Rehabilitation Medicine has over twenty PhD students working on their thesis within the framework of Expand, which stands for Extremities, Pain and Disability. The following research projects are a selection of the studies that are being carried out.
Marlies Bodde
CRPS-I and amputation
First supervisor: prof. dr. J.H.B. Geertzen.
Email: e-mailadres
Period of study: 1-1-2010 1-11-2012.
Complex Regional pain Syndrome Type I (CRPS-I) is a chronic pain syndrome in which the pathophysiology is still unknown. Patients with longstanding therapy-resistant CRPS-I often experience unbearable pain, infections and an afunctional limb which influences their health and possibilities for participation in daily activities. Sometimes these patients request for amputation. Amputation for this syndrome is not very common, but over 20 amputations have been performed at the University Medical Center Groningen. The decision for amputation is debatable since research has not shown that the procedure will lead to an improved quality of life yet and recurrence of symptoms was suggested to be nearly 100%.
This PhD-project gives an overview on what has been published on amputation for CRPS-I. There will also be an article about the findings of a histopathological study which was performed on nerve tissue that has been taken from several amputated limbs. A third study will be written as a co-author, discussing the quality of life and functional results of patients who underwent an amputation because of CRPS-Ι. A fourth study will be written on the correlation between resilience and recovery after CRPS-I related amputation using standardized questionnaires. A fifth study will be written as a summary on amputations that were performed in the UMCG by means of retrospective research into medical files.
Finally a standard amputation procedure (including amputation levels) for CRPS-I patients is presented based on the findings.
Joyce Bos
Promoting physical fitness and physical activity in children with a chronic disease
Emailaddress: e-mailadres
First supervisor: prof. dr. J.H.B. Geertzen.
Period of study: 01-01-2011 01-01-2015.
In most children with a chronic disease, physical fitness (PF) and physical activity (PA) are reduced in comparison to their healthy peers. As a consequence, children with a chronic disease are also restricted in their social participation. Sedentary lifestyle and low physical fitness increase the risk of cardiovascular disease, obesity and pre-diabetes.
The aim is to improve and optimise PF and PA for children with a chronic disease, especially for children with Juvenile Idiopathic Arthritis (JIA), Juvenile Dermatomyositis (JDM) and children who had a liver transplantation. In this study PF and PA levels are measured in JIA and liver transplant patients. The effect of a cognitive behavioural therapy program, using an internet based program and a training program, is measured on PF and PA in children with JIA and JDM.
Mihai Bragaru
Amputees and sports
First supervisor: prof. dr. J.H.B. Geertzen.
Email address: e-mailadres
Period of study: 01-09-2008 01-09-2012.
The main goal of this project is increasing amputees' sport participation. Both upper and lower limb amputees will be addressed for this project.
The project consists of several independent studies, which will provide an insight into a specific area, related to the topic of project. Two literature reviews started off the project, one concerning biomechanical, cardio-pulmonary, psychological and rehabilitation aspects of amputees who participate in sports; and one concerning sport prostheses and prosthetic adaptations used for sports. A qualitative study addressing the barriers and motivators for participation in sports of lower limb amputees, followed by a questionnaire study addressing upper limb amputees' sport participation habits and influential factors.
A training program for amputees, based on their physical capacity, will be developed at the end of the project, taking into consideration the previous results. This program can be used in rehabilitation therapy.
Lauren Fortington
Rehabilitation of the elderly amputee
First supervisor: prof. dr. J.H.B. Geertzen.
Email address: e-mailadres
Period of study: 01-09-2008 01-09-2012.
Most lower limb amputations in the Netherlands occur in patients over 60 years of age, due to chronic vascular conditions and/or diabetes. Almost half of all patients are discharged to a nursing home for their rehabilitation. The day-to-day treatment, activities and outcomes achieved through rehabilitation programs in the nursing homes for people with amputation are largely unknown. Insight into the mobility and functional outcomes may help to determine, for example, which patients benefit most from rehabilitation or who is most likely to return home, enabling a more targeted program to be designed or discharge planning to begin sooner.
Two studies – (1) a longitudinal, observational study of patients with lower limb amputation admitted to nursing homes, and (2) an interview study with Physiotherapists and Elderly Care Physicians - have been designed to gain greater understanding of the rehabilitation program currently provided in the nursing homes.
Eva Jaarsma
Barriers and facilitators for exercise for physically disabled
First supervisor: prof. dr. J.H.B. Geertzen.
Email: e-mailadres
Period of study: 15-03-2010 15-03-2014.
This project concentrates on the question how to get as many physically disabled people as possible to start exercising and stay active. In order to get an idea of what prevents and stimulates exercising the barriers and facilitators are being researched during exercise.
Fred de Laat
Measuring mobility in people with a lower limb amputation
First supervisor: prof. dr. J.H.B. Geertzen.
Email address: e-mailadres
Period of study: 01-09-2009 01-12-2012.
Limitation in mobility is regarded as one of the most relevant disabilities in the quality of life, following lower limb amputation. With prosthetic devices and rehabilitation, many people with a lower limb amputation are able to restore their mobility.
There is no gold standard to assess perceived limitations in mobility for people with a lower limb amputation. For transfers with a prosthesis (rising and sitting down) and for climbing stairs there is no assessment at all. For ambulatory mobility, one has to be able to rise and sit down first, before being able to stand. Thereafter walking and finally climbing stairs is an opportunity.
For a more detailed assessment of activity limitations in rising and sitting down, walking in- and outdoors and climbing stairs (perceived by patients at home), Roorda ea. designed the Questionnaire Rising and Sitting down, Walking Questionnaire, and Climbing Stairs Questionnaire.
The purpose of the thesis is to assess the test-retest reliability and the construct validity of these questionnaires and the outcome of mobility in rising and sitting down and climbing stairs in people with a lower limb amputation, using a prosthesis.
Sandra Lakke
Work performance of patients with Chronic Musculoskeletal Pain
First supervisor: prof. dr. J.H.B. Geertzen.
Email address: e-mailadres
Period of study: 01-09-2009 01-09-2013.
The incidence of patients with musculoskeletal pain who are limited to perform their physical activities during work is high. An overview of determinants of work performance was missing. We therefore investigated literature and merged the opinion of experts on determinants of work performance. This resulted in a focus on social determinants of work performance, especially the attitude and behaviour of the health care professional. Further study into the effect of health care professional´s attitude and behaviour on physical activities might help us to implement effective attitude and behaviour to health care professional students.
Jesse Verschuren
Sexuality and amputation.
First supervisor: prof. dr. J.H.B. Geertzen.
Email address: e-mailadres
Period of study: 01-02-2009 01-02-2013.
Over the next few years, the aim is to gain a better understanding of how a limb amputation influences the sexual life of patients (and their partners). Patients and partners are interviewed (together with Mariya Zhdanova). With this information a questionnaire about limb amputation and sexuality will be developed and sent out to all amputees in the Netherlands.
The health care workers working with amputees are also included in this PhD. They will receive a questionnaire to investigate if and how they address sexuality in patients who have had an amputation.
At the end of this study we hope to provide useful information to patients, partners and health care workers about how a limb amputation influences the patient's and the partner's sexual life.
Haitze de Vries
Working with Pain
First supervisor: prof. dr. J.H.B. Geertzen.
Email: e-mailadres
Period of study: 1-6-2008 31-09-2012.
Many people with chronic nonspecific musculoskeletal pain (CMP) become sick-listed or work disabled. The majority however stays at work despite their pain. Knowledge about the latter is limited, narrowing our views on work participation. The project Working with Pain tries to identify determinants for staying at work with CMP. A systematic literature review is conducted to identify factors that promote staying at work; an interview study explores why people with CMP stay at work despite their pain (motivators) and how they manage to maintain working (success factors). In a cross-sectional study the characteristics of workers with CMP will be explored and compared with sick-listed workers with CMP, following vocational rehabilitation.
Learning from the successful workers’ perspective and identifying factors, essential for staying at work may be useful for the clinical practice of (vocational) rehabilitation. Developing strategies for sustainable return to work might also be applicable in occupational and insurance medicine.
Alli Gokeler
Motor control ACL injuries
First supervisor: prof. dr. E. Otten.
Period of study: 31-12-2005 31-12-2013 (part time)
Email: e-mailadres
The study is a collaboration between the Center for Human Movement Sciences Groningen and the Rehabilitation Medicine Groningen.
It appears that patients after anterior cruciate ligament (ACL) injuries and subsequent ACL-reconstruction hold on to a motor control program which may have been useful in the beginning stage but seems redundant > 6 months after ACL-reconstruction where mechanical stability has been almost fully restored. This implies that cognitive changes in motor control have occurred after injury of the ACL, indicating a lack of adaptability to reorganize the CNS after reconstruction of the ACL, hence, resulting in a disturbed motor control.
Based on the above mentioned background it is expected that patients fail to modify their motor programming after ACL reconstruction. Furthermore, during the early stages of motor re-learning, the execution of movement requires much attention, so that there exists also a dependency on cognitive control.
In earlier research it has been established that throughout the learning stages, dependency on cognitive and visual control of movement diminish to normal values and that motor control becomes automatic again, indicating that the reorganization of motor control systems is completed. However, patients after ACL reconstruction may fail to do so. The goal of the study is to gain insight in the changes in motor control programming after injury to the ACL and subsequent reconstruction of the ACL.
Lex D. de Jong
Preventive positioning and electrical stimulation of the hemiplegic shoulder and arm
First supervisor: prof. dr. K. Postema.
Email: e-mailadres
Period of study: 01-01-2008 to 01-07-2012.
Stroke patients, especially those who have very limited recovery of arm function, are prone to developing secondary complications such as hemiplegic shoulder pain, contracture formation and spasticity.
These complications can cause difficulties in the performance of daily life activities. We set out to investigate whether an early initiated combined intervention (stretching agonist arm muscles by a positioning procedure coupled with simultaneous therapeutic electrical stimulation of their antagonists) could prevent the development of these secondary complications. To achieve this, we designed and performed a multicenter single-blind randomized controlled trial using a sample of patients in their rehabilitation phase after stroke. We also assessed the reliability of the passive range of motion measurements by our observers.
Helco van Keeken
Postural control after lower limb amputation; changes in body representation and the recovery of posteral control
First supervisor: prof. dr. E. Otten.
Email: e-mailadres
The study is a collaboration between the Center for Human Movement Sciences Groningen and the Rehabilitation Medicine Groningen.
For daily control and execution of locomotion it is crucial that a person can adapt his or her gait pattern to the environment and to divers situations. The ability to walk in complex environments is necessary for maintaining independence. Therefore, it is important that a person is able to perform difficult motor tasks.
A patient with a lower extremity amputation has to adapt to a new mechanical device to become functional independent again. For this purpose, the existing motor strategies used for balance control and locomotion have to be modified or new strategies have to be learned. With these strategies the amputee compensates for the lack of nerves and muscles, and the asymmetry in body mass. An amputee has to be able to maintain control over the prosthesis during the performance of a complex motor task, like obstacle crossing.
The aim of this research line is to identify which strategies amputee patients are using when interacting with a lower extremity prosthesis and how they develop these strategies during their rehabilitation period.
Two central questions are asked:
1. How do amputees recover functionally?
2. How can we improve their functionality and their recovery process?
The final goal of this project is to be able to provide guidelines for rehabilitation and prosthetics adjustment and design. Therefore, we have to understand amputee motor strategies and also we have to have insights in prosthetics dynamics.
Sobhan Sobhani
Ankle and foot overuse injuries in sports
First supervisor: prof. dr. K. Postema.
Email address: e-mailadres
Period of study: 15-12-2009 - 15-12-2013.
Unlike acute injuries, overuse injuries are subtle and usually occur over time. They are the result of repetitive micro trauma to the tendons, bones and joints. Sports players spend hours of training and practising certain movements and actions every day; consequently, overuse injuries are common in sports. The main goals of this project are to explore the extent of this problem especially in ankle and foot regions which are the most active body parts in almost all sports and also recommend any possible treatment methods or preventive strategies for ankle and foot overuse injuries. A systematic literature review regarding ankle and foot overuse injuries in sports has been conducted as the first step.
Sacha van Twillert
Self management education for prosthetic rehabilitation
First supervisor: prof. dr. K. Postema.
Email address: e-mailadres
Period of study: 01-09-2008 01-09-2013.
This innovation project started with a combination of case study and participatory research methodology into the content of and experiences in the regular prosthetic rehabilitation treatment for patients with a lower limb amputation. Problems and solutions for improvement brought forward by professionals and patients were collected and analyzed. Concerns of professionals that the skills learned in the clinical setting were not preserved after rehabilitation discharge lead to an explorative cohort study in which the perceived problems and needs of patients in their home setting were evaluated.
An extensive literature study on self management was conducted to explore principles and practices for treatment improvement. Two novel self management modules for patients with a lower limb amputation could be developed based on our findings. These modules encompass problem solving strategies for both psychosocial and motor behavior. These modules are further refined in the process of co creation with professionals and patients, and tested on their feasibility.
Hanneke Bouwsema
The development of an evidence based training protocol for myoelectric prostheses
First supervisor: dr. R. Bongers.
Email: e-mailadres
Period of study: 01-11-2008 01-05-2013.
The study is a collaboration between the Center for Human Movement Sciences Groningen and the Rehabilitation Medicine Groningen.
The rate of use of prosthetic arm devices in amputees is generally low. The current research project aims to develop a training program for prosthetic arm devices to increase the overall use and acceptance of prostheses. It is known that training increases the functionality of prosthetic use, and, presumably, the motivation to use the prosthesis. The training program aims to provoke natural learning processes. The first part of the research concerns discovering the natural learning processes of both amputees learning to use a myoelectric prosthesis as well as able-bodied participants learning to use a myoelectric prosthetic simulator. Based on the results the training program will be developed in the second part of the project. The tasks to be included in the training program, as well as their order of presentation, and the instructions therapists could apply at a certain stage of learning, will be developed. The training protocol will be evidence based, which becomes more and more a requirement in rehabilitation practice.
Ecaterina Golea Vasluian
Impact of prosthetic treatment on functioning of children with a unilateral congenital below elbow deficiency
First supervisor: prof. dr. C.K. van der Sluis.
Email address: e-mailadres
Period of study: 01-12-2009 01-12-2013.
Children with a unilateral congenital below elbow deficiency often receive an arm prosthesis at a young age. Reasons for prescribing a prosthesis are improvement of functioning in daily life, stimulation of normal development, answering specific needs, or prevention of secondary problems. Whether the prosthesis meets these reasons for prescription is doubtful, since the rejection rate of prostheses is considerable. More insight is needed into the functioning and treatment of children with a congenital below elbow deficiency with and without a prosthesis to clarify this subject. Functioning and rehabilitation treatment will be investigated in online focus group studies and in a cohort study among children with congenital below elbow deficiencies and healthy controls.
Sietske Romkema
Intermanual transfer in prosthesis training
First supervisor: prof. dr. C.K. van der Sluis.
Email address: e-mailadres
Periode of study: March 2011 – March 2015.
This study is about the use of intermanual transfer in prosthetic learning. Intermanual transfer implies that motor skills learned at one side of the body, transfer to the other side of the body. With a prosthetic simulator used on the unaffected arm it is possible to train the affected arm. This enables early training in rehabilitation, which is suggested to improve the prosthetic handling and acceptance.
As this training shows promising effects, it will be further investigated. The focus will be on training tasks, time schedule (frequency/intensity) and type of therapy (intermanual transfer alone or extended with mirror therapy and/or motor imagery).
Berry van Holland
Functional Labour Evaluation for Sustained Health and employment (the FLESH study)
First supervisor: prof. dr. M.F. Reneman.
Email address: e-mailadres
Period of study: 01-12-2011 30-11-2015.
A large meat processing company in the Netherlands is conducting a worker’s periodic health surveillance aimed to restore or maintain sustained health and employment. Employees are screened on biopsychosocial capacities and work demands. Following this surveillance, employees at risk are advised to start a tailored intervention program to improve their health or prevent health loss.
This study follows the employees of a selection of factories during this longitudinal trajectory. Eventually it evaluates the effects and cost effectiveness of both the surveillance and interventions.
Suzan van der Meer
Chronic pain (especially whiplash), work ability and functional capacity
First supervisor: prof. dr. J. van der Palen.
Email adress: e-mailadres
Period of study: 1-4-2011 1-6-2015.
Chronic nonspecific musculoskeletal pain (CMP) is highly prevalent in most developed nations. The complaints may lead to prolonged absence of work and thereby to high costs for work absenteeism and treatment. Much is unknown about the relationship between complaints and work related treatment options for patients with CMP.
In this study the relationship between self reported disability, performance based disability and psychological factors will be investigated in patients with complaints of whiplash. The effect of a cognitive behavioral approach on patients with CMP with and without a Functional Capacity Evaluation on work ability will be tested and a systematic review will answer the research question whether sub maximal physical and functional capacity can be detected in patients with chronic pain.
Franka Waterschoot
Effectiveness and cost-effectiveness of pain rehabilitation programs for patients with chronic musculoskeletal pain.
First supervisor: prof. dr. M.F. Reneman.
Email: e-mailadres
Period of study: 01-09-2009 01-09-2014.
Pain Rehabilitation Programs (PRP’s) are proven effective for patients with chronic musculoskeletal pain (CMP). Evidence about the relationship of dose on the effect of PRP however, is unavailable. This project opens a new aspect of PRP research: DOSE aspects of PRP.
Several studies will be conducted related to this aspect. The main goal of the project is to analyze the effect of shortening duration of PRP on effectiveness and cost effectiveness of PRP. For this goal we started a RCT within the pain rehabilitation department.
The results of the project would benefit patients, clinicians, insurance companies and health care providers as it contributes to optimize the duration of PRP and therefore better use of (public) resources.
Maurizio Trippolini
Functional Capacity Evaluations (FCE) in patients with whiplash associated disorders
First supervisor: prof. dr. M.F. Reneman.
Email address: e-mailadres
Period of study: 01-04-2011 31-12-2015.
Whiplash-associated disorders (WAD) are common and costly disorders to workers compensation and motor accident insurance systems and are a leading contributor to the burden of ill-health. According to the Swiss medical guidelines patients at risk for chronicity should be assessed within three months after injury. This assessment contains a Functional Capacity Evaluation specifically designed for patients with WAD. The reliability, safety and (prognostic) validity of a WAD FCE, however, have not been tested. There is a need to evaluate and establish the contribution of WAD-assessments, including a WAD FCE, to the course of reducing the burden of ill-health.
More information about Ph D-studies
Professor dr. P.U. Dijkstra,
Center for Rehabilitation
University Medical Center Groningen
P.O. Box 30.001
9700 RB Groningen
The Netherlands
e-mailadres
tel. +31 50 3610297