Lower Extremity
Perioperatieve zorg rondom de totale knie prothese
Hallux Valgus : preoperative criteria and surgical outcome - Axel Deenik 2015
Hallux valgus, commonly known as a bunion, is a deformity of the big toe which can eventually damage the rest of the foot. Wearing shoes with high heels and pointed toes has been known to influence the development of hallux valgus. Although the problem may seem minor, it can increase the risk of falling in elderly people. Surgical correction of the toe provides better results than non-surgical correction. Nevertheless, there is room for improvement in the surgical interventions currently being offered.
Of the many criteria involved in this condition, this dissertation found one that could be a predictor for the surgical outcome: the size of the hallux valgus angle on an X-ray. Of the two most common surgical interventions for hallux valgus, the simplest and least risky option proved to be just as effective as the more complex one, and is therefore the preferred treatment method.
Gait and balance characteristics in patients with diabetes type 2 : evaluation and treatment efficacy - Lara Allet 2009
The World Health Organisation has described type 2 diabetes as an international epidemic. Recent estimates indicated 171 million people in the world with diabetes in the year 2000. The number is projected to increase to 366 million by the year 2030. Approximately 58% of patients with type 2 diabetes have one or more complications from the disease resulting in an increased demand for medical services. The most symptomatic complication of this disease is peripheral neuropathy which affects nerve function from the periphery to more proximal regions. Approximately 50% of patients who have diabetes for more than 20 years develop peripheral neuropathy. Two main care paradigms are suggested for diabetic patients. The first paradigm is lifestyle management (including behavioural advice on diet and physical activity) and the second is medication (oral hypoglycaemics and insulin) proposed when lifestyle changes fail to be effective. In order to avoid the complications of diabetes, patients are recommended to be physically active for at least 30 minutes a day, 6 days a week. However, as diabetes is associated with an increased risk of injurious falls, this advice leads to a dilemma: how can individuals with an increased risk of falling carry out regular physical activity? Patients with inadequate gait stability, who experience a fall related injury, may not be able to meet these recommendations and may fall into a vicious circle of reduced physical activity levels leading to an increased risk of diabetic complications and decreased musculoskeletal function.
Stimulation of different foot structures and functions : effects on physical performance in older adults - Antonia Hartmann 2009
The primary public health goal is to increase the number of years of good health, and therefore to maintain independence and quality of life as long as possible. However, a fall can endanger mobility, physical performance and health of the elderly and is one of the major problems of older adults and care services for the aged. Since the risk of falling increases dramatically as the number of risk factors increases, the goal of fall prevention is to modify some of the strongest risk factors through, for example, physical exercises. Physical exercise is one of the most important intervention strategies that can significantly improve physical performance and contribute to maintenance of independence and quality of life. It has the strongest evidence to minimize or eliminate some of the strongest fall risk factors, such as impairments in balance, gait, strength and range of motion. Age-related changes in musculoskeletal and sensory characteristics of the feet are important risk factors too, but have not been the focus of exercise studies to date.
Evaluation of evidence-based clinical guidelines in physical therapy : ankle sprain as case example - Philip van der Wees 2009
Development and implementation of evidence-based clinical guidelines is a major focus of healthcare policy in many countries. Clinical guidelines are ‘systematically developed statements designed to help practitioners and patients to make decisions about appropriate healthcare for specific circumstances’. Development of clinical guidelines in health services is generally considered an important instrument to improve and manage the care process.
Important goals in guideline development are higher quality and improved costeffectiveness, ideally resulting in improved health outcomes. Moreover, the process of guideline development addresses the need to decrease variability in clinical practice, and practitioners’ desire to legitimize their profession in the eyes of external stakeholders. The concept of evidence-based practice, supported by clinical guidelines, is a common aspect of healthcare today.
New developments in the field of guideline research have resulted in the need to evaluate and update the procedure of the Royal Dutch Society for Physical Therapy (KNGF) for guideline development in physical therapy. One of the recent developments was the foundation of the AGREE collaboration (Appraisal of Guidelines, Research and Evaluation), which has published an instrument to appraise the quality of clinical practice guidelines. The AGREE Instrument provides a framework, including 23 criteria, to assess the quality of clinical practice guidelines. The instrument is based on international consensus about methods to develop evidencebased clinical guidelines, and also helps guideline developers to structure and improve the process of guideline development.
Another reason to undertake the present research project was that the international field of physical therapy lacked a body of knowledge about guideline development and implementation: it was unclear whether clinical guidelines can be used in physical therapy and what implementation strategies would be effective. Knowledge about applicability is essential for the process of updating the guidelines, and implementation strategies should be based on current knowledge. The World Confederation for Physical Therapy (WCPT) recognized the necessity of creating a body of knowledge and prioritized the development and implementation of clinical guidelines in its policy, in order to facilitate evidence-based practice.
These objectives and questions are reflected in this thesis, and fit the cyclic process of developing, implementing, evaluating, and updating clinical guidelines. Ankle sprain was the first guideline in KNGF’s guideline program, and is the case example used in this thesis to describe the development cycle.
Dynamic joint stability in athletes : the value of isokinetic dynamometry - Robert van Cingel 2007
Every year around 1.5 million Dutch recreational and elite athletes sustain new injuries. These sports injuries are divided into acute and overuse injuries and it is estimated that each year in the Netherlands there are 1.2 million acute injuries and 300.000 overuse injuries.About 50% of all injuries require medical attention, mostly from a physician or physiotherapist. Medical attention to overuse injuries is higher than to acute injuries (56% versus 50%).Physiotherapy plays an important role in the prevention and treatment of sports injuries.Therefore, research is needed to establish a solid basis of rehabilitation programs and injury prevention.The main purpose of this thesis was to gain a better insight into mechanisms at the basis of overuse and repetitive injuries of the ankle and shoulder joints in athletes.To assess dynamic joint stability four studies were carried out with an isokinetic dynamometer, which is a reliable and safe way of analyzing muscular performance and muscle activation characteristics.