanty.
Previous research among 58 patients with ABI found that immediately
after a VR-IPS programme return to work (RTW) was 86%.
18
Discussion and conclusions
RTW-rate decreased from 86% after VR-IPS to 56% 3-6 years later.
Compared to the literature, this percentage is favourable. For patients
who remained in the workforce, the working hours increased over
time. Many patients required adjustments in tasks.
Correspondentie
K.N.Verpoort
[email protected]
Clinical message
VR-IPS is a promising intervention for working patients after ABI.
19
6.
Objective
To (i) compare barefoot and in-shoe forefoot pressure parameters,
and (ii) assess the relationship between barefoot and in-shoe forefoot
pressure and foot pain, in patients with RA.
Comparison of barefoot and
in-shoe pressure measurements
in patients with
rheumatoid arthritis (RA)
Methods
Ninety-two patients with RA-related foot complaints were included.
Barefoot and in-shoe pressure parameters were obtained by EMED
and PEDAR pressure systems, respectively. Foot pain was assessed using
the Foot Function Index (FFI-pain) and Numeric Rating Scale (NRS-pain).
Results
Forefoot peak pressure (PP-forefoot) measured barefoot (mean
76.8 N/cm²) and in-shoe (mean 29.7 N/cm²) showed low, but significant
correlation (r=0.27, p=0.020).
Higher in-shoe PP-forefoot was related to lower NRS-pain (r=-0.25,
p=0.023). Higher in-shoe PP-forefoot was related to lower FFI-pain, but
not significantly (r=-0.14, p=0.242). Barefoot PP-forefoot showed
negative, not significant correlations with NRS-pain (r=-0.09, p=0.429)
and FFI-pain (r=-0.10, p=0.369).
S.I.C. Kerkhof MD1, L.D. Roorda MD PT PhD1, R. Dahmen MD1,2,
A. Jonkman MSc1, M. Steenbergen MSc1, A.F. Hoeksma MD PhD1,
J. Dekker PhD3,4,5,, M. van der Leeden PT PhD1
1
Amsterdam Rehabilitations Research Center | Reade, Amsterdam,The Netherlands
Slotervaart Hospital, Department of Rehabilitation, Amsterdam,The Netherlands
3
EMGO Institute for Health and Care Research,VU University Medical Center, Amsterdam,
The Netherlands
4
Dept. of Rehabilitation Medicine,VU University Medical Center, Amsterdam,The Netherlands
5
Dept. of Psychiatry,VU University Medical Center, Amsterdam,The Netherlands
2
Introduction
Barefoot pressure measurements are often used for diagnosis and
clinical decision making in rheumatoid arthritis (RA). However, in-shoe
pressure measurements could be clinically more relevant, since patients
wear shoes during most activities. Comparison of barefoot and in-shoe
pressure parameters, as well as data on the relationship of both
barefoot and in-shoe plantar pressure with foot pain, are lacking.
20
Discussion and conclusions
In-shoe and barefoot forefoot pressure showed low correlation, likely
because of the influence of footwear on pressure. Unexpectedly, higher
in-shoe forefoot pressure was related to less pain during walking.
Avoiding weight bearing on painful foot regions might explain this finding. Barefoot forefoot pressure was not significantly related to pain.
Correspondentie
S.I.C. Kerkhof
[email protected]
Clinical message
The low correlation between barefoot and in-shoe forefoot pressure,
the relationship between in-shoe pressure and pain found in this study,
and the fact that patients wear shoes during most activities suggest
that in-shoe measurements might be more suitable for diagnosis and
clinical decision making.
21
7.
Patients
All consecutive patients with CWP referred to a rehabilitation
programme over a period of 21 months
Multidisciplinary rehabilitation
programmes for chronic
widespread musculoskeletal pain:
results from daily practice
Methods
Retrospective study. The 15-week programme consisted of a
combination of cognitive behavioral therapy and exercise and individual
and group sessions with additional treatment modalities. Standardized
assessments were done routinely at baseline, discharge and three
months, and included the Pain Disability Index (PDI), the Pain
Catastrophizing Scale (PCS), the Multidimensional Pain Inventory (MPI),
numeric scales for pain and fatigue, the Canadian Occupational
Performance Measure (COPM), the 1 minute stair-climb test and the
RAND-36.
R. Koele BHS1, G.Volker1, F. van Vree MSc1, M. van Gestel MD1,
A. Köke PhD2, Prof. T.M.P. Vliet Vlieland MD PhD1,2,3
Results
165 patients were included (mean age 44.1 (SD 12.9) years), 143 (87%)
were women. Of 154 patients (93%) discharge data were available.
All outcomes showed statistically significant improvements between
admission and discharge (p<0.05, paired t-test or Wilcoxon signed rank
test), with the largest effect sizes (>1.0) observed for the COPM.
Longer duration of complaints was associated with less improvement
of the PDI. After three months significant effects still remained.
1
Rijnlands Rehabilitation Center, Leiden,The Netherlands
Kenniscentrum Adelante, Hoensbroek,The Netherlands
3
Dept of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical
Center, Leiden,The Netherlands
2
Objective
A growing body of evidence supports the effectiveness of a multicomponent approach for chronic widespread musculoskeletal pain
(CWP). This study aimed to describe the changes in pain, activities and
participation in patients with CWP taking part in a multidisciplinary
multi-component rehabilitation programme.
22
Discussion and conclusions
In daily rehabilitation practice, a 15-week multidisciplinary treatment
programme for patients with CWP showed statistically significant
improvements of pain, activities and participation.
Correspondentie
F. van Vree
[email protected]
Clinical message
In CWP, a multi-component intervention shows promising results, in
particular in patients with a relatively short duration of complaints.
23
8.
Objective
This study describes the occurrence of cognitive complaints in OHCA
survivors referred to a regular cardiac rehabilitation programme.
Do out-of-hospital cardiac arrest
patients in a regular cardiac
rehabilitation program experience
cognitive problems?
Patients
Consecutive OHCA survivors referred for cardiac rehabilitation to the
Rijnlands Rehabilitation Center between February 2011 and May 2013.
Methods
Patients were tested for cognitive complaints using the Mini-Mental
State Examination (MMSE<28) and the Cognitive Failure Questionnaire
(CFQ>32). Partners filled in the Informant Questionnaire on Cognitive
Decline in the Elderly (IQCODE>3.6). Besides, the Impact Profile
Autonomy questionnaire (IPA) was administered.
L.W. Boyce-van der Wal MA1,W.G.Volker1, Prof. T.P.M. Vliet Vlieland MD
PhD1,4, D.M.J. van den Heuvel PhD1, H. van Exel MD1,2, P.H. Goossens PhD1,4
Results
Seventy-seven patients were referred for regular cardiac rehabilitation,
mean age was 59 years (SD 13.8), 82% were male. The mean MMSE
(n=71) was 28.8 (SD 1.6), 8 patients scored <28; the mean CFQ (n=77)
was 20.9 (SD 9.4) 10 patients scored >32; the mean IQCODE (n=68)
was 3.1 (SD 0.3) and 4 patients scored >3.6. On the IPA the OHCAsurvivors with cognitive complaints (n=18) experienced more
problems on autonomy indoors (p=0.02), autonomy outdoors (p<0.01)
and family role (p=0.01) than those without cognitive complaints (n=58).
1
Rijnlands Rehabilitation Center, Leiden,The Netherlands
2
Department of Cardiology, Leiden University Medical Center,The Netherlands
3
Department of Accident and Emergency, Leiden University Medical Center,
The Netherlands
4
Department of Orthopaedics, Rehabilitation and Physical Therapy Leiden University
Medical Center,The Netherlands
Introduction
In out-of-hospital cardiac arrest (OHCA), hypoxic brain injury occurs
in 42-50% Cognitive problems due to hypoxic brain injury might hamper
cardiac rehabilitation. However, OHCA patients referred for cardiac
rehabilitation are not routinely screened for cognitive problems. The
incidence and severity of cognitive complaints in patients referred for
cardiac rehabilitation is unknown.
24
Correspondentie
L.W. Boyce
[email protected]
Discussion and conclusion
Cognitive complaints were seen in 23% of OHCA survivors referred
for cardiac rehabilitation. A correlation between cognitive complaints
and participation was found.
Clinical message
Screening of OHCA survivors admitted for cardiac rehabilitation seems
useful.
25
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sterk is verminderd
Verkrijgbaar in de populaire Progressive en AK
Symmetrical gel opbouw met Select stof
Uitwisselbaar met de Classic, Hybrid
en Silicone Progressive en AK Symmetrical
liners
Scan de QR code
voor meer informatie
Wilt u meer weten over deze revolutionaire nieuwe liner? Kijk dan op onze website
www.ortho-europe.nl/smarttemp, of neem contact met ons op via [email protected]