Robert van Cingel | HAN University (original) (raw)

Papers by Robert van Cingel

BackgroundIn treatment of low-back pain (LBP), motor control exercises have shown to be superior ... more BackgroundIn treatment of low-back pain (LBP), motor control exercises have shown to be superior to minimal interventions, but not to any other form of exercise therapy. Knowledge about variability in trunk motor behavior may help to identify patients that may be more likely to benefit from motor control exercises.ObjectiveThis systematic review aims to answer the question: Is variability of trunk motor behavior different between people with and without LBP and if so, do people with LBP show more or less variability? Furthermore, we addressed the question whether the results are dependent on characteristics of the patient group, the task performed and the type of variability measure.MethodsThis study was registered in PROSPERO (CRD42020180003). Studies were eligible if they (1) included a LBP group and a control group, (2) included adults with non-specific low back pain of any duration and (3) measured kinematic variability, EMG variability and/or kinetic variability. Risk of Bias was evaluated and a descriptive synthesis was performed.ResultsThirty-nine studies were included, thirty-one of which were included in the descriptive synthesis. In most studies and experimental conditions, variability did not significantly differ between groups. When significant differences were found, less variability in patients with LBP was more frequently reported than more variability, especially in gait-related tasks.ConclusionsGiven the considerable risk of bias of the included studies and the clinical characteristics of the participants with low severity scores for pain, disability and psychological measures, there is insufficient evidence to draw firm conclusions.

Isokinetics and Exercise Science, Aug 26, 2009

ABSTRACT The isokinetic strength of ankle inversion-eversion was twice tested, over a period of o... more ABSTRACT The isokinetic strength of ankle inversion-eversion was twice tested, over a period of one week, by the same examiner in apparently healthy 15 women and 15 men at 30 and 120 • /s. Test – retest measurements were examined for 1 and 3 sets of three repetitions. Intraclass correlation coefficients for the highest peak torque out of 1 set of 3 repetitions varied from 0.47–0.82 for men and 0.70–0.94 for women. The ICC for the mean-based PT (the 3 highest PTs out of 3 sets of 3 replicates) ranged 0.74–0.83 for men and 0.80–0.97 for women. Bland-Altman plots have indicated a largely homoscedastic distribution of the test-retest parameters. The standard error of measurement (SEM) varied from 3.6–7.00 Nm for men and 3.3–4.7 Nm for women (highest PT-based) and 2.9–5.7 Nm for men and 1.6–4.0 Nm for women (mean PT-based). Irrespective of either paradigm, there was much dispersion in the ICCs for both genders in other isokinetic parameters such as the time to PT and angle at PT. It is therefore concluded that the only reproducible isokinetic parameter under this test protocol is the peak torque.

BMC Musculoskeletal Disorders, May 27, 2011

Background: Hip arthroscopies are often used in the treatment of intra-articular hip injuries. Pa... more Background: Hip arthroscopies are often used in the treatment of intra-articular hip injuries. Patient-reported outcomes (PRO) are an important parameter in evaluating treatment. It is unclear which PRO questionnaires are specifically available for hip arthroscopy patients. The aim of this systematic review was to investigate which PRO questionnaires are valid and reliable in the evaluation of patients undergoing hip arthroscopy. Methods: A search was conducted in Pubmed, Medline, CINAHL, the Cochrane Library, Pedro, EMBASE and Web of Science from 1931 to October 2010. Studies assessing the quality of PRO questionnaires in the evaluation of patients undergoing hip arthroscopy were included. The quality of the questionnaires was evaluated by the psychometric properties of the outcome measures. The quality of the articles investigating the questionnaires was assessed by the COSMIN list. Results: Five articles identified three questionnaires; the Modified Harris Hip Score (MHHS), the Nonarthritic Hip Score (NAHS) and the Hip Outcome Score (HOS). The NAHS scored best on the content validity, whereas the HOS scored best on agreement, internal consistency, reliability and responsiveness. The quality of the articles describing the HOS scored highest. The NAHS is the best quality questionnaire. The articles describing the HOS are the best quality articles. Conclusions: This systematic review shows that there is no conclusive evidence for the use of a single patientreported outcome questionnaire in the evaluation of patients undergoing hip arthroscopy. Based on available psychometric evidence we recommend using a combination of the NAHS and the HOS for patients undergoing hip arthroscopy.

Journal of Orthopaedic & Sports Physical Therapy, Apr 1, 2018

Tool-33 (iHOT-33), developed in English, has been shown to be a valid and reliable questionnaire ... more Tool-33 (iHOT-33), developed in English, has been shown to be a valid and reliable questionnaire for young, physically active individuals with symptomatic hip joint pathology. U U OBJECTIVES: To translate and validate the iHOT-33 in Dutch (iHOT-33 NL) in the target population. U U METHODS: Translation and cross-cultural adaptation of the iHOT-33 were performed following existing guidelines. Young to middle-aged (18-50 years), active (Tegner activity score of 3 or greater) individuals presenting with symptomatic hip joint-related pain (numeric pain-rating score of 1 or greater) in a primary health care/ hospital setting were included. The iHOT-33 NL, Hip disability and Osteoarthritis Outcome Score (HOOS), European Quality of Life-5 Dimensions questionnaire (EQ-5D), numeric pain-rating score, and Global Perceived Effect score were completed by 214 patients. U U RESULTS: The intraclass correlation coefficient for test-retest reliability was 0.92 (95% confidence interval: 0.88, 0.94). Smallest detectable changes at individual and group levels were, respectively, 16.7 and 1.1 points. The Cronbach alpha was .9. Principalcomponent analysis revealed 4 domains of the iHOT-33 NL. Of the hypotheses used for construct validity, 87% were confirmed. No floor and ceiling effects were detected for the iHOT-33 NL total score. The minimal important change was 10.7 points. U U CONCLUSION: The iHOT-33 NL is a reliable and valid patient-reported outcome questionnaire for young, physically active individuals with symptomatic hip joint pathology. It can be used in research and clinical settings.

Gait & Posture, Sep 1, 2013

To investigate whether double-leg stance could reveal balance deficits in subjects with functiona... more To investigate whether double-leg stance could reveal balance deficits in subjects with functional ankle instability (FAI) and whether such an assessment of static balance would be correlated with measures of dynamic instability, 16 individuals with FAI and 16 healthy controls participated in this study. Static postural control was tested using double-leg stance (either with the eyes open (EO) or closed (EC)) on a dual-plate force platform. Dynamic balance was evaluated using the Multiple Hop Test (MHT) and a weight-shifting task. FAI subjects were significantly less stable in the anteroposterior direction during double-leg stance (as assessed by velocity of centre of pressure, VCP), both for the EO and EC condition. In the mediolateral direction the VCP values were also higher in FAI, but significance was only found for the EC condition (p=.02). FAI subjects made significantly more balance errors compared to healthy controls (p<.001) on both the affected and less affected leg during MHT. There were no significant differences between FAI and healthy subjects during the weight-shifting task. No relationship was found between double-leg stance and MHT measures (all correlations (rs) less than .30). This study suggests that static postural control during double-leg stance is impaired in FAI subjects. Although dynamic balance during MHT is also affected, no significant relationship was found between static and dynamic measurements, which indicate that they are most probably related to different aspects of postural control.

Isokinetics and Exercise Science, Dec 27, 2003

Optimization of different forms of training and testing in sports and therapy has traditionally b... more Optimization of different forms of training and testing in sports and therapy has traditionally been debated by various groups. Especially, the use of so-called open and closed kinetic chain exercises has frequently been a focal point. Scientific studies have indicated that no specific form of exercise and/or training has any particular advantage over the other. This applies to both assessment of efficiency, consideration of compression and shear forces, muscular activity and the extent of co-contractions. Unlike the broadly-applied non-specific and uncritical assessment of open and closed kinetic chain exercises, a specific application using the advantages of both procedures must be considered due to clinical, therapeutic and trainingphysiological aspects. Specificity refers to the training of either an isolated joint-muscle unit (arthron) or a system (group) of joints and muscles. Considering the original definitions and past misinterpretations, it appears logical to emphasize the role of physiological mechanisms operating in each form of training and testing. Therefore, the use of the term: single-joint (SJ) or multi-joint (MJ) training, is recommended since this would best reflect the area of application, according to a recent consensus expressed by EISCSA. Consequently, SJ and MJ exercises should be applied both in isolation and in combination as indicated by the principles of specificity. On the other hand, continuous use of the terms open and closed kinetic chain exercises is confusing, erroneous, leads to polarizing discussions and should hence be relegated to the past.

Physiotherapy Theory and Practice, Mar 28, 2018

This article presents and discusses a perspective on the concept of "solution space" in physiothe... more This article presents and discusses a perspective on the concept of "solution space" in physiotherapy. The model is illustrated with a subjective assessment of the way movements are performed and an objective quantification of the dynamics of the recovery process for a patient with a knee injury. Based on insights from the domain of human motor control, solution space is a key concept in our recovery model that explains the emergence of a variety of adaptive changes that may occur in the movement system recovering from an injury. The three dimensions that span the solution space are: (1) information and control processes; (2) time; and (3) degrees of freedom. Each dimension is discussed within the context of feasible physiotherapeutic assessments to identify and facilitate desirable behavioral patterns or bypass emerging but undesirable behavioral patterns that could impede both short-and long-term recovery. Central to this article is our view on the relationship between the recovery process and the three dimensions of the solution space, which determines the model's usefulness as a motor-rehabilitation monitoring tool.

BMC Musculoskeletal Disorders, Jul 4, 2017

Background: Fear of harm (FoH) after Anterior Cruciate Ligament Reconstruction (ACLR) should be a... more Background: Fear of harm (FoH) after Anterior Cruciate Ligament Reconstruction (ACLR) should be addressed in physical therapy as it hampers return to sports. However, there are no instruments assessing FoH specific for ACLR. The objective of this study is to describe the development and measurement properties of the Photograph Series of Sports Activities for ACLR (PHOSA-ACLR) measuring ACL injury related FoH. Methods: Based on literature and opinion of physical therapists with extensive experience in ACLR treatment, photographs depicting FoH inducing situations in ACL injury were considered for inclusion in the instrument. For each photograph the patients is asked to report perceived harmfulness. The set of photographs was completed by two samples of patients with ACLR: 1 cross-sectional sample (n = 55), and 1 test-retest reliability sample (n = 58). Internal consistency and structural validity were assessed in 109 patients. In 58 patients criterion validity was assessed by calculating pearson correlations with the Tampa Scale of Kinesiophobia (TSK). Correlations with selfreported knee function (KOOS and Lysholm score), and Knee Self-efficacy Scale (K-SES) were computed for hypothesis testing. Test-retest reliability was determined in a group of 55 patients, assessed twice with 1 week between assessments. Results: Twelve photographs depicting sports related movements that are likely to invoke FoH after ACLR were selected. Two items were deleted because of lack of discrimination. The remaining 10 items were included in the PHOSA-ACLR, and the scale showed excellent internal consistency (Cronbach's Alpha is .95). Items reflected one dimension, and was strongly correlated with TSK (r = .59). A priori formulated hypotheses are confirmed and testretest correlation was excellent (ICC = .86). Conclusion: The PHOSA-ACLR showed acceptable measurement properties. The PHOSA-ACLR gives specific information about fear invoking sports situations that are not measured by other kinesophobia measures. Therefore, the PHOSA-ACLR might be a valuable additional tool in rehabilitation of ACLR patients. Additional research is needed to determine responsiveness to change.

Clinical Journal of Sport Medicine, Mar 1, 2018

Objective: To compare glenohumeral range of motion and shoulder rotator muscle strength in health... more Objective: To compare glenohumeral range of motion and shoulder rotator muscle strength in healthy female junior elite handball players and controls. Design: Cross-sectional case-control study. Setting: Sports medical center. Participants: Forty elite female handball players and 30 controls active in nonoverhead sports participated in this study. Main Outcome Measures: Passive external rotator (ER), internal rotator (IR), and total range of motion (TROM) of the dominant and nondominant arm were examined with a goniometer. An isokinetic dynamometer was used to evaluate concentric and eccentric rotator muscle strength at 60 and 120 degrees/s with dynamic control ratio (DCR 5 ER ecc :IR con) as the main outcome parameter. Results: Except for the ER range of motion in the nondominant arm, no significant differences were found between groups for IR, ER of the dominant arm, and the TROM. Within the handball group, the side-to-side difference for IR of the dominant arm was 21.4 degrees. The ER and the TROM of the dominant arm were significantly larger, 6.3 and 4.9 degrees, respectively. For both groups, the DCR values were above 1 and no significant differences were found between the dominant and nondominant arm. The DCR values in the handball group were significantly lower than in the control group. Conclusions: Based on the adopted definitions for muscle imbalance, glenohumeral internal range of motion deficit and TROM deficit our elite female handball players seem not at risk for shoulder injuries. Prospective studies are needed to support the belief that a DCR below 1 places the shoulder at risk for injury.

Journal of Sport Rehabilitation, Aug 1, 2006

To determine concentric shoulder external-internal rotator strength, dominant and non-dominant sh... more To determine concentric shoulder external-internal rotator strength, dominant and non-dominant shoulder differences and agonist/antagonist ratios. Design: A transversal study of isokinetic dynamometry of healthy shoulders, 95% confi dence intervals are presented. Participants: 35 asymptomatic elite, male volleyball players. Measurements: Peak torque normalized for body weight was recorded at 60, 180, and 300°/sec. with a Cybex 6000 dynamometer. Results: (1) internal rotators were signifi cantly stronger than external rotators of the same shoulder; (2) internal rotators of the dominant arm were signifi cantly stronger than of the non-dominant arm; (3) no difference existed between external rotators of the dominant and the non-dominant arm; (4) external-internal rotator ratios of the dominant arm were signifi cantly lower than of the non-dominant arm; and (5) no differences were found between the ratios of each arm separately. Conclusions: Data presented are important for interpreting isokinetic shoulder rotator strength tests in elite volleyball players and could be relevant in rehabilitation and prevention of shoulder injuries.

International Journal of Sports Medicine, May 13, 2013

Elastic taping is widely used in sports medicine for correcting functional alignment and muscle r... more Elastic taping is widely used in sports medicine for correcting functional alignment and muscle recruitment. However, evidence regarding its influence on scapular dynamic positioning is scarce. This study aimed to investigate the effect of a specific kinesiotaping method on scapular kinematics in female elite handball players without shoulder complaints. 25 athletes (18.0±1.5 years) active in the highest national division were recruited. All subjects received an elastic adhesive tape (Kactive tape©) with the purpose to correct scapular position. 3-dimensional scapular motion measurements were performed (Fastrak®) during humeral elevation in the sagittal, frontal and scapular plane. The results showed that taping has a moderate to large effect (Cohen's d>0.7) towards scapular posterior tilting, in all 3 planes of humeral movement and for all angles of elevation (mean posteriorizing effect of 4.23°, 3.23° and 4.33° respectively for elevation in the sagittal, frontal and scapular plane, p<0.001). In addition, taping also moderately increased the scapular upward rotation at 30°, 60° and 90° of humeral abduction (mean increase of 2.90°, Cohen's d>0.7). Together these results suggest that kinesiotape application causes positive changes in scapular motion. This could support its use in sports medicine for preventing shoulder problems in overhead athletes.

BMC Research Notes, Jan 10, 2018

Objective: To determine the intrarater reliability of the Humac NORM isokinetic dynamometer for c... more Objective: To determine the intrarater reliability of the Humac NORM isokinetic dynamometer for concentric and eccentric strength tests of knee and shoulder muscles. Results: 54 participants (50% female, average age 20.9 ± 3.1 years) performed concentric and eccentric strength measures of the knee extensors and flexors, and the shoulder internal and external rotators on two different Humac NORM isokinetic dynamometers, which were situated at two different centers. The knee extensors and flexors were tested concentrically at 60° and 180°/s, and eccentrically at 60° s. Concentric strength of the shoulder internal and external rotators, and eccentric strength of the external rotators were measured at 60° and 120°/s. We calculated intraclass correlation coefficients (ICCs), standard error of measurement, standard error of measurement expressed as a %, and the smallest detectable change to determine reliability and measurement error. ICCs for the knee tests ranged from 0.74 to 0.89, whereas ICC values for the shoulder tests ranged from 0.72 to 0.94. Measurement error was highest for the concentric test of the knee extensors and lowest for the concentric test of shoulder external rotators.

Experimental Brain Research, Jun 4, 2016

Research Square (Research Square), Mar 27, 2020

Background. Fear of Movement is an important factor predicting return to sports in Anterior Cruci... more Background. Fear of Movement is an important factor predicting return to sports in Anterior Cruciate Ligament Reconstruction (ACLR). Fear for specific ACLR related movements can be addressed measuring the Photographic Sports Activities for ACLR (PHOSA-ACLR). This study was conducted to determine whether Fear of Movement assessed using the PHOSA-ACLR is a latent trait, and to analyse differences in PHOSA-ACLR in athletes with or without an ACL rupture. Methods. Data from three groups of participants were included in this study: 1) ACLR patients participated in a previous study measuring psychological dimensions after ACLR (n = 58); 2) first year physical therapy students at the HAN University of Applied Sciences (n = 169), and 3) junior football players that were enrolled in a training programme of the Professional Soccer club Vitesse (Arnhem) (n = 30). All participants completed the PHOSA-ACLR (scale score 0-10), and questions related to demographics. ACLR patients completed additional questionnaires to assess functioning and Fear of Harm. PHOSA-ACLR items were analysed with Item Response Theory using the Graded Response Model (GRM). Differences between three groups of participants were analysed using Univariate Analysis of Variance. Results. The two-parameter GRM with both location and discrimination (-2LL =-5485.05) showed a significantly better fit than the one-parameter model (-2LL =-5515.36), Common.EditSubmissionSteps.Transform.EquationText (1) = 30.31, p = 0.00). The items of the PHOSA-ACLR thus constitute a latent trait. The three groups of participants differed in reported fear of movement assessed with the PHOSA-ACLR after controlling for covariates gender and age. Physical therapy students reported higher levels of fear of movement compared to either ACLR patients and healthy soccer players (respectively 4.9 (95%CI 4.6-5.3); 3.6 (95%CI 2.5-3.7); 2.6 (95%CI 1.6-3.6)). Conclusion. PHOSA-ACLR items constitute a latent trait of fear of movement for ACLR specific movements. Contrary to expectations, PHOSA-ACLR is higher in first year physiotherapy students compared to patients rehabilitating from ACLR, and healthy junior soccer players. The PHOSA-ACLR might be useful for clinicians to identify high levels of fear of movement related to ACLR, and provide a tool to help the patient overcome fear of movement using exposure techniques.

Scandinavian Journal of Medicine & Science in Sports, Sep 17, 2015

Numerous athletes with patellar tendinopathy (PT) use a patellar strap or sports tape during spor... more Numerous athletes with patellar tendinopathy (PT) use a patellar strap or sports tape during sports. This study's aim was to investigate the short-term effect of these orthoses on patellar tendon pain. Participants performed the single-leg decline squat, vertical jump test, and triplehop test under four different conditions (patellar strap, sports tape, placebo, and control). Subsequently, participants practiced sports as usual for 2 weeks; during 1 week, they were assigned to one of the four conditions. Pain was measured with the visual analog scale (VAS). In total, 97 athletes with PT [61% male, age 27.0 (SD8.1), VISA-P 58.5 (SD12.7)] were analyzed. On the single-leg decline squat, the VAS pain score reduced significantly in the patellar strap (14 mm, P = 0.04) and the sports tape condition (13 mm, P = 0.04), compared with control, but not placebo. A significant decrease in VAS pain during sports was found in the sports tape (7 mm, P = 0.04) and placebo group (6 mm, P = 0.04). The VAS pain score two hours after sports decreased significantly in the patellar strap, sports tape and placebo group (8-mm, P < 0.001, 10 mm, P = 0.001 and 7 mm, P = 0.03, respectively). This study's findings indicate that an orthosis (including placebo tape) during sports can reduce pain in PT patients in the short term.

International Journal of Environmental Research and Public Health, Sep 16, 2020

Background: Fear of Harm (FoH) predicts return to sports in Anterior Cruciate Ligament Reconstruc... more Background: Fear of Harm (FoH) predicts return to sports in Anterior Cruciate Ligament Reconstruction (ACLR) and can be assessed using the Photographic Sports Activities for ACLR (PHOSA-ACLR). This study was conducted to determine whether FoH assessed using the PHOSA-ACLR is a latent trait, and to analyze differences in PHOSA-ACLR in athletes with or without an ACL rupture. Methods: Three convenience samples completed the PHOSA-ACLR: (1) ACLR patients (n = 58; mean age 25.9 years; range 17-56; SD = 8.2; 43% male); (2) first year Physical Therapy (PT) students (n = 169; mean age = 19.2; SD = 2.0; 48% male), and (3) junior football players (n = 30; mean age = 18.3; range 17-20; SD = 3.2; 94% males). ACLR patients additionally reported functioning and Fear of Movement. PHOSA-ACLR items were analyzed with Item Response Theory using the Graded Response Model (GRM). Differences between three groups of participants were analyzed using Univariate Analysis of Variance. Results: Data fitted the two-parameter GRM, and therefore the items of the PHOSA-ACLR constitute a latent trait. There was a significant difference between the three groups in PHOSA-ACLR after controlling for age and gender (F (2, 255) = 17.1, p < 0.001). PT students reported higher levels of FoH compared to either ACLR patients or healthy soccer players. Conclusions: PHOSA-ACLR items constitute a latent trait of FoH for ACLR-specific movements. Contrary to expectations, PHOSA-ACLR is higher in first year physiotherapy students compared to patients rehabilitating from ACLR, and healthy junior soccer players.

Human Movement Science, Jun 1, 2020

Following total knee replacement (TKR), patients often persist in maladaptive motor behavior whic... more Following total knee replacement (TKR), patients often persist in maladaptive motor behavior which they developed before surgery to cope with symptoms of osteoarthritis. An important challenge in physical therapy is to detect, recognize and change such undesired movement behavior. The goal of this study was to measure the differences in clinical status of patients pre-TKR and post-TKR and to investigate if differences in clinical status were accompanied by differences in the patients'' motor flexibility. Eleven TKR participants were measured twice: pre-TKR and post-TKR (twenty weeks after TKR). In order to infer maladaptation, the pre-TKR and post-TKR measurements of the patient group were separately compared to one measurement in a control group of fourteen healthy individuals. Clinical status was measured with the Visual Analogue Scale (VAS) for pain and knee stiffness and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Furthermore, Lower-limb motor flexibility was assessed by means of a treadmill walking task and a leg-amplitude differentiation task (LAD-task) supported by haptic or visual feedback. Motor flexibility was measured by coordination variability (standard deviation (SD) of relative phase between the legs) and temporal variability (sample entropy) of both leg movements. In the TKR-group, the VAS-pain and VAS-stiffness and the subscales of the KOOS significantly decreased after TKR. In treadmill walking, lower-limb motor flexibility did not significantly change after TKR. Between-leg coordination variability was significantly lower post-TKR compared to controls. In the LAD-task, a significant decrease of between-leg coordination variability between pre-TKR and post-TKR was accompanied by a significant increase in temporal variability. Post-TKR-values of lower-limb flexibility approached the values of the control group. The results demonstrate that a clinically relevant change in clinical status, twenty weeks after TKR, is not accompanied by alterations in lower-limb motor flexibility during treadmill walking but is accompanied by changes in motor flexibility towards the level of healthy controls during a LADtask with visual and haptic feedback. Challenging patients with non-preferred movements such as

Physical Therapy in Sport, Nov 1, 2017

Isokinetics and Exercise Science, Nov 19, 2007

Nine male and seven female asymptomatic elite badminton players were tested bilaterally to determ... more Nine male and seven female asymptomatic elite badminton players were tested bilaterally to determine concentric and eccentric strength values, conventional ratio and dynamic control ratio of shoulder rotator muscles. All tests were performed at 60 and 120 • /sec. The study shows significant differences that were similar for men and women: the dominant arm was stronger than the non-dominant arm, normalised peak torque values at 60 • /sec were higher than at 120 • /sec, the concentric internal rotator strength (IRS) was larger than the concentric external rotator strength (ERS) and the eccentric ERS was larger than the concentric ERS. For females the eccentric ERS was larger than the concentric IRS as opposed to men in whom the concentric IRS was larger than the eccentric ERS. For both sexes the CVR for the dominant arm was significantly higher than for the non-dominant arm. The DCR at 60 • /sec was significantly lower than at 120 • /sec and the DCR for females was significantly higher than for men. Data presented are important for interpreting isokinetic shoulder rotator strength tests in elite badminton players and could be relevant in rehabilitation and prevention of shoulder injuries.