[Favourable results of a rehabilitation programme with cognitive behavioural therapy and graded physical activity in patients with the chronic-fatigue syndrome]. / Gunstige resultaten van een revalidatieprogramma met cognitieve gedragstherapie en gedoseerde fysieke activiteit bij patiënten met het chronische-vermoeidheidssyndroom.

OBJECTIVE: To determine whether a specific course of interdisciplinary rehabilitation might lead to clinically significant changes in fatigue, experienced disability and physical function in patients with the chronic-fatigue syndrome (CFS). DESIGN: Prospective and uncontrolled. METHOD: 'Het Roessingh', a rehabilitation centre in Enschede, the Netherlands, has developed an interdisciplinary clinical rehabilitation programme for patients with CFS in cooperation with the 'Nijmeegs Kenniscentrum Chronische Vermoeidheid' [Chronic-Fatigue Knowledge Centre] in Nijmegen, the Netherlands. In this programme, physical, mental and social activities are gradually increased on the basis of cognitive behavioural principles and graded activity. Of the 127 successive persons who enrolled for the therapy during the period from August 2000 to December 2004, 99 fulfilled the inclusion criteria; they had a median duration of symptoms of 6 years. The results of treatment were evaluated by a measurement with the 'Checklist individuele spankracht' [Checklist individual muscle tone] before and after treatment and the scores on the 'Patiëntspecifieke beperkingen' [Patient-specific disability] and the Short form-36. The measured data were complete in 74 patients. RESULTS: Before rehabilitation, the levels of fatigue, disability and distress were high. After treatment, the studied population showed significant improvement in fatigue, experienced disability and physical function. The magnitude of the improvement was generally 'average'. At the end of treatment, 70% of the patients were clinically less fatigued, 68% experienced less disability and 55% functioned better physically. In 34% the level of fatigue was normalised after treatment, but 9.5% of the patients was more fatigue. CONCLUSION: The rehabilitation programme offered for CFS led to significant improvements in function and fatigue.

Current use of outcome measures for stroke and low back pain rehabilitation in five European countries: first results of the ACROSS project.

Objectives were to obtain a view on the current use of outcome measures for stroke and low back pain rehabilitation in five European countries. A postal questionnaire, comparable for different cultural situations, was distributed in August 1998 to 581 rehabilitation facilities in Ireland, Germany, Italy, Austria and the Netherlands. Of these, 102 settings responded. In stroke rehabilitation the Barthel Index is the dominant outcome measure, followed by the Functional Independence Measure and the Frenchay Activities Index. Besides the Visual Analogue Scale, the most used outcome measures in low back pain rehabilitation were the Oswestry Pain Disability Questionnaire and the Roland Disability Questionnaire. Outcome measures are more frequently used in stroke than in low back pain rehabilitation. The purpose of use is mainly for the measurement of effectiveness, while a relation with quality management is seldom made. There appears to be little agreement on which outcome measures to use. Little attention was found to have been given to the assessment of handicap, quality of life and patient satisfaction.

Construct validation of the Hoensbroeck Disability Scale for Brain Injury in acquired brain injury rehabilitation.

PURPOSE: To evaluate the construct validity of the Hoensbroeck Disability Scale for Brain Injury (HDSB) against the Disability Rating Scale (DRS). METHODS: The HDSB was correlated with the DRS at admission, 6 weeks later and at discharge in 33 brain injured patients during post-acute rehabilitation. Next, to study the longitudinal construct validity of the HDSB the mean changes in score of the HDSB and the DRS were correlated. Finally, the sensitivity to change over a 6-week period was evaluated by comparison of the effect sizes of the HDSB scores with the DRS scores. RESULTS: The HDSB subscales correlate high and in the expected direction with the DRS at all three points in time. The correlation of the changes between HDSB and DRS is moderate, but in the expected direction. The sensitivity to change in time of the HDSB is lower than that of the DRS. CONCLUSIONS: This study supports the validity of the HDSB as an instrument to describe the disability of acquired brain injury patients at a single point in time. Its ability to measure changes in disability over time is questionable and needs further investigation.