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Extremities Pain and Disability (EXPAND)

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The program Extremities, Pain and Disability (EXPAND) focuses on fundamental and patient-related research into physical disabilities and chronic pain. EXPAND’s major goal is to improve the quality of life of patients suffering from these conditions, so that they can reintegrate in society.

Programme Leaders   Mission and Description of the Programme  

Mission
Our research aims to improve the participation and quality of life of patients with musculoskeletal disorders and  pain and individuals who have undergone amputations of one or more of the extremities. Our research is of the highest quality and is tied in with our mission. It focuses on two priority areas:

  1. Disorders and amputations of the extremities
  2. Chronic pain

We have decided to integrate the two priority areas of amputations and pain in the coming years, with a specific focus on research questions spanning both areas. Integration of our study objects will result in further focus and strengthening of our research.
We further enhance our profile through our collaborations with national and international organizations working in the same fields. We actively disseminate our knowledge through publications in high-impact journals and presentations targeting wide audiences. We
make new insights into rehabilitation available so patients may optimally benefit from these. We embed and warrant our knowledge by training new generations of medical and paramedical students and providing refresher courses for professionals already working in the field.

Description of the Programme
Clinical rehabilitation commonly deals with complex cases involving multiple co-morbidities and complications rather than single pure pathologies. Treatment is concentrated on optimizing quality-of-life for disabled patients with multiple problems, for which there is no single curative intervention.
Rehabilitation programs explicitly aim to improve patients’ mobility, independence in self-care, ability to communicate, and ability to live independently and to engage in productive activities. Consequently, a bio-psychosocial rather than a biomedical model has been put forward as the underlying model. 
We decided to restrict the scope of clinical problems and treatment programs under study to:

  • Extremities: amputation, prosthetics and orthotics (lower and upper extremities) and disorders of lower and upper extremities; and
  • Specific and a-specific (low back) pain syndromes and work participation.

In the years to come, the research will become even more focused and the two priorities will be linked even more closely through the selection of research themes incorporating aspects of both.
In the near future, the research on extremities will focus on disorders of the hands and feet and amputation of extremities, more specifically on impairments, activities and participation.
The research on pain will focus on chronic pain and work participation. In new research projects, the two areas will be joined more explicitly.

Fully in line with EXPAND’s view, the mission of the Department of Rehabilitation Medicine, Centre for Rehabilitation, University of Groningen, University Medical Center Groningen (UMCG) is to bridge the gap between theory, research and practice in the various treatments of patients with disabilities due to accidents, diseases or ageing. Dissemination of knowledge and training of professionals and (potential) researchers has been stimulated. Moreover, multidisciplinary collaboration has been facilitated, as developments in knowledge of disablement and treatment processes need a multidisciplinary orientation.

Relevance to Healthy Ageing  

EXPAND research is a part of the main research theme of Healthy Ageing at the UMCG. In particular, our patients of interest rehabilitate with restrictions/limitations in the fields of activities and/or participation; i.e. crucial fields for healthy and high-quality ageing. The group of patients with chronic pain is increasing in size and importance as the group of persons with disabilities or handicaps grows due to the ageing in general and increasing medical technologies in particular. There is an important collaboration with two research groups within the UMCG, i.e. “Active Ageing” (group leader: CP van der Schans) and “Healthy Ageing at Work” (group leader: MF Reneman). Notably, both groups are chaired by a professor from EXPAND.

Two examples of EXPAND’s research projects   

Complex Regional Pain Syndrome type I and amputation
Researcher: Marlies Bodde

Complex regional pain syndrome type I (CRPS-I) is a serious condition, which occurs rarely. In a some cases it may result in a very painful and dysfunctional arm or leg. Some people who suffer from this syndrome see amputation of the affected limb as the only solution to regain quality of life.
In literature, opinions about this intervention vary strongly. Proponents highlight the improvement in quality of life and the ability of people to resume their normal activities. Opponents of amputation point out the potential for complications, in particular return of CRPS-I symptoms.
In our systematic review, we try to explain what is known and unknown in order to provide patients and caretakers with the information they need to decide whether or not to amputate. In addition, we have performed a study into the quality of life and resilience of people who opted to have an amputation. Other parts of the study relate to a histopathological description of the nerve tissue of the amputated limb and the description of the decision making process before amputation for this population.

Sexuality and limb amputation
Researcher: Jesse Verschuren

Up till now, limb amputation related research has mostly focused on developing better prostheses and reducing phantom pain. It is only recently that the psychosocial problems, including sexual problems, of people with a limb amputation have gained more attention. In this PhD project we focus on what happens to someone’s sexual life after such an amputation.
By interviewing patients and partners and sending out a survey to patients we hope to gain a better understanding of how an upper or lower limb amputation may influence someone’s sexual life. Professionals working in amputation departments of hospitals and rehabilitation centres are also included in this PhD project. They are asked how they deal with the sexual problems of their patients.
At the end of this PhD we hope to provide useful information to patients, partners and professionals concerning the influence of someone’s limb amputation on his/her sexual life.

Principal Investigators / nr of PhD students