Adelante

A descriptive quantitative study. To determine how much and what type of exercises and training were provided as part of usual physiotherapy and occupational therapy to participants of the SCI-MT Trial (the Early and Intensive Motor Training for People with Spinal Cord Injuries Trial). This information is important because the SCI-MT Trial concluded that additional motor training is redundant if people with SCI receive equivalent usual care as what was provided to participants of the SCI-MT Trial. Fifteen spinal injury units across Europe and Australia. Data were collected on the time participants of both groups of the SCI-MT Trial (n = 220) attended physiotherapy and occupational therapy provided as part of usual care over the 10-week intervention period. The International Spinal Cord Injury Physical Therapy and Occupational Therapy Basic Data Set was used to capture time spent on activity and impairment directed categories of exercises and training. Participants attended a median (interquartile range) of 8.3 (6.2 to 11.4) hours of physiotherapy and occupational therapy per week. Approximately 70% of therapy time was spent actively exercising or training with a median of 3.8 h per week spent on activity-directedand 1.9 h per week spent on impairment-directedexercises and training. The results of this study detail the amount and type of physiotherapy and occupational therapy that needs to be provided as part of usual rehabilitation care to render additional motor training redundant.

Background and objectives: Exerkines are signalling factors that are released from organs throughout the body during physical exercise (El-Sayes et al., 2019). Some of these exerkines are thought to contribute to the well-documented benefits of exercise on brain health and cognitive function, potentially delaying age-related cognitive decline (Erickson et al., 2011). However, research is still far from establishing a mechanism-based, evidence-driven exercise programme to prevent such decline. To date, most studies have focused on endurance training, leaving other training modalities underexplored. Moreover, few studies have simultaneously examined exercise-induced effects on blood, brain, and cognitive domains, limiting more holistic understanding of the underlying mechanisms. Research has also primarily involved healthy adults, whereas older adults at risk of Mild Cognitive Impairment (MCI) are less frequently studied. Importantly, the effects of exercise on cognition have never been investigated in persons with Spinal Cord Injury (SCI), a population with an elevated risk of age-related cognitive decline and dementia. The primary objective of the dissertation was therefore to gain a more comprehensive understanding of the mechanisms underlying the beneficial effects of exercise training, specifically resistance exercise in older adults and Neuromuscular Electrical Stimulation (NMES) in individuals with SCI, on brain health and cognitive function, with a particular focus on the role of exerkines in (exercise-induced) neuroplasticity. Methods: Eleven studies were conducted. Study 1 was a literature review describing exerkine release following acute and chronic endurance or resistance exercise and their effects on neuroplasticity via long-term synaptic potentiation. Study 2 summarised the findings from transcriptome and secretome studies identifying muscle-derived exerkines (myokines). Studies 3 and 4 were cross-sectional studies in older adults (n = 74) investigating the relationships between participant characteristics, blood (inflammatory and neurotrophic) and brain biomarkers (neurometabolites, regional grey matter volumes), and cognitive function. Studies 5–8 evaluated the effect of a single bout (n = 37) and a 12-week resistance exercise programme (n = 74) on blood and brain biomarkers and cognitive function in older adults. Studies 6 and 7 further compared outcomes between cognitively healthy older adults and those at elevated risk of MCI (based on the Montreal Cognitive Assessment). Study 9 systematically reviewed evidence on the effects of exercise interventions on cognitive performance in individuals with SCI and highlighted factors underlying their elevated risk of cognitive decline. Study 10 tested the effect of a single bout of NMES on exerkines and cognitive performance in persons with SCI. Study 11 described the protocol of a 12-week NMES intervention in individuals with SCI to examine the effect on exerkines and cognitive outcomes. Results: Study 1 identified 16 exerkines with known (in)direct effects on long-term synaptic potentiation. Study 2 reported 1,126 putative myokines, most with still unknown effects on the brain and body. Study 3 found associations between the circulating inflammatory marker kynurenine and signs of neuroinflammation and neurodegeneration in older adults. Study 4 showed that older adults with normal-to-slightly-elevated body weight and greater handgrip strength maintained larger brain volumes. Study 5 demonstrated improved working memory performance in older adults immediately after a single session of resistance exercise training compared to control group. Study 6 suggested hippocampal volume preservation over time in the resistance exercise group, and Study 7 revealed executive function improvements in older adults at elevated risk of MCI after 12 weeks of resistance training compared with control group. Study 8 demonstrated neurometabolic changes in older adults who contracted COVID-19 during participation. Study 9 confirmed that no prior studies have investigated exercise effects on cognitive function in individuals with SCI. Study 10 found increases in lactate levels, but no changes in cognitive performance after a single NMES session in persons with SCI. Study 11 described the design for a future 12-week NMES intervention study for individuals with SCI. Conclusions: The dissertation advances the understanding of exercise effects on brain health and cognition in older adults and individuals with SCI, providing a neurobiological basis for future research. Kynurenine levels, handgrip strength, and a healthy body weight emerged as potential biomarkers of brain health for older adults. The findings underscore the importance of monitoring cognitive functioning in persons with SCI. Although further research is needed to clarify the effect of different exercise modalities across populations with varying cognitive risk profiles, the present evidence reinforces the notion that physical exercise benefits brain function. A multimodal, enjoyable, and sustainable exercise programme maintained throughout life is likely to be the most effective strategy to mitigate or delay age-related cognitive decline. Keywords: aging, cognition, myokines, exercise, spinal cord injury

BackgroundMore self‐efficacy leads to greater confidence in one's ability to perform actions to achieve treatment goals. Therefore, self‐efficacy may affect patient recovery and health‐related quality of life (HRQoL) after ICU discharge.AimIn a cohort of mechanically ventilated COVID‐19 survivors, we examined the associations between self‐efficacy at 3 months and HRQoL at 3, 12 and 24 months after discharge.Study DesignMechanically ventilated survivors of the MaastrICCht cohort that completed a self‐efficacy assessment with the General Self‐Efficacy Scale (GSES) were included. HRQoL was measured using the EuroQol 5 Dimensions 5 Levels (EQ‐5D‐5L), subdivided into a health utility score (EQ‐HUS) and visual analogue scale (EQ‐VAS). Linear regression models were used to investigate associations between self‐efficacy and HRQoL and were adjusted for age, sex, body mass index (BMI), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, ICU length of stay and hospital discharge location.ResultsIn 87 ICU survivors, more self‐efficacy at 3 months after ICU discharge was associated with longitudinally higher EQ‐HUS (β = 0.01; 95% CI: 0.01–0.02; p < 0.001) and higher EQ‐VAS (β = 1.00; 95% CI: 0.66–1.35; p < 0.001) up to 2 years after ICU discharge. After adjustment for age, sex, BMI, APACHE II score, ICU length of stay, and hospital discharge location, associations were similar.ConclusionsMore self‐efficacy at 3 months after ICU discharge was associated with longitudinally higher HRQoL up to 2 years after ICU discharge in mechanically ventilated COVID‐19 survivors.Relevance to Clinical PracticeScreening for self‐efficacy in patients post‐ICU as well as developing interventions to improve self‐efficacy are a target post‐ICU to enhance HRQoL over the long term.

Background:Persons with knee osteoarthritis suffer from a prevalent chronic condition requiring comprehensive treatment approaches. To effectively cater to their needs, healthcare professionals must adopt an integrated health perspective and collaborate across disciplines. This study aimed to understand the viewpoints of patients and healthcare professionals and identify factors influencing collaborative care for persons with knee osteoarthritis.Methods:Semi-structured interviews were conducted with knee osteoarthritis persons and healthcare professionals involved in their care. Data analysis involved identifying common themes, patterns, and discrepancies among stakeholders. Interviews were coded using NVivo, and inductive analysis was employed to determine themes.Results:Nine healthcare professionals from various disciplines and eight patients with knee osteoarthritis participated. Five main themes emerged: diagnostics, communication, training conditions, integrated health perspective, and Perceived collaboration and support from healthcare professionals. Persons with knee osteoarthritis sought comprehensive diagnoses and expressed satisfaction. Healthcare professionals faced barriers like limited integrated health perspective and time constraints, stressing the need for interdisciplinary training and collaboration.Conclusion:Implementing an integrated healthcare vision is crucial for personalized care in chronic conditions like knee osteoarthritis. Continuous training and curriculum integration for healthcare professionals are necessary to prioritize integrated health perspectives and collaboration, thus better meeting the diverse needs of persons.

Small fiber neuropathy (SFN) is characterized by neuropathic pain, associated with decreased quality of life (QOL). It remains unclear which psychosocial factors play a role in SFN. The experience sampling method (ESM) allows a profound understanding of the real-time fluctuations in reaction to events. The main goal of this study was to increase knowledge of the interrelationships between pain intensity, physical activity, and psychosocial factors in patients with SFN in daily practice over time. A prospective observational ESM study with the PsyMate© application (smart-eHealth GmbH, Luxembourg) was conducted at the Adelante location of Maastricht University Medical Center+ in the Netherlands. Participants with idiopathic SFN, older than 18 years, with an indication for rehabilitation, were included. Pain intensity, fatigue, positive and negative affect, physical activity, avoidance behavior, and pain catastrophic thoughts were incorporated into the ESM questions. Participants received 10 beep signals per day followed by the above-mentioned questions, for consecutive 7 days. The results were analyzed with linear mixed-effect models. Twenty-one participants were included with a mean age of 48.24 (SD ± 13.89) years, of whom 76.2% were female. More pain (now) resulted in more physical activity (later) (a) and more physical activity (now) resulted in more pain (later) (b). The first association (a) is influenced by pain catastrophic thoughts and fatigue, and the second (b) by an increase in affective states and a lower level of avoidance behavior. In idiopathic SFN, pain intensity, and physical activity showed a 2-sided association, influenced by catastrophic thoughts, fatigue, affective states, and avoidance behavior.

ObjectiveThis study aimed to investigate the effectiveness of an adapted ACT intervention (BrainACT) in people who experience anxiety and/or depressive symptoms following acquired brain injury. MethodsThe study is a multicentre randomized controlled two-arm parallel trial. In total, 72 people who survived a stroke or traumatic brain injury were randomized into an eight-session ACT or control (i.e. psycho-education and relaxation) intervention. The primary outcome measures were the Hospital Anxiety and Depression Scale (HADS) and the Depression Anxiety and Stress Scale (DASS). Secondary outcomes were ACT process measures, participation, and quality of life. Outcome assessments were performed by trained assessors, blinded to treatment condition, pre-treatment, during treatment, post-treatment, and at 7 and 12 months follow-up. ResultsThere were no differences between groups on any outcome measure. Participants in both groups significantly improved on all outcome measures, except for participation frequency. More clinically relevant long-term improvements (i.e. recovered or reliable changes on the HADS) were found in favour of ACT for depressive and anxiety symptoms. ConclusionThe study was negative on the primary outcome measures. On an individual level, this study showed that especially on the long term ACT seems to show a more clinically relevant decrease in anxiety and depressive symptoms compared to an active control intervention. However, ACT was not superior in improving ACT-related processes such as psychological flexibility, cognitive defusion, and valued living nor in increasing participation or quality of life. Further large-scale group studies are warranted. Trial registrationThe study was originally registered in the Dutch Trial Register (now Clinical Trial Registry Platform), NL-OMON50203. Registered on 18/07/2018 and now to be found under https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON50203.

Objective To determine whether ESWT is able to safely and positively influence specific ADL activities in people with SCI and spasticity, measured by Goal Attainment Scaling (GAS). Study Design Multiple single-case experimental design with a randomized baseline length. Setting Rehabilitation centre. Subjects This study included 11 participants with SCI, aged >18 years (mean (SD) 63 (12.2) years), mean (SD) duration after injury 9 (8.1) years, with hindering spasticity in the upper or lower limb. Methods During the 3-week treatment phase, radial ESWT in the plantar flexors of the calf (n = 6) or in the flexors of the wrist/hand (n = 5) was applied weekly, followed by a 12-week follow-up phase. The primary outcome measure consisted of the Goal Attainment Scaling (GAS), in which three individual goals were set. Secondary outcome measures included range of joint motion, pain (0–10), 10-m walking test and Van-Lieshout-hand-function-test-for-Tetraplegia (short form). Results At descriptive level, in total, 28 of the 33 GAS items improved after ESWT and these effects generally were maintained during the follow-up phase. The results of all secondary outcome measures varied. No serious adverse events occurred. Conclusions In this study, ESWT resulted in improved performance of specific ADL items in most persons with SCI. More research is needed to confirm these results in a larger cohort.

Tinnitus (the perception of sound in the absence of any corresponding external source) is highly prevalent and can be distressing. There are unanswered questions about how tinnitus, suicidal thoughts, and suicidal behaviours co-occur and interact. To establish the extent of scientific literature, this scoping review catalogued primary reports addressing the associations between tinnitus, suicidal ideation, attempted suicide, and death by suicide. We searched OvidSP, Medline, EMBASE, PsycINFO, CINAHL, Google Scholar, EThoS, and ProQuest for all studies and case reports on ideation and/or attempted and/or completed suicide in the context of tinnitus. Twenty-three studies were included, and data were charted according to study type. Several epidemiological and other observational studies gave evidence of risk factors and an association between suicidal ideation, suicidal behaviour, and tinnitus. However, there was no evidence of the direction of causality. Qualitative studies are indicated to explore the patient’s experience and understand the dynamics of any interaction between tinnitus and suicidal thoughts and behaviours. A theory-informed model of tinnitus and suicide needs to be developed to inform the development of interventions and how tinnitus patients are supported clinically.

Wastewater‐based epidemiology (WBE) has been proven to be a useful tool in monitoring public health‐related issues such as drug use, and disease. By sampling wastewater and applying WBE methods, wastewater‐detectable pathogens such as viruses can be cheaply and effectively monitored, tracking people who might be missed or under‐represented in traditional disease surveillance. There is a gap in current knowledge in combining hydraulic modeling with WBE. Recent literature has also identified a gap in combining machine learning with WBE for the detection of viral outbreaks. In this study, we loosely coupled a physically‐based hydraulic model of pathogen introduction and transport with a machine learning model to track and trace the source of a pathogen within a sewer network and to evaluate its usefulness under various conditions. The methodology developed was applied to a hypothetical sewer network for the rapid detection of disease hotspots of the disease caused by the SARS‐CoV‐2 virus. Results showed that the machine learning model's ability to recognize hotspots is promising, but requires a high time‐resolution of monitoring data and is highly sensitive to the sewer system's physical layout and properties such as flow velocity, the pathogen sampling procedure, and the model's boundary conditions. The methodology proposed and developed in this paper opens new possibilities for WBE, suggesting a rapid back‐tracing of human‐excreted biomarkers based on only sampling at the outlet or other key points, but would require high‐frequency, contaminant‐specific sensor systems that are not available currently.