{"id":4805,"date":"2025-03-27T00:00:00","date_gmt":"2025-03-27T00:00:00","guid":{"rendered":"https:\/\/www.proefschriftmaken.nl\/portfolio\/theodore-paul-van-iersel\/"},"modified":"2026-03-18T08:30:51","modified_gmt":"2026-03-18T08:30:51","slug":"theodore-paul-van-iersel","status":"publish","type":"us_portfolio","link":"https:\/\/www.proefschriftmaken.nl\/en\/portfolio\/theodore-paul-van-iersel\/","title":{"rendered":"Theodore Paul Van Iersel"},"content":{"rendered":"","protected":false},"excerpt":{"rendered":"","protected":false},"author":7,"featured_media":4807,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"us_portfolio_category":[45],"class_list":["post-4805","us_portfolio","type-us_portfolio","status-publish","has-post-thumbnail","hentry","us_portfolio_category-new-template"],"acf":{"naam_van_het_proefschift":"PATIENT CENTERED MANAGEMENT OF ANTERIOR SHOULDER INSTABILITY","samenvatting":"voorspellend waren voor een succesvolle terugkeer naar sport, dat waren een zogenaamde \u2018Anterior Labral Periosteal Sleeve Avulsion\u2019 (ALPSA) en een benige Bankart laesie.\nHoofdstuk 6 presenteert de resultaten van een vergelijkbare studie als in hoofdstuk 5, echter gaat het om een vorm van OBR, een open Latarjet procedure. Er werden geen prognostische factoren gevonden die voorspellend zijn voor geen terugkeer naar sport. Desalniettemin onthulde het wel dat atleten die deelnamen aan sporten waarbij de schouder veel belast wordt door bovenhandse bewegingen, botsingen, en plotselinge stops, vaker niet terug konden keren naar sport.\n\nHoofdstuk 7 geeft een overzicht van de redenen van pati\u00ebnten om niet terug te keren naar sport na een ABR en OLP, de meest uitgevoerde operaties voor de behandeling van schouderinstabiliteit. De aanleiding hiervoor was dat het voor deze studie niet duidelijk was wat de reden was dat 3-40% van de pati\u00ebnten in de huidige literatuur niet terugkeren. Deze studie liet zien dat het merendeel van de pati\u00ebnten die niet terugkeert (70%) na deze operaties dat doet door een redenen die niet schouder functie afhankelijk is, zoals angst voor (recidiverende) schouderdislocaties, gebrek aan motivatie of een verandering in persoonlijke prioriteiten.\n\nIn hoofdstuk 8 werd het protocol voor een multicenter gerandomiseerde nationale studie (RCT) gepresenteerd, de MATASI TRIAL. In die RCT zal gekeken worden naar het effect van angst reducerende nabehandelingsmethoden op de kinesiofobie van pati\u00ebnten met schouderinstabiliteit, zoals naar voren kwam in de studie gepresenteerd in hoofdstuk 2. Meerdere Nederlandse ziekenhuizen en klinieken zullen meedoen aan deze studie, waar ongeveer 100 pati\u00ebnten voor nodig zijn blijkt uit de sample size berekening. De primaire uitkomst is angst voor (recidiverende) dislocatie en dit zal op 6 weken, 12 weken, 24 weken en 48 weken bekeken worden. Daarnaast zal er op 48 weken een functionele Magnetic Resonance Imaging (MRI) gemaakt worden, de zogeheten functionele hersenscan, waarbij hersenactiviteit gemeten wordt. In hoofdstuk 9 wordt verder ingegaan op de inhoud van het nabehandelingsprotocol waar de \u2018experimentele\u2019 groep mee zal revalideren.\n\nHoofdstuk 9 gaat over de studie die onderzocht heeft welke modaliteiten er in het rehabilitatieprotocol moeten zitten volgens internationale schouderexperts. In een viertal rondes werd gevraagd welke interventies als belangrijk werden geacht, wat na die rondes door de onderzoekers is omgevormd naar een consensus rehabilitatieprotocol (REPRO-protocol). In dit protocol is specifiek aandacht voor angst reducerende vormen van behandeling, aangezien het in de studies van hoofdstuk 2, 7 en in toenemende mate in de recente literatuur naar voren komt dat pati\u00ebnten deze angst ervaren.\nIn hoofdstuk 10 wordt teruggekeken op alle uitgevoerde studies naar pati\u00ebntgerichte zorg van schouderinstabiliteit in dit proefschrift. De onderzoeksvragen van de introductie worden beantwoord, er wordt gereflecteerd op het onderwerp en er worden aanbevelingen gedaan voor toekomstig onderzoek. Dit samen schetst het toekomstig perspectief van onderzoek naar de zorg van schouderinstabiliteit.","summary":"This thesis was carried out to gather more insight regarding the subject of patient centered care of shoulder instability. Chapter 1 is a general introduction into shoulder instability, its pathophysiology and the current non-operative and operative treatment options. Also, chapter 1 stated the research questions of this thesis.\n\nIn chapter 2 patient perspectives regarding the non-operative and operative treatment of shoulder instability is discussed, based on an online focus group study which we carried out. An important part of this study was having interactive group discussions between patients which can help healthcare professionals gather insight into these patient perspectives. This study revealed that fear of (recurrent) dislocation, preoperative counseling, communication between surgeons and physiotherapists and the need for a consistent postoperative rehabilitation protocol were important patient perspectives.\n\nChapter 3 continues with the results of the study presented in chapter 2, mostly the fear for (recurrent) shoulder dislocation that patients experience both before and after receiving treatment. Until the initiation of the Tampa Scale for Kinesiophobia in Shoulder Instability (TSK-SI) study, there was no scale available yet as a diagnostic tool for diagnosing kinesiophobia in patients with shoulder instability. For this study we asked Dutch shoulder specialized physiotherapists and orthopedic surgeons to help creating this diagnostic tool using a four round consensus study design, modifying the currently existing TAMPA scale, originally created to diagnose kinesiophobia in patients with chronic low back pain. This resulted in the 18-item TSK-SI, which will be validated during the MATASI TRIAL (chapter 8).\n\nChapter 4 provides a critical overview and meta-analysis of the current literature regarding the surgical treatment options when primary arthroscopic Labral repair (ALR) fails. For this study secondary ALR was compared with secondary open bony reconstruction (OBR). Moreover, these results were then compared with primary OBR. The most important finding of this study was that a BRP showed a lower recurrence rate when it was a primary procedure compared to when there was a ALR prior to the BRP.\n\nIn chapter 5 we looked into the prognostic factors for failure to return to sport (RTS) after an arthroscopic Bankart repair (ABR). This was important to investigate since 3-40% of patients who fail to RTS or who are not able to successfully RTS after an ABR in current literature, with \u2018successful\u2019 often being defined as the RTS to the same or higher level of sport. The study showed that glenoid bone loss and overhead use of the shoulder during work was predictive for failure to RTS after ABR. When looking at failure to successfully RTS, preoperative Body Mass Index (BMI) and preoperative professional sports level were significant predictors. In contrast, an \u2018Anterior Labral Periosteal Sleeve Avulsion\u2019 (ALPSA) and bony Bankart lesion facilitated successful RTS.\n\nChapter 6 presented the results of a comparable study that was presented in chapter 5. However, this study looked at prognostic factors of failure to RTS after a specific type of OBR, the open Latarjet procedure (OLP). There were no significant factors for failure to RTS. However, it did reveal that athletes participating in overhead\/collision shoulder sport with hitting movements and sudden stops were more prone to failure to RTS.\n\nChapter 7 provides a summary of reasons why patients do not return after ABR and OLP, which are the most frequent surgical procedures treating shoulder instability. We started to look into this because there were no studies summarizing these considerations, which is remarkable knowing that 3-40% of patients do not RTS in current literature. This study showed that the majority of patients who do not RTS (70%) after shoulder stabilizing surgery do so because of reasons which are not shoulder function dependent, like fear of (recurrent) dislocation, lack of motivation or change of personal interest\/priorities.\n\nIn chapter 8 the protocol of a new national multicenter randomized controlled trial (RCT) is presented, the MATASI TRIAL. This RCT will investigate the effect of fear reducing interventions during rehabilitation of patients undergoing ABR, as it showed to be an important patient perspective in chapter 2 and an important reason of patients not to RTS in chapter 7. Multiple Dutch hospitals and clinics will participate in this randomized study, in which roughly 100 patients have to be included based on the sample size calculations. The primary outcome is fear for (recurrent) dislocation and this will be measured after 6, 12, 24 and 48 weeks. Also, at 48 weeks functional Magnetic Resonance Imaging (MRI) scans will be made, in which brain activity is measured. In chapter 9 we described the content of the rehabilitation protocol which the \u2018experimental\u2019 group will undergo during the MATASI TRIAL.\n\nChapter 9 describes which modalities have to be included in the fear reducing rehabilitation protocol following ABR. For this study, international experts from different countries participated in a Delphi consensus study. During four rounds they were asked which interventions should be included in the rehabilitation protocol based on evidence based interventions. The final protocol will be used in the MATASI trial, as described in chapter 8.\n\nIn chapter 10 the studies of this thesis were reviewed and the author reflects on the subject of patient centered care of shoulder instability. Also, the research questions which are stated in the introduction were answered. Last, recommendations were made for future research which draws a perspective for following studies.","auteur":"Theodore Paul Van Iersel","auteur_slug":"theodore-paul-van-iersel","publicatiedatum":"27 maart 2025","taal":"EN","url_flipbook":"https:\/\/ebook.proefschriftmaken.nl\/ebook\/theodorepaulvaniersel?iframe=true","url_download_pdf":"https:\/\/ebook.proefschriftmaken.nl\/download\/ce11a89f-b086-4d8f-a3f4-3d566a7ab1c9\/optimized","url_epub":"","ordernummer":"FTP-202602261500","isbn":"","doi_nummer":"","naam_universiteit":"Vrije Universiteit Amsterdam","afbeeldingen":4807,"naam_student:":"","binnenwerk":"","universiteit":"Vrije Universiteit Amsterdam","cover":"","afwerking":"","cover_afwerking":"","design":""},"_links":{"self":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/4805","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio"}],"about":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/types\/us_portfolio"}],"author":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/comments?post=4805"}],"version-history":[{"count":1,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/4805\/revisions"}],"predecessor-version":[{"id":4808,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio\/4805\/revisions\/4808"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/media\/4807"}],"wp:attachment":[{"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/media?parent=4805"}],"wp:term":[{"taxonomy":"us_portfolio_category","embeddable":true,"href":"https:\/\/www.proefschriftmaken.nl\/en\/wp-json\/wp\/v2\/us_portfolio_category?post=4805"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}