38 CHAPTER 2 they keep track of the care and/or treatment they have received. Both groups will be reminded about the post-treatment measurement(s) in the week prior to the upcoming visit. Intervention The intervention under investigation is the rehabilitation programme developed and offered at the Radboudumc. This experimental intervention is compared to the usual care for NA in the Netherlands. Experimental intervention The experimental intervention is a 17-week specific rehabilitation programme. The programme starts with a visit to the specialised outpatient ‘Plexus clinic’ in week 1. During this visit, the patient is examined by a multidisciplinary team consisting of a rehabilitation physician, neurologist, physical therapist and occupational therapist. This specialised multidisciplinary team analyses the problems of the patient and provides a diagnosis and treatment advice. This treatment advice is implemented through four weekly sessions in weeks 2–5, two biweekly sessions in weeks 6–9 and two monthly sessions in weeks 10–17 (see Figure 4 for an overview). Each of the eight treatment sessions involves one hour of occupational therapy and one hour of physical therapy. When needed, interdisciplinary strategies are employed. The model depicted in Figure 5 forms the basis for the rehabilitation program. This model consists of several components that are addressed during the intervention program. The program combines strategies of relearning motor control to normalise scapular stability and coordination, 39 with strategies focused on self-management, including energy conservation, 37 to enable daily occupations. The focus and extent to which components are addressed are adjusted to accommodate individual patients’ needs. For a full description of the rehabilitation program, see IJspeert, Janssen1 and van Eijk, Groothuis. 6 Usual care (control group) The 25 NA patients in the control group will receive usual care for 17 weeks. The usual care may vary for each individual, and may even consist of no treatment at all. Patients are asked to keep a diary during this period, in which they will report on the care/ treatment they receive, including the type of care (e.g. physical or occupational therapy, acupuncture), number of sessions and composition of the care (e.g. strength training, aerobic training, massage). After 17 weeks, patients in the usual care group will start with the 17-week rehabilitation program at the Radboudumc as described above. Co-interventions During the experimental intervention, co-interventions can be employed if needed. These co-interventions may include, but are not limited to, analgesics and steroid medication. While undergoing the experimental intervention, patients are asked to refrain from seeking additional treatment for the upper extremity outside the scope of the rehabilitation program (e.g. additional therapy or care), unless this is discussed with the treating physician in advance. The use of any co-interventions will be registered.
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