Pain in patients with chronic idiopathic axonal polyneuropathy.

BACKGROUND/AIMS: Pain in patients with chronic idiopathic axonal polyneuropathy (CIAP) has never been studied in detail. The aim of the study was to investigate the pain experienced by patients with CIAP, and to determine whether pain is associated with health-related quality of life (HRQoL). METHODS: The McGill Pain Questionnaire (MPQ) and the RAND-36 were used in a cross-sectional study. RESULTS: Sixty-three of 91 patients with CIAP reported experiencing pain, describing it as nagging (56%) and annoying (52%). Of these patients, 27 were classified in a subgroup with neuropathic pain (median VAS = 33 mm), 25 in a subgroup with non-neuropathic pain (median VAS = 34 mm), and 11 in a mixed-pain subgroup (median VAS = 25 mm). Non-neuropathic pain was as common and as painful as neuropathic pain. Pain was strongly associated with the physical functioning domain of the RAND-36 in patients in the mixed pain subgroup (r = -0.71, p < 0.05). CONCLUSION: Neuropathic and non-neuropathic pain syndromes should be distinguished in patients with CIAP who experience pain, to enable appropriate tailoring of treatment.

The Neck Bournemouth Questionnaire cross-cultural adaptation into Dutch and evaluation of its psychometric properties in a population with subacute and chronic whiplash associated disorders.

STUDY DESIGN: Cross-cultural adaptation of an outcome questionnaire. OBJECTIVE: The aim of the study was to cross-culturally adapt the Neck Bournemouth Questionnaire (NBQ) for the Dutch language in a population of people with subacute and chronic whiplash associated disorders (WAD), and to assess its psychometric qualities. SUMMARY OF BACKGROUND DATA: The NBQ covers the salient dimensions of the biopsychosocial model of pain, and has been shown to be reliable, valid, and responsive to clinically significant change in patients with non specific neck pain. However, no Dutch validated version was available for patients with WAD at the time our study was initiated. METHODS: The English version of the NBQ was translated into Dutch (NBQ-NL) and back-translated according to established guidelines. The internal consistency (with help of Cronbach's alpha), construct validity, and convergent validity were estimated in a different group of 92 patients. Agreement and correlation between the NBQ-NL scores and counterpart questionnaires (SF-36, Neck Disability Index, Hospital Anxiety and Depression Scale, the General Perceived Self-Efficacy and a numerical rating scale for perceived pain) were investigated, using Bland and Altman method and Spearman rank correlation coefficient. Subsequently, 34 patients with subacute WAD completed the questionnaire twice over 1 to 3 weeks, to assess its test-retest reliability. RESULTS: Ninety-two patients, with subacute and chronic WAD, completed the study. Their mean age was 41 years (SD = 11). There were relative high mean scores on the Neck Disability Index (25.5; SD = 8.2), and the NBQ (43.9; SD = 14.8). The NBQ-NL was granted face-validity. Spearman rank correlation coefficient was 0.51 to 0.82 (except for General Perceived Self-Efficacy (0.21). The limits of agreement of normalized scores were relative variable, from small to wide. Cronbach's alpha (internal consistency) for the NBQ-NL whole scale was 0.87. The Intraclass correlation coefficient for the test-retest reliability was excellent (0.92) and the SEM was relatively low (3.7). CONCLUSION: Overall, the rank correlation level in general was good, whereas the agreement between questionnaires outcome was variable, most of which seems to be attributable to absolute scale differences. The NBQ-NL is a useable patient-orientated tool for assessing disability in clinical studies and clinical diagnosis in Dutch speaking patients with WAD.

Patients with chronic whiplash-associated disorders: relationship between clinical and psychological factors and functional health status.

OBJECTIVES: To examine the relative contribution of cervical impairments and psychosocial factors to perceived disability among people with chronic whiplash-associated disorders. DESIGN: A total of 86 patients with chronic whiplash-associated disorders participated in this observational, cross-sectional study. All patients were presented to outpatient physical therapy clinics. All patients completed the neck disability index. Depression, anxiety, and catastrophizing were measured with the Hospital Anxiety and Depression scale and the pain coping and cognition list, respectively. Cervical function was assessed by measuring the active range of motion. Stepwise and hierarchical regression analysis was used to estimate the contribution of cervical impairment and psychosocial functions to the variance in neck disability. RESULTS: Depressive symptomatology and catastrophizing explained 61% of the variance in neck disability index scores. Catastrophizing explained 57% of the variance in neck disability index scores and 15% of the variance in the sum scores of active cervical rotations. CONCLUSIONS: Catastrophizing explained the variance in both perceived neck disability and, to a lesser extent, active range of cervical motion, which suggests that pain-related catastrophizing plays an important role in the physical complaints of patients with chronic whiplash-associated disorders when referred to a physical therapist.

Physical fitness in children with haemophilia and the effect of overweight.

Although children with haemophilia are advised to participate in physical activities, their physical fitness has not been studied in a large group. In addition, children with haemophilia may be at increased risk for becoming overweight as a result of inactivity because of joint bleedings or because of overprotection. This study aimed to assess physical fitness (aerobic capacity), joint status, muscle strength, quality of life (QoL), self-reported motor competence and also prevalence of overweight and its association with physical parameters. Weight and height were measured. Skin folds were measured unilaterally at biceps, triceps, subscapular and supra-iliac sites. Aerobic capacity was determined on a cycle ergometer or with a 6-min walk test (6MWT). Muscle strength and active range of motion of elbows, knees and ankle joints were measured. Self-reported motor competence was measured with the 'Competentie BelevingsSchaal voor Kinderen'. Joint pain was scored on a Visual Analogue Scale. The Haemo-QoL Index was used to measure QoL. In 158 Dutch boys with haemophilia, with a mean age of 12.7 years (SD 2.9), normal aerobic capacity and muscle strength were found. Joint pain was reported by 16% of the participants. The prevalence of overweight (16%) was slightly increased when compared with healthy Dutch boys (13.5%). Being overweight had a negative association with the6MWT and QoL. Dutch children with haemophilia have normal aerobic exercise capacity and muscle strength. The majority also has normal joint mobility. Prevalence of overweight is slightly increased.

Outcome measures in physiotherapy management of patients with stroke: a survey into self-reported use, and barriers to and facilitators for use.

UNLABELLED: OBJECTIVE. To investigate physiotherapists' self-reported use of outcome measures as recommended in the Dutch Clinical Practice Guideline on Physiotherapy Management of Patients with Stroke (CPGPS) and to assess perceived barriers to and facilitators for the use of outcome measures in everyday practice. METHOD: A 41-item survey, including the barriers and facilitators questionnaire (BFQ), was sent by post to 400 physiotherapists in each of the following settings in the Netherlands: acute care hospitals (ACH; n = 100), rehabilitation centres (RC; n = 100), nursing homes (NH; n = 100) and private physiotherapy practices (PPP; n = 100). RESULTS: One hundred and eighty-nine physiotherapists returned the survey (47%; ACH, n = 57; RC, n = 67; NH, n = 26 and PPP, n = 39) and the surveys of 167 physiotherapists involved in stroke settings were analysed. These physiotherapists reported regularly using three (median; range 0-7) of the seven recommended outcome measures, with those working in RC or ACH reporting a significantly higher use than their colleagues in PPP (4 vs. 0 and 3 vs. 0; p < 0.001 and p = 0.02, respectively). The BFQ revealed that there were setting-specific facilitators, such as 'a positive attitude towards outcome measures' (as mentioned by 93% of the physiotherapists) and 'acquaintance with outcome measures' (90%), and barriers such as 'changing routines' (32%), 'time investment' (29%) and 'financial compensation' (21%). CONCLUSION: Despite an almost uniformly positive attitude, physiotherapists infrequently use the outcome measures recommended in the CPGPS. Robust setting-specific tailored implementation strategies based on the reported barriers and facilitators are needed.

Aerobic capacity in children with hemophilia.

OBJECTIVE: To determine whether aerobic capacity is normal in boys with different types of hemophilia compared with healthy peers and whether the level of aerobic capacity correlates with the amount of physical activity, joint health status, muscle strength, and anthropometrics. STUDY DESIGN: 47 patients (mean [SD] age, 12.9 [3.2] years; age range, 8.2-17.4 years) from the "Van Creveldkliniek" of the University Medical Center Utrecht, participated. Anthropometry, muscle strength, joint impairment, functional ability, and aerobic capacity were measured. The amount of energy expenditure during daily living was assessed. RESULTS: All boys were able to perform at maximal or near-maximal level on exercise tests, and none of them reported bleeds or other adverse events. Relative peak oxygen, peak heart rate, and peak working capacity were significantly lower compared with healthy control subjects. 30% had Z-scores >2 for weight. Total muscle strength was normal, and almost no joint impairment and no decrease in functional ability were found. CONCLUSION: The aerobic capacity of children with hemophilia is still lower than the normal population, whereas their overall muscle strength is comparable with healthy peers. The functional ability does not differ from healthy peers, and joint health status showed very minor impairments. A substantial proportion of Dutch children with hemophilia was overweight, without showing a reduction in the amount of self-reported physical activities.

Functioning of patients with chronic idiopathic axonal polyneuropathy (CIAP).

Although patients with Chronic Idiopathic Axonal Polyneuropathy (CIAP) report a slow deterioration of sensory and motor functions, the impact of this deterioration on daily functioning has not yet been investigated in detail. The first aim of this cross-sectional study involving 56 patients with CIAP was, therefore, to assess patients' functioning with use of the International Classification of Functioning, Disability and Health (ICF). The second aim was to find determinants of walking ability, dexterity, and autonomy. Fatigue and limited walking ability were present in most patients and differed considerably. In regression models, age, muscle strength, and fatigue together explained 63% of the variance in walking ability, which by itself explained almost 50% of the variance in patients' autonomy indoors and outdoors (42% and 49%, respectively). Muscle strength and sensory function scores together explained 30% of the variance in dexterity scores, which in turn explained only 13% of the variance in autonomy indoors. The diminished autonomy of patients with CIAP might be improved by reducing fatigue, by means of training, and by improving walking ability.